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Schools of Nursing Clinical Handbook

Jewish Hospital Louisville, KY

Revised September 2019

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Welcome ……………………………………………………………… 3

Mission/Vision …………………………………………………………… 4

Corporate Compliance…………………………………………………................

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Patient Rights/Responsibilities ………………………………………. 7

HIPAA Compliance ……………………………………………………… 10

Patient Care ………………………………………………………………. 12

Infection Control ……………………………………………………….... 17

Environment of Care Safety ………………………………………….... 22

Clinical Instructor Information ……………………………………… 30

Clinical Student Information ………………………………………… 34

Appendix ………………………………………………………………….. 39

Table of Contents

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On behalf of KentuckyOne Health, we welcome each of you as you begin your clinical experience. We encourage you to take advantage of the numerous learning opportunities that are available. Our goal is to provide for you an environment to facilitate your learning. We have provided you this manual to help ensure that you have the best clinical experience possible. It will provide you with basic information for various administrative, clinical, and safety procedures to maximize patient safety and minimize inherent healthcare associated risks. You are expected to familiarize yourself with the contents and follow these procedures and instructions while at our facilities. If you have any questions, please feel free to contact a hospital staff member or the System Education Department. You will be expected to wear a nametag, at chest level, in an easily visible position at all times while on the hospital campus. You should wear your school issued nametag, however, if you have not been issued one, you or your clinical instructor must obtain a temporary badge from Security. There are several policies and procedures referenced throughout this manual. Should you wish to refer to any of them; please contact your clinical instructor, any staff member or the System Education Department.

Welcome to KentuckyOne Health

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Our Mission/Vision

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Please review the policy KentuckyOne Health Corporate Compliance Code of Conduct.

KentuckyOne Health requires that persons associated with KentuckyOne Health to act in a non-abusive and legal manner and to report or correct wrongdoing wherever it may occur in the organization. As part of our commitment to excellence in health care, KentuckyOne Health implemented a Corporate Compliance Program to further the organization’s efforts to prevent and detect illegal, unethical and abusive conduct. The Compliance Program has two primary objectives: 1) to enhance and further demonstrate to our patients, the community, team members, medical staff, Board of Trustees, volunteers, benefactors, the government and third-party payers our commitment to honest and fair dealing; and 2) to centralize our efforts in preventing and detecting illegal, unethical or abusive conduct.

Each person associated with KentuckyOne Health:

Will conduct his or her activities in compliance with applicable laws.

Has a duty to act in a manner consistent with our core values, standards, policies and Corporate Compliance Code of Conduct.

Will respond to federal, state or local government requests for information on a timely basis and in a cooperative manner while preserving our organization’s legal rights.

Is prohibited by the federal Anti-Kickback Law from requesting, accepting, or offering anything of value for referred business that is payable by a federal health care program. We may not pay patients, physicians or other health care providers to refer patients to us.

Will comply with applicable laws and regulations regarding the evaluation and treatment of patients with emergency medical conditions regardless of their ability to pay. KentuckyOne Health must treat or stabilize and appropriately transfer all patients with an emergency medical condition regardless of ability to pay.

Will avoid situations that may present a conflict of interest. Conflicts of interest occur when personal interests or activities influence, or appear to influence, our ability to act in the best interest of KentuckyOne Health. A conflict of interest also may exist if the demands of any outside activities hinder or distract you from the performance of your job or cause you to use KentuckyOne Health resources for other than KentuckyOne Health purposes. You must avoid engaging in any activity, practice or act which conflicts with the interest of KentuckyOne Health or its patients.

Is committed to being good stewards of the environment. We recognize that our well being, and the well being of future generations, depends on our reverence for the environment. We should, whenever possible, conserve our natural resources; recycle; reduce waste and pollution;

Corporate Compliance

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eliminate toxins; and use environmentally preferable purchasing. Observance of environmental laws and regulations is one step in demonstrating our commitment.

Is prohibited from knowingly presenting or causing to be presented claims for payment or approval that are false, fictitious, or fraudulent by The Federal False Claims Act. Examples of potential false claims include: o Billing for services that were not provided at all. o Billing for services that were provided, but were not medically

necessary. o Submitting inaccurate or misleading claims about the type of services

provided. o Making false statements to obtain payment for products or services.

Must never disclose confidential information that violates the privacy rights of our patients. No KentuckyOne Health team member, affiliated physician or other health care provider has the right to access any patient information other than that necessary to perform his or her job.

You will be expected to sign an acknowledgement stating that you have received this manual and are familiar with the KentuckyOne Health Code of Conduct.

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Patient Rights Please refer to the KentuckyOne Health policy Patient Rights and Patient Responsibilities. KentuckyOne Health encourages respect for the personal preferences and values of each individual. We consider patients as partners in their hospital care. When patients are well informed, participate in treatment decisions and communicate openly with their doctor and other health professionals, they help make their care as effective as possible. Patients are informed of their rights in the Patient Handbook that they receive upon admission. Patient rights include the right to:

Receive fair and compassionate care at all times and under all circumstances.

Receive respect and recognition of personal dignity, values and beliefs; including cultural, psychosocial, and spiritual.

Be treated equally and receive the same level of care or treatment regardless of your race, color, national origin, disability, age or ability to pay.

Receive safe and appropriate medical care to the best of the organization’s ability.

Be informed of your rights before care is provided or discontinues, whenever possible.

Be informed of hospital rules and regulations that affect your behavior as a patient.

Personal privacy and to expect that documents and communication concerning your care will be treated as confidential.

Have family members, representatives and the physician of your choice notified promptly of your admission to the facility.

Know the name of the physician who has primary responsibility for coordinating your care and the names of other physicians or non-physicians involved in your care.

Access pastoral and other spiritual services.

Receive treatment in a safe environment free from abuse and harassment, and to be assisted in accessing Protective Services and/or Advocacy Services, as appropriate.

Receive personalized treatment through an individualized treatment plan and for you and/or your personal representative to participate in the development and implementation of your treatment plan. This organization values each patient’s cultural, racial, and religious customs as part of their treatment plan.

Appropriate assessment and management of pain.

Be free from restraints and seclusion of any form that are not medically necessary or are used as a means of coercion, discipline, convenience or retaliation by staff.

Patient Rights/Responsibilities

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Make and communicate Advance Directives. You have the right to receive assistance in formulating Advance Directives. Your access to care will not be affected if you do or do not have Advance Directives. Your wishes at the end of life will still be obtained and respected.

Participate in ethical decisions regarding your care, including decisions relative to care at the end of life. The dying patient has the right to care that optimizes comfort as well as dignity.

Be informed of potential research, investigation and clinical trials in order to decide if you want to participate or refuse to participate in research. You have the right to decline to participate in clinical studies, research or experiments. Refusal to participate will not affect your access to care or treatment.

The right to receive information including risks, benefits and reasonable alternatives in a language or method of communication that you understand pertaining to your health status, current diagnosis, treatment plan and prognoses in order for you to give informed consent or to refuse consent.

Refuse recording or filming made for purposes other than the identification, diagnosis or treatment of the patient.

Wear personal clothing and religious or other symbolic items, provided such items do not interfere with diagnostic procedures or treatment.

Receive information from your physician about the outcomes of your care, including unanticipated outcomes and prospects for recovery, in terms you can understand.

Refuse treatment to the extent allowed by law, and be informed of the significant medical consequences of this action.

Request a consult with other physician(s) and/or independent specialist(s), at your own expense.

Expect that the hospital will make a reasonable response to your request for services. The hospital will provide evaluation, service and/or referral(s) as indicated by medical necessity. Only after you have received information about the need for transfer, and it is medically permissible, will you be transferred to another facility. The receiving facility must have agreed to accept your transfer.

Receive continuity of care and notification in advance of any health care needs following discharge, including outpatient care options.

Timely notification if your insurance will not pay your bill and information about the grievance process if you disagree with your insurance company’s determination.

Receive an itemized explanation of your hospital bill.

Confidentiality of your clinical records and to review or obtain a copy of your medical record within a reasonable timeframe.

Present complaints and expect that corrective action will be taken, when indicated. The right to voice complaints about care without being subject to discrimination, reprisal or compromised access to future care.

To expect prompt response to and resolution of a grievance, including a written notice of the hospital’s decision, the name of a contact person, steps taken to investigate the grievance, the results of the grievance process and

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the date of completion. As appropriate to the nature of the grievance, the following individuals may assist you in initiating the grievance process: the physician, staff nurse or his/her supervisor, the patient representative, hospital administrator or a social worker.

Communicate your problems, concerns or complaints with the hospital to the Kentucky Cabinet for Health and Family Services by contacting the Office of the Inspector General, Division of Licensing and Regulation, 908 W. Broadway, Tenth Floor, Louisville, Kentucky 40203, (502) 595-4958, or you may contact The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, (800) 994-6610.

Patients who are candidates for participation in research or educational activities have the right to be advised if the hospital intends to engage in or perform research or educational activities affecting their care or treatment. Patients have the right to refuse to participate in such activities without compromising their care or affecting benefits to which they are otherwise entitled.

Patients have the right to information regarding the hospital’s policy on the forgoing of life support by withholding resuscitative services from patients.

Patients who are dying have the right to receive care that will provide them with comfort and dignity. The dying patient has the right to receive such care, which shall include: o Treatment of primary and secondary symptoms responsive to treatment,

as desired by the patient or surrogate decision maker, o Effective management of pain, o Acknowledgment of the psychosocial and spiritual concerns of the dying

patient and his/her family, o Acknowledgment of the expression of grief by the dying patient and

his/her family.

Receive the visitors designated, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and his or her right to withdraw or deny such consent at any time; KentuckyOne Health will o Not restrict, limit, or otherwise deny visitation privileges on the basis of

race, color, national origin, religion, sex, gender identity, sexual orientation, or disability;

o Ensure that all visitors chosen by the patient enjoy “full and equal” visitation privileges, consistent with the patient’s wishes.

