Northside Hospital Student Orientation

Welcome!!

We are so happy to have you as part of our team!

We hope that your experience at Northside Hospital will be a valuable stepping stone in

your career!

Purpose Of This Presentation

• Introduce Northside Hospital services

• Ensure accurate completion of required paperwork

• Provide information regarding key policy & procedural issues

About Northside Hospital

• Opened 1970

• Not-for-profit community hospital

• 444 bed full service hospital

• Named “Most Preferred Hospital” by the National Research Corporation 4 years in a row

Proud To Serve...

• Women’s

• Oncology

• Surgical

• Specialty medicine

• Emergency

Core Values At Northside

• Dignity

• Respect

• Pride

• Warmth

• Caring

Forms

• Must be completed, signed, dated & returned to instructor before arrival at Northside Hospital campus

• Acknowledgement and Release Form

• Health History– All questions must be answered in #6 (TB skin

test) & #7 (Rubella)

Name Badge

• Our policy requires that you wear your name badge AT ALL TIMES while you are on the Northside Hospital Campus

Dining At Northside Sandy Springs

• Two food services– McDonald’s – Morrison’s

• 30% discount with your name badge– Morrison’s: when open (6:30 AM - 7 PM)– McDonald’s: only when Morrison’s is closed

Dining At Northside Forsyth

• Only one food service, but 30% discount with your name badge applicable

Parking At Northside Facilities

• Please use the Women’s Center Deck, located on Hollis Cobb Drive directly opposite the Women’s Center

• Code required for entry for free parking; obtained from your instructor

• At Forsyth, use designated employee parking areas--no code required

Confidentiality

• Critical to maintain because:– Protect the trust patients have in their health

care providers– Requirement of Code of Ethics of various

professions– Required by regulatory & accrediting

organizations

Health Insurance Portability and Accountability Act…... HIPAA

Enacted to ensure that personal medical information (shared with doctors, hospitals and others who provide and pay for healthcare) is protected.

Establishes new restrictions on uses and disclosures of personal health information.

Allows patients enhanced protection and greater access to their medical records.

Organizations (Covered Entities) that are required by law to follow

HIPAA guidelines.Examples are:

› Healthcare Providers› Health Plans› Healthcare Clearinghouses› Business Associates who have access to patient

records. ( i.e. Consultants)

Protected Health Information (PHI)

• Any patient’s health or personal information transmitted through oral, recorded, paper, or electronic means.

Such as:

– Patient name and address.

– Social Security Number.

– Medical records.

– Billing information

Minimum Reporting Necessary

• PHI is to only be used or disclosed when it is necessary to carry out a specific function.

• This standard does not apply when PHI is used or disclosed for treatment purposes

Our Role for Privacy Notice

• We are required to inform patients of how we, as a facility, use and disclose their PHI.

• Patients must receive this notice on the date the first service is rendered.

• The right to access and control the PHI of minors is left to the parents - except when state law overrides parental control.

Patient’s Have Rights To:

• Restrict use and disclosure. (Although the provider, NSH, is not required to agree).

• Designate an alternate means for communication with the patient (i.e. work number vs home number)

• Inspect and amend their medical record or “state their part of the story”.

• Request a history of non-routine disclosures for as far back as 6 years.

• Contact the designated NSH privacy official with questions and breech of privacy complaints.

Tips On Confidentiality

• Avoid using waiting areas to interview or brief patients or family members

• Be mindful that there are often patients & family members on employee elevators, in hallways & in the cafeteria

Confidentiality & Technology

• Prior to sending a fax, check with the charge nurse in the department to which you are assigned

• Don’t leave computer displays showing confidential information--log-off when finished

