Cone Health - The Network for Exceptional Care



Clinical Instructor

Reference

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3.21.16 CL

Contents

1. Faculty Orientation Requirements page 3

2. Faculty Orientation Verification Form* page 4

3. Department Clinical Orientation Guidelines page 5

4. Instructor Guidelines for a Successful Clinical page 7

5. Out-Rotation Guidelines page 9

6. Preceptorship Guidelines page 10

7. Clinical Department Orientation Form* page 11

8. Nursing and Clinical Student Policy page 13

9. Faculty Department Pathway* page 16

Clinical Resources

• Sample Student Assignment Form page 20

• Sample Instructor Worksheet page 21

• Badge/Car Registration Request Process & Form page 22

• CHL (Epic) Request form* page 25

• CHL Reactivation Directions page 26

• Medication Safety and High-Alert Medications page 27

• Medication and Bar-Code Scanning (see P&P)

* Denotes forms that must be turned in

Clinical Placement Website



All current information and forms related to clinical are posted here.

Contact Information:

Staff Education Department

staff.education@ or 336.832.8173

Connie Lewter RN, MSN, CNE, NPDS

Clinical Education Coordinator

connie.lewter@ or 336.832.4363

Email contact for Department Leadership and anyone at Cone Health: firstname.lastname@

Instructor Orientation Requirements

Cone Health requires all newly hired clinical instructors, employees new to the faculty role, and those who have had clinical teaching experience in Cone Health but have not been in the system for a year or more to complete the following Orientation requirements:

Step 1. Access the Clinical Placement web site to review:

o Clinical Instructor Reference

o Note other important information found on the Clinical Placement Web Site

o Student Clinical Policy, Department Information,

o Department Orientation Form

o End of semester Student Surveys

Step 2. * Call Staff Education at 336.832.8173 to register for New Employee Clinical Orientation. All orientation is held in the Nursing Education Center (4th floor) at 200 E. Northwood, Greensboro, NC. Parking is provided in the upper lot on Olive Street.

Attend Tuesday New Employee Orientation: Step 3,4 &5

Step 3. 8a-12p Equipment Orientation

Step 4. 1p – 2p New Instructor meeting with Clinical Education Coordinator (CEC)

Contact Connie Lewter at connie.lewter@ or 336. 832.4363 to schedule a 1 – 1.5 hour meeting. If possible the meeting will be scheduled at this time.

Prior to the scheduled meeting- Review the Clinical Instructor Reference, print and bring it to the meeting, along with any questions you may have. Your school Education Partner may have arranged the Badge and CHL access/training for you. If not you will be provided with the forms you will need for this.

o Submit CHL request form to the Epic Center

o Submit Badge Request form to Security

Step 5. 2p – 5p Self-Guided Clinical Orientation modules. The CEC will provide directions to access the modules. The modules include two tests to complete and turned in to .

Step 6. Thursday – 8a-4p Cone HealthLink (CHL), (Epic, electronic medical record system) training. CHL training may be available at your school and if so you can arrange to do the training there.

Step 7. Department Orientation – Schedule 16 hours on the department where you will initially have students.

• Cone Health Employee- As needed or 8 hours, if not on the dept. where the employee works.

• After the initial dept. orientation, an 8 hours orientation is required for each new clinical site

• Contact Department Leadership to arrange orientation. See Clinical Placement website- ‘Clinical Department Information’ for department contact information.

* Indicates Cone Health Employee Exemption.

Cone Health Employees are not permitted to use Employee ID (badge, computer log in), perform CBG testing, or function as a staff member while in the instructor role. Please complete and submit requests for a 2nd CHL log-in and a 2nd badge per the instructions with the request forms. Forms are available at your school and included in this document.

For more information contact:

Connie Lewter, Clinical Education Coordinator connie.lewter@ 336. 832.4363

New Instructor Orientation Verification Form

Faculty Name: Print_____________________________ Sign: _______________________________

School: Phone: Email:

Your email address will be added to a Faculty Distribution List to receive periodic notifications.

As a new clinical faculty member joining our organization, we invite you to join us in our attempts to help you transition into your new role. We look forward to partnering with you to provide exceptional clinical experiences for students. Orientation to Cone Health is an integral part to your success as a clinical instructor.

Submission of this completed form is required prior to working with a clinical group at Cone Health.

For each item on the form you must have a signature validation.

Key- * indicates Cone Health Employee Exemption.

*Orientation:

Date: __________ (Tuesday 8a-4p) Staff Educator _____________________________

Date: __________ (Wednesday 8a-1p) Staff Educator _____________________________

Date: __________ (Thursday 8a-4p – CHL) Staff Educator _____________________________

Annual requirement - In addition to the New Faculty Orientation, verification of annual completion of the Core Orientation and the Cone Health Orientation must be maintained at the school.

Clinical Education Coordinator Meeting: Date: _______

Form: Clinical Faculty Handbook _____ Access to Clinical Placement website ______

Department Orientation - 16 hrs or Cone Health Employee 8hrs. As needed if staff on the department.