Patient Grievance KentuckyOne Health will make every attempt to resolve all patient complaints in a timely, reasonable and consistent manner. If a patient care complaint cannot be resolved at the time of the complaint by staff present, is postponed for later resolution, is referred to other staff for later resolution, requires investigation, and/or requires further actions for resolution, then the complaint is defined as a grievance and the grievance procedures shall be followed.

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If a patient makes a complaint to you, listen to their issues. If you are able to solve it, within your scope of practice, then do so. If you cannot, let the patient know that you will go get their nurse who is better able to help them.

General Guidelines for Protecting PHI Computers shall be locked (password protected) while away from the

desk. This applies even in secure areas of the workplace.

Workstations, laptops, cell phones and all removable media (flash drives, removable hard drives, CDs, DVDs) that contain PHI shall be encrypted according to the KentuckyOne Health Encryption Policy unless specifically exempted by Information Security Officer.

Never share your ID and password. Using another person’s ID is prohibited. Keep your passwords hidden.

Patient specific information shall never be discussed in common areas, including lobbies, elevators, break rooms or outside of the office (client interaction and on site CCA visits excepted).

Specific patient circumstances, questions or characteristics shall be discussed and disclosed only during business hours and exclusively for business purposes.

No patient information shall be left in common areas or on business machines.

Patient confidential information may only be printed when necessary. Any printed member information that is no longer needed must be shredded.

Examples of Personal Information Name, Address, Date Of Birth

Health Card Number

Facts about health

Health care and history related to exposures to disease

Information about payment for health care.

Social Security number

Confidentiality Guidelines Practice the Clean Desk Policy.

When in doubt of a document’s classification, always default to protect the document.

When copying documents, remain at the copy machine until the job is done, no exceptions.

Remove any paper containing PHI from printers and common areas, as soon as possible.

Dispose printed PHI in locked receptacles designated confidential information.

HIPAA Compliance

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Do not discuss diagnosis/disorder information, unless it is necessary.

Documents containing PHI must not be removed from the workplace.

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Patient Safety Patient safety is mission critical for us at KentuckyOne Health. We strive to provide safe and quality care to our patient’s everyday. Throughout the healthcare industry, care practices are being identified, which have been shown to increase the safety of patient care. Please see Appendix K for a comprehensive list of evidence based techniques to reduce error in a healthcare setting. Please take a moment to STAR. Stop, Think, Act, and Review before any patient care procedure. Remember while you are in nursing school, you are legally considered an unlicensed professional and are bound by those practice rules.

Stop - Ensure you have the right patient, the right procedure, and all necessary equipment.

Think – Should I have a clinical instructor or nurse observing me? The answer is yes if you are administering a medication or performing a procedure you have not been previously observed and checked off on. Do I have any questions or concerns about this situation? If anything seems unusual or off, or you simply are unsure; stop and wait for your clinical instructor or the patient’s nurse.

Act – Act only when you are sure previous steps are met, and you are confident and can safety and competently perform the patient care.

Review – Did you perform the care as safely as possible? Did you have the expected outcomes? If any questions or issues arise, notify your clinical instructor or the patient’s nurse immediately.

At KentuckyOne Health, we invite all our patients to be an active partner in their health care. Patients are given a publication on admission encouraging and giving helpful guidelines of how to become a partner in their care. It is through this partnership that we can ensure good care and prevent medical errors. Our facility practices the National Patient Safety Goals endorsed by the Joint Commission. Please review http://www.jointcommission.org/ for the most current National Patient Safety goals.

Emergency Procedures If an accident or injury should occur to you or a patient, immediately contact your clinical instructor and KentuckyOne Health supervisory staff (your nurse, the charge nurse, nurse manager, or house supervisor). When caring for patients, emergency situations do occur. If involved in an emergency situation, immediate help can be summoned by activating the emergency call light located in each patient room. On some units, the emergency call light is activated by pulling the call light cord from the wall. On

Patient Care

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other units, the emergency call lights are activated in the patient bathroom. Find out how the call light is activated on the unit. When a Code Blue Adult/Pediatric situation is recognized, the student is responsible for reporting the code by dialing 7777 and initiating CPR. Bag mask devices are available on all code carts and should be used in code situations.

Patient Armbands and Identification Please refer to the policy on Patient Identification and Armbands. KentuckyOne Health Policy states that all patients will be properly identified with two patient identifiers (patient name and date of birth) before any care, treatment, specimen collection or services is provided.

KentuckyOne Health uses the following color coded armbands to identify specific patient information:

WHITE - All JH, SMEH, FRI MCE, MCS and OLOP patients.

BLUE - Bloodless Medicine; to be put on at point of entry or when identified

PINK - Swallowing difficulties, water protocol; to be put on by Speech/Language Pathologist

YELLOW - Falls risk; to be put on by Nursing when identified

GREEN - Latex Allergy; put on at point of entry or when identified.

TAN - DNR; patient label will be secured on the band and put on by RN/LPN following DNR order verification. Whenever possible, the DNR band will be placed on the same extremity as the patient ID band.

WHITE WITH RED - When patients on the same unit have similar last names, a “Name Alert” tag is put on the front and spine of the chart.

WHITE* - Do not use this arm “Restricted Extremity”

Abuse Please refer to the policy Abuse Reporting (Adult) and Abuse Reporting (Child).

In accordance with Kentucky law, all reasonable suspicions of patient abuse, neglect, or exploitation must be reported to the Cabinet for Health and Family Services (CHFS) Department for Community Based Services (DCBS), Adult Protective Services and/or Child Protective Services.

If you suspect a patient is the victim of abuse/neglect/exploitation, it must be reported. Immediately notify your clinical instructor and the nursing supervisory staff on the unit (charge nurse, nurse manager, or house supervisor).

If you suspect a patient is being abused/neglected/exploited by a KentuckyOne Health employee, it must be reported. Immediately notify your clinical instructor and the nursing supervisory staff on the unit (charge nurse, nurse manager, or house supervisor).

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Restraints

Please refer to the policy Restraint and Seclusion. KentuckyOne Health Philosophy on Restraints and Seclusion:

All patients have the right to be free from restraint or seclusion of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff.

Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patients, team members, or others.

Preventing Patient Falls Please refer to the policy Falls Risk. KentuckyOne Health defines a fall as an unplanned descent to a lower level with or without injury to the patient. Patients are assessed for falls on admission including transfers to a new unit or level of care, after a fall, when there is a change in condition and daily as part of the daily assessment. Falls risk processes may be initiated any time based on clinical judgment regardless of falls risk.

KentuckyOne Health uses the ABCS and Morse Falls Risk Scale as its falls risk screening tool. Patients are identified as a falls risk with a yellow arm band and the appropriate falls risk sign.

Falling Stars – Falls Prevention (this patient is identified as being at increased risk for falls). Falling Stars with Cloud – Falls Protection (this patient has fallen during their hospital stay).

The patient will be identified as Falls Risk if they score 45 or greater on the Morse Falls Risk Scale and will be placed on the FALLS PREVENTION PROTOCOL.

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Falls Prevention Protocol Place Falls Prevention order in Clinician Valet and implement all of the following interventions:

Inform patient & family that the patient is at risk to fall and of the interventions that have been implemented.

Yellow armband

Yellow gown

Falling Star door sign

Bed alarm and/or low boy bed with mats (Note: Low boy beds are generally contraindicated in orthopedic surgery patients)

Non-skid slipper socks at all times

Remind patient & family to request assistance when getting up

Patient will remain “At arms length” when ambulating or toileting

Incorporate scheduled toileting in hourly rounds

Immediately answer call lights of patients on Falls Prevention

Clear a path to the bathroom

Night light at bedtime

Use gait belt for ambulation if not contraindicated

Patient wears glasses or hearing aide if applicable

Shower stool if applicable Consider these interventions as appropriate

Leaving bathroom light on

Obtaining PT/OT evaluation

Moving the patient closer to the nurses desk

Sitter Decision Tree evaluation

If a fall occurs or patient has fallen prior to hospitalization, in addition to KentuckyOne Health policy:

Change sign to a Falling Star Sign with Cloud

Add nursing order Falls Prevention: Patient has fallen

Pain Management At KentuckyOne Health, a patient’s pain is our concern. Assess your patients for pain with vital signs and watch for cues or listen for complaints of pain every time you are with a patient. If your patient is expressing pain, immediately let the nurse or your clinical instructor know. Here are some key points to help you address a patient’s pain:

Use the key phrase - “We may not keep you pain free, but we will do our best to control your pain”

Show the patient the Pain Poster hanging in their room. Indicate on the poster where you will write when their next pain med is due. Encourage them to use the phone number listed, if they do not feel we are doing all we should do to help control their pain

Do Hourly Rounding!!

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o Ask about pain and address any increased pain levels

Barriers to pain management - If it’s not time for more medication o Explain “you can have more medication in ___minutes. Can you make

it until then?” o Refer to the poster in the room o Request a medication adjustment from the physician

If the medication is not working - Ask, “What has worked for you at home?”

If you can’t give more medications - Explain why this is not possible o Decreased mobility o Prolonged healing times o Risk of respiratory depression o May affect neuro assessments

IV Therapy The IV Therapy Team manages all IV insertions, IV site rotations, central line dressing and PRN adaptor changes, inserting PICC lines, accessing and de-accessing infusaports, and removal of non-peripheral lines on all Medical Surgical units and most Intermediate/Step-Down units. Students should never insert, manipulate, or remove any IV line or administer any IV medications without direct supervision of a clinical instructor or the patient’s nurse. Clinical Instructors or students should never remove lines indicated to be removed by an IV Nurse only. Please refer to our IV Therapy Policy Manual online, a member of our IV Therapy team, or the nurse manager of a particular unit for more information.

