racticedevelopmentprogramme ... · racticedevelopmentprogramme Orientationandfamiliarisationclinicalp ... Asthma Cellulitis ... Management of chest pain- PQRST and GTN protocol

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Orientationandfamiliarisationclinicalp

racticedevelopmentprogramme















Medical

Assessment &

Planning Unit

(MAPU)

STUDENT NURSE ORIENTATION

MidCentral District

10/9/2016

Developed by: MDHB Nurse Educators

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Compassionate Courageous Respectful Accountable

CONTENTS

MEDICAL ASSESSMENT & PLANNING UNIT (MAPU) ........................................................................4

EXPECTATIONS OF THE STUDENT NURSE .........................................................................................5

TREASURE HUNT ...............................................................................................................................6

ORIENTATION TO KEY PEOPLE AND ROLES ......................................................................................6

EMERGENCY RESPONSE ...................................................................................................................7

WARD ROUTINE ................................................................................................................................8

OBJECTIVES .................................................................................................................................... 11

COMMON PRESENTATIONS TO MAPU .......................................................................................... 11

COMMON MEDICATIONS .............................................................................................................. 12

DOCUMENT MANAGEMENT SYSTEM CONTROLLED DOCUMENTS ............................................... 12

ESSENTIAL SKILLS: SUGGESTIONS .................................................................................................. 13

SCENARIO # 1: ISBAR Template ..................................................................................................... 14

EVALUATION OF YOUR PRECEPTOR .............................................................................................. 18

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Ki mai ki ahau, he aha te mea nui o tenei ao

Maaku e ki atu

He tangata, he tangata, he tangata

If you ask me what is the most important thing in the world,

My reply is this,

It is people, it is people, it is people

DOCUMENT CONTROL

Version Issue & Circulation Date Brief Summary of Change

1. 28th November 2016 Release authorised by Charge Nurse MAPU

2.

3.

Authors Raewyn Ormsby-Lobo; Debbie Perry; Yvonne Stillwell

Location MDHB: student

Contact Raewyn Ormsby-Lobo

Approved November 2016

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MEDICAL ASSESSMENT & PLANNING UNIT (MAPU)

Welcome to the Medical Assessment & Planning Unit (MAPU) team. We trust you will enjoy

your experience here, applying your theory to practice and further developing your clinical skills.

We hope that you will develop great working relationships with the patients, family/whānau and

the interdisciplinary team to both yours and the organisation’s benefit.

MAPU provides acute assessment, observation and/or treatment for up to 24 hours. Its purpose

is to reduce unnecessary admission to a ward and to focus on individualised outcomes for

patients. We expect that it will help to deliver faster, safer, better care for patients with acute

conditions who don’t need emergency treatment.

MAPU is staffed by experienced doctors, nurses and allied health professionals which means

patients can be seen by this specialist team, commence treatment earlier and return home as

soon as possible.

Key contacts for MAPU are:

MAPU Admin Support Ph: (06) 350 9190

Charge Nurse Debbie Perry Ph: (06) 356 9169 ext 7062 Pager: 503

Nurse Educator

Raewyn Ormsby-Lobo Ph: (06) 356 9169 ext 8752 Pager:381

Please contact the Charge Nurse to confirm your starts dates and times.

PRECEPTOR

You will be allocated one main preceptor who will be responsible for helping you to identify and

meet your objectives. We will endeavor to ensure that you work mainly with this preceptor.

However due to shift work this is not always possible. It is your responsibility to ensure the

nurse you are working with is aware of your objectives for the day/week. You must provide

evaluations and/or other paperwork to your preceptor in a timely fashion (i.e. not on the due

date). Your preceptor will not complete any evaluations if you give it to them on your last days

in the unit.

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EXPECTATIONS OF THE STUDENT NURSE

The shifts are: AM shift: 0700-1530 PM shift: 1430-2300 Night shift: 2245-0715 On the first day please complete the Student contact details form (page 19) and give it to

the Charge Nurse or nurse in charge of the shift.

It is expected that you arrive on time and if you are going to be late or unwell and cannot

come in please ring the ward on (06) 350 9190 and ask to speak to the Charge

Nurse/Associate Charge Nurse.

We endeavor to give you a fair roster with continuity of preceptor(s) wherever able. If you

are unable to work the shifts that you have been rostered, you need to discuss this with the

Charge Nurse.

You must complete the full shift that you are allocated to work. If you are unable to do so,

please discuss this with your preceptor.

The preceptor you are working with should be aware of your learning objectives. Please

discuss these at the start of your shift.

Your preceptor will work with you to help you learn about assessment and management of a

variety of conditions relevant to the setting.

If you are not achieving your objectives, please see the Charge Nurse.

Third year nursing students that are commencing their final placement need to identify early

in their placement which preceptor will be completing their documentation requirements

and ensure their preceptor has an adequate timeframe to complete this.

Please ensure that your uniform meets your institution standards and that your uniform is

clean, jewelry removed and hair tied back.

Please complete the Preceptor Evaluation Form (Page 18) and give this to the Charge Nurse.

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TREASURE HUNT

This list is designed to help you become familiar with the environment, but is by no means exhaustive of all the things you will be required to locate. Alcohol Swabs Tympanic thermometer covers

Blood Glucose machine Suction Equipment

Charge Nurse Office BP equipment

Controlled Drug Cupboard Clinical policies & procedures

Defibrillator Photocopier

Dressing Materials Laboratory forms

ECG machine “Notes on Injectable Drugs”

IV Syringes Bio-hazard bags

Linen supplies Roster

Oxygen isolation “shut off” valve Linen bags

Portable Phone Patient charts

Sling Hoist Sterile Gloves

Sluice room Stationery supplies

Staff meeting room Weighing Scales

Where to store your bags

ORIENTATION TO KEY PEOPLE AND ROLES

WHO/WHAT (√) when completed

(x) Not applicable

Chaplins

Charge Nurse(s) and Associate Charge Nurse(s) Clinical Nurse Specialists Exec Director of Nursing and Midwifery Duty Nurse Managers Human Resources

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Infection Prevention and Control Multi - disciplinary Team Members Nurse Directors Nurse Educators Nursing Practice Development (Kahikatea)

Occupational Health Preceptors Service Manager

EMERGENCY RESPONSE

The emergency number for Fire, Cardiac Arrest and Security is 777. In an emergency

situation, please follow the direction of the nursing and medical staff. Locate the following:

WHAT (√) when completed (x) if not applicable

Duress Button Procedure

Emergency Bells

Emergency Equipment

Emergency Phone Number

Emergency Response Flip Chart

Fire Extinguishers

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Fire Hoses

Portable Oxygen

Red Phone (fire emergencies)

Suction

WARD ROUTINE

TIME ACTION

0700

For AM Shift Handover from night staff to AM staff in the handover room,

followed by bedside handover. Coordinator takes pager from night staff.

0715

Introduce self to patients/staff. Ensure all falls prevention measures are in place. Check oxygen, suction and equipment in working order. Make your plan of care for the shift. Prepare medications to administer at appropriate times. Check your drug infusions and fluid balance charts. Take blood sugar levels on patients with diabetes prior to

breakfast.

0800-0900

Do a complete assessment for skin integrity, dressing changes needed and hygiene needs e.g. shower, bed bath and hair wash.

Document Ensure patients required to be nil by mouth for diagnostic tests

are aware and signs are attached to the bed to inform others. Ensure white board is up to date. Take vital signs as noted in Care Plan.

0900-1030 Consultant ward round begins: Avoid taking morning tea breaks during ward rounds.

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Ensure you are with your patient(s) when the team arrives. Ensure medical staff discuss the plan of care for the patient with

you. Morning tea –at the beginning of the shift liaise with the other

nurses in MAPU and the Nurse in Charge to organise tea and meal breaks.

Attend to patient’s hygiene needs. Delegate to HCA’s as appropriate.

Liaise with Allied Health professionals and complete necessary referrals.

Update documentation. Complete TrendCare categorisations & predictions by 0930hrs.

1100-1330

Update white board after consultant ward rounds. Ensure Trend Care is up to date. Dressings – CVL, wound dressings. Check IV lines. Pressure area care – turn/reposition patient and document. Half-hour lunch break should occur at this time. Handover your

patient to your preceptor before leaving the unit.

1400-1530

Check results of any routine blood tests. Update patient Admission to Discharge booklet. Bedside handover to afternoon staff following handover in

handover room. Negotiate with your preceptor to attend clinical teaching

sessions/tutorials. Total fluid balance charts for the shift. Empty drainage bags. Check linen and rubbish bags. General clean and restock of own work area – report low stocks.

TIME ACTION

1445-1700

For PM shift Bedside handover to afternoon staff following handover in

handover room. Introduce self to patients. Ensure all falls prevention measures are in place. Check oxygen, suction and equipment all in working order at the

head of each bed. Initial patient head to toe assessment and documented in notes. Make your plan of care for the shift. Check infusions.

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1700-1900

Be present for medical assessment by evening Doctors. Half-hour dinner break –at the beginning of the shift liaise with

nurses and the shift coordinator to organise tea and meal breaks. Vital signs/fluids/ monitoring as per care plan. Document any changes in the plan in the notes. Ensure Trend Care is up to date.

1930-2100 Settle patients for the night. Do a complete assessment for skin

integrity, dressing changes as needed. Vital signs/fluids/monitoring as per care plan.

2100-2300

Dim lights in MAPU Coffee break – at the beginning of the shift liaise with nurses and

the shift coordinator to organise tea and meal breaks. Charge to organise tea and meal breaks. Restock work trolley Check results of any routine blood tests. Vital signs/fluids checks as required. Update clinical record.

2245-2315

Empty Rubbish bags Catheter bags Linen Skip General clean and restock of own work area – report any low

stocks. Handover to night staff followed by beside handover.

Time Action

2245-2400

For Night Shift Introduce self to all patients. Ensure all falls prevention measures are in place. Check oxygen, suction and equipment. Make your plan of care for the shift. Check infusions. Total previous 24 hour fluid balance.

2400-0300

4 hourly vital signs/fluid check. Ensure Trend Care is up to date We encourage periods of rest and sleep for patients during the night where this is possible. If your patient is stable, please allow them to rest. Turn the lights as low as possible and minimise external sources of noise.

0400-0600

Review medications for all patients – fax morning requirements to pharmacy.

Full range of routine blood tests sent to lab now – if requested. Toilet all high risk of falls patients. Empty catheter bags. Check linen skip and rubbish has been emptied.

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Discard any reconstituted drugs at the end of your shift. General clean and restock of own work area – report low stocks.

0700 Welcome morning staff Handover

OBJECTIVES

Below are some of the objectives you should aim to complete during your placement in MAPU. To provide appropriate care to the patient and whānau with support and supervision from the preceptor: Assessment on admission Planning and implementation of care Documentation of care planned and provided Referrals to appropriate agencies Participation in discharge planning

These will be achieved by gaining an understanding of:

The multidisciplinary team and participating in the daily MDT meeting

Infection control practices and measures taken in the unit

Pain management principles

Fluid management/Fluid balance recording

Wound assessment and management

To perform assessments and implement appropriate prevention strategies for the following

nurse sensitive indicators:

Falls risk assessment Braden score MUST Intentional rounding Discharge risk assessment

COMMON PRESENTATIONS TO MAPU

Below is a list of common presentations that it would be useful to have read up on before you come for your placement with us.

Acute confusion Asthma Cellulitis Collapse/Syncope/TIA Gastroenteritis GI bleed Management of chest pain- PQRST and GTN protocol

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Management of respiratory disorders including exacerbation of COPD, Pneumonia, TB Management of delirium including CAM scores Management of diabetes and DKA Management of self harm and suicidal ideation Management of infection/sepsis UTI (Urinary tract Infection)/pyelonephritis

COMMON MEDICATIONS

Administration of IV therapy in MAPU is in accordance with the IV & Related Therapies Policy

available on the intranet. According to the Basic Certification Standard please note “Students

(nursing, midwifery, radiologic technology, anaesthetic technology), and their respective clinical

lecturers/clinical teaching associates are expected to adhere to the standards and principles of

this document”.

Some common medications or medication types used in MAPU are listed below. It would be

useful to have read up on before you attend your placement.

Anti coagulants such as warfarin, dabagatrin and clexane Antibiotics such as flucloxicillin Beta blockers such as Metoprolol Diuretics

During your time in MAPU you will have the opportunity to complete a medication competency checklist.

DOCUMENT MANAGEMENT SYSTEM CONTROLLED DOCUMENTS

Once on placement you will need to access relevant policies, procedures and guidelines. Ask your preceptor to help you find the Document Management System on the intranet. (Note: you cannot access this outside of the organisation.)

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ESSENTIAL SKILLS: SUGGESTIONS Essential Skills How to access

ABC smoking brief advice Access on-line module: https://learnonline.health.nz/login/index.php

1. Electrical Safety

Complete at Core skills

Fire Safety Complete at Core skills. Identify fire and evacuation procedure on first day in the clinical setting.

2. Hand Hygiene

Access www.handhygiene.org.nz

Code of Conduct Access via NCNZ website: http://www.nursingcouncil.org.nz/Nurses/Code-of-Conduct

Direction and Delegation Access via NCNZ website: http://www.nursingcouncil.org.nz/Publications/Standards-and-guidelines-for-nurses

Clinitek Urinalysis Clinitek Resource Folder: Skills Assessment Tool in clinical area

Novo Statstrip MDHB-4859 (Appendix 1 page 4) Skills Assessment Tool on Document Management System

O’Shea No-lift Core Skills and Refer to MDHB-2655 on Document Management System

https://learnonline.health.nz/login/index.php

http://www.handhygiene.org.nz/

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SCENARIO # 1: ISBAR Template

ISBAR is a standard mnemonic to improve clinical communication. It is used by MDHB staff to

ensure they communicate clearly, comprehensively, and concisely.

Identify Who you are and what is your role? Who the patient is

Situation What is going on with the patient?

Background What is the clinical background/context?

Assessment What do I think the problem is?

Recommendation What would you recommend?

I IDENTIFY Patient’s NHI, Name and DOB Name and title/role of staff handing over

S SITUATION

I am calling about <patient name and location>. The problem I’m calling about is__________________.

I am afraid the patient is going to arrest. I have just assessed the patient personally: Vital signs are: Blood pressure ____/____, Pulse ____, Respiration ____ and Temperature ___ I am concerned about the:

Blood pressure because it is over 200 or less than 100 or 30 mmHg below usual. Pulse because it is over 140 or less than 50. Respiration because it is less than 5 or over 40. Temperature because it is less than 96 or over 104.

B BACKGROUND The patient’s mental status is:

Alert and oriented to person, place, and time Confused and cooperative or non-cooperative Agitated or combative Lethargic but conversant and able to swallow Stuporous and not talking clearly and possibly not able to swallow Comatose. Eyes closed. Not responding to stimulation.

The skin is: Warm and dry/pale/mottled/extremities cold/ extremities warm

The patient is not or is on oxygen. The patient has been on ____ (l/min) or (%) oxygen for ____ minutes (hours) The oximeter is reading ____ % The oximeter does not detect a good pulse and is giving erratic readings.

A ASSESSMENT This is what I think the problem is: <say what you think is the problem> The problem seems to be

cardiac infection neurologic respiratory _____ I am not sure what the problem is but the patient is deteriorating.

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The patient seems to be unstable and may get worse; we need to do something. R RECOMMENDATION

I suggest or request that you <say what you would like to see done> Transfer the patient to critical care. Come to see the patient at this time. Talk to the patient or family about resus status. Ask the on-call family practice resident to see the patient now. Ask for a consultant to see the patient now.

Are any tests needed: Do you need any tests like CXR, ABG, EKG, CBC, or BMP? Others?

If a change in treatment is ordered then ask: How often do you want vital signs? How long do you expect this problem will last? If the patient does not get better, when would you want us to call again?

CHECKLIST: WHEN CALLING MEDICAL STAFF : 1. Have I seen and assessed this patient myself before I call? 2. Have I reviewed the patient’s active orders? 3. Do I have at hand:

The chart

List of current meds, IV fluids, labs, and most recent vital signs

If reporting lab work, date and time this test was done and results of previous tests for comparison

Resus status 4. Have I read the most recent medical staff progress notes and notes from the previous shift? 5. Is there a need to discuss this call with my Charge Nurse/Duty Nurse Manager? 6. When ready to call, remember to identify:

Self, unit, patient, room #

The admitting diagnosis and date of admission

Briefly, the problem, what it is, when it happened or started, and how severe it is 7. What I expect to happen as a result of this call 8. Document whom you spoke to, time of call, and summary of conversation

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Step One: Select two patients and write their primary diagnoses and key clinical data in the table below. For each patient, read the specified scenario and then use the ISBAR format to create a script that communicates the specified concern. NB: Remember confidentiality – do not include any identifiable patient information.

PATIENT CLINICAL DATA

SCENARIO SCRIPTING

Sample: 48-year-old male recovering comfortably for 12 hours after scheduled triple bypass

Your patient has reported a surprising spike in pain. You have called the registrar to report this change.

I This is RN Amy from ward 31 – I am looking after Mr. Smith, a 48 year-old man 12 hours post CABG

S The patient has experienced a spike in pain from level 4 to a level 8 over the past two hours.

B Mr. Smith’s pain levels and vital signs had been normal until two hours ago. He is not responding to current pain medications.

A The patient’s pulse, blood pressure, and respiration levels are elevated and there is additional tenderness in his abdomen.

R I recommend the patient be prescribed a stronger pain reliever and undergo radiology scans to verify that there is no internal bleeding

Your patient has becoming increasingly despondent and depressed. You are communicating this to their General Practice team.

I

S

B

A

R

You are concerned that your patient may be

I

S

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deteriorating. You have called the House Surgeon to discuss potential action steps.

B

A

R

R

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EVALUATION OF YOUR PRECEPTOR

Please return your evaluation to your Charge Nurse

Name of Preceptor_____________________________________ Date__________

Please read the following statements then tick the box that best indicates your experience

My Preceptor: E VG S NI

Was welcoming and expecting me on the first day

Was a good role model and demonstrated safe and competent clinical practice

Was approachable and supportive

Acknowledged my previous life skills and knowledge

Provided me with feedback in relation to my clinical development

Provided me with formal and informal learning opportunities

Applied adult teaching principals when teaching in the clinical environment

Describe what your preceptor did well

Describe anything you would like done differently

Signed:____________________________ Name:__________________________

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E = Excellent VG = Very Good S = Satisfactory NI = Needs Improvement

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CONTACT DETAILS

The staff on the ward care about your well-being as well as your education. They will notice and

be concerned if you don’t arrive for a planned shift, if there is illness on the ward or in the case

of an emergency. They may need to contact you to check you are okay and to let you know if

there needs to be a change to your shifts.

Please could you provide the ward with your contact details and an emergency contact using the

form below?

Your Name

Your Home Phone

number

Your mobile phone

number

Name of emergency

contact

Phone number of

emergency contact

From time to time the staff on the ward may need to contact your lecturer regarding your

progress, for support or in the case of problems.

Please could you supply the contact details of the Lecturer/CTA that will be supporting you

during this placement, in the form below?

Name of Lecturer/CTA

Phone number of

Lecturer/CTA

This information will be kept by a senior staff member for the length of this placement and then

will be destroyed. It will not be shared with anyone else without your permission unless there is

an emergency.

Documents

racticedevelopmentprogramme ... · racticedevelopmentprogramme Orientationandfamiliarisationclinicalp ... Asthma Cellulitis ... Management of chest pain- PQRST and GTN protocol