Welcome

Welcome! : 

Welcome! Agency Nursing Orientation

Slide2: 

History of Central DuPage Hospital (CDH) and Pledge Service Excellence Corporate Compliance 100,000 Lives Campaign Emergency Procedures CDH Specific Information Agenda/Topics to Be Covered

What Is Central DuPage Health?: 

What Is Central DuPage Health? Founded in 1964 Central DuPage Hospital (CDH) – a 361 bed acute care hospital Wynscape - a 200 bed skilled nursing/rehab facility Westbridge – a 77 bed assisted living and respite facility Wyndmere – a 245 apartment retirement community 5 community based Convenient Care Centers 70-member Central DuPage Physician Group CNS Home Health and Hospice

Our Values: 

Our Values Every employee is driven by our “ICARE” shared values. They are: Integrity We constantly strive to do the right thing. Compassion We care for and about you and each other. Accountability We freely accept responsibility for our decisions and actions. Respect We honor the dignity in you and we honor the dignity in each other. Excellence We pursue continuous improvement in all we do.

Service Excellence: 

Service Excellence Service Excellence is a way for us to provide exceptional service to patients and customers each and every time. Every customer and patient should be served “as if they were our loved ones”. The first area of Service Excellence is “First Impressions…Lasting Impressions” or creating a “WOW” (Warm Open Welcome). More information is available by accessing the CDH Intranet on a hospital computer and clicking on the Service Excellence Portal on the right side of the page.

Corporate Compliance : 

Corporate Compliance Because Central DuPage Health is committed to doing “right things right”, we are all bound by our Corporate Compliance program to communicate concerns. The organization’s policies indicate that retaliation will not occur should any employee report a violation in good faith. If you wish to just discuss the question, please feel free to call the Compliance Officer. If you request anonymity, it will be honored. The Compliance Officer Justine Dover can be reached on extension 35157 or externally at 630-933-5157. The Hotline number provides employees with the opportunity to report an alleged violation anonymously at extension 36666 or externally at 630-933-6666.

100K Lives Campaign: 

100K Lives Campaign The Institute for Healthcare Improvement has established the 100K Lives Campaign with the goal of avoiding 100.000 deaths between January 2005 and June 2006 and every year thereafter. This will be accomplished by making healthcare safer and more effective. Six distinctive measures will be implemented nationwide to accomplish this goal. At Central DuPage Hospital we owe patients the highest quality care. One way to ensure this is to participate in efforts such as the 100K Lives Campaign.  CDH has teams actively working on the 100K Lives Bundle components. 

100K Lives Campaign cont.: 

100K Lives Campaign cont. The components of the campaign are bundles – best practices that, when combined, provide a substantially greater improvement. The six bundles are: Rapid Response Teams – multidisciplinary team called when a patient is deteriorating and which helps prevent cardiac arrest or other adverse events Medication Reconciliation – process of ensuring medications are reconciled throughout the continuum of care Acute Myocardial Infarction care bundles Prevention of surgical site infections Prevention of central line infections Prevention of ventilator associated pneumonia

Emergency Codes: 

Emergency Codes Here is a listing of current codes at CDH. RED – Fire (refer to R.A.C.E.) GREEN – Actual/potential violent situation BLUE – Cardiac or respiratory arrest PINK – Infant or child abduction YELLOW – Trauma alert in Emergency Dept. WHITE – Medical assistance needed (i.e. falls, fainting)

Emergency Codes cont.: 

Emergency Codes cont. Here is a listing of more codes at CDH. GREY – Tornado seen in DuPage County BLACK – Tornado seen in area at CDH ORANGE – Hazardous material incident PURPLE – Evacuation plan is in effect TRIAGE – Disaster plan is in effect To report a code at CDH, dial 44444 and tell the operator which code and what unit the code is on. (On a CDH cell phone, dial 34444)

Rapid Response Team: 

Rapid Response Team A Rapid Response Team (RRT) is a highly skilled team of clinicians who bring critical care expertise to the patient’s bedside. The team is available to any provider at any time who wants a second opinion about what is happening with the patient. They are there to: Assist the primary staff member in assessing and stabilizing the patient’s condition Organize information that needs to be communicated to the physician Educate and support the staff during a challenging patient situation Any RN can activate the RRT for assistance in situations where the patient is experiencing early signs of distress.