• When using a copier, don’t leave material unattended

Questions About Confidentiality Practices

• Ask your preceptor or the charge nurse of the unit to which you are assigned

HIPAA contacts

• Pat Parker

NSH - all metro Atlanta locations, Alpharetta, Meridian Mark, John’s Creek

• Anne Reed

NSH Forsyth

Respect and Courtesy At Northside Hospital

• Knock before entering

• Introduce yourself before observing or initiating care in any setting

Other Supportive Services Available

• Patient Relations

• Pastoral Care

• Check with the charge nurse for more information on utilization or how to access

ENVIRONMENT OF CARE

Seven Elements of the Environment of Care

• Safety Management

• Fire Safety

• Security

• Emergency Management

• Utilities Management

• Medical Equipment

• Hazardous Materials

Safety Management

• Hospital Safety Officer: Dial 8784

• Use the emergency number to report all Code Blue, Safety, Security and Medical Emergencies.

• A Code Blue is someone who may be having a Heart Attack or Respiratory Arrest.

Safety Management

• Report all Needle Sticks and Injuries to your Supervisor.

• Use Standard Precautions when dealing with patient’s bodily secretions.

• Personal Protective Equipment (PPE) will be provided at no cost.

Security Management

• There is 24 hour Security on-site.

• “Code Pink” is the Infant Missing Code. Assist with search for infant.

Security Management

• Escorts are available by calling Security.

• Emergency Phones, Intercoms and Stairwell Alarms are available in Parking Decks.

• Report all Suspicious Persons to Security.

Fire Safety

• Code Red is the Code for Fire or Smoke.

• Use R-A-C-E if you discover a fire or smoke condition.

• Rescue: Your Patient and Yourself

• Alarm: Pull the nearest Alarm

• Contain: Close all Doors.

• Extinguish: Use a Fire Extinguisher

Fire Safety• Report all Smells of Smoke to emergency

number & Alert your Charge Person.

• Use P-A-S-S with Fire Extinguishers.

• Pull the pin.

• Aim at the base of the fire.

• Squeeze the handle.

• Sweep the fire.

Medical Equipment

• Notify Charge Person if Medical Equipment does not seem to be working correctly

• All Electrical Patient Equipment MUST have a three prong plug and an Up to Date Safety Inspection Sticker.

Emergency Management

• Code Orange is for Bomb Threats. Report suspicious items to Security. Do Not Touch or Move Suspicious Items.

• Code Grey is for Tornadoes. Close & Latch all Windows. Relocate patients to Inner Hallways if able. If not, protect patients by moving them away from windows.

Emergency Management

• Code Green is for External Mass Casualty. Continue in your present role and follow the instructions of your Charge Person.

• Bio-Terrorism: Use Standard Precautions for all patients. smallpox patients will be placed on Air Control & Contact Precautions. Plague patients will be placed on Droplet Precautions.

Hazardous Materials

• Material Safety Data Sheets can be obtained by contacting your Charge Person or the Hospital Safety Officer.

• Report all Chemical Spills to your Charge person.

• Use Personal Protective Equipment

Utilities Management

• Utility Systems include Elevators, Water, Electricity, Heating,Ventilation and Air Conditioning.

• Report any problems with Utility Systems to your Charge Person or the Hospital Safety Officer.

Environment of Care Summary

• Emergency Number: Atlanta = 8911, Forsyth = 54321

• Security Control Center Number: Atlanta = 8797, Forsyth = (678) 776-7869

• Code Blue: Cardiac & Medical Emergency

• Code Red: Code for Fires

• Race: Rescue, Alarm, Contain,Extinguish

• Hospital Safety Officer Number: 8784

• Code Pink: Missing Infant

• Use Standard Precautions

INFECTION CONTROLPRESENTS

ISOLATIONBIOTERRORISM

CLEAN/STERILE TECHNIIQUE

The Isolation Guidelines Has Two Major Parts

• Standard Precautions– Precautions for care of all patients regardless

of diagnosis

• Transmission Based Precautions– Precautions designed for care of specified

patients

EMPIRIC

• Isolate pending confirmation of diagnosis

• Based on experience

• “Educated guess”

Standard Precautions

• Used for all patients at all times

• Replaces Universal Precautions

• Barrier precautions the same

• Use common sense

Standard PrecautionsBarriers

• Handwashing

• Gloves

• Gowns/Aprons

• Masks

• Goggles

• Sharps containers

• Ventilation Devices

Standard Precautions Con't.

