Capacity
Capacity is driven by two components. Give an example of each (structural) and (human).
Structural components= beds/equipment, supplies to care of patients
Human components =staffing, competency and pt acuity
Connected care calls you says ca8 is "giving" pushback about an admit targeted to them. How do you intervene?
Pull up patient information in SCM. Have a conversation with the CS giving pushback and identify what specifically they feel is inappropriate for the floor. Use your expertise to identify if appropriate or not and coach as needed. Involve floor manager if continued unwillingness to take patient despite conversation.
What is the significance of a 20+ year employee in regard to staffing? Give some examples.
20+ year employees ARE eligible to float if placed mod start/on call
20+ year employee float last in most circumstances
If you have two nurses on the same unit that are 20+ years working the same shift it is possible one might float
BIO CS calls you and reports a BHT is asleep. What do you do?
Ask CS to obtain witness and wake up employee using the verbiage, "Hey, Elizabeth, I see you are asleep. I just woke you up"
Send employee home via LYFT offer, take badge, enlist security to let out of parking garage, notify manager and have CS and witness email their statements
Give some examples of when you would call Risk management in real time.
Patient elopement
Code Pink--actual abduction
Parent used cell phone to film/record code blue
Sentinel Event--harm reached patient
Family refusing vital signs despite a conversation with you and the AOC
Regarding capacity level (colors), what color does the house supervisor consider initiation of the capacity alert escalation process?
Orange
You are rounding on CV and you hear the charge say, "Yes, that surgery was cancelled" What do you do next?
Inquire from the CS the what and why about the cancelled case. Including who made the decision to cancel and escalate to leadership in real time.
It is Christmas eve and 3 nurses have requested off from the same floor. What would be your order to grant requests off based on the following?
Request off with PTO
Move to another day
Request off without PTO
Move to another day
Request off with PTO
Request off without PTO
A rehab nurse has a needlestick exposure and asks if they should notify their manager. What would be an appropriate response?
Their manager will be notified automatically when they fill in the online employee exposure form (in chrome on INDEX)
Explain what the AOC is and give examples of when you might reach out to them.
Admin on call--high level leader on call during off hours (lead DSB weekdays)
Call in emergencies to gain support
Add to any SITREP
Family refuses vital signs despite a conversation with you and all appropriate floor staff/physicians
Use as second opinion when you would escalate to Elizabeth during business hours
You identify acute care as yellow for capacity to start your shift but you know you have more planned discharges than admits. Two CS's are in count in acute care. Give an example of how you report capacity for acute care, having that knowledge (either to oncoming shift during handover or in DSB for dayshift)?
Acute care is green for staffing and yellow to start but will be green by end of shift
OR
Acute care is green for staffing and capacity
When you run a bed meeting what is the significance of obtaining capacity at the BEGINNING of the meeting?
Staffing and allocation of resources should be tied to capacity. Open capacity on appropriate floors is what drives throughput. Quick, efficient throughput is the goal
At the beginning of the shift a CA8 RN floated to CA9. As capacity increases you text out AC CS's to anticipate going in count to go up capacity. At 1400 CA8 calls requesting their nurse back. What do you say?
You let them know many CS's may ultimately be in count and we would not be sending their nurse back as increased handover sets us up for errors and is not productive
The CS from ca9 reports a needlestick at 2000 on Sunday night. What instructions do you provide regarding the employee and patient involved?
Provide paperwork found on INDEX for CS to complete labs on patient (source) and provide information that employee can report to occ health at 0700 since within 12 hrs of exposure (happened on Sunday night)
A toilet in a patient room on CV overflows and the toilet water passes the bathroom door into the patient room. What has to happen in that room from a facilities/infection prevention standpoint?
If water pass the bathroom door the room has to be blocked and infection prevention has to conduct testing on the walls inside the patient room.
We are on ICU admission triage. We have a rapid response on ca9 that will need ICU but we have no available ICU beds. Give some examples of what information an acute nurse might find using the Guidance Tool for Patients Pending Transfer to ICU document.
Guidance Tool for Patients Pending Transfer to ICU--this document gives guidance for vital sign frequency, expectation regarding meds, expectations on when to see physicians again, lists resources until ICU bed available, identifies the need for CC RN at bedside if inotropes are started or if patient is intubated.
This tool is found in Patient Throughput folder (capacity)
What is the appropriate amount of time a child would be in the ED awaiting a bed before they would be considered a "HOLD"? What is the significance of changing them to a hold in SCM?
4 hrs
The HOLD disposition:
Alerts providers so orders aren't missed/Providers may change
May change the location of the patient in the ED
Allows connected care to appropriately triage admissions
You are opening up ca3 as acute care overflow. Using the acuity policy, what is your minimum staffing with 3 patients?
"When a hospital has more than one patient in a unit, there is a minimum of one RN and one additional nursing personnel member in the unit (2)"
Based on the Acuity policy, you could staff with one nurse and one pct
You get a call from PICU CS that a pharmacy technician is acting "erratic" while stocking Omnicell. What do you do next?
Ask CS to stay with employee and not let leave area if at all possible.
Enlist security to meet you at location of pharmacy tech
Assess behavior/ enlist employees leadership/call AOC if need support
Complete for cause drug testing if after hours or escort to occ health
A patient's dad on ca 10 collapses and a code blue is called. As a house supervisor, what paperwork do you complete?
Complete RISE if CA10 CS didn't--House supervisor is responsible for RISE in any public area
Make sure CPR record is complete and sent with him to ER
Complete visitor/event record and code review --send both to quality via email
You do not have enough critical care staff to take care of existing patients in ICU? What program do we use in this case? What is your role in use of this program?
RN extenders and Support RN's--acute care nurses float to critical care.
We inform ac managers and CS teams to find best suited nurses to float to critical care
We inform cc managers and CS teams to find best suited assignments for nurse extenders
We let VP's know we will be using nurse extenders
Familiarize yourself with policy and even circulate in bed meeting
PICU east is 22/24 and PICU west is 21/24 to start your shift. PACU states they are pretty short staffed but could hold some acute care patients if needed. ED is well staffed with a low census? How do you verbalize the priority for throughput to connected care?
You verbalize PICU transfers take priority over ac PACU and ED admits because you know PACU does not hold critical care patients.
You let the ED know they will not be priority and to reach out if needed as well as let PACU know ac holds are likely.
You are working at Arrowhead and utilizing the Regional Floating algorithm. Give some examples of barriers to cross campus floating.
No appropriate assignment for available nurse (based on skill set)
No pool or volunteers willing to cross campus float
(This algorithm states order of cross campus floating as )
1. travelers
2. pool
3. Volunteers with appropriate skill set
The CS from CV calls and states a nurse got sputum in her eye. The CS wants to know how to order labs in SCM for the exposed employee...What do you tell the CS?
You inform the CS that SCM is not utilized for the lab orders for the patient (source) or the employee.
Paper requisitions are utilized found on INDEX under departments/occ health
You are on your first shift at Arrowhead and encounter an issue you didn't cover in orientation. Who do you call?
602-933-1133 WE GOT YOUR BACK!