TX - Care of Patients

Related Documents:  None

Comments:   None submitted

Downloadable Files:
Restraint Immobilization Record TX002F.pdf
Download the above form in Word 97 format zipped in a self extracting file: TX002F.exe

Related Documents:  None

Comments:   None submitted

To assure appropriate documentation of controlled substance use within an Operating Room. (OR).

POLICY:

Anesthesiology personnel shall only remove the quantity of controlled substances anticipated for a single case.  The Pyxis shall only be used for the removal and return of unused containers of controlled substances (e.g. vial, amp, manufacturer's pre-filled syringe, etc.).

Partial amounts of non-returnable controlled substances shall be wasted and shall not be used for another case.  The process of wasting of a controlled substance intended for use in the OR requires the presence of two (2) licensed professionals.

The Anesthesia Data Record (ADR) shall be used to document the medication administered and wasted. When documentation of waste is done at the Pyxis, two (2) licensed professionals who have access to the Pyxis will document the procedure.

RESPONSIBILITY:

Anesthesiology personnel with access to the OR Pyxis.

PROCEDURE:

1. Remove controlled substances anticipated for use in the case from the Pyxis.
2. Document controlled substances administered during the case in the designated area on the ADR.
3. Dispose of any non-returnable controlled substances in the presence of another licensed physician or nurse in the OR suite.
4. Document the g/mg/mcg amount wasted including the appropriate units in the designated section of the ADR at the time of disposal.
5. Authenticate the disposal by initials next to the waste documentation. Both the disposer and the witness shall initial the waste documentation.
6. When documenting waste at the Pyxis, both the disposer and the witness shall sign on to the Pyxis.  The Pyxis system in located in the Clean Core of the OR, so they have to pass it going to the next case. In this  manner, nobody is carrying narcotics around with them for the day. The Pharmacy provides a daily summary of all Pyxis activity to the department of Anesthesia QI physician who performs audits of his/her staff with respect to:

1. Choice and dose of agents for the case (i.e. were they appropriate)
2. Was waste documented as per policy and does the medical record match the Pyxis record for what was removed, administered, returned or wasted?

The Physician audits are placed in their credential file and a copy is given to the Pharmacy.  The Pharmacy also does random audits of use without notice to keep everyone honest.  Count discrepancies are handled just like any other unit; (resolved by end of shift in the Pyxis system or Controlled Substance discrepancy report is filled out for big time investigation)

Related Documents:  None

Comments:   Research-based Protocol

The protocol and Risk Score Guidelines are noted below.  It was necessary to include the remaining documents in the Adobe Acrobat Reader format.   They can be viewed or downloaded by clicking on the TX004F.pdf link noted below.

Downloadable Files:
Fall Prevention Policy In Word 95 format zipped in a self extracting file:   TX004P.exe
Download the or view additional forms/documents in Adobe Acrobat Reader format: TX004Fa.pdf

Fall Prevention Protocol

Purpose

To outline the nursing management of the patient 18 years of age and older with increased risk of falling as identified by fall risk score of 40 points or greater.

Level

Independent

Supportive Data

Identification of patients that may be at risk for accidental fall during hospitalization is necessary. All patients are assessed for fall risk daily at the time of the RN assessment and reassessed if orientation or alertness deteriorates and/or a fall occurs.

Although a fall risk score is assessed daily, patients identified as at risk for fall at any time during hospitalization will remain on the Fall Prevention Protocol for the duration of hospitalization unless documented otherwise by an RN or a physician. Any patient experiencing an accidental fall will remain on the Fall Prevention Protocol for the remainder of the admission.

1. Assess risk score daily at the time of RN assessment and reassess if patient orientation or alertness changes.
2. Monitor gait, balance and fatigue with ambulation.
3. Monitor closely after change in medications for possible side effects:

• sedation
• hypotension
• impaired balance
• impaired elimination
• impaired reaction time

