INPATIENT Annual Core Competency Performance Stations (Nursing) 2010 (Unlicensed Staff Direct & Non-Direct Care Providers * )

County of Los Angeles INPATIENT Annual Core Competency Performance Stations (Nursing) 2010 (Unlicensed Staff Direct & Non-Direct Care Providers * ) * Staff who work in patient care areas 1

ANNUAL CORE COMPETENCY PERFORMANCE STATIONS (NURSING UNLICENSED STAFF - DIRECT & NON-DIRECT CARE PROVIDERS) PREFACE This packet is designed to provide the unlicensed workforce member the information necessary to prepare for DHS annual core competency testing. Non-direct care unlicensed staff required to complete the competencies identified in this study guide are clerical/secretarial workforce members who work in a patient care area. Unlicensed clerical/secretarial workforce members who do not work in a patient care area complete the competencies identified in the Licensed & Unlicensed Staff - Non-Direct Care Provider self-study guide. The following table describes which workforce members must complete the testing requirements for nursing department unlicensed direct care and non-direct care providers. Workforce Member Direct care unlicensed staff including: Nursing attendants Student nurse workers Technicians Hospital medical assistants Non-direct care unlicensed staff who work in patient care areas including: Unit clerks Secretaries Student workers Unit support associates (eg, Escort) Testing Requirements Performance Checklist Performance Checklist ( Patient Identification, Role (Patient Identification, i n an Emergency, Safety with Role in an Emergency) Tubes) X --- --- X If your position is not listed in the table or you are not sure in which category you belong, consult your immediate supervisor. INSTRUCTIONS 1. Review the content in this packet as applicable to your requirements as indicated above. 2. Review the learning activities as described on the applicable clinical competency descriptions. 3. Clinical Nurse Specialists, Clinical Nurse Educators, Nursing Instructors, and Nurse Managers are available to answer any questions you may have regarding the content. Unlicensed clerical/secretarial workforce members who do not work in a patient care area complete the competencies identified in the Licensed & Unlicensed Staff - Non-Direct Care Provider self-study guide. 2

ANNUAL CORE COMPETENCY PERFORMANCE STATIONS (NURSING - UNLICENSED STAFF) TABLE OF CONTENTS Patient Identification (study material for direct care and non-direct care staff)... 3 Unlicensed Direct Care Provider Competency Documents... 5 Patient Identification Clinical Competency Description - Unlicensed Direct Care Provider... 6 Performance Checklist - Unlicensed Direct Care Provider... 7 Role in an Emergency Participant Handout... 8 Clinical Competency Description - Unlicensed Direct Care Provider... 9 Performance Checklist - Unlicensed Direct Care Provider... 10 Safety with Tubes Participant Handout... 11 Clinical Competency Description - Unlicensed Direct Care Provider... 14 Performance Checklist - Unlicensed Direct Care Provider t... 15 Unlicensed Non-Direct Care Provider Competency Documents... 16 Patient Identification Clinical Competency Description - Unlicensed Non-Direct Care Provider... 17 Performance Checklist - Unlicensed Direct Non-Care Provider... 18 Role in an Emergency Participant Handout... 19 Clinical Competency Description - Unlicensed Direct Care Provider... 20 Performance Checklist - Unlicensed Direct Care Provider... 21 3

PATIENT IDENTIFICATION Objectives: Upon completion of this section, the workforce member will be able to: 1. Differentiate between patient identifier and source of patient identification. 2. Give examples of patient identifiers and examples of non-patient identifiers. 3. Identify the required number of patient identifiers. 4. Identify situations that require use of two patient identifiers. I. Definition A. What are patient identifiers? An identifier is a piece of information specific to the person, for example the patient s name, medical record number (MRUN), telephone number, date of birth, social security number. An identifier is not the medium on which the information is kept (e.g., driver s license, identification card) (Table 1). In other words, two patient identifiers could mean name and MRUN, name and social security number, but not identification card and bed card. The Joint Commission requires the use of at least two patient identifiers when providing care, treatment, and services. 1. For inpatients, medical record number and name are the usual patient identifiers. 2. For outpatients, name and birth date are the usual patient identifiers. Table 1. Patient Identifiers, Sources of ID, Non-Patient Identifiers Patient Identifiers Examples Name Patient identification number Date of birth Social security number Address Telephone number Tag number (newborns and mothers) Sources of Identification Examples Driver s license Patient ID card Picture ID card Passport Alien registration card NOT Patient Identifiers Room number Bed number Diagnosis (the gun shot wound in bed 3) Organ of disease (the liver in bed 5) II. Purpose of using two patient identifiers The purpose of using two identifiers is to 1) reliably identify the individual as the person for whom care, treatment, or service is intended and 2) to match the care, treatment, or service to that individual (Table 2). The two patient-specific identifiers must be directly associated with the individual and the same two identifiers must be directly associated with the care, treatment, or service. For example, the name and medical record number on the patient identification band must match the name and medical record number on the medication label, blood transfusion documents, and specimen tube label. 4

