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WelcometoNewEmployeeorientationVCMCandSPHJuly2016

ServingthecommunityofVenturaCounty

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AboutVenturaCountyMedicalCenterandSantaPaulaHospital

VCMCisafullservice223bedAcuteCareHospitalincludinga43bedinpatientpsychiatricunit.WeareassociatedwithUCLAschoolofMedicineandhaveanationallyrecognizedFamilyMedicineResidencyprogramandhavebeen

educatingphysiciansheresince1928.VCMCresidentsaretrainedinbothinpatientandoutpatientmedicine,surgery,OB,ICU,ERandpediatrics.WehaveoneoftheoldestNICU’sinVenturaCountywhichwasopenedin1974.In2010,VCMCbecameaLevelIITraumaCenterforWestVenturaCountyprovidingcomprehensiveandcomplexcaretocriticallyinjuredpatientsinVenturaCounty.Notonlydowehavesomeofthetoptraumaphysicians,

surgeonsandnurses,wealsohaveawidevarietyofscreeningandpreventionprogramstodecreasetherisksofinjurywithinourcommunity.

SPHisafullservice49bedAcuteCareHospital.SPHisacampusofVCMCandservestheruralcommunitiesofSantaPaula,Fillmore,Piru,Saticoy,VenturaandOjai.SPHisavitalruralhealthcareaccesspointsituatedinthebeautifulhillsofSantaPaulaoverlookingthefertileSantaPaulaValley.Thesamehighqualityscreeningand

preventionprogramsarealsoavailableatourSantaPaulasite.

BothVCMCandSPHhavereceivedtheprestigiousBabyFriendlyHospitaldesignation.

OURMISSIONSTATEMENT

Providecomprehensive,responsible,compassionatehealthcareforourdiversecommunity,includingthosefacingbarriers,througheducation,anexceptionalworkforce,andforwardthinkingleadership.

Vision

ProviderofChoiceforIntegratedQualityHealthCare

PhilosophyofNursing

Webelieveinpatient/familyfocusedcare.Webelieveinpromotinghealthierlivinginourcommunity.Webelieveinacollaborative/multidisciplinaryapproachguardinganindividual’srighttoconfidentialityoftheirmedicalinformation.Webelieveinrespectingculturaldiversityandindividualityofeachpatient.Webelieveeach

professionalisaccountableandresponsiblefortheirindividualnursingjudgmentsandactions.

NewHospital

Ournewhospital,the“NorthTower,”iscurrentlyonscheduleformove-inattheendof2016.Theemergencydepartmentwillbethefirsttotransitionintothenewhospital.Priortotransitioningintothenewbuilding,there

willbescheduledtoursandcompetenciesforallstaff.

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ImportantPhonenumbers

VCMC SPHVCMCMain 652-6000 Admitting/Paging 933-8632Admitting 652-6071 NursingOffice 933-8620AncillaryServices 652-6693 AncillaryServices 652-6693Lab 652-6037 PatientAdvocate 652-6691NursingOffice 652-6001 PatientRep 933-8605PatientAdvocate 652-6691 SocialServices 933-8637Paging 652-6075PalliativeCare 652-6093Payroll 677-5133Radiology 652-6080SocialServices 652-3280

CodesorRapidResponse

VCMC 7-6666 SPH 7-8666

UnitSpecific

Unit Manager ManagerPhone# UnitPhone#DOU CristinaMartinez 652-3254 7-6054ER SarahMelgoza 652-6658 7-6165ICU CristinaMartinez 652-3254 7-6195IPU JeffHawkins 652-6032 7-6729MedSurg-2west GracieDiaz 652-5704 7-6244 MedSurg-3west GracieDiaz 652-5704 7-6271 Peds KurtPeifer 652-5763 7-6224Surgery GregAnderson 652-6067 7-6237Telemetry CristinaMartinez 652-3254 7-6572NICU JennyBaarstad 652-6084 7-6088OB LisaMcPheeters 652-6704 7-6090L&D LisaMcPheeters 652-6704 7-6090SPHDOU CarrieHolt 933-8632 7-8689SPHER CarrieHolt 933-8632 7-8663SPHICU CarrieHolt 933-8632 7-8689SPHMedSurg BeaFrias 933-8603 7-8487SPHOB LisaMcPheeters 933-8620 7-8620SPHSurgery AzelaOconer 933-8637 7-8637

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TimeCardsandCodes

Timecardsarecurrentlydonemanually.Yourunitpreceptorcanhelpyouwithyourfirsttimecard.Inthebackofthismanualyouwillfindactivitycodesspecifictoyourunitaswellastimereportingcodes(TRC)necessarytofillingoutyourtimecard(AppendixA).