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KentuckyOne Health has adopted standard precautions in accordance with the Center for Disease Control (CDC) Guidelines. Students need to be familiar with the infection control and exposure control plan manuals. The infection control manual contains the specific policies and procedures for isolation, standard precautions, and other infection control practices. The exposure control plan manual contains specific information related to preventing or reducing the risk of exposure to blood and/or other potentially infectious materials. Both manuals are located online.

Standard Precautions Infection control practices that apply to all patients, all the time, regardless of suspected or confirmed infection or illness. Standard precautions include hand hygiene, use of personal protective equipment, covering your mouth and nose with an arm or tissue when coughing or sneezing, and safe injection practices.

Key Points for Hand Hygiene Soap and water should be used when hands are visibly soiled. Hands should

be washed for 15 seconds.

Alcohol based hand cleaners are placed at the point of care. To use, apply enough cleaner to palm of hand to keep hands wet for approximately 15 seconds. You must wash your hands with soap and water after every 3-5 applications to prevent buildup on your hands.

Hand hygiene must be performed: o Upon arriving o When hands are soiled o Before and after direct patient contact o Before and after gloves are used o When moving from one patient task to another o After using the toilet o Before and after eating, drinking, or smoking o Before leaving the unit and upon return o Before entering and leaving isolation rooms o After any direct contact with secretions and or excretions of the patient o Between touching another patient o Routine hand hygiene should include all surfaces of the hands up to an

area above the wrist

Artificial nails, tips, or other artificial materials are not to be worn by individuals providing direct patient care or those that work in clinical areas. If polish is worn, it must not be cracked or peeling. You should inspect condition of the cuticle and area around the fingernails routinely to enhance appropriate hygiene.

Infection Control

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Medication Management and Hand Hygiene Medications can be contaminated if you failed to performed proper hand hygiene before preparing and administering the medication. Keep in mind that germs are in the environment and of course they cannot be seen with the naked eye.

Hand Hygiene should be done before setting up medications.

If environmental surfaces are touched before the medication is given then hand hygiene must be done before giving/opening up the medications.

Gloves should be worn if your crushing medication, again this is to prevent contamination of the medication.

After the medications are given then hand hygiene needs to be performed.

Hand Hygiene should be done before the IV medications are spiked and the tubing is primed.

Patient Care Equipment Reusable patient care equipment should not be used for the care of another patient until it has been appropriately cleaned by nursing/staff and/or reprocessed by Sterile Processing. Cleaning of this equipment is important to prevent equipment that may be soiled with blood, body fluids, and secretions/excretions in a manner that prevents skin and mucous membrane exposures. Contamination of clothing and transfer of germs to other patients and environments is a possibility when equipment is not properly cleaned. Equipment can be cleaned with the hospital approved disinfectant spray or disinfectant wipe. Listed are a few items that should always be cleaned in between patient use that normally are not sent to Sterile Processing for cleaning: wheelchairs/stretchers, blood pressure cuffs, and glucometers.

Environmental Control Follow hospital procedures for routine care, cleaning, and disinfection of environmental surfaces, beds, bed rails, bedside equipment and other frequently touched surfaces. The hospital approved disinfectant wipes can be used at the nurse's station to disinfect phones, charts, keyboards, the top of medication carts, and any environmental surface around your work area that may become contaminated with germs throughout the day.

Personal Protective Equipment Gloves - Always wear gloves whenever there is contact or anticipated contact with blood, bodily fluids, or non-intact skin. Gloves are available on every unit. Contact hospital staff on your assigned unit to identify where gloves are located. Should you need special gloves or a size that is not available on your unit, contact the supervisory staff of the unit so that your safety needs are met. Other Personal Protective Equipment – PPE can include gowns, masks, face shields, and goggles. You should wear appropriate personal protective

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equipment during procedures that are likely to cause exposure to blood and/or other potentially infectious material.

Respiratory Hygiene and Cough Etiquette Cover your mouth or nose when you cough or sneeze.

Use a tissue to contain respiratory secretions.

Perform hand hygiene if there is contact with respiratory secretions or contaminated objects.

Wear appropriate PPE when entering the room of a patient with poor respiratory hygiene and uncontained secretions, regardless of suspected or confirmed illness.

Isolation Please refer to the policy Isolation. Patients may need to be placed into isolation to prevent the spread of infection. When this happens you must adhere to KentuckyOne Health isolation guidelines to minimize your risks and minimize the risk of spreading disease to other patients. Read and follow all isolation signs posted and always wear the PPE indicated on the sign. If you have questions or concerns, please contact a KentuckyOne Health staff member or System Education. KentuckyOne Health has the following isolation guidelines:

Contact Precautions include organisms that are spread via direct or indirect contact such as all multidrug resistant organisms, wounds or abscesses with uncontained drainage regardless of infection, scabies, Clostridium Difficile infection (diarrhea), Rotavirus, and RSV. Wash hands when entering and leaving room. Protection guidelines include: follow standard precautions, gown and gloves when entering room – to be taken off inside room before leaving, use patient dedicated or disposable equipment, and clean and disinfect shared equipment.

Droplet Precautions include organisms that spread through mucous membrane contact with respiratory secretions such as bacterial meningitis, seasonal influenza normally seen Oct-Apr, Pertussis (whooping cough), and Mumps. Protection guidelines include: wash hands when entering and leaving room, following Standard Precautions, surgical mask with splash guard when entering room, to be taken off inside room before leaving, if contact with bodily fluids is likely, use gown and gloves in addition to mask with splash guard. The patient is to wear a surgical mask to contain secretions anytime out of the room.

Airborne Precautions include organisms that become suspended in the air and remain infectious over long distances such as pulmonary or laryngeal tuberculosis, chickenpox, disseminated herpes zoster (shingles), measles, and pandemic influenza. Students are NOT allowed to provide care to patients in Airborne Precautions. Airborne precautions include patients who have pulmonary or laryngeal tuberculosis,

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chickenpox, shingles, measles, or pandemic influenza. We do not fit test students for the N95 respirator.

Containment Isolation Carbapenem-resistant Enterobacteriaceae (CRE) is a family of untreatable or difficult-to-treat multi-drug resistant organisms (i.e. resistant Klebsiella). Other organisms (i.e. resistant Acinetobacter) may have the same resistance mechanism, but may not be an Enterobacteriaceae. These are referred to as Carbapenem- resistant Organisms (CRO). The treatment options for those infected are extremely limited. CRE and other pan-resistant organisms are associated with high mortality rates and have the potential for widespread transmission. All staff, providers, and visitors will strictly adhere to the hand hygiene policy. Patients with a CRE/CRO positive culture, or culture of another organism with pan-resistance, will be placed into a private room and CONTAINMENT ISOLATION will be implemented. Students are NOT allowed to provide care to patients in Containment Precautions.

Laundry All laundry that has been in a patient’s room must be placed in the soiled linen containers.

Hazardous Waste All hazardous medical waste must be disposed of in the appropriate hazardous waste container. The container must be closable, constructed to contain the contents and prevent fluid leakage and red in color or labeled with an appropriate biohazard warning label. Medical waste can include but is not limited to needles and sharps containers, suction canisters, and disposable items saturated with blood or bodily fluids. If you find medical waste that has not been disposed of properly, contact a hospital staff member immediately.

Bloodborne Pathogens Please refer to the policy Exposure Control Plan. As a healthcare provider, you may be at risk for occupational exposure to bloodborne pathogens, microorganisms that are present in human blood and can cause disease in humans. KentuckyOne Health has an Exposure Control Plan that provides requirements and protective measures to minimize the risk of exposure for healthcare providers. If you have any questions, please feel free to contact any hospital staff or Infection Control. Bloodborne Pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Exposure can occur from specific eye, mouth, other mucous membrane, non-intact skin, needlesticks or puncture wounds, or parenteral contact with blood or other potentially infectious material. To limit your risk of exposure:

Always use standard precautions, for all patients, all the time.

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Practice good hand hygiene and immediately perform hand hygiene after contact with blood or body fluids, and after removing gloves and PPE.

Always wear the appropriate personal protective equipment.

Dispose of sharps safely and in the appropriate sharps container.

Always use gloves when touching patient linens.

Avoid touching face and mucous membranes in areas where blood, body fluids, or specimens are present. This includes things such as eating, drinking, applying cosmetics or lip balm, or rubbing eyes or touching contact lenses.

If there is an exposure, immediately flush the area with water and notify your clinical instructor and nursing supervisory staff.

Latex Allergy Please refer to the policy Latex-Safe Environment. Many products used in a hospital setting contain latex including gloves, stethoscopes, catheters, tourniquets, and many others. Latex can cause allergic reactions in some people. Latex exposure can occur from direct contact or via inhalation of airborne latex particles. Reactions can range from contact dermatitis to anaphylaxis. All patients are screened on admission for latex allergy and identified by a green band. All patients identified with a latex allergy must be provided with a latex free cart/container from central supply. All products that are not made of metal, plastic, vinyl, or silicone could be made of latex even if it says it is hypoallergenic.

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Risk Management Should an accident or incident occur to you or a patient, immediately notify your clinical instructor and KentuckyOne Health supervisory staff (this could be the nurse, charge nurse, nurse manager, or house supervisor). KentuckyOne Health supervisory staff will notify Risk Management.

Safe Injection Practices KentuckyOne Health provides several safety mechanisms to reduce the risk of accidental needle stick including a needleless IV infusion system, an IV catheter with a passive safety mechanism, and safety needles for situations where needles must be used. To reduce the risk of possible exposure always use the safety features provided and always dispose of needles/sharps in the appropriate puncture resistant sharps container. Contact a staff member immediately if you see a needle/sharps that has not been disposed of in the appropriate manner or if the sharps container is full.

Hazardous Materials and Waste Management The United States Department of Labor for Occupational Safety and Health Administration (OSHA) developed the Hazard Materials and Waste Standard, (Standard 29 CFR 1910.120), which also includes that an organization guarantee employees and employers the "Right-To-Know" about potential chemicals hazards in the workplace.