Rapid Response Team cont.: 

Rapid Response Team cont. Activation criteria include: Staff is concerned/worried about a patient Acute change in respiratory rate to less than 8 or more that 24 breaths per minute Acute change in heart rate to less than 40 or more than 130 beats per minute Acute change in heart rhythm Acute change in systolic blood pressure to less than 90mmHg Acute change in level of consciousness Acute change in O2 despite application of oxygen Acute change in urinary output to less than 50ml in 4 hours Acute bleed New onset of seizures

Rapid Response Team cont.: 

Rapid Response Team cont. To activate the RRT, dial ext. 22425 (this triggers a text message to the RRT members) In the event the pager system is not working, call the operator and specify the request for RRT and the unit where the patient is located. **Be sure to notify the patient’s primary physician and bring the patient’s chart, list of medications (MAR or computer with electronic MAR) and Kardex to patient’s room for the team’s information

Core Measures: 

Core Measures What are Core Measures? In July, 2002, the JCAHO implemented a requirement that accredited U.S. hospitals will collect and report evidence-based, standardized performance measures for the services they provide. Core Measure sets were developed by JCAHO and Central DuPage Hospital has selected three sets to use here: Acute myocardial infarction (AMI) Heart failure Pneumonia The Core Measures define the best practices that will deliver the safe and effective care to patients with that diagnosis. Each Core Measure is made up of several Performance Measures.

Core Measures cont.: 

Core Measures cont. Core Measures checklists have been developed as triggers for the physicians, nurses and other caregivers to remind them of the evidence based best practices for the particular patient population. They list each of the Performance Measures for the appropriate diagnosis. The checklists will be placed on the inside front of the charts of patients with an admitting diagnosis of acute myocardial infarction, heart failure or pneumonia. If the diagnosis is made after admission, the appropriate checklist will be placed on the chart, since the same effective patient care should be given. Once one of the Performance Measures has been met and documented, the measure is checked off and initialed on the checklist. *Note – a patient may have more than one checklist if indicated (i.e. patient with heart failure and pneumonia)

Core Measures cont.: 

Core Measures cont. Responsibilities of the Staff RN: Initiate a Core Measures checklist for appropriate patients. Checklists are to be labeled with patient sticker and placed on the inside front of the chart. Partner with MD to ensure Performance Measures are achieved Include patient diagnosis and status of core measures any time report is given (shift-to-shift, transfer, or any other report). Document with a checkmark and initials on the checklist when the measure is documented. Use a pathway as indicated for the diagnosis

Core Measures cont.: 

Core Measures cont. Acute Myocardial Infarction (AMI )Performance Measures Aspirin received within 24 hours before or 24 hours after hospital arrival or document contraindications Beta blocker within 24 hours of arrival or document contraindications Smoking cessation advice/counseling given if smoker or has smoked within 1 year Aspirin prescribed at discharge or document contraindication Beta blocker prescribed at discharge or document contraindication ACE Inhibitor prescribed at discharge for LVSD or document contraindication Statins prescribed at discharge

Core Measures cont.: 

Core Measures cont. Heart Failure Performance Measures: LVF (Left ventricular function) assessment done. Left ventricular systolic dysfunction (LVSD) is defined as ejection fraction less that 40% or a narrative description in the progress notes or history and physical consistent with moderate or severe systolic dysfunction ACE Inhibitor prescribed at discharge or documentation of contraindications Smoking cessation advice/counseling given if smoker or has smoked within 1 year Discharge instructions given that include: Activity allowed Diet Follow-up Medications Symptoms worsening Weight monitoring

