WelcomeWelcome to Bethesda Health, Inc. We are pleased to be an integral part of the students’ educational experience as they strive to reach their career goals as a healthcare professional. I hope that the students will eventually consider Bethesda as their employer of choice. We feel we offer the perfect recipe for fledgling professionals that will launch their initiation into the healthcare arena as well as nurture their career development.

With that in mind, it is important that each of the entities - instructors, students, and staff understand the role they play in this endeavor. First and foremost the staff is here to take care of the patients’ healthcare needs, always putting the patient first. The instructor’s primary role is to educate the students directly as well as facilitate their experiences so they can benefit from a meaningful, pertinent, experience, which will highlight the didactic portion of their education. Furthermore, a common goal shared by all parties, is the safety of our patients and the environment that we all share. These philosophical tenets are part of our contractual agreement with the educational facilities and underpin all the policies and procedures of the institution.

The Education Resource Center sees their role in providing an organized system for coordination of the clinical rotations, matching the requested student experience with the closest clinical area of choice, and assuring that all credentials and screening procedures are adhered to. We are committed to providing an orientation to Bethesda for both instructors and students in the most expedient way possible. To that end, the Clinical Instructor Manual was created and we hope it is helpful to you. Your feedback is greatly appreciated, as it is a work in progress.

Please feel free to contact me if you feel we have fallen short of the very highest standards of patient care, or, that the students’ clinical experience here was anything less than satisfying. It will be a learning opportunity for each of us to improve upon the situation.

Amanda Murphy, MSN, RNDean, Bethesda College of Health SciencesDirector, Education Resource CenterBethesda Health, Inc.2815 S. Seacrest Blvd.Boynton Beach, FL 33435561-364-3066Fax: 561-364-3059

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TABLE OF CONTENTS

Bethesda Health’s History....................................................................................................................................3

About the ERC...............………………………………………………………………………………………...4

Clinical Internship Clearance Process..................................................................................................................5

Rotation Schedule....................................................................................................................................5

Steps and Responsibilities.......................................................................................................................5

Computer Access.....................................................................................................................................5

Student Nurse Program Participant Responsibilities............................................................................................6

Online Orientation................................................................................................................................................8

Accessing Clinical Systems..................................................................................................................................9

eCOS Guide........................................................................................................................................................10

MAK FAQs........................................................................................................................................................14

Health Screening & Background Checks...........................................................................................................22

Additional Information

Pre & Post Conference Rooms..............................................................................................................24

Parking...................................................................................................................................................24

Lunch……………………………………………………………………………………….…............24

Level 2 Preceptorship………………………………………………………………………................24

Medication Administration …………………………………………............................................…...24

Professionalism …………………………………………..............................................................…...25

Appendix A (Forms)..……………………………………………………………….........................................26

Student & Faculty Rotation Request.....................................................................................................27

Preceptor Request..................................................................................................................................28

Attestation..............................................................................................................................................29

Student & Faculty Affirmation..............................................................................................................30

Appendix B (Telephone Directories).………………....................……………………………………………31

Important Phone Numbers At-A-Glance..............…………………………………………………….32

Patient Services Administration Telephone Listing..............................................................................33

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BETHESDA HEALTH – OUR HISTORY

As the flagship of Bethesda Health, Inc., Bethesda Hospital East is a fully accredited, community, not-for-profit hospital offering a full array of healthcare services through our Centers of Excellence. 

Bethesda Hospital East opened its doors in 1959 with 70 beds, a medical staff of 32 physicians, 65 employees and a mission to serve the community. At that time, the Hospital's founders made a decision to establish Bethesda as a not-for-profit hospital. For over 60 years, the commitment to preserving this status has not wavered.

It is this commitment to our community that has allowed Bethesda to grow and become a 401-bed, community, not-for-profit hospital with a mission "to provide quality health services in a caring manner."

With 670 physicians in more than 40 areas of specialty, and a hospital staff of more than 2,500 employees, Bethesda Hospital East, and its affiliates, offer a full array of healthcare services including:

Comprehensive cancer care Comprehensive cardiovascular services Orthopaedics Maternity services including a Level III neonatal intensive care unit Advanced Primary Stroke Center Inpatient and outpatient rehabilitation Wound care and hyperbaric medicine And more

Building for a Lifetime1957 Groundbreaking ceremony for Bethesda Hospital East1959 Hospital opened with 32 doctors and 70 beds1959 First baby born at Bethesda1969 A rock from the pool of Bethesda in Jerusalem was sent to the Hospital by former Boynton Beach

residents. It remains on display in the Main Lobby of the Hospital.1980 A witty sign placed in front of the Hospital succinctly expressed Bethesda's community

ownership. . . priceless!2000 Bethesda's most aggressive expansion and renovation plan was presented and initiated: $100

Million Community Challenge Campaign2005 The 28-bed Cornell Institute for Rehabilitation Medicine opened on the 3rd floor of the Hospital to

serve the needs of patients requiring orthopedic and neurological rehabilitation.2005 The Bethesda Stroke Center became a Certified Primary Stroke Center, the first of its kind in Palm

Beach County2008 The Bethesda Heart Hospital, a 39-bed, heart hospital opened to provide the most comprehensive

level of cardiovascular services for the area's rapidly growing population.2008 The Walter S. and Lucienne Driskill Endovascular Center opened to allow surgeons to care for

patients with vascular problems using minimally invasive procedures.2009 Bethesda Hospital East, the first, not-for-profit, community hospital built in South Palm Beach

County, celebrated its 50th Anniversary on February 9, 2009.2010 Landmark groundbreaking of Palm Beach County's newest hospital, Bethesda Hospital West, on

May 25, 2010.2013 Bethesda Hospital West opened its doors on January 8, 2013. This 80-bed, all-private room

hospital will serve the western communities of Boynton Beach2016 Bethesda Health Urgent Care opened its doors in the Fall of 2016 providing care for a

comprehensive array of medical conditions with State-of-the-Art Imaging and Laboratory Services.2017 Bethesda Health merged with Baptist Health South Florida.

