Ppg Gdch Nur 33 Nursing Care

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GULFDIAGNOSTIC CENTER

HOSPITAL

NURSING POLICY Policy No:MED-NUR-P0033/12

TITLE: Nursing Standards of CareIssue Date : July 2012

Revision No.: Original

Department : Nursing Revision Date :

Section : Nursing Care Next Revision : July 2014

Distribution : Hospital Wide Page 1 of15

Nursing Standards of Care

APPROVAL SHEET

Prepared by:

Name Signature Date

Ms. Gela Mocanu

Head of Nursing Department

Reviewed by:

Name Signature Date

Prof. Dr. Emad Al Rahmani

Medical Director

Mr. Zuher ArawiIT, QA Manager

Approved by:

Name Signature Date

Mrs. Jamal KaddouraCo-founder & Hospital Director

__________________________________________________________________________________________________________________________________________________________________________________________________

Appendix: Yes [ ] No [ ]


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DOCUMENT AMENDMENT RECORD SHEET

Date Description of Change Page EffectedRevision

Number

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TABLE OF CONTENTS:

SUBJECTS PAGE NO.

1. DEFINITION 4

2. POLICY 4

3. SCOPE 4

4. RESPONSIBILITY 4

5. PROCEDURE 4-15

6. REFERENCE 15

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1. PURPOSE

1.1. The purpose of these standards is to ensure that all patients will receive quality nursing

care according to established standards, which are evidenced based and supported by amulti-disciplinary team.

1.2. Nursing policies are given where necessary to assist the nurse to find more information

if required.

2. POLICY

2.1. To ensure adequate Nursing Standards of Care for all patients.

3. RESPONSIBILITY

3.1. All Medical Staffs

4. PROCEDURE

4.1. PATIENT ASSESSMENT

4.1.1. Complete physical assessment will be performed on all new admissions and

transfers to the ward within 1 hour of admission and the first 2 hours of eachshift and prn.

4.1.2. All sections of the nursing assessment form including psychosocial, cultural,

spiritual assessment and initial discharge planning will be completed within

24 hours following admission.4.1.3. All entries in the nursing assessment form will be completed, dated and

timed,along with name, signature and staff number of the nurse who

completed the section. Information or sections not completed require reasonof no completion.

4.1.4. Risk assessment form, patient and family education form, and oral assessment

form will be completed within 24 hours of admission and updated as specifiedon the forms.

4.1.5. The nurse will obtain and interpret an ECG rhythm strip on all patients

requiring cardiac monitoring at the beginning of each shift and during anyepisodes of dysrhythmias or hemodynamic instability.

4.1.6. Nurses will report any clinically significant or symptomatic deviations in vital

signs to the attending physician as per the MEWS score.

4.1.7. Vital signs will be recorded every four hours, as per MEWS score, or as perphysician's order.

4.1.8. Temperatures will be documented with vital signs, every 4 hours on pyretic

patients, within 1 hour post administration of anti-pyretic therapy and as perMEWS score. Documentation of temperature readings will include the site

used.

4.1.9. An apical pulse will be checked for one minute and documented prior to theadministration of digitalis

4.1.10. Intake and output will be recorded on the Intake and Output Record for__________________________________________________________________________________________________________________________________________________________________________________________________



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patients who are nil by mouth, on diuretics (if recent or increased dosage),

receiving IVF; with urinary catheter, Intercostal drains, Renal/Cardiac

admitting diagnosis.4.1.11. The necessity of all lines and drains will be addressed on each shift. This

includes all IV lines, Foley catheters, and surgical drains.

4.2. The patient can expect that his/her health data will be analyzed and used to guide theplanning of care.

4.2.1. Patient problems will be identified within 1 hour of admission anddocumented with the assessment and plan of care.

4.2.2. A plan of care will be formulated, reviewed and revised as necessary at aminimum of once per shift, and when the patient's condition changes.

4.3. The patients physiological, behavioral and self-reporting indicators of pain will be

assessed, documented and treated according to their individual needs. This will be done:4.3.1. Immediately upon admission to the ward/unit

4.3.2. With vital sign assessment and upon discharge from the unit

4.3.3. When patient complains of pain or as per Non verbal Pain Scale4.3.4. Before analgesia administration

4.3.5. Following analgesia administration within:

4.3.5.1 60 minutes post oral / rectal analgesia.

4.3.5.2 30 minutes post intramuscular / subcutaneous transdermal administration.4.3.5.3 30 minutes post intravenous administration

4.3.6. The appropriate pain assessment tool will be used and reassessed for

effectiveness of analgesia as per policy4.4. Planning of Patient Care

4.4.1. The patient can expect that a written plan of care is documented, implemented

and evaluated in a systematic way.4.4.1.1 Nursing care will be planned according to the individual patients

holistic care requirements.

4.4.1.2 Implementation of the plan of care will be reflected in the nursingDocumentation.

4.4.1.3 The plan of care will be evaluated for achieving desired outcomes on

current /potential problems and revised as needed. This will be done by

the nurse as per Policy every shift and updated as necessary in the patientschart according to changes in the patients health status.

4.4.2. The patient can expect that the nursing plan of care is coordinated, developed

and implemented in collaboration with the multi-disciplinary team.4.4.2.1 The plan of care will be implemented in collaboration with the

multidisciplinary team on an ongoing basis through team conferences, clinical

rounds and/or multi-disciplinary referrals as appropriate.4.4.3. The patient can expect that the plan of care promotes continuity of care by:

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4.4.3.1 Encouraging the same nurse to have the same patient assignment as

much as possible, staffing permitting (taking into account the competency,

emotional and intellectual needs of the nursing staff).4.4.3.2 Including the patient / family in the care planning process.

4.4.3.3 Keeping the plan of care updated and reflective of current patient

problems.4.4.3.4 Including specific information related to the patient / family

educational needs as appropriate (documented as Patient and FamilyEducation (PFE) form).

4.4.3.5When leaving the unit during the shift, the nurse will give a completehandover of his/her assigned patient to another nurse competent to manage all

aspects of their assigned patients care.

4.4.4 Planning for care includes a succinct change-of-shift report which iscommunicated from nurse to nurse. At the change-of-shift report, pertinent patient

information is provided to ensure a smooth shift transition. Change-of-shift reports

include:4.4.4.1 Patient diagnosis, past medical history, current events, length of stay

and surgery or intervention date, if applicable

4.4.4.2 Review of focus charting, plan of care, outstanding procedures and

referrals.4.4.4.3 A review of the patients medication administration record including

IV infusions and calculation of doses and rates.

4.4.4.4 An update regarding family members, to include: who visited, theinformation that was shared and their level of coping.

4.4.4.5 Update regarding process of discharge planning.

4.4.4.6 Charge Nurse / Shift in charge is to receive the change of shift reportsat the end of each shift.

4.4.5 Psychosocial/Cultural/Religious Needs of The Patient

4.4.5.1 The patient/family can expect support of theirpsychosocial/cultural/religious wellbeing using

the following interventions:

4.4.5.1.1 Utilizing translation services when necessary to enhance

communication.4.4.5.1.2 Maintaining privacy during the delivery of care.

4.4.5.1.3 Explaining tests and procedures before performing them.

4.4.5.1.4 Providing an environment that allows the patient/family topractice their

Religious/cultural beliefs.

4.4.5.1.5 Encouraging family participation in the care of the patient, asappropriate.

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4.4.5.1.6 Allowing the patient the use of personal items, such as head

coverings for women, which do not interfere with medical or nursing

procedures or hospital valuable policy.4.4.6 Physical Needs of the Patient

4.4.6.1 The patient can expect assessment and supportive treatment and care of

physiological function for the following body systems: neurological,cardiovascular, respiratory, integumentary/musculoskeletal, gastro-intestinal, and

genitor urinary/reproductive.4.4.6.1.1 Neurological

4.4.6.1.1.1 A GCS will be completed on patients with an acuteneurological pathology, those who have undergone neurosurgery

or neurological interventional procedures as per physician orders

or:4.4.6.1.1.1.1 Every 1 hour for a minimum of 6 hours post

admission or procedure

4.4.6.1.1.1.2 Then, if stable, it is completed every 2 hoursfor 12 hours then every 4 hours for 12 hours, then every 8

hours and prn.

4.4.6.1.1.1.3 If not stable, the timings of the GCS will not

change and the Physician will be notified.4.4.6.1.1.2 The nurse will immediately notify the Physician if:

4.4.6.1.1.2.1 There is a new development of agitation or

abnormal behavior4.4.6.1.1.2.2 Any drop of more that two points in the GCS

4.4.6.1.1.2.3 Development of severe or increasing headache

or persistent vomiting4.4.6.1.1.2.4 New or evolving neurological symptoms or

signs.

4.4.6.1.1.3 Suspected spinal injuries will be immobilized andspinal precautions will be implemented until clear authorization

to mobilize is documentedin the medical records by the physician.

Verbal orders are not acceptable for spinal clearance and C-spine

precautions are to continue until a written order is received fromthe physician.

4.4.6.1.1.4 Any patient with a C-collar (hard collar) will have

collar released every 2 hours for care of the neck and pressure areaassessment. C-spine alignment will be maintained during release of

collar and this procedure requires a minimum of two competent

persons.4.4.6.1.1.5 For acute patients who have or are at risk of raised

intra-cranial pressure, care will be provided that prevents__________________________________________________________________________________________________________________________________________________________________________________________________



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elevations in Intra-Cranial Pressure (ICP) and/or promotes ICP

reduction including:

4.4.6.1.1.5.1 Maintain head and neck alignment.4.4.6.1.1.5.2 Maintain head of bed elevation at 30 degrees

4.4.6.1.1.5.3 Avoid hip flexion greater then 30 degrees

(consider reverse trendelenburg).4.4.6.1.1.5.4 Avoid positions that may increase intra-

abdominal or intrathoracic pressures such as prone or semi-prone.

4.4.6.1.1.5.5 Minimize stimulation and lighting; avoidprolonged periods of stimulation.

4.4.6.1.1.6Beds containing air mattresses will not be used for

patients with suspected or diagnosed spinal trauma.4.4.6.1.1.7The nurse will attempt to minimize injury to the seizing

patient by such measures as padding the side rails, placing a pillow

under head, and clearing the area of potentially harmful materials.The nurse will never attempt to place anything into the patient's

mouth.

4.4.6.1.1.8 Oxygen therapy may be required if the seizure is

prolonged e.g. longer than 5 minutes. All witnessed seizures willbe reported to the Physician.

4.4.6.1.1.9 Patients at risk for neurovascular compromise will have

a neurovascular assessment completed with the vital signs anddocumented in the patient chart. Documentation will include color,

warmth, movement, sensation & the presence of pulses distal to the

injury.4.4.6.1.2 Cardiovascular

4.4.6.1.2.1 A 12 Lead ECG will be carried out on all patients who

require cardiac investigations as deemed necessary by the treatingphysician or as part of the nurses assessment when deemed

necessary.

4.4.6.1.2.2 All monitored alarm limits will be assessed and

documented at the beginning of each shift and as patient conditionchanges.

4.4.6.1.2.3 High/low alarm limits will be set to a maximum of 20%

above and below the patients current reading.4.4.6.1.2.4 All monitor alarms will be on and audible at all times.

4.4.6.1.2.5 Alarms will be addressed immediately by the nurse and

corrective action taken accordingly.4.4.6.1.2.6 ECG electrodes will be changed every 24 hours and

prn.__________________________________________________________________________________________________________________________________________________________________________________________________



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4.4.6.1.2.7 A physicians written order and signed patient consent

must be obtained prior to the transfusion of blood / blood products

as per policy4.4.6.1.3 Respiratory

4.4.6.1.3 .1 Lung sounds will be auscultated on all patients at the

beginning of the morning and afternoon shifts. On night shift, lungsounds will be auscultated only if the patient is awake, or unstable.

4.4.6.1.3.2 The nurse will closely monitor the patient receivingoxygen by pulse oximetry and clinical assessment such as

respiratory rate and depth, presence of cyanosis, and mental status.4.4.6.1.3.3 Oxygen flow rate via face mask will be greater than six

(6) liters per minute. These patients may use nasal cannula to

permit mouth care and/or eating/drinking.4.4.6.1.3.4Oxygen flow rate by nasal cannula will not exceed six

(6) liters / min.

4.4.6.1.3.5 At least once per shift the nurse will assess the patientfor possible skin breakdown where tubing may cause pressure and

apply protective measures such as padding. (e.g. over ears and

bridge of nose)

4.4.6.1.3.6 Oxygen is to be started if SpO2 is less than 95% atroom air and Physician needs to be notified.

4.4.6.1.4 Integumentary/Musculoskeletal

4.4.6.1.4.1 A head to toe skin assessment will be carried out on all patientsevery shift and will be documented in the Nurses Notes. Particular

attention will be paid to vulnerable areas, such as bony prominences.

4.4.6.1.4.2 Immobile patients will be turned or repositioned at least every2 hours, including night shift. If this is not done, reasons will be

documented.

4.4.6.1.4.3 A 30 turn to either side is required to avoid positioning

directly on the trochanter, unless medically contraindicated.4.4.6.1.4.4 Reddened areas and bony prominences will not be massaged.

4.4.6.1.4.5 Pillows or foam wedges will be used to avoid contact between

bony prominences.4.4.6.1.4.6 Devices, such as pillows or foam wedges will be used to

relieve pressure on the heels and bony prominences of the feet. Heels

should be floating in air.

4.4.6.1.4.7 Shearing forces will be reduced by maintaining the head of thebed at no more than 30.

4.4.6.1.4.8 Friction will be reduced by the use of transfer sheets to move

patients.

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4.4.6.1.4.9 Rehabilitation or physiotherapy services will be consulted

when devices are required to reduce pressure, friction and shear.

4.4.6.1.4.10The nurse will protect and promote skin integrity by:4.4.6.1.4.10.1 Ensuring hydration through adequate fluid intake.

4.4.6.1.4.10.2 Showering when possible.

4.4.6.1.4.10.3Avoiding hot water and use a pH balanced, non-sensitizing skin cleanser.

4.4.6.1.4.10.4Minimizing friction and shear4.4.6.1.4.10.5The application of a non-sensitizing, pH balanced,

lubricating moisturizers and creams with minimal alcohol content.4.4.6.1.4.10.6Using protective barriers (e.g. Extra-thin

hydrocolloid, or transparent film) or protective padding to reduce

friction injuries.4.4.6.1.4.11 Minimize skin exposure to excess moisture. (e.g. urine,

faeces, perspiration, wound exudate, saliva etc).

4.4.6.1.4.12 When moisture cannot be controlled use absorbent pads,dressings or briefs that draw moisture away from the skin. Replace pads

and linen when damp.

4.4.6.1.4.13 forWound Care

4.4.6.1.4.13.1 Open wounds will be irrigated with the abovesolutions ONLY using a 30cc syringe and a 19g angiocath/cannula.

4.4.6.1.4.13.2 Physician or wound management team orders will

be followed for the type and frequency of dressing as per policy4.4.6.1.5 Gastro-Intestinal

4.4.6.1.5.1 Naso/Oro Gastric Tube [N/OGT] placement will be checked

following initial insertion, at the beginning of each shift and prior to use.4.4.6.1.5.2 If there is any doubt that tube is not in the stomach or the

patient becomes acutely breathless or develops difficulty in breathing

during administration of feed /medications, stop administration and notifyphysician.

4.4.6.1.5.3 Confirmation of tube placement will be made by:

4.4.6.1.5.3.1 Auscultation over the epigastric region whilst rapidly

injecting 10-20ml of air AND4.4.6.1.5.3.2 Aspirating 20 mLs of stomach contents AND testing

with pH indicator strip. A pH measurement of less than 5.0

requires an X-ray ordered and read by the physician in order toconfirm the placement of the tube.

4.4.6.1.5.4 The patients head of bed will be elevated to 30 degrees for all

feeds via N/OGT or PEG whether the feed is intermittent of continuous

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4.4.6.1.5.5 Bowel function will be monitored and documented on each

shift and a bowel protocol will be implemented as required according to

physicians order.4.4.6.1.5.6 For Percutaneous Drains:

4.4.6.1.5.6.1 Percutaneous drains will be secured firmly.

4.4.6.1.5.6.2 Accurately measure and record drainage output onintake and output record at the end of every shift or when emptied

or removed.4.4.6.1.5.6.3 The nurse will report any significant changes in the

character or volume of fluid, leaking of fluid or bleeding at site ofdrain to the nurse in charge.

4.4.6.1.5.6.4 The nurse will notify the Physician if total drainage is

greater than 300mls over 6 hours.4.4.6.1.5.7 Urinary/Fecal Ostomy

4.4.6.1.5.7.1 The nurse will report excessive bleeding from stoma

(a small amount of bleeding during cleaning is normal),discoloration, signs of necrosis, retraction below skin level or

herniation of 2.5 cms (or greater) more than usual to the nurse in

charge.

4.4.6.1.6 Genito-Urinary/Reproductive4.4.6.1.6.1 Urinary catheter and perineal care are performed with

soap and water during the daily bed bath and every 8 hours and

prn.4.4.6.1.6.2 Urinary drainage bags will be emptied using an aseptic

technique at the end of each shift [and prn] and recorded on intake

and output sheet.4.4.6.1.6.2 Silastic and Foleys urinary catheters will only be

changed if there is evidence of obstruction by encrustation or

mucus, symptomatic infection, or leakage around the catheter.Changes are documented in the multidisciplinary notes.

4.4.6.1.6.3 Urinary catheter tubing will be secured to the leg with

an elastic cuff.

4.4.6.1.7 Pre & Post-Operative Care4.4.6.1.7.1 Pre-op checklist will be completed prior to transfer to OT.

4.4.6.1.7.2 The nurse will initiate incentive spirometry to prevent

postoperative pneumonia in patients with underlying respiratory disease.This will be initiated pre-operatively if possible. Post-operatively, the

patient will be assisted to undertake the exercise every hour while patient

is awake for 24 48 hours post operatively or longer if required. Patienteducation will be documented in the Patient and Family Education form

(PFE).__________________________________________________________________________________________________________________________________________________________________________________________________



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4.4.6.1.7.3 A concise and appropriate handover will be given to the OT by

the nurse transporting the patient and will include ongoing infusions,

abnormal vital signs, allergies and latest capillary blood glucose level ifapplicable

4.4.6.1.7.4 The ward nurse will go to the Recovery Room to collect the

patient and receive handover from the staff.4.4.6.1.7.5 The ward Nurse will check and assess the following in the

Recovery Room prior to transport back to the ward: Operation performed,type of anaesthesia given, any medication or blood given, post operative

wound dressing and drainage,presence and/or quality of pain, presence ofanalgesia, level of consciousness and post operative orders.

4.4.6.1.7.6 Provide safe transportation for return to ward as per escort

policy4.4.6.1.7.7 Assess for pain and give analgesic as required as per Patient

Pain Assessment Policy.

4.4.6.1.7.8 Contacts the Physician if analgesia does not relieve pain in theallotted times.

4.4.6.1.7.9 Observations/vital signs will be completed and documented as

follows: 15 minute interval x 2 (started on arrival to the ward), every 30

minutes x 2, every 1 hour x 2, every 2 hours x 2 and every 4 hours.4.4.6.1.7.10 Deep breathing and coughing will be taught and encouraged

and analgesia provided, if required. Patient education to be documented in

the Patient and Family Education form (PFE).4.4.6.1.7.11 Fluid intake and urine output will be monitored and

documented every 2 hours for the first 8 hours.

4.4.6.1.7.12 The physician will be notified if the patient has not urinated 8hours post-op.

4.4.6.1.7.13 Patients will be supported and encouraged to mobilize as soon

as possible or as per physicians orders4.4.6.1.7.14 Patients will be kept NPO until there is a Physicians order to

feed the patient.

4.4.6.1.7.15 Oral care will be given to patients at least every 4 hours while

NPO.

5. INFECTION CONTROL

5.1. The patient can expect that infection control and prevention measures are implemented5.1.1 Suction liners and tubing will be changed every 24 hours and when required.

5.1.2 Irrigation bottles will be changed every 24 hours and dated and timed.

5.1.3 All disposable products used directly for the patient will be either discarded

or transferred with the patient.

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5.1.4 All medication vials and infusion solutions will be dated, initialed, and

utilized for no more than 24 hours and then discarded (exception: Insulin and

Heparin vials which are good for one month).5.1.5 Non-disposable equipment is cleaned between patient use and PRN.

5.1.6 Hand washing and/or hand disinfection with alcohol based gel will be

performed before and after patient procedures, between patients and uponentering and leaving the ward.

5.1.7Isolation barriers will be initiated according to policies5.1.8 Standard precautions will be applied to all patients.

5.1.9 Patients/visitors will be instructed regarding infection control measures.5.1.10 Peripheral vascular access device (PVAD) will be checked for phlebitis

and infiltration within 30 minutes of insertion and then every 2 hours if solutions

are being infused and every 4 hours if no solutions are being infused.5.1.11 IV tubing and burettes that are continuously used are changed every 96

hours and dated, timed and initialed.

5.1.12IV tubing and burettes that are NOT continuously used are changed every24 hours and dated, timed and initialed.

5.1.13 At any time IV tubing, secondary sets and add-on devices are disconnected

from the cannula they must be immediately discarded.

5.1.14 Peripheral IVs will be re-sited every 96 hours and prn. If it is difficult tostart an IV on the patient, the IV may be kept longer with a Physician's order

provided the site is free of complications, with documentation in the

multidisciplinary notes.5.1.15Blood and blood product IV tubing will be changed every 24 hours and

dated, timed and initialed.

5.1.16 TPN IV tubing will be changed every 24 hours and dated, timed andinitialed.

5.1.17 A transparent, occlusive dressing will be used for all invasive line insertion

sites. The catheter hub and tubing connection will be left exposed. Transparentdressings will be changed when damp, loosened, or soiled.

5.1.18Gauze dressings will be used for invasive lines which are leaking from the

site

5.1.19 All unused lines will be Normal Saline locked and will be capped withextension tubing with positive pressure valve. Closure cap will be changed

each time the line is accessed.

5.1.20 All CVC dressings will be assessed at least every 4 hours.5.1.21 CVC's will be checked for phlebitis and infiltration within 30 minutes of

insertion and then every 2 hours.

6. SAFETY

6.1 The patient can expect that their safety needs are addressed__________________________________________________________________________________________________________________________________________________________________________________________________



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6.1.1An identification bracelet will be placed on the patient upon arrival to the

unit with accuracy verified and then checked per shift for placement. The

identification bracelet may need to be replaced and/or re-sited due to edema, orprocedures prn.

6.1.2A falls prevention/ risk assessment will be performed daily. It will be placed

on the patient that is identified as high risk of fall. Appropriate interventions arefollowed as specified on the risk assessment form.

6.1.3 All bedside emergency equipment will be checked at the beginning of eachshift. This check will ensure all equipment is present and functioning.

61.4 Medications, hazardous supplies and cleaning materials will be kept underlock and key.

6.1.5Call bells will be within patient reach at all times.

6.1.6 Crash carts are maintained on each unit and checked as per policy6.1.7All equipment that is donated or brought into the hospital will be cleared by

Biomedical as per policy.

6.1.8Blood products will be double checked by two registered nurses beforeadministration. Vital signs will be documented before initiating infusion,

during and after the transfusion as per blood and blood product infusion

procedure.

6.1.9Patients will be observed at least once per hour by a member of the nursingstaff.

6.1.10 Patients requiring physical restraints will be assessed and evaluated as per

policy6.1.11 All patients being transported will be assessed against set criteria to

determine the type of escort required.

6.1.12The escorting nurse will ensure that the appropriate documentation hasbeen completed, and will accompany the patient.

6.1.13Transfers within the UAE will be according to policy

7. COMFORT

7.1 The patient can expect that comfort, rest and pain alleviation needs are supported

7.1.1 A bath and linen change will be done at least once per day unless

contraindicated by patient's clinical condition.

7.1.2 Lip and mouth care will be given as per oral assessment tool.7.1.3Male patients will be offered a shave each morning or as per patient/family

request; documentation will reflect if the patient or family has refused a shave.

Cultural norms and values will be adhered to.

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8. PATIENT EDUCATION / DISCHARGE PLANNING

8.1 The patient/family can expect education that supports their transition towards self-

care, and adaptation to their health/illness condition8.1.1 The nurse will collaborate with other services as appropriate.

8.1.2 The nurse will assess barriers to learning and level of learning achieved by

the patient.8.1.3 The nurse will document all teaching performed.

8.1.4 Appropriate patient and family education materials will be provided.8.2 The patient/family can expect that an individualized discharge plan of care is

assessed, established and implemented8.2.1 A Nursing Discharge Summary will be completed on all patients prior to

transfer or discharge.

8.2.2 Discharge planning will be initiated within 24 hours of admission anddocumented on the Initial Assessment Form.

8.2.3 Discharge planning will demonstrate a multidisciplinary collaboration with

necessary referrals8.2.4 All patient and family education will be documented on the Patient and

Family

Education Form.

8.2.5 Patients may be transferred to transit area prior to discharge8.2.6 If the patient is leaving against medical advice, the registered nurse inquires

why the patient requests to leave the hospital, notifies the MRP and document

this in the patients record as per policy.

9. REFERENCES

9.1 5 Million Lives Campaign. Getting Started Kit: Prevent Central Line Infections How

to Guide. Cambridge, MA: Institute for Healthcare Improvement; 2008. www.ihi.org Accessed 19 February, 2009

9.2Brain Trauma Foundation, (2007) "Guidelines for the management of TBI: American,

Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons,

(CNS), AANS/CNS Joint Section on Neurotrauma and Critical Care". Journal of

Neurotrauma; Volume 24, Supplement 1, 2007.

9.3Buchanan S, Coltart L, Cowie K, Davidson R, Don C, Elder F, Gravill P, Guild C,

Manson L, McGibbon G, Nardi A, Rait C, Wood A. (2007). Caring for the patientwith a tracheostomy - Best Practice Statement. NHS Quality Improvement Scotland.

March http://www.nhshealthquality.org/nhsqis/files/TRACHEOREV_BPS_MAR07.pdf

-Accessed 09 February, 20099.4Centre for Disease Control (CDC), [2003]. Guidelines for Preventing Health Care

Associated Pneumonia. CDC: U.S.A.

9.5 Centre for Disease Control (CDC), [2011]. Guidelines for Preventing of IntravascularCatheter Related Infections. CDC: U.S.A.

__________________________________________________________________________________________________________________________________________________________________________________________________

http://www.nhshealthquality.org/nhsqis/files/TRACHEOREV_BPS_MAR07.pdfhttp://www.nhshealthquality.org/nhsqis/files/TRACHEOREV_BPS_MAR07.pdf

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Ppg Gdch Nur 33 Nursing Care