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HARBOR-UCLA MEDICAL CENTER Department of Nursing

1. 3 Gloves must be worn when any of the following could occur contact with blood or other potentially infectious materials OPIM mucous membranes and non intact skin a Remove gloves at the conclusion of the activity b Do not wear the same pair of gloves when caring for more than one patient c Wash hands after removing gloves 4 Artificial fingernails and long natural fingernails are not permitted for those who have direct contact with patients who touch the patient as part of their care or service handle instruments or patient care equipment or for those who have contact with food a Artificial fingernail is defined as any material applied to the fingernail for the purpose of strengthening or lengthening nails eg tips acrylic porcelain silk jewelry overlays wraps fillers superglue any appliques other than those made of nail polish nail piercing jewelry of any kind etc Natural nails must be clean with tips less than inch long c Fingernail polish must be in good condition free of chips and preferably clear in color B Respiratory hygiene cough etiquette in healthcare settings To prevent the transmission of all respiratory infections in healthcare settings including influenza the following infection control measures should be implemented at the first point of contact with a potentially infected person Nursing Department Reorientation Self Study Guide Mandated Section 70 Infection Control Issues 1 Vis
2. I REQUIREMENTS A Informed Consent and Paul Gann Requirement All patients receiving transfusions of blood or blood derived product should provide consent prior to the initiation of the transfusion There is an exception made in the event of life or limb threatening emergency only It is the role of the physician to discuss the need for transfusion with the patient and inform the patient of the risks and benefits of transfusion The physician will obtain the patient s signature and signature of a witness on the consent form Informed Consent to Transfusion of Blood and Blood Products HH1009 available in English and in Spanish The physician will also obtain the patient s signature and signature of witness on the State Department of Health Services form Jf You Need Blood A Patient s Guide to Blood Transfusions HH687 also available in English and in Spanish A translator may be required if so the Interpreter Attestation During Informed Consent Form HH1001 must be completed HH687 is required by California State Law as specified in the Paul Gann Act If a patient or legal representative refuses blood transfusion after the risks benefits and alternatives have been explained the Refusal to Permit Blood Transfusion Form HH256 shall be signed and placed in the front of the medical record This refusal shall be communicated immediately to the patient s primary care nurse If a refusal form is present the nurse will ensure that a sticker
3. Patient Care Management 3 The term Limited English Proficiency LEP applies to a person who is unable to speak read write or understand the English language At a high school level At a college grade level Without the help of a minor family member At a level that permits the person to interact effectively with healthcare providers ae op 4 When an interpreter is used during an informed consent discussion the interpreter or healthcare provider must a Complete the Interpreter Attestation Form b Provide the care team with proof of foreign language proficiency c Have a second translator listen to the translation to attest to its accuracy d Contact the Healthcare Interpreter HCIN one hour before the informed consent discussion Answers to Study Questions l a 2 d 3 d 4 a If you answered all of the questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions INTERPRETER SERVICES Bibliography California Health and Safety Code 1259 http www leginfo ca gov Accessed June 21 2010 California Health and Safety Code 1367 8 http www leginfo ca gov Accessed June 21 2010 Interpreter services for limited English proficient LEP and non English speaking patients In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2009 Policy No 128 Interpreter services for the deaf hearing impa
4. 2 Criminal Intent The assault is a result of an attempt to rob steal or result in the commission of another crime In this case the assault is generally secondary to the intended crime 3 Worker vs Worker These assaults can be extremely serious Working in a stressful environment can create tension among employees 4 Personal Relationships These types of assaults are the result of personal relationships otherwise known as domestic violence which can interfere or jeopardize workplace safety The County of Los Angeles has a Zero Tolerance Policy for acts of workplace violence including threats that do not rise to the level of physical violence This policy requires mandatory reporting and discipline for any founded acts regardless of criminal prosecution If one suspects an employee who might commit an act of violence in the workplace but no threats or assaults have been made report the matter to one s supervisor immediately The key to prevention lies in intervention If an employee is acting in an erratic manner or creating a hostile work environment notify one s supervisor immediately V SENSITIVE HIGH SECURITY RISK AREAS IN THE HOSPITAL A Emergency Department Psychiatry Nursery Labor amp Delivery 7 West Pharmacy Cashiers and Warehouse VI STRATEGIES TO ELIMINATE OR MINIMIZE THE SECURITY RISKS A C 24 hour 7 days a week combination of Sheriff Department Sheriff Deputies private security
5. 2007 Policy 308D Emergency transfer of patients to other acute care facilities In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2007 Policy 308A Lipton MS Tremaine DW California Healthcare Association A Guide to Patient Anti Dumping Laws 4 ed Sacramento CA California Healthcare Association 2003 Luckman J Saunder s Manual of Nursing Care COBRA and EMTALA Philadelphia PA WB Saunders 1997 1788 1790 Reorientation Manual 2010 MandSec EMTALA doc Nursing Department Reorientation Self Study Guide Mandated Section 66 Infection Control Issues TRANSMISSION OF INFECTIOUS DISEASES Objectives Upon completion of this section the employee will be able to 1 Identify the most common methods of disease transmission from one person to another 2 Identify factors that render an individual susceptible to infection 3 Identify three situations in which hand hygiene with alcohol based hand rub is acceptable 4 Discuss three types of transmission based precautions at Harbor ULCA Instructions to the Employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 67 I Il MI Infection Control Issues TRANSMISSION OF INFECTIOUS DISEASES THE INFECTION CYCLE Infections occur as a result of a cycle of events The five components of th
6. Assess locking device for loosening IV ALTERNATIVE MEASURES Restraints are to be used only when alternative measures are ineffective in protecting the patient or others from injury Attempts of alternative measures to control the patient s physical activity in order to protect the patient or others from injury are critical and must be documented prior to placing the patient in restraints Restraints cannot be used as a punishment aversive treatment or for the convenience of staff The patient and family with the consent of the patient in the psychiatric areas will be notified of the reason for placing the patient in restraints Restraints should be applied only when a need is supported by patient behavior that will result in harm to self or others and alternative methods have proven to be ineffective The following is a list of alternative methods and specific examples that can be considered A Location change 1 2 Move the patient closer to the central nursing station a Provide the patient closer access to nursing staff It is also a good idea to move a patient away from the window if the patient is at risk of suicide Separate the patient from other patients a Allow the patient to experience a less stimulating and quieter atmosphere or different environment eg move the patient from a 4 bed to a 2 bed or a single bed room In the psychiatric areas the patient may be placed in open seclusion B Family involveme
7. Donor Type Unit X X X Group Rh Donor Number X X X Expiration X X X Date Time an RN or MD and may not verify with another LVN NOTE If any of the elements do not match NOTE An RN must verify the information with another RN LVN or MD An LVN must verify with DA the blood must be returned to the Blood Bank immediately DO NOT TRANSFUSE Nursing Department Reorientation Self Study Guide Clinical Competencies 14 Blood Products and Transfusion Inspection of the Unit H to hanging the product the RN LVN will inspect the unit for any abnormalities Container intact no leaks Abnormal appearance Cloudy appearance Excessive hemolysis Significant color change in blood bag as compared with tubing segments If there are any problems with the unit DO NOT TRANSFUSE return blood to the Blood Bank immediately Transfuse and Monitor the Patient After verification of patient identity the transfusion is begun The patient should be observed closely and vital signs recorded during the initiation phase first 15 minutes of the transfusion on the Transfusion Record If no untoward reactions are observed the flow rate is adjusted to infuse within the ordered time Most fatal incompatible transfusion reactions produce symptoms early in the course of the infusion The assigned responsible RN LVN monitors the patient s vital signs and observe for signs of reaction at least every hour until the unit is inf
8. For inter unit transfers prior to the originating area RN will complete as assessment and document on the Inter Unit Transfer form Upon arrival in the receiving unit an RN will validate in the presence of transporting staff member the patient s clinical status as described in the verbal report and document on the Inter Unit Transfer form as appropriate D Hand off communication at breaks and lunches Breaks lunches or when the primary assigned nurse has to leave the unit temporarily are considered a hand off and must meet the requirements of all effective hand off communications The hand off is general brief but includes enough information for the covering nurse to be able to manage any patient care need or emergency situation that arises during the assigned nurse s absence including but not limited to Diagnosis Surgeries and current condition Current and changed orders Patient safety concerns Medications given and due Known allergies and code status ie ae E Hand off communication at patient transport Patient transport to tests or procedures is a special type of hand off in that the communication may not only occur between nurses but may include hand off from licensed to non licensed care givers For hand offs to non licensed personnel the nurse must follow the procedure described below 1 Whenever non licensed staff transport patients a Ticket to Ride Patient Transport Hand off form containing key patien
9. Nursing Department Reorientation Self Study Guide Mandated Section 120 Environment of Care Issues 5 6 Match the emergency management station in Column I with the appropriate location in Column II Column I Column II Labor Pool a Employees Public Cafeteria Command Post b Conference Room 1L 1 by the Doctor s Dining Room 7 Which of the following syndromes could indicate possible bioterrorism a Influenza like illness acute rash with fever b Acute rash with fever neurologic syndromes c Acute respiratory distress with fever influenza like illness d All of the above 8 Ifa presenting patient is suspected or known to be exposed to hazardous chemical or radioactive materials the employee should immediately a Escort the patient into the Adult Emergency Department b Notify the Adult Emergency Department Attending Physician Instruct the patient to stay put until personnel wearing appropriate PPE arrive and escort transport him her to the decontamination area d Both b and c 2 9 Any person or area that comes into contact with a patient exposed to hazardous chemical or radioactive materials a Poses no risk to healthcare providers b May be decontaminated at a later date c Requires no special handling treatment d Is considered contaminated and must be secured and decontaminated Answers to Study Questions l d E 3 d 4 a 5 a 6 b 7 d 8 d 9 d If you answered all of the questions correctly go on to the nex
10. XI DISCHARGE By law the physician must notify the TB Control Liaison prior to the patient s discharge or transfer and there must be a written treatment plan approved by the health officer prior to discharge LA County TB Control requires that this notification occurs at least 24 hours prior to anticipated discharge At Harbor UCLA the TB Control Liaison 310 222 3443 is responsible for approval of discharged transferred TB patients or suspects PLEASE COMPLETE THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 94 Infection Control Issues TUBERCULOSIS Study Questions Select the best answer to each question DO NOT write in the manual 1 Tuberculosis is transmitted through anoop Airborne particles Parenteral exposure Ingestion of contaminated food Direct contact with infected person All of the following are typical symptoms of tuberculosis EXCEPT anoop Fever Cough Malaise Weight gain Which of the following persons is at a higher risk of developing TB disease than the general population a Person born in Alaska b Person who is well nourished c Person on long term corticosteroid use d Person who lives in an uncrowded and well ventilated home An asymptomatic healthcare worker has a positive PPD skin test and a negative chest x ray This person probably has a No TB b TB disease c TB infection d TB of the skin A hospitalized pat
11. present VIL TRANSMISSION BASED PRECAUTIONS Transmission based precautions are designed for patients documented or suspected to be infected with highly transmissible or epidemiologically important pathogens for which additional precautions beyond Standard Precautions are needed to prevent transmission in healthcare facilities Transmission based precautions are described as follows A Airborne Precautions These precautions are used for pathogens that are transmitted by airborne route over relatively large distances gt 3 feet such as tuberculosis measles measles virus and chicken pox varicella zoster virus Patients in airborne precautions require rooms with negative air pressure Employees visiting these patients require special respiratory protection ie N95 respirators A Droplet Precautions These precautions are used for pathogens that are transmitted by small respiratory droplets that travel only over short distances lt 3 feet such as influenza virus adenovirus rhinovirus and Neisseria meningitidis meningococcus Droplet precautions require that healthcare workers use masks such as N95 respirators when they are within 3 feet or less of a patient B Contact Precautions These precautions are used for pathogens such as Clostridium difficile MRSA and VRE that are transmitted via direct contact with an infected or colonized person Healthcare personnel caring for patients on contact precautions must wear a gown
12. the area as this may spread the contamination Appropriate PPE must be worn to clean the area Handle soiled linen as little as possible Place soiled or contaminated linen in a blue plastic bag Do not separate or double bag linen G Communication of hazards Refrigerators and freezers containing blood or OPIM will be labeled with a biohazard label All equipment used to process blood specimens or body tissue will be labeled with a biohazard label Containers used for the transport of blood body tissues or blood products will be red in color and labeled with either a biohazard sign or specific to its contents Nursing Department Reorientation Self Study Guide Mandated Section 81 Infection Control Issues VIL REQUIREMENTS FOR HANDLING SHARPS A Sharps Injury Protection SIP Program 1 3 There are policies and procedures in place designed to provide a safe environment for patients and workers The BBP Exposure Control Plan is a guideline for departments to use to prevent or minimize exposure to infectious diseases The SIP Program a component of the BBP plan describes requirements for a Identifying staff procedures and devices with greatest risk of exposure to bloodborne pathogens Training and education of staff using new safety devices or work practices c Evaluating and using safer devices Departments and employees should take an active role in selecting safety devices particularly devices that are unique
13. A Patient authorization is not required for PHI uses and disclosures for health care operations Patient authorization is required for using or disclosing PHI to raise funds for any organization other than itself Parents of minors have access to and control of the protected health information about their children under the Privacy Rule Exceptions apply when the minor is emancipated or self sufficient in which case the minor controls access to his her own PHI B The same set of HIPAA authorization requirements also apply to research uses and disclosures of PHI Authorization for research may be combined with an informed consent to participate in the research study or any other legal permission related to research It is also important to understand that authorization to access confidential data or information is not an authorization to release the data Hospital policies which address the release of confidential information should be followed Requests for information from the medical record should be referred to Medical Records Release of Information Section C Security concerns addressed by Harbor UCLA Medical Center include identification of 1 Each individual having access to information 2 Which information an individual can access 3 The obligation of the individual accessing the information to maintain confidentiality the release of information 4 The mechanism designed to secure information against unauthorized intrusion corruption
14. Acupuncture Hepatitis C Percutaneous e Hand washing Standard Precautions No e Contaminated blood amp plasma e Needle stick injuries e Gloves e Eye protection if splashing or splattering expected e Gowns VI IMPLEMENTATION OF THE BBP EXPOSURE CONTROL PLAN A Compliance 1 General a Medical history and physical examination cannot identify all patients infected with HIV or other bloodborne pathogens b Standard Precautions is the use of blood and body fluid precautions when caring for all patients at all times c Standard Precautions will be observed by all employees to prevent contact with blood or other potentially infectious materials OPIM All blood is considered infectious regardless of the source individual B Work practices 1 Wash hands following contact with blood OPIM and or contaminated work surfaces and after removal of gloves a Wash with soap and water when hands are visibly soiled b Waterless alcohol based hand hygiene preparations are recommended as an adjunct for soap and water for routinely decontaminating hands when they are not visibly soiled Do not eat drink apply cosmetics or handle contact lenses in work areas where there is a reasonable likelihood of occupational exposure to blood or OPIM Do not store food and or drinks in refrigerators freezers shelves cabinets or counter tops where drugs blood or OPIM are kept Do not mouth pipette or suctio
15. Any failure of a hospital to comply constitutes a violation and the hospital noting the failure is mandated to report the violation within 72 hours Failures to report a violation can also result in a fine IV VIOLATIONS A Alleged violations of EMTALA regulations are investigated by the Center for Medicare amp Medicaid Services CSM Hospitals and physicians that are found to be in violation of EMTALA can be fined up to 50 000 for each violation and the hospital s Medicare participation agreement can be terminated The fines can be both personal and institutional All violations are public record and can be used in malpractice suits EMTALA violations can be devastating to a facility The way to avoid citations is to comply with the regulations In order to comply with EMTALA staff members must be informed of the regulations and the penalties PLEASE COMPLETE THE STUDY QUESTIONS EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT EMTALA Study Questions Select the best answer to each question DO NOT write in the manual 1 EMTALA is designed to BoP Cover only patients who have no medical insurance coverage Frustrate hospitals into eliminating their Medicare provider status Enhance access by all persons to emergency services regardless of financial or insurance status Minimize the workload on the county hospitals by mandating patients be seen wherever they present 2 EMTALA applies to the following areas BoP Only
16. Avoid crowded storage and storage close to the ceiling Il STORAGE The following regulations for storage of hazardous materials are derived from mandates from Occupational Safety and Health Administration The Joint Commision and the Uniform Fire Code A Hazardous materials must be stored separately from nonhazardous supplies B Hazardous waste must be labeled Hazardous Waste and stored separately from hazardous materials C Hazardous materials should be separated according to Hazard Class see table D A barrier or distance should separate mutually reactive materials E Hazardous materials should not be stored on the floor without a spill tray F Flammables in quantities more than 8 pints must be stored in a Flammable cabinet when in patient access areas G Small containers causing small spills are preferable to large containers H Containers over 5 gallons need secondary containment spill tray I Areas with carcinogens should be labeled as such J Containers of hazardous materials must be made of materials that do not react with the contents They must be labeled and they must be closed when not in use If the chemical is in a container not provided by the manufacturer it must be labeled by the user with its chemical identity and hazard class Nursing Department Reorientation Self Study Guide Mandated Section 131 Environment of Care Issues IV PROTECTIVE EQUIPMENT A A chemical fume hoo
17. Calif Harbor UCLA Medical Center 2005 Tuberculosis cases drop 8 percent NurseWeek September 6 1999 25 Tuberculosis exposure control plan In Hospital and Medical Administration Policy and Procedure Manual Torrance Calif Harbor UCLA Medical Center 2007 Policy No 353 Reorientation Manual 2010 MandSec Tuberculosis doc Nursing Department Reorientation Self Study Guide Mandated Section 96 Environment of Care Issues ELECTRICAL UTILITY SAFETY Objectives Upon completion of this section the employee will be able to 1 2 List five factors contributing to electrical sensitivity Identify three types of patients who are electrically sensitive Describe how electrical safety is maintained in this hospital Identify how to check electrical equipment prior to use Report an electrical safety incident Instructions to the Employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 97 Environment of Care Issues ELECTRICAL SAFETY I INTRODUCTION A Everyone involved in direct patient care must be familiar with the safe use of electricity and the potential harm it can cause to patients and staff B All electrical equipment has a very small amount of current leakage which cannot be eliminated Touching the metal surfaces of a piece of electrical equipment causes electric current to flow through the bo
18. Manual in the work area for more detailed information PLEASE COMPLETE THE STUDY QUESTIONS FIRE LIFE SAFETY Study Questions Select the best answer to each question Please DO NOT write in the manual 1 Doors between the corridors and patient rooms are capable of preventing the transmission of a fire for approximately a 20 minutes b 60 minutes c 90 minutes d 120 minutes 2 According to the RACE response the first thing that should be done when a fire occurs is to ao re Notify the Unit Manager Dial 113 for the page operator Pull the nearest fire alarm box Remove persons from immediate danger 3 The correct number to call to report a fire is ae op 111 112 113 114 4 7 Match the priority evacuation movement during a fire in Column A with the patient classifications in Column B Column A Column B First a Bedridden patients Second b Wheelchair patient Third c Ambulatory patient Fourth d Patients closest to danger Nursing Department Reorientation Self Study Guide Mandated Section 111 Environment of Care Issues 8 The three elements that must be present to create a fire are Heat fuel grease Heat fuel oxygen Fuel grease paper Fuel burning liquid heat Bore 9 Which of the following extinguishers is effective on ALL types of fires a D b AB c BC d ABC 10 The steps of the PASS method of fire extinguisher use are Pull pin Aim extinguisher Squeeze handle Sweep
19. PHI requirements Risk management implementation of security measures that will reduce the risks of attacks or losses that were identified in the risk analysis Sanction disciplinary actions imposed on individuals for security violations Information systems activity review procedures regular review of information system activity records including audit logs and security incident tracking reports Security incident reporting and response addressing Actions that are considered security incidents The process to document such incidents The information that should be included in the documentation Appropriate responses for different types of incidents Contingency plan response to computer system emergencies Data back up create and maintain retrievable exact copies of electronic PHI Disaster recovery plan procedures to restore any loss of data Emergency mode operations plan procedures that make it possible to continue critical business activities that protect the security of electronic PHI during an emergency Business associate contracts and other arrangements ie MOU Contracts and other arrangements between DHS and outside entity that create receive maintain or transmit electronic PHI on behalf of DHS XII PHYSICAL SAFEGUARDS A Physical safeguards protect DHS electronic information system hardware and related buildings and equipment Security measures include protections from natural or environmental ha
20. abuse abandonment neglect or intentional emotional or psychological abuse a violation of personal rights and financial abuse or material exploitation C Intimate partner abuse 1 Intimate partner abuse is also referred to as spousal abuse partner abuse or domestic abuse This form of abuse is defined as the use of physical and or emotional force in intimate relationships among adults Although males and females can be victims of intimate partner abuse the victim is most commonly the female in heterosexual relationships Intimate partner abuse can also occur among same sex couples Most cases of intimate partner violence go unreported making it difficult to determine the actual incidence One study showed that 27 of female patients presenting to the emergency department had a history of physical or nonphysical partner abuse in the previous year Approximately 2000 women die each year at the hands of men who say they love them Forms of intimate partner abuse include physical violence sexual assault psychological assault and economic coercion The victim often lives every day in fear of the batterer There are many reasons why the victim may not be able to leave the abuser If the victim leaves the victim or the family may face more severe violence The victim has to leave the home family and friends and may risk losing the children In addition the victim may have no other means of economic support D Sexual a
21. abuse but no physical findings a recommendation can be made to the victim to contact law enforcement In this situation it is not required for the healthcare provider to contact law enforcement 4 Any mandated reporter who fails to report abuse may be guilty of a misdemeanor punishable by imprisonment or a fine In addition a mandated reporter who fails to report abuse may be held liable for civil damages for any subsequent injury to the victim Professionals who are legally required to report suspected abuse have immunity from criminal and civil liability for reporting as required or authorized PLEASE COMPLETE THE STUDY QUESTIONS FAMILY VIOLENCE Study Questions Select the best answer to each question DO NOT write in the manual 1 A leading cause of death in infants and children in the United States is aoe Abuse Epiglottitis Spousal abuse Sexual assault Elder dependent adult abuse includes aoe The failure of government to care for the elderly Neglecting a child s need for food clothing and shelter Physical force used to control a patient in a nursing home Various manifestations of abuse or neglect of an older person by persons upon whom she or he depends Bruising and fractures may be evidence of what type of abuse aor Neglect Exploitation Physical abuse Emotional abuse Healthcare providers who fail to report suspected or identified child or elder dependent adult abuse may be a Complying wit
22. admitted patients only on the ward and Progressive Care Unit PCU Trauma Transitional Care Unit TTCU areas Nurses working in other areas would not activate the rapid response team though they should be aware of the rapid response team process and assess changes in their patients BACKGROUND Patients who are initially stable can deteriorate clinically in a short period of time The ultimate form of clinical deterioration is a respiratory or cardiac arrest The hospital has created Code Blue and Code White teams to provide immediate response in these cases Information from researchers and healthcare improvement agencies shows that many patients who have a Code Blue Code White response actually begin to show signs of deterioration many hours before the Code Blue Code White is called Rapid Response Teams are now widely used to provide immediate assessment and stabilization long before a Code Blue Code White occurs The patient observation assessment includes the ongoing collection and analysis of patient data to determine the need for additional data the patient s care needs and the care to be provided The interpretation of information obtained from the patient and others is integrated to identify and prioritize the patient s needs of care SIGNS OF DETERIORATION Acute change in heart rate Acute change in systolic blood pressure Acute change in respiratory rate or effort Acute change in oxygen saturation Acute change in menta
23. and beverages are not allowed in the immediate area where chemotherapy drugs are prepared Once the chemotherapy is prepared for administration whether in the syringe or solution form the preparations are placed in a clear plastic bag and then double bagged in a yellow plastic bag labeled Caution Chemotherapy before dispensing to the clinical area C Handling of body fluids 1 Safety precautions must be considered when handling body fluids of patients who have received chemotherapy within the previous 48 hours Body fluids include blood vomitus urine or feces Universal or Standard Precautions include the use of latex gloves which are a direct barrier to skin exposure Wearing a disposable long sleeved and closed front gown which is discarded after every use may be indicated in some situations where splatter or spray is possible D Accidental exposure and spills 1 Incidental spills and breakages should be cleaned up immediately by properly protected person trained in the appropriate procedures The area should be identified with a warning sign to limit access to the area Incident reports should be filed to document the spill and persons exposed Personnel contamination Contamination of protective equipment or clothing direct skin or eye contact should be treated by a Immediately remove the gloves and gown Nursing Department Reorientation Self Study Guide Mandated Section 133 Environment of Care Issues Immedia
24. and damage 5 The processes to handle confidentiality violations 6 The proper disposal of documents containing confidential data when no longer needed D Data and information can be electronic eg the Hospital Information System or manual eg the medical record Electronic PHI has additional HIPAA requirements under the HIPAA Security Rule Nursing Department Reorientation Self Study Guide Mandated Section 19 Patient Care Management XI SECURITY RULE A The HIPAA Security Rule covers electronic PHI at rest which means in storage as well as during transmission which means sending electronically Any electronic PHI that is received created transmitted or maintained by DHS facilities is included under the Rule 1 DHS facilities must provide safeguards for the following Computer hardware and software Locations that house computer hardware and software Storage and disposal of data Back up of data Access to data Maintenance of facilities Visitor access to facilities gmeao ge Patients do not have the responsibility to ensure that information they send electronically is secure However once a patient s information containing PHI is received by DHS facilities it must be protected in accordance with the Security Rule 1 The Security Rule covers all electronic media Electronic media includes a Computer networks desktop computers laptop computers personal digital assistants handheld computers Computer s
25. are based on the principle that all blood body fluids nonintact skin secretions excretions except sweat and mucous membranes may contain infectious agents Standard Precautions include the use of proper hand hygiene before and after patient contact and the appropriate use of gloves gowns masks and eye protection depending on the anticipated exposure A Hand hygiene is one of the most important infection control measure for preventing healthcare associated infections 1 Hand washing hygiene Hands should be washed with soap and water a Before and after contact with each patient and when visibly dirty soiled or contaminated with blood or body fluids b After caring for patients with Clostridium difficile C difficile or Bacillus anthracis anthrax Before eating or handling food After using the restroom Before putting on gloves for patient care After the removal of gloves if gloves are visibly soiled with blood or bodily fluids When handling patient equipment va ho ao Nursing Department Reorientation Self Study Guide Mandated Section 69 Infection Control Issues h Before and after performing surgical procedures on patients Soap and water hand hygiene technique a Wet hands with water b Apply soap or antimicrobial product to hands c Rub hands together vigorously for at least 15 seconds covering all surfaces of the hands and fingers Rinse hands with running water and dry thoroughly with a disposabl
26. bata todo el torso desde el cvello hasta las rodillas los brazos hasta la mu eco y d blela alrededor de la espalda tesela por detr s a la altura del cuello y la cintura M SCARA O RESPIRADOR Aseg rese los cordones o la banda eldstica en la mitad de la cabeza y en el cuello Aj stese la banda flexible en el puente de la nariz Acom desela en la cara y por debajo del ment n Verifique el ajuste del respirador GAFAS PROTECTORAS O CARETAS Col quesela sobre la cara y los ojos y aj stela GUANTES Extienda los guantes para que cubran lo parte del pu o en la bata de aislamiento UTILICE PRACTICAS DE TRABAJO SEGURAS PARA MISMO Y LIMITAR LA PROPAGACION DE LA C OTEGERSE USTED ITAMINACI N Mantenga las manos alejadas de la cara Limite el contacto con superficies Cambie los guantes si se rompen o est n demasiado contaminados Realice la higiene de las manos SEQUENCE FOR REMOVING PERSONAL PROTECTIVE EQUIPMENT PPE Except for respirator remove PPE at doorway or in anteroom SECUENCIA PARA QUITARSE EL EQUIPO DE PROTECCION PERSONAL PPE Con la excepci n del respirador quitese el PPE en la entrada de la puerta o en la antesala Ous olmidi depis deadet la habitaci n del paciente y de cerrar la puerta Remove respirator after leaving patient room and closing door GLOVES Outside of gloves is contaminated Grasp outside of glove with opposite gloved hand peel off Hold removed glove in gloved han
27. bloodborne infection in the United States is a Hepatitis A b Hepatitis C c Salmonella d Tuberculosis 3 Which of the following can be prevented by a vaccine a HIV b Hepatitis B c Hepatitis C d Tuberculosis 4 Hepatitis B may be transmitted by Sharing meals Casual contact Sharing toilets Needle stick injuries Boge 5 The major effect that HIV has on the immune system is It destroys the cellular immunity It increases the red blood cell count It increases the white blood cell count None of the above Bese Nursing Department Reorientation Self Study Guide Mandated Section 84 Infection Control Issues 6 HIV may be transmitted by aoe Sharing meals Sharing toilets Casual contact Exchanging body fluids 7 The Bloodborne Pathogen Exposure Control Plan can be found in the aoe Red unit specific Specialty Manual Harbor UCLA Medical Center s Emergency Preparedness Manual Yellow Harbor UCLA Medical Center s Nursing Department Policy Manual White Harbor UCLA Medical Center s Hospital and Medical Administration Policy and Procedure Manual 8 Bloodborne pathogens may be transmitted by all of the following EXCEPT ao oP Sharps Exhaled air Medical waste Saliva in dental procedures 9 Personal protective equipment should be worn ao op For personal comfort When answering the unit telephone When charting outside the patient s room When there is possibility of exposure
28. dhs lacounty gov What to do if you are off duty and know a disaster has occurred 1 Do NOT automatically report to work on your off shift unless your department s Emergency Management Plan so specifies Plan on reporting for your next regularly scheduled shift And Wait to be contacted by your supervisor designee Turn on a radio to KNX AM 1070 If telephones are inoperable this radio station will broadcast call back notifications Report to work if so directed by your supervisor designee or radio call back notifications Wear your hospital identification in order to cross police lines Nursing Department Reorientation Self Study Guide Mandated Section 116 Environment of Care Issues VII EMERGENCY CONDITIONS amp BASIC STAFF RESPONSE A One is expected to recognize and provide basic response to the following emergency conditions 1 2 10 11 12 13 Cardiopulmonary arrest adult Code Blue Cardiopulmonary arrest pediatric Code White Bomb threat Code Gray Assaultive Patient Code Green Crisis Response Team Hazardous materials spill or release Code Orange Radioactive incident Code Orange Infant child abduction Code Pink Fire Code Red Emergency disaster response Code Triage Earthquake Evacuation Hostage situation Unusual incident The Emergency Conditions amp Basic Staff Response poster see following page provides a description of each emergency condi
29. five behavioral indicators of pain Each item is scored 0 2 resulting in a total score between 0 and 10 c Proxy pain report When a patient cannot self report pain such as a severely cognitively impaired individual the nurse can ask a family member or other significant other to rate the patient s pain This is called a proxy pain report Whenever possible the proxy pain rating shall be accompanied by the clues used by the rater to arrive at the pain rating number For example the family member may guess that the patient s pain is a 6 because the patient is frowning and moving his legs in bed The following apply to the use and interpretation of proxy pain ratings 1 Proxy pain ratings are merely a guess and should be used in conjunction with other assessment data in determining pain management interventions 2 Ordinarily proxy pain ratings are not used along with the patient s pain ratings because this violates the foundation of pain assessment only the patient can feel the pain However in a confused or demented patient who occasionally or irregularly reports pain or gives inconsistent information the patient s pain ratings may be used along with proxy pain ratings 3 When an observational tool is appropriate to use eg FLACC the proxy pain rating shall be considered in conjunction with the observational tool score 4 The Numeric Rating Scale NRS should be used as the tool to obtain a proxy pain rating 5 A proxy
30. guards parking attendants and weapon screening posts Emergency Department metal detectors Sheriff Department Sheriff Deputies presence Crisis Prevention Institute Managing Assaultive Behavior training panic alarms employee identification badges Psychiatry locked unit screen visitors and patients for weapons Crisis Prevention Institute Managing Assaultive Behavior training panic alarms patient identification employee Nursing Department Reorientation Self Study Guide Mandated Section 124 Environment of Care Issue identification badges D Nursery Labor amp Delivery Post Partum Sheriff Department monitoring of lobby and visitors infant identification checks staff enforcement of staff identification policy etc E Pharmacy security alarm system security video system doors all locked panic alarm in outpatient pharmacy staff identification badges F Cashiers bulletproof glass locked doors staff identification badges G Warehouse locked doors security alarm systems staff identification badges VII GENERAL PROCEDURES TO FOLLOW DURING A SECURITY INCIDENT A Telephone bomb threat 1 25 4 Dy Try to stay calm Note details of conversation and report to supervisor and Sheriff Department at ext 3311 for investigation and instruction Ask when the bomb will explode and where it is Search suspected areas for suspicious packages If found do not handle Wait for instructions B Suspicious
31. hours Doors to linen and trash chute rooms 1 hours Metal doors of laundry and trash chutes 1 hours Cross corridor doors marked BARRIER DOOR 20 minutes DO NOT BLOCK Exterior doors marked EMERGENCY EXIT Not rated provide exit to area of safe refuge Nursing Department Reorientation Self Study Guide Mandated Section 107 Environment of Care Issues B Floors The fire rating of the flooring is four hours Four hours of protection is provided for the floor above the level of the fire V EVACUATION OF PATIENTS A Evacuation Pre requisites 1 A determination by Medical or Nursing staff Hospital Administrator designee Administrative Nurse on Duty designee or public safety officer firefighter or Sherriff s deputy that patient care cannot safely continue Authorization to evacuate can only be given by the Hospital Administrator designee including HICS officers the Administrative Nurse on Duty designee or a public safety officer Identification of safe evacuation routes and evacuation methods B Types of Evacuation 1 2 Partial evacuation Patients are transferred within the hospital There are two levels of a partial response a Horizontal evacuation Individuals move or are moved from one smoke compartment beyond a set of barrier doors to another smoke compartment on the same floor to an area of safe refuge b Vertical evacuation Individuals move or are moved up
32. humiliation Which of the following statements best reflects Harbor UCLA Medical Center s philosophy regarding the use of restraints Patients may only be restrained if they are on an involuntary psychiatric hold Restraints may be utilized only in emergency situations with the patient s consent Alternative measures may be tried prior to the initiation of restraints in order to effectively maximize restraint use Restriction of a patient s mobility and movement by the application of restraints will be carried out only in those situations where alternative methods have been considered attempted and deemed ineffective How often should elimination and hydration needs be addressed for patients in restraints Bore Every shift Only when the patient requests A minimum of every 2 hours while awake As part of the every 15 minute observation while awake Nursing Department Reorientation Self Study Guide Mandated Section 35 Patient Care Management 6 In order to maintain comfort and safety for the patient in restraints patients should be positioned in proper body alignment in which of the following positions a Prone b Supine c Left lateral d Right lateral 7 When the CRT applies behavioral restraints an order must be obtained within a 1 hour b 2 hours c 4 hours d 24 hours Answers to Study Questions l d 2 d 3 d 4 d 5 d 6 b 7 a If you answered all questions correctly go on to the next section If yo
