WELCOME TO ETCH! This module contains: Instructions for completion of module Instructions for completion of module Welcome to ETCH Welcome to ETCH Service

WELCOME TO ETCH!WELCOME TO ETCH!

This module contains:This module contains:

Instructions for Instructions for completion of modulecompletion of module

Welcome to ETCHWelcome to ETCH Service ExcellenceService Excellence Family-Centered CareFamily-Centered Care Child LifeChild Life No Information PatientNo Information Patient Patient Safety GoalsPatient Safety Goals RestraintsRestraints Isolation/Infection ControlIsolation/Infection Control

Pain ManagementPain Management Child AbuseChild Abuse Death & DyingDeath & Dying Emergency CodesEmergency Codes Pneumatic Tube SystemPneumatic Tube System Dress CodeDress Code Parking and Other InfoParking and Other Info Forms to CompleteForms to Complete

Instructions for Completing the Instructions for Completing the ETCH ModuleETCH Module

Carefully read through the entire module.Carefully read through the entire module. When you have completed the module, download the When you have completed the module, download the

Completion Form and the Information Security Completion Form and the Information Security Compliance Statement Form.Compliance Statement Form.

Sign these two forms and turn in to your instructor.Sign these two forms and turn in to your instructor. IMPORTANT! These forms, along with your IMPORTANT! These forms, along with your

Centralized Student Orientation transcript and Centralized Student Orientation transcript and immunization record, MUST be in the ETCH immunization record, MUST be in the ETCH Education office PRIOR to your clinical rotation!Education office PRIOR to your clinical rotation!

Our PhilosophyOur Philosophy

Because Children are Special…

Our Mission…Our Mission…

Delivery of Care to patients between the ages of Delivery of Care to patients between the ages of birth to 21 years, in the East Tennessee and birth to 21 years, in the East Tennessee and surrounding regionsurrounding region

Education of patients, families, the community, Education of patients, families, the community, students in medical disciplines, ETCH employees students in medical disciplines, ETCH employees and healthcare providers in the CRPC areaand healthcare providers in the CRPC area

Research through participation in the BENCH Research through participation in the BENCH networking programnetworking program

Community Involvement Community Involvement

ETCH HistoryETCH History

Opened in 1937 Opened in 1937 and located on and located on Laurel Ave.Laurel Ave.

Originally called Originally called Knox County Knox County Crippled Crippled Children’s Children’s HospitalHospital

ETCH HistoryETCH History

Moved to 21Moved to 21stst and and Clinch in 1970Clinch in 1970

2018 Clinch Ave2018 Clinch Ave

P.O. Box 15010P.O. Box 15010 Much expansion Much expansion

since thensince then

ETCH 2007 ETCH 2007 ……155 bed facility with 155 bed facility with

multiple pediatric multiple pediatric subspecialtiessubspecialties

East Tennessee Children’s Hospital East Tennessee Children’s Hospital offers many services such as…offers many services such as…

Child LifeChild Life Pastoral CarePastoral Care Social Work Social Work Specialty Outpatient ClinicsSpecialty Outpatient Clinics Home Health ServicesHome Health Services Rehabilitation ServicesRehabilitation Services Clinical Nurse Specialists in the areas of Surgery, Critical Clinical Nurse Specialists in the areas of Surgery, Critical

Care, Hematology/Oncology, and Pulmonary CareCare, Hematology/Oncology, and Pulmonary Care Nutrition ServicesNutrition Services Healthy Kids ProgramHealthy Kids Program Ronald McDonald HouseRonald McDonald House

Service Excellence…Service Excellence…

Our Responsibility. Our Commitment.Our Responsibility. Our Commitment.

Children’s HospitalChildren’s Hospital

People don’t carePeople don’t care

how much we knowhow much we know

until they know how until they know how

much we care.much we care.

Service Excellence VisionService Excellence Vision

To be the kind of To be the kind of organization whereorganization where

children and familieschildren and familieswant to come for care,want to come for care,

physicians want to practice,physicians want to practice,andand

employees want to work.employees want to work.

Service Excellence…Service Excellence…Our Responsibility. Our Commitment.Our Responsibility. Our Commitment.

Statement of PurposeStatement of Purpose

We strive to give extraordinary care and service to our We strive to give extraordinary care and service to our patients, their families, members of the Children’s patients, their families, members of the Children’s Hospital family, and the communities we serve.Hospital family, and the communities we serve.

Our Philosophy of Service ExcellenceOur Philosophy of Service Excellence

**We take pride in our professions and feel personal ownership and We take pride in our professions and feel personal ownership and responsibility for achieving Children’s Hospital mission.responsibility for achieving Children’s Hospital mission.**We seek opportunities to be friendly and to help patients, families, and We seek opportunities to be friendly and to help patients, families, and coworkers.coworkers.**We are always courteous and respectful.We are always courteous and respectful.**We show care and compassion by acknowledging people’s feelings.We show care and compassion by acknowledging people’s feelings.**We demonstrate respect for privacy and confidentiality in all we do.We demonstrate respect for privacy and confidentiality in all we do.**We never tire of explaining what to expect, what we are doing, and We never tire of explaining what to expect, what we are doing, and why.why.**We try to understand how our work affects others and look for ways to We try to understand how our work affects others and look for ways to help each other.help each other.**We respect diversity among our patients, families, co-workers and We respect diversity among our patients, families, co-workers and community.community.

SHARE: Service Excellence in ActionSHARE: Service Excellence in Action

SS SENSE people’s needs before they ask.SENSE people’s needs before they ask.

HH HELP each other our through teamwork.HELP each other our through teamwork.

AA ACT with empathy and compassion.ACT with empathy and compassion. RR RESPECT the dignity and privacy of others.RESPECT the dignity and privacy of others.

EE EXPLAIN what is happening.EXPLAIN what is happening.

Customer Satisfaction: A fool’s gold?Customer Satisfaction: A fool’s gold?What is fool’s gold? Something that looks more What is fool’s gold? Something that looks more valuable than it really is. Let’s compare the difference valuable than it really is. Let’s compare the difference between customer “satisfaction” and “loyalty.”between customer “satisfaction” and “loyalty.”

The customer satisfaction formulaThe customer satisfaction formula::

Doing it right the first time+effective complaint handlingDoing it right the first time+effective complaint handling

The customer loyalty formula:The customer loyalty formula:

Doing more than is expected+Doing more than the Doing more than is expected+Doing more than the situation warrantssituation warrants

Does customer satisfaction = customer loyalty?Does customer satisfaction = customer loyalty?

On a five-point scale, people who mark a 4 (satisfied), On a five-point scale, people who mark a 4 (satisfied), compared to those who mark a 5 (very satisfied) are compared to those who mark a 5 (very satisfied) are 5 times more likely to defect to the competition.5 times more likely to defect to the competition.

SatisfactionSatisfaction is based much on convenience, while is based much on convenience, while loyal loyal customerscustomers will often drive longer to seek out your services will often drive longer to seek out your services because of the way they are treated and the service they because of the way they are treated and the service they receive. Loyal customers will tell others about how good you receive. Loyal customers will tell others about how good you are---they have a story to tell.are---they have a story to tell.

What separates the excellent from the best?What separates the excellent from the best?Nothing---They do the Nothing---They do the same thingssame things especially especially more more consistently consistently and and under pressure over time.under pressure over time.

The secret of excellence is The secret of excellence is consistencyconsistency and the and the enemy of excellence is enemy of excellence is too much variationtoo much variation..

Organizations with a reputation for world-class Organizations with a reputation for world-class service simply know how to attract and keep service simply know how to attract and keep individuals who will deliver the same courteous, individuals who will deliver the same courteous, compassionate care, day in and day out, compassionate care, day in and day out, regardless regardless of the circumstances.of the circumstances.

ATTITUDE: The one thing I have control over ATTITUDE: The one thing I have control over

An attitude is my An attitude is my frame of mind frame of mind when I approach a when I approach a situation. I situation. I choose choose my attitude in every situation.my attitude in every situation.

Stimulus--------*Interpretation----------ResponseStimulus--------*Interpretation----------Response

*All emotional growth in life occurs in the interpretation *All emotional growth in life occurs in the interpretation phase.phase.

Learn to ask: Learn to ask: What would cause me to act like that?What would cause me to act like that?

Asking this simple question when we are faced with Asking this simple question when we are faced with difficult people can help us maintain tolerance and even difficult people can help us maintain tolerance and even compassion for our patients, families, and co-workers.compassion for our patients, families, and co-workers.

Non-Verbal CommunicationNon-Verbal Communication

93% of what we communicate in attitude 93% of what we communicate in attitude is non-verbal.is non-verbal.– 7% 7% In words In words– 38% 38% By tone of voice By tone of voice– 55% 55% By body languageBy body language

– And it’s done in the first few seconds. Even And it’s done in the first few seconds. Even in job interviews by a professional, the in job interviews by a professional, the decision is essentially made in decision is essentially made in 2020 seconds! seconds!

Never get tired of explaining!Never get tired of explaining!

