1.Present a Professional appearance so that you can promote positive image to your customers. If you are not the problem, am not the problem together we can provide safety and support to our customers and ourselves. Keep yourself and the environment clean and free from infection. Wear your hospital name badge clearly above your waist
2. NO RESPONSE FROM THE DOCTOR, FOLLOW CHAIN OF COMMAND: If you need orders from the doctor.You made several attempts no response.Follow the chain of command. As a new nurse, you call the doctor to report a critical values and the doctor did not call you back.START THE CHAIN OF COMMAND IMMEDIATELY.
Notify Charge Nurse-Nurse Manager- Nurse Supervisor-Medical Director-Medical Staff president/Doctor on call-Write an Incident Report.
3.Patient Identification to reduce error in medication administration and others.Use TWO IDENTIFIER -Patient Name,Medical Records number or the Date of birth. Patient Identifier is use prior to any procedure, any treatment ,laboratory specimen collection and blood transfusion.
4. IMPROVE MEDICATION SAFETY: Label all medications and the containers. Medication containers are medicine cup, syringe, basin,and solution bottles. Label include medication name,Quantity, Strength, Diluents and Volume and the expiration date and time in 24hours or less.As soon as you finish preparing the medication label immediately so that you don’t forget.
5.UNAPPROVED ABBREVIATIONS:Call the doctor for clarification of orders and send orders to Pharmacy after clarification from the doctor.(Example of unapproved abbreviation U instead of UNIT)
6.ANTICOAGULANTS THERAPY:If the doctor ordered for you to start coagulant such as Warfarin. You must have a baseline INR(Required within 48hours )for Heparin baseline of PTT is a must.Patients on warfarin and other drugs should be monitored for potential interactions. Amiodarone with Warfarin. Other anticoagulants are enoxaparin,apixaban, argatroban,dabigatran,fondaparinux and rivaroxaban.
7.WRIST BANDS:Make sure that your patients have wrist bands that demonstrate the identified awareness .For example a fall risk patient should have yellow fall signs on the door,yellow gown and yellow wrist band.If patient is no Code ,use the wrist band, and for allergy use the Red wrist band and wrist the medication that the patient is allergic to on it.
8.PATIENT RIGHTS:All patients should receive a copy of their rights upon admission. It can be printed in English, Spanish or Vietnamese.
9.ABUSE:All health care professionals are required by law to report in writing Suspected or a known of patient abuse,assault, violence or neglect. For example child abuse,elder abuse,assault with weapon,domestic violence, sexual assault, maternal substance abuse, unusual condition etc.
10.PATIENT COMPLAINTS:Patient complaints and grievance Resolution policy. Staff should resolve patient and family complaints immediately. If you receive a complaint from patient/family, incident Report must be completed and submit to the manager.
11.PATIENT DISCHARGE:Patient should be informed early about the discharge process planning to go home or to other facility. The discharge will be ordered by the doctor and started by the nurse early to ensure that patient discharge needs are met.
12.PATIENT HISTORY AND PHYSICAL:
H&P that is patient history and physical must be completed within 24hours of admission or upto a week before admission and it should be updated upon admission or within 24hours of surgical intervention or any invasive procedure. H&P should be in patient EMAR or Chart before going to surgery.
13.REASSESSMENT: Reassessment of patients, assessment is done every shift in Medical surgical, and Telemetry units. Reassessment is Q4 and with changes in patient condition.
14.ADVERSE EVENTS:What are adverse events?. According to National Quality Forum, adverse event are events that should not happen in hospitals.
a. For example surgery on wrong patient.
b. Amputation of the wrong leg.
c.Retain foreign objects, death during or about 24hours after anesthesia is given.
d.Infant discharge home with the wrong family.
15. A COMPETENT NURSE: To be a competent nurse, you need to attend training with regular nursing update.Incorporate standards of behavior into your daily routine as a nurse. Attend in service maintain current license and certification.
16.What is PPE?.
It is a Personal Protective Equipment that is available in all work locations,and patient care areas.PPE are gloves, gowns, mask,and eye protection.
