Nursing Instructor Orientation - ProMedica Documents/for-health... · 2018-09-12 · nursing stations, or common work areas, break rooms, etc but not in direct care areas. •Students

ProMedica Nursing Instructor Orientation

Getting Started and Orienting Your Students

Prior to clinical start

Contact unit before starting and provide a syllabus for the semester. The hospital clinical coordinator can help with exactly who to contact for individual departments.

Review Dress Code – Research and Clinical Day School Dress Code FollowedWear ID Badges

For Full Guidelines for Student /Faculty use of Personal Electronic Devices refer to Core Orientation Module

Remind Students not to take pictures of ANY Patient Information

Clinical Sites• Clinical sites are determined well in advance of the semester.

• Confirm with your college that the clinical sites have been secured. • Please DO NOT contact departments directly if you need additional sites.

This communication MUST come from the college.

• Please contact site coordinator and the unit manager prior to sending students for unit observations. • A list of clinical site coordinators for each hospital is on the Faculty Page.

• Provide a list of your student’s names, clinical start/stop dates and your name to the clinical coordinator for each group.

Basic Pyxis Login Steps

• First time logging on use

• USER NAME: your ProMedica Instructor ID badge (begins with the numbers 88)

• PASSWORD: phs last 4 digits of your school ID (Example phs4321)

• You will then be prompted to create your personal password

• Issues with access check with pharmacy or contact PCNE

• Change in hospital assignments will require completion of a new Pyxis form

• Remember to complete the Pyxis ID form

Preparing students for the clinical experience

• Guide students to get a ProMedica ID badge if this is their first ProMedica clinical.

• Familiarize students with logging into myphs.ProMedica.org and other electronic applications.

• Securing scrubs if required for their rotation.

• Teach Glucose Meter using the Power Point from the Faculty page for those groups utilizing this point of care equipment. Always use the PPT located on the faculty page to assure you have the most recent information from our lab.• Please check with the site coordinator for the process used at that hospital for

training glucose equipment or process.

As you start to orient your students, remember to submit these forms for each group.

Submit to [email protected]

Please Include your name, hospital and unit, start/stop dates and student’s names with the paperwork

• Signed Student Attestation Form (required annually)

• Error Prevention Certification of Completion (required once with first ProMedica clinical)

• Completed Glucose Student Training Log (retrieve from Faculty Web Page)

Faculty and Students with TWO or more roles at ProMedica

Employees must always use Instructor or Student Badges and Passwords when functioning in that role.

An employee with access to the EMR or Pyxis may NOT use their employee ID/password and access while functioning as a faculty/instructor or student.

Each role must have a unique ProMedica ID number and badge for each type of role they hold. For Example, an employee may also work as a college instructor and be pursuing a graduate degree. In this instance this employee would have three separate ProMedica ID numbers and badges. Access must be linked to the appropriate ID and badge for that role.

ScrubEx PLEASE PRINT CLEARLY

User Last Name

User First Name

Rotation End Date

Badge#

Phone Extension

Dept. Contact _____________________ Phone ________________

Please choose one of the following for Occupation and one for Department:

Occupation DepartmentAnesthetist Anesthesiology

EVS Tech L & D

Nurse Engineering/Bio Med

PA Environmental Services

PCA OR

Perfusion PACU

Physician Cath Lab

Resident Radiology

Scrub Tech SDS

Staff Pre-OP

Student Heart Rythym

Surgeon

Vendor Other (specify)

Other (specify)

A $30 REPLACEMENT COST IS CHARGED PER UNRETURNED SET OF SCRUBS

Sizes: Choose your appropriate size Combination (Top/Bottom)

Small/Small X-Large/X-large 4X/4X

Medium/Medium 2X/2X

Large/Large 3X/3X

This Area To Be Completed By Manager/DirectorPlease select the appropriate location.

Bay Park

Flower Wildwood

Toledo

Please call 419.291.4060 Matthew Schnell with any questions or email [email protected]

Scrub Suit Size Application

Select a 4 digit PIN

Scrub Ex Access only for Metro area hospitalsForm found on faculty orientation pageStudent to fill out and faculty submit via email to [email protected]

Please call 419.291.4060 Matthew Schnell with any

questions or email [email protected]

End of shift

Handoff communication includes IV line tracing from patient to solution

Co-sign all student documentation, IV, meds, flowsheet etc.