75%75% of all medical malpractice lawsuits could of all medical malpractice lawsuits could have been prevented by have been prevented by explaining things better.explaining things better.

One of the most common complaints patients and One of the most common complaints patients and their families have is that things were not better their families have is that things were not better explained.explained.

The highest ranked quality desired in choosing a The highest ranked quality desired in choosing a doctor is the doctor’s doctor is the doctor’s willingness to listen and willingness to listen and explain in words I can understand.explain in words I can understand.

AttitudeAttitude

The longer I live, the more I realize the impact of attitude on life. The longer I live, the more I realize the impact of attitude on life. Attitude, to me, is more important than facts. It is more important than Attitude, to me, is more important than facts. It is more important than the past, than education, than money, than circumstances, than failures, the past, than education, than money, than circumstances, than failures, than successes, than what other people think or say or do. It is more than successes, than what other people think or say or do. It is more important than appearance, giftedness, or skill. It will make or break a important than appearance, giftedness, or skill. It will make or break a company… a church… a home. The remarkable thing is we have a company… a church… a home. The remarkable thing is we have a choice every day regarding the attitude we will embrace for that day. choice every day regarding the attitude we will embrace for that day. We cannot change our past… we cannot change the fact that people will We cannot change our past… we cannot change the fact that people will act in a certain way. We cannot change the inevitable. The only thing act in a certain way. We cannot change the inevitable. The only thing we can do is play on the one string we have, and that is our attitude. I we can do is play on the one string we have, and that is our attitude. I am convinced that life is 10% what happens to me and 90% how I react am convinced that life is 10% what happens to me and 90% how I react to it. And so it is with you… we are in charge of our attitudes.to it. And so it is with you… we are in charge of our attitudes.

Charles SwindollCharles Swindoll

Child/Family Centered CareChild/Family Centered Care

Children’s Hospital Children’s Hospital

Knoxville, TNKnoxville, TN

Definition of Child/Family Definition of Child/Family Centered CareCentered Care

Child/Family Centered Care is an approach to the Child/Family Centered Care is an approach to the planning, delivery, and evaluation of health care that planning, delivery, and evaluation of health care that

is grounded in mutually beneficial partnerships is grounded in mutually beneficial partnerships among health care providers, patients, and families. among health care providers, patients, and families.

It redefines the relationshipsIt redefines the relationshipsbetween and among consumers and health providers.between and among consumers and health providers.

**Child/Family Centered practitioners recognize the Child/Family Centered practitioners recognize the vital role that families play in ensuring the health vital role that families play in ensuring the health and well-being of infants, children, adolescents, and and well-being of infants, children, adolescents, and family members of all ages. They acknowledge that family members of all ages. They acknowledge that emotional, social, and developmental support are emotional, social, and developmental support are integral components of health care. They promote integral components of health care. They promote the health and well-being of individuals and families the health and well-being of individuals and families and restore dignity and control to them. and restore dignity and control to them.

**Child/Family centered care is an approach to Child/Family centered care is an approach to health care that shapes policies, programs, health care that shapes policies, programs, facility design, and staff day-to day facility design, and staff day-to day interactions. It leads to better health interactions. It leads to better health outcomes, and wiser allocation of resources, outcomes, and wiser allocation of resources, and greater patient and family satisfaction.and greater patient and family satisfaction.

Child/Family Centered Care is the Child/Family Centered Care is the Right Way to Treat People…Right Way to Treat People…**LeadershipLeadership**Human ResourcesHuman Resources**Architecture and DesignArchitecture and Design**Family participation in careFamily participation in care**Communicating with familiesCommunicating with families**Family to family support and networkingFamily to family support and networking**Linking families with community resourcesLinking families with community resources**Educating Child/Family Centered professional Educating Child/Family Centered professional collaboration in policy and program developmentcollaboration in policy and program development

In Child/Family Centered Care:In Child/Family Centered Care:**People are treated with dignity and respectPeople are treated with dignity and respect**Health care providers communicate and share Health care providers communicate and share complete and unbiased information with patients and complete and unbiased information with patients and families that are affirming and usefulfamilies that are affirming and useful**Individuals and families build on their strengths by Individuals and families build on their strengths by participating in experiences that enhance control and participating in experiences that enhance control and independenceindependence**Collaboration among patients, families, and Collaboration among patients, families, and providers occurs in policy and program development providers occurs in policy and program development and professional education, as well as in the delivery and professional education, as well as in the delivery of careof care

In a Hospital that Practices In a Hospital that Practices Child/Family Centered Care, Child/Family Centered Care, Administrative, Clinical, and Support Administrative, Clinical, and Support Staff:Staff:**Recognize the family is the constant in the child’s lifeRecognize the family is the constant in the child’s life**Facilitate collaboration between families and professionalsFacilitate collaboration between families and professionals**Honor the racial, ethnic, cultural, and socio-economic Honor the racial, ethnic, cultural, and socio-economic diversity of familydiversity of family**Recognize family strengths and respect various methods of Recognize family strengths and respect various methods of copingcoping**Share complete and unbiased information with parentsShare complete and unbiased information with parents**Encourage and facilitate family to family networkingEncourage and facilitate family to family networking**Understand and incorporate developmental needsUnderstand and incorporate developmental needs**Design accessible health care delivery systemsDesign accessible health care delivery systems

Core ConceptsCore Concepts

StrengthsStrengths CollaborationCollaboration PartnershipPartnership Information SharingInformation Sharing +Support+Support FlexibilityFlexibility EmpowermentEmpowerment

C/FCC in ActionC/FCC in Action

Inclusion of parents on Steering CommitteeInclusion of parents on Steering Committee Increased MD involvementIncreased MD involvement Parent Advisor ProgramsParent Advisor Programs Resident EducationResident Education Website ChangesWebsite Changes Chronic Care Parent NotebookChronic Care Parent Notebook NICU JournalNICU Journal Questions for My DoctorQuestions for My Doctor Family presence during procedures and codesFamily presence during procedures and codes Kangaroo Care in the NICUKangaroo Care in the NICU

C/FCC in Action, continuedC/FCC in Action, continued

Orientation / Inservices / Courses—Inclusion of Orientation / Inservices / Courses—Inclusion of Family Centered Care ConceptsFamily Centered Care Concepts

Disaster PlanningDisaster Planning Review of Parent MaterialsReview of Parent Materials Family Resource CenterFamily Resource Center Welcome Guide for FamiliesWelcome Guide for Families Inclusion of Parent Advisors on Hospital Inclusion of Parent Advisors on Hospital

CommitteesCommittees

Benefits of Child/Family Centered Benefits of Child/Family Centered CareCare

Improves medical and developmental Improves medical and developmental outcomesoutcomes

Leads to health care that is more responsive Leads to health care that is more responsive to patient and family-identified needs and to patient and family-identified needs and prioritiespriorities

Reduces health care costsReduces health care costs Enhances patient/family/staff satisfactionEnhances patient/family/staff satisfaction

Age-Specific InterventionsAge-Specific Interventions

Age-Specific Interventions are the Age-Specific Interventions are the skills you use to give care that skills you use to give care that

meets meets eacheach patient’s unique needs. patient’s unique needs.

Every patient is an individual Every patient is an individual with his or her own...with his or her own...

likes and dislikeslikes and dislikes feelingsfeelings limitations and abilitieslimitations and abilities experiencesexperiences

Everyone grows and develops in a Everyone grows and develops in a similar way or similar way or stagesstages that are that are

related to their agerelated to their ageBUTBUT

at their own pace.at their own pace.

Strategies to Enhance Coping:Strategies to Enhance Coping: Newborns:Newborns: Pacifier, Blanket, Soothing sounds, Touch, Music Pacifier, Blanket, Soothing sounds, Touch, Music Toddlers:Toddlers: Pacifier, Blanket, Favorite toy, Holding a hand, Pacifier, Blanket, Favorite toy, Holding a hand,

Party Blowers, Blowing bubbles, Pop-up books, Toys, Party Blowers, Blowing bubbles, Pop-up books, Toys, Mobiles, Pre-Post Procedural play, Play DoughMobiles, Pre-Post Procedural play, Play Dough

Preschoolers:Preschoolers: Party Blowers, Blowing bubbles, Counting, Party Blowers, Blowing bubbles, Counting, Pop-up Books, Holding a hand, Manipulative toys, Computer Pop-up Books, Holding a hand, Manipulative toys, Computer games, Listening to music, Singing songs, Pre-Post Procedural games, Listening to music, Singing songs, Pre-Post Procedural Play, Play DoughPlay, Play Dough

School Age:School Age: Deep breathing exercises, Music, Hand-held Deep breathing exercises, Music, Hand-held games, Computer games, Imagery/fantasy, Pretending to be in games, Computer games, Imagery/fantasy, Pretending to be in a favorite place or doing a favorite thing, Pre-Post Procedural a favorite place or doing a favorite thing, Pre-Post Procedural play, Squeezing Nerf ballsplay, Squeezing Nerf balls

Adolescents:Adolescents: Deep breathing exercises, Music (head sets are Deep breathing exercises, Music (head sets are popular), Computer games, Imagery/fantasy, Imagine a popular), Computer games, Imagery/fantasy, Imagine a favorite activity, Squeezing a Nerf ball, Hand-held gamesfavorite activity, Squeezing a Nerf ball, Hand-held games

Child Life Specialists-Child Life Specialists-What do they do?What do they do?

