2012 Annual Clinical Training and Policy Review

Transcription

1 2012 Annual Clinical Training and Policy Review Please review the following slides. Using the information from the slides along with your 2012 Joint Commission Survey Readiness Guidebook, complete the learning assessment. Remember, these learning activities provide only a highlight of the information contained in OUMC policies. It is expected that you will access the policy on the OUMC Intranet and carefully review any policy which directly applies to your job duties.

2 OBJECTIVES: Upon completion of this course, you should be able to: Acknowledge the hospital allows the patient a support individual, as defined by the patient, to be present for emotional support during the course of the patient s stay. Define Sentinel Event Acknowledge that Sentinel Events signal the need for immediate investigation Define pain Describe how to tell if a patient is in pain List a few non-pharmacological comfort measures for pain management Describe your role regarding the pain management of the patient Define hazardous waste materials Describe how to safely handle hazardous waste materials, the communication process for hazardous waste materials, and proper handling and disposal methods.

3 Objectives continued: Describe how the hospital identifies patients at risk for falling and steps you can take to create a fall risk safe environment Identify actions you can take to help create a Suicide Safe Environment Define restraints and seclusion Describe actions you can take to provide safe care to any patient in restraints. Acknowledge the goal of the hospital is that no patient will be placed into restraints or seclusion. Describe Family-Centered Care Define Population Specific Care Identify actions you can take to modify your care based on the individual needs of your patients.

4 Sentinel Events: Prevention and proactive management of risk Review Sentinel Events: OUMC Policy 13-02

5 Sentinel Event A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. Serious injury specifically includes loss of limb or function. Such events are called "sentinel" because they signal the need for immediate investigation and response. The hospital makes every effort to proactively eliminate risk or danger to our patients. It is important to report and investigate all Sentinel Events, but to also report, through your chain of command and the event reporting system, all near misses.

6 Sentinel Event: Near misses What is a near miss? A near miss is a mistake that does not reach the patient and has not caused harm. But the near miss has the potential to have caused harm had it reached the patient. Near misses are difficult to track. Staff tend to believe that if the mistake did not happen, or reach the patient, why report it? Reporting near misses helps us identify possible trends and system wide issues. Therefore, giving us the ability to proactively protect our patients.

7 Sentinel Events Some examples of near misses are: Medications: omitted dose, mislabeled meds, wrong dose or wrong patient Mislabeled lab specimens Missed treatments Potential exposures to chemicals Incomplete Time Outs A fall without injury Expired products Alarm failures Please report all near misses up your chain of command and the event reporting process.

8 Pain Management: Making a difference! Review Pain Management Guidelines: OUMC Policy 11-51

9 Pain Management: Making a difference! As an OU Medical Center System s employee caring for patients, you will come into contact with a patient that is in pain. So what do you need to know about pain management? The definition of pain How to tell if a patient is in pain Several non-pharmacological comfort measures Your role at OU Medical Center regarding the pain management of the patient.

10 Purpose of Pain Management To provide our caregivers specific pain management guidelines so that we can: Minimize pain in our patients Provide the best possible pain relief measures Respect and support the patient s rights to excellent pain management

11 Definition of Pain Pain is an unpleasant, sensory and emotional experience, associated with actual or potential tissue damage. Pain is identified based on what the patient says it is.

12 How can we make a difference? Identify signs of pain in our patients Have patient state pain level, location and duration Report pain issues or concerns to the RN in a timely manner Use non-pharmacological ways to decrease or relieve pain

13 How do we know the patient is in pain? Patient s self report Pain Physiological signs (increase or decrease heart rate, respiratory rate, blood pressure, diaphoresis) Behavioral cues (crying, moaning, groaning, screaming, sweating, whimpering, gasping, facial expression of pain, reluctance to move, restless, quiet, withdrawn) Assume pain is present when a known painful event has occurred Proxy report of pain (reports of pain from parents, family, or caregivers)

14 Non-Pharmacological Comfort Measures Environment (decrease noise/lights-minimize stimulation) Distraction (music/mobiles, imagery, soothing talk, soft voice) Position change (use blankets and pillows) Massage (back or extremity) Heat or Cold Therapy (when appropriate)

15 Teamwork Clinical Staff Clinical Staff have a duty to observe and report any signs of pain in our patients to the RN. They also are expected to utilize the Nursing Chain of Command for any concerns regarding the pain management of a patient. Remember, you are part of a team, and pain management is everyone s responsibility!