33. immediately familiar with the patient it is especially critical to communicate in a concise and efficient manner SBAR acronym for Situation Background Assessment and Recommendation is a communication framework for effectively briefing team members on the patient problem or clinical situation The SBAR technique has been shown to enhance clarity and understanding to get everyone moving in the same direction as quickly as possible When using SBAR to communicate the nurse should be prepared with relevant information such as most recent vital signs and laboratory results current symptoms or change in condition current medications allergies IV fluids and laboratory values as well as background information from the patient s chart Prior to utilizing SBAR staff members should read Nursing Department Policy Communication Interdisciplinary Team page 115 0 and the appendix entitled SBAR Report to a Physician The attachment is a guide with communication cues for each step SBAR is an effective tool for communicating in most situations so it is recommended that staff practice with various situations to become more proficient SBAR can help bridge the interdisciplinary gap facilitate more mutually satisfying communication and most importantly assure that the other provider hears critical information V CONCLUSION What is important to patients and their families is that effective systems for transferring patient related information be
34. in place so that the information is accurate and available when needed Although The Joint Commission requirements for hand off communication apply to all health care providers across the health care continuum nurses share responsibility for coordinating care through effective communication within and across care settings As patient advocates and leaders of the patient care team nurses have a responsibility to ensure patient safety through effective hand off communication Nursing Department Reorientation Self Study Guide Mandated Section 46 SBAR Report BEFORE CALLING THE PHYSICIAN Assess the patient Every SBAR report is different Focus on the problem Be concise Not everything Patient Care Management Review the chart for the appropriate physician to call Know the admitting diagnosis Read the most recent physician and nursing notes Have the chart in hand and be ready to report allergies medications IV fluids lab and test results in the outline below needs to be reported just what is needed for the situation Situation e State your name and unit e lam calling about Patient Name amp Room Number e The problem am calling about is e If this is a serious problem say what the code status is Background e Briefly state why the patient is in the hospital give a synopsis of the treatment to date Give the vital signs oximetry and how much oxygen is being given e Relate the complaint giv
35. in the U S 3 The risk of transmission depends on the amount of virus present in the source blood the amount of source blood involved in the exposure and the route of exposure C Complications Both HBV and HCV can result in chronic liver disease leading to liver cirrhosis cancer and death D Incubation Symptoms Treatment 1 2 The incubation period of HBV infection ranges from 45 180 days The incubation period of HCV infection ranges from 2 24 weeks Infection may range from no symptoms at all to flu like symptoms nausea vomiting fever In adults most acute HBV infections are self limited In those who develop chronic infection the HBV may severely damage the liver Most acute HCV infections are silent Unlike HBV HCV infection becomes a chronic infection in 75 85 of affected individuals Currently treatment for chronic HB V HCV infection involves some form of interferon Effectiveness of therapy varies There is no proven cure for chronic HBV or HCV infection E Prevention 1 HBV is preventable by the Hepatitis B vaccine a b The Centers for Disease Control CDC recommends the HBV vaccine for anyone frequently exposed to blood body fluids OSHA mandates that all employees at high risk for Hepatitis B be offered the vaccine free of charge The vaccine is available to employees through Employee Health A contraindication to Hepatitis B vaccine is hypersensitivity to yeast or any component of the
36. increase in oxygen saturation above 96 aoe re 6 Which observation in a 3 month old patient would identify a need for the nurse to call the RRT An acute decrease in heart rate to 60 An acute increase in respiratory rate to 30 An acute increase in oxygen saturation above 98 An acute decrease in systolic blood pressure to 100 aoe 7 Which observation in an 8 year old patient would identify a need for the nurse to call the RRT An acute increase in heart rate to 100 An acute increase of respiratory rate to 30 An acute increase in oxygen saturation above 96 An acute decrease in systolic blood pressure to 100 ae of Nursing Department Reorientation Self Study Guide Clinical Competencies 7 Rapid Recognition and Response to Changes in Patient Condition 8 Which observation in a 50 year old patient would identify a need for the nurse to call the RRT An acute increase in heart rate to 110 An acute increase in respiratory rate to 20 An acute decrease in oxygen saturation below 90 An acute decrease in systolic blood pressure to 100 ae op 9 Normal and abnormal vital signs parameters for the RRT can be found In the crash cart In the patients chart In the hospital policy manual On the Harbor UCLA Intranet ao re 10 Which of the following is NOT a sign of clinical deterioration a Acute change in heart rate b Acute change in mental status c Severe uncontrolled bleeding d Sudden change in blood su
37. is a complete Transfusion Order Form HH597 This order must include type of product number of units infusion rate if different from standard and fluid restrictions if appropriate The IV certified RN LVN will verify the presence of the informed consent in the patient s medical record Informed Consent to Transfusion of Blood or Blood Products HH1009 and the State Department of Health Services If You Need Blood A Patient s Guide to Blood Transfusions HH687E PL The patient s vital signs including temperature must be taken within 30 minutes prior to starting the transfusion and before the blood is picked up If the temperature is 100 F or above the transfusion should be held and physician notified The RN will only transfuse patients whose temperature is less than 100 F unless there is a specific written order to transfuse the patient with a temperature of greater than 100 F Nursing Department Reorientation Self Study Guide Clinical Competencies 13 Blood Products and Transfusion C Obtaining Blood Blood Products Verification of correct blood blood product and patient begins during the pick up of the blood product Any nursing employee physician or volunteer may pick up blood products The Blood Bank Technologist and the person picking up the blood together will verify the identification of the patient the blood group and Rh type donor number expiration date and time by comparing the information from the
38. minimal interruptions by others Il STRATEGIES TO SUPPORT SAFE AND EFFICIENT HAND OFF COMMUNICATION7 A B Use clear language avoiding vague unclear or potentially confusing terms he s doing fine or she s lethargic Incorporate techniques to communicate effectively such as limiting interruptions allowing sufficient time and focusing on the information being communicated Use repeat back and clarifying questions to ensure common understanding Standardize reporting following the guidelines in Nursing Department Policy Hand off Communication Nursing page 200 0 200 18 which describes responsibilities of RNs LVNs and NAs for hand off communication Also included are the recommended sequence and content to include in report Following a consistent format increases recall assists staff to record the information accurately and improves their ability to plan patient care Use technology to your advantage ensure that documentation is up to date orders are entered and patient care equipment is set to the patient s individual parameters as ordered by the physician Finally keep the report patient centered and avoid irrelevant details Nursing Department Reorientation Self Study Guide Mandated Section 43 Patient Care Management HI CRITICAL NURSING HAND OFFS Inter Unit Transfer Admission Transport Change of Breaks amp Shift Lunches Patient hand offs occur many times during the pat
39. not rounded 3 When reclining correctly lie on one s back or alternatively on one s side with knees bent Lying on one s abdomen places strain on the spine Change positions frequently 1 Get up and stretch frequently if one is required to sit for long periods 2 Change foot positions often if one is required to stand for long periods Use an object step stool to shift one s weight Keep one s weight evenly balanced when standing IV CAUSES OF BACK INJURY A B C D E F Poor posture poor body mechanics Decreased flexibility Lack of physical fitness Poor work habits Repetitive trauma Accidents V GUIDELINES FOR PREVENTING MUSCULAR AND SKELETAL INJURY The body can be thought of as a machine which must be used correctly to maintain health and efficiency Consider the following guidelines A Plan ahead 1 Assess the work to be done 2 Ensure one can lift carry the load 3 Request help when necessary Use good body mechanics Make sure one s path is clear Check equipment for safety 1 Lock all brakes on wheeled equipment such as beds wheelchairs gurneys etc before moving patient to and from wheeled equipment Obtain patient s cooperation 1 Be sure the patient understands what is going to happen 2 When working with another person plan timing of movement for a smooth action Nursing Department Reorientation Self Study Guide Mandated Section 6 Patient Care Manage
40. of 2 All of the following are critical nursing hand off situations EXCEPT Admission Transport Room change Inter unit transfer Boe 3 Which of the following is important to include during inter unit transfer communication a Transfer orders b Supplies and equipment needed c Diagnosis chief complaint and current condition d All of the above Answers to Study Questions l a 2 3 d If you answered all of the questions correctly go on to the next section of this competency If you missed 1 or more of the questions read the content again and repeat the study guide questions HAND OFF COMMUNICATION References 1 Improving handoff communications Meeting national patient safety goal 2E Joint Commission Perspectives on Patient Safety August 2006 6 8 9 15 2 Focus on five Strategies to improve hand off communication Joint Commission Perspectives on Patient Safety July 2005 5 7 3 Hand off Communication In Nursing Policy Manual Torrance CA Harbor UCLA Medical Center 2008 200 0 200 18 4 Crossing the Quality Chasm Washington D C Institute of Medicine National Academy Press 2001 Bibliography Hand off communication nursing In Nursing Department Policy Manual Torrance CA Harbor UCLA Medical Center 2008 200 0 200 18 Reorientation Manual 2010 MandSec Hand Off Communication doc Nursing Department Reorientation Self Study Guide Mandated Section 48 Patient Care Management FAMILY VI
41. of the patient s rights for privacy of health information 5 Identify how the security standards safeguard individual is protected health information from misuse and or unauthorized disclosure 6 Determine specific responsibilities for ensuring confidentiality of protected health information Instructions to the Employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 15 H HI Patient Care Management HIPAA AND CONFIDENTIALITY OF DATA AND INFORMATION INTRODUCTION Harbor UCLA Medical Center handles confidential data and information daily to meet the mission of the Medical Center Information is also used for patient care medical education and research A patient s diagnosis and laboratory results are examples of confidential information Confidential information can be verbal written or electronic In this study guide data is defined as uninterpreted observations or facts Information is defined as interpreted set s of data that can be used for decision making HIPAA AND CONFIDENTIALITY OF DATA AND INFORMATION A Harbor UCLA Medical Center policies and procedures require maintaining the security and confidentiality of data and information Departmental policies and procedures include data security See Hospital Policy No 627 Access to medical information is based on an employee s job title function an
42. or Privacy Liaison TREAT THE PATIENT S INFORMATION THE WAY YOU WOULD WANT YOUR OWN PERSONAL INFORMATION TREATED CONCLUSION Protected health information PHI may only be used or disclosed for treatment payment and health care operations unless authorized by the patient or allowed by law Protecting PHI is everyone s responsibility therefore become familiar with and follow all applicable policies and procedures Contact local HIPAA Security liaison or coordinator for any questions regarding the protection of electronic protected health information PLEASE COMPLETE THE STUDY QUESTIONS HIPAA AND CONFIDENTIALITY OF DATA AND INFORMATION Study Questions Select the best answer to each question DO NOT write in the manual 1 The Privacy Rule applies to protected health information PHI in all forms including electronic written oral and any other form a True b False If an employee sees a FAX with patient information lying on a counter top what should the employee do Read it to see if there is anything interesting in it Throw it in a wastebasket since apparently it wasn t important Read the name of the person it was sent to without reading the rest of it and deliver it to that person None of the above BOTS Discussing a patient s condition over the phone or in an open area of the care setting with the patient family or another provider is allowed as long as reasonable efforts are made to protect the pat
43. or down staircases and out of the building to an area of safe refuge Full evacuation Patients are transferred to other hospitals or health care facilities and or are discharged home a Evacuate the building from the top down Evacuation at lower levels can be accelerated easily if the danger increases rapidly C Evacuation Sequence Evacuate the most hazardous areas first those closest to danger or farthest from a safe exit Patients shall be evacuated in the following order 1 2 Patients in immediate danger Ambulatory patients who need little or no assistance to walk and go down stairs Non ambulatory wheelchair patients Non ambulatory special needs patients This group includes patients who are bed bound bariatric ventilator oxygen dependent on a legal hold or require a transport monitor D Evacuation Triage Status In the case of vertical evacuation to help plan for and resource the evacuation efforts Nursing staff shall assess each patient s color coded Evacuation Triage status 1 2 3 Green Ambulatory patients who need little or no assistance to walk and go downstairs Yellow Non ambulatory wheelchair patients Red Non ambulatory special needs patients Nursing Department Reorientation Self Study Guide Mandated Section 108 VI VII Environment of Care Issues E Evacuation Routes 1 3 Floors 3 through 8 are divided into three smoke compartments that are created by barrier door
44. or telephone systems Building 2 East is located next to the Parlow Library see map on following page The messenger should use the telephone at the east side entrance of the Centrex Building to dial O or ext 113 and the operator inside the building will respond If appropriate the messenger should return to the work area and assist co workers as needed C Contain fire using appropriate fire fighting method Close all doors and clear all corridors See section VIII D Extinguish the fire when safe to do so Nursing Department Reorientation Self Study Guide Mandated Section 106 Environment of Care Issues MAP SHOWING LOCATION OF BUILDING 2E CENTREX BUILDING CARSON STREET E 2 East Centrex Building LOADING l DOK J LOTC we VERMONT AVE CENTRAL DRIVE IV FIRE RATING INFORMATION A Doors The fire rating of a door refers to the period of time that the door is capable of preventing the transmission of fire For example if the fire is in a patient s room closing the door will provide twenty minutes of protection from the fire spreading to another area If the fire is outside the patient s room the reverse is then true the door will provide twenty minutes of protection Many of the door assemblies are labeled with their fire ratings The rating includes the door and the frame Door Fire Rating Corridor doors including patient room doors 20 minutes Staircase doors 14
45. packages 1 Unopened a Avoid handling packages that look suspicious b Evacuate and deny entry to the area c Notify Sheriff Department at ext 3311 Opened a If letter package is opened and suspected to contain a toxin or biohazard eg anthrax place trash can or similar object over the item Isolate the area Move to another location along with others who are in the immediate area Notify Sheriff Department at ext 3311 DO NOT GO HOME OR LEAVE COUNTY PROPERTY ene C Disturbance 1 2 Note details of incident and report to Sheriff Department at ext 3311 If possible stabilize situation D Theft of personal or county property 1 2 3 4 Do not leave valuable items unattended eg wallets pagers cell phones portable computers etc Do not be a hero Cooperate with the assailant Be a good witness note details and report to the Sheriff Department at ext 3311 Nursing Department Reorientation Self Study Guide Mandated Section 125 Environment of Care Issue E Infant Child Abduction 1 CODE PINK If an infant child is abducted or suspected to have been abducted a CODE PINK is called The procedure involves calling the hospital operator at ext 111 and informing the operator to activate a CODE PINK and stating the age of the infant child and the floor area of occurrence The staff of the floor of occurrence should activate the panic alarm if their floor has one as well as notify the c
46. patients in restraints are appropriately monitored and receive necessary interventions e Ensuring the patient is assessed for any potential injuries that may have occurred during the restraint process C Role of other patient care personnel 1 Under appropriate circumstances other properly trained members of the healthcare treatment team may monitor patients in restraints and or seclusion and provide necessary intervention VII FACTORS TO CONSIDER WHEN PATIENTS ARE IN RESTRAINTS A Underlying causes 1 Violent aggressive assaultive and destructive behavior a Psychosis Patients who are experiencing delusions and or hallucinations are at increased risk for aggressive assaultive behavior These symptoms often produce increased anxiety b Anxiety Anxiety is frequently the underlying factor related to aggressive assaultive behavior The behavior is an attempt to reduce anxiety levels c Intoxication and withdrawal from substances Many substances can cause an increase in agitation and paranoia when a person is intoxicated or withdrawing from a substance d Bipolar disorder manic phase Hallmark symptoms of this disorder include irritability that may escalate into hostility and combativeness when attempts are made to redirect behavior e Dementia Delirium Dementia and delirium may result in violent types of behaviors that pose Nursing Department Reorientation Self Study Guide Mandated Section 31 2 Patient Care Man
47. personnel regarding the use of pain medication s Instructions regarding the use of non pharmacologic interventions for pain management and when and how to contact a healthcare professional will also be provided 2 Staff education Pain management education is provided to all new hospital staff involved in patient care at their initial orientation and to all clinical staff as part of the hospital s annual Reorientation program In addition individual departments periodically provide their staff with pain management education appropriate to their particular patient population Documentation Initial screening of pain will be documented in the nursing admission flowsheet Subsequent assessments treatments reassessments and patient family education will be documented on the appropriate forms Evaluation Evaluation of the pain management regimen is a circular process It begins when the nurse first assesses the patient s pain by performing a complete pain assessment of the physiological and behavioral changes including the patient s own self report There are various assessment tools used in helping with the communication of the intensity of pain This is followed by pharmacological and or non pharmacological modalities identified by the multi disciplinary care team After an identified period of time patients are reassessed as to the relief of pain or for further analysis of the effectiveness of the intervention used At this time th
48. spontaneous combustion Personnel who have acquired any moisture or gel on their hands while performing chest compressions must not operate the defibrillator D Observe the following when working with external pacemaker wires and or box 1 Keep external pacemaker wires covered with gloves and or inside suction tubing to provide some form of insulation Never touch pacemaker wires or enclosure with wet hands Instruct patients not to shower while external pacemaker wires are in place Patients should also be instructed never to touch the television and or other electrical equipment while the external pacemaker wires are in place E To remove a patient from a cardiorespiratory monitor 1 2 Disconnect monitor cable from monitor OR remove electrodes from patient Do not disconnect the electrodes from the monitor cable Placing tape over the connection between the electrode lead wire and the monitor cable is a good reminder to not disconnect at this junction Important Any time a patient in contact with electrical or mechanical equipment complains of feeling an electrical tingling shock or burn immediately assess the patient and disconnect replace the equipment Then notify the physician Facilities Management the Nurse Manager and complete a Situation Report Nursing Department Reorientation Self Study Guide Mandated Section 100 Environment of Care Issues UTILITY SAFETY Each staff member must be able to answer
49. steps one should take to access interpreter services for a patient 1 Identify the language of the Limited English Proficient LEP patient 2 If one is bilingual and speaks the language of the patient s preference communicate with the patient in the preferred language 3 Utilize bilingual staff in one s work area if available 4 If bilingual staff are not available utilize the Video Monitoring Unit equipment in your area or call the Healthcare Interpreter Network HCIN at ext 5405 which will automatically connect you with an interpreter either at Harbor UCLA or part of the HCIN network which allows us access 24 hours day seven days week Nursing Department Reorientation Self Study Guide Mandated Section 39 Remember Patient Care Management If an in person interpreter is needed call ext 6557 for assistance Monday Friday 8 00 am 5 00 pm outside of these hours access the Interpreter Directory via the Harbor Intranet When requesting an interpreter provide the following information a The date and time interpreter is needed b The location where the interpreter is needed c The approximate length of time the interpreter is needed American Sign Language ASL can be accessed via the VMI units and dial ext 5405 to request sign language services Teletypewriter telecommunications devices for the deaf hearing impaired are available as listed below a A TTY TDD machine is housed in the Emergency Room for
50. the following questions For further clarification or information consult the Hospital Administration Policy and Procedure Manual and or the Hospital Fire Manual Q A Who would you notify if there is a mechanical emergency or if you have a piece of equipment in need of repair Call Mechanical at ext 3301 3302 or 3303 Monday thru Friday from 0730 1600 on County observed Holidays and at all other times Call ext 3326 Q Do you know when and why to use a red emergency outlet While all the outlets are supported by the emergency generators the RED outlets will be the last ones to lose power if the generators have difficulty These RED emergency outlets can be used at all times however their use should be restricted to life support equipment eg ventilators balloon pumps Some medication rooms have red emergency outlets available Use this outlet for the medication refrigerator to prevent critical medications from perishing when the refrigerator becomes inoperable during a power outage What would you do if you were in an elevator the elevator stopped and the door did not open What would you do if there was a patient in the elevator In the event that an elevator stops and the doors do not open follow the instructions below 1 Check if the emergency stop button has been pulled out If it is pulled out push it in and the elevator should start to run 2 If the emergency stop button is not pulled out and the elevato
51. the location where a hazardous chemical is present An MSDS contains necessary safety information for proper management of the hazardous material C Itis the SUPERVISOR S RESPONSIBILITY to ensure that labels and the MSDS are available and appropriate D Itis the EMPLOYEE S RESPONSIBILITY to read and make sure he she understands the information on the labels and the MSDS E The information on hazard class in the MSDS will guide the employee as to how to manage the material for proper 1 Storage 2 Protective Equipment 2 Spill and Emergency Response 4 Disposal Il HAZARD CLASS TABLE Chemicals can belong to more than one class HAZARD DEFINITION EXAMPLE PRECAUTIONS CLASS Reactive Materials that react violently Picric acid peracetic Store and transport explode or emit a toxic gas acid sodium azide carefully to avoid the upon such events as shock heat sodium cyanide hazard that will cause the or water reaction Flammable Materials that burn easily Alcohol xylene Store in flammable cabinet ignite at room temperature with Keep small amounts in spark stock Oxidizer Materials that support burning Iodine bleach Segregate from flammables of flammable chemicals hydrogen peroxide otherwise treat them as oxygen any chemical corrosives which are a containing per in its secondary property name Corrosive Materials that cause tissue Acids ammonia cidex Wear gloves and safety acid base or inju
52. to body fluids 10 The process of decontaminating a body fluid spill includes all of the following EXCEPT ao op Wearing gloves Pouring bleach onto spilled material Sprinkling absorbent powder over spilled material Sweeping up treated material and disposing into red bag 11 When touching contaminated surfaces which type of PPE should be worn ao op Gloves Goggles Gloves and mask Goggles and mask 12 Which of the following is true about safe handling of sharps ao op A contaminated needle should be recapped prior to discarding it The safety device does not need to be activated on needles used to mix medications Needles without a built in safety device must be protected by the Point Lok before disposal The safety device does not need to be activated if the needle is clean has not entered a patient CHECK YOUR ANSWERS TO THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 85 Infection Control Issues BLOODBORNE PATHOGENS AND HEALTHCARE WORKERS Answers to Study Questions If you answered all of the questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions References 1 California Department of Industrial Relations Division of Occupational Safety and Health DOSH Bloodborne Pathogens Regulation Title 8 CCR 5193 http www dir ca gov title 8 5193 html Accessed June
53. with TB airborne precautions may be discontinued when the patient has met the following criteria on effective therapy is improving clinically and has had three consecutive negative AFB sputum smears collected on different days a Because drug susceptibility results are not usually known when the decision to discontinue isolation is made all TB patients should remain in isolation while hospitalized until they have had three consecutive negative AFB sputum smears collected on different days and they demonstrate clinical improvement b For HIV positive patients with suspected pulmonary TB or for multidrugresistant TB MDR TB consult the Pulmonary Services for medical management and discontinuation of isolation More AFB smears may be required E In general infants do not require airborne precautions because they rarely aerosolize droplet nuclei and their bronchial secretions contain few acid fast bacilli as compared to adults with pulmonary TB However each case must be evaluated on an individual basis eg age of child symptoms F If the patient being admitted is a child the family household contacts accompanying the child will be asked to wear a mask until they have been ruled out for TB by their healthcare provider or the Health Department The family household contacts must wear the mask at all times while inside the hospital IX FACTORS FOR REDUCING TUBERCULOSIS TRANSMISSION A Early identification Early identification is a ke
54. 04 3 Corridor 1 floor 102 1 Corridor 1 floor 107 2 Corridor Basement B06 7 Corridor Basement B02 10 Corridor Basement BO1 10 Corridor B 05 Corridor PLEASE COMPLETE THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 102 Environment of Care Issues ELECTRICAL UTILITY SAFETY Study Questions Select the best answer to each question DO NOT write in the manual 1 Which of the following conditions make patients more electrically sensitive aoe Wet skin Pressure sores Presence of catheters All of the above 2 When multiple pieces of electrical equipment are being used for a patient ensure better grounding by aoe Testing the equipment for current leakage Plugging equipment into the same cluster of wall outlets Wrapping long cracked cords around the body of all equipment Checking that a current mechanical sticker is on each piece of equipment 3 All life support equipment in use should be plugged into ae op Any outlet The red outlets The blue outlets None of the above 4 In which of the following conditions should a power cord NOT be used aoe re A missing ground prong Cracked plastic portion of the plug A break in the insulation of the cord All of the above 5 A patient reports that she just felt a strange tingling through her body when she touched her siderail An appropriate action is to a Unplug the bed and try inserting plug in anot
55. 22 2010 2 NIOSH Alert Preventing Needlestick Injuries in Healthcare Settings http www cdc gov niosh Accessed June 22 2010 3 Migden C Occupational Safety and Health Bloodborne Pathogen Standard A B No 1208 September 30 1998 http www leginfo ca gov pub 97 98 bill asm ab_1201 1250 ab_1208 cfa 19980829 _031302_asm_floor html Accessed June 22 2010 Bibliography Bloodborne pathogen exposure control plan In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2008 Policy No 435 Centers for Disease Control and Prevention National Center for Infectious Diseases Division of Healthcare Quality Promotion and Division of Viral Hepatitis Exposure to blood What healthcare personnel need to know http www cdc gov ncidod dhqpwrkrprotect_bp_prevent html Accessed June 22 2010 Centers for Disease Control Hand Hygiene Guidelines Fact Sheet http www cdc gov od oc media pressrel fs021025 htm Accessed June 22 2010 Department of Industrial Relations Cal OSHA Consultation Services Education Unit A Best Practices Approach for Reducing Bloodborne Pathogens Exposure http www ca osha com pdfpubs BBP Best 1 pdf Accessed June 22 2010 Reorientation Manual 2010 MandSec BloodbornePathogens doc Nursing Department Reorientation Self Study Guide Mandated Section 86 Infection Control Issues TUBERCULOSIS Objectives Upon completion of this section the emplo
56. ALA 4 Identify potential violations of EMTALA regulations and their impact Instructions to the Employee Please read the following section then answer the study questions at the end of the section Nursing Department Reorientation Self Study Guide Mandated Section 63 Il HI Patient Care Management EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT EMTALA INTRODUCTION A The Emergency Medical Treatment and Active Labor Act EMTALA is a statute under the larger umbrella of the Consolidated Omnibus Budget Reconciliation Act COBRA EMTALA is designed to enhance access by all persons to emergency services and prohibit discrimination in the provision of emergency services to persons presenting with similar types of conditions regardless of financial or insurance status EMTALA is also referred to as the antidumping law The current definition of EMTALA includes patients anywhere on the campus Expansion of the definition includes the outpatient clinics emergency department labor and delivery psychiatric emergency department and any port of entry to the hospital or grounds There are many components to EMTALA and compliance with all portions is mandatory for any hospital receiving Medicare reimbursement Any institution that fails to comply with the regulations imposed by EMTALA may be subject to monetary penalties and risks termination of its Medicare provider status BASIC EMTALA REQUIREMENTS A Although there ar
57. BC carbon dioxide or ABC dry powder Do not use a water extinguisher for this class of fire as it will spread or splatter the fire Class C Electrical fires from burning motors television sets or monitors Turn off electrical source if possible Use extinguishers marked BC carbon dioxide or ABC dry powder NEVER use a water extinguisher because of the possibility of electrical shock Nursing Department Reorientation Self Study Guide Mandated Section 109 Environment of Care Issues VII HOW FIRE EXTINGUISHERS WORK A Water extinguishers A remove heat from the fire triangle B Carbon dioxide extinguishers BC produce a fog that displaces available oxygen at the base of the fire Carbon dioxide also cools the burning surface thereby removing the element of heat C Dry powder extinguishers ABC form a chemical barrier between the fuel and oxygen elements of the fire triangle IX FIRE FIGHTING EQUIPMENT A Use the proper extinguisher for the type of fire you are trying to extinguish See table below Type of Fire Extinguisher Effective For These Types of Fires Class A or H2O Paper wood or linen fires Class BC or CO Chemical or electrical fires Class ABC or Dry Chemical All types of fires Halon ABC Rated All types of fires K Type Combustible cooking media vegetable or animal oils and fats B Fire extinguisher operation 1 Although the operation of the majority of fire extinguish
58. Condition Report should also be filed VIL CHEMOTHERAPY ANTINEOPLASTIC DRUG SAFETY A Introduction 1 Only registered nurses who have successfully completed a chemotherapy administration course are allowed to administer chemotherapy However it is important that all staff providing direct patient care be familiar with chemotherapy drug safety Exposure of healthcare personnel to these drugs as well as other substances in the healthcare setting has become of increasing concern in recent years It is known that exposure to these drugs when administered for therapeutic reasons can have mutagenic damage to chromosomes and cells teratogenic damage to the developing embryo or fetus and or carcinogenic promote cancer development effects Exposure to chemotherapy drugs can occur during Drug preparation Drug transport Drug administration and disposal Direct contact with body fluids of patients receiving such drugs IV spills from tube connections es aocerp B Drug safety 1 Exposure during drug preparation can occur by absorption through the skin inhalation of fumes aerosols or powder or by ingestion of food or water if contaminated when located in the immediate area Pharmacists and pharmacy technicians are at greatest risk of exposure due to the amount of their contact with chemotherapy Preparation of chemotherapy drugs is therefore restricted to the pharmacy where special facilities and protocols can be implemented Food
59. E NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 135 Environment of Care Issues Answers to Study Questions l a 2 a 3 a 4 b 5 a 6 b If you answered all of the questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions References 1 California Code of Regulations Title 8 Paragraph 5153 Department of Industrial Relations http www calregs com Accessed June 22 2010 Bibliography Antioplastic Medications and pharmaceutical waste In Hospital and Medication Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2007 Policy No 431 Biohazardous waste in outpatient clinics In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2005 Policy No 474 Hazardous materials and waste management plan In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2009 Policy No 406 Hazardous Materials and Wastes Training Manual Torrance CA Harbor UCLA Medical Center 2009 Medical Waste Management Plan Torrance CA Harbor UCLA Medical Center 2009 Reorientation Manual 2010 MandSec HazardousMaterials doc Nursing Department Reorientation Self Study Guide Mandated Section 136 Environment of Care Issues RADIATION SAFETY PROGRAM Objectives Upon completion of this section
60. Essential information for identifying proper management of a hazardous material can best be obtained by aoe re Reading the MSDS Smelling the material Asking the Safety Officer Noticing the color and viscosity 2 All of the following are true regarding protective equipment EXCEPT aore N 95 respirators are available as one size fits all A chemical fume hood provides good protection for harmful vapors Medical gloves are sufficient hand protection for non corrosive toxics Rubber gloves and goggles are used when pouring corrosive materials such as Cidex glutaraldehyde 3 Which of the following is TRUE about pharmaceutical waste ao re It is considered hazardous waste It is not considered hazardous waste In small amounts it may be flushed down the sink In small amounts in may be disposed of in the trash 4 Two facts about a chemical that must be on the label ao re Health hazard and recommended disposal method Chemical identity of the substance and the hazard class Identity of the substance and the recommended disposal method Recommended personal protective equipment and recommended disposal method 5 Accidental exposure to chemotherapy drugs can occur via absorption through the skin inhalation or ingestion of contaminated food or water a b True False 6 Environmental Services housekeeping may clean up large chemotherapy spills a b True False CHECK YOUR ANSWERS TO THE STUDY QUESTIONS ON TH
61. F RADIATION SAFETY A Time Keep the length of exposure to a minimum 1 Assess the patient and the environment Plan patient care to accommodate minimal exposure to the radioactive patient B Distance Keep one s distance away from a source of radiation 1 Always maintain an appropriate distance away from the patient except when it is necessary for the patient s care The farther away one is from the source of radiation the less radiation one absorbs Wear lead aprons as appropriate eg for use with x ray fluoroscopic equipment Whenever possible without harm or discomfort to the patient encourage the patient to do self care Wear film badges as assigned in units 4E 5E and OR C Shielding Place shielding between the employee and the source 1 Whenever possible use the patient s body as a shield by standing in a position not directly adjacent to the site of the radioactivity D Contamination Control Confine the spread of radioactive contamination 1 Excreted radioactive waste can be dispersed around the room and contaminate staff and visitors For example the patient who receives radioiodine for therapy excretes radioiodine in the urine Precautionary measures in caring for radioactive patients a All signs and safety measures are placed and removed by the Radiation Safety Office b A sign indicating Caution Radioactive Material is placed on the door and on the bed in the patient s room c A C
62. Fact Sheet Hand hygiene guidelines fact sheet http www cdc gov od oc media pressrel fs021025 htm Accessed June 22 2010 Dermody TS Tyler KL Introduction to virus and viral diseases Mandell GL Bennett JE Dolin R eds In Mandells Douglas and Bennet s Principles and Practices of Infectious Diseases Vol 2 6 ed Philadelphia PA Elsevier Inc 2005 1729 1742 Hand hygiene in healthcare settings In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2008 Policy No 471 Hand hygiene in healthcare settings Joint Commission requirements In Department of Health Services Policy and Procedures Los Angeles CA Department of Health Services 2009 Policy No 392 3 Infection Control Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2005 Osterholm MT Hedberg CW Epidemiologic principles Mandell GL Bennett JE Dolin R eds In Mandells Douglas and Bennet s Principles and Practices of Infectious Diseases Vol 1 6 ed Philadelphia PA Elsevier Inc 2005 161 172 Centers for Disease Control and Prevention Guidelines for Environmental Infection Control in Health care Facilities Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee HICPAC http www cdc gov ncidod dhgqp gl_environinfection html Accessed June 22 2010 Reorientation Manual 2010MandSec TransmissionofInfectiousDiseases doc Nursing Departmen
63. HARBOR UC LA MEDIC AL CENTER Department of Nursing Self Study Guide 2010 UOI e USIIO9L 2010 Harbor UCLA Medical Center Department of Nursing Reorientation Self Study Guide isan official publication of HarborUCLA Medical Center Torrance Califomia All rights reserved The contents of this publication may not be reprinted without the written permission Harbor UCLA Medical Center Department of Nursing REORIENTATION SELF STUDY GUIDE EDITORS Paula Siler RN MS Michelle Sterling RN MSN Associate Director Nursing Training Coordinator Robin Watson RN MN CCRN Acting Director Clinical Professional Development CONTRIBUTORS Grace Chacon Taloma RN MBA HCM Dina Elias RN MSN Clinical Nurse Educator Critical Care Clinical Nurse Educator Jim Freeman Marianne Fr lich PhD Biomedical Electronics Supervisor Director Hazardous Materials Vince Jugo RN MSN Calvin Kwan MBA Medical Surgical Clinical Nurse Educator Associate Hospital Administrator Elizabeth Leon RN MSN Arlene Malabanan RN BSN Emergency Clinical Nurse Educator Director Clinical Resource Management Tecla Mickoseff MA Cynthia Moore BS Former Chief Executive Officer Associate Hospital Administrator Sandy Mungovan Jacqueline Munroe RN MSN Acting Director Information Systems Coordinator Nursing Quality Improvement Michael O Shea Julie Rees MSW Former Captain County Police Assistant Hospital Administrator Beth Rohrbach RN MSN MPH Elisa Sanchez RN BS
64. Hand off communication refers to the process of passing patient specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring continuity and safety of the patient s care In effective hand off communications caregivers provide accurate information about a patient s current condition ongoing treatment and services recent or anticipated changes in condition and actual or potential complications A Consider these situations in which a breakdown in hand off communication would occur 1 A patient is given a double dose of morphine because one nurse covering another for lunch was not told the patient had already received the medication 2 A Code Blue is called for a patient who is DNR because the patient s code status is not communicated during change of shift report 3 A patient falls during an x ray because the patient s Fall Prevention Measures status was not communicated prior to transport 4 A patient is left alone in the room after transfer because the nurse was not informed the patient had arrived 5 A delay in care results when a nurse fails to notify the on call physician of a change in the patient s condition Effective hand off communication must meet the following four requirements 1 Is interactive between caregivers 2 Is up to date 3 Provides an opportunity for the receiver to verify the information and review relevant historical data 4 Has
65. Human immunodeficiency virus HIV Diabetes Chronic malnutrition eg alcoholics IV drug users Immunosuppression due to long term corticosteroids or chemotherapy Bese Nursing Department Reorientation Self Study Guide Mandated Section 88 Infection Control Issues IV EPIDEMIOLOGY AND POPULATIONS AT RISK A According to the World Health Organization WHO TB kills approximately 2 million people each year and 5 000 people a day Currently there are 2 billion people worldwide infected with the TB bacillus In the United States during 2004 there was a nationwide 3 3 decline from 2001 in the number of TB cases reported to CDC Los Angeles County LAC was still the county with the highest number of TB cases in California for the year 2003 It accounted for 29 4 of the TB cases in California 3 230 cases provisional data and 6 4 of the TB cases in the United States However during 2003 there were 949 TB cases confirmed in LAC representing a 7 4 decrease in TB cases from 2002 Similar to the whole nation this was the eleventh year of decline since 1992 Anyone can get tuberculosis Tuberculosis however is more prevalent in certain subsets of the population such as persons born in countries with a high incidence of tuberculosis eg Hispanics Asian Pacific Islanders Certain living conditions also place an individual at higher risk of infection such as crowding poor lighting poor ventilation homelessness and long term car
66. MHA Clinical Nurse Specialist Program Director Patient Flow Cathy Taylor PT Susan Ulit RN MSN Director Rehabilitation Services Critical Care Clinical Nurse Specialist Sreedevi Warrier RN MSN MA Medical Surgical Clinical Nurse Educator Nursing Department Reorientation Self Study Guide i REORIENTATION SELF STUDY GUIDE SECTION REVIEWERS Special thanks to the following people who reviewed individual sections of the manual Peter Allen David M Applebaum MS Assistant Director Facilities Management Officer Radiation Safety Holli Mason MD Mary Ann Berliner MLS Director Library Services Director Transfusion Medicine and Serology Director Pathology Residency Training Program Christine Nakagawa PharmD Cassandra Noble OT Pharmacy Educator Supervisor Occupational Therapy Christina Russo MBA CLS Cora Zawrotny RN MSN Quality Assurance Coordinator Pathology Nurse Manager Psychiatric Emergency PUBLICATION SUPPORT Francisco Acevedo Intermediate Typist Clerk Nursing Department Reorientation Self Study Guide ii PREFACE This study guide is designed to update each employee on important issues that assist them in providing safe patient care Reorientation consists of two sections Mandated Section Patient Care Management Body mechanics ergonomics HIPAA and confidentiality of data and information use of restraints interpreter services hand off communication family violence pain management and Emerge
67. MTALA also applies to emergency patients who are transferred into or out of Harbor UCLA Medical Center Caring for patients transferred into the facility requires knowledge of previous treatment Adequate documentation and information must be received from the hospital sending the patient EMTALA requires notification of the receiving hospital and copies of the patient s chart X rays EKGs laboratory work and any other necessary information to be sent with the patient Requests from other hospitals to transfer a patient should always be accepted when the patient is requiring higher level of care Patients who are transferred out of Harbor UCLA must be sent with all documents listed above that would aid the receiving facility In addition to the above mentioned information the patient must be informed of the risks and benefits of transfer The benefits of transfer should outweigh the possible risks Consent to transfer must be evident The patient must be stabilized prior to transfer All transferred patients must be transferred with equipment and personnel appropriate for the medical Nursing Department Reorientation Self Study Guide Mandated Section 64 Patient Care Management condition for which the transfer is initiated The appropriate mode of transport is required as well as qualified personnel to accompany the patient All transfer patients must have evidence of EMTALA requirements documented in both the sending and receiving hospitals
68. OLENCE Objectives Upon the completion of this section the employee will be able to 1 Identify a leading cause of death in infants children and adolescents in the U S 2 Define elder dependent adult child and intimate partner violence 3 List three common signs of physical abuse 4 State the reporting requirements for healthcare providers when abuse is detected or suspected Instructions to the Employee Please read the following section then answer the study questions at the end of the section Nursing Department Reorientation Self Study Guide Mandated Section 49 Patient Care Management FAMILY VIOLENCE I INTRODUCTION A Family violence is a comprehensive term that involves violence against children and adults including the elderly and or dependent adults One component of family violence is intimate partner violence which is violence between domestic partners whether a spouse boyfriend and or girlfriend or previous partner Millions of Americans in the United States are affected by family violence each year Although family violence may occur against males the majority of victims are women and children The National Crime Victimization Survey NCVS estimates that more than 1 million non fatal domestic violence incidents and 1 800 murders occur annually as a result of domestic violence Family violence involves child abuse sexual abuse intimate partner abuse and elder or dependent adult abuse The abuse can be phys
69. Patient Condition section there are 5 multiple choice questions and you are allowed to miss 1 question Blood Products and Transfusion section there are 10 multiple choice questions and you are allowed to miss 2 questions Licensed staff assigned to the following areas roles do not need to complete the Blood Products and Transfusion section 8West Ambulatory Care NOTE Licensed staff working in Infusion Clinic must complete the competency CRU Employee Health Patient Flow Facilitator Psych ER Urgent Care Clinic Wound Care Team 6 PLEASE DO NOT WRITE IN THE MANUAL Nursing Department Reorientation Self Study Guide Clinical Competencies 1 Rapid Recognition and Response to Changes in Patient Condition RAPID RECOGNITION AND RESPONSE TO CHANGES IN PATIENT CONDITION Objectives Upon completion of this section the nurse will be able to 1 2 a Discuss normal and abnormal vital signs for age specific patients Recognize indications of a deteriorating patient Identify critical changes in patient s condition according to Harbor UCLA Medical Center s policy Define the ultimate form of clinical deterioration Identify the patient areas which the Rapid Response Team responds State the correct sequence for activating the Rapid Response Team Identify the differences between the Rapid Response Teams and Code Blue White Teams Instructions to the employee Please read the following secti
70. STIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Clinical Competencies 6 Rapid Recognition and Response to Changes in Patient Condition RAPID RECOGNITION AND RESPONSE TO CHANGES IN PATIENT CONDITION Study Questions Select the best answer to each question DO NOT write in the manual 1 The ultimate form of clinical deterioration is Chest pain Respiratory distress A very fast heart rate Respiratory or cardiac arrest aoe re 2 A patient is admitted to the cardiology service with a diagnosis of CHF If this patient were to require an RRT which RRT should the nurse call a Medical RRT b Surgical RRT c Pediatric RRT d OB GYN RRT 3 The nurse identifies that the patient is not responding and appears in cardiac arrest The nurse should page a The primary physician b Respiratory Department c The Rapid Response Team d The Code Blue White Team 4 According to researchers and healthcare improvement agencies patients show signs many hours before the Code Blue White is called Nurses can identify these signs by monitoring patients a Every four hours b At the end of each shift c Ongoing throughout the shift d At the beginning of each shift 5 Which observation in a 5 day old patient would identify a need for the nurse to call the RRT An acute decrease in heart rate to 110 An acute increase in respiratory rate to 40 An acute decrease in systolic blood pressure to 50 An acute
71. Section 55 Patient Care Management PAIN MANAGEMENT Objectives Upon completion of this section the employee will be able to 1 Identify patients rights regarding assessment and treatment 2 Identify severity of a pain score based on a 0 to 10 pain scale 3 Identify the pain score at which pain interventions should be initiated and or revised 4 Identify principles of pain management Instructions to the Employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 56 Il MI Patient Care Management PAIN MANAGEMENT BACKGROUND Despite scientific and medical advances which have provided a better understanding of pain and its treatment pain is often undertreated Hospitals around the country are beginning to improve the way they approach the assessment and treatment of pain Pain management is a focus of concern and assessment by The Joint Commission which has established standards in this area of patient care In addition to The Joint Commission s new standards the State of California under Title 22 issued a Legislative Bill AB 791 that was signed into law on 9 15 1999 This Bill included Section 1254 7 which reads a Pain is to be assessed and treated promptly effectively and for as long as pain persists b Every health facility licensed pursuant to this chapter shall as condition of lice
72. Self Study Guide from where you obtained it Nursing Resources Nurse Manager Building N 18 or Parlow Library PLEASE DO NOT WRITE IN THE MANUAL PLEASE SEE FOLLOWING PAGE Nursing Department Reorientation Self Study Guide Mandated Section 3 Patient Care Management BODY MECHANICS Objectives Upon completion of this section the employee will be able to 1 Identify two advantages of utilizing proper body mechanics 2 Describe how to establish proper balance in performing daily tasks 3 Differentiate between proper and improper technique when lifting and carrying heavy objects Instructions to the Employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 4 Il Patient Care Management BODY MECHANICS INTRODUCTION It is important to understand human movement in order to prevent injury while performing tasks There are mechanical principles or rules that govern all movement and determine what the body can and cannot do These principles apply regardless of the type of activity involved Body mechanics is the application of laws of physics to the human body at rest or in motion REASONS FOR USING PROPER BODY MECHANICS A To prevent injury to self or patients B To prevent fatigue C To maintain good general health and physical appearance D To increase capacity to work comfortably E To increase producti
73. Suspected Dependent Adult Elder Abuse to the Los Angeles County Ombudsman at 310 395 4090 Mail the original report within 48 hours to WISE Senior Center Ombudsman Program at P O Box 769 Santa Monica California 90406 0769 c Incident occurred at Harbor UCLA Medical Center 1 Notify the Los Angeles County Sheriff Dept at x 3311 2 IMMEDIATELY contact your supervisor manager 3 FAX the Report of Suspected Dependent Adult Elder Abuse immediately to Adult Protective Services at 213 738 6485 Mail the original report within 48 hours to Adult Protective Services Central Intake at 3333 Wilshire Blvd 4 Floor Los Angeles California 90010 C Unit Clerk Unit clerks when available will assist in FAXING and mailing the reports D Supervisors Manager The supervisor manager is responsible to ensure appropriate agencies have been notified and a PSN report has been completed Intimate partner abuse State law AB 1652 requires that when physical injury occurs in cases of intimate partner violence healthcare providers are required to report the violence as soon as possible to local law enforcement by telephone A written report shall be sent within 48 Nursing Department Reorientation Self Study Guide Mandated Section 53 Patient Care Management hours of receiving the information At Harbor UCLA Medical Center Los Angeles County Sheriff s should be notified and they will contact local law enforcement If there is a history of physical
74. Table 1 Role of IV certified RNs and LVNs IV Certified RN and IV Certified LVN 1 May start packed red cells whole blood platelets fresh frozen plasma and cryoprecipitates including any irradiated blood products via peripheral lines on patients 2 May transfuse patients through the lower extremities when deemed necessary by a physician and accompanied by a physician s written order 3 Does not transfuse patients whose temperature is greater than 100 F without a physician s written order 4 Will not transfuse blood under positive pressure eg Tyco Pump except as described below 5 Will not use blood warming devices except as described below IV certified RN 1 May use long term venous access devices eg Hickman Port a Cath jugular lines and central lines when necessary to administer blood products following correct procedures for line access IV Certified RN assigned to Adult Critical Care Emergency Nursing Labor and Delivery PACU and Pediatrics 6E PICU NICU and Level II Nursery 1 May use positive pressure eg Tyco Pump in extreme emergencies to administer blood products 2 May use blood warming devices when necessary 3 May transfuse patients through lower extremities when necessary without a physician s order 6E 6EICU NICU Level II Nursery B Preparation for Transfusion A series of checks is carried out prior to beginning a transfusion The RN LVN verifies there
75. Transfusion Record HH964 Compatibility Tag Unit Label and Physician Order according to the procedure posted at the Blood Bank The Blood Bank Technologist fills in the date time of release the amount and signs as having released the unit on the Transfusion Record The individual who picks up the unit also signs the Transfusion Record as having received the unit and verified the information In the event a non licensed staff or volunteer picks up the blood product he she is to give the products obtained from the Blood Bank directly to licensed direct care giver who will be transfusing the blood If for any reason blood is picked up and administration is not initiated within a few minutes the product must be returned to the Blood Bank within 20 minutes for proper storage All unused blood products must be returned to the Blood Bank Blood products may not be stored in a ward unit refrigerator D Verification of Patient Identity At the bedside the RN LVN hanging the blood blood product must verify with another licensed individual that the information on the Transfusion Record form the blood label on the unit the compatibility tag and the patient s identification band are the same by comparing the information according to the Table 2 Table 2 Verification of Transfusion Information Transfusion Compatibility Unit Pt Id Record Form Tag Label Bracelet Patient s Name X X X Patient s MRUN X X X Recipient s Type X X
76. VICES Objectives Upon completion of this session the employee will be able to 1 Describe Harbor UCLA s responsibility to provide interpreter services to patients 2 Describe the actions the employee must take to access interpreter services utilizing the Video Medical Interpreting VMI units and other telephone technologies deployed throughout the medical center 3 Describe how to document in the patient s chart when an interpreter is used Instructions to the Employee Please read the following section then answer the study questions at the end of the section Nursing Department Reorientation Self Study Guide Mandated Section 38 Il Patient Care Management INTERPRETER SERVICES INTRODUCTION A Harbor UCLA Medical Center ensures the availability of interpreter services free of charge for Limited English Proficiency LEP patients An LEP person is one who is unable to speak read write or understand the English language at a level that permits him her to interact effectively with healthcare and social services agencies and providers LEP patients and patients who are hearing impaired will have interpreter services available to them at the point of service or any point requested or identified during the provision of services A patient is not required or expected to use family members or friends as interpreters and family members and friends should not be used unless specifically requested by the patient Minors 18 yea
77. a MMWR Morb Mortal Wkly Rep 2005 54 RR 12 1 81 2 World Health Organization 2006 Tuberculosis Facts http www who int entity tb publications 2006 tb_factsheet_200_1_en pdf Accessed June 22 2010 3 Epidemiology Fact Sheet Total Tuberculosis Cases Los Angeles County Department of Health Services Tuberculosis Control Program Los Angeles CA 2002 Bibliography American Thoracic Society Treatment of tuberculosis and tuberculosis infection in adults and children Am Jour of Resp and Crit Medicine 1994 149 359 361 374 Centers for Disease Control and Prevention Guidelines for preventing the transmission of mycobacterium tuberculosis in health care settings 2005 MMWR Morb Mortal Wkly Rep 2005 54 RR17 1 141 Centers for Disease Control and Prevention National Center for HIV STD and TB Prevention Division of Tuberculosis Elimination Questions and answers about TB 2005 http www cdc gov nchstp tb faqs qa htm Accessed June 22 2010 Centers for Disease Control and Prevention Recommendations for preventing transmission of hepatitis C virus HCV infection and HCV related chronic disease MMWR Morb Mortal Wkly Rep No RR 19 1998 No 47 1 39 Centers for Disease Control and Prevention Tuberculosis General information 2006 250010 1 2 http www cdc gov tb Accessed January 9 2008 Emmett P Hepatitis C The silent epidemic NurseWeek April 19 1999 14 16 Infection Control Policy and Procedure Manual Torrance
78. accept emails from unknown sources or load files from electronic media that are not scanned for viruses Be aware of your departmental contingency plans if automated systems used for patient care go down Ensure that all areas used to store PHI are properly secured Ensure that only authorized personnel have access Keep paper records related to patients out of publicly accessible areas Keep lab reports correspondence and other items regarding patients out of common areas Access confidential information only to do one s job Staff should view only medical records of patients for whom they are treating or caring Dispose of PHI properly shred documents do not throw them in the trash Used approved methods to destroy electronic PHI before reuse or disposal When faxing PHI to someone else indicate that the FAX is confidential Call and advise the receiving party when it is ready to send Ask the individual to stand by to intercept the document and confirm receipt Be aware that violations of privacy or security policies and procedures are subject to disciplinary action Nursing Department Reorientation Self Study Guide Mandated Section 22 XVI Patient Care Management 13 Understand and comply with the Acceptable Use Policy for County Information Technology Resources 14 Understand the law and comply with the medical center s policies and procedures If an issue is found report the problem to the immediate supervisor
79. activity in information systems containing or using electronic PHI c Integrity prevents electronic PHI from being improperly altered or destroyed d Person or entity authentication procedures to verify that a person or entity seeking access to electronic PHI is the one he she or it is claiming to be e Transmission security protects against unauthorized access to electronic PHI while it is being transmitted XV ROLES AND RESPONSIBILITIES A Successful compliance with the HIPAA Privacy and Security Standards involves creating systems that limit access to PHI to the minimum amount necessary for staff to perform their job functions and to protect the availability and integrity of such information Each employee is responsible for protecting each patient s privacy by following the guidelines below 1 10 11 12 Specifically do not leave patient information in places where other people can see it if they have no need to know the information to perform their job If PHI is left out do not read through it close the chart cover it or put it away in its appropriate place Log off on the HIS terminal when leaving the computer station or after obtaining the necessary data Do not share computer passwords or leave them out where they can be seen Change passwords at least every 90 days Ensure that computers and laptops used to access electronic PHI are physically and technically secured Protect PCs from viruses Do not
80. agement immediate risk to the patient or others Behaviors which interrupt medical treatment that have the potential for patient harm a Underlying medical conditions may precipitate altered mental status Conditions that may cause altered mental status include fever electrolyte imbalance brain tumors and head injury Patient s fear and anxiety 1 Explain the procedure to the patient 2 Give the patient specific behavioral reasons for use of restraints eg You are not able to control your behavior You hit the staff broke windows 3 Convey that the use of restraints is not a punishment but rather for the patient s safety and the safety of others 4 Specify the expected behavior that will lead to the discontinuation of restraints Comfort and safety 1 Restraints should be applied securely to ensure patient safety 2 Restraints should be placed to allow for the maximum amount of movement possible and rotated as clinically indicated 3 Patients should always be positioned supine and in proper body alignment 4 Consider reducing number of restraints as part of evaluation of patient readiness to discontinue restraints The patient s decreased autonomy 1 2 Patients who require the use of restraints become dependent upon the nursing staff to meet all of their basic needs which include safety fluid intake nourishment elimination needs skin integrity and hygiene All staff must be aware of pat
81. all employees who as a result of performing their job duties can reasonably anticipate contact with blood and other potentially infectious materials OPIM B Employees are required to adhere to these standards Disciplinary action may result if an employee does not comply C Occupational exposure is determined by the employee s category and its department and task specific Refer to the Bloodborne Pathogen Exposure Control Plan BLOODBORNE PATHOGENS DEFINITION A C Bloodborne pathogens BBP are pathogenic microorganisms present in blood or body fluids which can cause disease in humans Hepatitis B virus HBV hepatitis C virus HCV and human immunodeficiency virus HIV are the primary BBP of concern to the healthcare worker These infections can be transmitted to the healthcare worker by accidental exposure through breaks in the skin punctures wounds or mucous membranes eg eyes mouth BBP may be found in blood or other potentially infectious material OPIM and the following body fluids 1 Semen 2 Vaginal secretions 3 Cerebrospinal fluid 4 Synovial fluid 5 Pleural fluid 6 Pericardial fluid 7 Amniotic fluid 8 Saliva in dental procedures 9 Breast milk 10 Any other body fluid that is visibly contaminated with blood eg urine 11 Fluids where it is difficult or impossible to differentiate between body fluids Bloodborne pathogens may also be found in medical waste and sharps 1 Medical waste includ
82. amily members who engaged in close interpersonal activities eg sharing meals sharing toilets have not demonstrated an increase in HIV transmission C Incubation Symptoms Prevention Treatment 1 The incubation period of symptomatic HIV infection ie virus is variable ranging from months to years If a significant exposure has occurred HIV specific antibodies usually appear 6 weeks to 4 months following exposure Blood tests are used to confirm seroconversion Common symptoms that may occur 1 6 weeks after exposure include fever rash malaise myalgias arthralgias headaches night sweats pharyngitis and lymphadenopathy There is no known cure for HIV infection However post exposure prophylaxis if given early enough may prevent seroconversion Nursing Department Reorientation Self Study Guide Mandated Section 77 Infection Control Issues Mode of Transmission Health Care Worker Precautions mate ous Pee Nace Precautions Preventable HIV Secretion Excretions e Hand washing Standard Precautions No e Sexual intercourse e Gloves e Perinatal exposure e Eye protection if splashing or e Blood products splattering expected e Needle stick injuries e Gowns Hepatitis B Secretion Excretions e Hand washing Standard Precautions Yes e Blood products e Gloves e Sexual intercourse e Eye protection if splashing or e Sharing of drug needles splattering expected e Needle stick injuries e Gowns e Hemodialysis e
83. and gloves prior to any contact with the patient or his her bedside environment Nursing Department Reorientation Self Study Guide Mandated Section 71 Infection Control Issues Please refer to the Harbor UCLA Medical Center s Infection Control Manual on each unit for information regarding A Care of the patient in isolation 1 2 Type of isolation to be used for patients with various types of infections Isolation attire room set up informing patient checking isolation order Transportation of an isolation patient from one room or unit to another post mortem care for the patient in isolation Instructions to be given to visitors of patients in isolation Care of linen dishes charts lab specimens trash and equipment used by the patient in isolation B Daily and terminal cleaning of the isolation room on each unit PLEASE COMPLETE THE STUDY QUESTIONS TRANSMISSION OF INFECTIOUS DISEASES Study Questions Select the best answer to each question DO NOT write in the manual 1 The most common method of transmitting diseases from one person to another is by way of aoe Droplets The hands Air currents Contaminated clothing Factors likely to contribute to an individual getting an infection include a b c d Extremes of age Poor nutritional status Frequent periods of high stress levels All of the above Measures to prevent the spread of infection in the work area include a Handwashing or
84. and or fractures in different stages of healing and marks on the body indicating objects used to inflict pain belt loops rope cigarette burns or a chain In partner abuse the risk of physical abuse increases when the woman becomes pregnant B Neglect 1 Neglect is the failure of the caregiver to adequately provide care and support Although there Nursing Department Reorientation Self Study Guide Mandated Section 51 Patient Care Management may be no physical signs of abuse neglect can leave lasting mental and physical problems Neglect can include the failure to provide any of the following food clothing or shelter assistance in personal hygiene medical care protection from health and safety hazards and nutrition Neglect can also involve the lack of human contact care and support C Sexual abuse Typically the adult victim will report the abuse If the victim is a child pain and bleeding are the most common complaints Other medical symptoms that may indicate abuse include itching dysuria discharge constipation encopresis enuresis chronic recurrent abdominal pain sexually transmitted diseases and unexplained genital trauma Behavioral indicators may include appetite or sleep disturbances phobias neurotic or conduct disorders guilt acting out withdrawal depression or excessive sexual behavior VI INTERVENTIONS A Healthcare providers are obligated by law to report any suspected or identified child a
85. and organizations All employees regardless of role specific duties or job descriptions have a responsibility to protect confidential patient information If patients do not trust their health care providers to ensure confidentiality of PHI the consequences are severe The quality of care could be compromised if patients do not disclose information Employees are responsible for keeping PHI confidential being sensitive respecting the patient s right to privacy and knowing and applying the organization s policies and procedures VI PATIENTS RIGHTS A The HIPAA privacy regulation empowers patients by guaranteeing them access to their medical records giving them more control over how their PHI is used and disclosed and by providing recourse if medical privacy is compromised The rule will protect medical records and other personal health information maintained by health care providers hospitals health plans and health insurers Nursing Department Reorientation Self Study Guide Mandated Section 17 Patient Care Management B The Health Insurance Portability and Accountability Act of 1996 and the Federal Privacy Regulations April 2001 established the patient s right to privacy of their health information These rights include access to information amending the information accounting for disclosures requesting restrictions filing a complaint and receiving notice z 1 Right to Access Patients have the right to access
86. and repeat the study guide questions References 1 Office of the Assistant Secretary for Planning and Evaluation Administrative Simplification in the Health Care Industry http aspe hhs gov admnsimp Accessed June 22 2010 2 US Department of Health and Human Services National Institutes of Health HIPAA Privacy Rule and its impact on research http privacyruleandresearch nih gov Accessed June 22 2010 Bibliography Safeguards for protected health information In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2005 Policy No 706 Reorientation Manual 2010 MandSec HIPAA doc Nursing Department Reorientation Self Study Guide Mandated Section 24 Patient Care Management USE OF RESTRAINTS Objectives Upon completion of this section the employee will be able to 1 2 Discuss the organizational philosophy related to the use of restraints Identify alternative interventions prior to the use of restraints Differentiate between the behavioral and non behavioral justifications for the use of restraints seclusion List types of physical restraints Provide examples of patient behavior that justifies initiating behavioral or non behavioral restraints Identify the process for calling a Code Green to activate the Crisis Response Team CRT Describe the potentially harmful effects of restraints Discuss the importance of patient and family education related to use of re
87. appropriately on the observation record 2 Non behavioral justification monitor patient every 15 minutes or more frequently if indicated Nursing Department Reorientation Self Study Guide Mandated Section 33 Patient Care Management B When the patient is placed in restraints for Behavioral or Non behavioral justifications the patient is immediately assessed for appropriate application and then every 15 minutes for the following Note Patients in Behavioral restraints require continuous in person observation 15 Minute Observations for Patients in Physical Restraints Any signs of injury associated with restraint or seclusion eg such as swelling and or color change on the restrained limbs Circulation and range of motion in the extremities not applicable for side rail restraint Nutrition and hydration Hygiene and elimination Vital signs respiratory rate for behavioral justification for non behavioral justification routine per unit vital signs are sufficient Physical and psychological comfort Readiness for reduction or discontinuation of physical restraint and seclusion C Documentation 1 Observations are documented on the Behavioral Restraint Nursing Observation and Care Record or the Non behavioral Restraint Nursing Observation and Care Record by checking the appropriate boxes and initialing the column All adverse effects are documented when observed and described in the Nursing Evaluation and Progress Notes 2 C
88. asks in combination with eye protection devices or chin length face shields must be worn whenever there is potential for blood or OPIM splashing into the face d Protective fluid resistant disposable gowns aprons and shoe covers boots selected areas are worn when there is the possibility of exposure to body fluids Nursing Department Reorientation Self Study Guide Mandated Section 79 SEQUENCE FOR DONNING PERSONAL PROTECTIVE EQUIPMENT PPE The type of PPE used will vary based on the level of precautions required e g Standard and Contact Droplet or Airborne Infection Isolation 1 GOWN m Fully cover torso from neck to knees arms to end of wrists and wrap around the back Fasten in back of neck and waist MASK OR RESPIRATOR Secure ties or elastic bands at middle of head and neck Fit flexible band to nose bridge s Fit snug lo face and below chin Fit check respirator GOGGLES OR FACE SHIELD Place over face and eyes and adjust to fit GLOVES Extend to cover wrist of isolation gown Keep hands away from face Limit surfaces touched Change gloves when torn or heavily contaminated Perform hand hygiene Infection Control Issues SECUENCIA PARA PONERSE EL EQUIPO DE PROTECCION PERSONAL PPE El tipo de PPE que se debe utilizar depende del nivel de precauci n sea necesario por ejemplo equipo Est ndar y de Contacto o Aislamiento de infecciones transport por golas o por aire 1 BATA Cubra con la
89. ated locations on campus where staff carry out specific disaster response functions during a Code Triage incident HOSPITAL INCIDENT COMMAND SYSTEM HICS A Command Responsible for overall management of disaster response and recovery media relations coordination with outside agencies and maintaining safety B Operations Responsible for providing medical and psychological direct patient care and ancillary support services providing for management of utilities security and hazardous materials response C Planning Responsible for collecting evaluating and disseminating status reports and other pertinent information tracking the movement of patients admitted to relocated within or discharged from the facility due to the disaster D Logistics Responsible for ensuring communications acquiring needed resources managing the Labor Pool providing for employee health and well being and family care and supporting other HICS functions E Finance Responsible for tracking seeking reimbursement for and paying costs associated with the hospital s disaster response and recovery incidents EMERGENCY MANAGEMENT STATIONS During a Code Triage incident HICS officers and other Harbor UCLA personnel use pre designated emergency management stations to perform disaster response and recovery work The key emergency management stations and their locations unless otherwise designated are as follows A Command Post Staging A
90. aution Radioactive Material label is placed on the outside cover of the patient s chart Anyone providing direct care to patients who receive therapy with radionuclides must read and be familiar with the information on the Radiation Protection Guide for Hospital Staff Nursing Department Reorientation Self Study Guide Mandated Section 138 Environment of Care Issues HI PROTOCOLS FOR IN HOUSE EMERGENCY PROCEDURES FOR FIRES OR OTHER MAJOR EMERGENCIES WHEN RADIATION IS INVOLVED A Follow the RACE response Rescue Alarm Contain Extinguish This has already been covered in the section on Fire Life Safety 1 Call ext 113 to state the location of the fire 2 Notify Radiation Safety Officer at ext 2835 During nonbusiness hours call the Nursing Shift Supervisor for instructions on how to notify the Radiation Safety Officer 3 Notify all personnel in the area Control contamination 1 Avoid tracking contamination or passing contaminated equipment into clean areas by emergency workers 2 A Radiation Safety representative will provide input related to fire fighting or other activities where radiation is involved Monitor 1 A radiation safety representative will supervise the area 2 Monitor all persons involved in combating the emergency Report 1 The responsible investigator forwards a complete history of the incident to the Radiation Safety Officer IV RADIATION EXPOSURE LIMITS TO PERSONNEL A C Radiation safe
91. bed or restraints Healthcare providers often have a false sense of security and may believe that patients who are restrained cannot get out of bed Increased incidence of nosocomial infection and new pressure ulcers a The patient whom is in restraints depends on care being provided by healthcare providers which may lead to an increased incidence of nosocomial infections b The constant skin friction caused by the patient trying to get out of restraints can potentially cause skin breakdown Skin breaks can lead to the development of pressure sores which can evolve into an acute infection Regression helplessness decreased autonomy and low self esteem a Feeling a lack of control and increased dependence on another person for normal activities of daily living can be humiliating and result in a decreased sense of self worth for the patient Expression of strong feelings of humiliation and vulnerability that may persist for months after being placed in restraints a Experiences are hard to forget especially when one is not able to understand the reason for the restraints or the behavior that led to being restrained Increased feelings of anxiety a The forced immobility and restriction of movement often results in increased anxiety which may lead to panic VIN MONITORING AND DOCUMENTATION A Continuous monitoring 1 Behavioral Justification While in restraints a patient must receive continuous in person observa
92. buse Sexual abuse or rape is sexual activity perpetrated against the will of a victim Sexual assault is a crime of power and control not a crime of passion Sexual assault victims include women children and less often men The InterAgency Council on Child Abuse and Neglect ICAN identifies sexual abuse for a child as any sexual activity between a child and an adult or person five years older than the child This includes exhibitionism lewd and threatening talk fondling and any form of intercourse Medical symptoms may accompany and indicate sexual abuse The complaints are generally located in the ano genital region Vague non specific complaints are also common V IDENTIFICATION OF ABUSE Healthcare workers must be aware of the signs and symptoms of abuse in order to quickly and accurately identify the victim and file the appropriate reports The various types of abuse are exhibited in many ways but the following information includes some of the typical findings for each A Physical abuse 1 Physical abuse involves the willful infliction of physical pain injury or unreasonable confinement Injuries associated with physical abuse include cuts bruises broken bones sprains facial injuries organ contusions burns miscarriages related to trauma use of drugs and alcohol during pregnancy and unprotected exposure to extreme temperatures Clues to a history of physical abuse include numerous scars bruises over soft tissues
93. buse and elder dependent abuse Intimate partner abuse must be reported if there is a current injury The issue of abuse must be addressed and follow up care initiated Harbor UCLA Medical Center has social services staff available to assist in identification evaluation and reporting the various forms of abuse Referrals and assistance to community resources are also available through the Clinical Social Work Department The National Domestic Violence hotline 1 800 799 SAFE is a 24 hour resource to help victims find local assistance Rainbow Services is a local Domestic Violence 24 hour community resource for Harbor UCLA contact number is 310 547 9343 1 Healthcare providers should provide the following e A private environment to interview and examine the patient e A safe environment If the batterer is not present and the chief complaint is abuse safety is aconcern Location of the batterer available weapons influence of drugs or alcohol and whether or not he she knows the victim s location are all important to ensure the safety of the victim and staff e A non judgmental non critical attitude e Treatment for injuries preparation of the patient for all required tests lab work and photographs e Referrals to clinical social work department advocates shelters and 24 hour hotlines e Education of the victim regarding abuse and a safety plan e Adequate documentation of statements made by the victim description of injuries who cau
94. c goals 5 Healthcare providers will work collaboratively to provide the best pain management regime treatment plan for the patient C Reassessment Reassessment is key in achieving an effective pain management regimen Nurses are to monitor pain routinely and record it as a fifth vital sign Reassessment should occur on a regular basis after an initial report of pain and following each intervention taken to relieve the pain Reassessment following an intervention should occur in a time frame appropriate to the intervention In addition it is very important to document the effectiveness of the interventions provided Patient reassessment and outcome documentation provide valuable information that will guide and dictate the patient care plan for pain management Many patients wait until their pain is severe to ask for medication which makes pain control much more difficult Patients that are able to anticipate pain and ask for medication accordingly report better pain control than those who wait for their pain to become severe before asking or taking medication D Education 1 Patient and family education a Patients and their families will be informed of their right to adequate pain management and the role they can play in working with our staff to assure effective pain management Nursing Department Reorientation Self Study Guide Mandated Section 60 Patient Care Management b Patients and or caregivers will be counseled by pharmacy
95. call and the caller informs the employee that there is a bomb which of the following actions should be avoided Panic and hang up the phone Notify the Sheriff Department immediately Ask when the bomb will explode and where it is Pay attention to the words voice nuances and background noises BoP All of the following are considered sensitive high risk security areas EXCEPT Cashier Emergency Department Nursery Labor amp Delivery Respiratory Therapy Department BOTS Which of the following strategies minimize or eliminate security risks Staff identification badges Metal detectors at hospital entrances Presence of Sheriff s Department security guards All of the above aoe All of the following are the correct process procedure to take when CODE PINK is activated EXCEPT Activate the panic alarm on the floor of occurrence if the floor has a panic alarm Secure affected unit and only staff with identification badges can enter that ward or unit Only the nursing staff on the unit of occurrence should check the surrounding areas and rooms The only open entrance to the facility during the CODE PINK will be the Emergency PCDC West entrance Bop CHECK YOUR ANSWERS TO THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 127 Environment of Care Issue SECURITY Answers to Study Questions If you answered all of the questions correctly go on to the next section If
