UM Sylvester Student Orientation Self-Study Packet

Student Orientation Self-Study PacketStudent Orientation Self-Study Packet Page 1 of 21 of 21

to the

UM Sylvester Comprehensive CancerUM Sylvester Comprehensive Cancer CenterCenter

MISSION, VISION, AND VALUES 2

A LONG AND PRESTIGIOUS HISTORY 3

OVERVIEW OF FACILITY SERVICES 4

NURSING RESPONSIBILITIES IN CLINCIAL AREAS 9

MEDICATION ADMINISTRATION 10

INCIDENT REPORTING 10

GENERAL SAFETY GUIDELINES 11

CODE RED (FIRE) 12

CODE BLUE (CARDIAC ARREST) 14

CODE YELLOW ( BOMB THREAT) 15

CODES 15

NEUTROPENIC PRECAUTIONS 15

INFECTION CONTROL 16

PAIN ASSESSMENT/PATIENT SAFETY/IV THERAPY 17

DRESS CODE/PARKING/BREAKS/SICK CALL 19

HOURS OF OPERATON 20

VISITNG HOURS/TELEPHONE 21

ADDITIONAL REQUIREMENTS 21

Welcome

Student Orientation Self-Study PacketStudent Orientation Self-Study Packet Page 2 of 21 of 21MISSION, VISION, AND VALUES

MISSION

We seek to reduce the human burden from cancer and other serious illnesses through research, education, prevention, and the delivery of quality patient care.

VISION

UM/Sylvester will become a fully integrated program of patient care, education, and research with an international reputation for excellence.

UM/Sylvester will provide new hope for cancer patients in our extended community, which includes South Florida, the southeastern United States, the Caribbean, and South America.

UM/Sylvester will promote efficient, community responsive health care, and generate resources to sustain and enhance innovative cancer programs.

VALUES

Excellence – to go beyond the limits in accomplishments and expectations.

Compassion – to work and care for the welfare of others, along with a desire to alleviate suffering.

Respect – to recognize the worth, quality and importance of others.

Discovery – to embrace the never-ending quest for new knowledge and awareness.


A LONG AND PRESTIGIOUS HISTORY

First established in 1937. National Children’s Cardiac Hospital (NCCH).

Present building occupied in 1963. Continued as a Children’s Cardiac Hospital.

Obtained by the University of Miami in 1965 Integrates adult focused care.

In 1971, the building was enlarged and renamed University of Miami Hospital and Clinics.

In 1992, after a generous donation from the Sylvester family, the Sylvester Cancer Center was opened.

Today, it serves as the hub for cancer-related research, diagnosis, and treatment at the University Of Miami Leonard M. Miller School of Medicine. Since opening 15 years ago, UM/Sylvester has transformed cancer research and treatment in South Florida and beyond.

UM/Sylvester handles nearly 1,600 inpatient admissions annually, 175,000 outpatient visits, performs 2,600 surgical procedures, and treats 3,400 new cancer patients. All UM/Sylvester physicians are on the faculty of the Miller School of Medicine, South Florida's only academic medical center.


OVERVIEW OF FACILITY SERVICES

UM/Sylvester employs approximately 600 people – over a third of which are nursing professionals.

3 Nursing Units have a capacity for patient overnight stays:1. Inpatient Unit2 nd floor UMHC building Carol James, RN Acting

Manager : Operates 24/7 Maximum capacity = 38 beds Mainly cancer related treatment and post-operative patients

2. Comprehensive Treatment Unit (CTU) 2 nd floor SCCC building Dianne McKenzie, RN, MSN, AOCN ® Director: Consists of 7 private 24-hour overnight stay rooms that operate

24/4 Consists of 22 cubicles for outpatient chemotherapy

administration that operate Monday thru Friday

3. Perioperative Services2 nd floor SCCC building Maria Cabrera, RN, BA, MA Director : Outpatient and complicated surgical procedures Operates 24/6 – Scope of service includes:

4 cubicles in Holding Unit for preoperative preparation 3 cubicle Acute PACU (Recovery Room) 4 stepdown/24-hour stay beds in recovery room 6 recliner spaces as stepdown/predischarge area 5 active Operating Suites Pain Management Services

Surgeries include: Oncological Head & Neck Surgery, General Surgery (e.g.

