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Ireland Center Knowledge Rehab > Unit 1 - Basics of TJC Accreditation > Flashcards

Unit 1 - Basics of TJC Accreditation Flashcards

1
Q

What are the isolation categories used at COA?

(Give an example of each)

A
  • Airborne (Chicken Pox, TB),
  • Droplet (German Measles, Meningitis),
  • Contact (MRSA draining wounds, Lice)

(See Isolation Precautions Guide for an extensive list)

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2
Q

What is the PPE process for transporting a patient on contact isolation?

A

Airborne or Droplet Precautions: The patient must wear a surgical mask during transport

Contact Precautions: When appropriate, have patient wash hands prior to transport.

For ambulatory or wheelchair assisted patients, change patient’s gown or cover clothes with clean gown prior to transport. When appropriate, drape the stretcher or wheel chair assisted patient with a sheet or other clean cover.

(See “Transporting Patients on Isolation Precautions”)

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3
Q

What is the kill time for

  • Cavi Wipes?
  • Sani-wipes?
  • Bleach wipes?

Where is the expiration date located for these wipes?

A

Kill time for the:

  • Cavi Wipes is 1 minute.
  • Sani-Wipes is 2 minutes.
  • Bleach wipes is 4 minutes.

(The expiration date is on the side of the container.)

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4
Q

How often are refrigerator and freezer temps monitored?

A

Refrigerator and freezer temps are continually monitored by the Primex system and recorded in the electronic system every 8 hours.

Refrigerators/freezers that are unable to be monitored by an electronic device, departments will adhere to the “Down Time” procedure for monitoring.

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5
Q

Why monitor refrigerator and freezer temperatures?

A

Refrigerator & freezer temps are monitored to ensure that correct temperature is maintained for items stored in the department’s refrigerators/freezers.

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6
Q

What are reportable diseases?

A

Reportable diseases are those that require mandatory reporting.

A list, along with the plan for reporting these diseases is available in LuciDoc under the Infection Control Policy and Procedure Manual, titled: Reportable Communicable Diseases/Reporting Procedure.

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7
Q

Where do a discharged patient’s medications need to be placed?

A

Return Bin (and/or) Lowest ring on Just in Time pole

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8
Q

How are look-alike sound-alike (LASA) medications identified? Where can you find this list if Lucidoc is not available?

A

Tall man lettering, symbol on medication label (if from pharmacy), med pyxis segregation. List available in LuciDoc.

(Updated list hung in med rooms.)

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9
Q

What precautions do we take for Protect From Light medications?

A

Meds on the PFL list are protected from light during storage and transport by pharmacy. Some meds must be protected throughout administration.

(List available in LuciDoc.)

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10
Q

How are High Alert Medications identified?

A

Indicated on EMAR, and on High Alert Medication policy available in LuciDoc.

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11
Q

What is the process for Hazardous Medications?

A

Know the classification of the hazardous medication. Follow the guidelines for PPE, administration, and disposal of syringes, tubing, etc. based on whether it is category 1, 2, or 3.

(List available in LuciDoc. Category listed in eMAR.)

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12
Q

When do topical medications expire?

A

Topical medications are good for one year, unless that date goes beyond use date (expiration date by manufacturer.)

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13
Q

What does the RACE acronym mean?

A

Remove/Rescue Activate/Alarm Contain Extinguish/Evacuate/Enhance (varies according to situation)

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14
Q

What does the PASS acronym mean?

A

Pull, Aim, Squeeze, Sweep

(in reference to a fire extinguisher)

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15
Q

How often are fire drills conducted in the hospital?

A

Quarterly

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16
Q

How are chemical/hazardous med spills handled?

A

Contain using the Chemo Spill kit & call EVS.

Also call Safety and Security Officer at 638-9100 if unable to contain.

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17
Q

Where are spill kits located?

A

In the med room

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18
Q

Where may one find the Emergency Operations Plan?

A

LuciDoc

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19
Q

Where are the fire extinguishers located?

A

On 4D, at the end of each hall way near the exists

  • 2 on Child – near laundry room and near day room
  • 2 on EA – near Child pod entrance and near adolescent pod entrance
  • 2 on Adolescent – near laundry room and near conference room B
  • 2 in the Milieu - across from staff lounge and near charge nurse office
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20
Q

Where is the resident physician button located?