Child Life Specialists are individuals who Child Life Specialists are individuals who have a degree in a type of early childhood have a degree in a type of early childhood education or development. education or development.

They may sit for a national certification They may sit for a national certification exam after obtaining a certain number of exam after obtaining a certain number of clinical hours on the job.clinical hours on the job.

They have many roles, and this may vary They have many roles, and this may vary institution to institution.institution to institution.

The Role of the Child Life The Role of the Child Life Specialists At ETCHSpecialists At ETCH

Provide therapeutic play for stressed, anxious Provide therapeutic play for stressed, anxious patients.patients.

Provide play opportunities and other experiences Provide play opportunities and other experiences which foster continued growth and development which foster continued growth and development and prevent adverse reactions.and prevent adverse reactions.

Provide developmentally appropriate education Provide developmentally appropriate education and preparation to patients for upcoming and preparation to patients for upcoming procedures. Help patients express their feelings procedures. Help patients express their feelings and cope with stress in ways that enhance their and cope with stress in ways that enhance their sense of mastery and self-esteem.sense of mastery and self-esteem.


Teach patients appropriate coping techniques – Teach patients appropriate coping techniques – relaxation, deep breathing, etc…relaxation, deep breathing, etc…

Provide distraction for patients during procedures Provide distraction for patients during procedures in the clinical setting and other procedural areas in in the clinical setting and other procedural areas in the hospital.the hospital.

Initiate medical play with patients to encourage Initiate medical play with patients to encourage the expression of fears and misconceptions.the expression of fears and misconceptions.

Incorporate place to encourage positive Incorporate place to encourage positive interactions with taking medicine and other interactions with taking medicine and other behaviors to be in compliance with their treatment behaviors to be in compliance with their treatment plan.plan.


Provide planning/scheduling to help with patient Provide planning/scheduling to help with patient behavior modification.behavior modification.

Serve as a resource to all departments relating to Serve as a resource to all departments relating to development and psychosocial issues and provide development and psychosocial issues and provide ways by which these needs can be met.ways by which these needs can be met.

Provide a means by which the hospital staff can Provide a means by which the hospital staff can make meaningful observations of patients in make meaningful observations of patients in normal play and educational situations to better normal play and educational situations to better assess the patient’s progress and needs.assess the patient’s progress and needs.


Orient new Child Life students and Orient new Child Life students and volunteers to the appropriate departments.volunteers to the appropriate departments.

Organize volunteers to provide the Organize volunteers to provide the following services:following services:– Requested toys and suppliesRequested toys and supplies– Visits to the playroom and teen room Visits to the playroom and teen room

(inpatient)(inpatient)– Play at the bedsidePlay at the bedside

Child Life Staff…Child Life Staff…

During your rotation, During your rotation, notice the Child Life notice the Child Life staff and how they staff and how they interact with your interact with your patients! patients!

Child Life Specialists Child Life Specialists provide an invaluable provide an invaluable service to our patients service to our patients and families here at and families here at ETCH!ETCH!

No Information ProcedureNo Information Procedure

East Tennessee Children’s HospitalEast Tennessee Children’s Hospital

What is the purpose of “No What is the purpose of “No Information”?Information”?

This procedure provides guidelines for addressing a “No This procedure provides guidelines for addressing a “No Information” status on a patient and outlines steps to Information” status on a patient and outlines steps to initiate, authorize, notify personnel, and flag pertinent initiate, authorize, notify personnel, and flag pertinent records.records.

The procedure defines a “No Information” patient as The procedure defines a “No Information” patient as one one who is not acknowledged as being in the institution.who is not acknowledged as being in the institution.

The procedure provides a basis for all staff that may have The procedure provides a basis for all staff that may have contact with the patient. contact with the patient. Everything is done on a need to Everything is done on a need to know basis.know basis.

Who can Who can initiateinitiate (ask for) “No (ask for) “No Information” status?Information” status?

Legal guardianLegal guardian

(HIPAA, (HIPAA, admitting sec. admitting sec.

will ask)will ask)

Department of Department of Children’s Children’s ServicesServices

Nursing StaffNursing Staff

Security Security OfficersOfficers Social WorkSocial Work

Law Law Enforcement Enforcement

OfficersOfficers

Community Community RelationsRelations Attending MDAttending MD

Who has theWho has the authority to authority to authorize (give the OK)?authorize (give the OK)?

Nursing Nursing CoordinatorsCoordinators

Nurse ManagersNurse Managers Nursing DirectorsNursing Directors Social WorkSocial Work SecuritySecurity

Flagging the medical record…Flagging the medical record…

Meditech - admitting flags the patient as Meditech - admitting flags the patient as confidential by preceding the patient’s confidential by preceding the patient’s name with a “c” (e.g. cSmith, John). This name with a “c” (e.g. cSmith, John). This patient’s medical record is tracked by patient’s medical record is tracked by Information Systems. All staff DO have Information Systems. All staff DO have computer access to confidential patients, computer access to confidential patients, but volunteers do not.but volunteers do not.

Medical Record – chart is flagged with the Medical Record – chart is flagged with the name “Cody Seagreen” name “Cody Seagreen”

Flagging the medical record…Flagging the medical record…

Patient assignment board – room number will list Patient assignment board – room number will list the name “Cody Seagreen”the name “Cody Seagreen”

Label – tag with “Cody Seagreen”Label – tag with “Cody Seagreen” Patient door sign – “Cody”Patient door sign – “Cody” Surgery ScheduleSurgery Schedule – actual patient name will be – actual patient name will be

listedlisted Patient census – actual name will print if run by Patient census – actual name will print if run by

authorized personnelauthorized personnel Over-the-bed card – actual patient name listed Over-the-bed card – actual patient name listed

(keep door closed, call child by REAL name)(keep door closed, call child by REAL name)

Responding to requests for Responding to requests for information…information…

Respond to ALL requests Respond to ALL requests for information with the for information with the following: following: “We have no “We have no information on a patient information on a patient by that name.”by that name.”

Community relations will Community relations will respond to all media respond to all media requests for information.requests for information.

Patient Safety Goals for ETCHPatient Safety Goals for ETCH


Patient Safety GoalsPatient Safety Goals

Improve accuracy of patient identification.Improve accuracy of patient identification. Improve effectiveness of communication among Improve effectiveness of communication among

caregivers.caregivers. Improve safety of using medication.Improve safety of using medication. Universal protocol for preventing wrong person, Universal protocol for preventing wrong person,

wrong site, wrong procedure surgery.wrong site, wrong procedure surgery. Reduce risk of health care-associated infections.Reduce risk of health care-associated infections. Accurately and completely reconcile medications Accurately and completely reconcile medications

across the continuum of care.across the continuum of care. Reduce the risk of patient harm resulting from falls.Reduce the risk of patient harm resulting from falls.

The next few slides will present the PatientSafety Goals and the systems in place here at ETCH to reach these goals.

Use at least two patient identifiers whenever: taking blood samples or other specimens for clinical testing, administering medications or blood products, or providing any other treatments or procedures.

–Inpatient units: Name and E number (account #)

–Clinic uses: Name and E number

–ED Uses: Name and Birth Date

–Radiology: Name and Date of Birth

–Neurology Lab: Name and E number

Improve Accuracy ofPatient Identification

When treatment involves an Invasive Procedure such as:

–Vascular catheterizations

•to include PICC lines, femoral lines, etc.

–Endoscopies

•GI procedures and bronchoscopies

–Lumbar punctures

–Implantations

•Extraventricular drains, Intracranial bolt, etc.


Invasive Procedures (cont)

–Bone marrow aspirations

–Paracentesis

–Surgical procedures performed outside the Operating Room

fracture myringotomies in the ED

reductions circumcisions

Then, a Pre- Procedure Checklist, Invasive Procedures is to be completed.


Improve Effectiveness of Communication Among Caregivers

Approved abbreviations may be used on any permanent Approved abbreviations may be used on any permanent charting document. Approved abbreviations are those charting document. Approved abbreviations are those deemed acceptable by the Medical Records Committee deemed acceptable by the Medical Records Committee when charting on a patient document in lieu of the written when charting on a patient document in lieu of the written word or phrase. Only approved abbreviations are to be word or phrase. Only approved abbreviations are to be used.used.

Reference: Medical Abbreviations and Eponyms, 2Reference: Medical Abbreviations and Eponyms, 2ndnd Edition, Sheila Sloane, 1997.Edition, Sheila Sloane, 1997.

The Registered Nurse The Registered Nurse mustmust obtain clarification of obtain clarification of orders from the MD orders from the MD priorprior to carrying out an order to carrying out an order containing an unapproved abbreviation or illegible containing an unapproved abbreviation or illegible order.order.

