Nursing Student Clinical Handbook Jewish Hospital Louisville, KY Revised April 20 th, 2016
On behalf of KentuckyOne Health - Jewish Hospital, we welcome each of you as you begin your clinical experience. We encourage you to take advantage of the numerous learning opportunities that are available. Our goal is to provide for you an environment to facilitate your learning. We have provided you this manual to help ensure that you have the best clinical experience possible. It will provide you with basic information for various administrative, clinical, and safety procedures to maximize patient safety and minimize inherent healthcare associated risks. You are expected to familiarize yourself with the contents and follow these procedures and instructions while at our facilities. If you have any questions, please feel free to contact a hospital staff member or the System Education Department. You will be expected to wear a nametag, at chest level, in an easily visible position at all times while on the hospital campus. You should wear your school issued nametag, however, if you have not been issued one, you or your clinical instructor must obtain a temporary badge from System Education. There are several policies and procedures referenced throughout this manual. Should you wish to refer to any of them; please contact your clinical instructor, any staff member or the System Education Department. 2
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Jewish Hospital Guidelines for Affiliating Nursing Students Nursing Student Expectations o Must complete all required forms and paperwork before the clinical group will be allowed on the unit. o Computer and Information Usage Agreement completed by the students and clinical instructor. See Appendix A. o Nursing Student Scavenger Hunt completed by the students to familiarize yourself with the unit. See Appendix B. o Evaluation of Clinical Experience completed by the students and instructor at end of rotation. See Appendix C. o Exhibit B Confidentiality Statement completed by students and instructor, this is our legal HIPAA documentation. See Appendix D. o Handbook Acknowledgement completed by the students and the clinical instructor to verify that they covered the information in the handbook. Provided by Clinical Instructor. o Our Values and Ethics at Work Reference Guide must be reviewed by both faculty and students and is available at http://www.kentuckyonehealth.org/documents/volunteers/oveaw% 2012.23.14.pdf o Must maintain a professional appearance. o Must arrive on time for scheduled clinical. o Must get report from the nurse caring for the assigned patient. o Must report off to the nurse caring for the patient at the end of duty and when leaving the floor for any reason. o Will not copy or print any portion of the patient s medical record, all documents with protected health information must be placed in the shred bins at the end of the shift. o Must wear a visible nametag at all times. o Will not remove medications from the medication pyxis. o Will abide by all Student Practice Guidelines listed below. Policy Stat Library- Students may access hospital policies via the Intranet on any hospital computer. Student Practice Guidelines - Students may perform any skill they have learned and successfully mastered according to your school criteria while caring for KentuckyOne Health patients. KentuckyOne Health has a few guidelines for patient care by students: o Students are given VIEW-ONLY access to our computer programs. This will be arranged through your clinical instructor. 4
o Students will be able to pass medications under the direct supervision of a nurse or their clinical instructor. The nurse or clinical instructor will sign on to Cerner using their user name and password. The student will scan and pass the medications using our Medication Administration Guidelines. Nurses or Clinical Instructors should never share their user names and passwords with the students. o Students will not administer any high alert medications that require an independent double check by two nurses. See Appendix E. o Students will not administer IV medications in an emergent situation. o Students will not administer any blood or blood products. o Students will not accept verbal or telephone orders from physicians. o Students will not provide care to patients in Airborne precautions including TB, chicken pox, shingles, measles, or epidemic influenzas; may provide care for other isolation patients. o Students and Clinical Instructors are to follow the policies and procedures of their assigned unit. Orientation Affiliating Nursing Students must be oriented by their clinical instructor to policy and procedure expectations as it relates to the student nurse. Confidentiality Students are obligated to refrain, both in and out of the hospital, from discussing any patient or any information about a patient with any person except in the line of duty in accordance with all HIPAA regulations. Dress Code - Please refer to the policy Dress Code and Standard for Professional Appearance. Students are encouraged to bring only minimal items into the clinical setting. Students are encouraged to leave valuables, money, backpacks, and books at home. Bring only what is required to successfully complete the clinical. o To convey a professional appearance, clinical instructors and students are expected to follow the KentuckyOne Health Dress Code and Standards of Professional Appearance. Business or business casual attire when not in a clinical setting Scrubs with or without lab coats as required by your school of nursing when in a clinical setting All clothing must be clean, neat, and well fitting. Minimal jewelry, no more than two earrings per ear. Facial and oral jewelry is not acceptable. Long hair should be pulled back. Hair may conform to current fashion but must be neatly groomed and not interfere with patient care or safety. Extreme hairstyles are not permitted. Artificial fingernails, nail extenders, nail wraps or other artificial nail components are not to be worn by healthcare workers who provide direct or indirect patient care. If polish is worn, it should be in good condition. Nametags must be worn at chest level at all times. 5
Facial hair must be neatly trimmed and well groomed. Make-up should be conservatively applied. Tattoos should be kept to a minimum and be covered, if possible. Offensive and/or large tattoos, those that depict violence or sexual and/or racial overtones, must be kept covered. Buttons, pins, etc. which are objectionable because of their size or inappropriate message (such as profane or provocative language, political preferences, or business advertising) are not permitted. Bloodborne Pathogens Students who experience needle stick injuries or exposure to blood and body fluids may seek counseling as appropriate per the student s affiliating agency policy. Needle Stick Prevention Think safety first! o Use the safety features provided, including our needless systems o Place needles and other sharps in a sharps container immediately o Never recap needles o Never place needles in the bed or in linens o Do not leave needles on tables in the room o Never overfill sharps containers and notify staff immediately of containers that need to be emptied Medication Administration Students may administer medications according to hospital/department approved policies and procedures, at the discretion and under the supervision of the Clinical Instructor or RN knowledgeable of the patient, provided that the student has had appropriate theoretical preparation and instruction. Parking - Nursing students are assigned to park in the Visitor s Parking Garage located on Muhammad Ali Street. It can be accessed from Muhammad Ali Street or Brook Street (the driving lane behind Heart and Lung building). Nursing Students must have a parking pass in order to not be charged for parking. o Please direct any questions in reference to parking to the Security Coordinator, Kathy Garvin. Kathy can be reached Monday through Friday at 587-4497. o We want to make every effort to provide and meet your parking needs. Please feel free to contact us if we can be of any further assistance. Cafeteria- The Jewish Hospital cafeteria, Chestnut Café, offers a discount with a valid student ID. Chestnut Café is located off the Chestnut Street Lobby. Hours of operation are 5:30am-2:00am. Wall Street Deli is located in the main lobby of the Outpatient Care Center Building. Hours of operation are 7:00am-7:30pm on weekdays, Saturday 10:00am-5:00pm, and Sunday 11:00am-4:00pm. Library- Jewish Hospital has access to Mosby s E-Clinical Reference online. Mosby s provides an array of educational materials including access to research information, evidence based skills, journal articles, patient education materials, and many more. 6
