Exam #2 Review
= PREP EXAM 2
= MGMT EXAM 2
Motacki and Burke (Ch. 7, 8, 9, 10, &
11)
Understand how the joint commission impacts nursing care (documentation,
medication safety, pain management, med reconciliation, etc.)
• All about SAFETY.
• “Do not use” abbreviations list:
o MgSO4 = X
o qd = X
o qod = X
o prn - ok
o NPO = ok
o STAT = ok
o U for units = X
• How does the Joint Commission impact nursing care? – documentation safety [National Pt Safety Goals (NPSGs)]
o What are they? (6)
▪ 2 forms of ID
▪ …
▪ …
▪ …
▪ …
▪ …
• Joint Commission Surveyors:
o Looks for safety!
o Measure (surveys) institutional compliance (of rules and regulations) – how do they do that?
▪ Do they do staff interviews – (walk around and talk to pts and staff) = YES
▪ look at education documentation on in-service days for staff (glucometer teaching) = NO
• look at the education material we supply pts and their families = YES
▪ Review/look at medical records (audit charts) = YES
• What are they looking for?
o unsigned HCP orders.
▪ Ex) RN takes phone order – HCP has to sign to complete the chart
• RN must document “received report”
• After getting an order via phone – write down the order,
verbatim, repeat the order back to MD.
▪ Can suspend HCPs privileges if they find an old chart with no signature.
o Unapproved abbreviation (RNs responsibility to catch it)
▪ “U” cannot be used for “Units”.
o What with no nursing notes on it (UNSAFE PRACTICE)
o No vital signs documented (UNSAFE)
o Administered BP med but no BP documented (UNSAFE)
▪ Look at employee records (through Human Resources) = NO
• Look at CPR certification, immunizations, license, etc. (through employee health) = YES
o Medication Reconciliation:
▪ Joint Commission goals include safe and accurate delivery and reconciliation of medication
administration. Goal measured – use of an admission medication list.
▪ Process for Med Reconciliation:
• 1) obtain a list of current meds for pt
• 2) develop an accurate list of newly prescribed meds
• 3) compare new meds to the list of current meds
• 4) identify and investigate any discrepancies and collaborate with HCP as necessary
, • 5) communication the finalized list with the pt, caregivers, HCP, and other team members.
▪ Started at admission (list of pts meds that they are taking when they come in to the hospital).
▪ EX) pt goes to day surgery – pt has complications in day surgery – we need to now admit them.
• Do the day surgery workers check the admission record before they send the patient to surgery?
o Yes – its required (can be fined).
o Every time a pt is moved from one area to another– med reconciliation is complete.
o Every time the pt comes back – medication reconciliation is complete.
▪ Why? – pt had surgery to get their thymus removed, now they come back
and they might not need a certain medication anymore or need a new one.
▪ DO A MED RECONCILIATION ACROSS THE CONTINUM OF CARE
• ESPECIALLY AT DISCHARGE.
▪ Pt is ordered 2x the med that is different when collected prior to admission, RN will – call MD to verify order.
o PAIN & the Joint Commission:
▪ Have to have 2 forms of pt ID before administering any care to pts.
▪ Reassessment & Evaluation (nursing process) of pain relief – MUST BE DOCUMENTED!
▪ Most common impact on RN of Joint Commission Standard through management of pain standard.
Action comply with standard = documentation of relief of pain.
Understand the RN’s role in reporting unsafe practices within the hospital:
• Pg.102
• Autonomy – privilege of self-determination in deciding what happens to one’s body - (stop tx, holding med, delegating).
o Pt making their own decisions.
▪ KNOW EXAMPLES!!!
▪ Pt is receiving chemo & wants to stop it now; as the pts advocate, RN will say – pt wants to stop the meds.
• Beneficence – duty to do good to others. Provide caring attention and treat with respect
o EX) Sitting down with a pt and talking to them in a stressful situation (empathy/sympathy)
o EX) Giving meds on time
• Veracity – adherence to the truth/honesty
o REPORTING UNSAFE PRACTICES!!! – called VERACITY!
▪ EX) RN sees unsafe practice by HCP and reports it to risk management.
▪ EX) seeing a doctor recap a needle and then putting it in the sharps.
