REGIONAL HOSPITALS COMPETENCY BASED · PDF fileREGIONAL HOSPITALS COMPETENCY BASED ORIENTATION...

REGIONAL HOSPITALS

COMPETENCY BASED ORIENTATION

STANDARDIZED STUDY MODULES

FOR THE CERTIFIED NURSING ASSISTANT

Care of the Patient with CVA

Conflict Management

Infection Control

Care of the Surgical Patient

Care of the Patient with

Respiratory Needs

Falls/Risk Prevention

Skin Integrity

Restraint and Seclusion

Pain and Comfort Management

Care for the Dying Patient

Time Management

Mandatory Reporting

CBO/Nurse Assist/HCMH/8/13/2004/

ORIENTATION MANUAL

Regional Hospital Network Hancock County Memorial Hospital

PROGRAM: Competency–Based Orientation DEPARTMENT: Nursing WORK AREA: Regional Hospital Network-HCMH JOB CLASSIFICATION: Certified Nursing Assistant WRITTEN BY: Becky Finch RN Jodi Asche CNA Mary Vold RN BSN Beverly Nelson CNA Diane Vrieze RN


REGIONAL HOSPITAL CBO MANUAL FOR THE NURSING ASSISTANT

TABLE OF CONTENT

1. Introduction

2. CBO Completion Record

3. Skills Checklist

4. Calendar of Events/Progress Notes

5. Evaluation Forms-preceptor and orientee

6. Checklist I

7. Checklist II Cover Page

8. Fall/Risk Prevention Study Module

9. Infection Control Study Module

10. Skin Integrity Study Module

11. Care of the patient with CVA Study Module

12. Mandatory Reporter Study Module

13. Pain and Comfort Management Study Module

14. Care of the Patient with Respiratory Needs Study Module

15. Care of the Dying Patient Study Module

16. Care of the Surgical Patient Study Module

17. Time Management Study Module

18. Loss and Grief Study Module

19. Conflict Study Module

20. Restraint Study Module


MERCY HEALTH NETWORK-NORTH IOWA REGIONAL HOSPITAL NETWORK

USING THE ORIENTATION MANUAL

This competency-based orientation manual is a collaborative effort of staff, educators, managers and administrators. The information included here is designed to be the framework for an orientation program that is competency based and utilizes preceptors as teachers, role models, and socializers. To use this manual:

• Complete the self-assessment portion of Organizational Competency Checklist I and Competency Checklist II, utilizing the Code for Self-Assessment listed at the top of each page.

• Meet with the preceptor and plan orientation activities.

• Upon completion of orientation activities

• Complete the CBO Completion Record and distribute as stated on the CBO Completion Record. • Complete Orientee and Preceptor evaluation forms and distribute as stated on the evaluations.

PREFACE

The goal of this health care system is to provide optimum health care for all who see our services. The Mercy Health Network-North Iowa is a system of affiliated hospitals, physician clinics and regional specialty services providing health care to residents of an eleven county service are.

Affiliated Network Hospitals: Regional community hospitals are affiliated with Mercy Medical Center-North Iowa through formal contracts. Under this arrangement, administrative and other services are provided to the community hospitals in an effort to improve the coordination and efficiency of health care services throughout the region. Network facilities are located in the following Iowa communities: Algona, Belmond, Britt, Cresco, Iowa Falls, Emmetsburg, Hampton, New Hampton, and Osage. The hospitals range in bed size from 18 to 92 (including skilled and intermediate care beds). Mercy Clinics: The Mercy Clinics is a system of physician clinics throughout North Central Iowa that provide family and specialty medical services. Medical services are provided by physicians, nurse practitioners, and physician assistants. There are approximately 150 physicians and physician extenders in the Network. Many services are provided in the clinics of the Mercy Clinics. These services include preventative/wellness care, diagnostic evaluations, prenatal care and referral to specialty services. Regional Specialty Clinics: In an effort to improve access to specialty services for persons in rural settings, the physicians of the Mercy Medical Staff developed specialty clinics to be held in rural health care facilities. Clinics representing the medical specialties of surgery, orthopedics, urology, cardiology, pathology and otolaryngology are examples of services provided throughout the region. CBO/Nurse Assist/HCMH/8/13/2004/

OVERVIEW OF THE ORIENTATION PROGRAM

Orientation is defined as the means by which new staff members are introduced to the philosophy, goals, policies, procedures, role expectations, physical facilities, and special services in a specific work setting (American Nurses Association, 1998). This orientation program is a competency based approach to helping the orientee gain the necessary knowledge, skills, attitudes, and values to perform his/her role and responsibilities under the varied circumstances of the actual work setting (Alspach, 1995: Bazinet, Erickson & Thomas, 1989; DiMauro & Mack, 1989; Katz & Green, 1992; Stewart & Vitell0-Ciccu, 1989). A person’s competence is demonstrated by his/her actual performance in the work setting. (Sparso, 1999). The purpose of this orientation program is to:

• Facilitate your adjustment to and integration into the new environment.

• Facilitate your ability to gain knowledge and master skills effectively and efficiently.

• Meet regulatory agency requirements concerning staff orientation.

A preceptor will provide leadership during the orientation period. This preceptor is an experienced staff person who has received additional education to enhance the learning experience. The preceptor’s goals for this orientation are as follows:

• Design an orientation program in which the orientee demonstrates competency and self-confidence under the guidance of a preceptor

• Provide a systematic learning process to enable new staff to be more productive in a shorter period of time. • Promote the integration of education and work values when new orientees are adjusting to practice • Support principles of adult learning • Enhance professional growth of the preceptor and increase job satisfaction • Attract desirable candidates for professional positions by providing successful orientation outcomes. Your goals as an orientee follow:

• Discuss the organization, philosophy, and concept of the community healthcare system

• Integrate the health care facility’s standards, policies and procedures into practice/job

• Accept initiative and independence in identifying and meeting individual learning needs

• Demonstrate competency

• Demonstrate confidence in ability to function as a health care team member

• Utilize and communicate with other departments and personnel effectively

• Demonstrate problem solving capabilities through formal and informal conferences with the preceptor and director; recommend changes when appropriate

• Promote professional practice by participating in professional activities

• Complete orientation evaluations CBO/Nurse Assist/HCMH/8/13/2004/

MODULES IN THE ORIENTATION PROGRAM As you proceed through this orientation program, you will gain knowledge and information needed to care for patients/clients. The modules described below contain information needed to carry out various components of patient/client care. It is through study and practice that you will attain the knowledge, confidence, and skill to care for patients/clients in the health network. The modules comprising this competency-based orientation manual are as follows: MODULE 1: INTRODUCTION The preface and overview statements delineate the purpose of an orientation program the preceptor’s goals for the orientation program and the orientee’s goals. The modules in the orientation manual are described. MODULE 2: CBO COMPLETION RECORD The CBO Completion Record is your orientation documentation form. As you complete each checklist, exam, and evaluation, record the outcome on your CBO Completion record. This record must be signed by you, your preceptor, and your Manager/Director upon completion of your orientation; then distribute the CBO Completion Record as sated at the bottom of the Record. MODULE 3: CALENDAR OF ORIENTATION EVENTS/ PROGRESS NOTES These documents are used by you and your preceptor to plan and evaluate your orientation activities. Designed to aid the learning process, Orientation Progress Note forms are provided for the preceptor(s) and the orientee to evaluate the orientee’s progress. MODULE 4: SKILLS CHECKLIST These skills checklists address equipment and/or procedures you need to know for your job. Record the completion of these on your CBO Completions record. MODULE 5: ORGANIZATIONAL COMPETENCY CHECKLIST The organizational competency checklist addresses organization-wide activities. Record the completion of this checklist on your CBO Completion Record. MODULE 6: JOB SPECIFIC COMPETENCY CHECKLIST This competency checklist addresses activities pertinent to your job role and responsibilities. Record the completion of this checklist on your CBO Completion record. MODULE 7: EVALUATION FORM: This provides an evaluation by the preceptor and the orientee at the end of the Orientation. CBO/Nurse Assist/HCMH/8/13/2004/

MODULE 8: REGIONAL HOSPITALS: FALL/RISK PREVENTION STUDY MODULE FOR THE CERTIFIED NURSING ASSISTANT This study module provides guidelines for patient care to prevent falls. MODULE 9: REGIONAL HOSPITALS: INFECTION CONTROL STUDY MODULE This study module addresses the issues of infection control in healthcare. MODULE 10: REGIONAL HOSPITALS: SKIN INTEGRITY STUDY MODULE FOR THE CERTIFIED NURSING ASSISTANT This module contains information related to the largest body organ. MODULE 11: REGIONAL HOSPITALS: THE PATIENT WITH CVA STUDY MODULE FOR THE CERTIFIED NURSING ASSISTANT This module focuses on the certified nursing assistant’s responsibilities related to care of the patient

with a CVA. MODULE 12: REGIONAL HOSPITALS: MANDATORY REPORTING STUDY MODULE FOR THE CERTIFIED NURSING ASSISTANT This module outlines what constitutes pediatric and adult abuse and the reporting process. . MODULE 13: REGIONAL HOSPITALS: PAIN AND COMFORT MANAGEMENT STUDY MODULE FOR THE CERTIFIED NURSING ASSISTANT

This module focuses on the nursing responsibilities related to pain and pain management.

MODULE 14: REGIONAL HOSPITALS: CARE OF THE PATIENT WITH RESPIRATORY NEEDS STUDY MODULE FOR THE CERTIFIED NURSING ASSISTANT This study module focuses on certified nursing assistant care of the patient with respiratory concerns. MODULE 15: REGIONAL HOSPITALS: CARE OF THE DYING STUDY MODULE FOR THE CERTIFIED NURSING ASSISTANT This module provides guidelines of care for the dying patient. MODULE 16: REGIONAL HOSPITALS: CARE OF THE SURGICAL PATIENT STUDY MODULE FOR THE CERTIFIED NURSING ASSISTANT This study module outlines basic care of the surgical patient by the certified nursing Assistant. CBO/Nurse Assist/HCMH/8/13/2004/

MODULE 17: REGIONAL HOSPITALS: TIME MANAGEMENT STUDY MODULE

This study module focuses on organizational and time management skills. MODULE 18: REGIONAL HOSPITALS: LOSS AND GRIEF STUDY MODULE FOR THE CERTIFIED NURSING ASSISTANT Most people relate loss and grief only with a dying patient; this module focuses on loss and grief related to loss of control, loss of body image, loss of self-esteem, loss of body part(s) or function(s), loss of sexuality, loss of role performance, loss of social role, poor prognosis, cancer, and loss of life. MODULE 19: REGIONAL HOSPITALS: CONFLICT MANAGEMENT STUDY MODULE FOR THE NURSING ASSISTANT Conflict and conflict resolution measures are delineated. MODULE 20: REGIONAL HOSPITALS: RESTRAINT AND SECLUSION STUDY MODULE This module delineates the use of restraints and seclusion including the philosophy, goals, and policy/procedure of the organization. CBO/Nurse Assist/HCMH/8/13/2004/

REGIONAL HOSPITAL NETWORK CBO COMPLETION RECORD CERTIFIED NURSING ASSISTANT

Name: ________________________________ (Orientee)

ORIENTATION CHECKLISTS DATE COMPLETED PRECEPTOR’S

INITIALS Organizational Competency Checklist I Competency Checklist II - NA Preceptor Evaluation of Orientation

Orientee Evaluation of Orientation

Skills checklists need to be completed by the orientee. Demonstrate each skill to the preceptor.