• Handwashing (Most important prevention)– Consider waterless when no sinks– before patient care– after removing PPE– between tasks– after patient care completed

Standard Precautions Con’t

• Gloves– for venipuncture, vascular access, when touching

contaminated items– clean gloves for mucous membranes & change

often

• Gowns– to prevent soiling of uniform and skin

contamination when pt. care requires contact with blood, body fluids or nonintact skin

Standard Precautions Con’t

• Mask & Goggles– to protect mucous membranes of the eyes, nose

and mouth from droplets of blood or body fluids

– use anytime there is a potential risk

• THIS MEANS SUCTIONING!!!

Transmission Based Precautions

• Designed for patients known or suspected to be infected or colonized with transmissible or epidemiologically important organisms

Transmission Based Precautions, con’t:

• Three Types:– Airborne Precautions– Droplet Precautions– Contact Precautions

• New precautions called STANDARD PLUS– Use Gloves to enter room & for all patient

contact

Airborne Precautions Use For:

• Airborne spread, tiny droplets

• TB - Suspect or confirmed

• Chicken Pox - (Varicella)– or disseminated Zoster

• Measles - (Rubeola)• Small Pox - (BT)• Hemorrhagic

Fevers - (BT)– (Ebola, Lassa,

Marburg )

Airborne Precautions

• Mask – use at all times– N95 for TB & SMALLPOX– surgical mask for CP & other

• Isolation room needed– negative pressure– keep door closed

AIRBORNE Con’t.

• Add CONTACT PRECAUTIONS – for Chicken Pox , disseminated Zoster &

Smallpox ( Use 2 signs)

– Teach patient to cover nose & mouth when coughing

Droplet Precautions use for

• Large Droplets

• Acute respiratory infections

• N.meningitides pneumonia caused by : influenza, Mycoplasma,, parvovirus, pertussis, Plague

Droplet Precautions Con’t

• Mask – Surgical Mask is the primary barrier unless

patient has large amounts of secretions or drainage

– Wear mask when working within 3 feet of patient

– Wear Mask when suctioning– Wear mask on patient when transporting

Contact Precautions Used For:

• Drug Resistant Bacteria– MRSA, VRE &, Others Identified by ICC

• C. Difficile

• Major Drainage from wound infections

• Diarrhea if patient is incontinent

• Highly Contagious skin infections ie: scabies, lice, impetigo

Contact Precautions

• Wear gloves and gowns when entering the room

• Remove all ppe before leaving the room

• Transmission by direct pt. contact or contact with items in the environment

• Create a barrier ALL THE TIME

• May use empirically

Northside Isolation For Resistance ( Orange Sign)

• Use With Contact Isolation Sign

• Important Points– Wear all PPE when entering room– Remove all PPE before leaving– Don’t touch doorknobs and surfaces after

gloves are contaminated

New Precautions Called Standard Plus

• Standard Precautions With Gloves– Wear gloves to enter room and for all contact

with patient– designed for patients who have a hx of MRSA,

VRE but who have no symptoms of infection, drainage, or an invasive device in place

Standard Precautions:Other Components

• Linen - Clean Cover Or Store In Closet– Never toss on floor– Never shake– Consider used as contaminated

• CPR - Masks Available

Standard Precautions:Other Components

• Waste - Georgia Regs– Red Bagged

• Fluid filled containers• Microbiological, pathological

– Tissue

– Rotoclave- Onsite

• Blood Spills - clean up by using gloves, paper towels and disinfect area

• Sharps - Empty 3/4 Full

Standard Precautions:Other Components

• Exposures– First aid– Report ASAP to Employee Health in off hours

your supervisor / ER/ school– Source testing– Pep prophylaxis/vaccine– Use safety devices

Standard Precautions

• Exposure Control Plan (ECP) In The Manual

• Tuberculosis Plan

• Vaccines

Bioterrorism

• What Is Bioterrorism?– Bioterrorism is the intentional use of pathogenic

organisms , (bacteria, viruses, fungi) or toxins into a community to cause disease and inflict terror.