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EDUCATION RESOURCE CENTER

Phone (561) 737-7733 X84497Fax: (561) 734-2545

The Education Resource Center supports the mission of the hospital, that is, “Providing quality healthcare in a caring manner.” To that end, we are committed to make available education services that assist the organization achieve its goals. The ERC is located on the lower level of the hospital, roughly under the Emergency Department. We are open from 7:30 a.m. until 3:30 p.m. with lunch taken 12 noon and 1:00 p.m.

STAFF

Amanda Murphy Dean, Bethesda College of Health SciencesDirector, Education Resource CenterX63066

AmandaKM@BaptistHealth.net

Patricia Britton Coord., Clinical Education/ Workforce DevelopmentX85118

PatriciaBrit@BaptistHealth.net

Ruth DeZayas E-Learn Instructional DesignerX4076

RuthAD@BaptistHealth.net

CLINICAL INTERNSHIP CLEARANCE PROCESS

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Rotation SchedulesRequests for clinical rotation are done on a first-come, first-serve basis. These requests must be submitted by the designated date of each semester for consideration utilizing the Centralized Clinical Placement System (CCPS) for nursing rotations only. All other clinical rotations must make requests directly to Amanda Murphy (AmandaKM@BaptistHealth.net) in our Education Resource Center utilizing the Affiliation Request or Preceptor Request Form. Requests can only be made by the school. Student requests will not be honored. If your previous request for a unit was granted, do not assume that next semester you will automatically be placed on the same unit or that the hospital will have availability. Any late requests may not be granted.

Once individual school’s rotation requests have been approved and confirmed they will not be changed. Instructors will not be allowed to deviate as we are running a tight schedule, and even an overlap of one hour on a unit can be detrimental to the students, staff, and patients. If there are any deviations, we may cancel the clinical rotation.

Steps and Responsibilities 1. Clinical Coordinator: Requests student for affiliation to respective department via email utilizing

CCPS (nursing only), Affiliation Request, or Preceptor Request Form to AmandaKM@BaptistHealth.net.

2. Education Resource Center: Accept or deny student request via email. We cannot say yes to any school if there's not a contract and insurance between the school and Bethesda that's currently active.

3. Clinical Coordinator: Once accepted, instruct student to complete the orientation requirement and email you the signed affirmation form: https://www.bethesdaweb.com/student-orientation

4. Clinical Coordinator: Once the student has completed the online orientation, you will forward this proof AND the completed and signed STUDENT SCREENING FORM to AmandaKM@BaptistHealth.net. Students CANNOT complete and submit this form. It must come from the School Coordinator. This must be completed at least two weeks prior to the first day of rotation.

5. Education Resource Center: Once all these requirements are received, the clearance will be emailed to the Clinical Coordinator.

6. Clinical Coordinator: Acknowledge receipt of clearance.

**Students can’t be on site without these steps being completed first.**

Computer AccessAll Instructors must attend a mandatory computer orientation prior to the start of the clinical rotation when they are a new instructor to Bethesda Health in order to receive access to clinical systems. Classes are limited so please plan accordingly. The Clinical Coordinator is to contact the Education Resource Center via email, AmandaKM@BaptistHealth.net, to make arrangements. No Instructor will be given access after a clinical rotation has commenced.

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STUDENT NURSE PROGRAM PARTICIPANT RESPONSIBILITIES

Responsibilities of the Academic Institution:

A. To maintain and follow an up to date annual contact on file in the administrative office of the Vice President, Risk Management.

B. To maintain standards recommended in the Rules and Regulations of the Florida State Board of Nursing and the State Plan for Education.

C. To employ qualified, professional registered nursing faculty who shall be responsible for determining the philosophy, objectives, and development of the curriculum.

D. To request, in writing, clinical areas desired through the Education Resource Center (ERC) at least 30 days prior to actual clinical experience.

Responsibilities of the Registered Nurse Instructor:

A. To be familiar with the orientation packet prepared by ERC for Registered Nurse Instructors and to complete the Hospital’s orientation program, health screening, drug testing and background checks prior to the first day of clinical.

B. To check in and provide all required paperwork for the instructor and the students before the first day of clinical.

C. To provide a written schedule of the student’s clinical experience to the ERC and the respective Patient Services Director at least one week prior to the student’s first clinical experience.

D. To select and correlate the student's patient assignments in cooperation with Nursing personnel.

E. To supervise the student in performing new procedures and during their clinical practicum.

F. To inform the Patient Services Director or Charge Nurse of the student's clinical level of knowledge and ability to perform patient care duties and goals and objectives of experience prior to the first clinical experience.

G. To plan concurrent instruction to meet the objectives of the program.

H. During an observational experience where a student does not provide hands on care to nor assume any responsibility for patients, the instructor shall be immediately available by telephone or beeper to all students. In addition, the goals of the observational experience must be provided to the Department Director or designee prior to the student’s first observational day.

I. Instructors must obtain a badge with their specific number affording them access to clinical systems and CMBG monitoring devices. Instructors will complete the CMBG competency as required. ERC will inform HR to issue the badge. All Bethesda Health ID badges must be returned at the end of each clinical rotation to the ERC. Returning instructors will report to the ERC to obtain their badge for their next clinical rotation.

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Responsibilities of the Hospital:

A. To share in the education of the student through the cooperation, guidance and supervision of the hospital’s Nursing staff and, in conjunction, with the guidance and supervision provided by the Registered Nurse Instructor.

B. To make available to faculty and students, the hospital facility and clinical services for planned clinical practicum’s as the clinical areas availability permits. The hospital has the right to limit the number of students in each patient care area per shift.

Responsibilities of the Student Nurse:

A. To complete orientation packet prior to clinical experience, the Student Data Sheet and comply with current health screening, drug testing and background check requirements prior to the first day of clinical.

B. To conform to the charting policies and procedures of the Patient Services Division. It will be the responsibility of the Registered Nurse assigned to the student's patient to review the Patient Care Notes.