Post Conference Space

Conference Room needed Check with unit manager for room availability on unitMetro Facilities (Bay Park, Flower, Toledo, and Toledo Childrens) use Catertrax

Regional Facilities (Bixby/Herrick, Defiance, Fostoria, Fremont, Monroe) schedule through site coordinator

Think HIPAA before using Public Space (ex.Cafeteria)

All students are required to report off to the primary RN prior to leaving

Encourage students to give a full report (hand off communication)

Faculty please provide unit with a contact phone number to reach you if questions come up related to patient care and students

Catertrax

• Use Catertrax to book a classroom for TH/TCH/WOSH/FH

• Located at Mypromedica.org• Found under ProMedica Apps• Select Catertrax

• For other locations or if the room you need to use is not in Catertrax, please contact the site coordinator listed on the Faculty Web Page.

Accessing and Setting up an Account in Catertrax

Accessing Catertrax MyPromedicaMy WorkCatertrax

Choose Hospital

Click Sign inSign in or Set up new account

Scroll down to Room ReservationsAnd click on schedule a room reservation

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Create New Reservation in Catertrax

Will open to month view calendar

Identify number of participantsIdentify location

Rooms that are availablewill display

Item available in room will be identified

Click Reserve

Next Provide Requested Detail

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Provide Additional Details

If room does not come with needed equipment etc. –(A)it is requested hereFYI this does not include clinical equipment (glucometer from staff dev)

(C) Once all need information added click Make Reservation

Verify Information

(B) Room Setup can be requested

(D) Verify Information

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B

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D

Click Manage Reservations

View all your reservations

Click Delete Selected Reservations

Double Check Click OK

Check Delete

Message verifies it was deleted

Password Help

To Review/Delete Room Reservations and further questions/issues

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To Delete a Reservation/sOther issues/questions/concerns

Computer Use and Documentation-Instructor Reminders

What if an Instructor or Student is Injured or Has an Exposure or Injury Incident

A RL6 injury report is filed and the ouch line instructions are followed

“visitor” category is used for event reporting

Follow your school policy regarding the injuries and exposure.

Students need to have insurance. They will be billed for treatment.

Call ouch-line and if directed, go to emergency center for evaluation and initial treatment

For complete policy regarding Exposures refer to:

What if student or instructor experiences an error that leads to a actual or near miss patient

event or injury?

• All events related to an actual, a near miss, or a good catch (which prevents the incident from reaching the patient) should be documented in the RL6 reporting system.

• Detailed instructions are in the faculty/student’s core module.

What if a Student/Faculty is Impaired

Impaired students or faculty are immediately removed from the patient area

School must be contacted

Since the impaired student/faculty cannot drive, the school must assume responsibility for the student or faculty which includes arranging transportation

Use of personal electronic devices

• Students and faculty in the clinical setting may carry cell phone in silent mode. Phone calls should not be made in patient care areas or within hearing distance of patient care areas.

• Other electronic devices (tablets or laptops) may be used to access reference material. These devices may be used in nursing stations, or common work areas, break rooms, etc but not in direct care areas.

• Students are invited and encouraged to use hospital-provided computers to access reference material provided and endorsed by ProMedica for clinical use including: Lexicomp, Lippincott, Krames, EMMI, and ProMedica policy and procedure manuals.

Keep Current as things change…..The Center of Nursing Excellence maintains pages to help support Instructors/Faculty to remain informed as clinical topics change over time. As appropriate, when education is released for staff, a copy is placed on this page for your review.

Once logged into myProMedica.1. Our system2. Departments3. Center of Nursing Excellence4. Nursing Faculty Links

EPIC/DocumentationInformation

• EPIC class for Student on-line modules.

• Must complete and submit completion before access is given. • If students give you completion EPIC

paperwork submit to • [email protected]

• EPIC for Instructors • See web page for training schedule• Prior EPIC experience contact

• [email protected]• Change in assignment may require

additional EPIC classes.• May need EPIC Clin doc, Stork

Classes (OB), or ASAP (EC)

• Student EPIC modules See student web page

• All submission paperwork is required before granting access to EPIC. Remember a 48 business hours before access is granted.

• Difficulties with EPIC log on Call IT Service Desk 419-291-3646

FYI-EPIC Tips Sheets available: MyPromedicaOur SystemEPICLinksTraining

• Dual sign-off is required for the administration of high risk medications indicated on the MAR as !! Icon

• Co-sign acknowledges or verifies documentation done by another. This is not used as an independent double check for high risk medications.

Student and instructor are considered one and staff nurse acts as the second licensed nurse.

