WOR/PACU. Name. Wilmer Eye Institute Johns Hopkins Hospital

Transcription

1 W/PACU NCB Orientation Name Wilmer Eye Institute Johns Hopkins Hospital

2 General Information: Please refer to Faculty and Staff User Guide for more information. Patient Transport No patient transport should occur o On level 2 (Main Hospital Corridor) o On Level 4 and 5 connection between patient units o Through patient care units To transport to and from Weinberg, use level 3 (Staff0only entrance) Public elevators Patients and guests travel in separate elevators in separate lobbies located in both the adult and children s towers. Staff will use public elevators. Patient Transport Elevators To ensure patient privacy, eight elevators four in each- tower are designated for patient transport. Soiled and Clean Materials Individual elevators moving either clean or soiled materials are housed in separate lobbies in each tower. Emergency Phone Numbers Emergency Codes New Hospital Address 1800 Orleans St. Baltimore, MD 21287

3 Room Number Codes Room # Important Phone Numbers /ICU Pharmacy Room Description Children s 4 th Floor Nurse Coordinator beeper Control Desk Anesthesia Workroom Critical Care Tech beeper Equipment Specialist Beeper Clean Core if any Patient Family Waiting area Tube system to Pathology Adult Emergency Department Prep 4 th Floor PACU 4 th Floor Prep 3 rd Floor PACU 3 rd Floor Central Store (Basement) Blood Bank WIL Pathology WIL Ultrasound WIL Pathologist (Dr. Eberhart) Key Pad 4221 Scope Storage A Scope Clean Scope Decontamination Shared Equipment Anesthesia Supply Staff Lounge Call Rooms Medications Equipment/Wilmer Male Locker Room Female Locker Room 4311 Location 1. Location NCB Pediatric s are located at 4 th floor of the Bloomberg s Children s Center. Wilmer cases will be done in Locker rooms are located on the hallway near the PREP/PACU. Each locker rooms will have its own showers and restrooms. 3. Scrub and jacket valets are also located on the hallway near PREP/PACU. 4. Surgical accessories such as caps, masks, gowns, and bunny suits are located at the Control Desk and all over entrances. 5. Fire extinguishers, fire exits, fire hose and alarms are located all throughout the operating rooms. Fire extinguishers are available in each room. 6. Oxygen shut off valves are located outside of each suites. 7. There are two Sub Sterile Area in the Peds. It is located in one of each ends of the Clean Core. 8. Ophthalmic Supply Cart will be kept at Central Sterile located at the B2, Shiekh Zayed Tower. 9. Instument cart will be kept at Peds, Clean Core near ICU and Operating Room Pharmacy are located on the third floor. 11. Pathology lab will remain at Weinberg. Process for specimen procurement will remain the same.

4 Freezer/Refrigerator Ophtha (Wilmer) Cart Isolation Carts Instrument Pyxis General Supplies and Glove Supply Pyxis Crash Cart Return Cart Workstation NCB Level 4 To patient transport elevator From elevators (Double doors) H A L L W A Y Clean Case Cart 4167 Soiled Utility 4169 Restrm Trash Equip Room 4248 O R C O R R I D O R 402 Sub- Sterile Equip O R Equip O R C O R R I D O R C L E A N 403 Equip 4267 Equip C O R E 404 Equip 4271 C O R R I D O R Equip Pump Storage MED 4284 Restrm Children s Operating Room Anes Supp 4286 Equip Alcove Sub- Sterile Anes Control 4292 Control Desk Anes Shared Equip 4288 O R C O R R I D O R Phys Dict Room Scope Decon Lounge Scope Clean Minor Room 4293 RN Educ 4307 OnCall 4312 PICU Lounge 4310 OnCall 4312 OnCall 4312 ECMO Storage 4314 Conference Room Anes Bill/Post Male Locker Room 4202 Equip Alcove Equip Storage 4225 Female Locker Room 4218 Trash Scope Store 4221 Scope Store Staff Wkrm To Peds PACU Scrub Machines H A L L W A Y From Peds Prep

