Broward Health Department of Learning/Clinical Education

Transcription

1 To: From: All Current and Future Contractors Broward Health Department of Learning/Clinical Education Date: January 2016 In order to assist you in meeting the regulatory educational requirements for Broward Health and in alignment with Joint Commission and CMS mandates, Broward Health has loaded multiple educational programs onto our Internet Site ( to facilitate your employees (contractor s) compliance. These programs are web based and interactive which link to an exam and subsequent certificate of completion. Educational Programs which offer contact hours will require a minimal processing fee since each regional clinical education department must process the contact hours via CE Broker and issue a certificate for Continuing Education Credit if the participant wishes to obtain contact hour credit for the program. All internet based educational programs do have a certificate of completion which is free to the individual. Below, please reference the clinical check list and Education requirements (Attachments A & C). This is in addition to the general contractor requirements which are identified in the Vendor Package. Web page snaps shots (Attachment B, Figures 1-3) identify the path to the web page. You must select the appropriate category which you will be fulfilling and complete each link as indicated. Please note, the requirements for regulatory bodies are constantly being modified and Broward Health Department of Learning is working to keep the learning modules up to date and provide you with the tools you need to be compliant as our partners in patient care. Thank you. If you have any questions, you may contact the Regional Clinical Education Departments at the numbers below. Broward Health Medical Center Broward Health Coral Springs Broward Health Imperial Point Broward Health North Broward Health Corp Department of Learning

2 HUMAN RESOURCE ADMINISTRATION POLICIES AND PROCEDURE MANUAL POLICY #: HRAM 2.14 SUBJECT: HR Guidelines for Regulatory EFFECTIVE 7/1997 Compliance for Agency/Contracted Personnel DATE: SPONSOR: HR REVISED: 7/2000, 7/2003, 1/2005, 2/2008, 12/2008, 6/2009, 11/2014 APPROVED: APPROVED System-wide FOR USE: SVP/CHRO, Dionne Wong PURPOSE: To provide mechanisms for agency and contracted personnel to satisfy regulatory agency standards. GUIDELINES: I. CONTRACT ACCOUNTABILITY: Any and all agreements between Broward Health and an organization which results in any of the following described business relationships with agency and contracted personnel, must clearly establish that said organization will be held accountable for meeting all applicable TJC and/or other regulatory requirements. II. DEFINITION OF TERMS AGENCY PERSONNEL: Defined as non-broward Health employed workers who are furnished on a per diem or irregular basis by an external agency to perform a specific function at one of Broward Health facilities. These workers are directly employed by the agency and receive their pay and benefits directly from the agency. CONTRACTED SERVICES: Defined as non-employee personnel who perform services on-site at our facilities and/or provide services pursuant to a contract between Broward Health and the provider. INDEPENDENT CONTRACTORS: Defined as an individual(s) with a direct contractual relationship with Broward Health for a defined contractual period of time and one who is not obtained through an agency or outside contracted service. Individual clinical services such as: surgical first assists or orthopedic technicians. SPECIAL NOTE: Professional Contracted Services that do not practice within the physical environment of a Broward Health Facility may be exempted from specific aspects of this policy. At a minimum, the professional contracted services individuals must comply with all aspects of professional licensure requirements if applicable, OIG requirements, Broward Health Code of Conduct and all HIPAA and privacy policies.