Core Measures cont.: 

Core Measures cont. Pneumonia Performance Measures: Oxygenation assessment by arterial blood gas or pulse oximetry within 24 hours of arrival Blood culture completed within 24 hours of arrival or prior to first dose of antibiotics Initial antibiotic received within 4 hours of arrival Smoking cessation advice/counseling given if smoker or has smoked within 1 year Pneumococcal vaccination status documented (vaccine given, prior vaccination, patient refusal, or vaccine contraindicated

Accessing Policies and Procedures: 

Accessing Policies and Procedures All Policies and Procedures (including Safety and Emergency) are available on the CDH Intranet which is accessible from every hospital computer. In addition, Safety and Emergency P&P are in the orange manual located on each unit. The exception - Maternal/Child division P&P are in the process of being put onto the intranet. They are located in the CDH InFolder located on the upper right side under “Quick Links”. The MSDS information is located on-line and is also accessed in the “Quick Links” section of the CDH Intranet.

Blood Borne Pathogens : 

Blood Borne Pathogens In spite of the best precautions, you may be exposed to bloodborne pathogens. If this happens, immediately do the following: Identify the source individual if possible Notify your supervisor and complete the “Bloodborne Pathogens Exposure Report”. Page the Employee Health Nurse, on call 24 hours. Wash the area with soap and water. If the eyes or mucous membranes are affected, flush immediately with tap water. If you consent, a baseline blood sample will be drawn and tested. The source individual’s blood will be drawn and tested. Test results will be made available to you and your confidentiality will be carefully maintained. Immediate action can lessen your risk of contraction of a disease.

Child Abuse Reporting : 

Child Abuse Reporting YOU are considered a mandated reporter of child abuse. A mandated reporter is any professional that works with children in the course of their professional duties. These include: Health Care Professionals (MD, RN, PT, etc) Social Workers Members of clergy A mandated reporter is legally obligated to inform DCFS when it is determined there is reason to believe that a child has been harmed or is in danger of being harmed, AND that a caretaker either committed the harm or should have taken steps to protect the child from the harm. Call 1-800- 25-ABUSE to report child abuse If you have questions, refer to the white Mandated Reporter Resource Manual on the patient care unit or consult a BHS Social Worker.

Domestic Violence Screening: 

Domestic Violence Screening Many battered persons are reluctant to identify themselves as victims of domestic abuse for a number of complex reasons. Since it is sometimes difficult to identify adult domestic violence victims, CDH staff should be aware of the potential of domestic violence. All men and women 18 years and older are screened in private to determine if they are safe in their home and safe in their current relationship.

Domestic Violence Screening cont.: 

Domestic Violence Screening cont. If a screen is positive for domestic violence: It is important to convey an attitude of concern, respect and confidentiality to the patient, reassuring that the safety of the patient is the primary concern. Notify the BHS Social Worker on call Emphasize the importance of immediate safety and longer term safety. Offer the patient the telephone number of Family Shelter Services in Glen Ellyn (469-5650) or Mutual Ground Shelter in Aurora (897-0080) and link the patient by telephone immediately if possible. If the patient prefers, provide the phone numbers for later contact.

Elder Abuse Reporting: 

Elder Abuse Reporting In Illinois, licensed healthcare workers are required to: Report elder abuse/neglect if the person is unable to report abuse or neglect himself and is 60 years of age or older. Provide information regarding services available to victims of suspected elder abuse or neglect. CDH medical, nursing or any patient care staff will refer patients suspected of being victims of elder abuse/neglect to the BHS Social Worker. Reporting by professionals is mandated for older persons who are suspected of being abused, neglected or financially exploited and who are unable “due to dysfunction” to report for themselves. With elder abuse, there are 2 different hotlines – one for reporting elder abuse in general and one to report abuse in a long term care facility. The social work staff will assist in the reporting process.

