An Educational Guide for Residents and Medical Students General

An Educational Guide
for
Residents and
Medical Students
General Orientation
Table of Contents
Mission Statement
Unit Locator
Conferences to Attend
Helpful Hints
Codes and Emergency Responses
Guidelines for Residents
Infection Control
Handwashing/Hand Hygiene
Isolation Precaution Guidelines
Isolation Precautions Quick Reference Recommendations
Medication Prescribing
Medical References / Online PDR
Abbreviations and Symbols Which Cannot Be Used
Medications Requiring Special Credentialing Privileges
Radiology Department
Patient Safety / Outcomes Management
Resident Supervision
Progress Notes
Important Phone Numbers
p. 3
p. 4
p. 5
p. 6
p. 17
p. 20
p. 22
p. 28
p. 29
p. 30
p. 31
p. 32
p. 33
p. 34
p. 35
p. 38
p. 40
p. 44
p. 53
Children’s Hospital Mission
Statement
“So that all children may have a better chance to live . . .”
Children’s Hospital delivers extraordinary care to children, educates
health care professionals, and promotes pediatric research.
Vision Statement
“So that all children may have a better chance to live . . .”
As a national leader in pediatric health care, Children’s Hospital will
be the choice for care for children in the Heartland.
Family-Centered Care
The Family is the center and constant in a child’s life. Care is
collaborative with families. We honor racial, ethnic, religious, cultural
and socioeconomic diversity of families. Infant feeding rooms,
parents’ day beds and refrigerators, wireless computer access, 24
hour visitation for parents, sibling play areas and outdoor play/rest
areas are examples of family-centered care.
Service Excellence
Customer service at Children’s is extremely important. At Children’s
we define service excellence as a personal investment by everyone
in every role to exceed the customer’s expectations.
Patient Rights
Patient rights will be posted in each of the patient rooms on
their marker board.
Main Campus Address:
8200 Dodge Street
Phone system number prefix: 955
Hospital Main Switchboard: 955-5400
Important Phone Numbers–Prefix 955
Access Center/Admitting
5410
Call Center (Dietary, Maintenance, 8999
Utilities and Environmental Service)
Child Life Specialists
Each unit is assigned a specialist; pager
#’s are available through the unit secretary
or charge nurse.
Code 4 (If no Code 4 call button)
4444
Corporate Compliance
Hotline/HIPAA
3250
Emergency Department
5150
Employee Health
6020
Facilities (prox cards/parking tags)
(Pat Copeland)
3748
Family Resource Library
3834
House Supervisor
7901
Information Technology Help Desk
6700
Medical Education – Mary Noah
Cindy Cook – GME
6070
6061
Medical Records
3800
Medical Staff Office
3775
Methodist Numbers
Dial 9 – then 7 digit number
Pathology
5500
Pharmacy
5470
Radiology
5602
Rainbow House
7815 / 7837
Security
5300
Social Work
5418
888-8420 pager
Level 6
6MS-6th floor Med-Surg - 24 beds, Rooms 601-624
6 years and up; diabetic patients regardless of age
Level 5
5MS-5th floor Med-Surg - 24 beds, Rooms 501-524
18 months – 5 years, cardiac patients regardless of age
Telemetry, IMC
Level 4
4MS-4th floor - 24 beds, Rooms 401-424
Newborn – 18 months
Level 3
Air handling and access to Auditorium and Pavilion
Level 2
PEDS ICU-Pediatric Intensive Care - 17 beds,
Rooms 201-217, Atrium Viewing, Coffee Shop
Level 1
CARES-Pre & postop care, sedation, infusion, observation - 25
beds, OR – 6 rooms, PACU, Cath Lab, Access Center, Atrium,
Gift, ATM machine, Volunteer Services, Pavilion Access
Lower Level 1 Emergency Department – 13 rooms, 2 Trauma Rooms,
Radiology – CT/MRI Room, 2 Ultrasound, 1 Nuclear Medicine;
Pharmacy
Lower Level 2 Visitor Parking
Lower Level 3
Cafeteria, 24-hour vending, Classrooms, Medical Staff Office and
Lounge, Resident Lounge, Health Information Management
(Medical Records), Mail and Duplicating, Environmental Services,
and Visitor Parking
Lower Level 4 Visitor Parking
Lower Level 5 Sub-Basement and Employee and Resident Parking
Pavilion
Clinics – 2, 3, 4
Administration
North Tower
4th Floor, NICU, Eating Disorders Program, Helmet Lab, 5th Floor
NICU
111 Building
Human Resources
East Office
Annex
Graduate Medical Education, Continuing Medical Education,
Infection control, Outcomes Management, Support Services
Conferences to Attend
Formal Resident Teaching
Rounds
9-10 AM
See Monthly
Calendar
M –W –TH
PMC (Patient Management
Conference)
8 – 9 AM
Glow Aud
Thursday
Grand Rounds
8 – 9 AM
Glow Aud
Friday
Hospitalist Teaching Rounds
Varied
5th Floor
Conference
Daily
Noon Conference
12 – 1 PM
Glow A
M–F
Student Lectures
1 – 4 PM
Glow A
Wednesdays
CHILDREN’S HOSPITAL MAIN CAMPUS AND PAVILION
EMERGENCY CODES
PROBLEM
BOMB
THREAT
Threat of a bomb on
campus
DESCRIPTION
* Dial 6911 to report
Administration will delegate
responsibility for search/
evacuation until police arrive
Complete evaluation
form as directed
CODE 4
Pediatric
Cardiac/Resp
PEDIATRIC cardiac or
respiratory medical
emergency
* Push blue Code button or call
4444
* Shout Code 4
* Assess pts' ABCs (Airway,
Breathing, Circulation)
* Start CPR
*Assigned staff will respond
to code
* Perform Code 4 tasks as
designated
Complete Code 4
evaluation form and
send to PCM
* Secure and search area
* Dial 6911 to initiate Code
Adam
Complete evaluation
* Staff to monitor designated
as requested
exterior exits
* Watch for & report suspicious
behavior to Security
* Visitors will be asked to
stay in the hospital
CODE ADAM Missing person of any
age
Abducted/
missing person
CODE BLUE
Adult
Cardiac/Resp
INITIAL RESPONSE
ADULT visitor cardiac or * Dial 9-911
respiratory medical
* Assess pts' ABCs (Airway,
emergency
Breathing, Circulation)
* Start CPR
* Notify Children's ED physician
to assist
CODE DECON Victim presents to the
hospital contaminated
with hazardous material
SECONDARY RESPONSE
* Ambulance crew will take
over treatment on arrival
* Assist ambulance crew
as requested
* Recognize the victim is
ED and Decon Team will triage
contaminated
and initiate decontamination
* Isolate victim outside the
procedures
hospital, away from others
* Notify the ED at 5150;
ED will notify Decontamination
Team
Cardiac or respiratory
* Methodist staff will dial 3444 to Children's NICU response
CODE PINK
call Children's NICU response
team will take over treatment
Methodist L&D arrest of newborn at
Methodist Hospital Labor team
on arrival
emergency
& Delivery
Complete variance
report
ED/Decon Team
complete evaluation
form if indicated
Children's NICU
response team will
complete necessary
documentation
forms
CODE RED
Fire
Fire, smoke or smell of
something burning
CODE RED
DRILL
Security conducts monthly drills for fire. The trigger is a wooden white disc with a red X painted on it. If you find this
respond with I will activate RACE, follow directions, and then notify the nearest employee and ask that they respond to the
Code Red Drill.
CODE TRIAGE External: Situation
resulting in significant
Disaster
influx of pts requiring tx
which affects normal
operations
Internal: Disaster within
the hospital which
affects normal
operations
Rescue those in danger
Activate the alarm (shout Code
Red/Fire, pull nearest fire alarm,
dial 6911)
Contain the
fire (Close all doors) Extinguish
the fire
or Evacuate if necessary
(elevators can be used)
FOLLOW-UP
Physicians not in critical areas
report to Med Staff for triage.