In-service and Continuing Education- Programs are open to students on a space available basis at a discounted fee and pre-registration is required. Information is available by calling 587-2585. Smoking- Jewish Hospital is a smoke-free environment. All patients, visitors, and employees are prohibited from smoking on the premises. Eating and Drinking In accordance with OSHA guidelines, eating and drinking is not permitted in the patient care area or the nurse s station. Behavior Please maintain appropriate professional behavior at all times. Language of a sexual or abusive nature is prohibited. Please refrain from comments or jokes that may be offensive to others. Should you witness such behaviors, please contact your clinical instructor and/or the nurse manager immediately. Call-Ins-If you are unable to attend a clinical, please contact your instructor prior to time of clinical. If this is not possible, please call the unit and leave a message with the Charge Nurse. Personal Items - Please bring as few personal items into the hospital as possible. Storage space is limited. A representative from the unit will show you where your coats and bags can be stored. The hospital is not responsible for the loss of any personal items, so money and valuables should be kept on your person at all times. Lost and found is located in Security. Ethical Issues - Occasionally an ethical issue will arise when dealing with the medical treatment of patients. Jewish Hospital has an Ethics Committee that can provide consultation in ethical issues involving medical treatment. The person on call for the Ethics Committee can be contacted by calling the hospital operator to get the information for the Ethics person on call. You can also contact the hospital chaplain staff through Kathy Lesch at 587-3793 or Rabbi Nadia Siritsky at 540-3793. Witness - Students are NOT permitted to sign or witness the signature of any legal paper or document. 7
HIPAA for Clinical Instructors and Students Please refer to the policy Protected Health Information (PHI). Clinical Instructors and students must sign the Confidentiality Statement and the Computer and Information Usage Agreement prior to accessing any patient information. General Guidelines for Protecting PHI Computers shall be locked (password protected) while away from the desk. This applies even in secure areas of the workplace. Workstations, laptops, cell phones and all removable media (flash drives, removable hard drives, CDs, DVDs) that contain PHI shall be encrypted according to the KentuckyOne Health Encryption Policy unless specifically exempted by Information Security Officer. Never share your ID and password. Using another person s ID is prohibited. Keep your passwords hidden. Patient specific information shall never be discussed in common areas, including lobbies, elevators, break rooms or outside of the office (client interaction and on site CCA visits excepted). Specific patient circumstances, questions or characteristics shall be discussed and disclosed only during business hours and exclusively for business purposes. No patient information shall be left in common areas or on business machines. Patient confidential information may only be printed when necessary. Any printed member information that is no longer needed must be shredded. Examples of Personal Information Name, Address, Date Of Birth Health Card Number Facts about health Health care and history related to exposures to disease Information about payment for health care. Social Security number Confidentiality Guidelines Practice the Clean Desk Policy. When in doubt of a document s classification, always default to protect the document. When copying documents, remain at the copy machine until the job is done, no exceptions. Remove any paper containing PHI from printers and common areas, as soon as possible. Dispose printed PHI in locked receptacles designated confidential information. Do not discuss diagnosis/disorder information, unless it is necessary. Documents containing PHI must not be removed from the workplace. 8
Corporate Compliance Please review the policy KentuckyOne Health Corporate Compliance Code of Conduct. KentuckyOne Health requires that persons associated with KentuckyOne Health to act in a non-abusive and legal manner and to report or correct wrongdoing wherever it may occur in the organization. As part of our commitment to excellence in health care, KentuckyOne Health implemented a Corporate Compliance Program to further the organization s efforts to prevent and detect illegal, unethical and abusive conduct. The Compliance Program has two primary objectives: 1) to enhance and further demonstrate to our patients, the community, team members, medical staff, Board of Trustees, volunteers, benefactors, the government and third-party payers our commitment to honest and fair dealing; and 2) to centralize our efforts in preventing and detecting illegal, unethical or abusive conduct. Each person associated with KentuckyOne Health: Will conduct his or her activities in compliance with applicable laws. Has a duty to act in a manner consistent with our core values, standards, policies and Corporate Compliance Code of Conduct. Will respond to federal, state or local government requests for information on a timely basis and in a cooperative manner while preserving our organization s legal rights. Is prohibited by the federal Anti-Kickback Law from requesting, accepting, or offering anything of value for referred business that is payable by a federal health care program. We may not pay patients, physicians or other health care providers to refer patients to us. Will comply with applicable laws and regulations regarding the evaluation and treatment of patients with emergency medical conditions regardless of their ability to pay. KentuckyOne Health must treat or stabilize and appropriately transfer all patients with an emergency medical condition regardless of ability to pay. Will avoid situations that may present a conflict of interest. Conflicts of interest occur when personal interests or activities influence, or appear to influence, our ability to act in the best interest of KentuckyOne Health. A conflict of interest also may exist if the demands of any outside activities hinder or distract you from the performance of your job or cause you to use KentuckyOne Health resources for other than KentuckyOne Health purposes. You must avoid engaging in any activity, practice or act which conflicts with the interest of KentuckyOne Health or its patients. Is committed to being good stewards of the environment. We recognize that our well being, and the well being of future generations, depends on our reverence for the environment. We should, whenever possible, conserve our natural resources; recycle; reduce waste and pollution; eliminate toxins; and use environmentally preferable purchasing. 9
Observance of environmental laws and regulations is one step in demonstrating our commitment. Is prohibited from knowingly presenting or causing to be presented claims for payment or approval that are false, fictitious, or fraudulent by The Federal False Claims Act. Examples of potential false claims include: o Billing for services that were not provided at all. o Billing for services that were provided, but were not medically necessary. o Submitting inaccurate or misleading claims about the type of services provided. o Making false statements to obtain payment for products or services. Must never disclose confidential information that violates the privacy rights of our patients. No KentuckyOne Health team member, affiliated physician or other health care provider has the right to access any patient information other than that necessary to perform his or her job. You will be expected to sign an acknowledgement stating that you have received this manual and are familiar with the KentuckyOne Health Code of Conduct. Patient Rights and Responsibilities Patient Rights Please refer to the KentuckyOne Health policy Patient Rights and Patient Responsibilities. KentuckyOne Health encourages respect for the personal preferences and values of each individual. We consider patients as partners in their hospital care. When patients are well informed, participate in treatment decisions and communicate openly with their doctor and other health professionals, they help make their care as effective as possible. Patients are informed of their rights in the Patient Handbook that they receive upon admission. Patient rights include the right to: Receive fair and compassionate care at all times and under all circumstances. Receive respect and recognition of personal dignity, values and beliefs; including cultural, psychosocial, and spiritual. Be treated equally and receive the same level of care or treatment regardless of your race, color, national origin, disability, age or ability to pay. Receive safe and appropriate medical care to the best of the organization s ability. Be informed of your rights before care is provided or discontinues, whenever possible. Be informed of hospital rules and regulations that affect your behavior as a patient. Personal privacy and to expect that documents and communication concerning your care will be treated as confidential. 10
Have family members, representatives and the physician of your choice notified promptly of your admission to the facility. Know the name of the physician who has primary responsibility for coordinating your care and the names of other physicians or non-physicians involved in your care. Access pastoral and other spiritual services. Receive treatment in a safe environment free from abuse and harassment, and to be assisted in accessing Protective Services and/or Advocacy Services, as appropriate. Receive personalized treatment through an individualized treatment plan and for you and/or your personal representative to participate in the development and implementation of your treatment plan. This organization values each patient s cultural, racial, and religious customs as part of their treatment plan. Appropriate assessment and management of pain. Be free from restraints and seclusion of any form that are not medically necessary or are used as a means of coercion, discipline, convenience or retaliation by staff. Make and communicate Advance Directives. You have the right to receive assistance in formulating Advance Directives. Your access to care will not be affected if you do or do not have Advance Directives. Your wishes at the end of life will still be obtained and respected. Participate in ethical decisions regarding your care, including decisions relative to care at the end of life. The dying patient has the right to care that optimizes comfort as well as dignity. Be informed of potential research, investigation and clinical trials in order to decide if you want to participate or refuse to participate in research. You have the right to decline to participate in clinical studies, research or experiments. Refusal to participate will not affect your access to care or treatment. The right to receive information including risks, benefits and reasonable alternatives in a language or method of communication that you understand pertaining to your health status, current diagnosis, treatment plan and prognoses in order for you to give informed consent or to refuse consent. Refuse recording or filming made for purposes other than the identification, diagnosis or treatment of the patient. Wear personal clothing and religious or other symbolic items, provided such items do not interfere with diagnostic procedures or treatment. Receive information from your physician about the outcomes of your care, including unanticipated outcomes and prospects for recovery, in terms you can understand. Refuse treatment to the extent allowed by law, and be informed of the significant medical consequences of this action. Request a consult with other physician(s) and/or independent specialist(s), at your own expense. Expect that the hospital will make a reasonable response to your request for services. The hospital will provide evaluation, service and/or referral(s) as 11