Surgical Site Verification: 

Surgical Site Verification When a patient is to undergo an invasive procedure, no matter where….(in the OR, on the patient care unit, or in the Emergency Department, Cath Lab, Diagnostic Imaging, Convenient Care etc.), a time out must be performed. The purpose of a time out is to verify that it is the correct patient, correct procedure, correct side, correct physician, correct equipment is available and that the specific consent and paperwork are correct. The key questions in whether a time out is required is…. “Does the procedure require a specific consent?” If a specific consent is required, then a time out is also required before beginning the procedure. The RN or tech must reference the procedure written on the consent against the medical record documents. During the time out, the procedure to be performed is read directly from the consent

Surgical Site Verification cont.: 

Surgical Site Verification cont. The time out must be documented. – remember “if it wasn’t documented, it wasn’t done”. The Site should be marked if the procedure involves: A Left or Right distinction - i.e. Right Hand Multiple structures - i.e. fingers or toes A level of the spine Who marks the site? The physician doing the procedure marks the site. The site is marked with an indelible surgical marker. A “Sharpie” pen should not be used.

Patient Identifiers: 

Patient Identifiers EACH TIME a specimen is obtained or medication/IVs are administered, the patient’s identification must be verified. For a banded patient, the two identifiers are the name and medical record/account number. For a non-banded­ patient, the two identifiers are the name and the birth date. The patient identifiers must be verified by comparing with the Medication Administration Record (MAR), specimen label, or other appropriate source. Don’t forget – a room number/bed number is never used as a patient identifier.

Physician Orders : 

Physician Orders Verbal orders are NEVER taken, except in an emergency situation. When receiving a telephone order, the RN: Writes the complete order in the chart Then reads it back to the physician. Makes sure the physician has acknowledged the correct order before hanging up. Asks for the physician’s number and transcribes it with the order, Takes a telephone order only from a physician, never from a third party (such as the office nurse, etc.)

Risk to Fall: 

Risk to Fall We want to ensure the safety of all of our patients. To do so, we have implemented a comprehensive system for reducing and preventing falls. All patients are assessed on admission and reassessed every 8 hours and PRN for their risk to fall. On admission, all patients are considered at least a Level I Risk to Fall due to their unfamiliar surroundings Patients are assessed at a Level II Risk to Fall if they are post-procedure, taking medication that can increase falls, need assistance, are forgetful, have bowel or bladder urgency, have a history of falls, communication deficits or equipment needs. Patients are assessed at a Level III Risk to Fall if they are confused, disoriented or are unwilling or unable to comprehend or follow directions.

Risk to Fall cont.: 

Risk to Fall cont. Communication of Risk to Fall: Level I – every patient considered at least a Level I Level II – a purple wristband is applied and a notation is made on the Kardex Level III – an orange wristband is applied, a “Falling Leaf” magnet is placed outside the room on the door frame and a notation is made on the Kardex. Report is given to all caregivers regarding Risk to Fall An informational sheet is given to each patient’s family that explains the Risk to Fall program. The patient and family are informed if the patient is assessed at a Level II or III.

Risk to Fall cont.: 

Risk to Fall cont. Interventions: Level I – orient patient to surroundings, maintain clutter-free environment with necessities close at hand, bed locked and in low position, treaded socks while ambulating and accommodations made for visual, communication or physical disabilities Level II – all of the above, plus inform the family, provide assistance for patient when out of bed, use of assistive devices and frequent offer of toileting Level III – all of the above plus consider moving close to nursing station, provide constant supervision when transferring, transporting, ambulating, toileting, etc., complete a diversional activity assessment, pharmacist reviews medication, implement guidelines for wandering and diversional activities. Risk to Fall assessments and interventions are documented every shift and PRN.

Ethics Committee: 

Ethics Committee The Medical Ethics Advisory Committee of Central DuPage Health is a diverse group of healthcare professionals and community members who provide a non-judgmental forum where issues of human dignity and respect can be safely discussed. When an ethical question is raised regarding the care of a patient, the patient, a family member / healthcare surrogate, or any member of the caregiving team may refer the question to the committee for discussion To initiate a consultation, call the Central DuPage Medical Staff Services, from 8:00 a.m. to 4:30 p.m. Monday through Friday, at 630-933-6201. When an urgent situation arises at other times, call the hospital operator at 630-933-1600 and ask for the administrative house supervisor.