Interventions

4. Place green arm band on patient wrist.
5. Post a fall risk sign in a highly visible area of patient room.
6. Discuss high risk for fall status with patient and/or family upon initial score of 40 points or greater.
7. Review "Tips to Prevent Falls" teaching sheet with patient and family.
8. Maintain bed in low position with siderails up when not in attendance.
9. Maintain chair and bed in locked position at all times.
10. Reorient to surroundings and environment as needed
11. Monitor patient and environment for safety at least every 2 hours.
12. Place call light and frequently used items within reach. Utilize night light in patient room.
13. Offer bedpan, urinal, or assistance to bathroom at mealtime, at bedtime, and upon awakening.
14. Provide non-skid slippers for patients without footwear.
15. Obtain walker, cane, or wheelchair from home if patient has needed assistive devices prior to admission. Assist with/supervise transfers and ambulation.
16. Consider placement in room or area of high visibility.
17. Discuss benefits of continuous supervision with family as appropriate.
18. Communicate high risk fall status at shift report and upon patient transfer to other department or unit.

19. Fall risk score with the daily assessment and repeated as reassessed.
20. Notification of high risk fall status to patient and/or family upon initial score of 40 points or greater.
21. Teaching to patient and/or family using "Tips to Prevent Falls" education materials.
22. Enter "high risk for injury related to fall risk" to the plan of care, with initiation of the Fall Prevention Protocol on the plan of care.

REFERENCES:

Hendrich, A. Et al. (1995) Hospital falls: development of a predictive model for clinical practice. Applied Nursing Research. 8 (3), 129-39.

McCloskey, J. & Bulechek, G. (1992). Nursing Interventions Classification. St. Louis: Mosby Year Book.

Wood, L. et al. (1992). Fall risk protocol and nursing care plan. Geriatric Nursing, 13(4), 205-6.

APPROVAL:

Protocol Committee, 12/90; Procedure/Protocol Committee
Revised:  5/94, 8/94
Reviewed:  2/97

DISTRIBUTION:
Generic Process Standards Manual - All Nursing Units

Fall Risk Score

The Fall Risk Score is assessed on admission and reassessed daily and for any change in orientation or level of consciousness.

Implement the Fall Prevention Protocol for adult patients (age 18 or >) who score 40 or more total points. Although the score is reassessed daily, patients identified as at risk any time during hospitalization will remain on the Fall Prevention Protocol for the duration of hospitalization unless documented otherwise by an RN or a physician. Any patient experiencing an accidental fall will remain on the Fall Prevention Protocol for the remainder of the admission.

All hospitalized patients require general safety precautions and receive a copy of "Tips to Prevent Falls" upon admission. Staff will review "Tips to Prevent Falls" with patient and/or family upon initial score of 40 or more total points.

Unsteady Gait (20)

When ambulating or transferring independently or with assistance, the patient is uncertain, insecure, wobbly, unstable, wavering, weak, or shaky on their feet.

Disoriented (10)

If the patient is not oriented to person and place and time and situation, then they are disoriented.

Incontinent (10)

Unable to control urination or defecation. Does not include patients with drainage devices.

Diagnosis of Psychosis or Dementia (10)

Patient has a primary or secondary diagnosis of any of the following:

• Schizophrenia
• Brief Reactive Psychosis
• Dementia
• Alzheimer's Disease
• Multi-infarct Dementia
• Organic Delusional Syndrome
• Organic Mood Syndrome
• Organic Personality Syndrome
• Organic Hallucinosis

History or Recent Fall (10)

Patient has fallen within the past 3 months.

Taking Sedatives (10)

See list attached as TX004F.pdf above

See list below, or attached as TX004F.pdf above

Related Documents:  None

Last JCAHO Survey: September 1997

Comments/Facility Type:   System wide policy, used in three acute care hospitals - A 300 bed acute care,  a 100 bed acute care, and a 30 bed acute care (rural setting)

Latex Allergy Care for Patients/Staff

GOAL:

To identify patients and staff with known latex allergy and provide them with a latex free environment.

POLICY:

Latex-safe environments will be provided for latex allergic patients needing medical, surgical, or dental procedures. Latex-safe areas are defined as those containing only non latex materials across the continuum of care.

Latex-allergic workers will use only non-latex gloves. Latex free material will be readily available to health care workers. Other individuals in the same work environment will use powder free, low protein gloves.

Questionnaires will be administered by Employee/Occupational Health to all new employees to determine risk or presence of latex-related allergies.

Scope of Policy:

This policy will apply to all Your Health Systems entities which provide or support direct patient care activities.