17. HAND WASHING:Cleanse with soap and water when hands are visibly solid .To reduce the risk of healthcare associated infections. Soap and water for 20 to 30seconds,use hand sanitizer frequently. Wet hands to wrist ,and then rub the alcohol gel for 20 to 30seconds until alcohol absorbs completely. Every hospital employees are responsible for prevention and control of infection. Practice safe personal hygiene to protect yourself and others.( Stay home if you are sick,cough into tissues. Do not touch your face. )It is important to comply with WORLD HEALTH ORGANIZATION (WHO)or CDC on proper hand hygiene guidelines
18.SUICIDAL RISK ASSESSMENT: It is done upon admission and every shift. Each facility has SUICIDAL RISK IDENTIFICATION. Once your patient more than three years old assess for suicidal risk. Educate patient family on the signs of suicide and to call the lifeline. National Prevention lifeline 1800 273 Talk.
19. WHAT IS 72HOURS HOLD?. It is known as 5150. It is when someone voluntarily check himself or herself into the mental hospital for psychiatric treatment. Patient is placed on 1:1 watch for suicide. 72hours legal hold will be imposed.Psychiatric Consultation ordered to evaluate patient and treatment. If after 72hours hold patient need Psychiatric treatment then 5250 form will be needed.
20. RAPID RESPONSE TEAM:When you see something, say something because early recognition and interventions for changes in conditions. Be proactive.
21.MEDICATION UNATTENDED: Medications must be well secured at all time.Do not leave medications unattended. Do not leave medication at the bedside.
22. MEDICATION USE VERIFIED:
23. HIGH ALERT MEDICATION: Injectable potassium chloride. Chemotherapy agents. Heparin,other coagulant and thrombolytic.,Opiate and narcotic. Concentrated Sodium chloride >0.9.
24.HIGH RISK MEDICATIONS ARE: Heparin and Insulin.
25.Single Dose vial : Discard immediately after use .It is meant to be used ONCE because it has no antimicrobial preservative .MULTIPLE DOSE VIAL: When you open it, put your initial and the date that you open it.It usually last for 28DAYS. Follow your facility policy and procedures.
26. HOSPITAL ACQUIRED CONDITIONS: are not reimbursed by Medicare or insurance companies because it was not present on admission. It is publicly reported to shame the facility. It is listed as a serious preventable condition. Examples of HAC:
Use evidence based practice and protect your facility.
Falls with injuries or death.
b.Pressure ulcer stage 3 or 4.
c.Incompatible blood transfusion reactions.
d.Poor glycemic control .
e.Infection associated with surgery. F
f. Foley,Central line.
PE/DVT post total joint surgery.
Anticoagulant should be started 24hours after surgery.
Apply SCD as soon as patient returns from surgery unless contraindicated.
“NB:It is categorize as SENTINEL Events for all known cases of permanent loss of function,health care associated infection or death”
27. RESTRAINT: Two types of restraint are: 1.Nonviolent or nondestructive behavior restraint. ( Used to be called Medical-Surgical restraint)It is used on patient for medically necessary situation so that treatment and nutrition are given.Patient is pulling lines and tubes.Patient action that prevents healing and medical management of patient. Restraint should be signed by attending doctor within 24hours. Please note that side rails are restraint. 2.Violent Restraint is known as Destructive Behavioral Restraint. It is use to prevent patients from harming themselves or others. Behavior such as assault, hitting,throwing objects,scratching. Leather restraint are used for Violent Self- Destructive Behavioral restraint. (Seclusion is usually use in Psychiatric hospital)Chemical restraint is the use of medication to control behavior. The initial restraint will need a second eyes to make sure that the application of restraint is justified. So a second tier signature of charge nurse is needed.
Soft restraint: Wrist /Ankle.
Soft restraint: Hands.Leather(Wrist,ankle, four point)
Patients on restraint are check every two hours for safety, circulation, nutrition and potty. And eyeballs every 15minutes and documented. *If a patient dies while on restraint, it must be REPORTED to CDPH.*