Environment
RACE and PASS stand for?
What is
Rescue, Activate, Confine, and Extinguish AND
Pull, Aim, Squeeze, Sweep
Where is your department Process Improvement (PI) board, and what information is on it?
Press Ganey Scores (from patient surveys), GI/ Pulmonary turn-around times, HH compliance, and chart audit compliance. This is updated monthly.
What extension do you dial if you are reporting any code?
88
True or False:
Saline flushes can be stored in a non-locked cabinet since they are typically in a wrapped packaging.
False. Saline is still considered a medication and should be stored in a locked packaging that only nursing can access.
When should you perform hand hygiene?
Reasons for placing an engineering a work order
What is:
Stained ceiling/ floor tiles, cracks in the wall, pain chipping, broken furniture, loose hinges, plumbing issues
Enter a work order through the Intranet.
Requests--> Engineering Work Orders
What should we do if the patient reports a pain of 2 and their goal is a 0?
We have to initiate an intervention that would help alleviate their pain and then reassess. This should be documented in the EMR.
Besides pharmacological interventions, what other interventions can you implement?
What are the names of your CDS and Clinician
Enjoy the points!
If you are obtaining a blood glucose on your patient and the result comes back critical. What is your next step.
Repeat the result within 15 minutes.
Enter an appropriate comment.
Notify the provider of the result.
Critical highs are rechecked with a lab draw.
What is the appropriate cleaning solution and wet time when disinfecting the iSTAT and glucometer machines?
Bleach for 3 minutes.
After 3 minutes of "wet time", the solution can be cleaned with a gauze pad.
What should you do if there is a fire and your patient is connected to oxygen?
Connect the patient to a portable tank, turn off the oxygen in the room, and follow RACE.
What should we do if the provider has not completed the H&P prior to the start of the procedure?
Kindly remind the provider that this is required prior to starting the procedure. This is a TJC expectation.
You hear the code button go off but are not present for the initial loss of pulse or respirations. What is your next step?
Go get the crash cart. This will ensure someone is responder two and brings the defibrillator ASAP.
True or False: If a patient is an inpatient 1013/2013 and comes to Pre-OP with a sitter. You can send them away as you can take it from there!
False: They need to stay with the patient as they are the designated employee present to ONLY watch the patient and report the patient's state- even when sedated.
You are transporting a dirty scope to the reprocessing room. Can you wear gloves when handling the closed bin or the cart?
No. You should remove the gloves when handling the outside of the equipment.
What should you do if there is a chemical spill in your department?
Small spills can be cleaned with the available spill kits.
Large spills require CODE CLEAN to be activated.
What steps should you follow in a Code Silver?
RUN caution if you don't know the location of the active shooter
HIDE by closing/ locking doors (when possible), turn off the lights, silence all electronics, keep out of sight, and duck under furniture when possible
or FIGHT as a last resort
Code clean involves chemical spills or hazardous materials
Code orange involves decontamination of individuals who have been exposed to hazardous materials/ chemicals
When a patient is admitted in the PACU setting, how often should you monitor vitals and what all should be included in each assessment?
During handoff
q5 minutes for 15 minutes then q15 minutes until discharged
If patient is being recovered in PHASE II by the same nurse providing care in Phase I, the Phase I discharge vital signs can also act as the PHASE II admission vital signs.
When the patient has met the Aldrete requirement (Score >9) for discharge from Phase II, but is waiting to be discharged (i.e. bed rest, inability to void, ride home):
If Vital signs are stable, they may be taken every 30 minutes x 2, then every hour for 2 hours, then every 4 hours.
Follow this frequency unless the patient’s condition requires more frequent vital signs, or more frequently per physician orders. If a patient receives an opioid medication in Phase II PACU (by any route), the patient should remain in Phase II PACU until an additional set of vital signs is taken, which will be 30 minutes after the administration of the opioid medication.
Your patient is having a PEG placed and the provider is using CHG to disinfect the skin prior to insertion. How long does the CHG have to stay on the abdomen before the drape can be placed?
3 minutes per the manufacturer's instructions
What if there is a spill in your department and you are not sure which chemical was spilled?
If unsure which chemical was spilled, activate code clean for the HAZMAT team to appropriately handle the spill.
If we are not sure how toxic the chemical is or it is not in the SDS, then HAZMAT is activated by dialing 88 for code clean.
According to the AHA's Get With The Guidelines- timely defibrillation for a shockable rhythm will ensure better outcomes for the patient. What is this timeframe?
2 minutes since the initial event was detected.
The PACU documentation includes
Vital signs
Assessment
Aldrete score
Discontinuation of the peripheral IV (if being discharged) including the IV infusion dynamic group (IV pump next to the fluid name in the MAR)
Discontinuation of the Pre-Op Order set/ Power Plan
Education of discharge instructions (including MAC when applicable)
Copy of the cardiac rhythm for every patient
What is:
Charge Nurse/ Supervisor or Physician when applicable
Department Manager/ Leadership
House Coordinator
Director of Endoscopy Services
* Per NSH policy: a verge report may be initiated at any stage for process improvement, but the HC will place one when their assistance is needed*
Your patient is scheduled for a procedure but has disseminated Shingles (Varicella-Zoster Virus). You are not sure what isolation type is required. What is your next step?
Appendix A on the Intranet is a CDC-guided document that lists the official recommendations on proper PPE and contact types.
Intranet- Policies Procedures Main Page- Infection prevention- Reference Materials- Appendix A CDC Isolation Recommendations