Lake Health Systems Nurse Reference Guide

Transcription

1 Lake Health Systems Nurse Reference Guide Learning Management System - Log onto LMS icon or using the following URL: ADP ipay Statements - You will need to register at: - To view your payroll statements from work and also from home 1 / 22

2 Frequently Called Numbers West Hospital Extensions DIV 4 North = PACU = DIV 4 South = PACU Bed A= DIV 4 East = PACU Bed B = DIV 4 West = PACU Bed C = CCR/ 5 East = PACU Bed D = MCU = PACU Bed E = / 22

3 SDU A Pod = Radiology = SDU B Pod = Radiology Bed 1 = SDU C Pod = Radiology Bed 2 = SDU 3 West = Radiology Bed 3 = Geropsych = Radiology Bed 4 = ICU Neuro = Radiology Bed 5 = ICU North = ICU South = ICU East = ER = OB = / 22

4 TriPoint & West Hospital Extensions Med Tele = Surg Tele = ICU/SDU = ER = OB = TriPoint Nursing Supervisor = West Nursing Supervisor = Staffing Office = 36022, 33113, 36077, / 22

5 Nursing Office Fax Number = (W) (Tri) Throughput Assistant = Call-off Line = West Pharmacy = Nutrition Issues= Vocera the group Nutrition Manager Vocera Information 5 / 22

6 - How to log in: - Press the call button and wait for the prompt to ask you for your name - How to log off: - Press the call button and say log me out - How to start a call: - Press the call button and say Call - Press the call button to end the conversation - How to add to group: - Press the call button and say Add me to - Press the call button and say Remove me from - To add Flex Team to ED: - Press the call button and say Join ED conference - To remove Flex Team from ED: - Press the call button and say Leave ED conference - How to place a call on hold: - To place a call on hold or to be in Do Not Disturb mode, simply press the button on the top of the vocera badge. You will see a blinking yellow indicator light which lets you know that all calls are placed on hold. - To take a call off hold or to no longer be in Do Not Disturb mode, press the button again. You will see that the indicator light is now green. - To locate a team member: - Press the call button and say Locate 6 / 22

7 Blood Draw Order - Blood Cultures - Blue Top - Green/Yellow Top - Lavender Top Blood Culture Draw Order 1. Aerobic 2. Anaerobic A-Line: Equipment / Set-up 1. A-Line starter kit (radial and femoral) 2. Pressure bag and transducer kit inch extension transducer cable 4. Draeger pigtail 5. Prime 6. Physician to insert line 7. Connect to Draeger monitor 7 / 22

8 ECG ELECTRODE PLACEMENT (V1) 4 th intercostal space, right of sternum (V2) 4 th intercostal space, left of sternum (V4) 5 th intercostal space, in the midclavicular line (V3) Midway between V2 and V4 8 / 22

9 (V6) 5 th intercostal space, in the midaxillary line (V5) Same level as V4, at anterior axillary line (between V4 and V6) CORE MEASURES Acute MI 9 / 22

10 - PCI within 90 minutes of arrival - Aspirin at arrival or within 24 hours - ACE or ARB for Ejection Fraction - Aspirin at discharge - Beta Blocker at discharge - Statin at discharge - LDL drawn within 24 hours of admission - Smoking Cessation education SCIP - Surgical Care Improvement Project - Antibiotics administered within 1 hour prior to surgical incision - Appropriate antibiotics - Prophylactic antibiotics discontinued within 24 hours of anesthesia end-time - Appropriate hair removal - Normal patient temperature within 15 minutes post-op - Patients on beta blocker prior to admission received beta blocker in perioperative period - VTE prophylaxis from arrival to within 24 hours after anesthesia end-time (mechanical and pharmacological) - Foley discontinued by post-op day 2 Pneumonia - Blood cultures drawn prior to first antibiotic (Only for ICU or septic patient) - First antibiotic within 6 hours of arrival 10 / 22