16 Safe Handling of Hazardous Substances Review Hazardous Drugs OUMC Policy and Chemotherapy Administration/Training NUR A/P

17 Safe Handling of Hazardous Substances What are hazardous substances? Hazardous substances are the body fluids of patients that are being treated with medications called hazardous medications. This includes sweat, tears, urine, feces, and other body fluids. Hazardous drugs may be administered for many reasons, including rheumatoid arthritis or a past history of cancer. This means that everyone coming into contact with patient body fluids must take precautions when handling or disposing of them. The nurse caring for your patient will inform you if the patient is receiving a hazardous drug and therefore requires special handling.

18 Routes of Exposure The goal of special handling of body fluids is to reduce the risk of exposure to hazardous substances. The most common way to become exposed to hazardous substances is through absorption. Absorption can occur through: Direct contact of hazardous substances with skin, mucus membranes or eyes, such as contacting a patient s sweat with bare hands. Splashing of the face or eyes with urine when emptying a foley bag.

19 Potential Exposure Effects Acute: Direct Exposure Irritation of oral mucosa, eyes, skin, nausea, vomiting, dizziness, headache. Chronic: Repetitive low-level encounters Liver damage, malignancies, reproductive alterations. Even though you may not see symptoms of exposure immediately, hazardous substances can build up in your body and cause harm. That is one reason why safe handling is so important.

20 How do I stay protected? Use Personal Protective Equipment (PPE) Gloves should be used during all patient contact. Gowns should be worn when a patient s body fluids may contact your clothing ( such as when you turning a patient who is sweating). Masks, gowns, and face-shields should be used when splashing of body fluids is possible. Use PPE while the patient is receiving the hazardous drugs that are causing contamination of body fluids, and for 48 hours after the last dose.

21 Precautions to minimize exposure Minimize splashing Encourage men to sit on toilet rather than stand Toilets must be double flushed with lid down if present (face away from toilet when flushing) Use disposable Ostomy pouches Bedpans, urinals, and emesis basins can also have hazardous residue for as long as 48 hours and therefore must be emptied and rinsed thoroughly. Anticipate the needs of the situation, and be prepared with the appropriate PPE before you begin!

22 Your safety is important Special handling of patients who are receiving hazardous medications is required to keep you safe. Individuals who are pregnant or lactating, or men/women trying to conceive, should avoid direct contact with hazardous medications. Maintain open communication regarding hazardous substance handling requirements with the nurse(s) caring for your patients.

23 Precautions to minimize exposure: Management of spills Always have a spill kit available. Your manager or director can order them. If there is a body fluid spill, isolate it and prevent others from contacting it. For spills larger than 5cc, you will need to use a spill kit and report to your supervisor immediately.

24 What kind of PPE should I use for hazardous material? Gloves powder free latex or nitrile gloves; double gloving recommended if does not interfere with technique Gowns lint free, low permeability fabric with a solid front, long sleeves, and tight fitting elastic or knit cuffs Facemasks/shields/goggles use what is standard issue for your unit Contaminated PPE should be disposed of in a yellow chemo bucket, not the regular trash. The chemo bucket must: Be puncture proof Have a lid that seals securely and remains closed Be labeled with appropriate warning Linens exposed to hazardous drug or body fluids should go in GREEN chemo linen bag

25 Material Safety Data Sheet (MSDS) Direct Program MSDS are available for all chemicals used in the facility. MSDS sheets contains the most current safety information on the potential hazards and how to work safely with the chemical product.

26 MSDS Direct can be accessed via the intranet And then, Material Data Safety Sheets Click on Document Library

27 What happens if an exposure occurs? Remove PPE and/or any contaminated clothing Take care not to spread contamination Place contaminated items in proper disposal bin Wash affected area immediately with soap and water Eye exposure: immediately flush for a least 15 minutes in sink Seek immediate medical attention through the ER and report incident to Employee Health Notify your supervisor Complete an occurrence report in the QM module

28 The goal is to keep you safe! Exposure can be prevented through safe handling of patients who are taking hazardous drugs. Safe handling of hazardous substances is vitally important for the safety of everyone. Talk to your supervisors about any concerns you have related to the safe handling of patients and their body fluids.