Use extinguisher to put out
the fire
Pull the pin
Aim hose at base of fire
Squeeze the handle
Sweep from side to side
Evacuate if directed
by Command Post
or Fire Chief
* Determine & communicate
Complete evaluation
Dept needs/questions to
form as directed
Command Post
* Initiate Dept-specific staff recall
plan as directed by Command
Post
CHILDREN’S HOSPITAL MAIN CAMPUS AND PAVILION
EMERGENCY CODES
PROBLEM
DR. MAJOR
Disruptive/
Unruly person
DESCRIPTION
INITIAL RESPONSE
SECONDARY RESPONSE
FOLLOW-UP
When any person
demonstrates or
threatens violent or
disruptive behavior
Dial 6911 and ask to speak to
Dr. Major
Security Dept will respond and
assist in problem resolution
Complete variance
report
HAZARDOUS
MATERIAL
SPILL
Release or spill of
chemicals or hazardous
materials
* Dial 8999 to report & get
MSDS (6911 if emerg)
* Contain spill
* Remove pts, visitors & staff
from affected area
Safety/Security Dept will
direct appropriate clean-up
and disposal based on MSDS
instructions
Complete variance
report
TORNADO
WARNING/
HIGH WIND
WARNING
Tornado warning or high
wind warning has been
issued for Douglas
County
* Evacuate to sheltered areas
* Search and verify that all pts,
visitors & staff have been
evacuated
Stay in the sheltered area until
the operator announces that the
warning has been cancelled
Complete evaluation
form as directed
TORNADO
WATCH
Conditions are favorable * Prepare pts, equipment &
Listen for weather updates
for development of
supplies for potential evacuation
tornado
to sheltered area
* Close drapes and blinds
* Determine shelter areas in
case patient evacuation is
necessary
* Clear hallways and rooms to
be used as shelter areas
None
CHILDREN’S HOSPITAL MAIN CAMPUS AND PAVILION
SYSTEMS FAILURES AND BASIC STAFF RESPONSE
FAILURE OF WHAT TO
EXPECT
COMPUTER
SYSTEM
ELEVATORS
HVAC (Heating,
Ventilation, Air
Conditioning
NURSE CALL
SYSTEM
WHO TO CONTACT
STAFF RESPONSIBILITY
Notify Help Desk at 6700, M-F Follow instructions given by the IT Help Desk
7a.m. –10 p.m. *Notify Call
Center at 8999 after hours and
they will forward the problem to
the IT Help Desk
*Review Department evacuation plan
*Use stairways for floor Notify Call Center at 8999
*Identify patients who might need to be
to floor movement
relocated if outage continues
*Delivery of medications
and support services will
be delayed
*Assess & meet patient needs when possible
*Notify Call Center at 8999
No heat, no air
*Restrict use of hasardous/odorous
*Contact Infection Control at
conditioning, no
chemicals
888-8388
ventilation
*Assign CCPs to remain in area
*Patients will be unable Notify Call Center at 8999
*Assure that staff is “roving” to check on
to contact the nursing
patients frequently
staff
*Give patients the assigned RN spectra
*Equipment alarms may
link phone number to use during outage
not be heard
*Code 4 button will not
work
SCM, MISYS, Intranet,
SRM, Internet, Outlook/
Email, Network will not
function
CHILDREN’S HOSPITAL MAIN CAMPUS AND PAVILION
SYSTEMS FAILURES AND BASIC STAFF RESPONSE
FAILURE OF WHAT TO
EXPECT
WHO TO CONTACT
OXYGEN/
SUCTION/
VACUUM
No oxygen or suction or Notify Call Center at 8999
vacuum will be available
through wall outlets
POWER/
ELECTRICITY
Generator not
working
Notify Call Center at 8999
*Total darkness
*Some battery-powered
equipment will work
*Phones will work
*Elevatiors will not work
*Code Triage may be
called
*7 to 10 seconds before Notify Call Center at 8999
generator will start
*RED/ORANGE outlets
only will work
*Some lights out
*Some bathrooms will
not work
*Ice machines will not
work
*Limited elevator service
Clogged toilet, sink or
Notify Call Center at 8999
floor drain
POWER/
ELECTRICITY
Generator still
works
SEWER
*Assess patients’ needs and communicate
them to Respiratory Therapy
*Obtain needed supplies out of supply
room or off the crash cart
*Assess, prioritize & meet essential patient
needs
*Contact Command Post for assistance, if
appropriate
Immediately assure that essential equipment is
plugged into RED/ORANGE outlet
*Do not flush toilets
*Do not use water
*If flooding/overflow occurs, contain water,
notify floor below and call Infection Control
at 888-8388
Assess inventory of sterile supplies and/or
Equipment to determine if hospital operations
will be interrupted
Use the “Failure phones”, overhead paging, cell
phones, pay phones and runners as needed
STEAM
No hot water,
sterilizer, heating
TELEPHONE
SYSTEM
Black “Failure phones” are
located in critical departments;
refer to Emergency Procedures
Manual for locations and
procedures
Arrange for hand delivery of medications,
Delivery of medications, Notify Call Center at 8999
Specimens, supplies and documents
specimens, supplies
and documents will be
delayed
TUBE SYSTEM
WATER
Notify Call center at 8999
STAFF RESPONSIBILITY
*No dial tone
*Spectralink phone will
not work
*No water
*Toilets won’t flush
Notify Call Center at 8999
*Conserve water that is available
*Use hand degermer instead of soap
*Be sure to turn off water at the faucet so that
when water comes back on, we don’t have overflow
“Environment of Care” Safety within the organization, please
review the EOC structure which can be found on the intranet under
Policies/Safety/ Environment of Care Management Plan.
Patient Safety
Children’s Patient Safety Program is integrated throughout the
hospital. Key elements include encouraging reporting of any patient
safety issue; proactively assessing high risk processes i.e. medication
administration and responding promptly if an error should occur.
Important patient safety tips include:
•
Children under 4 years are in cribs unless a waiver is
signed.
•
Keep side rails up unless an adult is at the bedside.
•
Children in regular beds should be at lowest level. Assure
their access to the call light.
•
All patients wear an ID band. Parents will receive a
temporary prox card for access. We have a liberal sibling
visitation policy. Please review it.
•
Allergies are noted with red bands on wrists and red tags
on the chart. All patients are screened for latex sensitivity.
We maintain a latex-safe environment. Latex is treated as
an allergy. Latex precautions signs are posted.
•
No rubber or latex balloons are allowed.
•
Cellular phones are to be used only in designated areas in
the building.
•
Breast feeding is encouraged. We have breast pumping
rooms and milk is stored according to hospital policy.
•
For any concerns related to patient safety you may call
955-3250 (the Corporate Compliance/HIPAA/Patient
Concern/Safety Hotline).
•
No food or drink allowed in patient care areas.
2007 JCAHO National Patient Safety Goals. Refer to “JCAHO” tab
on Hospital Intranet for further information.
• Identify your patient
• Improve Communication among Caregivers – SBAR (see SBAR form
at the back of this booklet)
• Use Medications Safely – See policy on Medication Prescribing
• Reduce Infections – Use proper hand washing procedures
• Reconcile Medications – See policy on Medication Reconciliation
across the continuum of care and Medication Reconciliation Form at
the back of this booklet
• Reduce falls
Helpful Hints for House Staff
Access Center Access Center is comprised of RNs and Registrars. Physicians call
955-5410 to facilitate admission. The Access Center:
•
Schedules all admissions (except those done after hours
which channel through the Emergency Department).
•
Scheduling and coordinating outpatient tests.
•
Insurance Pre-certification and authorization for all
inpatient admissions and outpatient surgeries.
•
Collaboration with physicians, and case managers to
determine most appropriate admission status for patients.
Patients requiring testing just for Radiology Department will
need to be scheduled individually. The office can call 955-5410,
the Automated Attendant service to facilitate that.
Patient Education:
Patients scheduled for outpatient tests (i.e. Pathology,
Radiology) will need to be given information FROM THE
PHYSICIAN'S OFFICE regarding pre-procedural preparation.
Child Abuse
CAT Team
(Children’s
Advocacy
Team)
Recognition/
Response to
Abuse
Situations
The CAT Team is a multidisciplinary team composed of physicians,
nurses, social workers, child life specialists, chaplains, psychologists.
The team reviews all cases of actual or suspected abuse or neglect for
referral as needed. Anyone suspecting is expected to report. See CAT
team manual.
Contact: 888-8420
We are concerned about everyone’s safety here at Children’s. We
expect you to assist in keeping staff and families safe in Children’s
Hospital. If you ever witness any form of abuse or violence at
Children’s, report it to your supervisor immediately. Consult with
supervisory resident, attending, or hospitalist when abuse is
suspected.
Child Life
Services
Child Life Specialists are professionals with a degree in childhood
development or related field and national certification. Their role is
to: lessen the potential negative impact of medical care and
hospitalization, support the normal growth and development of
children during hospitalization illness, help children understand the
sequence, nature and reason for procedures and routines and assess
the coping strategies of children and their families. The department
includes an Art Therapist and Teacher. Some activities facilitated by
the Child Life Specialists include Play Room activities, providing
play for children unable to use play rooms, distraction, medical play,
pet therapy, school re-entry, enriching the environment of the patient,
and meeting the developmental needs of the patient.
Code 4
• Crash carts have uniform contents organized following Broslow
tape.
• Every inpatient will have an Emergency Medication Dosing Sheet
on the foot of the bed that is weight specific to him or her.
Review and understand these sheets.
Mouth-to-mask ventilators and resuscitation bags in the room in the
bottom drawer on the head wall. No mouth to mouth resuscitation.
Activate Code 4 by pulling Code 4 Blue Button or dial 4444.
Emergency PPE’s are located in the bottom drawer on the head wall.
ALL rooms have O2, air, suction equipment, O2 tubing,
resuscitation bags and monitors.
Computers Children’s uses a computerized medical patient record system. You are
allowed access into Children’s patient computer system after your name
has been entered into our user database. Computer training will occur
during your orientation to Children’s. The orientation will be held on the
first day of your rotation at 8:00 AM. If you are unable to attend the
orientation, you can call Cindy Cook (955-6061) in the Graduate Medical
Education office to arrange an alternative time.
There are several components of the medical patient record system that
will be used by the residents. They are:
• Sunrise Clinical Manager (SCM), where orders are entered, results can
be viewed, documents that are transcribed into our system can be
retrieved, and patient information can be accessed. You will also be
able to access the PACS (radiology) system through SCM.
• ChartMaxx is the Medical Records application where documents can
be signed and other documents can be retrieved. Verbal orders that
are not signed in SCM must be signed in ChartMaxx.
• PACS is the online radiology viewing system.
SCM contains orders, results, medication and IV charting, and patient
information.
• Log into SCM by clicking the Citrix icon or tab (looks like colorful
buildings)
• Log on. Your user name and password will be provided to you by
Cindy Cook (Graduate Medical Education). You will be prompted to
change your password. Your new password must consist of six or
more letters and/or numbers.
Please remember: You MUST sign your verbal/telephone orders at
Children’s. When a verbal or telephone order is entered as requested by
you, it must be electronically signed by you in SCM before leaving your
shift, and before the patient is discharged. If a patient is discharged before
a verbal order is signed, the order must then be signed in the ChartMaxx
application. Contact the Medical Records Department, located on Lower
Level 3, for log-in information and instructions.