11 - Appropriate antibiotic - Pneumonia and Influenza vaccination - Smoking Cessation education - Oxygen Assessment Heart Failure - Left ventricular function assessment (EF=ejection fraction) - ACE or ARB for EF - Smoking Cessation education - Discharge instructions (activity, diet/fluid, meds, worsening symptoms, weight monitoring, follow-up appointments) Stroke - Thrombolytic therapy (TPA) within 3 hours of symptom onset. If not ordered, reason must be documented. - VTE prophylaxis within 24 hours of arrival (mechanical and pharmacological) - LDL drawn within 48 hours or 30 days prior to admission - Anti-thrombotic therapy - PT, OT and speech consults - Stroke education - Discharge on statin, anti-thrombotic and anticoagulation therapy for atrial fibrillation 11 / 22

12 ** For medications or treatments contraindicated, reason must be documented by physician ** AIDET A: ACKNOWLEDGE THE PATIENT Acknowledgment is the first opportunity to make a person real. The 10-5 rule should be used with respect to acknowledgement. In other words, when you are 10 feet away, look up, smile, and make eye contact to demonstrate approachability. When you are 5 feet away, acknowledge the person verbally (eg, Good Morning, how are you? ). It also is recommended that you use the patient s last name if possible. In their article An Evidence-Based Perspective on Greetings in Medical Encounters, Makoul, Zick, and Green say, Because greetings are one way to ensure proper identification of patients they may well be considered a fundamental component of patient safety. In fact, 91.3% of patients wanted to be addressed by their name. 12 / 22

13 I: INTRODUCE Tell the patient your name, title, and credentials so she knows who will be caring for her. Remember the Patient Bill of Rights says that patients must know who is caring for them at all times and in what role. We introduce ourselves not for our comfort, but for the comfort of the patient, It also is recommended that you use an introduction that manages up (positively positions) your skill set, experience, and certifications, as well as those of your coworkers and other departments. You might say, Hello Mrs. Williams, my name is Jim Johnson. I m a registered nurse, and I ll be caring for you today. Here at Lake Health, patient satisfaction is very important to us, so I want to be sure you receive excellent care. I ve been in health care 20 years now.the last 5 years have been right here at Lake Health. You re very fortunate that Dr. Campbell is your physician today. She is one of our very best. D: DURATION How long will the wait/test/procedure/visit take? How long will it be until the results are available? How long will it be before the doctor comes in? ED personnel always tell me, But I don t know how long it s going to be! So should we just let patients wait for 6 hours and hope they don t notice? Don t be afraid of the big bad D (duration). We know that if a patient comes in with abdominal pain, he or she is likely going to spend the next 4 hours with us. If patients are getting fluids and pain medications and have to get a computed tomography scan of the abdomen with contrast, then we ll need to see how they do and if they can tolerate liquids before going home. They are going to be here for the afternoon. So tell them. Under-promise, then over-deliver. Patients will give us lots of latitude if we are honest in our communications with them. When possible, offer concrete time expectations. If that time passes, don t worry that you didn t make the goal. Just return to the patient and update him or her. 13 / 22

14 E: EXPLANATION Explanation connects back to clinical quality and patient safety. In one study, 2 of the top 4 factors that engendered complete trust in a physician were: (1) the patient got as much medical information as they wanted, and (2) the patient was told what to do if symptoms continued, worsened, or returned. When patients leave your facility, it is important that they have a very clear understanding about what you want them to do once they are home. In fact, studies of patient behavior show that only half the patients who leave a doctor s office typically take the prescribed medication. According to the Office of the Inspector General, noncompliance with medications results in 125,000 deaths each year from cardiovascular disease alone. T: THANK YOU Your patients have a choice. If they don t have a positive experience, they might just drive right past you to the hospital down the street. So say, Thanks for coming in today or Thank you for letting me take care of you or Thank you for choosing Lake Health. Is there anything else you need before you go? Are there any other questions I can answer? The point is to show care and compassion for the patients and their families who may be dealing with difficult situations when the patient goes home. A thank you also provides an opening for the patient to thank staff for the care they have provided and to have a final moment to say goodbye. 14 / 22