Material Safety Data Sheets Material safety data sheets (MSDS) are forms made by manufacturers that detail the properties of a particular substance. MSDS include procedures for handling or working with that substance in a safe manner, and includes information such as physical data, toxicity, health effects, first aid, reactivity, storage, disposal, protective equipment, and spill-handling procedures. At KentuckyOne Health, MSDS are available on the Intranet. Please contact any staff member or your clinical instructor to review the MSDS.

Emergency Codes and Student Responsibilities All codes are activated by dialing 7777 and identifying the situation. Code Yellow External (External Disaster) - This code is called in the event of an external disasters, such as a fire, mass vehicular accident, flood, or other incident resulting in a probability of the hospital receiving a large number of casualties. Students should return to their unit and report to their clinical instructor or supervising nurse for further instructions. Code Yellow Internal (Evacuation) - This code is called in the event of an internal disasters such as catastrophic utility failures (i.e., water, electrical, gas, sewer or communication), equipment failures, fire, threats of harm or civil

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disturbances, or building Structure Damage. Students who do not have a purpose in that area will stay away until an “All Clear” is announced. Students from that area will report to their clinical instructor or supervising nurse for additional instructions. Should an evacuation be required:

Evacuation (directions will be given by the supervisor) o Remove guests from immediate danger. o Evacuate laterally – e.g. 6-East to 6-West. o Form teams, guide ambulatory guests to a safe area, use litters

stored behind end stair doors for those not able to walk. o Use exits at end of corridors for down traffic. o Smoke rises; stay near the floor for fresher air. o Do not jump, but evacuate for rescue. o Once out of building, individuals are taken to Norton Hospital or

University Hospital. Code Red - This code is called in the event that the fire detection system is engaged for any reason.

o In the event of a fire remember to RACE:

Remove

Activate

Confine and Contain

Extinguish o When using a fire extinguisher remember to PASS:

Pull

Aim

Squeeze

Sweep o Close doors to patient rooms. o Do not pass through fire doors unless evacuation is necessary. o Never block fire doors with anything that would prevent them from

closing automatically. o Types of Fire Extinguishers

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Tornado / Severe Weather Alert (Tornado)-An announcement is paged and the alert tone is sounded in the event that a tornado warning is issued for the immediate area by the National Weather Service. Students should return to the unit and report to their clinical instructor or supervising nurse for further instructions. Code Stroke – Stroke response needed. Rapid Response – Medical assistance needed. Code Blue Adult or Pediatric – This code is called for a medical emergency for respiratory or cardiac arrest. If a student identifies a Code Blue they must:

Notify other staff on the unit by pressing the call or CODE light, pulling the call light out of wall, calling for help (if in a patient room).

Dial 7777 to notify the operator. State the following information: o Code Blue Adult or Code Blue Pediatric o Unit Name (4 West, 5 South, etc.) o Patient Room Number

Wait for the operator to verify before hanging up.

Begin CPR.

Second person should bring Code cart. Code Gray – Called when an uneasy situation arises in the work area and security assistance is needed. Dial 7777 and give the location. Code Silver - Called when security assistance is needed and the individual may possibly be armed with a weapon. Dial 7777 and give the location.

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Code Pink Infant or Child – Missing infant or child. Golden Alert – Missing adult. Code Orange (Internal or External) – Called when there is a hazardous spill either internally or externally. Dial 7777 and give the location. Code Black - Bomb Threat. Immediately have someone call 7777 to notify of bomb threat. Then note the following (from the policy Code Black-Bomb Threat, Attachment A Bomb Threat Report Form):

Note Date, Time and Extension called

Exact words of caller

Ask “Where is the Bomb? When will it explode? What kind of bomb is it? What does it look like? Where are you calling from? “

Note the gender and age of the caller, does the voice sound familiar?

Note the quality of the voice and speech, they type of language they used, did they have an accent, and their manner

Was there background noise? If so what?

What type of phone connection did you have?

Was there anything else you noticed about the call? Code X – Evacuation of area or of facility. Students should report to their clinical instructor or a supervising nurse for further instructions. Shelter in Place - is used when events warrant the need to maintain a secure environment for the safety of the patients, staff and others already inside the facility. This code can occur internally and externally depending upon the situation and other contributing factors. (Examples of other contributing factors that can activate the Shelter-In-Place are inclement weather.) Students will report to their clinical instructor or a supervising nurse for further instructions.

Security Services The Jewish Hospital Security Department is staffed 24 hours a day, 7 days a week to ensure a safe and secure environment for staff, patients, visitors, and everyone else. They utilize roving patrols, stationary posts, and closed circuit television and alarms to monitor activity in and around the hospital. Security also provides the following services:

Escort to the car outside normal shift change time around the clock

Motorist Assist

Regular 24-hour patrol of campus

Coordinates “lost and found” If you have any questions or concerns regarding a security issue, you can contact security by dialing:

Contact Purpose Phone (Outside)

Phone (In-House)

Security Dispatch

General security issues

587-4484 4484

Emergency Security emergency 587-4999 4999

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Firearms and Concealed Weapons The organization prohibits firearms and weapons on the facility premises. Individuals with firearms or weapons are asked to secure such BEFORE entering the facility, which may include either securing firearm or weapon in trunk of vehicle or checking it in with the Public Safety and Security Personnel. Police policy dictates they are not at liberty to relinquish their weapon(s), therefore, as an organization we encourage our personnel to be mindful of the fact. When law enforcement representatives present themselves at the facility we may suggest to them to check in their weapon(s) with the Public Safety and Security personnel until the individual leaves the premises.

Electrical and Equipment Safety Most equipment in the healthcare setting is electric. This means there is a risk of electric shock from medical equipment. To help prevent any electrical accidents you should report any electrical hazards, use equipment properly, disconnect, label, and report any malfunctioning equipment, and use power cords and outlets properly. Electric safety includes things such as:

Removing malfunctioning equipment from service

Do not use equipment on which liquids have been spilled or on wet surfaces.

Do not jerk cords from the outlets.

Use only three pronged plugs.

Protecting patients from electrical shock. For questions or to report malfunctioning equipment, please contact a hospital employee to place a work order to our Engineering Department. Our Engineering Department can also be contacted via phone at 587-4043.

Utility Safety Loss of Electrical Power – In the event of a loss of hospital loss of power, we have emergency power systems in place. It takes only a few seconds for power to the lights and equipment here at the Jewish Hospital Medical Campus to be switched to the backup sources. Here are a few key points to remember as you go through your day, to help us be ready should we lose power:

• All red outlets are on emergency power • Make sure all life support equipment is plugged into a red outlet at all

times. All red outlets are connected to emergency power systems and will maintain power in the event of a loss of power from LG&E.

• Black & green dots, orange triangles & other marks on outlets and switches are markers for use by the engineering dept only and are not relevant to emergency power.

• Make note of exit signs in your area. Are they lit? If not, please assist the engineering team by putting in a work order to have it repaired.

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• Flashlights should be in working order and readily available to staff in all areas, for use during a power outage.

Medical Equipment Safety Medical equipment safety is everyone’s responsibility. If you find malfunctioning or broken equipment, remove it from use and notify your clinical instructor and nursing staff on the floor to fill out a work order. Should malfunctioning equipment cause an incident, immediately notify your clinical instructor and nursing supervisory staff on the unit.

Slips, Trips, Falls Slips, trips and falls can cause injury or even death in the workplace. Here are some safety tips to reduce the risk of slips, trips, and falls:

Choose slip resistant shoes

If you spot a wet or slippery floor, report it immediately.

Heed posted safety signs.

Keep floors clear and uncluttered.

Use proper lighting.

Back Safety Healthcare is a high-risk setting for back pain and injury. Healthcare workers who lift and move patients are at especially high risk for injury. The following are ways that healthcare workers may prevent injuries:

Ergonomic best practices o Avoid fixed or awkward positions o Avoid lifting without using the proper devices or equipment o Avoid highly repetitive tasks o Avoid forceful exertions o Provide support for your limbs o Use proper posture and body mechanics o Keep tools close to you to avoid reaching, twisting, or bending

When standing, wear good comfortable shoes, stand up straight, keep the knees flexed, and use a foot rest or alternate feet every few minutes if you must stand for long periods of time.

When sitting, form 90 degree angles at the knees and hips.

When lifting, bend at the knees and hips. Keep the head up. Maintain the natural curves of the spine. Lift with the muscles of the legs. Use assistive devices whenever possible.

Workplace Violence Please refer to the policy Workplace Violence Prevention Plan. Statistics show that violence in the hospital setting is increasing rapidly.

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When people (including patients, families, and friends) come into the hospital they are already highly stressed due to the very nature of a hospital environment and whatever is happening to them. In almost all situations where a person is becoming agitated or aggressive there is an underlying fear that is the cause. If we can keep ourselves aware of this, it will help us in working effectively with people who are upset. Hospital environment stressors include: bright lights, many personal questions, forms to fill out, lengthy waiting, strange environment, and fear of the unknown. Coping abilities to handle stress are much decreased, and because of this stress inappropriate aggressive behavior may occur. Staff must always be aware that people must be understood as cognitive, emotional, physical, social, and spiritual beings. Use Coping Skills to De-escalate the Situation This is the time when the participants call upon existing coping skills to resolve the problem presented or to reduce anxiety. Communication skills that should be used routinely that will assist in de-escalating potential violence include:

Non-Verbal - Before any words are spoken, non-verbal communication has begun. This includes the way you walk, facial expressions, posture and gestures. We must be aware of our non-verbal communication. Our non-verbal communication can provoke a patient. Effective use of non-verbal communication can provide a prompt for the patient to use internal control to get back on track.

Verbal - When talking to an individual, it is important to take care in what you say (language, vocabulary) and how you say it (tone). Controlling our verbal rate, pitch and tone, the para-verbal communication can be critical.