29 Fall Prevention Review Review Fall Risk Assessment and Prevention: OUMC Policy 11-59

30 Create an Environment of Patient Safety It is NOT acceptable for a patient to fall. We must do everything in our power to prevent patient falls. Staff should be aware of the risk and the high cost of patient falls Preventing falls is an urgent priority! Staff accountability for falls prevention is imperative. There are actions we can take to prevent falls, such as: Use the safe from falls room set up Look for Humpty Dumpty and Falling Star signage on doors and charts Look for the yellow wrist band that signifies fall risk Educate our patients and their families on Fall reduction techniques.

31 Tips to educate our patients and families on fall reduction techniques Tell your patients the following: Your safety is important to us. Use your call light and ask for help when getting out of bed. Tell us if you feel dizzy, weak, or lightheaded. Your IV pole, tray table, wheelchair can roll away from you. Don t use them to support yourself when you get up. Keep things like your phone, glasses or hearing aids within reach. Wear shoes or non-skid slippers every time you get out of bed. Use your walker, cane or assistive device. Use handrails in the bathrooms and hallways. Call, don t fall!

32 What defines a Fall? Fall: A sudden, uncontrolled, unintentional, downward displacement of the body to the floor/ground or other object, excluding falls resulting from violent blows or purposeful actions. Near Fall: A sudden loss of balance that does not result in a fall or other injury. Un-witnessed Fall: Occurs when a patient is found on the floor and is unable to report how the event occurred. Patient Reported Falls: When a patient reports a fall has occurred but it has not been witnessed or reported.

33 Risk Factors for Falls Confusion Impulsive behavior Lethargic/sedation Use of cane/walkers/crutches Dizzy/orthostatic hypotension Incontinent Unsteady gait Tethered devices Urgency/frequency of urination History of falls Decreased muscle coordination

34 The RN will : Fall Risk Evaluation Assess for fall risk on admission using the Fall Risk Evaluation Tool. Re-assess the patient every shift, following any change in shift or transfer to another unit or facility. Risk Categories: No Risk - global precautions for every patient High Risk - for every patient identified as high fall risk (all Pediatric patients less than 3 are automatically High Risk)

35 Pediatric fall risk How do we know if a patient is at risk for falling? Look for a Falling Star or Humpty Dumpty on the patient s door and a yellow band on the patient s wrist. Adult fall risk

36 Hourly Rounding: Proven to help reduce falls Studies have shown that hourly rounding reduces falls by 50%!!! Remember the 4 P s during Hourly Rounding? Pain address it frequently! Position and reposition often! Personal Items/Placement of items and furniture around the room so they do not pose an additional risk for falls. Potty ask our patient if we can assist them to the toilet! Nursing will round hourly and all staff should check the patient for the four Ps when you are in the room!

37 Environmental Monitoring Environmental monitoring--this is not an environment that they are accustomed to, therefore we have to de-clutter all patient spaces and ensure appropriate room lighting and low bed positioning.

38 Fall Safe Room Set-Up Yellow bracelet on patient Safe footwear - non-skid socks or slippers Fall Risk signage on door Patient & family educated on fall risk and precautions Exit from bed on bathroom or patient s dominant side Bed rails up except on exit side of bed Bedside table on non-exit side of bed Bed maintained in locked and low position Call light, bed controls, phone, water, meal tray and urinal in reach Bed or chair alarm on as appropriate IV pole on exit side of bed Room always free of clutter Ensure that cords/cables are not a trip hazard Adequate lighting / night light Wheels locked on all equipment Dry floor - clean up of spills

39 Let s look at a room that is not set up in a safe manner aimed at preventing falls.

40 What s Wrong With This Room? Side rail on side toward the bathroom raised. Patient may climb over to get to bathroom. Phone not where patient can easily reach. Patient may fall trying to reach for phone. Water / personal care items not left where patient can reach. Patient may fall when trying to reach for a drink or other items. Over the bed table (rolling furniture) left on side of bed closest to the bathroom. Patient may use this for support and fall when it moves. Call light not in easy reach of patient. Bedside commode left at bedside. Patients may not recognize their limitations and move to commode with out calling for help. Commodes need to be placed in patient s bathroom when not in use.