ETCH “Do Not Use” Abbreviations ListETCH “Do Not Use” Abbreviations List All Chemotherapy drugs: Use the complete spelling for drug names.All Chemotherapy drugs: Use the complete spelling for drug names. MS, MSO4, or MgSO4-(Magnesium sulfate or Morphine sulfate) –MS, MSO4, or MgSO4-(Magnesium sulfate or Morphine sulfate) –

Use the complete spelling for drug names.Use the complete spelling for drug names. TAC-(triamcinilone)-Use the complete spelling for drug names.TAC-(triamcinilone)-Use the complete spelling for drug names. Ug-(microgram)-Use “mcg”Ug-(microgram)-Use “mcg” U or u; IU-(Unit or International unit)-Write out “unit” or U or u; IU-(Unit or International unit)-Write out “unit” or “ “ international units”international units” QD or QOD-(every day or every other day)-Write out “every day” QD or QOD-(every day or every other day)-Write out “every day”

or “every other day”or “every other day” X3d-(Days OR doses)- Write out “for three days” or “for three X3d-(Days OR doses)- Write out “for three days” or “for three

doses”doses” Zero after decimal point (1.0)-(1 mg)-Do not use terminal zeros for Zero after decimal point (1.0)-(1 mg)-Do not use terminal zeros for

doses expressed in whole numbersdoses expressed in whole numbers No zero before decimal point (.5mg)-(0.5mg)-Always use zero before No zero before decimal point (.5mg)-(0.5mg)-Always use zero before

a decimal when the dose is less than a whole unit.a decimal when the dose is less than a whole unit. Miscellaneous corrections-Do not write over words for corrections. Miscellaneous corrections-Do not write over words for corrections.

Line or “X” out errors. Line or “X” out errors.

Read-Back Policy

–For verbal or telephone orders, OR for telephonic reporting of critical test results, the order or result should be “read back” according to procedure. The procedure requires that the first and last name of the prescriber be included when reading back the order. (Nursing Policy PO4 “Physician Orders Procedure”)

–Reporting Results-Critical test results and lab values must be both reported and received by the responsible, licensed caregiver in a timely manner.

-Trends in test results must be recognized and reported.

-Utilize the “Report results to physician/PA/NP” intervention as part of the care plan to document

“Hand Off” Communication

-Be sure to provide accurate/pertinent patient care information to the healthcare provider assuming care of the patient, allow time for questions

Improve Effectiveness of Communication Among Caregivers

Remove concentrated electrolytes from patient care units. There should be no sodium chloride with

concentrations > 0.9%.

Standardize and limit the number of drug concentrations available in the organization.

Each unit to develop a list of “look-alike, sound alike drugs” to be reviewed annually to help prevent errors

Label all medications, medication containers on and off sterile fields

Improve the Safety of Using Medications

Universal Protocol for

preventing wrong site,

wrong procedure, wrong

person surgery.

This protocol involves the following steps:

–Pre-op verification (documents, patient expectations)

–Marking site

–Timeout (active communication)

Comply with current CDC hand hygiene guidelines.

Manage as sentinel events all identified cases of unanticipated death or major permanent loss of function associated with a health care-acquired infection.

Reduce the risk of Healthcare Associated Infections


Full report available at

–http://www.cdc.gov/handhygiene/

Specific recommendations

–Indications for handwashing and hand antisepsis

•Visibly soiled, use soap and water

•Not visibly soiled, may use alcohol-based hand rub

•List of specific clinical circumstances

•Towelettes are not a substitute

•Non-alcohol-based hand rubs not recommended


Specific recommendations (cont)

–Hand hygiene technique

•Alcohol-based hand rub – until dry

•Soap and water — at least 15 seconds

–Surgical hand antisepsis

–Selection of hand hygiene agents

–Skin care

–Other aspects of hand hygiene

•No artificial nails for direct caregivers

Accurately and Completely Reconcile Medications Across the Continuum of Care

This goal requires a complete and accurate list of the patient’s Current medications be placed on the chart on admission to

the hospital system, at transfer and at discharge. The list iscompared and reconciled with other prescribed medications to

prevent errors of omission, duplication, wrong dose etc.All home medications (including herbals) and new med orders

on admission will be listed on the form. The form is placed on top of the order section of the chart. At discharge, any

meds the MD wishes to continue at home should be added to the bottom of the form. Therefore, the form serves as both

the admission and discharge medication order sheet for the MD.The Outpatient Surgery nurse is responsible for obtaining a medication history

and recording on the Pre-Operative Record. The Outpatient Medication Reconciliation form will be placed on the chart prior to transport to surgery. The

MD will review and sign the Outpatient Medication Reconciliation Sheet.

The MD is responsible for filling out the Admission/Discharge MedicationOrder Sheet.

A new requirement is that the complete list of medications be given to the patient when discharged from the hospital. This requirement goes into effect January 2007.

Here is our current AdmissionDischarge Medication OrderSheet…

If a patient is transferred to PICU, or Surgery, a summary list of all current medicationsis printed for the MD’s review and use as anorder sheet formedications. This Transfer MedicationReconciliation OrderSheet is available throughthe Pharmacy Module.

Reduce the Risk of Patient Harm From FallingUtilizing existing data on our patient falls from the last few years and using research from Children’s Memorial Hospital in Chicago, ETCH determined that our patients at greatest risk for falls are those on seizure medications and those receiving PT/OT services.

•Our existing seizure precautions contain interventions such as keeping the bed in the low position and keeping the side rails up. These interventions, as well as others related to safety, are reassessed every shift.

•For patients in our NICU and PICU, interventions were added to the routine plan of care - under the category of safety. This ensures appropriate documentation.

•Lastly, physical therapists are documenting the education process regarding a patient’s risk for falls in the progress notes and on the IPER. This documentation addresses the patient/family’s understanding of the risk of falls, and what can specifically be done to prevent falling. From the IPER, the nurse can then reassess and determine if the patient/family needs reinforcement with this teaching.

Encourage Patients’ Active Involvementin their Own Care as a Patient Safety Strategy….

ETCH is beginning to look at ways to define and communicate different ways for patients and theirfamilies to report concerns about safety, andencourage them to do so….

Compliance with this goal begin in January 2007.

The Organization Must Identify Safety Risks Inherent in its Patient Population…

ETCH must evaluate how we identify patients at riskfor suicide.

Compliance with this goal will begin in January 2007.

“Patient safety must remain the first priority.”

Restraint Use at ETCHRestraint Use at ETCH

Physical RestraintPhysical Restraint

Any manual method or physical or mechanical Any manual method or physical or mechanical device that restricts freedom of movement or device that restricts freedom of movement or normal access to one’s body, material or normal access to one’s body, material or equipment attached or adjacent to patient’s body equipment attached or adjacent to patient’s body that he or she cannot easily remove which include:that he or she cannot easily remove which include:

* Soft wrist* Soft wrist

* Soft ankle* Soft ankle

* Soft vest* Soft vest

*** Leather restraints are not used at ETCH!*** Leather restraints are not used at ETCH!

Important!!Important!! Patients rights, including the right to be free Patients rights, including the right to be free

from unnecessary seclusion and restraint from unnecessary seclusion and restraint and to receive the least restrictive treatment and to receive the least restrictive treatment possible, must be protected and upheld for possible, must be protected and upheld for patients secluded and restrained, in postural patients secluded and restrained, in postural and safety support devices, and requiring and safety support devices, and requiring routine treatment immobilization.routine treatment immobilization.

Restraining devices are used only when Restraining devices are used only when alternative measures to provide safety are alternative measures to provide safety are ineffective. These may include, but are not ineffective. These may include, but are not limited to: limited to:

* Increased supervision* Increased supervision

* Pain control (if applicable)* Pain control (if applicable) * Emotional reassurance* Emotional reassurance * Reorientation* Reorientation * Diversion* Diversion

What Students Need to Know!What Students Need to Know!

Read the policy on Read the policy on Restraints!Restraints!

If you are assigned to If you are assigned to a patient requiring a patient requiring restraint, notify your restraint, notify your instructor, allowing instructor, allowing her or the patient’s her or the patient’s nurse to guide you in nurse to guide you in your care of that your care of that patient. patient.