PROCEDURE:

A. Responsibilities:

1. Physician Staff: The physician is responsible for documentation of a patient’s latex allergic response and any confirming diagnostic test in the medical record

2. Nursing Services: The nurse is responsible for assessment of patient allergies including documentation and notification of other health care professionals. The nurse will provide a latex/free environment by obtaining a "latex free cart" from Central Supply. Documentation to include:

a. A note in the patient’s progress notes to document the type of allergic reaction to latex.

b. "Latex Allergy" sticker to be placed on the front of the chart and on Kardex.

c. "Latex Allergy" sign to be posted over the patient’s bed.

d. "Latex Allergy" armband to be placed on the patient on admissione. Computer notification to Pharmacy, Radiology, Laboratory, and Dietary. Other departments will be notified if providing care (e.g. Respiratory Therapy, Physical Therapy, Surgery, G.I. Laboratory, Ultrasound, etc.)

3. Materials Services: Central Supply will maintain and provide a "latex free cart" stocked with commonly used latex-free supplies and the armbands. Cart contents will be listed on the outside. Additional supplies will be ordered directly from Central Supply. Materials Department is responsible for providing "latex free" supplies and will be a resource to staff/physicians on the latex content in supplies.

4. Pharmacy: Responsible for providing latex free injectable supplies and IV solutions. See pharmacy protocol.

5. Surgery: Is responsible for providing a latex free surgical environment. See Surgery protocol (to include OPS and Eye Center).

6. Laboratory Services: Responsible for obtaining sample for Allastat Testing. See Laboratory Protocol. Will also provide latex free blood draws and testing.

7. Dietary: Personnel will use non-latex gloves when preparing food for latex-allergic patients.

8. Employee/Occupational Health is responsible for evaluation and treatment of existing employees and referral to an Allergist if symptoms persist.

B. Provision of latex free environment for patients:

1. Provision of a latex free environment.

a. Any patient suspected of having a latex allergy will be treated in a latex free environment until blood results available.

b. Patient will be placed in a private room in which latex products will be removed or covered. (e.g., gloves, B/P cuffs)

c. A latex free environment including equipment and supplies will be used during any patient procedure.

d. Blood products and IV solutions will be administered in a latex free manner.

e. Medications will be provided in a latex free manner.

2. Monitor the patients for symptoms of latex allergy: skin rash, hives, swelling, eye tearing or itching, wheezing, bronchospasm, chest pain or tightness, nasal congestion.

3. If a reaction occurs:

a. Stop using the agent.

b. Observe for serious reactions such as bronchospasm or anaphylaxis.

c. Injectable Epinephrine and Benadryl will be readily available for inadvertent exposure.

d. Contact the physician and have the CPR Cart readily available.

e. Initiate CPR if necessary.

4. Education will be provide to the patient and family on latex allergy and the types of

procedures which can place them at risk for a latex allergic reaction.

C. Provision of latex free environment for employees:

1. Identification of known or suspected latex allergic Health Care Workers is accomplished through use of a latex allergy questionnaire that becomes part of the employee’s health record.

2. Employee/Occupational Health will be responsible for counseling employees on the potential for latex sensitivity and identifying latex containing items so the employee can avoid them whenever possible. New employees will be referred to their personal physician for advisement.

3. Employees may require possible job modification or reassignment in order to accommodate them in accordance with legal requirements.

4. Education of employees on latex allergy awareness will be covered at new employee orientations and required annually safety reviews.

5. Latex free Materials/Supply will be readily available to staff.

Related Documents:  None

Last JCAHO Survey: April 1996

Facility Type:   Acute Care/600 inpatient beds

Outcome: The patient with an allergy or sensitivity to latex will have care provided with latex-free materials and be monitored for potential reactions with appropriate interventions if needed.

Level:  Independent

Supportive Data:  Latex allergy has been recognized as a significant problem for specific patients. An immediate and systemic reaction to latex is defined as a Type I response. A Type IV response is a delayed local reaction to latex. A Type IV response can progress to Type I with repeated exposure, putting the patient in great danger of cardiac and respiratory failure.

Patients with both types of reaction to latex must be cared for according to the Latex Sensitivity/Allergy Protocol. Patients at highest risk for latex sensitivity and/or allergy include those with spina bifida, patients with chronic urologic abnormalities, persons who have had multiple surgeries, healthcare providers, and others with occupational exposure to latex.