– Primary Agents• Anthrax• Botulism• Plague• Smallpox

Bioterrorism

• What Is Your Role?– NSH has a bioterrorism plan– Take directions from your

supervisor– Apply appropriate isolation

• Standard precautions for all.

• Smallpox - place in airborne/contact precautions

• Plague - droplet precautions

Appropriate Use Of Clean and Sterile Technique

• Basic Principles– Microorganisms are capable of causing illness

in humans– Microorganisms can be transmitted by direct or

indirect contact– Illness can be prevented by interrupting

transmission

Definition Of ASEPSIS

• Clean technique - refers to practices that reduce the numbers of microorganisms to prevent or reduce transmission

• Surgical technique- refers to practices designed to render and maintain objects and areas maximally free from microorganisms

Clean Technique

• Reduce numbers of skin microorganisms by handwashing or cleaning

– Use soap for routine care– Apply friction to increase amount of soil

removed– Clean from areas of clean to areas of less clean

Clean Technique (Cont.).• Barrier techniques reduce transmission from

patient to personnel– Use no-touch dressing technique to avoid

contaminating sterile supplies

– Use sterile gloves for dressing application

– Wear clean gloves or apron or gown to protect clothing

– Wear clean gloves to avoid contact with infectious material

– Room placement important ie: neg pressure

Surgical Technique

• Provide maximum reduction of skin microorganisms without damaging tissue

• Surgical Scrub– Cleanse with soap to remove soil– Use antimicrobial agent: may leave residue to

continue suppression– Apply friction with scrub brush

Sterile TechniqueProvide Maximum Reduction

• Patient Prep– Use antiseptic agent– Remove hair when necessary. Note: When hair

removal is necessary, it should be done with a depilatory or, less desirably , by clipping, rather than by shaving with a razor.It should be done immediately before the procedure,

Sterile Technique

• Use barrier techniques to decrease transmission of microorganisms from personnel to patient– Maintain area of sterile field with sterile gloves

gowns and drapes– Wear appropriate attire as indicated by risk of

procedure and area of hospital where the procedure is performed

Surgical Technique

– Environmental Controls To Reduce Microorganisms During Surgical ProceduresUse special treatment rooms

– Control activity to reduce airborne transmission• Keep doors closed during procedures

• Exclude visitors and unnecessary personnel

• Avoid cleaning activities in the area during surgical procedures

Reprocessing Equipment Between Patients

– Discard disposables after each patient use.

– Use mechanical cleaning or change cover of surfaces not in contact with abraded skin, mucous membranes, or infectious secretions/excretion (e.g., exam. tables, stretchers, wheelchairs.)

– Use mechanical cleaning and disinfection of noninvasive equipment that may become contaminated with body fluids (e.g., electrodes, ear speculums, stethoscopes, blood pressure cuffs, outside surfaces of equipment such as ventilators or intravenous pumps.)

PATIENT’S RIGHTS AND RESPONSIBILITIES

PARTNERING WITH OUR PATIENTS AND FAMILIES

Patient Rights

• Patients have the right to privacy, confidentiality, ethics consultation, refusal of treatment, safety, interpretation when needed, assessment & management of pain and more

• For a complete listing of patients rights, see “Your Rights and Responsibilities as a Patient” fact sheet

Patient Responsibilities

• Patient responsibilities include asking questions, providing accurate information, following treatment plans and more

Patient Rights & Responsibilities

• Northside encourages patients and families to be active members of their healthcare team in order to provide the highest quality of care

