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Little Company of Mary Hospital

Direct Patient Care For

Student Nurses and Faculty

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You are a Valuable Member of Our Team

Thank you for entering

health care!

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Mission

In solidarity with the Sisters of the Little Company of Mary we are entrusted to serve the community through our ministry of Catholic Health Care

We are the empowered laity – the Greater Company of Mary

Rooted in a deep heritage of prayerful support of the sick and dying, we strive to enhance the sacredness of life and human dignity.

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Professionalism: take pride in your quality based, respectful care

Compassion: respect patients and families by listening to and assisting with their needs

Quality: promote highest level of safety in your care for quality patient outcomes. Anticipate patient needs

Responsibility: patient care, environmental and financial resources are in your hands

Core Values

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Attitude Maintain a professional attitude

Sense of Ownership Take pride in your work

Commitment to Co-Workers Treat co-workers with respect

Appearance Dress appropriately for the clinical setting

Communication Keep communication open among nursing staff, students and instructors

Customer’s Rights Give respectful care

Safety & Awareness Be aware of your environment

Elevator Etiquette Allow everyone to get off the elevator before you get on Do not block people exiting the elevator Do not discuss patients, patient’s families or co-workers on the elevator Keep voice down when with a group

Standards of Performance

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Is a Service Recovery ProcessFor ACTing on patient complaintsIt allows us to take corrective action to prevent the

problem from occurring againWe:

A: Apologize for mistake

C: Correct the problem promptly

T: Take action so problem will not occur again

Gift Program

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Introduce yourselfBe polite, listen attentively to your patientMake eye contactExplain why you are thereFirst impressions count!

“In the first 8-30 seconds after a customer talks with or sees you an opinion of you and your facility has been formed”

(Personal Growth January 2009)

What you do, does make a difference!

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Hourly Rounding at LCM Occurs on all patients

Every hour from 6am-10pm Every two hours from 10pm-6am

Focus on the 4P’s Pain – using the 1-10 scale

Positioning – is the patient in a comfortable position Toileting (potty) – does the patient need to go to the bathroom Placement – move items within reach (table, call light, tissue, phone, water, urinal)

A scan of the environment To be sure that all items are within reach To insure safety measures are in place To deliver the care patients need and expect

All above documented on Inpatient Hourly Rounding Log The white board in the patients room will be updated at the beginning of tour of duty:

With patients goal Ask the patient, “The one most important thing I can do for your care?”

Names of caregivers

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The Employee Parking lot is located on the east side of California at 95th Street.

Park on east portion of lot closer to Office Max

Enter the hospital through the revolving door at the front entrance

Other designated parking areas Blue - Employee/Volunteer Green - Physician Yellow - Patient/Visitor Red- Unavailable

LCMH is undergoing a campus transformation

Parking will be restricted **Students are to park at a

remote location Evergreen Bath &

Tennis 91st and California West end of parking lot

Check with your instructor for up to date information

Parking at LCMH

East

Parking

Lot

Student ParkingEvergreen Bath and Tennis91st California

95th Street

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91st Street

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In order to maintain safety it is required that students and instructors :

Wear their school picture ID in clear badge holder ID must be worn at chest level

Must wear your school uniform and ID during clinical Must wear professional dress with lab coat and ID if in hospital other than clinical

No Cut offs Flip flops Tank tops Jeans

If the hospital provided you with the clear badge holder please return it to your faculty at end of clinical.

Student Identification

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Smoking is not allowed in the hospital, or in areas surrounding the hospital including sidewalks and parking lots

Tobacco-Free

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HIPAA protects the privacy of individually identifiable health information

When working in the clinical setting ask your self Do I need to know this to complete my patient

care???? If you answer “no”, then stop

If you answer “yes”, follow the HIPAA TIPS ……………

Health Insurance Privacy And Portability Act (HIPAA)

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HIPAA TIPS

Don’t talk about a patient’s condition in front of others

Keep patient information safe Close off the computer Put charts away

Copying of any portion of the medical record is a HIPAA violation and can be prosecuted by law