5 Emerg GPS Cart Peds Vasc Cart Peds Stapler Cart GPS Lap Cart Peds Ortho Specialty Perc Cart Positioning Devices Peds GU Cart Suture Core and Perfusion Connectors Plastics Cart General Supplies & Glove/Solutions Peds Neuro Supplies ENT Supply Special Order ENT Induction Room Supply 5 Special Cardiac Order Supplies Gen Supplies Perfusion Supplies Return Cart 1 Wilmer Cart Crash Cart 2 Cranifacial Implant Cart Isolation Cart Supply Pyxis Instrument Cart Freezer/Refrigerator Cart VP Shunt Cart Emergency Crani & GPS Cart Peds ENT Cart NCB Level 4 CLEAN CE Potential Carts 6 Burn Cart Workstation

6 New Clinical Building Level 3

7 Guide for Admission of Post-Op Pediatric Ophthalmology Patients to The Children s Center Background: This guideline was created because there has been confusion regarding who should be the attending for post op Wilmer patients, usually infants, admitted to The Children s Center after having an operative procedure at Wilmer. Goal: To standardize the process of transfer of these patients to The Children s Center and promote communication between ophthalmology, anesthesiology, and pediatrics General Rule #1: Any ophthalmology patient under age 2 years needing admission to The Children s Center will be admitted to the Zinkham service with a pediatric attending. 1. All pediatric post-op ophthalmology patients under age 2 years who require admission to The Children s Center will be admitted to the Zinkham service with a pediatric attending. After admission, the ophthalmology staff will continue to provide care in a cofollow role. Only the pediatrics staff will write orders on these patients. 2. After the procedure is performed, the ophthalmologist will page the pediatrics senior resident for the Zinkham Team at (410) The resident will inform the Zinkham attending of the admission. These admissions will always be admitted to the Zinkham team, unless it is absolutely necessary to send to the Neill team. 3. The ophthalmologist will communicate with the pediatric resident regarding the case and anticipated management of ophthalmologic issues. The pediatrics team will write admission orders in POE. 4. The anesthesiologist will sign-out to the senior pediatric resident as well. This may be done by phone or in person at Wilmer. The pediatric senior resident will determine the need to assess the patient in person prior to transfer. 5. The ophthalmologist is responsible for doing the surgical dictation. The pediatric attending is responsible for doing the hospital discharge, including the post-op course General Rule #2: Any ophthalmology patient over age 2 needing admission to The Children s Center will be admitted to an ophthalmology attending. 1. All Pediatric post-op ophthalmology patients over age 2 years that require admission to The Children s Center will be admitted to an ophthalmology attending. 2. If the ophthalmology attending feels he or she needs assistance from the pediatric team to help manage the patient, he or she can page the pediatric shift coordinator at (410) and request that the Zinkham team co-follow the patient. This will be primarily desired for medical complex children with non-ophthalmic issues. The ophthalmology team, not the pediatric team, will write all POE orders. 3. If a pediatric co-followed is requested, the ophthalmologist will page the pediatrics senior resident for the Zinkham Team at (410) and communicate with the resident regarding the case and anticipated management of ophthalmologic issues. 4. If a pediatric co-follow is requested, the anesthesiologist will also sign-out to the senior pediatric resident. This may be done by phone or in person at Wilmer. 5. If a pediatric co-follow is requested, the pediatric senior resident will determine the need to assess the patient in person prior to transfer to CMSC. 6. If a pediatric co-follow is NOT requested, the ophthalmology attending and/or fellow will manage the patient without pediatric input. If at any point during the patient s hospitalization, the ophthalmologist feels the patient needs a pediatric co-follow he or she can page the shift coordinator and request that the Zinkham team co-follow the patient. The ophthalmology attending will be able to consult all pediatric subspecialties regardless of whether or not there is a pediatric co-follow. ***Please contact the Pediatrics Chief Residents for questions regarding these guidelines. (Updated 2/2009)

8 NCB Level 4 Post Anesthesia Flow (Inpatients) Day of Surgery RN coordinator sends patient from floor 1hr prior to surgery 1 PREP/PACU RN receives patient from floor 4 Nurse completes preprocedure verification (Room Ready) 2 5 Room Ready? Validation of preop checklist complete PRE/PACU RN calls Anes Yes No Nurse gather pre-procedure verification elements Anesthesia conducts interview and obtain consent. Transports patient to 8 Surgery finish 9 10 Call PREP/PACU RN for hand-off report Determine bed number Surgeon ensures post-op orders are written Nurses Anesthesia Provider Surgeon 11 Patient transported to PACU 4 th Floor Note: No post-op orders, no admission to PACU PREP/PACU Nurse Unit Scheduler Discharge to Home or Admit Admit 12 Discharge PREP/PACU RN notifies Shift Coordinator for Bed Assignment SC 3/6/2012 Discharge 13