3 POLICY # HRAM 2.14 SUBJECT: HR Guidelines for Regulatory Compliance for Agency/Contracted Personnel HR ADMINISTRATION 1. All contracted agency who work within the physical environment of a Broward Health Facility are required to provide a signed profile in accordance with the contract agreement on personnel furnished by their agency/contract services ensuring that the supplemental personnel member being furnished to Broward Health facility has been screened and meet all requirements of the job. This profile may be changed to be specific to the unit/department requesting the agency employee (Appendix A). 2. All agency, contracted individuals and independent contracted personnel working within the physical environment of a Broward Health Facility are oriented to Broward Health and the department/unit they will be working in through the following methods: a. Broward Health Orientation All agency, and contracted personnel are required to complete the Broward Health Orientation materials and documents available on via the Broward Health Web Pages located at before the first scheduled worked shift at any Broward Health facility. The personnel must sign all documents provided on the web which are to be placed in the agency personnel s Broward Health file. Additional signed documentation may be required for each agency/contracted individual for access to any computer or electronic information system. b. Facility/Department/Unit Orientation All agency and contracted personnel are oriented to their facility/department or unit during their first day of work. Refer to Clinical Education/ A Practical Guide to Competency Assessment for Broward Health Leaders Handbook for department specific template. c. Annual Reorientation & Regulatory/Mandatory Updates All agency and contracted personnel who continue to work at Broward Health are required to complete all Broward Health mandated annual updates which includes but is not limited to: Annual Environment of Care & HIPAA Updates which are available via the Broward Health Web Pages as well as furnishing proof of licensure and appropriate competencies. 3. Competency/Performance Assessment: a. Proof that the agency and contracted personnel (including populations served specific competencies) must be provided to Broward Health at the time the agency and/or independent contracted personnel reports to work. b. Competency assessments (including population served specific competencies, if applicable) must be completed on agency and contracted personnel after the initial shift by Broward Health and thereafter annually by the contracted services company and or designee for the independent contractor. Performance appraisals will be conducted by the agency/contracted Service Company (their employer) according to agency services' policies for all agency and contractors. c. Performance appraisals will be made available to Broward Health upon request within 24 hours and/or during random audits.

4 POLICY # HRAM 2.14 SUBJECT: HR Guidelines for Regulatory Compliance for Agency/Contracted Personnel HR ADMINISTRATION d. Full/Complete Agency personnel files Do Not need to be kept nor monitored by the organization/department utilizing them. However, Full/Complete Agency/Contract/Independent Contractor personnel files must be accessible by Broward Health Administration (designee) upon request within 24 hours and/or during random audits. Broward Health will maintain, at a minimum, proof of orientation, licensure/credentials validation and on-going competency and licensure/certification validation on site. 4. COMPLIANCE & FILE MAINTENANCE The individual manager(s) utilizing and/or supervising the agency and contracted personnel is(are) responsible for establishing and maintaining the education file as well as ensuring compliance with all policy requirements listed. (See Exhibit A) The education file includes but is not limited to: Primary source license verification (if applicable) Supportive Identification (Passport, Driver s License or State ID) Signed acknowledgment of Job Description Initial assessment of competency/evaluation Evidence of completion of Broward Health Orientation and HIPAA/Compliance Programs and tests Signed confidentiality and Data Security Forms Verification from contracting company - proof of 10 pane negative drug screen Verification form contracting company level I background check (level II background check is required for pediatric areas and behavioral health) Verification of initial health screening : free of communicable diseases III. Annually, the education file must be updated to include: Primary source license verification (renewal) if applicable Verification of annual health screening Evidence of completion of all Broward Health Annual Environment of Care & HIPAA and other assigned updates. These materials are available via the Broward Health Web Pages. Annual assessment of competency/evaluation INDEPENDENT CONTRACTORS: By the nature of their "independent" contractual relationship defined by IRS, assessment of Independent Contractor's performance is measured by the most appropriate person who can monitor the outcomes of the services contracted. Assessment and competency is measured, at the end of the first worked shift at Broward Health and prior to renewal of the contract or annually whichever comes first. (See Attachments A, B, & C). Employees/managers of similar disciplines must evaluate the independent contractor s competencies in the area of their expertise. For example the Orthotists or Prosthetics would be evaluated by the Rehab Department Manager or their designee since this job category does not exist in the Broward Health employee category).