96. cated by the ambulance ramp Note Any person or area that comes into contact with a Hazmat or RAM exposed patient is considered contaminated and must be secured and decontaminated PLEASE COMPLETE THE STUDY QUESTIONS EMERGENCY PREPAREDNESS Study Questions Select the best answer to each question DO NOT write in the manual 1 Code Triage alerts staff to the following Boop A bomb threat An infant child abduction A combative or armed individual Activation of the Emergency Preparedness Management Plan 2 The five Hospital Emergency Incident Command System HEICS functional sections are ao of Operations Finance Logistics Security Planning Finance Logistics Security Planning Management Planning Management Operations Finance Logistics Logistics Security Planning Management Operations 3 When Code Triage is announced on duty staff without specific predesignated disaster response assignments should immediately report to aoe gp angr The Command Post to give a status report The Labor Pool to obtain a disaster response assignment The Mass Casualty Triage Admission area to help with incoming casualties One s normally assigned workstation to check in with their supervisor and await instructions from the supervisor his her designee or a HEICS officer All of the following are alternate means of emergency communication EXCEPT Telepathy Pay phones Walkie talkies Runner messengers
97. cedures are contained in Policy EPP No 30 Patients Exposed to Hazardous Materials and or Radioactive Materials in the Emergency Preparedness amp Management Manual A Definitions 1 Hazardous Material Any chemical substance usually a liquid or gas that produces a toxic response in humans 2 Radioactive Material Any substance capable of emitting ionizing radiation 3 HazMat Exposure A patient presenting for treatment due to hazardous chemical s exposure The patient may or may not have been decontaminated prior to arrival at Harbor UCLA Nursing Department Reorientation Self Study Guide Mandated Section 119 Environment of Care Issues 4 Radioactive Material Exposure RAM A patient presenting for treatment due to exposure to radioactive material s The patient may or may not have been decontaminated prior to arrival at Harbor UCLA B What to do when one suspects exposure to hazardous chemical or radioactive materials Any Harbor UCLA employee or unit that identifies a known or suspected HazMat or RAM exposed patient who has presented at Harbor UCLA without prior notification by paramedics or the Medical Alert Center must immediately 1 Notify the Adult Emergency Department Attending Physician at ext 3516 3517 or 3520 2 Instruct the patient to stay at present location until personnel wearing appropriate personal protective equipment PPE arrive and escort transport the patient to the decontamination area lo
98. cian s order Arrangements may be made with the Blood Bank to split a unit if indicated Refer to Table 4 for administration guidelines Nursing Department Reorientation Self Study Guide Clinical Competencies 16 Table 4 Administration of Blood Products Blood Products and Transfusion Product Filter Administration Maximum Comments Rate Infusion As Ordered Time Packed Red Blood 170 260 micron Infuse over 2 3 Max of 4 Cells PRBCs amp hours hrs unit Whole Blood 170 260 micron Infuse as rapidly Max of 4 Obtain coagulation panel Fresh Frozen as tolerated hrs unit prior to administration Plasma FFP usually within 1 hour 170 260 micron Infuse rapidly Max of 4 Do NOT use IV pump Platelets using gravity hrs unit Syringe pump may be used flow to administer small volumes to infants 170 260 micron Infuse rapidly in Expires 4 Obtain fibrinogen level prior Cryoprecipitate less than 1 hour hours after to administration preparation in Blood Bank Leukapheresis 170 260 micron Infuse over 1 4 Max of 4 Granulocytes Do not use hours or as hrs unit Lymphocytes microaggregate ordered Monocytes filter Filter contained Usually 5 10 Check Obtain complete package in package minutes or less package from Blood Bank diluent insert for concentrate transfer and guidelines filter needles Reconstitute Factor VII VIII IX Reconstituted according to package product must be administered wit
99. cific instructions given to the employee as to the possibility of exposure to blood or other infectious material It is done through the use of a mechanical device or one handed technique c No alternative is available Immediately after use place disposable sharps in a puncture resistant leak proof sharps container Sharps containers are picked up by the Environmental Services staff and replaced when three fourths full Never overfill a sharps container For service between regular pickups call the Environmental Services supervisor VIII NEEDLELESS SYSTEMS California Legislation AB1208 requires healthcare institutions to use engineering controls that include sharps prevention technology including but not limited to needleless systems and needles with Nursing Department Reorientation Self Study Guide Mandated Section 82 Infection Control Issues engineered sharps injury protection Engineered sharps protection consists of physical attributes built into a device that reduces the risk of an exposure injury Examples include barrier creation blunting encapsulation withdrawal or other mechanisms A Injury from sharps can occur any time a needle or other sharp device is used Approximately 38 of sharp injuries occur during use and 42 occur after use and before disposal B Whenever possible a needleless system is to be used for withdrawing blood from indwelling catheters administering medication into IV lines and for any ot
100. clinic patients Only private hospitals Only emergency departments Clinics emergency department labor and delivery psychiatric emergency department 3 According to EMTALA a medical screening examination must be completed for the following patients EXCEPT a Any patient admitted for same day surgery b Any patient presenting to the emergency department c Any patient presenting to labor and delivery in active labor d Any patient walking in to a clinic asking to be seen for a medical condition 4 Potential penalties for violations to EMTALA include a Loss of license b Reduction in number of staff hired c Tickets from law enforcement to individuals involved Nursing Department Reorientation Self Study Guide Mandated Section 65 Patient Care Management d Monetary fines and termination of Medicare participation status Answers to Study Questions If you answered all of the questions correctly go on to the next section If you missed one or more read content again and repeat the study guide questions Bibliography Acceptance of ED to ED transfer requests for patients with an emergency medical condition In Hospital Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2007 Policy 308C Acceptance of ED to ED transfer requests for patients without an emergency medical condition In Hospital Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center
101. ctives of the Bioterrorism Response Plan are to 1 Enhance detection of suspected confirmed bioterrorism incidents 2 Coordinate with the regional public health disaster management and public safety structure 3 Develop and implement appropriate medical and environmental response measures 4 Identify and allocate available needed resources and request and allocate additional and or replenishment resources 5 Implement public information and campus security plans 6 Educate staff students and volunteers about appropriate bioterrorism detection and response measures see attachment Bioterrorism Syndromes Poster Actions to take if one suspects bioterrorism Any Harbor UCLA staff member or unit that detects possible bioterrorism symptoms in a patient or receives external notification of a suspected confirmed bioterrorism event likely to impact Harbor UCLA must immediately notify 1 Hospital Administration at ext 2101 weekdays 0800 1700 2 Nursing Service Office at ext 3434 after hours weekends and holidays 3 The Adult Emergency Department Attending Physician at ext 3516 3517 or 3520 Ix PATIENTS EXPOSED TO HAZARDOUS CHEMICAL OR RADIOACTIVE MATERIALS Harbor UCLA has established standardized procedures to report respond to and recover from suspected or known incidents of patients exposed to hazardous chemical or radioactive materials These exposures could be accidental or as a result of terrorist activity The pro
102. ctivities Continue to reinforce the current reality and day to day activities Provide direction slowly and maintain a calm manner Assist the patient in identifying sources of fear anxiety frustration Use open ended questions to help the patient identify the source of his her fears Orient and reorient patient to the room environment plan of care and staff who are providing care Nursing Department Reorientation Self Study Guide Mandated Section 28 Patient Care Management 3 Verbal de escalation Encourage patient to express emotions or feelings Ask the patient how he she feels and listen to what the patient is saying Assist the patient in verbalizing feelings by using emphatic responses Reflect and clarify statements the patient has made Use direct communication and talk with not at the person 4 Redirection Help the patient identify appropriate expressions of their emotions and facilitate his expression by allowing the patient to verbalize his her feelings to the appropriate person provide a journal and time for quiet reflection etc 5 Offer voluntary time out Allow time for the patient to be alone or pull the curtain around the bed Provide decreased stimulation In the psychiatric units time out may take place in the patient s room or a seclusion room with the door remaining unlocked 6 Offer medication s to decrease irritability agitation or pain Assist the patient to feel comfortable by offer
103. cts and Transfusion BLOOD PRODUCTS AND TRANSFUSION Study Questions Select the best answer to each question DO NOT write in the manual 1 Which of the following items must be completed prior to non emergent administration of blood and blood products a Informed Consent to Surgery listing surgical procedure and possible blood transfusion b A complete physician s order for blood or blood product and Refusal to Permit Blood Transfusion c Refusal to Permit Blood Transfusion and Informed Consent to Transfusion of Blood and Blood Products d If You Need Blood A Patient s Guide to Blood Transfusions and Informed Consent to Transfusion of Blood and Blood Products A confirm type specimen a Is required for group O patients only b Is ordered on all patients at Harbor UCLA c Requires a second blood draw preferably by a second provider d Requires two specimens to be drawn at the same time by same provider Which of the following definitions is correct Type and Screen means that the donor s blood has been screened for infection Type and Cross means that the recipient s blood has been screened for infection Type and Cross means that specific donor product units are set up and ready for use Type and Screen means that specific donor product units are set up and ready for use ao op The IV certified RN and IV certified LVN May start platelets via peripheral IV lines Have the same roles related to blood transfusi
104. d Slide fingers of ungloved hand under remaining glove at wrist Z Peel glove off over first glove Discard gloves in waste container GOGGLES OR FACE SHIELD Outside of goggles or face shield is contaminated To remove handle by head band or ear pieces Place in designated receptacle for reprocessing or in waste container GOWN Gown front and sleeves are contaminated Unfasten ties Pull away from neck and shoulders touching inside of gown only Turn gown inside out a Fold or roll into a bundle and discard MASK OR RESPIRATOR Front of mask respirator is contaminated DO NOT TOUCHI Grasp bottom then top ties or elastics and remove Discard in waste container GUANTES jEl exterior de los guantes est contaminado Agarre la parte exterior del guante con la mano opuesta en la que todavia tiene puesto el guante y quiteselo Sostenga el guante que se quit con la mano enguantada Deslice los dedos de la mano sin guante por debajo del otro guante que no se ha quitado todavia a la altura de la mu eca Quitese el guante de manera que acabe cubriendo el primer guante Arroje los guantes en el recipiente de deshechos GAFAS PROTECTORAS O CARETA jEl exterior de las gafas protectoras o de la careta est contaminado Para quit rselas t melas por la parte de la banda de la cabeza o de las piezas de las orejas Col quelas en el recipiente designado para reprocesar materiales o de materia
105. d Clinic admissions prior to transfer from the sending unit the originating area RN will complete an assessment and document on the Admission Report Summary Upon arrival in the receiving unit an RN will validate in the presence of the transporting staff member the patient s clinical status as described in the verbal report and document on the Admission Report Summary B Hand off communication at change of shift Experts encourage staff to include the following actions during shift report Diagnosis Surgeries and current condition Assessment and monitoring parameters Current and changed orders Plan of care goals including short term and long term outcomes Patient teaching plan and progress Patient safety concerns ON OS BIS Nursing Department Reorientation Self Study Guide Mandated Section 44 Patient Care Management 7 Interdisciplinary coordination of care issues 8 Ongoing discharge planning factors C Hand off communication at inter unit transfer Inter unit transfers usually signify a change in patient acuity such as a downgrade from ICU care to step down or ward or may involve a change in medical service The reason for transfer is important to communicate along with information on Diagnosis chief complaint and current condition Transfer orders Supply and equipment needs Known allergies and code status Medications given and due Patient safety concerns Interdisciplinary coordination of care issues SN RO
106. d should be used when possible for handling corrosives and toxics B Respirators 1 Respirators are used as protection from exposure to chemicals when all other methods of protection have been exhausted Respirators are also used for protection in an emergency response and may be used where the exposure is judged less than harmful but the smell is unpleasant Respirator types must be approved by HazMat for the purpose used not all chemical respirators protect against the same chemicals Respirators may be used only after a health examination by Employee Health that is the law and after appropriate training and fit testing have been completed N 95 Respirators are designed for protection against airborne pathogens dust and chemical mists They can not be used for protection against chemical vapor These respirators do not protect against vapor V GENERAL EMERGENCY SPILLS AND EXPOSURES A Exposure 1 2 Irrigate the contacted area with water If the lungs are affected get fresh air or oxygen Immediately go to the Emergency Department and bring information about the spilled material MSDS or container with label B Spill 1 If the agent and its hazard are known the hazard is minimal and the employee is trained in clean up the employee should follow the prescribed procedure Examples are A pathology technician cleaning up an acid spill with acid absorbent A nurse cleaning up a minor formalin spill with For
107. d the level of confidentiality of the information Employees are required to sign an Employee Acknowledgement of Data Security Responsibilities form annually Contract staff are held to the same confidentiality policies as County employees B The Joint Commission and the Health Insurance Portability and Accountability Act HIPAA mandate confidentiality of medical information HIPAA is a federal law protecting the privacy of individual s health information and regulating access to it Confidentiality applies to current and historical data All confidential reports or logs containing confidential information are to be destroyed appropriately 1 Keeping health information private is the most far reaching part of the Health Insurance Portability and Accountability Act HIPAA HIPAA involves standards relating to Privacy Security and Electronic Transactions The rules and standards that govern protected information and how it is shared are reviewed in this Self Study Guide 2 Everyone who works in the healthcare industry needs to be familiar and comply with HIPAA The question to ask is How can I protect the privacy of patient health information HIPAA is a very detailed law and the penalties for violating it are severe It is important that all health care team members understand their responsibilities under HIPAA By protecting the confidentiality of patients personal health information healthcare team members protect their r
108. deaf hearing impaired patients to communicate with medical center regarding hospital related activities The TTY TDD phone number is 310 328 2352 b Public TTY TDD machines pay phones are located on the first floor of the hospital at the following two locations 1 PCDC West entrance 2 Adjacent to the Gift Shop v If an interpreter is used one must document in the patient s medical record the name and title of the interpreter v If an interpreter is used during an informed consent discussion the interpreter or healthcare provider must complete the Interpreter Attestation Form PLEASE COMPLETE THE STUDY QUESTIONS INTERPRETER SERVICES Study Questions Select the best answer to each question DO NOT write in the manual 1 When encountering a Limited English Proficiency LEP patient the employee should ao op Seek the assistance of a bilingual staff member in the department Ask the patient s 16 year old daughter to interpret for today s visit Ask the patient to bring an interpreter with him her for future appointments B and C 2 When unable to find an interpreter within one s department area during the day the first step should be ao op Call the patient s physician Request the patient s 16 year old daughter to interpret Ask the patient if he she has a friend who can interpret Call the Harbor UCLA Medical Center s Language Center Nursing Department Reorientation Self Study Guide Mandated Section 40
109. dy Low electrical current flow cannot be felt and usually causes no bodily harm However injury can occur if the individual is electrically sensitive Electrically sensitive individuals are those who have catheters tubes wet or broken skin surgical wounds fevers and or pressure sores C Since current leakage cannot be completely eliminated from electrical equipment hospitals must decide on the maximum allowable limits in its different areas At Harbor UCLA the maximum current leakage allowance in patient care areas is 300 microamperes II FACTORS WHICH CONTRIBUTE TO ELECTRICAL INJURY Three factors may contribute to electrical injury skin condition atmospheric conditions and electrical leakage from equipment A Skin condition Skin provides insulation from the harmful effects of the environment including electrical currents When the skin is dry and intact an individual is less sensitive to electricity and therefore is less likely to receive an electrical shock Conditions that may contribute to electric shock include Wet and or broken skin Pressure sores Surgical wounds Presence of catheters or drainage tubes Presence of an external pacemaker wire Perspiration or excessive diaphoresis DOO B Atmospheric conditions On a cool cloudy day and when an individual is not perspiring he or she is less sensitive to electricity On a hot humid day and when the individual is perspiring he or she is more sensitive to electric
110. e Management Bibliography Crisis Prevention Institute Inc Risk of Restraints Understanding Restraint Related Positional Asphyxia 2004 Elkin M Perry A Potter P Nursing Interventions and Clinical Skills 3 ed St Louis MO C V Mosby 2004 Gillies J Moriarty H Short T Pesnell P An innovative model for restraint use at the Philadelphia Veterans Affairs Medical Center Nursing Administration Quarterly 2005 29 45 56 Haber J Kramovich Miller McMahon A Price Hoskins P Comprehensive Psychiatric Nursing 5 ed St Louis MO Mosby 1997 473 474 Hospital interpretive guidelines patients equal rights page Healthcare Financing Administration State Operations Manual Available at hcfa www gov pubforms Accessed June 22 2010 International Association of Nonviolent Crisis Intervention Certified Instructors Decreasing Physical Restraints Through Nonviolent Crisis Intervention Available at http www iancici org router aspx DocID 610 Accessed June 22 2010 Joint Commission on Accreditation on Healthcare Organizations Bed Rail Related Entrapment Deaths Available at http jointcommission org SentinelEvents SentinelEventA lert sea_27 htm Accessed June 22 2010 Joint Commission on Accreditation on Healthcare Organizations Preventing Restraint Deaths Available at http jointcommission org SentinelEvents SentinelEventAlert sea_8 htm Accessed June 22 2010 Joint Commission on Accreditation of Healthcare Orga
111. e difficulty being separated from the victim or appear overly concerned IV TYPES OF ABUSE A Child Abuse 1 Child abuse includes physical and emotional abuse neglect intentional poisoning sexual assault and maternal to fetal drug abuse Children younger than 4 years old are at greatest risk of severe injury or death In 2003 children younger than 4 years accounted for 79 of child maltreatment fatalities with infants under one year accounting for 44 of deaths DHHS 2005 Elder dependent adult abuse 1 Elder abuse and neglect is defined by the American Medical Association as actions or the omission of actions that result in harm or threatened harm to the health or welfare of the elderly The incidence of elder abuse is estimated to affect 1 5 to 3 2 million people The number of reported cases has steadily increased over the years Elder abuse includes persons over age 65 2 Dependent adults are persons aged 18 65 who are mentally or physically challenged Elder abuse is difficult to detect since its victims tend to be isolated and are often reluctant to report abuse and or neglect caused by the caretaker Frequently the caretaker is a family member There is Nursing Department Reorientation Self Study Guide Mandated Section 50 Patient Care Management often fear of losing the caretaker s assistance or personal independence if abuse is reported The primary types of elder dependent adult abuse include physical
112. e facilities Other conditions that place people at risk for TB include HIV infection immunosuppression corticosteroid use or chemotherapy chronic malnutrition alcoholics and intravenous drug users and caring for persons in high risk groups V SYMPTOMS OF TB DISEASE A The symptoms of pulmonary tuberculosis make it difficult to differentiate between TB and other diseases Typical symptoms include malaise weakness night sweats anorexia fever lymphadenopathy weight loss chronic cough and hemoptysis coughing up blood All symptoms do not occur in every case and some may be symptoms of other lung diseases VI SCREENING A B In most cases a PPD skin test can identify a person infected with the tuberculosis bacteria PPD skin tests must be administered read and documented by Employee Health or their designee The result of the PPD test should be read at 48 72 hours after administration A positive reaction can detect infection within 2 10 weeks after the exposure For the general public a PPD skin test is only performed if the person has symptoms or has been exposed to someone with tuberculosis disease People who work in healthcare or schools have this test performed yearly or more often if they work in a high risk area Interpretation of Mantoux tuberculin skin test results 1 A reaction of 5 mm or more of induration should be considered positive if the individual meets any of the following criteria has had close c
113. e infection cycle are A Susceptible host For microorganisms to continue to exist and cause disease and infection they must find a source that will accept them Susceptibility is the degree of resistance the potential host has to the organism Port of entry The organism must find a way to enter the host in order to multiply and cause infection The port of entry is usually though not exclusively the same as the exit route Methods of transmission The methods by which organisms are passed from one person animal or object to another are through blood body fluids the respiratory and enteric tracts direct contact and vertical transmission The most common direct means of transmission is by the hands Reservoir The reservoir for growth and multiplication of microorganisms is the natural habitat of the organism In the hospital patients visitors nursing medical staff and other hospital personnel may serve as reservoirs Route of exit The exit is the point of escape of the organism from the reservoir The organism cannot extend its influence unless it escapes from the reservoir by some means There is a primary exit escape for each type of microorganism Common routes of escape in humans are the respiratory gastrointestinal urinary tract and breaks in the skin THE ETIOLOGIC AGENT The extent to which any microorganism is capable of causing disease or infection is dependent upon factors such as the A B Number of
114. e many components of the EMTALA law some basic requirements include providing a medical screening examination to all patients seeking examination or treatment for a medical condition providing stabilizing treatment to those patients with emergency medical conditions and maintaining logs of all patients that present for care and transfers in and out of the facility A central log must be kept in each area that receives walk in or emergency patients If a patient presents for medical care the log must include the patient s name and whether the person was transferred and where the patient was transferred to The Medical Center must provide a medical screening examination to all patients who request examination or treatment for a medical condition regardless of ability to pay This also applies to patients who present at clinics requesting services This examination must be the same for each individual presenting with the same complaint The screening examination may include a physical assessment consultation from an on call specialist laboratory or radiological tests or any means of determining whether an emergency medical condition exists The medical screening examination cannot be delayed while determining the patient s ability to pay or insurance coverage If the facility is unable to provide a medical screening examination then the patient must be appropriately transferred to an area such as the emergency department TRANSFERS A E
115. e nurse can choose to continue with the same intervention or call the physician to discuss other alternative interventions This process of assessing treating and reassessing the patient s pain is a circular process that may continue on for a long time until the patient s pain is relieved PLEASE COMPLETE THE STUDY QUESTIONS PAIN MANAGEMENT Study Questions Select the best answer to each question DO NOT write in the manual 1 According to the legislative standards on pain management pain should be assessed at the least ao op Once a day Every one hour Every eight hours Every time a full set of vital signs is done Placebos should be used to manage pain in substance abuse patients a b True False On a pain scale of 0 to 10 a pain score of 6 represents which level of pain a b c Mild Severe Moderate Nursing Department Reorientation Self Study Guide Mandated Section 61 Patient Care Management 4 For most patients a pain rating than on a 0 to 10 scale signals the need to either initiate or revise pain interventions aor COW NWN 0 5 Following an intervention to relieve pain reassessment of the patient s pain rating should occur a Within one hour b With the next set of vital signs c Within a time frame appropriate to the intervention d When the patient calls the nurse still complaining of pain Answers to Study Questions l d 2 b 3 c 4 b Je If you answered all o
116. e on the sticker Defibrillators that were put into service within the last 5 years are tested for output accuracy every 6 months and defibrillators that have been in service for more than 5 years are tested on a 4 month cycle by the Bio Med Department Red outlets are emergency outlets that should be used for life support equipment Equipment which is considered life support such as defibrillators ventilators balloon pumps heart bypass pumps etc Critical medical equipment without battery backup also should be plugged into the red emergency outlets A cardiac bedside monitor would be considered a critical medical equipment IV MEASURES WHICH SHOULD BE EMPLOYED BEFORE USING ANY PIECE OF ELECTRICAL EQUIPMENT Before using any piece of electrical equipment always check A General appearance of the equipment As 2 Check body of the equipment for cracks holes protruding wires etc Cord condition Check for intact insulation check for cracks breaks etc Check for the presence and condition of the ground third prong on plug if applicable Assess the intactness of plug plastic portion Ensure that the cord fits the outlet and the fit is snug aoe a Check the on off switch for proper function The switch must work 100 of the time Never compromise this standard B Other points to remember 1 2 Keep long cords coiled and out of the way of traffic To ensure that equipment with rechargeable batteries
117. e towel e Use towel to turn off the faucet if applicable 2 Alcohol based hand rub hygiene Guidelines developed by the Centers for Disease Control and Prevention CDC and infection control organizations recommend that healthcare workers use an alcohol based hand rub a gel rinse or foam to routinely clean their hands between patient contacts as long as hands are not visibly dirty An alcohol based hand product may be used instead of soap and water in the following situations a Hands are not visibly soiled b Before and after having direct contact with patient s intact skin c Before donning gloves for inserting invasive devices eg central lines urinary catheters intravenous catheters that do not require a surgical procedure After contact with mucous membranes or non intact skin if hands are not visibly soiled e If moving from a contaminated body site to a clean body site f After touching equipment furniture near the patient Alcohol based hand rub hygiene technique a Apply product to palm of one hand and rub hands together covering all surfaces of hands and fingers until hands are dry Follow the manufacturer s recommendations regarding the volume of product to use c The use of hand rubs does not replace hand washing with soap and water To prevent the build up of emollients after repeated use of alcohol based hand rub washing with soap and water after 5 10 applications has been recommended by certain manufacturers
118. eficiencies Treatment of thrombocytopenia dysfunctional platelet disorders active platelet related bleeding or Platelets prophylactic use for serious risk of bleeding Medical conditions including leukemia solid tumors central nervous system trauma Serves as a source for clotting factors fibrinogen Factor VIII Factor XIII vWF and fibronectin Cryoprecipitate Used for the control of bleeding associated with fibrinogen deficiency and treatment of Factor XIII deficiency Treatment of neutropenic patients with documented infections unresponsive to antimicrobial therapy Neonatal sepsis Leukapheresis Granulocytes Lymphocytes Monocytes B Transfusion Guidelines There are general guidelines that apply to blood blood product administration 1 All blood components must be transfused through a filter designed to remove clots and aggregates The tubing should be changed after every second unit of blood blood product transfused No medications or solutions should be added to or infused through the same tubing with blood blood products other than normal saline Medications may not be added to blood blood products The transfusion order must be rewritten if blood blood product was not given within 48 hours of the time ordered Proper rate ensures that the unit will infuse within the recommended time If the patient s condition requires a slower infusion rate it should be noted on the physi
119. eft for coping with infection Nutritional status Individuals who are malnourished are more susceptible to infections Fatigue When an individual is tired his her immune system is suppressed Age During infancy and childhood and in the elderly the immune system no longer functions as well as it did These groups are more susceptible to infections Concomitant medical treatment Medical treatments such as chemotherapy antibiotics glucocorticosteroids prednisone prednisolone and some non steroidal anti inflammatory drugs Indocin predispose individuals to infections V EMPLOYEE WORK PRACTICES AND HEALTH A C D Maintain personal health and cleanliness to protect self and patients eg handwashing personal grooming and cleanliness long hair contained pulled back off of face short clean fingernails Healthcare workers with exudative lesions or weeping dermatitis should refrain from direct patient care and handling of patient care equipment until the condition resolves Employees with lesions or unexplained rash should go to Employee Health for evaluation Use safe work practices and appropriate personal protective equipment PPE Report for annual health evaluation and TB surveillance per policy VI STANDARD PRECAUTIONS Standard Precautions These precautions formerly called Universal Precautions are used for all patients regardless of suspected or confirmed infection status Standard Precautions
120. en by the patient and the pain level e Relate the physical assessment pertinent to the problem especially any changes e Pay special attention to mental status skin temperature and emotional state of the patient Assessment e Give your conclusions about the present situation Words like might be or could be are helpful A diagnosis is not necessary e If the situation is unclear at least try to indicate what body system might be involved State how severe the problem seems to be e If appropriate state the problem could be life threatening Recommendation e Ask for whatever you think you need to care for your patient which might include An order or request for an in person physician evaluation Make sure to clarify how often to do vital signs and under what circumstances to call back BE SURE TO DOCUMENT THE CHANGE IN PATIENT S CONDITION THE PHYSICIAN NOTIFICATION N ACTION TAKEN PLEASE COMPLETE THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 47 Patient Care Management HAND OFF COMMUNICATION Study Questions 1 A Ticket to Ride form should be used for which of the following situations A CNA is transporting a patient to X ray RN is admitting a patient form ER or Clinic A surgical tech is transporting a patient to OR for surgery An RN and LVN are transferring a patient from a medical surgical ward to an ICU inter unit transfer ao
121. en can be converted to a type and cross without the need for a new specimen If an unexpected antibody is detected during the type and screen it is identified and donor blood must be antigen typed Therefore it is advisable to request crossmatched blood if there is a reasonable expectation of need when a patient has an antibody because of the additional time required A type and cross is a laboratory test done to confirm that blood from a donor and blood from the recipient are compatible The same procedure described in type and screen is performed with the addition of checking cells from a donor unit with plasma from a patient to rule out unexpected incompatibility This is known as the cross match With a type and cross specific donor product units are set up and ready to issue for a specific recipient Once donor blood is crossmatched with a potential recipient the units are available for only 3 days This is because the specimen used to cross match is canceled automatically the third day after the specimen is drawn This three day expiration is a regulation designed to aid in detecting antibodies that may be forming especially when patient has been transfused within past three months If the patient has not had a previous transfusion and is not pregnant the Blood Bank may be consulted to determine if the cross matched unit s may be held longer in rare circumstances Confirm type In order to protect against potentially
122. ent Reorientation Self Study Guide Clinical Competencies 10 Blood Products and Transfusion BLOOD PRODUCTS AND TRANSFUSION Refer to the following policies procedures Blood and Blood Products Transfusion Administration and Monitoring Department of Nursing Procedure Manual Torrance CA Harbor UCLA Medical Center 2010 p 50 0 Blood and Blood Products Transfusion Administration and Monitoring Hospital and Medical Administration Policy and Procedure Manual 2005 Policy 317B I INTRODUCTION Administration of blood products is a multistep process requiring the coordination of several members of the healthcare team The physician determines the need and orders the blood product speaks with the patient and obtains informed consent for the transfusion The IV certified RN and LVN ensure that all the required paperwork is in order initiate and monitor the transfusion and record the patient s vital signs while observing for signs and symptoms of transfusion reaction The Blood Bank plays a key role in preparing the blood products for transfusion and verification of information prior to release of the blood product This competency highlights some of the key safety points related to blood and blood product administration The competency is not meant to be a reiteration of existing policies and procedures Refer to the above policies and procedures for complete procedural steps related to the administration of blood and blood products
123. ent to carry out the plan Involuntary Holds Being on a Psychiatric Involuntary Hold 5150 is not a behavioral justification for use of restraints Restraints may be used on voluntary or involuntary patients The patient s behavior is the determining factor 2 Non behavioral indications a b Patient attempts to remove lines tubes or disrupt other essential medical devices Patient requires bedrest to limit mobility and is unable to follow plan of care B Types of physical restraints 1 2 3 Soft wrist ankle restraints including cloth vest Hard wrist ankle restraints Walking wrist restraints a less restrictive alternative used only in the behavioral health care and psychiatric inpatient units C Inspection of restraints Restraints must be inspected prior to during application and after application for the following 1 Soft restraints Bop Broken stitching Frayed or cut straps Broken cracked deteriorated buckles ring closures or other type of connectors Any other signs of deterioration Hard polyurethane restraints a Ensure that the cuff and belt are clean Dirty hard restraints must be sent to Central Supply for cleaning Polyurethane is not deteriorated broken or cracked Verify that locking device locks and can easily be opened A restraint key must be available on the unit Nursing Department Reorientation Self Study Guide Mandated Section 27 Patient Care Management e
124. eople or environment Emergency Spill Any spill hazardous to people environment or with unknown effects Unintended release of radioactive material Infant or child is missing or known to be abducted The number announced after Code P ink indicates the estimated age of the abducted infant child Fire smoke or smell of same Activation of Emergency Management Plan in response to a disaster Significant shaking of the building Remaining in area is dangerous to life health ors safety Clinic area to address the needs of the patient first Clinic area to address the needs of the patient first Don thang up Keep caller on the line by asking for as much information as possible about bomb s location type etc Clinical staff attempt to redirect and de escalate patient Trained user cleans spill with appropriate materials and personal protective equipment Evacuate amp deny entry to area Call HazMat Office x2835 or Operator x111 Notify your supervisor Isolate the spill and evacuate Deny entry Call Radiation Safely x28350r Operator x111 Notify your supervisor Call Operator x11 AND County Police x3311 R eport the incident amp age last known location of infant child ContainmentN otification a Rescue persons in danger a Activate alarm a Cose doors a Extinguish fire if possible Call Operator x113 R eport location Return to normally assigned worksta
125. er an investigation is completed Boe All of the following expose the healthcare worker to radiation EXCEPT Looking at an x ray on the x ray view box Working in an area that has fluoroscopic equipment Standing within two feet of a person having an x ray Caring for a patient who received radioactive material ao re The Radiation Protection Guide for Hospital Staff is a comprehensive manual available on all Nursing Units a True b False CHECK YOUR ANSWERS TO THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 140 Environment of Care Issues Answers to Study Questions If you answered all questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions Bibliography Radiation protective devices lead aprons shield and gloves In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2008 Policy No 470 The Radiation Protection Guide for Hospital Staff Torrance CA Harbor UCLA Medical Center 2005 YOU HAVE COMPLETED THE MANDATED SECTION Please complete the Mandated Section take home exam at this time Direct care giving licensed nurses continue on to the Clinical Competency Section Please refer to the table on page iii of this manual or consult your immediate supervisor if you have questions about which sections of Reorientation y
126. er blood bag tag and sign on Report of Transfusion section of Transfusion Record that patient identification was verified Disconnect the transfusion from the extension set and flush the extension set with a normal saline flush Infuse normal saline at 30 mL hour with a new set of IV tubing Note Neonatal Pediatric Infuse NS only if ordered Notify the physician and the Blood Bank immediately All transfusion reactions however minor must be reported to the Blood Bank immediately Continue to monitor the vital signs until the patient s condition is stable Document assessments interventions and evaluations on the appropriate nursing record The physician will complete Report of Transfusion Reaction section on the Transfusion Record Send Transfusion Record the entire transfusion set lab copy pink top tube and any additional specimens the Blood Bank may request to the Blood Bank The decision to reinstate the transfusion rests with the physician following consultation with the Blood Bank SUMMARY OF KEY SAFETY POINTS The Informed Consent to Transfusion of Blood and Blood Products HH1009 and If You Need Blood A Patient s Guide to Blood Transfusion HH687 must be completed and in the medical record for all patients receiving non emergent blood transfusion Writing blood transfusion on a surgical consent is not acceptable as informed consent Ifa patient or legal representative refuses blood transfusion the Refusal to Permit Bl