All medications are co-signed by the instructor.

Cosigning Students Documentation

Dual sign-off verses Co-sign

Cosign ALL link is not recommended since it would sign ALL documentation regardless of students discipline.

Cosign in one of three ways:• Cosign all of student documentation at once• Cosign groups of documentation based on

time and location in chart• Cosign each entry individually

Printed direction are located atmyphs.PromedicaOur SystemDepartmentsCenter of nursing ExcellentNursing Student/FacultyNursing Student

Clinical Topics of InterestFall Prevention

Safe Patient Handling

High Risk Mediation Administration

Restraint Use

Lab Test Directory and Critical Values

Specimen Collection

Small Equipment Cleaning

Patients are screened for fall risk, using the Morse Fall Risk Assessment by licensed nurse

On admission to facility

On any transfer from one unit to another

Following a fall

Following any change in condition

All patients are considered a High Fall Risk until they have been screened and scored

Patients are classified into one of three levels of fall risk based on their Morse Fall Score

High Risk -45 and higher

Moderate Risk -25 to 44

Low Risk-0 to 24

Patient at Moderate or High Risk for fall are identified with signage that is visible to all care providersand yellow Fall Risk wristband –Defiance Regional Hospital and Fostoria Community Hospital do not use yellow wrist band

Fall Prevention

Safe Patient Handling

Otherwise staff responsibility to use equipment and students observe

Students who have been trained to use the SPH can use it.ProMedica Health System Employee Nursing School Lab

All health care personnel responsible for transferring patients receive training on the correct procedures for lifting and moving patients before utilizing SPH equipment

Patient/family cannot refuse SPH but can refuse care

RN is responsible for assessing, implementing and communicating the SPH equipment

Whiteboards, bedside communication tools, magnets, etc.

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MaxiSlide is a very common piece of SPH equipment in many departments. Linked here is a video for those who have never used this equipment

Hover over the black space to the right and a play bar will appear below to start and control the video.

MaxiSlides

Nursing Student and High Risk Medications

High Risk Medication are double checked independently by two licensed practitioners with authority to administer the medicine

Double check is performed by the nursing student –instructor/preceptor dyad (function together as one) and another licensed nurse

Policy located at mypromedicaMy workSystem And Business Unit PoliciesCORP Clinical Policy and Procedures

Then the nursing student may administer the medication under the directSupervision of the instructor/preceptor

Independent Double Check Includes:6 RIGHTS

1. correct patient 2. correct medication3. correct dose4. correct route5. correct time6. With appropriate documentation & Includes comparison of the medication Order MAR (medication administration record)

Insulin includes verification of blood glucoseHeparin includes verification of Anti-Xa or PTT

Designated High Risk Medications Requiring an Independent Double Check

Attachment A

All controlled substance infusions are double checked at Toledo, Bixby and Herrick Hospital

Chemotherapeutic agents are administeredfollowing ProMedica Cancer Institute practices

In the Neonatal ICU IV therapyis only observed by the student

For Pediatric Patients students may not administer TPN, lipids, or moderate sedation

For Pediatric Patients only senior level practicum may Administer IV push

Restraint and Seclusion Education

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Defining Restraints

Any manual method, physical or mechanical device, material or equipment that immobilizes or reduces the ability of a patient to move his/her arms, legs, body or head freely

Equipment required for treatments and procedures are NOT considered restraints

Physical: holding patient down

Mechanical: limb restraint, four side rails, Geri chair with tray locked

Restraints:

Must be manufactured for the purpose of a restraint

Never restraint over patient’s chest or abdomen

No vest restraints are used in ProMedica

Inappropriate uses can include such things as sheets tucked so tightly patient can not move; restraining limb with kerlix,

Orthopedically prescribed devices such as splints, casts, slings, tractionSurgical dressing or bandages

Protective equipment such as helmets; seizure pads

Positioning for tests, exams, surgical procedures, and post-procedure care

Physical holding of patients for the purpose of conducting routine physical exams or tests

Examples:

IV arm boards, radiotherapy procedures, postural drainage support,

Forensic and correction restrictions used for security purposes

Chemical: is a drug or medication used to manage the patient’s behavior or restrict the patient’s freedom of movement that is not a standard treatment or dosage for the patient’s condition

Physical Measures Psychological Measures

Environmental Measures

Basic needs provided: thirst, hunger, elimination, & fatigueProvide snack per order