indicated by medical necessity. Only after you have received information about the need for transfer, and it is medically permissible, will you be transferred to another facility. The receiving facility must have agreed to accept your transfer. Receive continuity of care and notification in advance of any health care needs following discharge, including outpatient care options. Timely notification if your insurance will not pay your bill and information about the grievance process if you disagree with your insurance company s determination. Receive an itemized explanation of your hospital bill. Confidentiality of your clinical records and to review or obtain a copy of your medical record within a reasonable timeframe. Present complaints and expect that corrective action will be taken, when indicated. The right to voice complaints about care without being subject to discrimination, reprisal or compromised access to future care. To expect prompt response to and resolution of a grievance, including a written notice of the hospital s decision, the name of a contact person, steps taken to investigate the grievance, the results of the grievance process and the date of completion. As appropriate to the nature of the grievance, the following individuals may assist you in initiating the grievance process: the physician, staff nurse or his/her supervisor, the patient representative, hospital administrator or a social worker. Communicate your problems, concerns or complaints with the hospital to the Kentucky Cabinet for Health and Family Services by contacting the Office of the Inspector General, Division of Licensing and Regulation, 908 W. Broadway, Tenth Floor, Louisville, Kentucky 40203, (502) 595-4958, or you may contact The Joint Commission, One Renaissance Boulevard, Oakbrook Terrace, Illinois 60181, (800) 994-6610. Patients who are candidates for participation in research or educational activities have the right to be advised if the hospital intends to engage in or perform research or educational activities affecting their care or treatment. Patients have the right to refuse to participate in such activities without compromising their care or affecting benefits to which they are otherwise entitled. Patients have the right to information regarding the hospital s policy on the forgoing of life support by withholding resuscitative services from patients. Patients who are dying have the right to receive care that will provide them with comfort and dignity. The dying patient has the right to receive such care, which shall include: o Treatment of primary and secondary symptoms responsive to treatment, as desired by the patient or surrogate decision maker, o Effective management of pain, o Acknowledgment of the psychosocial and spiritual concerns of the dying patient and his/her family, o Acknowledgment of the expression of grief by the dying patient and his/her family. 12
Receive the visitors designated, including, but not limited to, a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a friend, and his or her right to withdraw or deny such consent at any time; KentuckyOne Health will o Not restrict, limit, or otherwise deny visitation privileges on the basis of race, color, national origin, religion, sex, gender identity, sexual orientation, or disability; o Ensure that all visitors chosen by the patient enjoy full and equal visitation privileges, consistent with the patient s wishes. Patient Grievance KentuckyOne Health will make every attempt to resolve all patient complaints in a timely, reasonable and consistent manner. If a patient care complaint cannot be resolved at the time of the complaint by staff present, is postponed for later resolution, is referred to other staff for later resolution, requires investigation, and/or requires further actions for resolution, then the complaint is defined as a grievance and the grievance procedures shall be followed. If a patient makes a complaint to you, listen to their issues. If you are able to solve it, within your scope of practice, then do so. If you cannot, let the patient know that you will go get their nurse who is better able to help them. Patient Care Patient Safety Patient safety is mission critical for us at Jewish Hospital. We strive to provide safe and quality care to our patient s everyday. Throughout the healthcare industry, care practices are being identified, which have been shown to increase the safety of patient care. Please see Appendix F for a comprehensive list of evidence based techniques to reduce error in a healthcare setting. Please take a moment to STAR. Stop, Think, Act, and Review before any patient care procedure. Remember while you are in nursing school, you are legally considered an unlicensed professional and are bound by those practice rules. Stop - Ensure you have the right patient, the right procedure, and all necessary equipment. Think Should I have a clinical instructor or nurse observing me? The answer is yes if you are administering a medication or performing a procedure you have not been previously observed and checked off on. Do I have any questions or concerns about this situation? If anything seems unusual or off, or you simply are unsure; stop and wait for your clinical instructor or the patient s nurse. Act Act only when you are sure previous steps are met, and you are confident and can safety and competently perform the patient care. 13
Review Did you perform the care as safely as possible? Did you have the expected outcomes? If any questions or issues arise, notify your clinical instructor or the patient s nurse immediately. At Jewish Hospital we invite all our patients to be an active partner in their health care. Patients are given a publication on admission encouraging and giving helpful guidelines of how to become a partner in their care. It is through this partnership that we can ensure good care and prevent medical errors. Our facility practices the National Patient Safety Goals endorsed by the Joint Commission. Please review http://www.jointcommission.org/ for the most current National Patient Safety goals. Emergency Procedures If an accident or injury should occur to you or a patient, immediately contact your clinical instructor and KentuckyOne Health supervisory staff (your nurse, the charge nurse, nurse manager, or house supervisor). When caring for patients, emergency situations do occur. If involved in an emergency situation, immediate help can be summoned by activating the emergency call light located in each patient room. On some units, the emergency call light is activated by pulling the call light cord from the wall. On other units, the emergency call lights are activated in the patient bathroom. Find out how the call light is activated on the unit. When a Code Blue Adult/Pediatric situation is recognized, the student is responsible for reporting the code by dialing 7777 and initiating CPR. Bag mask devices are available on all code carts and should be used in code situations. Patient Armbands and Identification Please refer to the policy on Patient Identification and Armbands. KentuckyOne Health Policy states that all patients will be properly identified with two patient identifiers (patient name and date of birth) before any care, treatment, specimen collection or services is provided. KentuckyOne Health uses the following color coded armbands to identify specific patient information: WHITE - All JH, SMEH, FRI MCE, MCS and OLOP patients. BLUE - Bloodless Medicine; to be put on at point of entry or when identified PINK - Swallowing difficulties, water protocol; to be put on by Speech/Language Pathologist YELLOW - Falls risk; to be put on by Nursing when identified GREEN - Latex Allergy; put on at point of entry or when identified. TAN - DNR; patient label will be secured on the band and put on by RN/LPN following DNR order verification. Whenever possible, the DNR band will be placed on the same extremity as the patient ID band. 14