Date: __________ # of hours ___ Staff Member:_____________________________

Date: __________ # of hours ___ Staff Member:____________________________

Date: _______ # of hours ____ Staff Member: _________________________

• Annually and each new department - complete and submit a Department Pathway _______

• Submit Badge Request form to Security Services & call 336.832.7849 to schedule appointment to pick up.

• Submit the CHL log-in and training request form to the Epic Center.

NPDS Clinical Education Coordinator: ________________________ Submission Date: _______

Department Specific Clinical Orientation

Clinical Instructor department orientation is required prior to instructing on a new department. Contact the department leadership to arrange this orientation. Instructors new to Cone Health are required to have a 16 hour orientation. Experienced instructors need to arrange an 8 hour orientation. Re-orientation of faculty with prior experience on the department is determined between the instructor and the department leadership.

Shadow Experience: Staff preceptor

❖ Clinical faculty is paired with an Experienced Staff Member

• Spend time with clinical faculty

• Introduce faculty to staff members

• Share Unit information with faculty member

• Provide a unit orientation to faculty

• Allow faculty to work with preceptor on preceptor’s assignment

• Allow faculty to interact with various patients and families

Information Sharing

❖ Basic unit information

• Number of beds

• Staffing ratio (number of patient’s per nurse)

• Top 10 most common diagnoses

• Common meds

❖ Clinical Assignments

• How best to arrange for student assignments

▪ Pre-clinical

▪ Day of clinical

▪ Staff input

❖ Posting student assignment for staff access

• Where to post

• Department format

• Information required- example:

▪ Patient Care Assignment

Faculty name

Student’s name

Room number/ patient’s initials

Start and End time

Student’s Clinical responsibilities

o Medication administration

o Patient care responsibilities, documentation etc.

❖ Basic Access Needs

• Pyxis Access

▪ Tutorial requirement, Pharmacy notification by Leadership

• Supply access

▪ location and codes

• Report design

▪ Initial report- walking rounds and how to accommodate for student report

▪ End-of-clinical Experience report to patient’s primary nurse

❖ Documentation - Instructors are to make their CHL Work List and include all of the patients their students are working with each day of clinical. Because the NCBON does not require healthcare facilities to have a policy regarding co-signatures, Cone Health has chosen not to have one. Typically the individual school programs will have their own practice requirements. The student, instructor and school can be tracked to that patient documentation through CHL log-ins.

❖ Hands on demonstration of Bedside Equipment

• Monitors, vital sign equipment, special scales

• Common equipment (feeding pumps, lift equip etc.)

Discussion Time

❖ Meet and Discuss Factors that Hinder or Enhance the Learning Environment for Students:

• Discuss staff expectations of students and of faculty

• Discuss course objectives for the clinical experience; guidelines for interacting with students

System-wide Student Orientation talking points

• Caution against posting any patient care related comments on social media

• No cell phones are allowed in patient care areas; be sure to give students the department number for significant others to reach them if needed.

• Students are not permitted to print out any material and must not use any patient identifiers on notes they take off the department.

• Your school may have a policy regarding co-signature of student documentation. In addition, Instructors need to make patient list on CHL including all of the patients the students care for that day.

• Caution regarding topics of discussion in public areas.

Faculty Guidelines to Successful Collaborative Clinical Experiences

Cone Health requires all newly hired clinical instructors, Cone Health employees new to the clinical faculty role, and those who have been out of the health system a year or more to complete the Faculty Orientation Program. Contact the Staff Education Department to coordinate the process 832-8173.

See the Clinical Placement web site for more information:



Cone Health is committed to supporting our community and our school affiliates by providing quality experiences for students and faculty. Some initiatives include:

➢ A culture that values collaboration with our affiliate partners to provide exceptional clinical experiences

➢ Welcoming Orientations to incoming students

➢ Pass Port clinical orientation process for students and faculty.

➢ On-line Clinical Placement process

➢ New-Faculty Orientation

➢ Multiple clinical opportunities throughout the Cone Health system

➢ Mosby’s Nursing Consultant resource on the Intranet

➢ Frequent updates of new initiatives for clinical faculty

➢ Instructor department orientation and competencies

Faculty Commitment to Students

➢ Student Supervision and Teaching.

It is the primary responsibility of the instructor to teach, supervise, and engage students while on the department. Staff is available to “help” the students; their primary responsibility is to patient care.

• Clinical day - No students are permitted on the department without instructor present.

➢ Verify annual Core and Cone Health Orientation has been completed

➢ Provide Department Orientation

• Ensure each student has on proper attire (School and Cone Health dress code policy) and has a school photo ID on and visible while in clinical

• Have students sign and then give the signed Department Orientation Document to your school Education Partner who will reconcile with the request for the department and submit to Staff Education. Due the first week of clinical

➢ Provide private space for group meetings.

➢ Documentation - Instructors are to make their CHL Work List and include all of the patients their students are working with each day of clinical. Schools may require instructor co-signatures.

Faculty Commitment to Department Staff and Patients

➢ Maintaining open communication between faculty/student/and staff is imperative to patient safety and fosters a collegial relationship. It encourages a climate of collaboration and mentorship and adds to the overall positive clinical experiences between student, faculty, and staff.

