Welcome to Monash Health

Orientation for Undergraduate Midwifery Students

Undergraduate Clinical Midwifery Educators Objectives

After reading this Orientation package student midwives should be able to: • Identify Monash Health vision and values and are expected to work within these • Discuss the expectations whilst on clinical placement • Identify Monash Health Policies and procedures in relation to communication, OH&S, incident reporting and emergency management. • Be ready for clinical placement

Monash Health

• ’s largest • Monash Medical health service Centre • Services 32% of - Clayton metro plus • Dandenong a vast regional • Casey Hospital population • Springvale • 40 sites, 6 major Community Health Centre • Over 13,000 staff • 2100 beds • Provides care across the lifespan

Vision and Values

Our Vision: Better Health in Our Community

Our Values: Integrity Compassion Accountability Respect Excellence

Our values underpin the way we deliver our services. Putting our Patient’s First

• Every Patient

• Every Hour

• Every Day Patient First Protocol

1. Introduce: Inform the patient you are here to do your round 2. Check: woman and baby needs, pain levels, comfort. 3. Assist: with their needs 4. Reposition: Think pressure, moisture, friction 5. Environment • Buzzer, TV remote control and bed light • Bedside table, water and tissue • Rubbish bin/bag to be near the bed

Ask if there is anything else the patient would like while you are in the room and let them know you’ll be back in an hour Foundations of Care Monash Health Services

• Car Parking- For short term clinical placements at Monash Health, a parking permit can be purchased. A deposit of $20 for the card is required but is refunded on return of permit. Parking will be $5.00 per day. For longer term placements (i.e. greater than 4 weeks) you can purchase a photo ID proximity card for $20 which is non-refundable. At Casey Hospital students can park in the public car park, go to reception and ask for a discount card. Parking will be $5.00 per day. Cashiers available Tuesday, Wednesday and Friday. Unfortunately, there is no parking for students available at Dandenong. You will need to park in an all day spot in the surrounding streets and ask for assistance, if required, to get to your car at night e.g.. staff midwives or security.

Car Parking

Clayton • Pay $20 deposit to cashier and the number of days of parking (can add more days if required) • Take receipt to security for parking ticket Casey • Take student ID to cashiers for replacement discounted parking ticket. Dandenong Free Parking is available at The Oasis Swim Centre Cleeland Street- Remember to move your vehicle closer to the hospital before dark on a PM shift, this can occur outside of meal breaks

Monash Health Services

• Security- All sites have 24hr, 7 days a week security arrangements. Contact security staff if you detect a breach in security or you require them to escort you to your car at night. They will only escort you to hospital car parks, not street parking. • Food/Cafeteria- Each ward has a fridge and microwave for staff use and free tea and coffee. There are food and drink vending machines and public cafes available at each site. Monash Health Services

• Library- All sites have a library which can be accessed by students during hours of operation. Students are not permitted to borrow books, journals or other library resources. Photocopy machines are available. Monash Health Midwifery Placement Information

• Clayton Campus – 52 North & South, EPC, Fetal Monitoring, PAU, Monash Newborn, 51 North and Birth Suite are located on level 5, signs will direct you to the wards. Students attending Birth Suite PAU & Postnatal will need to press the buzzer at the door and ask to be directed to handover. Student’s should introduce themselves and after handover will be allocated to a Midwife to work with for the shift. • Antenatal clinics are located on level 2 (ground floor) near patient Pharmacy. Maternity clinics are in “Clinic D”. Check shift times on the legend as these vary. Monash Health Midwifery Placement Information • Dandenong Campus – Birth Unit and Maternity Services are both situated on the ground floor, go in the main entrance and follow the long corridor until you reach the end. Students should introduce themselves and ask to be directed to handover. • Antenatal clinic is located 135 David street, Dandenong. (Next to multi level staff car park) Please check legend and locations at the bottom of the roster. Monash Health Midwifery Placement Information • Casey Campus – Antenatal clinic is situated at Corner of Deveney street and Princess highway, Pakenham. Birth is on 2nd floor. Go in the main entrance up the “sweeping” staircase, and follow the sign to Ward G. Postnatal is on the ground floor. Follow the sign to ward B. Student’s should introduce themselves and ask to be directed to handover. Confidentiality

• Confidentiality forms – Must be completed prior to entry on the ward • Patient – don't share information between patients • Family - Confirm patient is happy for family to know any information • Colleagues – Fellow student • Monash Health – Location of discussions i.e. café not a good place to discuss patients as family may be around. • Internet – DO NOT discuss any clinical placement details on Facebook/twitter • Debriefs– Anything said in debrief is confidential and not to be discussed on the wards. Consent

• You must obtain verbal consent from a patient prior to performing any care.

• The patient must be aware that you are a student

• The patient must be informed by you if you are performing a procedure for the first time

• The patient has the right to refuse care from you.