9 NCB Level 4 Post Anesthesia Flow (Emergency) Clinic Physician Patient scheduled Physician enters contacts NCB in OMRIS orders to POE Charge Nurse Informs PREP/ PACU Charge Nurse informs PREP/PACU Clinic staff (Physician / Resident) brings patient to 4 th Floor PREP/PACU Prep complete PRE/PACU RN calls Anes Nurse completes preprocedure verification Anesthesia conducts interview and obtain consent. Room Ready? 10 Transports patient to 11 Nurses Charge Nurse/Coordinator Anesthesia Provider Surgeon/Clinic Physician/Resident Call PREP/PACU RN for hand-off report Determine bed number 12 Surgery finish 13 Surgeon ensures post-op orders are written 11 Patient transported to PACU 4 th Floor Note: No post-op orders, no admission to PACU PREP/PACU Nurse Unit Scheduler Discharge to Home or Admit SC 3/6/2012 Discharge Discharge 13 Admit 12 PREP/PACU RN notifies Shift Coordinator for Bed Assignment

10 NCB Level 4 PEDIATRIC Post Anesthesia Flow (SDAD) Patient scheduled in MIS 1 2 EPIC Check-in Ready (Prior to day of surgery) 3 Day of Surgery Patient Registered/Time Stamped 4 Prep Start Nurse completes preprocedure verification Prep complete PRE/PACU RN calls Anes Anesthesia conducts interview and obtain consent. Room Ready? YES Transports patient to 8 Surgery finish 9 10 Call PREP/PACU RN for hand-off report Determine bed number Surgeon ensures post-op orders are written 11 Nurses Anesthesia Provider Surgeon 12 Patient transported to PACU 4 th Floor Note: No post-op orders, no admission to PACU PREP/PACU Nurse Unit Scheduler Discharge to Home or Admit Peri-Op PSC SC 3/6/2012 Discharge Discharge 14 Admit 13 PREP/PACU RN notifies Shift Coordinator for Bed Assignment

11 NCB Level 3 Adult Ophthalmic Surgical Patient Flow (Inpatients) 1 Day of Surgery th Floor RN Coordinator sends patient from floor 1hr prior to surgery Hand-off 4 th Floor Coordinator and 3 rd Floor PREP RN 3 rd Floor PREP RN receives patient from floor 4 Nurse completes preprocedure verification (Room Ready) 2 Validation of preop checklist complete PRE/PACU RN time stamps- patient ready 5 Room Ready? No Nurse gather pre-procedure verification elements. 3 6 Surgeon marks patient in PREP Yes 7 8 Anesthesia conducts interview and obtain consent in PREP Transports patient to Surgery finish 9 10 Call 3 rd Floor Adult PACU RN Determine bed number Surgeon ensures post-op orders are written Nurses RN Coordinator Anesthesia Provider Patient transported to 3rd Floor Adult PACU 11 Note: No post-op orders, no admission to PACU Surgeon PREP/PACU Nurse team (Surgeon / Nurse / Anesthesia Provider) hand-off given to PACU RN Unit Scheduler Discharge to Home or Admit Hand-off SC 3/9/2012 Discharge Discharge 13 Admit 12 PREP/PACU RN notifies Shift Coordinator for Bed Assignment

12 Patient scheduled in OMRIS NCB Level 3 Adult Ophthalmic Surgical Patient Flow (Emergency) Clinic Physician informs NCB 4 th Floor Charge Nurse Physician enters orders to POE 4 6 Clinic staff (Physician / Resident) brings patient to AED to get registered and prepped for surgery Nurse completes preprocedure verification Surgeon Ready Anesthesia Ready AED prep complete 5 7 Room Ready 4 th Floor Coordinator sends for the patient Hand-off Report AED RN and 4 th floor RN Coordinator 8 A transports patient from AED to 9 Nurse interviews patient Surgeon Marks the eye Anesthesia conducts interview and obtain consent. Surgery start/ finish Call 3 rd floor PACU RN to determine bed number Surgeon ensures post-op orders are written A Nurses 12 Note: No post-op orders, no admission to PACU Charge Nurse/Coordinator Patient transported to 3rd Floor Adult PACU Anesthesia Provider Surgeon/Clinic Physician/Resident Team (Surgeon/Nurse/Anesthesia Provider) give hand-off report to PACU PREP/PACU Nurse Adult Emergency Dept (AED) Discharge to Home or Admit 13 Hand-off Discharge Admit SC 3/9/2012 Discharge 14 PREP/PACU RN notifies Shift Coordinator for Bed Assignment