➢ Prior to the start of the clinical day, faculty must post a list of student patient-care responsibilities on the department and inform the patient’s primary nurse about these activities.

➢ At the beginning of the shift and throughout the day, faculty should encourage collaboration between the student and patient’s primary nurse related to patient expectations and how the student can assist with patient care during the clinical experience.

➢ Absence from clinical: If, for any reason, faculty finds it necessary to cancel a scheduled clinical day you must notify the department staff of your decision. They look forward to having your student’s and appreciate knowing when they will not be coming on the assigned shift.

➢ Protect Privacy: Conferences are prohibited in public areas. Printed materials with patient identifiers are not permitted off the department.

Faculty Commitment to Department Leadership

Clinical Instructors responsible for clinical group rotations, out-rotations and preceptorships are required to contact Department Leadership at least one week prior to the first clinical day. See Clinical Department Information (posted on the Clinical Placement website) to find leadership phone contact information. Provide department leadership with the following information by email:

▪ Type of Program, level of student

▪ Clinical Course Objectives and specifically what outcomes are expected from this clinical experience

▪ Clinical Schedule – days scheduled on department, start/end date and any days scheduled off the department.

▪ List of students – if a rotation, state when each student will be on the department

➢ Conference and Storage Space: Space for pre/post conference and student meetings is limited throughout the system. Clinical faculty must arrange for a private meeting room for student pre/post conference or any group meeting. This can be done at every campus. You may want to ask the Department Leadership for space on the department, however, if there isn’t a room available on the department to accommodate your need please call the following room reservation contacts. MC- Mark Whitted 832-8176, MC Heart and Vascular Room- Robin Edwards 832-9999, WL- 832-0140, WH- Contact Department Leadership, AP- Vickie Walker 951-4355.

• No group-meeting should be conducted in public areas.

➢ Clinical Hours: Every effort must be made to begin the clinical day at the start of the “traditional” shift. 7A, 3P, 7P. Students should be available to participate in the reporting process. This eliminates the need for a second report from the nurse, miscommunication, and contributes to an overall smoother shift transition.

Faculty Commitment to Staff Education Department

➢ If documentation and medication administration will be a required part of the clinical experience, please contact Staff.Education@ for information about how to request training and Cone Healthlink Access codes.

➢ Faculty who intend students to use Cone Health’s computer charting system/pass medications must arrange training. Computer Access codes are required prior to the start of clinicals. Contact the NFC to arrange training and access to Cone HealthLink.

➢ Submit the Clinical Orientation Agreement by the end of the first week of clinical

• This verifies that students have been oriented to the clinical department.

➢ Have students complete the Clinical Exit Survey, for each department they have clinical experiences in. See Survey Monkey Link on the Clinical Placement Website.

Cone Health Out-Rotations

All out-rotation requests are arranged through the Cone Health Staff Education Department using the Group Clinical Request Form-set. These requests are submitted exclusively through the School’s Education Partner affiliated with Cone Health. Unless otherwise agreed upon, direct contact with department leadership for clinical placement is not made until approval has been obtained through Staff Education.

Out-rotations are defined as 1 – 2 day specialty department clinical experiences, previously arranged for students in a clinical group on a Cone Health hospital campus. The purpose of the out-rotation is to supplement the clinical group department experience. This is a non-instructor led experience with the student shadowing or providing direct patient care under the supervision of the appropriate department staff as instructor guidelines permit. The Instructor is responsible for contacting the department and providing:

• Course syllabus

• Specific clinical objectives and guidelines for the out-rotation clinical experience

• Schedule with students names and dates of rotations

• Instructor contact information

Instructors are to be on the same hospital campus as where the out-rotation experience occurs unless previously approved, by the department leadership, to be as a different campus at the time of the clinical experience. Out-rotations are not to be scheduled independent of a clinical group scheduled at Cone Health.

Out-rotation sites are listed on the Group Clinical Request form posted on the Clinical Placement website.

Undergraduate Student Preceptorships

APOC (Academic Point of Contact) Information

Request a precepted experience for a student by sending an email to Staff.Education@

using the following format:

• Subject Line: Semester / School / Program / Preceptor Request

Example: Fall 2020 Best University BSN Nursing Preceptor Request 

In the body of the email list:

• Number of preceptors needed

• Start Date / End Date

• Number of hours

• Campuses – if student(s) will not available for all campuses

• General type of department / patient population preferences

• Additional Comments:

Due dates are the same as for the group requests:

Fall April 15th Spring October 15th Summer March 15th

Confirmation

• Arranging for preceptorships requires time for communications and consideration of multiple variables by the department leadership. Preceptors will be confirmed as soon as possible, but typically cannot be accomplished until a month prior to the semester requested, if the request was submitted by the deadline.

• Upon receiving confirmation of the preceptors, submit a list of the students and the corresponding assigned preceptor / clinical site to staff.education@ . This is due prior to the Start date.

• School faculty are required to contact the department director and preceptor to set up a meeting as needed to discuss the details of the preceptorship and to provide pertinent information prior to initiating the clinical rotation. Preceptors will provide information that can be used in the student’s clinical evaluation but will not be responsible for the overall evaluation. Leadership retains the right to decline based on departmental changes.