5 POLICY # HRAM 2.14 SUBJECT: HR Guidelines for Regulatory Compliance for Agency/Contracted Personnel HR ADMINISTRATION Attachments: Forms Distribution: HR Personnel & System Management Authors: Human Resource Team & Legal Council

6 ATTACHMENT A Broward Health AGENCY/CONTRACTOR EMPLOYEE PROFILE, page 1 Name of Contracted Personnel Skill Type Name of Agency: Items Required Received Yes Received No Renewal/Expiration Date Comments Required credentials Licensure/Certification (See Job Description)- Clinical Personnel - Refer to section II for additional Credential Requirements Primary Source License and Verification CPR if applicable Supportive ID Documentation Passport, DL State ID Reviewed list of excluded individuals/entities (LEIE) via the online database. Completed National Sexual Predator/Offender Search Verification Contracting Company Verification of Background check with a minimum of ten year criminal history Level I, Level II background screen for behavioral health and pediatric areas. Signed Acknowledgement of Job N/A for contracted vendors Description Initial Shift Assessment of Competency/ Evaluation Orientation Checklist N/A for contracted vendors Evidence of Completion : General Orientation Materials BH Orientation & Test BH HIPAA/Compliance & Test BH Risk Management BH Code of Conduct BH Compliance Policies Flu Vaccination Education Signed Confidentiality & Data Security Form Contracting Company Verification of negative ten (10) panel Drug Testing (in accordance with Drug Free Workplace Standards) Verification of Initial Health screening (free of any communicable diseases, Rubella, Measles, Mumps and any other vaccinations. Hepatitis series if needed) Provide proof of completed Mantoux (Also known as Purified Protein Derivative PPD) test within the past six months and annually thereafter.

7 Broward Health AGENCY/CONTRACTOR EMPLOYEE PROFILE, page 2 Name of Contracted Personnel Skill Type Name of Agency: Items Required Received Yes Received No Renewal/Expiration Date Comments ANNUALS Verification of annual Health Screening including PPD Evidence of completion of all Broward Health Annual Updates: Broward Health Orientation HIPAA/Compliance Broward Health Risk Management Broward Health Code of Conduct Broward Health Compliance Policies And others as required by BH region Flu Vaccination Education and Accept/Declination Form Facility Required Annual Policy Reviews Annual Assessment of Competency/Evaluation License Verification (renewal)

8 ATTACHMENT B Figure 1 Finding the Orientation Requirements: SELECT CAREERS Figure 2

9 Figure 3

10 ATTACHMENT C Educational Requirements for Agency/Contracted Staff (updated 12/15) All Staff ( clinical or non -clinical as well as licensed or unlicensed) need at a minimum: List Date Completed for Each Module Clinical (Non-Nursing Staff) need the following in addition to the minimum requirements listed to the left: List Date Completed for Each Module Broward Health Orientation (Annual) BH HIPAA Compliance (Annual) Current Licensure Required Education- Per the State Licensing Board BH Annual Risk Management Course (Annual) Code of Conduct (Annual) BH Compliance Policies (Acknowledgement form) FLU Vaccination Course (Annual) Hand Hygiene (Annual) Cultural Sensitivity in Healthcare (Annual) Current American Heart Association BLS card (every 2yrs)- Expiration Date: ACLS, PALS, or NRP (based on BH equivalent Job Description and population)- (every 2 yrs) SBAR and Stroke Awareness (annual) Stroke Awareness Team Collaboration Course (Annual Team Component Title May Vary) Clinical Nursing Staff (Nonmonitored, Non-Critical Care Areas) need the following in addition to the minimum listed for all staff above: List Date Completed for Each Module Clinical Nursing Staff (Cardiac monitored, Critical Care, or Perioperative Areas ) need the following in addition to the minimum listed for all staff above and to the left: List Date Completed for Each Module Current Licensure Required Education- Per the State Licensing Board ACLS, PALS, or NRP (based on BH equivalent Job Description and population) (every 2 yrs) Current American Heart Association BLS card (every 2 yrs)- Expiration Date: Unit-based Skills Competency Validation (Initial and Annual per specialty area): Restraints Competency Validation (Annual): Sedation Course (every 2 yrs) Perioperative Nurses (above plus these courses): Compressed Gas Cylinder Safety (Annual) Recognition of Impaired Practitioners (every 3yrs) Dysphagia (Annual at BHCS only) Formaldehyde (Annual) Laser Safety (Annual) Stroke Awareness SBAR Awareness (Annual) Plum A+ (One-time only) Every three years for the following courses: Anticoagulation Course Blood Administration Course IV Medication Administration Pain Management Living, Dying & Death Impaired Practitioner

