SC Ports & Telephone Orders Flashcards
What are key elements in the process of receiving telephone orders?
- Organization
- Accuracy
- Critical thinking and judgement skills re: communicating relevant pt information
When are times we might need physician orders via the phone?
- New patient admit to ward
- Serious change in patient’s condition
- Patient needs a med that is outdated and has not been reordered
What are the seven steps of telephone orders?
1) Prepare before placing the phone-call (anticipate physician needs, have relevant data ready)
2) Identify hospital, ward and yourself at beginning of call
3) Identify the patient (with enough information to identify particular pt, give brief history pertinent to call [e.g. reason for admission, major health problems])
4) State current patient problem and request clearly and concisely
5) Write all orders given on scrap paper
6) Repeat orders back to physician (ensuring it is correct; also gives physician time to review appropriateness of order)
7) Once off phone, record physicians order on order sheet
What modalities, according to physician preference, should we call?
1) Physician’s office during weekdays
2) Cell phone
3) Direct page (if known)
4) Physician’s call service
5) On weekends and after hours during the week, home phone
As a student, what should i have accumulated prior to the call? What questions should I ask?
- Have I seen and assessed patient myself before calling?
- Has siuation been discussed with resource nurse or preceptor?
- Review the chart for appropriate physician to cell
- Know admitting dx and admit date
- Have I read most recent MD progress notes and notes from nurse prior to my shift
- Ensure the following is available in front of me: chart, list of current meds, allergies, IV fluids and labs, most recent VS, lab results including date, time and previous values for comparison, and code status
What does SBAR stand for?
Situation, Background, Assessment and Recommendation
Why might a SC port be preferred for symptom management>
- Repeated injections are uncomfortable
- IV infusions can be uncomfortable, decrease mobility and make d/c home difficult and expensive
Why might we place a SC port?
- Impaired venous access
- Poor oral intake (GI obstruction, drowsiness, dysphagia)
- Increasing frequency of s/c meds
- Potentially easier for home-care
- Intractable symptoms
- Reduces peaks and troughs of med levels
What do we need to consider before initiating a port?
- What is causing symptoms? Are they exacerbated by anxiety?
- Etiology of pain
- What are the alternatives?
- Pre-existing conditions (e.g. skin or clotting disorders)
- Peripheral edema
- Is it appropriate?
- Patient preference
What do we assess prior to insertion?
- Patient or family education (e.g. method of administration, troubleshooting)
- Safety (site selection appropriate)
- Resources available
- Patient comfort
- Place patient in comfortable position
- Select appropriate, comfortable site and expose site
- Hand hygiene
- Cleanse area with CHD 2% with alcohol 70% 60 seconds to dry
How do we insert?
1) remove plastic sheath covering needle
2) Grasp wings and hold together, ensuring bevel of needle facing upward
3) Grasp subcut fold of at least 1 inch between thumb and forefinger
4) Insert at 30-45 degree angle, with bevel up
5) Cover site and wings with small breathable transparent drsg
6) remove stylet with straight con’t motion
7) Change injection cap to appropriate needless injection cap
8) Apply clamp to tubing
9) Label site clearly with date and time of insertion with initials and med name/dilution
10) Document