WHITE WITH RED - When patients on the same unit have similar last names, a Name Alert tag is put on the front and spine of the chart. WHITE* - Do not use this arm Restricted Extremity Abuse Please refer to the policy Abuse Reporting (Adult) and Abuse Reporting (Child). In accordance with Kentucky law, all reasonable suspicions of patient abuse, neglect, or exploitation must be reported to the Cabinet for Health and Family Services (CHFS) Department for Community Based Services (DCBS), Adult Protective Services and/or Child Protective Services. If you suspect a patient is the victim of abuse/neglect/exploitation, it must be reported. Immediately notify your clinical instructor and the nursing supervisory staff on the unit (charge nurse, nurse manager, or house supervisor). If you suspect a patient is being abused/neglected/exploited by a KentuckyOne Health employee, it must be reported. Immediately notify your clinical instructor and the nursing supervisory staff on the unit (charge nurse, nurse manager, or house supervisor). Restraints Please refer to the policy Restraint and Seclusion. KentuckyOne Health Philosophy on Restraints and Seclusion: All patients have the right to be free from restraint or seclusion of any form, imposed as a means of coercion, discipline, convenience, or retaliation by staff. Restraint or seclusion may only be imposed to ensure the immediate physical safety of the patients, team members, or others. Preventing Patient Falls Please refer to the policy Falls Risk. KentuckyOne Health defines a fall as an unplanned descent to a lower level with or without injury to the patient. Patients are assessed for falls on admission including transfers to a new unit or level of care, after a fall, when there is a change in condition and daily as part of the daily assessment. Falls risk processes may be initiated any time based on clinical judgment regardless of falls risk. Jewish Hospital uses the ABCS and Morse Falls Risk Scale as its falls risk screening tool. Patients are identified as a falls risk with a yellow arm band and the appropriate falls risk sign. 15
Falling Stars Falls Prevention (this patient is identified as being at increased risk for falls). Falling Stars with Cloud Falls Protection (this patient has fallen during their hospital stay). The patient will be identified as Falls Risk if they score 45 or greater on the Morse Falls Risk Scale and will be placed on the FALLS PREVENTION PROTOCOL. Falls Prevention Protocol Place Falls Prevention order in Clinician Valet and implement all of the following interventions: Inform patient & family that the patient is at risk to fall and of the interventions that have been implemented. Yellow armband Yellow gown Falling Star door sign Bed alarm and/or low boy bed with mats (Note: Low boy beds are generally contraindicated in orthopedic surgery patients) Non-skid slipper socks at all times Remind patient & family to request assistance when getting up Patient will remain At arms length when ambulating or toileting Incorporate scheduled toileting in hourly rounds Immediately answer call lights of patients on Falls Prevention Clear a path to the bathroom Night light at bedtime Use gait belt for ambulation if not contraindicated Patient wears glasses or hearing aide if applicable Shower stool if applicable Consider these interventions as appropriate Leaving bathroom light on Obtaining PT/OT evaluation Moving the patient closer to the nurses desk 16
Sitter Decision Tree evaluation If a fall occurs or patient has fallen prior to hospitalization, in addition to KentuckyOne Health policy: Change sign to a Falling Star Sign with Cloud Add nursing order Falls Prevention: Patient has fallen Medication Administration Medications at Jewish Hospital are administered using a bar code scanning system in Cerner. Students are given view only access to Cerner. Students are not given access to the medication pyxis and are not allowed to pull medications out of the medication pyxis. The nurse or clinical instructor will go with the student into the patient room and sign in to Cerner and observe the administration of all the medications. The student will verify the patient's name and DOB and scan patient's ID band & ordered medications. The student must name each medication to the patient and the reason for giving prior to administration. If the system gives a warning the nurse or clinical instructor must check the warning, the student is responsible for making the nurse or clinical instructor aware of all warnings. Please refer to the following policies to guide your practice with Medication Administration: Medication Administration High-Alert High-Risk Medications Medical Orders: Written and Verbal Red Rules for Patient Safety Pain Management Here at KentuckyOne Health a patient s pain is our concern. Assess your patients for pain with vital signs and watch for cues or listen for complaints of pain every time you are with a patient. If your patient is expressing pain, immediately let the nurse or your clinical instructor know. Here are some key points to help you address a patient s pain: Use the key phrase - We may not keep you pain free, but we will do our best to control your pain Show the patient the Pain Poster hanging in their room. Indicate on the poster where you will write when their next pain med is due. Encourage them to use the phone number listed, if they do not feel we are doing all we should do to help control their pain Do Hourly Rounding!! o Ask about pain and address any increased pain levels Barriers to pain management - If it s not time for more medication o Explain you can have more medication in minutes. Can you make it until then? o Refer to the poster in the room 17
o Request a medication adjustment from the physician If the medication is not working - Ask, What has worked for you at home? If you can t give more medications - Explain why this is not possible o Decreased mobility o Prolonged healing times o Risk of respiratory depression o May affect neuro assessments IV Therapy Jewish Hospital has an IV Therapy team that is staffed 24 hours a day/7 days a week. The IV Therapy Team manages all IV insertions, IV site rotations, central line dressing and PRN adaptor changes, inserting PICC lines, accessing and deaccessing infusaports, and removal of non-peripheral lines on all Medical Surgical units and most Intermediate/Step-Down units. Students should never insert, manipulate, or remove any IV line or administer any IV medications without direct supervision of a clinical instructor or the patient s nurse. Clinical Instructors or students should never remove lines indicated to be removed by an IV Nurse only. Please refer to our IV Therapy Policy Manual online, a member of our IV Therapy team, or the nurse manager of a particular unit for more information. 18
Infection Control Jewish Hospital has adopted standard precautions in accordance with the Center for Disease Control (CDC) Guidelines. Students need to be familiar with the infection control and exposure control plan manuals. The infection control manual contains the specific policies and procedures for isolation, standard precautions, and other infection control practices. The exposure control plan manual contains specific information related to preventing or reducing the risk of exposure to blood and/or other potentially infectious materials. Both manuals are located online. Standard Precautions Infection control practices that apply to all patients, all the time, regardless of suspected or confirmed infection or illness. Standard precautions include hand hygiene, use of personal protective equipment, covering your mouth and nose with an arm or tissue when coughing or sneezing, and safe injection practices. Key Points for Hand Hygiene Soap and water should be used when hands are visibly soiled. Hands should be washed for 15 seconds. Alcohol based hand cleaners are placed at the point of care. To use, apply enough cleaner to palm of hand to keep hands wet for approximately 15 seconds. You must wash your hands with soap and water after every 3-5 applications to prevent buildup on your hands. Hand hygiene must be performed: o Upon arriving o When hands are soiled o Before and after direct patient contact o Before and after gloves are used o When moving from one patient task to another o After using the toilet o Before and after eating, drinking, or smoking o Before leaving the unit and upon return o Before entering and leaving isolation rooms o After any direct contact with secretions and or excretions of the patient o Between touching another patient o Routine hand hygiene should include all surfaces of the hands up to an area above the wrist Artificial nails, tips, or other artificial materials are not to be worn by individuals providing direct patient care or those that work in clinical areas. If polish is worn, it must not be cracked or peeling. You should inspect condition of the cuticle and area around the fingernails routinely to enhance appropriate hygiene. 19
