Guided Skills Tour
What type isolation is C-Diff considered?
Contact Isolation –Soap and Water Only
Gown and Gloves
Show Door Sign
If severe sepsis criteria is met, you should anticipate/ask for what orders?
Sepsis Protocol
1.) Blood cultures
2.) Lactate Level
3.) Antibiotics
4.) Crystalloid IV fluids (30ml/kg over 2-4 hours)
Your pt has had a change in his level of consciousness and you need to contact his neurosurgeon, Dr. Brown.
What is his answering service phone number?
325-671-5233
How do you keep your patients’ information safe while documenting in EMR?
*Turn screen off when you walk away.
*Ensure the screen is not visible to outsiders.
*Do not allow a physician (or anyone else) to use your login to look up his/her own pts.
What is the proper signage for a suicidal patient?
Precautions Please Check in at Nurses Station
You need to discontinue an IJ, how do you position your patient?
Supine or Trendelenburg (if tolerated) with head turned away & access site lower than the heart level. Have them remain flat for 30 minutes after your remove the line.
When are antibiotics administered for the patient diagnosed with sepsis?
After Blood Cultures have been drawn
You need a French translator, how do you access MARTTI?
Most units have MARTTI on surface tablets or fill out MARTTI request on the Hendrick Hub Translator Services sight. Contact Patient Relations for any questions or concerns.
According to the Suicide Precaution Item Removal Checklist, what would be removed from a moderate- risk patient’s room?
Hendrick Hub>Policy Stat>Suicide Precautions>Attachment
You are feeling bullied on your unit, what is HMC’s stance on workplace violence?
Policy
Behavior & Performance Expectations: Zero Tolerance
What is returned to the lab in the event of a suspected transfusion reaction?
Remainder of blood
and
Blood Tubing
What kinds of patients receive a VTE (venous thromboembolism) risk assessment by the nurse?
All patients 18 and over
Are Demerol, Regular insulin, and Rocephin compatible?
Are they compatible with Lactated Ringers?
All three drugs are compatible.
*LR and Rocephin at the Y-site are questionable. If it is questionable, would you do it?
What policies cover Fall Risk Scores and Interventions?
Humpty Dumpty Fall Risk
Fall Precautions
Fall Response Team
According to our policy, what documentation is required for patients’ restraints?
Type & location of restraints
The necessity of continued use
If less restrictive methods are appropriate
Care plan updated
A physician's order has been obtained for every day unless protocol is in place
Restraints have been released & reapplied Q2H
Food & Fluids offered Q2H
Toileting offered Q2H
ROM or freedom of movement provided Q2H
What is the maximum amount of time you can spend on each suction pass, when suctioning a tracheostomy?
Ensure that each suction pass does not last longer than 15 seconds . . .
List examples of Catheter Associated Urinary Tract Infections (CAUTI) or Central Line Associated Blood Stream Infections (CLABSI) prevention.
CAUTI
Remove foley when no longer medically indicated
Catheter care and peri care at least daily
Only prompt for UA if patient is symptomatic
CLABSI
Scrub the hub between each syringe (15 sec.)
Never reuse syringes, even saline flushes from the same patient
Daily bathing is a critical piece of CLABSI prevention
Where can you find the location for the MedSled closest to your unit?
Hendrick Hub>Environment of Care>MedSled-Locations & Use
Where can you listen to the daily safety call and/or add a potential safety concern?
•The Hendrick Hub Main Page
•Click on the Blue Patient Safety Information Tab
Your patient is hypotensive at 62/40 (47). What emergency action do you perform immediately?
1.) RRT
2.) Large-bore IV with bolus of Lactated Ringers or Normal Saline.
3.) 100% O2 via non-rebreather (or assist with ventilation if needed.)
4.) Draw STAT H/H
5.) STAT Type/Cross for 4 units PRBCs