Infection Control: 

Infection Control HANDWASHING The single most important thing you can do to prevent nosocomial infections!! Handwashing with soap and water is the standard for hand hygiene. Use of Prevacare, alcohol-based hand sanitizer is allowed if no visible soil is present (actually is the best at killing bacteria and least drying to skin). Hibiclens antimicrobial skin cleanser is routinely used for handwashing in critical care areas and for patients in Contact Precautions.

Infection Control cont.: 

Infection Control cont. Discontinuing Isolation Precautions Infection Control is consulted prior to discontinuing any isolation precautions. They can be reached at extension 36467 in QSS (Quality and Safety Services). A physician order alone does not meet CDH criteria for discontinuing precautions, developed by the IC Committee (a medical staff committee) and based on CDC guidelines. Always document in your charting that Infection Control was consulted before precautions were discontinued

Pain Management : 

Pain Management PAIN RATING SCALES USED AT CDH Adults - numerical 0-10 pain rating scale Nonverbal adult patients only – use descriptors in the “non-verbal” section or document behaviors. Should have documentation to show patient is truly nonverbal and unable to use a pain scale For Pediatric patients: NPASS scale – up to 2 months of age FLACC scale – 2 months to preverbal toddler, up to age 18 for cognitively impaired patients Faces scale – approx. 7 years of age to adult

Pain Management cont.: 

Pain Management cont. Pain assessments are performed on admission, every shift and within 1 hour of any pain intervention An intervention must be offered with any pain rating of 4 or higher and/or anytime the patient is dissatisfied with any level of pain. Each patient on admission is given the handout “Understanding Your Pain” which is reviewed with the RN. Patient and family must be educated on any equipment, especially on the need for ONLY the patient to push the PCA button. Any PCA rate or syringe changes must be co-signed by another RN. Inpatient Nurse Clinicians from the Pain Management department are available for consult by calling ext. 31311 or pager 5166.

High-Risk Medications: 

High-Risk Medications CDH has implemented a computer-based medication administration system. If you are on a long-term contract or will be at CDH on a consistent basis, you will take a class on this system (Admin Rx) and administer medications. If you will be at CDH only occasionally, you will not administer medications on the units using Admin Rx. High-alert medications are flagged using red lettering and have a secondary red alert. Look-alike/sound-alike medications are labeled with “tall man lettering” and are never stored near each other. For both types of medications, both the generic and the trade names will be used whenever appropriate.

High-Risk Medications cont.: 

High-Risk Medications cont. Medications that are double checked before administration include: Heparin – each time Insulin – each time Narcotic via continuous infusion and PCA – on initiation and with any program change Any drug administered through PCA or Epidural – on initiation and with any change The process for co-signing medications will be shown to you on the patient care unit if needed.

Restraints: 

Restraints Our goal at CDH is to keep patients safe and support their medical care and treatment while avoiding the use of unnecessary restraints. We recognize that restraints have the potential to produce serious consequences to the patient. Therefore we employ restraint only after alternative measures have been attempted and proved unsuccessful. Restraints are NEVER used as punishment or disciplinary measure nor for the convenience of the staff. Restraint decisions regarding use, application and methods are based on patient assessment by a registered nurse and/or physician. There are two types of reasons for restraints – medical reasons and behavioral health reasons. Each is subject to a different set of guidelines with specific interventions and documentation requirements. If you as an agency nurse have a patient requiring restraint, the charge RN will assist you and furnish you with the appropriate Policy and Procedure.