11 Nursing Orientation Please Review this Booklet Prior to Attending Nursing Orientation This booklet is designed to assist you in preparing and being successful in Nursing Orientation. It provides general information about each of the components on which you will be assessed. To assist with your Success on the PBDS assessment, we recommend that you review the content in this booklet prior to your scheduled date to attend Nursing Orientation so that you are familiar with the assessment. We will then review the assessment with you during the prep class so that you are comfortable with the process. This booklet also contains information about the Math and the Basic Arrhythmia Assessments given during Nursing Orientation. A list of websites is included for each assessment that you can use to remediate prior to taking the assessment(s). All acute care clinical staff will complete the math assessment. All nurses working in monitored areas and that have experience with ECGs will take the basic arrhythmia assessment. You have a confirmed space in the Broward Health Nursing Orientation Day Time Date Content Week 1 Monday Broward Health Corporate Information Service Center (BHC ISC) 2 nd floor Conference Room Wednesday BHC ISC 2 nd floor Conference Room BHMC Travelers ONLY Friday BHC - ISC 1st floor Training Room A & B Week 2 Monday BHC - ISC 1st floor Training Room A & B 7:45 am 4:30 pm 8 am 10 a.m 8 am 4:30 pm 8 am 4:30 pm PBDS Prep Math Assessment Basic Arrhythmia Assessment (if applicable) Broward Health Medical Center (BHMC) Travelers ONLY! Point of Care Testing and then report to the BHMC Staffing Office Computer Documentation Training (ED nurses will attend Friday only for FirstNet training) Computer Documentation Training

12 Broward Health is committed to excellence in patient care, patient safety and nursing competence. To ensure your success we are providing this booklet as an introduction to our nursing orientation process and the PBDS assessment. Review the contents of this booklet prior to attending nursing orientation and bring it with you for use during nursing orientation. Nursing Orientation Highlights An overview of the Math and Basic Arrhythmia assessments and websites to be used for remediation prior to taking the assessments An Overview of the Performance Based Development System (PBDS) with examples of the PBDS assessment tools: o What If o Clinical Judgment PBDS Results Results will be communicated to you by your agency representative who receives the results from the Broward Health regional staffing offices. Contracted nurses who have acceptable results on their PBDS assessment will continue with computer training during nursing orientation, and the manager will provide a schedule for the duration of your contract. Contracted nurses who have unacceptable results on their PBDS assessment will not continue, the contract will be voided and you will not be working for Broward Health. Directions: Nursing Orientation is held at: Broward Health (BH) Information Service Center (BHC ISC) 1608 SE 3 rd Avenue 2nd floor Conference Room Fort Lauderdale, FL

13 Nursing Orientation Highlights Contact Information Classroom Expectations & Dress Code Computer Training 2

14 Orientation Highlights Welcome to our Healthcare Team! We are pleased that you have joined our Broward Health team and will share in our philosophy of healthcare excellence. Expectations for Anyone Working at Broward Health Broward Health (BH) is committed to providing a work environment that supports the philosophy of teamwork, collaboration, and professional growth. Broward Health employees, medical staff, contracted staff and vendors shall engage in conduct standards/expectations that support our mission and vision and demonstrate courtesy, dignity, and respect. Below are guidelines to assist you in being successful during your orientation period and throughout your employment/contract with Broward Health Your facilitator is here to help you navigate through the program. If you have questions or problems, please discuss them with your facilitator. Time and Attendance Arrive on Time Return From Breaks and Meal On Time Sleeping We all have unplanned events but arriving late more than once does not leave a good impression on your new manager or your peers. Tardiness can be interpreted by others as lack of commitment or dependability, and this reduces the trust needed for teamwork among employees (HRAM Policy #2.18). Tardiness occurs when an employee reports to his or her designated work area after the three-minute tardy grace period for the assigned shift or assigned time to return from meal breaks (HRAM Policy #2.18). If you have an emergency and need to return to class late, notify your facilitator. If you need to leave class, notify your manager and the facilitator. Broward Health does not allow sleeping during meal periods or rest breaks (refer to the Employee Handbook received upon hire). Note: Orientation/class time is considered work time and therefore all time and attendance policies will be enforced. If there is repeat tardiness during orientation (3 events or more) this will be reported to your manager. Smoke Free Workplace Broward Health facilities are designated as smoke free. Smoking will not be permitted anywhere on the Broward Health campus, including parking garages and cars located on the property. Smoking should not be disruptive to our fellow employees, neighboring community, and visitors ; Rev , ,