The latex sensitivity screen is done on all patients at the time of hospital admission and prior to any outpatient treatment or testing.

Assessment

1. Monitor high risk patients for symptoms of sensitivity or allergic response.

2. Report presence of latex sensitivity or latex allergy to physician.

3. Report signs of potential latex reaction to physician.

Interventions

4. Place all patients with a history of spina bifida (myelomeningocele) on latex sensitivity precautions (steps 6-9).

5. Institute latex allergy measures only for those with known Type I and Type I reactions (steps 10-19).

Latex Sensitivity Precautions

6. Use only latex-free gloves; remove all latex gloves from room.

7. Avoid use of latex wherever possible. Private room and special cleaning not necessary. Glass/latex-free syringes and intravascular systems are not needed.

8. Use stopcock in IV system to inject meds, except when using latex-free needleless systems.

9. Monitor for signs of systemic latex allergy response, even if patient has never had a systemic response.

Latex Allergy Measures

10. Use only latex-free gloves; remove all latex gloves from room.

11. Ensure patient has a private room housecleaned by staff using powder-free nonlatex gloves.

12. Consider use of a hepafilter in patient room if powdered latex gloves have been used within the past year.

13. Utilize only latex-free supplies.

14. Obtain a current list of latex-free supplies from the Safety Department at the time of admission and weekly thereafter as latex-free supplies change often.

15. Use only latex-free or glass syringes.

16. Place Latex Allergy sign on patient door and document latex allergy or sensitivity with other allergy information.

17. Use stop-cock in IV system to inject meds, except with use of latex-free needleless systems.

18. Wrap all equipment containing latex in webril or stockinette before coming in contact with the patient (i.e. stethoscope tubing, BP cuff tubing).

19. Wrap extremity with latex-free material (stockinette, webril, gown, towel) before applying tourniquet or blood pressure cuff.

Teaching

20. Explain to Spina Bifida patient and family the reasons for avoiding latex products.

21. Review patient education materials listing common items containing latex.

22. Stress the importance of relaying allergy information to all healthcare providers.

23. Encourage use of a medical alert tag.

Documentation

24. Physician notification of patient history of latex sensitivity and/or allergy.

25. Physician notification of a potential latex reaction.

26. Patient teaching and response to teaching about latex allergy.

REFERENCES:

Brown, J. (1994) Latex allergy requires attention in orthopaedic nursing. OrthopaedicNursing, 13 (1) 7-11.

Beezhold, D., Kostyal, D., Wiseman , J. (1994). The transfer of protein allergens from latex gloves. AORN Journal, 59 (3) 605-13.

Reis, J. (1994). Latex sensitivity, AORN Journal, 59, (3) 615-21. American Association of Nurse Anesthetists Latex Allergy Protocol, April 1993.

APPROVAL: Professional Staff QA Committee, 4/95

Revised: 12/95; 11/96; 11/98

DISTRIBUTION: All Patient Care Areas

Related Documents:  None

Last JCAHO Survey:

Facility Type:  

• competency tool for agency sitters (equal to inhouse sitters)
• basic skills and responsibilities provided on each sitter assignment
• "activity list" filled out at start of assignment that serves somewhat like a report
• a grid from our policy that indicates appropriateness of sitters
• a "care module" that is in draft form and still needs piloting (the need for such a documentation tool is that, like so many places, sitter use is on the rise without a consistent approach to rationale and steps needed for each assignment)

TX007Fa - Continuous Observation Activities List
TX007Fb - Policy Grid - Indicating the Appropriateness of Sitters
TX007Fc - Basic Skills and Responsibility for Sitters
TX007Fd - Competency Tool for Sitters
TX007Fe - Care Module

Downloadable Files:
All of the abobe listed files can be downloaed inWord 95 format.  They have been zipped in a self extracting file:  TX007F.exe

To download teh file, For Windows, right click on the above download file and choose "Save Link As..." and save the file to your
directory of choice. Once downloaded, double-click on the downloaded file to extract the two files for the scoring
spreadsheet and the instructions.

Related Documents:  None

Last JCAHO Survey:  February 1999

Facility Type:   Acute Care

Downloadable or Viewable Documents: 
Conscious Sedation Policy online and Downloadable in Adobe Acrobat Reader Format:   TX008P.pdf
You can view the file if you Adobe Acrobat Reader installed by simply clicking on the link, or you can download it by right clicking and specifying the directory on your computer where you want the file to be downloaded.  Please see information on the About this Site page to download Adobe Acrobat Reader.

Conscious Sedation Policy Downloadable in a self-extracting executable file in Word95 format: TX008P.exe
For Windows, right click on the above download file and choose "Save Link As..." and save the file to your directory of choice.  Once downloaded, double-click on the downloaded file to extract the two files for the scoring spreadsheet and the instructions.

Related Documents:  None

Last JCAHO Survey:  April 1996

Facility Type:   Acute Care/600 Beds

Downloadable or Viewable Documents: 
Conscious Sedation Policy online and Downloadable in Adobe Acrobat Reader Format:   TX009P.pdf
You can view the file if you Adobe Acrobat Reader installed by simply clicking on the link, or you can download it by right clicking and specifying the directory on your computer where you want the file to be downloaded.  Please see information on the About this Site page to download Adobe Acrobat Reader.

Conscious Sedation Policy Downloadable in a self-extracting executable file in Word95 format: TX009P.exe
For Windows, right click on the above download file and choose "Save Link As..." and save the file to your directory of choice.  Once downloaded, double-click on the downloaded file to extract the two files for the scoring spreadsheet and the instructions.

Related Documents:  All are grouped here

Last JCAHO Survey:  March 1999

Facility Type:   Acute Care 62 Bed Rural

Downloadable or Viewable Documents: 
Adobe Acrobat Reader Format:  
Restraint and Seclusion Policy: TX010Pa
Restraint Protocol for Patients Interfering with Treatment:  TX101Pb
Restraint Protocol for Patients at Risk for Fall:  TX010Pc

You can view the files if you Adobe Acrobat Reader installed by simply clicking on the link, or you can download it by right clicking and specifying the directory on your computer where you want the file to be downloaded.  Please see information on the About this Site page to download Adobe Acrobat Reader.

All three policies are downloadable in a self-extracting executable file in Word95 format: TX010P.exe
For Windows, right click on the above download file and choose "Save Link As..." and save the file to your directory of choice.  Once downloaded, double-click on the downloaded file to extract the two files for the scoring spreadsheet and the instructions.

Related Documents:  None

Last JCAHO Survey:  Not submitted

Facility Type:   Not submitted

Downloadable or Viewable Documents: 
Adobe Acrobat Reader Format:  
Restraint Interventions/Alternatives Pathway: TX011F.pdf

You can view the files if you Adobe Acrobat Reader installed by simply clicking on the link, or you can download it by right clicking and specifying the directory on your computer where you want the file to be downloaded.  Please see information on the About this Site page to download Adobe Acrobat Reader.

The pathway is downloadable in a self-extracting executable file in Word95 format: TX011F.exe
For Windows, right click on the above download file and choose "Save Link As..." and save the file to your directory of choice.  Once downloaded, double-click on the downloaded file to extract the two files for the scoring spreadsheet and the instructions.

Related Documents:  None

Last JCAHO Survey:  Not submitted

Facility Type:   Acute Care, Childrens

Downloadable or Viewable Documents: 
Adobe Acrobat Reader Format:  
Restraints and Seclusion Policy: TX012P.pdf

You can view the files if you Adobe Acrobat Reader installed by simply clicking on the link, or you can download it by right clicking and specifying the directory on your computer where you want the file to be downloaded.  Please see information on the About this Site page to download Adobe Acrobat Reader.

The policy is downloadable in a self-extracting executable file in Word95 format: TX012P.exe
For Windows, right click on the above download file and choose "Save Link As..." and save the file to your directory of choice.  Once downloaded, double-click on the downloaded file to extract the two files for the scoring spreadsheet and the instructions.

Related Documents:  None

Last JCAHO Survey:  Not submitted

Facility Type:   Not submitted

Downloadable or Viewable Documents 
Adobe Acrobat Reader Format:  
Outpatient Surgery Report: TX013F.pdf

You can view the files if you Adobe Acrobat Reader installed by simply clicking on the link, or you can download it by right clicking and specifying the directory on your computer where you want the file to be downloaded.  Please see information on the About this Site page to download Adobe Acrobat Reader.