Advance Directives: 

Advance Directives CDH recognizes the right of adult patients to communicate decisions regarding their medical care through an Advance Directive. When a patient arrives for care, registration personnel or RN inquire if the patient has an Advance Directive. If the Advance Directive is with the patient, it is placed on the chart and scanned into the Electronic Medical Record at discharge. If Advance Directive on file, it is obtained from Medical Records (before 7/05) or from the Electronic Medical Record If the Advance Directive is at home/lawyer’s office, etc., the family is asked to bring it to CDH. If the patient does not have an Advance Directive, he/she is offered information about it. The form used at CDH for Advance Directives is titled “Five Wishes” . It is a user-friendly document that allows the patient to make his/her wishes known in practical language.

Specimen Labeling : 

Specimen Labeling Agency RNs DO NOT perform phlebotomy by venipuncture, capillary puncture or point of care testing at CDH. Process for non-blood specimens collected by an agency RN. Add initials and the time of collection to the lab label. Apply the label to the specimen at the patient’s bedside after matching that label with the patient’s wristband. Process for line draw specimens collected by an agency RN. Take lab labels to bedside. Ask the patient their name if patient is coherent. Compare the patient’s wristband with the name and account number on all lab labels. Following line draw procedure, draw the blood specimen into a syringe and using the yellow transfer device, fill the tubes appropriately, (cultures first, then blue, red/yellow, green, lavender) Flush all central lines with 20cc saline after blood draw.. Add your initials and the time on the labels Put lab labels on all tubes according to the test and type of tube as indicated on the label, adding the time, initials and “L.D.” for Line Draw.

Computerized Tube System: 

Computerized Tube System CDH utilizes a pneumatic tube system for the transport of medications, blood products, and specimens. There are two types of carriers: Green carriers and bags are used to transport medications. Red carriers and bags are used to transport blood products and specimens. These carriers are not interchangeable. Always inspect a carrier before picking it up or opening it. If there is spillage, ask the charge nurse to assist you. Green carriers are returned to Pharmacy immediately after removing medication so they are available for them to use, avoiding delays waiting for an available carrier.

Consents: 

Consents The physician is responsible for obtaining the informed consent. The nurse witnesses the patient's signature on the consent. If the patient states he/she understands the procedure and the risks involved, the nurse can obtain the patient's signature on the consent and sign as the witness on the consent.   If the patient states he/she does not understand the procedure and the risks involved, the nurse does not obtain the patient's signature and notifies the physician of the patient's response.

CIWA: 

CIWA The literature supports screening of all adult and adolescent patients to detect problem drinking. A tool known as the CAGE questionnaire is used to identify patients who might be alcohol dependent. Our modified CAGE assessment question is in bold type and found in the section labeled “Social Habits” on the Patient Needs Assessment (PNA). It reads, “ Are you concerned with abstaining from alcohol during your hospital stay?” A “Yes” response to this question indicates that the patient may be alcohol dependent therefore, the nurse must proceed to the next step… continue to assess the patient for AWS using the CIWA-Ar scale.

CIWA cont.: 

CIWA cont. Once you have determined the patient is at risk for alcohol dependency, you need to determine if the patient requires medication to help manage his/her withdrawal from alcohol.   The tool used to assess the need for medications is the CIWA-Ar scale. This scale measures 10 manifestations of AWS and takes no more than 3 to 5 minutes to score. assess the patient for AWS using the CIWA-Ar scale. Results of the CIWA-Ar score fall into three categories: 0-7: Mild symptoms; no need for medication at this time; re-assess using the CIWA scale in 4 hours 8-15 : Moderate symptoms; medication and continued re-assessment using the CIWA –Ar every 2 hours per Alcohol Withdrawal Physician Order Set until a score of 7 or less is achieved  Greater than 15 : Severe symptoms; medication and continued re-assessment using the CIWA –Ar every 1 hour per Alcohol Withdrawal Physician Order Set until a score of 7 or less is achieved If the patient scores 8 or above, notify the physician immediately. Report your findings and have the Alcohol Withdrawal Physician Order Set ready to transcribe the physician's orders.