Listening - The most important skill for you to develop is listening. Staff who can listen and respond appropriately will have success in de-escalating patients.

Tips in Dealing with Violence Do

Listen carefully and monitor non-verbal signals, validate the participant's feelings.

Respect the personal space.

Observe the environment for unsafe, potentially dangerous objects.

Decrease environment stimuli.

Set limits calmly and firmly.

Maintain non-critical, non-domineering attitude and body language.

Know where a phone is and how to access emergency help

Attend in-services to update your skills.

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Do Not

Promise more than you can deliver.

Criticize or argue with the participant

Approach an aggressive or out of control person without back-up from other staff members

Yell or become aggressive.

Crowd or attempt to touch the patient.

Attempt to reason with a patient/person whose psychosis is drug related.

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General Information The clinical instructor must complete these steps prior to the start of clinical and/or prior to students being on the unit:

Required Forms: Please complete the forms at the end of this packet, and

turn them into Sarah Woolwine. Forms can be brought to the Education Office or emailed to sarahwoolwine@kentuckyonehealth.org. Forms must be completed and signed before any clinical experience can begin.

o Handbook Acknowledgement completed by the students and the clinical instructor to verify that they covered the information in the handbook. Appendix A

o Computer and Information Usage Agreement completed by the students and clinical instructor. See Appendix B.

o Confidentiality Statement completed by students and instructor, this is our legal HIPAA documentation. See Appendix C.

o Validation of Clinical Orientation completed by students and instructor. See Appendix D.

o Our Values and Ethics at Work Reference Guide must be reviewed by both faculty and students and is available at http://www.kentuckyonehealth.org/documents/volunteers/OVEAW%2012.23.14.pdf

Helpful resources available to you: o Nursing Student Scavenger Hunt completed by the students to

familiarize yourself with the unit. See Appendix E. o Clinical Student Assignment Sheet completed by instructor and

posted on unit. See Appendix F.

These should be completed and given to Sarah Woolwine on the final day of your clinical experience:

o Evaluation of Clinical Experience completed by the students and instructor at end of rotation. See Appendix I.

o Evaluation of Clinical Instructor completed by manager on the unit at the conclusion of the clinical. See Appendix J.

Computer Access: Students will be given view only access to our computer system if

requested.

Students should NOT document in our computer system.

Jewish Hospital Clinical Instructor Information

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If you would like for your students to have view only access to our computer system, please contact sarahwoolwine@kentuckyonehealth.org or 502-587-4194.

Instructors will be given access to our computer system and will be permitted to document medication administration only. Please contact sarahwoolwine@kentuckyonehealth.org for information on how to request access.

Clinical instructors will be provided a 1 hour computer orientation. Please contact Sarah Woolwine at sarahwoolwine@kentuckyonehealth.org or 502-587-4194 to set up your computer instruction.

Glucometer Access: Students are not permitted to use the glucometers.

PolicyStat Library: Clinical instructors and students can access hospital

policies via the Intranet from any hospital computer. You will receive instruction on this in your computer orientation class.

Student Identification: Students are required to wear identification while on

the unit. If a student does not have a school identification badge, please contact the Security Department at 587-4484 so that name badges can be made.

Parking: Parking passes are required. Please email Sarah Woolwine at

SarahWoolwine@KentuckyOneHealth.org with the dates of clinical and the number of parking passes needed.

Meeting Conference Areas: Nursing students should not gather and meet

in the public waiting areas on the first floor of the hospital. Space for visitors is limited and the 1st floor areas are designated for patients and families. Nursing students should not gather and meet in the break rooms on the units. Nursing students are welcome to meet in the cafeteria before their clinical. Meeting rooms are subject to availability and must be arranged in advance by the clinical instructor by emailing MonicaFort@KentuckyOneHealth.org.

Contact the Nurse Manager for your clinical unit. See Appendix G

for Nurse Manager Units and contact information.

Clinical Orientation: Instructors are expected to orient students using the

student orientation manual and have them sign the Handbook Acknowledgement, the Computer and Information Usage Agreement, the Confidentiality Statement, and Validation of Clinical Orientation forms (Appendix A-D). It is expected this will be done on or before the first day of clinical. Students will not be allowed on the units until these forms are completed and signed. These forms can be turned in to Sarah Woolwine or emailed to sarahwoolwine@kentuckyonehealth.org

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Evaluation: Instructors and students are encouraged to complete the Clinical

Learning Environment Survey. These forms can be turned in to Sarah Woolwine.

Clinical Instructor Evaluation: At the end of the clinical rotation,

instructors should give the nurse manager or designee the Clinical Instructor Evaluation. The nurse manager or designee will return it to Sarah Woolwine. See Appendix J.

If you have any questions, concerns, or would like more information; please see Appendix G for contact information.

Clinical Instructor Expectations

Must complete all required forms and paperwork before the clinical group will be allowed on the unit.

Must maintain a professional appearance by wearing a scrubs or scrubs with a lab coat

Must wear a visible nametag at all times.

Must arrive on time for scheduled clinical.

All changes to clinical placement must be approved through Sarah Woolwine at SarahWoolwine@KentuckyOneHealth.org

Must maintain professional conduct including upholding the KentuckyOne Health Standards of Performance and the KentuckyOne Health Mission, Vision, and Values during the clinical.

Must contact the Nurse Manager for your clinical unit and: a. Provide them your contact information b. Set up a time with them to familiarize yourself with the unit c. Provide them a copy of the syllabus for the class, objectives, and

any special student needs d. Provide them with the form: Nursing Student Assignment Sheet

Must notify the unit if the clinical group will not be reporting for a scheduled day.

Must provide a formal assignment sheet, this form is provided at the end of the packet.

Must remain with the students at all times during the clinical rotation.

If the rotation does not require faculty on site students must know how to contact the instructor at all times.

Must sign in and observe all medication administration if passing medications with the students. The instructor will NOT share their passwords with the students.

Instructor or Nurse must pull all medications for the students from the medication pyxis.

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Clinical Unit Expectations Representative from the unit will provide the Clinical Instructor with unit

orientation including a tour and where to post assignments, where not to congregate, where to keep charts, when not to take charts, etc.

Representative from the unit will provide Clinical Instructor codes to all locked areas the students will need to enter to perform their duties. Room codes may be distributed to students.

Should nurses on unit assume precepting a student, then that nurse will assume responsibility of direct supervision of student at that time, including supervising all treatments and all medication administration.

Staff on unit will be responsive and helpful.

Observational Experiences Observational experiences MUST be arranged through Sarah Woolwine who will schedule it with the clinical site. Each clinical group will be permitted one observation location per semester. Once a site has been confirmed clinical instructors are expected to:

Introduce themselves to the manager of the clinical site and provide them with contact information

Contact the observational site manager and work out the details with a schedule of observations including the student’s name, dates, and times they will be observing.

Grievance Policy Any and all grievances regarding student and/or faculty members will be investigated to the fullest extent possible. Complaints founded or not, will be reported to all applicable personnel (clinical instructor, clinical coordinator, nurse manager, nurse educator) within 48 hours of the occurrence. Substantiated grievances, documented by way of a formal letter, may also be reported the Dean of the Nursing School as determined by the nursing department.

Chain of Command/Emergency Preparedness In the event of low patient census, regulatory inspections, or other unit activities that may be prohibitive to the achievement of learning goals and objectives, students may participate in other nursing and non-nursing activities as deemed appropriate by their clinical instructor (i.e., conducting physical assessments, providing patient hygiene, taking vital signs, passing meal trays). Due to the volume of students who are scheduled in KentuckyOne Health facilities, placement/observation on another unit will only be permitted upon approval by the Nursing Education Department during regularly scheduled office hours.

Nursing Student Expectations

Jewish Hospital Clinical Student Information

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o Must complete all required forms and paperwork before the clinical group will be allowed on the unit.

o Handbook Acknowledgement completed by the students and the clinical instructor to verify that they covered the information in the handbook. Appendix A

o Computer and Information Usage Agreement completed by the students and clinical instructor. See Appendix B.

o Confidentiality Statement completed by students and instructor, this is our legal HIPAA documentation. See Appendix C.

o Validation of Clinical Orientation completed by students and instructor. See Appendix D.

o Nursing Student Scavenger Hunt completed by the students to familiarize yourself with the unit. See Appendix E.

o Evaluation of Clinical Experience completed by the students and instructor at end of rotation. See Appendix I.

o Our Values and Ethics at Work Reference Guide must be reviewed by both faculty and students and is available at http://www.kentuckyonehealth.org/documents/volunteers/OVEAW%2012.23.14.pdf

o Must maintain a professional appearance. o Must arrive on time for scheduled clinical. o Must get report from the nurse caring for the assigned patient. o Must report off to the nurse caring for the patient at the end of duty and

when leaving the floor for any reason. o Will not copy or print any portion of the patient’s medical record, all

documents with protected health information must be placed in the shred bins at the end of the shift.

o Must wear a visible nametag at all times.

Student Practice Guidelines - Students may perform any skill they have

learned and successfully mastered according to your school criteria while caring for KentuckyOne Health patients. KentuckyOne Health has a few guidelines for patient care by students:

o Will not administer any type of blood or blood product o Will not accept verbal or telephone orders from physicians o Will not administer IV meds in an emergent situation o Will not care for patients in Airborne precautions including TB, chicken

pox, shingles, measles, or epidemic influenzas; may provide care for other isolation patients

o Students are NOT allowed to provide care to patients in Containment Precautions.

o Students are given VIEW-ONLY access to our computer programs. This will be arranged through your clinical instructor.

o Students will be able to pass medications under the direct supervision of a nurse or their clinical instructor.

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The nurse or clinical instructor will sign on to Cerner using their user name and password. The student will scan and pass the medications using our Medication Administration Guidelines.