C. To report all known errors to the instructor and assigned Nurse, along with appropriate documentation on required forms.

D. To report to the nurse responsible for their assignment prior to break, lunch or completion of shift.

Responsibilities of a Bethesda Registered Nurse:

A. If a Student Nurse in an RN Program conducts an assessment and identifies the patient's problems under the supervision of the Registered Nurse Instructor, the RN assigned to the patient must repeat the assessment and evaluation.

B. Monitored strips will be interpreted by the Nurse employee assigned to the patient and documented in the Patient Care Notes by same. The Student Nurse may interpret the monitor screen/monitored strips, but only under the supervision of a qualified Bethesda Registered Nurse.

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ACCESSING ONLINE ORIENTATION

We are proud to share the hospital with you as you continue your training in the healthcare field. Although we certainly hope that an emergency such as a fire, hurricane or hazardous spill does not occur while you are with us, you should know what to do in the event it does. For your information, we have prepared eight computer presentations. You can take these courses wherever you can access the Internet. The Internet address for the site is:

https://www.bethesdaweb.com/student-orientation

Under Orientation there are links to each of the presentations. Every student and faculty member on site is expected to read each presentation and affirm that they understand and will abide by the information provided.

Below is the list of courses that you will be expected to complete.

o HIPAAo Infection and Environmental Controlo Influenza Vaccinationo Stratus VRIo Tanko Universal Pharmaceutical Waste

Faculty and students are expected to sign and submit the affirmation form found on the same website above only after completion as everyone will be held responsible for the information. Anyone found to have submitted the form and not complete each presentation will be removed from site permanently and the school could face possible suspension from clinical rotations at Bethesda Health.

If you have concerns or challenges, please feel free to contact any member of the ERC team at 561-737-7733 ext. 84497.

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INSTRUCTIONS FOR ACCESSING CLINICAL SYSTEMS

NETWORK

1. Log on – 6 digits employee #2. Password – Bethesda1233. Press enter4. Prompted to change password every 90 days

ECOS

1. Log on – 6 digits employee #2. Password – Bethesda123 or 1234563. Press enter4. Prompted to change password every 90 days

MAC

1. Log on – 6 digits employee #2. Password – 6 digits employee #3. Prompted to immediately change password – must be at least 6 digits long4. Next screen asks for User ID

a. Scan barcode on front of badge5. Prompted to change password every 90 days

HELP DESK

1. From a Bethesda phone dial – 84357a. Password problemsb. Account locked

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eCOS:Quick Reference Guide

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Navigating Patient Record

Patient Record and Clinical Summary are both used for navigating patient information. Patient Record is useful for researching documents over a period of time, while Clinical Summary is best for real-time data on the current visit and will therefore be used most frequently.

To view patient assessments, click beside patient name on census.

1. View ResultsWhen you open the Clinical Summary, the default view is the “Overview”, the physician’s patient summary

view (screen divided into four boxes).

The list of tabs located on the left display important patient information. Vitals, labs, imaging, documentation, etc., can be selected and will display data (in chronological order) from the last three days. Use the arrow to see more days. Columns either directly display values or contain icons which open information separately.

To open Transcriptions documents, click on the icon to the left. This opens the file’s related application. Note that this action will NOT log you out of eCOS - simply close the window when finished viewing the information and you will return to eCOS.

2. View Clinical Documentation

Electronically Documented Notes – progress notes (as well as post-op notes) created in eCOS are found under Provider Documentation. The specialty, date and author will display under this header for each note; click on the note to display it, or click Provider Documentation to see all notes at once. Clicking on a note’s header will either minimize or maximize it.

NOTE: Physician documentation previous to July 2016 is located under Physician Documentation, and these progress notes are called Daily Notes.

In the Patient Record module Daily Notes are divided by specialty, and can be individually opened.

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“Physician Daily Notes” box shows notes that are completed with and will show notes that are still ‘in progress’ with .

“Physician Documentation” box shows the same documents but in a print-friendly version.

Transcriptions – documents transcribed through the phone transcription service are located in the Transcription tab. A transcription must be viewed in the Medical Record’s EMR program; therefore, you must click on the “face” icon to see the information.

NOTE: Operative Reports will be found under the Transcriptions tab in Clinical Summary rather than Provider Documentation, as it is an external document.

Scanned documents – any hand-written document are scanned by Medical Records into the EMR after discharge. To see these documents:

3. View Medications Go to Clinical Summary and select Meds/MAR, located on the left column. Active med and IV orders immediately list for current visit, but you can navigate through the row of med tabs to find more detailed information.

Scheduled MAR shows previous dispense time and/or future dispense times.Next to the date & time: a check indicates it was given, red circle indicates it was NOT administered. To see

the reason for non-administration, click on the red circle. Hover over any details for more information.

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Click on this icon, “Access Websites Related to This

Patient,” and choose “EMR-PT Specific Browse”

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MAKHelp Book:

Frequently Asked Questions

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FIRST TIME SIGNING INTO MAK

1. To get into MAK click on this ICON.

2. It will prompt you to logonIn the “Logon ID:” Space Type your Invision Sign on (usually the last 6 numbers of your social security Number) In the Password space retype your Invision Sign on – EXACTLY what you typed for Logon ID (Do not type your Invision Password)It will prompt you to change your password. Please enter any six-character password that you will remember. It may be letters or numbers or a combination of both.The next screen you will see asks for your user ID, this is where you would scan your badge.