Certificationpaywillautomaticallybeaddedtoyourtimecardonceyouhavefilledouttherequestform.Certificationsmustbejobrelated.Regularemployeescanbecompensated$0.813foreachcertificationuptofive,perdiememployeesuptothree.Youwillfindacopyofthisforminthebackofthismanual(AppendixB).

TimeAdjustmentForms–IfyoufindthatthereisanerroronyourtimecardpleasefillouttheTimeCardAdjustmentformandhaveitsignedbyyourmanager.Youwillfindacopyoftheforminthebackofthismanual.(AppendixC).

RegularemployeesarealsoeligibleforTextbookandTuitionReimbursement.Youwillfindinformationonthisinthebackofthismanual(AppendixD).

Competencies

Competenciesmaybedeliveredinavarietyofmethods.Competencieswillconsistofhospitalwidecompetenciesandunitspecificcompetencies.

TargetSolutionsisouronlinetrainingcenter.Youwillreceiveinstructionstosetthisuponceyouactivateyourcountyemail.

ReportinganInjury

Ifyouareinjuredonthejobpleasereporttheinjuryimmediatelytoyournursemanagerandthenursingsupervisor.Theywillassistyouinfillingouttheappropriatepaperworkandyoushouldseekmedicalcareasappropriate.

HIPAAPatientPrivacyandConfidentiality

Everypatientwithinoursystemhastherighttoexpectabsoluteconfidentialityoftheirmedicalrecordandhealthcareinformation.VCMC/SPHhasazerotoleranceforunauthorizedentryintoapatientsoryourownchart.Theonlyacceptablereasonstoaccessamedicalrecordareasfollows:youareateammemberprovidingcare,peerrevieworchartaudit,billingorinsurancepractices,partofalegal,regulatoryorlitigationmatter,reviewingaspartofastudentnursingassignment.Anyotherreasonsmustbeapprovedbyadministrationinwriting.IfyouwouldliketolookupyourownmedicalrecordpleasefillouttheappropriateforminMedicalRecordsandtheywillbehappytoassistyou.RefertoPolicy109.001

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Professionalism

Weexpectallemployeestoconductthemselvesinaprofessionalmannerwhileatworkorwhenrepresentingouragency.

SocialMedia–theuseofpersonaldevicesshouldbelimitedtowork-relateduseonly.Pleasedonotdiscusspatientrelatedsituationsonsocialmediaandpleaserefrainfrompostingonsocialmediawhileatwork.Alsorefrainfrompostingphotographsofyourselfand/orcoworkersinthesettingoftheworkplace.Ifyouneedtomakeaphonecallorcheckyouremail,pleasedosoonyourbreak.

DressCode–PictureIDmustbewornabovethewaist.Pleasereporttoworkcleanandwellgroomedandfreeofstrongfragrances.Professionalattireshouldbeworn,nojeans.Ifyouareprovidingdirectpatientcare,pleasewearauniformandappropriatefootwear.Noartificialnailsandnaturalnailsmust¼”orshorterinlength.

HealthyWorkEnvironment

Wewantallemployeestoworkinanenvironmentthatissafe,empowering,supportiveandsatisfying.TheCountyofVenturahasaZeroTolerancepolicyforbullying,violent,ordisrespectfulbehaviorandweencourageyoutoreportanysuchbehaviortoyourdirectsupervisor.

Bullying–canbeanyverbal,non-verbalorphysicalbehaviorthatdiminishesanotherperson’sneeds,concerns,orcontributions.PleasedoyourpartinhelpinguscreateaHealthyWorkEnvironment.

SickCalls

Pleasedoyourpatientsandyourco-workersafavoranddon’tcometoworksick.Ifyouneedtocallinsick,youmustnotifyyourmanagerand/orthenursingsupervisoratleast2hourspriortothestartofyourshiftsothatyourshiftcanbecovered.Annualflushotsareofferedtoallemployees,freeofchargethroughEmployeeHealthServices.Ifyouchoosenottoreceivetheflushot,youwillwearamaskforeveryshiftduringfluseason,asrecommendedbytheCDCinordertoprotectco-workersandpatientsfromillness.