Mastectomies), Urological Procedures, Facial Plastic & Reconstructive Surgery, Endoscopic Sinus Surgery, and many more …


Outpatient Clinic Areas include:1. OPD-1 Clinic 1st floor UMHC building Kimberly McDuffie, RN

Acting Manager:Services include: Arthritis Clinic Endocrinology Hepatology Infectious Diseases Internal Medicine

Nephrology Orthopedics Pulmonology General Surgery Vascular Surgery

2. Spine Institute 1 st floor UMHC building Kimberly McDuffie, RN Acting Manager: Services include: Neurospinal Injury and Disease

3. Radiation Oncology Department Ground floor SCCC building (RadOnc) Cynthia Bradley, RN, BSN, OCN® Manager : Services include: Clinic area for pre and post treatment assessments Radiation therapy treatment suites

4. Hematology Oncology Clinic 2 nd floor SCCC building (HemOnc) Lisette Zelaya, RN Manager : Services include: Hematology Oncology Medical Oncology Bone Marrow Procedures

5. Gynecology Oncology Clinic Ground floor SCCC building (GYO) Lisette Zelaya, RN Manager : Services include: Gynecology health assessments Gynecologic oncology

6. Surgical Oncology Clinic (SurgOnc) 2 nd floor SCCC building Joan

Brewer, RN Manager : Services include: Sinus & Voice Clinic General/Surgical Oncology Physicians Thoracic Surgery Facial Plastic & Reconstructive Surgery


7. Head and Neck Clinic 1 st floor SCCC building Lisette Zelaya, RN Acting Manager : Services include: Head and Neck Cancer Screening Surgical Evaluation and Follow-Up

8. Mohs Clinic2 nd floor UMHC (across from inpatient) building Maria Cabrera, RN, BA, MA Director : Dr. Mohs invented procedureServices include: Cutaneous Surgery for Basal Cell, Squamous Cell

Carcinomas Melanoma and other skin cancers

9. GI/Special Procedures 1 st floor SCCC building Jean Tyson, RN Manager Special Procedures; Alex Medina, RN, BSN Acting Manager GI Procedures : Services include: GI/Colorectal Clinic Area GI Procedure Area

(e.g. Colonoscopy, Sigmoidoscopy)

10. General Medicine Clinic 3 rd floor UMHC building Carmen Enfante, RN, MSN Manager : Services include: Treatment of various general/internal medicine illness

(e.g. UTI’s, Back Pain, Hypertension)

11. Cardiology Clinic 3 rd floor UMHC building Nicolle Doel, RN Acting Manager : Services include: Pediatric & Adult Cardiac Assessment and Care


12. Cardiology Non Invasive Lab Clinic 3 rd floor UMHC building Maria Cabrera, RN, BA, MA Director :

Services include: Pediatric & Adult Non-Invasive Diagnostics Stress Testing Tilt Table Testing – Syncope History EKG Dobutamine Stress Test Stress Echocardiogram Pacemaker Evaluation Metabolic Stress Test

Ancillary Departments:1. Radiology Services including 1 st floor UMHC building:

Mammography, Nuclear Medicine, Ultrasound, CT Scan, etc.

2. Interventional Radiology Services1 st floor UMHC building :

Arteriogram Venogram Biliary Catheter Placement Cardiac Catheterization Port/Hickman Catheter Placement

3. Full Service Laboratory 2 nd floor SCCC building: Phlebotomy and Diagnostics

4. Respiratory Therapy/Pulmonary Lab2 nd floor SCCC building: Hospital wide Respiratory Care Pulmonary Treatments (Pentamadine) Pulmonary Function Testing

5. Patient relations 2 nd floor SCCC building

6. Pharmacy 2 nd floor SCCC building


NURSING: KEY PERSONNELName Title Phone Number

Anne Smith Chief Nursing Officer 305-243-4388

Elizabeth Smith Director of NursingDirector of Education

305-243-4388

Dianne McKenzie Director, Comprehensive Treatment Unit

305-243-5234

Maria Cabrera Director Per-Op Services 305-243-5210

Carol James Acting Manager Inpatient Unit 305-243-6894

Deborah O’Connor Director Ambulatory Services 305-325-4519

Tony Astles Staff Educator 305-243-9192

Eileen Butler Oncology Educator 305-243-9192

Margaret Suppa Administrative Assistant Clinical Nursing Services

305-243-4388

Brenda Lee Education Office Coordinator 305-243-9192

Maggie Kane Infection Control 305-325-5620


NURSING RESPONSIBILITIES IN CLINCIAL AREAS

Outpatient Clinics New patient evaluation Follow up patients post diagnostics/surgery Duties similar to physician office Nurses check in patients, take drug and allergy history as well as

weight and vital signs; – record on Patient Discharge Form; Complete medication reconciliation form