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INDEXQuestion Page

1. How do I set up my personal census?..........................................................................................................18

2. How do I select people from multiple units (i.e. 3e and 3w)?.....................................................................18

3. How do I add people to my personal census during the day – i.e. admissions transfers?...........................18

4. How do I remove people from my personal census? ..................................................................................18

5. Once I am in my personal census how do I move from patient to Patient?.................................................18

6. What do I do if I am on the blue screen, and I want to give meds or look at a patient’s medications or it

doesn’t automatically go into a particular patients chart? ...........................................................................18

7. What do these tabs mean – the items with writing on them that look like file folders?..............................18

8. How do I verify a Medication?....................................................................................................................19

9. How do I see what the medications purpose is, and how do I print out medication information for

a patient?......................................................................................................................................................19

10. What do I do if an order is incorrectly entered by pharmacy?....................................................................19

11. How do I print a MAR if the physician needs one or if I am sending the patient to a SNF?......................19

12. How do I pass meds without a MAR?.........................................................................................................20

13. How do I administer a med on MAK? .......................................................................................................20

14. What do I do if the screen says the “drug is not recognized”?....................................................................20

15. What do I do if the patient is not recognized? – Shows as wrong patient?.................................................20

16. What does it mean when a med is highlighted in pink?..............................................................................20

17. How do we chart blood sugar?....................................................................................................................20

18. How do I see a blood sugar result if it has already been entered?...............................................................21

19. How do I give coverage for Blood sugars/i.e. see sliding scale and give insulin?......................................21

................................................................................................................................................................................

20. What do I do if I entered a wrong value of Blood sugar, pulse, or dose of medication?............................21

21. What do I do with this message entry thing on my active worklist?...........................................................21

22. What do I do if a patient refuses a medication?..........................................................................................21

23. What do I do if the patient has refused a med and now wants it, or if for some reason I have to give a

medication that has already been charted as not administered?...................................................................22

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Question Page

24. What do I do if I forgot to hit chart/forgot to use MAK?

Or what do I do if there are medications still on my active worklist, but I gave them already?.................22

25. How do I change the time that I administered a medication?......................................................................22

26. What does the little red star next the prn’s mean?.......................................................................................22

27. How do I administer Stat medication?.........................................................................................................22

28. What do I do if I can’t scan the stat med (i.e. doesn’t have a barcode, barcode won’t scan)?....................22

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1. How do I set up my personal census?Click - New Patient ListSelect-Nurse Station CensusClick - SelectClick on the selected patientTo select multiple patients, hold down the Control key and highlight each patient. (Holding down the control key allows you to select multiple patients at the same time)Click - Add to PersonalClick “Select Patient” to look at your patients individually or hit cancel if you want to get out of MAK and log off

2. How do I select people from multiple units (i.e. 3e and 3w)?First select New patient list and set up your personal census from the first unit (i.e. 3e). After you have followed steps above to set up the personal census –select cancel.At the top of the screen you will see an option that says “location” (This is only available from the blue screen)Click on location – then select the other unit that you have patients on (i.e. 3w). Then select new patient list, nurse station census and add patients to your list as described above.

3. How do I add people to my personal census during the day – i.e. admissions transfers?Clock close on your patient’s chart to get back to the blue screen.Click new patient list Click nurse station census, selectHighlight the patient you would like to add and click Add to Personal.The patient will be added to your personal census.

4. How do I remove people from my personal census? Click New patient ListSelect – Personal CensusClick on the patient(s) you would like to remove (see above for how to select multiple patients)Click - RemoveClick - Cancel

5. Once I am in my personal census how do I move from patient to Patient?“Next” will take you to your next patients“Previous” will take you back to the previous patient that you were looking at

6. What do I do if I am on the blue screen, and I want to give meds or look at a patient’s medications or it doesn’t automatically go into a particular patients chart? Click on “Chart Select Patient By Census”. It is the top selection to the left of the screen. It will give you all of your patients

7. What do these tabs mean – the items with writing on them that look like file folders?

Med SummaryBrand new orders.This tab will have all the drugs that have been ordered on your patient since they have been admitted. Drugs that are highlighted in yellow have been discontinued.

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Active Worklist/To Do ListWhat time meds are dueWill see a 4-hour window of medsWhen a med is given, it pops off the “Scheduled” list and goes to the “Charted List”. PRN meds stay on the list because they can be given multiple times throughout the day. Meds highlighted in peach are more than 2 hours late

DemographicsUnder this tab you will be able to find the patient’s admission date and their financial class.

Lab ResultsLabs associated with med pass.These results come over from the lab.Shows the result from the last time that the lab was drawn

InterventionsAllow you to see what pharmacy is doing. You can Click on the drug, Click History, Comments—It would say what was discussed with the MD (like, “Not true allergy” or “Medication not in stock” or “Auto-substitute”)

Charted List/Done ListCan see what was given as far back as from admissionAt 6am every morning, the previous day’s MARs will print and be filed in each patient’s chart (Physicians can look at Med Access to see up to the minute medication administration information)

Med SummaryA summary of all of the medications that have been ordered on the patient. MAK will automatically bring you to this page if you have new orders – i.e. new medications or discontinued medications.Red Pen = New orderBlue Pen = Medication that needs to be verified by 2 nurses

8. How do I verify a Medication?Click on the new medication/orderA window pops up so that the nurse can verify the MDs orderAny weird instructions will be in the “Directions” boxClick – Verify (if the order is correct)

9. How do I see what the medications purpose is, and how do I print out medication information for a patient?In the verification screen - highlight the name of the drug (i.e. in the white window click on the medication name)Then Click “Drug Info” and an Education Monograph will pop up and give you a simple explanation of the medicationClick “Report” to print out the Educational Monograph and you will be able to give this information to patients and families.

10. What do I do if an order is incorrectly entered by pharmacy?When you are in the verification window (white window that pops up when you click on an unverified medication), Click on Rx Message. You can then type a message to the pharmacy to let them know that an order is incorrect. A question mark will appear next to the order until pharmacy re-looks at the order and fixes it. When that process is complete, the pen will appear again. (You will have to verify all orders that have been fixed by pharmacy)

11. How do I print a MAR if the physician needs one or if I am sending the patient to a SNF?You have to be on the screen that looks blue and has file folders on the left side. To get here from a patient’s chart press close.Click on - “Request MAR/IVAR/Discharge MAR” – You can print a Mar from any time of the patient’s admission.