SafePatientHandlingandLifting

TheSafePatientHandlingandLiftingpolicyhasbeenimplementedtoimprovethesafetyofourpatientsandhealthcareworkforce.Itprovidesformethodsoracombinationofmethodstoreplacemanualliftingandtransferring.Staffwilluseappropriatehandlingandmobilitytechniques,mechanical,non-mechanical,andtransferaidsordevicesinaccordancewitheducation,training,andmanufacturer’sinstructionsandguidelines.Staffwillrefrainfrommanualliftingmethodsforsafepatienthandlingtasksandmobilityinallbutexceptionalorlifethreateningsituations.Policy100.099

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“Liftteam”isdefinedasanyhospitalemployeesspecificallytrainedtohandlepatientlifts,repositioningandtransfersusingpatienttransfer,repositioningorliftingdevicesasappropriateforthespecificpatient.

PalliativeCare

• PalliativeCareTeamincludes:Physician,Nurses,aPsychologist,andaChaplainwhosegoalistoimprovequalityoflifeforboththepatientandthefamily.

o PhysicalWell-Beingo PsychologicalWell-Beingo SocialWell-Beingo SpiritualWell-Being

• PalliativeCareisappropriateatanyageandatanystageinaseriousillness,andcanbeprovidedtogetherwithcurativetreatment.

BloodTransfusion

• RNandanotherlicensedstaff(RN,LVNorPhysician)verifybloodagainstunittagandagainstpatientbandsatbedside

o Nameo MRNo Bloodbando ABO/Rho Unit#o Verifyexpirationdateandtime

• Bothmustsignunittagandco-signinCerner• Tagmustremainattachedtoblooduntilcompletion• Verifyingpersonmustremainatbedsideuntiltransfusionisconnectedtopatientandinfusionisstarted• Starttransfusionslow(75ml/hr)andincreasetoprescribedrateafter15minutesifpatienttoleratingwell.• Bloodtransfusionmustbecompletedwithin4hours• Tubinglifefortransfusionis4hours• Vitalsigns

o Upto30minutespriortotransfusiono 15minutesafterstartingtransfusiono Atcompletionoftransfusion

• WatchforsignsoftransfusionreactionincludingTRALI–mostcommonisfevero Stoptransfusionimmediatelyo StartNormalSalinetokeepveinopeno NotifyPhysiciano ReturnBloodtothebloodblankwithtubing,completedbloodtransfusionreactionform,andurine

specimeno MonitorVSo Enterlaborderfor“TransfusionReactionInitial”

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o DocumentinCerner(note)o CompleteNotificationForm

• RefertoPolicyE.1

OneLegacy

• OneLegacyisthenon-profitorganizationdedicatedtosavinglivesthroughorgan,eyeandtissuedonationintheseven-countygreaterLosAngelesarea.

• AsrequiredbyCMS,VCMCandSPHwillreferALLDEATHStotheappropriateOrganandtissueProcurementOrganProcurementOrganization,whichisOneLegacy.

• Donationshouldnotbediscussedwithfamily,insteadanypotentialdeath,imminentdeathoractualdeathshouldbereferredtoOneLegacyat800-338-6112.Theywillreviewthecaseanddetermineifandwhentoapproachfamily.

• RefertoPolicy100.048

QualityAssessmentandPerformanceImprovement

• HospitalAcquiredinfections(HAI)o Greatestprevention–WashyourHands

• CatheterAssociatedUrinaryTractInfections(CAUTI)o Assesseveryshiftfornecessity,removeassoonaspossibleo Bedsidebladderscanningo FollowUrinaryCatheterAssessment,MaintenanceandBestPracticesBundleo FollowNurse-DrivenFoleyRemovalProtocolo Policy1.3

• CentralLineAssociatedBloodStreamInfections(CLABSI)o Assesseveryshiftfornecessity,removeassoonaspossibleo CentralLineInsertionProcess(CLIP)formoneverycentrallineinsertionattempto PolicyE.10,E.9,E.5o FollowCVCCareandMaintenanceBestPracticeBundleo Capsandtubingchangedevery96hoursorafterblooddrawsortransfusionso Dressingchangewithin24hoursofinsertionandatleastevery7dayso AllportsofCentralLinesshouldbecoveredwithone-timeuseCurosProtectivePortandtip

protectors.Theseshouldbechangedanytimetheyareremovedforanyreasonorevery7days• SurgicalSiteInfections(SSIs)

o Pre-operativeChlorhexidineGluconatebathingo Smokingcessationo Glucosecontrolpre,postandintraoperativeo ObservanceofAsepticTechnique