When a verbal or telephone order is entered into SCM, as requested by
you, a red flag will appear in the ‘To Sign’ column in SCM. Signing the
order on paper will not remove the red flag from SCM; you must still sign
the order electronically. See directions below, for signing
verbal/telephone orders in SCM.
To electronically Sign a Verbal or Telephone Order in SCM:
1)
2)
Log in to SCM (you will be on the Patient List page). If you have
an unsigned verbal or telephone order, you will see a red flag in
the ‘To Sign’ column. Double Click on the red flag to open the
‘To Sign’ column for the patient.
Select the ‘Signature Manager’ icon (looks like a hand writing on a
piece of paper). If this icon is not available, please call the
3)
4)
Helpdesk at 955-6700 or Cindy Cook at 955-6061 and someone
will respond to assist you in adding this icon.
A screen will open with a list of all your unsigned orders including
discharged patients. All orders will be pre-checked. Click the
“Sign” button to sign up to 200 orders at once. A red line will
appear through the check mark: this indicates the order (s) has
been signed. If at any time, you feel an order has been entered in
error, uncheck it before your sign the others. After signing the
other orders, check the one in question and select the “Refuse”
button. A screen will appear asking the reason you are refusing to
sign the order.
If red flags are still appearing in the “To Sign” column, click the
refresh icon to update the information.
To add yourself as a care provider in SCM:
• Highlight the patient’s name
• Select the ‘Add Care Provider’ icon (looks like two people talking to
each other). A screen will open.
• Select the ‘Add Me’ button. Your name and provider type will
populate into those fields.
• Open the drop-down box by ‘Role’ and select “House
Officer/Resident”
• Click the ‘OK’ button
• The patient will now appear on your ‘My List’
To remove yourself as a care provider:
• Highlight the name of the patient.
• Click on the tab titled ‘Patient Info’
• Select ‘Care Providers’ from the upper box on the left. All care
providers will display.
• Double click on your name. This will open the Care Providers screen.
• Open the calendar at the top, and select today’s date (or whatever date
in the future that you will no longer be seeing this patient)
• Click OK. The patient will fall off your ‘My List’ at 11:59pm of the
day you selected.
.
To Find a Patient:
• Click the “Find Patient” icon. This will open the “Find
Patient” screen.
• Type in their last name (and their first name, if known).
Click the “Search” button. A list of all patients with that name
will appear.
• Double click on the patient you are looking for. This will open a
screen which lists all of their visits.
• Double click on the visit you want to open.
• The patient will now be on a “Temporary List” for you to sign the
orders as above.
• The Temporary List will disappear when you log off.
Other Information:
• If you are unable to log in to the Children’s network or into SCM,
please contact the Helpdesk at 955-6700 (or the Call Center at 9558999, after hours).
• Passwords automatically expire every 180 days. If you forget your
password, or if it has expired, please notify the Helpdesk to reset.
• Sharing passwords is prohibited.
• If you need assistance with SCM, please contact Cindy Cook at 9556061.
Confidentiality Recognize any situations, printed information and computer
information that constitute a potential confidentiality issue. Act to
prevent breeches. Computer or printed material containing patient
names, diagnosis, ID numbers, etc., MUST be de-identified or
shredded. Blue recycling bins are available on all floors.
Consults
Corporate
Compliance
When requesting a consultation from a different service, write an
order in the patient chart. In addition, you MUST call the service
you are consulting directly to discuss the medical issues physician to
physician to clarify specific patient needs or physician to ancillary
staff (i.e. Social Work or Child Life).
The Corporate Compliance Plan outlines expectations and standards
that all hospital staff, including medical students and residents, are
expected to follow as they are involved in the affairs of the Hospital.
Children’s Corporate Compliance program includes a Corporate
Compliance Officer, a publicized plan, and a hotline number.
The Purpose of the Corporate Compliance Plan is to:
• Provide standards by which hospital staff conduct themselves.
• Inform staff of how to report compliance related concerns.
• Inform staff of their duty and obligation to report any suspected
or actual violations of any laws, regulations or standards included
in the plan.
Outlines the Children’s Hospital Code of Conduct which includes:
Excellence in Service for Children and Families, Cooperative Work
Relationships, Confidentiality of Information, and Conflicts of
Interest.
Reporting of Concerns
• Call the confidential Compliance Hotline-955-3250
• Ask a hospital supervisor or manager
• Talk to the Corporate Compliance officer
Review the Corporate Compliance Plan and sign the form.
Cultural
Diversity
Children’s Hospital honors the importance of diversity in our
interactions with our families, patients, visitors, and employees.
Characteristics of diversity include but are not limited to; race,
gender, ethnicity, education, age, sexual orientation, ability, and
religion. Culture may be defined as shared norms and practices of a
group. The Family Centered Care Model in practice at the hospital
incorporates multi-faceted aspects of diversity in the care delivery
process. We expect all interactions to focus on ethics, trust,
recognition of differences or similarities, values and communication.
Resources for cultural diversity include Interpreters, Social Work
(contact through Operator), Family Resource Library, Child Life
Department, Pastoral Care, and a Cultural Resource guide on the
hospital Intranet under the Clinical Resource tab.
Dress Code
Dress in a professional manner. Wear your photo ID (from your
home university is OK) at all times. No open toe shoes are allowed.
Stockings are required. The Dress Code Policy is available on
Children’s Hospital intranet under policies.
Ethics
Committee
Children's Hospital acknowledges and respects the varied life views
of families and patients. The multidisciplinary committee is
composed of medical staff, administration, nursing, social work,
pastoral care, and community volunteers. The committee meets
monthly and as needed for case consultation. The three major goals
of the committee are: Education, Development of Policies and
Guidelines, Consultation and Case Review.
Any individual may consult the Ethics Committee by calling the
hospital operator and asking for the Ethics Committee Chair, Gary
Lerner, MD, or the chaplain on-call.
Emergency
Department
If you are called to see a patient in the Emergency Department you
must consult with your specialty attending and the Emergency
physician to coordinate treatment plans prior to seeing patient.
Emergency
Procedures/
Entire manual is located on Hospital Intranet and can be accessed by
clicking the icon. Please review the contents as you are accountable
to follow our procedures.
MSDS
HIPAA
Material Safety Data Sheet are available in the Safety Director’s
Office (Lower Level 1)
Hospitals and health systems are responsible for protecting the
privacy and confidentiality of their patients and patient information.
The Health Insurance Portability and Accountability Act of 1996
(HIPAA) mandated regulations that govern privacy standards for
health care information. These regulations mandate that Protected
Health Information (PHI) cannot be used or disclosed without
written consent or authorization from the patient. These regulations
also afford the individuals the opportunity to agree or object to a use
or disclosure of PHI. As a member of Children’s Healthcare Services
team, you will be held responsible for protecting the confidentiality
of individually identified patient information, whether in automated
or paper form. This patient information may include, but is not
limited to, personal information such as: name, address, date of birth,
medical information found in the patient chart, or information
regarding payment. Throughout the institution you will see cover
sheets on charts and clipboards with a picture of S.C.I.P., our
HIPAA mascot. S.C.I.P. stands for Security, Confidentiality,
Integrity, and Privacy. He helps us remember to respect privacy
and keep ALL patient information confidential.
No patient information can be visible. Report any violations to our
Hotline phone number, 402-955-3250. Our Privacy Officer is
available at 955-4122. Children's Hospital Joint Notice of Privacy
Practices is available in English and Spanish on the Intranet, front
page.
Hospitalists
The Hospitalists offer 24 hours a day, 7 days a week service. Any
physician may refer patients to this service. The Hospitalist physician
will assume attending level care for your hospitalized patient or
provide pediatric consultation. 955-7720 only (local).
Information
Technology
Department
Internet/
Intranet
Information Technology (IT) is our computer department. The
hospital website at www.chsomaha.org provides detailed specific
information regarding hospital services.
Hospital Intranet contains the hospital policy and procedures as well
as in system phone book, department links, internal newsletters,
training, a suggestion box and calendars. It can be accessed from any
internal PC using the “Explorer” icon
Contact: Helpdesk: 955-6700.
Interpreting
Services
Interpreting services are available through the Social Work
Department. For Spanish speaking patients/families, an interpreter is
available 24-hours a day, seven days a week. For other languages or
for hearing impaired patients/families, interpreters or use of the
language line may be coordinated through the Social Work
department or by contacting the Supervisor at 977-5414.
Library,
Virtual
Children’s Hospital has several medical references available for you
use as part of a virtual Library reference system. The information is
available on the Children’s Hospital intranet and can be accessed
using the blue “e” icon on the main page. Resources available
include: Hospital Formulary, PDR (available under Links –choose
Micromedex). Virtual Library – available under Links – includes
dMedicine, Ovid, and Uptodate.
Medical
Records
Completion
You are required to complete medical records in a timely manner.
Orders must be timed, dated and written in a legible script.
Both ChartMaxx and SCM (Sunrise Clinical Manager) codes are
required, along with an author ID number for dictation for medical
record completion. They are obtained through HIM (Healthcare
Information Management) and or Medical Staff Office.
The HIM Department is located on Lower Level 3 of the hospital
next to the classrooms. There are two workstations for physicians to
dictate reports and complete medical records electronically on
ChartMaxx and SCM. Computers are also available in the Medical
Staff Lounge, at all Nursing units including Emergency Department
and at selected Physician Offices on “Childrens Physician Network”.
HIM Department is staffed Mon.–Fri. 7am to 8pm and Sat & Sun
8am to 4:30pm to assist physicians with any questions. Please
review the Medical Staff policies related to Medical Records.