Medication Management and Hand Hygiene Medications can be contaminated if you failed to performed proper hand hygiene before preparing and administering the medication. Keep in mind that germs are in the environment and of course they cannot be seen with the naked eye. Hand Hygiene should be done before setting up medications. If environmental surfaces are touched before the medication is given then hand hygiene must be done before giving/opening up the medications. Gloves should be worn if your crushing medication, again this is to prevent contamination of the medication. After the medications are given then hand hygiene needs to be performed. Hand Hygiene should be done before the IV medications are spiked and the tubing is primed. Patient Care Equipment Reusable patient care equipment should not be used for the care of another patient until it has been appropriately cleaned by nursing/staff and/or reprocessed by Sterile Processing. Cleaning of this equipment is important to prevent equipment that may be soiled with blood, body fluids, and secretions/excretions in a manner that prevents skin and mucous membrane exposures. Contamination of clothing and transfer of germs to other patients and environments is a possibility when equipment is not properly cleaned. Equipment can be cleaned with the hospital approved disinfectant spray or disinfectant wipe. Listed are a few items that should always be cleaned in between patient use that normally are not sent to Sterile Processing for cleaning: wheelchairs/stretchers, blood pressure cuffs, and glucometers. Environmental Control Follow hospital procedures for routine care, cleaning, and disinfection of environmental surfaces, beds, bed rails, bedside equipment and other frequently touched surfaces. The hospital approved disinfectant wipes can be used at the nurse's station to disinfect phones, charts, keyboards, the top of medication carts, and any environmental surface around your work area that may become contaminated with germs throughout the day. Personal Protective Equipment Gloves - Always wear gloves whenever there is contact or anticipated contact with blood, bodily fluids, or non-intact skin. Gloves are available on every unit. Contact hospital staff on your assigned unit to identify where gloves are located. Should you need special gloves or a size that is not available on your unit, contact the supervisory staff of the unit so that your safety needs are met. Other Personal Protective Equipment PPE can include gowns, masks, face shields, and goggles. You should wear appropriate personal protective equipment during procedures that are likely to cause exposure to blood and/or other potentially infectious material. 20
Respiratory Hygiene and Cough Etiquette Cover your mouth or nose when you cough or sneeze. Use a tissue to contain respiratory secretions. Perform hand hygiene if there is contact with respiratory secretions or contaminated objects. Wear appropriate PPE when entering the room of a patient with poor respiratory hygiene and uncontained secretions, regardless of suspected or confirmed illness. Safe Injection Practices KentuckyOne Health provides several safety mechanisms to reduce the risk of accidental needle stick including a needleless IV infusion system, an IV catheter with a passive safety mechanism, and safety needles for situations where needles must be used. To reduce the risk of possible exposure always use the safety features provided and always dispose of needles/sharps in the appropriate puncture resistant sharps container. Contact a staff member immediately if you see a needle/sharps that has not been disposed of in the appropriate manner or if the sharps container is full. Isolation Please refer to the policy Isolation. Patients may need to be placed into isolation to prevent the spread of infection. When this happens you must adhere to KentuckyOne Health isolation guidelines to minimize your risks and minimize the risk of spreading disease to other patients. Read and follow all isolation signs posted and always wear the PPE indicated on the sign. If you have questions or concerns, please contact a KentuckyOne Health staff member or System Education. Jewish Hospital has the following isolation guidelines: Contact Precautions include organisms that are spread via direct or indirect contact such as all multidrug resistant organisms, wounds or abscesses with uncontained drainage regardless of infection, scabies, Clostridium Difficile infection (diarrhea), Rotavirus, and RSV. Wash hands when entering and leaving room. Protection guidelines include: follow standard precautions, gown and gloves when entering room to be taken off inside room before leaving, use patient dedicated or disposable equipment, and clean and disinfect shared equipment. Droplet Precautions include organisms that spread through mucous membrane contact with respiratory secretions such as bacterial meningitis, seasonal influenza normally seen Oct-Apr, Pertussis (whooping cough), and Mumps. Protection guidelines include: wash hands when entering and leaving room, following Standard Precautions, surgical mask with splash guard when entering room, to be taken off inside room before leaving, if contact with bodily fluids is likely, use gown 21
and gloves in addition to mask with splash guard. The patient is to wear a surgical mask to contain secretions anytime out of the room. Airborne Precautions include organisms that become suspended in the air and remain infectious over long distances such as pulmonary or laryngeal tuberculosis, chickenpox, disseminated herpes zoster (shingles), measles, and pandemic influenza. Students are NOT allowed to provide care to patients in Airborne Precautions. Airborne precautions include patients who have pulmonary or laryngeal tuberculosis, chickenpox, shingles, measles, or pandemic influenza. We do not fit test students for the N95 respirator. Latex Allergy Please refer to the policy Latex-Safe Environment. Many products used in a hospital setting contain latex including gloves, stethoscopes, catheters, tourniquets, and many others. Latex can cause allergic reactions in some people. Latex exposure can occur from direct contact or via inhalation of airborne latex particles. Reactions can range from contact dermatitis to anaphylaxis. All patients are screened on admission for latex allergy and identified by a green band. All patients identified with a latex allergy must be provided with a latex free cart/container from central supply. All products that are not made of metal, plastic, vinyl, or silicone could be made of latex even if it says it is hypoallergenic. Laundry All laundry that has been in a patient s room must be placed in the soiled linen containers. Hazardous Waste All hazardous medical waste must be disposed of in the appropriate hazardous waste container. The container must be closable, constructed to contain the contents and prevent fluid leakage and red in color or labeled with an appropriate biohazard warning label. Medical waste can include but is not limited to needles and sharps containers, suction canisters, and disposable items saturated with blood or bodily fluids. If you find medical waste that has not been disposed of properly, contact a hospital staff member immediately. Bloodborne Pathogens Please refer to the policy Exposure Control Plan. As a healthcare provider, you may be at risk for occupational exposure to bloodborne pathogens, microorganisms that are present in human blood and can cause disease in humans. KentuckyOne Health has an Exposure Control Plan that provides requirements and protective measures to minimize the risk of exposure for healthcare providers. If you have any questions, please feel free to contact any hospital staff or Infection Control. 22
Bloodborne Pathogens include, but are not limited to, hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV). Exposure can occur from specific eye, mouth, other mucous membrane, non-intact skin, needlesticks or puncture wounds, or parenteral contact with blood or other potentially infectious material. To limit your risk of exposure: Always use standard precautions, for all patients, all the time. Practice good hand hygiene and immediately perform hand hygiene after contact with blood or body fluids, and after removing gloves and PPE. Always wear the appropriate personal protective equipment. Dispose of sharps safely and in the appropriate sharps container. Always use gloves when touching patient linens. Avoid touching face and mucous membranes in areas where blood, body fluids, or specimens are present. This includes things such as eating, drinking, applying cosmetics or lip balm, or rubbing eyes or touching contact lenses. If there is an exposure, immediately flush the area with water and notify your clinical instructor and nursing supervisory staff. 23
Environment of Care Safety Risk Management Should an accident or incident occur to you or a patient, immediately notify your clinical instructor and KentuckyOne Health supervisory staff (this could be the nurse, charge nurse, nurse manager, or house supervisor). KentuckyOne Health supervisory staff will notify Risk Management. Hazardous Materials and Waste Management The United States Department of Labor for Occupational Safety and Health Administration (OSHA) developed the Hazard Materials and Waste Standard, (Standard 29 CFR 1910.120), which also includes that an organization guarantee employees and employers the "Right-To-Know" about potential chemicals hazards in the workplace. Material Safety Data Sheets Material safety data sheets (MSDS) are forms made by manufacturers that detail the properties of a particular substance. MSDS include procedures for handling or working with that substance in a safe manner, and includes information such as physical data, toxicity, health effects, first aid, reactivity, storage, disposal, protective equipment, and spill-handling procedures. At KentuckyOne Health, MSDS are available on the Intranet. Please contact any staff member or your clinical instructor to review the MSDS. Emergency Codes and Student Responsibilities All codes are activated by dialing 7777 and identifying the situation. Code Yellow External (External Disaster) - This code is called in the event of an external disasters, such as a fire, mass vehicular accident, flood, or other incident resulting in a probability of the hospital receiving a large number of casualties. Students should return to their unit and report to their clinical instructor or supervising nurse for further instructions. Code Yellow Internal (Evacuation) - This code is called in the event of an internal disasters such as catastrophic utility failures (i.e., water, electrical, gas, sewer or communication), equipment failures, fire, threats of harm or civil disturbances, or building Structure Damage. Students who do not have a purpose in that area will stay away until an All Clear is announced. Students from that area will report to their clinical instructor or supervising nurse for additional instructions. Should an evacuation be required: Evacuation (directions will be given by the supervisor) o Remove guests from immediate danger. o Evacuate laterally e.g. 6-East to 6-West. o Form teams, guide ambulatory guests to a safe area, use litters stored behind end stair doors for those not able to walk. o Use exits at end of corridors for down traffic. o Smoke rises; stay near the floor for fresher air. o Do not jump, but evacuate for rescue. 24