Schedule diagnostics, such as lab, x-ray, mammography, etc. Assist physicians with treatments and procedures Schedule appointments for consults and return visits Provide patient education for discharge

Over Night Stay Units: 24 hours CTU – Perform infusion therapy, including blood products,

chemotherapy, and various intravenous medication therapies – Also has an outpatient treatment area, Prived pateint education

PACU – Post surgical observation and critical monitoring

Inpatient Unit: Extended stay treatment and monitoring: Post surgical care Multiple dose chemotherapy infusions Blood support – replacement therapy Radiation therapy – radioactive implants Tracheostomy care/ Ostomy care Palliative and hospice care Pain management Patient education/Discharge planning Documentation of nursing process on forms – Progress Notes, Graphic

record, flow records, MAR

MEDICATION ADMINISTRATIONIn orientation, you will review nursing medication administration medication

policy #132 Pyxis Medication Distribution System:


Stock medication appropriate to various patient care areas kept in Pyxis System

Includes stock Intravenous Solutions, all controlled drugs, and some intravenous, parenteral, and oral medications

Note: NO Potassium or Dilantin is kept in Pyxis

Physician order medications: Orders faxed to Pharmacy when received

Pharmacy fill immediate dose requirements Pharmacy provides pre mixed bags of IV medication solutions Medication carts with individual patient cassettes for prescribed

medications not included in Pyxis profile

Prescription Medications: We have a full service Outpatient Retail Pharmacy area 2ndl floor

SCCC building

INCIDENT REPORTING

Incident is an occurrence that has caused, or has the potential to cause, injury to a patient, employee, physician or visitor. For incidents involving a registered patient we record on the Patient

Safety Report For incidents involving any other person (not a registered patient) we

record on the UM Injury/ Accident Report

For any reportable incident you MUST inform your preceptor and nursing instructor immediately: You will be involved in completing the appropriate incident report Never make mention of incident report in Nurse’s Notes on Patient’s

Medical Record Forward all incident reports to Risk Management A sentinel event occurs as a result of an unanticipated death or major permanent loss of function, not related to the expected course of the patient illness or underlying condition

Suicide of a patient in a setting where the patient receives around-the-clock care (e.g., hospital, residential nursing or treatment centers, crisis rehabilitation center)

Infant abduction or discharge to the wrong family Rape Hemolytic transfusion reaction involving administration of blood and

blood products having major blood group incompatibilities


Surgery on the wrong patient or wrong body part Within 24 hours of their occurrence the sentinel event needs to be

reported to the Risk manager.

GENERAL SAFETY GUIDELINES

As part of minimizing or preventing potential safety hazards, the following guidelines are established: Never block aisles or exits with boxes, chairs, stretchers, etc., even temporarily.

Positively NO RUNNING! Traffic passes to the right.

Approach corners and corridor intersections cautiously, using the overhead mirrors to avoid collisions.

Push vehicles, carts, stretchers, etc. SLOWLY. See your way ahead.

Push vehicles, carts, stretchers, etc. from the end (not the sides) to avoid smashing your fingers. Keep patient hands inside bed rails and wheelchairs.

Discard disposable items in the proper containers.

DO NOT eat or drink in the work area.

Wipe up spills immediately.

Observe NO SMOKING rules. Smoking is allowed in designated areas ONLY. Sylvester courtyard area – the cubicles at the end of each side UMHC area – outside in front of trailer

Be alert to potential safety hazards and report them to your instructor/preceptor.

REMEMBER: It is everyone’s responsibility to maintain a safe work environment for our patients, visitors, and co-workers. Prevention and/or prompt recognition of potential safety hazards are key. When in doubt, check it out! Bring all identified potential safety hazards to the attention of your instructor/preceptor. In case of emergencies, take prompt action. Do not delay taking appropriate action.


