Nursing School Student Orientation 1-4-2021 1 Henry Ford Health System • Founded by Henry Ford and opened in 1915 • HFHS includes multiple hospitals, medical centers, and a wide range of other health services • Henry Ford Hospital • Henry Ford Allegiance Health • Henry Ford Macomb Hospital • Henry Ford West Bloomfield Hospital • Henry Ford Wyandotte Hospital • Henry Ford Kingswood Hospital Welcome to Henry Ford Hospital Our Mission To improve human life through excellence in the science and art of health care and healing. Our Values HFHS Guide to World Class Service I encourage INNOVATION & CURIOSITY I will COACH & INSPIRE Continuously learn, ask questions, offer creative ideas Encourage each other to grow and develop; practice and challenge the status quo productive feedback I act with COURAGE I own SAFETY & HIGH RELIABILITY Behave authentically and risk vulnerability; speaking Embrace high standards to ensure excellence in care and from both the head and heart service I demonstrate INTEGRITY & TRUSTWORTHINESS I communicate with EMPATHY & TRANSPARENCY Honor commitments and confidentiality; deliver on Understand the thoughts and feelings of others; be open and promises honest I champion DIVERSITY & INCLUSION I ensure OUTCOMES & ACCOUNTABILITY Support an environment where all people thrive and Commit to achieving results through collaboration and succeed data-based decisions Culture of Caring 5 Policies and Procedures Nursing students & Faculty will adhere to HFHS standards, policies & procedures. These can be accessed from OneHENRY. HFHS Dress Code ID Badge must be worn and visible at all times • Both School ID badge & HFHS badge • HFHS employees cannot use their employee ID badge during clinical If a student forgets, loses or damages a HFHS badge • Notify the instructor • There is no admittance to the clinical unit with out a badge If a student leaves the clinical rotation or school, faculty must contact HFH badge office to deactivate badge. • ALL badges EVERY time must be returned to where they where obtained with in a week of last clinical day noted on ACEMAPP. • Deposit is forfeited if badges are not returned Nurse Dress Code • No open-toed shoes or cut outs i.e. crocs • No artificial nails; nails no longer than ¼ inch • Natural hair color and back off the shoulder • Jewelry • No bracelets • No more than one necklace • Maximum of two rings • Earrings may not hang more than 1 inch below lobe • Tattoos should be covered if possible. No offensive, vulgar or obscene tattoos are to be visible 8 Use of Scents and Colognes Acceptable • Use of deodorant & light, mild perfume or after-shave, light scented mouth wash • All clothing worn during the shift must be free of the odor of tobacco. Breath, skin, and hair must also be free from any scent of tobacco Unacceptable • Excessive or heavy scent of any kind either from poor hygiene, strong perfume, or any other scented personal products HFHS ID Badges Badge and Badge Buddy • Badge is needed to leave some of the parking areas • Return to the instructor on the last clinical day • Students are not to return badges individually Badge Deposit • If badge is not returned by the end of clinical date noted in ACEMAPP, deposit will be forfeited • Badges are returned every semester after every clinical both student and instructor. A new deposit is required every semester. Guidelines • Students must be introduced to patients • Name and School are to be on the white board in room. • Patients have the right to refuse care from any student • Includes observation • Each patient assigned to a student must also have a staff RN assigned • Students can not print/make copies of any medical records • This is a breach of security and confidentiality and may result in the loss of school privileges at HFH. Reporting Responsibilities Report to the patient’s RN at the beginning of the shift Receive report from the patient’s RN • Identify student’s role in assigned patient care Report to patient’s nurse and instructor • All new abnormal findings • Changes in patient condition • One half hour before leaving the unit • Patient status update at least every 2 hours Always leave a contact number • Provide end of shift report with up to date patient status to the patient’s RN prior to leaving the unit Student Documentation All Students must complete a one-time scheduled 4-hour EPIC training All student documentation must be co-sign by instructor Students can NOT • Witness consents • Print or make copies of any part of the electronic medical record or hard chart for any reason Nursing Care Students can perform the following tasks ONLY with Clinical Instructor Supervision • Change IV tubing • Maintain IV line • Change & flush central line with direct observation • Perform blood glucose test • Direct Clinical