41 Now let s look at a fall safe room set up

42 Fall safe room set up Phone within patient s reach. Side rail closest to bathroom lowered so they do not try to climb over rail. Call light within patient s reach. Side rail away from bathroom up so patient can reach bed controls Over the bed table (all rolling furniture) on side of bed away from bathroom so patient does not use movable furniture for support. Check that phone cord, power cords, O2 tubing, IV lines, etc. are out of the way and not a trip hazard. Brakes locked before you leave Keep pathway to bathroom clear of obstacles. Bed in low position before you leave.

43 It takes everyone working together to help prevent falls! Ensure that all proper safety interventions are in place for every patient, every time!

44 Suicide Precautions: Patient Management Review Suicide Precautions: Patient Management: OUMC Policy 11 71

45 It is the policy of OU Medical Center to create an environment of care that will foster the accurate identification and successful management of patients who are at an increased risk for suicide or self destructive behaviors. Patients at risk for suicide and/or self- destructive behavior require: intensive support close observation frequent re-assessments for their emotional and physical well-being.

46 Staff responsibilities regarding patients at risk for suicide Every patient will be screened for risks of suicide. Once a patient is identified as at risk then there are some important roles and responsibilities that staff must follow.

47 The RN s role The nurse completes a psychosocial assessment which includes screening the patient s risk of suicide on all admissions. If the nurse determines the patient to be at risk for suicide, or if there are clinical concerns beyond the scope of the screening, the nurse will immediately place the patient on suicide precautions. Support Staff may be placed as a Sitter for the patient at risk of suicide.

48 Three levels of observation When the physician s orders are obtained, suicide precautions are implemented by the RN at the appropriate level as ordered. Based on patient data, one of the following levels of observation is utilized. Level 1 - Standard observation Level 2 - Line of sight observation Level 3-1:1 monitoring and observation Review the detailed guidelines for the three levels of observation in Attachment A in Suicide Precautions: Patient Management OUMC Policy 11-71

49 Sitter s role 1. Maintains observation of patient at appropriate level. 2. Documents observation of patient status at least every 15 minutes. 3. Ensures all visitors have checked in with nursing staff, monitors visitation to ensure that no contraband of any kind is exchanged. 4. Ensures that no objects are brought into the room that creates the potential for self-harm by patient.

50 Sitter s Role continued: Sitters don t just sit. They are a very important part of our team. Sitters help keep our patients safe!! Sitters should assist with the following: Monitor VS Complete bath and linen changes Toileting Mobility in room Nutrition Oral hygiene Call the nurse if you are concerned about the patient

51 RN s Responsibility to the Sitter For Level 3 = 1:1 Observation: Assures that all sitters are aware that patient is to be within an arm s reach at all times. This includes: Accompanying the patient whenever he/she leaves the unit for procedures, scheduled appointments, or other activity. Having patient in direct sight while patient is in the bathroom and/or shower.

52 Sitter s Documentation flow sheet Flow sheet form can be retrieved through edemand.

53 Suicide Precautions Flow Sheet (The form from edemand) edemand forms are found on the Intranet under the Document Library section

54 What about the other members of the patient care team? What roles do other patient care team members such as environmental service, food service and charge nurses, play in suicide prevention? The following slides will review the actions these team members take to keep our at risk patients safe.

55 Charge Nurse s Role 1. Supports the nursing staff in initiating suicide precautions in a crisis situation until collaboration with the attending physician can occur. 2. Assigns a hospital designee to stay with patient until arrangements for appropriate levels of observation and monitoring are made. Contacts staffing office for assistance as needed. 3. Patients are assigned to rooms designated as suicide precaution s safe rooms whenever possible. If a room is not available, notify the Bed Management Coordinator and/or the Nursing Officer On-Call (NOC) for a room assignment.

56 Continued: 5. Ensure meals are served with proper set-up and finger foods are to be provided whenever possible. 6. Places sign on patient s door stating, All visitors must check in at nurse s station. 7. Includes in patient report and handover that patient is at risk for suicide and the level of monitoring and observation ordered for patient.