SKILLS CHECKLISTS DATE

COMPLETED PRECEPTOR’S

INITIALS Abbreviations-refer to text Alarm Camera System/Radio Civil Defense/Bioterrorism Pager Ambulating, Cane, Crutches, Walker Apply Elastic Stockings/anti-embolism Stockings, (Ted Hose), Ace Wrap, SCD’s

Aqua K Pumps Assist with Oral Hygiene Back Rub Bag-Valve Mask Resuscitation Bath: Partial, Complete, Whirlpool, Bag, Shower, Sitz Bair Hugger Bed Controls/Bed Alarms/Close-Open-Occupied Bed Pan or Commode Bed Scale/Standing Scale Blanket Warmer (Recovery Room) Blood Pressure (Manual) Call System Cardiac Monitor Cast Care Catheter Care and Empty Drainage Bag Colostomy Care Communication/Resident’s Rights/Facility Directory (HIPAA) CPM (Continuous Passive Motion) Croup Tent Dopplers (Location) Emergency Call System Enema Administration (SS-Fleets-Colon Flushing) Geri Chair Grooming-Dressing/Undressing a Resident Hand Washing Technique Heat and Cold Application Hemoccult Testing, Stool Specimen Collection Hoyer Lift/Scale



Incentive Spirometery Lift and Move a Resident in Bed Machines: Copy, Fax, Computer Measure Intake and Output Nail Care NG Drainage Disposal Noninvasive BP/Pulse Ox/Cardiac Monitor Obstructed Airway: Conscious/Unconscious Adult O2

Tank, Concentrator, Mask, Flow Meter and Tubing; Nebulizer setup Passive Range of Motion PCA Pump Position Resident in Bed Post Mortem Care Prepare a Resident for a Meal and Feed a Resident Provide Incontinent Care Pulse Oximeter/O2 Sat. Machine (Hand held) Put on Nonsterile Gloves Restraints Routine Urine Sample/24o Urine, Straining Urine Shampoo a Resident’s Hair Shaving a Resident with an Electric Razor Sputum Specimen Collection Transfer a Resident from Bed to Chair or Chair to Bed Transfer with Hoyer Lift Trapeze Urinal for a Male Resident Vital Signs Whirlpool Bath Maintenance


Patient Care Study Modules Required Score

Possible Score

Preceptor’s Initials

Date Passed/ Completed

Module 1. Care of Patient with CVA/Stroke 8 10 2. Care of the Surgical Patient 10 12 3. Comfort and Pain Control 17 20 4. Care of Respiratory Patient 16 19 5. Mandatory Reporter 4 5 6. Domestic Violence 38 45 7. Conflict Management No Exam - 8. Restraint & Seclusion No Exam - 9. Time Management 21 25 10. Infection Control 13 14 11. Care of the Dying Patient No Exam - 12. Fall Risk Prevention 13 16 13. Loss & Grief 9 10 14. Skin Integrity 10 12



INITIALS PRECEPTOR’S SIGNATURE

Orientee Signature _____________________________________ Date ___________________ Preceptor Signature ____________________________________ Date ___________________ Manager/Director ______________________________________ Date ___________________ Comments: ___________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Upon completion of the orientation, the supervisor forwards a copy of the completed CBO Completion Record to each of the following:

• Human Resources (original) • Nurse Manager/Director


REGIONAL HOSPITAL NETWORK CBO WEEKLY CALENDAR OF EVENTS AND PROGRESS NOTES

FOR THE CERTIFIED NURSING ASSISTANT (Completed Weekly by Orientee and Preceptor)

DIRECTIONS Orientation is a progressive learning process. Thus, in an effort to evaluate the orientee’s progress, the orientee and preceptor are to complete and discus this Orientation Progress Note on a weekly basis. The orientee and preceptor are to discuss each learning outcome listed on the following pages, and then check the list; if the item was met, not met, or not applicable. If not met, or the orientee needs more assistance document needed instruction. Upon completion, submit the Orientation Progress Note/Calendar of Events to the Manager/Director. It is expected that the orientee will need assistance early in the orientation process and progress to an efficient, coordinated, confident, and professional practice. CBO/Nurse Assist/HCMH/8/13/2004/


FOR THE CERTIFIED NURSING ASSISTANT (Completed Weekly by the Preceptor)

ORIENTATION WEEK __1__

MET (√)

NOT MET (√)

NOT APPLICABLE

(√ Complete and review Self-assessment on Organizational Competency Checklist I and II

Meet with the supervisor and preceptor to review and organize the specific orientation process

Tour the facility department layouts Meet healthcare team members Locate equipment and supplies Complete New Employee Checklist-Human Resources Review emergency codes and equipment procedures Discuss overview of personal safety (MSDS) Review safety and hazard procedures Review infection control measures Review Personnel Policies Discuss patient and staff rights and confidentiality Discuss areas of growth and needed instruction Complete CBO Progress Note/Evaluation Review and discuss the Skills Checklist Communication methods/skills ongoing Documentation for operations/patients

Comments: Progress Successful Performance: Area needing further instruction/information: Orientee Signature: _________________________________________________ Date: ______________________ Preceptor Signature: _______________________________________________ Date: ______________________ Manager/Leader Signature: ___________________________________________ Date: ______________________ File in Manager’s File for a minimum of 6 months. CBO/Nurse Assist/HCMH/8/13/2004/



Calendar of Events/Weekly Evaluation ORIENTATION WEEK _1-2__ or as negotiated with Manager/Director

MET (√)

NOT MET (√)

NOT APPLICABLE

(√ • Skills Demonstrations/observation

• Bed control/alarm/call system • Hand washing technique • Lifting and moving patient/observe • Transfer patient/bed/chair/observe • Oxygen equipment and use • Use of non sterile gloves • Alarm Systems/Radio Civil Defense

• Emergency call system • Complete Fall/Risk Prevention Study Module

• View Videos • Lifting and moving patients • Patient fall prevention • Transferring patients

• Complete Week 1 Orientation Progress Note including areas needing further orientation

• Record on the CBO Completion Record Comments: Progress Successful Performance: Area needing further instruction/information: Orientee Signature: _________________________________________________ Date: ______________________ Preceptor Signature: _______________________________________________ Date: ______________________ Manager/Leader Signature: ___________________________________________ Date: ______________________ File in Manager’s File for a minimum of 6 months.

REGIONAL HOSPITAL NETWORK CBO


WEEKLY CALENDAR OF EVENTS AND PROGRESS NOTES FOR THE CERTIFIED NURSING ASSISTANT

(Completed Weekly by the Preceptor)

Calendar of Events/Weekly Evaluation ORIENTATION WEEK _1 or 2_ or as negotiated with Manager/Director

MET (√)

NOT MET (√)

NOT APPLICABLE

(√ • Discuss handling of equipment • Clean orderly work environment • Review job description • Location of equipment and supplies • Infection control study module • Skin care study module • Skills demonstrations

• Bathing • Back rubs • Oral care • Catheter Care • Creams? • Measure I & O








MET (√)

NOT MET (√)

NOT APPLICABLE

(√ • Skills Demonstrations (continued)

• Positioning in bed • Prepare patient for meal • Vital signs/B/P-manual • Pulse Oximeter • Bed Pan • Commode • Urinal • Incontinent care • Ambulate patient • Review admission/discharge procedure

• Complete Week 2 Orientation Progress Note including

areas needing further orientation







MET (√)

NOT MET (√)

NOT APPLICABLE

(√ • Demonstrate Patient Care-Use of Equipment • Demonstrate Infection Control and Proper Waste

Disposal

• Care of the CVA Patient Study Module • Skills Demonstrations

• Hoyer Lifts/scales • Measure weights • Hemoccult stool collection • Stool/urine sample • Sputum sample collection • Gallup Survey • Provide care for a variety of patients • Documentation for operations/patients • Communication methods ongoing







Calendar of Events/Weekly Evaluation ORIENTATION WEEK _3 _

MET (√)

NOT MET (√)

NOT APPLICABLE

(√ • Mandatory Reporter Study Module • Pain and Comfort Management Study Module • Skills Demonstrations

• Whirlpool • Shaving • Shampoo • Trapeze use • Nail Care • Grooming/dressing • Colostomy care • Provides care for a variety of patients • Documentation for operations/patient care • Communication methods ongoing






Calendar of Events/Weekly Evaluation ORIENTATION WEEK _3 or 4 _ or as negotiated with Manager/Director

MET (√)

NOT MET (√)

NOT APPLICABLE

(√ • Provides care for a variety of patients • Care of the Respiratory Patient Study Module • Care of the Dying Patient Study Module • Care of the Surgical Patient Study Module • Skills Demonstrations

• Obstructed airway • PCA pump • Heat and cold application • Incentive Spirometry • Ted hose/Ace wrap/SCD • Bair Hugger • Blanket warmer • NG drainage • Aqua K pad • CPM

• Complete Week 3-4 Orientation Progress Note including areas needing further orientation





Calendar of Events/Weekly Evaluation ORIENTATION WEEK _4 or 5 _ or as negotiated with Manager/Director


MET (√)

NOT MET (√)

NOT APPLICABLE

(√ • Provides care for a variety of patients • Demonstrates C • Demonstrates Personal and Patient Safety Measures • Complete CBO Completion Record • Complete Orientation Progress Notes for week 4/5 • Time Management Study Module • Grief and Loss Study Module • Post Mortem Care • Conflict Management Study Module • Restraint and Seclusion Study Module • Implements knowledge from study modules • Skills Demonstrations:

• Restraints • Fax machine/computer, copy machine • Doppler • Croup tent • Bag mask valve resuscitation • Cast care • Cardiac monitor • B/P monitor


• Record on the CBO Completion Record and give to Director

• Complete Preceptor Evaluation and oversee Evaluation Comments: Progress Successful Performance: Area needing further instruction/information: Orientee Signature: _________________________________________________ Date: ______________________ Preceptor Signature: _______________________________________________ Date: ______________________ Manager/Leader Signature: ___________________________________________ Date: ______________________ File in Manager’s File for a minimum of 6 months.