A

In each nursing station

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21
Q

What is the emergency phone number? (i.e. resident physician or CHAT?)

A

8-9288

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22
Q

How does one ensure proper preventative maintenance of all equipment?

A

Each piece of equipment should be labeled with a bio-med sticker. All equipment is checked annually and has a due date for preventative maintenance.

(If expired notify the Bio-Med Department for correction.)

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23
Q

What is the adverse drug reaction phone number?

A

638-9876 it is the Med Safety/Ethics Hotline

(Also, Report ADRs to the MD/NP and Fill out a PSR)

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24
Q

Who is the Corporate Compliance Officer?

A

Salena Whalen-Stalker.

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25
Q

How do you report a compliance issue?

A

Call the Corporate Compliance Hotline 1.800.624.9775

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26
Q

Where may one find the following:

  • Safety Data Sheets,
  • LIP ECHO,
  • COA e-mail,
  • Patient Safety Reports,
  • TJC information
  • SmartWeb
A

COA Resources Folder:

  • Safety Data Sheets – explains handling chemical exposures, including chemos
  • COA e-Mail – should be checked weekly by each staff member
  • LIP ECHO – verify an MD or NP can perform a procedure
  • PSR – report a safety event or issue
  • TJC information – review for Joint Commission visit
  • SmartWeb – call or page someone
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27
Q

What is the responsibility of the staff member related to a Fire Alarm?

A

Fire - close all doors, RACE and PASS

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28
Q

What is the responsibility of the staff member related to a Prepare for Surge?

A

Disaster drill- (call all staff for ETA. Send staff/equipment to command station, await further instructions.)

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29
Q

What is the responsibility of the staff member related to a Severe Weather Watch?

A

Severe thunderstorm or tornado watch (close blinds, plug equipment into red emergency outlets)

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30
Q

What is the responsibility of the staff member related to a Severe Weather Warning?

A

Severe weather, tornado warning (close all blinds, protect patients from glass, ambulatory patients to wear shoes, no crosswalks used to transport patients during this time)

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31
Q

What is the responsibility of the staff member related to a Missing Child Alert?

A

Missing infant or child- guard all entries/exits, allow no one on or off the unit, search unit for missing person

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32
Q

What is the responsibility of the staff member related to a Lockdown in Effect?

A

Critical incident/act of violence- staff should account for patients, do not leave the safety of unit until event is over. Staff directly involved in any critical incident should do everything in their power to avoid placing themselves or guests in harm’s way.

*** If on the unit, remember: run, hide, fight

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33
Q

What does an active shooter situation require?

A

RUN-HIDE-FIGHT

  • If threat is off the unit, stay in place and wait for help
  • If threat is on the unit, RACE.
    • Rescue any persons exposed to the threat if it can be done safely; Alarm, notify security at 638-4444; Contain the threat by locking yourself behind doors. Hide; Evacuate if safe or enhance your situation by placing additional obstacles between you and the shooter. If you must engage do so vigorously.
  • Fight would be a last resort.
  • Security will dispatch officers to the sighting area & + call 911.
34
Q

Where is the panic button located?

A

The red switch in each nursing station.

35
Q

What is unit evacuation plan, and where are the evacuation routes?

A

Staff should be able to articulate a “lateral evacuation” for fire. However, if there is a need to evacuate the building, we would go to the CPM auditorium. Staff should also be able to point out stairwells on unit.

36
Q

What is universal protocol?

A

A “time-out” prior to a procedure that allow for correct identification of the patient, and identification of the correct procedure and the correct site. Applies to all surgical and nonsurgical invasive procedures. Medical Record must be available in room where procedure is performed. Remember, this is a HARD STOP! Everyone in the room stops what they are doing & participates in the “timeout”.

We are unlikely to be involved in a timeout on 4D. However, it is important to know this requirement just in case. (Examples might include PICC line placement or bone marrow aspiration)

37
Q

When and how is pain assessed & reassessed?

A

Pain is initially assessed on admission and pain scale and score are identified. Assess and reassess whenever a change warrants and document response to intervention.

Pain is also assessed: at beginning and end of shift, change in condition, when pain is expressed and not to exceed Q2H or as appropriate if patient receives intervention for pain.

