Infection control
Which wipes can you clean the glucometer?
Purple or orange top wipes
What items are considered a strangulation risk and must be removed from the room?
Where do expired medications go when found?
Store expired medications in the Return to Pharmacy bin. Pharmacy- pick upexpired meds daily
What are examples of criteria for non-violent restraint?
Restraints for non-violent behavior is based on criterion:
• Dislodgement of device/disruption of treatment that may threaten life and/or interfere with necessary care (e.g., pulling at or removing lines, tubes, dressings) OR
• Observed action or behaviors that place patients at high risk for injury due to impaired safety awareness (e.g., lack of understanding of one's physical and cognitive limitations, wandering, climbing over the bed rails, patients cannot be redirected) OR
• Risk for self-disruption of skin integrity (e.g., obsessive/compulsive behavior such as picking or scratching).
Visibly soiled glucometers should be cleaned using which two step method?
Step 1: Clean off blood with one wipe. No wet time is needed for this step.
Step 2: Disinfect with a second wipe following the appropriate wet time for the wipe
What should you do if two or more PRN orders for the same or similar indication with no direction regarding sequence of administration (example multiple PRN meds for pain, nausea, constipation)
Obtain clarification orders from the provider before administering.
Where do insulin pens get disposed?
The black box.
What type of non-violent restraints require constant observation?
Patients in four-point limb restraint and patients in a vest with bilateral upper limb restraints must be continuously monitored.
Should reagents and glucose test strips be dated? If so what are the expiration times for each?
Yes!! Strips expire in 6mo. Reagents expire in 3mo.
When should a CPO be initiated for high-risk SI patient?
If the suicide screening indicates high risk for suicide, do not leave the patient alone. CPO is to be implemented immediately.
How do we store and label pill splitters?
Label pill splitter with patient’s name, store in med drawer, and send with patient when transfers to another uni
When do non-violent restraint orders expire?
As long as the patient continues to meet the ordered restraint criteria, the order remains active and does not require daily renewal. Orders for restraints remain in effect until:
• The patient’s behavior or situation no longer requires restraint.
• The criteria or type of restraint changes (new order required).Orders must be discontinued as soon as the patient no longer meets the restraint use criteria. Nurses can discontinue the order. If an order is not discontinued promptly and a new episode begins under the same order, this can look like a standing (PRN) order.
What are the wet times for each wipe. White, red/gray, purple, orange?
Simply remember: 4, 3, 2, 1!
• 4 min: orange top
• 3 min: red and gray top
• 2 min: purple top
• 1 min (or until dry): white top
• When in doubt, look at the wipe container to find wet time.
Completion must be documented:
• Within 1 hour of the initiation of precautions
• Qshift
Which medications can be self administered?
Inhalers/Pancreatic enzymes/ocean spray/CHG/over the counter skin cream/mouth rinses/ophthalmic solutions/PCA/nebulizers for CF patients only.
If an authorized prescriber is not available to issue an order for restraints what do we do?
RN may initiate restraint and/or seclusion based upon an appropriate assessment of the patient. A verbal or written authorized prescriber order must be obtained promptly (ideally within minutes but no greater than 1 hour after application).
Explain the 6-step process for transporting soiled instruments.
1. Obtain a clean red biohazard bin. Bring it to the
location of the procedure.
2. Pre-clean by removing blood and bioburden using
gauze and water. Open hinged instruments. Dispose of
single-use instruments.
3. Contain used instruments in the red biohazard bin or
a biohazard bag (for non-sharp instruments)
4. Transport to soiled utility room.
5. Treat with point of use (POU) spray.
6. Deliver to Central Sterile Processing as soon
as possible.
Give some examples of medications that are okay to leave bedside.
Follow PAT036- Examples:
Pancreatic enzymes/
Open vials must be dated to expire within 28-day after opening.
What are the documentation requirements for violent restraints. List each time and what needs to be documented.
Initiation and with changes: Attempted alternatives, date/time of initiation and discontinuation, type of restraint, observed behaviors requiring restraints, education of patient/family regarding rationale for initiation and criteria for discontinuation, any injuries, significant changes in patient’s condition, plan of care, names of staff assisting in restraint/seclusion episode and circumstances.
• Every 15 minutes observed behaviors that require restraint continuation, respirations.
• Every hour Skin integrity, circulation.
• Every 2 hours or anytime the patient’s behaviors no longer provide justification for restraints: assessment for readiness for release from restraints, range of motion while awake, fluids/elimination, and meals at regular timeframes.
• Daily: Attempted alternatives (methods attempted but not effective or rationale for not using alternatives), offer opportunity for bath/shower, oral hygiene