57 Food and Nutrition Personnel Role Ensures that all meals are served with proper set-up i.e. disposable/paper products only; plastic utensils only when necessary. Finger foods are served whenever appropriate. Environmental Service Personnel Role Ensures plastic trash bags are removed from room and are replaced with paper bags only or the liner is left out of the trash receptacle.

58 Here are more ways to ensure safety for the at risk for suicide patient: Place patient in a suicide-safe gown Initiate/conduct search of patient and patient s personal possessions for contraband. Contact Police/Security to dispose of contraband. Environmental safety: Items or objects that have the potential for self-harm are removed/secured Itemize personal belongings and valuables and give items to family. If family is not available, secure valuables in a locked area or send to police/security if appropriate. DO NOT allow objects or packages to be brought in by visitors for the patient until it is thoroughly searched and determined to be necessary and safe for the patient s use.

59 Suicide Safe Environment Readiness checklist Use the checklist to help you make the patient s room safe! Print and review the detailed guidelines Suicide Safe Environment Readiness Checklist in Attachment B, located in the Suicide Prevention policy and place on the front of the patient s chart.

60 Patient/Family Education The nurse will initiate the following education for the patient and the family. The Clinical Staff may need to reinforce it. a) Risk level, associated restrictions, and rationale are provided to the patient and family. b) Inform family/visitors that potentially harmful items are not to be given to the patient. c) Provide and review Crisis Center/Suicide Hotline information.

61 WHAT HAPPENS IF A PATIENT ATTEMPTS SUICIDE IN THE HOSPITAL? Provide resuscitation and care to patient as needed. Notify the nurse immediately Notify Nursing Director/Clinical Coordinator If the attempt was successful or the patient was significantly harmed: Notify OUHSC Police Services or Security personnel. And leave the room undisturbed as much as possible. Notify the Medical Examiner. Assist with a Patient Notification in the Meditech QM Module.

62 For the Autumn Life Center at OUMC Edmond Edmond campus only: Ensure that individuals wishing to visit the Autumn Life Center are approved to do so and that activities of visitors are appropriate while on the unit. Notify the designee assigned to monitor a patient of all visitor approvals.

63 Restraints and Seclusion Review Restraints and Seclusion: OUMC Policy

64 Why do all clinical staff need to know about restraints? While caring for patients at OU Medical Center, you may come into contact with a patient in restraints. As a clinical employee, everyone needs to know: The definition of a restraint and of seclusion The types of restraints used Why the patient may be in restraints Your role in caring for the safety and well-being of that patient. The goal is to have no patient in restraints or seclusion within the OU Medical Center System 64

65 Definition of a restraint: A restraint is any manual method, physical or mechanical device, or material or equipment attached or adjacent to the patient s body that immobilizes or reduces the ability of the patient to move their legs, body, arms or head freely. 65

66 Definition of Seclusion Seclusion is not just confining an individual to an area but involuntarily confining them alone in a room or an area where they are physically prevented from leaving. 66

67 Reasons patients are placed in restraints or seclusion The purpose for Non Violent/Non Self Destructive restraint are to promote medical healing versus The purpose for Violent/Self Destructive restraint is to provide protection 67

68 Chemical restraint Medication is a restraint when: It is used to control behavior or to restrict freedom of movement It is not being used as normal treatment for the patient s condition 68

69 High risk / vulnerable patients Vulnerable patient populations who are at risk for being placed in restraints or seclusion unjustly: Very young or elderly Cognitively challenged Patients who have a history of restraints History of disorientation/mental illness History of drug/alcohol abuse 69

70 Structured well being monitoring process A patient in restraints is provided structured ongoing monitoring by an assigned staff member who is trained and has demonstrated competency. A patient in restraints will be monitored: Every 2 hours to for non-violent restraints 3 times an hour for violent restraints Always confirm the patient s health, well-being, patient rights and dignity are maintained. 70

71 Structured Ongoing Well Being Monitoring Can be performed by RN & Clinical Staff Monitoring should include: Vital signs Signs of injury related to restraints Respiratory and cardiac status Hydration and nutritional needs Hygiene and toileting Input & Output Psychological status Skin integrity Readiness for release 71