38
Q

Define mild, moderate, and severe pain according to pain scale used.

A
  1. Numerical – Patient must give the number. NOT a nurse’s assessment.
  2. FACES – Patient must point to picture. NOT a nurse’s assessment.
  3. FLACC- Nurse’s assessment (Face, Legs, Activity, Crying, Consolability)
  4. Behavioral Pain Scale - Nurse’s assessment (Face, Appearance, Body posture, Vocalization, Activity) Note: 7-10 Severe Pain 4-6 Moderate 1-3 Mild

* Do not use infant pain scales on 4D. (ex. CRIES, NIPS, N-PASS)

39
Q

What are the 2 patient identifiers?

A

Name and patient birthdate

(The medical record number and picture book should be used as a third identifier.)

40
Q

With what does one compare the 2 patient identifiers to confirm correct patient?

A

Ask patient name and birthdate of patient and compare med/intervention to the information available on the patient wristband.

41
Q

Where are lab specimens labeled? By whom? Why?

A

Lab specimens are ALWAYS labeled at the patient’s bedside by the person obtaining the lab. This is done because the collecting person must always compare the lab label and the patient wristband to avoid labeling errors.

42
Q

What is the process if a prescriber gives you a Telephone Order?

A

CPOE telephone orders: Once the order has been completed & you hit submit, the order should be read back to the prescriber.

43
Q

What form of communication do we use to report a problem/issue to MD/CRNP here at COA?

A

SBAR

  • S-situation
  • B-background
  • A-assessment
  • R-recommendation
44
Q

What format does COA nursing staff use for hand-off of care communication?

A

IPASS

  • I Illness Severity
  • P Patient Summary
  • A Action
  • S Situational Awareness-Plan of Care, Family Issues, etc.
  • S Synthesis-Clarification of questions by the receiver
45
Q

When are patients assessed for falls risk?

A

On admission, and each shift. Also assessed after any patient status change or post fall.

46
Q

How do we identify a patient who is at risk for falls?

A

Initial Assessment is completed on admission by using the Humpty Dumpty Falls Risk Scale. If a patient is deemed a falls risk, scoring greater than 12 on Humpty Dumpty & age greater than or equal to 3 years, a yellow falls risk armband is placed on patient and on their door. A plan of care is developed and routinely updated.

(Document education provided.)

47
Q

What is/are the indications for restraint use?

A

Restraints are ONLY applied when patient is demonstrating behaviors that are an IMMEDIATE danger to themselves or others. Otherwise, we use less restrictive interventions such as supportive or directive behaviors.

48
Q

When would less restrictive intervention be used?

A

Anytime you can alter a patients risk for harming self or others without the use of restraints.

49
Q

Give an example of a less restrictive intervention.

A

Examples: Distraction, coping techniques, sensory adjustments, etc…

50
Q

What is the difference between a restraint release and discontinuation?

A

Release – may include releasing the manual restraint and allowing the patient to go to the restroom without leaving the patient alone. The key in these situations is that you are acting as the restraint during the time that they are free from the device itself.

Discontinuation – removal of restraints, when you are not able to act as the restraint. For example, they stop their behavior and you allow them to go back to their room unsupervised.

51
Q

What is the time frame to notify LIP and obtain order AND for LIP to complete face to face assessment?

A

Non-violent (not common in psych) Order obtained ASAP within 12hrs and no face to face required Violent (common in psych) Order obtained ASAP within 1 hour and face to face required within 1 hour

52
Q

How often must a restraint order be renewed?

A

Non-violent – one-time order, no PRN;

Violent – Renew orders every 4 hours for 18yo and older, 2 hours for 9-17yo, 1 hour for under 9yo, Note: Must consult LIP prior to renewal of order up to 24hrs, after 24hrs, another face-to face by LIP must occur prior to renewal, no PRN

53
Q

What are the restraints monitoring and reassessment requirements?

A

Non-violent – Document Q2hrs and determine when each item is scheduled for evaluation based on patient needs,

Violent – Document every 15 minutes with continuous monitoring

54
Q

Where are restraints documented?

A

Restraint Peds Flowsheet … and Plan of Care (with changes in plan of care)

55
Q

How often do we document in the plan of care?