Table 2. Rationale for Using Two Identifiers Intent Identify the individual as the person for whom the service or treatment is intended. Match the service or treatment (e.g., medication administration) to that individual. Action (Example) Check the order and compare the patient s name and MRUN on the physician order sheet with the patient s name and MRUN on the patient s identification bracelet. Check the medication administration record (MAR) and compare the patient s name and MRUN on the MAR with the patient s name and MRUN on the patient s identification bracelet. III. Patients without identification bracelets Patients in the ambulatory care setting may not have armbands. For outpatients, name and birth date are the usual patient identifiers. When verifying the patient s name, ask the patient to state their name, rather than asking the patient to answer a passive question such as, Are you Juan Garcia? IV. Situations requiring use of two patient identifiers Use two patient identifiers when providing care, treatment, and services. Examples of situation requiring use of two patient identifiers include: A. Administration of medication, blood, intravenous fluid B. Collecting blood samples and other specimens for clinical testing C. Labeling laboratory specimens D. Distributing diet trays E. Measuring vital signs F. Transporting patients to diagnostic/procedural areas G. Delivering diet trays H. Labeling allergies on patient chart, or armband I. Transcribing medications J. Transcribing orders (laboratory tests, x-ray, diets, etc) K. Ordering laboratory tests, diets, x-rays, consults V. Safety risks related to discrepancies in patient identification Services and treatments could be harmful if given to the wrong patient. A few examples of consequences of not accurately identifying patients include the following: A. Wrong patient receives a treatment/procedure 1. Vital signs are obtained and documented on a wrong patient 2. A patient receives a medication or diet tray meant for another patient 5

3. Patient has allergic reaction because patient s allergies documented on wrong patient 4. Blood is administered to a wrong patient 5. Prescriptions given to wrong patient 6. Expressed breastmilk given to the wrong baby B. Wrong patient is sent for and receives a medical treatment/procedure (eg, xray) 1. Wrong patient is sent to radiology or other diagnostic procedure 2. Surgery is performed on the wrong patient 3. Wrong patient is discharged or transferred C. Patient gets unnecessary treatment based on mislabeled laboratory specimen VI. Steps to take if patient identifiers do not match up Anytime there is a discrepancy in patient identifiers, or doubt about accurate patient identity, the first step is to stop the procedure. Unlicensed staff should notify the Registered Nurse. The procedure should not continue until patient identify can be verified. If the treatment, procedure, service has already been provided, personnel must follow facility specific policy related to reporting the error to supervisors and Risk Management. VII. Conclusion Services and treatments could be harmful if given to the wrong patient. It is imperative to accurately identify patients using two unique pieces of information about the person, called patient identifiers. Nurses must know the procedures they perform that require verification through the use of two patient identifiers. Whenever possible, patients must be actively included in the identification process. 6

UNLICENSED DIRECT CARE PROVIDER DOCUMENTS Unlicensed direct care providers include nursing attendants, student nurse workers, and technicians (e.g., surgical, orthopedic) 7

PATIENT IDENTIFICATION Clinical Competency Description - Direct Care Provider Competency Statement: Discusses procedures related to patient identification and correctly identifies a patient. Critical Behaviors Learning Activities Method of Evaluation Verbalizes the number of patient identifiers to use before performing patient related tasks. States acceptable patient identifiers. Describes purpose of using two patient identifiers. Identifies procedures that require use of two patient identifiers based on policy. Identifies potential safety risks related to discrepancies in patient identifiers. Discusses actions to take if patient identifiers do not match up. Demonstrates interventions designed to ensure accuracy of patient identification using two patient identifiers. Reviews the Patient Identification study material in this packet. Reviews facility specific policies/procedures related to patient identifiers. Completes Patient Identification performance checklist (direct care provider) with 100% accuracy. 8

PATIENT IDENTIFICATION Performance Checklist - Direct Care Provider Name Pass / Fail Performance Criteria Met Not Met Comments Verbalizes the number of patient identifiers required by the Joint Commission to ensure accurate patient identification. States the two patient identifiers approved for patient identification per facility protocol (e.g., name, MRUN, birthdate). Describes purpose of using two patient identifiers. Identifies two situations that require use of two patient identifiers. Identifies two potential safety risks related to discrepancies in patient identification. States what action to take if the patient identifiers do not match. Given a medical record (chart) stamped with a patient s identification card, selects the correct patient identification card and patient. Signature of Evaluator: Date: 9