CODE RED (FIRE)

Treat all fire alarms as the ‘real thing’ until informed otherwise.

NEVER BECOME COMPLACENTNEVER BECOME COMPLACENT

When fire alarm sounds proceed to close all unit doors – reassure all patients that they are not in danger and will be attended to if necessary.

Do not leave your unit – report to your preceptor/instructor for further instructions.

Upon arrival to your assigned unit familiarize yourself to location of fire pull-stations and fire extinguishing equipment.

Ask your preceptor the correct evacuation route for patients and personnel, locate emergency exits, and ask about procedures used in that unit.

Know location of Oxygen Shut Off Valve.

If you discover a fire on your unit, we use the acronym:

R – remove patients from danger

A – activate pull station alarm and call 6-6000

C – confine fire by closing doors and windows

E – extinguish or evacuate


We have ABC fire extinguishers for use on Electrical, Paper and Chemical fires. To use a fire extinguisher remember PASS:

P - pull the pin

A - aim at the base of the fire

S - squeeze the trigger

S - sweep from side to side

If fire is small and confined to a small area: Fight it!Fight it! Always leave yourself an exit! Stay calm – Don’t panic

CODE BLUE (CARDIOPULMONARY ARREST)

Nursing Services Policy and Procedure Manual, Inpatient Section, Policy #110 “CODE BLUE” Code Blue Procedure:

Establish unresponsiveness. Call out for help – “Code Blue” and location

Initiate BLS protocols as per AHA/BLS. Activate Code Blue system by:

a. Dial 6-6565 (code blue phone will ring in Inpatient Nurses’ Station).


b. State “Code Blue” give location of arrest (indicate unit/area room number and floor). If it is a pediatric arrest, it should be indicated at this time.

Crash Cart/Defibrillator will be delivered to scene. Code Team to arrive within 3-5 minutes. AEDs located #1 entrance UMHC building 1st floor by

security desk and #2 main information desk SCCC building ground floor by radiation oncology

Students to observe and help only as directed by preceptor and nursing instructor.

CODE YELLOW (BOMB THREAT) Bomb threat called in… Refer to Quick Guide Bomb

Threat Checklist On Inside Cover

Notify your preceptor immediately!

CODES AND OTHER SAFETY REMINDERS

REFER TO ORANGE QUICK REFERENCE EMERGENCY PREPAREDNESS PROCEDURE BOOK

CODES DEFINITION

PROCEDURE

Code Yellow Bomb ThreatDial 6-6000 to notify Security and report situation

Code Blue Cardiopulmonary ArrestDial 6-6565 and announce Code Blue

Code D Internal DisasterNotify Administrator or designee who will then notify security to activate procedure

Code RedFire

Dial 6-6000 to notify Security and report situation




CODES DEFINITION

PROCEDURE




Code RedFire




CODES DEFINITION

PROCEDURE




Code RedFire


NEUTROPENIC PRECAUTIONS Nursing Policy #185Neutropenia is the single most important factor associated with infection in immunocompromised patient

Infections that develop in a patient who is neutropenic can be life threatening

Neutropenia is defined as Less than 1000cells/mm3 circulating neutrophils.

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Student Orientation Self-Study PacketStudent Orientation Self-Study Packet Page 16 of 21 of 21Normal counts range from 2500 to 6000cells/mm3ANC = absolute neutrophil count important determining patients risk for infections

The most important thing you can do to prevent most infections:

WASH YOUR HANDS!

Use of Alcohol based products in between patients care and washing hands with soap/water:

Helps prevent the spread of disease and infection

All IV sites and central venous catheters Adherence to policies for aseptic technique for CVC care and peripheral site and tube changes per policy

Insertion medication No rectal temperature taken nor any suppositories or enemas to be administered to these patients

Temperature equal to above 100.5°F; vitals signs at least every four hours

Fever may be the only sign of infectionSystem assessment every shift

Protective isolation In hospital when neutrophil count less an 1000cell/mm3 patient placed in private room, no fresh cut flowers, no visitors or staff to care for patient with transmittable diseases

Patient and family education Essential for most patients experience neutropenia while at home

Infection Control

INFECTION CONTROL Nursing Policy #162A thorough infection control program can: Help shorten the patient’s stay/decrease hospital cost

Decrease nosocomial infectionsStandard precautions means: Wearing appropriate personal protective equipment (PPE).The most important thing you can do to prevent most infections:

WASH YOUR HANDS!