127. ers is the same there are exceptions Read the instructions on the fire extinguisher to learn the individual variations 2 Be sure that one has begun the RACE response R Remove all persons from immediate area A Alarm pull the fire alarm station and call 1 1 3 C Contain close the doors E Extinguish the fire 3 Stay between the fire and the exit Do not let the fire block one s escape path in case it gets out of control 4 Make sure one uses the correct type of fire extinguisher on the fire A common error which can be fatal is using a water type fire extinguisher on a grease or electrical fire C Steps in the use of a fire extinguisher Follow the PASS method Pull Aim Squeeze Sweep 1 Pull the pin out Some extinguishers require release of a lock hatch pressing a puncture lever or other motion 2 Aim the extinguisher nozzle horn or hose at the base of the fire 3 Squeeze or press the handle 4 Sweep from side to side at the base until the fire goes out Nursing Department Reorientation Self Study Guide Mandated Section 110 Environment of Care Issues D Smothering a fire A non acrylic blanket can be used to smother some fires Small fires in the bedding and on a person s clothing can usually be smothered with a blanket IMPORTANT e Always notify the fire department to remove a burned mattress pillow bedding or waste basket from the building as they may contain burning embers e Refer to the Fire
128. es liquid or semi liquid blood or OPIM contaminated items that contain liquid or semi liquid blood contaminated sharps pathological or microbiological wastes containing blood Nursing Department Reorientation Self Study Guide Mandated Section 75 Infection Control Issues 2 Sharps include any object that can be reasonably anticipated to penetrate the skin or other body part that may result in exposure Examples of sharps include needle devices scalpels lancets broken glass broken capillary tubes exposed ends of dental wires dental knives drills and burs 3 BBP may be found on contaminated work surfaces IV HEPATITIS B AND C HBV and HCV A Description HBV and HCV are viral infections of the liver B Transmission 1 Transmission of HBV and HCV occurs primarily after exposure to blood or body fluids from persons who have acute or chronic HBV HCV infections 2 HBV and HCV are transmitted in four primary ways a Sexual contact eg unprotected intercourse Parenteral exposure eg needle sharing blood exposure tattooing Perinatal exposure HBV and HCV may be transmitted from mother to fetus however HBV transmission is more common Recipient of blood blood products Blood screening programs for HBV and HIV were initiated in spring 1986 in the U S Some patients may have received transfusions in other countries where screening of blood is less stringent Blood screening programs for HCV were initiated in 1991
129. exposure occurred TB is not spread on dishes drinking glasses or other objects TB INFECTION VERSUS TB DISEASE A TB infection is caused by the multiplication of Mycobacterium tuberculosis in the alveoli of the lung 1 2 3 Persons with TB infection have no symptoms have a negative chest x ray and are not contagious Persons with TB infection usually have a positive reaction to the purified protein derivative PPD tuberculin skin test Treatment at this point can prevent TB from developing into active disease B TB disease occurs when all of the mycobacteria are not destroyed or the body s immune system fails and the bacteria continue to spread and begin to destroy lung tissue 1 Two to ten weeks after the initial TB infection the body s immunologic response usually prevents the development of TB disease Approximately 5 of untreated infected persons will develop TB disease within the first 2 years after infection Another 5 will develop TB disease later in life The lungs are usually the first part of the body exposed to the Mycobacterium tuberculosis and are the primary areas where TB occurs TB can be spread to other organs through the lymph system and the blood vessels Persons with TB disease can pass TB germs to others Untreated TB disease can cause serious illness and death Certain medical conditions increase the risk of progression from TB infection to TB disease These conditions include
130. f suspected dependent adult elder abuse immediately or as soon as possible following these procedures A Any employee care custodian health care practitioners and support staff who learns of a suspected elder or dependent adult abuse situation must 1 Notify the patient s physician 2 Complete a Report of Suspected Dependent Adult Elder Abuse form B Health Care Practitioner Care Custodian 1 Ifthe victim is an inpatient or is being admitted to the hospital place a request for consultation by the Clinical Social Work Department via the Hospital Information System 2 Enter a PSN report documenting the suspected abuse and the agency notified 3 Take the following steps depending on where the abuse occurred a Incident occurred in a Private residence 1 Call the Elder Abuse Hotline at Adult Protective Services APS at 213 351 5431 Monday Friday 8 30 am to 5 pm or 877 477 3646 after hours weekends and holidays 2 FAX the Report of Suspected Dependent adult Elder Abuse immediately to Adult Protective Services at 213 738 6485 Mail the original report within 48 hours to Adult Protective Services Central Intake at 3333 Wilshire Blvd 4 Floor Los Angeles California 90010 b Incident occurred in a Licensed facility outside of Harbor UCLA Medical Center 1 Call the local Los Angeles County Ombudsman at 800 334 9473 Monday Friday 8 30 am to 5 pm or 800 231 4024 after hours weekends and holidays 2 FAX the Report of
131. f the questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions References 1 State of California Department of Consumer Affairs Board of Registered Nursing Pain Assessment The Fifth Vital Sign February 2000 http www rn ca gov practice pdf npr b 27 pdf Accessed June 22 2010 Bibliography Department of Veterans Affairs Pain as the 5 vital sign toolkit October 2000 http www va gov oaa pocketcard painSth vital sign paintoolkit_Oct 2000 doc Accessed June 22 2010 McCaffery M Pasero C Pain Clinical Manual Bowlus B Watts B eds 2 ed St Louis MO Mosby 1999 2 14 Pain assessment and management In Nursing Policy Manual Torrance CA Harbor UCLA Medical Center 2005 355 0 355 12 Pain management program guidelines In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2006 Policy No 383 Reorientation Manual 2010 MandSec PainManagement doc Nursing Department Reorientation Self Study Guide Mandated Section 62 Patient Care Management EMERGENCY MEDICAL TREATMENT AND ACTIVE LABOR ACT EMTALA Objectives Upon the completion of this section the employee will be able to 1 State the purpose of the EMTALA legislation 2 Discuss the expanded scope of EMTALA and how the changes impact areas of the hospital 3 Discuss medical screening and transfer requirements related to EMT
132. fatal labeling errors a confirm type specimen will be requested on any patient without a history in the Blood Bank and who is not group O Most patients will not require a confirm type If a patient has a blood type on record at Harbor UCLA that blood type will count as the first draw and any new specimen is the confirm specimen or clot Also any new patients who are group O do not need confirmation as O is the universal donor When a confirm type is required the Blood Bank staff will call the unit and ask for a second specimen The confirm type specimen is to be a second draw preferably by another person This confirm type specimen may be requested by the blood bank per protocol no additional prescriber order needed for any type and screen or type and cross order that meets criteria for the confirm type sample Nursing Department Reorientation Self Study Guide Clinical Competencies 12 Blood Products and Transfusion MI ADMINISTRATION OF THE TRANSFUSION A Roles and Responsibilities Registered nurses and licensed vocational nurses state certified in IV therapy who have completed IV Therapy Part I and II at HUCLA may participate in blood transfusions Table 1 identifies the roles LVNs not certified in IV therapy may participate in patient preparation teaching regarding blood transfusion observation of patients receiving transfusions and interventions as appropriate in response to signs of a transfusion reaction
133. fected blood products PREVENTION Blood collection centers are mandated to mitigate TRALI risk This is most often done by excluding female donors from production of plasma based products or using donors with few pregnancies Treatment should be supportive Maintain circulatory support and intubate if necessary Diuresis is contraindicated The use of steroids has not been found to be beneficial PREVENTION Crossmatch blood sample should be drawn within 3 days prior to blood transfusion Administer irradiated blood products to susceptible patients Screen blood donors and pretest blood products Screen blood donors and pretest blood products Screen blood donors and pretest blood products Nursing Department Reorientation Self Study Guide Clinical Competencies 21 Blood Products and Transfusion REACTION TYPE Epstein Barr virus cytomegalovirus malaria Other infections eg Chagas disease Bahesiosis unknown viruses DELAYED TRANSFUSION REACTIONS ONSET SIGNS AND CAUSE SYMPTOMS Viral syndrome and Transfusion of signs specific to infected blood particular infecting products agent Transfusion of infected blood products PREVENTION Screen blood donors Apply good blood banking practices and donor screening testing Avoid unnecessary transfusion Nursing Department Reorientation Self Study Guide Clinical Competencies 22 Blood Produ
134. fety procedures in a calm manner to allay fear and panic of patients and visitors An effective fire prevention program and a well rehearsed fire emergency plan will ensure hospital fire safety SMOKING POLICY A Smoking is prohibited in all indoor areas of Harbor UCLA Medical Center and buildings occupied by the Los Angeles Biomedical Research Institute and the Medical Foundation This policy covers all individuals within the boundaries of Harbor UCLA Medical Center B Smoking is permitted outdoors but not within 20 feet of entrances C All individuals on hospital premises must follow the smoking policy Employees and volunteers must enforce the smoking policy with all fellow employees volunteers patients and visitors PROCEDURE TO FOLLOW WHEN A FIRE OCCURS IN AREAS OCCUPIED BY PATIENTS Please refer to Fire Manual for more explicit instructions Follow the RACE response Remove Alarm Contain Extinguish A Remove Remove all persons from immediate danger B Alarm Activate the nearest fire alarm box pull station to summon the fire department Fire engines will arrive at the hospital within minutes of alarm activation Dial ext 113 to state the location of the fire The operator will then announce the location of the fire on the overhead paging system All employees are to return to their unit immediately Send a messenger to the Centrex Building Building 2 East Telecommunications if a power failure has blocked the alarm and
135. fusion reaction The nurse will review the signs of delayed transfusion reaction with the patient and counsel him her to report any abnormal signs or symptoms experienced over the next few months and to notify his her healthcare provider about the transfusion when seeking care for any illness or condition Refer to Appendix A for a listing of potential transfusion reactions A transfusion reaction may occur immediately or may be delayed A patient may experience symptoms such as chills and fever within a few minutes while an infectious disease may incubate for several months Reactions with a short onset include acute hemolytic febrile nonhemolytic mild allergic to anaphylactic circulatory overload sepsis and Transfusion Related Acute Lung Injury TRALI TRALI is a leading cause of transfusion mortality in the United States Signs and symptoms of TRALI include dyspnea hypoxemia cyanosis fever hypotension non cardiogenic pulmonary edema and pulmonary infiltrates on chest xray If any transfusion reaction is suspected the nurse monitoring the patient must stop the transfusion immediately If an LVN identifies the suspected reaction she he must immediately notify the assigned responsible RN Stopping the transfusion immediately may limit the extent of potential injury to the patient The Blood Bank may provide helpful consultation in the management of these patients The assigned responsible RN LVN will verify patient identity with the pap
136. g hands or forearms on the sharp table edge SIGNS AND SYMPTOMS TO INDICATE RISK FOR INJURY A Numbness or tingling in the arms or hands B Weakened grip C Decreased range of motion in the arms or hands D Swelling in the arms hands or fingers E Weak or painful arms hands wrists shoulders neck or back Patient Care Management V PREVENTING AND REDUCING RISK FACTORS THAT MAY LEAD TO INJURIES VI A B C T _ K zo Reduce or avoid repetitive motions Reduce the amount of force needed to perform job tasks Reduce awkward or difficult movements reaches and stretches by reorganizing the work area move parts closer to you change the work surface height etc Use the right tool for the job and use it correctly Use proper lifting techniques Use proper posture when standing or sitting Use good body mechanics Use appropriate equipment lifts transfer belts bed scales etc Change job tasks Properly store materials on storage rack heaviest materials are placed between 15 inches 45 inches where bending stresses are reduced moderately heavy items on the bottom racks between 2 inches 15 inches and lightest materials on the top racks at 45 inches 60 inches Lock brakes on wheeled equipment eg beds wheelchairs gurneys etc PREVENTING INJURIES RELATED TO COMPUTER WORKSTATIONS A Maintain good posture when working Sit all the way back in the chair against
137. gar CHECK YOUR ANSWERS TO THE STUDY QUESTIONS Answers to Study Questions 1 d 2 a 3 d 4 c 5 c 6 a 7 b 8 c 9 c 10 d If you answered 8 out of 10 questions correctly go on to the next section If you missed 3 or more read the content again and repeat the study questions Nursing Department Reorientation Self Study Guide Clinical Competencies 8 Rapid Recognition and Response to Changes in Patient Condition RAPID RECOGNITION AND RESPONSE TO CHANGES IN PATIENT CONDITION References Assessment Reassessments In Nursing Policy Manual Torrance CA Harbor UCLA Medical Center 2008 30 0 30 3 Ornato J Scarpinato L Zimetbaum P Critical first steps in cardiac emergencies Patient Care 2004 38 3 12 3 16 19 21 Patient Safety Council of Harbor UCLA Medical Center This issue Rapid response teams Patient Safety 2010 6 2 1 2 Rapid recognition and response to changes in patient condition In Harbor UCLA Medical Center Policy Manual Torrance CA Harbor UCLA Medical Center 2009 Policy No 351 Rodgers B Emergent conditions In Nettina S Lippincott Manual of Nursing Practice 8th edition Ambler PA Lippincott Williams amp Wilkins 2006 1139 1172 Reorientation Manual 2010 ClinicalCompetency RapidRecognitionAndResponse doc Nursing Department Reorientation Self Study Guide Clinical Competencies 9 Blood Products and Transfusion BLOOD PRODUCTS AND TRANSFUSION Objectives Upon completion
138. h the victims request b Expressing their right to not get involved c Guilty of a felony punishable by imprisonment and a fine d Guilty of a misdemeanor punishable by imprisonment or a fine CHECK YOUR ANSWERS TO THE STUDY QUESTIONS ON THE NEXT PAGE Answers to Study Questions Nursing Department Reorientation Self Study Guide Mandated Section 54 Patient Care Management If you answered all the questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions References 1 Kellerman A Heron S Firearms and family violence Emergency Medicine Clinics of North America 1999 17 699 716 2 Department of Health and Human Services DHHS Administration on Children Youth and Families ACF Child maltreatment 2003 http www acf hhs gov programs cb pubs cm03 index htm Accessed June 22 2010 3 Donetelli NS Elder abuse and neglect In Newberry L ed Sheehy s Emergency Nursing Principles and Practice 5 ed St Louis Mosby 2003 770 774 4 Clarke ME Pierson W Management of Elder Abuse in the Emergency Department Emergency Medicine Clinics of North America 1999 17 631 644 5 Moore S Intimate partner violence In Newberry L ed Sheehy s Emergency Nursing Principles and Practice 5 ed St Louis Mosby 2003 763 769 6 Feldhaus KM Koziol McLain J Amsbury HL Norton IM Lowenstein SR Abbott JT Accuracy of 3 brief screening questions f
139. harge nurse nurse manager Sheriff Dept and shift nurse manager as appropriate Nursing staff on the unit of occurrence should check the surrounding areas and rooms count all babies children if applicable and secure the medical records of the mother and infant child involved When the CODE PINK is activated the affected unit is secured and only staff with identification badges can enter that ward or unit Sheriff Deputies and local law enforcement may become involved The hospital is also secured Staff are directed to look for and report any suspicious persons or bundles to the Sheriff s Dept at ext 3311 Persons leaving the Medical Center will be routed so that the only exit will be by the Outpatient Pharmacy Gift Shop lobby exit The only open entrance to the facility during the CODE PINK will be the Emergency PCDC West entrance If the abduction is observed it is important to obtain a description of the infant child and abductor Attempt to note the sex hair skin color height weight clothing as well as any distinguishing characteristics such as glasses tattoos etc 2 PINK IDENTIFICATION BADGES To facilitate the security of babies children at Harbor UCLA the staff working with mothers and babies on the 6 and 7 floors in the areas of 7E Labor amp Delivery Level II Nursery 6E NICU and 7 West have been issued pink identification badges The pink badge identifies that these staff are authorized to remove an infant from the mothe
140. hazardous chemical or radioactive materials Instructions to the Employees Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 113 Il II Environment of Care Issues EMERGENCY PREPAREDNESS DEFINITIONS A Disaster Any situation or occurrence that is known or is likely to affect 10 or more patients and or may exceed Harbor UCLA s ability to respond using standard operating procedures Examples earthquake fire power or water failure bioterrorism labor strikes hazardous chemical or radioactive material exposure plane crash riot or other mass casualty incident B Emergency Preparedness Management Plan A preestablished disaster response plan designed to establish a safe environment maximize continuity of patient care minimize any loss of function provide the best possible care for incoming casualties and enable Harbor UCLA to act as a community resource in the event of a disaster C Emergency Preparedness Manual A facility wide manual that contains general and disaster specific mitigation preparedness response and recovery procedures D Code Triage A code announced via the overhead paging system to notify staff that Harbor UCLA is in a disaster response mode A text and telephone page to key staff ie Chairs Service Directors Nurse Managers E Emergency Management Stations Predesign
141. he base of your neck down with your fingers have achieved a good facial fit Now perform a Fit Check 4 When in an airborne precaution room healthcare workers must wear a N 95 respirator In order for the respirator to be effective it must filter out particles as small as one micron The respirator must be fit tested to the employee and must be refit tested per OSHA Regulations currently annually The N 95 respirator used at Harbor UCLA is disposable and should be used only once Patients and visitors wearing a mask are not required to be fit tested Apply a respirator before entering the room Remove the respirator OUTSIDE the room Remember Don t share the air The door to the respiratory isolation room is to be kept COMPLETELY closed at all times even if the patient is temporarily out of the room This is the only way to reduce aerosol escape and to prevent microbial contamination of the air outside the isolation area B Negative pressure isolation rooms 1 Negative pressure isolation rooms have directional airflow devices which contain a pink ball in a tube and the ball moves back and forth depending on the direction of the airflow between the room and the corridor Staff entering the room should check the directional airflow prior to entering a room in use for airborne precautions a If the pink ball is on the outside of the room it means the air is flowing from the patient s room into the corridor ie positi
142. hecking the awake asleep column every 15 minutes indicates that the patient was evaluated for all of the above assessments 3 When the patient is restrained for behavioral reasons vital signs minimally respiratory rate are recorded every 15 minutes 4 The following must be documented a minimum of every 2 hours for all patients in restraints Fluids provided if patient is not NPO while patient is awake Toileting provided urinary and bowel measures while patient is awake Range of motion provided while patient is awake not applicable for side rail restraint Rotation of restraints when clinically indicated aor 5 If elimination or food fluid intake are contraindicated because of the medical condition or plan of care a notation must be made on the appropriate Nursing Observation and Care Record 6 Any adverse effects from the use of restraints such as swelling and or color change on the restrained limbs are documented at the time of occurrence and a note is entered on the Nursing Evaluation and Progress Note Any related interventions and responses must also be documented in the Nursing Evaluation and Progress Note 7 For restraints used with behavioral justification document ongoing assessment interventions and evaluations AIE However this does not eliminate the need for AIE documentation in the nurses notes 8 The date and time that restraints are removed must be documented on the appropriate Nursing Observation a
143. her outlet Ignore the complaint and wait and see if she complains again Report this to administration Facilities Management skin care team physician and complete a Situation Report Disconnect remove replace the equipment report this to the physician Facilities Management Nurse Manager and then complete a Situation Report CHECK YOUR ANSWERS TO THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 103 Environment of Care Issues ELECTRICAL UTILITY SAFETY Answers to Study Questions If you answered all of the questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions Bibliography Assessment of the condition of electrical equipment In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2004 Policy 439 Electrical safety guide In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2004 Policy 438 General hospital and patient safety In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2010 Policy 444 Patient s personal electrical equipment In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2008 Policy 455 Reorientation Manual 2010 MandSec ElectricalUtilitySafety d
144. her procedures with the potential for an exposure incident C Engineered safety devices eg safety needles blood transfer device will be used for phlebotomy D Use only approved attachments devices for vascular access devices IX PROCEDURE TO FOLLOW WHEN SHARPS INJURY NEEDLESTICK OR MUCOUS MEMBRANE EXPOSURE OCCURS Consult the Bloodborne Pathogen Exposure Control Plan Policy No 435 in Harbor UCLA Medical Center s Hospital and Medical Administration Policy and Procedure Manual for complete information A Wash flush the exposed area immediately B Notify supervisor C Report to Employee Health immediately or Emergency Department if Employee Health is closed D Fill out an industrial accident report X POST EXPOSURE EVALUATION AND PROPHYLAXIS A Workers who sustain needlestick sharps injuries or other bloodborne pathogen exposure must receive a confidential post exposure medical evaluation and follow up immediately within 2 hours after the exposure incident B Initial evaluation 1 The route of exposure and circumstances under which incident occurred are documented 2 The source individual is identified and documented 3 The source individual s blood will be tested as soon as possible after consent is obtained to determine HBV HCV HIV and syphilis infectivity If consent is not obtained from the source individual the employer shall establish that legally required consent cannot be obtained 4 Testing will not be do
145. hin 3 hours directions Neonates Blood products are pre filtered to permit infusion through a syringe pump and the syringe is labeled with this information 7 If the transfusion is interrupted eg IV infiltrates the transfusion may be reinitiated and completed or administered until the maximum infusion time has elapsed Once the maximum infusion time has elapsed the transfusion must be stopped and remaining blood blood product discarded Examples Wrenn i SRT A transfusion of 1 unit of PRBCs is begun at 1000 At 1200 the IV infiltrates The nurse is able to restart the IV within 20 minutes and the transfusion is completed at Transfusion must be 1300 3 hours a a aa ae SEA completed by 1200 h A transfusion of 32 mL of PRBCs is begun at 0800 on a premature infant and ordered to run over 4 hours 8 mL hr At 1100 the IV infiltrates and 8 mL of blood remains to be transfused An IV can not be successfully inserted before 1200 The PRBCs must be discarded The nurse should notify the prescriber so that additional PRBCs can be ordered Nursing Department Reorientation Self Study Guide Clinical Competencies 17 Blood Products and Transfusion C Transfusion Reaction When the transfusion is complete the post transfusion vital signs are taken and compared against the baseline vital signs The patient will be observed for four 4 hours following transfusion for signs of trans
146. ials Safety Office sorts the chemical waste according to hazard characteristics 1 toxic 2 flammable 3 reactive and 4 corrosive B Pharmaceutical waste materials are disposed of as Hazardous Waste a waste that requires incineration This waste is combined with the sharps waste in the Wards and Clinics and placed in secure lined lockable containers labeled Hazardous Waste and Pharmaceuticals When full and after being locked the containers are collected by designated waste handlers The containers are picked up regularly C Medical infectious waste containing blood and other bodily fluids is placed in biohazard containers red bags and boxes These red containers are kept separately from other trash D Chemotherapeutic waste materials 1 Chemo bulk All actual visible or solid waste is placed in HazMat waste container and picked up by Hazardous Materials Safety as Hazardous Waste Chemo trace Trace waste with no detectable chemotherapy waste is placed in yellow bags or white and yellow containers labeled Chemotherapy or Biohazard Chemo sharps Are placed in Chemotherapy Sharps containers PLEASE COMPLETE THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 134 Environment of Care Issues HAZARDOUS MATERIALS COMMUNICATION AND SAFETY PROGRAM Study Questions Select the best answer to each question DO NOT write in the manual 1
147. ical or emotional There are mandatory reporting requirements for abuse For child and elder dependent adult abuse reporting is mandatory even if there is not a current injury Reporting is mandatory for domestic violence when the patient has a current injury as a result of the abuse Any healthcare provider who fails to report abuse may be found guilty of a misdemeanor and fined 1 000 and or six months in jail Il CYCLE OF VIOLENCE A Violence often occurs in patterns The cycle of violence typically has three phases First there is a period when the batterer gets edgy and tension builds up Second the batterer explodes and abuse occurs This can last a few minutes or several hours In the third phase there is a period of relative calm and making up also known as the honeymoon phase The batterer may be sorry or act as if nothing happened He or she is interested in resolving the situation and often promises never to do it again However the tension almost always starts to build over time and the cycle starts again Ill THE ABUSER BATTERER A There are no typical abusers They come from all ethnic groups and cross all social and economic boundaries Some common characteristics include low self esteem social isolation unrealistic expectations of the child elder or spouse unmet emotional needs need to control role reversal substance abuse and multiple stressors Frequently the batterer will hover over the victim and hav
148. id repetitive motions Use proper lifting techniques and body mechanics All of the above Bop 6 Strategies to reduce and or prevent risk factors that may lead to injuries when using the computer include a Increase glare on monitor b Increase repetitive motions c Place monitor screen above eye level d Keep wrists straight and hands relaxed Answers to Study Questions l d 2 0a 3 d 4 a 5 d 6 d If you answered all of the questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions Bibliography Ergonomics Program In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2006 Policy No 462 UCLA Ergonomics University of California Los Angeles Part 19 Worker Capability Physical or Repetitive Motion http ergonomics ucla edu Tips_users html Accessed June 22 2010 Reorientation Manual 2010 MandSec Ergonomics doc Nursing Department Reorientation Self Study Guide Mandated Section 14 Patient Care Management HIPAA AND CONFIDENTIALITY OF DATA AND INFORMATION Objectives Upon completion of this section the employee will be able to 1 Identify patient information that is considered confidential 2 Identify how the privacy standards protect individuals from the misuse of their health information 3 Differentiate identifiers for patients that must be kept confidential 4 State one component
149. ient s privacy such as using lowered voices or talking in an area apart from other people a True b False When conducting an investigation of an alleged crime the Sheriff Department may have access to the patient s medical record a True b False Nursing Department Reorientation Self Study Guide Mandated Section 23 Patient Care Management 5 The Security Rule requires covered entities to do which of the following Stop all electronic bank transactions Keep all data confidential even if it is not electronic Convert all protected health information on paper to electronic PHI Protect the integrity confidentiality and availability of the electronic protected health information they collect maintain use or transmit 6 Part of the Security Rule requires that access to computers or computer systems containing electronic protected health information must be ao re Wherever space allows Freely available to everyone Restricted to authorized users Available only in located rooms aoe op 7 Physical safeguard requirements of the Security Standards include protection of a covered entity s a Patients b Electronic information systems c Buildings and equipment related to electronic information systems d All of the above Answers to Study Questions l a 2 C 3 a 4 b 5 d 6 c 7 d If you answered all of the questions correctly go on to the next section If you missed one or more read the content again
150. ient s visit or hospital stay Standards for hand off communication apply to any situation in which two or more providers team members communicate patient information for the purposes of maintaining continuity of care during a handoff Critical hand off points such as those identified in the diagram above provide greater opportunities for miscommunication and error Whenever responsibility for patient care is transferred completely or temporarily a verbal exchange of information should occur between accountable RNs licensed nurses following the specific guidelines for each patient care area as described in the Nursing Department Policy Hand off Communication Nursing page 200 0 200 18 Finally the hand off is not complete unless it includes an opportunity for visual validation of the patients condition and review of documentation or historical data eg kardex chart daily flow sheet MAR The following hand off communication that occurs during admission change of shift inter unit transfer breaks and lunches and patient transport will be implemented based on the nurses scope of practice A Hand off communication at admission During admission the hand off communication from clinic or ED nurse to ward ICU nurse should include but is not limited to information on Diagnosis chief complaint and current condition Situations to monitor Stat admission orders Supply and equipment needs Known allergies and code status SuPer For ED an
151. ient with suspected pulmonary TB can be removed from airborne precautions when angr The patient reports feeling better The patient s blood culture results are negative Isoniazid and rifampin have been administered for 5 days The patient is on effective therapy improving clinically and has had three consecutive negative AFB sputum smears collected on different days When in the room of a patient with active tuberculosis which of the following MUST be worn Boe Gloves Mask goggles and gloves at all times N 95 respirator even if patient is absent from room Gown and goggles when in contact with the patient When leaving an airborne precaution isolation room the respirator must be removed and discarded Boe Outside the patient s room Prior to leaving the patient s room Once the patient is deemed noninfectious After contact with the patient is completed CHECK YOUR ANSWERS TO THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 95 Infection Control Issues TUBERCULOSIS Answers to Study Questions If you answered all of the questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions References 1 Centers for Disease Control and Prevention Controlling Tuberculosis in the United States Recommendations from the American Thoracic Society CDC and the Infectious Diseases Society of Americ
152. ients who are in restraints on the unit at any given time Risks and potentially harmful effects of use of restraint 1 Increased incidence of injury a Do not restrain a patient in a prone position Restraining a patient in a prone position may predispose the patient to suffocation Restraining a person in the prone position restricts the ability to breathe decreasing the supply of oxygen Restraint related positional asphyxia occurs when breathing is severely compromised and the resulting lack of oxygen leads to disturbances in the rhythm of the heart Prone position is a hazardous and potentially lethal restraint position Some people are more at risk for positional asphyxia than others Factors that increase the risk include obesity extreme physical exertion or struggling prior to or during restraint use pre existing heart or respiratory problems and use of alcohol or other drugs Because of the known risks identified with prone positioning patients are to be placed and maintained in the supine position when restrained in bed b Physical restraints can lead to death by strangulation Patients attempting to get out of restraints can pull or tug the restraints in all directions potentially causing strangulation c Increased incidence from falls out of bed Patients who are restrained have an increased Nursing Department Reorientation Self Study Guide Mandated Section 32 Patient Care Management tendency to try to get out of
153. ights and avoid penalties C HIPAA and California State law overlap in many health care team members areas Always follow the more stringent rule PRIVACY STANDARDS The HIPAA privacy regulations require organizations to maintain patient confidentiality Increased staff training and security of records is key to compliance The Privacy Standards require that the patient s be formally notified of the use and disclosure of his her medical information and to have full access to his her records A The Privacy Standards protect individuals from the misuse of their health information from 1 People not involved in a patient s treatment eg Office of Public Safety Sherriff s Department 2 Insurers using it to deny life or disability coverage 3 Employers using it for hiring or firing decisions 4 Reporters using it for any number of reasons 5 Family members or other patient contacts eg neighbors Nursing Department Reorientation Self Study Guide Mandated Section 16 Patient Care Management The Privacy Standards apply to health information that is written spoken electronic or communicated and maintained in any other form The core concept in the Privacy Standards is that Protected Health Information PHI should be disclosed only to those who need it to provide and or pay for care Direct care providers physicians nurses etc need access to information and patients are entitled to see anything in their own records Othe
154. igns an authorization form allowing the release of information Authorization forms may be obtained from Medical Records B A limited number of exceptions to disclosure authorizations is permitted when there is an overriding public health or governmental risk or activity or in reporting abuse or neglect or for judicial and law enforcement purposes Nursing Department Reorientation Self Study Guide Mandated Section 18 Patient Care Management IX PATIENTS RIGHTS TO PHI A With a few exceptions patients have the right to access inspect and copy their health information Requests must be granted within 30 days if the information is located on site and within 60 days if the information is located off site The provider may charge the patient for the actual cost of making copies of the health information B There are some exceptions to the patient s right to access PHI Before the health information is released to the patient any element that falls under one of the exceptions should be identified and removed or covered up in a way that they cannot see it The exceptions include 1 Psychotherapy notes 2 Information that a health care professional determines could be harmful to the patient 3 Information compiled for use in a civil or criminal trial or administrative proceeding 4 Certain health information maintained by a covered entity that falls under the Clinical Laboratory Improvements Amendments of 1988 X SPECIAL ISSUES
155. iled information b Employees with a history of positive PPD skin test will be screened for signs and symptoms annually or every 6 months if working in a high risk areas c Employees with a history of negative PPD skin test who convert to positive after hire or those with signs or symptoms of possible TB will receive further follow up to ensure employee is free of communicable diseases chest x ray exposure history symptom review etc d In the event of a diagnosis of active TB in a patient or employee where there may have been unprotected exposure to other employees every attempt is made to identify employees that may have been exposed Employee Health will notify these employees and conduct post exposure follow up per policy e Please note TB surveillance and post exposure follow up is conducted by Employee Health Self testing is not allowed REPORTING By law healthcare providers are required to provide written notification for all TB cases and suspected TB to LAC DHS TB Control At Harbor UCLA the current method of notification is to call the TB Liaison Nurse 310 222 3443 Any patient placed in airborne precautions and worked up for TB constitutes a TB suspect and must be reported In addition to phone notification to the TB liaison there is a case report form that must be completed by the physician and placed on the chart Nursing Department Reorientation Self Study Guide Mandated Section 93 Infection Control Issues
156. ing pain medication as needed To decrease irritability and agitation caused by hypoxia and or electrolyte imbalances assess and provide interventions to maintain the patient s electrolytes and oxygen saturation within normal limits Offer psychotropic medications as indicated Have the nurse with the best relationship with the patient offer the medication 7 Set clear firm enforceable limits Remember when giving a patient limits instructions should be clear and simple Tell the patient what the healthcare team s objectives and expectations are eg calling the nurse when he she needs to go to the bathroom not to be out of bed without assistance Inform patient of consequences associated with behavior Explain exactly what behaviors are inappropriate and why they are inappropriate 8 Verbally contract with the patient for safe appropriate behavior The goal of a nurse patient verbal contract is to increase the patient s involvement in his her plan of care and give the patient a sense of control for his her treatment plan For example the nurse orients the patient on initial contact regarding safety practices Furthermore the nurse should receive verbal acknowledgment and agreement from the patient regarding the plan of care Environmental 1 Maintain patient territorial space Inform the patient on admission which areas in the room are for individual use and which areas are shared such as the bathroom and sink Respect personal s
157. intensity on a scale of 0 10 2 Bieri Faces Pain Scale A self report measure used to assess the intensity of pain Initially developed for the use in children and is now used in adults as well because it has been found reliable and valid There are 6 faces arranged along a horizontal line in increasing pain intensity Each face has a corresponding numeric score Numeric scores are 0 2 4 6 8 10 3 Discomfort Indicator Scale for the Cognitively Impaired An observational tool of six categories of behaviors which include noisy breathing negative vocalization sad facial expression frightened facial expression tense body language and fidgeting Nursing Department Reorientation Self Study Guide Mandated Section 58 Patient Care Management b Pediatric populations 1 Premature Infant Pain Profile PIPP A multidimensional tool that consists of 7 indicators which include three behavioral indicators brow bulge eye squeeze naso labial furrow and two physiological indicators heart rate and oxygen saturation Total possible score is 21 2 Echelle Douler Inconfort Nouveau Ne EDIN Scale Five behavioral indicators of prolonged pain facial activity body movements quality of sleep quality of contact with nurses and consolability Each descriptor is scored 0 3 for a total possible score of 15 3 Poker Chip Tool Four red poker chips that are used to indicate pieces of hurt 4 FLACC An observational tool that consists of
158. inutes of the call being placed 2 Telephone orders for treatments will not be accepted by the nurse once a rapid response has been called Telephone orders for urgent diagnostic studies will be accepted 3 The first job of the RRT responders will be to assess the situation and provide immediate stabilizing treatment 4 The physician member of the team will determine the identity of the patient s existing medical team and contact the intern currently covering that patient if he she is not already present 5 The patient s nurse will provide any needed medical information and nursing interventions The nurse remains accountable for the patient during the RRT response C Disposition 1 The respiratory care practitioner from the RRT may be released when the RRT physician determines that he she is not needed and or he she is relieved by another respiratory therapist The physician from the RRT may be released when care is turned over to another R2 or higher or he she has determined that the patient is stable and does not require further urgent intervention The RRT physician will complete section 2 of Form HH 1013 the Rapid Response Record prior to leaving the immediate area If care is immediately handed over to another resident PGY 2 or above completion of the form may also be delegated to that person The patient s nurse documents assessments interventions and outcome in the patient s chart PLEASE COMPLETE THE STUDY QUE