Complaints

• Most complaints to CME • CME can then escalate the issue as required

• If complaint pertains to CME • Contact Nursing and Midwifery Education and Strategy on 9594 2609 • Please ask to speak with Sara Davies

Sick leave

If you are sick there are 3 phone calls you must make:

-call the ward you are on, -email and call or message CME on mobile -call your University

You must get a medical certificate from your GP to be sighted by the CME and your university You may need to make up sick leave.

Rosters

• You should arrive 10 minutes before the start of each shift.

• Take the time to read the key on your roster so you are aware of your shift times.

• You may only change shifts with your clinical educators approval.

• This clinical placement takes priority over other outside commitments.

“Tools of the trade”

• Stethoscope • Highlighters • Note pad • Pens • Drug guide • Pick-pocket • Scissors • Name badge

Expectations

• Be punctual. Wear correct uniform be well presented & name badge to be worn at chest level • Identify yourself as a student midwife to women, staff and visitors

• Bring everything you need: I.D., nurse’s watch, stethoscope, pens, pocket notepad etc

• DO NOT CARRY MOBILE PHONES (access only during breaks)

Clinical Expectations

• Seek own learning opportunities • Be prepared. Research the ward you will be on & learn some of the common diagnoses. Learn the common abbreviations used on the ward. • Learn who or what your resources are & use them! It’s up to you to get the most out of your clinical time. • Thinking about the pathophysiology behind your patients’ conditions. • Learn the commonly used medications and abbreviations on your ward.

Clinical Expectations

• Ensure your documentation is thorough, professional and up-to-date. Print your name, year level and university next to your signature and have it countersigned by the midwife you are buddied with. • Maintain patient confidentiality & privacy at all times. • Bed safety checks to be done at the start of every shift. • Manual blood pressures & pulses for the first week (no dynamaps please).

Clinical Expectations

• Don’t sit at the desk unless you are writing your notes-there’s always something to do. • If there’s any change in your patient’s condition, make sure you tell someone! • Answer the telephone and enquires and assimilate yourself into ward routine as much as possible. When answering the telephone , identify the ward, state your name and that you are a midwifery student. If you are unable to assist the caller, please take a message and relay it to the appropriate person quickly. Clinical Expectations

Things that the CME will be assessing when students are on placement: • Prioritisation of care • Clinical Assessments • Time management • Confidence and taking initiative in patient care • Communication with health care team • Documentation • Medication safety • Critical thinking Clinical Expectations

Midwifery Notes: What do I need to include? • Norms/trends, anything out of the ordinary? • What have you done about it? E.g. contacted Dr, NFO, given meds/fluids etc, & outcome e.g. pain relieved, now normotensive • If uncomplicated you can write- All postnatal care and assessments as per guidelines. No outstanding issues, concerns or complications identified by observation or reported by the woman • Patient plan– ?for d/c Wednesday • Notes need to be objective not subjective • Finish by signing & printing your name, year level and university and getting buddy midwife to co-sign.

Clinical Expectations

Medication administration: • Right patient Students must be • Right medication directly supervised • Right dose at all times when • Right route administering • Right time medications! • Right documentation • Right Monitoring This includes IV • Allergies Therapy

Supervision

Direct Supervision Indirect Supervision Direct supervision is Indirect supervision is provided when the provided when the registered nurse or midwife registered nurse or midwife is actually present, is easily contactable but observes works with and does not directly observe directs the person who is the activities. being supervised.

Guidelines on delegation and supervision for nurses and midwives, ANMC Clinical Midwifery Educator (CME) role • Support to student and buddy midwife • Assist students to seek out learning opportunities within a safe environment & reflect on these. • Resource for clinical questions. • Provide accurate, realistic but fair assessment of student performance. • Patient/client advocate. • Conduct clinical tutorials & debrief sessions.

What makes a successful student?

• “Tools of the trade” • Adaptability & • Student Uniform problem solving • Shows initiative ability • Good communicator • Self directed • Good knowledge base • Enthusiasm and ability to apply • Prioritisation of knowledge clinical time

• Keen & motivated

Assessments

Clinical Assessment Tool will be completed by your buddy midwife or your educator. Mid and End of placement reports will be completed by your educator • Mid-way feedback/interim report • Final assessment/Formative report on your last day. • Please give your Tool to your buddy midwife at the start of the shift. Also remind your Educator that the Mid-way feedback is required.

Daily Feedback Sheets- Please print this out and bring to placement to be completed by your buddy midwife each day. This is a useful tool for you to receive constructive feedback

Communication Telephone etiquette ISBAR • I – IDENTIFY: yourself (name, position, location) & patient • S – SITUATION: Why are you calling (if urgent – say so) • B – BACKGROUND: Tell the story • A – ASSESSMENT: What you think is going on • R – REQUEST: What you want from them.