Please refer any nurse who expresses interest in being a preceptor to their department director. Cone dos not support recruitment of preceptors for a particular school.

The Cone Health Badge and CHL (Epic) log-in and training – request forms, including instructions will be attached to the confirmation you receive after you submit the request.

For CHL, please contact Keya Shah, Keya.Shah@ to schedule a time when the student, or if more than one, all students can attend one training schedule or whatever works out best for the trainer and the students.

Student Requirements (Prior to clinical and annually)

1. Orientation:

▪ Complete the Core Orientation found on the Cone Health Clinical Placement Web site. Complete (pass with an 80%) the post-test provided by your school.

▪ Complete the Cone Health Orientation Power Point. Sign the Orientation Acknowledgement form; to be maintained in your record at the school.

▪ Submit Core test and Orientation Acknowledgment form to the school for your records.

2. Contact preceptor or CPOC to arrange schedule and exchange contact information prior to 1st clinical.

3. Comply with on-boarding requirements. See

4. Follow CH dress code. Wear a CH photo ID badge. Register vehicle and display parking decal (included on the Badge form).

5. CHL (Epic) log-in and training per your Academic Point of Contact (APOC).

Clinical Department Orientation Form

The Cone Health Clinical Orientation Agreement is to be used by clinical faculty orienting students to the Department. Not all content can be covered in the formal orientation program. Each signature verifies that the student has received a Cone Health orientation, documentation training as applicable, and a departmental clinical orientation. Clinical Orientation and the attached Signature Agreement Form are required for each new clinical rotation.

Cone Health supports the following Standards of Behavior as a means to better serve our patients and community. Affiliates of Cone Health such as volunteers, contract personnel, vendors, students and others should be aware of these policies and agree to abide by these principles as evidenced by their signature below.

CONE HEALTH- As a mission-driven organization, we value:

Outstanding Service -We are committed to outstanding care, services and management.

Caring Spirit -We demonstrate respect and compassion for all individuals.

Innovative Climate -We are committed to creativity and individual initiative.

Integrity -We are an organization characterized by high ethics and integrity.

Financial Viability - We are committed to financial viability to ensure the future of our organization.

STANDARDS OF BEHAVIOR

-Maintain a professional appearance. -Demonstrate a positive attitude to everyone.

-Maintain a safe, clean and attractive environment. -Communicate with compassion and courtesy.

-Anticipate the needs of customers and others. -Maintain customer privacy and confidentiality.

-Hold each other accountable to the Standards of Behavior.

CONFIDENTIALITY

As an affiliate of Cone Health, I understand and agree that I must hold confidential Cone Health information and all medical and patient information in confidence. I am not allowed to access any confidential information, medical record or computer system unless necessary to perform my job duties. I may not access or ask someone to obtain for me my medical information or that of family/others, unless needed to perform my job duties. I may not discuss, review and/or reveal in any way confidential information that I may have as a result of my affiliation with Cone Health unless to do so is within my assigned job duties. It has been explained to me and I understand that I am fully accountable for my actions. Further, I understand that violation of Cone Health policies regarding privacy and confidentiality or any other breach of confidentiality will result in immediate disciplinary action, up to and including termination.

CORPORATE COMPLIANCE

It is the intent of Cone Health to maintain sound, ethical standards in all that we do. Policies and procedures in support of these standards are placed throughout the organization. I understand that as an affiliate of Cone Health I am required to support those standards. I understand that there is a Corporate Compliance Hotline if I have concerns after talking with my supervisor, that the call may be anonymous, and that Cone Health has a policy of non-retaliation.

SAFETY/QUALITY CONCERNS

Cone Health, the Joint Commission and the North Carolina Division of Health Services Regulation (DHSR) are committed to patient safety and quality care. If I have a concern regarding safety or quality, I should:

1. Notify my immediate supervisor or the Director in the area.

2. If appropriate, have the incident entered into the Safety Zone Portal.

3. If I have an ongoing concern after seeking the assistance of the Director and Vice President, I may discuss the matter in a confidential manner by using Cone Health’s Compliance Hotline. The hotline number is 832-8888 or toll free 1-866-506-8890.

4. If I continue to have concerns, I have the right to contact Joint Commission or DHSR @

Cone Health, Joint Commission and DHSR support a non-retaliation-reporting environment.

Clinical Department Orientation Signature Page

By signing this document, I have completed the Student/Faculty Orientation and agree to abide by Cone Health policies while associated with Cone Health and to seek assistance with and/or clarification of these policies if needed. I have experienced a department specific orientation.

____________________ __________________ ________

Hospital/Department Semester Date

______________________ ________________________ ____________________________

School/Program Print- Faculty Name Faculty Signature

____________________ _________________________

Clinical Day(s) Clinical Hours (example 7a-7p)

Student: Print first and last name Student Signatures

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This agreement must be completed and returned to your school Education Partner. The Education Partner will reconcile the orientation documentation with the clinical placement request and submit to the Staff Education Department before the end of the first quarter of the clinical rotation. Failure to comply will result in the cancellation of your clinical assignment.