Attention Residents: All residents must sign-off on their
orders/medical records before completing their rotation at Childrens
Hospital.
Contact #s: Main Line: 955-3800
Physician Coordinator: 955-3807
HIM Director: 955-3803
All radiology orders require a clinical indication for the test (i.e.
skeletal survey for child abuse or skeletal survey for osteogenesis
imperfecta.)
Parking
Residents must park below the parking gate on Lower Levels 4 and
5 of the main campus parking garage. It will be prox card accessible.
You must obtain a parking sticker from Medical Education (Cindy
Cook – 955-6061). Place your green parking permit on the outside of
the rear window, lower left-hand corner of your vehicle(s).
Pathology
Patient and
Family
Education
Patient Care
and Safety
Concerns
The Pathology Service at Children's Hospital offers comprehensive
laboratory testing for pediatric patients. The laboratory, which is
directed by a board-certified pediatric pathologist, utilizes state-ofthe-art techniques and includes a virology lab..
Contact: To speak to a pathologist or to consult about a patient, call
(402) 955-5500.
An index of patient education resources is available on the Intranet.
Any caregiver can access and print materials from any hospital
computer. The hospital internet website, chsomaha.org, also has
patient teaching sheets that are printable from your office.
All Patient Concern and Safety Reports are to be sent to the
Performance Improvement Office.
Patients/families have the right to voice concerns regarding the
care they receive or safety of services without recrimination.
They further have the right to have their concerns reviewed and
resolved in a timely, fair and equal manner and to know the
process that Children’s uses for the identification and
investigation of identified care-related concerns. When you
identify a family with a concern:
Initiate Patient/family care concern reporting process. – Patient
Concern Hotline: 955-3250
• Hospital staff member receiving the concern should always try to
immediately resolve the concern to the satisfaction of the
patient/family. Listen and gather information. Contact staff nurse
or charge nurse.
• Hospital staff member documents the concern received and the
steps taken to attempt to resolve the concern on a Patient/Family
Safety and Concern Report Form.
• Completed form should then be forwarded to the clinical
supervisor to determine whether additional steps, including a
formal investigation of the concern, need to be taken.
• All patients/families will be made aware of the patient/family care
concern reporting process at the time of admission.
• When the concern cannot be resolved promptly by staff present
and formal investigation is required, the grievance procedure is to
be followed. Under such circumstances, the Corporate
Compliance Officer is to be notified.
Patient Safety
Activities and resources that provide substance to the patient safety
program include:
• Ongoing performance monitoring
• Variance/incident reporting process
• Sentinel Event Policy
• Safe Medical Device Reporting
• Disclosure Policy
• Patient Care/Safety Concern Report
Other important Children’s Hospital guidelines:
• All crib rails should be in highest position.
• Big beds are to be kept in “low” position with side rails up
• and access to call light MUST be within reach.
• No rubber balloons. Only mylar balloons are allowed.
• Consider normal growth and developmental levels when
dealing with any child (i.e. choking hazards, balance).
• Allergies are noted with red allergy bands on the child and a
red sticker on the chart. Latex allergies also have signs posted
outside the doors under the room numbers. (See Latex Policy.)
• All patients are screened for allergies.
• All patients wear identification bracelets.
• Children's Hospital follows the Nebraska State Car Seat Safety
law.
• Restraints require special procedures.
Pet Therapy
Pet therapy occurs at Children’s Hospital each week in a cooperative
effort through Volunteer Services and Child Life. We also include
staff, so if you like dogs, please feel free to pet them as they make
their way through the hospital. Please do not promise a patient that
they will get to see the dogs or pet them – Child Life is required to
screen patients according to hospital policy. All eligible patients will
be given an opportunity and if you have a specific request, please
feel free to contact Child Life.
Playrooms
Promises
Psychological
ServicesFamily
Support
Center
Policies
Playrooms are located on the 6th, 5th, and 4th floor inpatient units and
many of the outpatient clinic areas. The inpatient playrooms,
specifically, are for patient use and most importantly, are medically
safe zones. In other words, staff may not conduct any type of
medical test, exam, procedure or medically-oriented conversation – it
is a place for children to just be children. In keeping with this rule,
white coats are not allowed in the playrooms and there is a coat hook
located outside the door for your convenience. Please introduce
yourself to the unit Child Life staff member and ask for specific
guidelines about the playroom and, seriously, go play with the kids
when you have a few moments.
Building trust is one of the key elements to consider when treating
children and building trust takes team work. If you make a promise
to a child – ice cream, pet therapy, a video game at bedside – you
must be in direct control to make that promise come true. If one
person in the continuum of care breaks trust with a child, the patient
may have a very difficult time trusting any other hospital staff
member for the duration of their stay. Before making a promise,
please be familiar with policies and procedures. If you are uncertain,
ask a staff member.
The Family Support Center of Children's Hospital offers
psychological evaluation and counseling services to children of all
ages and their families. Services can be provided to inpatients,
outpatients and emergency patients.
The center has a staff of licensed clinical psychologists and licensed
social workers who specialize in a variety of areas and work closely
with physicians to provide comprehensive mental health services.
For consultation or to refer inpatients or outpatients, call (402) 9553900.
You are responsible to follow Hospital policies. Hospital policies
and procedures are available on the computer. Choose the blue “e”
icon from the desktop and click the policies button on the home page.
Staff policies are available on the intranet.
Prox Cards
Residents that rotate for more than 2 months will require picture ID
prox cards. Call 955-3748 to arrange a time.
Residents at Children’s Hospital for only 1 rotation and Medical
Students will have temporary prox cards issued on their first day of
orientation. A $20 deposit is required which will be returned when the
card is turned in. The cards are obtained in the Security office on
lower level 1 across from Emergency. Their phone number is 9555300.
Rainbow
Symbol
This 5x5 inch laminated color symbol of a rainbow is posted on the
door of a child for whom death is imminent. It is a communication
tool to allow for all staff to recognize the situation and observe
appropriate/respectful/caring behaviors.
Resident
Lounge
The lounge is located on Lower Level 3 next to the Medical Staff
Lounge. The lockers in this area are for your valuables. You should
bring your own locks.
Resources
• Graduate Medical Education:
Cindy Cook
955-6061
pager 888-8638
Back up - Mary Noah
955-6070
• Clinical Supervisor (Charge Nurse for the Shift):
955-7906
955-7905
955-7904
• Patient Care Mgr (PCM):
955-4480
• Hospitalist Attendings Operator or
Dr. Amy Holst
Dr. Jay Snow
Dr. Pat Doherty
• VP of Medical Affairs:
Dr. David Christensen
Scrubs
955-5400
Administration
955-4109
Children's Hospital provides hospital owned scrubs to adhere to
infection control standards in the perioperative environment. Navy
blue scrubs with the Children's logo are the property of Children's
Hospital and are provided with the expectation that authorized users
will change into the scrubs at the beginning of a shift, and remove
worn scrubs before leaving the hospital at the end of the shift.
Hospital owned scrubs will be stocked only in the OR and should
leave the hospital ONLY in the case of an emergency.
Scrub usage or possession by unauthorized staff without the written
authorization of their manager is considered theft. (See Disciplinary
Policy) Residents not complying with this policy will be reported to
the Chairman of the Department of Pediatrics to be addressed
according to their school policy. Children's Hospital Administration
Policy ADM013A.
Children's scrubs may be purchased for $10.00 a set through Medical
Education.
Security
There are blue panic buttons throughout the parking garage. Press
them in an emergency. Security will immediately respond.
To open an automatic door (by the service elevator, for example) the
sensor needs to be activated. Do not open them by using the push bar.
Failure to use the sensor misaligns the magnets and the doors will not
close properly. If the door has a secured access, a PROX card must be
used.
Sedation
You may not write orders for sedation for patients at Children’s until
you have completed the Sedation Credentialing process for
Children’s Hospital. That includes:
View the Sedation video
Review the Sedation Policy
Complete the Sedation Post test
Complete advanced airway management training (PALS, ACLU,
ATLS, NRP) or other credentialing
A letter of recommendation from the medical director of your
residency program. These items are available from your residency
coordinator, Children’s education department, or Children’s Medical
staff office.
Credentialing for PCA is done by:
Reviewing the hospital policy on PCA and signing the Children's
Hospital privileges form available through Education or Medical
Staff Office.
Sleep Rooms
Sleep rooms with showers are available if needed. Call the
Supervisory Resident at 955-7979.
Work Flow on • No coffee, drinks or food allowed in patient care areas or when
making rounds.
Patient Floors
• For questions or concerns related to nursing, call the Clinical
Supervisor or Patient Care Manager on duty for that unit. If they
are not present, you can always reach the Operations Director of
Patient Care (they have 24-hour accountability). The operator can
assist you in paging the director.
• Patient care staff work shifts run 7am-7:30pm, and 7pm-7:30am.
• Residents assigned to inpatient wards will receive stickers typed
with your name and pager #. This MUST be placed in the small
clear pocket on the front of your patients' charts.
• Alcoves on each floor contain patient chart and clipboard with
daily flow sheets, all current lab summaries and admission
records. Leave them at the alcove. When orders are written, fold
the order sheet diagonally and “flag” the order by turning on the
MD light on the side of the alcove. Take any stat orders to any
staff member.
• Please review the patient safety and Code 4 responsibilities.
• Nurses and other patient caregivers carry radio frequency phones.
Nurse assignments and phone numbers are listed on the white
board in the Clinical Supervisor’s office and Resident Work
Rooms.
• Clinical Supervisor’s (charge nurse for the floor for the day) name
and phone number are listed on the white board. (See page 8.)