▪ EX) someone incorrectly charts pain medication, and then takes them.
▪ EX) reporting RN to risk management for bad practice.
o Obligated to report unsafe practices – not to the person, only to the superior.
• Fidelity – duty to keep one’s word is important to maintain a respectful work environment.
o Do what you say you’re going to do.
▪ EX) say you are going to the blood bank for them.
▪ EX) say you are going to pick up someone’s shif t and then at the last minute not show up or say you can’t.
• Justice – not being biased.
o Fair and equal to all patients.
• ***Nonmaleficence – do no harm - hold the medication because BP is too low.
Know the RN’S role in ethical decision making (DNR, living will, family
relationships, etc.)
• Pg.102
• What about families that can’t make a decision about their family members care – what do/can we do?
o GET ETHICS COMMITTEE INVOLVED!
▪ We must as an RN we have to refer the family to the hospital ethics committee.
o Pt has MODS from septic shock. Pt is ventilator dependent and has a Doppler measurement BP of 80 mmHg. Family
is resistant to permit terminal weaning. RN will – ask family to meet with hospitals ethics committee.
o Pt with advance directive wants DNR & now says, “I can’t breathe, do something” –RN will – initiate resuscitation.
o Living Will – gives directions regarding end-of-life care.
Understand prioritization of care (charge RN assignments, RN bedside care, etc.)
• To prioritize the patients and RN Ch 9 pg 113. What can the RN do before delegating? What can she initiate without an
order? (aspirin, before a beta blocker is ordered for a patent that come in with chest pain)
, Nursing responsibilities leading up to the activation of the RRT.
• Know the RN role, that lead up to call the RRT, the RN needs to do her part before calling.
o Would call for chest pain, SOB, seizure, BERT (Behavioral Rapid Response)?
▪ Before alerting the RRT, the nurse needs to do her assessment, and prioritizing care.
• EX) Pt has SOB/Chest Pain – (IN ORDER) assess first, give O2, breathing tx (if respiratory pt), EKG,
check blood glucose – do all BEFORE you call a rapid
response.
o CXR – done AFTER rapid response team is called.
• DO NOT always call RRT right away!
• American Heart Association & American College of Cardiology standards of care for the cardiac pt (prioritization of care):
o Protocols for an acute MI:
▪ EX) Someone comes into the ER having an MI, what are some of the main protocols we are going to do?
• Aspirin (1st) – upon arrival – quick!
• O2
• EKG
• Nitro
o Pt needs to get transferred to ICU immediately – pt with NTG for pain.
• morphine
• diagnostic exams / labs for MI = (CK-MB, Troponins, cardiac enzymes)
Magnet Hospital Status:
• What does this mean? What are these hospitals doing to receive this kind of status?
o LOOK IN BOOK FOR SPECIFICS.
o All have a minimum of BSNs = YES
o Salary’s = NO does not deal with.
o Forming community relationship or bonds within the community = YES
o Quality improvement initiatives (improving quality of care) = YES
o Nursing leaderships / Nursing teachers / Preceptorships = YES
o Shared governance – ?
KNOW JOINT COMMISSION – RECOMMEND READING PWPT SLIDES
ASKS ABOUT DIFFERENT ORGANIZATIONS AND WHAT THEY DO! (SATA)
What do federal and state departments of health regulatory agencies do in hospitals? (what is their jurisdiction in hospitals?)
• Investigate & make judgments on complaints brought by consumers of services (pts/families) in the hospital & in the public.
o EX) HIPPA complaint
National Institute of Health (NIH):
• Headed up by who? – Benjamin Carson (the Secretary of the US Department of Health and Human Services).
• What does the NIH do? – all about one major thing – RESEARCH about health.
HOSPITAL – FINES:
• HCP leaving charts unsigned = FINE
• Not washing hands when coming out of pts room = FINE
• HIPPA violation = FINE
• Equipment not tested (not up-to-date with sticker) = FINE
• Sharps container is full and over-flowing = FINE
• PPE not being used properly (breech in isolation protocol) = FINE
Infection Control:
• Who monitors compliance of infection control? – infection control nurse (management/administrative position)
o Scrubbing the hub of the IV tubing port
o IV tubing – labeled & dated.
o Sterile dressing changes – all done within 72 hrs.