REGIONAL HOSPITAL NETWORK

CBO SKILLS CHECKLIST CERTIFIED NURSING ASSISTANT

Name: ________________________ Facility: _______________________


Completion Date: _______________ This Completion record lists the skills checklists that need to be completed by the orientee. Each facility must maintain in its files a copy of the specific checklists used in the facility.

SKILLS CHECKLISTS DATE COMPLETED

PRECEPTOR’S INITIALS

Abbreviations-refer to text Alarm Camera System/Radio Civil Defense/Bioterrorism Pager Ambulating, Cane, Crutches, Walker Apply Elastic Stockings/anti-embolism Stockings, (Ted Hose), Ace Wrap, SCD’s

Aqua K Pumps Assist with Oral Hygiene Back Rub Bag-Valve Mask Resuscitation Bath: Partial, Complete, Whirlpool, Bag, Shower, Sitz Bair Hugger Bed Controls/Bed Alarms/Close-Open-Occupied Bed Pan or Commode Bed Scale/Standing Scale Blanket Warmer (Recovery Room) Blood Pressure (Manual) Call System Cardiac Monitor Cast Care Catheter Care and Empty Drainage Bag Colostomy Care Communication/Resident’s Rights/Facility Directory (HIPAA) CPM (Continuous Passive Motion) Croup Tent Dopplers (Location) Emergency Call System Enema Administration (SS-Fleets-Colon Flushing) Geri Chair Grooming-Dressing/Undressing a Resident Hand Washing Technique Heat and Cold Application Hemoccult Testing, Stool Specimen Collection Hoyer Lift/Scale Incentive Spirometery Lift and Move a Resident in Bed Machines: Copy, Fax, Computer Measure Intake and Output Nail Care NG Drainage Disposal Noninvasive BP/Pulse Ox/Cardiac Monitor Obstructed Airway: Conscious/Unconscious Adult O2

Tank, Concentrator, Mask, Flow Meter and Tubing; Nebulizer setup Passive Range of Motion


PCA Pump Position Resident in Bed Post Mortem Care Prepare a Resident for a Meal and Feed a Resident Provide Incontinent Care Pulse Oximeter/O2 Sat. Machine (Hand held) Put on Nonsterile Gloves Restraints Routine Urine Sample/24o Urine, Straining Urine Shampoo a Resident’s Hair Shaving a Resident with an Electric Razor Sputum Specimen Collection Transfer a Resident from Bed to Chair or Chair to Bed Transfer with Hoyer Lift Trapeze Urinal for a Male Resident Vital Signs Whirlpool Bath Maintenance

Orientee Signature: _____________________________________________ Date: _______________________

Preceptor Signature: ____________________________________________ Date: _______________________

DON/CNM Signature: ____________________________________________ Date: _______________________

Comments: ________________________________________________________________________________

__________________________________________________________________________________________

Upon completion of the orientation, the supervisor is responsible for forwarding a copy of this completed CBO Completion Record to each of the following:

• Human Resource Department

• Nursing Manager/Director


REGIONAL HOSPITAL NETWORK Hancock County Memorial Hospital

ORGANIZATIONAL COMPETENCY

CHECKLIST I

REGIONAL HOSPITAL NETWORK Code for Self-Assessment ORIENTATION CHECKLIST I A=Comfortable B=Needs Experience C=Unfamiliar

Competency Statement 1: Demonstrates knowledge of emergency codes and equipment. Self-Assess

Performance Objectives The Preceptor and the Orientee Will:

Performance Objectives Met (√ & Preceptor’s Initials)

To Be Completed By:


A. Locates codes poster B. Discusses correct

procedure for: 1. Code Purple/Code

Pink 2. Code Yellow 3. Code Grey 4. Code Blue 5. Code White 6. Code Black

Watch/Code Black Warning

7. Code Red 8. Code Orange

C. Locates the following: 1. Emergency exits 2. Fire extinguishers 3. Crash cart supplies 4. Fire doors 5. Pull boxes 6. Control Panels

D. States emergency phone number.

E. Discusses how to use: 1. Fire fighting

equipment 2. Phone system

F. Discusses how to use stairwells-not elevators in Code Red.

G. Discusses appropriate disaster responses.

H. Locates and discusses disaster evacuation plan.

A. Locate codes poster. B. Locate emergency equipment

specific to job classifications. C. Demonstrate/Discuss use of

emergency equipment specific to job classification.

D. Review Disaster Response policy, both for the institution and for the department.

E. Demonstrate how to use fire-fighting equipment.

A. ___________ B. ___________ C. ___________ D. ___________ E. ___________ F. ___________ G. ___________ H. ___________

End of Day 1

REGIONAL HOSPITAL NETWORK Code for Self-Assessment ORIENTATION CHECKLIST I A=Comfortable B=Needs Experience C=Unfamiliar Competency Statement 2: Assures personal safety when working through knowledge of proper and safe use of equipment and protocols for handling incidents. Self-Assess



To Be Completed By:


A. Uses proper safety devices.

B. Uses proper body mechanics.

A. State need for safety glasses, hepatitis immunization, sharps safety, protection/isolation from excess exposure to anesthesia gases, etc.

B. Discuss policies and procedures to promote safety.

C. State OSHA requirements for employee and employer.

D. Demonstrate appropriate body mechanics to ensure personal safety.

A. ___________ B. ___________

End of Day 1



Competency Statement 3: Structures a safe environment by implementing procedures and safe use of equipment Self-Assess

Performance Objectives A. Maintains order in work

environment. B. Demonstrates knowledge

of safe operation of equipment.

C. Reviews electrical safety hazards.

D. Discusses appropriate responses to a utility failure.

E. Discusses when and how to send equipment for repair.

F. Demonstrates proper handling and disposal of hazardous/isolation materials.

G. Locates MSDS (Material Safety Data Sheets).

H. Demonstrates principles of infection control procedures.

I. Instructs personnel and others in infection control procedures when appropriate.

J. Follows cleaning/disinfection principles.

K. Ensures that work environment is safe for customers/patients based upon age-specific needs/developmental needs: 1. Neonate 2. Pediatric 3. Adolescent 4. Adult 5. Geriatric

The Preceptor and the Orientee Will: A. Review electrical safety

information. B. Review department response

to utility failure (i.e., electrical failure, generator does not start, etc.).

C. Discuss equipment maintenance.

D. Discuss how to take a piece of equipment out of service.

E. Discuss role of building maintenance personnel and how to access them.

F. Review infection control policies and procedures including standard precautions.

G. Locate MSDS (Material Safety Data Sheets).

H. Discuss procedures for: 1. Sharp Disposal 2. Infectious waste disposal 3. Hazardous waste

disposal I. Schedule for mandatory

employee education/BLS as needed.

J. Review guidelines to promote patient safety: 1. Review essential safety

risk measures for self and others

2. Review policy regarding patient identification/allergy stickers (if applicable)

3. Provide equipment and supplies based on patient care needs

Performance Objectives Met (√ & Preceptor’s Initials) A. ___________ B. ___________ C. ___________ D. ___________ E. ___________ F. ___________ G. ___________ H. ___________ I. ____________ J. ____________ K. ____________

To Be Completed By: End of Day 1



Competency Statement 3: Structures a safe environment by implementing procedures and safe use of equipment. Self-Assess



To Be Completed By:

K. Review body mechanics to ensure safety of self, other people and equipment.

L. Demonstrate how to contact law enforcement.

M. Demonstrate and review electrical safety procedures.

N. Review the policy/guidelines as related to in-service.

O. Discuss how to obtain departmental supplies and to maintain department inventory.

P. Discuss age-appropriate safety measures applicable to work environment.

Q. Demonstrate how to contact poison Control.

End of Day 1



Competency Statement 4: Discuss the patient’s and staff’s right to confidentiality and support. Self-Assess



To Be Completed By:

A. Defines role in using patient confidentiality.

B. Discusses aspects of job performance that can increase a patient’s and/or staff member’s confidentiality.

C. Identifies who should have restricted access to information.

D. Identifies that there is a bioethics policy and procedure.

E. Discusses the various rights of patients.

F. Discusses advanced directives.

G. Discusses the policy for the procurement and donation of organs and other tissues.

H. Discusses the policy to protect patients and respect their rights during research, investigation, and/or clinical trials involving human subjects.

A. Review concept of patient advocacy.

B. Review confidentiality policy. C. Review employee handbook. D. Review purpose, function,

and structure of bioethics committee (if applicable);

E. Discuss patient rights. F. Discuss advanced directives. G. Discuss policy regarding

organ procurement/donation (ISOPO).

H. Discuss HIPPA.

A. ___________ B. ___________ C. ___________ D. ___________ E. ___________ F. ___________ G. ___________ H. ___________

End of Day 1



Competency Statement 5: Demonstrates knowledge of personnel policies. Self-Assess



To Be Completed By:

A. Complies with dress code. B. Complies with Employee

Health policies and guidelines: 1. Pre-employment

physical 2. TB testing 3. Hepatitis B vaccine 4. Immunization for

measles 5. Immunization for

rubella/titer C. Reports for work on time

and begins works promptly.

D. Completes time and attendance accurately.

E. States understanding of job description.

F. States understanding of performance appraisal system

G. Discusses how and when to complete incident report.

H. Demonstrates respect for persons of all cultures.

A. Review dress/grooming guidelines.

B. Review hospital’s philosophy, mission statement, and values.

C. Review non-smoking policy. D. Discuss hepatitis vaccine/TB

testing/measles immunization/rubella titer guidelines for personnel.

E. Discuss organizational structure of department(s).

F. Discuss: 1. Job description 2. Performance appraisal

system 3. Payroll policies 4. Overtime calculations 5. Holiday premium 6. Holiday benefits 7. When checks are cut 8. Flex pay 9. Vacation/Time off 10. Illness policy 11. Employee handbook

contents G. Discuss time and attendance

protocols. H. Review staffing, attendance,

and disciplinary action policies.