Use of Alcohol based products in between patients care and washing hands with soap/water:

Helps prevent the spread of disease and infection

Remove all personal protective equipment (PPE) before leaving a patient care area:

THIS IS A MUST!

You must consider that all patients may carry HIV or Hepatitis B infection:

KEEP THIS IN MIND AT ALL TIMES!

Other important Key Points: It is not acceptable to eat/drink in the work areaYou must wear eye protection/mask if splashing or spraying of body fluid is anticipated.If you come in contact with blood or other body fluids, you should wash your skin immediately.You must clean equipment and work surfaces at the end of your shift or when they are visibly contaminated?DO NOT recap needles. List of Disposal Containers:

CLEAR plastic bag – paper, cups, etc. RED plastic bag – biohazard waste, any material saturated

with blood Puncture resistant container – needle/sharps

Transmission-based precautions: Droplet - transmitted by large particle droplets

Student Orientation Self-Study PacketStudent Orientation Self-Study Packet Page 17 of 21 of 21containing microorganism. Droplets can be generated from coughing, sneezing, talking, during suctioning or bronchoscopy. (ex: meningitis, pneumonia, mumps, rubella)

Precaution: Gloves, gown, surgical mask, protective eyewear, private room

Airborne = transmitted by airborne droplet nuclei. (ex: measles, chickenpox, tuberculosis)

Precaution: N95 particulate respirator mask, gloves, private room with negative pressure.

Care giver & visitors must have immunity Pt’s room door must remain closed

Contact - transmitted by direct patient contact or by contact with items in the patient’s environment. (ex: VRE, MRSA, scabies, conjunctivitis)

Precaution: Gloves, gown, strict handwashing

PAIN MANAGEMENT Nursing Policy #1901. An assessment of Pain will be completed at beginning of each clinic visit, for each pre and post procedure and upon admission.

Document on designated form for pain assessment.

2. An ongoing assessment of pain and management will continue throughout the patient’s hospital stay following this format:

Standardized Pain Scale from 1 to 10. Document on Pain Assessment ToolPain is whatever the perceiver states it is.

3. Patients response to pain following intervention must be documented as follows:

Refer to specified guidelines on Pain Assessment Tool, based upon route of administration.Time frame for reassessment of pain is based on the intervention.

PATIENT SAFETY/FALL RISK Administrative Policy #285 1. Nursing staff will assess the patient for safety/fall risk at the time of admission, every shift and as change in condition:

Place patient at risk for falls on Fall precautions. Place a Purple armband.

1. The following reporting system is used for all patient falls:

Patient Safety Report.

PATIENT SAFETY ALERT ARMBANDSPatient safety alert armbands: White In-patient ID band

YELLOW ALLERGY

Red RED Rr BLOOD

Purple FALL


IV THERAPY1.Periopheral IV SITE CARE /SITE CHANGE per policy is:

Q96 hours and PRN.

2.Central venous catheter Port change needle every 7 daysOcclusive dressing change every 7 daysGauze dressing change every other day

3. IV tubing change per policy is:IV tubing Q 72 hrs, TPN/Lipids is 24 hours

4. IV fluids are documented as follows: Signed off on MAR, any IV flow sheets,

RESTRAINTS Administrative Policy #143It is the policy of the university of Miami Hospital and Clinics and Sylvester Comprehensive Cancer center to decrease restraint use through effective, preventative strategies or use of innovative alternative measures. If alternative measures are ineffective, the less restrictive method of restrain impossible is used and applied and removed by qualified staff. The restraint must be discontinued at the earliest possible time. All patients have the right to the safe implementation of restraint by trained personnel.Patient population (s) or risk factors of those prone to the use of restraints:

Patients who are confused, disoriented, have an unsteady gait and are prone to wandering with a risk for injury, pose a danger to self or others, and which have not responded to alternatives attempted.

