Care of Patients

•When must Informed Consent be obtained and who can obtain it?

•For any procedures involving risks including invasive procedures; whenever sedation or anesthesia is issued; and for blood administration.

•Consent to treat is also obtained at the time of admission.

•It is the responsibility of the physician to obtain informed consent

•the nurse only witnesses the signature.

Q: Does your organization have a Resuscitative Team?

Yes, The Rapid Response Team (RRT).

Q: What is the function of the Rapid Response Team?

The RRT are specially trained staff who response to changes in the patient’s condition found to be worsening, by directly assisting staff members to prevent patients from deteriorating any further.

Q: What number do you dial to activate the RRT?

50

What is a DNR?

“Do Not Resuscitate (DNR)”,

otherwise known as No CODE. A medical order that a Code will not be called to restore cardiopulmonary resuscitation in the event of a cardiac arrest and/or respiratory arrest.

The admitting physician determines that it is little or no benefit or that the outcome is medically questionable to apply cardiopulmonary resuscitation.

The admitting physician discusses with the patient or the surrogate/proxy in the case of incapacity that cardiopulmonary resuscitation has no probable benefit.

A physician order must be obtained for “DNR” and documents the patient’s wishes in the medical record.

Nursing alerts all appropriate staff.

Nurse is responsible for verifying that an orange“DNR” label has been placed on the patient’s chart.

Organ Donation / Gift of Life Program:

LCHPSC Organ/Tissue Donation Policy provides criteria/guidelines:

To assist nursing and medical staff in identifying potential organ/tissue donors.

For organ donor qualifications

For timely referral of potential donor to the Organ Procurement Organization (OPO).

Upon admission, ALL patients are asked if they have signed an organ donation card. If Yes, a copy is included in their medical record.

The MD/RN caring for the patient is responsible for evaluating the patient’s organ/tissue donation status.

The Organ Procurement Organization (OPO) MUST be notified of all deaths within 60 minutes.

The OPO designee will request, by phone, approval for donation from the legal next of kin, answer questions and provide instructions at the time of call.

Life Alliance Organ Procurement Organization Hotline

1-800-255-GIVE (1-800-255-4483)

Assessment of Patients

Q: When must the initial assessment be completed?

The RN will initiate patient assessment within 8 hours of admission. After surgical or invasive procedure, the patient is assessed within 15 minutes of arrival to the unit and as needed. Ø

Q: How often are patients reassessed?

At least every 2 hours, more often if patient’s condition warrants it and whenever the patient’s condition significantly changes. Ø

Q: When are the patients screened for an admission?

During the initial assessment, we screen for abuse/neglect, pain, functional status/rehab, fall risks, nutritional needs, skin/wound, and smoking.

Critical Test Values:

    Defined as diagnostic test results that fall outside the normal ranges/values that will require rapid communication of results. Critical values may include but not be limited to Laboratory, Radiology, EKG and Imaging.

    Critical Laboratory Values:

Laboratory technologist will call the nurse responsible for the patient upon identification of critical care value immediately within 5 minutes. The laboratory technologist shall ask the nurse to read the results back to verify that they were understood correctly.

The nurse will initiate action based on existing protocol/orders or contact the physician/designee immediately within 30 minutes of receipt of the critical lab result.

Upon contact with physician/designee, the nurse will ask receiver to read-back the results to verify that they were understood correctly.

Reporting of Critical / Abnormal Values:

The laboratory technologist will notify the pharmacy of the critical value result. If an order is received by the Pharmacy relevant to the critical

value result, the order will be processed appropriately. If the Pharmacy has not received an order within 30 minutes of laboratory notification, Pharmacy will inform the nurse in charge of the critical value results.

Q: Whenever a nurse takes a telephone or verbal order in our hospital, he or she must repeat it back to the physician to confirm that it  was understood correctly. Is this acceptable?

No. Simply repeating back the order is not sufficient. Whenever possible, the receiver of the order should write down the complete order, then read it back, and receive confirmation from the individual who gave the order.    Please refer to Policy #: Critical values PC-0105

Q: Which patients should have their pain assessed?

All patients have the right to have their pain recognized, assessed, and addressed appropriately. Pain assessment is performed upon initial inpatient admission, upon admission for invasive or surgical procedures, and for outpatients. Ø

Q: How do you assess your patient’s pain?

Pain is assessed and treated using a 0-10 scale. Patients are asked about the location, quality, and onset of pain. A comfort goal is established with the patient.

If the patient is unable to give a pain score (unconscious, nonverbal, cognitively impaired) use the nonverbal pain, indicators to estimate pain (FLACC Scale) (Wong-baker Faces)

“Hands-off” Communication (SBAR)

   Occurs in the nursing shift change, temporary responsibility for staff  leaving the unit for a short time, anesthesiologist report to post  anesthesia recovery room nurse, ER to in-patient unit, report different  hospitals, nursing homes, home health care, laboratory, and radiology results sent to physician offices.

Use “12-Hour Change of Shift Report” at shift changes.

Use “Hospital to Hospital form” when transferring patient to another hospital or facility.

Patient/Family Education:

Q: How is the patient’s readiness to learn and deficits/barriers to learning assessed? Where is this information documented?

It is assessed during the admission process and documented on the initial patient assessment form/Education Form

Q: What types of education programs are available for patients?

Safe use of medications, safe use of medical equipment, hand washing hygiene, potential food-drug interactions and other nutritional matters; rehabilitation techniques to promote independent function; community resources available including immunization; fall prevention; plan of care. Speak – up.