• NotificationandIncidentReportingo ReportallsafetyrelatedeventsandsentineleventstoManager/NursingSupervisoro SubmitElectronicNotificationFormfoundPolicies&Proceduresandicononeverydesktop

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• PatientExperiences–NursingRelatedSurvey o Listencarefully,communicatewithcourtesyandrespecto Answercallbellspromptlyandattendtopatientsneedso Makeeveryattempttoprovideappropriatepaincontrolo Educateyourpatientsonnewmedications,diagnosis,anddischargeinstructionso Rememberpatientsneedaquietenvironment

• ComplaintsandGrievanceso VCMC/SPHgoalisearlycomplaintresolution.o Anystaffmembercanreportthepatientcomplainttomanagementorthepatientadvocateto

expediteresolutiono Anycomplaintthatcannotberesolvedimmediatelybecomesagrievanceandwillbehandedoff

tothepatientadvocatewhowillformalizetheprocess

VCMC/SPHCoreMeasures2016

• HospitalBasedInpatientPsychiatricCareReportingMeasureso HBIPS-1Admissionscreeningforviolencerisk,substanceuse,psychologicaltraumahistoryand

patientstrengthsiscompletedo HBIPS-2Hoursofphysicalrestraintuseo HBIPS-3Hoursofseclusionuseo HBIPS-5Patientsdischargedonmultipleantipsychoticmedicationswithappropriatejustification

• HospitalInpatientQualityReportingMeasureso Sepsis(SEP)

§ SEP-1EarlyManagementBundle(63dataelements)inadults18yearsandolderwithadiagnosisofsepsis,severesepsisorsepticshock

o AcuteMyocardialInfarction(AMI)§ AMI-7aFibrinolytictherapyreceivedwithin30minutesofhospitalarrival

o Stroke(STK)§ STK-1VTEprophylaxis§ STK-4Thrombolytictherapy§ STK-6Dischargedonastatinmedication§ STK-8Strokeeducation

o VenousThrombusEmbolism(VTE)§ VTE-1VTEprophylaxis§ VTE-2ICUVTE § VTE-3VTEpatientswithanticoagulationoverlaptherapy§ VTE-5VTEwarfarintherapydischargeinstructions§ VTE-6HospitalacquiredpotentiallypreventableVTE

o EmergencyDepartment(ED)§ ED-1MediantimefromEDarrivaltoEDdepartureforadmittedEDpatients§ ED-2AdmitdecisiontimetoEDdeparturetimeforadmittedpatients

o Immunization(IMM)§ IMM-2Screenallinpatientsforinfluenzaimmunizationstatus

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o PerinatalCare(PC)§ PC-01Numberofpatientswithelectivedeliverypriorto39weeks

Stroke

• Stroke

Patientswithsuddenstroke-likesymptoms,andlastknownwelltimeiswithin6hoursofpresentingintheEmergencydepartmentorinpatients,willbetriagedandconsideredforeligibilityintheadministrationofIVt-PA,standardizedtreatmentfortransientischemicattack,ischemic,orhemorrhagicstroke,neurosurgicalservices,admissionasanobservationorin-patienttoadesignatedunit,and/orinter-hospitaltransferforneuro-interventionalservices.Physiciansutilize/accessneurologicalexpertisetoexpeditecareofthestrokepatient.Neurologicalexpertise(asdefinedbyVCMC/SPHmedicalpolicies)isavailablewithin15minutes,eitherbytelephoneand/ortelemedicine.Amultidisciplinaryapproachisintegratedinthestrokesystemtopromotethoroughcommunicationanddecisionmakingforbestoutcomes.RefertohandoutsinAppendixE

• SwallowScreen

Thenurse,competentinswallowscreening,willaccuratelyidentifypotentialpatientsatriskforaspirationandperforma“Threestepswallowscreen”.First,thepatients’presentationandpastmedicalhistorywillbereviewedtoidentifythepredispositionforaspiration.Second,asimple3ouncewatertestwillbeconductedandthenursewillproceedtothethirdstepifthepatienttolerates3ouncesofwater.Third,3sipsofwaterwillbegivenandadeterminationwillbemadeforapassorfailstatus.The“Threestepscreenwillbeconductedtodetermineifpatientsareatriskforclinicallysignificantaspirationorrequireaspeechreferralforadefinitiveswallowevaluation.RefertohandoutsinAppendixE

MedicationSafety

RefertohandoutsprovidedbyTorriBoghossian,MedicationSafetyOfficer

Glucostabilizer

RefertohandoutsprovidedbyClaireRithner,DiabeticEducator

Restraints

Restraintisanymanualmethod,physicalormechanicaldevice,materialorequipmentthatimmobilizesorreducestheabilityofapatienttomovehisorherarms,legs,bodyorheadfreely.Physicalrestraintsaretheonlytypeofrestraintsusedhere,VCMCdoesnotusemedicationrestraints.