Nurse Manager:
= PREP EXAM 2
= MGMT EXAM 2
Motacki and Burke (Ch. 7, 8, 9, 10, &
11)
Understand how the joint commission impacts nursing care (documentation,
medication safety, pain management, med reconciliation, etc.)
• All about SAFETY.
• “Do not use” abbreviations list:
o MgSO4 = X
o qd = X
o qod = X
o prn - ok
o NPO = ok
o STAT = ok
o U for units = X
• How does the Joint Commission impact nursing care? – documentation safety [National Pt Safety Goals (NPSGs)]
o What are they? (6)
▪ 2 forms of ID
▪ …
▪ …
▪ …
▪ …
▪ …
• Joint Commission Surveyors:
o Looks for safety!
o Measure (surveys) institutional compliance (of rules and regulations) – how do they do that?
▪ Do they do staff interviews – (walk around and talk to pts and staff) = YES
▪ look at education documentation on in-service days for staff (glucometer teaching) = NO
• look at the education material we supply pts and their families = YES
▪ Review/look at medical records (audit charts) = YES
• What are they looking for?
o unsigned HCP orders.
▪ Ex) RN takes phone order – HCP has to sign to complete the chart
• RN must document “received report”
• After getting an order via phone – write down the order,
verbatim, repeat the order back to MD.
▪ Can suspend HCPs privileges if they find an old chart with no signature.
o Unapproved abbreviation (RNs responsibility to catch it)
▪ “U” cannot be used for “Units”.
o What with no nursing notes on it (UNSAFE PRACTICE)
o No vital signs documented (UNSAFE)
o Administered BP med but no BP documented (UNSAFE)
▪ Look at employee records (through Human Resources) = NO
• Look at CPR certification, immunizations, license, etc. (through employee health) = YES
o Medication Reconciliation:
▪ Joint Commission goals include safe and accurate delivery and reconciliation of medication
administration. Goal measured – use of an admission medication list.
▪ Process for Med Reconciliation:
• 1) obtain a list of current meds for pt
• 2) develop an accurate list of newly prescribed meds
• 3) compare new meds to the list of current meds
• 4) identify and investigate any discrepancies and collaborate with HCP as necessary
, • 5) communication the finalized list with the pt, caregivers, HCP, and other team members.
▪ Started at admission (list of pts meds that they are taking when they come in to the hospital).
▪ EX) pt goes to day surgery – pt has complications in day surgery – we need to now admit them.
• Do the day surgery workers check the admission record before they send the patient to surgery?
o Yes – its required (can be fined).
o Every time a pt is moved from one area to another– med reconciliation is complete.
o Every time the pt comes back – medication reconciliation is complete.
▪ Why? – pt had surgery to get their thymus removed, now they come back
and they might not need a certain medication anymore or need a new one.
▪ DO A MED RECONCILIATION ACROSS THE CONTINUM OF CARE
• ESPECIALLY AT DISCHARGE.
▪ Pt is ordered 2x the med that is different when collected prior to admission, RN will – call MD to verify order.
o PAIN & the Joint Commission:
▪ Have to have 2 forms of pt ID before administering any care to pts.
▪ Reassessment & Evaluation (nursing process) of pain relief – MUST BE DOCUMENTED!
▪ Most common impact on RN of Joint Commission Standard through management of pain standard.
Action comply with standard = documentation of relief of pain.
Understand the RN’s role in reporting unsafe practices within the hospital:
• Pg.102
• Autonomy – privilege of self-determination in deciding what happens to one’s body - (stop tx, holding med, delegating).
o Pt making their own decisions.
▪ KNOW EXAMPLES!!!
▪ Pt is receiving chemo & wants to stop it now; as the pts advocate, RN will say – pt wants to stop the meds.
• Beneficence – duty to do good to others. Provide caring attention and treat with respect
o EX) Sitting down with a pt and talking to them in a stressful situation (empathy/sympathy)
o EX) Giving meds on time
• Veracity – adherence to the truth/honesty
o REPORTING UNSAFE PRACTICES!!! – called VERACITY!
▪ EX) RN sees unsafe practice by HCP and reports it to risk management.
▪ EX) seeing a doctor recap a needle and then putting it in the sharps.
▪ EX) someone incorrectly charts pain medication, and then takes them.