Isolation/Infection ControlIsolation/Infection Control


Standard PrecautionsStandard Precautions-All patients will be considered to be on Standard Precautions-Applies to blood, all body fluids except sweat, non-intact skin, & mucous membranes-Gloves are to be worn when coming in contact with any of the above-Gowns are to be worn when splashing is likely-Mask or face shields when splashing is likely

References Available on ALL References Available on ALL Units:Units:

OSHA ManualIsolation Guidelines ManualInfection Control Nurse x8191Employee Health Nurse x8644Policies/Procedures – ETCHnet –

nursing infection control

Contact IsolationContact Isolation

PUDDLE – lyingaround

-#1 way thingspassed-Contact with thesecretions (feces, emesis, nasal secretions)-Secretions live on dry surfaces,some for 72 hours-Infected secretions make contact with mucous membranes (mouth)

-Hand washing is the #1 way to prevent spread…-Gloves when entering room for touching ANYsurface/patient/bed/linens/equipment-Gowns if uniform/clothes will touch patient/bed/linens/equipment

Droplet IsolationDroplet Isolation

-The infectious materialis big, thick, heavy respiratory droplets-Coughed, sneezed out,then drop to the ground-When drop, die-Usually droplet isolation does not last very long

-Mask if working within 3 feet of patient-Maintain StandardPrecautions

Combination Droplet plus Contactrefer to algorithms for diagnoses of

Meningitis and Pneumonia

Airborne IsolationAirborne Isolation-Infectious materialsare airborne particles-Airborne plusContact -AFB precautions –very strict isolation, Hepa mask required(children with TBare not always on Isolation)

Airborne-Observe Standard Precautions-Mask unless you areimmune

Linens and Isolation…Linens and Isolation…

-Remember – -Remember – all all linens are handled as linens are handled as infectiousinfectious– Blue bagsBlue bags – blood – blood

and/or body fluidsand/or body fluids

– Green bagsGreen bags – clean – clean linens you determine linens you determine can’t be usedcan’t be used

– Red bagsRed bags – – ONLY if ONLY if SATURATED/DRIPPING SATURATED/DRIPPING with bloodwith blood

Trash/Disposable items and Trash/Disposable items and Isolation (B.I.C.)Isolation (B.I.C.)

Anything with blood (B) goes into red bag trash.Anything with blood (B) goes into red bag trash. The disease and mode of transmission of the organism in question The disease and mode of transmission of the organism in question

determines the way secretions/excretions are disposed of.determines the way secretions/excretions are disposed of. Any Any materials containing the infectious (I) agent go in red bag trash materials containing the infectious (I) agent go in red bag trash (diapers of a Rotovirus patient, tissues used with an RSV patient).(diapers of a Rotovirus patient, tissues used with an RSV patient).

Tissues, diapers etc. not containing the infectious agent are put into Tissues, diapers etc. not containing the infectious agent are put into regular trash.regular trash.

If the disposable item is a suction container with body fluids, add the If the disposable item is a suction container with body fluids, add the solidifier and put into Red bag trash.solidifier and put into Red bag trash.

If the disposable item is either a syringe (without needle) or IV tubing If the disposable item is either a syringe (without needle) or IV tubing and there is visible blood present, these must go into Red bag trash.and there is visible blood present, these must go into Red bag trash.

Foley bags containing urine always go into red bag trash.Foley bags containing urine always go into red bag trash. Chemotherapy (C) materials go into red bag trash.Chemotherapy (C) materials go into red bag trash.

In Summary…In Summary…

Stop and apply the signs…Stop and apply the signs… Use personal protective equipment…Use personal protective equipment… Use appropriate trash bags for contaminated Use appropriate trash bags for contaminated

items…(BIC)items…(BIC) Educate parents…Educate parents… PRACTICE isolation principles!PRACTICE isolation principles!

Pain Assessment and Pain Assessment and ManagementManagement

PhilosophyPhilosophy

The staff at Children’s Hospital believes that pain is a The staff at Children’s Hospital believes that pain is a negative experience best measured by the individual in negative experience best measured by the individual in pain. Compassionate care includes the assessment of pain pain. Compassionate care includes the assessment of pain on admission and regularly during the visit, accompanied on admission and regularly during the visit, accompanied by effective interventions. Pain is manageable through by effective interventions. Pain is manageable through pharmacological and non-pharmacological interventions pharmacological and non-pharmacological interventions using a multidisciplinary approach with the patient and/or using a multidisciplinary approach with the patient and/or care giver as an integral part of the team. Effective pain care giver as an integral part of the team. Effective pain management focuses on minimizing the pain and the management focuses on minimizing the pain and the adverse psychological and physiological effects of adverse psychological and physiological effects of unrelieved pain. unrelieved pain.

Pain Management includes:Pain Management includes:

Assessment includes:Assessment includes: Assessment on admissionAssessment on admission Pain historyPain history Pain description and intensity Pain description and intensity

using appropriate pain scalesusing appropriate pain scales Before, during and after pain Before, during and after pain

producing eventsproducing events Each new report of painEach new report of pain Before and after each pain Before and after each pain

management intervention: management intervention: pharmacological and non-pharmacological and non-pharmacologicalpharmacological

Supportive care includes:Supportive care includes: Pharmacologic relief-give as Pharmacologic relief-give as

ordered per physicianordered per physician Provide non-pharmacologic Provide non-pharmacologic

pain relief measures: including pain relief measures: including behavioral techniques such as behavioral techniques such as breathing techniques, breathing techniques, relaxation, rocking, etc.; relaxation, rocking, etc.; cognitive interventions such as cognitive interventions such as positive thoughts, distractions, positive thoughts, distractions, medical play; and sensory medical play; and sensory interventions such as hot/cold, interventions such as hot/cold, stroking; repositioning.stroking; repositioning.

DocumentationDocumentation

Record location, description, intensity and Record location, description, intensity and pain scale used.pain scale used.

Record pharmacological/non-Record pharmacological/non-pharmacological interventions. Note any pharmacological interventions. Note any side effects of medication. Note sedation side effects of medication. Note sedation level when opioids in use. level when opioids in use.

Record response to pain interventions.Record response to pain interventions. Record assessment data as needed. Record Record assessment data as needed. Record

in accordance with unit specific standards.in accordance with unit specific standards.

Pediatric MythsPediatric Myths

Children don’t experience pain like adults or they won’t Children don’t experience pain like adults or they won’t remember it. One myth is that young children, particularly remember it. One myth is that young children, particularly infants, have immature central nervous systems and this infants, have immature central nervous systems and this immaturity decreases pain intensity.immaturity decreases pain intensity.

The fact is that the anatomic requirements for pain The fact is that the anatomic requirements for pain processing are intact by mid to late gestation. Research processing are intact by mid to late gestation. Research further indicates that preterm infants may have a greater further indicates that preterm infants may have a greater sensitivity to pain that term infants and older children sensitivity to pain that term infants and older children because their ability to modulate the pain is not developed.because their ability to modulate the pain is not developed.

Pediatric MythsPediatric Myths

Children are at an increased risk for respiratory Children are at an increased risk for respiratory depression from opioids. depression from opioids.

Research indicates that infants older than 1 month Research indicates that infants older than 1 month

are at no greater risk for respiratory depression are at no greater risk for respiratory depression from opioids than older infants. Careful from opioids than older infants. Careful monitoring can minimize adverse effects.monitoring can minimize adverse effects.

Numeric Pain ScaleNumeric Pain Scale

0 1 2 3 4 5 6 7 8 9 10No

PainModerate

PainWorst PossiblePain

*The patient is asked to rate pain from 0 to 10, with 0 equaling no pain and 10 equaling the worst possible pain.

This scale should be used for children age 7 or above.

WONG-BAKER FACES PAIN SCALEWONG-BAKER FACES PAIN SCALE

Explain to the patient that each face is a person who may feel happy because they have no pain or sad because they have some pain. The

scale ranges from “0 No Hurt” to “10 Hurts Worst”, (as much as you can imagine), although you don’t have to be crying to feel this bad. Ask them

to choose the face that best describes how they are feeling.

*This scale is recommended for persons ages 3 and older.

Optimal management of the Optimal management of the patient experiencing pain patient experiencing pain

enhances healing and promotes enhances healing and promotes physical and psychological physical and psychological

wellness.wellness.

Recognizing Signs & Symptoms Recognizing Signs & Symptoms of Child Abuseof Child Abuse

CHILD ABUSECHILD ABUSERecognizing Signs & Symptoms of Child

Abuse

There are four forms of Child Abuse:

Physical Abuse

Physical Neglect

Sexual Abuse

Emotional Abuse/Neglect

This module will help you to recognize signals of child abuse and the characteristics of abusive parents.

Four Forms of Child AbuseFour Forms of Child Abuse

Physical AbusePhysical Abuse

Definition:Definition: The non-accidental injury of a child. The non-accidental injury of a child.

Guidelines to follow Guidelines to follow in determining non-accidental injury in determining non-accidental injury are:are:

• Any injury that requires medical treatment outside the range of normal corrective measures.

• Any punishment that involves hitting with a closed fist or instrument, kicking, inflicting burns, or throwing the child obviously represent child abuse.


Physical NeglectPhysical Neglect

Definition:Definition: Failure to provide the necessities of life for Failure to provide the necessities of life for a child. a child.

Examples would include:

• Lack of Medical care• Inadequate nourishment and/or housing• Lack of supervision


Sexual AbuseSexual Abuse

Definition:Definition: The exploitation of a child for the sexual The exploitation of a child for the sexual gratification of an adult or any significantly older person. gratification of an adult or any significantly older person.

It is called It is called incest incest if it occurs between family if it occurs between family members.members.