• Typeso Non-violent–formanagementofbehaviorthatdisruptsorinterfereswiththepatients’abilitytoheal

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o Violent–forthemanagementofviolentorself-destructivebehaviorthatjeopardizestheimmediatephysicalsafetyofthepatient,staff,orothers.

o Seclusion–involuntaryconfinement,usedonlyforthemanagementofviolentorself-destructivebehavior

• Alwaysattemptalternativemethodsfirsto Diversiono FamilyInvolvemento Sitteratbedside

• Whenrestraintsarenecessary,chooseleastrestrictive,optionsincludeo Handmittso Vesto Limbrestraints

• Ordersarerequiredassoonaspossibleforallrestraintso Emergencyinitiationo TemporaryPhysicalHoldo ViolentorSeclusion–

§ agebaseddurationorsoonerifable§ In-personre-orderifneeded>24hours

o Non-violent§ Re-ordereachcalendarday

• Properapplicationo Useonlyhospitalapprovedrestraintso UseQuickreleaseslipknotso Assuredeviceislooseenoughtoprovideadequatecirculationandbodyalignment

• Documentation• PlanofCare• RefertoPolicy100.075

CrashCart

• Crashcartshouldbekeptlockedatalltimeswhennotinuse.• Everynurseshouldbecomefamiliarwiththecrashcartanditscontents.• Crashcartshouldbecheckedasperunitpolicy.• RefertoPolicy100.055

CodeBlue&RapidResponse

Anycodeshouldbecalledusingthefollowingemergencynumbers

• VCMC7-6666• SPH7-8666

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CodeBlue–CardiacArrest(alongwithcallingtheabovenumber,thein-roomcodebuttonshouldbeactivated,whereavailable).Refertopolicy100.055

RapidResponse–Calledforanypatientwhoexhibitshemodynamic,respiratoryorneurologicalinstability/deteriorationorwhenthenurseisotherwiseconcernedaboutapatientandisunabletoreachphysician.Refertopolicy100.086

Sepsis

Sepsisisanewcoremeasureandeveryadultpatientmusthaveadocumentedscreen–• Intriage• Uponadmission• Atleastevery12hours• Anychangeorworseningofconditionoranytimeyouareconcerned

UnderstandingSepsis-Firstyoueitherhaveaninfectionorsomesortofphysiologicaltraumaorevent.• SIRS–systemicinflammatoryresponsesyndrome.Canbecausedbyinfectionorotherinsult.• Sepsis–systemicresponsetoinfection,youhavetohaveaninfectiontohavesepsis.Thatwould

beSIRSplusdocumentedorpresumedinfection.• SevereSepsis–sepsisplussepsis-inducedorgandysfunctionortissuehypo-perfusion.• SepticShock-severesepsisplushypotensionnotreversedwithfluidresuscitation.

WhatisaPositiveSepsisScreen?• Apatientscreenspositiveforsepsisiftheymeet2ormoreofthecriteriafromQuestion1AND1or

moreofthecriteriafromQuestion2oftheSepsisClock(AppendixF)• IfbothcriteriaaremetthenaLactatemustbedrawn,followSepsisProtocol(AppendixG)

WhodrawstheLactate?• Drawingalactateisasharedresponsibility• RT,RN,Physician,phlebotomist• MUSTberunbyRT,DONOTsendtolab• MUSTbeplacedonice,MUSTbetoanalyzerandprocessedwithin15minutes

LactateResults• Lactate<2mmol/L–Assessforseveresepsisasnotedonsepsisclock• Lactate>2but<4mmol/L(2.1to3.9)–RNtonotifythephysicianofresultsandcontinuewithsepsisclock• Lactate>4mmol/L–

o EmergencyDepartment-RN(ordelegate)callsaCODESEPSIS,notifiesphysicianstatandcontinueswithSepsisClock

o Inpatient-RN(ordelegate)overheadpagesCODESEPSISandnotifiesphysicianandcontinueswithSepsisClock

SepsisCare� Obtainurineculture(beforeantibioticsifpossible)� TwosetofBloodculturesbeforeantibiotics� Antibioticswithin3hourofseveresepsis� A30ml/kgcrystalloidinfusionforhypotensionand/orLactate>4.Documentfluidstartandcompletion

time.

