LOMA LINDA UNIVERSITY CHILDREN S HOSPITAL NICU FLOAT INFORMATION SHEET

Transcription

1 LOMA LINDA UNIVERSITY CHILDREN S HOSPITAL NICU FLOAT INFORMATION SHEET Resource Persons: Shift Coordinator (TL 1) Ext Teamleader 2 Ext Teamleader 3 Ext Teamleader 4 Ext Teamleader 5 Ext Shift Buddy: NICU Patient Care Director: Tristine Bates Ext NICU Nursing Managers: AM: Ext PM: Ext AM SHIFT Managers- Cynthia Grijalva, Heidi Seto, Betsy Tan, & Veronica Tsui. PM SHIFT Managers- Loren Neiswender, Sandy Russell, & Susan Rojas. ADMINISTRATIVE CHARGE NURSES: o Aloha Malit (ECMO) Ext & o Rene Santiago (TRANSPORT) Ext NICU Charge Nurses: Ext Ext AM Shift Charge Nurses- Lorene James,, Katie Thompson, & Tracey Weatherill. NOC Shift Charge Nurses- Karen Graves, Sharon Halbrook, Stella Kim, & Sheila Sia. Shift Hours: AM Shift NOC shift PERSONAL BELONGINGS: Personal belongings can be placed with you at your bedside for safe keeping. ASSIGNMENTS: Your patient assignment will be posted at the front desk located on the patient assignment list. Please introduce yourself to one of the teamleaders. They will guide you to your assigned room and introduce you to a buddy in the room as a resource. We understand how challenging it is to float to another unit. We really appreciate you! Thank you! HAND WASHING: We require a full three minute scrub of your hands and arms to the elbows before entering room (Remove all jewelry), or Use Surgicept (Waterless surgical hand antiseptic)- Place cupped hand under surgicept for 3 squirts or 2 ml in each hand, clean under nails, and rub hands & forearm and let dry. In between patients: o Sanitize with alcohol (rub all hand surfaces & let dry), or wash hands for 15 seconds before and after direct patient contact. o When visibly soiled or contaminated, please wash hands for 15 seconds. (i.e. After diaper change, after using a restroom, or in patients suspected/confirmed of having Clostridium Diff.) SCRUBS/GOWNS:

2 Special scrubs are no longer necessary when working in the NICU. EQUIPMENTS: All equipment and bedside counters are cleaned with Hydrogen Peroxide Cleaner Disinfectant Wipes at the beginning of the shift. Accucheck machines are cleaned with the Cavicide 1 wipes found in each room. REPORT: Shift report is given at the patient s bedside. Both off-going and on-coming nurses need to sign on/off the Task List located in LLEAP, indicating reports have been given or received and IV rates have been verified. DOCUMENTATION: Please acknowledge all new orders on LLEAP. All documentations will be done on e-mar & LLEAP. o Intake/ Output- 12 hour totals are completed at 1600 and hour totals are documented in the I & O interactive view located under the urinary assessment. o All Meds are verified each shift during report thru physicians orders and e-mar. COMMUNICATION: To use the NICU intercom system, press 96 and deliver your message while depressing the M button. Press C when you are finished. To reach all physician areas in an emergency situation, press 99, then M. Red emergency buttons are located near each patient bedside if you need help STAT and cannot call. To reach the front desk for 3700 NICU, dial ext , and dial ext for 3800 NICU. To reach the front desk through the intercom system, press 362, then M. NICU phone, beeper, and intercom directories are located next to all phones. Each shift different Physicians, Residents and NNPs are assigned to cover the unit. This list is located outside of each room on 3700 NICU and also 3800 NICU. Please arrange coverage with your buddy or a teamleader anytime you need to leave your bedside and give a quick SBAR report. Per policy, we never leave a room unattended. MEAL BREAKS A teamleader will come around at the beginning of the shift to collect Lunch Times. When going on your lunch, please give a brief report on your patients to a team leader. FIRE SAFETY/SECURITY: In case of FIRE emergency, the ABC fire extinguishers are located below every water fountain in the patient care area hallway in 3700 NICU. The ABC fire extinguisher for 3800 NICU is located on the walls next to the entrance door by Bed # 1 and Bed # 12.