Alternatives must be attempted prior to restraint use

Quiet area Nutrition/hygiene Change area Diversional activity Bed alarm Reassurance Family interaction Pain management Commode Orientation Reposition Medications Close to nursing station Sitter Music/TV

Criteria for the use of restraints: Non-behavioral reasons – patient is unable to follow directions to refrain actions that can injure self, impulsivedisconnecting/removing therapeutic devices, medically unsafe attempts at mobility Behavioral reasons – Combative, danger to self and others

Monitoring/Documentation The following will be assessed, monitored and documented: Alternatives attempted Behavior Respiratory status Compromised circulation Restraint device Vital signs (BP, HR, RR) Removal and reapplication appropriately to provide care Whether less restrictive methods of restraint are possible Patient rights, dignity maintained

Student Orientation Self-Study PacketStudent Orientation Self-Study Packet Page 19 of 21 of 21 Hydration and nutrition needs Elimination and hygiene needs Skin integrity Skin care and repositioning Signs of injury Range of motion/Exercise of limbs

DRESS CODE

Uniform as per School’s policy: Uniforms must be neat, clean, and wrinkle-free.

Hair must be clean and neat. It should be confined up and off shoulders.

Nails must be clean and trimmed. No artificial nails permitted. Nail polish, if worn, must be conservative and remain intact without

chipping, no appliqué, or peeling.

Jewelry that does not create a safety hazard may be worn. No dangling earrings. Watch with a second hand is a required part of the complete uniform. Dangling or bangle bracelets are not permitted.

Hosiery must cover all exposed areas of the legs. No socks or knee-highs with skirts or dresses.

Shoes must be clean. No sandals or canvas shoes.

ID badge must be worn at all times in a visibly acceptable area.

PARKING

Students may park in any of parking garages on UM medical campus. Sylvester parking requires valet charge of $20.00.


BREAKS

You may take breaks as per your instructor’s approval Please notify your preceptor that you will be taking a break

SICK CALL

Notify your individual instructor

HOURS OF OPERATION

Cardiology Clinic.................................................8:00a.m.-6:00p.m.Cardiology Lab.....................................................8:00a.m.-6:00p.m.Nursing Administration........................................8:00a.m.-5:00p.m.CTU (Mon., Tues., Thurs.)...................................24 hours

(Wed &Fri.)................................................7:00a.m.-7:30p.m.Cafeteria...............................................................7:15a.m.-9:00p.m.Employee Health..................................................7:30a.m.-4:00p.m.General Medicine.................................................8:00a.m.-5:00p.m.GYO.....................................................................8:00a.m.-4:30p.m.Head & Neck Clinic.............................................8:00a.m.-5:00p.m.HemOnc...............................................................8:00a.m.-4:30p.m.Infection Control..................................................8:00a.m.-5:00p.m.Inpatient................................................................24 hoursLaboratory............................................................24 hoursMedical Records...................................................7:00a.m.-11:30p.m.OPD-1...................................................................8:00a.m.-9:30p.m.Periop Services.....................................................24 hours (Except Sat/Sun)

GI.................................................................8:00a.m.-5:30p.m.Special Procedures.......................................7:30a.m.-5:00p.m.Mohs Clinic.................................................8:30a.m.-5:00p.m.

PharmacyInpatient.......................................................24 hoursObservation & Surgical...............................24 hoursOutpatient Clinics........................................8:00a.m.-5:30p.m.Take Home Prescriptions.............................9:00a.m.-5:00p.m.


RadOnc.................................................................8:00a.m.-5:30p.m.Radiology.............................................................6:30a.m.-8:00p.m.Respiratory Therapy.............................................6:30a.m.-11:00p.m.Risk Management.................................................24 hoursSurgOnc Clinic.....................................................8:00a.m.-5:00p.m.Transportation......................................................24 hours

VISITING HOURS

Inpatient Nursing Units: 11:00am–9:00pmBREAKS, TELEPHONE, AND SICK CALLTELEPHONE

For an outside line, dial 9 + 305 + phone number To dial in-house, dial 6 + extension

ADDITIONAL REQUIREMENT S

A computer based learning module program in, ULearn, will be assigned to you for your review and completion. You will receive instructions in orientation as to how to access this system. It requires a login with sign in which will be your C Number and password. Each student must read the material in the modules, complete the testing for each module and present the certificate of completion prior to beginning your clinical rotation on the unit. Failure to complete this process will result in your inability to begin clinical rotation on the units at UMSylvester

UM Sylvester Student Orientation Self-Study Packet

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