Nurses or Clinical Instructors should never share their user names and passwords with the students.

o Students will NOT administer any high alert medications that require an independent double check by two nurses. See Appendix H.

o Students will NOT remove medication from the pyxis.. o Students and Clinical Instructors are to follow the policies and procedures

of their assigned unit. o Students should only perform CPR if they are the first responder and

identify the need to initiate. Otherwise, only hospital personnel should be performing CPR.

Orientation – Affiliating Nursing Students must be oriented by their clinical

instructor to policy and procedure expectations as it relates to the student nurse.

Dress Code - Please refer to the policy Dress Code and Standard for

Professional Appearance. Students are encouraged to bring only minimal items into the clinical setting. Students are encouraged to leave valuables, money, backpacks, and books at home. Bring only what is required to successfully complete the clinical.

o To convey a professional appearance, clinical instructors and students are expected to follow the KentuckyOne Health Dress Code and Standards of Professional Appearance. Business or business casual attire when not in a clinical setting Scrubs with or without lab coats as required by your school of nursing

when in a clinical setting All clothing must be clean, neat, and well fitting. Minimal jewelry, no more than two earrings per ear. Facial and oral

jewelry is not acceptable. Long hair should be pulled back. Hair may conform to current fashion

but must be neatly groomed and not interfere with patient care or safety. Extreme hairstyles are not permitted.

Artificial finger nails, nail extenders, nail wraps or other artificial nail components are not to be worn by healthcare workers who provide direct or indirect patient care. If polish is worn, it should be in good condition.

Nametags must be worn at chest level at all times. Facial hair must be neatly trimmed and well groomed. Make-up should be conservatively applied. Tattoos should be kept to a minimum and be covered, if

possible. Offensive and/or large tattoos, those that depict violence or sexual and/or racial overtones, must be kept covered.

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Buttons, pins, etc. which are objectionable because of their size or inappropriate message (such as profane or provocative language, political preferences, or business advertising) are not permitted.

Policy Stat Library- Students may access hospital policies via the Intranet on

any hospital computer.

Medication Administration – Students may administer medications

according to hospital/department approved policies and procedures, at the discretion and under the supervision of the Clinical Instructor or RN knowledgeable of the patient, provided that the student has had appropriate theoretical preparation and instruction. Medications at Jewish Hospital are administered using a bar code scanning system in Cerner. Students are given view only access to Cerner. Students are not given access to the medication pyxis and are not allowed to pull medications out of the medication pyxis. The nurse or clinical instructor will go with the student into the patient room and sign in to Cerner and observe the administration of all the medications. The student will verify the patient's name and DOB and scan patient's ID band & ordered medications. The student must name each medication to the patient and the reason for giving prior to administration. If the system gives a warning the nurse or clinical instructor must check the warning, the student is responsible for making the nurse or clinical instructor aware of all warnings. Please refer to the following policies to guide your practice with Medication Administration:

Medication Administration

High-Alert High-Risk Medications

Medical Orders: Written and Verbal

Parking - Nursing students are assigned to park in the Visitor’s Parking Garage

located on Muhammad Ali Street. It can be accessed from Muhammad Ali Street or Brook Street (the driving lane behind Heart and Lung building). Nursing Students must have a parking pass in order to not be charged for parking.

o Please direct any questions in reference to parking to Security: 587-4484. o We want to make every effort to provide and meet your parking needs.

Please feel free to contact us if we can be of any further assistance.

Cafeteria- The Jewish Hospital cafeteria, Chestnut Café, offers a discount with

a valid student ID. Chestnut Café is located off the Chestnut Street Lobby. Hours of operation are 5:30am-2:00am. Wall Street Deli is located in the main

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lobby of the Outpatient Care Center Building. Hours of operation are 7:00am-7:30pm on weekdays, Saturday 10:00am-5:00pm, and Sunday 11:00am-4:00pm.

Library- Jewish Hospital has access to Mosby’s E-Clinical Reference online.

Mosby’s provides an array of educational materials including access to research information, evidence based skills, journal articles, patient education materials, and many more.

In-service and Continuing Education- Programs are open to students

on a space available basis at a discounted fee and pre-registration is required. Information is available by calling 587-2585.

Smoking- Jewish Hospital is a smoke-free environment. All patients, visitors,

and employees are prohibited from smoking on the premises.

Eating and Drinking – In accordance with OSHA guidelines, eating and

drinking is not permitted in the patient care area or the nurse’s station.

Behavior – Please maintain appropriate professional behavior at all times.

Language of a sexual or abusive nature is prohibited. Please refrain from comments or jokes that may be offensive to others. Should you witness such behaviors, please contact your clinical instructor and/or the nurse manager immediately.

Call-Ins- If you are unable to attend a clinical, please contact your instructor

prior to time of clinical. If this is not possible, please call the unit and leave a message with the Charge Nurse.

Personal Items - Please bring as few personal items into the hospital as

possible. Storage space is limited. A representative from the unit will show you where your coats and bags can be stored. The hospital is not responsible for the loss of any personal items, so money and valuables should be kept on your person at all times. Lost and found is located in Security.

Ethical Issues - Occasionally an ethical issue will arise when dealing with the

medical treatment of patients. Jewish Hospital has an Ethics Committee that can provide consultation in ethical issues involving medical treatment. The person on call for the Ethics Committee can be contacted by calling the hospital operator to get the information for the Ethics person on call. You can also contact the hospital chaplain staff through Kathy Lesch at 587-3793 or Rabbi Nadia Siritsky at 540-3793.

Witness - Students are NOT permitted to sign or witness the signature of any

legal paper or document.

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Appendix

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Appendix A Handbook and Ethics at Work Guide Acknowledgement

School: Semester:

Instructor: Unit:

The following students have received the Jewish Hospital Student Orientation Manual and reviewed the Ethics at Work guide. The content of the manual and guide has been covered in their orientation class. By signing this form, I am indicating that I have received this manual and Ethics at Work guide and have read the contents, and understand that I need to comply with the guidelines outlined in the manual and Ethics at Work guide. I know who to contact with questions or concerns. Corporate Compliance Acknowledgment and Certification I acknowledge that I have received information how to access the KentuckyOne Health Corporate Compliance Code of Conduct on the KentuckyOne Health Intranet and I agree to read it completely. I also agree to discuss any questions or concerns regarding the KentuckyOne Health Corporate Compliance Code of Conduct with my unit’s supervisor or other member of management. I certify that I will comply with the KentuckyOne Health Corporate Compliance Code of Conduct, KentuckyOne Health Corporate Compliance policies and procedures, and all KentuckyOne Health policies and procedures. I understand that it is my responsibility to report any concerns regarding possible violations of these standards and policies. Furthermore, I understand that KentuckyOne Health will not retaliate against me for making a good-faith report.

Student Names (Signature and Printed):

1.

2.

3.

4.

5.

6.

7.

8.

9. _____

10.

Orientation Instructor: Date:

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Appendix B Computer and Information Usage Agreement

(KentuckyOne Health Workforce members not employed by KentuckyOne Health)

KentuckyOne Health considers maintaining the security and confidentiality of protected health information a matter of its highest priority. All those granted access to this information must agree to the standards set forth in this computer and information usage agreement. All those who cannot agree to these terms will be denied access to protected health information entrusted by our patients to this organization. Each person accessing KentuckyOne Health data and resources holds a position of trust relative to this information and must recognize the responsibilities entrusted in preserving the security and confidentiality of this information. The following conditions apply to all those having access to protected health information.

As a condition of my association with KentuckyOne Health, I agree to the following:

1. I understand that I am responsible for complying with the KentuckyOne Health policies based on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that are available to me for review.

2. I will treat all information received in the course of my association with KentuckyOne Health, including but not limited to the patients of KentuckyOne Health, as confidential and privileged information.

3. Upon cessation of my association with KentuckyOne Health, I agree to continue to maintain the confidentiality of any information I learned at KentuckyOne Health and agree to turn over the keys, access cards, or any other device that would provide access to KentuckyOne Health or its information.

4. I will respect the privacy and rules governing the use of any information accessible through the computer system/network and only access and/or utilize protected health information that I have a need to know in order to perform my assigned duties.

5. I will respect the confidentiality of any reports or documents printed from any information system containing patient/member information and handle, store and dispose of material appropriately.

6. I will not disclose information regarding the patients KentuckyOne Health to any person or entity other than as necessary to perform my duties and as permitted under the organization’s policies. I understand that the information accessed through all KentuckyOne Health information systems contains sensitive and confidential patient care, business, financial and hospital employee information which should only be disclosed to those authorized to receive it.

7. I will not use or disclose any information that identifies a patient except that which is allowed by KentuckyOne Health policies based on HIPAA regulations.

8. I will prevent unauthorized use or viewing of any information in files maintained, stored or processed by KentuckyOne Health.

9. I will not remove any worksheet, record, report or copy of such from the area or office where it is kept except in the performance of my duties. I will report any violation of this code.

10. I will not seek personal benefit or permit others to benefit personally from any confidential information or use of equipment available through my work assignment.

11. I will not log on to any KentuckyOne Health computer systems that currently exist or may exist in the future using a password other than my own.

12. I will safeguard my computer password and will not post it in a public place, e.g., the computer monitor, or a place where it will be easily lost, e.g., on my nametag.

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13. I will not allow anyone, including other employees, to use my password and/or authentication device to log on to the computer or alter information under my identity.

14. I will not utilize anyone else’s password and/or authentication device in order to access any KentuckyOne Health system.

15. I will log off of the computer as soon as I have finished using it.

16. I will not attempt to establish electronic communication to the KentuckyOne Health network except by approved methods.

17. I will use an approved cover sheet for all faxes containing protected health information.

18. I will not use E-mail to transmit a patient’s protected health information unless instructed to do so by my management.

19. I will comply with KentuckyOne Health Internet and Electronic Mail usage policies and in particular will not use these business tools for non-KentuckyOne Health commercial or personal use.