72 Everyone s responsibility Immediately notify a nurse or a physician if you discover a patient who is in restraints or seclusions when: Airway is compromised ex: choking, Breathing is compromised ex: not breathing normally, Circulation is compromised ex: restraint is too tight and the hand is turning blue, Dignity is compromised ex: the patient s gown is lifted exposing themselves, but is restrained and unable to pull the gown down for themselves

73 Family Centered Care Placing the patient and the family at the center of all that we do! Review: Rights and Responsibilities of Patients: 10-04

74 Family Centered Care Family Centered Care encompasses our efforts to always put the patient and the patient s family at the center of all that we do. One tool we use to implement Family Centered Care is Population Specific Care. The goal of Population Specific Care is that staff will modify care to meet the individual needs of the patient and that staff members are knowledgeable about the specific care, treatment and services required by certain populations

75 Basics to consider in Population Specific Care Population Specific Care is patient care based on individual patient needs. Age, Culture, Ethnicity, Religion and stages of psychological development are some examples of where and how we can modify our care based on our patients needs. Let s look at components of some of these examples.

76 Cultural Awareness in Population Specific Care OUMC System is committed to providing culturally competent care OUMC System recognizes differences in values, beliefs and practices. Diversity exists among individuals even within a given culture. Some patients will be receiving care outside the mainstream medical system Each patient operates within a cultural blueprint. You have resources on the intranet that can help you better understand different cultures and how to change your care based on individual patient needs.

77 You can find help on the Intranet with Culturally Appropriate Care here.

78 Stages of Psychological Development Developmental a. Infant b. Toddler 18 month-3 years c. Preschooler d. School-Age Child Care needs a. Fully dependent for food and comfort b. Toilet training, may put objects in mouth be aware of choking risks c. Exploring, learning to use tools and make art d. Learning confidence, hospitalization can conflict with school and sports

79 Stages of Psychological Development continued: Developmental e. Adolescent f. Young Adult g. Middle-Age Adult h. Older Adult Care needs e. Being sick can interrupt growing social relationships f. Developing romantic relationships, be aware of impact of hospitalization g. Work, and parenthood can be negatively impacted by being in the hospital h. Reflecting on life, give support surrounding end of life care.

80 There are some stressors that are common to all stages of psychological development: Separation from primary caregiver can cause anxiety be aware that hospitalization can separate patients from the normal caregivers. Fear of the unknown Hospital environment - Sights, Sounds, Smells can be frightening to our patients Pain Management Pain and the fear of pain can affect all age groups All of these examples gives us opportunities to modify our care to meet the individual needs of our patients.

81 Family Centered Care What families need: Respect Access to resources Choices Opportunities to meet others facing similar challenges Clear information Consistency of care giving

82 Goals for Family-Centered Care: Provide services to all family members Involve the patient and family in as many decisions as possible. Recognize diversity in culture, religion, parenting styles Provide adequate information to make decisions Put the patient and the family at the center of all that we do! OU Medical Center System does have a PI team focusing on improving our Family-Centered Care focus campus wide.

83 Family-Centered Care continued: Patients have rights that are referred to as the Rights and Responsibilities of the Individual. Family-Centered Care gives us the tools to ensure our patient s rights are met. To better meet the needs our of patients and their families, our hospital allows a family member, friend, or other individual to be present with the patient for emotional support during the course of stay. It is important to remember that the patient defines who their support individual is. It may or may not be the patient's surrogate decision-maker or legally authorized representative.

84 Language Assistance can help you modify care to meet your patient s needs Tools you can use for patient Language Assistance Spanish Translators onsite TTY/TDD Machine MARTTI (My Accessible Real-Time Trusted Interpreter) Multiple languages available Sign Language Interpretation Designed to help you better communicate with your patients

85 2012 Annual Clinical Training and Policy Review Conclusion

86 The information in this course is a brief overview of important OU MEDICAL CENTER Policies and Procedures as well as important initiatives on campus. You are expected to access the appropriate polices related to these topics and review them further as needed. All OU MEDICAL CENTER policies are available online for review in the Compliance 360 system located on the intranet. Click on Document Library and you can search Compliance 360 for all OUMC policies

87 Thank you Your attention to this important information helps keep our patients safe!