If patient information is necessary for your learning process and to deliver patient care

Keep the information within the learning environmentShare pertinent information with the staff to provide quality care for the patient

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HIPAA Guidelines: Releasing Information Over the

TelephoneAt LCMH on admission the patient and his/her

personal representative will be given a paper with a four digit identification number The last four digits of the current visit number

Any calls received requesting patient information will only be honored if the caller knows the identification number

For unresponsive patients having no family request assistance from Case Management

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In an effort to maintain patient safety ALWAYS verify:

Patient’s name Patient’s date of birth1. By having the patient verbalize this information 2. Verifying the information with the patient’s ID band.

Patient Identification

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Cell Phones

Cell phones are not to be used in the clinical area! For any reason!

Cell phones can only be used in public areasThe lobby The cafeteria

Staff nurses will use hospital issued cell phones for communication with physicians and families

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All hospital policies can

be found on Meditech-LCHM’s computer system Under “Patient Care Services Policies and Procedures”

Your instructor will have access to LCMH’s library

Hospital Policies

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Get report.Let RN and Care Partner know what you will be doing for

your patientLet RN and Care Partner know when you are leaving the

unitsReport off to RN when clinical completed

Communication

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When a patient is identified to be at risk for fall. Fall Protocol is initiated

Follow the information provided in the Fall Prevention Protocol Packet

Found on MDC cart Fall protocol (yellow) ID band is placed on patient. Fall protocol signage is placed outside the patient’s

door and on the front of the patient’s chart Before leaving the patient’s room

Meet patient’s toileting needs Place the bed in the low position De-clutter the walk way Place the phone within reach Place the call light within reach Ask “Is there anything else I can do for you

before I leave your room?”

Fall Prevention Protocol

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At LCM we reduce the use of restraints as much as possible We use the least amount of restriction for the least amount of time The dignity and rights of our patients MUST be maintained at all times At lease every two hours we meet the patient’s needs of:

Nutrition Toileting Repositioning

We follow the the “Three Ps” Potty Pain Positioning

When a patient is in Medical Restraints staff will document every two hours

Restraint Policy at LCMH

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Restraints at LCMHBehavioral Restraints

Are applied when a patient is at risk to harm self or others

Students usually do not take care of these patients

Must have a 1:1 sitter at all times

Medical Restraints Are applied when a patient is

interfering with their healthcare The need for medical restraints

is reevaluated frequently and a doctors order is required

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Latex AllergyAlways be aware of allergies

identified by the patientLatex-free gloves are on the units for use with patients

having a latex allergy or if you have a latex allergyLatex-free equipment is available for those patients with a

latex allergyMDC has a list of all available latex free equipment

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Call Light Used At LCMHVolume Control on the side

Nurse Call Button

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TV Control

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Nurse Call Button

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TV Control

Volume Control on the side

This call light is used in some of the patient rooms

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Pain is observed in patients of all ages When accessing pain use the age appropriate pain tools

Available for newborns to the elderly Our Pain Scale at LCMH

0 – 10 with verbiage and Smiley Faces 0 being no pain 10 being the worst possible pain

A Patient’s self-report is the only reliable report of pain Report patient’s self-report of pain to the nurse At LCMH a pain score of equal to or greater than a 4 requires intervention

It can interfere with activities of daily living and hinder recovery LCMH Care Partners can document the patient’s self report

Pain Across the Continuum

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Patient Handout on Pain Assessment at LCMH

LCMH’s platform of care: “In Pursuit of Pain-Free Health Care”

A copy of Our “Commitment to Pain” sheet Is given to all patients on admit

Is available, on every unit, in many different languages

Explains LCMH’s philosophy on pain relief

Explains how they will rate their pain

Explains what the patient can expect fro us

Explains how the patient can help manage their pain

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At LCMH care is provide taking into consideration The growth and development the physiological changes that

occur with the aging process

Age Appropriate Care

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Wash your hands!! Wash your hands!!! Signage will be placed outside the patient’s room indicating the

type of isolation precaution the patient is on Wear the appropriate personal protective equipment (PPE)

