SPECTRUM HEALTH



SPECTRUM HEALTH Revised 8/2011Radiology RN Orientation Validation ToolOrientee Name: Kimberly ‘Kim’ Thompson Unit: Interventional RadiologyEmployee Number: _____________________________________Preceptor Signature/Initials:Self Assessment Code (SAC) Key:0 = No knowledge or experience1 = Need assistance2 = Can perform independently3 = Able to resource othersValidation Options:O = preceptor observes the orientee performing behavior or skill according to standardV = orientee verbalizes knowledge and understanding of behavior according to standardNOTES: All entries must be legible and in black ink.Learning resources are listed under each critical behavior. Learning resources that are italicized are considered mandatory and MUST be read, dated and initialed by orientee before validation of behavior. Where there is a space for an example, please write the example on the line provided. If example was verbalized to preceptor, please indicate so on the line provided. CRITICAL BEHAVIORS TO BE VALIDATED BY THE END OF ORIENTATIONSACValidation: preceptor to date, initial and circle methodCOMPETENCY #1: The nurse collects and analyzes client health data.Performs/Reviews and documents initial/admission assessment and history and physical (H&P).Clinical Policy: Assessment Standards for Nursing (Review Date)________________Clinical Policy: Histories and Physicals (H&P) for Patients Undergoing Operative and Invasive Procedures______________________________________________________OVPerforms and documents individualized, focused assessment based on patient needs, status, and procedure (includes pain assessment).O VAssesses patient for reactions/allergies to foods, drugs, latex, contrast/iv dyeClinical Policy: Latex Avoidance Precautions_________________________________Cerner Overview Classes ( for Allergy documentation)___________________________Ensures patient with contrast allergy pre-medicated______________________________OVIdentifies abnormal assessment findings.Example A: ________________________________________________________________Example B: ________________________________________________________________OVA.B.Review/Documents medication history.O VValidates medication history against office information (if applicable).O VRecognizes medication contraindications specific to procedure (e.g. metformin, tricyclic antidepressants, and anti-coagulants).O VDocuments/Reviews pertinent lab results (e.g., CBC, Platelet count, K+, GFR, Creat, PT/INR, PTT, Glucose).OVRecognizes abnormal diagnostic findings.Example A: ________________________________________________________________Example B: ________________________________________________________________OVA.B.Recognizes contraindications to contrast administration (e.g. allergy, impaired renal function)Clinical Policy – Department Specific (Radiology) – Intra Arterial Contrast Media Screening and AdministrationO VPatient EducationAssesses patient/significant other/parent educational needs/learning style.Provides and documents individualized procedure-specific patient/significant other/parent educationAdult Interdisciplinary Education Record______________________________________O VUniversal Protocol CPOL-U00-S2502Clinical Policy: Universal Protocol for All Invasive Procedures____________________Verifies correct patientClinical Policy: Patient Identification______________________________Verifies correct procedureVerifies correct procedure siteVerifies pre-procedure verification checklistParticipates in “time-out”Documents Universal Protocol in CernerO VInformed Consent MSPOL-MS4.13Medical Staff Policy: Informed Consent_________________________________________Validates that procedure on consent matches ordered procedureVerifies that informed consent has occurredO VCOMPETENCY #2: The nurse develops a plan of care that prescribes interventions to attain expected outcomesCorrelates assessment data and anticipates management options.Example A: __________________________________________________________Example B: __________________________________________________________O VA.B.Develops and documents an individualized plan of care based on assessment data:Diagnosis (e.g. pain, anxiety)Outcomes (e.g. acceptable pain score, alleviate anxiety) Interventions (e.g. comfort, positioning, appropriate sedation/analgesia) OVInvolves patient/significant other/parents in developing plan of care.MR # ____________; MR# ____________ O VCollaborates with other members of the health care team to meet patient needsRadiologists, Radiology Technicians, Mid-Level Providers, ARS Nurses/Staff, Pharmacists, Inpatient Staff Nurses, Emergency Department, Patient Escort, etc. OVOrganizes and prioritizes patient care.O VIdentifies urgent/emergent situations and reprioritizes care (e.g. contrast reaction, cardiac/respiratory arrest, over sedation)Clinical Policy: CPOL-C00-S0005 Cardiopulmonary Arrest Example A: ____________________________________________________Example B: ____________________________________________________O VA.PETENCY #3: The nurse implements the interventions identified in the plan of care.Maintains a safe patient care environment.Safety/Disaster Manual______________________________Infection