Each team is assigned a color. Each team will have stickers with
the name of the resident and their pager for ease of contact.
• When answering unit phones, please include your name, title and
location (Dr. 6th floor, etc.).
• No food or drink allowed in patient care areas.
Review isolation precautions carefully . Do not remove a patient from
isolation until appropriate cultures return.
Assess all patients' need for isolation at time of admission.
• Charts MUST (HIPAA) be kept in cupboard, behind closed door
unless in use.
Guidelines for Residents
HOSPITALISTS: The hospitalist is a formal pediatric teaching and patient care
service. Patients admitted to the service are from numerous referral sources.
Consult must be requested. The team will assume the care of medically
complicated transfers from the PICU if the patient does not have a local
physician.
Daily hospitalist teaching rounds begin at 9:30 a.m. through approximately 11:00
a.m., Monday-Friday. Saturday and Sunday involve patient work rounds only and
will generally start at 8:00 a.m.
To reach hospitalist call the operator.
Team Assignments:
There are 3 resident teams at Children's Hospital, White, Blue, and Yellow.
Teams consist of :
Supervisor #1 (HOIII) Pager 888-8336 (Blue)
Supervisor #2 (HOIII) Pager 888-8335 (Yellow)
Supervisor #3 (HOIII) Pager 888-8341 (White)
Peds Residents
Family Medicine Residents
Medical Students
Consultation: When writing the orders for a consult, please specify A) the
service and physician or group, and B) the reason for the consult. In addition, if a
resident writes the order s/he is responsible for notifying (call them directly) the
consultant of the consult and to supply the consultant with the pertinent clinical
information. Please request consultation and notify the consultant as early in the
day as possible to allow the consultant flexibility in planning their day.
Off-Service Notes: Off-service notes must be written at the end of each month
on all patients who have been hospitalized for greater than 48 hours prior to the
change of service. The off-service note should be written in sufficient detail so
that the incoming residents can easily and quickly gain an understanding of the
clinical course and current problems of the patient. It should include a brief
summary of the history leading to admission, the hospital course to date, current
medications, pending lab studies, and a summary of each organ system including
problems and treatment. The off-service note should be placed in the chart,
dated, timed, and signed. An off-service note does not need to be written on any
patient who will be discharged on the first day of the new rotation.
INFECTION CONTROL
Resources
Hospital Epidemiologists:
• Dr. Archana Chatterjee or designee
•
•
•
•
•
Infection Control Practitioners:
Dual Pager
888-8388
Sharon Plummer, RN, BS, CIC
955-3814
Brenda Heybrock, RN, CIC
955-3819
Office located at the East Office Addition
Infection Control Policy/Procedure
• Available on the Intranet – Policies tab – Infection Control
• Contains information on:
Diseases and sings and symptoms on when to isolate
(Disease Specific Isolation/Precaution Guidelines)
Hand hygiene guidelines
Blood Borne Pathogen Exposure Control Plan
Tuberculosis Exposure Control Plan
Employee Health Guidelines
Definitions:
Exposure Control Plan: written plan outlining the Children’s
effort to reduce the potential exposure to blood borne
pathogens. It describes various policies and procedures,
including the use of engineering controls (needleless
systems, red biohazard containers and personal
protgect9ive equipment or PPE’s) and work practices (hand
hygiene, wearing of the personal protective equipment)
UNIVERSAL ISOLATION PRECAUTIONS: protecting
oneself from exposure to bloodborne pathogens through use
of PPE’s (gowns, gloves, masks and goggles), work
practices, and engineering devices.
STANDARD PRECAUTIONS: protecting oneself from
exposure to all blood/body fluids, secretions, and excretions.
Standard Precautions encompasses Universal Precautions.
All human blood and certain human body fluids are treated
as if known to be infectious for HIV, HBV or other bloodborne
pathogens.
Biohazard waste: blood/body fluid that is drippable,
pourable, or flakable. This includes bottles that contain
human breast milk.
At Children’s, Universal Precautions and Standard
Precautions are practiced for all patients at all times.
Specific Procedures
1. Perform hand hygiene when entering and leaving
patient rooms by:
• Wash hands with soap and water for 15 seconds. Use
antimicrobial soap if performing an invasive procedure
or working with multiple drug resistant organisms.
• Hand sanitize by rubbing product into hands and wrist,
and allowing to dry. You cannot use hand sanitizer if
hands are visibly soiled or when working with spore
forming organisms, before eating or after using
restroom.
2. Do not recap sharps:
• Dispose of contaminated sharps in appropriate
labeled biohazard containers. Avoid puncture
injuries by using self sheathing sharps.
3. Use resuscitation bags, mouth-to-mask-to-mouth
ventilation devices when performing resuscitation:
• Do not use mouth-to-mouth resuscitation.
4. Dispose of biohazard waste in RED waste containers
or bags:
• All other waste is disposed of in clear/brown plastic
bags.
5. Bag used linen:
• Used linen is considered potentially contaminated;
including
linen soiled with blood/body fluid and is to be placed
in clear plastic bags that are visibly marked “linen”.
Blood Borne Pathogen Exposures
Significant Exposure: Any parenteral needlestick
or cut with a blood/body fluid contaminated sharp object,
mucous membrane splash in eye, nose, or mouth or
cutaneous prolonged skin contact to non-intact skin.
Follow the steps below for an Exposure to Blood or Body
Fluids:
1. Provide patient safety first.
2. Wash the area with soap and water. If exposure occurs
to mucous membranes or eyes, remove contacts and
flush for 20 minutes at nearest eye bath station.
3. Contact your supervisory Resident or Faculty member
and your own Student Health.
4. Contact Employee Health at 955-6020 during business
hours.
• If closed, you will need to contact the House
Supervisor,
Patient Care Manager or CNC and significance and
risk of exposure will be determined.
• You will need to leave a message with EH with the
following information:
• Your name and spelling of last name.
• Donor name and spelling of last name – person
who you were exposed to.
• Type of exposure (needle stick, cutaneous,
splash to mucus membrane).
• Date and time of exposure.
• Phone number where you can be reached.
• This information will be logged and tracked and
the event will be evaluated for significance and
risk.
5. If a double exposure occurs, both parties will need to
have an BBF exposure follow-up.
6. If exposure is “significant” and “high risk” prophylaxis is
recommended and is to be initiated within 2 hours by
your Student Health or their designee.
7. Your Student Health Department will obtain all
laboratory follow-up on you and will follow up as
needed.
8. Children’s Employee Health will obtain all donor testing
and follow up as needed.
9. UNMC and NHS students/residents – call 888-OUCH
Creighton Students – call 280-2735 (9-5pm) or call
444-4480
Creighton Residents – call Creighton University
Employee Health at 280-5833.
10.
An “HIV” Informed Consent is required prior to any
testing.
Do not write the order for source testing on the
patient’s chart.
Isolation Precautions:
1. Transmission Based Isolation Precautions are practiced for:
• Patients with known or suspected infectious disease,
• Patients who have signs and symptoms of a potential infectious
disease or
• Patients who are being tested fro an infectious etiology.
2. Isolation precautions should not be discontinued until
cultures are final or negative or you have consulted with
Infection Control.
3. If it is determined that isolation is not needed, a written order
for “no isolation precautions required due to non-infectious
etiology” is to be entered into the patient record.
Diseases of Concern:
Chickenpox
1. All patients should be screened for chicken
pox exposure or have documented evidence of
varicella vaccination two weeks prior to
exposure.
2. Airborne Complete isolation precautions are
required for any exposed patient admitted,
who has not been vaccinated or had history of
disease. Since varicella is not a routine
vaccination, specific
verification/documentation on the vaccination
status is required.
3. If patient is unvaccinated and without history
of disease, the exposed patient is contagious
48 hours before vesicles appear and until all
lesions are dry and crusted over.
4. Incubation period is from the 8th day after rash
onset in the index patient through the 21st day
of the last exposure. Every day exposed to
the rash is considered a new exposure day.
5. If V-ZIG is given, the incubation period is
extended through the 28th day.
Pertussis
1. Adults have waning immunity to Pertussis.
Immunized adults have lesser disease, but are
still contagious.
2. Non-immunized children are at high risk for
increased morbidity and mortality.
3. If you do not wear a mask within 3 feet of a
patient with Pertussis, you will be considered
exposed and will need prophylaxis before the
incubation period starts.
4. If prophylaxes are not given and if you
develop signs and symptoms within the
incubation period you will be off work until
you have had treatment.
5. Droplet Isolation Precautions are required for
any patient with a known diagnosis of
Pertussis or is being tested for Pertussis.
6. Adult Pertussis vaccine is now available
through Employee Health programs.
Tuberculosis (TB)
1. Is a pulmonary disease caused by
Mycobacterium tuberculosis and is usually
spread by the airborne route.
2. Airborne PRM Isolation precautions are
required for patients with suspected or
confirmed TB, or if a PPD is ordered to rule
out pulmonary, tracheal or endobronchial TB.
If PPD is for routine testing and not TB is
suspected, a “no airborne PRM order for PPD
testing” is needed on the chart.
3. Do not enter the room of any patient with
suspected or known TB unless you have been
fit tested with the Particulate Respirator
Masks (PRM) used at Children’s.
4. Any symptomatic adults accompanying the
child who is suspected of having TB are to be
asked to wear a mask in public areas and are
to be assessed for active disease.
Multiple Drug Resistant Organisms (MDRO)
1. Complete Isolation Precautions are required
for all patients who are suspected or have a
confirmed MDRO (MRSA, VRE) until
eradication testing is determined to be
negative. (See IC MRSA eradication testing
p/p).