Connie Lewter, RN MSN, CNE

Staff Educator II Clinical Education Coordinator

Cone Health

Staff Education

1200 N. Elm St.

Greensboro, N.C. 27401-1020

Staff Education Staff.Education@

Phone #- 336-832-8173 and Fax #- 336-832-7175T

Policies and Procedures

|Policy Title: |

|Nursing and Clinical Students at Cone Health |

|Department Responsible: |Policy Code: |Effective Date: |Next Review/Revision Date: |

|Nursing |ER-SED-2010-64 |August 10, 2010 |June 2016 |

|Title of Person Responsible: |Approval Council: |Date Approved by Council: |

|Manager, Staff Education |Nursing Executive Committee and Nursing Leadership Council |August 10, 2010 |

PURPOSE:

Cone Health (CH) is dedicated to providing a safe healthcare environment for all patients, as well as a learning environment for all students. Clinical students will have access to a wide array of educational opportunities designed to facilitate the development of highly skilled and knowledgeable professional caregivers. In partnership with educational institutions, students will practice under the direct supervision of faculty instructors and/or Cone Health Registered Nurse (RN) preceptors, as well as other licensed practitioners. The licensed professional, whether faculty instructor or Cone Health preceptor, will supervise all care provided by the student in the clinical setting.

DEFINITIONS:

1. “Student” shall mean a student officially enrolled in the Program at an Educational Institution who participates in a clinical experience at any of the Cone Health sites. Students shall include undergraduate, graduate, and licensed professionals returning to the clinical setting for a clinical/occupational experience as part of their educational program.

2. “Faculty” shall mean each individual employed by or affiliated with the Institution of Education to instruct and supervise students as part of the Program.

3. “Preceptor” shall mean an individual who is an employee of Cone Health and facilitates student learning and provides guidance and evaluation of students at CH as part of the Clinical/Occupational Experience.

4. “Clinical/Occupational Experience” shall mean a structured learning experience at CH in which a student provides care to patients under the guidance of a faculty instructor or Cone Health preceptor.

5. “Program” shall individually and collectively mean the program(s) in which student(s) is/are enrolled at an Educational Institution and receive all pre-clinical placement training and education related to their field.

POLICY:

Overview

Clinical students may perform activities that are permitted within the scope of practice for the level of education (RN or LPN, EMT, CMA, CNA, ST) school and clinical agency policy, provided licensed faculty/preceptor or RN is supervising them. No student will be allowed to perform a procedure that requires specialty training and/or certification for their practice discipline.

This Policy Applies to:

All Cone Health facilities and to all clinical students.

Dress Code for Students/Faculty

1. Students must wear the designated school uniform or abide by the unit-specific attire (ex. scrubs, business casual). Students/faculty must wear an authorized school photo ID while on duty and identify themselves as a student/faculty at all times. Additionally, students and faculty must adhere to the Cone Health policy for Dress Code (Human Resources Policy # II-ER-6).

2. Cone Health employees participating in clinical experiences as a student or faculty must identify themselves as a student/faculty and wear an authorized school photo ID while in the student/faculty role. They may not wear their Cone Health ID or use their employee logons while performing in their student/faculty role.

Faculty Instructor/Student Orientation

1. Cone Health requires all newly hired faculty instructors, and those who have had clinical teaching experience in Cone Health, but have been away for a year or more, to attend the General Clinical & Nursing Orientation and complete Cone Health's Faculty Orientation process. Cone Health employees new to the faculty instructor role, may be exempt from the General Clinical & Nursing Orientation component of the Cone Health Faculty Orientation process.

2. Faculty instructors will complete unit-based orientation prior to supervising students on the unit. Faculty will contact the director of the department PRIOR to the clinical experience to arrange this orientation.

3. Faculty must contact the department director to share course and clinical objectives, the student list, scheduled dates and times of clinical, and faculty contact information, PRIOR to beginning the clinical experience. Failure to submit the contact information, objectives, student list, dates of clinical, etc. will result in the clinical group not being allowed on the department. The instructor will be responsible for notifying the Department Director when schedule changes affect the presence or absence of students in the clinical area.

4. Each semester, and as changes occur, the Educational Institution is required to submit a roster of all faculty instructors supervising students in clinical rotations no later than the first day of the clinical experience. This list should be sent electronically to the Cone Health Staff Education Mail Box: staff.education@.

5. Faculty instructors are responsible for orienting students to Cone Health prior to their arrival on the department according to the Cone Health Student and Faculty Orientation Process. This information is current on the Cone Health Clinical Placement website.

6. Annually, faculty and students must complete the on-line Core Orientation process and the Cone Health Orientation process found on the Cone Health Clinical Placement website.

Supervision of Students

1. Student supervision is the responsibility of the faculty instructor or Cone Health preceptor.

2. Faculty instructors must be present in the facility at all times and be available by phone or pager. Exception: For precepted or graduate students, a faculty instructor must be available by phone or pager while the student is within Cone Health.

3. Ultimate responsibility for patient care rests with the patient’s Cone Health primary caregiver. At any time the Cone Health primary care giver deems necessary, he/she can assume care of any patient assigned to a student.