15 Cell Phones Personal cell phones and communication devices must be turned off, or placed on vibrate while on duty. You may seek approval in advance from the orientation facilitator if you have a family situation that requires an immediate response. If cell phone use is necessary during break time, keep your voice volume low so that you don t interrupt staff working in nearby offices. No texting during class time. Refer to the Broward Health Employee Handbook for detailed information on the use of Cell Phones and Electronic Devices. NOTE: Individuals not observing the cell phone guidelines during orientation will result in a warning then dismissal. Your manager will be informed of this occurrence. Dress Code It is the policy of Broward Health that employees present a professional appearance at all times. In addition to having an appropriate appearance, safety concerns are also related to the dress code. Please review the guidelines below. (HRAM Policy #2.22) Acceptable Attire Business suit, sport coat, dress pants, dress shirt and tie, business suit or dress, dress slacks, dress skirt, dress blouse Polished dress shoes, socks or hosiery. If you choose to wear scrubs to orientation, please ensure that they are clean and pressed. Unacceptable Attire Mini or micro-mini dresses, skirts, shorts or skorts Blue Jeans and clothing made of blue jean denim material Spandex leggings Athletic wear See-through clothing Halter or short midriff tops Unit/Department Specific Dress Code Contact your supervisor/manager for unit designated dress code and colors. Classroom Etiquette Please do not carry on private conversations when there is a speaker. Remember you are here to learn the essentials to prepare you for your new position, so keep distractions to a minimum to respect your speakers, peers, and your facilitator. This is a work environment so please keep conversations and noise in the hallways to a minimum so as not to disturb staff working in nearby offices. Please be tidy and clean up after yourself when using the restrooms or kitchen area and clean your desk area at the end of the day. No cell phone usage during class time (refer to cell phone guidelines listed above). Please refer to the following policies and procedures in the Human Resource Administration Manual (HRAM) and the Employee Handbook on the intranet under the HR tab for more detailed information on Broward Health employment standards. HRAM Policy # 2.18 HRAM Policy # 2.22 HRAM Policy # 2.23 Employee Handbook Time Attendance (Attendance and Punctuality) Appropriate Appearance Standards Conduct Standards General Employee Information and Conditions of Employment 4

16 PBDS Don t discuss other individuals PBDS results or their experience. Focus on what You need to know to feel comfortable with Your PBDS assessment. Computer Training All nursing areas will receive training on our computerized documentation system. You will be given more information on the training schedule during orientation. If your computer skills are minimal and you feel that you will need assistance during the computer training sessions please inform your facilitator in advance. We want this to be a positive learning experience for everyone. About Broward Health Our name Broward Health reflects our commitment to our Mission and Vision to provide world class healthcare to the Broward County community, our physicians and all our employee partners. Our Mission Our Five Star Values Our Vision The mission of Broward Health is to provide quality health care to the people we serve and support the needs of all physicians and employees. Exceptional Service to our Community Collaborative Organizational Team Fostering an Innovative Environment Accountability for Positive Outcomes Valuing Our Employee Family The vision of Broward Health is to provide world class health care to all we serve. 5