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12. How do I pass meds without a MAR?When ready to pass meds, go to the Pyxis machine. Use the “Remove By Due Time” function.Click on and set the range times and the computer will display all medications due between those times.

13. How do I administer a med on MAK? You must be on a portable computer –Once you have selected a patient, and their information is showing – click on Active work list. Click on the medication that is dueScan the drug Medication will be highlighted in green (see below if medication is not highlighted in green) IF you have multiple meds to administer to the patient scan all remaining medications to be administered.Then, take the portable computer cart to the patient’s bedside (or at least to the doorway of the patient’s room)Click “ID Patient”Scan the patient’s braceletYou will get a green check mark (see below if you do not get a green checkmark)Administer the medicationClick “OK”Click “Chart”

14. What do I do if the screen says the “drug is not recognized”?1. Check to make sure it is the correct drug/dosage/form/time.2. If drug is the correct drug, dose, form etc. – you may use the “override” button on the screen. It looks

like a barcode and is located on the bottom left of the screen. If possible – save the package with barcode intact, give it to the charge nurse and ask them to save it for someone from the MAK team who will pick it up. When using the override button it will ask you to indicate a reason for overriding - you may use the dropdown arrow to choose from several preformatted reasons or type in a reason.

3. If it is the wrong drug – click on the drug and scan the correct drug. ***ALWAYS be very careful to verify the correct drug if you are unable to scan the medication**** The drug will show as highlighted in light yellow because you have overridden the scan.

15. What do I do if the patient is not recognized? – Shows as wrong patient1. Check that it is the correct patient2. If it is not the correct patient – leave gracefully and go to the correct patient to administer the

medications?3. If it is the correct patient – Make sure you have the correct armband – i.e. if the patient comes

from the ED and still has a “E” bracelet on – you must reprint a bracelet on the floor to make MAK work. (This may also happen with patients who are 23hour observations and have been converted to an inpatient). Another way to check is to make sure that the patient number in MAK matches the patient number on the armband.

16. What does it mean when a med is highlighted in pink?This means that the medication is more than 2 hours late – You may still administer the medication.

17. How do we chart blood sugar?Scan the barcode for the CMBG that is attached to each portable computer monitorClick ID patient if you are actually acquiring the blood/result real time. Scan the patient’s braceletAfter you click OK on the screen when it displays the green checkmark, type the blood sugar result in the box next to blood glucose toward the top of the screen.Click chart

If you are entering the blood sugar after it has been collectedScan the barcode for the CMBG that is attached to each portable computer monitorClick ID patient then click on the override button on the ID patient windowClick preformatted reason for why you are not scanning the patient’s bracelet (like Blood Glucose test strip)Click - OKType in the patient’s blood sugar in the correct boxClick - Chart

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18. How do I see a blood sugar result if it has already been entered?Click on Charted List folderClick on the arrow on the bottom of the scheduled medications to scroll to the right. (The arrow is toward the middle of the screen on the right side and points to the right) You will see the column titled blood sugar – look at the row for whatever time you are looking up.

19. How do I give coverage for Blood sugars/i.e. see sliding scale and give insulin?Under the Active List, the sliding scale will be under the prn’sYou have 2 options to see the sliding scale.

1. Double Click on the Insulin order, Click Dose details (toward the right of the white window that pops up). Note the correct dose according to the patient’s blood glucose

2. Click on the arrow to the left of the insulin order and you will get the dropdown screen with the sliding scale (but you will only see what can fit on the screen)

To give the InsulinHighlight the drugScan the InsulinWill ask how many unitsEnter the # of units that you wish to giveOK – the follow normal procedure for administering meds (click ID patient and so on)

20. What do I do if I entered a wrong value of Blood sugar, pulse, or dose of medication?Click on charted listSelect medicationClick ReviseRevise the information (i.e. change blood sugar, pulse, etc.)Click Revise reason – select from dropdown list or type your own reasonClick chart

21. What do I do with this message entry thing on my active work list?Double click on message entryRead reminder/directionsClick on override (Click on the barcode to the bottom left of the window)Pick “message only” for reasonClick OKProceed on to administer other medications or if you are not administering any more medications override the patient armband (see above)

22. What do I do if a patient refuses a medication?If you have not already clicked on chart – -Select the medication and click “not administered”(located on the bottom of the screen). -It will make you indicate why you are not giving a medication. (You may use the preformatted reasons by clicking on the dropdown arrow to the right of the blank or you may type in your own reason.)-Continue by pressing chart or continuing to scan medications

If you have already clicked on chart - Click on the charted listClick medNot AdminType in the reason the med wasn’t actually given or use preformatted reason (described above)Click OKStatus will change to “Not Admin”

(You can click on Hx to see why a medication was not administered)

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23. What do I do if the patient has refused a med and now wants it, or if for some reason I have to give a medication that has already been charted as not administered?To re-administer medicationHighlight medScan medScan patient’s IDType in the reason that you were able to give the med again

24. What do I do if I forgot to hit chart/forgot to use MAK? Or what do I do if there are medications still on my active work list, but I gave them already?Most likely you forgot to hit chart to chart the medications as given.Go to the Active work list, select the medication, click the override button (barcode). Indicate the reason that you are overriding the scan (i.e. med scanned already). DO this for all medications that you had administered. Select ID patient – override patient ID indicating that you forgot to use MAK or scanned patient already.

