Comprehensive Care
What are some of the topics covered by the Comprehensive Care Standard?
Falls prevention and management
Pressure injury prevention and management
Malnutrition screening and assessment
Clinical care
Management of cognitive impairments
End of life care and decision making
Use of seclusion and restraint
What are three examples of approved patient identifiers?
Name
DOB
MRN
Is the transfusion of blood products a Level 1 or Level 2 procedure? Explain why.
Level 2; requires written consent and an additional proceduralist.
How are patients and families supported to directly escalate concerns in your area?
Discuss concerns with nursing staff
REACH program - call the AHNM and escalate concerns which are then escalated to the treating team
What processes are in place for preventing and managing pressure injuries?
Risk assessments
Skin assessments
Nutrition assessment and treatment
Repositioning and early mobilisation
Support surfaces (air mattresses, cushions etc)
Patient education
What is the process for handover on your unit?
Safety huddle
Check safety equipment
Chek patient identifiers
Face to face verbal handover at bedside
Include patient and family
Discuss sensitive information privately
What are some signs and symptoms of a possible acute transfusion reaction?
Hypotension
Tachycardia
Tachypnoea
Dyspnoea
Desaturations
Increase in temp >1 degree
Rash/urticaria
What is your clinical emergency response process?
"Between the Flags" system
Regular observation and monitoring of patients
If patients trigger Yellow or Red zone criteria (including nursing concern), call for Clinical Review or MERT
Initiate appropriate nursing actions.
Work with response team
Ensure either ongoing plan for ward based management/re-assessment of patient or transfer of care to higher acuity area.
What processes are in place to manage patients with, or at risk of, developing delirium?
Early risk screening
Identifying and treating underlying causes
Orientation tools, Top 5
Environment management
Avoiding use of antipsychotic medications
Specialling
How do you arrange for an acute transfer of care to another facility? What information is required to be handed over to the receiving facility?
Confirm patient is for transfer, medical team to attain accepting doctor
Place patient on portal/request transport (awaiting bed confirmation)
Advised patient has bed available
Book transport - communicate with patient and family
Handover to receiving facility - all relevant clinical information using ISBAR structure
What actions should you take if you suspect your patient is having an acute transfusion reaction?
Cease infusion
A-G assessment including observations
Initiate appropriate therapy
Call for Clinical Review/MERT as required
Document assessment in progress notes
Do not recommence transfusion until patient has been reviewed
What are the requirements for frequency of observations after a Clinical Review?
30 minutely until between the flags or altered calling criteria met
1hrly every hour for four hours
4hrly for 24 hours
How do you prevent a seclusion or restraint episode?
De-escalation techniques
Delirium management to prevent escalation of behaviours
Use of sedative medication if required
Specialling/engaging patient in activities
What is the difference between Level 1 and 2 Procedure Safety Checklists? Provide an example of level 1 and 2 procedures.
Level 1:
Procedures are performed independently and don't require written consent
E.g. IV cannulation, IDC insertion, CVAD management, TTE, spirometry
Level 2:
Requires at least 2 people to perform procedure and a written consent
E.g. blood transfusion, lumbar puncture, CVAD insertion, ascitic drain insertion
What are the documentation requirements for the transfusion of blood products?
Written patient consent
Fluid order charted
Observations charted
Independent checks signed
Progress note documented
Fluid balance updated
L2 procedure checklist
How can you escalate care if you are not receiving the required response from a medical team?
REACH program
Escalate to CNE/NUM
Escalate to DDON/DON
Escalate to AHNM