CIWA cont.: 

CIWA cont. Our regulatory agencies have specific discharge criteria that they use to measure whether or not a discharge plan is appropriate for a patient with AWS. Here are the general guidelines:   The patient must have: A scheduled follow-up appointment documented in the medical record at time of discharge. Patient refusal of follow-up should be documented on the Discharge Summary. A description of the type of follow-up service recommended i.e. outpatient, partial hospital, etc. This must also be documented in the medical record In addition to the two criteria above, the patient must also have ONE of the following:   No evidence of intoxication or acute withdrawal (i.e. CIWA Ar less than 10 in 2 measurements at least 8 hours apart) AND/OR the patient's medication can be safely administered in another setting PLUS they do not meet any of the continued stay criteria Patient agrees to enter continuing addictions and/or psychiatric treatment Patient refuses any continued treatment and does not meet any continued stay criteria- remember this must be documented in the medical record!!!

Communication Impairments: 

Communication Impairments All patients requiring communication in methods other than spoken English will be offered Interpretation Services, (including Sign Language) or the appropriate assistive devices at no cost to the patient at the earliest possible point of contact. The name of the translator(s) is to be documented in the Medical Record. In an emergency situation, if a delay in communication would put the patient at risk, an untrained interpreter may be used until a Medically Trained Interpreter arrives or is available by phone. A Medically Trained Interpreter should be used to communicate with a patient unless the patient requests to have a family or friend interpret. The caregiver will honor the request after confirming that the patient understands that a medically trained interpreter can be requested at any time.

Communication Impairments: 

Communication Impairments Even if requested by the patient, it is inappropriate to have minors (individuals under 18 years of age), other patients, or other patients' visitors interpret, except in life threatening emergency situations. In such situations a trained interpreter should be called at the first opportunity. When using the interpreter requested by the patient, if there is concern with the quality of communication to or from the patient, a Medically Trained Interpreter (phone or in person) can be asked to monitor the conversation (or take over interpretation if the patient prefers) to ensure that information is being relayed to the patient completely and accurately.

Communication Impairments cont.: 

Communication Impairments cont. For immediate needs page Interpreter Services at pager #1270 (Spanish in-person), M-F 6am- 11pm, Weekends and Holidays 7am- 11pm. For all other languages, arrangements will be made to bring in Medically Trained Interpreters from outside agencies for situations requiring an in-person interpreter. Call Pacific Interpreters (Phone Service) at 1- 877- 446-8377, (24 hour availability). Access code is 31 + your 4 digit department code. Please note: the use of a phone interpreter is encouraged when an in-person interpreter is not readily available. The charge nurse will assist you as needed. American Sign Language Interpreters and Audio/Visual equipment for Sign Language Interpreters can be obtained through Interpreter Services or through the House Supervisor (x31449) during evenings, weekends and holidays.

Blood Administration: 

Blood Administration If your patient requires blood/blood products, the charge nurse will assist you with the requisition process. A consent for the administration of blood/blood products is obtained prior to administration. The transfusion must be completed within 4 hours of issue from the Blood Bank. Verification of the patient identification with the product must be accomplished by two persons. One person must be an RN or physician. The second person may be an RN, LPN, Surgical Technologist or PCT. Both must sign the transfusion form Identification Verification. The RN Transfusing the blood must BEGIN THE INFUSION SLOWLY AND REMAIN WITH PATIENT FOR FIRST FIFTEEN MINUTES The charge nurse will assist you with any questions and provide you with the Policy and Procedure.

Blood Administration cont.: 

Blood Administration cont. Adverse transfusion reactions may include: Nausea Uneasy feelings            Heat/pain at the infusion site Itching                            Headache                        Chills Chest/back pain            Myalgia                           Fever Flushing                         Hypotension                 Hemoglobinuria           Oliguria / anuria              Shock                              Generalized oozing Hives                                Difficulty Breathing      Cyanosis Tachycardia

Slide53: 

Thank You!