25. How do I change the time that I administered a medication?Click on Charted ListClick on the medication that you need to change the time for (you must do this one at a time – you cannot change multiple patients at the same time)Click Revise (button toward bottom center of screen on charted list)Change the time that you administered the medicationSelect revise reason (can use dropdown list to indicate that you are changing the Time of administration (TOA))Click Chart

26. What does the little red star next the prn’s mean?You must do follow up on any medication given on a prn basis for pain.What do I do?Click starred entryAddress Pain Scale and Pain LocationYou may change date/timeYou can address effectiveness

27. How do I administer Stat medication?Only works on meds that can be overridden in PyxisClick Chart (Pharmacy Review Pending)Scan med –(watch for Allergy to be highlighted in red, if it is – question the order – hit cancel)

28. What do I do if I can’t scan the stat med (i.e. doesn’t have a barcode, barcode won’t scan)?Click the override button (barcode) on the screenType the drug in that you want to give – click enterWhen the list of drugs appears - Highlight Drug/dosage/FormGive Reason for overridingCan change the doseCan change the route

22

ADDENDUM TO SCHOOL AFFILIATION AGREEMENTStudent and Faculty Screening

A) Student Health . All students shall pass a medical examination acceptable to the Hospital prior to their participation in the Program at the hospital at least once a year or as otherwise required by Florida law, School and/or treatment if necessary, including transportation in case of illness or injury while participating in the program at hospital. In no event shall the hospital be financially or otherwise responsible for said medical care and treatment. Students will have the following health records completed and available for inspection prior to the first day of their educational experience at the Hospital:

(i) Tuberculin skin test within the past 12 months or documentation as a previous positive reactor and chest x-ray; and

(ii) Proof of Rubella and Rubeola immunity by positive antibody titers or 2 doses of MMR; and(iii) Varicella immunity, by positive history of chickenpox and or proof of varicella immunization;

and(iv) Proof of Hepatitis B immunization or declination of vaccine, if patient contact is anticipated,

and/or positive titer(v) One time dose of Tdap (for pertussis) following completion of primary 3-dose series of DPT

(Diphtheria, Pertussis, Tetanus,) (vi) Negative drug screen

B) Background Checks . School shall, in a timely manner at either School’s expense or the student’s expense, conduct (or have conducted) a level two background check on each and every student assigned to the program and every member of the staff/faculty responsible for supervision and/or instruction. If school has students or staff/faculty on-site at hospital prior to the execution of this agreement, then school shall immediately conduct a retrospective background check on such persons. The background check for students shall include, at a minimum, the following:

(i) Criminal Search (7 years or up to 5 criminal searches);(ii) Violent Sexual Offender and Predator Registry Search;(iii) HHS/OIG List of Excluded Individuals/Entities.

The background check for staff/faculty, if licensed or certified caregivers, shall include all of the above, in addition, shall include the following:

(i) Education verification (highest level);(ii) Professional License Verification;(iii) Certification and Designations Check;(iv) Professional Disciplinary Action Search

C) Drug Screening . Only Laboratories licensed by the State of Florida Department of Health and Rehabilitation and approved by the National Institute of Drug Abuse will be utilized for testing. Such laboratories are required to and shall comply with Florida law and rules established by the Department of Health and Rehabilitative Services.

The drug screen will be conducted for at the least, the following drugs. All levels equal to or exceeding the following state-defined levels shall be reported as positive:

Amphetamines 1,000 ng/ml Cannabinoids...........................50 ng/ml Cocaine...................................300 ng/ml Phencyclidine…………..........25 ng/ml Methaqualone…………..........300 ng/ml Opiates………………… .......2,000 ng/ml Barbiturates…………… ........300 ng/ml Benzodiazepines……….........300 ng/ml Synthetic Narcotics: Methadone...............................300 ng/ml Propoxyphene.........................300 ng/ml

*ng/ml = Nanogram/milliliter23

School shall immediately report completion of the health screening and findings of the background check and drug screening to the Hospital designee before the first day of clinical rotations.

Should the background check/drug screen disclose adverse information as to any student and/or member of the staff/faculty, the Hospital designee will determine the status of the student/faculty regarding participation in the Program at the Hospital

Updated 03/2013

24

ADDITIONAL INFORMATION

Pre & Post Conference Instructors needing to complete conferences may not do so in any public areas including but not limited to the hospital’s main lobby, Dunkin Donuts, cafeteria, etc. Any school found in violation will immediately be removed from the premises and the remainder of the rotation will be canceled.

ParkingBethesda East- Students and Faculty may only park on the 4th floor of the parking garage. The 2nd & 3rd floor are reserved for employees. The 1st floor is reserved for patients, their families, and visitors. The parking garage is located across the street from the Emergency Department. Instructors must ensure Student compliance with Bethesda Health Inc.’s parking regulations.

Bethesda West- Please park in employee parking, located in the rear of the building and by the ED. Faculty and Students may enter through the ED since the employee entrance will require badge access.

Any Student or Faculty found violating parking regulations will be reported to their institution and jeopardize the institution’s future acceptance at Bethesda Health Inc.

LunchBethesda East- The hospital’s dining room is located on the lower level to the extreme south of the building. 

Bethesda West- The cafeteria is located on the first floor just off the lobby.

Students and Faculty are NOT to use the cafeteria or dining area between the hours of 12 noon and 12:30 p.m.

Level 2 PreceptorshipsRequests for preceptorships must be made in writing at the beginning of the semester for which they are to occur, regardless of when they start during the semester. Requests must include the following:

Faculty name and beeper number Nursing student's name(s) and contact information Preferred area Date range of preceptorship Shift Total number of hours to be completed Any day(s) restrictions and or pertinent information that would facilitate placement of the student

Background and screening information must be submitted 2 weeks before the first day of preceptorship.

Medication AdministrationNursing students may give medications according to the hospital’s medication administration standards located in the Clinical Operations Regulations Manual # 2212 with supervision by a faculty member or staff nurse preceptor.  The student’s faculty member/nurse preceptor is responsible for ensuring that the medication is given correctly.Nursing students CANNOT:

Take verbal or telephone physicians. Transcribe physician orders Sign out and witness waste of controlled substances Give IV push medications Give controlled substances Hang or verify blood products Perform a peripheral IV start Interpret cardiac rhythms Perform a medication double check on any high alert medication. Nursing students may, however,

draw up and administer such medication under supervision AFTER a double check has been COMPLETED by two RNs.

25

ProfessionalismIt is imperative that everyone who interacts with patients, family members and friends, and vendors do so in a professional manner. Therefore the following must be observed at all times.

