Name of the assessment used for skin
Braden Score
Name of the assessment used for falls
John Hopkins Fall Risk Score
What organism is most associated with central line infections?
Staphylococcus aureus
Name the protocol used for catheter removal
Nurse Driven foley catheter removal
Name the policy in PolicyTech for medications that are at greater risk of causing significant patient harm when they are used in error.
High Alert Medication
How often is the Braden Scale performed?
On admission, once per shift, PRN
What is the score that indicates the High Risk fall risk category
Greater than 13
First line medication in treating Central Line infection
Ampicillin or Vancomycin
*Daptomycin or Linezolid
Should foley catheters have dependent loops?
No (use the green clip to secure to bed sheet)
What nursing action is required with high alert medications that are continuous infusions will be verified by the oncoming nurse
Shift verification process
What are the 4 risk categories in the Braden Scale?
SEVERE RISK: Total score 9
HIGH RISK: Total score 10-12
MODERATE RISK: Total score 13-14
MILD RISK: Total score 15-18
Name 4 of the 7 fall risk components that make up the John Hopkins assessment
Age, Fall History, Elimination (bowel/bladder), medications, patient care equipment, mobility and cognition
What type of hygiene is ordered in the central line bundle to help prevent skin infection and reduce risk of CLABSI
CHG Treatment Bath
What percentage of UTIs developed in hospitals are associated with a urinary catheter?
About 75%
Name 2 medications or classes of medication that are common on med surg units that require nurse verification handoff
Heparin (anticoagulants)
Hydromorphone, Morphine, Fentanyl, Ketamine (opioids)
What is the name of the assessment completed upon admission and transfer from one unit to another?
Four Eyes
Where do you document fall precautions refused in Epic flowsheet
Daily Cares/Safety flowsheet; under fall risk interventions
What ml syringe is used to flush central lines (PICCs)
10 ml syringe
What is the process to obtain a urine culture from a patient with a long term indwelling catheter?
Remove or change the catheter before sending a urine culture to accurately diagnose UTI
Chemotherapy agents can be given on non-oncology floors in which form (medication route)?
PO, IM, SC or topical
IV medications must be administered by N8 staff
Identify: 
Pressure Ulcer Stage 3
Name the steps in the fall precautions refusal pathway
Escalate to nursing leadership first, if patient continues to refuse preventions, escalate to medical provider. Document refusal and escalation in flowsheet
Who is responsible for removing central lines? What paper needs to be filled out with each line removal?
2 medical professionals
Central line removal form
What is the urine test commonly ordered prior to urine culture?
UA with reflex to culture
What signage is placed outside the door of the patient who is receiving chemotherapy medications?
Purple HD Sign