Control Manual____________________________Universal Precautions___________________________MSDS Vault/Right to Know__________________________MRI Safety Video (obtain from MRI department)_________Completes a walk through to find fire alarms, fire extinguishers, oxygen shut-off valves, and eye wash stations_____________________________________________________OVMaintains and validates Radiation Safety skills:Utilizes techniques to minimize radiation exposure, (e.g., minimize time, maximize distance, maximize shielding )Identifies consequences of exposure to scatterDemonstrates proper use of radiation tabs (waist and collar)A.B.C.O VA.B.C.Maintains confidentiality of patient information. OVProvides emotional, psychosocial and spiritual care.Example A: _________________________________________________________Example B: _________________________________________________________OVA.B.Provides age-specific careExample A of early adulthood (18 - 35 years) care: __________________Example B of middle adulthood (35 - 65 years) care: _________________Example C of older adulthood (>65 years) care: _____________________Age specific universal competency for patient care areasA.B.C.OVA.B.C.Provides culturally sensitive careExample A: ____________________________________________________________Example B:_____________________________________________________________Utilizes interpretation services when appropriate____________________________OVA.B.Demonstrates patient advocacy.Example A: ___________________________________________________________Example B: ___________________________________________________________Administrative Policy: Patient Rights and Responsibilities ADM-P00-S0283Communicates patient needs/concerns to physician and other team membersAsks, “What is your most important concern re: this encounter” and/or “Is there anything else I can do for you?”OVA.municates with physician/designee regarding patient status (who to call, when to call, how to call and what to say.)Clinical Policy – Orders: Telephone and Verbal ______________________________Physician call schedule located/reviewed/discussedOVAdministers and documents medications using the “5 Rights” (right patient, right drug, right dose, right route, right time).Learning Resources:Clinical Policy – Department Specific ( Pharmacy): Controlled Substances_____________________________________________________________Clinical Policy – Department Specific (Pharmacy): Medication Administration__________________________________________________________Clinical Policy – Department Specific ( Pharmacy): IV Push – Adult__________________________________________________________________Clinical Policy Manual – Department Specific: Pyxis Automated Medication Distribution SystemIVP Compatibility chart (accessed via MicroMedex Trissel’s)Drug reference booksClinical Policy – Department Specific (Radiology) – Intra Arterial Contrast Media Screening and Administration________________________________________________O VManages and documents intravenous therapy, sedating drugs, narcotics, and narcotic antagonists.A. Heparin Heparin Nomogram Order Sheet _____________________________________B. TPA/RPAThrombolytic Order Sheet___________________________________________C. VersedD. AtropineE. FentanylNarcanRomaziconXanaxNitroglycerinProtamineReoproL. ContrastA.B.C.D.E.F.G.H.I.J.K.L.O VA.B.C.D.E.F.G.H.I.J.K.L.Manages and documents administration of blood/blood products.Clinical Procedure: Blood/Blood Components Administration (Adult)________________OVManages the patient with pain.Clinical Policy: Pain/Comfort Assessment__________________________________OVManages the patient with diabetes.Clinical Policy: Hypoglycemia Management for the Adult (Including Obstetric) PatientValidates technical skills – Point of Care testing: Blood glucose meterClinical Procedure: Glucose-Bedside (SureStepFlexx) If signed off from another unit, please indicate which unit ______________OVManages the patient with protective devices/restraints.Clinical Policy: Restraints – Management of the Patient in Restraints_________________Clinical Procedure: Restraints – Application of__________________________________ Clinical Policy – Department Specific (Radiology): Management of Patient Restraints in Radiology_______________________________________________________________OVManages the patient in isolation.Infection Control Policy: Category-Specific Isolation___________________________OVManages the patient undergoing procedural sedation.Clinical Policy: Sedation/ Analgesia___________________________________________Sedation Class – Class Date____________________________________________Basic Life Support (BLS)Expiration Date_______________________________________Advanced Cardiac Life Support (ACLS) Expiration Date___________________________OManages the patient requiring cardiac monitoringObtains/documents vital signsPulse OximetryAutomated non-invasive BPCorrectly places EKG leadsEKG interpretationReviews and tailors alarmsCity-Wide Basic EKG course (if needed) – Completion Date_______________________Transducer pressuresOVValidates skills of the circulating role:Transfers patient to table observing