2. If other MDRO’s are suspected, contact IC
for assistance.
3. Known MDRO’s are communicated via the
SCM system – patient information tab –
significant events section.
Handwashing/Hand Hygiene Table Based on CDC
Recommendations
Products That May Be Used* for Hand Decontamination
Activities
Hand hygiene must be
practiced by all employees
before and after contact with
patient or patients environment
Hands visibly soiled with any
proteinaceous material
Soap and
Water
Antimicrobial Soap and Water
(see specific practice
categories)
Hand
Sanitizer
*
*
*
*
*
Not to be used
Sink with soap and water not
readily available
Before eating and after going
to restroom
Exposed to suspected or
proven Bacillus anthracis,
Clostridium species or other
spore forming organisms
Hands are not visibly soiled
After removing gloves
Before and after direct contact
with intact skin, mucous
membranes, non-intact skin,
wounds or dressings.
*
*
*
Not to be used
*
*
Not to be used
*
*
*
*
*
*
*
After moving from a
contaminated body site to a
clean body site
After contact with patient's
inanimate objects, including
medical equipment
Before performing invasive or
non-invasive procedures
Before putting on Sterile
gloves
Before preparing medication
Isolation rooms
Before performing an invasive
procedure
*
*
*
*
*
*
*
*
*
*
*
*
*
*
See also PICU, NICU, Dress Code, Surgical Hand Antisepsis policies and the Exposure
Control Plan for specific policy/procedures.
MINIMUM TRANSMISSION-BASED ISOLATION
PRECAUTION GUIDELINES
Standard Precautions are for all patients and for all blood, body fluids,
secretions, excretions (excluding sweat), broken skin, or mucous
membranes.
TYPE OF
ISOLATION
MASKS
GOWNS
GLOVES
Eye
Protection
AIR
PRESSURE
CONTROL
Yes
For all with
URI + or
per doctor's
order
Yes
Yes
*
Normal pressure
Per
doctor
order
Per doctor
order
*
Normal pressure
or positive per
doctor order
PRECAUTION
Complete
Protective
Airborne
Yes
If soiling
likely
For
touching
infective
material
*
Negative
pressure
Airborne
PRM
3M 1860
PRM
If soiling
likely
For
touching
infective
material
*
Test daily for
negative
pressure
Contact
No
If soiling
likely,
Yes
*
Equal pressure
TYPE OF
ISOLATION
MASKS
GOWNS
GLOVES
Eye
Protection
AIR
PRESSURE
CONTROL
For
touching
infective
material
*
Equal pressure
PRECAUTION
touching
patient or
environment
Droplet
Yes
If soiling
likely,
touching
patient or
environment
? - Use of mask depends on patient condition. Everyone entering the room
with upper respiratory disease, must wear a mask.
+ - URI - Upper Respiratory Infection
* - Use if potential exposure to eyes or mucous membranes per standard
precaution
Isolation Precautions Quick Reference Recommendations
ADMITTING DIAGNOSIS or
DIAGNOSTIC TESTING
Chicken Pox (Varicella zoster)
Diarrhea/Vomiting
Hepatitis Screen
Influenza
Meningitis (CSF)
Bacterial > 6 weeks of age
Bacterial < 6 weeks of age
Viral-Etiology unknown
> 6 weeks of age
< 6 weeks of age
Pertussis (Whooping Cough)
Pharyngitis
Strep Screen
ISOLATION
PRECAUTION In
Addition to Standard
Precautions
Airborne/Complete
Contact
Contact until Hepatitis A
neg
Droplet
Droplet
None
Contact
Contact/Droplet
Contact
Droplet
Contact/Droplet (Rapid
results are not
considered final)
Contact/Droplet (Rapid
results are not
considered final)
Contact/Droplet
Contact/Droplet
Contact/Droplet (Rapid
results are not
considered final)
Respiratory Enterovirus, Adenovirus Contact/Droplet
Contact
Rotavirus
Contact
RSV (Respiratory Syncytial Virus)
Respiratory Signs/Symptoms
Respiratory Viral Panel
Tuberculosis Pulmonary (TB) AFB
Gram Stain
Culture
PPD
Airborne PRM-Neg
Pressure Rm
C. difficile
Culture & Sensitivity (wounds)
Bacterial Stool (C & S)
Viral Stool
Enterovirus, Adenovirus
Contact
Contact if drainage
Contact
Final Results Available
(Isolation MAY change
based upon these results)
3-5 Days
5 Days
3 Days
6 Days
Reported out as FA in 24
hours, culture preliminary
@ 2 days, 4 days, and
final @ 6 days
Duration of illness
Rapid within 24 hours
CULTURE 3 DAYS
If rapid is negative,
culture is always done
Duration of Illness
5 Days
Reported as Preliminary in
2-3 days, and final @ 5
days
5 Days
Rapid in 24 hours
3-5 Days
3 Days
3 weeks to 3 months
Read after 48-72 hours
See the Infection Control Manual for additional information.
3 Days
3 Days
10 Days
Medical Staff Policy
Medication Prescribing Policy
Children’s Hospital will utilize risk-reduction strategies identified locally and nationally to
reduce the risk of medication errors associated with medication prescribing.
PROCEDURES:
1. Medication orders will be written in a matter that clearly and legibly denotes the intention of
the prescriber.
2. Medication order requirements must include the date and time of each order, the appropriate
unit/weight for medication orders (when appropriate), and the use of the metric system
instead of apothecary (e.g. tsp, tbsp, etc.).
3. Once a medication order is signed, no changes to the order can be made. A new order must be
written to change the order.
4. Medication orders must include the signature and printed name of the prescriber. Medication
orders written by residents must also include a contact number (pager or phone).
5. All previous orders are canceled when a patient goes to surgery.
6. The use of “Renew”, “Repeat”, and “Continue” orders are not acceptable. Blanket resume or
continue orders are not allowed.
7. When a patient has a planned, non-emergent transfer to another level of care following surgery
or a procedure, all orders must be confirmed using the Transfer/Post-Procedure Order Form
• Nursing will print the Transfer/Post-Procedure Order Form from SCM just prior to
transferring the patient to surgery or to another unit.
• The attending physician who is responsible for transferring the patient is accountable
for the review, and renewal/discontinuation of orders.
• Services that do not provide primary care for the patient may write an order for the
primary service to provide post-procedure orders. The primary service would assume
responsibility for completing the Transfer/post-Procedure Order Form.
• The Transfer/Post Procedure Order Form may be faxed to a physician’s office for
review and response if needed for timely action.
• All orders received on the Transfer/Post Procedure Order Form will be transcribed into
SCM.
• The review of orders using the Transfer/Post-Procedure Order Form does not apply to
the following situations:
a. Unplanned, emergent transfers where the use of this form could delay
treatment
b. Certain patients where an anticipated, therapeutic intervention will require
more intensive monitoring for a limited time frame (less than 6 hours).
Examples may include: IMC telemetry monitoring during KCL
replacement infusion, short term monitoring in PICU following chest tube
placement.
8. All chemotherapy orders written by residents must be co-signed by an attending physician
prior to dispensing.
9. All chemotherapy orders must include an indication for use as well as mg/kg , mg/metered
squared, or max dose in addition to the final calculated dose)
10. Numbers less than 1 are expressed with a zero preceding the decimal point (e.g. 0.1 mg).
Doses consisting of whole integers are expressed without a decimal point and trailing zeroes
are prohibited.
11. Certain abbreviations and symbols have demonstrated an increased risk of misinterpretation
and cannot be used in handwritten orders (see Attachment A- Abbreviations and Symbols
Which Cannot be Used.) The prescriber will be contacted for clarification prior to
implementation of any handwritten order containing a prohibited abbreviation or symbol;
clarification will be documented on the patient’s record and a variance report will be
completed with each instance of use of a prohibited abbreviation in a handwritten order.
12. Medication orders must include a specific dose, interval and route. If a medication is written
with a dose range the order must have a fixed time interval. Range in dose may not be more
than three times the minimum dose. If the order is written for analgesia and does not provide
explicit instructions for administration from the physician, the nurse will give the dose based
on the patient assessment as directed by the pain management policy and Clinical Practice
Guideline on pain. Continuous medication infusions must include drug, amount of
drug/kg/time, desired rate, and diluent. All medication drips will be written in mcg/kg/min
except:
• Heparin units/kg/hour
• Fentanyl mcg/kg/hr
• Morphine mcg/kg/hr
• Furosemide mg/kg/hr
• Insulin units/kg/hour
13. For the medications listed below (chemotherapy moved to #6), if the prescribed dose exceeds
dose recommended in Pediatric Dosing Handbook, orders must be written in mg/kg ,
mg/metered squared, mEq/kg, or “adult dose” next to the medication order.
• aminoglycosides and vancomycin
• digoxin
• Intravenous controlled substances
• Intravenous potassium supplement (excluding those in maintenance IV fluids
and TPN)
14. Heparin and insulin orders will not include the abbreviation “U”. Regular insulin must be
written out.
15. Orders for iron will specify desired salt with the dose being written in terms of the elemental
iron dose
Medical Staff Policy: Medication Prescribing Page 3 of 3
16. Orders for intravenous calcium supplements will specify the desired salt with the dose being
written in terms of the calcium salt. Orders for oral calcium supplements will specify the
desired salt with the dose being written in terms of elemental calcium.
17. Orders for oral and intravenous magnesium supplements will specify the desired salt with
the dose being written in terms of the magnesium salt.
In the event that a health care professional receives an order where the
medication orders are not complete, that individual practitioner will be contacted
for clarification. It is the responsibility of the prescriber to make the appropriate
clarifications on the chart order.