NEVER ENTER AN ISOLATION ROOM WITHOUT THE APPROPRIATE PPE

Antibacterial soap & alcohol based cleanser are available in every patient room

Red garbage cans are placed in each patient room for biohazard waste

Infection Control Issues

Isolation gowns are NOT DISPOSABLE

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Artificial nails spread infection and are not allowed

Natural nails should be < ¼ inch long

Always check signage outside the

patients room for PPE to be used

If the patient has C-Diff

They will be on Contact “Plus” Isolation

Wash hands with soap and water

This is the ONLY way to kill C-Diff

Alcohol gels DO NOT kill C-Diff”

Infection Control Tips

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Infection Control Guidelines• Health care institutions are mandated by

regulatory agencies • These mandates require students have specific immunizations for

their protection

• If you are sick DO NOT come to the clinical setting• A make up day can be arranged with your faculty if school

policy allows• Though not required consider getting the flu vaccine

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• The N95 Respirator is a special fit-tested mask • Worn when caring for patients on Airborne isolation-in negative air flow rooms

• Staff are trained on the proper use of the N95 Respirator• Students will not care for patients in negative air flow rooms

• Commonly seen conditions requiring Airborne Precautions include suspected or confirmed:

• MTB (mycobacterium tuberculosis)• Positive AFB (acid fast bacilli)

until MTB is ruled out• Varicella/Chickenpox• Varicella/Shingles

• If disseminated• More than 25 vesicles

N95 Respirator

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Exposure to blood and body fluids is taken very seriously at LCMH

Take all precautions to reduce exposure to blood or body fluids

If exposed to blood or body fluids

Report it to your faculty and charge nurse immediately

Wash exposed area with soap and water for 3-5 minutes Rinse splashes to eyes or mouth with water or sterile saline for 10 minutes Wash puncture wounds with soap and water for 3-5 minutes Report to the Emergency Room

Treatment needs to be completed within 2 hours

You are financially responsible for treatment you receive. Uniforms soiled with blood or body fluids will be cleaned by the hospital

Notify the charge nurse You will be given scrubs in exchange for your soiled uniform Your cleaned uniform will be returned when you return the scrubs

Exposure Incidents

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Occurrence Reports

If involved in an occurrence with potential to cause harm to anyone an occurrence report needs to be filled outOccurrence Reports are on the Meditech computer systemReport the occurrence to your instructor and the nurse managerDocumentation of the occurrence is only in the Occurrence

Report computer module

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Linen Utilization

LCMH has initiated a linen campaignTo ensure proper and efficient use of linen items for

patient comfort and safetyTo limit the misuse and the unnecessary

contamination of linen LCMH spends more than

$500,000 annually on linen processing $400,000 annually in linen replacement

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Linen “As Needed” Bed Change

Changing the linen “as needed”

Is a new conservative program at LCM H

It is easy on the environment by

Protecting our natural resources

Conserving water

Exposing fewer chemicals into the environment

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“As Needed” Bed Change Guidelines

Straighten bed linens every day

Change the patient’s bed linens with what is needed when needed

When the bed is visibly soiled

When the bed is damp

When the Physician’s request or care giver requests the

bed linens be changed

When the patient requests or a family member requests

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Steps to follow to go“Easy on the Environment”

Maintain LCMHs commitment to outstanding patient care while being “easy on the environment” Enter the patient’s room Exchange only what is needed Explain the process Educate the patient on how

they are helping to protect

the environment

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What to do With Soiled Linen

All soiled linen is to be put in BLUE plastic bags while still in the patient’s room

Any linen that is brought into a patient’s room is considered contaminated and must be placed in BLUE plastic bagsOnly linen that will be used should be brought into

the patient room

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Do Not Resuscitate A DNR means the patient has chosen to have no intervention or

partial interventions if they become unresponsive without a pulse A doctor’s order MUST be on chart if patient has a “Do Not

Resuscitate” status Always know your patient’s code status

A sticker is placed on on front of chart to indicate the patients code status

No Code Status Partial Code Status

DNR Status

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Rapid Response Is activated when a patients condition is deteriorating