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� Norepinephrineifhypotensiondoesnotrespondtoinitialfluidresuscitationwithin1hour� Repeatlactatewithin4hoursofseveresepsisifinitiallactate>2

RefertoPolicy100.201

WoundCare

• GoalistoPreventpressureulcersinsteadoftreat• RiskAssessmentusingtheBradenScoring

o Score<18callsforearlyinterventiono AtleastQ2hrturnso Offloading

• Accuratedocumentationandpicturesuponadmission• Documentation

o Shiftassessmento Turnso Ofwoundifpresento Notificationformfilledoutandmanagernotified

• PlanofCareenteredasappropriate• Appropriatebedorbedsurface• RefertoAppendixH

Age&CulturalSpecificPatientCenteredCare

• CulturalCompetencyo WevaluethediversepopulationthatweserveinVenturaCounty.Allpatientsandlovedones

mustbetreatedwithdignity,respectandwithculturalsensitivity.Refertopolicy100.053• AgeSpecificgroupsforphysiologicalandpsychologicalcare.Refertopolicy108.017

o Neonate–first4weeksoflifeo Infants–upto1yearo Toddler–1-3yearso Preschool–3-5yearso SchoolAge–6-12yearso Adolescent–13-18yearso YoungAdult–19-44yearso Adult/MiddleAge–45-65yearso OlderAdults/Geriatrics–over65years

AddressingPain&Sedation

• Painmustbedocumentedwitheverysetofvitalsigns.Painisdocumentedbeforeand30minutesafteradministrationofpainmedications.

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• Sedationlevelmustbedocumentedanytimeapatientisonmedicationsforsedationandorwhenthatmedicationistitrated.

• Treatmentofpainandsedationmayvarydependinguponage,sizeandpatients’individualperceptionofpain.

• PainScalesusedatVCMC/SPH(AppendixI)o VisualAnaloguePainScale–askpatienttoratepainonscaleof0-10o FacesRatingPainScale–askpatienttoratepainonscaleof0-10usingpicturesoffaceso VenturaObservationalPainScale(VOPS)–ascoringsystemusedtoratepaininthenon-verbal

adultpatiento Face,Legs,Arms,CryandConsolability(FLACC)–ascoringsystemusedtomeasurepainin

infantsandchildrenwhoareunabletocommunicatetheirpaino NeonatalPain,AgitationandSedationScale(N-PASS)–ascoringsystemusedtodeterminepain,

agitationandsedationleveloftheneonate• AgitationScale(AppendixJ)

o RichmondAgitationandSedationScale(RASS)–ascoringsystemusedtomeasureagitationorsedationlevelofapatient

o NeonatalPain,AgitationandSedationScale(N-PASS)–ascoringsystemusedtodeterminepain,agitationandsedationleveloftheneonate

• RefertoPolicy100.076

InterpretationServices

• VCMC/SPHhasavailableaninterpretationserviceformanydifferentlanguages.Thesedevicesarelocatedineachnursingstation,onthe2ndand5thfloorsofAFMCbuilding,andthreemoredevicesarelocatedinAncillaryservicesandareavailablebycallingDebbieHillinAncillaryServices.

FallPrevention

• FallPreventionProgramo VCMCTraumaincollaborationwithEMSidentifypre-hospitalfallso ElectronicFallFormisfilledout,ahomereferralforsafetycheck,etc.ismadeasappropriateo Fallpreventioneducationalmaterialsaredeliveredtopatientupondischargeo Ifpatientisadmittedareferraltosocialservicesismadeandappropriatereferralsaremade

• InhospitalFallPreventiono Goal–Reducefallsbyidentifypatientsatriskandinitiateinterventionsthatpreventaperson

fromfallingo Fallisdefinedasalossofuprightpositionthatresultsinlandingonthefloor,groundoranobject

offurnitureorsuddenuncontrolled,unintentional,non-purposeful,downwarddisplacementofthebodytothefloor.

o Completefallassessmentonadmissionandevery12hours,atchangeofcondition,attransfertoanewunitorafterafall.