BadgesStudents must wear a school issued ID badge while in the hospital. Faculty will be issued a Bethesda Health ID badge upon receiving clearance and completing computer orientation. All Bethesda Health ID badges must be returned at the end of each clinical rotation to the ERC. Returning instructors will report to the ERC to obtain their badge for their next clinical rotation. ID badges must be visible, above the waist, and worn with the photo side displayed with no object obscuring the photograph or name. Flu stickers must be visible on all badges.

Cell phonesThe use of cell phones by the faculty or student at any time during the clinical rotation is strictly prohibited, which includes voice or text messaging.

Nails Nails will be kept to a short length, no more than 1/8” past the tips of the fingers.

Insures more thorough cleaning Reduces tearing of gloves. Reduces scratching patients. Artificial nails including acrylic, gels and wraps are prohibited from being worn by any healthcare

worker. Nail ornaments are also prohibited. Polish, if used, must be clear or of a non-offensive design and color. Nails must be freshly painted.

Coat must be intact over entire nail. There is to be no chipping, cracking, or peeling.

Hair Hair must be neat and clean and not in a style or length that would interfere in the performance of job duties or create a safety hazard. No extreme styles or colors (e.g., Mohawks, Punk) are permitted. Coverings may be required in certain work areas for reasons of safety, sanitation or infection control. For those providing direct patient care, hair that is shoulder length or longer, falls forward, or is so full that it does not present a professional appearance must be secured off the shoulders and away from the face.

JewelryJewelry should be worn conservatively and must not interfere with care. Students and Instructors providing direct patient care may not wear hand, wrist, or nail jewelry, with the exception of a plain wedding band and a watch. Earrings may not exceed 1 inch in length or diameter. Body jewelry, such as nose rings or jewelry for tongues, lips, face, must be removed. Tattoos must be covered.

Cosmetics Heavy perfume and cologne are not acceptable. Strong scents may be offensive to patients and co-workers and therefore are to be avoided. Make-up is permissible in moderation. Application of dramatic colored eye shadows, rouges, blushes, nail polish or lipsticks is unacceptable.

26

Appendix AForms

27

Education Resource Center2815 South Seacrest BlvdBoynton Beach, FL 33435

Tel # 561-737-7733 ext. 84497 Fax# 561-734-2545

Clinical Rotation – Student and Faculty Rotation Request(This form must be completed by the Coordinator and sent back to the AmandaKM@BaptistHealth.net)

Date:

Name of School:      

Name of Course:      

Program: (RN, LPN, etc)       Number of Students      

Dept. Unit Location:      

Day(s) of the week on approved unit: Mon Tues Wed Thurs Fri Sat Sun

Clinical Start Date & Time:       Clinical End Date & Time:     

Instructor Name:      ________________________________Instructor Contact Number:      

Will the Instructor be on site with the students? (Y / N) Check if Instructor is New to Bethesda

Coordinator Name:      

Coordinator Contact Number:       Coordinator E-mail Address:     

(Y / N)Copy of Course Objectives sent to ERC

Current Contract on File with Bethesda

Current Certificate of Insurability on File with Bethesda

Completed Health Screening

Current BLS card on File with Bethesda

Completed Background Screening

Received Influenza Vaccination

Completed Online Orientation

Completed Attestation form by Coordinator on File with Bethesda

Completed Computer Orientation for New Instructor Only

28

Education Resource Center2815 South Seacrest BlvdBoynton Beach, FL 33435

Tel # 561-737-7733 ext. 84497 Fax# 561-734-2545

Preceptor Request Form(This form must be completed by the Coordinator and sent back to the AmandaKM@BaptistHealth.net)

Date:

Name of School:      

Program: (RN, LPN, etc)       Number of Students      

Dept. Unit Location:      

Day(s) of the week on approved unit: Mon Tues Wed Thurs Fri Sat Sun

Clinical Start Date & Time:       Clinical End Date & Time:     

Coordinator Name:      ________________________________Coordinator Contact Number:      

Student Name Indicate if

Bethesda employee

(X)

Indicate if BSN

preceptor required

(X)

Requested Department

*

Preceptor Name Approved Dept.

                                                                                                                                                                                                                                                     

* Available Departments: Med/Surg│Telemetry│Maternity/L&D│ NICU │Peds │ED

29

Section B- Approved Preceptor Information (To be completed by

Section A – School and Student information (To be completed by the School Coordinator)

BETHESDA HEALTH INC.Education Resource Center2815 South Seacrest BlvdBoynton Beach, FL 33435

Tel # 561-737-7733 ext. 84497 Fax# 561-734-2545Clinical Rotation – Attestation Form

Date: Name of School:       Program: (RN, LPN, etc)       Number of Students       Dept. Unit Location:       Day(s) of the week on approved unit: Mon Tues Wed Thurs Fri Sat SunClinical Start Date & Time:       Clinical End Date & Time:      Instructor & Coordinator Name:       Check if Instructor is New to Bethesda Coordinator Contact Number:       Coordinator E-mail Address:      Official Use Only- Verified against CCPS (Check Box)

NOTE:School official must complete and submit this form to the Education Resource Center. Students CANNOT complete and submit this form.As stated in the Affiliation Agreement and school curriculum, all student requirements for clinical programs will be kept in the student's file at the school and completed prior to start of clinical rotation at the Hospital: Health Clearance, BLS (CPR), Domestic Violence, HIV/AIDS, and specific clinical competencies as they apply to the rotation. Results of the drug screen, immunization record and background investigation will be reviewed by the school for compliance with contractual guidelines, and retained by the school until the student graduates and must be produced within a reasonable time upon request of the Facility. The online orientation must be completed PRIOR to start of rotation. Email completed forms to AmandaKM@BaptistHealth.net Coordinator Signature (Required):       Your signature above affirms that each student has completed all requirements set forth by Bethesda Health Inc.

