Critical Results
How long do you have to notify a physician after receiving a critical result?
30 Mins
How long is the consent good for?
For the length of the patients stay or if the patient revokes it.
Dr. A is here to do a bronchoscopy. The RT has everything ready. What should you, as the patients nurse, do first?
Validate consent has been obtained and signed.
How after do you need to document on the care plan?
Every shift on every patient
How often do you need an order for restraints?
Every calendar day.
Where do you document critical results notification?
Provider Notification Flowsheet
Who can sign off on blood?
2 RN's. The patients assigned nurse and the House Supervisor or CNO.
Dr. A is here to do a bronchoscopy. Do you need an actual order for "bronchoscopy"?
YES! Without it, we should not be doing the procedure. Just like we should not give a med if we don't have the order.
How often do you need to document on education?
Every shift on every patient
How often does a nurse need to release and ROM?
Every 2 hours
What does our policy define as a critical result for Glucose?
<40 mg/dL and >500 mg/dL
You receive a stat order for albumin. Per policy, how much time do you have to get that hung?
30 minutes
Your patient has an order for Morphine for severe pain and Norco for moderate pain and rates their pain at a 9. They request to have Norco. Is it within policy to administer Norco ordered for moderate pain?
Yes. The policy states A lower level of PRN pain medication may be administered if it is the preference of the patient (e.g. the patient reports a pain level of 6 but only wishes to take Tylenol which is ordered for pain level 1- 3).
If the patient chooses a lower level of PRN pain medication than is prescribed, the nurse should document the patient’s preference in the medical record.
You just placed a Foley (or a purewick) on your patient, what care plan should be added?
Altered Urinary Status
If I miss my restraint documentation by 1 minute, is that ok?
NO. Our policy says every 2 hours. They will ding us if it is not every 2 hours.
Your patients blood glucose level was 35. You followed the Change in Patient Condition (RRT) protocol for Hypoglycemia. Does that require a critical result notification to the physician?
Yes, we have to call all critical results
You have an order for lasix written for NOW. How long per policy to have to administer the medication?
1 hour
You have an order for morphine Q2 for Severe pain, Norco Q4 for moderate pain, and Tylenol Q6 for mild pain. The patient tells you their pain level is at a 9. You gave morphine 1 hour ago. What is your next step?
Call the physician and ask for an order to give Norco for severe pain when severe pain exists before next morphine administration. Then administer Norco per that order.
Am I allowed to complete care plans and education that no longer pertain to my patient? For instance, the patient had a sepsis care plan, they are no longer showing signs of sepsis and antibiotics are completed.
YES and you should!
If I think my patient is ready to be out of restraints, is it ok if I untie the restraints and watch them for a few hours to see how they do? If they need them, I'll just tie them back.
No. If you think your patient is ready to be out of restraints, you must have a safety huddle with HS, RN, NA, and RT to all agree it is safe. If in agreement, DC the restraint order and DC the restraints. If patient fails and need restraints again, obtain a new order.
On Select Tulsa audits, what step of the Critical Results policy is not being followed consistently?
Entering all information in the Provider Notification Flowsheet. This is a crucial part of showing we are following our policy to a surveyor.
You have an order for morphine every 2 hours PRN for severe pain. You last gave the medication at 1400. It is not 1550 and the patient is asking for their Morphine, complaining of severe pain. Can you administer the medication 10 minutes early?
NO. Our policy states PRN medications cannot be given prior to the full frequency ordered.
Moderate pain is defined as what numeric rating scale (NRS) numbers?
4-6. We should only be using NRS (0-10) and CPOT scores for pain. FLACC and Wong-Baker Faces scale are not appropriate for our patient population.
Am I expected to document education on falls every shift?
Yes, per the falls policy. Patient or family will be educated on falls precautions using the Select Falls Brochure every shift and document.
The wife of your patient is a nurse at Saint Francis. She states that she is staying with her husband, and she will untie the restraints and watch him closely. Is that allowed?
No. We do not allow family to replace the use of restraints when a patient meets the need for them. If they untie the restraints after you have given them the education, escalate to HS and CNO.