Computer Use by Students

1. All clinical students doing documentation of patient care must complete the appropriate Cone HealthLink computer training class. Upon successful completion of the documentation training exercise the student will be given a computer access code.

2. No student will use a Cone Health staff member or faculty's access code to enter the electronic documentation system or any other electronic data base.

Documentation/Charting by Students

1. Students may document in the patient’s medical record with the supervision of the faculty instructor or Cone Health preceptor.

2. Students must comply with all Cone Health documentation policies.

Medications

1. Students administering medications must be under the direct supervision of a Registered Nurse. It is required that nursing students be observed either by their clinical faculty, by the RN assigned to the students, or by the RN preceptors in the preparation, administration and documentation of insulin, anticoagulants and all IV push medications.

2. Students will not be issued passwords for the automated medication dispensing system. Medications must be obtained through the faculty instructor or Cone Health preceptor.

3. Administering and charting medications will be according to the Cone Health Policy, "Medication Administration and Bar Code Scanning".

4. Students may not administer investigational drugs or any drugs that require specialized training to administer (e.g., chemotherapeutic drugs, vasoactive drugs, and Intravenous conscious sedation).

5. Students are not permitted to conduct narcotic counts.

PREVIOUS REVISION/REVIEW DATES:

|Date |Reviewed |Revised |Notes |

|October 1, 2005 | | |Original effective date. |

|April 2012 | | | |

|April 2013 | | | |

|June 2013 | | | |

|June 11, 2015 | | |Updated formatting to match current policy template; no content changes. |

|Annual NURSING INSTRUCTOR COMPETENCY PATHWAY |School | |

| | | |

|Instructor name | | |

|Student Learning & Patient Focus: Demonstrates basic knowledge of system, hospital, and department policies and procedures | | |

|Annual Instructor competency requirements are met by completing this form including the annually RN department competencies for the instructor’s clinical | | |

|department site. and as needed for any additional department the instructor attends. | | |

|Annual Orientation requirements have been met: | | |

|Instructor signature:__________________________________________________________ Date __________ | | |

|(CORE Orientation test and Cone Health PP Acknowledgement form on file at school) | | |

| |Date | |

| |Department | |

| |Competency | |

| |Validator’s | |

| |Name(s) | |

|COMPETENCY |LEARNING ACTIVITIES | METHODS OF EVALUATION / Preceptor Initials & Date |

|Department Specific | | |

|Demonstrates knowledge of: | |Verbalizes understanding of: |

|Scope of service & dept. mission, pt. pop. |Review scope of service/dept. mission |Scope of service/dept. mission ____/____ |

|Disaster Plan (general in annual Orientation) |Read department disaster plan/ department role |Department disaster plan ____/____ |

|Department Quality Improvement Initiatives |Discuss Department Quality Improvement Initiatives |Verbalizes Department Quality Improvement Initiatives ___/___ |

|Fire Safety (general in annual Orientation) | | |

|Annual Department RN Competencies – see page 4 | | |

| |Locate fire exits, fire extinguishers, pull stations, O2 shut-off valves |Locates dept fire exits, fire extinguishers, pull stations, & O2 shut-off valves |

| | |____/____ |

| | | |

|Generic Clinical Resources | | |

|Patient Education Resources |Discuss use of Exit Care & Patient Education Network |Verbalizes how to instruct students about use of: Exit Care __/__ ; On-Demand |

| | |Patient Education Network _____/___ |

|Locate on Chart: | | |

|Advance Directives | |Verbalizes how to instruct students to find: |

|Allergies | |Advance Directive information___/__ |

|Hall Pass |Review Hall Pass Instruction |Allergies____/____ |

| | |Hall Pass____/____ |

|Demonstrates knowledge of Core Measures: |Review education material for Core Measures that are pertinent to your department. | |

|Pneumonia |(Homepage ->Departments -> Quality Improvement -> Quality Informatics/Core |Verbalizes how to instruct students regarding nursing interventions related to |

|Myocardial infarction |Measure->Useful Links-> “At a Glance” for each Core Measure) |Core Measures that apply to department. ____/____ |

|Heart Failure | | |

|Surgical Care Infection Prevention (SCIP) | | |

|VTE | | |

|Safely operates the following equipment: | |Demonstrates proper operation of: |

|Alaris IV pump |Practice Alaris IV Pump Functions: Programming | |

| |Primary/Secondary Infusions and Channel Labels, |Alaris IV pump ____/__ |

| |Clearing Pump, Using Guardrails, Administering Boluses | |

| | | |

|Electronic BP Monitor |Review operation of Electronic BP Monitor |Electronic BP monitor ____/____ |

| | | |

|Safe Pateint Handling equipment used on the department |Review how to use safe patient handling equipment used on department. |Safe patient handling equipment ____/____ |

| | | |

|Zoll |Review operation of the Zoll Monitor | |

| | |Zoll ____/____ |

|Restraints |Review restraint policy | |

| | |Restraint Competency Check-off___/___ |

| | |Verbalizes understanding and importance of teaching students about the |

|Improve the accuracy of patient identification | |following Policies: |

|Improve the safety of using medications |Review the Nursing and Clinical Student Policy |Nursing and Clinical Student Policy ______/_______ |