LANPage Communication

Paging • Lan Page • Computer system • A standardized format for LAN Paging exists • Maximum of 80 characters per message • Phone • *8 enter pager number followed by # • Then enter your extension number # • Only use if computer system is down

Sending a LAN Page

Access LAN Page system via any computer on the network The LAN Page icon is located on the desktop

Type in Holder Number and click Search or Type in the Pager Number into the boxes

Type in the Message using the standardised format Policy and Procedures • Policy • Statement of expectations • Procedure • Implements a policy • Steps required to complete an activity • Why do we have them • Evidence Based • Best practice standard • Standardisation throughout Monash Health • Located on the intranet *On day 1 of your placement you should ask to be shown the Intranet and Policies & Procedures page*

Riskman Incident Reporting

• Monash Health has a no blame culture • Meaning that the Incident report isn’t filled out as a means to blame someone but to look at ways to prevent incident occurring again or in the case of near misses ever occurring. • By reporting incidents, you are protecting patients, staff, visitors and the organisation. It means that Monash Health can implement strategies to improve care and safety.

Riskman Incident Reporting

• Monash Health uses Riskman as its incident reporting program • Riskman is available on every computer within Monash Health • There are 4 different levels of Incident Investigation that can be undertaken Riskman Incident Reporting

• If an incident occurs: • Notify buddy midwife • Notify In charge of shift • Notify CME ASAP • CME will need to complete the Riskman report, however you will need to be there to assist and provide information regarding the incident.

Reporting of incidents involving students

Taken from Reporting incidents involving students – Procedure 2011 O H & S

• Monash Health has a no lift policy • Slide sheets or lifting machine • Report any injuries to ward and clinical educator • Monash Health is smoke free Infection Control

STOP STOP STOP STOP

AIRBORNE DROPLET STRICT CONTACT CONTACT PRECAUTIONS PRECAUTIONS PRECAUTIONS PRECAUTIONS APPLY APPLY APPLY APPLY

WEAR N95 MASK WEAR MASK ON WEAR LONG GLOVES ON ENTERING ENTERING ROOM SLEEVE GOWN & REQUIRED ON ROOM GLOVES ON ENTERING ROOM ENTERING ROOM GOWN & GLOVES REQUIRED FOR PATIENT CONTACT

Airborne Droplet

Gloves As per Standard Precautions. As per Standard Precautions. Gowns As per Standard Precautions. As per Standard Precautions. Particulate filter (N95) mask before Surgical mask if within one metre of Masks entering the room. patient/before entering the room. Goggles/Face shield As per Standard Precautions As per Standard Precautions Patient charts May be in room May be in room Handling of As per Standard Precautions. As per Standard Precautions. equipment

Yes – negative pressure. Yes or cohort with other patients Single room colonised of infected with the same Door closed. organism. Door may remain open.

Limit to essential movement only. Notify area receiving patient prior Limit to essential movement only. Notify Transfer of patients to transfer. area receiving patient prior to transfer. Patient to wear surgical mask or Patient to wear surgical mask. N95 if tolerated. Contact Strict Contact Gloves On entering the room. On entering the room. Short sleeved, if anticipate contact with the patient or their Long sleeved on entering the room. Gowns environment. Discard after use, do Discard after use, do not reuse not reuse Masks As per Standard Precautions. As per Standard Precautions. Goggles/Face shield As per Standard Precautions As per Standard Precautions Patient charts Outside room Outside room Ideally, dedicate equipment to individual patient use. Clean with detergent and water followed by Sodium Hypochlorite Ideally, dedicate equipment to or 70% alcohol if incompatible with individual patient use. Clean with Sodium Hypochlorite. Any item unable to Handling of detergent and water before reuse. equipment be cleaned is discarded. Any item unable to be cleaned is Linen is double-bagged at the doorway as discarded. it is taken from the room. All waste is double-bagged at the door of the room Yes or cohort with other patients colonised/infected with the same Yes or cohort with other patients Single room organism. colonised or infected with the same organism. Door may remain open. Door may remain open. Limit to essential movement only. Transfer of patients Notify area receiving patient prior Limit to essential movement only. Notify area receiving patient prior to transfer. to transfer. Gowns and gloves not required Gowns and gloves not required unless Visitors unless involved in direct patient involved in direct patient care care Infection Control

• Hand washing > Avagard is located at the end of every bed, outside every room & various other locations throughout the ward > USE IT!!!! • Standard precautions > gloves and protective goggles. • Waste disposal- General waste into black, white or clear bags. Anything not contaminated with blood. Clinical waste into yellow biohazard bags- waste contaminated with blood or human tissue. • Sharps disposal- sharp objects into yellow sharps container. Don’t overfill.