17 Math Assessment Basic Arrhythmia Assessment PBDS Prep 6

18 Math Assessment All nurses will complete a Math Assessment. You will be given a handout with drug calculations and conversions and a practice worksheet prior to the math assessment. Passing score is 84%. If this score isn t achieved, your manager may determine an action plan to ensure competency in the areas missed. To ensure a successful score, it is highly recommended that any of the following math review web sites be reviewed prior to taking the assessment. Math Review Websites Math Worksheet IV Calculations Dosage Quiz 1. The order reads: Administer 1000cc 125cc/hr. The drop factor on your IV tubing is 20gtts/cc. How many gtts/min? 2. The order reads: Administer 1000cc of D5NS over 10 hrs. The drop factor on your tubing is 15 gtts/cc. How many gtts/min? cc D51/2NS with 20mEq KCL over 12 hrs. Drop factor: 10gtts/cc How many gtts/min? 4. Doctor orders Ancef 1gm q 6hrs IVPB. Ancef is added to 50cc D5W to run over 30 minutes. Drop factor: 15gtts/ml How many gtts/min? 5. Doctor orders 1 unit of PRBC s to run over 4 hours. The unit of blood contains 450cc Drop factor for the tubing is 10gtts/ml How many gtts/min? 6. Mr. Marlboro is on Heparin for a P.E. Your orders read 750U/hr. You enter the room and as you introduce yourself, you glance at the IV bag. The label indicates there are 25,000U of Heparin in 250ml D5@. The IVAC is currently running at 13ml/hr. a. What is the concentration of Heparin per ml? b. Is this IV rate correct? If not, what should the rate be? 7. Mr. Peter Victor Cisneros is receiving 45ml/hr. Because you are a superior nurse, you know that this information is not adequate for your documentation. You look at the IV label and see the concentration is 4mg/ml. How many mg/min? Answers on page 8 7

19 Basic Arrhythmia Assessment Nurses with experience in Basic Arrhythmia that will be working in areas with cardiac monitoring must achieve a score of 80% and not miss any lethal arrhythmias on the Basic Arrhythmia Assessment. If this score isn t achieved, your manager may determine an action plan to ensure competency in the areas missed. Areas required to take the Basic Arrhythmia assessment include: Critical Care areas, Telemetry/PCU, Remote Tele units, Emergency Room, Labor & Delivery, Post Anesthesia, Endoscopy, Same Day Surgery, Cath Lab, Interventional Radiology, and Nursing Supervisors. To ensure a successful score, it is highly recommended that the following web sites be reviewed prior to taking the assessment. Basic Arrhythmia Review Websites Answers to Math Worksheet - IV Calculations Dosage Quiz ml x 20gtt/ml = 42gtts/min 60 minutes (you divide by 60 because there are 60 minutes in 1 hour) ml x 15gtts/ml = 25gtts/min 600 minutes (10 hrs x 60) ml x 10gtts/ml = 14gtts/min 720 minutes 4. 50ml x 15gtts/ml = 25gtt/min 30 minutes ml x 10gtts/ml = 19gtts/min 240 minutes 6a U = 100U/ml 250ml 6b. No!! because 750U/hr =8ml/hr.Not 13ml/hr 100U/ml 7. 4mg/ml x 45ml/hr = 3mg/min 60 minutes 8

20 PBDS Prep What If This assessment component reflects your ability to make priority decisions for unplanned events and determine acceptable subsequent interventions. You will be given a brief clinical situation where you will prioritize the urgency of the action needed. The priorities are identified as: MUST DO and requires intervention within one hour. SHOULD DO and requires intervention by the end of the shift. COULD DO is not urgent, can be delayed until the next shift or another time. All items that you identify as "MUST DO", you will need to list the specific actions you will take. You will type your response to the Must Do rating in the Action Taken column. This is a sample of the online form with an acceptable response to a Must Do rating. Key points: There is no need to type your responses in complete, grammatically correct sentences Outline/bullet format is fine Your responses reflect the actions you need to take at that time, not during the entire hospital stay 9