o Once out of building, individuals are taken to Norton Hospital or University Hospital. Code Red - This code is called in the event that the fire detection system is engaged for any reason. o In the event of a fire remember to RACE: Remove Activate Confine and Contain Extinguish o When using a fire extinguisher remember to PASS: Pull Aim Squeeze Sweep o Close doors to patient rooms. o Do not pass through fire doors unless evacuation is necessary. o Never block fire doors with anything that would prevent them from closing automatically. o Types of Fire Extinguishers 25
Tornado / Severe Weather Alert (Tornado)-An announcement is paged and the alert tone is sounded in the event that a tornado warning is issued for the immediate area by the National Weather Service. Students should return to the unit and report to their clinical instructor or supervising nurse for further instructions. Code Blue Adult or Pediatric This code is called for a medical emergency for respiratory or cardiac arrest. If a student identifies a Code Blue they must: Notify other staff on the unit by pressing the call or CODE light, pulling the call light out of wall, calling for help (if in a patient room). Dial 7777 to notify the operator. State the following information: o Code Blue Adult or Code Blue Pediatric o Unit Name (4 West, 5 South, etc.) o Patient Room Number Wait for the operator to verify before hanging up. Begin CPR. Second person should bring Code cart. Code Gray Called when an uneasy situation arises in the work area and security assistance is needed. Dial 7777 and give the location. Code Silver - Called when security assistance is needed and the individual may possibly be armed with a weapon. Dial 7777 and give the location. Code Pink Adult or Child Missing child or adult. Student is to stop what they are doing and look for the person. Code Orange (Internal or External) Called when there is a hazardous spill either internally or externally. Dial 7777 and give the location. Code Black - Bomb Threat. Immediately have someone call 7777 to notify of bomb threat. Then note the following (from the policy Code Black-Bomb Threat, Attachment A Bomb Threat Report Form): Note Date, Time and Extension called Exact words of caller Ask Where is the Bomb? When will it explode? What kind of bomb is it? What does it look like? Where are you calling from? Note the gender and age of the caller, does the voice sound familiar? Note the quality of the voice and speech, they type of language they used, did they have an accent, and their manner Was there background noise? If so what? What type of phone connection did you have? Was there anything else you noticed about the call? Code X Evacuation of area or of facility. Students should report to their clinical instructor or a supervising nurse for further instructions. Shelter in Place - is used when events warrant the need to maintain a secure environment for the safety of the patients, staff and others already inside the facility. This code can occur internally and externally depending upon the situation and other contributing factors. (Examples of other contributing factors that can activate the Shelter-In-Place are inclement 26
weather.) Students will report to their clinical instructor or a supervising nurse for further instructions. Security Services The Jewish Hospital Security Department is staffed 24 hours a day, 7 days a week to ensure a safe and secure environment for staff, patients, visitors, and everyone else. They utilize roving patrols, stationary posts, and closed circuit television and alarms to monitor activity in and around the hospital. Security also provides the following services: Escort to the car outside normal shift change time around the clock Motorist Assist Regular 24-hour patrol of campus Coordinates lost and found If you have any questions or concerns regarding a security issue, you can contact security by dialing: Contact Purpose Phone (Outside) Phone (In- House) Security General security 587-4484 4484 Dispatch issues Emergency Security emergency 587-4999 4999 Firearms and Concealed Weapons The organization prohibits firearms and weapons on the facility premises. Individuals with firearms or weapons are asked to secure such BEFORE entering the facility, which may include either securing firearm or weapon in trunk of vehicle or checking it in with the Public Safety and Security Personnel. Police policy dictates they are not at liberty to relinquish their weapon(s), therefore, as an organization we encourage our personnel to be mindful of the fact. When law enforcement representatives present themselves at the facility we may suggest to them to check in their weapon(s) with the Public Safety and Security personnel until the individual leaves the premises. Electrical and Equipment Safety Most equipment in the healthcare setting is electric. This means there is a risk of electric shock from medical equipment. To help prevent any electrical accidents you should report any electrical hazards, use equipment properly, disconnect, label, and report any malfunctioning equipment, and use power cords and outlets properly. Electric safety includes things such as: Removing malfunctioning equipment from service Do not use equipment on which liquids have been spilled or on wet surfaces. Do not jerk cords from the outlets. Use only three pronged plugs. 27
Protecting patients from electrical shock. For questions or to report malfunctioning equipment, please contact a hospital employee to place a work order to our Engineering Department. Our Engineering Department can also be contacted via phone at 587-4043. Utility Safety Loss of Electrical Power In the event of a loss of hospital loss of power, we have emergency power systems in place. It takes only a few seconds for power to the lights and equipment here at the Jewish Hospital Medical Campus to be switched to the backup sources. Here are a few key points to remember as you go through your day, to help us be ready should we lose power: All red outlets are on emergency power Make sure all life support equipment is plugged into a red outlet at all times. All red outlets are connected to emergency power systems and will maintain power in the event of a loss of power from LG&E. Black & green dots, orange triangles & other marks on outlets and switches are markers for use by the engineering dept only and are not relevant to emergency power. Make note of exit signs in your area. Are they lit? If not, please assist the engineering team by putting in a work order to have it repaired. Flashlights should be in working order and readily available to staff in all areas, for use during a power outage. Medical Equipment Safety Medical equipment safety is everyone s responsibility. If you find malfunctioning or broken equipment, remove it from use and notify your clinical instructor and nursing staff on the floor to fill out a work order. Should malfunctioning equipment cause an incident, immediately notify your clinical instructor and nursing supervisory staff on the unit. Slips, Trips, Falls Slips, trips and falls can cause injury or even death in the workplace. Here are some safety tips to reduce the risk of slips, trips, and falls: Choose slip resistant shoes If you spot a wet or slippery floor, report it immediately. Heed posted safety signs. Keep floors clear and uncluttered. Use proper lighting. 28
Back Safety Healthcare is a high-risk setting for back pain and injury. Healthcare workers who lift and move patients are at especially high risk for injury. The following are ways that healthcare workers may prevent injuries: Ergonomic best practices o Avoid fixed or awkward positions o Avoid lifting without using the proper devices or equipment o Avoid highly repetitive tasks o Avoid forceful exertions o Provide support for your limbs o Use proper posture and body mechanics o Keep tools close to you to avoid reaching, twisting, or bending When standing, wear good comfortable shoes, stand up straight, keep the knees flexed, and use a foot rest or alternate feet every few minutes if you must stand for long periods of time. When sitting, form 90 degree angles at the knees and hips. When lifting, bend at the knees and hips. Keep the head up. Maintain the natural curves of the spine. Lift with the muscles of the legs. Use assistive devices whenever possible. Workplace Violence Please refer to the policy Workplace Violence Prevention Plan. Statistics show that violence in the hospital setting is increasing rapidly. When people (including patients, families, and friends) come into the hospital they are already highly stressed due to the very nature of a hospital environment and whatever is happening to them. In almost all situations where a person is becoming agitated or aggressive there is an underlying fear that is the cause. If we can keep ourselves aware of this, it will help us in working effectively with people who are upset. Hospital environment stressors include: bright lights, many personal questions, forms to fill out, lengthy waiting, strange environment, and fear of the unknown. Coping abilities to handle stress are much decreased, and because of this stress inappropriate aggressive behavior may occur. Staff must always be aware that people must be understood as cognitive, emotional, physical, social, and spiritual beings. Use Coping Skills to De-escalate the Situation This is the time when the participants call upon existing coping skills to resolve the problem presented or to reduce anxiety. Communication skills that should be used routinely that will assist in de-escalating potential violence include: Non-Verbal - Before any words are spoken, non-verbal communication has begun. This includes the way you walk, facial expressions, posture 29