A

Status updates are entered with reassessment, changes in patient status, and/or changes in the plan of care. The Plan of Care is reviewed/updated by the RN/LPN every shift and as needed for inpatients. Be sure you can you verbalize the Plan of Care on your patients

56
Q

How often is education documented on the Plan of Care?

A

Beginning with admission and continuing throughout the patient stay. All care providers add to the education plan when learning needs are identified, when plans for education are made, and when teaching occurs.

57
Q

Why is QC performed daily for Accuchek, Clinitek and EPOC?

A

To ensure machine is properly calibrated.

58
Q

When do Accucheck controls and strips expire?

A

Accuchek – 3-month expiration for controls, strips expire by date on bottle

59
Q

How does one identify if a provider has privileges to practice at COA?

A

LIP-ECHO icon in the COA Resources folder

60
Q

Name unit level PI projects? Hospital wide PI/QI?

A

Hospital wide, staff should be able to articulate SPS HAC bundles.

  • 3 HAC focuses are CLABSI, ADE, and Pressure Injury.
  • Other PI projects specific to 4 Dearth include Falls, Plan of Care, and ASD Admissions.
61
Q

What is CHAT?

A

CHAT is Children’s Hospital Assessment Team and is the rapid response team.

62
Q

Who reconciles medications?

A

Prescribers

63
Q

How often is the defibrillator checked?

A

Daily

64
Q

What do white armbands mean?

A

White- patient armband

65
Q

What do solid green armbands mean?

A

Solid Green - family/caregiver

66
Q

What do green/white stripe armbands mean?

A

Green/White stripe- sibling

67
Q

What do yellow armbands mean?

A

Solid yellow- falls risk

68
Q

What do yellow/white stripe armbands mean?

A

Yellow/White stripe- surgical site marking for Universal Protocol

69
Q

What do Red armbands mean?

A

Red- indicates allergy

70
Q

Who should receive a suicide risk screening?

A

Patients who present to the ED outpatient or inpatient care setting with a primary complaint that is emotional or behavioral in nature.

71
Q

What tool is used for the screening?

A

The Columbia -Suicide Severity Rating Scale Screen.

72
Q

What is the difference between a suicide risk screening and a suicide risk assessment?

A

Nurses do screenings Physicians/NPs do assessments

73
Q

What do we do if a patient who is found to be at risk for suicide?

A
  • Immediately place on 1:1 observation
  • Placed in hospital-issued attire. May keep underwear on; no underwire bras.
  • Full suicide assessment performed by an LIP w/in 24 hours & daily.
  • Staff member assigned to be w/ pt. @ all times. Visitors are not responsible for observing the pt.
  • Safety check performed Q15 minutes
  • Education is provided to the family.

(See Suicide Risk Assessment Policy).

74
Q

What would you do if you find a suspicious item?

A

Leave it untouched, call Security, remove patient/families from immediate area

75
Q

How do you know patient care equipment is safe to use?

A

Clean green label, current orange Biomed sticker, no evidence it was dropped, no frayed cord

76
Q

What is the correct procedure to waste a medication?

A

Have additional nurse witness (actually watch) as the correct amount of unneeded medication is wasted into the white controlled substance bin. Both document amount wasted in the pyxis.

77
Q

What should be monitored and documented on a patient in restraints?

A

Circulation, skin integrity, VS, nutrition/elimination needs, ability to follow instructions, range of motion, improvement in behavior, level of distress/agitation, and how restraints are secured to the bed

78
Q

Describe our process for orientation.

A

Orient to 4D based on general competencies with an experienced staff member of your same or similar role. Orientation paperwork and competencies specific for your role.

79
Q

What PPE is worn for a category 1 or 2 hazardous med?

A

Double gloves for pills.

Double gloves and gown for liquids; face shield or goggles if there is a chance of spill or spray.

80
Q

What items are disposed of in the yellow bin?

A

Gowns, gloves, empty bags, syringes, and tubing, diapers from patients receiving hazardous medications.

81
Q

What are the 5 (+1) medication rights you should check prior to each med you give?

A

Remeber “DR. TIME”

  • Drug
  • Route
  • Time
  • Identification (i.e. Patient)
  • Medication
  • (Education)

Ireland Center Knowledge Rehab (1 decks)

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