safety measures.Ensures patient comfort.Prepares site.Performs patient preparation/positioning.Performs room and basic table set-up.Initiates monitoring (ECG, NIBP, Oximetry).Assists scrub/physician with gowning and gloving.Assembles and zeroes transducers.Opens sterile items.Obtains and charges medications.Transfers patient to holding area or unit.Provides report to floor or receiving RN.A.B.C.D.E.F.G.H.I.J.K.L.O VA.B.C.D.E.F.G.H.I.J.K.L.Validates skills for functioning in a sterile field:Ensures packages have valid expiration dates.Ensures packages are without breaks in integrity.Opens first flab away from person.Drops on field or presents to scrub person.Maintains 12 inches distance from sterile field.Peels edges of sealed packages to maintain asepsis.Clinical Policy – Department Specific(Perioperative): Aseptic Technique_______________A.B.C.D.E.F.O VA.B.C.D.E.F.Manages the patient experiencing contrast reaction. OVManages the patient experiencing a contrast extravasation.Clinical Procedure: ExtravasationDepartment Procedure (Radiology): Contrast Material ExtravasationOVCompletes STARS incident report/good catch when appropriateAdministrative System Policy: Risk Identification through the Electronic Incident Reporting System – Patients and VisitorsDepartment Specific (Radiology) Policy – Safety Policy: Incident ReportingO VManages the patient requiring the removal of a femoral sheaths:Obtains order to pull sheath. Performs focused assessment for cardiac/peripheral vascular symptoms and perfusion distal to sheath site.Obtains ACT (if necessary).Validates technical skills: ACT measurement (Adults only) Clinical Procedure: Activated Clotting Time (ACT) - ACTII/ACT Plus_____________Obtains appropriate equipment and applies monitors.Explains procedure to patient.Removes sheaths.Obtains hemostasis.Maintains pressure without hematoma formation but with maintenance of distal perfusion.Instructs patient when to hold groin pressure.Applies dressing/bandaid.Documents sheath removal process.Obtains orders for post-sheath removal (bedrest, pain management, etc.)Clinical Procedure: Sheath Removal____________________________________________A.B.C.D.E.F.G.H.I.J.K.L.O VA.B.C.D.E.F.G.H.I.J.K.L.Assesses and documents site condition, hematoma formation.O VShadow day with Radiology Holding Room/Department Nurse______________________Manages and documents care provided to patients undergoing computerized tomography (CT)BiopsiesDrainage proceduresCardiac StudiesCT EnterographyManages and documents care provided to patients undergoing Magnetic Resonance Imagery (MRI)Xanax sedationGeneral anesthesiaCardiac StudiesMRI safety guidelinesOVA.1.2.3.4.B.1.2.3. Manages and documents care provided to patients undergoing invasive procedures using various modalities (special procedures, ultrasound, CT, fluoroscopy, etc.).A. Percutaneous BiopsiesB. Percutaneous DrainsC. Percutaneous Transhepatic CholangiogramD. Feeding TubesE. TIPSS-Transjugular intrahepatic portosystemic shuntF. Central Venous Catheters and Long Term Venous Access DevicesG. VertebroplastyInterventional Angiography1. Angioplasty2. Embolizations3. Retrieval of Intravascular Foreign Body4. Stent Placements5. Thrombolytic Therapy 6. Vena Cava Filter Placement/RemovalI. Diagnostic Angiography7. Abdominal8. Aortic9. Peripheral10. Carotid11. Cerebral12. Pulmonary13. VenogramJ. Other____________________________________________________________________OVA.B.C.D.E.F.G.H.1.2.3.4.5.6.I.7.8.9.10.11.12.13.PETENCY #4: The nurse evaluates the patient’s progress toward attainment of outcomes. Evaluates and documents patient response to plan of care or events.OVEvaluates and documents patient progress toward outcomes.A. Example of physiologic outcome:________B. Example of educational outcome:________OVA.B.Revises plan of care to meet patient outcomes.OVCoordinates patient care with other departments (e.g., Surgery/Anesthesia, ICU, Bed Management, etc.)Calls report to receiving provider (when appropriate)_____________________________Clinical Policy: “Handoff Communication”____________________________________OVPlans for the discharge needs of the patient.Discharge Instructions____________________________________________________Schedules patient for follow-up appointment___________________________________Appropriate follow-up documentation________________________________________Notify Advanced Radiology Services (ARS) Nurses (if indicated)__________________OVValidates Technical SkillsValidates technical skills: Cerner Order EntryA. Specimen order entryB. Logs in lab specimensC. Type and Screen collection/orderCerner Order Entry Class – Class Date______________________________Clinical Policy: Laboratory Specimens_______________________________A.B.C.OVA.B.C.54.Validates technical skills: Crash Cart checkTurn on AED___________________________________________________Place leads/attach AED pads_______________________________________Opens door to change mode to manual, pacing, etc._____________________Crash cart check_________________________________________________Defibrillator owner’s manual on cartO55.Validates technical skills: VenipunctureI.V startsPhlebotomy (for blood patches, lab work, etc.)O