I. Discuss parking regulations. J. Verify locker assignment,

location and combination (if applicable).

K. Discuss meal and break procedures.

L. Discuss organizational structure of Mercy Network and facility.

A. ___________ B. ___________ C. ___________ D. ___________ E. ___________ F. ___________ G. ___________ H. ___________

End of Week 1

REGIONAL HOSPITAL NETWORK Code for Self-Assessment ORIENTATION CHECKLIST I A=Comfortable


B=Needs Experience C=Unfamiliar Competency Statement 5: Demonstrates knowledge of personnel policies. Continued. Self-Assess



To Be Completed By:

M. Review the department QI program and individual staff role and responsibility.

N. Review unit/department’s expectations of attendance at education programs offered.

O. Review units/departments education plan.

P. Review department in-service planning.

Q. Discuss department meetings/committees and employees’ role in these.

R. Review use of Policy/Procedure manuals.

S. Review posting of “informational materials” (if applicable).

End of Week 1

REGIONAL HOSPITAL NETWORK Code for Self-Assessment ORIENTATION CHECKLIST I A=Comfortable B=Needs Experience


C=Unfamiliar Competency Statement 6: Demonstrates knowledge of department layout. Self-Assess



To Be Completed By:

A. Locates locker room: 1. Locker assignment 2. Bathroom

B. Locates offices. C. Uses telephones. D. Locates other areas as

determined by work environment.

A. Tour the department. B. Locate the following:

1. Policy and Procedure Manual

2. Reference materials 3. Safety manual 4. MSDS manual 5. Infection Control manual

C. Demonstrate how to use phone: 1. Paging system 2. Receiving calls 3. Placing calls

D. Demonstrate how to use fax machine.

A. ___________ B. ___________ C. ___________ D. ___________

End of Week 1



B=Needs Experience C=Unfamiliar Competency Statement 7: Demonstrates knowledge of department’s functions and locations. Self-Assess



To Be Completed By:

A. Locates hospital’s departments.

B. Discusses Regional Hospital Network concept and locations.

C. Discusses other department’s functions pertinent to job classification.

A. Tour the hospital. B. Discuss

activities/responsibilities of the following departments/areas (as applicable): 1. Diabetic Services 2. Employee Assistance

Program 3. Employee Health Nurse 4. Facilities 5. Family Practice/Clinic 6. Finance 7. Foundation 8. Cardiac Rehab 9. Cardiovascular

Diagnostics 10. Mobile Cardiovascular

Diagnostics 11. Respiratory Care 12. Human Resources 13. Information Desk 14. Laboratory 15. Linen Services 16. Maintenance 17. Marketing/Public Affairs 18. Materials Management 19. Medical Records 20. Nutrition Services 21. Radiology 22. Sleep study 23. QI 24. Outreach clinics 25. Chemotherapy 26. Telemedicine 27. Admitting 28. Aging Services 29. Administration 30. Business Office 31. Rehabilitation Services 32. Outpatient Services

A. ___________ B. ___________ C. ___________

End of Week 1



B=Needs Experience C=Unfamiliar Competency Statement 7: Demonstrates knowledge of department’s functions and locations. Continued. Self-Assess



To Be Completed By:

C. Discuss Regional Hospital Network concept and sites.

D. Discuss how to utilize interdepartmental mail system.

End of Week 1

Competency Statement 8: Demonstrates knowledge of clinical unit physical layout. Self-Assess



To Be Completed By:

A. Locates patient rooms. B. Locates exam room/Eye

Room. C. Locates utility rooms. D. Locates sitz bath, tub

rooms. E. Locates nurse’s station. F. Locates medication area. G. Locates nutrition center. H. Locates conference room. I. Locates public bathroom. J. Locates public waiting

room. K. Locates public phone. L. Locates mail facilities.

A. Tour the Unit. B. Introduce orientee to unit

personnel.

A. ___________ B. ___________ C. ___________ D. ___________ E. ___________ F. ___________ G. ___________ H. ___________ I. ___________ J. ___________ K. ___________ L. ___________

End of Week 1 (Applicable to clinical staff only)


CBO/Nurse Assist/HCMH/8/13/2004/ C=Unfamiliar

Competency Statement 9: Demonstrates knowledge of patient room physical layout. Self-Assess



To Be Completed By:

A. Locates call light control. B. Locates side rails. C. Locates emergency call

lights. D. Locates Oxygen/Suction

outlets. E. Locates emergency (red)

outlets. F. Locates family cots

(optional). G. Locates thermostat. H. Locates patient TV guide. I. Locates bathroom,

emergency call lights. J. Locates closets. K. Locates telephone. L. Locates bedside stand

supplies. M. Locates closing drapes for

privacy. N. Locates bed

control/specialty mattress.

O. Locates sharp/glove container.

D. Tour patient room. E. Review call light use. F. Review side rail use. G. Review oxygen/suction

outlets use. H. Review emergency (red)

outlet locations. I. Review optional family cot

use and how to obtain them. J. Review thermostat control. K. Review TV guide and CCTV. L. Review bathroom location. M. Review closet and telephone

locations. N. Review standard bedside

stand supplies. O. Review privacy measures. P. Demonstrate bed control and

positioning Q. Review bed controls. R. Review purpose and use

specialty mattresses.

A. ___________ B. ___________ C. ___________ D. ___________ E. ___________ F. ___________ G. ___________ H. ___________ I. ___________ J. ___________ K. ___________ L. ___________ M. ___________ N. ___________ O. ___________




B=Needs Experience C=Unfamiliar Competency Statement 10: Demonstrates knowledge of exam room physical layout. Self-Assess



To Be Completed By:

A. Locates cupboards-including restocking.

B. Locates sterile/exam gloves.

C. Locates exam table sheets.

D. Locates exam table drawers.

E. Locates gowns. F. Locates PAP smear

supplies. G. Locates speculums.

A. Tour the exam room. B. Review location of supplies

listed. C. Demonstrate set up for a

physical (RN, LPN). D. Demonstrate set-up for a PAP

smear (RN, LPN).

A. ___________ B. ___________ C. ___________ D. ___________ E. ___________ F. ___________ G. ___________




Competency Statement 11: Demonstrates knowledge of utility areas physical layout. Self-Assess



To Be Completed By:

A. Locates utility area supplies: 1. IV fluids 2. IV supplies 3. Blood tubing 4. Clean housekeeping

utensils 5. Toiletry items 6. Urine specimen

bottles (sterile, clean catch, routine)

7. Respiratory supplies (nasal cannula, masks, humidity, suction, flow metes, tracheostomy supplies)

8. Suction supplies 9. Dressing supplies 10. Sterile water 11. Normal saline 12. LP tray

(adult/pediatric) 13. Feeding tube

supplies 14. Emergency trach set 15. Sterile drapes 16. Hemoccult supplies 17. Peri-pads, panties 18. Abdominal binders 19. Ted hose 20. Aqua-K pads 21. Stockinet 22. Urological supplies 23. Urine strainer 24. Pneumothorax kit 25. Irrigation sets 26. Extra pillows 27. Disposable ambu

bags 28. Enema supplies 29. Isolyzer 30. Reorder supply list

A. Tour the utility rooms. B. Review location and use of

supplies as listed. C. Review location of supplies in

soiled utility room as listed.

A. ___________




Competency Statement 11: Demonstrates knowledge of utility areas physical layout. Continued. Self-Assess



To Be Completed By:

B. Locates Soiled Utility Area: 1. Linen chute/cart 2. Linen hampers 3. Hopper 4. Cleaning supplies 5. Glass disposal

container 6. Isolation garbage 7. Vases for flowers 8. Recycling containers 9. Housekeeping

supplies 10. Lost and found 11. Central supply soiled

utensil tray

B. ___________




Competency Statement 12: Demonstrates knowledge of nurses’ station physical layout. Self-Assess



To Be Completed By:

A. Locates physician call schedule.

B. Locates reference books. C. Locates chart supplies. D. Locates Kardexes &

standing orders. E. Locates requisition forms. F. Locates Addressograph,

Lab printer (changing ribbons, paper, inc, etc.).

G. Locates teaching sheets (colonoscopy, EGD, barium enema, PCA).

H. Locates daily census sheet.

I. Locates telephones: 1. Paging system 2. Call transfers

J. Locates made-up charts. K. Locates charts at bedside

in rack. L. Locates 24-hours patient

care data. M. Locates policy and

procedure manuals. N. Locates forms & paper

supplies. O. Locates information &

memo boards/posting of educational offerings.

P. Uses computer. Q. Locates care plans. R. Locates patient-nurse

communication system. S. Locates fax machine/copy

machine. T. Locates pharmacy in/out

basket.

A. Tour the Medical/Surgical Unit nurses station.

B. Review location of supplies listed.

C. Demonstrate use of addressograph.

D. Demonstrate changing lab printer.

E. Review phone policies. F. Review paging system G. Review patient confidentiality

policy. H. Review chart holder.

A. ____________ B. ____________ C. ____________ D. ____________ E. ____________ F. ____________ G. ____________ H. ____________ I. ____________ J. ____________ K. ____________ L. ____________ M. ___________ N. ____________ O. ____________ P. ____________ Q. ____________ R. ____________ S. ____________ T. ____________

End of Week 1 (Applicable to nursing personnel only)



C=Unfamiliar Competency Statement 12: Demonstrates knowledge of nurses’ station physical layout. Self-Assess



To Be Completed By:

U. Locates file cabinets. V. Locates diet board. W. Locates Pastoral Services. X. Locates interdepartmental

mail. Y. Locates pervious records

and thinned charts.

U. ____________ V. ____________ W. ___________ X. ____________ Y. ____________




Competency Statement 13: Demonstrates knowledge of medication room physical layout. Self-Assess



To Be Completed By:

A. Locates refrigerator. B. Locates stock meds on

med carts/cupboards: 1. Oral 2. IM 3. Subq 4. IV 5. Topical 6. Suppositories

C. Locates med carts. D. Locates syringes and

needles. E. Locates suture supplies. F. Locates subclavian tray,

supplies. G. Locates IV supplies. H. Locates IV fluids and

tubing. I. Locates med filters. J. Locates crash cart. K. Locates intermittent

infusion plugs. L. Locates sharps

containers. M. Locates glucose

monitoring supplies. N. Locates thermometers

and refills. O. Locates eye bags. P. Locates trach supplies. Q. Locates electric razors. R. Locates

defibrillator/monitor/crash cart.