Definition:Definition: Excessive, aggressive or unreasonable Excessive, aggressive or unreasonable parental behavior that places demands on a child to parental behavior that places demands on a child to perform beyond his/her capabilities. perform beyond his/her capabilities.

» Sometimes emotional abuse is not what a parent Sometimes emotional abuse is not what a parent does, but what the parent doesn’t do.does, but what the parent doesn’t do.

» Children who receive no love, care, support or Children who receive no love, care, support or guidance will carry those scars into adulthood.guidance will carry those scars into adulthood.

Emotional Abuse / NeglectEmotional Abuse / Neglect

OVERVIEWOVERVIEW

Child abuse is not usually a single physical attack or Child abuse is not usually a single physical attack or a single act of deprivation.a single act of deprivation.

It occurs across economic and social lines and is It occurs across economic and social lines and is usually a pattern of behavior.usually a pattern of behavior.

It takes place over a period of time and its effects are It takes place over a period of time and its effects are cumulative.cumulative.

The longer the child abuse continues the more The longer the child abuse continues the more serious the injury to the child.serious the injury to the child.

REPORTING ABUSEREPORTING ABUSE

All 50 states have MANDATORY reporting laws for All 50 states have MANDATORY reporting laws for child abuse.child abuse.In Tennessee, the state agency that deals with child In Tennessee, the state agency that deals with child abuse or neglect is the Department of Child Services abuse or neglect is the Department of Child Services (DCS).(DCS). Anyone who suspects child abuse or neglect MUST Anyone who suspects child abuse or neglect MUST report it.report it. At Children’s Hospital we would report any suspicions At Children’s Hospital we would report any suspicions to the Social Work Department.to the Social Work Department.

The behavior and attitudes of the parents, their own life

histories, even the condition of their home, can offer

valuable clues to the presence of child abuse and

neglect.

INDICATORS OF ABUSIVE PARENTS

• Were often abused as children• Were expected to meet high demands by their parents• Were unable to depend on their parents for love/nurturing• Cannot provide emotionally for themselves as adults• Expect their children to fill their emotional void

CHARACTERISTICS OF ABUSIVE PARENTS

These parents…These parents…


These parents…These parents…

• Have poor impulse control• Expect rejection• Have low self-esteem• Are emotionally immature• Are isolated, have no support system

• Marry a spouse who is not emotionally supportive and who passively supports the abuse

• May seem unconcerned about the child• May see the child as bad, evil, a monster or witch• Usually offer illogical, unconvincing/contradictory

explanations or have no explanations of child’s injury• Usually attempt to conceal the child’s injury or protect the

person responsible• Routinely employ harsh, unreasonable discipline

inappropriate for child’s age or transgressions


They…They…

Recognition and prompt action on Recognition and prompt action on the part of healthcare providers are the part of healthcare providers are

important in the important in the prevention of further abuse! prevention of further abuse!

Death and DyingDeath and Dying

Caring for children nearing the end of Caring for children nearing the end of life…life…

ETCH 2006ETCH 2006

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•Respecting patient and family goals, wishes and choices

•Caring for the entire family

•Using resources and skills from different team members

•Listening to and attending to the concerns of the caregiver

•Building systems and mechanisms of support

Principles for End of Life Care


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Children are DifferentChildren are Different

Children understand the concept of death Children understand the concept of death differently according to their age and differently according to their age and developmental stagesdevelopmental stages

Children most often focus on living, not on dyingChildren most often focus on living, not on dying Children do not have the same burdens as Children do not have the same burdens as

parents, such as financial concerns, but children parents, such as financial concerns, but children are often ‘protecting’ their parents or other family are often ‘protecting’ their parents or other family members at the same time that their families are members at the same time that their families are trying to ‘protect’ themtrying to ‘protect’ them

•Children don’t die:

•The death of a child is so unthinkable, painful, that many individuals cannot accept the possibility that it may occur

•It is ‘unnatural’ for a child to precede it’s parents, even grandparents, in death

•It can’t happen to my child

Barriers to end of life care


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BUT CHILDREN DO DIEBUT CHILDREN DO DIE Over 50,000 children between the ages of 0-Over 50,000 children between the ages of 0-

19 die in the United States each year19 die in the United States each year 26,000 children die in the first year of life 26,000 children die in the first year of life

from:from:– AsphyxiaAsphyxia– Congenital Birth DefectsCongenital Birth Defects– PrematurityPrematurity– Respiratory distressRespiratory distress– SIDSSIDS

Where do children die?Where do children die?

When hospitalized, most deaths occur in When hospitalized, most deaths occur in intensive care units, either in the NICU or the intensive care units, either in the NICU or the PICUPICU

Many of those deaths may be unexpected and Many of those deaths may be unexpected and despite all efforts and intents by the healthcare despite all efforts and intents by the healthcare staff to preserve lifestaff to preserve life

On the other hand, many of the deaths have On the other hand, many of the deaths have been anticipated by the hospital staff and been anticipated by the hospital staff and efforts have been made to ‘prepare’ the family efforts have been made to ‘prepare’ the family

Why don’t children die at home?Why don’t children die at home? Sudden tragic or traumatic Sudden tragic or traumatic

deathdeath Difficult to predict when Difficult to predict when

children will diechildren will die Difficult to make decisions for Difficult to make decisions for

minorsminors Difficulty in transporting and Difficulty in transporting and

caring for children on caring for children on ventilatorsventilators

Parental fears of controlling Parental fears of controlling symptoms effectivelysymptoms effectively

Families rely on long term Families rely on long term relationship with hospital care relationship with hospital care teamteam

Lack of pediatric palliative Lack of pediatric palliative care expertise in the care expertise in the communitycommunity

Insurance issues such as lack Insurance issues such as lack of payment for home services of payment for home services or refusal to allow life-or refusal to allow life-extending measures alongside extending measures alongside comfort measurescomfort measures

How can we provide the best How can we provide the best possible care?possible care?

Multi-disciplinary= MD’s, nurses, chaplains, social Multi-disciplinary= MD’s, nurses, chaplains, social work, child life, nutritionists, respiratory therapists work, child life, nutritionists, respiratory therapists

Culturally sensitive=religious differences, family Culturally sensitive=religious differences, family dynamics and interactions, ceremoniesdynamics and interactions, ceremonies

Family centered=care extends beyond patients to all Family centered=care extends beyond patients to all other significant family members; family wishes are other significant family members; family wishes are honoredhonored


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Healthcare members as Healthcare members as AdvocatesAdvocates

Studies reveal that most times parents Studies reveal that most times parents perceive that their child perceive that their child ‘‘suffers some suffers some or a great deal’or a great deal’ with symptoms and with symptoms and side effects their child experiences prior side effects their child experiences prior to death—to death—even when providers even when providers described the child as ‘comfortable’described the child as ‘comfortable’

Our greatest goal is to assist the child Our greatest goal is to assist the child and the family in the achievement of and the family in the achievement of what they perceivewhat they perceive as a ‘good’, as a ‘good’, peaceful deathpeaceful death


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Family SupportFamily Support

Many different team members may be called Many different team members may be called upon to support family members, extended upon to support family members, extended family and friendsfamily and friends

Families develop a special attachment for Families develop a special attachment for those who share this very special journey with those who share this very special journey with themthem

Any team member may become the one person Any team member may become the one person a specific family member wants to talk with, a specific family member wants to talk with, vent to, cry onvent to, cry on


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Patient Care ConferencesPatient Care Conferences

The physical, medical, emotional needs of the patient with a life-The physical, medical, emotional needs of the patient with a life-limiting diagnosis are not only overwhelming to the family, but limiting diagnosis are not only overwhelming to the family, but oftentimes also to the healthcare providersoftentimes also to the healthcare providers

Patient care conferences are an excellent means of improving Patient care conferences are an excellent means of improving communication, brainstorming for new ideas, providing continuity of communication, brainstorming for new ideas, providing continuity of care and being supportive of one anothercare and being supportive of one another

Any team member can request a patient care conference and one may Any team member can request a patient care conference and one may be helpful even if every single team member is not able to attendbe helpful even if every single team member is not able to attend

Common reasons for a patient care conference are: anticipated Common reasons for a patient care conference are: anticipated discharge, pain control, difficulties with coping, etc.discharge, pain control, difficulties with coping, etc.


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Ethical ConsiderationsEthical Considerations Sometimes we may not agree with the care a Sometimes we may not agree with the care a

patient is receiving from his/her family, physician, patient is receiving from his/her family, physician, hospital nurse, home health agency, etc.hospital nurse, home health agency, etc.

Please refer to policy/procedure regarding “Ethical Please refer to policy/procedure regarding “Ethical Patient Care Issues” E03 in the nursing documents Patient Care Issues” E03 in the nursing documents found on etchnet.found on etchnet.