Talk to patient do not talk over your patient

De-clutter room, position commode & walker near bedside

Adequate pain managementComfort measures

Active listening/ reflective listening

Use diversional activities, such s TV/music and give simple tasks such as folding linens

Maintain oxygen therapy Family involvement Utilize activity apron/cart(where available)

Promote ambulation while talking with patient

Explain procedures Frequent rounding

Manageagitation/anxiety/fear

Reassurance/Re-orientation

Use bed or chair alarm

Reposition, elevation of extremities

Distraction/redirection/Interrupt & redirect

Sit with patient

Use cushions or pads to maintain safety

Reminding of limitationsLimit setting: if & then;when & then

Increase observation or move closer to nurses station

Relaxation techniques Collaborate with health care team & evaluate treatment plan; consider possible medication changes 32

Indications for Non-Violent Restraints

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Indications for: Violent restraints or Seclusion

Demonstrating behaviors that place the patient atrisk for discontinuation of lines or tubes

Demonstrating behaviors that place the patient atrisk for discontinuation of artificial airway

A safety risk due to developmental delay or cognitive limitations

Patient is a threat toward self or others

Angry or aggressive toward self and/or others

Threatens and attempts to hurt self and/or others

When Restraints are Necessary Restraints and seclusion may only be used to ensure the immediate physical safety of the patient, staff, or others

Restraints and seclusion may only be used after alternatives to restraints were attempted and unsuccessful

Restraints are discontinued at the earliest possible time

Restraints are NOT utilized as an intervention for fall prevention

Choosing the Least Restrictive Intervention

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Least Restrictive

• i.e. Finger Mitts

• Case Scenario: Patient with dementia trying to pull NG tube out

More Restrictive

• i.e. Bilateral soft wrist restraints

• Case scenario: Applied after patient pulled NG tube out with patient companion at bedside

Most Restrictive

• i.e. 4 point hard/locked restraints

• 26 year old male in acute psychotic episode trying to strangle the nurse

Restraints are implemented in the least restrictive manor that minimizes risk of physical or physiological harm

Physical Distress

•Assess for signs of Restraint Related Positional Asphyxia. This occurs when the person being restrained is placed in which he/she cannot breath properly and is not able to take in enough oxygen.

•The pressure applied to the arms and legs when a person is being restrained face down can impact that person’s ability to breath effectively.

Cardiopulmonary Distress

•Shallow, rapid breathing

•Grunting

•Bluish tinge to fingernails or around mouth

•Flushed or pale complexion

•Cold extremities

•Nasal flaring

•Absence of breathing

Vascular

•Assess circulation under all restrained extremities

•Numbness, tingling sensation to feet and hands

•Patient complaining of pain in restrained area

•Color of extremity pale, bluish tinge

•Cold extremities

•Pulses palpable

•Capillary Refill

NeurologicalDistress

•Confusion

•Disorientation

•Flashbacks

•Seizures

•Vomiting

•Diarrhea

•Hyperventilation

•Difficulty breathing

•Unconsciousness

•Headache

Musculoskeletal Distress

•Pain

•Bruising/redness

•Discoloration

•Swelling

•Crepitus or cracking

•Crinkling

•Snapping

•Grinding feeling or sound under the skin, around the lungs, or in the joints

Monitoring Patient Safety in Restraints

Patients placed in mechanical restraints are at risk of injury or death

Patients placed in mechanical restraints should never be placed prone (face down)

While in restraint the patient shall be monitored

Patient’s Rights, Dignity, and Safety must always be maintained

Psychological DistressBeing restrained can...

Be frightening & traumatic Interfere with relationship between the caregivers and patient being restrained Result in the restraint person feeling loss of control of their lives

Wrap the limb holder cuff around the patient’s wrist so the buckle and connecting strap is on the ulnar side of the wrist (opposite the thumb)

Wrap the limb holder cuff around the patient’s wrist so the buckle and connecting strap is on the ulnar side of the wrist (opposite the thumb

Close the quick-release buckle on the cuff. Insert TWO fingers (flat) under the buckle and pull the strap snug, but not so tight as to restrict circulation

Attach the “hook” end of the cuff strap to the “fuzzy” backing on the cuff to keep the quick-release buckle from sliding

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Able to get one finger between restraint and person’s limbAble to get two finger between clip and restraintDo not abduction or externally rotate limbsDo not place patient in a prone (face down) positionDo not position in such a way that limits chest expansion

Limb Holder/Attach Quick Release Cuff to Patient

Adjust the bed strap to allow desired freedom of movement , without compromising patient or caregiver safety

Secure restraints to a part of the bed frame or chair that will not result in injury to the patient with its movement (not side rails)

PEEK-A-BOO MITT

APPLICATION INSTRUCTIONS1. Insert the patient’s hand into the mitt, palm down.