13 Instrument Process for Scheduled Cases Instrument Process for Emergency Cases Wilmer MM Staff refers to pick list for Tray(s) and/or instruments needed for a G NCB Case Wilmer Materials Management (MM) NCB G Materials Management (MM) NCB G MM Staff gets G Trauma Tray from Sterile Core and places it on case cart Selected tray(s) and/or instruments are placed inside built case cart (Bendann) Wilmer Nurse Wilmer Central Sterile Processing CSP Surgery NCB G MM Staff brings case cart from Bendann to NCB Surgery Wilmer Nurse places contaminated/used instruments and trays inside case cart. Wheel used case cart to soiled utility room Wilmer Nurse places unused instruments and trays on bin on top of case cart. Place bin inside return cart in Clean Core Wilmer Nurse places contaminated/used instruments and trays inside case cart. Wilmer Nurse places unused instruments and trays on bin on top of case cart. NCB G MM Staff brings used case cart back to Bendann Wheel used case cart to soiled utility room Place bin inside return cart in Clean Core Wilmer CSP reprocessed G Trauma Tray NCB G MM Staff returns used case cart to Bendann Cora to determine process to return G Trauma Tray/Instruments to NCB Sc

14 Supply Process for Scheduled cases Surgeon schedules case CSS informs Wilmer MM Staff of scheduled case in NCB Surgeon Centralized Scheduling Staff (CSS) Wilmer Materials Management (MM) NCB Materials Management (MM) Wilmer Nurse Wilmer MM staff builds case cart in Bendann NCB MM Staff brings case cart from Bendann to NCB Suite NCB MM Staff brings Ophthalmic Supply Cart in suite (Day of surgery) Wilmer Nurse prepares room/checks supplies Are supplies complete? YES NO Wilmer Nurse gets missing supplies from Specialty Cart Wilmer Nurse does case YES Are supplies complete? NO Wilmer Nurse calls/informs NCB MM Coordinator of missing items Tel: Surgery Finish Checks NCB storeroom for supplies YES Wilmer Nurse places unused supplies on bin on top of case cart Are supplies complete? NO Place bin inside return cart in Clean Core NCB SC Coordinator will call Wilmer MM for missing supplies Wilmer MM Staff sends missing supply to NCB Sc

15 Supply Process for Emergency Cases Surgeon schedules case NCB MM Staff builds case cart 1. Use DPC pick list to pick supplies 2. Picks Instrument/trays from pick list to put on case cart Surgeon NCB Materials Management (MM) Wilmer Nurse NCB MM Staff brings case cart to Suite NCB MM Staff brings Ophthalmic Supply Cart in suite (Day of surgery) Wilmer Nurse prepares room/ checks supplies Are supplies complete? YES NO Wilmer Nurse gets missing supplies from Ophth Supply Cart Wilmer Nurse does case YES Are supplies complete? NO Wilmer Nurse calls/informs NCB MM Coordinator of missing items Tel: Surgery Finish Checks NCB G storeroom for supplies Wilmer Nurse places unused supplies on bin on top of case cart YES Are supplies complete? NO Place bin inside return cart in Clean Core NCB G MM Staff brings missing supplies from Bendann SC 2/28/2012

16 Equipment Process for Scheduled cases NCB ES pulls equipment list from schedule Wilmer Nursing Staff NCB Equipment Specialist (ES) NCB ES obtain equipment from Wilmer equipment room and places it in Suite (Day of Surgery) Wilmer RN determines equipment is complete Are equipment complete? Proceed with Surgery Yes No Page equipment specialist to obtain additional equipment Pager: Wilmer RN audits DPC and submits corrections to Sharon Baylis/Sheila Cortes using DPC sheet If ES is unavailable, Wilmer staff obtain equipment from Wilmer equipment room. Are equipment complete? Surgery Finish No When preparing for next case, Wilmer staff can push equipment that are not needed outside suite MM sends missing equipment to NCB from Bendann NCB ES returns equipment to Wilmer Equipment Room Sc

