1. Little Company of Mary
Hospital
Direct Patient Care
For
Student Nurses and Faculty
1
1

2. You are a Valuable Member of Our Team
Thank you for entering
health care!
2

3. 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.
3

4. Core Values
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
4

5. Standards of Performance
 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
5

6. Gift Program
Is a Service Recovery Process
 For ACTing on patient complaints
 It allows us to take corrective action to prevent the
problem from occurring again
 We:
A: Apologize for mistake
C: Correct the problem promptly
T: Take action so problem will not occur
again
6

7. What you do, does make a
difference!
Introduce yourself
Be polite, listen attentively to your patient
Make eye contact
Explain why you are there
First 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)
7

8. 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
8

9. Student Parking
Parking at LCMH
Evergreen Bath and
Tennis
91st California
91st Street
 The Employee Parking lot is located on C
the east side of California at 95th Street. A
 Park on east portion of lot closer to
Office Max L
 Enter the hospital through the revolving I
door at the front entrance
F
 Other designated parking areas
 Blue - Employee/Volunteer O
 Green - Physician N
 Yellow - Patient/Visitor
 Red- Unavailable I
 LCMH is undergoing a campus A
transformation
 Parking will be restricted A
 **Students are to park at a
remote location V East
 Evergreen Bath & E Parking
Tennis Lot
 91st and California
 West end of parking lot 95th Street
 Check with your instructor
for up to date information
9

10. Student Identification
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.
10

11. Tobacco-Free
Smoking is not allowed in the
hospital, or in areas surrounding
the hospital including sidewalks
and parking lots
11

12. Health Insurance Privacy And Portability Act
(HIPAA)
 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 ……………
12

13. 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 environment
 Share pertinent information with the staff to provide quality care for the patient
13

14. HIPAA Guidelines:
Releasing Information Over the
Telephone
At 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
14

15. Patient Identification
In an effort to maintain patient safety
ALWAYS verify:
Patient’s name
Patient’s date of birth
1. By having the patient verbalize this information
2. Verifying the information with the patient’s ID band.
15

16. Cell Phones
Cell phones are not to be used in the clinical area! For any
reason!
Cell phones can only be used in public areas
 The lobby
 The cafeteria
Staff nurses will use hospital issued cell phones for
communication with physicians and families
16

17. Hospital Policies
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
17

18. Communication
Get report.
Let RN and Care Partner know what you will be doing for
your patient
Let RN and Care Partner know when you are leaving the
units
Report off to RN when clinical completed
18 18

19. Fall Prevention Protocol
 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?”
19

20. Restraint Policy at LCMH
 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
20

21. Restraints at LCMH
Behavioral 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
21

22. Latex Allergy
Always be aware of allergies
identified by the patient
Latex-free gloves are on the units for use with patients
having a latex allergy or if you have a latex allergy
Latex-free equipment is available for those patients with a
latex allergy
 MDC has a list of all available latex free equipment
22

23. Call Light Used At LCMH
Volume Control on the side
Volume Control on the side
Nurse
Call
Button TV
Control
|
Nurse Call Button
|
TV Control
|
This call light is used in some of the patient rooms
23

24. Pain Across the Continuum
 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
24

25. 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
25

26. Age Appropriate Care
 At LCMH care is provide taking into consideration
 The growth and development the physiological changes that
occur with the aging process
26

27. Infection Control Issues
 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
Isolation gowns are NOT DISPOSABLE
27

28. Infection Control Tips
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”
28

29. 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
29

30. N95 Respirator
• 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
30

31. Exposure Incidents
 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
31 31

32. Occurrence Reports
If involved in an occurrence with potential to cause harm to
anyone an occurrence report needs to be filled out
 Occurrence Reports are on the Meditech computer system
 Report the occurrence to your instructor and the nurse manager
 Documentation of the occurrence is only in the Occurrence
Report computer module
32

33. Linen Utilization
 LCMH has initiated a linen campaign
 To ensure proper and efficient use of linen items for
patient comfort and safety
 To 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
33

34. 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
34

35. “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 35

36. 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
36

37. 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 bags
 Only linen that will be used should be brought into the patient
room
37

38. DNR Status
 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
38

39. Emergency Codes
 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
39

40. 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 40

41. Emergency Codes
 Code 66
 Water sprinkler activation
 Activate by calling Security 5313
 Announce Code 66 and your location
 Code 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
41

42. 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
42

43. Code 70
 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
43

44. Code 99
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
44 44

45. 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
http://www.health.com/health/static/hw/media/medical/hw/h5551195.jpg
 The Nursing Supervisor
 The stroke coordinator
45

46. 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
46

47. 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
47

48. 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
48

49. Crisis Intervention Team
• 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
49

50. 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
50

51. 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!
51

52. Medication Policies
What medications students DO NOT give
 Blood or any blood products
 The initial dose of any IV medications
 Chemotherapy
52

53. 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
53

54. MAR
Information contained on
MAR
 Patient visit #
 Patient Name
 DOB
 Patient Medical
Record #
 Age
 Date Admitted
 Primary Diagnosis
 MAR Date
 Allergies
54

55. PRN MAR
MK Nowicki RN MKN
55

56. IVAR
50 50
650
56

57. 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
57

58. Measuring I&0 at LCMH
Fluid 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 58

59. Ergonomics
Always ask for assistance with
lifting or moving patients
Bend your knees and lift with
your legs
Tighten 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
59

60. Safety & Emergency Preparedness
Safety and Emergency preparedness are necessary
 To promote and maintain a safe and secure environment for patients, staff
and visitors
LCMH 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
60

61. Our Platform at LCMH
“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
61

62. The Future of LCMH
To be completed in the fall of 2012 62

63. References
References provided on request
63