Anyone can activate a Rapid Response Families, patients and visitors are educated on

Rapid Response Activate by dialing 5960

Announce Rapid Response and your location Code 70

Is activated when a patient is unresponsive without a pulse Code Brain

Is activated when a patient has an acute ischemic stroke and requires TPA

Code Purple The Perinatal Hemorrhage Rapid Response Team

Emergency Codes

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Emergency Codes Code 99

Is activated in fire situations Activate by pulling the nearest fire alarm

Know the locations of the fire alarms Code 33 Yellow

Is activated in a disaster Standby Wait for direction from your instructor

Code 33 Red Is activated in a disaster

Wait for direction from your instructor Code 33 Orange

Is activated in a hazardous material or Bioterrorism situation If you discover a Hazmat incident

Activate by calling Security 5313 Announce Code 33 orange and your location

Wait for direction from your instructor

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Emergency CodesCode 66

Water sprinkler activation Activate by calling Security 5313

Announce Code 66 and your locationCode Gray

Is activated in a sever weather watch Wait for direction from your instructor

Code Black Is activated in a sever weather warning

A tornado or severe thunderstorm has been sighted in Southern Cook County

Wait for direction from your instructor

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Emergency Codes Code Kid

Is activated in an infant abduction Activate by dialing 5960

Announce Code Kid and your location Be alert to any unusual activity

Report unusual activity to security 5313 Code Dr. Blue

Is activated for security assistance if you feel threatened and the offender is present or if you see a suspicious person Activate by calling 5313

Announce Dr. Blue and your location Code Silver

Is activated when there is an armed intruder Activate by calling Security 5313

Announce Code Silver and your location If you hear a Code Silver called DO NOT go to that area

Crisis Intervention Team Is activated for violent patient situations

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Know your patient’s code status! If you find someone

unresponsive and without a pulse Activate a Code 70

Activate by dialing 70 and announce Code 70 and your location Begin CPR Compressions only until Code 70 team arrives

Code 70

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Fire situations• Fire Plan: R – Rescue patient from room

A – Alarm, know where they are C – Contain, close door

E – Extinguisher to room • Fire Extinguisher Plan: P – Pull the pin A – Aim at base of fire S – Squeeze the trigger S – Sweep base of fire

Code 99

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Code Brain A Code Brain

Is activated when a patient with acute ISCHEMIC stroke meets the criteria for thrombolytic therapy (TPA) (Tissue Plasminogen Activator) treatment

A MD order has been received for TPA administration

Process Activate by calling 5960

Announce Code Brain and your location

Included in the “Code Brain” batched page will be The house MD The Nursing Supervisor The stroke coordinator

http://www.health.com/health/static/hw/media/medical/hw/h5551195.jpg

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Symptoms of a Possible Stroke Acute stroke signs and symptoms

SUDDEN ONSET F = FACE

Uneven smile Facial droop/numbness Vision disturbance in one or both eyes Double, blurred or blackened vision

A = ARM Weakness, numbness difficulty walking Balance or coordination difficulties

S = SPEECH Slurred speech Inappropriate words Mute Difficulty understanding words Confusion

T = TIME This is a MEDICAL EMERGENCY – Call 911

Other Headache May be sudden and severe in nature

http://braininjurypeervisitor.org/web_images/act_fast.jpg

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What To Do If You Recognize Signs and Symptoms of a Possible Stroke

For Patients on Medical/Surgical Units Activate the “Rapid Response Team”

Dial 5960 and announce Rapid Response and your location ICU RN will

Access the patient Order ACUTE STROKE PROTOCOL diagnostics Accompany the patient for STAT Acute Stroke Protocol Plain Brain CT Transfer the patient to ICU if needed

For Visitors and Patients Outside Inpatient Units Activate by dialing 70 and announce Code 70 and your location

Code team will transport the victim to the Emergency Room upon stabilization For Patients and Visitors Outside the Hospital