159. ired In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2009 Policy 128A US Department of Justice Americans with Disabilities Act Title IV Telecommunications http www ada gov pubs ada htm Accessed June 21 2010 US Department of Justice Civil Rights Division Disability Rights Section A guide to disability rights laws http www usdoj gov crt ada cguide htm Accessed June 21 2010 Reorientation Manual 2010 MandSec Interpreter Services doc Nursing Department Reorientation Self Study Guide Mandated Section 41 Patient Care Management HAND OFF COMMUNICATION Objectives Upon completion of this section the nurse will be able to 1 Identify four requirements of effective patient hand offs 2 Identify five critical hand off situations 3 Discuss the nurse s responsibility for hand off communication 4 Describe the procedure for hand off to non licensed personnel Instructions to the employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 42 Patient Care Management OVERVIEW OF HAND OFF COMMUNICATION Poor communication has been identified as the root cause of nearly 70 of patient safety issues in which patients died or suffered serious physical or psychological injury At least half of communication breakdowns occur during handoffs
160. iscussed These controls reduce the risk of injury for employees and the cost of treatment B Reporting injuries helps management identify patterns of tasks or environments where similar activities occur This will help protect fellow workers from further injuries PLEASE COMPLETE STUDY QUESTIONS ERGONOMICS Study Questions Select the best answer to each question DO NOT write in the manual 1 The term ergonomics generally means The study of computer software All the causes of workplace injuries How much work that can get done in one shift The study of people and their physical relationship to their work aor The most common risk factor identified as causing injuries is are Repetitive motions Good body mechanics Proper lifting techniques Locked brakes on wheeled equipment aoe Some of the signs and symptoms that may indicate ergonomic injuries are Chest pain Nausea and vomiting Tired feet from walking all day Pain or numbness of the hands wrists arms and neck BoP Suspected ergonomics issues should be reported to Supervisor and Safety Officer Human Resources and Supervisor Employee Health and County Sherriff s Supervisor and employee s private physician Tore Nursing Department Reorientation Self Study Guide Mandated Section 13 Patient Care Management 5 Strategies to reduce and or prevent risk factors that may lead to injuries include Reorganize work area Reduce or avo
161. ity therefore his her chances of electrical injury are greater C Condition of equipment 1 Electrical equipment must be maintained in good working condition in order to keep the current leakage at or below the 300 microamperes standard of our hospital 2 All new medical electrical electronic equipment used in patient care areas is checked by the Bio Med Electronics Department to make sure that the current leakage is below 300 microamperes 3 Patients and staff are protected from excessive current leakage by the use of the third prong on the power plug Therefore equipment used in patient care areas must have a three pronged plug 4 Never use an extension cord or any equipment with only 2 prongs on its plug Nursing Department Reorientation Self Study Guide Mandated Section 98 Environment of Care Issues HI HOW ELECTRICAL SAFETY IS MAINTAINED AT HARBOR UCLA A Multiple pieces of electrically operated equipment used for a single patient should be plugged into the same cluster of wall outlets This will allow for better grounding 1 Electrical and electronic equipment are checked at regular time intervals depending on the device At the time of inspection the Bio Med Department places a sticker on the equipment indicating preventative maintenance has been performed on the equipment and the unit is safe to use on a patient Notify the Facilities Management at ext 3301 for any equipment displaying a date beyond the due dat
162. l status Acute change in urinary output to less than 50 mL in 4 hours adults only Severe uncontrolled bleeding Any staff member is worried that the patient is deteriorating even in the absence of any of the above criteria OE TON 2 a Nursing Department Reorientation Self Study Guide Clinical Competencies 3 Rapid Recognition and Response to Changes in Patient Condition Age specific vital signs parameters are summarized in the table below and the RRT should be activated for acute changes Table 1 Age Specific Vital Signs Parameters Age Heart Rate Respiratory Rate Systolic Blood Oxygen Pressure Saturation Adult Less than 40 Less than 8 Less than 90 Less than 90 More than 130 More than 28 Pre teen Adolescent Less than 50 Less than 5 Less than 90 over 10 years More than 100 More than 25 More than 140 School Age Less than 60 Less than 8 Less than 90 6 10 years More than 120 More than 25 More than 120 Less than 94 Toddler Preschooler Less than 60 Less than 10 Less than 90 1 5 years More than 180 More than 30 More than 110 Infant Less than 70 Less than 15 Less than 80 30 days 1 year More than 180 More than 50 More than 110 Neonate Less than 80 Less than 20 Less than 60 0 30 days More than 200 More than 60 More than 90 Despite oxygen Despite supplemental oxygen therapy or the patient requires a non rebreather mask Nursing Department Reorie
163. le and their physical relationship to their work For most settings this refers to the relationship of the worker s body to the equipment and materials he or she handles Information obtained from the study of people and their work can help prevent reduce or eliminate injuries ERGONOMICS PROGRAM Harbor UCLA Medical Center has an ergonomics program The basic elements of this program include A Analyzing worksites where injuries have occurred or are suspected to have risk factors present that may cause injuries B Controlling risk factors 1 Engineering controls involve adjusting or modifying the physical layout of the job or equipment so that awkward body positions are reduced 2 Administrative controls involve managing the timing and or patterns of job tasks to reduce the duration repetition and force required to get the tasks done without causing injuries 3 Staff training and education RISK FACTORS THAT MAY LEAD TO INJURIES The main risk factor on the job is lifting and transferring patients supplies or equipment Other risk factors can be at a desk computer or other workstations A combination of the following risk factors may include A Repetitive motions B Awkward postures position joint positions that are not in the natural resting position C Static postures positions held without moving D High force demands for pulling pushing lifting and gripping E Mechanical compression of soft tissues restin
164. les de deshecho BATA jla parte delantera de la bata y los mangas est n contominadas Desate los cordones Tocando solamente el interior de lo bata pasela por encima del cuello y de los hombros Voltee la bata al rev s D blela o enr llela y des chela MASCARA O RESPIRADOR La parte delantera de la mascara o respirador est contaminada j NO LA TOQUE Primero agarre la parte de abajo luego los cordones o banda el stica de arriba y por ltimo quitese la m scara o respirador Arr jela en el recipiente de deshechos INMEDIATAMENTE DESPUES O DE PROTECCI N PERSONAL Nursing Department Reorientation Self Study Guide Mandated Section 80 Infection Control Issues D Handling and transporting specimens of blood or OPIM 1 Specimens of blood or body fluids are placed in a leak proof container placed in a plastic bag to prevent spillage during transport and handling to the laboratory Specimens to be transported out of the hospital are placed in a leak proof container clearly marked with a Biohazard label E Containment and decontamination of blood or other body fluid spills 1 The method of containing and decontaminating blood and body fluid spills involves the use of an absorbent disinfectant which absorbs and transforms the fluid into an easily handled semi solid Gloves must be worn during the clean up process Clean up procedure a Don disposable gloves b Sprinkle absorbent powder over
165. malex A Facilities Management employee cleaning up a minor diesel spill with vermiculite A nurse cleaning up a manageable chemotherapy spill with a designated kit A nurse or Environmental Safety employee cleaning up spill from a mercury thermometer with a designated kit ono TP If the hazard is too great or if the employee is not trained or does not have any information about the chemical or are for any other reason unsure the employee should a Alert other employees and the supervisor to the area of the hazard b Remove all persons from immediate danger and cordon off the area c Close the door and post a warning sign d Call ext 2835 for help or call the supervising operator and ask to get in contact with the HazMat officer Remember to report name location phone number and nature of spill VI REPORTING A Report a HazMat spill or incident to one s supervisor and to the HazMat Safety Office at ext 2835 and County Sherrif s at ext 3311 for clean up response Report to HazMat even if is has been cleaned up B Report an industrial injury to your supervisor to Employee Health at ext 2360 and to HazMat at ext 2835 Nursing Department Reorientation Self Study Guide Mandated Section 132 Environment of Care Issues C Report a threatened release or spill to one s supervisor the HazMat Office at ext 2835 and the Director of Environmental Safety at ext 2836 Complete an online Patient Safety Net report An Unsafe
166. ment F Lifting or moving 1 Grip objects securely 2 Whenever possible slide patient or object over a friction free surface rather than lifting 3 Use a step stool to get closer to objects above shoulder level 4 Stay in shape by following a sensible diet and exercise program PLEASE COMPLETE STUDY QUESTIONS BODY MECHANICS Study Questions Select the best answer to each question DO NOT write in the manual 1 Which of the following are expectations of using good body mechanics Prevention of injury to self and patient Increased capacity to work comfortably Maintenance of general good health and a safer environment All of the above aog 2 When lifting items to balance oneself correctly one must Lift with one s back Place feet close together Keep knees and hips straight Keep the item as close to one s body as possible aoe 3 Proper balance may be established by which of the following Keeping weight on one foot only Placing feet apart and centering oneself Keeping feet together and leaning forward Tilting backward slightly while spreading feet apart aoe 4 Which of the following guidelines should be followed when carrying heavy objects a Lean backward b Hold the object at arm s length c Use whatever method is comfortable d Hold the object as close to the body as possible Answers to Study Questions l d 2 d 3 b 4 d If you answered all of the questions correctly go on to the next secti
167. mergency Medical Services Agency and each other County wide Integrated Radio System CWIRS An 800 megahertz radio system that allows all County departments and their major facilities to communicate with each other and the County s Emergency Operations Center Satellite radio phone The hospital s SatRad system enables satellite facilitated radio and phone communications Payphones These phones are on a different system than the hospital s desk wall phones Pay phones may work when desk wall phones do not function E mail V YOUR ROLE AND RESPONSABILITIES IN A CODE TRIAGE INCIDENT A General responsibilities 1 2 a Return to your normally assigned work station Check in with your supervisor Await further instructions from your supervisor designee or a HICS officer B Nursing responsibilities 1 2 3 Return to your normally assigned unit Check the status of your patients Ensure all life critical equipment is plugged into a red plug inpatient nurses Nursing Department Reorientation Self Study Guide Mandated Section 115 4 5 Environment of Care Issues Check in with your supervisor Identify your patients who could be safely discharged within the next 2 and 12 hours Await further instructions from your supervisor designee or a HICS officer C Physician responsibilities D 1 2 Review the status of your assigned patients Identify any of your inpatients
168. n Nursing Department Reorientation Self Study Guide Mandated Section 122 Environment of Care Issue SECURITY I LOS ANGELES COUNTY SHERIFF DEPARTMENT The Sheriff Department is responsible for safeguarding patients staff visitors and property Sheriff Deputies are assigned for this purpose and represent the County of Los Angeles in the administration of their duties A To prevent a crime or if a crime is being committed staff must contact Sheriff Department at ext 3311 Sheriff Deputies respond as law enforcement officers using law enforcement techniques following Sheriff Department policies and procedures The Sheriff Deputies may return the patient to the care of the medical provider In the event a patient remains in custody of the Sheriff Deputies written notification is provided to appropriate medical and or administrative staff by completing the Consent for Release of Medical Information for Patients in Police Custody and placing the white copy in the patient s medical record When Sheriff Deputies respond in a law enforcement capacity to a situation involving a patient clinical staff who are present shall document 1 The date time and description of the incident necessitating calling the Sheriff Department 2 The name of Sheriff Deputy who responded 3 The actions taken by Sheriff Department eg removed the patient from the hospital or returned the patient to the custody of medical staff In law enforcement
169. n Respiratory Therapy amp B 217 CT Scan Nuclear Medicine amp Ultrasound B 200 HOSPITAL Main Oxygen Shutoff PCDC Endoscopy Laboratory PCDC OSSA outpatient recovery PCDC Vascular Catheterization Laboratory PCDC Cardiac Catheterization Laboratory PCDC Pulmonary Function and Exercise Lab PCDC Urgent Care exam rooms PCDC Cardiology suite corridor PCDC Module C PCDC Module B PCDC Module A PCDC Main Shutoff LOCATION OF VALVE 8E 27 Corridor Wall opposite 7W Nurse Station Wall opposite 7E Nurse Station Corridor of each suite Corridor of the room Corridor of the room Wall opposite 6W Nurse Station Wall opposite 6E Nurse Station Wall opposite 5W Nurse Station Wall opposite 5E Nurse Station Wall opposite 4W Nurse Station Wall opposite 4E Nurse Station Wall opposite 3W Nurse Station C Bay near isolation room 7 3W 32B Corridor Wall opposite 3E Nurse Station Corridor outside of each suite 2E 35 Corridor Inside the PACU near bed 6 2W R8 Corridor 2W 41 Corridor 2B 8 Corridor 2B 9 Corridor 2B 7 Corridor 2B 6 Corridor 2B 10 Corridor 2F 8 Corridor 2F 8 Corridor 2F 10 Corridor 1G 7 Corridor 1A 6A Corridor Inside main room near the North automatic door 1H 6 Corridor B 253 Corridor B 152 Corridor B 200 Corridor not in use at this time B 151 Corridor 2 floor 207 4 Corridor 2 floor 201 Corridor 2 floor 202 15 Corridor 2 floor 202 21 Corridor 2 floor 2
170. n blood Handle specimens of blood or OPIM in such a way as to prevent leakage Do not use hands to pick up broken glassware that may be contaminated Use mechanical means such as brush and dust pan tongs or forceps Nursing Department Reorientation Self Study Guide Mandated Section 78 Ts Infection Control Issues Do not open empty or place hands into sharps containers C Personal Protective Equipment PPE 1 2 Each employee will use PPE during all procedures to minimize exposure to blood or OPIM PPE is located either in a cart or cabinet and is clearly marked Personal Protective Equipment PPE is worn only for the purpose of preventing exposure to blood or OPIM Gowns are not worn for personal comfort All PPE will be removed prior to leaving the work area eg patient room laboratory or other immediate areas where procedures are performed PPE is NOT to be worn at the desk Remove PPE prior to leaving operative or procedural areas PPE will be placed in the appropriate container for disposal Specific requirements for PPE use a Gloves are to be worn when there is a possibility of direct contact with blood OPIM mucous membranes and broken skin when performing vascular access procedures and when handling or touching contaminated items or surfaces b Disposable gloves must be replaced when torn or contaminated DO NOT wash or decontaminate for reuse Wash hands after removing gloves c M
171. n place to provide guidelines for this process Adherence to these guidelines helps ensure a safer transfusion process PLEASE COMPLETE THE STUDY QUESTIONS Nursing Department Reorientation Self Study Guide Clinical Competencies 19 REACTION ONSET TYPE Acute hemolytic Febrile nonhemolytic Mild allergic Anaphylactic Circulatory overload APPENDIX A TRANSFUSION REACTIONS TRANSFUSION REACTIONS Usually during first 5 to 15 minutes but may occur at any time during administration Within 6 hours of transfusion Within 6 hours of transfusion Immediate Dependent on clinical condition volume and rate of infusion Dependent on degree of contamination and clinical condition of the host SIGNS AND SYMPTOMS Chills fever a feeling of heat at infusion site low back pain tachycardia hypotension shock renal failure Sudden chills and fever rise of gt 2 F headache flushing muscle pain Flushing itching hives Anxiety hives wheezing tightness in chest difficulty swallowing progressing to cyanosis shock cardiac arrest Cough dyspnea pulmonary edema hypertension tachycardia jugular venous distension Unexpected fever chills altered level of consciousness vomiting diarrhea shock Infusion of ABO incompatible blood Sensitization to donor s white blood cells Sensitivity to foreign plasma proteins Infusion of IgA proteins to IgA deficient recipien
172. n posted on the door 1 Patients and families must be educated about the need for airborne precautions and their responsibility to adhere to the precautions Patient education booklets are available on each unit 2 Patients must remain in their rooms except as necessary to leave for diagnostic tests or with permission to go outside They are not permitted free access to the wards lobbies clinics other patient rooms or cafeteria and must wear a mask anywhere in the facility outside their isolation room 3 When leaving their rooms for diagnostic tests patients must be escorted and must wear properly applied masks Nursing Department Reorientation Self Study Guide Mandated Section 90 Separate the edges of the Infection Control Issues N95 Particulate Filter Respirator and Surgical Mask Directions for Application Slightly bend the nose wire Hold the respirator upside Using your index fingers While holding the respirator to fully open it to form a gentle curve down to expose the two and thumbs separate the headbands with your headbands two headbands index fingers and thumbs cup the respirator under your chin Pull the headbands Release the lower Position the remaining Conform the nosepiece Continue to adjust the up over your head headband from your headband on the crown across the bridge of your respirator and secure the thumbs and position it of your head nose by firmly pressing edges until you feel you at t
173. ncy Medical Treatment and Active Labor EMTALA Infection Control Issues Transmission of infectious diseases bloodborne pathogens and healthcare workers and tuberculosis Environment of Care Issues electrical utility and fire life safety emergency preparedness security hazardous materials communication and safety program and radiation safety Clinical Competencies Two clinical competencies that have been identified are related to Rapid Recognition and Response to Changes in Patient Condition and Blood Products and Transfusion These competencies are required by the majority of licensed nurses throughout the hospital The following table describes which employees must complete the above sections of Reorientation Appropriate Mandated Section Clinical Personnel infection control Competencies environment of care etc Direct care giving Registered Nurses Interim Permittee Non direct care giving Registered Nurses Nurse Practitioners Nursing Department only Licensed Vocational Nurses Student Workers Nursing Attendants Nursing Escort Staff Intermediate Clerks Unit Secretaries Intermediate Clerks Unit Secretaries in non patient care areas e g CPD NSO Direct care giving Technicians If your position is not listed in the table or you are not sure in which category you belong consult your immediate supervisor Nursing Department Reorientation Self Study Guide iii ABOUT THIS STUDY GUIDE If you are required t
174. nd Care Record Nursing Department Reorientation Self Study Guide Mandated Section 34 Patient Care Management CONCLUSION In summary restraints and or seclusion are to be utilized only when alternative less restrictive interventions have been tried and deemed ineffective Restraints are utilized only when there is a risk of imminent injury to the patient or others behavioral justification or as an adjunct to care in order to prevent the disruption of essential treatment non behavioral justification PLEASE COMPLETE THE STUDY QUESTIONS USE OF RESTRAINTS Study Questions Select the best answer to each question DO NOT write in the manual 1 Important aspects of patient and family education regarding the use of restraints include Bop Criteria for release of restraints Behavior necessitating the use of restraints The organization s philosophy related to the use of restraints All of the above All of the following are appropriate alternatives that may be tried prior to placing a patient in restraints EXCEPT BoP Decreasing environmental stimuli Offering medication to the patient Setting limits on inappropriate behavior Encouraging the patient to leave against medical advice The potentially harmful effects of restraints would include which of the following BOTS Increased sense of autonomy Decreased incidence of limb injury Decreased incidence of pressure sores Increased feelings of helplessness and
175. ne if consent is not given or if the HBV HCV or HIV status is known 5 Results of the source individual s testing is made known to the exposed employee The employee is informed as to required confidentiality regarding the source individual s identity and infectious status 6 The employee s blood may be tested for HBV HCV and HIV as soon as feasible after consent is obtained If employee consents to baseline blood collection but not to HIV testing the employee s blood sample is preserved for 90 days During those 90 days the employee may elect to have his her blood tested Nursing Department Reorientation Self Study Guide Mandated Section 83 Infection Control Issues C Post exposure prophylaxis is provided when medically indicated If treatment is recommended it should be instituted as soon as possible Employee Health will provide drugs and the employee will be issued the medication at no charge D Counseling is available to the exposed employee PLEASE COMPLETE THE STUDY QUESTIONS BLOODBORNE PATHOGENS AND HEALTHCARE WORKERS Study Questions Select the best answer to each question DO NOT write in the manual 1 The three bloodborne pathogens of primary concern to healthcare workers are Salmonella hepatitis B tuberculosis Tuberculosis hepatitis B hepatitis C Hepatitis B hepatitis C human immunodeficiency virus Hepatitis B human immunodeficiency virus tuberculosis pao op 2 The most common chronic
176. nizations FAQs Restraint and Seclusion Available at http www jcaho org Accessed June 22 2010 Kozub M Skidmore R Least to most restrictive interventions Journal of Psychosocial Nursing 2001 39 32 38 Medscape Medical News New Guidelines for Restraint Use in ICU Available at http www medscape com Accessed June 22 2010 Office of Public Safety use of force on Harbor UCLA campus In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2005 Policy 138 Quinn CA Nurses perceptions about physical restraints Western Journal of Nursing Research 1993 15 148 162 Rogers P Bocchino N Restraint free care Is it possible American Journal of Nursing 1999 99 26 34 Staten P JCAHO solutions Firmly grasp new restraint and seclusion standards Nursing Management 2003 34 12 14 Swanger K Tomlin C Moving toward restraint free patient care Journal of Nursing Administration 2000 30 325 329 Terpstra TL Van Doren E Reducing restraints Where to start Journal of Continuing Education in Nursing 1998 29 10 16 The use of restraints including seclusion In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2010 Policy No 347 Reorientation Manual 2010 MandSec UseofRestraints doc Nursing Department Reorientation Self Study Guide Mandated Section 37 Patient Care Management INTERPRETER SER
177. noting No Blood Products is placed on the chart indicating the refusal NO BLOOD PRODUCTS Prior to administering blood products the IV certified RN LVN checks that consent forms have been completed and original copies are placed in the medical record Nursing Department Reorientation Self Study Guide Clinical Competencies 11 Blood Products and Transfusion B Type and Screen Type and Cross Confirm Type 1 Prior to receiving a blood blood product transfusion the patient must have his her blood typed in order to ensure that the patient receives a product compatible to the patient s own blood type ABO incompatible transfusions can be fatal even if only a fraction of the unit is transfused A type and screen determines the blood type ie ABO and Rh group eg Rh positive or Rh negative of red blood cells and screens serum for the presence of potentially hemolyzing antibodies A type and screen is usually ordered for patients who will probably not require blood transfusion during surgery or other procedure Providing that the antibody screen is negative donor blood is not crossmatched and reserved for the patient Once the type and screen is done if blood is unexpectedly required during surgery it can be quickly within 5 minutes crossmatched because the blood bank has a record of patient ABO and Rh types as well as the negative antibody screen The original type and screen specim
178. nsure include pain as an item to be assessed at the same time as vital signs are taken STANDARDS ON PAIN MANAGEMENT The Joint Commission requires that all hospitals A Recognize a patient s right to appropriate assessment and management of his her pain B Assess the existence nature and intensity of pain in all patients C Record the results of pain assessment in a way that facilitates regular reassessment and follow up D Establish policies and procedures supporting appropriate prescription and ordering of pain medications E Monitor patients continuously after procedures for pain intensity and quality and responses to treatment F Ensure staff competency in pain assessment and management and address pain management in the orientation of all new staff G Teach patients about pain and about managing pain as part of their treatment H Educate patients and their families about effective pain management practices I Address each patient s need for pain management in the discharge planning process J Collect data about the appropriateness and effectiveness of pain management ORGANIZATIONAL STATEMENT ON PAIN ASSESSMENT AND MANAGEMENT Harbor UCLA Medical Center supports every patient s right to have his her pain assessed and treated Untreated pain may have negative effects on a patient s physical emotional and spiritual health An individual in pain may have difficulty accepting participating in and responding to medical trea
179. nt The patient in the psychiatric area will be informed of the right to have family informed of any episodes of restraint or seclusion 1 Educate patient and family Inform the patient and family of the organization s philosophy on the use of restraints and seclusion Include the patient and family in identifying behaviors requiring restraint seclusion identifying alternatives and the treatment plan Inform the family of the reasons for the use of restraints placing an emphasis on safety In the psychiatric area this requires the patient s consent Encourage family members to bring things that the patient likes or needs Ask the family to bring pictures of loved ones significant other pets or religious items that can help to individualize the patient s environment Family involvement is encouraged in the psychiatric areas however personal items from home that are sharp breakable or determined to be unsafe by the psychiatric staff must be kept at the nurses station and are not allowed at the bedside Family support and involvement in the patient s care must be encouraged Allow family members to give baths assist in patient care needs interpret for the patient or just stay at the bedside to hold the patient s hand C Therapeutic interactions 1 1 1 de escalation Remove patient from a situation or discussion when the patient has been observed feeling powerlessness and help him her to refocus on here and now a
180. nt s temperature is less than a 99 0 F b 100 0 F c 101 0 F d 102 0 F 10 Within what time frame must a blood transfusion be initiated after pick up from the Blood Blank a 20 minutes b 30 minutes c 2 hours d 4 hours 11 A nursing attendant picks up blood from the blood bank Upon return to the ward the nursing attendant must deliver the blood product to the a clerk b charge nurse c medical student d licensed care giver who will be administering the blood CHECK YOUR ANSWERS TO THE STUDY QUESTIONS Answers to Study Questions l d 2 3 c 4 a Jne 6 b T a 8 d 9 b 10 a ll d If you missed one or more questions read the content again and repeat the study questions Nursing Department Reorientation Self Study Guide Clinical Competencies 24 Blood Products and Transfusion BLOOD PRODUCTS AND TRANSFUSION References 1 Kamel H Giordano G eds TRALI An Update Blood Bulletin 2006 8 2 Southeast Blood Centers website http www scbcinfo org publications bulletin_v8_n2 pdf Accessed June 20 2010 Bibliography American Association of Blood Banks American Red Cross Council of Community Blood Centers Circular of Information for the Use of Human Blood and Blood Components American Red Cross 2009 Blood and Blood Products Transfusion Administration and Monitoring In Department of Nursing Procedure Manual Torrance CA Harbor UCLA Medical Center 2010 p 50 0 Blood and Blood Product
181. nt Body Mechannies ss evicciavsuis sieves ceestossansd teens ceecesaduebons deveude E OEE E OaE REA EPST OOT 4 EP SONOMUICS einne costes sveccniesdactebeslecGudssensvelssduciubssceccasslaeostdseaecedectucheusitgsdecendsstbcouussunecebsutenssuactebes dee 9 HIPAA and Confidentiality of Data and Information 0 ieee eee eeeeereceeceeeeseeseseeseseeaeeseeseeeaseas 15 Uses0F ReStraints s 2iceninialasien isi clintiashiailietchiawed AA E idl atari bananas 25 Interpreter Services seeds ces oesi a castowepeandstenescastune sees tuseaessdsatues sess teuadeasbuneavdalea nivssonesuesueeentoneasvelanedeeree 38 Hand off Communicationsin onerare ae ee ea Eae EO E Ea aS EEE a EEEa oan ES 42 Family Violene ecoin n E A T EE tet A e N T 49 Pain Management nien a E E EEE EEA EEA eTA EEEN igs SEEE ERS 56 Emergency Medical Treatment and Active Labor Act EMTALA s sesessssessssersssresrsresrsresesiesesreresrses 63 Infection Control Issues Transmission of Infectious Diseases cece cece cseeseceeceseeseeecescesessecseceseesecsecsecesecsessesesseassaeeaeeaeegs 67 Bloodborne Pathogens and Healthcare Workers c cee eeeesceseesecseceseesecseeeecesecseeseeeseeaesseeeseaeegs 74 PUDELCULOSIS 0i4icosinvisbeabeLadvcu s divbosbatelaos cases aatls dodueesssdiosstededwes AT 87 Environment of Care Issues Blectrical Wtility Safety feces ike tes lessees inks cis Seeds duchanhe cig Subs eauseevte a aa a a Sung scusedvheevs seuseunsodonedublavieunsscs 97 Fire Life Safet
182. ntact with patients at higher risk of TB or perform cough inducing procedures Each department identifies employees with occupational risk Employees should discuss their confidential personal risk factors with Employee Health VII TREATMENT OF TB A For adults and children who do not display signs of the active disease have a negative chest x ray but have recently tested positive with a PPD skin test preventive therapy with isoniazid is given for 6 12 months to decrease the risk of TB Such persons may continue to work during this time B Once a person is found to have signs and symptoms consistent with tuberculosis treatment is begun The person may not work until a physician certifies that the disease is no longer communicable Treatment for active disease should always include two or more tuberculosis medications to prevent the emergence of resistant tuberculosis bacilli Multidrug resistant tuberculosis can occur in two ways C Infection by tuberculosis bacteria that is already resistant to the drugs D Patient non compliance or mismanaged treatment where the patient takes inadequate types or doses of appropriate medication E Treatment for multi drug resistant TB disease or exposure to multidrug resistant TB is determined on an individual case basis VIII PREVENTING TRANSMISSION OF TB IN THE WORKPLACE A Patients with known or suspected active TB are to be placed in a negative pressure room and have an airborne precautions sig
183. ntation Self Study Guide Clinical Competencies 4 IV RAPID RESPONSE TEAMS Rapid Recognition and Response to Changes in Patient Condition There are four different rapid response teams covering the different clinical services in the hospital Rapid Response Team Coverage Clinical Service Medical RRT consists of e Day float resident from 8am 5pm or ward call resident for nights weekends and holidays e Respiratory care provider RCP e ICU nurse when available Medicine Family Medicine Hospitalist Neurology Psychiatry Surgical RRT consists of e Trauma surgery junior resident on call e RCP e ICU nurse when available Trauma Surgery Colorectal Surgery GI Oncology Surgery Vascular Surgery Cardiothoracic Surgery Endovascular Surgery Orthopedic Surgery Head and Neck Surgery ENT Oral Maxillofacial Surgery OMFS Plastic Surgery Urology Neurosurgery Pediatric RRT consists of Pediatrics e Pediatric Intensive Care Unit PICU resident or designee e RCP from PICU or Neonatal Intensive Care Unit NICU e A NICU nurse will respond to pediatric RRT requests initiated from 7E Level II Nursery 7E L amp D or 7W a PICU nurse will respond to all other pediatric RRT requests OB GYN RRT consists of Obstetrics e Resident carrying Gynecology consult pager Gynecology e RCP e ICU nurse when available The Patient Flow Facilitator will also respond to all RRT activations t
184. ny manual methiod or physical or mechanical device material or equipment that immobilizes or reduces the ability of a patient to move his or her arms legs body or head freely b A drug or medication when it is used as a restriction to manage the patient s behavior or restricts the patient s freedom of movement and is not a standard treatment or dosage for the patient s condition Seclusion the involuntary confinement of a patient alone in a room or area from which the patient is physically prevented from leaving Seclusion is used only for management of violent or self destructive behavior Restraint does not include devices for medical immobilization eg use of arm board during IV therapy surgical positioning orthopedically prescribed devices surgical dressings or bandages protective helmets or methods to protect the patient from falling out of bed side rail use The physical holding of a patient for the purpose of conducting routine physical examinations or tests is also not considered a form of restraint B All Harbor UCLA Medical Center employees including both direct and indirect care providers need to be aware of the hospital s philosophy regarding the use of restraints and seclusion as well as general factors to consider when restraints are utilized This section of the reorientation study guide will provide the individual with the philosophy regarding the use of restraints and seclusion Factors to consider jus
185. o complete the MANDATED SECTION please read the following All employees of the Nursing Department will obtain and read the Nursing Department Reorientation Self Study Guide annually and sign an agreement of understanding stating they have read understand and will apply the concepts from the Self Study Guide Mandated Section In addition all employees in the Nursing Department will independently complete an open book exam on the Mandated Section of this Self Study Guide The answer sheet must be submitted to the Clinical Professional Development staff in Building N 18 Monday through Friday except county holidays between 0730 1630 If you are required to complete CLINICAL COMPETENCIES please read the following The table on the previous page identifies nursing department licensed staff that are required to complete the Clinical Competencies annually The material you will need to review to successfully complete the written examination is included in this self study guide IT IS IMPORTANT THAT YOU READ THE STUDY GUIDE PRIOR TO TAKING THE CLINICAL COMPETENCY EXAM OR YOU WILL BE ASKED TO RETURN TO YOUR WORK AREA Reorientation Manual 2010 MandSec Intro doc Nursing Department Reorientation Self Study Guide iv NURSING DEPARTMENT REORIENTATION SELF STUDY GUIDE MANDATED SECTION TABLE OF CONTENTS Instructions for Completing Mandated Section eee eesceeesecseceeceseesecsecsecesecsececsesesessesseseaneaeeseeneseasegs 3 Patient Care Manageme
186. o help coordinate any needed transfers or resources V ACTIVATING THE RAPID RESPONSE TEAM A Activation 1 Any staff member who recognizes criteria for a deteriorating patient admitted to a ward or Progressive Care Unit PCU Trauma Transitional Care Unit TTCU should notify that patient s nurse at once Patients and families are also informed as part of unit orientation that they should notify the patient s nurse if they think the patient is getting worse The nurse will then assess the patient and determine if RRT activation is needed In the rare instance that a patient s nurse cannot be identified and or contacted any staff member may activate the rapid response team by calling the page operator s stat paging line ext 111 2 The nurse will tell the page operator which of the four RRTs they wish to activate based on the patient s clinical service If the nurse is unsure the Medical RRT will be activated Nursing Department Reorientation Self Study Guide Clinical Competencies 5 Rapid Recognition and Response to Changes in Patient Condition 3 The patient s nurse will begin documenting the response by completing section 1 of form HH 1013 the Rapid Response Record and document assessment in the nursing notes B Response 1 Upon notification of a rapid response the RRT members will respond to the patient s bedside immediately The goal is to have all members of the team at the patient s bedside within 5 m
187. oc Nursing Department Reorientation Self Study Guide Mandated Section 104 Environment of Care Issues FIRE LIFE SAFETY Objectives Upon completion of this section the employee will be able to 1 Identify the fire rating of commonly used doors in the hospital 2 Describe the correct course of action when a fire is discovered in the work area 3 Describe the location of the closest fire alarm box in the work area 4 State the extension to call to report a fire 5 Identify the priority movement plan for patients when evacuation off the ward is necessary 6 Describe the 3 elements that must be present to create a fire 7 Identify the proper extinguishers for the following types of fire a Wood paper and bedding b Electrical wiring and equipment c Chemicals and burning liquids 8 Explain the steps of the PASS method of extinguisher use Instructions to the Employee Please read the following section then answer the study questions at the end of the section Nursing Department Reorientation Self Study Guide Mandated Section 105 Il M Environment of Care Issues FIRE LIFE SAFETY INTRODUCTION Because fire can occur anywhere each employee must familiarize him herself with hospital policies and procedures pertaining to fire safety If a fire does occur in the hospital every effort must be made to confine it An employee must perform fire prevention measures and in the event of a fire emergency institute fire life sa
188. of this section the nurse will be able to 1 2 List the documentation requirements needed prior to administration of blood products Describe the process for confirm type Differentiate between type and screen and type and cross Discuss the role of the RN and LVN related to transfusion of blood products List information that must be verified prior to initiation of transfusion Describe at least one indication for each type of blood product Discuss administration parameters of specific blood products Discuss transfusion reactions and identify appropriate nursing interventions Identify the time frame in which a blood blood product transfusion must be initiated after pick up from Blood Bank 10 Identify the maximum patient temperature allowed prior to initiation of blood transfusion 11 State the individual to which a blood product may be delivered if picked up by non licensed personnel 12 Describe the process for handling an unhung unit of blood at time of patient transfer Instructions to the employee Please read the following section then answer the study questions at the end of this section Licensed staff assigned to the following areas roles do not need to complete the Blood Products and Transfusion section 8West Ambulatory Care licensed staff working in Infusion Clinic must complete the competency CRU Employee Health Patient Flow Facilitator Psych ER Urgent Care Clinic Wound Care Team Nursing Departm
189. oftware applications c Magnetic tapes disks compact disks USB storage devices and other means of storing electronic data d Telephone voice response fax back and other systems that are used as input and output devices for computers Paper to paper person to person telephone calls video teleconferencing or messages left on voice mail are not covered by the Security Rule however these and other methods of transmission of PHI not listed as electronic media are covered under HIPAA Privacy 1 A HIPAA Security Officer is required to oversee security implementation and enforcement of the Security Rule The Security Officer guides the organization in determining the best ways to implement the Security Rule The County of Los Angeles and the Department of Health Services have appointed HIPAA Security Officers to oversee security on a County and DHS level respectively Questions regarding HIPAA Security can be referred to Harbor s Information Systems at ext 5448 The Centers for Medicare and Medicaid Services CMS is responsible for ensuring compliance with the Security Rule Suspected violations are reported to the Office of Inspector General The Office of Inspector General will investigate and may recommend penalties up to 250 000 and or 10 years in jail for unlawful use of PHI 1 The Security Rule is comprised of the following three categories of standards a Administrative Safeguards b Physical Safeguards c Technical Safeguard
190. on If you missed one or more read the content again and repeat the study guide questions Nursing Department Reorientation Self Study Guide Mandated Section 7 Patient Care Management Bibliography Body mechanics computer In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2006 Policy No 463 Body mechanics exercises to relieve muscles in sustained positions In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2006 Policy No 464 Reorientation Manual 2010 MandSec BodyMechanics doc Nursing Department Reorientation Self Study Guide Mandated Section 8 Patient Care Management ERGONOMICS Objectives Upon completion of this section the employee will be able to 1 Define the term ergonomics 2 Describe selected ergonomic risk factors that could be identified in the workplace 3 Identify selected signs and symptoms that could indicate existence of ergonomic risk factors 4 State the procedure for reporting ergonomic issues Instructions to the Employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 9 Il II IV Nursing Department Reorientation Self Study Guide Mandated Section 10 Patient Care Management ERGONOMICS INTRODUCTION Ergonomics is the study of peop