20. I will ensure all electronic storage media (CD, DVD, floppy diskette, computer hard drive, etc.) containing protected health information is destroyed according to KentuckyOne Health policy.

21. I will respect the ownership of proprietary software. I will not make unauthorized copies of such software even when the software is not physically protected against copying.

22. I will respect the procedures established to manage the use of all systems.

23. I understand that all access to the system will be monitored.

I understand that my access to protected health information maintained by KentuckyOne Health is a privilege and not a right afforded to me. By signing this agreement, I agree to protect the security of this information and maintain all protected health information in a manner consistent with the requirements outlined under the federal privacy regulations. Any breach of the terms outlined in this agreement will subject me to penalties, including disciplinary action, under KentuckyOne Health policies as well as any applicable State and Federal law. By signing this agreement, I agree that I have read, understand and will comply with all the conditions outlined in this agreement

________________________________ ________________________________ Signature Title Print Name (Middle Initial included) ____________________________ __________________________________ Company or Organization Name Affiliated KentuckyOne Health Department __________________________________ Signature Date

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Appendix C

Catholic Health Initiatives Confidentiality and Acceptable Use Requirements

As a condition of being a member of the CHI Workforce, I understand and affirm the following: Catholic Health Initiatives (CHI), including its affiliates and subsidiaries, treats information about CHI’s business, patients, residents and their

families, and workforce as confidential in accordance with applicable laws and regulations. During the course of my association with CHI, I may

access, use or disclose Confidential information.

• CHI Confidential Information means any information, regardless of the format that it is in, (for example, paper, electronic, oral conversations,

films, images) about a patient, resident, employee, student, physician, professional staff, other CHI workforce members, or CHI business

and financial operations, that is not available to the public. CHI Confidential Information includes information that I may create, access, or

obtain on behalf of CHI.

• CHI Confidential Information also includes, but is not limited to, protected health information, billing, payroll, employment records, employee

benefits, payment card and cardholder information, trademark, copyright, intellectual property, technical ideas and inventions, written

published works, contracts, supplier lists and prices, price schedules, business practices, marketing, or strategy, CHI Confidential Information

of third parties for business purposes, or information that is only intended for internal use even if not officially designated as Confidential

or Internal Use Only.

Therefore, in the course of my association with CHI, I acknowledge that:

1. I will only use, access, or disclose CHI Confidential Information as needed to perform my assigned responsibilities and in accordance with CHI

polices, standards and approved processes. I will use, access, and disclose CHI Confidential Information in such a manner as to prevent

unauthorized use or disclosure of such information

2. I understand I am responsible for reading and complying with all CHI Policies and Standards, including CHI Privacy and Information Security

Policies and Standards.

3. I understand I am responsible for reading and complying with the information contained in the Information Privacy and Security Practices for

Non-Employees Handbook. I may receive this handbook from my CHI Sponsor, and may direct any questions to the CHI Sponsor.

4. I will complete assigned Privacy and Information Security education as outlined in credentialing agreements, business associate agreements,

student affiliations agreements, or any other agreement that establishes me as a workforce member. I must produce evidence of completion

of required education timely upon request.

5. Confidentiality violations: If I violate CHI Privacy or Information Security policies and standards, or applicable law and regulation, I am subject to

discipline under applicable policies, agreements, rules, regulations, bylaws, or any other oversight instrument, including will result in actions up

to and including termination of my relationship with CHI.

6. I understand that my obligation to maintain the confidentiality of CHI Confidential Information extends beyond termination of my association

with CHI, and I agree that I will not disclose or use CHI Confidential Information for any purpose after my employment or association ends.

7. In my association with CHI, I may be assigned access to CHI systems. I understand that passwords, verification codes, or electronic signature

codes assigned to me are the equivalent to my personal signature; and I am responsible and accountable for all actions or entries made and

retrievals accessed using my password, verification or electronic signature code regardless of whether it is used by me or by another individual;

and I will not share my CHI passwords, verification codes, or electronic signature codes with another individual or make them accessible for

others to discover. If a password or code is compromised, I will immediately take steps to change it.

8. In my association with CHI, I may be assigned or use CHI IT Assets. I understand that CHI maintains ownership of CHI IT Assets (e.g., computer

workstations, laptops, tablets, smartphones, remote desktops, and similar devices, and removable disk or storage devices, including USB storage

devices, external hard drives, writeable CDs/DVDs) and the CHI Confidential Information contained on these CHI IT Assets. Unless authorized,

I will not install, download, reconfigure, reverse engineer, copy/duplicate, or remove any software on CHI IT Assets. I understand that I am

responsible for preventing unauthorized access to, and use of CHI IT Assets by following established CHI policies, standards, guidelines, and

instructions.

9. I will immediately report any Privacy or Security incident involving CHI Confidential information or IT Assets to the designated Privacy or Security

officer, or the ITS Service Desk, regardless of how insignificant I may think the incident is. This includes immediately reporting the loss or

theft of a CHI IT Asset or other device that contains CHI Confidential Information or can access a CHI network or other CHI system, even if

that device is personally-owned.

10. I understand that I do not have, and should not expect any personal privacy rights when using CHI IT Assets or accessing CHI systems.

11. If I use a CHI-issued, a personally-owned, or a third party-provided mobile device (e.g., smartphone, tablet, laptop) to access any CHI network,

systems or applications, including CHI Exchange/Outlook (e.g., email, calendars and contacts) I will adhere to all requirements and conditions

set forth in CHI Information Security Standard ITS13-S8 Mobile Device Security.

Print Name:

Sign and Date:

43

Appendix D

Validation of Clinical Orientation to Jewish Hospital Please initial each item indicating you have received the following information pertaining to your clinical rotation and have had your questions answered to your satisfaction. KentuckyOne Health Mission, Vision, Values and Standards of Performance Dress Code Parking/Identification Badges Infection Control

Hand Washing

Personal Protective Equipment

Standard Precautions

Isolation

Blood spills/exposure Health Information Management Smoking Policy Patient Rights and Ethics Restraint and Seclusion Incident Reporting Hospital Safety Information

Emergency and Disaster Codes and Response

Hazardous Materials and Waste Management o Material Safety Data Sheet o Using appropriate waste bags (red, yellow, or trash) o Pharmaceutical Waste

Medical Equipment Safety ______Patient Safety ______Patient Identification and Armbands including Two Patient Identifiers Administering medications

High Alert High Risk Medications

Medical Orders Written and Verbal

Red Rules for Patient Safety I have read and understand the Jewish Hospital Orientation information. All my questions have been answered satisfactorily. Signature______________________________________ Date______________ Name Printed__________________________________ School Affiliation_______________

44

Appendix E

Nursing Student Scavenger Hunt

Instructions: Locate the following items on your unit. Write the location of the item in terms that will help you remember the location. If you need assistance, ask the clinical instructor or the staff for help. If an item is not applicable to your unit, write N/A in the space.

ITEM

LOCATION ON NURSING UNIT

General Orientation

1. Linens

2. Employee Lounge

3. Conference Room (If unit has one)

4. Clean Utility Room

5. Soiled Utility Room

6. Tube System

7. Thermometer

8. Blood Glucose Meters

9. Clean Linen Cart

10. Trash Chute/Laundry Chute or Hamper

11. Housekeeping Closet

12. Emergency Crash Cart

13. Employee Bathroom

14. Kitchen

15. Linen Hamper

16. Manager’s Office

Safety

1. O2 Turn-off Valve

2. Fire Alarms

3. CO2 Fire Extinguishers (red)

4. H2O Fire Extinguishers (silver)

5. Fire Exits

6. Fire Hose

7. Emergency Exit Plan Diagram (if posted)

45

Medications

1. Med Room

2. Medication Carts

3. IV Therapy Manual

4. Pyxis Med Station

5. Patient IV Meds

6. IV Fluids (Stock)

7. IV Tubing

Central Supplies 1. Pyxis Supply Station

2. List 5 items found in the Pyxis Supply Station

Dietary

1. Kitchen

2. List 5 items found in the Kitchen

Patient Room Check Operation of the following items. 1. Call light/TV control

2. Emergency Light

3. Bed Operation

4. Thermostat

Emergency Equipment

1. Code Cart

2. Defibrillator/Monitor

3. Backboard

46

Appendix F

Nursing Student Assignment Sheet

Date: School:

Instructor: Instructor Contact Number: Time on Unit: Time Leaving Unit:

Student/Patient /Room# Clinical Focus Areas (please circle tasks the student will be expected to perform)

Comments (Please specify any specific focus the student might have)

Bath Personal Care Bed

Ambulation Treatments

Oral Meds IM Meds IV Meds

Bath Personal Care Bed

Ambulation Treatments

Oral Meds IM Meds IV Meds

Bath Personal Care Bed

Ambulation Treatments

Oral Meds IM Meds IV Meds

Bath Personal Care Bed

Ambulation Treatments

Oral Meds IM Meds IV Meds

Bath Personal Care Bed

Ambulation Treatments

Oral Meds IM Meds IV Meds

Bath Personal Care Bed

Ambulation Treatments

Oral Meds IM Meds IV Meds

Bath Personal Care Bed

Ambulation Treatments

Oral Meds IM Meds IV Meds

Bath Personal Care Bed

Ambulation Treatments

Oral Meds IM Meds IV Meds

Bath Personal Care Bed

Ambulation Treatments

Oral Meds IM Meds IV Meds

47

Appendix G Contact Information

Sarah Woolwine, MSN, RN-BC, PCCN

sarahwoolwine@kentuckyonehealth.org Phone: (502) 587-4194 Fax: (502)562-7069 Office Location: Room 874 of Jewish Hospital. If no one is in the office, you can slide the forms under the door. Monica Fort, Administrative Assistant

MonicaFort@KentuckyOneHealth.org

Phone: (502) 407-3057 Office Location: Room 870 of Jewish Hospital.

