Incident Management & Nursing Policies (Policy 2.09, NPP 303, NPP 511)
This system is the centralized database use to record and track SIRs.
What is WaRMSS?
True or False: Employees must wear their identification badge on the upper torso.
True
Staff complete this checklist each shift to ensure areas are secure.
What is the Unit Safety Checklist (PSH 7592)?
Patients at risk of suicide may require this type of monitoring.
What is 1:1 or augmented observation?
All absences must be documented on this form.
What is the Absence and Additional Time Worked Report (DSH 0634)?
Staff must complete both the Interdisciplinary Note (MH 5624) and Special Incident Report (DSH 2512) within this amount of time after an incident.
What is 2 hours?
All RN Progress Notes must be completed within this many days after the end of the reporting period.
1 to 4 days
Staff must check for ligature points such as shower rails and hooks, these are considered what kind of risks?
What are environmental risks?
What medical staff are authorized to write enhanced observation orders?
Enhanced Observations requiring a physician’s order shall be written by a Psychiatrist, Licensed Psychologist, or Primary Care Physician (PCP), as consistent with their scope of practice and clinical privileges.
Employees must submit medical notes to this person, not HR.
Who is the immediate supervisor?
The Unit Supervisor shall complete Level II of the MVR process within _____ from initiation of the MVR.
1 business day
Nursing Weekly/RN Progress Notes are filed chronologically in section II IDN-Interdisciplinary Note tab. How long are these notes required to remain in the chart?
For at least six months or thinned after three months with the Unit Supervisor’s approval.
Visual checks of all patients must be conducted ____ every ____.
Once & Hour
This individual is responsible for the policy on Enhanced Observation of Patients
The medical director
Define "Separate Instance"
"Separate instance" is defined as any number of consecutive days used for illness prior to returning to duty. Individual consecutive days off used for illness should not be counted as separate instances.
What is the responsibility of the Unit Supervisor as it relates to NPP 303.
The Unit Supervisor shall ensure that each patient is assigned to a “case manager” (RN) and a “counselor” (PT/LVN).
What happens if a DSH-Patton employee violates the clothing and grooming standards policy?
The employee will be sent home to change on their own time.
Unit Supervisors shall maintain sign in/out records (PSH 7138 Day Book Log) for a period of _____.
5 years
This is the definition of enhanced observation
Any increase in staff observation or care of a patient that is not normally provided to all patients.
An employee must have 12 months of service and 1,250 hours worked to qualify for what types of leave?
What is FMLA/CFRA?
Incident Management tracking and trending data with appropriate analysis, and recommendations is reported no less than quarterly to what committee?
Quality Council Quarterly & the Governing Report
This is the purpose of AD 4.26
To promote a professional appearance of all hospital personnel and to promote a safe and healthy environment.
When courtyards are open, there shall be always at least two (2) staff members supervising the use of the courtyard. Where is one staff member required to remain situated?
Along the courtyard fence area.
Who is responsible to ensure staff are properly trained on AD 15.09?
Unit Supervisors/Supervising Registered Nurses, Nursing Mentors, Managers and Staff Development Center (SDC) will ensure that staff are trained on this policy.
After how many instances should you address staff for submitting late/inaccurate 634s?
Supervisors will take appropriate administrative action for chronically late or inaccurate DSH0634 forms (chronically late or inaccurate is defined as two (2) or more late/inaccurate DSH0634 forms submitted to supervisor in a six (6) month period).