References:
Policy ADM076.POL Pain management, and CPG 35: Pain/discomforts in infants,
children/adolescents.
MEDICAL STAFF POLICY: Medication Prescribing
ABBREVIATIONS AND SYMBOLS WHICH CANNOT BE USED
Elective
Elective
Required
Elective
Required
Required
Elective
Elective
Required
Required
Required
Required
Elective
Required
Required
Gr
Do not use apothecary measures
Mg
Write out "microgram"
Write out "morphine sulfate" or "morphine"
MSO4
MTX
Write out "methotrexate"
q.d. or QD or
Write out "once daily" OR "daily"
Q.D.
q.o.d. or QOD or Write out "every other day"
Q.O.D.
r
Write out "rectal"
TIW or tiw
Write out "three times a week"
U or u
Write out "units"
IU
Write out "international units"
MgSO4
Write out "magnesium sulfate"
MS
Write out "morphine sulfate" or "morphine"
S.C. or S.Q.
Write out "sub-q" or "subQ" or "subcutaneous"
Trailing zero for whole numbers should never be used
Leading zero for numbers less than one should always be used
Medications that Require Special Credentialing or Privileges for Ordering
Patient Controlled Analgesia (PCA)
Patient Controlled Analgesia (PCA) is a technique whereby the patient can self-administer doses of intravenous
analgesic medications, such as morphine or meperidine, via a preprogrammed infusion pump, with or without a basal
infusion. Any physician may obtain privileges to order intravenous opioid medication via a PCA at Children’s
Hospital. The process for obtaining privileges will be to read this policy, PCA Order Form, and Guidelines for
Patient Controlled Analgesia (PCA) Initiation, and sign a statement indicating the information has been
reviewed. Details of dosing and the policy can be found in the credentialing packet.
Sedation
The Medical Staff policy has defined four levels of sedation for procedures:
Minimal Sedation (Anxiolysis):
*Patient responds normally to verbal commands
*There are no restrictions on the ordering of medications for minimal sedation.
*Medications include oral and intranasal midazolam, low dose (<50mg/kg) chloral hydrate, and oral
diazepam (see sedation credentialing packet for dosing details).
Moderate sedation:
*Drug-induced depression of consciousness during which a patient responds purposefully to verbal
commands, either alone or accompanied by light tactile stimulation.
*Physicians must be credentialed to order moderate sedation. If a resident is ordering
moderate sedation, their attending physician must also be credentialed. There is a
sedation nurse practitioner available during normal business hours who provides
sedation for cases where the attending physician is not credentialed.
*Medications include: IV/IM midazolam, IV lorazepam, IV diazepam, higher doses of chloral
hydrate (50-100mg/kg), IM or PO pentobarbital, IV/IM morphine, IV/IM meperidine
(see sedation credentialing packet for dosing details).
ONLY ANESTHESIOLOGISTS CAN PRESCRIBE MEDICATIONS FOR DEEP SEDATION OR
GENERAL ANESTHESIA.
Deep sedation:
*Drug-induced depression of consciousness during which a patient
cannot be easily aroused but responds purposefully following repeated or
painful stimulation. Patients may not be able to maintain adequate
respiratory function.
General anesthesia:
*Drug-induced loss of consciousness during which patients are not arousable, even by painful
stimulation. Often ability to maintain respiratory function is absent. Cardiovascular function may be
impaired.
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Medication Reconciliation across the Continuum of Care
One of the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)’s
National Patient Safety Goals (#8 to be specific) requires that all healthcare organizations
“Accurately and completely reconcile medications across the continuum of care”.
The nursing staff will be the ones printing the forms and doing the initial information
gathering.
The pharmacists are available to assist in gathering medication histories, and doing some
investigating in those rather challenging cases.
Responsibility for the LIP (Licensed Independent Practitioner) to perform the reconciliation
and documentation (sign the form).
Readers Digest Version:
What is Medication Reconciliation Across the Continuum of Care??
*Goal: Reduce medication errors.
*Process:
-Get a complete and accurate list of meds upon admission
-Review that list whenever patient transfers level of care and write new orders as
appropriate
-Upon discharge, communicate complete and accurate list of current medications to
patient and next provider of care
What does reconciliation mean?
*Appropriately and consciously CONTINUING, DISCONTINUING, or MODIFYING a
medication order
*3 parts
-Verification: collection of information
-Clarification: ensuring the medications and doses are appropriate and accurate
-Documentation: changing orders or giving reason for differences
ADMISSION
*Nurse
-Initiates “Medication Reconciliation/Admission Orders Form” in conjunction with
family/caregiver
*LIP
-Reviews list
-Ensures list filled out COMPLETELY and ACCURATELY
-Performs RECONCILIATION by checking CONTINUE, DISCONTINUE, or MODIFY
-This list now serves as admission orders for home meds
TRANSFER
*Nurse
-Prints “Transfer/Post-Procedure Active Orders” form
*LIP
-Reviews list
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-Marks appropriate box to continue or discontinue order
-Reviews “Medication Reconciliation/Admission Orders Form” in chart (documents this
has been done by checking appropriate box on form)
-Writes any additional orders as appropriate
DISCHARGE
*Nurse
-Prints “Discharge Orders” list
*LIP
-Uses list as template for writing discharge orders
-Marks appropriate box to continue or discontinue order
-Reviews “Medication Reconciliation/Admission Orders Form” in chart (documents this
has been done by checking appropriate box on form)
-Writes any additional orders as appropriate
*Nurse
-Transcribes discharge orders into SCM and prints copy for the patient/family
*Medical Records
-Sends discharge instructions to primary care provider
Radiology Department
We strive to make exams available. Film jackets can be accessed as
follows:
1. Inpatient exams filed alphabetically in radiologist reading room.
2. PICU and NICU are on rolo-scope in radiologist reading room.
3. Current day’s fluoroscopy and ultrasound on rolo-scope in radiologist
reading room.
4. Current day’s MRI’s and CT’s will not be filed until at least 2 hours
following the exam.
5. File room personnel are available to assist physicians in locating films
for review.
6. Digital film viewing is available in Radiology, Emergency, NICU and
PICU.
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HIPAA
Our policies and practices reflect HIPAA legislation. Patient
confidentiality will be protected. Film copies for educational purposes are
not allowed.
CHECKING OUT FILMS
All films MUST be checked out with the file room.
Inpatient films do not leave the hospital. However, they can be checked
out within the hospital. Inpatient films must be returned the same day.
Discharged, expired or outpatient films can be checked out for a
maximum of two weeks.
ACCESSING RESULTS
Check the computer before calling the department to access results.
Please note that all ultrasound, MRI and CT reports are retrieved under
Nuclear Medicine.
ORDERING EXAMS
Appropriate clinical information (reason for ordering test) must be
entered at the time the radiology exam is ordered.
Exam preps are listed in the computer. If an exam is specifically ordered
“no prep”, the patient must still be fasting.
Questions regarding exams to be ordered should be discussed with the
Resident or the Supervisory Resident or Radiology Faculty.
Appropriateness of exams should be given full consideration with regard
to “stat” exams and exams done for convenience.
AVAILABILITY OF RADIOLOGISTS
The radiologists concentrate on completing all fasting patient exams
throughout the morning. They are also involved with Nuclear Medicine,
CAT scans and MRI procedures.
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If there is a need to make a clinical diagnosis on a patient, feel free to
consult with a radiologist. If seeking a radiologist for educational
purposes, wait until after lunch.
Radiology Conference is scheduled every Thursday at 11am.
RADIOLOGY VIEWING ROOMS
Radiology viewing rooms are available for accessing patient films and
reviewing them with the proper lighting.
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Radiology Call Report Categories
Emergent Cases
The radiologist will provide an immediate verbal report for the purpose of
expediting care in emergent cases. If you are referring a child for a
radiological examination in an emergent case please have your staff tell
this to the Radiology Department when ordering the study.
Urgent Cases
In cases that are not emergent, but where a report is needed within
several hours of the study being completed, you may call the radiologist
for a verbal report. If the radiologist is available, they will provide a report
at that time. If they are not available, you will be called back within 2
hours.
Rapid Report
In non-emergent cases but situations where a rapid report would be
beneficial, you can request that a report be faxed to you. This will be
done on the day of the exam or the next day.
These categories are intended to provide both the referring physician and
the radiologist the ability to provide service to the patient.
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Patient Safety / Outcomes Management
Performance Improvement is the process to reduce loss associated with
patient, employee or visitor injuries, property loss or damage, and other
sources of potential organizational liability.
Patient Care / Safety Concern Reporting
Patients/Families have the right to voice concerns regarding the care they
receive without recrimination. They further have the right to have their
concerns reviewed and resolved in a timely manner and to know the
process that Children’s uses for the identification and investigation of
identified care related concerns.
In order to assure prompt, fair and equal consideration of patient/family
concerns related to the quality of care received, Children’s has developed
a patient/family care concern reporting process. Upon receiving a
concern the hospital staff member should always try to immediately
resolve the concern to the satisfaction of the patient/family. The hospital
staff member helps document the concern received and the steps taken
to attempt to resolve the concern on a Patient Care/Safety Concern
Report Form. Completed form is forwarded to the clinical supervisor to
determine whether additional steps, including a formal investigation of the
concern, need to be taken. All patients/families will be made aware of the
patient/family care concern reporting process at the time of admission.
Ask charge nurse for assistance.
Variance/Incident Reporting
A variance/incidence report is to be completed on any occurrence that is
not consistent with the routing operation of the hospital or the routine care
of a patient. Reportable variances include any unexpected or unplanned
occurrence that affects or could potentially affect a patient or a visitor.