§ MorseFallScale(Adult)(AppendixK)

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§ HumptyDumptyFallScale(Pediatric)(AppendixL)o Highrisk>45onMorseFallScale

§ Yellowwristband§ Re-assessenvironmentandre-orientpatientasneeded§ Assuresupervisionandassistance§ Notifyphysician(iffalloccurs)§ Notificationform(iffalloccurs)

o Educatepatient&familyonfallriskreduction–callbutton,footwear,etc.o Bedsinlowpositiono Answercalllightspromptly

• RefertopoliciesA.24and107

SBAR

• Therecommendedmodeofcommunicationbetweenhealthcareproviderstodiscusspatients,patientneedsandpatientrelatedeventsatVCMC/SPH

• WhatisSBARo S=Situation–Whatisgoingonwiththepatient?Aconcisestatementoftheproblem.o B=Background–Whatistheclinicalbackgroundinformationthatispertinenttothesituation?o A=Assessment–Whatdidyoufind?Analysisandconsiderationsofoptions.o R=Recommendation–Whatactionorrecommendationisneededtocorrectthe

problem?Whatdoyouwanttohappenforthispatient?• WhySBAR

o Asimplemethodtohelpstandardizecommunicationo SBARallowsallpartiestohavecommonexpectations:

§ Whatisgoingtobecommunicated§ Howthecommunicationisstructured?§ Requiredelements

o Focusesontheproblem,notthepeopleo TheformatofSBARallowsprofessionalstodelivershort,organizedandpredictableinformation

inaneasytounderstandformat.• ImplementingSBARforpatienthandoffs

o Handoffsincludeverbalcommunicationo Face-to-faceinteractiono Opportunitytoaskandanswerquestionso Documentation

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APPENDIXA-ActivityCodes–UnitSpecific

VCMC

6010 Intensive Care - ICU 6020 Definitive Observation - DOU 6050 PICU 6070 NICU 6171 Med Surg - 3 North 6173 Med Surg - 3 West 6174 Med Surg - 4 North (OB) 6177 Med Surg - 2W 6290 Pediatric Acute 6340 Psychiatric Acute - IPU 6380 Obstetrics Acute - OB 6381 Obstetrics Acute - OB 6530 Nursery Acute - TCN 7010 Emergency Services - ER 7400 Labor and Delivery - L&D 7421 Surgery (General) - OR 7425 Surgery - Pre-Op 7426 Surgery - GI Lab 7427 Surgery - PACU

SPH

6011 Intensive Care - ICU 6131 Definitive Observation - DOU 6180 Med Surg - M/S 6385 Obstetrics Acute - OB 6535 Nursery Acute - TCN 7015 Emergency Services - ER 7405 Labor and Delivery - L&D 7423 Surgery - Pre-Op 7424 Surgery - GI Lab 7428 Surgery - PACU 7429 Surgery (General) - OR 7435 Surgery - SDS

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APPENDIXB–PerDiem

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APPENDIXB–regularfulltime

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APPENDIXC

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APPENDIXD

Textbook & Tuition Reimbursement

All Regular full and part time employees are eligible for textbook & tuition reimbursement for job related courses, workshops and seminars. Courses must be taken on employees own time with proof of successful completion.

How much?

x $600 per fiscal year for lower division courses x $900 per fiscal year for upper division or graduate coursework x $900 Nurse certification testing fee reimbursement x $2000 RN to BSN coursework with pre-approval (40 employee slots available)

Did you know...

x All courses need pre-approval for guaranteed reimbursement (Pink T&T sheet) x Per our contract, "Reimbursement will be made to the employee within 2 weeks after the grade cards and

receipts have been received by the Agency head" x New employees must work 1040 hours to be eligible x Part time employees will be reimbursed on a pro rata basis

What's the Process?

Before Class

x Prior to class fill out the pink "Textbook & Tuition Reimbursement Application" and turn it in to your manager for signature. It will be sent to Nursing Administration for processing.

x A copy will be returned to you with instructions on how to fill out the "Textbook & Tuition Claim" form.