The 5 Moments of Hand Hygiene

1. Before touching the patient

2. Before a procedure

3. After a procedure or body fluid exposure risk

4. After touching a patient

5. After touching the patient’s environment MONASH HEALTH GENERIC RESPONSE

Whilst emergencies differ, the R.A.C.E. concept offers a set of immediate, generic responses which are easily memorised and appropriate in most circumstances

R.A.C.E. PRINCIPLE R

A

C

E Emergency Codes > Dial 999

• Red - Fire/Smoke • Orange - Evacuation • Purple – Bomb threat • Black – Personal threat • Yellow – Internal Emergency • Blue – Medical Emergency • Brown – External Emergency

Clinical Parameters of the Deteriorating Patient • These parameters are intended to identify patients requiring immediate clinical review. • May warrant a MET call. • A significant change in pulse rate • A change in respiratory rate • Decreased blood pressure • A fall in urine output • A deterioration of Oxygen levels. • A deterioration of conscious state. Medical Emergency Team (MET Calls) > Dial 999

• MET Call Criteria • Airway - Respiratory distress, threatened airway. • Breathing • RR > 30/min, RR < 6/min

• SaO2 <90% on Oxygen • Difficulty speaking. • Circulation • Blood pressure <90 systolic, despite treatment • Pulse > 130 • Neurological • Drop in GCS • Fitting • Other - Concerned, need prompt attention. (Be aware that separate criteria exists for paediatric MET calls) Code Blue > Dial 999

Basic Life Support • DRS ABCD To activate the Resuscitation Team • Call 999 or 000 for residential Midwife Role • CPR, Scribe, runner Get to know your emergency equipment • Emergency buzzers, Crash cart, resuscitation equipment in rooms.

Maternity Emergencies

• CODE PINK (Clayton and Dandenong) Initiated for : Preterm Birth on Postnatal Ward, Maternal Collapse, APH, PPH, Convulsion, Cervical/Prostin hyper stimulation, Shoulder Dystocia. Ring 999, state Code Pink, state location Maternity Emergencies

• Code GREEN ( Monash Medical Centre, Dandenong and Casey) Initiated for Cord Prolapse, Ominous CTG, Lactate > 5.7, Unsuccessful instrumental delivery, caesarean for 2nd twin Call 999, state code green, go directly to Theatre Maternity Emergencies

• NEONATAL CODE BLUE- all sites Initiated for neonatal collapse Ring 999, state neonatal code blue, state location Summary

Thanks for taking the time to thoroughly read your orientation package prior to clinical placement. We look forward to working with you on the wards at Monash Health.

Please pay close attention to your required checklists and send to the appropriate site educator. You can contact us on the details provided below if you have any questions. Midwifery Student pre-placement checklist Midwifery students visiting Monash Health sites must complete the following checklist before clinical placement. Failure to meet these requirements may result in the student being sent home to complete pre-placement requirements. Student name and signature………………………………. University……………………………………...... Date………………………………………………………….. I acknowledge that I have completed the following orientation requirements as listed below prior to attending clinical placement and agree to abide by all these requirements during my clinical placement  Monash Health Orientation- I have read the above document  Confidentiality- I have read and completed the confidentiality form  Professional Conduct- I have received and understood my roster and am aware of the notification process if I am sick during clinical placement  Completed the survey by following this link http://www.surveymonkey.com/s/YQBK7T2  I am up to date with immunisation requirements, have current police and working with children’s check  I have scanned and emailed the confidentiality form, the above documentation and this completed checklist to the relevant clinical midwifery educator after completing all the material as outlined above

Monash Health confidentiality agreement

I, ______(name) Of______(home address) In the state of Victoria acknowledge that during the course of my placement within Monash Health I will be exposed to materials, data and information which are confidential to Monash Health and or clients of Monash Health. I agree to treat such materials, data and information as confidential information, to receive it in strict confidence and use it only for purposes connected to my placement with Monash Health. I shall not disclose any confidential information without the express consent of Monash Health. I agree that my obligation to preserve confidentiality of confidential information shall survive my placement at Monash Health and that Monash Health may, if confidentiality imposed under this agreement is breached, institute such legal action against me as Monash Health shall determine. Signed:______Date:______Clinical teacher:______Ensure the above is signed and emailed to your clinical teacher at Monash Health prior to placement.

Please print this document out and bring it to placement each day. Clinical Undergraduate Educators

• Monique Vermeulen • Undergraduate Midwifery Deakin University, LaTrobe University, Education Office phone ACU 95946962 Phone 0414589923 [email protected] • Undergraduate Clinical Education Coordinator • Georgette Payet-Dale Sara Davies phone 95942609 , Victoria University

Phone 0417125683 [email protected]

• Sarah Hillis Clinical Support Midwife Phone 0407834436 [email protected]