V56.Validates technical skills: Access Implanted Port Clinical Procedure: Long Term Venous Access Device (LTVAD)_____________________O V57.Validates technical skills: Draws blood sample from central line.Clinical Procedure: Long Term Venous Access Device (LTVAD)_____________________Clinical Procedure: Peripherally Inserted Central Catheter (PICC)___________________O V58.Validates technical skills: Removes central line.Clinical Procedure: Peripherally Inserted Central Catheter (PICC)___________________O V59.Validates technical skills: IV infusion pumpO V60.Validates technical skills: Loads/unloads injector. O VScrub Role61.Validates technical skill of performing a surgical scrub.O62.Validates technical skills:Performs gowning & gloving self.Performs gowning & gloving others.OA.B.63.Validates technical skills of carrying out the scrub role:Prepares site.Drapes patient and equipment.Operates manifold.Sets up transducer.Assists physician with sheath placement.Ensures air-free system at all times.Identifies anatomical landmarks on fluoroscopy:Femoral headAortic archClavicleSpine Cardiac SilhouetteHooks up catheter to injector.Assist with injection of contrast media.Exchanges Guide wires.Misc: Monitor lead placement, denture removal, table control 101(w/ Rad Tech instruction)A.B.C.D.E.F.G.1.)2.)3.)4.)H.I.J.K.O VA.B.C.D.E.F.G.1.)2.)3.)4.)H.I.J.K.NOTES: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Activated Clotting Time (ACT II) CompetencyDIRECTIONS:Enter your name, unit and UPOS number above. Complete the quiz by choosing the ONE best answer for each question. Do a QUALITY CONTROL and PATIENT test in the presence of another certified staff member. The other staff member must sign the back of the form. QUIZ1.Electronic Quality controls need to be done every ___ hours while the ACT II is in use.4812242. The test cartridge must be warmed in heat block for at least __________, prior to performing ACT test.1 minute but no longer than 1 hour3 minutes but no longer than 8 hours10 minutes but no longer than 4 hours15 minutes but no longer than 8 hours3.ACT II machine temperature display must be between ____ and _____ degrees centigrade. 36.0 and 37.036.0 and 38.036.5 and 37.537.0 and 37.54. When adding sample to cartridge, the blood may not come in contact with the black flag above the double fill line.TrueFalse5.After the blood sample is added you must tap ACT cartridge to suspend the activator.TrueFalse6. When doing a patient test, the difference between the two results can be no more than:5%10%12%15%7. TRUE or FALSEBoth the User ID and patient identification must be scanned. Plug machine in and turn on using toggle switch on back of machine. Allow machine to do self-test. Main Menu will display.Press Quality Control buttonChoose “QC Due Status”. This will either display the date and time QC is due OR will indicate that QC is past due. Press “Exit to Quality Control Menu” and then “Exit to Main Menu”. If QC is past due, machine will lock out until QC is done. Obtain Electronic Quality controls. Press “Enter ID”. Press “User ID” and scan laboratory barcode (same as SSF). Press “Exit to Main Menu”. Press “Cartridge Type” twice so it displays “ACTtrac”, then press “Enter”. Press “Quality Control”. Validate that Control Type indicates “98-102”. If it does not, press “Control Type” until it does and then press enter. Ensure that machine is between 36.5 and 37.5 degrees. Insert Electronic Quality Control (set to 98-102) and engage heat block. Allow test to run. Validate that results are within range and screen states “PASS”. Select “Quality Control”. Press “Control Type” until is displays “190-204” and then press “Enter”. Change dial on electronic quality control to the 190-204 setting and re-engage. Allow test to run and validate that results are within range and screen states “PASS”. Replace Electronic Quality Control in carrying case. If test does NOT pass, repeat test. If QC still does not pass, remove machine from service and contact Point of Care Department in the Laboratory for service. If QC has been done and passed within last eight hours, proceed to perform patient test. Place patient cartridge in heat block to pre-warm for between 3 minutes and 8 hours. Press “Main Menu”. Press “Enter ID”. Press “Patient ID” and scan patient name band. Press “User ID” and scan laboratory barcode (same as SSF).Press “Exit to Main Menu”Press “Cartridge Type” until display reads “HR-ACT” then press “Enter”. Obtain blood sample once cartridge is warmed. Make sure black ‘flags’ are pointing backwards. Remove cartridge from heat block and gently tap to suspend activator. Fill cartridge to between two scored lines without getting blood on the black flag or nub. Place cartridge in heat block and engage. Once results are displayed, validates that results are less than 12% different. Remove cartridge from heat block and dispose properly. Documents results. Turn power switch off. Unplug machine and return to proper unit storage location. I have observed the staff member performing an ACT test according to guidelines printed above. Observer’s Signature: ................
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