(Mary Potter Physicians’ Pavilion, Halsted Center, Burbank Facility, Palos Diagnostic Center Call 911 to activate the Emergency Medical System

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Code Purple Code Purple is the Perinatal Hemorrhage Rapid Response Team

This Is a perinatal situation requiring additional staff, lab, blood products, personnel and equipment

To activate dial 70 Announce Code Purple and your location

The Code Purple team consists of Lab Respiratory Nursing Supervisor ICU RN Various physicians

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• Is activated for violent patient situations • Activate by calling 5960

• Announce you need the Crisis Intervention Team and your location

• The Crisis Intervention Team consists of• Security personnel• The Nursing supervisor• Pastoral Care personnel• A Behavioral Health RN

Crisis Intervention Team

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Documentation

• If documenting in the Meditech Computer system

• Document under your instructors Meditech number• Make a note: “Documentation done by and your name”

• Performing a blood glucose with the LifeScan meter• Is done under your instructors INS # number

• Rather than documenting in the computer system • A hand written note may be done on the Progress Notes

• Co-signed by faculty

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Medication Administration

• Medications are obtained from

the automated dispensing machine - Pyxis• Using your your instructors bio-ID.

• Remember the RIGHTS of

medication administration• Right patient• Right time and frequency• Right dose• Right route of administration• Right drug

• You are responsible for all medications you administer!

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Medication Policies

What medications students DO NOT giveBlood or any blood productsThe initial dose of any IV medicationsChemotherapy

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Medication Documentation

Documentation of medications and IV’s is Done on the Medication Administration Record - MAR,

PRN Medication Administration Record - PRN MAR and the IV Administration Record - IVAR

The MAR, PRN MAR and IVAR are kept on the patient’s clipboard

All medications must be Signed by you Co-signed by your faculty

According to LCMH policy

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MARInformation contained on MAR

Patient visit # Patient Name DOB Patient Medical

Record # Age Date Admitted Primary Diagnosis MAR Date Allergies

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PRN MAR

MK Nowicki RN MKN

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IVAR

650

50 50

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High Alert Medications

• Be aware of those medications that when taken as recommended can cause injury to the patient

• Always do a 2 RN check on High Alert Medications • Such as insulin. • This is a 2 RN check• Between instructor and RN• Not just student with faculty

• Your faculty has the LCMH policy regarding what medications are High Alert Medications

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Measuring I&0 at LCMHFluid Equivalents

1 oz.= 30cc

Plastic glass 210cc

1 cup (8oz) 240cc

Plastic Pitcher 900cc

Soup Bowl 180cc

Milk Carton 240cc

Jello/Ice Cream/ Fruit Ice ½ cup 120cc

Juice (foil cover) 120cc

Juice (plastic cover) 80cc

Pop 1 can (12oz) 360cc

Coffee/Tea (8oz) 240cc

Ensure 1 can 240cc

Small Milkshake (8oz) 240cc

Large Milkshake(16oz) 480cc

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Always ask for assistance with lifting or moving patients

Bend your knees and lift with

your legsTighten your stomach muscles

and pull the object close to your body

Be sure the weight of the object isn’t more than you can lift

Ergonomics

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Safety and Emergency preparedness are necessary To promote and maintain a safe and secure environment for patients, staff

and visitorsLCMH has information on Chemical spills and directions on cleaning the spill

This can be found in the Material Safety Data Sheet (MSDS) Found in the Environment of Care (EOC) manual on each unit

In the event of a power failure All rooms are equipped with red outlets for critical care equipment

LCMH is part of a Hospital and Community Emergency Response System This is a community based response by healthcare organizations to

emergencies

Safety & Emergency Preparedness

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“Pursuit of Pain-Free Health Care”

In our efforts to maintain this platform LCMH Provides Minimally invasive procedures

such as Da Vinci robotic surgery Diagnostic tools

Laparoscopic cameras 40-slice CT scanners

Continues to promote a health care experience that provides

Easy access Personal attention

Our Platform at LCMH

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The Future of LCMH

To be completed in the fall of 2012

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ReferencesReferences provided on request