ROLE IN AN EMERGENCY Participant Handout Direct Care Provider Initial steps to take during a code blue 1. Establish unresponsiveness Shake and Shout ( Are you OK? Are you OK? ) If victim does not respond: 2. Call a Code Blue Yell, Code blue, get the crash cart When calling a code blue, follow the procedure for calling a code blue at your facility (e.g., do you push a button or call an operator, what extension do you call, what do you tell the operator?) 3. Return to patient and start CPR Open airway with head tilt-chin lift (be prepared to demonstrate). Look, listen and feel for 5-10 seconds If no signs of breathing, give two breaths and watch for chest rise Start compressions (demonstrate proper hand placement for compressions). Place hands on the center of the chest, between the nipple-line. How can the unlicensed direct care provider (e.g., NA) can help during a code blue? 1. Help put CPR board under patient 2. Obtain supplies 3. Remove unnecessary equipment 4. Offer comfort to other patients/family members 5. Maintain patient privacy 6. Take specimens to laboratory Opening the airway Adult, child, infant 1. Tilt the head back and lift the chin gently with your fingers while pushing down on the forehead with the other hand. Proper hand placement for chest compressions Adult: 1. Place the heel of one hand on the lower half of the breastbone. 2. Place the heel of second hand on top of the first hand. Child 1. Place heel of one hand on the lower half of the breastbone (not over the very bottom of the sternum). Infant 1. Place 2 or 3 fingers of one hand on the lower half of the infant s breastbone about 1 finger s width below the imaginary nipple line. 10

ROLE IN AN EMERGENCY Clinical Competency Description - Direct Care Provider Competency Statement: Demonstrates understanding of the unlicensed direct care giver s role during an emergency Critical Behaviors Learning Activities Method of Evaluation Reviews the Role in an Emergency Participant Handout Direct Care Provider. Verbalizes understanding of the following: The initial steps to be taken in a Code Blue. How to call the Code Blue team. Additional ways the unlicensed direct care provider can assist during a Code Blue. Demonstrates proper technique for opening the airway. Demonstrates proper hand placement for compressions. Reviews DHS and facility-specific policies/procedures related to Code Blue. Completes Role in an Emergency performance checklist (direct care provider) with 100% accuracy. 11

ROLE IN AN EMERGENCY Performance Checklist - Direct Care Provider Name: Pass / Fail States initial steps to be taken during a Code Blue. States how to call a Code Blue. Performance Criteria Met Not Met Comments States three ways the unlicensed direct care provider can assist during Code Blue. Demonstrates proper opening of the airway. Demonstrates proper hand placement for compressions. Signature of Evaluator: Date: 12

SAFETY WITH TUBES Participant Handout TUBE NAME PURPOSE SAFETY CONCERNS DO NOT DO!!! #1 = IV IV Tube for things to go into the body Fluids/Nutrition Medications Blood Report redness and swelling Prevent bending or twisting Report alarming IV pump Report if tube has been pulled on or out Report if blood in tubing Report if patient complains of pain at site DO NOT... Disconnect Clamp Shut off alarm on IV pump #2 = Feeding Tube Feeding Tube NG Tube Other names Nasogastric Tube Tube for things to go into the body Fluids Nutrition (feeding) Medications Tube for things to go out of the body Suction stomach fluid Protect patient from pulling tube Keep patient s head of bed greater than 30 degrees when feedings are running Report alarming feeding pump Report if tube has been pulled on or out DO NOT... Clamp Stop feedings Remove tube Shut off feeding pump 13

TUBE NAME PURPOSE SAFETY CONCERNS DO NOT DO!!! #3 = Foley Catheter Foley Tube for fluid to go out of the body Drain urine Keep urine bag below level of bladder Secure tube Empty drainage bag every shift Report and record I/O s Prevent bending or twisting Protect tube from pulling Report if tube has been pulled on or out Report bloody urine or bleeding from tube NOTE: (This is the ONLY tube that unlicensed care providers can empty) DO NOT... Irrigate Clamp Insert #4 = Chest Tube Chest Tube Tube for things to go out of the body Drain air, fluid, or blood from the lung cavity Protect tube from pulling Keep collection device in upright position Report difficulty breathing Prevent bending or twisting Report if tube has been pulled on or out DO NOT... Clamp Disconnect from suction Lay collection device on side 14

TUBE NAME PURPOSE SAFETY CONCERNS DO NOT DO!!! #5 = Wound Tube Wound Tube Other names JP Drain Jackson Pratt Tube for fluids to go out of the body Drain wound Help heal wound Protect tubes from pulling Prevent bending or twisting Report if tube has been pulled on or out DO NOT... Disconnect Clamp Disconnect from suction Disconnect from wound vac Irrigate #6 = Tracheostomy Trach Other names Breathing Tube Tracheostomy Tube for things to go in and/or out of the body Remove secretions by suctioning patient Help breathe (air goes in and out) Report difficulty breathing Report soiled or bloody dressing, velcro strap (ties), or trach DO NOT... Suction trach Change dressings 15