A. Tour the medication room. B. Review location of

supplies/equipment listed. C. Review Occupational

Exposure to blood or other potentially infectious materials policy.

D. Discuss medication cart security.

A. ____________ B. ____________ C. ____________ D. ____________ E. ____________ F. ____________ G. ____________ H. ____________ I. ____________ J. ____________ K. ____________ L. ____________ M. ___________ N. ____________ O. ____________ P. ____________ Q. ____________ R. ____________

End of Week 1 (Applicable to nursing and pharmacy personnel only)



C=Unfamiliar Competency Statement 14: Demonstrates knowledge of nutrition center physical layout. Self-Assess



To Be Completed By:

A. Locates coffee pot. B. Locates microwave oven. C. Locates refrigerator. D. Locates ice machine. E. Locates pop dispenser. F. Locates hot

chocolate/soups. G. Locates baby foods. H. Locates

cups/spoons/pitchers. I. Locates kitchen supplies. J. Locates enteral

supplements. K. Locates dietary snacks. L. Locates toaster.

A. Tour the nutrition center. B. Review location of

supplies/equipment as listed. C. Discuss patient snack

distribution and schedule.

A. ____________ B. ____________ C. ____________ D. ____________ E. ____________ F. ____________ G. ____________ H. ____________ I. ____________ J. ____________ K. ____________ L. ____________

End Week 1 (Applicable to nursing and dietary staff only)



Competency Statement 15: Demonstrates knowledge of conference room/report room physical layout and use. Self-Assess



To Be Completed By:

A. Locates bulletin board. B. Locates resource

(teaching) materials. C. Locates paper supplies. D. Locates tape recorder (if

applicable). E. Locates informational and

memo boards/posting of educational offerings.

F. Locates TV/VCR. G. Uses:

1. Physician-patient, nurse-patient conferences (private, confidential information)

2. Shift report-assignment sheets

A. Tour the conference room/report room.

B. Review location of supplies/equipment as listed.

C. Review the use of tape recorder and taping procedure.

A. ____________ B. ____________ C. ____________ D. ____________ E. ____________ F. ____________ G. ____________


ORIENTATION CHECKLIST I A=Comfortable B=Needs Experience C=Unfamiliar

REGIONAL HOSPITAL NETWORK Code for Self-Assessment


Competency Statement 16: Demonstrates knowledge of unit’s patient education resources. Self-Assess



To Be Completed By:

A. Locates printed materials. B. Locates VCR/tapes. C. Locates education

information/materials. D. Locates Cardiac Rehab. E. Locates CCTV (if

applicable).

A. Locate patient education supplies.

B. Discuss education procedures.

C. Discuss diabetic education. D. Discuss Cardiac Rehab’s role.

A. ____________ B. ____________ C. ____________ D. ____________ E. ____________


Competency Statement 17: Demonstrates knowledge of staff lounge and manager office locations. Self-Assess



To Be Completed By:

A. Locates staff bathroom B. Locate manager’s office

End of Week 1



ORIENTATION CHECKLIST I A=Comfortable B=Needs Experience C=Unfamiliar Competency Statement 18: Practices positive customer relations. Self-Assess



To Be Completed By:

A. Identifies the unit’s/department’s immediate and ultimate customers.

B. Identifies the unit’s/ department’s internal and external customers.

C. Discusses the types of services offered by the customers.

D. Discusses the types of services received from the customers.

E. Uses e-mail appropriately: 1. Sends concise

messages 2. Review messages

frequently 3. Responds to

messages in a timely manner

4. Uses extended absence message when appropriate

5. Uses appropriate language

F. Uses voice mail appropriately: 1. Sends concise

messages 2. Review messages

frequently 3. Responds to

messages in a appropriate manner

4. Uses extended absence greeting when appropriate

5. Uses appropriate language

A. Identify the following customers pertinent to area of responsibility: 1. Immediate 2. Ultimate 3. Internal 4. External

B. Introduce orientee to immediate, ultimate, internal, and external customers.

C. Tour departments with whom the orientee will have contact and meet the customers/personnel. Discuss the unit’s/department’s relationships to the orientee’s unit/department.

D. Role-play situations to promote positive customer relations.

E. Discuss patient/family complaint opportunities and strategies.

F. Discuss Gallup survey process and findings, including applicable Impact Plan.

G. Discuss employee recognition and reward program.

A. ____________ B. ____________ C. ____________ D. ____________ E. ____________ F. ____________

End of Week 1



B=Needs Experience


B=Needs Experience

C=Unfamiliar Competency Statement 18: Practices positive customer relations. Continued. Self-Assess



To Be Completed By:

G. Discusses patient/family complaint management strategies: 1. Review appropriate

use 2. Reviews HEAT and

how to handle customer complaints

H. Discusses the Gallup survey process, results, and their significance to the job: 1. Do I know what is

expected of me at work?

2. Do I have the materials and equipment I need to do my work right?

3. At work, do I have the opportunity to do what I do best every day?

4. In the last 7 days, have I received recognition or praise for doing good work?

5. Does my supervisor, or someone at work, seem to care about me as a person?

6. Is there someone at work who encourages my development?

7. At work, do my opinions seem to count?

G. ___________ H. ___________

End of Week 1

ORIENTATION CHECKLIST I A=Comfortable


C=Unfamiliar Competency 18: Practices positive customer relations. Continued. Self-Assess



To Be Completed By:

8. Does the mission/purpose of my company make me feel my job is important?

9. Are my coworkers committed to doing quality work?

10. Do I have a best friend at work?

11. In the last 6 months, has someone at work talked to me about my progress?

12. This last year, have I had opportunities at work to learn and grow?

I. Discusses the Impact Plan (as applicable to worksite) and its significance to the job.

J. Discusses employee recognition and reward program and its significance to the job.

I. ___________ J. ___________

End of Week 1



B=Needs Experience C=Unfamiliar

Competency Statement 19: Discusses Regional Hospital Network. Self-Assess



To Be Completed By:

A. Identifies location of network hospitals.

B. Discusses the contractual relationship between managed hospitals and Mercy and management services agreement.

C. Discusses the service departments may provide to the managed hospitals.

D. Discusses the regional specialty clinics.

A. Introduce facility management staff.

B. Read introduction section of CBO manual.

A. ___________ B. ___________ C. ___________ D. ____________

End of Week 1


REGIONAL HOSPITAL NETWORK Hancock County Memorial Hospital

ORGANIZATIONAL COMPETENCY

CHECKLIST II

ORIENTATION CHECKLIST II-Page 2 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable CBO/Nurse Assist/HCMH/8/13/2004/

Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Demonstrates principles of infection control Self- Assess

Performance Objectives:

The Preceptor and the Orientee will: Performance Objectives Met ( & Preceptor’s Initials

A. Uses personal protective

equipment effectively B. Utilizes appropriate biohazard

procedures

C. Performs cleaning and disinfecting

procedures

A. Discuss and review the following:

1. Isolation 2. Gloves 3. Appropriate mask 4. Hand washing 5. Gowns 6. Goggles 7. Personal protective equipment

B. 1. Red/Blue/Black/bag 2. Biohazard stickers 3. Bioterrorism 4. Proper disposal of sharps 5. Blood tubing 6. NG canister 7. JP drains 8. Auction canisters 9. Sterilization technique 10. Clean technique 11. Asepsis

C.

1. Management of linens a. Hospital Linen b. Patient belongings

2. Instrument cleaning for C.S. 3. Wash counters and water

pitchers with Micro quat 4. Cleaning and disinfecting patient

room after discharge a. During use

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ A5 _____ ___ A6 _____ ___ A7 _____ ___ B1 _____ ___ B2 _____ ___ B3 _____ ___ B4 _____ ___ B5 _____ ___ B6 _____ ___ B7 _____ ___ B8 _____ ___ B9 _____ ___ B10 ____ ___ B11 ____ ___ C1a ____ ___ C1b____ ___ C2 _____ ___ C3 _____ ___ C4 _____ ___ C4a ____ ___

ORIENTATION CHECKLIST II-Page 3 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience


C=Unfamiliar Competency Statement: Demonstrates principles of infection control Self- Assess



C. Performs cleaning and disinfecting Procedures (cont’d) D. Avoid cross contamination

C. Discuss and review the following:

5. Cleaning equipment a. Bed pan b. Urinal c. Commode d. Emesis Basin e. Bath basin f. Cleaning beds

D. 1. Food storage in room and in

refrigerator 2. Complete Infection Control Study

Module 3. Complete Infection Control Study

Module Final Exam

C5a ____ ___ C5b ____ ___ C5c____ ___ C5d ____ ___ C5e ____ ___ C5f ____ ___ D1 _____ ___ D2 _____ ___ D3 _____ ___

ORIENTATION CHECKLIST II-Page 4 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Knowledgeable of all safety procedures and supplies


Self- Assess



A. Demonstrate ability to perform

safety measures related to patient care.

B. Identify safety precautions for

environment and equipment

A. Discuss and review safety procedures relevant to the Certified Nursing Assistant 1. Transporting with Gurney and

wheelchair 2. Staying with patient during

transport or procedure 3. Keeping track of patient-if

wandering 4. Patient wrist bands 5. Restraints 6. Crib and child safety (side rails

and net) 7. Fall prevention 8. Bed alarms 9. Seizure and confused patient

precautions a. Mat on floor b. Padded side rails c. D.T.’s

10. Complete Restraint Seclusion Study Module

11. Complete Mandatory Reporting Study Module

12. Complete Mandatory Reporting Study Module Final Exam

B. 1. Latex allergy 2. Disaster plan-department

specifications 3. Helicopter safety plan (remove

cars/watch doors) 4. Locking doors/unlocking doors

a. Mon.-Fri. weekly routine b. Weekend Routine/Holiday

Routine c. Clinic doors d. Atrium doors e. West Summit

doors/weekends/holidays f. Staff lounge g. Front Atrium doors h. Summit House

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ A5 _____ ___ A6 _____ ___ A7 _____ ___ A8 _____ ___ A9a____ ___ A9b ____ ___ A9c ____ ___ 10 _____ ___ 11 _____ ___ 12 _____ ___ B1 _____ ___ B2 _____ ___ B3 _____ ___ B4a ____ ___ B4b ____ ___ B4c ____ ___ B4d ____ ___ B4e ____ ___ B4f ____ ___ B4g ____ ___ B4h ____ ___

ORIENTATION CHECKLIST II-Page 5 Code for Self Assessment Department: Nursing- Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Knowledgeable of all safety procedures and supplies Self- Performance Objectives: The Preceptor and the Orientee will: Performance