| |Review Medication Safety and High Alert Medications Policy |Medication Safety and High Alert Medications Policy ______/_______ |

| |Review Medication Administration and Bar-Code Scanning Policy |Medication Administration and Bar-Code Scanning Policy ______/_______ |

| |(Policies are in the Instructor Reference document. |Safety Zone Portal (SZP) reporting ______/_______ |

| | | |

| |Adverse drug event reporting and incident reporting/Safety Zone Portal (SZP) |Verbalizes understanding and importance of teaching students: |

| | |--Patient identification process prior to medication |

| | |administration_______/______ |

| | |--Safe patient medication administration______/______ |

| | |--Medication labeling ______/______ |

| | |--Dating of multi-dose vial _____/_____ |

| | | |

| | |Verbalize understanding of faculty communication requirements:: |

| |Review the faculty communication requirements (Instructor Reference): |- Prior to beginning clinical rotation ______/______ |

|Improve the effectiveness of communication among |Prior to beginning clinical rotation |- Beginning and end of shift ______/______ |

|caregivers |Beginning and end of shift | |

| | |Demonstrates ability to review with students: |

| | |--Fall risk assessment ___/___ |

| |Patient Safety plan, fall risk scoring, and alternatives to restraints |--Restraint Competency Check-off___/___ |

|Reduce the risk of patient harm resulting from falls |--Restraints policy & procedure and audit tool |Discuss alternatives to restraints ____/____ |

| | | |

| | |Demonstrates process for involving patients/families in their care_____/______ |

| | | |

| | | |

| | | |

| | | |

|Demonstrates knowledge of infection prevention |Discuss hand hygiene/cleaning of patient care equipment |Verbalizes understanding of and importance of instructing students regarding: |

| |Demonstrate infection prevention precautions (isolation types) |appropriate hand hygiene______/______ |

|Reduce the risk of healthcare–associated infections (NPSG)|( Contact (C. Diff) |infection prevention precautions ____/____ |

| |Contact (VRE, MRSA, Scabies, Chicken Pox) | |

| |( Airborne | |

| |( Neutropenic | |

| |Droplet | |

| |Review Infection Prevention Policies regarding patient isolation | |

|Demonstrates knowledge of early activation of Emergency | | |

|Response Teams |Know how to recognize the event and call for help |Verbalizes how to recognize the event and call for help |

|Improve recognition and response to changes in patient | |Demonstrates operation of AED___/___ |

|condition (NPSG) | | |

|Code Blue | | |

| | | |

|Rapid Response Team (RRT) | | |

| | | |

| | | |

|Code Stroke | | |

Annual Instructor Department Specific Competency Validation Form

Required annually and for every department the instructor uses within the year.

Name: ________________________________ School __________________ Campus / Department __________________ Date: _________

| |Competency |Method |Date |Staff Nurse / Qualified Observer/ |Comments |

| | | | |Clinical Education Coordinator or | |

| | | | |Self-Eval | |

|2 | | | | | |

|3 | | | | | |

|4 | | | | | |

|5 | | | | | |

|6 | | | | | |

|7 | | | | | |

Methods: DO = Department Orientation AS= competency met through instructor’s work at the Academic Site CHE = competency met as a Cone Health employee

PK = current Knowledge gained in Previous instructor role NA= department competency is Not Applicable to the Instructor role

Evaluation:

Staff Nurse / Preceptor/ Qualified Observer / or Clinical Education Coordinator (CEC) Comments:

Instructor Comments: _________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________

___________________________________________________________________________________________________________________________________

Signature of Staff Nurse / Preceptor/ Qualified Observer / or Clinical Education Coordinator:

Signature of Instructor:

Date:

Department Assignment Communication Form

School: _________________________ Program: _______________________________

Instructor: __________________________ Contact telephone # ___________________

Date: ______________ Time: _________________ Conference Time: ________

|The request form can be obtained from the Academic Education Partner at your school. Email completed form to | | |

|keya.shah@ or fax to 336-832-9060 between 8am - 12pm Monday - Friday for questions. | | |

| | |

| | | | |

|Training/access requests must be received at least 4 weeks in advance of requested clinical start date. | |

CHL Reactivation Directions

After 30 days of inactivity, CHL access will be disabled.  The instructor or Education Partner will be required to call IT to have it reactivated. The following directions have been provided for our school affiliates. Certified Trainers at the schools will also receive information regarding this.

The best way for the schools to request reactivation would be for the instructors to send the rosters to the IT Help Desk at conehealthprod@service-. They can use the same rosters that they send us at the beginning of the semester to request the account build. They would just need to note which students will be returning for another clinical rotation and the dates the rotations will start. My team will be happy to review the accounts and make sure that they are active in time for the student’s rotation.

The students can still utilize password self-service to reset their passwords if they have expired during the Christmas/summer breaks. However, an account reactivation will have to be done by the instructor/preceptor initiating a ticket with the Help Desk that will get routed to the Security & Access Management Team. For submitting a ticket, when asked for the students SSN, use the student’s school ID number.