Should you feel you are in a situation that puts Should you feel you are in a situation that puts you in direct conflict of your own ethics, please you in direct conflict of your own ethics, please discuss it with your instructor and he (or she) will discuss it with your instructor and he (or she) will assist you in resolving that issueassist you in resolving that issue


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BoundariesBoundaries Sometimes it is very difficult to find the balance of Sometimes it is very difficult to find the balance of

caring for and supporting a family yet not caring for and supporting a family yet not overstepping professional boundariesoverstepping professional boundaries

It is It is always inappropriatealways inappropriate when our patient’s families when our patient’s families know as much about our problems, situations, or know as much about our problems, situations, or loved ones as a close friend would know; We are loved ones as a close friend would know; We are taking care of their family—they are not taking care taking care of their family—they are not taking care of usof us

Likewise, we only need to know enough pertinent Likewise, we only need to know enough pertinent information about a family to allow us to take information about a family to allow us to take excellent care of that patient excellent care of that patient

It is It is NEVER NEVER about about USUS


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Where is the Where is the balance? balance?

Is it possible to care for someone without caring about Is it possible to care for someone without caring about them?them?

Is it possible to provide comfort to a child who is Is it possible to provide comfort to a child who is dying and not be affected by that?dying and not be affected by that?

Is it possible to become so involved with the family Is it possible to become so involved with the family that it detracts from our ability to provide optimum that it detracts from our ability to provide optimum care for the patient?care for the patient?

Taking Care of UsTaking Care of Us How do we refill our tank?How do we refill our tank? What are things we can do for ourselves that What are things we can do for ourselves that

heal our spirit?heal our spirit? How do we manage stress?How do we manage stress? How do we know when to step back? How How do we know when to step back? How

can we know when enough is enough?can we know when enough is enough? Do we support—rather than enable– each Do we support—rather than enable– each

other?other?


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IdeasIdeas Exercise—no, really Exercise—no, really Eat healthy—contrary to popular belief, Eat healthy—contrary to popular belief,

chocolate does not have heal all powerschocolate does not have heal all powers Laugh—find something, someone who will Laugh—find something, someone who will

always tickle your funny bonealways tickle your funny bone Cry—when you need to--in private, among Cry—when you need to--in private, among

friends, at funerals; however, patient’s friends, at funerals; however, patient’s families should not be the ones to comfort youfamilies should not be the ones to comfort you

Spend time with the people you love doing Spend time with the people you love doing things that are fun for youthings that are fun for you


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ETCHETCHEmergency CodesEmergency Codes

Emergency Phone NumberEmergency Phone Number

Dial “333” to report an Dial “333” to report an emergencyemergency

Report Location and Report Location and type of emergencytype of emergency

Be specific!Be specific! Emergency Code Plan Emergency Code Plan

Notebook in each Notebook in each work areawork area

Code RedCode Red

RescueRescue

AlertAlert

ConfineConfine

ExtinguishExtinguish

Code BlackCode Black

Bomb ThreatBomb Threat Report to your original Report to your original

work area & wait for work area & wait for instructionsinstructions

Stay calm and alert!Stay calm and alert! Report anything Report anything

suspicioussuspicious

Code WhiteCode White

Tornado Warning Tornado Warning (sighting of a tornado)(sighting of a tornado)

Remain calm…speed is Remain calm…speed is essentialessential

Move patients & visitors Move patients & visitors to center of building to center of building away from windowsaway from windows

Close blinds, drapes & Close blinds, drapes & doorsdoors

Code AbleCode Able

External DisasterExternal Disaster Code Able I : Code Able I : Any mass casualty Any mass casualty

incident that threatens the integrity and incident that threatens the integrity and function of the institution and requires function of the institution and requires mobilization of all hospital resourcesmobilization of all hospital resources

Code Able II: Code Able II: Any mass Any mass casualty incident involving nuclear, casualty incident involving nuclear, biological and /or chemical injuries, and biological and /or chemical injuries, and that threatens the integrity and function that threatens the integrity and function of the institution and requires of the institution and requires mobilization of all hospital resourcesmobilization of all hospital resources

Initiate Disaster PlanInitiate Disaster Plan

Code GreenCode Green

Security breeches that Security breeches that threaten immediate threaten immediate danger to patients, danger to patients, staff or hospital staff or hospital propertyproperty

Security will respond Security will respond immediatelyimmediately

Other designated staff Other designated staff may respondmay respond

Code PinkCode Pink

3 levels3 levels-Code Pink 0 (<1 yr)-Code Pink 0 (<1 yr)-Code Pink 1 (1 – 5yrs)-Code Pink 1 (1 – 5yrs)-Infant or Child -Infant or Child

AbductionAbductionCode Pink 5 (>5 yrs)Code Pink 5 (>5 yrs)

Nursing –secure area Nursing –secure area & support family& support family

Security – secure all Security – secure all exitsexits

Code Boy/GirlCode Boy/Girl

Elopement / Runaway Elopement / Runaway riskrisk

Secure areaSecure area Be alert!Be alert!

Code 99Code 99

Medical EmergencyMedical Emergency BLS certified staff BLS certified staff

will begin CPRwill begin CPR Non BLS certified Non BLS certified

staff will call code and staff will call code and seek nursing seek nursing assistanceassistance

Code Team will Code Team will respond and will be in respond and will be in charge of the situationcharge of the situation

PNEUMATIC TUBE SYSTEMPNEUMATIC TUBE SYSTEM

I THINK I JUST I THINK I JUST SENT THAT SENT THAT STOOL TO STOOL TO PHARMACYPHARMACY……

PNEUMATIC TUBE SYSTEM PNEUMATIC TUBE SYSTEM - Key Points- Key Points

ALL SPECIMENS ALL SPECIMENS MUST BE SEALED IN MUST BE SEALED IN A BIOHAZARD BAG A BIOHAZARD BAG AND THEN SEALED IN AND THEN SEALED IN A PADDED A PADDED ““BUBBLEBUBBLE”” BAG BEFORE BEING BAG BEFORE BEING PLACED IN A TUBE PLACED IN A TUBE FOR TRANSPORTFOR TRANSPORT

USE EXTRA PADDING USE EXTRA PADDING AS NEEDED TO AS NEEDED TO ASSURE STABILITYASSURE STABILITY

DO NOT SEND ANY DO NOT SEND ANY SPECIMENS THROUGH SPECIMENS THROUGH THE TUBE SYSTEM THE TUBE SYSTEM THAT CANTHAT CAN’’T READILY T READILY BE REPLACED OR BE REPLACED OR MAY LEAKMAY LEAK

Pneumatic Tube System Pneumatic Tube System –– Key Points Key Points

Packaging and handling of items to be Packaging and handling of items to be transportedtransported– Secure breakable items in the carrier with either Secure breakable items in the carrier with either

a liner or bubble wrapa liner or bubble wrap– Place all items, with the exceptions of plastic Place all items, with the exceptions of plastic

bags of IV fluid and medical records, into a zip bags of IV fluid and medical records, into a zip lock bag prior to placing in the carrier\Reuse lock bag prior to placing in the carrier\Reuse bags that have been used to transport bags that have been used to transport pharmaceuticals, sterile supplies or paperpharmaceuticals, sterile supplies or paper


Packaging and handling of items to be Packaging and handling of items to be transported transported –– Continued Continued……....– Snap the carrier properly at both ends or middle Snap the carrier properly at both ends or middle

latch prior to sending through the tubelatch prior to sending through the tube– Wash hands after handling a carrier - the Wash hands after handling a carrier - the

pneumatic tube system is not cleanpneumatic tube system is not clean


Laboratory Specimens - ContinuedLaboratory Specimens - Continued……– Place specimen(s) in BIOHAZARD zip lock bag with Place specimen(s) in BIOHAZARD zip lock bag with

the following precautions:the following precautions:

» Only specimens from the same patient in one bagOnly specimens from the same patient in one bag

» Wrap glass items (blood culture bottles, glass tubes) Wrap glass items (blood culture bottles, glass tubes) with bubble wrap before placing in Biohazard zip with bubble wrap before placing in Biohazard zip lock baglock bag

» Place all labels or paperwork in the side pouch of Place all labels or paperwork in the side pouch of the biohazard bagthe biohazard bag

» Secure zip lock closureSecure zip lock closure


Laboratory Specimens Laboratory Specimens –– Continued Continued……– Place BIOHAZARD bag within the bubble Place BIOHAZARD bag within the bubble

wrap bag, Add extra bubble wrap as necessary wrap bag, Add extra bubble wrap as necessary and fold bag to immobilize contentsand fold bag to immobilize contents

– Note:Note: This step is critical for Blood Culture This step is critical for Blood Culture bottles and glass tubes to prevent breakage! bottles and glass tubes to prevent breakage!


Blood product bags can be Blood product bags can be ““returnedreturned”” via via the tube system with the following the tube system with the following precautions:precautions:– Remove Remove allall sharps sharps– Close Close allall tubing ends tubing ends– Place in BIOHAZARD bag with paperwork in Place in BIOHAZARD bag with paperwork in

the outside pouchthe outside pouch


Laboratory SpecimensLaboratory Specimens– Check to ensure that all container lids or tube Check to ensure that all container lids or tube

stoppers have been tightened securelystoppers have been tightened securely– Note:Note: For Urine or liquid stool specimens - For Urine or liquid stool specimens - do do

not completely fill containersnot completely fill containers!!