• In keeping with this “partnership” philosophy, every patient that is admitted to Northside Hospital receives a written copy of their rights and responsibilities along with ways to help prevent medical errors (available in English and Spanish)

Patient Rights & Responsibilities

• Other patients rights reference materials:– Patient/Family/Visitors Guides located in all patient

rooms and patient access areas– Mosby’s Multicultural Reference Guide

• Located on patient care units and in Health Resource Library

– Multi-Faith Informational Manual • Located on patient care units and in Health Resource Library

• Information regarding Northside’s Ethical Code of Conduct can be found in policy F-018

ASSESSMENT

Initial Patient Assessment• Physical, psychological, and social status• Nutritional, functional, and educational needs • Department's specific content• Determines the need for care or treatment,

– H & P (done by MD) • Inpatient: on chart within 24 hrs

• Outpatient: on chart prior to procedure

– Nursing Assessment completion:• Inpatient: on chart within 24 hrs

• Outpatient: on chart prior to procedure

Patient Reassessment• Done according to the department's specific

policies and procedures on reassessing patients.

• Done when– significant change in the patient's condition – when a significant change occurs in the patient's

diagnosis.– According to department specific, patient specific

guidelines

Interdisciplinary Plan of Care

– Shows collaboration and coordination of patient care among disciplines

– Interdisciplinary Plan of Care is supported by:• Interdisciplinary Clinical Guidelines

• Standards of practice

• Protocols

Interdisciplinary Plan of Care

• Interdisciplinary Plan of Care includes the following sections:– Admission date, diagnosis– Problem identification and prioritization– Consultation visits– Nutrition– Diagnostics

Interdisciplinary Plan of Care

• Continued:– Activity– Treatments/Interventions– Psychosocial/Spiritual– Patient/Family Education– Discharge Plan– Goals/Outcomes

Interdisciplinary Plan of Care

• Nursing evaluation should reflect patients progress toward goals/outcome criteria (achievement or non achievement of the goals/outcome criteria)

• If a patient does not meet outcome criteria for identified problems prior to discharge, they should be referenced in the discharge education, follow-up, transfer note etc.

Patient Safety-Restraints

• Definition: – Method of physically restricting a person's freedom of

movement, physical activity, or normal access to his or her body, including medication.

• Goal:– Limit use of restraints to situations where alternative

measures have failed & only when the possible benefits clearly outweigh the risks

Patient Safety-Restraints• Your role:

– Restraints always require an MD order prior to implementation• Restraints used as part of a procedure are not considered a restraint

– Communicate with patient’s nurse prior to any treatment/procedure/interaction

– Communicate assessment findings relevant to patient’s behavior to patient’s nurse

– If restraints are removed prior to treatment/procedure, have patient’s nurse check re-application prior to leaving patient unattended

• DEFINITION: An uncontrolled or unintentional descent from a higher elevation to a lower elevation

• CAUSE OF FALLS: Age; gait; impaired cognition, vision and mobility; medications; failure to call for assistance; elimination; environmental issues

• Falls occur in all Service Areas!• Falls occur on all shifts!• Restraints do not prevent falls!

Patient Safety-Falls

Patient Safety-Falls• Fall Prevention:

– All patients are assessed on admission and each shift

– “Risk to Fall” assigned to patients with the following criteria:

• History of falls

and/or

• Combination of two or more factors: age>70, gait problems, fatigue/weakness, disorientation/confusion, medications affecting balance, judgement &/or level of consciousness

Patient Safety-Falls• ‘Risk to Fall Plan’

– Confidential ID with “Yellow Armband”

– Frequent monitoring: toileting & ADLs every 2 hours or as indicated

– Pt & Family Ed Plan - teaching tool

– Environmental Safety precautions• Keep pathways clear

• Provide assistance with mobility

– Communicate concerns to RN coordinating patient’s care

Patient Safety-Falls• FALL EVENT

– Notify patient’s nurse immediately

– Assess patient for injury

– Complete an Incident Report• Report is forwarded to unit manager and Risk Management