Assess Objectives Met ( & Preceptor’s Initials

C. Identify safety precautions for

Environment and equipment (cont’d)

5. Smoking 6. O2 Safety 7. Electrical safety-Green tags 8. Close Circuit TV 9. Silencing alarms-Lab, 02, Boiler,

fire 10. Parking lot safety and watching

doors security

C5 _____ ___ C6 _____ ___ C7 _____ ___ C8 _____ ___ C9 _____ ___ C10 ____ ___

Comments ________________________________________________________________________________ Orientee Signature _______________________ Preceptor Signature _________________________________ ORIENTATION CHECKLIST II-Page 6 Code for Self Assessment Department: Nursing- Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Participates effectively in Code Blue Self- Performance Objectives: The Preceptor and the Orientee will: Performance



A. Identify the role of the nurse aide

during code blue and communicate with appropriate staff

B. Collaborate with nurse during CPR C. Manage equipment used in a code

blue

A. Discuss and Review the role of the

Certified Nursing Assistant during the resuscitation of a patient 1. Call Staff:

A. X-ray B. Lab C. Nurse D. Doctor

2. Record events during code (narrative documentation of drug administration and procedures being performed)

B. 1 Uses resuscitation air bag

2. Participates in CPR C.

1. Retrieve crash cart, IV poles or supplies

2. Unlock ER & MD doors

A1A ____ ___ A1B ____ ___ A1C ____ ___ A1D ____ ___ A2 _____ ___ B1 _____ ___ B2 _____ ___ C1 _____ ___ C2 _____ ___

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________ ORIENTATION CHECKLIST II-Page 7 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar


Competency Statement: Documents appropriately on patient care related forms and daily operations form Self- Assess



A. Documents appropriately on patient care related forms B. Documents appropriately on forms

for daily operations

A. Discuss and review the following: 1. I & O Recording diet board

2. Work Sheet 3. Patient orientation to room/

patient belonging 4. Incident/injury report

B. 1. Chart filing

2. Work slip (for broken equipment)

3. Time sheet 4. Week/monthly cleaning list 5. Room cleaning checklist 6. Paging/Answer phone 7. Telephone log book/phone

listings 8. Dating things when opening

them

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ B1 _____ ___ B2 _____ ___ B3 _____ ___ B4 _____ ___ B5 _____ ___ B6 _____ ___ B7 _____ ___ B8 _____ ___

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________ ORIENTATION CHECKLIST II-Page 8 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar


Competency Statement: Demonstrates proper handling of equipment/supplies Self- Assess



A. Locates and utilizes equipment

safely B. Manages the supplies appropriately

A. Discuss and review the following: 1. Supply cart and supply closet

2. Hopper room 3. Hoyer lift 4. Linen basket 5. Warming closet 6. Water pitchers 7. IV poles 8. Equipment storage room 9. Thermometer-maintenance 10. Refill Micro Quat jug

B. 1. Restock supplies 2. Method to request/order needed

supplies 3. Food stock/disposal

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ A5 _____ ___ A6 _____ ___ A7 _____ ___ A8 _____ ___ A9 _____ ___ A10 ____ ___ B1 _____ ___ B2 _____ ___ B3 _____ ___

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________ ORIENTATION CHECKLIST II-Page 9 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B= Needs Experience C=Unfamiliar Competency Statement: Assists the patient in their personal hygiene activities


Self- Assess



D. Demonstrate the ability to perform

personal hygiene activities and performs comfort measures to the patient

A. Discuss the hygiene activities. Locates Patient Care Reference Book Manual – (use the text) 1. Bathing 2. Dressing 3. Hair care 4. Nail care 5. Oral Care 6. Shaving 7. Hearing aid 8. Glasses 9. Skin care 10. Peri care 11. Foley care 12. Foot care 13. Eye care 14. Toileting

Bed pans Urinals Commode

15. Bladder training 16. Back rubs (HS) 17. Change of patient condition 18. See study module on pain

management 19. Complete study module for skin

care 20. Complete skin care study module

final exam

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4_____ ___ A5 _____ ___ A6 _____ ___ A7 _____ ___ A8 _____ ___ A9 _____ ___ A10 ____ ___ A11 ____ ___ A12 ____ ___ A13 ____ ___ A14 ____ ___ A15 ____ ___ A16 ____ ___ A17 ____ ___ A18 ____ ___ A19 ____ ___ A20 ____ ___

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________ ORIENTATION CHECKLIST II-Page 10 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B= Needs Experience C=Unfamiliar Competency Statement: Provides comfort measures to patients Self- Performance Objectives: The Preceptor and the Orientee will: Performance



A. Provide physical and emotional

comfort measures

A. Discuss and Review the duties of the

Certified Nursing Assistant 1. Back rubs/feet rubs 2. Dim lights 3. Quiet environment 4. Fresh water 5. Social contact/limit visitors or

having family sit with patient 6. Report to nurse uncontrolled

pain 7. Cool cloth/fresh linens 8. Soft music 9. Provide emotional support 10. Aqua K pad 11. Positioning/extra blankets 12. Support use of analgesic/PCA-

pain medication 13. Patient satisfaction 14. Service excellence 15. Hospitality

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ A5 _____ ___ A6 _____ ___ A7 _____ ___ A8 _____ ___ A9 _____ ___ A10 ____ ___ A11 ____ ___ A12 ____ ___ A13 ____ ___ A14 ____ ___ A15 ____ ___

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________ ORIENTATION CHECKLIST II-Page 11 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Provide adequate fluid and nutrition Self- Performance Objectives: The Preceptor and the Orientee will: Performance



A. Provide appropriate support and

assistance B. Provide appropriate nutrition C. Provide appropriate fluids

A. Discuss and review the activities of

the Certified Nursing Assistant providing fluids and nutrition.

1. Ensure the patient has their

teeth (clean and well fitted) 2. Feed patient if needing

assistance 3. Keep track of intake and

outputs 4. Encourage a leisurely pace 5. Clarify with family if they want

to be involved in feeding 6. Make sure utensils are clean

and the tray is attractive 7. Wash hands before and after

assisting the patient with eating 8. Provide a bib/clothing protector 9. Ensure the food tray is clean

before putting it away for the next meal

10. Position patient in chair or HOB 90o(as tolerated)

B.

1. Make sure tray is attractive 2. Offer snack 3. Offer supplements and fluids

when ordered 4. Verify appropriate diet

C. 1. Thicken foods if necessary 2. Fresh water to pitchers and

observe I &O as needed

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ A5 _____ ___ A6 _____ ___ A7 _____ ___ A8 _____ ___ A9 _____ ___ A10 _____ __ B1 _____ ___ B2 _____ ___ B3 _____ ___ B4 _____ ___ C1 _____ ___ C2 _____ ___

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________ ORIENTATION CHECKLIST II-Page 12 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Assist the patient with mobility and transfers Self- Assess


The Preceptor and the Orientee will: Performance Objectives Met ( &


Preceptor’s Initials

A. Assist patient with mobility and transfers

A. Discuss and review the duties of the

Certified Nursing Assistant 1. ROM/Active and passive 2. TED’s/ SCD’s 3. Fallen patient-correct lifting 4. Ambulating and lifting 5. Transfer to

commode/wheelchair/cart 6. Hoyer 7. Slide and slipcover 8. Side rails 9. Ambulance transfers 10. Gait belt 11. Log rolling/positioning/lifting up

in bed 12. Activities-games, TV, VCR 13. Wheelchair mobility 14. Assisting with wheelchair,

walker, canes, crutches 15. Prosthetic, splints and braces 16. CPM 17. Complete Fall Risk/Prevention

Study Module 18. Complete Fall Risk/Prevention

Study Module final exam

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ A5 _____ ___ A6 _____ ___ A7 _____ ___ A8 _____ ___ A9 _____ ___ A10 ____ ___ A11 ____ ___ A12 ____ ___ A13 ____ ___ A14 ____ ___ A15 ____ ___ A16 ____ ___ A17 ____ ___ A18 ____ ___

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________ ORIENTATION CHECKLIST II-Page 13 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Provide appropriate care to the post-op patient Self- Assess


The Preceptor and the Orientee will: Performance Objectives


Met ( & Preceptor’s Initials

A. Prepare for receiving the post-op

patient B. Continuous monitoring of post-op patient C. Assures safety precautions D. Implement comfort measures


Certified Nursing Assistant 1. Get report 2. Get room ready

B. 1. Vital signs 2. Cardiac monitor 3. Pulse Ox 4. Check dressings and drains

C. 1. Assess respiratory distress 2. Side rails up 3. Call light in reach 4. Emesis basin in reach 5. Bed alarm system on if needed 6. Oxygen safety precautions

D.

1. Positioning 2. Pain control 3. Ambulation 4. Communicate with family 5. Complete Care of the Surgical

Patient Study Module 6. Complete Care of the Surgical

Study Module Final Exam

A1 _____ ___ A2 _____ ___ B1 _____ ___ B2 _____ ___ B3 _____ ___ B4 _____ ___ C1 _____ ___ C2 _____ ___ C3 _____ ___ C4 _____ ___ C5 _____ ___ C6 _____ ___ D1 _____ ___ D2 _____ ___D3 _____ ___ D4 _____ ___ D5 _____ ___ D6 _____ ___

Comments_________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature __________________________________ ORIENTATION CHECKLIST II-Page 14 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Provides Rehabilitation/Restorative Care Self- Assess





A. Identify your role in the rehabilitation/restoration process

A. Discuss and review the role of a

Certified Nursing Assistant during Rehabilitation and Restoration Care

1. Repeating exercises with patient to achieve the best result possible

2. Maintain safe environment 3. Maintain positive attitude 4. Motivating patient to achieve

the highest possible wellness 5. Promoting some degree of

independent activity 6. Assist with ADL’s

a) Dressing b) Eating c) Bathing d) Mobility e) Toileting f) Personal hygiene

7. Complete Stroke Study Module 8. Complete Respiratory Study

Module 9. Complete Care of Surgical

Patient Study Module

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ A5 _____ ___ A6 _____ ___ 7 ______ ___ 8 ______ ___ 9 ______ ___

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________ ORIENTATION CHECKLIST II-Page 15 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Assists the RN with skilled procedures Self- Assess





A. Assist the nurse in performing procedures B. Demonstrates ability to properly

handle specimens C. Demonstrates ability to perform

skilled procedures

A. Discuss and review the duties of the Certified Nursing Assistant

1. Suction/wall portable 2. Discuss and review crash cart

location 3. Croup tent 4. IV care and pump-blood tubing 5. Feeding tube pump 6. Dressing change 7. Pain Buster 8. Vital signs during blood

transfusion 9. Epidural/PCA pump 10. Sterile technique 11. Recording during code (crash

cart) locate and mobilize 12. Cleaning instruments after

procedures B.