191. on May use blood warming devices when indicated May use central lines to administer blood products ao re The nurse hanging blood blood products must verify the following prior to beginning administration Patient name MRUN and blood type donor type unit Group Rh Patient name and MRUN donor type unit Group Rh and donor number Patient name MRUN and blood donor type unit Group Rh donor number expiration date and time Patient name MRUN and blood type patient history of previous blood transfusion donor type unit Group Rh donor number expiration date and time ae op Which product is indicated for a patient with symptomatic anemia Platelets Red blood cells Fresh frozen plasma Leukapheresis lymphocytes ae op Nursing Department Reorientation Self Study Guide Clinical Competencies 23 Blood Products and Transfusion 7 Packed red blood cells PRBCs should be administered Over 2 3 hours Very slowly up to 6 hours unit As rapidly as tolerated usually within 1 hour Up to 72 hours from the time the order was written ae op 8 A patient with dyspnea cyanosis fever hypotension non cardiogenic pulmonary edema and pulmonary infiltrates on chest xray following blood transfusion may be experiencing Sepsis Anaphylactic reaction Acute hemolytic reaction Transfusion Related Acute Lung Injury TRALI ao op 9 Unless a physician s order specifies otherwise blood may be transfused only if the patie
192. on then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Clinical Competencies 2 Il IIL Rapid Recognition and Response to Changes in Patient Condition RAPID RECOGNITION AND RESPONSE TO CHANGES IN PATIENT CONDITION INTRODUCTION The Rapid Response Team RRT is designed to improve staff s ability to recognize and respond quickly and appropriately to a deteriorating patient Harbor UCLA patient care staff are trained to recognize signs of clinical deterioration Any staff member who recognizes these signs will initiate a rapid response by notifying a specially trained team The team will be responsible for responding immediately to the patient s bedside performing initial assessment and intervention and notifying the patient s existing care team if they are not already part of the team or aware of the response The nurse s role is ongoing assessment of the patients status It is the responsibility of the nurse to identify changes in the patients condition and decide an appropriate response If the nurse assesses that the patient s condition is deteriorating the nurse may choose to activate the rapid response team The nurse may choose not to activate the rapid response team if a resident PGY 2 or above from the primary team is already present and managing the patient although activation is still an option if additional resources are needed The RRT will respond for
193. on sequence 1 Those in greatest danger 2 Ambulatory 3 Semi ambulatory 4 Non ambulatory 5 Close all doors Call Operator x111 R eport location describe situation Nursing Department Reorientation Self Study Guide Mandated Section 118 Follow Up Document occurrence in patient chart cument occurrence in jent chart With assistance from County Police visually search for bomb Document occurrence in patient chart e report ete repor ete repor If you see suspected abductor or missing infant child call County Police x3311 R eport suspect s description and direction of travel Evacuate if necessary Implement emergency response precautions and procedures as necessary Report damage injury to supervisor or department manager Report to designated evacuation assembly area Account for all staff and patients Complete report of the incident Environment of Care Issues VII BIOTERRORISM RESPONSE A Bioterrorism Response Plan Harbor UCLA has developed a Bioterrorism Response Plan that establishes standardized procedures to report respond to and recover from a suspected or known bioterrorism incident This plan is contained in Policy EPP No 45 Bioterrorism Response in the Emergency Preparedness amp Management Manual The plan is an integral part of the overall Emergency Preparedness Management and Infection Control programs The obje
194. ontact with an infectious case of TB has a chest x ray consistent with TB is immunosuppressed is infected with HIV or is a member of a group at high risk for HIV infection 2 A reaction of 10 mm or more of induration should be considered positive in all other persons a Persons having a newly positive mantoux as defined above must have a chest x ray A positive PPD test does not necessarily mean that the person has tuberculosis A follow up chest X ray is required to assess pulmonary status If the person has a positive PPD skin test and positive chest x ray findings a sputum specimen will be collected and sent to the lab for acid fast bacillus smears and culture to confirm the diagnosis of tuberculosis The employee may not work until the results of the sputum diagnostic test s are confirmed Nursing Department Reorientation Self Study Guide Mandated Section 89 Infection Control Issues 3 Appropriate measures to prevent spread of infection are implemented discussed in Sections VIII and IX At Harbor UCLA Medical Center employees are monitored by Employee Health All employees must have a pre employment physical which includes a two step PPD tuberculin skin test and a chest x ray Employees are followed annually thereafter or after any suspected exposure OSHA requires that employees who work in high risk areas be tested every six months Increased TB surveillance is required for Healthcare Workers HCW who have close prolonged co
195. ood Transfusion HH256 MR must be signed and placed in the front of the medical record The nurse must also place a sticker on the chart noting No Blood Products Blood may be transfused only if patient s temperature is Jess than 100 F unless there is a specific order to transfuse with a temperature greater than 100 F Non licensed staff or volunteer who pick up blood or blood products must give the product directly to the licensed direct care provider who will be administering the transfusion A confirm type specimen must be a separate draw from the original type and screen or type and cross preferably drawn by another person Nursing Department Reorientation Self Study Guide Clinical Competencies 18 Blood Products and Transfusion If blood administration is not initiated within 20 minutes from pick up from the Blood Bank the blood must be returned to the Blood Bank An IV Certified LVN must verify information on the Transfusion Record form compatibility tag unit label and patient identification bracelet with an RN or MD not another LVN Unhung blood product may not accompany a patient during transfer to another area of the hospital Blood may accompany a patient during transfer only if the product is hung and infusing Members of the healthcare team have specific roles in the preparation administration and monitoring of blood blood product transfusions Policies and procedures are i
196. or detecting partner violence in the emergency department JAMA 1997 277 1357 1361 7 Collaborative for Alternates to Violence and Abuse CAVA Intimate Partner Violence IPV A Community Response A Training for Healthcare Providers 2005 Bibliography Adult sexual assault In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2007 Policy No 332A Child abuse and neglect In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2006 Policy No 332B Fountain K Pierce B Child abuse and neglect In Newberry L ed Sheehy s Emergency Nursing Principles and Practice 5 ed St Louis Mosby 2003 744 762 Grausz HM Pelucio MT Adolescent Violence Emergency Medicine Clinics of North America 1999 17 595 602 Intimate partner violence domestic violence In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2008 Policy No 332C Mitchell C Kuelbs C Advanced Training in Domestic Violence for Healthcare Providers California Medical Training Center 2001 Suspected abuse or neglect of dependent adults or elders In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2009 Policy No 332D Reorientation Manual 2010 MandSec FamilyViolence doc Nursing Department Reorientation Self Study Guide Mandated
197. or for specialized procedures Employees must be aware of the specific safety devices being used in their department B Effective sharps handling techniques 1 All procedures involving the use of sharps in connection with patient care eg withdrawing body fluids accessing a vein or artery or administering vaccines medications or fluids shall be performed using effective handling techniques and other methods designed to minimize the risk of a sharps injury Policies and procedures identify work practices that describe effective techniques and other methods designed to minimize the risk of sharps injuries C Disposal of sharps 1 Use activation of safety device safety devices eg shielded winged needle sliding needle guard snap over needle guard must be activated before disposal in the sharps container Sixty two percent of all reported needlestick injuries are associated with hollow bore needles such as hypodermic winged steel IV stylet and phlebotomy needles In the absence of a built in safety device the needle is to be protected by the red Point Lok device prior to disposal The safety feature or Point Lok must be used for all needles Ten percent to 25 of needlestick injuries occur when recapping a used needle Never bend recap or shear contaminated needles and sharps The only exceptions are if a Required by specific medical procedure such procedures must be identified by the department and spe
198. or inspect their health record and obtain a copy from their health care provider Patients may access or copy their health records as long as the information is retained There are few exceptions to access related to psychotherapy notes and protections under state law 2 Right to Amend Patients have the right to request an amendment to their medical record The request must be put in writing and submitted to Medical Records The organization will then review and determine agreement or disagreement The request for amendment becomes part of the permanent medical record 3 Right to Account for Disclosures Patients have the right to request a list of when and where their confidential information was released within the last six months the date of the disclosure the name of the person or entity who received the information and address and a brief description of the reason for the disclosure The exception is for treatment payment or healthcare operations 4 Right to Request Restrictions Patients have the right to request their provider or hospital to restrict the use and disclosure release of their confidential information however the provider or hospital is not required to comply with the restrictions if the use and disclosure do not otherwise violate HIPAA Privacy Standards 5 Right to File a Complaint Patients have the right to file a complaint if they believe their privacy rights were violated 6 Right to Receive Notice Pa
199. or will 1 Page the Crisis Response Team nursing team members at the dedicated beeper number 2 Overhead page Code Green and specify the patient location including the room bed number 2 When the CRT arrives additional attempts will be made to de escalate the emergency before behavioral restraints seclusion are initiated by the Crisis Response Team Restraints shall be implemented in the least restrictive manner possible in accordance with safe and appropriate restraining techniques and used only when less restrictive measures have been found to be ineffective The patient s plan of care will be modified as appropriate The patient shall be evaluated and treated for any injuries Licensed Independent Practitioners and qualified nursing staff are authorized to remove restraints prior to the expiration of the order if appropriate If a patient commits a crime the staff must contact the Sheriff Department at ext 3311 VI ROLES AND RESPONSIBILITIES A The Licensed Independent Practitioner s responsibilities include 1 Completing a face to face assessment of the patient s current clinical condition including the following a An evaluation of the patient s immediate situation b The patient s reaction to the intervention Nursing Department Reorientation Self Study Guide Mandated Section 30 4 5 Patient Care Management The patient s medical and behavioral condition The need to continue or te
200. organisms Virulence and potency of the organisms Source of the organisms Ability of the organisms to enter the body Ability of the organisms to establish themselves within the body ELEMENTS THAT AFFECT AN ORGANISM S MULTIPLICATION AND GROWTH A B Food supply All organisms need an adequate supply of nourishment in order to thrive Water Organisms multiply rapidly in a moist environment Oxygen Some organisms require oxygen Oz to live while others do not Organisms which cause tetanus and gangrene do not require O2 Temperature Each class of organism has a temperature at which it thrives Most organisms multiply and grow readily in a warm environment pH alkalinity or acidity of a medium Microorganisms are sensitive to pH changes Solutions used for terminal and daily routine cleaning will alter pH on various types of surfaces decreasing the ability of organisms to grow Note Terminal cleaning is the cleaning of a room and equipment after a patient has been discharged from the room Nursing Department Reorientation Self Study Guide Mandated Section 68 F Infection Control Issues Light Microorganisms are inhibited or destroyed by ultraviolet light and usually thrive best in a dark environment IV FACTORS INFLUENCING THE SUSCEPTIBILITY OF THE HOST A Stress Individuals whose stress levels are elevated and or who have been exposed to stressors for long periods of time may have little energy l
201. orne Patients need to wear a mask only when leaving their isolation room E Initiation of chemotherapy Effective chemotherapy reduces coughing the amount of secretions and the number of organisms in the sputum When a patient is receiving chemotherapy as part of his her TB treatment the nurse must ensure that the patient takes his her anti TB medications as well F Further patient teaching 1 2 6 Inform patients to stay in their rooms keeping the doors closed at all times Instruct patients to cover their mouth nose and cough or sneeze into tissues Instruct visitors about the importance of wearing a mask properly when in a patient s room Educate patients on the importance of following the drug therapy airborne precautions and the need to continue to see their physician Make efforts to decrease the patient s feelings of anxiety and social isolation associated with the implementation of airborne precautions Document patient and visitor education in the medical record G Regular TB surveillance in employees refer to TB Control Policy for more detailed information 1 Employees receive pre employment screening for TB disease All employees are required to be screened at least annually thereafter 2 TB surveillance a For employees with a history of negative PPD skin test a skin test is placed annually Employees working in high risk areas will be skin tested every 6 months see TB Control Policy for more deta
202. ou must complete Reorientation Manual 2010 MandSec RadiationSafetyProgram doc Nursing Department Reorientation Self Study Guide Mandated Section 141 Clinical Competency Section Direct Care Licensed Staff Only NURSING DEPARTMENT REORIENTATION SELF STUDY GUIDE CLINICAL COMPETENCIES TABLE OF CONTENTS Rapid Recognition and Response ccesccscescssesceesceseeeessesseesecaeesecsaesecsaecesssecaeesecneeseesaeeesseesaeeeesaecaeesaeenesaeeaeeaesaeeaeeneees 2 Blood Products and Transfusions c cccccccccsessscsscsecessessecesccccecsesseessesscesssssessesecessesssessssececsesscasssssescsessnssesssesseesesenes 10 INSTRUCTIONS FOR CLINICAL COMPETENCIES 1 Review the content in each section 2 Complete the study questions at the end of each section 3 Check your answers against the answer key provided for each set of study questions 4 Complete the Clinical Competencies test and submit during Skills Assessment Workshop If Clinical Competencies are not completed during Skills Assessment Workshop bring completed test to Clinical Professional Development Building N 18 Monday thru Friday except county holidays between the hours of 0730 1630 5 The Clinical Competencies test consists of two sections Rapid Recognition and Response to Changes in Patient Condition and Blood Products and Transfusion There are a total of 15 questions on the test divided in two sections Rapid Recognition and Response to Changes in
203. pace 2 Respond promptly to the patient s request for help Answer the patient call light as soon as possible provide information or a reason for delay of service treatment 3 Decrease environmental stimuli Encourage all patients in a room to help maintain a reasonable noise level with their visitors telephone conversations television or radios Also keep the lights dim during sleeping hours 4 Increase the frequency of interactions Visit the patient more frequently when the patient is confused or having episodes of disorientation Provide a companion to stay with the patient to observe the patient keep the patient safe and oriented 5 Provide clocks and calendars Orient the patient to time and place and point out assistive devices like clocks and calendars 6 Involve the patient in diversion activities and meaningful activity exercise Have the patient perform simple repetitive tasks eg word games and other such activities Designate a safe area for the patient to ambulate if condition allows 7 Music therapy Offer to call the volunteer office to borrow a tape recorder and audio cassettes Nursing Department Reorientation Self Study Guide Mandated Section 29 E Patient Care Management and or ask the family to bring the patient s favorite musical tapes Research has shown that listening to music over a period of time can decrease the patient s level of anxiety Support systems 1 In house coun
204. pain rating shall be documented as such in the medical record 6 Therapeutic interventions should not be decided solely based on proxy pain report 7 Vital signs may be considered with caution during a proxy pain assessment Vital sign changes occur only in acute pain not chronic pain Additionally many conditions eg fever and drugs eg beta blockers can alter the normal physiologic responses to pain d Assumed pain present When a patient is unable to self report and condition or therapy renders use of an established pain assessment tool inappropriate eg patient is receiving neuromuscular blockers and or is on heavy sedation a pain treatment plan may be initiated based on assumed pain present Examples of criteria that may be used to determine the presence absence of assumed pain include 1 Presence of pathologic conditions or procedures that usually cause pain eg trauma surgery 2 Behaviors such as facial expressions body movements groaning crying 3 Physiologic measures eg changes in heart rate blood pressure intracranial pressure these are often the least sensitive indicators of pain in the critically ill patient If the nurse thinks the patient is having pain following assessment based on the above criteria the nurse will record Assumed Pain Present A numeric score is not assigned Nursing Department Reorientation Self Study Guide Mandated Section 59 Patient Care Management 3 Pain rating
205. r s room or nursery The mothers who deliver babies at Harbor UCLA are instructed not to give their baby away to anyone without a pink identification badge Staff without a pink identification badge who must remove a baby from a mother s room for any reason must first inform the mother s nurse The nurse with the pink identification badge will then inform the mother that the removal of the baby is necessary VII PROCESSES FOR REPORTING A SECURITY INCIDENT THAT INVOLVES PATIENTS VISITORS PERSONNEL OR PROPERTY A Bea good witness by noting any relevant details eg people time place injuries or loss regarding the incident B Notify one s supervisor and the Sheriff Department at ext 3311 PLEASE COMPLETE THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 126 Environment of Care Issue SECURITY Study Questions Select the best answer to each question DO NOT write in the manual 1 The telephone number within the Medical Center to contact the Sheriff s Department is a 3333 b 3311 c 3113 d 1234 If a stranger or unknown person is in a work area all of the following actions should be taken EXCEPT a Notify Sheriff s Deputies or Security b Ignore the person and avoid eye contact c Ask the subject if he she is lost or needs help d Note their description anything out of the ordinary and evaluate his her behavior If an employee receives a phone
206. r still does not operate use the telephone in the panel under the control board to notify the operator Give the operator the number of the elevator in which you are located posted above the control panel 3 If there is a patient in the elevator check the patient s condition treat if necessary and then follow the procedure in step two Where are the medical gas valves located in your area Who is authorized to shut off medical gas valves Refer to the list on the following page for medical gas valve locations Only Clinical Staff or the Facilities Management and or the Fire Department with the guidance of clinical staff are authorized to shut off this medical gas valve Nursing Department Reorientation Self Study Guide Mandated Section 101 Environment of Care Issues MEDICAL GAS VALVE LOCATIONS AREA SERVED 8E Heart Station TW Ward 7E Labor Rooms and Nurseries TE Delivery Suites TE Nursery 1 TE Nursery 2 6W ICU Ward 6E Ward ICU NICU SW Ward SE Ward ICU GCRC 4W Ward CCU 4E Ward 3W Ward 3W Isolation rooms 7 amp 8 3W ICU CTU 3E Ward 2E Surgery Suites 2E Monitor Room 2E PACU 2W 10 and Peds ER 2W 41 Radiology 2B 8 Urology Clinic 2B 9 Urology Clinic 2B 7 Urology Clinic 2B 6 Urology Clinic 2B 10 Urology Clinic 2F 7 ENT Clinic 2G 9 Eye Clinic 1B 2 1F 3 1F 13 Peds Clinic 1 floor Peds ER 1A 6 Dental Clinic 1 floor ER RX 1 amp 2 1K 4 1J 5 1J 6 1 floor CT Sca
207. rates on chest xray Anti HLA or anti granulocyte antibodies in the donor plasma are the most common etiology This causes sequestration and degranulation of WBCs in the pulmonary capillary bed DELAYED TRANSFUSION REACTIONS 2 14 days post transfusion can occur from 3 days to several weeks post transfusion Occurs over time in patients who chronically receive transfusions 7 14 days post transfusion SIGNS AND SYMPTOMS Fever mild jaundice decreased hematocrit hnemoglobin Congestive heart failure dysrhythmias diabetes cirrhosis Fever faint red rash diarrhea hepatitis The destruction of transfused RBC s by alloantibodies not detectable during pre transfusion testing Deposition of iron in the heart endocrine organs liver spleen skin and other major organs as a result of multiple gt 100 long term transfusions Replication of donor lymphocytes in the transfused patient NONIMMUNOLOGIC COMPLICATIONS Incubation period 1 6 months Incubation period 2 weeks 3 1 2 months May be asymptomatic for several years or develop flu like syndrome within 2 4 weeks Anorexia malaise nausea vomiting fever dark urine jaundice Similar to Hepatitis B but less severe Night sweats unexplained weight loss diarrhea fever lymphadenopathy Transfusion of Hepatitis B infected blood product Transfusion of Hepatitis C infected blood products Transfusion of HIV in
208. rea Conference Room 1L 1 next to the Doctors Dining Room by the Ambulance Entrance B Command Post Building 1 East Surgery amp Anesthesiology department offices C Labor Pool Employee Public Cafeteria This is the labor pool for all non physician personnel D Physicians Labor Pool Resident s Lounge Room 1L 4 adjacent to the Doctors Dining Room Nursing Department Reorientation Self Study Guide Mandated Section 114 Environment of Care Issues E Mass casualty Triage Area Ambulance Ramp IV ALTERNATE COMMUNICATIONS If a disaster disables Harbor UCLA s phone system the hospital can use the following alternate means of communication A Internal communications 1 4 Two way radios Radios have been pre deployed to all inpatient nursing units the Nursing Service Office the Centrex operator and some ancillary departments HICS officers receive these radios during a Code Triage incident E mail The Command Post e mail address is HUCLACodeTriageCommandPost dhs lacounty gov Runners Staff or volunteers delivering written messages Runners MUST know where to deliver messages and how to get there Cell phones Appropriate for small scale incidents that only affect the hospital B External communications 1 2 6 HAM radios The most reliable means of external disaster communications ReddiNet A closed e mail system that links County and private emergency rooms to the County s E
209. remains operational keep it plugged in at all times even when not in use Never use any electrical equipment if a The cord or plug feels warm b Any suspicious odors are coming from equipment c Equipment operates erratically One must never attempt to repair electrical equipment Nursing Department Reorientation Self Study Guide Mandated Section 99 Environment of Care Issues To report equipment in need of repair or to report a mechanical emergency call ext 3301 Monday Friday 0730 1600 On county observed holidays and at all other times call ext 3326 When working in patient rooms never touch the patient and the equipment at the same time since one s body can act as a conductor of electricity from the equipment to the patient One may not feel the shock because one may be less sensitive to electricity than the patient However the patient may be more electrically sensitive because of wet skin pressure sores and or catheters C Observe the following when working with defibrillators 1 Direct all personnel to Stand Clear of the bed and any equipment in contact with the patient prior to the discharge of the electrical energy from the defibrillator Remove any excess conductive gel or moisture from the chest wall prior to the release of a charge of joules to help prevent arcing Remove nitroglycerin paste or patches from the chest to help prevent arcing Remove oxygen from the immediate environment to prevent
210. rminate the restraint or seclusion Alternative intervention methods attempted or considered prior to restraints seclusion Indications justifications for restraints seclusion moan Providing a written order if restraint and or seclusion is clinically justified Conducting an in person re evaluation prior to expiration of original order PRN orders are not accepted Participating in daily reviews of restraints and or seclusion use related to his her patients Consulting with support services eg Social Work Occupational Therapy Recreational Therapy and Dietary Services as needed The above is applicable for the physician primarily responsible for the patient s ongoing care orders For behavioral restraint an attending physician is consulted as soon as possible if he she did not order the restraints seclusion B The Registered Nurse s responsibilities include 1 Crisis Response Team RN a Serves as a team leader for the Crisis Response Team b May initiate restraints seclusion in an emergency without a physician order All RN s a Ensuring that the behavior necessitation use of restraints and alternatives considered tried are documented in the medical record b Ensuring the patient is advised on the purpose of restraints and or seclusion and the circumstances under which the restraints and or seclusion shall be discontinued c Completing and documenting an initial assessment and ongoing reassessment d Assuring that
211. rs or younger may not be used as interpreters under any circumstances LEGAL REQUIREMENTS A Title VI of the Civil Rights Act of 1964 and other federal State and Joint Commission regulations and standards require that we provide linguistic accessibility to LEP persons to ensure meaningful access to programs and services 1 Linguistic access is defined as immediate responsiveness to individual linguistic needs so that an LEP or hearing speech impaired person can effectively communicate with healthcare providers 2 Interpreter Services must be available at all times and at no cost to the patient HI GUIDELINES FOR ACCESSING INTERPRETER SERVICES A Harbor UCLA Medical Center has a Language Center located in Bldg N 17 ext 6557 with dedicated full time interpreters To maximize the use of the in house interpreters Harbor UCLA has deployed Video Medical Interpreting VMI equipment and various telephone technologies ie Polycom speaker phones dual handheld cordless phones handset splitters as well as participate in the Healthcare Interpreter Network HCIN HCIN participation allows hospitals to share interpreter services whereby health system based interpreters from numerous California public hospitals and Language Line telephonic interpretering services are available 24 hours 7 days a week via real time videoconferencing and various telephone technologies with an average connect time of less than one minute The following are
212. rs who are not direct care providers should receive the minimum information necessary Anyone not involved in the patient s healthcare should receive PHI only with the patient s consent IV PROTECTED HEALTH INFORMATION PHI A The term protected health information as defined in HIPAA means any health information created or received by a health care provider health plan employer life insurer school or university The information is protected because it contains confidential information This information can be found in 1 Medical records 2 Insurance claims information 3 Payment information 4 Almost all information related to a person s health care The privacy rules place limits on the use and disclosure of a person s protected health information or PHI Protected health information is defined as any health information that could reveal the identity of a patient such as 1 The patient s name address or phone number 2 The patient s health insurance number 3 The patient s social security number 4 Any other information that identifies a patient It is critical for organizations to determine strategies to protect a patient s health information One method is identifying the minimum necessary information that individuals need to access in order to perform their job duties This is accomplished through security codes and limits access V CONFIDENTIALITY A Privacy of PHI is important to patients
213. ry wax remover paint glasses minimize organic remover inhalation Nursing Department Reorientation Self Study Guide Mandated Section 130 Il HAZARD CLASS TABLE Continued Environment of Care Issues description of any material that causes sickness if ingested touched or inhaled Reactive oxidizers and corrosives and some that may have other characteristics such as Halon or insecticides HAZARD DEFINITION EXAMPLE PRECAUTIONS CLASS Toxic This class is a general All the above Avoid skin contact inhalation and ingestion Toxic subclass Materials that can cause sickness or death even from Mercury phenol Store under lock and key Take extreme care to avoid much a hazard as flammables but still burn easily curtains Extremely cyanide azide Toxic or exposure to small quantities cacodylic acid osmium skin contact inhalation and Poison tetroxide ingestion Toxic Materials that increase the Antineoplastic Take extreme care to avoid Subclass probability of contracting medication skin contact inhalation and Carcinogen cancer Chemotherapy ingestion formalin chromium benzene arsenic Toxic Materials that could decrease Nitrous oxide Take extreme care to avoid Subclass reproduction and may cause ribavirin ethylene skin contact inhalation and Teratogen birth defects oxide ingestion Combustible Materials which are not quite as Diesel paper rags
214. s 2 Each Standard has implementation specifications There are two 2 types of implementation specifications a Required Must be followed as they are written in the Security Rule Nursing Department Reorientation Self Study Guide Mandated Section 20 Patient Care Management Addressable Must be implemented if reasonable and appropriate for the organization If not implemented an explanation for why it was not reasonable or appropriate must be provided Note Addressable does NOT mean optional These must be addressed either through implementation or explanation XII ADMINISTRATIVE SAFEGUARDS Administrative Safeguards require written documentation of the security measures Policies and procedures must ensure prevention detection containment and correction of security violations Policies and procedures must also ensure that all workforce members have appropriate access to electronic PHI in order to perform their job A These documented measures policies and procedures must be kept on file for at least 6 years and updated through periodic review A review might be triggered by an established review cycle a change in technology or a new security threat or incident 1 The Security Rule requires that each organization implements Administrative Safeguard policies and procedures regarding a b Risk analysis an accurate review of the risks involved in meeting the confidentiality integrity and availability of
215. s Each compartment has its own staircase The basement and floors 1 and 2 have more than three smoke compartments and exit staircases See the floor plan posted in your area for evacuation routes and instructions NEVER USE AN ELEVATOR DURING A FIRE F Evacuation Equipment 1 2 3 MedSleds For vertical evacuation on non ambulatory wheelchair and non ambulatory special needs patients Wheelchairs Gurneys G Patient Preparation for vertical Evacuation of Inpatients 1 Assess the patient s color coded Evacuation Triage Status 2 Place the appropriate colored Evacuation Triage Status tag on the patient s gown shirt dress 3 Tape the patient s ID card to his her Kardex and staple the patient s Kardex to their gown 4 For vertical evacuation secure non ambulatory patient to MedSled FIRE SCIENCE Three elements must be present to create a fire These elements are Heat Fuel Oxygen This is known as the fire triangle To extinguish a fire the triangle must be broken by eliminating at least one of the 3 elements Portable fire extinguishers are designed and formulated to break up the fire triangle CLASSES OF FIRES A Class A Combustibles such as wood paper trash linens These fires are deep burning Use extinguishers that are marked either A water or ABC dry powder Class B Chemicals such as burning liquids eg gasoline paint alcohol cooking grease Use extinguishers marked either
216. s a The following severity levels apply for pain scores that use a scale of 0 10 Mild pain 1 3 Moderate pain 4 6 Severe pain 7 10 b For most patients a pain rating of greater than 3 on a 0 10 scale signals the need to either initiate or revise pain interventions Revisions to the pain treatment plan may include adding or changing analgesics increasing an analgesic dose and or adding a non pharmacological strategy B Treatment Pain treatment is based upon underlying principles of pain management and analgesic pharmacology standard guidelines for opioid dosing titration and opioid equivalency non opioid treatment of chronic pain syndromes and pain management protocols The following principles of pain management should be followed 1 When possible provide treatment that is specific to a patient s diagnosis as well as to potentially painful procedures 2 Do not use a placebo in the assessment or management of pain unless it is a part of a clinical study approved by the hospital s Institutional Review Board 3 Assess the results of treatment and adjust therapy accordingly until the best possible outcome is achieved Use pharmacological and non pharmacological interventions to achieve optimum pain relief 4 Provide the patient with realistic goals and expectations A pain free hospital or healthcare experience is not always realistic but minimizing of pain and managing of unavoidable induced pain are realisti
217. s Transfusion Administration and Monitoring In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2005 Policy 317B Department of Pathology Harbor UCLA Medical Center Laboratory User s Manual Hudson OH Lexi Comp Inc 2006 Infusion nursing standards of practice Journal of Infusion Nursing 2006 29 15 S4 S90 National Blood Resource Education Program s Nursing Education Working Group Transfusion Therapy Guidelines for Nurses NIH Publication 90 2668 Bethesda MD National Institutes of Health 2002 Nettina SM The Lippincott Manual of Nursing Practice 8th ed Philadelphia PA Lippincott Williams amp Wilkins 2006 783 791 Reorientation Manual 2010 ClinicalCompetency Blood_Products_and_Transfusions doc Nursing Department Reorientation Self Study Guide Clinical Competencies 25
218. sed the injuries photographs of injuries and behaviors noted Documentation is necessary and important Complete documentation can support the victim s case in court LEGAL ISSUES A Reporting requirements To provide for the safety of the victim there are mandated reporting requirements for health practitioners when abuse is detected or suspected Health practitioners are defined as a physician or surgeon resident intern and licensed nurse as well as others For the full definition see State of California Penal Code Section 1165B At Harbor UCLA Medical Center County Police and the Clinical Social Service Department can be contacted to assist with reporting the abuse Nursing Department Reorientation Self Study Guide Mandated Section 52 Patient Care Management The requirements are as follows L Child Abuse The State of California Penal Code mandates that all health practitioners report incidents of suspected abuse or neglect of children to a child protective agency immediately or as soon as possible by telephone They must also prepare and send a written report within 36 hours of receiving the information Reporting is mandatory even if there is not a current injury A child is defined as any person under the age of 18 years The 24 hour Department of Child Protective Services DCS hotline number is 1 800 540 4000 Elder dependent adult abuse State law AB 3988 mandates all healthcare providers to report incidents o
219. seling Offer the patient the opportunity for counseling by referring him her to the chaplain or social services to increase social support 2 Community support Encourage the patient and family to contact friends church members and other people who may offer the patient and family emotional support in their own environment V ACTIVATION OF CRISIS RESPONSE TEAM CRT Harbor UCLA Medical Center uses a Crisis Response Team CRT to respond in any emergency situations in which their assistance is requested for behavioral management of patients The team works with unit staff to diffuse crisis situations maintain safety and to initiate behavioral restraint seclusion if necessary The CRT provides 24 hour 7 day week coverage throughout the hospital to assist in these emergencies Code Green is the code identified to activate the CRT A E When alternatives have failed to de escalate violent aggressive behavior in patients that represents an immediate and serious danger to safety a Code Green will be called to activate the Crisis Response Team CRT which consists of one trained behavioral health registered nurse Team Leader and 4 other behavioral health nursing staff members 1 To activate Code Green a Dial ext 111 b Caller to 1 Provide his her name 2 Identify the emergency as a Code Green 3 Identify the location unit room bed number and telephone extension 4 Provide a brief description of the situation c The operat
220. side to side a True b False Answers to Study Questions l a 2 d 3 4 d 5 C 6 b 7 a 8 b 9 d 10 a If you answered all of the questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions Bibliography Fire safety management plan In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2007 Policy 409 Reporting fire and life safety failures and user errors In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2004 Policy 468 Reorientation Manual 2010 MandSec FireLifeSafety doc Nursing Department Reorientation Self Study Guide Mandated Section 112 Environment of Care Issues EMERGENCY PREPAREDNESS Objectives Upon completion of this section the employee will be able to 1 2 Discuss Code Triage Describe the elements of the Hospital Emergency Incident Command System HEICS List alternate forms of emergency communication Identify the location of key emergency management stations Describe his her disaster response role and responsibilities in a Code Triage incident Identify potential bioterrorism syndromes and describe how to report the presence of patients suspected or known to have been victims of bioterrorism Describe how to report the presence of patients suspected or known to have been exposed to
221. situations where the use of force is required the deputy ensures that the incident and actions taken are documented in the Use of Force Report Form In situations where use of force involves pepper spray tasers or batons on a patient appropriate clinical staff Hospital Administration and Sheriff s Department personnel shall 1 Meet to review and evaluate the events leading up to the incident and the actions taken by clinical and law enforcement personnel within 72 hours 2 Identify appropriate measures to minimize the possibility of similar occurrences in the future as well as ensure the incident was appropriately documented 3 Document the results of this review and evaluation using the Administrative Review form I EMPLOYEE IDENTIFICATION BADGES A B The Sheriff s Department requires all hospital staff to have and wear a photo identification badge while on the grounds of Harbor UCLA Medical Center Persons without identification should be questioned Persons with IDENTIFICATION NOT RECOGNIZED should also be questioned Federal law requires that a police report must be filed for all lost or stolen government identification Ill REPORTING SUSPICIOUS PERSONS A It is important to report suspicious persons to the Sheriff Department When encountering a person in a work area that does not belong the first and most important thing to do is to acknowledge that person Upon acknowledging a strange person if he she does no
222. spilled blood and body fluids until completely covered and liquid is absorbed and becomes semi solid Remove gloves discard and wash hands d Call Environmental Services Supervisor or Office at ext 3350 Environmental Services will remove the semi solid material with a dust pan and whisk broom or spatula dispose of it in a red bag and remove from the unit e Clean and disinfect the contaminated area with a hospital grade germicidal detergent f After disposing of waste properly wash hands thoroughly p An absorbent powder is used to treat liquid medical waste in suction canisters by sanitization and solidification Properly labeled treated waste is then disposed of in a red bag and sent to the autoclave on the loading dock for sterilization before final disposal F Work environment 1 2 All employees are responsible to help keep the facility clean and safe Environmental Services is responsible for the routine cleaning of the facility final cleanup of a medical waste spill and replacing and locking sharps containers A written schedule for cleaning work sites and methods of decontamination will be followed by Environmental Services All solutions used for cleaning disinfecting equipment surfaces are to be approved by the Infection Control Committee prior to its purchase Surfaces and equipment contaminated with blood or body fluids are cleaned with a detergent solution followed by a disinfectant spray DO NOT flood