• Fall data included on monthly unit report card

• Unit leadership reviews fall data and addresses issues at staff meetings

Patient Safety-Armband Alerts• Yellow: Risk to Fall

– Educate patient / family on Safety Tips to prevent falls

– Check physical environment for safety measures

• Pink: Lymphedema Precautions– Criteria applies to patients with history of Breast

Cancer surgery where axillary nodes removed; dialysis arm shunt and upper extremity surgery

• Orange: Do Not Resuscitate– Armband should list “No-Code” or “Limited

Code” with limitations listed

DOCUMENTATION

General Guidelines• All medical record entries must be done in

black ink & dated & timed

• Errors are corrected by crossing through the error, writing “error” above the notation & initialing the error; do not erase or use correction fluid

• Signature form is to be used by all members of the interdisciplinary healthcare team to sign on the chart initially;afterward, use initials for any chart entry

General Guidelines (Cont.)• All categories of forms must be completed--

do not leave blanks• Charting by exception:

– A checkmark will be placed in the appropriate column if patient meets defined assessment criteria

– If patient does not meet defined assessment criteria, place an asterisk in the appropriate time column & document abnormal findings using bolded letter or narrative note

Nursing Process

• “S” (subjective) & “O” (objective) used by LPN

• “A” (assessment) documented by observations & narrative notes; RN function to use data to identify problem & develop plan

• “P” (plan) documented on computerized Interdisciplinary Plan of care; RN function to coordinate care

Nursing Process (Cont.)

• “I” (intervention) documented on acuity tool, flow sheets, through narrative notes or checklists; completed by all who provide care

• “E” (evaluation) documented at least once per shift; evaluates progress to goals & effectiveness of treatment; RN responsibility

MEDICATION ADMINISTRATION

Five Rights

• Right patient

• Right drug

• Right dose

• Right time

• Right route

RN Responsibilities

• Verifying medication order

• Coordination of administration & documentation of all routine, PRN & STAT medications

• Administration of all IV solutions, central line fluids & piggyback solutions

Respiratory Therapist’sResponsibilities

• May accept & document telephone/verbal orders for respiratory/inhaled medications (e.g., inhaled bronchodilators, sodium bicarb, etc)

• May administer & document inhaled medications

Dietitian Responsibilities

• May accept & document verbal orders for diets or nutritional supplements

• May provide & document oral nutritional supplements to patient

Pharmacist Responsibilities

• May accept & record telephone or verbal orders for all medications

• Assesses medications, dosages, interactions, etc. on patient encounters

• Dispenses medication in accordance with physician orders

Prior To Administration...

• Medications must be verified by an RN prior to administration

Medication Scheduling

• First dose of routine doses should be given within 2 hours of order

• Oral medication should be scheduled to maximize patient sleeping times

Cultures Before Antibiotics

• When cultures are ordered prior to antibiotic administration, notify MD if cultures have not been obtained within 2 hours of written order

• Physician is to specify how to proceed

Labeling Open Medications

• NSS IV flush bottles are intended as one use only; discard any unused portion after withdrawing desired amount

• Other medications that are multi-use vials (e.g., insulin) must be labeled with date & time opened, as well as initials of individual who opened the vial

Other Labeling Issues

• If medication is drawn up into a syringe but there is a delay in administration, the syringe must be labeled with medication name, dose, date, time drawn up & initials; such medications should NOT be left lying on countertops, etc., but should be secured appropriately

Other Labeling Issues (Cont.)

• Leave oral medications in wrappers until ready to administer;it is not acceptable to put pill into med cup in med drawer unlabeled

Checks & Balances• A double check with an RN is required for

dosage calculation for specific drugs:– heparin– insulin– thrombolytics

• Prior to administration, a double check of the dosage drawn up is required for:– heparin– insulin

Checks & Balances (Cont.)