1. Hemoccult a. Emesis b. Stools

2. 24° urine-strain-CNS-stools 3. Collecting sputum 4. Weigh chucks and diapers 5. Assist with wound culture 6. Manage draining tubes

C.

1. Bed making 2. Colon flushing 3. Ice pack/warm pack 4. O2 5. TPR-Telemetry Unit

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ A5 _____ ___ A6 _____ ___ A7 _____ ___ A8 _____ ___ A9 _____ ___ A10 ____ ___ A11 ____ ___ A12 ____ ___ B1a ____ ___ B1b ____ ___ B2 _____ ___ B3 _____ ___ B4 _____ ___ B5 _____ ___ B6 _____ ___ C1 _____ ___ C2 _____ ___ C3 _____ ___ C4 _____ ___ C5 _____ ___

ORIENTATION CHECKLIST II-Page 16 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Assists the RN with skilled procedures


Self- Assess



C. (Cont’d)

6. Drains and Foley 7. Incentive Spirometer 8. Aqua K pad 9. Colostomy & Illeostomy 10. Cast Care 11. SCD-Ted’s 12. I&O 13. See CNA skills check list 14. Bair Hugger 15. Heel and elbow protectors 16. Hoyer 17. Whirlpool 18. Enema 19. Feeding tube 20. Supra pubic catheter

C6 _____ ___ C7 _____ ___ C8 _____ ___ C9 _____ ___ C10 ____ ___ C11 ____ ___ C12 ____ ___ C13 ____ ___ C14 ____ ___ C15 ____ ___ C16 ____ ___ C17 ____ ___ C18 ____ ___ C19 ____ ___ C20 ____ ___

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________ ORIENTATION CHECKLIST II-Page 17 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Provide care to patients with specific needs: Dementia, Respiratory Problems, and CVA/Stroke Self- Assess




A. Provide effective care to specific

needs patients-Dementia


Certified Nursing Assistant with patients that have specific care needs for dementia 1. Provide safe environment 2. Confused-orient to date, time,

place 3. Use bed alarms/chair alarms 4. Use pillow cushions 5. Wandering-direct supervision 6. Fall-gait belts 7. Self injury-padded rails 8. Communicate and reminiscing 9. and redirecting to manage

behaviors 10. Education and emotional support

to families 11. ADL support 12. Emotional support and

socialization for patient 13. Validation therapy and

reminiscing 14. Provide observations 15. Report behaviors 16. Discuss code white 17. Explain “sun-downers” syndrome

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ A5 _____ ___ A6 _____ ___ A7 _____ ___ A8 _____ ___ A9 _____ ___ A10 ____ ___ A11 ____ ___ A12 ____ ___ A13 ____ ___ A14 ____ ___ A15 ____ ___ A16 ____ ___ A17 ____ ___





B. Discuss and review the duties of the

Certified Nursing Assistant with patients that have specific care needs for Respiratory Problems 1. Gather information about

patient 2. Explain use of oxygen

equipment and tanks 3. Oral care 4. Comfort measures 5. Report high rate/low rate

changes in mental status 6. Perform pulse oximeter 7. Skin protection for nasal

cannula 8. Provide humidity if oxygen is

over 5L 9. Provide emotional support to

patient and family 10. Positioning of patient or bed 11. Oxygen safety 12. Complete Respiratory Study

Module 13. Complete Respiratory Study

Module Final Exam

B1 _____ ___ B2 _____ ___ B3 _____ ___ B4 _____ ___ B5 _____ ___ B6 _____ ___ B7 _____ ___ B8_____ ___ B9 _____ ___ B10 ____ ___ B11 ____ ___ B12 ____ ___ B13 ____ ___





C. Provide effective care to specific

needs patients-CVA/Stroke

C. Discuss and review the duties of the

Certified Nursing Assistant with the patients that have specific care needs for CVA/Stroke 1. Provide safety 2. Positioning 3. Bowel care 4. Care of patient with tube feeding 5. Complete CVA/Stroke Study

Module 6. Complete CVA/Stroke Study

Module Final Exam 7. Complete Skin Integrity Study

Module 8. Complete Skin Integrity Study

Module Final Exam

C1 _____ ___ C2 _____ ___ C3 _____ ___ C4 _____ ___ C5 _____ ___ C6 _____ ___ C7 _____ ___ C8_____ ___

Comments _________________________________________________________________________________ Orientee Signature ___________________________ Preceptor Signature _______________________________ ORIENTATION CHECKLIST II – Page 20 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Complete admission process Self- Assess




A. Prepare patient room for admission B. Assess patient C. Communication/support for patient

and family


Certified Nursing Assistant 1. Bed 2. Blankets 3. Pad 4. Put valuables in safe 5. Explain TV 6. Put clothing away 7. Provide H2o

B. 1. Weight 2. Vital signs 3. Assess skin 4. Report abnormal findings to

nurse 5. Observe HIPAA 6. Put on ID/Allergy bracelets

C.

1. Direct patient family to appropriate areas for admission 2. Communicate with family

A1 _____ ___ A2 _____ ___ A3 _____ ___ A4 _____ ___ A5 _____ ___ A6 _____ ___ A7 _____ ___ B1 _____ ___ B2 _____ ___ B3 _____ ___ B4 _____ ___ B5 _____ ___ B6 _____ ___ C1 _____ ___ C2 _____ ___

Comments_________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature___________________________________ ORIENTATION CHECKLIST II – Page 21 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar Competency Statement: Complete patient discharge process Self- Assess




A. Discuss and Review the duties of the

Certified Nursing Assistant

5.

B.

C1 _____ ___

A. Prepare environment for patient discharge

B. Assess patient before discharge C. Transport patient

6. Portable 02

1. Restock materials A1 _____ ___ A2 _____ ___

2. Check list for cleaning room 3. Pack patient belongings

A3 _____ ___ 4. Getting valuables and medications

A4 _____ ___ Supply wheelchair A5 _____ ___

A6 _____ ___

1. Take vitals before leaving 2. Skin condition B1 _____ ___ 3. Family concerns B2 _____ ___ 4. Leaving AMA, LOA B3 _____ ___

B4 _____ ___ C.

1. Transfer by wheelchair to front door or to the ER door

2. Assist with transfer to the car C2 _____ ___

Comments_________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature __________________________________

ORIENTATION CHECKLIST II – Page 22 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable

C=Unfamiliar Competency Statement: Provide appropriate supportive care to the dying patient

Job Classification: Certified Nursing Assistant B=Needs Experience

Self- Performance Objectives:


Initials

Assess Met ( & Preceptor’s


A. Collaborate with hospice program A. Discuss and review the duties of the Certified Nursing Assistant

1. Follow hospice protocol (comfort care)

B.

3. Clean, dry, comfortable bed

1. Hospitality

3. Socialization

5. Complete Pain Control Study Module Final Exam

B2 _____ ___

C1 _____ ___

C3 _____ ___ C4 _____ ___

2. Follow hospice nurse instructions

A1 _____ ___ A2 _____ ___ 3. Complete Care of the Dying

Study Module 4. Complete Care of the Dying

Study Module Final Exam A3 _____ ___

5. Complete Loss and Grief Study

Module A4 _____ ___

6. Complete Loss and Grief Study

Module Final Exam A5 _____ ___

A6 _____ ___ B. Provide comfort care 1. Oral Care 2. Skin Care B1 _____ ___

4. Repositioning B3 _____ ___ B4 _____ __ C. Provide emotional support C. Provide for family needs

2. Sleeping arrangements C2 _____ ___

4. Complete Pain Control Study Module

C5 _____ ___

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________

ORIENTATION CHECKLIST II-Page 23 Code for Self-Assessment Department: Nursing-Regional Hospitals A=Comfortable Job Classification: Certified Nursing Assistant B=Needs Experience C=Unfamiliar

Competency Statement: Provides Post Mortem Care Self- Assess



A. Provides Post Mortem Care

A. Discuss and review the duties of the Certified Nursing Assistant with


patients that have specific care post mortem.

1. Discuss signs of approaching A1 _____ ___ death

2. Assist mortician with transfer of patient body

A2 _____ ___ A3 _____ ___

3. Prepare body for transfer 4. Remove tubes or medical

equipment A4 _____ ___ A5 _____ ___

5. Close eyes and mouth 6. Teeth and glasses go with the

body A6 _____ ___ A7 _____ ___

7. Bathe body A8 _____ ___ 8. Position body at 30° and position

hands 9. Allow family time with body

following cleaning

A9 _____ ___ A10 ____ ___ 10. Complete Grief/Loss Study

Module A11 ____ ___ 11. Complete Grief/Loss Study

Module Final Exam

Comments _________________________________________________________________________________ Orientee Signature _______________________Preceptor Signature ___________________________________

Name: _______________________________

PRECEPTOR EVALUATION OF CBO PROGRAM (Completed by preceptor(s) at completion of CBO)

REGIONAL HOSPITAL: CBO EVALUATIONS FOR CERTIFIED NURSING ASSISTANT PRECEPTOR

Unit/Dept. ____________________________ Date: ________________________________

Rate each of the following statements on a scale of 1-5 with 1 being strongly disagree and 5 being strongly agree. This will give Mercy Medical Center-North Iowa the opportunity to improve the orientation process. 1-Strongly Disagree to 5- Strongly Agree


1 2 3 4 5 1. I served as an effective role model for the orientee. 2. I helped the orientee socialize into the work group. 3. At the beginning of the orientation, the orientee and I assessed the orientee’s level of performance/competencies as stated on Checklist I and Checklist II and then identified learning needs. 4. I designed an orientation program in which the orientee demonstrated competency and self-confidence under my guidance/support. 5. I provided a systematic learning process that enabled the orientee to be more productive in a shorter period of time. 6. I promoted the integration of education and work values as the orientee adjusted to his/her practice/job.

7. I supported the principles of adult learning. 8. I grew professionally as a result of being a preceptor 9. Overall, I rate the orientation as a success. 10. Comments:

Upon completion, please forward a copy of this evaluation to:

• Human Resource Department

• Your Immediate Supervisor/Manager

REGIONAL HOSPITAL: CBO EVALUATIONS FOR

Date: ________________________________

Rate each of the following statements on a scale of 1-5 with 1 being strongly disagree and 5 being strongly agree. This will give Mercy Medical Center-North Iowa the opportunity to improve the orientation process.