and gestures. We must be aware of our non-verbal communication. Our non-verbal communication can provoke a patient. Effective use of non-verbal communication can provide a prompt for the patient to use internal control to get back on track. Verbal - When talking to an individual, it is important to take care in what you say (language, vocabulary) and how you say it (tone). Controlling our verbal rate, pitch and tone, the para-verbal communication can be critical. Listening - The most important skill for you to develop is listening. Staff who can listen and respond appropriately will have success in deescalating patients. Tips in Dealing with Violence Do Listen carefully and monitor non-verbal signals, validate the participant's feelings. Respect the personal space. Observe the environment for unsafe, potentially dangerous objects. Decrease environment stimuli. Set limits calmly and firmly. Maintain non-critical, non-domineering attitude and body language. Know where a phone is and how to access emergency help Attend in-services to update your skills. Do Not Promise more than you can deliver. Criticize or argue with the participant Approach an aggressive or out of control person without back-up from other staff members Yell or become aggressive. Crowd or attempt to touch the patient. Attempt to reason with a patient/person whose psychosis is drug related. 30
Appendix A Computer and Information Usage Agreement (KentuckyOne Health Workforce members not employed by KentuckyOne Health) KentuckyOne Health considers maintaining the security and confidentiality of protected health information a matter of its highest priority. All those granted access to this information must agree to the standards set forth in this computer and information usage agreement. All those who cannot agree to these terms will be denied access to protected health information entrusted by our patients to this organization. Each person accessing KentuckyOne Health data and resources holds a position of trust relative to this information and must recognize the responsibilities entrusted in preserving the security and confidentiality of this information. The following conditions apply to all those having access to protected health information. As a condition of my association with KentuckyOne Health, I agree to the following: 1. I understand that I am responsible for complying with the KentuckyOne Health policies based on the Health Insurance Portability and Accountability Act of 1996 (HIPAA) that are available to me for review. 2. I will treat all information received in the course of my association with KentuckyOne Health, including but not limited to the patients of KentuckyOne Health, as confidential and privileged information. 3. Upon cessation of my association with KentuckyOne Health, I agree to continue to maintain the confidentiality of any information I learned at KentuckyOne Health and agree to turn over the keys, access cards, or any other device that would provide access to KentuckyOne Health or its information. 4. I will respect the privacy and rules governing the use of any information accessible through the computer system/network and only access and/or utilize protected health information that I have a need to know in order to perform my assigned duties. 5. I will respect the confidentiality of any reports or documents printed from any information system containing patient/member information and handle, store and dispose of material appropriately. 6. I will not disclose information regarding the patients KentuckyOne Health to any person or entity other than as necessary to perform my duties and as permitted under the organization s policies. I understand that the information accessed through all KentuckyOne Health information systems contains sensitive and confidential patient care, business, financial and hospital employee information which should only be disclosed to those authorized to receive it. 7. I will not use or disclose any information that identifies a patient except that which is allowed by KentuckyOne Health policies based on HIPAA regulations. 8. I will prevent unauthorized use or viewing of any information in files maintained, stored or processed by KentuckyOne Health. 9. I will not remove any worksheet, record, report or copy of such from the area or office where it is kept except in the performance of my duties. I will report any violation of this code. 10. I will not seek personal benefit or permit others to benefit personally from any confidential information or use of equipment available through my work assignment. 11. I will not log on to any KentuckyOne Health computer systems that currently exist or may exist in the future using a password other than my own. 31
12. I will safeguard my computer password and will not post it in a public place, e.g., the computer monitor, or a place where it will be easily lost, e.g., on my nametag. 13. I will not allow anyone, including other employees, to use my password and/or authentication device to log on to the computer or alter information under my identity. 14. I will not utilize anyone else s password and/or authentication device in order to access any KentuckyOne Health system. 15. I will log off of the computer as soon as I have finished using it. 16. I will not attempt to establish electronic communication to the KentuckyOne Health network except by approved methods. 17. I will use an approved cover sheet for all faxes containing protected health information. 18. I will not use E-mail to transmit a patient s protected health information unless instructed to do so by my management. 19. I will comply with KentuckyOne Health Internet and Electronic Mail usage policies and in particular will not use these business tools for non-kentuckyone Health commercial or personal use. 20. I will ensure all electronic storage media (CD, DVD, floppy diskette, computer hard drive, etc.) containing protected health information is destroyed according to KentuckyOne Health policy. 21. I will respect the ownership of proprietary software. I will not make unauthorized copies of such software even when the software is not physically protected against copying. 22. I will respect the procedures established to manage the use of all systems. 23. I understand that all access to the system will be monitored. I understand that my access to protected health information maintained by KentuckyOne Health is a privilege and not a right afforded to me. By signing this agreement, I agree to protect the security of this information and maintain all protected health information in a manner consistent with the requirements outlined under the federal privacy regulations. Any breach of the terms outlined in this agreement will subject me to penalties, including disciplinary action, under KentuckyOne Health policies as well as any applicable State and Federal law. By signing this agreement, I agree that I have read, understand and will comply with all the conditions outlined in this agreement. Signature Title Print Name (Middle Initial included) Company or Organization Name Signature Date Affiliated KentuckyOne Health Department Estimated Departure Date if applicable 32
Appendix B Nursing Student Scavenger Hunt Instructions: Locate the following items on your unit. Write the location of the item in terms that will help you remember the location. If you need assistance, ask the clinical instructor or the staff for help. If an item is not applicable to your unit, write N/A in the space. ITEM LOCATION ON NURSING UNIT General Orientation 1. Linens 2. Employee Lounge 3. Conference Room (If unit has one) 4. Clean Utility Room 5. Soiled Utility Room 6. Tube System 7. Thermometer 8. Blood Glucose Meters 9. Clean Linen Cart 10. Trash Chute/Laundry Chute or Hamper 11. Housekeeping Closet 12. Emergency Crash Cart 13. Employee Bathroom 14. Kitchen 15. Linen Hamper 16. Manager s Office Safety 1. O 2 Turn-off Valve 2. Fire Alarms 3. CO 2 Fire Extinguishers (red) 4. H 2 O Fire Extinguishers (silver) 5. Fire Exits 6. Fire Hose 7. Emergency Exit Plan Diagram (if posted) Medications 1. Med Room 2. Medication Carts 33
3. IV Therapy Manual 4. Pyxis Med Station 5. Patient IV Meds 6. IV Fluids (Stock) 7. IV Tubing Central Supplies 1. Pyxis Supply Station 2. List 5 items found in the Pyxis Supply Station Dietary 1. Kitchen 2. List 5 items found in the Kitchen Patient Room Check Operation of the following items. 1. Call light/tv control 2. Emergency Light 3. Bed Operation 4. Thermostat Emergency Equipment 1. Code Cart 2. Defibrillator/Monitor 3. Backboard 34
Strongly Disagree Disagree Agree Strongly Agree Not Applicable Appendix C Clinical Learning Environment Survey This survey is designed to assess clinical nursing students perceptions of the clinical learning environment at Jewish Hospital. Participation in this survey is voluntary. Your responses are anonymous and confidential. Unit: School: Which degree are you seeking (circle one): ADN Year in School: BSN Healthcare Experience: Yes No Number of Years: For each of the following statements, please choose a number to indicate your level of agreement. Staff nurses regularly provide feedback to nursing students for the work that is done. Staff nurses are interested in supervising students. Staff nurses are good role models. Staff nurses are willing to spend time teaching nursing students. Staff nurses guide nursing students to perform new skills. Staff nurses show a positive attitude towards the supervision of nursing students. The unit staff is easy to approach. The unit staff knows the nursing students by their names. 35