• Those drips that require precise dosing and/or titration must be administered via an infusion pump

Insulin Procedures• Rounding: if the dose is 0.5 units or greater,

round up to the nearest whole number; if the dose is less than 0.5 units, round down to the nearest whole number

• Only insulin syringes are to be used for insulin administration

• Discard insulin vials 4 weeks after opening

• Insulin may be stored at room temperature after opening

Hypoglycemia

• If a hypoglycemic reaction occurs or the blood glucose is ≤ < or = 60, shut off insulin drip (if present) & treat the patient according to hypoglycemic protocol

Irrigating Solutions

• Label bottles with date & time when opened

• Discard all irrigation solutions 24 hours after being opened

Controlled Drug Procedures

• All narcotics are kept in controlled drug storage cabinets or PYXIS

• On non-PYXIS units, the keys to the controlled drug storage cabinet are to be on a registered nurse employed by Northside Hospital at all times

• On PYXIS units, keys to controlled drug storage cabinets are kept in PYXIS

Controlled Drugs (Cont.)

• In the event of a drug discrepancy (whether PYXIS or non-PYXIS unit), personnel are expected to remain on the unit until all discrepancies are found or accounted for

Waste Procedures For Controlled Drugs

• There should be no wasted narcotics except for partial doses

• A controlled drug waste will be witnessed & “signed” by 2 RNs (either manually on paper or electronically in PYXIS)

• If an entire dose of an oral or injectable drug is refused, broken or not used for any reason, it must be returned to the Pharmacy by PYXIS or manually by the RN

Waste By Broken Ampules

• In the event of a broken ampule, the breakage should be witnessed by 2 RNs & the broken glass returned to pharmacy with a discrepancy report

Medications From Home

• A patient may not take medications from home unless the pharmacy does not have that particular drug

• If the patient presents medications from home, they should be:– sent home with the patient’s family, or– locked up with the patient’s valuables if there is

no one to take them home

Medications From Home (Cont.)

• If indicated & the physician writes the order that the patient is to take the home meds:– The medications must be sent to pharmacy for

identification

– The medication must be written on the MAR as a scheduled medication

– Medication must be kept in Medication Cart on unit, not at bedside

– Doses must be documented as per usual

Documentation Of Routine Meds

• All routine medications will be charted on the Routine Medication Administration Record (MAR)

• Document the EXACT time of administration of the following:– Aminoglycosides– Vancomycin– Antiarrhythmics– Theophyllines– Digoxin

Documenting PRN Meds

• All PRN medications will be charted on the PRN MAR at the time they are administered

• Documentation to include dosage, route &/or site

• Effectiveness of PRN medication must also be documented using the effectiveness codes

Special Documentation Requirements

• All insulin will be charted on the diabetic flow sheet as well as the Routine MAR

• All anticoagulants will be charted on the Routine MAR if they are regularly scheduled; Coumadin ordered on a daily basis is recorded on the “one time only” section of the Routine MAR

Documentation Of Single Dose Meds

• All one time only medications will be charted on the Routine MAR in the “one dose medication” section

• All preop medications will be charted on the Routine MAR in the “one dose medication” section

General Med Documentation

• If a generic drug is given, the generic drug being used must be written above the ordered medication on the MAR

• Each individual who records medications on Routine or PRN MAR will also identify herself/himself on the signature form

• All allergies must be recorded on the Routine & PRN MAR in addition to the Master Allergy Sheet

Medications Not Given

• If a med is not given, initial the appropriate time slot, circle initials & place the appropriate code for meds not given beside circled initials

• The physician must be informed if a patient refuses or misses a dose of medication

Discontinuation Of Meds

• When a scheduled med is discontinued, it will be stamped or written “D/C” on the MAR

• When a PRN medication is discontinued, it will be stamped or written “D/C” on the MAR

• All D/C’d meds must be verified by an RN with initials & date

QUESTIONS??

• Feel free to ask your charge nurse, preceptor or instructor

BEST WISHES!

• We look forward to seeing you soon!