When the inspection flap is open, the back of the hand should be visible.

2. Wrap the wrist strap around the smallest part of the patient’s wrist, through the plastic ring, and secure with the hook and loop fastener.

3. Slide ONE finger (flat) between the device and the inside of he patient’s wrist to ensure proper fit. The strap must be snug, but not compromise

circulation.TO VIEW HAND AND FINGERS

1. Reach under the inspection flap, detach the hook and loop fastener, and pull back the flap to expose the hand.

2. To close the inspection flap, tuck into the end of the mitt and press the hook and loop closure together firmly

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Physical Restraint: Violent or Destructive/ Seclusion

Seclusion: The involuntary confinement of an individual in a room alone, for any period of time, from which the individual is physically prevented from leaving.Seclusion may only be used for the management of violent or destructive behavior of patients

when there is an immediate danger of harm to self or others.

Triggers For Violent Restraints and Seclusion

Triggers can be internal or external causes of an acting-out behavior:

Loss of personal power – need to know that one is still in control and can still act as an individual

Need to maintain self-esteem - trying to save face in a crisis because of peer pressure

Fear – not knowing what is happening, or knowing the results an action will cause an unpleasant response

Failure – not being able to complete a task, or falling short of a goal

Attention seeking – reinforcement of a response, or wanting attention from staff and others

Displaced anger – outside factors which trigger acting-out behavior toward staff

Psychological/physiological causes – such as drug-induced behavior states, hunger, pain, insomnia, or psychological disorders

Discontinuation of Violent Restraints

• Restraints are removed progressively alternating extremities

• Last two are removed at the same time

• A patient is never left in one restraint

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Locked Restraint Applicant

Twice as Tough- quick release on cuff. Key used to unlock strap

Application Instructions HighlightsConnecting StrapsBefore use inspect cuffs and straps for excessive wear; cracked or broken buckles or locksAlways secure both wrists to help prevent patient releaseWrap strap around movable part of bed frame, out of patient’s reachClose quick- release buckle; listen for “snapping” sound and pull firmly on straps to ensure good connectionApplying CuffsPosition blue side against skin around wrist. Attach the black hook and loop pieces together followed by the blue hook and loop pieces.Ensure 1 finger can slide between the cuff and the inside of the patient’s wrists to ensure cuff is snug enough to prevent escape, but not interfere with circulation

RestraintOrders, Monitoring, and Documentation

Assessment, Treatment, Interventions and response is documented a minimum of every 2 hours

Non-Violent - Document of patient response/behavior is every 2 hours

Violent Restraints –Document of patient behavior/safety is every 15 minutes

Primary RN for the patient is responsible for obtaining appropriate order, individualized plan of care, delegation and monitoring of care

Primary RN delegates the application or discontinuation of restraints

• Restraints are removed at earliest possible time

Primary RN delegates the type of restraint and locations of restraints

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Intervention should be chosen based on the individualized assessment of the patient’s medical or behavioral status and clinical situation

Search -topic

Lab Test Directory

Other quick link resources are available

Select specific topicMyPromedicaMy Work Applications

Resources Include: Patient Collection InformationRelated PoliciesFormsRequisitions

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PATIENT SAFETY: CRITICAL TEST REPORTING

ProMedica policy

Primary Care Nurse is responsible for follow up with the prescriber.

A Licensed caregiver (ex. Physician, RN, LPN) is to receive the critical result.

So…students are encouraged to observe process but can not be involved in the process

See Clinical orientation module and/or policy for detailed process

Patient Collection Information

For Example: Urine Culture Information Including The Following Can Be Obtained:

Directions for obtainingclear catch midstream

Preferred Collection Container with directions

Collection from Foley Catheter with BD Vacutainer

Approved Products

Small Equipment Cleaning Between Patient Use

Remember to use the Oxivir tb or Sani-Cloth wipes for routine cleaning between uses of small surfaces such as stethoscopes and glucometers

Thank You and Welcome to ProMedica

Remember your main resources as you move forward in your orientation:

• Modules on ProMedica.org

• Clinical Site Coordinators at each hospital

• Leadership team on the unit you will be teaching

• Center of Nursing Excellence ([email protected])