CERTIFIED NURSING ASSISTANT ORIENTEE

Name: _______________________________ Unit/Dept. ____________________________

ORIENTEE EVALUATION OF CBO PROGRAM (Completed by orientee at completion of CBO)

1-Strongly Disagree to 5- Strongly Agree 1 2 3 4 5


1. My preceptor served as an effective role model for me. 2. I now feel like a part of the department staff. 3. The preceptor helped me identify my learning needs. 4. The preceptor and I selected experiences to meet my learning needs. 5. My preceptor directly observed my performance and provided feedback. 6. I am confident in performing my job as outlined in my job description and orientation. 7. I am confident in my ability to function as a healthcare team member. 8. I demonstrate problem-solving capabilities and recommend changes when appropriate.

9. Overall, I rate the orientation as a success. 10. Comments:

Upon completion, please forward a copy of this evaluation to:

• Human Resource Department • Your Immediate Supervisor/Manager

Title: Regional Hospital: Fall Risk/Prevention Study Module for the Certified Nursing Assistant Purpose: This module will help the Certified Nursing Assistant identify a patient’s risk factors for falling and interventions to help prevent falls Competency: Provide appropriate fall prevention measures based on patient fall risk assessment Objectives: Upon completion of this module, the orientee will:

A. Identify patients’ specific risk factors

B. Describe the safety measures to prevent falls C. Explain the purpose and complications of restraints and how to use them safely D. Identify restraint alternatives


Content: A. Risk factors for falls B. Safety Measures to prevent falls C. Restraints

E. Alternative to restraints

D. Risks of restraint use

Summary: Required Activities:

A. Read and study the Fall/Risk Prevention Study Module B. Provide care to patients with a fall risk C. Complete the final exam with the minimum accuracy of 85% D. Review video “Prevent Patient Falls”.

Approved By:

Mary Vold RN BSN Beverly Nelson CNA Diane Vrieze RN

Page 1

Introduction

Becky Finch RN Jodi Asche CNA

: One-third of all persons age 65 and older that live at home have a fall incident and

Only about one-half of older persons who are able to walk independently prior to fracturing a hip can do so following surgical repair; they often require canes, walkers, or the assistance of others. (Tideiksarr, 1996). An older person who falls is at significant risk for disability which in many cases,

one-half of those fall repeatedly (Tideiskarr, 1996).

results in nursing home placement. In fact, falls that result in broken hips account for 40% of nursing home admissions (Ebersole & Hess, 1998). Fall mortality increases with advanced age and more than doubles with each decade of life. It is the leading cause of accidental death in men and women over the age of 86 (Ebersole & Hess, 1998, Tideiksarr, 1998). The consequence of a fall effects not only the patient, but the family and the institution/facility, too. Falls in the older person are a major source of death and CBO/Nurse Assist/HCMH/8/13/2004/

disability and represent a major health problem. Overview:

People at risk for falling don’t just have to worry about falling in unfamiliar settings. Healthy, active persons are more likely to fall as a result of external factors and usually fall while away from home. The elderly tend to tall in their own environment while transferring and ambulating (Institute of Medicine, 1992). Most studies agree that the majority of falls that happen in hospitals or extended care facilities occur in bathrooms, bedrooms, or dining areas. Very few incidents happen in hallways. Peak times are during the night (usually while getting up to go to the bathroom) and from 6:00-10:00 a.m. and 4:00-8:00 p.m., periods of heightened activity (Wilson, 1998).

Content: A. Risk factors for falls

g. Bathtubs and showers 2. An urgent need to urinate is a major cause of falls 3. Fall risk increases with age

a. Light switches are within reach

5. Frequent checks are made on persons with poor judgment or memory 6. The person is assisted to the bathroom as soon as requested or the bedpan, urinal or commode is

provided

10. Crutches, canes and walkers have non-slip tips

12. Wheels of beds, wheelchairs and stretchers are locked when transferring persons

b. Lower the bed position c. Call light placed within reach d. Moved walker out of reach or items left that could cause dangers

C. Restraints

1. Most falls happen in bedrooms and bathroom: They are caused by: a. Throw rugs b. Poor lighting c. Cluttered floors d. Furniture that is out of place e. Pets under foot f. Slippery floors

4. Most falls happen in the evenings or change of shifts 5. Medications may cause an increase in the risk for falls

B. Safety Measures to prevent falls

1. Good lighting

b. Night-lights in bathrooms, hallways, and bedrooms 2. Hand rail on both side of stairs and in bathrooms

a. Safety rail b. Grab bars

Page 2

3. Floors and stairs are uncluttered 4. Tubs and showers have non-slip surfaces or non-slip bath mats

7. Offer at regular times the assistance to the bathroom-bedpan, urinal or commode 8. Bed in lower position 9. Bed rails are kept up-if ordered by Doctor

11. Wheelchair brakes are in working order

13. A safety check of the room is made after visitors leave or after giving the patient a bath a. Check the side rails


A restraint is any item, object, device, garment, material, or chemical that restrains a person’s freedom of movement or access to one’s body. Restraints are used only as a last resort to protect patients from harming themselves or others.

Restraints were once used to prevent falls. However, research shows that restraints cause falls.

There are legal, emotional, physical, and social complications associated

7. Arranging for companions and sitters

13. Outdoor time

15. Reclining chairs 16. Frequent observations

Restraints can cause serious injury and even death.

with the use of restraints.

D. Risks of restraint use 1. Agitation 2. Anal incontinence (unanswered call light when patient needs to use the bathroom, commode or

bedpan 3. Anger 4. Bruises 5. Cuts 6. Dehydration 7. Depression 8. Embarrassment 9. Fractures 10. Humiliation 11. Mistrust 12. Nerve injuries 13. Strangulation 14. Pressure sores

Page 3

E. Alternative to restraints

2. Diversion activities: example, television, videos, music, games, books 3. Pillows and positional aids 4. Keep call light within reach 5. Meeting food, fluid, and elimination needs 6. Visits by family friends and volunteers

8. Spending time with the patient 9. Reminiscing with the patient 10. A calm, quiet environment 11. Allowing wanders in a safe area 12. Exercise programs

14. Electronic warning devices on beds and doors

17. Moving the patient closer to the nurses station CBO/Nurse Assist/HCMH/8/13/2004/

18. Frequent explanation about required medical equipment and devices 19. Orienting confused individual to person, time and place. Providing calendars and clocks 20. Good lighting

Summary: Falling can cause serious physical and psychological trauma, especially in the elderly, and may lead to limited mobility, complications of excessive bed rest, and untimely

the age of 85 (Ebersole & Hess, 1998). Preexisting medical conditions combined with

than those of their younger counterparts. Even if they have not fallen, just the fear of

directly or indirectly affect mobility.

Name: ____________________

death. In fact, falls are the leading cause accidental death in men and women over

a tendency to have lower reserves cause elderly people to suffer poorer outcomes

falling and loss of self-esteem often results in tragic life-style changes that either

Score: ____________________

Regional Hospitals: Fall/Risk Prevention Final Exam for the Certified Nursing Assistant

1. True or False Most falls happen in the bathroom and bedrooms?

2. True or False Falls are the leading cause of accidental death in men and women over the age of 85. 3. Name three risk factors that could cause a fall

A. __________________________________________________________________


B. __________________________________________________________________ C. __________________________________________________________________

4. Name three safety measures to prevent falls. A. __________________________________________________________________

B. __________________________________________________________________ C. __________________________________________________________________

5. What are three risks in using restraints?

B. _________________________________________________________________

A. _________________________________________________________________ B. _________________________________________________________________

C. _________________________________________________________________ D. _________________________________________________________________

E. _________________________________________________________________

10. Most happen in the evenings

A. _________________________________________________________________

C. _________________________________________________________________

6. List some alternatives to restraints

Fall/Risk Prevention Final Exam Answer Key

1. True 2. True 3. 1. Throw Rugs 2. Poor lighting 3. Cluttered floors 4. Furniture that is out of place 5. Pets under foot 6. Slippery Floors 7. Bathtubs and Showers 8. An urgent need to urinate also is a major cause 9. Risk will increase with age

11. Medications can increase risk of falls CBO/Nurse Assist/HCMH/8/13/2004/

4. Safety Measures to prevent falls

1. Good lighting a. Light switches are within reach b. Night-lights in bathrooms, hallways, and bedrooms

2. Hand rail on both side of stairs and in bathrooms a. Safety rail b. Grab bars

3. Floors and stairs are uncluttered 4. Tubs and showers have non-slip surfaces or non-slip bath mats 5. Frequent checks are made on persons with poor judgment or memory 6. The person is assisted to the bathroom as soon as requested or the bedpan, urinal or commode is

provided 7. Offer at regular times the assistance to the bathroom-bedpan, urinal or commode 8. Bed in lower position

11. Wheelchair brakes are in working order

1. Diversion activities: example, television, videos, music, games, books

3. Keep call light within reach

8. Reminiscing with the patient 9. A calm, quiet environment

12. Outdoor time 13. Electronic warning devices on beds and doors

15. Frequent observations

9. Bed rails are kept up-if ordered by Doctor 10. Crutches, canes and walkers have non-slip tips

12. Wheels of beds, wheelchairs and stretchers are locked when transferring persons 13. A safety check of the room is made after visitors leave or after giving the patient a bath

a. Check the side rails b. Lower the bed position c. The placement of signal light d. Moved walker out of reach or items left that could cause dangers

5. Alternative to restraints

2. Pillows and positional aids

4. Meeting food, fluid, and elimination needs 5. Visits by family friends and volunteers 6. Arranging for companions and sitters 7. Spending time with the patient

10. Allowing wanders in a safe area 11. Exercise programs

14. Reclining chairs

16. Moving the patient closer to the nurses station 17. Frequent explanation about required medical equipment and devices 18. Orienting confused individual to person, time and place. Providing calendars and clocks


19. Good lighting

6. Risks on Using Restraints

3. Anger

8. Embarrassment

10. Humiliation

1. Agitation 2. Anal incontinence (unanswered call light when patient needs to use the bathroom, commode or

bedpan

4. Bruises 5. Cuts 6. Dehydration 7. Depression

9. Fractures

11. Mistrust 12. Nerve injuries 13. Strangulation 14. Pressure sores


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