21 Clinical Judgment This assessment component validates your ability to: Recognize and label clinical problems Manage the problem effectively and state the interventions Identify the urgency involved Explain and state the rationales for your interventions You will view a short (1-2 minute) video clip of a clinical situation. You will have 5 7 minutes to type your response based on the video simulation and a narrative description. The 5 7 minutes is utilized to add an element of real time to the clinical situation since we routinely have to react quickly. This is a sample of the narrative description. Narrative Description: Mr. Reese is a 22-year-old carpenter who fell from a roof this morning. He sustained a fractured pelvis and ruptured spleen. He underwent an emergency splenectomy and returned from the Recovery Room one hour ago. Currently he is undergoing a blood transfusion, his temp is 101.6, pulse is 90, resp 32, BP 148/98. One hour later Mr. Reese is observed to have a temp of 102.9, a rash on his face and trunk and he is chilly with the covers pulled up over his head. Complete the Clinical Judgment form based on this information. This is a sample of the online form with acceptable responses. 10

22 Key points: There is no need to type your responses in complete, grammatically correct sentences Outline/bullet format is fine Your responses reflect the actions you need to take at that time, not during the entire hospital stay If you think the patient needs: IV access, oxygen, safety precautions, airway assessment, etc., make sure to write it even if you see it on the PBDS vignettes. Don t forget to give a frequency for your interventions that need to be repeated. For example, Neuro checks every 15 minutes. The next page is a Clinical Judgment Aide that you can use when taking your assessment. It will serve as a reminder of the actions you need to take and the format of how to type your responses. 11

23 Patient Problem: Clinical Judgment Aide Label the problem: What is wrong with the patient? Example: AMI, renal failure, DKA, pulmonary embolus Keep in mind that you are not diagnosing the patient. You are only indicating what you think is going on with the patient. Interventions Describe the Priority Actions you would take to manage the problem It is easier to number each response. Your numbers are not intended to reflect the order in which you are doing the intervention; rather they will correspond to your rationales. 1. Call MD How soon? Write STAT or Now if you need immediate response from the MD. Note: LPN notify RN 2. Paint the Picture - Tell him: Observations, assessment provided in the PBDS script, v/s, lab, x-rays, change in condition, adverse response to therapy. Any history if relevant to identify the problem. 3. ANTICIPATE ORDERS: For medications, procedures, etc. (once you have indicated call MD, it is assumed you will have an order for dependent interventions). 4. Monitor: What are you monitoring? How often? LOC, Glucose, O 2 sat., respiratory status, response to treatment 5. Assess: What system? How often? Be specific. Cardiac: Heart rhythm, circulation Respiratory: Breath sounds, rate, depth Neuro: LOC, movement, reflexes GI: Bowel sounds, tenderness, distention, ascites GU: bladder distention, I & O, vaginal bleeding Vital Signs: Which ones? How often? Be specific, state relevant v/s only. Note: Indicate priority by stating how often you will repeat them. 6. Independent Nursing Actions CALL MD Initiate Protocols Elevate HOB Comfort measures be specific CPR, call a Code Inform other team members Rationales for Actions Why did you do what you did? You should have 1 rationale for each intervention, i.e. if you have 3 interventions you should have 3 rationales Ask yourself, am I including the actions needed to take to keep this patient safe? 1. To inform MD of condition changes To get orders Potential complication/emergent situation 2. To give enough information to the MD so he/she can determine what the problem is and provide relevant orders. 3. Medications: i.e., Tylenol = rationale: to reduce temperature Procedures: i.e., Chest x-ray = to confirm diagnosis or evaluate response of treatment 4. Baseline parameters To monitor condition Assess for changes and response to interventions Assess the response to treatment 5. Baseline assessment/identify symptoms that could differentiate diagnosis Monitor for changes Assess response to treatment/medications 6. Inform of condition, Communicate urgency, Get orders for treatment, protocols, tests, transfer To intervene in a timely manner To allow increased chest expansion/improve breathing/decrease workload of heart To provide comfort To maintain circulation/oxygenation To get help, consultation TIPS TO REMEMBER: If you think the patient needs: IV access, oxygen, safety precautions or airway assessment make sure to write it even if you see it on the PBDS vignettes. Remember to give a frequency for your interventions that need to be repeated, i.e., Neuro checks every 15 minutes. 12