Agency Nurse Orientation
Oconee Regional Medical Center
Welcome to Oconee Regional Medical Center’s Agency Nurse orientation page. In order to prepare you for your experience, you are required to complete the orientation module and tests prior to your first shift at the hospital. After reading the entire module, print the attached test and complete. Fax the following completed forms to: 478-454-3934.
All agency nurses must report to the Overhouse Supervisor’s office (454-3703) prior to their shift. The office is located on the 3rd floor of Cobb Tower. The OHS will assign you an ORMC badge and give you an evaluation form to be completed by the charge nurse for that unit. After the completion of your shift, you must report to the OHS office to return the badge along with the completed evaluation form. The OHS will NOT sign your agency time slip without the badge and form.
All agency nurses must complete PCS (Patient Care Systems) computer training and BMV (Bedside Medication Verification) prior to their first shift at ORMC. You will need to schedule this with the coordinator at your facility.
It is important to us that you have a good experience working with the ORMC family. If you have any questions or concerns, please feel free to contact me at 478-454-3709.
~Shantee Henry, Clinical Educator
Orientation Module: Part 1
ORMC Mission Statement
Foundations of Stellar Service
Exceed Expectations (Go the Extra mile)
The 4 Behaviors of Stellar Service
CMS’s HCHAPS (Hospital Consumer Assessment of Healthcare Providers and Systems) measures patients’ perception of how often they received high quality care and service: “Top Box” (The percentage who answered a question using the most positive response or highest numeric value). HCAHPS questions and ratings include:
We all differ from one another. As students in the health care industry, our differences can become more important due to the extremely personal nature of the service we provide. As we work with employees and patients/families, and maintain an environment that is respectful of all people. No one can know and understand all the ways we differ from one another. However, we can create an environment that is respectful of differences. To do this, you must be aware of your own feelings about differences and consistently use behaviors that communicate respect.Learn to recognize, respect and work with patient’s different cultures, values, beliefs, practices and rituals. If you need to access translation services, including sign language, promptly call the Patient Representative or the Overhouse Supervisor after hours.You have a big role to play when it comes to embracing cultural difference and sensitivity toward other cultures. It is the policy of ORMC to respect the cultural and ethnic needs and desires of the patients that we serve if at all possible. This may include:
Population Specific or Age Specific Considerations for Assessment
The goal of patient assessment is to develop and implement an individualized interdisciplinary plan of care for the patients and the families. In the creation and implementation of this plan of care, it is imperative that the appropriate age-related or population specific considerations be addressed. These considerations for care must address the chronological age of an individual and be amended to conform to the individual’s level of cognitive development. The following attachment outlines age categories and age appropriate considerations for assessment and treatment and can be readily utilized for plans of care. (Complete the age-specific competency test)
Suspected Abuse, Neglect, Violence and Exploitation Assessment
Population specific considerations should also be utilized for patients when there is suspected abuse or neglect. ORMC policy ADM-CL-565 supports licensed health care providers in directing them to “disclose PHI about an individual whom ORMC reasonably believes has been a victim of abuse, neglect, or domestic violence to a government authority, including a social service or protective service agency, authorized by law to receive reports of such abuse, neglect, or domestic violence”. ORMC policy ADM-CL-563 addresses the reporting of suspected child abuse or neglect.
Health Insurance Portability and Accountability Act (HIPAA)
Definition of HIPAA
The Health Insurance Portability and Accountability Act of 1996 is a multifaceted piece of legislation covering three areas:
a. Insurance Portability:
Portability ensures that individuals moving from one health plan to another will have continuity of coverage and will not be denied coverage.
b. Fraud enforcement (accountability):
Significantly increases the federal government’s fraud enforcement authority in many different areas.
c. Administrative simplification:
Ensures system-wide, technical and policy changes, in healthcare organizations in order to protect patient’s privacy and the confidentiality of identifiable protected health information.
Patient confidentiality is a conscious effort by every healthcare worker to keep private all personal information revealed by patients and their families and/or medical records during a hospital visit. You may have access to confidential information about patients and their families. You must never discuss, disclose or review any information about a patient’s medical condition with any other person unless they have proper authorization.
Every student must read the Code of Conduct booklet and sign the Confidentiality Form (at the end of this module).
Identifiable Protected Health Information
Protected health information (PHI), under the US Health Insurance Portability and Accountability Act (HIPAA), is any information about health status, provision of health care, or payment for health care that can be linked to a specific individual. Consider everything inside a patient’s chart (paper or electronic) as identifiable protected health information. Assure that patient confidentiality and privacy are not compromised.
Environment of Care
This section prepares you to safely respond to an emergency situation at work as well as at home. This section will help you learn how to respond to unexpected events and emergencies, as your actions could have an impact on patients, parents and coworkers. Following these procedures may ensure safety for you, our patients and their families.
Code Red = Fire
Code Red means there is a fire somewhere at the hospital.
RACE is a national acronym used to help you remember what you must do in case of a fire.
Evacuate horizontally following your unit’s evacuation plan. Do not use elevators, use only stairs. Remember to CLOSE ALL DOORS.
Code Blue = Adult Cardiopulmonary Arrest
If a patient, visitor or employee has cardiac or respiratory arrest, call for help by dialing 3999 on any in-house phone. All patient rooms have a “Code Blue” button. It is preferable to use this if available. Give the number of the patient’s room or area where the victim is located. The switchboard operator will page “Code Blue” on the Overhouse page to activate the code team. Begin CPR if you are certified to do so.
Code R = Rapid Response Team
Code Pink = Infant/Child Cardiopulmonary Arrest
Code Black = Tornado sighted in the area
Code Adam = Infant/Child abduction
Code Triage = an event that significantly disrupts the environment of care and/or the care and treatment of patients
Patient incidents involving medical equipment or products must be reported to Risk Management (3552) and Biomed (3799) in accordance with the Safe Medical Devices Act (SMDA).
Personal Safety Tips
Waste Disposal: There are several types of hospital waste. Each type of waste has its own type of waste container.
Biohazard Waste is any type of waste that is contaminated by blood or other body fluids contaminated with blood. All items contaminated with more than a small amount of blood, drainage, or infectious secretions are discarded in red bags for incineration. These containers have the Biohazard symbol. Note: always wear Personal Protective Equipment (PPE) when handling Biohazardous Waste.
Sharps are substances that can poke or cut your skin, such as needles, broken ampules and/or lancets. Sharps are disposed of into a hard, plastic Sharps Box. Sharps may be contaminated; therefore, you must always wear PPE when handling sharps.
ORMC agency nurses need to follow a basic level of caution during their work activities. They include:
Comply with hospital and unit specific dress code regulations
Universal or Standard Precautions are a set of standardized precautions to be used for all patients, regardless of illness or medical condition for the prevention of blood-borne pathogens.
Hand washing is required before and after patient contact as it is the single most important action in preventing the transmission of disease.
Personal Protective Equipment (PPE) is worn to protect against blood/body fluid exposures. Staff should know location of PPE in each patient care area and be familiar with them when barriers are indicated and used as required.
*Gloves for hand protection
*Gowns to protect clothing
*Protective eyewear to reduce risk of splashes, use goggles or masks with shield
*Masks to reduce risk of respiratory exposure
Avoid touching face or eyes during patient care activities. Many respiratory viruses are readily transmitted through the mucus membranes of the eyes, nose, and mouth.
Avoid eating, drinking, or applying lipstick or lip balm in patient care areas. Enteric viruses such as Rotavirus may survive for up to 5 days on environmental surfaces.
Staff should know the location of eye wash stations in patient care areas and use to immediately cleanse eye if contamination with blood, body fluid or hazardous chemicals should occur.
Injuries with contaminated sharps present a significant risk to healthcare workers. Blood borne pathogens, which have been documented to be transmitted by percutaneous exposure, include: Hepatitis B, Hepatitis C, and Human Immune-deficiency Virus (HIV). Hepatitis B is best prevented by administration of Hepatitis B vaccine. Post exposure prophylaxis for HIV requires administration of anti-retroviral medications. There is currently no prophylaxis for Hepatitis C.
Handling Sharps Safely
*Never recap used needles by hand. If needles must be recapped, use on handed scoop method or recapping device (activate protective covering).
*Do not bend or break needles.
*Keep used sharps separate from other items such as gauze and alcohol wipes.
*Always point a used sharp away from your body.
*If assisting with a procedure always be aware of where the sharp is being placed.
*Never clean up broken glass by hand.
*Do not overfill a sharps container. If it appears to be over 2/3 full, notify Environmental Services at 3100.
*Do not open, reach into, empty, or clean a sharps container.