After Class

x Fill out the "Textbook & Tuition Claim" form x Attach proof of payment AND proof of satisfactory completion x Sign the claim form and return it to your manager for their signature. The form then goes to Nursing

Administration x Reimbursement check will be mailed to your home address

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APPENDIXE

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APPENDIXF

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APPENDIXG

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SIRS SEPSIS SEVERE SEPSIS SEPTIC SHOCK

DEFINITIONS

SystemicInflammatoryRespons

eSyndrome(SIRS)Musthaveatleast2ofthefollowing:• Temp<

96.8F• Temp>

100.4• HR>90• RR>20• WBC<

4,000• WBC>

12,000• Bands>

10%

SIRS

+ Infection

/ Suspect

ed Infection

16% Mortality

Rate

SIRS +

Infection/ Suspected Infection

+ Organ Dysfunction

Musthaveatleast1ofthefollowing:• Lactate>2• SBP<90• SBPdecrease>40mmHgfrombaseline**• MAP<65• Bilirubin>2*• Creatinine>2*• Platelets<100*• INR>1.5*• PTT>60seconds*• UO<0.5ml/kg/hourfor2hours*• Respiratoryfailure(requiringCPAP/BIPAP)*

*newforpatient**ReasonforrequiredfromMD>20%MortalityRate

SIRS +

Infection/ Suspected Infection

+ Organ Dysfunction

+ LA > 4

and/or

Persistent Hypotension In The 1 Hour After 30ml/Kg IVF Bolus Completion

What is hypotension?

• SBP<90• SBPdecreaseofmorethan40mmHGfrompatientsbaseline

• MAP<65>46%MortalityRate

TO D

O L

IST

Recognize & Assess for infection

Order & draw lactate within 30 minutes of recognition

w/in 3 hours of meeting severe sepsis: 1. Initial Lactate level 2. Blood cultures before antibiotics 3. Broad Spectrum Antibiotics

o If C-diff suspected then ORAL Vancomycin to be started w/in 3hrs.

4. *IF initial hypotension START LR/NS 30ml/kg bolus (rate no less than 126ml/hr)

w/in 4 hours of initial lactate: 1. Repeat Lactate Level

o Only required if initial LA>2 (Cerner automatically orders)

2. IF patient received bolus: assess & document BP x2 w/in hour bolus completes. *done to assess if patient is in Septic Shock

w/in 3 hours of meeting septic shock: 1. Initial Lactate level & repeat w/in 4hr

when ≥ 4 2. Blood cultures before antibiotics start 3. Broad Spectrum Antibiotics o If C-diff suspected then ORAL

Vancomycin to be started w/in 3hrs. 4. START LR or NS 30ml/kg. Assess &

document BPx2. w/in 6 hours of meeting septic shock 1. Start Vasopressors within 6 hours post IVF

bolus completion for persistent hypotension 2. MD/PA/NP Need to document bolus status &

tissue perfusion assessment from either option below: a. Focus assessment doc by MD/PA/NP:

1.All 4 Vitals: HR, B/P, Temp & RR 2.Cardiopulmonary assessment 3.Capillary refill 4.Skin color exam

b. MD/PA/NP to document on 2 options below: 1.CVP 2.ScvO2 or SvO2 3.Bedside CV ultrasound 4.Passive leg raise OR Fluid Challenge

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APPENDIXH

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APPENDIXI–PainScales

VisualAnalogue&Faces

FLACC–Face,Legs,Activity,CryandConsolability

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VOPS–VenturaObservationalPainScale

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N-PASSNeonatalPain,AgitationandSedationScale

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APPENDIXJ–AgitationScale

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APPENDIXK

MorseFallScale

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APPENDIXL

HumptyDumptyFallScale

Parameter Criteria ScoreAge Lessthan3yearsold 4

3tolessthan7yearsold 37tolessthan13yearsold 213yearsandabove 1

Gender Male 2Female 1

Diagnosis NeurologicalDiagnosis 4Alterationsinoxygenation(respiratorydiagnosis,dehydration,anemia,Anorexia,syncope,dizziness,etc.)

3

Psych/BehavioralDisorders 2OtherDiagnosis 1

CognitiveImpairments Notawareoflimitations 3Forgetslimitations 2Orientedtoownability 1

EnvironmentalFactors Historyoffallsorinfant–toddlerplacesinAdultbed 4Patientusesassistivedevicesorinfant–toddlerincriborfurniture/lighting

3

Patientplacedinbed 2Outpatientarea 1

ResponsetoSurgery/Sedation/Anesthesia

Within24hours 3Within48hours 2Morethan48hours/None 1

MedicationUsage Multipleusageof:Sedatives,hypnotics,barbiturates,phenothiazines,Antidepressants,laxatives,diuretics,narcotics

3

Oneofthemedslistedabove 2Othermedications/None 1

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