17 Equipment Process for Emergency Cases Wilmer Nursing Staff NCB Equipment Specialist (ES) Weekday Weekend Page NCB ES to obtain equipment Pager: NCB ES unavailable on weekends Are NCB ES available? Wilmer Staff obtain equipment from Wilmer equipment room NO YES Wilmer staff obtain equipment from Wilmer Equipment Room NCB ES acquire equipment form Wilmer Equipment Room Surgery Return equipment after surgery Are NCB ES available? NO YES Next Case : Staff pushes equipment outside suite. Page NCB ES No Case to follow: Leave equipment in room NCB ES returns equipment to Wilmer Equipment Room Sc 2/6/2012

18 Option 1 Ophthalmic Cart (Wilmer Supplies) Nurses takes supplies from Ophtha Cart to use in a case Surgery NCB MM will do an Ophtha Cart Par Level NCB MM sends (How?) par level to Neal Wilmer Materials Management (MM) Staff NCB Materials Management (MM) Staff Circulating Nurse Neal sends supplies to NCB MM to refill cart. (How?) All nurses (NCB/ Wilmer) document on MIS consumption screen for supplies used. Neal charges NCB for expensed out supplies NCB MM charges patient for used items SC 2/29/2012

19 Pathology, Cytology, and Microbiology Eye Pathology - New location Smith Building, 4 th Floor Room Schedule: Monday Friday, work hours - All specimens are delivered to Smith Building location. Microbiology - Location: Meyer Basement (B1)-105 across Core Lab. - Schedule: Open 24 hours, 7 days a week. SPECIMENS Routine specimens o Received by pathology staff. o If staff unavailable, bring specimen to room 4031 A or can be left in large yellow bin in Smith Register specimen onto log book. o May also be brought to Surgical Pathology accessioning desk at Weinberg 2237 (currently under construction; use Weinberg 2222). Rush Specimens o Received by pathology staff. o If staff unavailable, bring specimen to room 4031 A. Eye Specimens (Cytology) o Cytology specimens are time sensitive. If unable to be delivered promptly, refrigerate specimens to preserve cell life. o Fluid eye specimens collected in syringe are brought to Cytology by Eye Pathology Staff during work hours (tel #: ). o Specimens collected after hours can be brought to Surgical Pathology Accessioning desk or kept in Wilmer to be stored and refrigerated until the following morning (regular work days only). Microbiology (Swab and Ocular Surface Pack) o Eye specimens especially ocular surface packs are considered critical specimens and are typically hand-delivered to Microbiology as specimens can easily be lost in the tube system. o For any questions, call Brandon at Frozen Section o Surgeons must inform Dr. Eberhart in advance if frozen are planned for surgery. o Weinberg pathologist may also process Wilmer frozen section. o For unplanned frozens (after hours or weekends), call Surgical Pathology Accessioning desk (2-1588).

20 Zayed/Bloomberg 4

21 Zayed/Bloomberg 4 Nelson 4 = fire extinguisher = fire alarm pull station = oxygen shut off = smoke zone = 2 hour fire separation = stair well Bloomberg

22 Zayed/Bloomberg 4 Notes: Zayed Bloomberg is technically one building. One building means one fire alarm system. That means if the PICU goes into alarm...the whole entire 4th floor also goes into alarm. And of course this works vice versa...if there is an alarm in the echo lab...picu is going into alarm. The alarm will sound off on the floor that is in alarm, 2 floors up and 1 floor below. What will be announced when an alarm is activated is the location of where it was activated so you will hear if it was in either the Zayed wing or the Bloomberg wing but just remember...both areas will be alarming. What makes one building separate from another?...say CMSC from Blalock or...meyer from Osler...is that there is a 2 hour fire separation between the buildings so they can be treated as different buildings. Zayed and Bloomberg do not have this consistent fire separation. It DOES exist...however...on the floors that have the s. So 3, 4, 5, and 8 there is a 2 hour fire separation between what is considered Bloomberg and the far east side "bridge" area of Zayed (technically the location of the s is physically in Zayed). Because of this 2 hour fire separation...your written plan which I will send you in a little bit...you initially keep moving from smoke zone to smoke zone and if for some reason a whole area needs to be evacuated...you can cross over the 2 hour fire separation into Bloomberg. Your other option...if moving in the other direction...is that you can evacuate into Nelson 4. The red line shows your smoke zones. Echocardio is a zone. Adult imaging is a zone. Children's surgery is a zone. Children's imaging and prep and PACU are a zone. Then you see the 2 hour fire rating separating you from Bloomberg. For any questions, call Anita stone at

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