SAFETY WITH TUBES Clinical Competency Description Competency Statement: Provides safe and appropriate handling of various tubes. Critical Behaviors Learning Activities Method of Evaluation Identifies and names each of the following tubes (by photo). a. IV b. Feeding tube c. Foley d. Chest tube e. Wound tube f. Tracheostomy States one purpose of each tube. States one safety concern for each tube. Reviews the Safety with Tubes Participant Handout Reviews facility-specific policies/procedures related to various tubes. Completes the Safety with Tubes Performance Checklist with 80% accuracy. 16

SAFETY WITH TUBES Performance Checklist Name: Pass / Fail Performance Criteria Met Not Met Comments Names each of the following tubes (must answer correctly for 5 of the 6): a. IV b. Feeding tube c. Foley d. Chest tube e. Wound tube f. Tracheostomy States one purpose of each of the following tubes (must answer correctly for 5 of the 6): a. IV b. Feeding tube c. Foley d. Chest tube e. Wound tube f. Tracheostomy States one safety concern for each of the following tubes (must answer correctly for 5 of the 6): a. IV b. Feeding tube c. Foley d. Chest tube e. Wound tube f. Tracheostomy Signature of Evaluator: Date: 17

UNLICENSED NON-DIRECT CARE PROVIDER DOCUMENTS Unlicensed non-direct care providers include unit clerks and secretaries. 18

PATIENT IDENTIFICATION Clinical Competency Description Non-Direct Care Provider Competency Statement: Discusses procedures related to patient identification and demonstrates application of two patient identifiers. Critical Behaviors Learning Activities Method of Evaluation Verbalizes the number of patient identifiers to use before performing patient related tasks. States acceptable patient identifiers. Describes purpose of using two patient identifiers. Identifies procedures that require use of two patient identifiers based on policy. Identifies potential safety risks related to discrepancies in patient identifiers. Discusses actions to take if patient identifiers do not match. Demonstrates interventions designed to ensure accuracy of patient identification using two patient identifiers. Reviews the Patient Identification study material in this packet. Reviews facility-specific policies/procedures related to patient identifiers. Completes Patient Identification performance checklist (non-direct care provider) with 100% accuracy. 19

PATIENT IDENTIFICATION Performance Checklist Non-Direct Care Provider Name: Pass / Fail Performance Criteria Met Not Met Comments Verbalizes the number of patient identifiers required by the Joint Commission to ensure accurate patient identification. States the two patient identifiers approved for patient identification per facility protocol (e.g., name, birth date, MRUN). States the purpose of using two patient identifiers. States two clerical situations that require use of two patient identifiers. States one safety concern if patient identifiers are not utilized by clerical staff. States the action to take if a lab was ordered on the wrong patient. Given a medical record (chart) stamped with a patient s identification card, selects the correct patient identification card and MAR for transcription. Signature of Evaluator: Date: 20

ROLE IN AN EMERGENCY Participant Handout Non-Direct Care Provider How to call the Code Blue team 1. Yell, Code blue, get the crash cart 2. When calling a code blue, follow the procedure for calling a code blue at your facility (e.g., do you push a button or call an operator, what extension do you call, what do you tell the operator?) How can the unlicensed non-direct care provider (e.g., clerk) can help during a code blue? 1. Obtain supplies 2. Bring the crash car 3. Offer comfort to other patients/family members 4. Maintain patient privacy 5. Take specimens to laboratory 6. Call the clergy if necessary 21

ROLE IN AN EMERGENCY Clinical Competency Description Non-Direct Care Provider Competency Statement: Demonstrates understanding of the clerk's role during an emergency Critical Behaviors Learning Activities Method of Evaluation Verbalizes understanding of the following: How to call the Code Blue team. Additional ways clerical staff may assist during the Code Blue. Reviews the Role in an Emergency Participant Handout Non-Direct Care Provider. Reviews DHS and facility-specific policies/procedures related to Code Blue. Completes Role in an Emergency performance checklist (non-direct care provider) with 100% accuracy. 22

ROLE IN AN EMERGENCY Performance Checklist Non-Direct Care Provider Name: Pass / Fail Verbalizes how to call a Code Blue. Performance Criteria Met Not Met Comments Verbalizes three additional ways clerical staff may assist during a Code Blue. Signature of Evaluator: Date: DHS_Annual_Core_Competency_SSG_2010_Unlicensed.doc Orig: 12/22/09; Rev 01/19/10 (RW) 23