*When using sharps remember to activate protective covering.
Reporting a Blood/Body Fluid Exposure
If you are injured by a contaminated sharp, the incident must be reported immediately.
Patient Safety Goals
Improve the accuracy of patient identification
Improve the effectiveness of communication among caregivers
Improve the safety of using medications
Reduce the risk of healthcare-associated infections
Accurately and completely reconcile medications across the continuum of care
Identifies safety risks inherent in its patient population
Universal Protocol for preventing wrong site, wrong procedure, wrong person surgery
CHAIN OF COMMAND/INCIDENT REPORTS
ORMC’s primary patient education systems are Krames and Lexicomp. Both of these web-based software programs allow the hospital staff to access and print out patient information about illnesses or medications. The health sheets are available in English and Spanish, with many available in more languages than this. The content is written on a 6th through 8th grade reading level and is updated on a regular basis by the respective editorial boards. They are located on the hospital’s Intranet under “User Applications”. Any of our staff will be happy to assist you with accessing these.
At ORMC, the patient’s self-report of pain is the single most valuable indicator of pain. The patient and their caregiver can expect that pain will be evaluated using an appropriate pain scale. The pain scales include: 0-10 pain scale, FLACC pain scale, or the Wong-Baker Faces pain scale. Patients will be taught that the goal of pain management is prevention (when possible) and that early intervention in the course of pain management is important. Patient care providers will respond to the patient’s report of pain as quickly as possible. Nursing will assess the effectiveness of interventions within 1 hour or as appropriate according to the patient’s condition and/or the intervention utilized. The outcome goal for pain management is to bring the pain to a level acceptable to the patient. A pain assessment is performed and documented upon admission, after any known pain producing event, and with each new patient report of pain, and at every 2 hour rounds.
A restraint is any involuntary method of restricting an individual’s freedom of movement or normal access to his/her body. Restraints may be physical or chemical and may only be applied after all other measures have failed (moving closer to nurse’s station, family or sitter at bedside, distraction, etc). A physician’s order (orange colored form) must be obtained and reordered every 24 hours as needed. The nurse must initiate a care plan specific for restraints and update as needed. During the time the patient is in the restraint, the patient is assessed every 2 hours for the following elements to ensure that the patient’s safety and health are maintained: Patient’s physical needs (circulation checks, elimination, hydration, nutrition and hygiene) are met at least every two hours while the patient is awake. During these checks, the nurse should release the restraint and perform range of motion to the limb. Only staff that has been deemed competent to apply restraints may do so.
See Form Below……
All patients are assessed on admission utilizing the Fall Risk Assessment Tool. A score of fifty-one (51) or greater points OR a fall during hospitalization will initiate High Risk Fall Precautions. A Status Change Assessment, which includes a Neurological Assessment, should be done after any patient fall, and every four (4) hours for the first twenty-four (24) hours following a fall. On each shift, during the reassessment process, check the appropriate boxes utilizing the Fall Risk Assessment Tool. Hourly Rounding is done to address the “Three P’s” (pain, potty, and positioning), and to conduct environmental assessment for patients who have been identified to be “at risk” to fall. Communication to other departments that the patient is at risk to fall is done using the Transfer/Hand-off form.
Patients at risk for falls are identified by placing the “Red Sock Alert” card on the white board in the patient’s room, a magnetic “Fall Precaution” warning label on the exterior door frame of the patient’s room, and red slip-resistant socks to be worn by the patient.
Reducing the Risk of Falls handout should be given to the patient and family.
EMTALA is the federal anti-dumping statute
EMTALA applies to all hospitals with a dedicated emergency department
An EMC also means…
Furthermore… if needed
A pregnant woman may be transferred…
EMTALA requirements end…
EMTALA applies to…
If a patient refuses care..
While the patient is in the hospital…
EMTALA is legal, not medical…
OCONEE REGIONAL MEDICAL CENTER
Age-specific competencies are tools for learning more about how to best meet each patient’s unique needs as you care for him or her. By demonstrating your understanding of age-related differences, you can ensure that our facility meets Joint Commission standards.
There are many ways to learn about each patient’s specific needs. Depending on the patient and your job, it may be appropriate to:
Each patient is unique.
Always keep in mind that:
Avoid stereotyping a patient – consider all the factors that may affect his or her care needs.
Orientation, Assessment, And Form Downloads
Note: All material is provided in PDF format.
Click on the link below to download: