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JumpStartResourceManual

By Jay Zigmont, PhD, CHSE-A on behalf of the JumpStart Team

Learning InnovatorLearning in [email protected]

Revised September 24, 2014

Bargar, Brandon

Biegler, Elizabeth

Bury, Peter

Cavalieri, Ashley

Clark, Philip

Edwards, Tricia

Eggerichs,Jennifer

Faber, Melinda

Garee, Sarah

Harris, Derek

Harris, Le-Ann

Hayes, Karen

Heberling, James

Hothem, Kelly

Latham, Richard

Lenhart, Betsy

Lewis, Jodi

Linley, Jennifer

Minser, Katie

Mitchell, Janie

Muddle, Jonathan

Nguyen, Ngan

Nutter, Kelly

Oocumma, Nichole

Rees, Thomas

Roderick, Betsy

Seiler, Rebecca

Smith, Judy

Tost, Paula

Wade, Angie

Warner, Ryan

Winner, Cheryl

Zigmont, Jason

For Further Information contact:

Jay Zigmont, PhD, CHSE-A

Learning Innovator

Learning in Healthcare

[email protected]

Or

Tricia Edwards, RN

Learning Consultant

OhioHealth Learning

[email protected]

Copyright 2014©

JumpStartLearningTeamOHIOHEALTH LEARNING

A FAITH-BASED, NOT-FOR-PROFIT HEALTHCARE SYSTEMRIVERSIDE METHODIST HOSPITAL + GRANT MEDICAL CENTER + DOCTORS HOSPITAL + GRADY MEMORIAL HOSPITALDUBLIN METHODIST HOSPITAL + DOCTORS HOSPITAL–NELSONVILLE + HARDIN MEMORIAL HOSPITAL MARION GENERAL HOSPITAL + REHABILITATION HOSPITAL + O’BLENESS HOSPITAL + MEDCENTRAL MANSFIELD HOSPITAL MEDCENTRAL SHELBY HOSPITAL + WESTERVILLE MEDICAL CAMPUS + HEALTH AND SURGERY CENTERS + PRIMARY AND SPECIALTY CARE URGENT CARE + WELLNESS + HOSPICE + HOME CARE + 28,000 PHYSICIANS, ASSOCIATES & VOLUNTEERS

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This manual is the result of over 2 years of work of over 150 people in order to build a unique, competency based RN Orientation program that integrates experiential learning, deliberate practice and the Learning Outcomes Model (Zigmont et al, 2011a) to make RNs more competent, faster. The program is unique in that it is an iterative process, embracing continuous improvement after each JumpStart session. Therefore the manual is regularly updated as the program developments are implemented.

JumpStart is designed to address all three areas of the Learning Outcomes Model including the Individual, their Experiences and the Environment (Zigmont et al, 2011a)

THE INDIVIDUAL:

+ All new RNs to OhioHealth attend JumpStart. A conscious decision was made to have both new graduates and experienced RNs in the same course. We find that the new graduates enjoy seeing the experienced RNs in the course and learn from them. At the same time, experienced RNs often find that the new graduates may have learned things that were not taught previously.

+ Learning is done in small groups (max of 7 students to 1 facilitator). Each learner gets an opportunity to utilize necessary the equipment. During the scenarios, 2 learners actively participate while the remainder actively observe.

+ As it is an experiential learning based program, all learners are able to utilize their prior experience and are assessed based upon their level of performance (Beginning, Developing, or Proficient, See the General Nursing Orientation Manual (Competency Based Manual and Rubric) in the back of this manual). The formative assessment completed during the JumpStart program provides a framework for an individualized orientation on the unit. The simulation based assessment replaced Performance Based Development System (PBDS) Test that was previously used. The intent is to move from measuring knowledge to measuring competency.

+ Orientees are also assessed at the mid-point and end of their orientation. The mid-point and end assessments are completed on the unit by a 3rd party assessor (not the educator, preceptor, or manager who is currently responsible for the orientee).

+ The focus of the scenarios is on building robust mental models that can be easily translated to practice. The 3D Model of Defusing, Discovering and Deepening (Zigmont et al, 2011b) is utilized for debriefing, allowing learners to actively participate in the experiential learning cycle, and creating mental models through analogical reasoning.

EXPERIENCES:

+ The entire JumpStart program is experiential. Leaners start with skills stations and scenarios, and then continue on to real-life experiences on their unit. The program intentionally removed all ‘lecture’ or ‘classroom’ based learning in favor of simulation and having the learners spend more time on the unit than in the classroom.

+ Skills stations integrate clinical applications and documentation with the core nursing skill. Scenarios also include documentation and clinical applications where applicable.

+ Relationship based care, service expectation standards, and overall customer service are integrated throughout and debriefed. Therefore, the emphasis is placed on the old axiom, “how you do, what you do”.

+ All scenarios include standardized patients or actors. The only scenario that utilizes a manikin is the DNR (e.g. post-fall) case, and does not necessarily have to be a high fidelity manikin. We use the patient monitor from our high fidelity simulators to

JumpStartOrientationManualWelcome

TO WHOM IT MAY CONCERN:

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+ Standardized patients provide feedback during the debriefing. Although the debriefing is led by one of our skilled facilitators, learners often state that the feedback from the standardized patients is key for their learning.

+ Scenarios are approximately 15 minutes in length followed by 30-45 minutes of debriefing.

ENVIRONMENT:

+ Skilled mentors are essential both during the JumpStart Orientation program and on the unit. JumpStart educators complete a 24-hour Certificate in Experiential Learning program and then are mentored through multiple sessions. Preceptors on the unit complete an 8 hour program that focuses on experiential learning and assessment.

+ Multiple On-Unit Changes were needed to sustain the orientation program:• Preceptors / Orientees maintain a stepped or reduced assignment the first 1-3 weeks. The reduced patient assignment for the

preceptor and orientee allows for increased learning and quicker engagement. Further allowing questions to be asked and answered in a safe environment Orientees will follow the preceptor’s schedule. Orientees are assigned to the preceptor that will best support their learning and engagement in the hiring unit. By requiring orientees to follow the preceptor’s schedule, they are able to build a collegial relationship, preceptors can more easily assess and be accountable for the evaluation of the orientee, and tracking the orientees development is easier.

• Orientees will follow the preceptor’s schedule. Orientees are assignmed to the preceptor that will best support their learning and engagemenet in the hiring unit. By required orientees to follow the preceptor’s schedule; (a) they are able to build a collegial relationship, (b) preceptors can more easily assess and be accountable for the evaluation of the orientee, (c) and tracking the orientees development is easier.

• Orientees will have no more than two preceptors during their unit-based experience. It is very difficult to follow a deliberate practice model when mentors continually change. Orientees previously reported an average of 4-7 preceptors during their unit-based orientation. The higher number of preceptors contributes to inconsistent feedback, inaccurate orienteeassessment, and decreased new hire engagement.

• Preceptors are preceptors only. In many cases, the preceptor would also be assigned to the charge role or floated to another unit. To support orientee learning, the preceptor should focus solely on precepting. Multiple roles can be confusing and overwhelming to an orientee. Hence, dual roles can also inhibit the preceptor/orientee dynamics.

• Preceptors are required to attend preceptor training. Data shows that most preceptors had not attended a training course. As a result, it was difficult to determine preceptor competence and/or set standards for managing orientees. The existing preceptor course was changed to include how to facilitate deliberate practice and the impact of experiential learning styles.

• Regular meetings with orientee, preceptor, manager, or educator should be established. In many cases, the manager, educator, preceptor, and orientee were unaware of orientee weaknesses, progress, or successes. The lack of communication was attributed to the busy patient management expectations. But, the lack of direct feedback, evaluation and “check-in” often resulted in unidentified or misdiagnosed orientee issues/problems, difficulty in remediating orindividualizing orientation experiences, and an extended orientation length. Definition of “regular” is established by the hiring unit and may vary by orientee.


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Together, these changes have resulted in an average of over 3 weeks reduction in orientation length. Incremental cost for the program was approximately $700 resulting in a net savings of over $3,000 per RN.

The JumpStart program can be adapted to meet your hospital’s needs, or serve as a capstone for a university RN program. As long as appropriate credit is given (JumpStart Program, Zigmont, J., et al., 2014), you may use all of the information, scenarios, skills stations and materials within this manual.

If you need assistance implementing a JumpStart program, would like to observe our program, attend our Certificate in Experiential Learning program or have any comments or questions, please contact Jason Zigmont, [email protected] or Tricia Edward, [email protected]..

Yours in Service,

Jay Zigmont, PhD, CHSE-ALearning InnovatorLearning in [email protected]


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TIME SESSION/ACTIVITY LOCATION

8:00 – 8:30 a.m. Registration

• Sign-in• Complete OhioHealth Forms

Center for Medical Education + Simulation

(CME+I) 4 Red

8:30 – 9:15 a.m. Opening Session

• Housekeeping• Where are you today?• Learning Styles

Large Group, Conference Room

9:15 – 12:30 p.m. Skills Stations

• Station 1: Rhythm Recognition• Station 2: 02 Therapy• Station 3: Waive Test• Station 4: Clinical Applications

Conference Room Clinical Skills Lab Breakout Rooms

12:30 – 1 :15 p.m. Lunch On your own

1:15 – 2:00 p.m. Tour of Simulation Lab Large Group,

Simulation VCU’s

2:00 – 4:00 p.m. Simulations & Debriefing Exercises • CHF• Find the Wound

1-4 Groups of Simulation(Depending on size)

4:00 – 4:30 p.m. Closing

Q&A Conference Room

JumpStartAgendaDAY ONE:

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• General RN Orientation Manual• Where are you today?


(CME+I) 4 Red

8:30 – 12:00 p.m. Skills Session

• Station 1: IV Pumps• Station 2: Rhythm Recognition &

Intervention• Station 3: Peripheral IV• Station 4: Clinical Applications &

Med Administration


12:00 – 1 :00 p.m. Lunch

On your own

1:00 – 4:00 p.m. Simulation Debriefing Exercises • STEMI• IDDM• Fall


4:00 – 4:30 p.m. Closing

• Q&AConference Room

JumpStartAgendaDAY TWO:

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8:00 – 8:30 a.m. Registration

• Where Are You Today?• What to Expect on the Unit• Manager, Educator, Preceptor, and

Orientee Expectations/Responsibilities


(CME+I) 4 Red


• Station 1: Rhythm Recognition &Intervention

• Station 2: Blood Administration• Station 3: Safe Patient

Handling/Restraints• Station 4: Clinical Applications &

Med Administration


12:00 – 1 :00 p.m. Lunch On your own

1:00 – 4:00 p.m. Simulation & Debriefing Exercises • Pre-Op Preparation/Sepsis• End of Life• Stroke


4:00 – 4:30 p.m. Closing

Q&A Conference Room

JumpStartAgendaDAY THREE:

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• Where are you today?• Mid-point and end-point

assessments


(CME+I) 4 Red


• Station 1: Rhythm Recognition &Intervention

• Station 2: Defibrillation• Station 3: Central Line Dressings &

Blood Draws• Station 4: Clinical Applications &

Med Administration


12:00 – 12:45 p.m. Lunch

On your own

12:45 – 2:00 p.m. Basket of Questions Large Group,

Conference Room

2:00 – 4:00 p.m. Simulation and Debriefing Exercises • Clinical Institute Withdrawal

Assessment (CIWA)• Central Line


4:00 – 4:30 p.m. Closing

• Q&A• 1:1 Meeting with JumpStart RN

+ Review skills & progressreport

+ Confirm email andassessment dates

Conference Room

JumpStartAgendaDAY FOUR:

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LearningStylesInventoryWELCOME TO OHIOHEALTH

As part of your orientation experience we will be discussing the learning styles that work best for you. Understanding your learning style will assist you, your preceptor, and the JumpStart team in the orientation process. Please complete this online assessment before the first day of JumpStart.

Directions for completing the Learning Styles Inventory is below.

You have been asked to complete the Learning Styles Inventory (LSI)1. The LSI is a 12-item assessment tool that identifies preferred learning styles.

TO ACCESS YOUR SURVEY ON THE INTERNET:

+ Write down your user name and password below as you will need them to log onto the site.

Username:

Password:

+ From your internet browser, go to https://surveys.haygroup.com

+ This will bring you to the Hay Group Surveys login screen. Enter your username and password exactly as they appear above.

+ Click the login button to continue, and follow the isntructions to complete your survey.

PLEASE COMPLETE YOUR SURVEY BEFORE DAY ONE OF YOUR ORIENTATION

If you have any questions regarding the survey, please contact a JumpStart team member.

Thank you for your participation.

1 Kolb, D. A. (1984). Experiential learning: experience as the source of learning and development. Englewood Cliffs, NJ: Prentice Hall.

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SampleOrienteeFeedbackReport KOLB LSI FEEDBACK1

Learning Styles Inventory: Graph 2

Learning Styles Inventory: Graph 1

1 Kolb, D. A. (1984). http://learningfromexperience.com/research_library/the-process-of-experiential-learning.


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Day One

Breakdown

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Pre-brief with Team

Time: 7:30 a.m. - 8:00 a.m.

Summary:Orientation day one team will pre-brief the days events, team assignments, course expectations, etc. Team will assist with final set-up.

Objectives:

+ Pre-brief agenda and team assignments.

+ Troubleshoot/anticipate issues and needs, etc.

+ Set-up room, sign-in area, course handouts, etc.

Opening/Introductions/Registration

Time: 8:00 a.m. - 8:30 a.m.

Objectives:

+ Complete OhioHealth forms.

+ Review the days activities and agenda as well as expectations for JumpStart.

+ Introduction of participants; Where are you today?

+ Complete online learning styles assessment if not completed.

Orientation for Simulation/ Experiential Learning Styles

Time: 8:30 a.m. - 9:15 a.m.

Summary:Participants will identify their Experiential Learning style using the Kolb LSI v3.1, and identify ways to make their learning more effective.

Objectives:

+ Learners will identify their experiential learning style.

+ Learners will identify two strategies to improve their learning based on their personal style.

+ Learners will be able to explain their educators/preceptors how they learn best.


Karen Hayes, JumpStart educator, with student

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Skills Stations

Time: 9:15 a.m. - 12:30 p.m.

Summary:Orientation day one staff will pre-brief the days events, staff assignments, course expectations, etc. Team members will assist with final set-up.

Objectives:

+ Station One: Rhythm Recognition

+ Station Two: Oxygen Therapy

+ Station Three: Waive Testing

+ Station Four: Clinical Applications


RhythmRecognitionOverview:

The process of interpreting rhythms is discussed along with sinus and atrial rhythms.

Talking Points:

+ Rhythm interpretation process: rate, regularity, P waves, QRS

+ Sinus rhythms: Normal sinus rhythm, sinus bradycardia, sinus tachycardia, sinus arrhythmia, sinus pause

+ Possible causes and treatments of each

+ How does each rhythm affect cardiac output?

+ Practice rhythm strips

+ Demonstration of synchronized cardioversion using Philips defibrillator for the treatment of SVT and A-fib.

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All oxygen adjuncts will be set out on a table for learners. There will be extra types of 02 equipment that will not be needed in the case study:

The instructor will begin reading the case study. The learners will guide the scenario. The instructor will cover each 02 adjunct as they pick them. The scenario may not go in this order. Press on the manikin’s pulse to change the sats from high to low.

Learner 1:

+ Recognize that venti mask is needed (RN will demonstrate use of the venti-mask and set it up using the various pieces in the bag and set the LPM on the flow meter)

Learner 2:

+ Recognize the need for a change in oxygen therapy and initiate 02 at 100% non-rebreather mask (RN will demonstrate use of non-rebreather mask and number of LPM. They should include that bag will fill with oxygen)

Learner 3:

+ Discuss oxymizer (not appropriate for acute illness because of the expense) goes up to 12 LPM = 82% (great for patients that have chronic illness and will need lots of 02 for long periods of time [viz. COPD, hospice, lung/heart transplant])

Learner 4:

+ Demonstrate use of high flow oxygen set-up

Learner 5:

+ Verbalize reasons and need for use of an aerosol mask (e.g. moisture, weaning, loosen secretions)

+ Set up aerosol mask but discuss that respiratory needs to do this for infection control purposes

Talking Points:

+ PSA can’t regulate 02 flow - it’s a medication!

+ Think about the underline reason (i.e. diagnosis) the patient needs 02 and what you can do for treatment

+ Most admission order sets has “wean 02 to keep sats above 88 or 92% (whatever is normal for your patient)”, that means to wean up AND down

+ Include appropriate times to call MD & RT


OxygenTherapy

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Running Controls

+ Controls are to be run on each unit machine once every 24 hours after 1am (on night shift) by the PSA. If there is no PSA on duty, the RN will need to perform this function. If you see the warning – “Run QC immediately” this means you must run “Hi” and “Lo” control checks before the meter can used.

+ Control solutions are good for three months after opening. Control solutions must be marked with opening date. Test strips are good until the manufacturer expiration date – Note: Do not expose test strips to moisture, light, or leave the bottle open.

Entering a Patient’s ID without an Admission Number

+ Enter the patient’s last name and first initial using the alphabet keypad for the patient’s ID if they have no admission number.

+ Enter VSTR if the patient is a visitor.

+ Enter STFF if the patient is a staff member.

Cleaning the Machine

+ If the machine becomes soiled use preapproved disinfectant/alcohol; attempt to avoid using on window. If it is necessary to clean the window, use cleaner then wipe off with water and dry with a 2x2.

+ Make sure the machine is thoroughly dry before putting it in the base unit.

Downloading the Meter

+ Meters should be downloaded every twenty-four hours by PSAs after 1 a.m. If there is no PSA on duty, the RN will need to perform this function.

+ Downloading base versus charging base (review stickers that mark this).

+ Always make sure that meter is in the base with the green light on = which indicates charging when not in use.

+ Battery life of the meter is highly variable and depends on the length of use. Best practice is to always place meter back on charging base after use.

Problems with Meter

+ Stickers on front of meter identify who to call if there are problems with the meter, such as repairs (Note: This is usually a lab person, and not bio-med).


BloodGlucoseMeter

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Entering Comment Codes

+ Comments must be added when a control failed, the patient result is considered critical* and if the test result was repeated, to identify which result should be downloaded, so that the patient won’t be charged for more than one result.

+ *Critical Values:

Adults: <40 or > 400mg/dl.

Neonates: <40 or >145 mg/dl.

+ You may enter up to three comments at a time using the comment screens or customize it using the alphabet keypad.

Procedure: Quality Controls

+ Step 1: Verify that the three month open and expiration date are on the control vials

+ Step 2: Each time controls are performed, a “High” and “Low” control must be done on each machine being used.

+ Step 3: Scan when you can – barcodes on ID badge, control vials, test strip vial, etc.

+ Step 4: Insert strip in meter at the prompt.

+ Step 5: Dose strip with control solution when seeing a hanging drop by touching the curved side to a drop of control solution

+ Step 6: Add comments when results are displayed – pass (controls OK); fail (repeat test; user error, will replace controls, etc.)

Procedure: ACCU-Chek Inform

+ Step 1: Review steps to obtain blood glucose up to the blood collection step.

+ Step 2: Wristband scanning– discuss EPID check of patient ID which requires the operator to identify they have entered the correct patient – Touching “No” to this screen will return the user to the patient ID entry screen so the correct ID may be entered.

+ Step 3: Show scanning of employee badge (clock # on back of badge, not OPID on front of badge).

+ Step 4: Show correct use of lancets (side finger approach) and application of blood to the test strip.

+ Step 5: Wipe away 1st drop blood.

+ Step 6: “Comfort Curve” strips, side approach, must be fully loaded (no yellow visible) for accurate reading.

+ Step 7: Practice turning meter off by quickly hitting purple button. It should be turned off before returning to the

base.

BloodGlucoseMeter

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Documentation

+ Where: Diabetes Flowsheet on HED (Horizon Expert Documentation)

+ When: After obtaining blood sugars.

Participants complete the following

+ Return demonstration of one quality control test (either high or low)

+ The quiz that associates must pass is online in the Learning Module System. Once new associates have completed the classroom return demonstration, instructor is to grade the course in the LMS as soon as possible.

Policies

+ Riverside Methodist Hospital : #82-09-R

+ Grant Medical Center: #82-06-G

+ Grady : Blood Glucose Monitoring

+ Doctor’s: #21a


BloodGlucoseMeter

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BloodGlucoseChecklist

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1. You need to perform a glucose test on a person that does not have an admission number. What do youenter in the patient ID field?a.) Whatever is fastest to enter. c.) VSTR if the patient is a visitor, STFF for an associate.b.) The patient’s last name and first initial. d.) Both B and C are correct.

2. How often are liquid controls run?a.) Both levels every 24 hours after 1 am. c.) Whenever you get around to it.b.) Mondays and Thursdays. d.) I didn’t know we ran controls.

3. Your level 2 control fails. What do you do?a.) Check the opened expiration date and c.) First A then if it still fails, B. rerun the control. b.) Try again with a different control vial. d.) Put the meter back, someone else can deal with it.

4. How frequently are the meters to be downloaded?a.) Once a week c.) Only when the meter locks me outb.) At least once every 24 hours, but more d.) Once a month often is better.

5. The meter drops on the floor and a piece falls off, who do you call?a.) Ghostbusters c.) The contact person listed on the front of the meterb.) Clinical Engineering d.) The purchasing person for my department

6. The meter has blood smeared on it. What do you do?a.) Call the number listed on the meter. c.) Clean it with alcohol or disinfectant, making sure it is dryb.) Let it soak in a sink of water. before downloading or charging it.

d.) Call Environmental Services.

7. A comment needs to be added to the test result in the following situation(s):a.) A control failed or the patient result is c.) Comments are never needed. considered critical. b.) Both a and d d.) The test was repeated and the first result should be charted.

# Correct out of 7 __________ Passing score is 6 correct

By signing below, I verify that I have been trained and am competent to perform blood glucose testing using theAccu-Chek Inform glucose meter. I verify that I have read the procedure, and acknowledge that it is my responsibility to renew competency validation annually.Signed: Date:

I have observed this individual performing a glucose level determination using the Accu-Chek Inform glucosemeter, and consider this person competent to perform the procedure.Signed: Date:


BloodGlucoseCompetency

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Procedure: Quality Controls - HemaPrompt©

+ Step 1: The developer for the HemaPrompt© is added to the test card by slowly and smoothly pulling the long silver tab

+ Step 2: A positive control is determined by the presence of a blue check mark which idicates that the test card is working.

+ Step 3: The negative control is indicated by a white background and/or a pink check mark.

+ Step 4: If a blue check mark fails to appear, get a new test card and repeat the test.

Procedure: HemaPrompt Patient Test

+ Step 1: Apply a thin smear of stool or gastric specimen from two different areas using both ends of the applicator stick to each of the windows on the test card. More than one type of specimen can’t be tested on the card at the same time(i.e. both specimens must be fecal or gastric).

+ Step 2: Slowly and smoothly pull the silver tab to add developer.

+ Step 3: After adding developer wait sixty seconds before reading results.

+ Step 4: A positive patient test result is determined by viewing blue coloration in the test area

Documentation

+ Where: Nursing flow sheet and/or PSA charting flow sheet HED (Horizon Expert documentation system) -- Riverside, Grant, Doctor’s, and Dublin

+ When: After obtaining test results

Participants complete the following:

+ Return demonstration of HemPrompt testing using a canned dog food sample

+ Quiz is on-line in the LMS. Once new associates have completed the classroom return demonstration. Instructor is to grade the course in the LMS as soon as possible.

Policies:

+ Riverside Methodist Hospital: #85-06-R

+ Grant Medical Center: #86-07-G

+ Grady : Hemoccult Slide for Occult Blood

+ Doctor’s: #21.20


Fecal&GastricOccultBloodTest

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1. What specimens can be tested on the HemaPrompt FG test card?a.) Fecalb.) Sputumc.) Gastric d.) a and be.) a and c

2. How is the developer added to the test card?a.) Slowly and smoothly pull the silver tab.b.) 2 drops from developer dropper bottle.

3. After adding developer wait before reading results.a.) 30 secondsb.) 60 secondsc.) 2 minutesd.) 3 minutes

4. The internal positive control is determined by the presence of a blue check mark.a.) Trueb.) False

5. The negative control is indicated by a white background.a.) Trueb.) False

6. How positive is a patient test result determined?a.) A blue check mark on right side of test card.b.) Blue coloration in the test areac.) No color in the test area

7. What action would be taken if the positive internal monitor fails to appear?a.) Collect a new specimen and repeat testb.) Get a new test card and repeat test

8. Can more than one type of specimen (eg gastric and fecal) be tested on same card?a.) Yesb.) No


Fecal&GastricOccultBloodQuiz

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Date: __________________________

Name: ______________________________________________________ Clock #: ______________________

Unit/Location: _______________________________________________ Campus: ______________________

Please circle one of the following: Initial Training & Competency, 6 monthCompetency, Annual Competency

By signing below, I verify that I have been trained and am competent to perform the occult bloodprocedure. I verify that I have read the procedure, and acknowledge that it is my responsibility to review the procedure and renew competency validation annually.

Name: ________________________________________ Date: _____________________

I have observed this individual perform the occult blood procedure, and consider this personcompetent to perform this procedure.

Trainer: _______________________________________ Date: _____________________

© OhioHealth Inc. 2014. All rights reserved.


Fecal&GastricOccultBloodCOMPETENCY

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Clinical Applications covers the basic use of Horizon Expert Documentation (HED) to include the initial assessment, head to toe assessment, medication reconciliation, care plans, allergies, health history and passing

Day One: Familiarization with Care Organizer and Flowsheets to include basic charting and error correction. A basic health history is also completed.

JumpStart orientees being trained on clinical applications


ClinicalApplications

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Lunch on your Own

Time: 12:30 p.m. - 1:15 p.m.

Tour and Introduction to Simulation

Time: 1:15 p.m. - 2:00 p.m.

Objectives:

+ Familiarize orientees with simulation ground rules, expectations and equipment

+ Review adult learning principles and applications to JumpStart

+ Explanation and orientation of Standardized Patients

Simulation and Debriefing Exercises

Time: 2:00 p.m. - 4:00 p.m.

Simulation and Debriefing Exercise 1: CHF Scenario: Orientees will observe patient with mild CHF symptoms and respond to patients condition. Included in this scenario is the evaluation of patient’s readiness for discharge and a review of CHF readmission protocols (STAR Initiative).

Simulation and Debriefing Exercise 2: Assessment: Wound Management Scenario: Orientees will be given the opportunity to respond to a dementia patient complaint. Included in this scenario are pain management, skin assessment, and wound care.

Closing / Q&A

Time: 4:00 p.m. - 4:30 p.m.

Objectives:

+ Identify take-homes

+ Answer questions

+ Plus/Delta


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FOR EDUCATORS

Introduction: Jamie JumpStart is a 55 year old patient on a medical surgical floor. Jamie has a history of HTN and MI with cardiac stent placement. Jamie was diagnosed with CHF 1 year ago and has an EF of 28%. Jamie was brought in several days ago with complaints of dyspnea and a weak cough. Jamie is stabilized and is ready to go home. The Orientees are to discharge the patient. The Orientees will enter into the room and find the patient with slight short of breath (SOB). There will be pizza box/McDonalds wrapper sitting on the bedside table. The patient will begin to complain that this is the third admission this year with these same symptoms. The patient states, “I don’t understand what is going on, why is this happening to me; why do I have to take so many meds, why do I have to eat less salt, what’s the big deal?”

Objectives: + Describe assessment findings in a patient with CHF

+ Identify educational needs of the patient

+ Demonstrate service excellence standards in communication with patient

+ Identify components of STAR initiative

Scenario Flow: + Scenario excellence standards

+ Treating all people with courtesy and respect

+ Showing care and compassion

+ Building a trusting relationship

+ Keep patient at center of what we do

Debriefing Points: + STARS Initiative (ways to prevent readmission)

+ Assessment findings relavant to CHF (see educational supplemental)

+ Congestive Heart Failure Core Measures

Simulation ScenarioJamieJumpStart,CHF

DAY ONE SCENARIO

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FOR LEARNERS

Introduction: Jamie JumpStart is a 55 year old patient on a medical surgical floor. Jamie has a history of HTN and MI with cardiac stent placement. Jamie was diagnosed with CHF 1 year ago and has an EF of 28%. Jamie was brought in several days ago with complaints of dyspnea and a weak cough. Jamie is stabilized and is ready to go home

Additional Information: + Name: Jamie JumpStart

+ Admission Diagonses: Complaints of dyspnea and a weak cough

+ Situation: Discharge patient

+ Last set of VS:

BP: 110/70

HR: 90

RR: 22

Sp02: 92%

Let us help!If you have any questions please direct them to the RN educator or preceptor working

with you during your experience.

Simulation ScenarioJamieJumpStart

DAY ONE SCENARIO

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SCENARIO INFORMATION FOR SIMULATIONIST

Vital Signs (Initial State):

BP: 110/70

HR: 90

RR: 22

Sp02: 92%

Patient History: + Hypertension

+ CHF

+ Stent

Simulation ScenarioJamieJumpStart

DAY ONE SCENARIO

Supplies Needed: + Standardized Patient

+ Computer with scanner for charting

+ Discharge sheet

+ Food wrapper

+ Computer they are charting on needs mirrored onto monitor in debrief room

Scenario Flow:

+ Wash hands

+ Introduce self

+ Being discharged

+ Identify patient

28

FOR EDUCATOR

Introduction:Taylor JumpStart is a 94 year old diagnosed with a UTI. Taylor was admitted to the hospital with a fever and an increase in confusion. Taylor is currently stable. The learner will enter the room for their hourly rounding and Taylor will be complaining with a constant message of my back hurts. When asked any questions, the patient will continue to answer with “my back hurts.” The Orientee should roll the patient to assess their back. After rolling the patient on their side, the RN should notice that the patient has a stage 2 Decubitus Ulcer. The scenario will be concluded when the Orientee stages the wound.

Objective: + Describe characteristic of wounds

+ Demonstrate wound measurement

+ Identify components of pain assessment

+ List strategies to prevent controlled analgesia errors

+ Use star technique (stop, think, act, review)

+ Select appropriate interventions to prevent, detect, and

manage wounds

Simulation ScenarioTaylorJumpstart,WoundManagement

DAY ONE SCENARIO

Scenario Flow: + Wash hands

+ Introduce self/SBAR Bedside Report

+ Assess patients back

+ Obtain pain medication

+ Assess pain

1. Subjective - pain scale

2. Objective - physical assessment, skin assessment

+ Identify pressure ulcer

+ Stage pressure ulcer

+ Notify appropriate staff

Debriefing Points: + Wound care and prevention

+ STAR technique (stop, think, act, review)

+ Review 5 Rights of medication adminstration

+ Discuss characteristics of wounds and staging

+ Discuss and demonstrate wound measurement

+ Discuss pressure ulcer prevention

29

FOR LEARNER

Introduction:Taylor JumpStart is a 94 year old diagnosed with a UTI. Taylor was admitted to the hospital with a fever and an increase in confusion. Taylor is currently stable and you have received report from Taylor’s RN who went to lunch. You will enter the room to do your hourly rounding.

Additional Information: + Name: Taylor JumpStart

+ Situation: Time to do hourly rounding

+ Last set of VS:

BP: 130/84

HR: 95

RR: 18

Sp02: 96%

MEWS: Was at 2

Let us help!If you have any questions please direct them to the RN educator or preceptor

working with you during your experience.

Simulation ScenarioTaylorJumpstart,WoundManagement

DAY ONE SCENARIO

30



BP: 130/84

HR: 95

RR: 18

SP02: 96%

Patient History: + Hypertension

+ CAD

+ MI x2

Simulation ScenarioTaylorJumpStart

DAY ONE SCENARIO



+ Moulage bed sore on patients lower back

+ Morphine

+ ID band

+ Wound packet


+ Introduce self/SBAR bedside report

+ Identify patient

+ Note that patient has bed sore

+ Note that it was not passed on or charted during admission

+ Stage ulcer

Radiology: + Chest x-ray (normal)

32

Day Two

Breakdown

33

Pre-brief with Team

Time: 7:30 a.m. - 8:00 a.m.

Summary:Orientation day two staff will pre-brief the days events, staff assignments, course expectations, etc. Team will assist with final set-up.

Objectives:

+ Review Day One successes, issues, etc.

+ Pre-brief agenda and staff assignments

+ Troubleshoot/anticipate issues/ needs / etc.


Opening and Group Assignment

Time: 8:00 a.m. - 8:30 a.m.

Objectives:

+ Review days activities/agenda

+ Where are you today? Check yourself today

+ General nursing orientation manual

+ Assign skill station groups

Note: SDS/MSA is set-up, tear down and float between stations

Skills Stations

Time: 8:30 a.m. - 12:00 p.m.

+ Station One: IV Pumps

+ Station Two: Rhythm Recognition & Intervention

+ Station Three: Perpheral IV

+ Station Four: Clinical Application & Medication Administration


34

Five learners at an IV pump with “brain” & 2 channels All 5 will return demonstrate basic Alaris© pump functions and when appropriate pull meds/ fluids from the pyxis, scan and chart in computerized charting system.

Start with step 1 and instruct all students through steps 1- 5 using the provided order sheet

Step One:

+ Review MD order for MIV

+ Select correct MIV from pyxis

+ Prime MIV tubing (with ports) with ordered fluid

+ Turn pump on

+ Choose pump mode

+ Enter 10 digit admission number. (Note: do not use medical record number). Get into the habit of using guardrail IV fluids

+ Select correct MIV on pump

+ Program pump at ordered rate

+ Load tubing – go top down and let it drop down (blue to blue)

+ Open clamps & Press start

+ Tubing expires in 96 hours –must be labeled (use right hand side) Bags are good for 24 hours –must be labeled

+ Have learners label one set of tubing with date, time, and initials

Step Two:

+ Hang a piggy back using backpriming technique – have one set of piggyback tubing

for use (demonstration with whole group first –then return demonstration by

associates on individual pumps) • Piperacillin/Tazobactam (Zosyn) 4.5g IVPB every 6 hours • Pause pump right before you connect it

+ Discuss safety/ infection reduction reasons for backpriming

The backpriming method should be used to clear incompatible medications

from the tubing- system closed • The secondary IV tubing stays connected to the primary & reduces risk of

contamination • Piggyback tubing only needs changed every 96 hours when using this

technique- make sure that it is labeled • Should not be used for medications designated as hazardous


IVPumps

35

Step Three:

+ Start insulin using PPO • INTRAVENOUS INSULIN INFUSION PHYSICIAN ORDERS

Use for patients with the following conditions; hyperglycemia; secondary to sepsis; on TPN; stress inducedhyperglycemia

Step Four:

+ Bolus patient with Insulin

+ Adding another channel: start at the top and pop it on – clicks on

+ Portless tubing

Step Five:

+ Increase insulin drip /outside of guardrails - change rate to 66 instead of 6

+ Discuss the importance of guardrails

Policy: IV Therapy: Central Ohio OhioHealth Individual Campus Nursing Policy and Procedure Committees


IVPumpscontinued

36

DAY TWO OVERVIEW: Junctional and Ventricular Dysrhythmias

Talking Points:

Junctional Rhythms: Premature Junctional Contractions and Junctional Rhythm

Ventricular Rhythm: Ventricular Fibrillation, Idioventricular, Agonal, Asystole, Pulseless Electrical Activity

+ How does each rhythm affect cardiac output

+ Possible causes and treatments of each including the 2010 AHA guidelines for each (including H’s and T’s in PEA)

+ Defibrillation only used for pulseless VT and VF

+ Practice rhythms strip and Turning Point©

Clinical Applications covers the basic use of Horizon Expert Documentation (HED) to include the initial assessment, head to toe assessment, medication reconciliation, care plans, allergies, health history, and passing medications.

Day Two: The steps for passing a medication to include completion of a medication reconciliation and getting an order from a doctor for a medication.


RhythmRecognition


37

Participants will practice peripheral IV start, use of tourniquet, as well as how to sign/date IV site.

Each participant will have one IV appendage and all supplies needed for IV insertion. The Instructor will lead learners through the process. Each learner will return demo the process.

+ Wash hands and take universal precautions

+ Inform Patient of Procedure

+ Place tourniquet to identify sight

+ Open start kit

+ Scrub for a minimum of 30 seconds with ChloraPrep. Allow the site to dry for a minimum of 30 seconds before initiating venipuncture

+ Choose and prep AngioCath™ (18g, 20g, 22g)

+ Insert AngioCath at 20 degree angle with bevel up

+ After flash advance catheter (Not Needle)

+ Attach J Loop with microclave cap to Catheter

+ Flush with normal saline

+ Apply Centurion SorbaView© Dressing to catheter

+ Date, time, and initial on dressing

+ Properly dispose of needle in sharps container

Each learner will remove their PIV and cover site.

Each learner will chart the PIV insertion in the computerized charting.

Talking Points:

+ Mask if group knows latex allergy modifications

+ Sub-Q butterfly will be available and shown to RNs but insertion will not be demonstrated.


PeripheralIV

38

Lunch on your Own

Time: 12:00 p.m. - 1:00 p.m.


Time: 1:00 p.m. -4:00 p.m.

Simulation and Debriefing Exercise 1: Acute MI / STEMI Scenario

+ Orientees will respond to a change in a stable patient where signs of MI are identified

+ Orientees will appropriately obtain a 12 lead ECG and manage the STEMI process

Simulation and Debriefing Exercise 2: IDDM Scenario

+ Orientees will be challenged with a newly diagnosed diabetic patient. The scenario includes management of glycemic control and providing patient education with the presence of a family member.

Simulation and Debriefing Exercise 3: Fall Scenario

+ Fall risk assesment, prevention, and identifying appropriate risk reduction measures are practiced in this scenario. Bedside report, purposeful rounding and identification of the need for help is practiced and observed.

Closing / Q&A

Time: 4:00 p.m. - 4:30 p.m.

Objectives:


+ Answer questions

+ Plus/Delta


39

FOR EDUCATORS

Introduction: Jesse JumpStart is a 54 year old admitted to the hospital for COPD exacerbation on a monitored floor. Jesse is stable and due to be discharged later in the day. You are coming in to answer the call light. Jesse is now complaining of chest pain rated on 8/10 with radiating pain into his/her jaw. Jesse is now anxious and diaphoretic. The RN is to start a focused assessment. Orientee is expected to call doctor and obtain a 12 Lead EKG (provided to them) and recognize that the patient is a STEMI. Scenario is now complete.

Objectives: + Identify Critical Cardiac Events (STEMI)

+ Identify Initial Management of STEMI

Scenario Flow: + Wash Hands

+ Answer Call/Introduce Self

+ Assessing chest pain • Onset/Duration • Severity • Quality • Radiation

+ 12 Lead ECG before NTG

+ Recognizing ST Elevation on Tele/ECG

+ 02 & Nitro

+ ASA

+ Frequent Reassessing of BP and pulse

+ IV Access

+ Call Physician • Rapid Response/Response Team • ASA/Plavix before they go

+ Identifying Hx

+ Chain of Command

Debriefing Points: + STEMI Protocol

+ Core Measures

+ Call for Help • Resources available/Emergency Response Roles

• Response Team/RRT • MD

+ Components of physician phone call • SBAR • Five rights • Physician name • Read back

+ Labs

1. Cardiac Enzymes

2. CPK

3. Troponin

+ Communication via Service Excellence Standards

1. Treating all people with courtesy and respect

2. Showing care and compassion in everything I do or say

3. Connecting with every person to build a trustingrelationship

Simulation ScenarioJesseJumpstart,MI/STEMI

DAY TWO SCENARIO

40

FOR LEARNERS

Introduction: Jesse JumpStart is a 54 year old admitted to the hospital for COPD exacerbation on a monitored floor. Jesse is stable and due to be discharged later in the day. You are to answer the call light.

Additional Information: + Name: Jesse JumpStart

+ Admission Diagonses: COPD Exacerbation

+ Situation: Answering call light

+ Last set of VS:

BP: 130/80

HR: 86

RR: 22

Sp02: 94%



Simulation ScenarioJesseJumpStart

DAY TWO SCENARIO

41 42



BP: 92/60HR: 110RR: 22, labored respirationsSp02: 94%ECG: NSR with ST ElevationBreath sounds: ClearBowel sounds: PresentSkin: Cool, clammy, ashen colorLOC: alert & oriented

Patient History: + COPD

+ Smoker

+ Family Hx of CAD

+ Obesity

+ High Cholesterol

Simulation ScenarioJesseJumpStart

DAY TWO SCENARIO

Supplies Needed: + Human patient simulator

+ Code cart

Scenario Flow:

+ Wash Hands

+ Answer Call/Introduce Self

+ Identify Patient

+ Performed Focused Assessment

+ Report Clinical Findings

+ Anticipate Physician Orders

+ Recognize and Start STEMI Protocols

Labs: + CPK—WNL

+ Troponin – 4.0

+ H & H – 14/42

+ Electrolytes – WNL

+ Cholesterol 288 w/ poor LDL/HDL ratio

+ Chem 7: WDL

+ ABG’s: pH – 7.36; PO2: 90; HCO3: 24

+ PCO2: 38

Radiology: + X-ray showing COPD

Physician Response:My work load is crazy right now I am trying to recall the patient. What do you suggest our course treatment should be?

+ NTG 0.4 mg Sublingual x3, Morphine IVP 4mg, ASA x2

+ 12 Lead EKG

+ IV

+ Cardiac Enzymes (CPK, Troponin)

+ Pulse Oximetry

+ O2 (2-4L via NC)

+ Cardiac Catheterization (ONLY IF RN KNOWS IT’S A STEMI)

43

FOR EDUCATORS

Introduction: Riley JumpStart is a 50 year old who is admitted to the step down unit for DKA. Riley is a newly diagnosed Type 2 Diabetic. The patient’s friend is in the room with Riley. The Orientee must ask Riley’s permission for the friend to stay. Orientee must conduct bedside report with peer and complete a Patient Assessment. Patient is due to be discharged later that day. The patient also needs diabetic counselling. The Orientee is expected to check glucose which will come back 201. The Orientee will then administer Insulin subcutaneously. The conclusion of the scenario will be after the teach back.

Objectives: + Demonstrate comprehensive bedside report

+ Identify need for patient education related to new disease process

+ Demonstrate service excellence standards in communication with the patient


+ Involving Pt in Bedside Report

+ Service Excellence Standards

+ Identifying Insulin administration

+ Review patient education concerns

1. How to give Insulin

2. Performing glucose monitoring

3. Diabetic diet education

4. Identifying s/s of hypo and

hyperglycemia, and treatments

Debriefing Points: + Communication via Service Excellence Standards

1. Treating all people with courtesy and respect

2. Showing care and compassion in everything I do and say

3. Connecting with every person to build a trusting relationship

4. Seeking to understand needs and striving to exceed expectations

5. Keeping the patient at the center of everything we do

+ Poor d/c planning

1. Start upon admission

2. Make sure resources are contacted before d/c

+ Communicating implications of new Dx

+ Prioritization

+ Indentifying resources

1. DM educator

2. Case management

3. Social work

4. Dietician

+ Insulin order sets – review with preceptor

Simulation ScenarioRileyJumpstart,IDDM

DAY TWO SCENARIO

44

FOR LEARNERS

Introduction: Riley JumpStart is a 50 year old who was admitted five days ago to the ICU for DKA. Riley is a newly diagnosed Type 2 diabetic. Riley was transferred a couple of days ago to the step down unit and is planning to go home later today. It is the beginning of your shift (0715) on Saturday. Riley’s friend is there in the room. You will start by giving bedside report, check Riley’s BS.

Additional Information: + Name: Riley JumpStart

+ Admission Diagonses: DKA

+ Last set of VS:

BP: 118/70

HR: 64

RR: 14

Sp02: 99%

Last Glucose: drawn at 2130, 140



Simulation ScenarioRileyJumpStart

DAY TWO SCENARIO

45



BP: 118/70HR: 64RR: 14Sp02: 99%

Patient History: + IDDM

Simulation ScenarioRileyJumpStart

DAY TWO SCENARIO

Supplies Needed: + Standardized Patients (2)


+ Insulin

+ Glucometer

+ 50 unit Insulin needles

Scenario Flow:

+ Wash Hands

+ Introduce Self/SBAR bedside report

+ Identify patient

+ Obtain glucose

+ Administer Insulin

+ Scan patient scan drug

Labs: + Glucose Readings:

• 130 • 135 • 124 • 139

47

FOR EDUCATORS

Introduction: Alex JumpStart is an 89 year old being admitted for a right shoulder injury. Alex is awaiting an MRI to decide the next course of action. Alex is sitting in bed and states my shoulder hurts. At the end of the assessment the standardized patient will wait for their opportunity to fall to the ground. The scenario will be concluded when Orientee calls for help.

Objectives: + Identify at risk for falls

+ Utilize appropriate safety measures to reduce falls and fall risk

+ Perform a pneumonia/flu vaccine assessment (protocol)

+ Discuss MRI safety


+ Pain assessment

+ Initiate MRI form

+ Pneumonia assessment

+ Fall safety • Put up rail • Stay at bedside

Simulation ScenarioAlexJumpstart,Fall

DAY TWO SCENARIO

Debriefing Points: + Core measures: Pneumonia

ALL patients

1. Vaccination screen done on allpatients

2. Pneumococcal vaccine assess andadminister if indicated

3. Age 65+ older

4. Chronic disease- any age

5. Given 2nd time after age 65 (2nd dosemust be at least 5 years after 1st)

6. Maximum of 2 Pneumococcal vaccines in lifetime

7. Flu vaccine (October, March) assessand administer if indicated

+ Swarm Card

+ UOR/How to report an unanticipated adverse event (JC #30)

+ Define Fall • Witnessed, un-witnessed, assisted

+ Recognize impact of falls on patient, family, healthcare

Debriefing Points continued:

+ Fall Risk Assessment (Schmid) • Mobility, mentation, elimination,

prior fall history, medication • Completed every shift • If someone falls, need to do a

post assessment

+ Identify reasons for falls and select appropriate interventions to prevent falls and follow-up actions if a fall occurs

+ Identify methods to communicate increased fall risk with other team members

+ Appropriate patient specific interventions

+ Charting Do’s (Risk MGMT) • Chart objectively and factually

(“Patient found on floor, statesshe fell.”)

• Use clear and concise language, avoid abbreviations, etc.

• Chart changes in the patientcondition/notification of MD

Debriefing Points continued: + Charting Don’ts (Risk MGMT)

• Chart emotionally or defensively • Blame, criticize, point out mistakes

of other caregivers • Alter, erase, or tamper the records • Use vague terms or abbreviations • Chart critical remarks about

patient’s personality, race, etc.

+ Record premature conclusions

+ MRI safety

+ Flu Vaccine: prevention measures, transmission, impact of influenza. (JC)

+ Purposeful Rounding • 4 P’s

48

FOR LEARNERS

Introduction: Alex JumpStart is an 89 year old being admitted for a right shoulder injury. Alex is awaiting an MRI to decide the next course of action. You are to enter the room, start with bedside report and complete pneumonia vaccine assessment.

Additional Information: + Name: Alex JumpStart

+ Admission Diagonses: Right shoulder injury

+ Situation: Assess patient

+ Last set of VS:

BP: 120/74

HR: 71

RR: 16

Sp02: 99%



Simulation ScenarioAlexJumpStart

DAY TWO SCENARIO

49



BP: 120/74HR: 71RR: 16Sp02: 99%

Patient History: + Heart valve replacement

+ Dementia

+ Fibromialgia


DAY TWO SCENARIO

Supplies Needed: + Standardized patient


+ Yellow socks

+ Yellow wrist band

+ Yellow magnets

+ MRI Safety Form

+ Computer they are charting on needs mirrored onto monitor in debrief room

Scenario Flow:

+ Wash Hands


+ Identify patient

+ Do Pneumonia vaccine assessment on PC

+ Patient Falls

+ Scenario ends with call for help

51

Day Three

Breakdown

52

Pre-brief with Team

Time: 7:30 a.m. - 8:00 a.m.

Summary:Orientation Day Three the team will pre-brief the days events, team assignments, course expectations, etc. The team will assist with final set-up.

Objectives:

+ Review Day Two successes, issues, etc.

+ Pre-brief agenda and team assignments

+ Troubleshoot/anticipate issues and/or needs, etc.



Time: 8:00 a.m. - 8:30 a.m.

Objectives:


+ Where are you today? Check yourself today

+ What to expect on the unit

+ Manager, educator, preceptor & orientee responsibilities



Skills Stations

Time: 8:30 a.m. - 12:00 p.m.

+ Station One: Rhythm Recognition & Intervention

+ Station Two: Blood Administration

+ Station Three: Safe Patient Handling & Restraints



53

DAY THREE OVERVIEW: Heart blocks

Talking Points:

+ First Degree, Second Degree Type 1 and Type 2, Third Degree Heart Blocks

+ Possible causes and treatments of each

+ How does each rhythm affect cardiac ouput

+ Practice rhythm strips and Turning Point©


RhythmRecognition

Clinical Applications covers the basic use of Horizon Expert Documentation (HED)

to include the initial assessment, head to toe assessment, medication reconciliation, care plans, allergies, health history and passing medications.

Day Three: Documentation of IV’s to include correct documentation of I&O data. A focused head to toe assessment is also completed.


54

Goal: Each participant will administer a unit of packed red blood cells.Objectives: 1. Identify components required for blood administration

• Type and cross match vs. type and screen • Consent for administering blood • Obtain supplies

• Alaris© Pump • Y blood tubing • Vital signs • Verification at the bedside • At least #20 gauge IV or higher • Normal Saline (250ml or 500ml)

• Check to see when blood is ready (blood must be hung within 30 minutes of obtaining it from the lab) • Types of blood products and reasons for administration: Packed RBC’s, Platelets, and FFP

2. Review documentation related to blood administration • Care Manager – Review Tab – Blood Bank • Care Manager – Flowsheets – Transfusion Record • Orb – use live patient (7 Yellow or OHSD – strong likelihood they have a patient with a blood product) • Esource or Care Manager – Policies and Procedures: (Transfusion of Blood Components and Management of the

Transfused Patient - P128.024) • Ask policy questions and have them locate answers:

1. Who can perform bedside verification of blood administration?

2. How long can a type and screen specimen be used for crossmatching red blood cells?

3. Perform adminstration of blood product • Prime Y blood tubing • Program Alaris© Pump using KO rate/red blood cells setting Double checks with PRBC’s

1. Blood Tag/Blood Baga. Nameb. Numberc. Expiration date

2. Patient/Blood Taga. Nameb. Number

c. Date • Spike blood • Stop saline • Set rate for blood administration • Infuse blood


BloodAdministration

55

4. Discussing troubleshooting actions with blood administration to provide patient safety • Why do you stay with the patient for 15 minutes? • What signs and symptoms do you look for to identify possible transfusion reactions? • What are interventions for transfusion reactions (refer to P&P)? • Can your patient travel with blood infusing?

REVIEW BASIC STEPS OF BLOOD ADMINISTRATION:

+ Look up type & cross

+ Check blood consent

+ Check to see when blood is ready

+ Obtain supplies • Pump • Tubing • Vitals • 2 RNs to verify blood

+ Obtain blood product (Note: timing of expiration)

+ Verify correct patient & correct product with 2 RNs

+ Chart

+ Administer blood product

+ Ask crucial questions: • Why do you stay with patient for 15 minutes • What signs & symptoms are you looking for to identify possible transfusion reactions • What are your interventions for transfusion reactions • Can your patient Travel with blood infusing


BloodAdministrationcontinued

56

Goal: To provide information and resources for Safe Patient Handling and Mobility.

Objectives:

+ Discuss the benefits of Safe Handling and Movement for associates, patients, and families

+ Identify equipment and resources available for Safe Patient Handling and Mobility

+ Discuss case scenario using lift equipment for patient transfer

+ SPHM benefits for staff and patients (2 posters)

+ Review common equipment used for SPHM: Floor Based Lift , Stand Assist Device, Air Assisted Lateral Transfer Device and Friction Reducing Device (FRD)

+ Resources available for SPHM

+ Group of five will pick a scenario from a white board and determine which piece of lift equipment would be appropriate for this patient (floor based lift and stand assist device)

+ Review of case scenario

+ Demonstration and group participation using lift equipment for selected case scenario


SafePatientHandlingandMobility(SPHM)

57

Objectives: Participants will:

1. Identify strategies to prevent the use of restraints.

Common strategies/alternatives used to prevent the use of restraints. • Comfort measures • Distraction • Bed alarm • Tolieting • Frequent checks • Frequent explanations • Close to nurses station • Evaluate tube d/c • Family at bedside • Call light within reach • Evaluate the environment and meds • Supervision • Frequent ambulation • Hide lines/tubes • Something to squeeze/ hold / fold

2. Recognize two types of restraints (activity - matching game)

Physical safety and violent and/or self destructive behavior. • Definition • Initial Orders • Ongoing Orders • Documentation

3. Discuss use of side rails for safety and when used as a restraint


Restraints

4. Apply and/or release safety restraints according tothe policy and procedure. Types of restraints: vest, soft, etc.

• Death reporting requirements • Demo/return demo of soft restraint

5. Review documentation of restraints in HED - CareOrganizer

58

Lunch on your Own

Time: 12:00 p.m. - 1:00 p.m.


Time: 1:00 p.m. - 4:00 p.m.

Objectives:

Simulation and Debriefing Exercise 1: Pre- Op Preparation/ Sepsis

+ Scenario: Orientees will have the opportunity to review surgery preparation for a patient with a complex history. During preparation the RNs will discover abnormal vital signs and an unexpected patient condition. Critical thinking will be utilized as the participants address patients concerns and condition using sepsis identification criteria and protocols.

Simulation and Debriefing Exercise 2: End of Life

+ Scenario: The role of the health care provider in managing end- of- life care measures like organ donation, processing orders and code status are practiced in this scenario. Appropriately communicating with the care team, responding to family concerns, and identifying clinician, patient and family support resources is included.

Simulation and Debriefing Exercise 3: Stroke

+ Scenario: A bedside report leads to a noticed change in patient state in this scenario. Orientees will be given the challenge of implementing the stroke assessment and protocol.

Closing / Q&A

Time: 4:00 p.m. - 4:30 p.m.


+ Answer questions

+ Plus/Delta


59

FOR EDUCATORS

Introduction: Morgan JumpStart is a 77 year old patient status post colon resection for bowel obstruction 24 hours ago. Call light triggered by patient with complaint of increased pain at surgical site. Hx DM type II, MI 6 years ago. Patient restless with dressing intact, states pain worse at site. Decreased LOC, responds only to tactile stimuli.

Objectives: + Identify early SIRS/Sepsis criteria

+ Demonstrate interventions to promote tissue perfusion in the presence of sepsis

+ Indentify interventions for stabilization/treatment of patient in severe sepsis/MODS as appropriate to practice area


+ Assess trends in key lab studies

+ Assess patient for presence of infection

+ Communicate urgency for situation to providers

+ Anticipate resources and interventions • Problem solve with complicating/

confounding distractors (limited)

Debriefing Points: + Pain assessment

+ Early recognition of SIRS/Sepsis/Severe Sepsis and aggressive treatment

+ Procalcitonin and Lactate levels in sepsis and responses

+ Sepsis alert in some campuses

+ Inadequate fluid resuscitation with initial physician call

+ Rapid decline

+ Implications of end organs dysfunction (LOC, kidneys, liver – coagulapathies, etc.)

+ Venous blood gasses

+ Hemoblobin and transfusion use in sepsis

+ R/O other possible causes (anxiety, bleeding, infection, MI)

+ Tissue perfusion • Fluid bolus • Dopa/dobutamine • Hemoglobin and transfusion use is sepsis

Simulation ScenarioMorganJumpstart,Septic

DAY THREE SCENARIO

60

FOR LEARNERS

Introduction: Morgan JumpStart is a 77 year old with a colon resection from a bowel obstruction yesterday. You will respond to a call light.

Additional Information: + Name: Morgan JumpStart

+ Admission Diagonsis: Post operative infection

+ Last set of VS:

BP: 96/60

HR: 110

RR: 22

Sp02: 99%



Simulation ScenarioMorganJumpStart

DAY THREE SCENARIO

61



BP: 96/60HR: 110RR: 22Sp02: 96%Temp: 99, jumps to 102

Patient History: + Hx DM type II

+ MI 6 years ago.

Simulation ScenarioMorganJumpStart

DAY THREE SCENARIO

Supplies Needed: + Standardized Patient with bloody

dressing on foot

+ Standardized Patient with IV in AC


+ IV pump

+ IV tubing

+ .9 NS

+ Thermometer



+ Identify Patient

+ Assess pain

+ Assess dressing site and check vitals x2

63

FOR EDUCATORS

Introduction: Alex JumpStart is an 89 year old who has a history of a fall which caused a subarachnoid bleed. Alex is currently unresponsive is currently on O2 at 100% NRB. There is one family member in the room with the patient. The doctor has just made Alex a DNR-CC and hands the RN the orders. The family member asked, “Is he/she in pain?” The Orientee will check orders and administer Morphine. The family member asks the RN, “Can he/she hear me?” and “What would you do if this was your parent?” The RN will attempt to or answer the questions and the scenario will end.

Objectives: + Demonstrates service excellence standards to patient and family members

+ Identify needs of dying patient and family members

+ Differentiates between the different types of code statuses Scenario Flow: + Wash Hands

+ Communication via Service Excellence Standards • Treating all people with courtesy and

respect • Showing care and compassion in

everything I do and say • Connecting with every person to build

a trusting relationship • Seeking to understand needs and

striving to exceed expectations • Keeping the patient at the center of

everything we do

+ Utilizes resources • Chaplain • Social Work • Case Manager

Debriefing Points: + Types of advanced directives

• Living will • Durable power of attorney for healthcare

+ Code Status • DNR-CC, DNR-CC Arrest (refer to back of order sheet)

+ Death by Fall • Involvement of risk management

+ Organ and Tissue donation- Role of Chaplain/Designated Requestor

+ Role of chaplain • LOOP • Death certificate • Calling funeral homes • Call family

+ Hope in Remembering packets

Simulation ScenarioAlexJumpstart,#2EndofLife

DAY THREE SCENARIO

64

FOR LEARNERS

Introduction: Alex JumpStart is an 89 year old who has a history of a fall which caused a sub arachnoid bleed. Alex is currently unresponsive on 100% NRB. There is one family member in the room with the patient. The doctor just left the room and handed you a set of orders that includes Morphine 4mg IV every hour, discontinue monitor, and change code status to DNR-CC.

Additional Information: + Name: Alex JumpStart

+ Admission Diagonsis: Initial right shoulder injury that caused a fall resulting in head bleed

+ Situation: Enter the room and clarify the Doctors orders




DAY THREE SCENARIO

65



BP: 54/36HR: 40RR: 8Sp02: 85%

Patient History: + Heart valve replaced

+ Dementia

+ Fibromyalgia


DAY THREE SCENARIO

Supplies Needed: + Human patient simulator

+ Standardized Patient for family member

+ Allergy band

+ NRB on human patient simulator

+ DNR-CC form filled out

+ Hope in Remembering packets



+ Take orders from doctor

+ Administer Morphine

+ Answer questions from family

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FOR EDUCATORS

Introduction: Vic JumpStart is a 65 year old who was admitted for uncontrolled HTN. The Orientee will be conducting a bedside report with a peer. During the bedside report the reporting nurse will notice that the patient has an obvious deficit that was not present the last time she check on them at 0500. The time now is 0730. The patient will be presenting as aphasic with right-sided weakness. The Orientee will be expected to find out the time of last known normal rule out any mimics(e.g. glucose check). Initiate Stroke protocol, and call for help. At that time, the scenario will end.

Objectives: + Identifies critical neurological changes in patient’s condition (CVA)

+ Performs neurological assessment. Initiates use of appropriate resources

+ Demonstrates effective communication using SBAR when giving report


+ Initiates bedside report

+ Recognizes changes in neuro status

+ Neuro assessment • FAST

+ Accu-Chek©

+ Notices change in B/P

+ Notifies physician of status change

+ Notices tele change

+ Initiates response/STROKE alert

+ Chain of command

Debriefing Points: + STROKE Alert

+ FAST; face, arm, speech, time

+ MEWS

+ Bedside Report

Simulation ScenarioVicJumpstart,CVA

DAY THREE SCENARIO

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FOR LEARNERS

Introduction: Vic Jumpstart is a 65 year old who was admitted for uncontrolled HTN. You will start by conducting a bedside report with one of your peers.

Additional Information: + Name: Vic JumpStart

+ Admission Diagonsis: HTN

+ Situation: Patient has been without complaints all night

+ Last set of VS:

BP: 160/90

HR: 66

RR: 16

Sp02: 96%



Simulation ScenarioVicJumpStart

DAY THREE SCENARIO

69



BP: 188/102HR: 90RR: 16Sp02: 95%

Patient History: + HTN

+ A-fib

+ TIA

Labs: + All labs were WNL

+ 12 lead ECG showing A-fib

Simulation ScenarioVicJumpStart

DAY THREE SCENARIO


+ Accu-chek© Inform machine

+ 12 lead ECG, A-fib



+ Notice change in patient status

+ Accu-chek© Inform

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Day Four

Breakdown

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Pre-brief with Team

Time: 7:30 a.m. - 8:00 a.m.

Summary:Orientation Day Four team will pre-brief the days events, team assignments, course expectations, etc. The team will assist with final set-up.

Objectives:

+ Review Day Three successes, issues, etc.

+ Pre-brief agenda and staff assignments

+ Troubleshoot/anticipate issues/ needs / etc.



Time: 8:00 a.m. - 8:30 a.m.

Objectives:


+ Where are you today?

+ Mid-point and end-point assessments



Skills Stations

Time: 8:30 a.m. - 12:00 p.m.

+ Station One: Rhythm Recognition & Intervention

+ Station Two: Defibrillation

+ Station Three: Central Line Dressings & Blood Draws



73

DAY FOUR OVERVIEW: Heart blocks

Talking Points:

+ Discussion of pacemaker functions and types

+ Practice rhythm strips and Turning Point©

+ Demonstration of transcutaneous pacing using the Phillips© defibrillator

Objectives:

1. Define assigned roles during a code blue situation • Mini code blue scenario will be performed; followed by debriefing – focus on defibrillation (compressions,

bagging, code cart, calling a code, running errands)

2. Review basic principles of defibrillators • Monophasic vs. Biphasic • Phillips© vs. LifePack© • Current AHA standards for defibrillation

• 200 joules for newer biphasic defibrillators; some recommend 150 • 360 joules for older monophasic defibrillators

• Defibrillatable rhythms: pulseless Vtach and Vfib • Defibrillation vs. Cardioversion

3. Discuss actions to provide for the safety of the patient and the healthcare team during defibrillation • Remove oxygen away from patient or turn off • � Ensure safety of patient and code team participants • � All medication patches should be removed from the torso • � Make sure that patient is on a dry surface without any water, blood, urine or IV fluid on the floor or bed that • could contact the patient or healthcare team • � Patient skin should be dry • � Make sure there is correct pad placement and adherence • � Never place pads or paddles over electrodes, pacemakers or ICDs • Inspect cables for damage, cracks, or fraying • “All Clear” should be loud and assure that no one is touching the patient or bed • Charge paddles after positioning on the chest for safest delivery (hands free is best practice)


RhythmRecognition

DefibrillationStation

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4. Demonstrate safe defibrillation using monophasic and/or biphasic defibrillator • Associates will rotate around Sim Man and perform defibrillation (someone bagging, compressing, using

defibrillator; looking at Code Blue record)

5. Demonstrate cardioversion using monitors – display SVT

6. Discuss the components of the defibrillator safety check (completed by the charge nurse)

A. INSPECTION • Step 1: Inspect the physical condition of the defibrillator

• Case and controls are clean and in good condition • Supplies available: monitoring electrodes and ECG cable, defib pads, hands free pads and cable, pacing

pads and cable, recorder paper

• Step 2: Inspect cables for damage, cracks, and fraying • Power cords, ECG cable, hands free cable, pacing cable, defibrillator paddle cables

• Step 3: Inspect power supply • With the unit plugged in AC outlet – Verify BATT CHRG • Indicators and AC power indicators are illuminated

• Step 4: Inspect paddles (include pediatric paddles) • Paddles, assemblies, and plates are clean, not pitted, or damaged

• Step 5: Ensure recorder has paper

B. TESTING • Step 1: Remove defibrillator power cord for AC outlet

• Test on battery

• Step 2: Turn power to monitor position • Confirm the display iluminates

• Step 3: Depress the RECORD button • Ensure the recorder runs; and time and date are correct

• Step 4: Ensure that Prevention Maintenance (PM) is not due by checking the PM tag

• Step 5: Document check on defibrillator checklist


DefibrillationStationcontinued

75

DOCUMENTATION:

+ Where: Defibrillator safety checks will be documented on a log maintained by the unit management on each floor.

+ When: Defibrillators will be checked per policy, (i.e. every Monday, Wednesday, and Friday by nursing staff).

+ Biomedical Equipment staff will perform a monthly “charge test” and document on the same equipment log utilized by the nursing staff.

+ Biomedical Equipment Staff will conduct performance inspections every six months.

5 LEAD ECG PLACEMENT

1. Identify sites for 5 lead ECG placement • Snow over grass (white/green); Smoke over Fire (black/red); Chocolate close to my heart (brown)

2. Discuss troubleshooting techniques for 5 lead ECG • Leads changed • Artifact/ Movement

Work with preceptor on unit to learn monitors: • Pacer/AICD • Checking monitor limits (alarm fatigue) • Check alarms • Change gain


DefibrillationStationcontinued

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TAKE THIS TO YOUR UNIT. FIND YOUR CODE CART AND FILL IN THE BLANKS BELOW.

Location of Code Cart: ________________________________________

Location of Defibrilator: ______________________________________

Type of Monitor: Monophasic / Biphasic

Amount of Joules Used to Defib: _______________________________

Type of Pads: _______________________________________________

Type of Defib Used: Hands Free / Paddles


UnitBasedDefibrillationInformation

need more info?

Talk to your Preceptor and Educator!

Your unit may differ from the equipment used in JumpStart, please use this form and discover what you will use on your unit.

77

CARE OF, DRESSING CHANGE, BLOOD DRAWS & REMOVAL

All 5 learners will have a central line site – Varies between IJ, SC, or PICC x2

Each learner will have a dressing change kit (CVC & PICC)

Talking points include:

+ Review insertion checklist

+ Best practices to prevent CLABSI: • Recognize daily review criteria • Importance of cleaning port sites (15 sec scrub or Swab Caps) • Chlorhexidine Gluconate Baths (detailed education done with preceptor on the unit)

+ Femoral Lines: • Should be avoided unless other sites are not available or in emergent situations • Discuss with the physician the need to replace the catheter ASAP (no longer than 48 hours) • Activity restriction: Bedrest

+ Blood cultures should not routinely be drawn from central venous catheters

The instructor will guide the group step by step through the following procedures;

DRESSING CHANGE:

+ Change transparent dressing every 7 days or PRN if non-occulsive, damp, or soiled

+ Change gauze dressing every 48 hours or more frequently if non-occlusive, damp, or soiled • Apply non- sterile gloves and mask and have patient turn head away from dressing site. If patient is unable

to keep head turned away from site, cover patient’s nose and mouth with a mask. • Remove old dressing • If securement device is to be changed, wash hands and apply sterile gloves. Place foam strips from package

over catheter to hold it securely in place, then changed securement device • Assess site. Note any of the following: redness, swelling, drainage, tenderness to palpation. • Remove gloves • Wash hands • Apply sterile gloves • Cleanse skin around exit site with chlorhexidine gluconate 2% in a back and forth motion for at least 30

seconds • Allow to air dry for 30 seconds if skin was dry • If skin was moist before applying chlorhexidine gluconate, scrub area for 2 minutes, then allow to dry for 2

minutes • Apply skin prep • Chlorhexidine gluconate is friction- activated. Back and forth scrub is necessary. Drying is crucial for

antimicrobial action • Apply new securement device • Apply transparent dressing with notched portion around catheter to seal area and maintain an occlusive

dressing • Document date, time, and initial dressing


CentralLines

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BLOOD DRAW:

+ Blood draw includes tube labeling and correct patient identification demonstration

+ Blood cultures should not routinely be drawn from central venous catheters Avoid drawing coagulation studies from lines with heparin infusing. (Heparin adheres to the internal lumen). • Wash hands • Stop all IVs running through any lumen for approximately one minute prior to drawing blood

• Prior to lab draw from patient with TPN infusing, stop TPN. • Flush TPN lumen and lumen to be drawn from with 10ml normal saline each • Allow TPN to remain off for 2- 5 minutes prior to starting lab draw procedure, which prevents inaccurate labs.

+ Identify patient using name and birth date

+ Put on gloves

+ Cleanse injection cap with alcohol pad for at least 15 seconds Or, remove SwabCap® if present (If a SwabCap® was on and in place at least 5 minutes, it is not necessary to scrub with an alcohol prep pad)

+ Vacutainer method: • Connect Luer Lok Access Device© to injection cap • Insert yellow- top tube into Luer Lok Access Device© • Push tube into luer adapter until blood is noted in tube • Fill tube half way with blood (5ml of 10ml tube) • Remove discard tube (this is your waste) • Insert new lab tube and repeat until all labs are drawn • Remove Luer Lok Access device©

+ Cleanse cap with alcohol swab for at least 15 seconds, allow to dry and then flush with 20 ml normal saline and remove syringe

+ Restart infusions or clamp catheter

+ Apply new SwabCap®

+ Label specimen with the date, time, and nurse clock number at the bedside

+ Place in specimen bag before leaving room


CentralLinescontinued

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REMOVAL: + Obtain physician’s order to remove line + Wash hands + Place patient in supine position with head of bed flat or in slight Trendelenburg position if patient can tolerate.

Note: The lower the site of entry below the heart, the lower the pressure gradient and less likelihood of a venous air embolism).

+ Ask patient to turn head away from catheter. + Apply non-sterile gloves, mask and goggles + Remove old dressing + Assess site + Wash hands + Open sterile packages and apply sterile gloves + Clean site with Chlorhexidine Gluconate 2% + Remove sutures (if present) + Instruct patient to exhale and hold breath as catheter is withdrawn. + Withdraw catheter in one continuous motion and examine catheter for intactness Immediately apply pressure

to exit site for 2- 5 minutes or until hemostasis has occurred + Apply petroleum based ointment and a sterile gauze dressing to seal the skin to vein tract + Apply transparent dressing in kit over sterile gauze to create an occlusive dressing. + Assess patient for signs of complications: air embolism, pneumothorax, bleeding (air hunger, wheezing,

dyspnea, and decreased breath sounds) + Leave occlusive dressing in place for 24- hours

Procedure for the Insertion, Removal and Care of Peripherally Inserted Catheters (P.I.C.C.)34- 06- RCentral Venous Catheters (excluding implanted ports and peripherally inserted central catheters)P- 128.008


CentralLinescontinued

80

Clinical Applications covers the basic use of Horizon Expert Documentation (HED) to include the initial assessment, head to toe assessment, medication reconciliation, care plans, allergies, health history and passing medications.

Day Four: The administration of a pain med to include getting the med

from the pyxis, using resources to answer any questions (dilution, how fast to push, when reassessment should be accomplished) and completion of a pain assessment/reassessment.

New Nurses learning policies in the Clinical Applications station.



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Lunch on your Own

Time: 12:00 p.m. - 12:45 p.m.

Basket of Questions

Time: 12:45 p.m. - 1:45 p.m.

Objectives:

+ Review questions and topics from the week’s participants led by the preceptor


Time: 2:00 p.m. - 4:00 p.m.

Simulation and Debriefing Exercise 1: Psych/ Suicide/ Alcohol

+ Orientees will be challenged with appropriately conducting a psych-social and suicide risk assessment. Practice using the CIWA while managing a difficult patient is included

Simulation and Debriefing Exercise 2: Central Line & Pain Management

+ In this scenario orientees are given the opportunity to observe or practice management of central line including dressing change and medication administration. Responding appropriately to pain and disrrhythmias is included.

Closing / Q&A

Time: 4:00 p.m. - 4:30 p.m. + Identify take-homes + Answer questions + Meeting with orientee to discuss progress record & documentation.

Discuss orientee goals.

+ Confirm email

+ JumpStart course evaluations

+ Review unit-based orientation expectations

+ Provide contact information for orientation staff


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FOR EDUCATORS

Introduction: Sammy JumpStart is a 45 year old who was admitted for a suicide attempt by taking Tylenol™ and drinking a bottle of vodka. Sammy is currently alert and talking. There is a sitter in the room and Sammy is dressed in a blue gown. The Orientee will begin SAD assessment. During that assessment the RN should recognize the signs of withdrawal (e.g. tremors, etc.). After noticing this, the RN should convert to a CIWA assessment. During the CIWA Sammy will become more anxious, with worsening tremors and hallucinations. At this time the Orientee should administer Ativan for sedation completing this scenario.

Objectives: + Recognizes signs and symptoms of alcohol withdrawal

+ Identify management of ETOH withdraw (CIWA)

+ Initiate the suicide risk identification assessment tool SAD


+ Recognizes sign of ETOH withdrawal

+ Initiates SAD assessment

+ Complete CIWA and administers meds

Debriefing Points: + SAD Assessment

+ CIWA Assessment

+ Personal and patient safety

+ What if Sammy not Sally

+ What are some methods to de-escalate • Make connections with patient • Distractions

• Music • Dimming lights • Guided imagery

+ What to do if patient should escalate • Medication • Security • Restraints

+ Resources • Security • Additional staff • Social worker • Case management • Sitters • Future state; safety aides • Family

Simulation ScenarioSammyJumpstart,Psych

DAY FOUR SCENARIO

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FOR LEARNERS

Introduction: Sammy JumpStart is a 45 year old who was admitted for suicide attempt using Tylenol™ and drinking a bottle of vodka. Sammy is currently alert and talking. There is a sitter in the room and Sammy is dressed in a blue gown.

Additional Information: + Name: Sammy JumpStart

+ Admission Diagonses: Suicide attempt

+ Situation: It is time to do Sammy’s initial assessment and SAD assessment. The patient has symptom triggered CIWA ordered but has not needed medicated yet.



Simulation ScenarioSammyJumpStart

DAY FOUR SCENARIO

84



BP: 100/60HR: 92RR: 16Sp02: 96%

Patient History: + Alcohol abuse

Labs: + All labs were WNL

Simulation ScenarioSammyJumpStart

DAY FOUR SCENARIO


+ Blue gown

+ Sitter in the room

+ Computer for charting

+ CIWA and SAD assessment, paper version or on PC

+ Lorazepam (Ativan)



+ Start SAD assessment

+ Notice signs of withdrawlal

+ Start CIWA assessment

+ Administers medication Lorazepam (Ativan)

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FOR EDUCATORS

Introduction: Kelley JumpStart is a 71 year old who is admitted to the hospital for Pancreatitis. Kelley was previously in the ICU and received a CVC two days ago. Kelley has been transferred to the step down unit. As of now, Kelley has been stable. Both RNs are to go in for bed side report. As the RN enters the room Kelly is complaining of pain. The RN should complete a pain assessment and acknowledge Sinus Tachycardia. Administer pain medication. While giving pain medication, the orientee should recognize that the dressing is loose and needs changed.

Objectives: + Manage patient with severe pain

+ Demonstrate central line dressing change

+ Identify correct heart rhythm


+ Complete pain assessment

+ Give pain medicine

+ Change CVC dressing

+ Initiate bedside report

+ Priority settings

Debriefing Points: + Purpose of Bedside Report

+ Sinus Tachycardia

+ Priority Setting

+ RBC

Simulation ScenarioKelleyJumpstart,CVC

DAY FOUR SCENARIO

87

FOR LEARNERS

Introduction: Kelley JumpStart is a 71 year old who is admitted to the hospital for Pancreatitis. Kelley was previously in the ICU and received a CVC two days ago. Kelley has been transferred to the step down unit. As of now, Kelley has been stable. You will start your scenario with bedside report.

Additional Information: + Name: Kelley JumpStart

+ Admission Diagonses: Pancreatitis

+ Situation: You are doing bedside report. Your patients next dose of pain medicine is available.

+ Last set of VS:

BP: 130/74

HR: 126

RR: 20

Sp02: 97%



Simulation ScenarioKelleyJumpStart

DAY FOUR SCENARIO

88



BP: 130/74HR: 126RR: 20Sp02: 97%

Patient History: + ETOH Abuse

+ HTN

Simulation ScenarioKelleyJumpStart

DAY FOUR SCENARIO

Supplies Needed: + Human Patient Simulator

+ CVC on Human Patient Simulator, to push medicine

+ Dressing loose

+ Laptop with scanner

+ Pain medicine - morphine vial

+ CVC dressing change kit

Scenario Flow:

+ Wash hands

+ Introduce self/SBAR bedside report

+ Complete pain assessment

+ Give pain medication - morphine

+ Complete lab draw

+ Change dressing of sterile dressing

90

Orientee: ______________________________________________________________

Unit: _________________________ Hire/Start Date: _________________________

Preceptor: ______________________________________________________________


GeneralNursingOrientationManual

91

DIRECTIONS FOR SECTION COMPLETION

+ The orientee is to complete the Self Assessment column using the competency descriptions provided.

+ Document orientation activities by placing the DATE and INITIALS in the appropriate column when the orientee participates in and/or completes a listed clinical skill.

Orientation Activity: • Clinical Performance - The orientee provided the care or performed the skill in the clinical setting. Completed

only by preceptor observing the skill. • Learning Activity -The orientee obtained the needed knowledge about the specific care or skill through

clinical observation, discussion, class, e-learning module, article, etc.

+ Assess competency for each listed clinical skill using the following criteria: • Beginning (B) - Demonstrates limited/minimal knowledge/skill; requires maximum preceptor support to

perform the skill or deliver care. Examples: new graduate, new to specialty area, or brand new skill. • Developing (D) - Continues to build on knowledge/skill; requires coaching, assistance, and/or monitoring to

perform the skill or deliver care. • Proficient (P) - Demonstrates consistent knowledge/skill; independently performs the skill or delivery of care.

The preceptor is used only as a resource. • Performance Concern (PC) - Demonstrates a pattern of inability to safely and independently perform skill in

the clinical environment; requires constant monitoring from preceptor. Managerial notification is required. • Non-Applicable (NA) - The item has absolutely no “contextual” relevancy to the clinical practice area.

+ Document the assessment by placing initials and date in the appropriate column for each clinical skill. • Once the orientee is Proficient with a clinical skill; no further documentation is needed unless there has been

an identified deficiency. • If the orientee has not had an opportunity to perform a listed skill or participate in an orientation activity

related to the skill, address this in an action plan at the end of the orientation period. • If a “Performance Concern” is documented, supporting examples must be documented in the “Comments”

section and the manager must be notified.

If the orientee only had a Learning Activity for a listed skill, the competency assessment should be documented as either (B) -Beginning or (D) - Developing. At the end of orientation, all of the skills should have been addressed in some format or an action plan developed if the skill is not able to be assessed during clinical performance.


CoreClinicalSkills

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CoreClinicalSkills

93


CoreClinicalSkills

94


CoreClinicalSkills

95


CoreClinicalSkills

96


CoreClinicalSkills

97


CoreClinicalSkills

98


CoreClinicalSkills

99


CoreClinicalSkills

100


UnitSpecificClinicalSkills

101


UnitSpecificClinicalSkills

ADD SHEETS HERE AS NEEDED FOR UNIT SPECIFIC CLINICAL SKILLS

102


Orientee’sProgressReportThis report is to be used to capture orientation activities, progress, and evaluate the orientee’s performance on either a daily and/or weekly basis. It also functions as a tool to promote discussion between the orientee and preceptor on the orientee’s progress and the development of weekly performance goals.

Directions for Section Completion

+ The preceptor and the orientee are to collaborate and complete this report at least once a week.

+ Complete the areas at the top of the form.

+ Types of Patients: Document a brief summary of the types of patients the orientee was assigned addressing diagnoses, treatments, complications, equipment, specialty skills, etc.

+ Workload / Acuity: Document the number of patients the orientee was responsible for and indicate the overall acuity level by placing a checkmark in the appropriate box. If the orientee was just observing, place a checkmark in the shadowing box.

+ Goals: Document if the previous report’s goals were met. If not, document the reason why they were not met.

+ Indicate the orientee’s progress by placing a checkmark in the appropriate column for each assessment area using the following criteria: • Beginning (B) - Demonstrates limited/minimal knowledge/skill; requires maximum preceptor support to perform the

skill or deliver care. Examples: new graduate, new to specialty area, or brand new skill. • Developing (D) - Continues to build on knowledge/skill; requires coaching, assistance, and/or monitoring to perform the

skill or deliver care. • Proficient (P) - Demonstrates consistent knowledge/skill; independently performs the skill or delivery of care. The

preceptor is used only as a resource. • Performance Concern (PC) - Demonstrates a pattern of inability to safely and independently perform skill in the clinical

environment; requires constant monitoring from preceptor. Managerial notification is required. • Non-Applicable (NA) - The item has absolutely no “contextual” relevancy to the clinical practice area.

+ Comments: Document supporting information in the Comments section of each assessment area as needed. If a Performance Concern is documented, supporting examples must be documented in the Comments section.

+ Orientee’s Self Assessment: Encourage the orientee to identify and document things they are doing well, any areas of improvement, and needed clinical experiences.

+ Goals: In collaboration with the orientee, determine and document the next week’s performance goals.

+ Signature: Both the orientee and the preceptor sign and date the report after reviewing and discussing it.

104


Orientee’sProgressReport

105


Orientee’sProgressReport

Orientee’s Self Assessment

Identify at least two things that you did well: ______________________________________________________________________Identify at least one thing that you need to improve or gain experience with: ___________________________________________

Goals: __________________________________________________________________________________________________________________________________________________________________________________________________________________________Additional Comments: __________________________________________________________________________________________________________________________________________________________________________________________________________________________

Discussed and reviewed with orientee:Orientee’s Signature / Date: __________________________________ Preceptors Signature / Date: ___________________Orientee’s Signature / Date: __________________________________ Preceptors Signature / Date: ___________________

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108


CurrentDatabaseInformation

+ Name

+ Facility Unit

+ Start date

+ Recommended number of weeks

+ Calculated week for mid and end point assessment Scheduled and completed mid and end point

+ Actual finish date

+ Dated comments/observations

+ Mid- point notes

+ End- point notes

+ Nursing School

+ Type of program (LPN, ADN, BSN etc)

+ Additional education/certification: ACLS, PALS etc (refer to sheet)

+ Past experience as an RN (dates, Clinical service and level of care, Position)

+ Facility and unit and shift they were hired to

REVISED ORIENTATION LENGTHS

109


JumpStartFAQforManagersandEducators

WHY IS THE ORIENTATION PROCESS CHANGING?

RNs make up a large percentage of OhioHealth staff and playing a critical role in patient care, quality and safety. For this reason, ensuring the “right start” of these OhioHealth employees is critical to their long-term employment, organizational stability, and achieving a balanced scorecard. The constantly changing healthcare environment has shown us the importance of ensuring effective and efficient transition to practice among nurses with orientation budgets having increased each year, orientation length is a key component of these costs. Educators, preceptors, managers, and orientees participated in focus groups; sharing what works and doesn’t work for RN Orientation. This feedback, comments, and suggestions resulted in multiple recommendations for improving the on-boarding process. Participants said they needed hands on learning opportunities, skill assessment, and fewer Learning Management System modules during the OhioHealth onboarding process.

WHO WILL PARTICIPATE IN THE JUMPSTART?

All RN associates, new to OhioHealth, who work in the inpatient setting, will participate in JumpStart. This includes new graduate and experience RNs.

WHAT DOES THE NEW ORIENTATION LOOK LIKE?

+ There are three distinct parts to the RN Orientation Process: JumpStart week, Assessments and Unit-based orientation weeks.

+ 1. The JumpStart week consists of the following:

+ • Day One is New Associate Orientation (NAO).

+ • Day Two begins the RN Orientation JumpStart with Introduction to Experiential Learning, the orientation process and clinical applications (computer and simulation training).

+ • Day Three – Four consist of hands-on skill assessment, practice and clinical preparation.

+ 2. Assessments. The JumpStart, mid-point and end-point assessments provide a measure of orientee competence and readiness for unit-based orientation and safe patient care. Assessments assist the unit manager, educator and preceptor in developing a unique, orientee-centered experience. The skills assessed and evaluated align with the General Nursing Orientation Manual representing both clinical and behavioral basic nursing skills. The assessment results will be used to establish a baseline, track progress and confirm the final level of competence upon conclusion of the orientation. The mid-point and end-point assessment will be scheduled prior to the end of JumpStart. The dates will be included on the summary report.

+ • JumpStart Assessment. At the end of JumpStart week, orientees will have several parts of their orientation manual completed. Those skills practiced and/or demonstrated by the orientee will be checked off. A summary of clinical skills demonstrated during JumpStart, but not listed in the manual, will be provided.

+ • Mid-point Assessment. The results of this assessment will be used to drive the final weeks of the orientation. Crucial discussions and decisions about orientee progress, length extension or shortening should also be made.

+ • End-point Assessment. The results of this assessment can be used to confirm the decision to end or extend orientation and to identify supports necessary for the orientee.

110


JumpStartFAQforManagersandEducators

3. Unit-based Orientation. The JumpStart recommendations should be used to create and manage a unique unit-based orientation. The current recommended guidelines for hours/weeks of the unit-based orientation are as follows:

NOTE: The Director can extend orientation by one week, and any extensions beyond one week need approval by the CNO.

WILL NEW GRAD HIRES BE MIXED WITH EXPERIENCED RN NEW HIRES?JumpStart provides a safe, structured clinical environment to practice and demonstrate skills. Although the experienced RNs may find some skill stations a review, they will benefit from observing others with varying practice levels. The new graduates may learn from observing the experienced RNs. All JumpStart participants will be given the opportunity to learn OhioHealth procedures.

WILL PER DIEM AND TRAVELERS CURRENTLY PARTICIPATE IN JUMPSTART?At this time, they will not be required to participate in JumpStart.

THE REDUCED PRECEPTOR/ORIENTEE ASSIGNMENT WILL AFFECT MY PRODUCTIVITY. HOW CAN IT BE IMPLEMENTED?Evidenced based research has shown reducing the preceptor patient assignment during the first few weeks supports more effective and efficient new hire onboarding. The preceptor will have time to communicate with the orientee, better observe their competency level, and build the necessary orientation experiences. If the orientee is given the time to interact with their preceptor more closely in these first few weeks, their transition is improved and they will be able to complete orientation faster. Directors and managers will need to identify methods to implement a reduced preceptor patient assignment.

111

References

Zigmont, J.J, Kappus, L, Sudikoff, S.N. (2011a) Theoretical Foundations of Learning Through Simulation. Seminars in Perinatology, 35 (2), 47-51

Zigmont, J.J, Kappus, L, Sudikoff, S.N. (2011b) The 3D Model of Debriefing: Defusing, Discovering, and Deepening. Seminars in Perinatology, 35 (2), 52-58

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Environment

Learner Experience• Well-Tuned

LearningOrientation

• Mental Models• Analogical

Reasoning

• Simulations• Patients• Positive and

Negative

• Skilled Mentors• Equipment/Location• Policies

ImprovedPatient

Outcomes

Learning Outcomes Model, Zigmont et.al, 2011a

jumpstart€¦ · after each jumpstart session. ... on the unit by a 3rd party assessor (not the...

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