HELP
At 0200 a nurse asks you for help...
-402A's call bell is not working.
-Water is draining from the sink (leaking)
-Power Chart is on a Downtime
Who to call when in-charge
Medical Equipment repairs: FMO
Two staff do not show up for shift. What do you do?
-BE curious. look at flowsheet, does anyone have their numbers/information.
-call staffing and let them know to put out shifts
-call CSO and see if there are any extra help in the building.
You have a sick call. What do you do?
-Look at staffing, how are your baseline numbers?
-Call scheduling/Put staff through to scheduling/update Facebook.
-Call CSO, help elsewhere?
-Update assignments
CSO call and tells you they are decanting ER and sending a patient to your hallway. What do you do?
-Is the patient an appropriate hallway pt.? request more information.
-Review Assignments someone has to take the hallway pt.
A 46yr old male "Tim" is admitted with lower leg cellulitis and alcohol withdrawal.
Meds: IV antibiotics and diazepam for CIWA 14.
HX: Schizophrenia and HTN
Tim is refusing his antibiotics.
-Educate on the importance of IV antibiotics.
-Pt. is not certified under the MHA has the right to refuse care.
At 2330 a nurse asks you for help...
They need a new Heparin Bag-how can you get one?
Their IV blew and they need a new one STAT and can't get their Foley inserted. It's a rough night already
If NOT unit stock then on-call pharmacist to locate: High alert high risk med.
Ask for help in the places that are more comfortable with these skills....difficult foley? 7AB? etc..ask around trade help!
A staff member mid-shifts feels unwell and states they have to leave.
review assignments-assign patients until help can arrive
call CSO-maybe there is help elsewhere?
check in with sister floor.
let staffing/Facebook know
A patient is deteriorating a 70 year old "Marg"
210/80 and headache
HR: 110
RR:20
As charge you are now the "GO-TO" for all help.
-help support staff for assessment, review orders,
-MRP/CCOT for support.
-support with delegating other patients if MRN is 1:1.
You have a patient targeted to you from ER to your hallway, but they are on droplet precautions. What do you do?
-Investigate/Be curious. Why are they on droplet?
-Is there another patient ER can target more appropriate to your hallway?
-Can you move an appropriate patient from a room into the hallway and ER pt. to room?
Tim is now certified under the MHA.
He is still refusing his antibiotics
-Tim still has the right to refuse non-psychiatric medication.
-The MHA only covers psychiatric medication and treatment.
-The hope is that with psychiatic tx pt. will improve and agree to other medical treatments.
You used the AED (where are these located?!)
Who is responsible for these?
Where do you get new pads?
How do you put away?
-RT audits but no standards
-should be added to your Night checks
-call RT/ICU/ER for new pads!
An RN is deployed to you 30 minutes into the NX shift.
-arrange assignments and thank them!
-quick tour/check in
-do they know the codes (break room, Narcotic cupboard)
-ensure they are on the flowsheet and have signed their own deployment log if applicable.
MRP is aware of Marg's vitals and symptoms-NO new orders
-Marg starts having Left side neglect. You call MRP but no reply.
-talk about CCOT VS. MRP
-when MRP is not answering with Urgent Medical Emergency but not yet a CODE BLUE call Hospitalist STAT pager (24/7).
-Hot stroke protocol if warranted.
Your unit had an unexpected violent incident.
The event is now resolved. How can you support your unit?
What reporting and debriefing would you recommend?
PSLS
workplace call center
inform CNL/Manager
Hot debrief
Tim is now threatening staff with his IV pole.
He is also having auditory and visual hallucinations.
call code white
222
make self and others safe
A staff member slips and falls and hurts their ankle...What do you do?
-assess and support.
-call security as they are our First Aid Attendant.
-Give information for Workplace call center.
-Review assignments and let CNL/Manager/CSO know.
HCA needs to be deployed, you go to have the conversation and they refuse saying
" If you deploy me I'm leaving"
-keep conversation respectful
-Be curious
- ask team if there are any volunteers for deployment
-Request help from CSO
What is Hot Stroke Protocol?
as Charge what are your priorities?
FAST SCREEEN
Blood sugar VS FAST VAN
Face/Arms/Speech
one or more FAS?
Time last seen normal or unkown/woke up
Vision Aphasia Neglect
CALL MRP/Stroke nurse
Obtain order: CT + CTA EVT protocol
call medical imaging STAT CT "coming down" GO! do not wait!
IVx 20g
Your unit had an unexpected Code Blue
The event is now resolved. How can you support your unit?
What reporting and debriefing would you recommend?
EFAP
inform CNL, manager,
CSO can help lead hot debrief.
Tim pulls out a knife and is threatening to harm.
Security has been called
Call 911-police when there is a threat with a weapon, assault or threat of assault, bomb threat, theft or vandalism.
maintain safety
A staff member has a needlestick injury? What do you do?
-Wash area with soap and water only
-Support staff to go to ER ASAP and let them know you had a Blood & Body Fluid Exposure, you will receive a package.
-ensure source BW is done
-update CNL/Manager/CSO/call workplace call center.
-review assignments. do not delay going to ER!
What does XX or OR mean on the flowsheet?
orientation.
Ensure these are not placed into baseline shifts
A patient is deteriorating: SIRS
BP: 82/40 HR: 110 RR: 28 Temp: 38.7 SPO2 89% RA
MRP orders fluid bolus septic BW and antibiotics
What other support do you have?
CCOT
RT
colleagues
As charge-do you need to re-arrange assinment to help nurse as they are most likely 1:1 paitent.
A family member is upset with the care of their loved one...
PCQO
Give Manager information and let CNL manager know.
Tim is certified under the mental health act and is now missing.
search unit/floor
call security, let MRP know, call contacts
Director's Warrant (Form 21) authorize police to bring back an involuntary patient back to facility.
fill out a police communication tool