Instructor observation • Clinical instructor badge • Documentation Nursing Care (continued) Students CANNOT perform the following: • Perform phlebotomy or start IV’s • Perform ECG’s • Administer IV push medications • Give Respiratory treatments • Administer Chemotherapy • Adjust or discontinue alarms • Administer and/or hang blood or • Remove PICC or central line catheters blood products • Provide care to a patient requiring an N95 • Titrate drips mask • Accept telephone orders • Witness Consents 15 Remember the Basic Rights • Right patient • Right drug • Right dose • Right route • Right time • Right documentation 16 Medication Administration HFHS unit RN’s cannot substitute for the RN Clinical Instructor • ONLY RN Clinical Instructors are approved to access the Pyxis medication system and remove medication • RN Clinical Instructors MUST be present when administering medications. • EVERY medication & order must be double checked by faculty & co-signed by faculty at time of administration • The student must SCAN the patient armband and SCAN the medication barcode before administering medication • Exception: if the student is in a management/leadership course and partnered with a Staff RN, the Staff RN will double check and co-sign all medications in EPIC Medication Administration Record (MAR) • Document in Epic/Co-signed by RN Clinical Instructor • Patient Header: Note allergies highlighted in bright yellow • Review the “Start/Stop” Date & Time MAR • All medications must be scanned with the bar code scanner prior to administration. • The current time will be reflected in the “time filed” of the medication administration window. • Ensure all fields are correct then Click “accept” (your signature) box will appear for instructor to place his/her dual signature at that time. MAR • Discontinued meds will appear highlighted in yellow on the MAR in the Electronic Medical Record (EHR) • When a range medication is ordered (ex. 1-2 tablets), document how many were given • If more than one tablet/vial is given you must scan both packages to satisfy total dose SAFETY Safety • Plain Language Emergency Codes • Rapid Response Team • Patient Identification • Patient Hand Off • Infection Control • Restraints • Fall Risk Plain Language Emergency Alerts The illustration on the right displays the new Plain Language Emergency Alerts that replaces the Color Codes. For additional details, please Click Here. Role in an Emergency Be familiar with the Plain Language Emergency Alerts and the responsibilities Student • Report to your Clinical Instructor • Follow instructions from Clinical Instructor & follow unit protocols • Know evacuation plan and where emergency equipment is kept on your unit • Return to your unit if not on unit Clinical Instructor • Report to the charge nurse for further instructions • Gather all students to provide guidance with role responsibilities Rapid Response Team (RRT) • Always report patient changes to the patient nurse; no matter how small • Provides clinical support to the General Practice Unit nurse in caring for patients identified to be physically deteriorating • Purpose is to decrease morbidity and mortality through early and aggressive intervention • 24 hour coverage, 7 days a week RRT Criteria • Respiratory Distress- increase in oxygen • Tachycardia with heart rate > 130 requirements to 50% Venturi mask, • Bradycardia with heart rate < 60 labored breathing, restlessness, lethargy, use of accessory muscles, respiratory rate • Seizures new, prolonged or repeated < 10 or > 30, decrease in pulse oximetry < • Acute mental status changes 90% or significant deviation from baseline • Acute stroke signs • Blood Pressure- SBP > than 180 or SBP < Any condition that warrants concern than 90, or any significant deviation from • and does not meet above criteria baseline • Chest pain Predictive Model: Deterioration Index 27 What is the Deterioration Index (DI)? • The Patient Deterioration Index (DI) predictive model is an auto calculation composed of 125 data elements that includes demographics, vital signs, lab results, and assessments and can identify with a high level of accuracy, patients at low, medium or high risk for an adverse event or mortality. • DI is not intended to replace clinical judgment • DOES NOT replace Stroke Alert, Sepsis Alerts, or Rapid Response Triggers 28 What is the Deterioration Index (DI)? • Deterioration Index score automatically recalculates a score every 20 minutes based on documentation • Includes: Observation and General Practice Unit patients 18 years and older 29 What are the Deterioration Index Demographics (DI) components? • Age (in years) Vital Signs (most recent in last 72 hours) • Systolic Blood Pressure • If the values are outside of the • Temperature normal range, the components