Strongly Disagree Disagree Agree Strongly Agree Not Applicable High quality care is provided to patients. Staff nurses regard the nursing student as a learner rather than a worker. The clinical instructor is a good role model. The clinical instructor provides prompt feedback to students for the work that is done. The clinical instructor is easy to approach. The clinical instructor provides adequate guidance with new skills. The clinical instructor has good knowledge and skills. The clinical instructor devotes sufficient time to teaching students. The clinical instructor is readily available to assist learning. I enjoyed my time working on the unit. I am happy with the experience I have had on this unit. I look forward to clinical practice The experience on the unit makes me eager to become a staff nurse Nursing students have difficulty finding help when needed I feel stressed with the amount of work to be done on the unit There is a conflict between procedures taught in the classroom and the real situation on the unit. Nursing students are given a lot of responsibility without adequate supervision. 36
Strongly Disagree Disagree Agree Strongly Agree Not Applicable Nursing students compete with each other to practice skills. Theory learned in the classroom is reinforced on the unit. Nursing students are considered to be part of the unit team. Nursing students are taught to link theory to practice. What is learned in the classroom is being practiced on the unit. Nursing students are encouraged to ask questions. Nursing students teach one another Nursing students help one another to carry out allocated tasks Tool modified from: Chaun and Barnett Clinical Learning Environment Evaluation Tool 2012 What did you like best about your clinical experience? What did you like least about your clinical experience? Please list any staff you would like to recognize from your clinical experience. 37
Appendix D EXHIBIT B KentuckyOne Health d/b/a JEWISH HOSPITAL Statement of Understanding and Confidentiality Agreement I,, by signing this Statement of Understanding and Confidentiality Agreement, do hereby represent that I have read and understand the following: 1. A shadowing or clinical learning experience has been arranged for me at Jewish Hospital ( Hospital ) as part of the interview process, an agreement with my school, or a student observation request. 2. I understand that this experience does not entitle me to any wages, workers' compensation, other benefits or guaranteed employment with Hospital. 3. While shadowing a Hospital employee performing duties or participating in a clinical experience at Hospital, I will conduct myself in accordance with Hospital policies and standards of conduct. 4. I understand that Hospital is not responsible for injuries that I incur solely as a result of my own negligence. I acknowledge that I will be responsible for paying for any medical treatment I receive as a result of injuries incurred during the course of my experience and that I am encouraged to maintain personal health insurance. 5. I understand that I am required to have current TB tests and immunizations and that Hospital is not responsible for my exposure to any communicable diseases during this experience. 6. I understand that information regarding patients or former patients is confidential. I agree to permanently maintain the confidentiality of all patient information obtained during my experience and understand that an inability to maintain patient confidentiality during this experience will result in immediate dismissal and/or additional legal ramifications. 7. I understand that any action on my part which is not fully consistent with the above statements may warrant termination of this experience. 8. I understand that I may be required to undergo a criminal background check, Medicare/Medicaid exclusion check, and/or drug screening. 9. I understand that I may be required to submit to a health screening consistent with the laws and regulations or hospital policy, including a drug screening. 10. I understand that Hospital may terminate my experience at any time, with or without cause. I have read and understand the above statements and accept them as conditions of my experience at Hospital. Signature: Date: Printed Name: Witness Signature: 38
Appendix E HIGH-ALERT/ HIGH-RISK MEDICATIONS (11/11) General Description / Qualifying Characteristics Drugs Included (Lists may not be all inclusive) Safety Strategies Chemotherapy / Antineoplastics All products are included. Verbal orders for chemotherapy are prohibited. New orders must be written for each cycle of chemotherapy. Chemotherapy is stored only in the Pharmacy (segregated and labeled). Pharmacy prepares chemotherapy products. Maximum dose warnings are installed in pharmacy computer system. Two pharmacists review/confirm chemotherapy orders and all necessary calculations and must initial worksheet. Chemotherapy doses are labeled as such when dispensed from pharmacy and are delivered in a special transport bag. Chemotherapy agents are flagged as such on the MAR. Only chemo-certified nurses can administer chemotherapy. Two nurses check labeled product against physician order prior to administration. Concentrated Electrolytes Magnesium Sulfate Injection, Concentrate Outside pharmacy, Magnesium Sulfate concentrated vials are stored only in a non-matrix Pyxis drawer or crash cart with cautionary labeling. Otherwise, a premixed solution is available for use. Potassium Chloride Injection, Concentrate Concentrated Potassium Chloride vials are not stored outside Pharmacy with the exception of Open Heart Surgery at JH. Only 20mEq vials are stored in a non-matrix drawer of Pyxis in a bag labeled Caution Must be Diluted. Pre-mixed potassium solutions are purchased for use whenever possible. Potassium Phosphate Injection, Concentrate Concentrated Potassium Phosphate vials are not stored outside the pharmacy. All Other Concentrated Electrolytes Concentrated vials are not stored outside the pharmacy. No concentrations of sodium chloride greater than 0.9% are stored outside the pharmacy. Direct Thrombin Inhibitors, Intravenous Argatroban Bivalirudin (Angiomax) Lepirudin (Refludan) Infusion pumps are used to administer intravenous direct thrombin inhibitors. Number of concentrations available is limited. - Argatroban concentration is standardized to 1mg/1mL. Pharmacist dosing consult is available upon prescriber request. Two nurses check all doses and/or pump settings at initiation and at any rate changes. - Dosing is standardized to mcg/kg/minute. 39
Heparin, Unfractionated Injection, Intravenous administration only Heparin, Unfractionated Injection Intravenous administration only Standardized protocol and pre-mixed solution are used for heparin therapy in Acute Coronary Syndromes, DVT, CVA, Stroke, TIA. Infusion pumps are used to administer intravenous heparin. Number of concentrations of heparin is limited; Heparin concentrations greater than 5,000 units/ml are not purchased. Storage is segregated. Two nurses check all IV bolus doses and/or pump settings at initiation and at any rate changes. Oral anticoagulants Rivaroxiban (Xarelto) Dabigitran (Pradaxa) Only unit-dose products are used. Dosing adjusted per protocol for renal dysfunction. Rivaroxiban should be avoided in severe hepatic impairment (Child-Pugh classes B and C) or in patients with coagulopathy associated with hepatic disease. Routine PTT/PT/INR testing not required by FDA for these products. Warfarin (Coumadin) Only unit-dose products are used. Anticoagulation policy establishes guardrails for initial therapy dosing. A baseline International Normalized Ratio (INR) is available for all patients started on warfarin. Initial dose is not dispensed from pharmacy without appropriate baseline INR. Subsequently, a current INR is available and used to monitor and adjust therapy; anticoagulation policy establishes minimum monitoring requirements. Food and Nutrition/Dietary is notified of all patients receiving warfarin, and the patient s diet is monitored according to the established Food/Drug Interaction program. Insulin Includes all insulin products: Regular Insulin (Novolin or Humulin R), NPH Insulin (Novolin or Humulin N), 70/30 Insulin (Novolin or Humulin 70/30), Insulin Apart (Novolog), Insulin Lispro (Humalog Insulin Glargine (Lantus), etc. Standardized concentration is used for all insulin infusions. Pharmacy prepares all insulin infusions. Limited insulins are stored in Pyxis in non-matrix drawers. Two nurses check product selected (insulin vial) and dose prepared (syringe) for all insulin doses. Two nurses check pump settings at initiation of insulin infusions. List may not be all inclusive. Patient Controlled Analgesia (PCA); Epidural infusions; and Other Continuous Infusion Opiates Morphine, Fentanyl, Hydromorphone, (Dilaudid), Meperidine (Demerol), Bupivicaine (Marcaine, Sensorcaine), Ropivacaine (Naropin) Standardized PCA order form is available for use. Pre-mixed morphine and meperidine PCA syringes are purchased. They are segregated in storage. Pharmacy prepares all other admixtures. Two nurses check syringe/bag for correct drug and strength and all settings at initiation, syringe/bag change, and setting changes. Look-Alike / Sound-Alike Medications See Look-Alike / Sound- Alike Medication list. Per Look-Alike / Sound-Alike Medication Policy. 40
Appendix F 41