Faculty Name(*If onsite*)

Licensure Number

Health Screening

(Date Completed)

Date Results

Certification/ Disciplinary

Action Search& Designation

check(If applicable)

Date Results

Background Checks

Date Results

Influenza Vaccination

Last Four-Social

Security Number

Date Completed √ No

                                             

                                                          

                     

Student Name

Drug Screen and Health Screening(Date Completed –indicates clear *)

Background Checks Last Four-Social Security Number

Influenza Vaccination

Date ResultsDate

completed √ No

1.                                          2.                                          3.                                          4.                                          5.                                          6.                                          7.                                          8.                                          9.                                          10.                                          11.                                          12.                                          

30

Education Resource Center2815 South Seacrest BlvdBoynton Beach, FL 33435

Tel # 561-737-7733 ext. 84497 Fax# 561-734-2545

Affirmation of Completing Student and Faculty Orientation(This form must be completed and sent back to AmandaKM@BaptistHealth.net)

Date:

Name of School:      

Program: (RN, LPN, etc)       Dept. Unit Location:      

Day(s) of the week on approved unit: Mon Tues Wed Thurs Fri Sat Sun

Clinical Start Date & Time:       Clinical End Date & Time:     

In signing below, I acknowledge that I have read the information on the Bethesda Health’s website for student and faculty orientation. I have reviewed all of the power

points on my to-do list and completed and passed all of the post tests. I understand the material provided and will

follow Bethesda Health’s policies, procedures, and guidelines.

________________________________ ________________________________ Student / Faculty Signature Student / Faculty Printed Name

________________________________ ________________________________ Date School Affiliation

31

Appendix BTelephone Directory

32

Important Phone NumbersAt-A-Glance

Bethesda Health, Inc. 561-737-7733

Education Resource Center X84497

Help Desk X84357

Nursing Supervisor X84408

Critical Care Unit X84600

Surgical Services X84554

Clinical Informatics X84385

Labor & Delivery X84545

Women & Infant Services X84516

Neonatal Intensive Care X84531

Pediatrics X84552

Pediatrics Intensive Care X84123

Clinical Medical (3E) X85491

Clinical Medical (3W) X84535

Oncology (3W-80’s Hall) X84415

Clinical Surgical (2E) X84524

Clinical Surgical (2W) X84653

Orthopaedic Institute (4N2) X82663

Emergency Services X84512

Telemetry (3N) X84690

Cornell X83970

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     CNO 72750

Kelly Dennison Executive Assistant 70020     

Jackie Fogle Assistant VP Patient Services BHE 84503Heidi Stanton Executive Assistant 84501

  Administrative Nursing Supervisor 84408     

Ana Machado-Rosacker Assistant VP Patient Services BHW 70030Mary Vijayan  Manager Clin Surg 70203/70380

Doroty Dessalines Manager Tele 70040Martha Morales Clinical Educator CCU/ Tele/ ICU 70450

     Jane Kiah  Executive Director Bethesda Heart Hospital 85422

Cheryl Roddy Director CVICU & Step Down Units 83733Tracy Wilson Director Interventional Services 83565

     Debra Stolic Admitting 84425

     Roger Royal Exec Dir Perioperative Services BHE /BHW 84718

Brenda Valdez-Chinapoo Clinical Manager Surgical Services (BHE) 84005Cheryl Costello Clinical Manager Surgical Services (BHW) 73440

Barbara Rey ANM ENDO/ASC (BHE) 84116Maryjane "MJ" Palmer ANM ENDO/ASC/PACU (BHW) 70360

Jenifer Henry ANM Surgical (BHW) 70350Sherry William - Bain Supervisor Central Supply 83241

Clinical Educator 84381Stephanie Shapiro Business Systems Manager 84721

Barbara Hunter Office Assistant 84381Ariane Adams ANM- PACU 84549

     Sheryle Barrett Director Cardiopulmonary (BHE/BHW) 84771

Beth Boggs Manager Sleep Lab/EEG 84398

Earsel McCleeseDiagnostics

Coordinator/Echo/Stress/EKG/PFT/ABG 83528  Charge Therapist 83552  Clinical Educator 84770     

Al BarrioDirector Critical Care Services/Tele/BPU

BHE BHW 84994Michelle Hilker Clinical Manager/Critical Care Services 85032

Sally Clinton Clinical Educator/Critical Care Services 84219Carolyn Taormina Clinical Manager/Tele 84569Natalie Bermudez Clinical Educator/Tele 85131

     Kristen Billings Director Clinical Informatics (BHE/BHW) 84845

Jonathan Barcenas Clinical Informatics Specialist 84385 Lisa Marino, Alyssa Goodman Clinical Informatics Assistants (CIA) 83267

     Director Women and Children Services 85333

Victoria Urman Clinical Manager L&D 84216Lauren Smith Clinical Manager WIS 84908

Constance Butterworth Clinical Manager PEDS/PICU/NICU 84540Monique Scholine Clinical Educator WIS 84502

Abigail BurdickMaternal Family Health Liasion/Lactation

Consultant 84977     

Paula Friend Director Clinical Surgical Services/Ortho 84432Chrissy Hamilton Clinical Manager 84780

     Gail Fontana Director Care Coordination 84504

34

Billie Lou Smith Care Coordination Hub 84016Business Center C3 Tele (5th Floor) 70500Business Center C3 Clinical/Surgical (4th Floor) 70400

     Sandra Raymond Director Clinical Medical/Oncology/Infusion 84493Michelle Rodewald Clinical Manager 3 Medical/Oncology/Infusion 84655

Cindy Todd Clinical Educator 3 Medical/Oncology/Infusion 84687  ANM Infusion Suite 84763     

Director Emergency Services (BHE/BHW) 84759Nicole Sidaway Clinical Manager BHE 83625

  ANM (BHE) 83031Romina Carreras Clinical Manager BHW 70403

     Laura Alexander Hospice Manager (Trustbridge) 85630 East

     Lisa Kloc Director, Cornell 83999

Earnest Escobar Manager Rehab Program IP 84576Mike Cortese Manager Rehab Program OP 736-5446

Cherry Quintero Nursing IP 83970

35