223. straints Describe how often an opportunity for elimination food and fluid intake and range of motion must be provided for patients in restraints Instructions to the Employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 25 Patient Care Management USE OF RESTRAINTS AND SECLUSION I ORGANIZATIONAL PHILOSOPHY Harbor UCLA Medical Center is committed to preserving the dignity safety comfort and personal freedom of each individual seeking medical or psychiatric care Our goal is to prevent reduce and attempt to eliminate the use of restraints and seclusion throughout the facility by raising the level of awareness and competence among staff through education focused on the use of restraint or seclusion Restriction of a patient s physical freedom of movement by the application of restraints will only be carried out in those situations where appropriate alternative non physical interventions have been considered attempted and deemed ineffective The organization is committed to utilizing non violent physical crisis interventions to control and prevent crisis situations that have the potential to lead to the use of restraints and seclusion Il DEFINITION A This section addresses the use of restraints in all clinical areas As defined by the Centers for Medicare Medicaid Services CMS 1 Restraint a A
224. t who has developed IgA antibody Fluid administered faster than the circulation can accommodate Infusion of contaminated blood products Blood Products and Transfusion PREVENTION Verify and document patient identification from sample collection to transfusion Administer blood products with leukocyte depleting filter Treat prophylactically with antihistamines Transfused washed or deglycerolized RBC s or use blood from IgA deficient donor Adjust flow rate based on patient s condition Have blood bank split units of blood products for patients at risk for fluid overload Collect process and store blood according to blood bank regulations Examine blood components carefully before administration for purplish discoloration visible gas bubbles or obvious clots Start transfusions within 20 minutes of blood pick up and complete within 4 hours Nursing Department Reorientation Self Study Guide Clinical Competencies 20 Blood Products and Transfusion REACTION TYPE Transfusion Related Acute Lung Injury TRALI REACTION TYPE Delayed Hemolytic Iron Overload disease Hepatitis B Hepatitis C HIV 1 Graft versus host TRANSFUSION REACTIONS During the transfusion or up to 6 hours following the transfusion SIGNS AND SYMPTOMS Dyspnea cyanosis hypoxemia fever hypotension chills non cardiogenic pulmonary edema infilt
225. t Reorientation Self Study Guide Mandated Section 73 Infection Control Issues BLOODBORNE PATHOGENS AND HEALTHCARE WORKERS Objectives Upon completion of this section the employee will be able to 1 Identify the location of the Bloodborne Pathogen Exposure Control Plan in his her unit 2 Identify the three primary bloodborne pathogens that are of concern to the healthcare worker 3 Identify sources of bloodborne pathogens 4 Indicate which bloodborne pathogen infection can be prevented by a vaccine 5 Discuss the selection use and removal of personal protective equipment PPE 6 Describe the containment and decontamination process for a visible body fluid spill in a patient care area 7 Explain the procedure to follow when sharps needlestick injury or mucous membrane exposure occurs Instructions to the Employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 74 Il MI Infection Control Issues BLOODBORNE PATHOGENS AND HEALTHCARE WORKERS PURPOSE A The Bloodborne Pathogen Exposure Control Plan describes measures policies procedures work practices special equipment to eliminate or minimize employee occupational exposure to blood or other fluids that comply with Cal OSHA Bloodborne Pathogen Standard CCR Title 8 5193 EMPLOYEE RESPONSIBILITY A OSHA Bloodborne Pathogen Standards cover
226. t be included on the label of the container 3 Describe the proper storage procedure for hazardous materials 4 Identify proper use of personal protective equipment 5 Describe proper disposal of chemical hazardous waste medical waste including sharps trace and bulk antineoplastic chemotherapy waste other pharmaceutical waste and empty glass containers 6 Identify three main routes of exposure to cytotoxic or antineoplastic chemotherapy drugs Instructions to the Employee Please read the following section and then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 129 Environment of Care Issues HAZARDOUS MATERIALS COMMUNICATION AND SAFETY PROGRAM Note This section highlights information from the Hazardous Materials and Wastes Training Manual This manual is present in all departments if it is not available call the HazMat office at ext 2835 fora copy A Respiratory Protection Plan a Medical Waste Management Plan and the Antineoplastic Chemotherapy Medication as a Hazardous Material Manual may also be obtained The employee is responsible for complying with the information in the manuals and plan I HAZARDOUS MATERIALS IDENTIFICATION A The LABEL on a container holding a hazardous material must be marked with the CHEMICAL IDENTITY and HAZARD CLASS of the most dangerous components B There must be a Materials Safety Data Sheet MSDS available at
227. t information will be completed by a licensed nurse reviewed with and handed to the non licensed escort prior to transport Exceptions a When the patient is transported to OR L amp D OSSA Endoscopy Cath Lab Interventional Radiology OR if a pre op pre procedure checklist has been completed for the patient a Ticket to Ride does not have to be completed For admissions ER clinic or inter unit transfers the Ticket to Ride form is not used c Ifthe patient is transported by an RN to another area then it does NOT have to be done Nursing Hand off Communication guidelines specific to the area apply 2 The non licensed staff member will hand the form to the provider in the receiving diagnostic procedural or clinical area for review 3 Upon return to the originating area or unit the non licensed staff member should hand the form to the accountable nurse who will document the time the patient returned and place the form in the patient whereabouts binder to be retained for one month or the duration of the patient s inpatient stay whichever is longer Nursing Department Reorientation Self Study Guide Mandated Section 45 Patient Care Management IV INTERDISCIPLINARY HAND OFFS The primary objective of any patient hand off is the accurate transfer of information in a systematic manner that is timely and explicitly understood When communicating with physicians and other interdisciplinary team members who are not
228. t one s shoulder and elbow Nursing Department Reorientation Self Study Guide Mandated Section 11 Patient Care Management Customize your computer settings The screen font contrast color etc can be adjusted to maximize comfort and efficiency Reduce glare Place one s monitor away from bright lights and windows Use an optical glass glare filter when necessary Take eye breaks and intermittently refocus on distant objects Work at a reasonable pace and take frequent stretch breaks Take 1 or 2 minute breaks every 20 30 minutes and 5 minute breaks every hour Every few hours try to get up and move around Wrist rest Document holder Is same height and distance from the user as the screen Screen Is slightly below eye level Desk or table top allows leg room Su for pport to and posture adjustments lower back Seat height and angle allows comfortable posture Feet rest comfortably on floor or footrest A well designed computer workstation Nursing Department Reorientation Self Study Guide Mandated Section 12 VII Patient Care Management HOW AND TO WHOM TO REPORT ERGONOMICS ISSUES A Always report any symptoms or concerns to one s immediate supervisor B One may also contact the Safety Officer at ext 2835 VII THE IMPORTANCE OF REPORTING ERGONOMICS ISSUES A Injuries can be prevented or reduced in severity by employing the engineering and administrative controls previously d
229. t provide a valid explanation of why he she is there notify Sheriff Department immediately Nursing Department Reorientation Self Study Guide Mandated Section 123 B Environment of Care Issue Use the acronym DANGER to respond to a suspicious person Do approach strangers in one s area Ask if you can be of assistance Note anything out of the ordinary Give information or assistance if needed Evaluate what one sees and hears Report suspicious circumstances immediately to the Sheriff Department at ext 3311 Be prepared to include a description of the person s including gender age hair color height weight clothing mode of transportation if applicable IV WORKPLACE VIOLENCE PREVENTION A Healthcare providers routinely care for patients and visitors in a state of heightened emotional stress due to the illness injury they or their loved one has suffered When in this state patients and visitors can become defensive less tolerant and lose some process for rational thought When confronted with long delays and often unsatisfactory solutions to their problem they can act out A variety of forces can impact and trigger an incident of workplace violence or assault Recognition of behavioral problems prompt intervention and strict enforcement of policies is the best solution to prevent these incidents There are four classifications of workplace assaults 1 Customer Client These are simple non fatal assaults
230. t section If you missed one or more read the content again and repeat the study guide questions Bibliography Emergency management plan In Hospital and Medical Administration Policy and Procedure Manual Torrance Calif Harbor UCLA Medical Center 2010 Policy No 408 Emergency management purpose and plan In Emergency Preparedness and Management Manual Torrance Calif Harbor UCLA Medical Center 2008 Policy EPP1 Emergency Preparedness and Management Manual Torrance Calif Harbor UCLA Medical Center 2009 Hospital emergency incident command system HEICS In Emergency Preparedness and Management Manual Torrance Calif Harbor UCLA Medical Center 2005 Policy EPPS Reorientation Manual 2010 MandSec EmergencyPreparedness doc Nursing Department Reorientation Self Study Guide Mandated Section 121 Environment of Care Issue SECURITY Objectives Upon completion of this section the employee will be able to 1 Identify different roles of the Los Angeles County Sheriff Deputies at Harbor UCLA Medical Center 2 Describe actions to minimize security risks 3 Identify sensitive high security risk areas of the hospital 4 Discuss the County of Los Angeles Zero Tolerance Policy 5 Identify the process to follow during a telephone bomb threat 6 Define actions to be taken during a Code Pink Instructions to the Employee Please read the following section then answer the study questions at the end of this sectio
231. tely cleanse the affected skin with soap and water c Flood the affected eye at eyewash fountain or sink for at least 15 minutes for an eye exposure d Obtain Medical attention At Harbor UCLA go to the Emergency Room also for inhalation of Hazardous Drugs in powdered form Clean up When a spill occurs the area should be isolated and aerosol generation avoided In Harbor UCLA use the Kendal Chemotherapy Drug SPILL KIT Blue and Green Liquid spill is limited by gently covering with absorbent sheets or spill control pads or pillows a Protective apparel including respirators should be used Most Chemotherapy Drugs are not volatile therefore do not require chemical respirators c All contaminated surfaces should be thoroughly cleaned 3 times with detergent and water then rinsed with clean water Contaminated materials and sharps are disposed of in respective chemotherapy waste containers Spill Kits and disposal containers should be kept near area where the hazardous drugs are used Follow the manufacturer s instructions located on the Spill Kit Use the supplies included in the kit except use your own N 95 respirator It has been fit tested and is better than the one that comes with the kit VII MANAGEMENT OF HAZARDOUS WASTE A Chemical waste is dated and labeled Hazardous Waste and held in the generating department or service in a dedicated area until pick up by the Hazardous Materials Safety Office The Hazardous Mater
232. the backrest Keep your knees equal to or lower than your hips with your feet supported Keep your elbows in a slightly open angle 100 110 degrees with your wrists in a straight position The keyboard tilt can help you attain the correct arm position Avoid overreaching Keep the mouse and keyboard within close reach Center the most frequently used section of the keyboard directly in front of the user Center the monitor in front of the user at arm s length distance and with the screen slightly below his her eye level One should be able to view the screen without turning or tilting one s head up or down Place source documents on a document holder positioned between your monitor and keyboard If there is not enough space place documents on an elevated surface close to the user s screen Use good typing technique Float your arms above the keyboard and keep your wrists straight when keying If one uses a wrist rest one must use it to support his her palms when pausing not while keying Hit the keyboard with light force The average user keys four times harder than necessary Limit repetitive motions Reduce keystrokes with macros and software programs Reduce using the mouse with scroll locks and keystroke combinations Keep wrists straight and hands relaxed when using the mouse with a tight grip or extended fingers above the activation buttons Avoid moving the mouse with one s thumb or wrist Movement should originate a
233. the employee will be able to 1 Identify information resources regarding radiation safety 2 Discuss how radiation exposure occurs in the hospital 3 Identify the basic principles of radiation safety 4 Describe protocols used in case of radiation exposure during an emergency Instructions to the Employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 137 Environment of Care Issues RADIATION SAFETY PROGRAM I HOW IS AN EMPLOYEE EXPOSED TO RADIATION A Working in a hospital may expose an employee to a variety of environmental hazards including radiation This exposure can occur while taking care of a patient who received radioactive materials or while working in areas that have radiation generating machines or sources Sources of radiation Radiation producing machines eg x ray fluoroscopic equipment portable x ray machine a Exposure no longer exists once the exposure switch of the x ray machine is turned off Radiation ceases instantly and neither the patient nor the machine give off any additional radiation Radionuclides used in diagnostic testing small quantities of radioactive materials with short lives tests done on tissue and blood samples in vitro and in vivo eg scan procedures done in nuclear medicine Radioactive materials used in treatment eg radiation implants Il BASIC PRINCIPLES O
234. tients have the right to receive a Notice of Privacy Practices handout which describes how medical information is used and disclosed how to access and obtain a copy of their medical record a summary of patient rights under HIPAA and how to file a complaint and contact information VII REASONABLE PRECAUTIONS A Hospitals and providers must take reasonable steps to ensure that PHI is kept private The government knows however that it is impossible to guarantee the privacy of PHI in ALL situations Certain activities are permitted for example calling out a patient s name in waiting areas as necessary in caring for the patient a physician or nurse talking about a patient s condition or treatment over the phone or shared treatment area with the patient family or other provider Reasonable efforts must be made to protect the patient s privacy such as using lowered voices or talking in a place apart from other people Patient care discussions should not occur in elevators B Organizations create policies procedures and systems to protect patient privacy These include selecting a privacy coordinator providing privacy training for the workforce and identifying sanctions to deal with privacy violations Vill DISCLOSURE A Protected health information may only be used and disclosed for purposes of treatment payment and health care operations PHI may NOT be used or disclosed for any other purposes unless the patient reads dates and s
235. tification for the use of restraints and safety considerations for both patients and staff will be emphasized C There are two distinct types of classifications and guidelines related to the use of restraints 1 Behavioral justifications Used in emergency situations when the patients exhibit violent aggressive and or destructive behaviors which represents imminent risk of an individual s self harm or harm to others Non behavioral justifications medical surgical Used as an adjunct to medical surgical care Includes patients that are restrained for reasons other than violent aggressive or destructive behaviors i e attempting to pull out lines tubes or other necessary medical devices Nursing Department Reorientation Self Study Guide Mandated Section 26 Patient Care Management Ill BEHAVIORAL NON BEHAVIORAL RESTRAINTS A Indications Restraints seclusion are initiated only in those situations where alternative interventions have been attempted and deemed ineffective 1 Behavioral indications 9 Patient is physically threatening to self staff other patients by attempts to hit kick bite etc Patient is verbally threatening staff or other patients with bodily harm and indicates intent to carry out threat Patient is physically destroying property throwing objects breaking windows etc Patient is forcefully grabbing people Patient is expressing a suicidal plan such as jumping out of a window with int
236. tion Check in with your supervisor Check on patients under your care Await further instructions Duck amp cover under desk or table Protect head and avoid glass and outside walls Identify or follow instructions from public safety personnel Administrator designee area of evacuation assembly area and safe evacuation route to get there Initial Response 2ndary Response Call Operator x112 for overhead Code Blue page if necessary Report location Call Operator x112 for overhead Code White page if necessary Report location Have co worker call Operator x11L R eport incident Do NOT use cell phone Call Operator x111 R eport Code Green emergency location Describe situation Appropriately dispose of materials Seek decontamination amp treatment for victims Trained user cleans spill with appropriate materials and personal protective equipment appropriately disposes of material Go to nearest exit watch for 2 Infant or large package carries by adult not escorted by staff a Any child fitting the announced age Use fire extinguisher to extinguish the fire a Pull the pin a Aim the extinguisher a Squeeze the handle a Sweep nozzle at base of fire Managers designees assess area for damage submit Code Triage Status Report form to Command Post Room 1 L 1 ASAP Triage yourself Assess area for damage injury Render first aide Relocate persons in danger Evacuati
237. tion the appropriate phone extension to report the emergency condition and a description of the basic initial secondary and follow up responses to the emergency condition The poster is displayed at each inpatient nurses station outpatient clinic and the office of each Department Chair and Service Director Nursing Department Reorientation Self Study Guide Mandated Section 117 CARDIAC ARREST Adult Code Blue CARDIAC ARREST Peds Code White BOMB THREAT Code Gray ASSAULTIVE PATIENT Code Green HAZARDOUS MATERIALS Code Orange Spill or Release RADIOACTIVE INCIDENT Code Orange INFANT CHILD ABDUCTION Code Pink Age FIRE Code Red Do NOT use elevator EMERGENCY RESPONSE Code Triage EARTHQUAKE EVACUATION HOSTAGE Person held against their will Environment of Care Issues HARBOR UCLA MEDICAL CENTER EMERGENCY CONDITIONS amp BASIC STAFF RESPONSE See Emergency Preparedness amp Management Manual and Unit Policies for Additional Details Description An adult arrests in any area of the hospital Adult Cardiac code team assistance is necessary A child infant arrests in any area of the hospital Pediatric Cardiac code team assistance is necessary Notification that a bomb has been placed on campus Threat usually from outside caller A patient requires behavioral management Crisis Response Team assistance is necessary Incident Spill S mall spill with no hazard to p
238. tion by a nursing staff member In the psychiatric area when a patient is in seclusion only he she must be continually observed by a nursing staff member in person for the first hour After the first hour further observation may be performed by continuous audiovisual monitoring Continuous in person observation is accomplished by utilizing a sitter a Sitter policy and essential sitter duties When a patient is being continually monitored the sitter policy must be followed A sitter will be provided for patients restrained for behavioral reasons in the Adult Medical Surgical Wards Adult Pediatric Emergency areas 7 West Ward and Pediatric Ward A sitter will also be provided for patients in restraints and for patients in seclusion for the first hour in the locked psychiatric units The sitter s duties are as follows 1 Remain within view and immediate contact of the patient at all times If at any time the sitter is unable to remain within view of the patient he she must notify the RN responsible for the patient so an alternate sitter can be made available to remain and monitor the patient 2 Provide general nursing care to the patient being observed 3 Provide continuous in person observation 4 Provide a safe environment including removal of potentially dangerous objects from the room and screening any items brought by family and friends 5 Report ongoing behavioral observations to the RN responsible for the patient 6 Document
239. tment Patients receiving care at Harbor UCLA Medical Center have their pain assessed on initial treatment When pain is present a detailed assessment will be performed which includes identification of the intensity quality location duration and other characteristics of pain Pain assessment appropriate to the patient s age will be recorded to facilitate regular reassessment and follow up The patient will be reassessed if the pain persists or the initiation of potentially painful procedures or with changes in the patient s medical status Nursing Department Reorientation Self Study Guide Mandated Section 57 IV Patient Care Management Because pain is a subjective experience each patient is the best judge of the intensity of his her pain and the effectiveness of his her treatment If the patient is unable to communicate with the healthcare team input will be sought from the patient s family or significant other s regarding the patient s pain and its treatment Patients will be educated about pain and its treatment A variety of interventions will be made available Education on the assessment and treatment of pain will be taught to staff involved in patient care appropriate to their patient population THE CARE OF A PATIENT IN PAIN Pain management revolves around four components assessment treatment education and documentation Key points from each component are described below A Assessment pain as the fifth
240. ty policies and procedures are designed to limit radiation exposure to personnel to As Low As Reasonably Achievable ALARA The basic philosophy behind this concept is that no exposure to radiation is desirable or without risk Each person should avoid unnecessary exposure Personnel working actively in radiation therapy are issued film badges personnel dosimeters which measure the radiation received In general maintaining a distance of 6 feet from the patient being x rayed with a portable x ray unit and staying out of the main radiation beam is adequate to ensure the safety of individuals in the vicinity of the patient PLEASE COMPLETE THE STUDY QUESTIONS ON THE NEXT PAGE Nursing Department Reorientation Self Study Guide Mandated Section 139 Environment of Care Issues RADIATION SAFETY PROGRAM Study Questions Select the best answer to each question DO NOT write in the manual 1 Principles of radiation safety include Keep time exposure distance shielding and contamination at a minimum Keep time exposure and distance to a minimum use shields and control contamination Keep time exposure and distance to a maximum use shields and control contamination Keep time exposure to a minimum maintain safe distance use shields and control contamination Boe In case of a fire in an area where radiation is used one needs to notify the Radiation Safety officer Immediately Within 2 weeks After the fire is contained Aft
241. u missed one or more read the content again and repeat the study guide questions USE OF RESTRAINTS References 1 Centers for Medicare amp Medicaid Services CMS Glossary Available at http www cdc gov ncidod dhqpwrkrprotect_bp_prevent html Accessed June 22 2010 2 The use of restraints including seclusion In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2010 Policy No 347 3 Hendrich LA Immobility and Restraints A Resource Manual St Louis Mosby Yearbook 1996 11 26 4 Gorman LM Sultran D Luna Raines M Psychosocial Nursing For General Patient Care Philadelphia F A Davis Company 1996 39 111 5 Wyka GT Nonviolent Crisis Intervention A Practical Approach for Managing Behavior Brookfield Wisc Aspen Publishing 1988 2s 5s 6 Kozub M Skidmore R Seclusion and restraint understanding recent changes Journal of Psychosocial Nursing 2001 39 25 31 7 Miles SH Irvine P Deaths caused by physical restraints The Gerontologist 1992 32 762 766 8 Strumpf NE Evans LK Physical restraints on hospitalized elderly Perceptions of patient and nurse Nurses Research 1988 37 132 137 9 Lofgren RP McPherson DS Graniere R Myllenbeck S Sprafka JM Mechanical restraints on the medical wards Are protective devices safe Am J of Public Health 1989 79 735 738 Nursing Department Reorientation Self Study Guide Mandated Section 36 Patient Car
242. ual alerts a Post Cover your Cough posters Emphasizes covering coughs and sneezes and hand cleaning b Personal Protective Equipment Posters are available that demonstrate the donning and removing personal protective equipment 2 Respiratory hygiene cough etiquette The following measures to contain respiratory secretions are recommended for all individuals with symptoms of a respiratory infection a Cover the nose and mouth when coughing or sneezing Ensure the availability of tissues for patients visitors and staff b Use tissues to contain respiratory secretions and dispose of them in the nearest waste receptacle after use c Perform hand hygiene eg hand washing with non antimicrobial soap and water alcohol based hand rub or antiseptic hand wash after having contact with respiratory secretions and contaminated objects materials 3 Masking and separation of persons with respiratory symptoms a During periods of increased respiratory infection activity offer masks to persons who are coughing Masks are used to contain respiratory secretions b Encourage coughing patients to sit apart at least three feet away if possible from others in common waiting areas 4 Healthcare workers precautions to minimize exposure to respiratory droplets a Healthcare personnel should wear a mask for close contact with coughing patients such as when examining a patient with symptoms of a respiratory infection particularly if fever is
243. use of alcohol based hand rub before and after caring for patients Teaching the patient to cover nose and mouth with tissue when coughing or sneezing c Eliminating artificial fingernails and maintaining short clean and natural nails for health care workers who have direct contact with patients d All of the above Nursing Department Reorientation Self Study Guide Mandated Section 72 Infection Control Issues 4 All of the following are true about hand hygiene EXCEPT Natural nails must be clean with tips less than 1 4 inch long Fingernail polish must be in good condition and free of chips c Artificial fingernails are permitted for those who have direct contact with patients handle instruments or equipment that will be used directly on patients or those who have contact with food d Artificial fingernails are not permitted for those who have direct contact with patients handle instruments or equipment that will be used directly on patients or those who have contact with food SP 5 Standard precautions should be used with a All patients b Patient in a high risk group c Patient in a surgery care setting d Patient with known blood borne infections Answers to Study Questions l b 2 d 3 d 4 c 5 a If you answered all of the questions correctly go on to the next section If you missed one or more read the content again and repeat the study guide questions Bibliography Centers for Disease Control and Prevention
244. used The nurse is responsible for reviewing signs of transfusion reaction with the patient and instructing him her to notify the nurse immediately if any symptoms are experienced see Appendix A Do NOT transfer a patient to another area of the hospital with a blood product picked up from Blood Bank but not yet infusing Return the blood product to the Blood Bank If a blood transfusion is in progress and the patient needs to be transferred an RN or IV certified LVN must accompany the patient to maintain ongoing monitoring of unfinished blood product The status of the transfusion and the ongoing monitoring requirements will be included in the hand off communication Nursing Department Reorientation Self Study Guide Clinical Competencies 15 Blood Products and Transfusion IV BLOOD PRODUCTS A Types of Blood Products Refer to Table 3 for an overview of types and indications of various blood products Table 3 Types of Blood Products Product Indication Packed Red Blood Cells Increases oxygen carrying capacity by increasing volume of circulating RBCs Rae G sand Whole Blood Used for symptomatic anemia Source of plasma proteins including coagulation factors Indicated for management of preoperative or bleeding Fresh Frozen Plasma FFP patients requiring replacement of multiple coagulation factors eg liver disease DIC Patients undergoing massive transfusion who have clinically significant coagulation d
245. vaccine Nursing Department Reorientation Self Study Guide Mandated Section 76 2 Infection Control Issues d The vaccine must be administered in three injections over a six month period of time to achieve maximum protection A small percentage of individuals do not develop sufficient numbers of antibodies even after the series of three vaccines and may require additional injections Currently there is no vaccine for Hepatitis C V HUMAN IMMUNODEFICIENCY VIRUS HIV A Description 1 2 HIV attacks the body s immune system eventually causing acquired immune deficiency syndrome AIDS It destroys the cellular immunity of infected individuals leaving them susceptible to a variety of opportunistic infections A person infected with HIV may carry the virus without developing symptoms for years B Transmission 1 HIV is transmitted in four primary ways Sexual contact eg unprotected intercourse with an HIV positive individual Parenteral exposure eg needle sharing blood exposure tattooing Perinatal exposure and transfer of HIV in breast milk Transfusion of blood products Blood screening programs were initiated in spring 1986 in the U S Some patients may have received transfusion in other countries where screening of blood is less stringent ae op HIV is not transmitted by casual contact Although the virus has been detected in a variety of body fluids studies of persons living with HIV infected f
246. ve pressure b Tf the pink ball is on the inside of the room the air is flowing from the corridor into the patient s room ie negative pressure Patients placed in airborne precautions require negative pressure rooms ie pink ball should be inside the room thus preventing potentially contaminated air from the patient s room from flowing out into the corridor The door to the room must be kept closed and properly posted with an airborne precaution sign Nursing Department Reorientation Self Study Guide Mandated Section 91 Infection Control Issues a If the door to the room is closed and the pink ball remains on the outside of the room the room is not suitable for airborne precautions Please notify the Charge Nurse and the Facilities Management that the room needs service and notify Bed Control that the room is not available until checked and cleared by the Facilities Management b If the room is occupied by a patient who requires airborne precautions the patient must be moved to another negative pressure isolation room and notify Infection Control at ext 3838 Mask the patient during transport C TB patients may not be grouped together cohorted in a shared room D Discontinuation of airborne precautions 1 A patient isolated for suspected TB should be isolated until an alternative diagnosis is established or the patient has had 3 consecutive negative sputum AFB smears collected on different days 2 For patients
247. vital sign All patients receiving care at Harbor UCLA Medical Center will have their pain assessed upon initial treatment and will be routinely reassessed at the same time a complete set of vital signs is taken at the initiation of potentially painful procedures and when changes in medical status occur 1 The following principles of pain assessment should be followed Ask the patient about the presence of pain Be proactive Believe the patient s report of pain Since patients have little experience with pain scales provide comparative examples such as no pain is 0 toothache is 4 labor pain is 8 and the worst possible pain is 10 Perform a complete initial assessment of the patient s pain which includes the following 1 Onset location duration characteristics aggravating factors relieving factors associated symptoms intensity OLDCARAT 2 The source and origin of the patient s pain 3 Aggravating and relieving factors what makes the pain worse or better To provide a standardized approach to pain assessment by staff in all departments in all patient care settings a number of pain assessment tools have been identified for use at Harbor UCLA Medical Center Selection of the appropriate tool is based on patient s age cognitive ability and condition Tools used at Harbor UCLA include the following Universal tools 1 Numeric Rating Scale A scale from which the patient is asked to verbally rate pain
248. vity Ill PROPER BODY MECHANICS A Use proper lifting technique 1 Place feet apart to provide an adequate base of support which will assist in maintaining balance 2 When lifting an object keep it as close to one s body as possible 3 Maintain the inward curve of one s lower back at all times 4 Point one s feet in the direction of movement 5 Bend one s knees and hips to get down to the level of the work Do not overreach especially when handling large bulky objects 6 Center oneself over the load 7 Lift the load straight up keeping one s spine in a neutral position Lift pull with one s body weight 8 Lift with one s legs NOT one s back 9 Do not twist or turn suddenly when lifting or carrying 10 Set an object down properly lower object by bending one s hips and knees letting one s legs do the work 11 Always push not pull an object when possible B Use proper posture when sitting standing or reclining 1 When standing correctly the spine has a natural S curve The shoulders are back and the S curve is directly over the pelvis 2 When sitting correctly knees should be at a 90 angle Hips should be positioned to the rear of the chair with the lower back not overly arched Use a towel roll behind one s lower back to Nursing Department Reorientation Self Study Guide Mandated Section 5 C Patient Care Management maintain the inward curve Shoulders and upper back are
249. who could safely be discharged within the next 2 12 and 24 hours Housestaff Check in with your supervisor Attending MDs and or Senior Residents Check in with your assigned housestaff Await further instructions from your Department Chair Attending MD Senior Resident or a HICS officer Individuals with additional Code Triage responsibilities 1 Nurse Managers Charge Nurses Department Chairs Service Directors or their designees Submit a Code Triage Status Report form to the Command Post Staging Area Conference Room 1L 1 as soon as possible after the Code Triage page Use this form to report the loss of any critical systems equipment supplies and the location of any trapped or injured individuals This form is available on the Harbor intranet Code Triage link Staff with a pre assigned HICS role Report to the Command Post Staging Area Conference Room IL 1 as soon as possible after Code Triage notification Exception Emergency Department staff VI INFORMATION NEEDED TO PERFORM DUTIES DURING A CODE TRIAGE INCIDENT A Where to find the Emergency Preparedness and Management Manual On the Harbor intranet Click on the Code Triage link How to obtain or replenish critical resources including manpower 1 2 3 Call the Command Post at ext 2141 Submit a written request to the Command Post Staging Area E mail a request to the Command Post at HUCLACodeTriageCommandPost
250. y niinen sues bss cache tes a ae aa a aa ana ea areae ae de aaa aaeei ei seais eani 105 Emergeticy Preparedness s ici s siuis eiior ere E a E EENEN ENT est etch S Eaa 113 CCULIEY areri yp in et p aE E E E E EE A E E AA EE E E E E E S A A 122 Hazardous Materials Communication and Safety Program eee eee eee eeceseeeceeceeeeseeaeeeeeeeeaees 129 Radiation Safety Programas scciecescictecs sts enoet aeo e a ceeveds dubs ee a i cheundes cut luues OEO naro PREES 137 Nursing Department Reorientation Self Study Guide Mandated Section 2 INSTRUCTIONS FOR COMPLETING MANDATED SECTION Review the content in each section Complete the study questions at the end of each section Check your answers against the answer key provided at the end of each set of questions Complete the Mandated Section and Clinical Competency licensed staff as appropriate test s and answer sheet Tests and answer sheets are available from your Nurse Manager Parlow Library or Building N 18 Clinical Nurse Specialists Clinical Nurse Educators and Nurse Managers are available to answer any questions you have regarding the Reorientation Self Study Guide and its contents Submit the completed Reorientation Mandated Section and Clinical Competency licensed staff as appropriate test s and answer sheet to Clinical Professional Development staff in Building N 18 Monday through Friday except county holidays between the hours of 0730 1630 Return the Reorientation
251. y to early appropriate airborne precautions Be aware of signs and symptoms and communicate with physicians B Appropriate isolation and adequate ventilation Airborne precaution rooms must provide negative pressure in relation to the hallway 1 The room should also have an exhaust system that allows the air in the room to be vented to the outside and not be recirculated There should be a minimum of six air exchanges per hour 2 Rooms without proper air control should not be used for patients with TB In addition the door must be kept closed at all times even if the patient temporarily leaves the room A list of approved negative pressure rooms is posted in the Emergency Department and in each ward 3 In settings where a negative pressure room is not available patients with suspected TB should wear a mask and be placed in a room apart from other patients and visitors Post an airborne precaution sign on the door and keep the door closed C Ultraviolet light Ultraviolet light UV has been shown to kill the tuberculosis bacteria These UV lights may be used as an adjunct to respiratory isolation precautions and should never be considered a replacement for adequate ventilation and negative pressure Nursing Department Reorientation Self Study Guide Mandated Section 92 Infection Control Issues D Masking the mouth and nose of the patient Covering the mouth and nose reduces the chance of secretions and bacteria from becoming airb
252. yee will be able to 1 2 Identify the route of tuberculosis transmission Describe the symptoms of tuberculosis disease Identify individuals at increased risk of developing tuberculosis Differentiate between tuberculosis infection and tuberculosis disease Describe the treatment of tuberculosis Describe the strategies for preventing tuberculosis transmission in the workplace Instructions to the Employee Please read the following section then answer the study questions at the end of this section Nursing Department Reorientation Self Study Guide Mandated Section 87 Il IIL Infection Control Issues TUBERCULOSIS DEFINITION A Tuberculosis TB is a communicable disease caused by the bacterium Mycobacterium tuberculosis MTB TB is spread from person to person by airborne particles called droplet nuclei 1 Droplet nuclei containing Mycobacterium tuberculosis are produced when a person with TB disease of the lungs or larynx coughs sneezes speaks sings or breathes 2 Droplet nuclei remain airborne indefinitely or until removed by natural or mechanical ventilation TRANSMISSION A Transmission may occur when a person inhales air containing the droplet nuclei 1 2 The risk of transmission depends primarily on the degree of infectiousness of the person with TB disease source duration of exposure state of health of the person inhaling the droplet nuclei and characteristics of the environment in which
253. you missed one or more read the content again and repeat the study guide questions Bibliography Crime prevention and workplace violence prevention In Harbor UCLA Medical Center Office of Public Safety Reorientation Manual Torrance CA 2005 Hospital staff identification badge In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2005 Policy No 201 Infant child security In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2005 Policy No 447 Kwan C Management Bulletin Torrance CA Harbor UCLA Medical Center Los Angeles County November 22 2005 Publication MBNO 05 70 Office of Public Safety use of force on Harbor UCLA campus In Hospital and Medical Administration Policy and Procedure Manual Torrance CA Harbor UCLA Medical Center 2005 Policy No 138 Threat management policy guidelines and resources In Department of Health Services Human Resources Manual Torrance CA Harbor UCLA Medical Center 1999 Policy No 620 Reorientation Manual 2010 MandSec Security doc Nursing Department Reorientation Self Study Guide Mandated Section 128 Environment of Care Issues HAZARDOUS MATERIALS COMMUNICATION AND SAFETY PROGRAM Objectives Upon completion of this section the employee will able to 1 Describe methods for identifying a hazardous material 2 Identify two facts about a chemical that mus
254. zards and unauthorized access 1 An organization must implement policies and procedures to a b Limit physical access to DHS electronic information systems and the facility or facilities where they are kept Restrict access to computers or computer systems containing electronic PHI to authorized users eg passwords Assign security responsibilities to individuals who will supervise the use of approved security measures Limit access to data viewed on workstations eg logging off the computer before leaving a workstation and automatic time outs Disposal or re use of electronic media containing electronic PHI Nursing Department Reorientation Self Study Guide Mandated Section 21 Patient Care Management XIV TECHNICAL SAFEGUARDS A Technical safeguards include the use of computer technology solutions to protect the integrity confidentiality and availability of electronic PHI 1 The Technical Safeguard standards require written documentation of security measures policies and procedures implemented with respect to a Access control ensures appropriate technical solutions are in place to protect the integrity confidentiality and availability of electronic PHI For example electronic systems which handle confidential data and information require two tiers for security eg user identifier and password b Audit control requires implementation of hardware software and or procedures that record and examine

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