▪ EX) reporting RN to risk management for bad practice.
o Obligated to report unsafe practices – not to the person, only to the superior.
• Fidelity – duty to keep one’s word is important to maintain a respectful work environment.
o Do what you say you’re going to do.
▪ EX) say you are going to the blood bank for them.
▪ EX) say you are going to pick up someone’s shif t and then at the last minute not show up or say you can’t.
• Justice – not being biased.
o Fair and equal to all patients.
• ***Nonmaleficence – do no harm - hold the medication because BP is too low.
Know the RN’S role in ethical decision making (DNR, living will, family
relationships, etc.)
• Pg.102
• What about families that can’t make a decision about their family members care – what do/can we do?
o GET ETHICS COMMITTEE INVOLVED!
▪ We must as an RN we have to refer the family to the hospital ethics committee.
o Pt has MODS from septic shock. Pt is ventilator dependent and has a Doppler measurement BP of 80 mmHg. Family
is resistant to permit terminal weaning. RN will – ask family to meet with hospitals ethics committee.
o Pt with advance directive wants DNR & now says, “I can’t breathe, do something” –RN will – initiate resuscitation.
o Living Will – gives directions regarding end-of-life care.
Understand prioritization of care (charge RN assignments, RN bedside care, etc.)
• To prioritize the patients and RN Ch 9 pg 113. What can the RN do before delegating? What can she initiate without an
order? (aspirin, before a beta blocker is ordered for a patent that come in with chest pain)
, Nursing responsibilities leading up to the activation of the RRT.
• Know the RN role, that lead up to call the RRT, the RN needs to do her part before calling.
o Would call for chest pain, SOB, seizure, BERT (Behavioral Rapid Response)?
▪ Before alerting the RRT, the nurse needs to do her assessment, and prioritizing care.
• EX) Pt has SOB/Chest Pain – (IN ORDER) assess first, give O2, breathing tx (if respiratory pt), EKG,
check blood glucose – do all BEFORE you call a rapid
response.
o CXR – done AFTER rapid response team is called.
• DO NOT always call RRT right away!
• American Heart Association & American College of Cardiology standards of care for the cardiac pt (prioritization of care):
o Protocols for an acute MI:
▪ EX) Someone comes into the ER having an MI, what are some of the main protocols we are going to do?
• Aspirin (1st) – upon arrival – quick!
• O2
• EKG
• Nitro
o Pt needs to get transferred to ICU immediately – pt with NTG for pain.
• morphine
• diagnostic exams / labs for MI = (CK-MB, Troponins, cardiac enzymes)
Magnet Hospital Status:
• What does this mean? What are these hospitals doing to receive this kind of status?
o LOOK IN BOOK FOR SPECIFICS.
o All have a minimum of BSNs = YES
o Salary’s = NO does not deal with.
o Forming community relationship or bonds within the community = YES
o Quality improvement initiatives (improving quality of care) = YES
o Nursing leaderships / Nursing teachers / Preceptorships = YES
o Shared governance – ?
KNOW JOINT COMMISSION – RECOMMEND READING PWPT SLIDES
ASKS ABOUT DIFFERENT ORGANIZATIONS AND WHAT THEY DO! (SATA)
What do federal and state departments of health regulatory agencies do in hospitals? (what is their jurisdiction in hospitals?)
• Investigate & make judgments on complaints brought by consumers of services (pts/families) in the hospital & in the public.
o EX) HIPPA complaint
National Institute of Health (NIH):
• Headed up by who? – Benjamin Carson (the Secretary of the US Department of Health and Human Services).
• What does the NIH do? – all about one major thing – RESEARCH about health.
HOSPITAL – FINES:
• HCP leaving charts unsigned = FINE
• Not washing hands when coming out of pts room = FINE
• HIPPA violation = FINE
• Equipment not tested (not up-to-date with sticker) = FINE
• Sharps container is full and over-flowing = FINE
• PPE not being used properly (breech in isolation protocol) = FINE
Infection Control:
• Who monitors compliance of infection control? – infection control nurse (management/administrative position)
o Scrubbing the hub of the IV tubing port
o IV tubing – labeled & dated.
o Sterile dressing changes – all done within 72 hrs.
Nurse Manager:
