attestation: new employee orientation - nursing education · 2019-07-11 · attestation: new...

1 VCMC Nursing Education 805-652-6045. Revised 5/2019

Attestation: New Employee Orientation

As employee at Ventura County Medical Center & Santa Paula Hospital, I take personal responsibility not to divulge, misuse or deface any confidential information, either medical and/or institutional, that I may have access to during and following my affiliation with Ventura County Medical Center & Santa Paula Hospital.

As an employee at Ventura County Medical Center & Santa Paula Hospital I understand the expectations and standards pertaining to:

Conduct & Behavior

Dress Code

Cell Phone Use

HIPPA & Password Protection

Diversity & Integrity

Substance Use

Organization Chain of Command

Injury Reporting

Non-smoking campus

Staff Parking

Lippincott & PolicyStat

AIDET Assessment Tool

Name: ________________________________________ Credential(s): __________________

Employee ID: ____________________ VCMC/SPH Department: ___________________ Circle one

I understand the content and expectations as a Ventura County Medical Center & Santa Paula Hospital staff member. I will uphold the mission and practices while will adhering to the hospital policies.

Employee Signature_________________________________________________ Date: _____________


Competency Validation Tool: HAND HYGIENE

Self Assessment Evaluators Assessment

Level of Performance Method of Evaluation Level of Performance M- Met; able to demonstrate

expected knowledge, skills

NM-Not Met; Needs review, practice, and re-evaluation

OB= Observation RP= Review Policy SD=Simulated Demonstration T= Test V= Verbalization

M- Met; able to demonstrate expected knowledge, skills


Performance Criteria Code Code Code I. KNOWLEDGE

1. Review hospital policy “106.055 Hand Hygiene” RP 2. Verbalizes the WHO 5 Moments of Hand Hygiene V 3. States the appropraite hand hygiene agents which

may be used for specific conditions (ie. soap and water for C. Diff)

V

4. Recalls rubing time frames for soap and water and ABHR (Alochol based hand rub)

V

II. SKILL

1. Hand Hygiene with Soap & Water a. Wets hands and applies enough soap to cover

all surfaces of hands, vigorously rubs hands for at least 40-60 seconds including palms, back of hands, between fingers, and wrists

b. Rinses thoroughly keeping fingertips pointed down, Drying hands and wrists thoroughly

c. Discards paper towel in wastebasket d. Uses paper towel to turn off faucet to prevent

contamination to clean hands

SD

2. Hand Hygiene with ABHR a. Applies enough product to adequately cover

all surfaces of hands b. Rubs hands including palms, back of hands,

between fingers until all surfaces dry for 20-30 seconds

SD

3. Inspection a. No artificial nails or enhancements b. Natural nails are clean, well groomed, and

tips less than ¼ inch long

OB

III. ATTITUDE

1. Identify situations that empeed on hand hygiene performance

2. Express feelings of hand hygiene for patient and staff protection

V

Name: _____________________________________________ Credential(s): __________________

Employee ID: ________________ VCMC/SPH Department: ___________ Job Title:_____________ Circle one

I understand the content and have completed the above competency assessment. I believe that I am a competent provider of this service as a result of training, experience and/or competency verification and will adhere to the hospital policy 106.055 Hand Hygiene.


Evaluator’s Signature: ____________________________________________________ Date:______________

References: WHO, CDC


Competency Validation Tool: HAND HYGIENE

1. Artificial nails are allowed at VCMC/SPH Hospital

a. True

b. False

2. Gel nail polish is allowed at VCMC/SPH Hospital

a. True

b. False

3. Nail Polish is allowed (in good repair without chipping) at VCMC/SPH Hospital

a. True

b. False

4. Alcohol- based hand rub is effective after contact with patients with C. Difficle or their environment

a. True

b. False

5. Nails are to be kept long ( ½ inch of white visible above the quick)

a. True

b. False

6. The WHO 5 Moments of Hand Hygiene include (select all that apply)

a. before touching a patient

b. before clean/aseptic procedures

c. after body fluid exposure/risk

d. after touching a patient

e. after touching patient surrounding

7. How many seconds are needed to perform hand hygiene with soap and water?

a. 5-10 seconds

b. 10-20 seconds

c. 20-40 seconds

d. 40-60 seconds

8. After using gloves there is no need for hand hygiene.

a. True

b. False




Competency Validation Tool: RESTRAINT & SECLUSION









1. Review hospital policy “100.075 Restraint and Seclusion”

RP

1. Describes indications for restraint and difference between Non-Violent/Non-Self-Destructive Restraints, Violent/Self-Destructive Restraints and Seclusion

2. Identifies types of restraints available and criteria for each

3. Understands an order for restraints must be obtained preferably prior to application, although in emergency situations, no later than 30 minutes of implementing, including the justification and type of restraint

4. Identifies assessment, monitoring and documentation requirements for Non-Violent/Non-Self-Destructive Restraints and Violent/Self-Destructive Restraints and Seclusion

5. States the need to perform a face-to-face physical and behavioral assessment for Violent/Self-Destructive Restraints/Seclusion within one hour of initiating Violent/Self-Destructive Restraint/Seclusion

6. Understands continuation order requirements for Non-Violent/Non-Self-Destructive Restraints, Violent/Self-Destructive Restraints and Seclusion

V

II. SKILLS

1. Describes restraint alternatives (physiologic, psychological and environmental modifications) and least restrictive interventions prior to restraint application

V

2. Verbalizes the need to monitor and document Q2 hours for any signs of injury, LOC, circulation sensory and motor:

a. Perform and document Q2 hours: ROM, position change, hygiene, elimination, hydration, nutrition, and reassesses need to continue restraints

V




I understand the content and have completed the above competency assessment. I believe that I am a competent provider of this service as a result of training, experience and/or competency verification and will adhere to the hospital policy 100.075 Restraint and Seclusion.


Evaluator’s Signature: ____________________________________________________ Date:_____________








Performance Criteria Code Code Code 3. Demonstrates appropriate application of restraints

using quick release tie of limb restraints, maintaining a 2 finger gap

SD

4. Demonstrates application of a restraint vest, securing with quick release tie

SD

III. ATTITUDE

1. Engages the Patient/Family in understanding the purpose/reason for restraint, care, monitoring being provided and commitment to insuring basic rights and human dignity

2. Nurse demonstrates an attitude that incorporates a culture of safety

3. Demonstrates the use of least restrictive methods of restraints

4. Explain reason for restraint and demonstrate required nursing observation in a timely manner

V


Competency Validation Tool: STATSTRIP GLUCOSE METER







NM-Not Met; Needs review,

practice, and re-evaluation

Performance Criteria Code Code Code IV. KNOWLEDGE

1. Reviews hospital policy “108.032 Blood Glucose Testing with Nova StatStrip Glucose Meter”

RP

2. States the use of 2 patient identifiers V 3. Understands blood sample can be capillary,

arterial or venous V

4. Verbalizes quality control (QC) is conducted every 24 hours

V

5. States product used to clean meter after every patient use and docking of meter for data transfer to EMR

V

V. SKILL

1. Perform QC a. Power meter on b. Enter Operator ID on screen key pad or

barcode scan c. State how you would enter patient’s ID

number d. Scan the test strip lot number

information e. Place the test strip into the meter f. Apply solution sample g. View test data on screen; Accept or

reject the result h. Remove and dispose of the test strip

SD

VI. ATTITUDE

1. Discusses the impact of glucose sampling and mainitining aseptic technique

SD



I understand the content and have completed the above competency assessment. I believe that I am a competent provider of this service as a result of training, experience and/or competency verification and will adhere to the hospital policy 108.032 Blood Glucose Testing with Nova StatStrip Glucose Meter.

Operator ID:_______________________ (First & last initials + last 4 of SSN)


Evaluator’s Signature: ____________________________________________________ Date:_______________

PASS FAIL Achieved 100% on StatStrip Meter Test is Passing (Remediation plan must be attached for fails)


Competency Validation Tool: STATSTRIP GLUCOSE METER

1. What is the function of the StatStrip Meter?

A. To provide qualitative indication of a high

blood glucose level

B. To measure a patient’s glucose level from a

urine sample

C. To measure a patient’s blood glucose level

from a a whole blood sample

D. To diagnose diabetes

2. Erroneous results can occur when:

A. Strip are not filled on first touch

B. Strips are not stored in vial with the cap

tightly sealed

C. Strips are used after the “use by” date

D. All of the above

3. Abnormal value reading requires:

A. Retesting the same specimen

B. Retesting the same specimen unless it is

consistent with prior result

C. Using a fresh specimen from a new stick

unless it is consistent with prior results

D. None of the above

4. “Flow Errors” may occur with:

A. Extreme high or low hematocrit

B. If you touch the strip to the finger

C. Strip was not filled on first touch of blood

and was retouched to the blood again

D. All of the above

5. The meter must be flat or pointing downward

while obtaining sample.

A. True

B. False

6. When obtaing a sample from the patient you

MUST use 2 patient identifiers.

A. True

B. False

7. Which of the following apply to StatStrip

Glucose Control Solution?

A. Rotate each control solution vial before

application

B. Do not use control solution after expiration

date

C. A and B

D. None of the above

8. Meter must be cleaned and returned to the

docking station after each patient use.

A. True

B. False

9. It is important to insert the test strip all the way

into the test strip holder before testing sample.

A. True

B. False

10. The StatStrip Meter, when used with the

StatStrip Test Strips, can be used to test which

of the following blood sample types?

A. Arterial and Venous

B. Neonatal

C. Capillary

D. All of the above

11. Which of the following methods can be used for

applying blood to the test strip?

A. Heel or finger stick

B. Syringe

C. Pipette

D. All of the above

12. What cleaning solution should be used to clean

the StatStrip Meter?

A. 10% bleach solution

B. Any ammonia-based cleaning solution

C. Alcohol

D. Windex




1

Competency Validation Tool: HIGH PERFORMANCE CPR







NM-Not Met; Needs

review, practice,

and re-evaluation


1. Understands the concept of uninterrupted chest compressions

V

II. SKILLS

1. Minimally interrupted chest compression a. Place the heel of one hand on the center of

patients chest b. Place the heel of one hand on the center of

patients chest (lower third of breast bone) c. Place the heel of your other hand over the first

and lace your fingers together d. Immediately begin chest compressions with

optimal rate (100- 120 bpm) e. Perform adequate age appropraite depth ( 2-

2.4”) f. Perform full chest recoil (avoid leaning) g. Rotate rescuer on compressions every 2 min h. Perform rhythm assessement every 2 minutes i. Do not stop compressions for intubation, meds,

IV access for longer than 10 seconds

SD

III. ATTITUDE

1. Identifies the positive patient outcomes of utilizing uninterrupted chest compressions

V



I understand the content and have completed the above competency assessment. I believe that I am a competent provider of this service as a result of training, experience and/or competency verification.




Competency Validation Tool: ZOLL DEFIBRILLATOR








practice, and re-

evaluation


1. Reviews the hospital policy “100.229 Synchronized Cardioversion: ZOLL R-Series & PHILIPS Agilent XL Heartstream”

RP

2. Locates: a. Defibrillator on crash cart b. Two ZOLL OneStep™ CPR hands-free pads

or two Philips disposable conductive pads c. Cardiac lead patches

SD

3. Daily checks are to be performed according to the hospital policy “100.055 Code Blue and Crash Carts”

V

II. SKILL

1. Advisory Mode

a. Select “Defibrillator” Mode (RED)

b. Announce “Stand Clear”, stopping CPR

c. Press “Analyze”

d. Follow voice prompts and press “Shock” if recommended

SD

2. CPR Feedback a. Demonstrates steps to achieve CPR index,

performing proper rate/depth and prompting

SD

3. Manual Defibrillation a. Select “Defibrillator” Mode b. Press “Charge” c. Announce “Stand Clear”, stopping CPR d. Confirms shockable rhythm e. Press “Shock” f. Defines and adjusts energy levels

SD

4. Synchronized Cardioversion a. Select “Defibrillator” Mode b. Puts device in “SYNC” Mode c. Selects desired energy d. Press “Charge” e. Announce “Stand Clear”, stopping CPR f. Press “Shock” to deliver synchronized shock g. Demonstrates that “SYNC” Mode must be

activated for each shock

SD











practice, and re-

evaluation

Performance Criteria Code Code Code 5. Pacing

a. Select “Pacing” Mode b. Turn up pacing output (mA) until capture is

achieved-defines capture c. Adjust pace rate d. Understands 4:1 button for visualizing

patients underlying rhythm

SD

6. Pad and Paddle Check a. Select “Defibrillator” Mode b. Press “Energy Select” down to 30 joules c. Press “Charge” d. Once charge-ready tones sounds, press

“Energy Select” down to 20 joules, disarming unit

e. Press “Energy Select” up to 30 joules f. Press “Charge” g. Press “Shock” for a pad check and press

buttons on back of paddles for a paddle check

SD

III. ATTITUDE

3. Identify situations that lead to defibrillator errors 4. Identify rhythms which call for defibrillation or

synchronized defibrillation

V

I understand the content and have completed the above competency assessment. I believe that I am a competent provider of this service as a result of training, experience and/or competency verification and will adhere to the Hospital Policy 100.229 Synchronized Cardioversion: ZOLL R-Series & PHILIPS Agilent XL Heartstream.



REFERENCES: Zoll R-Series


Competency Validation Tool: STROKE

1. After admitting a patient with ischemic stroke, you note deterioration in their LOC. Select the appropriate actions. (Select all that apply)

a. Stat Finger stick Glucose. b. Place the patient in the supine position. c. Complete a FAST screen or NIHSS. d. Administer an anxiolytic.

2. Which of the following are considered stroke symptoms? (Select all that apply)

a. Sudden headache b. Vision loss c. Motor weakness in limbs d. Balance altered e. Facial droop

3. Which of the following are considered acceptable parameters for acute stroke in the management of blood pressure? (Select all that apply)

a. An ischemic stroke: permissible hypertension.

b. A TIA: permissive hypertension c. Intracranial hemorrhagic: systolic BP at or

below 140 mmHg. d. An ischemic stroke: systolic at or below 90

mmHg, diastolic at or below 60 mmHg. 4. Educational support for the TIA patient ready for

discharge from the unit includes which of the following? (Select all that apply)

a. Risk factors for stroke and signs/ symptoms. b. Call 911 for sudden stroke symptoms onset. c. Education regarding medication

prescriptions. d. Medications for stroke prevention and

follow-up with health care provider.

5. Which of the following patients may be considered eligible for endovascular treatment? (Select all that apply)

a. An acute ischemic stroke; imaging reveals a large thrombus in the middle cerebral artery. The symptom onset is two hours ago

b. An acute ischemic stroke. The symptom onset is unknown.

c. A patient experiencing new onset of stroke symptoms during one hour after admission to the unit.

d. An acute ischemic stroke with loss of vision on left eye: The symptom onset is 12 hours.

6. The door to CT scan time is 20 minutes. a. True b. False

7. The timeframe goal from door to needle IV t-PA for eligible patients is 110 minutes.

a. True b. False

8. Teleneurology (robot) is available around the clock at VCMC and SPH.

a. True b. False

9. A nurse performs the bedside swallow screen. a. True b. False

10. The timeframe goal for CT scan, labs, chest x-ray and EKG results is within 45 minutes.

a. True b. False

Score: _______10




I understand the content and have completed the above competency assessment. I believe that I am a competent provider of this service as a result of training, experience and/or competency verification.


Evaluator’s Signature: ____________________________________________________ Date:_____________

REFERENCES: Clinical Guide for GlucoStabilizer®

Competency Validation Tool: GLUCOSTABILIZER®








Performance Criteria Code Code Code

I. KNOWLEDGE 1. Review hospital policy “DM.004 Adult IV Insulin

Infusion Policy” and “DM.002 Pediatric Inpatient Diabetes and Hyperglycemia Management” if relevant

RP

2. Understands a physician order is required to initiate and discontinue application of GlucoStabilizer® software and the scope of practice

V

3. Informed of pediatric implications (2-18 yrs) V

II. SKILLS

1. Locates and logs into GlucoStabilizer® link in computer

SD

2. Performs the following functions within

GlucoStabilizer®

software:

a. Starts new drip

b. Unique patient identifier

c. Glucose entry

d. Lock program, minimize screen

e. Responds to alert

f. Modify

g. Carb coverage

h. Stop/hold system with reasons

i. Monitor drip

j. Resume drip

k. History and graph

l. Drip Weaning Repot (print)

m. Change setup

n. Log out

SD

3. Performs appropriate EMR documentation while using the GlucoStabilizer® software

SD

4. React to alerts and is able to perform troubleshooting SD

III. ATTITUDE

1. Identify benefits of utilizing the GlucoStabilizer® software

V




Competency Validation Tool: MEDICATION ADMINISTRATION (INITIAL)


Level of Performance Method of Evaluation Level of Performance

M- Met; able to demonstrate

expected knowledge,

skills


practice, and re-

evaluation



expected knowledge,

skills


practice, and re-

evaluation


I. KNOWLEDGE

1. Review of the hopsital policy “100.025 Medications:

Ordering, Administration and Documentation”;

“PH.52 Medication Handling”; “PH.70 High Alert

Medications”; PH.42 Adverse Drug Reaction

Reporting System

RP

2. States location of appropriate computer resources:

a. PolicyStat

b. Lippincott

c. Micromedex

d. Up-to-Date

V

3. Understands the critical thinking process includes:

a. Consideration of co-morbidities, organ

function, lab values, avaliable routes

b. Black box warnings

c. Understands inidications, side effects, drug

interactions, compatibility and dose limits

of administered medications

V

4. Patient education

a. Comprehends patient education is required

explaining the purpose and potential side

effects using Teach Back method for each

medication

V

II. SKILLS

1. Safety

a. States 7 Rights of Medication

Administration

b. Utlizies 2 patient identifiers with each

medication administration

c. States safe handeling, preperation and

labeling of medications

d. Understands TJC NPSG guidelines for

administration practice

e. Recognizes the need to review parameters

specific to medicaiton (labs, VS, I&O, etc)

RP,T,V





Level of Performance Method of Evaluation Level of Performance


expected knowledge,

skills


practice, and re-

evaluation



expected knowledge,

skills


practice, and re-

evaluation


f. Verbalizes the process of reporting

medication errors and near misses

g. Describes the process of reporting Adverse

Drug Reactions (ADR) according to the

hospital policy

h. Indentifies medications requiring 2 RNs:

Double check vs. indepent verification

2. Timing

a. Identifies time-critical and nontime-critical

scheduled medications in accordance to

the hospital policy

b. Identifies time requirements of time-critical

and nontime-critical scheduled medications

in accordance to the hospital policy

c. Aware of actions to be taken when

medications are not administered within

the permitted timeframe of scheduled

medications

V

3. Process

a. Understands the hospital policy of barcode

scanning compliance

b. Aware of appropriate documentation

within EMR

c. Verbalizes the process for approproaite

narcotic waste

V

III. ATTITUDE

1. Identify situations that lead to medication errors

2. Discuss feelings & attitudes related to medication

errors

V

I understand the content and have completed the above competency assessment. I believe that I am a competent provider of this service as a result of training, experience and/or competency verification and will adhere to the Hospital Policies 100.025 Medications: Ordering, Administration and Documentation; PH.52 Medication Handling; PH.70 High Alert Medications; PH.42 Adverse Drug Reaction Reporting System.


Evaluator’s Signature: ____________________________________________________ Date:______________

REFERENCES: TJC, CMS


Medication Safety and Policy Review: New Hire Nursing

1. List the “7” rights of medication administration according to administration policy 100.025

a.

b.

c.

d.

e.

f.

g.

2. Name two regulatory agencies that survey acute care hospitals and enforce medication safety.

a.

b.

3. All policies, protocols, and clinical practice guidelines must be approved by the necessary committees

prior to use or initiation.

a. True

b. False

4. A “Just Culture” is a system that finds blame in medication event reporting.

a. True

b. False

5. Which of the following are examples of how VCMC and SP Hospitals foster patient safety around the

use of medications?

a. The use of automated dispensing cabinets (ADCs; PYXIS)

b. Drug information resources (Micromedex)

c. VCMC Pharmacist available 24 hours a day, seven days a week

d. A Just Culture

e. All of the above


Employee ID: ____________________ VCMC/SPH Department: ___________________ Circle one Date: _______________________________


Heparin Infusion Protocol

1. True or False: Anti-Xa is the lab for measuring the effectiveness of heparin infusions.

2. True or False: Heparin works by breaking down clots which are already formed.

3. What is the most appropriate dose for 60 year old patient who weighs 90 kg for the treatment atrial fibrillation?

a. 5,000 units iv bolus then 12 units/kg/hr

b. 7,000 units iv bolus then 12 units/kg/hr

c. 10,000 units iv bolus then 18 units/kg/hr

d. No bolus, 11 units/kg/hr

4. Provider needs to be contacted when

a. Hemoglobin decrease by 1 mg/dL from baseline

b. Active signs of bleed

c. 2 consecutive anti-Xa that are supratherapeutic or 3 consecutive anti-Xa that are subtherapeutic

d. B and c

e. All of the above

5. Heparin infusion was initiated at 1200. The first anti-Xa level was drawn at 1800 and resulted at 1900 as 0.24

unit/mL (subtherapeutic). The rate adjustment was made at 1930. What time should the next anti-Xa level be

ordered?

a. 0000 (midnight)

b. 0130

c. 0200

d. Next morning with AM labs


Employee ID: ____________________ VCMC/SPH Department: ___________________ Circle one Date: _______________________________


Use the following table to answer question 6.

Table 1: Low Bleeding Risk

Goal anti-Xa: 0.3 – 0.7 unit/mL

Anti-Xa Rebolus or Hold Rate Adjustment Recheck Anti-Xa

<0.2 40 units/kg ↑ 2 units/kg/hr 6 hours

0.2 – 0.29 20 units/kg ↑ 1 units/kg/hr 6 hours

GOAL 0.3-0.7 NONE NONE Continue q6hr until

therapeutic x 2 then

qAM

0.71-0.8 NONE ↓ 1 unit/kg/hr 6 hours

>0.8 Hold 60 minutes ↓ 3 unit/kg/hr 6 hours

6. Patient weight = 85 kg and the most recent anti-Xa level was subtherapeutic at 0.15 unit/mL. What is the most

appropriate dose to be given as a rebolus?

a. 3400 units

b. 3000 units

c. No rebolus is necessary

d. 2000 units

7. True or False: Patients who have epidural catheter for pain management, proper timing of initiation of heparin

infusion is listed on the VCMC Clinical Practice Guideline for Anticoagulation Management surrounding Epidural/

Intrathecal/Lumbar Puncture.

8. What is the most proper action to take when preparing patient to go to the OR who is on heparin infusion?

a. Document zero rate when the infusion was turned off.

b. Discontinue heparin infusion along with future lab monitoring and PRN re-bolus doses from Cerner. This

can be done by the provider or as a TORB by the nursing staff with co-signature from provider.

c. Post procedure/surgery, it is provider’s responsibility to give new starting rate as well as new anti-Xa

goal.

d. Post procedure/surgery baseline anti-Xa results are not to be used in dose adjustment (addition or

subtraction from the new ordered rate) per nomogram when re-starting infusion.

e. All of the above

9. True or False: We can start enoxaparin right after heparin infusion is discontinued.

I understand the content and have completed the above assessment. I believe that I am a competent provider of this service as a result of training, experience and/or competency verification and will adhere to the hospital policy Anticoagulation Management.


Evaluator’s Signature: _______________________________________________ Date:______________

attestation: new employee orientation - nursing education · 2019-07-11 · attestation: new...

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