•
The variance report is to be completed as soon after the event as
possible and prior to leaving the work site. This is done on line by
nursing staff or involved employee. Ask CLINICAL SUPERVISOR for
assistance.
8
•
Notify your supervisory resident or faculty and the CLINICAL NURSE
SUPERVISOR if you are involved in such an occurrence.
• Variance reports are NOT a part of the patient’s medical record and
are NOT to be copied for any purpose. Do not make reference to
inpatient chart that variance has occurred when writing notes.
• If an environmental hazard exists related to the variance, protect
anyone in vicinity and notify CLINICAL SUPERVISOR or house
supervisor.
• Resident peer review issues are handled through the Medical Staff
Education Committee.
Resident Supervision at Children's Hospital is a Medical
Staff Policy
Specifies the mechanism by which house staff are supervised by members of the
medical staff.
The policy is intended to guide the residents, clinical staff and health information
personnel in ensuring that in-hospital patient care activities in which residents
participate are appropriately supervised and documented during the course of their
Children's rotation. This supervision begins with the resident's initial contact with
the attending physician and the patient, continues through the daily contact the
resident has with the patient, with the attending physician and is completed when all
of the documentation of the hospital stay is collected for the permanent medical
record.
EXCEPTIONS
1.
The supervising resident must consider new requests for the participation in
patient care in light of current and expected patient care responsibilities. The
supervising resident has the option of declining additional patient care
responsibilities ( in consultation wit the VPMA) if additional patient
responsibilities would jeopardize current patient care.
2.
Residents may write patient care orders as delegated by the
admitting/attending physician. These orders will be carried out by the clinical
staff if written in accordance with the Medical Staff policy on prescribing
medication.
BACKGROUND
Residents provide care to patients hospitalized at Children's Hospital in a variety of
teaching service rotations, with supervision provided by privileged attending
9
physicians. Residency training allows and requires residents to participate in
patient care with increasing degrees of independence. Although all resident care is
supervised, and the attending physician is ultimately responsible for care of the
patient, the proximity and timing of supervision, as well as the specific tasks
delegated to the resident physician depend on a number of factors including:
a.
the level of training (i.e. year of residency) of the resident;
b.
the skill and experience of the resident with the particular care situation;
c.
the acuity of the situation and degree of risk to the patient.
PROCESS
1.
Residents must be members of an approved residency program that has a
signed agreement with Children's to interact with Children's patients and their
families. Residents must also meet unrestricted licensure requirements as
outlined by their respective residency program.
2.
Approved residents may interact with patients at Children's hospital with the
permission and under the direction of admitting/attending physicians.
Residents may not be granted medical staff membership or clinical privileges.
Medical care begins with admission of the patient, continues through the daily
progress of the hospitalization, and concludes with discharge of that patient
from the hospital with completion of the permanent medical record on that
patient.
3.
Specific resident responsibilities are addressed in the documents received
from the resident programs. Key, specific responsibilities of the supervising
attending physician and of the resident are listed below.
• Residents must wear identification that identifies them as a resident and
must introduce themselves by name and as a resident physician prior to
patient contact.
• The admitting/attending physician contacts the resident to give important
background information of the medical condition of the patient and to notify
the resident of the patient's expected time of arrival.
• The admitting/attending physician shall evaluate the patient in person and
be in a position to confirm the finding of the resident and discuss the care
plan in the following time table: within 2 hours for an unstable and
deteriorating patient; or within 24 hours for a stable medical patient
admitted to a general hospital bed.
• The supervising admitting/attending physician confirms the objective
findings of the resident, reviews the differential diagnosis and discusses
patient care management with the resident.
• At least on a daily basis, the admitting/attending physician will review with
the resident progress of the patient, make necessary modifications in the
plan of care and assure thorough documentation in the medical record.
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• When a patient develops a condition that the resident feels is potentially
dangerous for that patient, the resident will notify the supervising resident
and the admitting/attending physician to report these developments. The
resident may also request an intensivist consultation (see medical staff
policy on Evaluation & Management of Medical-Surgical Floor Patients with
New Clinical Findings).
• As the level of skill and knowledge increases for the individual resident,
admitting/attending physicians may delegate increasing levels of
responsibility and allow increasing levels of participation in patient care,
including the performance of procedures.
• Residents can perform procedures under the supervision of the
admitting/attending physician who has privileges to perform the procedure.
Residents may never perform a procedure if the attending is not privileged
for the procedure.
• Residents may write admitting orders, daily orders and daily progress
notes. They may dictate the admission history and physical notes,
operative notes and consults. The resident my write or dictate the
discharge summary at the discretion of he attending physician and program
director.
• As with patient care in general, procedural skills may be taught to the
residents by admitting/attending physicians. Because residents are not
formally, at any point in their training, privileged for the independent
practice of medicine, including the performance of procedures, members of
the medical staff must provide direction for each procedure they delegate
to a resident.
• The admitting/attending physician must assume the completeness and
accuracy of the medical record by reviewing documentation and making
additional comments in the medical record progress note.
• Residents may be required to be PALS and/or NRP certified and prepared
to perform emergency life saving care when needed and should do so
without delay.
• Residents will receive an orientation to Children's Hospital at the beginning
of their experience. This orientation will include, but is not limited to, fire
safety, isolation policies, medication prescribing rules, and responding to
blood and body fluid exposure.
• Residents at the request of the supervising attending physician, may
coordinate the patient discharge by performing and recording pertinent
discharge findings, arranging discharge medications, follow-up visits,
providing orders for combined services and coordinating with nurse case
managers and social workers.
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MEASURING PERFORMANCE – Resident Performance is monitored with a
Peer Review process.
Patient care delivered by residents is subject to the same performance
improvement process as the attending/admitting physician. Quality concerns
regarding care delivered by residents are forwarded to the Performance
Improvement Office. The need for individual case review is determined by the
VPMA. Cases requiring individual review are forwarded to the Medical Education
Committee. All reported quality concerns are logged in the Performance
Improvement Office.
The VPMA may suspend the practice of any physician in training if there may be a
threat to the health or safety of any patient or if the behavior of the resident is
unacceptable. This suspension is temporary, until there is a formal review by the
Medical Education Committee. The Medical Education Committee will make a
recommendation relative to the resident's performance, to the hospital's president
and CEO and to the applicable program director.
The Medical Education Committee reports annually to the Medical Executive
Committee and Professional Affairs Committee ( a subcommittee of the Governing
Board) on the performance of the participants of the residency program.
Resident Teaching Service
Review the teaching service policy. Evaluation of residents by attendings is
expected with each interaction (they use blue cards). Evaluation of faculty by
residents is done with the yellow cards.
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Required Completion of Post Procedure or Operative Progress
Notes
Joint Commission Standards require timely and complete documentation
in the medical record.
IM.7.3.2.1 When the operative report is not placed in the medical record
immediately after surgery, a progress note is entered immediately.
Intent of IM.7.3 through IM.7.3.5
The record includes the preoperative diagnosis, a complete description of
the surgical procedure and findings, the names of all practitioners
involved in the patient’s care, the postoperative course, evidence of the
patient’s readiness for discharge from postsedation or postanesthesia
care, and details of the discharge.
When the operative report is not placed in the medical record immediately
– for example, when there is a transcription or filing delay – an operative
progress note is entered in the medical record immediately after surgery
to provide pertinent information for anyone required to attend to the
patient. Postoperative documentation includes at least the following
records: Any unusual events or postoperative complications.
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15
16
17
Side 1
Admission Medication Reconciliation Orders
Med Reconciliation-Admission Orders (Pharmacy) #MR111111DH-011507
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Side 2
Updated Medication Reconciliation Orders
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SBAR Report for a Change in Patient Condition
What is SBAR?
S
B
A
SBAR is a technique that provides a framework for communication
between members of the healthcare team about a patient’s condition.
Situation
State your name and your role.
I am calling about: (patient name and room number).
The problem I am calling about is: (state the problem).
Background
State the admission diagnosis and date of admission (age & NOP status if appropriate).
State the pertinent medical history.
Give a brief synopsis of the treatment to date.
The patient is or is not on oxygen or Vent Settings:
Assessment
change in oxygen requirements.
Most recent vital signs:
BP____ Pulse ____
Labs:
RR ____ O2 sat ____
Temp ___ Current Weight ___
Any Changes from prior assessments, such as:
R
Respiratory Rate/Quality/O2
Requirements
Retractions/Use of Accessory
Muscles
Skin Color
Pulse/BP/Perfusion
HR/Rhythm Changes
Neuro Changes
GI/GU
Pain
Wound Drainage/Drain
Output
Intake/Output
Other:
Other:
Recommendation
“I request” or “Do you think we should”: (state what you think needs to be done).
• That you come see the patient now.
• Transfer the patient to ICU.
• Talk with the family about the patient status.
• Ask for a consultant to see the patient now.
P:\Resident Orient_Info
20
Important Phone Numbers – Prefix 955
Access Center/Admitting
5410
Call Center (Dietary, Maintenance,
Utilities and Environmental Serv
8999
Child Life Specialists
Each unit is assigned a specialist;
pager #’s are available through
the unit secretary or charge nurse.
Code 4 (If no Code 4 call button)
Corporate Compliance
Hotline/HIPAA
Emergency Department
4444
3250
Employee Health
6020
Family Resource Library
3834
House Supervisor
7901
Information Technology Help Desk
8999
Medical Education
6070
6061
Medical Records
3800
Medical Staff Office
3775
Methodist Numbers
Pathology
Dial 9 – then 7 digit
number
5500
Pharmacy
5470
Radiology
5602
Rainbow House
7815 / 7837
Security
5300
Social Work
5418
888-8420 pager
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5150
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