Unit Ext Manager Voicemail Email Specialty Level

7 H&L 2570 Angie Freeman

2571 AngieFreeman@KentuckyOneHealth.org

Post Op CABG Inter. Tele.

8 H& L 2580 Angie Freeman

2571 AngieFreeman@KentuckyOneHealth.org

Post Op CABG Inter. Tele.

OHRR/CVIC

4480 Shannon Brackett

4474 ShannonBrackett@KentuckyOneHealth.org

Cardiac Open Heart ICU

5 Tower 4458 Danielle Lurie

2839 DanielleLurie@KentuckyOneHealth.org

Cardiopulmonary VAD Inter. Tele.

6 Tower 4468 Jamie Maurer

4186 JamieMaurer@KentuckyOneHealth.org

Vascular/Chest Pain Unit Inter. Tele.

7 Tower 4478 Jamie Maurer

4186 JamieMaurer@KentuckyOneHealth.org

Vascular/Chest Pain Unit Inter. Tele.

4 West 4740 Kara Case 4905 KaraCase@KentuckyOneHealth.org

Intermediate Inter. Tele.

4 T (ICUA) 4363 Brittany Adams

4591 BrittanyAdams2@KentuckyOneHealth.org

Cardiac ICU ICU

4 T (ICUB) 4366 Brittany Adams

4591 BrittanyAdams2@KentuckyOneHealth.org

Medical I ICU ICU

4 T (SCUC) 4369 Brittany Adams

4591 BrittanyAdams2@KentuckyOneHealth.org

Medical II ICU ICU

4 S (ICU F) 4786 Sarah Diachenko

2591 SarahDiachenko@KentuckyOneHealth.org

Transplant Surgical ICU ICU

5 S (ICU G) 4601 Sarah Diachenko

2591 SarahDiachenko@KentuckyOneHealth.org

Neuro ICU ICU

6 West 4624 Tracy Fultz 8306 TracyFultz@KentuckyOneHealth.org

Surgical Med Surg. Med Surg.

3 East 4434 Connie Devine

561-3908 ConnieDevine@KentuckyOneHealth.org

Abdominal Transplant Med Surg.

5 East 4545 Denise Yocom

7453 DeborahYocom@Kentuckyonehealth.org

Neuro/Stroke Inter. Tele.

5 West 4456 Kara Case 4905 KaraCase@KentuckyOneHealth.org

Med Surg. Med. Surg.

9 Frazier 7453 Denise Yocom

7453 DeborahYocom@KentuckyOneHealth.org

Acute Orthopedics Med. Surg.

ED 4421 Connie Manley

4276 ConnieManley@KentuckyOneHealth.org

Emergency Department ED

48

Appendix H

HIGH-ALERT/ HIGH-RISK MEDICATIONS

General Description

Drugs Included

(Lists may not be all inclusive)

Safety Strategies

Chemotherapy / Antineoplastics

All injectable products included

Verbal orders for chemotherapy are prohibited.

New orders must be written for each cycle of chemotherapy.

Chemotherapy is stored only in the Pharmacy (segregated and labeled).

Pharmacy prepares chemotherapy products.

Two pharmacists review/confirm chemotherapy orders and all necessary calculations and must initial worksheet.

Chemotherapy doses are labeled as such when dispensed from pharmacy and are delivered in a special transport container.

Only chemo-certified nurses can administer chemotherapy.

Two nurses check labeled product against physician order prior to administration.

Concentrated Electrolytes

Magnesium Sulfate Injection, Concentrated

Magnesium Sulfate concentrated vials/syringes are stored outside pharmacy, only in a non-matrix Pyxis drawer or crash cart with cautionary labeling. Otherwise, a premixed solution is available for use.

Potassium Chloride Injection, Concentrated

Concentrated Potassium Chloride vials are not stored outside Pharmacy with the exceptions of : 1) Open Heart Surgery at JH - 20mEq vials only are stored in a non-matrix drawer of Pyxis in a bag labeled “Caution – Must be Diluted”; 2) Shelbyville - only in a labeled “high risk box” located in the night cabinet, accessible only by the nursing supervisor.

Premixed solutions are purchased for use whenever possible.

Potassium Phosphate Injection, Concentrated

Concentrated Potassium Phosphate vials are not stored outside the pharmacy with the exception of Shelbyville, where it is stored only in a labeled “high risk box” located in the night cabinet, accessible only by the nursing supervisor.

All Other Concentrated Electrolytes

Concentrated vials are not stored outside the pharmacy.

No concentrations of Sodium Chloride greater than 0.9% are stored outside the pharmacy.

Direct Thrombin Inhibitors, intravenous

Argatroban,

Bivalirudin (Angiomax®)

Infusion pumps are used to administer intravenous direct thrombin inhibitors. Weight-based dosing is standardized to defined units in the programmable infusion pump.

Anticoagulation policy establishes dosing and monitoring guidelines.

Number of concentrations available is limited. Pharmacist dosing consult is available upon prescriber request.

Two nurses check all doses and/or pump settings at initiation and at any rate changes.

49

Heparin, Unfractionated

Injection,

intravenous administration only

Heparin, Unfractionated Injection -

Intravenous administration only

Standardized order sets are available for heparin therapy in acute coronary syndromes, VTE, and CVA.

Anticoagulation policy establishes monitoring guidelines.

Infusion pumps are used to administer continuous intravenous heparin. Weight-based dosing is standardized to defined units in the programmable infusion pump.

Number of concentrations of heparin is limited; Heparin concentrations greater than 5,000 units/mL are not purchased; Storage is segregated.

Two nurses check all IV bolus doses and/or pump settings at initiation and at any dose changes.

Insulin All products are included

Standardized protocols are available for insulin therapy.

Standardized concentration is used for all insulin infusions.

Limited insulin products are stored in non-matrix Pyxis drawers.

Two nurses check product selected and dose prepared for all insulin doses.

Two nurses check pump settings at initiation and bag changes of insulin infusions.

Neuromuscular Blocking Agents

(NMBA)

Cisatracurium

(Nimbex®),

Rocuronium

(Zemuron®),

Vecuronium

(Norcuron®)

NMBAs will be clearly labeled with high alert signage in pharmacy, critical care and surgical areas.

For administration in critical care areas, “Neuromuscular Blockade in the Critical Care Setting” policy will be followed.

Oral anticoagulants

Xa Inhibitors:

Rivaroxiban (Xarelto®),

Apixaban

(Eliquis®),

Edoxaban

(Savaysa®)

Direct Thrombin Inhibitors

Dabigitran (Pradaxa®)

Only unit-dose products are used.

Anticoagulation policy establishes monitoring guidelines.

Warfarin (Coumadin®)

Only unit-dose products are used.

Anticoagulation policy establishes monitoring guidelines.

Intravenous / Subcutaneous Prostanoids

Epoprostenol

(Flolan®),

Treprostinil,

(Remodulin®)

Standardized units will be used for all medication orders (ng/kg/min and mL/day).

Intravenous/Subcutaneous pump settings and sustainability of tubing/connections will be checked at medication initiation, dose change, and every cassette change by two RNs. The double-check will be documented.

50

Thrombolytics

TPA,

tenecteplase -

Includes all thrombolytics used for TREATMENT of thrombotic conditions.

Thrombolytic use for catheter declotting is EXCLUDED.

Dose calculations of thrombolytic administered for the treatment of ischemic stroke and STEMI are checked by two RNs prior to administration. The double-check is documented.

With the exception of IV bolus doses, infusion pumps are used to administer intravenous thrombolytics.

Two RNs perform an independent and documented double-check of the syringe used to deliver the bolus dose and/or all pump settings at initiation of infusion of thrombolytic therapy.

Patient Controlled Analgesia (PCA);

Epidural infusions;

Other Continuous Infusion Opiates

Morphine,

Fentanyl,

Hydromorphone, (Dilaudid®) ,

Meperidine (Demerol®),

Bupivicaine (Marcaine®, Sensorcaine®),

Ropivacaine (Naropin®)

Standardized PCA order form is available for use.

Premixed morphine and meperidine PCA syringes are purchased. They are segregated in storage.

Pharmacy prepares all other admixtures.

Two nurses check syringe/bag for correct drug and strength and all settings at initiation, syringe/bag change, and setting changes.

Look-Alike / Sound-Alike Medications

See Look-Alike / Sound-Alike Medication list

Per facility policy.

Hazardous Medications

Antineoplastics and per NIOSH list

Per facility policy.

51

Appendix I

Evaluation of Clinical Site Please either visit the following website or scan the QR Code below to access the clinical site evaluation form. This form should be completed at the conclusion of the clinical rotation. https://www.surveymonkey.com/r/PMCNTXX

52

Appendix J

KentuckyOne Health – Jewish Hospital Clinical Instructor Evaluation

(To be completed by Nurse Manager or Designee)

Instructor:__________________________ School:_______________________ Unit:_____________ Evaluator:______________________________ Date:_____________ Please indicate which response best reflects your experience with the above clinical instructor using the following scale. 5: Strongly Agree 4: Agree 3: Neutral 2: Disagree 1: Strongly Disagree 1. Contacted the nurse manager prior to clinical to introduce themselves and

orient to the unit. 5 4 3 2 1

2. Maintained a professional appearance and conduct. 5 4 3 2 1

3. Provided Nursing Student Assignment Sheets with clearly defined clinical expectations. 5 4 3 2 1

4. Maintained communication and had good rapport with nurse manager, charge nurse, and staff. 5 4 3 2 1

5. Was readily available to students at all times. 5 4 3 2 1

6. Sought learning opportunities for students. 5 4 3 2 1

7. Handled student issues in a professional manner. 5 4 3 2 1

8. This was an appropriate clinical for this unit. 5 4 3 2 1

9. I would like this clinical instructor back on my unit. 5 4 3 2 1

Comments:

Return Completed Form to Sarah Woolwine in Nursing Education

53

Appendix K