ITEMS THAT MAY NOT BE SENT ITEMS THAT MAY NOT BE SENT

THROUGH THE TUBE SYSTEMTHROUGH THE TUBE SYSTEM Laboratory Laboratory

– Surgical specimensSurgical specimens– CSF specimens (Spinal fluid) from LPCSF specimens (Spinal fluid) from LP– Formalin and/or alcohol preserved specimensFormalin and/or alcohol preserved specimens– Tissues for pathologyTissues for pathology– Trach traps, Gastric washingsTrach traps, Gastric washings– Blood products for transfusionBlood products for transfusion

ITEMS THAT MAY NOT BE SENT THROUGH ITEMS THAT MAY NOT BE SENT THROUGH THE TUBE SYSTEMTHE TUBE SYSTEM –– Continued Continued……..

PharmacyPharmacy– ChemotherapyChemotherapy– NarcoticsNarcotics– Employee prescriptions; over the counter Employee prescriptions; over the counter

purchasespurchases Central SupplyCentral Supply

– Employee purchasesEmployee purchases

ITEMS THAT MAY NOT BE SENT THROUGH ITEMS THAT MAY NOT BE SENT THROUGH THE TUBE SYSTEMTHE TUBE SYSTEM –– Continued Continued……..

Other ItemsOther Items– Contaminated patient used products (ie, Contaminated patient used products (ie,

instruments, sharps) used laryngoscope blades instruments, sharps) used laryngoscope blades may be sent if placed into Biohazard Bag, may be sent if placed into Biohazard Bag, sealed placed in bubble wrap and then placed in sealed placed in bubble wrap and then placed in containercontainer

– Patient valuablesPatient valuables– Any container that might leakAny container that might leak

Pneumatic Tube System Spill Pneumatic Tube System Spill ProcedureProcedure

Stop sending carriers from the station where the Stop sending carriers from the station where the contamination was first noticedcontamination was first noticed

Notify Engineering and state:Notify Engineering and state:– Receiving stationReceiving station’’s numbers number

– Sending stationSending station’’s number (if known)s number (if known)

– Type of spill (specimen type and suspected amountType of spill (specimen type and suspected amount

– Time the contaminated carrier arrived (or was first Time the contaminated carrier arrived (or was first noticed)noticed)

– Number of contaminated carriers that have arrivedNumber of contaminated carriers that have arrived

– If no answer, page at 417-0328If no answer, page at 417-0328

Pneumatic Tube System Spill Pneumatic Tube System Spill Procedure Procedure –– Continued Continued ……

Remove contents of carrier using protective Remove contents of carrier using protective clothing (utilizing Standard Precautions, ie., clothing (utilizing Standard Precautions, ie., gloves; gown and goggles as needed)gloves; gown and goggles as needed)

Discard the specimen and secondary containment Discard the specimen and secondary containment bag into red bag trashbag into red bag trash

Call the sending station and notify of spill (request Call the sending station and notify of spill (request another specimen if applicable)another specimen if applicable)

Place the carrier in a biohazard bag, contact Place the carrier in a biohazard bag, contact Central Service and deliver the carrier to Central Central Service and deliver the carrier to Central ServiceService

Pneumatic Tube System Spill Pneumatic Tube System Spill Procedure Procedure –– Continued Continued ……

Complete an Employee Injury Report form Complete an Employee Injury Report form explaining the type of exposure and personnel explaining the type of exposure and personnel exposed. Call Employee Health or Infection exposed. Call Employee Health or Infection Control (or the Nursing Coordinator if on nights, Control (or the Nursing Coordinator if on nights, weekends, or holidays)weekends, or holidays)– DO NOTDO NOT leave a voice-mail message - Contact with leave a voice-mail message - Contact with

Employee Health or the Coordinator must be made Employee Health or the Coordinator must be made within 2 hours within 2 hours

– When a spill occurs, the entire system will be shut When a spill occurs, the entire system will be shut down for clean up by Engineeringdown for clean up by Engineering

Dress Code for Students Dress Code for Students at ETCHat ETCH

At Children’s Hospital, projecting a At Children’s Hospital, projecting a professional image is important in our work.professional image is important in our work.

Students should be in school uniforms when in the hospital. Students should be in school uniforms when in the hospital. Identification should be visible at all times! Uniforms should be neat, Identification should be visible at all times! Uniforms should be neat, clean and not interfere with your work. clean and not interfere with your work.

Students must maintain a clean body, free of odors, Fingernails must be Students must maintain a clean body, free of odors, Fingernails must be clean, neatly trimmed and no more than ¼ inch in length. Due to clean, neatly trimmed and no more than ¼ inch in length. Due to infection control concerns, the use of artificial nails and/or extenders is infection control concerns, the use of artificial nails and/or extenders is prohibited for students in clinical areas. The use of perfumes, prohibited for students in clinical areas. The use of perfumes, colognes, aftershave and other scented items must be avoided. colognes, aftershave and other scented items must be avoided.

Hair must be neat and well groomed. No hairstyle that detracts from the Hair must be neat and well groomed. No hairstyle that detracts from the ability to carry out your responsibilities will be allowed. Mustaches ability to carry out your responsibilities will be allowed. Mustaches and beards must be well groomed and neatly trimmed. and beards must be well groomed and neatly trimmed.

Feet must be covered with hose or socks at all times. Shoes must be Feet must be covered with hose or socks at all times. Shoes must be clean. Sandals, open-backed shoes and canvas shoes are not permitted clean. Sandals, open-backed shoes and canvas shoes are not permitted for clinical areas. for clinical areas.

Dress Code, cont.Dress Code, cont.

Students who are in the building to pre-plan or for other Students who are in the building to pre-plan or for other school-related tasks must be dressed appropriately and be school-related tasks must be dressed appropriately and be properly identified. properly identified.

The following are NOT allowed: Jeans, leather skirts or The following are NOT allowed: Jeans, leather skirts or pants, sweat pants, shorts or tight-fitting pants, mini-skirts, pants, sweat pants, shorts or tight-fitting pants, mini-skirts, halter or spaghetti strap tops, sleeveless tops, tight-fitting halter or spaghetti strap tops, sleeveless tops, tight-fitting or sheer tops, air-brush or screen printed T-shirts. or sheer tops, air-brush or screen printed T-shirts.

Jewelry should be appropriate. Earrings and jewelry Jewelry should be appropriate. Earrings and jewelry should not be excessive. Female students should wear no should not be excessive. Female students should wear no more than two earrings per ear, male students should more than two earrings per ear, male students should refrain from wearing earrings while in the clinical area.refrain from wearing earrings while in the clinical area.

Students SHOULD wear lab coats and school ID when on Students SHOULD wear lab coats and school ID when on campus! campus!

Parking:Parking:During your clinical rotation, you may park in the ETCH Employee During your clinical rotation, you may park in the ETCH Employee

Parking Garage at the end of White Ave, past Primary Care Center, which Parking Garage at the end of White Ave, past Primary Care Center, which is located on the corner of 22is located on the corner of 22ndnd Ave and White (not shown on map). Ave and White (not shown on map). If you arrive before 8 AM, you may enter the garage without a card, If you arrive before 8 AM, you may enter the garage without a card, however if your clinical start time is between 8 AM-2 PM, you must however if your clinical start time is between 8 AM-2 PM, you must obtain an entry card from your instructor. IF you are scheduled for obtain an entry card from your instructor. IF you are scheduled for clinicals AFTER 2 PM, you may park in the MOB Parking Garage clinicals AFTER 2 PM, you may park in the MOB Parking Garage

(#7 on the map)(#7 on the map)

Come Prepared!Come Prepared!

Come in dress code! Wear your Student Come in dress code! Wear your Student ID!ID!

Due to very limited storage space, bring as Due to very limited storage space, bring as little with you as possible! Do not bring little with you as possible! Do not bring large backpacks, coats, etc.! large backpacks, coats, etc.!

Leave your valuables at home! Leave your valuables at home! No cell phones in patient care areas! No cell phones in patient care areas!

Children’s Hospital wishes the Children’s Hospital wishes the very best to each of you in your very best to each of you in your

new career!new career!

Success is not the key to happiness. Success is not the key to happiness. Happiness is the key to success. If Happiness is the key to success. If you love what you are doing, you you love what you are doing, you

will be successful.will be successful.

~~Albert SchweitzerAlbert Schweitzer~~

FINAL STEP:FINAL STEP:Click the link below to view and then PRINT these 2 pages:

Children’s Hospital Component Compliance FormChildren’s Hospital Component Compliance Form

&

Information Security Compliance StatementInformation Security Compliance Statement

Sign both and give the originals to your instructor

Click here for forms

Documents

WELCOME TO ETCH! This module contains: Instructions for completion of module Instructions for completion of module Welcome to ETCH Welcome to ETCH Service