15 We have 3 opportunities to explain or use key words to ensure that patients are compliant with our care at the end of their visit. First, when a physician does a formal close with a patient, the physician essentially is contracting with the patient that he or she will be compliant with discharge instructions. Secondly, nurses can manage up physicians and reinforce expectations by saying, I know Dr. Smith has shared discharge instructions with you. What questions do you still have? Offer information about what will happen next and what the patient should expect, and ask, Do you understand your discharge instructions? The third and last opportunity to ensure that patients are compliant with discharge instruction is during the discharge phone call. An excellent time to check in is within 72 hours after the patient goes home to learn if prescriptions were filled, if the patient needs further instructions, and to see how he or she is doing. AIDET & KEY WORDS 1.) A- Acknowledge Stop, look and Listen Smile, make eye contact Listen intently 15 / 22

16 2.) I- Introduce Beginning of shift introductions Discuss daily schedule Inform patient and family about your unit and visiting hours 3.) D- Duration (Time Parameters) Daily schedule Pain management schedule Anticipated length of procedure Shift hours you will be working with and for the patient 4.) E- Explain Procedures Medications 16 / 22

17 Discharge planning, anticipated discharge date 5.) T Thank End of shift message; It was a pleasure caring for you today. Thank you for choosing Lake Health. Your words should: - Send the right message about our service-we are here to provide excellent, quality nursing care - Send a consistent message-we want patients to be satisfied with our care - Avoid words that show we do not care- We are short staffed. That is not my patient. There s/he goes again using his call light. Remember, your body language delivers 55% of the message, tone of your voice represents 38% of the message and words 7% - Make eye contact, Smile - Show you have time to listen and talk!! 17 / 22

18 CRITICAL THINKING WHEN CALLING DOCS 1.) Have I seen and assessed this patient myself before I call? 2.) Are there standing orders? 3.) Do I have at hand: A. The chart B. List of current meds. IV fluids, and labs C. Most recent vital signs, 02 sat, blood sugar etc. D. If reporting lab work, date and time this test was done and results of previous test for comparisons E. Code status 4.) Have I read the most recent MD progress notes and notes from the nurse who worked the shift ahead of me? 18 / 22

19 5.) Does anyone else need to speak with this MD 6.) When ready to call, remember to: A. Identify self, unit, patient, room# B. Know the admitting diagnosis and date of admission C. Briefly state the problem, what it is, when it happened or started, and how severe it is. 7.) What do I expect to happen as a result of this call? 8.) Document whom you spoke to, time of call and summary of conversation, objectively 9.) If verbal orders received, read back to MD prior to ending conversation 19 / 22

20 CODE STEMI PROCESS 1.) Pt admitted via ED with tentative MI diagnosis 2.) 12 lead ECG obtained 3.) Immediately present ECG to physician for interpretation 4.) Stat Vital signs, weight in kilograms 5.) Activate Code STEMI- Call operator- Overhead page CODE STEMI. Stat call to On-Call Interventionalist 6.) Follow Emergency Dept/ Cath Lab STEMI Order 7.) Consider Primary PCI (Goal: Door to Balloon less than 90 minutes) 8.) PCI transfer to Cath Lab with RN as instructed 20 / 22

21 9.) Admit to ICU following procedure, make sure Supervisor obtained bed BRAIN ATTACK PROCESS Acute onset of weakness or inability to speak for less than 2 hours: Activate the Code Brain Attack, Page and Notify On Call Neurologist of Potential Alteplase (tpa) Patient 1.) Call operator and Activate the Code Brain Attack page 21 / 22

22 2.) Follow the Acute Brain Attack Order set 3.) Test to be done STAT 4.) Keep patient NPO 5.) Determine treatment plan 6.) Transfer to appropriate level of care 7.) Notify family of pt. status 8.) Access pt using NIH Stroke Scale 22 / 22