Policies and Procedures

|Policy Title: |

|Medication Safety and High-Alert Medications |

|Department Responsible: |Policy Code: |Effective Date: |Next Review/Revision Date: |

|Pharmacy |PR-PHA-2003-74 |June 5, 2015 |April 2018 |

|Title of Person Responsible: |Approval Council: |Date Approved by Council: |

|Executive Director of Pharmacy |Medical Executive Committee |August 2003 |

PURPOSE:

To assure the safety of our patients by utilizing specific monitoring and double checks for identified medications.

POLICY:

High-alert medications are those listed below and will be safely administered to the patient through the use of specific processes. In order to keep our patients safe, we use Pyxis profiling, barcoding, CPOE (computerized physician order entry), smart infusion pumps, dual sign-off by nursing staff for certain high-alert medications, medication safety software for pharmacists, and other processes to enhance patient safety in medication ordering, preparation, and administration.

PROCEDURE:

Safety of Specific High-Risk Medications:

Medications in this section have specific tasks assigned to assure safety in preparation and delivery:

• Continuous Drug Infusions: All continuous drug infusions are categorized as high risk and are used in conjunction with a smart infusion pump system including guardrails. In addition, continuous drug infusion concentrations have been standardized. Periodic studies are performed to measure the use of smart infusion guardrail use.

• Chemotherapeutic Agents: In addition to nursing double check policy, special double checking procedures, standard competencies, and policy revision take place within the Pharmacy Department.

• Concentrated Electrolytes: Concentrated electrolytes are not stored as a floor stock item. These are prepared and dispensed by Pharmacy.

• Insulin: Insulin U-500 is a concentrated insulin for which specific Cone Health Pharmacy procedures and education have been developed. The procedure is attached to the medication entry in the electronic medical record.

• Neuromuscular Blocking Agents: Special labeling and colored storage bins are used (in pharmacy and nursing units outside of the operating room).

• NICU Medications:

1. Syringes given by RN on the NICU are drawn up in pharmacy using a two-provider check.

2. Neonatal drug therapy has been standardized in the Pharmacy Department and floor stock on the nursing unit has been severely restricted.

• Promethazine (Phenergan®) Injection: Special label precautions are given to nurses that administer IV promethazine. Dosing adjustments are made based on age and LFTs. (Pharmacy and Therapeutics Committee directive.)

• Renally Cleared Medications: Clinical information system and decision support alerts are combined with pharmacist review to assure correct dosing.

• Sound-Alike/Look-Alike Medications: There is special emphasis on this topic with a multidisciplinary medication safety team. Examples include posted TALL MAN lettering for medication name (e.g., on storage location, in Pyxis, in infusion pumps), ancillary labels (“STOP – Look / Sound-Alike Drug”) placed on medication storage locations (in pharmacy, Pyxis, etc.). See attached list of sound-alike/look-alike medications and mechanisms to reduce risk.

• Tissue Plasminogen Activator (tPA, alteplase, Activase®) for Stroke:

1. The Pharmacy, Emergency Department or Administrative Coordinator will use the stroke calculator program to print out explicit instructions for programming the infusion pump.

2. The first RN, along with a second RN watching, will program the pump to deliver the correct bolus and infusion dose of tPA from the stroke calculator instruction sheet.

High-Alert Medications Requiring a Double Check:

The following medications are considered high-alert medications and require a double check verification process prior to administration. High-alert medications in this category require documentation of the double check on the electronic medication administration record (eMAR).

1. Insulin injections.

2. Tissue plasminogen activator (tPA, alteplase, Activase®) for stroke.

3. Chemotherapeutic agents.

4. Patient-controlled analgesia (PCA).

The verification process includes correct medication, dose, and route for selected patient. Documentation will include the verification in the eMAR.

The following may perform the double-check process:

• Pharmacist/Pharmacist

• RN/RN (or LPN)

• Pharmacist/Provider

• RN/Pharmacist

• RN/Provider

• CareLink may use RN and paramedic for verification

REFERENCES/LINKS:

• Cone Health Sound-Alike/Look-Alike Medications Poster

• Cone Health Sound-Alike/Look-Alike Medication List

• Cone Health High-Alert Medications Poster

• Institute for Safe Medication Practices. Independent double checks: undervalued and misused: selective use of this strategy can play an important role in medication safety. ISMP Medication Safety Alert! 2013 Jun 13. Accessed 3 April 2015 from

PREVIOUS REVISION/REVIEW DATES:

|Date |Reviewed |Revised |Notes |

|August 1, 2003 | | |Original effective date |

|January 2005 | |X | |

|January 2006 | |X | |

|September 2009 | |X | |

|September 2011 |X | | |

|December 2011 | |X | |

|August 2013 | |X | |

|October 2013 |X | | |

|April 2014 | |X | |

|May 4, 2015 | |X |Updated hyperlinks. Updated formatting to match current policy template. No content |

| | | |changes. |

|June 5, 2015 | |X |Added PCA to list of medications requiring double-check, added hyperlink to high-alert |

| | | |meds poster. |

Cone Health would like to

thank you for your partnership

with us in providing

exceptional care for our patients

and exceptional learning experiences

for your students.

Update 3.8.16 CL

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