3 3700 fire alarms are located in each of the following locations: 1. Outside of room # 3741 on side Next to stairwell. 3. Back hallway, next to room # Outside of room # 14 on side 2. Red panic buttons to notify security are located at the front desk for 3700 & 3800 NICU, and on the inner walls of the patient care hallways on Side 1 and 2 for HOSPITAL/ UNIT MANUALS: All of the required hospital manuals can be found on-line at the VIP web page under LLUCH departments. Click on NICU for manual options and policies and procedures. Another valuable resource is our NICU reference book. The book is located by each bedside in a white folder. SHIFT RESPONSIBILITIES: AM RESPONSIBILITIES 1. Daily BP, abdominal girth, and liver level. 2. Head Circumference on infants requiring daily measurements. 3. Change beds on all non-vented/non-cpap babies every 2 weeks. 4. Order TPN and non-tpn IV s 5. Change TPN and lipid IV s. 6. Document 12hr I&O in Change suction 1600 and PRN (Label with date, time, and initials) 8. Update Care plan, parent interactions, & Task List. NOC RESPONSIBILITIES 1. Daily weights. 2. Baths & Linen changes are done on Saturdays, Wednesdays and PRN. 3. Weekly length and head circumference (Saturday noc s) 4. Document 12hr I&O in AM lab draws. 6. AM X-rays (Please notify RT to assist you.) 7. Change non-tpn IV s. 8. Change beds on all ventilator & CPAP babies every 2 weeks. 9. Update & sign Care Plan, chart caregiver interactions, & check Task List. The Shift Responsibilities are posted on the walls of each patient room under Patient Care Guidelines. MEDICATIONS: All patient medications are located in the white medication refrigerator in each room. Medications for each individual patient are held in a blue cubby with their name labeled on it. We have three Accudose Med Stations in 3700 and one in 3800-N. The Accudose houses all narcotic medications and STAT medications. Please ask one of the supervisors to create a temporary ID and password for you that will last a twelve hour shift. Always perform independent double checks on any medications/ivs that require bedside mixing and high alert medications. Any Blood Products are always checked through independent double checks by the patient s bedside. PLEASE call a team leader to double check blood. BLOOD GLUCOSE MONITORING:

4 Blood glucose test is performed 1-3 hours after the main IV fluid and/ or IV glucose concentration is changed. Please notify the infant s doctor for blood glucose results less than 45 mg/dl and for blood glucose results greater than 150 mg/dl. Recheck blood sugar every 30 mins (or otherwise indicated by the physician) until sugar is within normal range. IVs / PICC LINE: IV sites are monitored and documented hourly for signs of infiltration. Pay attention to the actual volume reading on the Braun pump, space pump, or medfusion pump to determine how much has infused over the previous hour. Pull through all IV fluid totals on LLAP every hour. IV + PO = ml/hr means that the IV rate per hour and the amount of the infant ate (amount of feeding % frequency of feeding) should equal the amount of the ml/hr ordered. Therefore, you need to increase or decrease your IV rate based on how much the infant ate for that feeding. PICC (Percutaneous Intravenous Central Catheter) line is maintained by the NICU nurse. Blood is never infused via these lines. Blood is never drawn out of these lines. If you note a problem with a PICC line, please inform a team leader or PICC Nurse immediately. ARTERIAL lines are maintained by the NICU nurse. If you have questions or note a problem with an arterial line, please inform a team leader or an Arterial Line Nurse immediately. PHYSICIAN ORDERS: The nurses are responsible for taking off and carrying out all orders. Please always double check orders with your buddy or a team leader. HELPFUL INFORMATIONS: Bag and Mask- Must have access to a bag and mask of appropriate size at each patient bedside. ID Bands- All infants must have an ID band on an extremity. Please ask parents for infant ID # (this is the Hollister number on the original ID bands), and confirm the number with infant band before giving information over the phone, and at the bedside. Temperature Control-The normal temperature range for our infants is 36.5 C 37.0 C. Please report any variation from normal range to the team leader. o Isolettes are required for infants weighing less than 1800 grams. Vital Signs- Routine vital signs are every 2 hours for NPO infants. Infants with routine feedings such as every 3 hours have vitals done prior to each feeding. Infants are to remain on the cardiorespiratory monitors at all times with alarms set and in the on position. Blood pressures are done at least every AM or more frequently if indicated on the plan of care. Infants on pulse oximeters have their saturation documented every hour and whenever there is a deviation from the normal range. The normal vital sign range are as follows: o Heart Rate: bpm (Term infants), and bpm (Preterm infants) o Respiration: o Temperature: 36.5 C C o Blood Pressure: S (40 65), D (20 40), Mean (28 50) o O2 Saturation: % for spontaneous room air infants. Please keep saturation range between 88 94% for infants on supplemental oxygen and titrate oxygen as needed to maintain range.

5 Formula/Breast Milk: o Breast milk Storage- We have 4 breast milk freezers located on side 1 in the clean utility rooms. There is 1 breast milk freezer in 3800-N equipment room. Please ask the resource buddy or a team leader to obtain the code or badge access. The thawed milk is stored in the breast milk refrigerators located outside of patient rooms. Please date, time, & initial all thawed or fresh milk. Thawed milk is good for 24 hours only. Fresh milk is good in the refrigerator up to 4 days. o Donor Breast Milk- All Donor Breast Milk must be signed out in the Log Book located outside of room 2 for 100% traceable accuracy per State Regulation. There are two different donor breast milks banks: (Medelac & San Jose) Medelac- Please record the SN number on NICU Daily Care/Safety under feeding on LLEAP. San Jose- Please record the LOT number on NICU Daily Care/Safety under feeding on LLEAP. Thawed Donor Breast Milk is good for 24 hours. Any additives to the breast milk is good for 24 hours. o Formula Storage- All formulas are stored in cabinet on side 1 in the clean utility room. Once open, please refrigerate formula in the formula labeled refrigerators outside of patient rooms. Please date, time, & initial all bottles. Discard any formulas opened greater than 24 hours. Formula Mixing- All powdered formula or additives are mixed in the milk room. If you have stat orders from the hours of 0030 to 0600, please inform a team leader to assist you. VISITING POLICY: The NICU visiting policy is to be followed at all times. An exception for special circumstances can be made by the NICU director Tristine Bates and the Managers. The visiting policy is as follows: o Must check parents with infant Hollister number on the blue/ pink bands. o Visiting Hours are from , & o Only two people are allowed at the bedside each time, and one person must be the parent with the support ID band. o Children under 14 years old are not allowed on the unit unless they have arranged a sibling visit through the Child Life Department. o During RSV season (November through end of March), only parents and grandparents with good health can visit. UNIT LAYOUT: Please see the attached NICU floor plan to help you navigate through our unit for your shift.

6 NURSE EVALUATION OF FLOAT EXPERIENCE FLOAT UNIT _NICU/3700 or 3800N We appreciate you coming to our unit to help. We hope it was a pleasant experience for you. Please take the time to fill out this evaluation form and return it to one the unit Supervisors. We appreciate and need your input so that we can make floating to out unit more rewarding. Name/Title: Home Unit: Date Floated: Shift Worked: Yes No (If your answer is No, please explain your reason. Positive comments are also welcomed.) Have you floated to this unit before? Were you able to take a meal break? Were you made aware of the unit routine/ supplies? Was there an adequate report given? Were you assigned a resource person? Was the staff courteous, friendly, and helpful? Were your questions answered? Did you feel you were able to deliver safe care? Were you asked to perform a procedure which you did not feel comfortable to do? (If Yes, please specify procedure) Other Comments/ Suggestions: