Clinical Nursing Administration 2023 PDF

Nursing Administration Department 4 year th Nursing practice Prepared by: Nursing Administration Department staff  Demographic data Student Name:..............................................................................................

Nursing Administration Department 4 year th Nursing practice Prepared by: Nursing Administration Department staff  Demographic data Student Name:........................................................................................... Address:......................................................................................................... Group Number:............................................................................................ Area:………………….........................................................................................  List of contents Table of Content Pages Patient assignment 4 Shift report 14 Kardex 22 Time schedule 34 Staff performance 42 Incident report Nursing note Objectives:  Define assignment  List 3 purpose of patient care assignment  Apply patient care assignment principles in developing assignment  Differentiate between different methods of patient care assignment  Develop patient care assignment for one unit Outlines:  Definition of patient care assignment  Purpose of assignment  Principles underlying patient assignment  Characteristics of a good assignment:  Methods of patient care assignment 1. Case method. 2. Functional method. 3. Team method.  Importance of interns' cooperation in assignment Definition: Assignment refers to a written delegation of duties for the care of a group of patients by trained employees assigned to the unit, based on their knowledge, skills, job description, and the patients' nursing needs. Purposes of assignment: 1-To delegate the work to be done by the nursing personnel employed in the unit based on the administrative policies, order of authorities, and job description. 2-To suggest the appropriate method for delivering nursing care with maximum efficiency and minimum effort. 3- To gain the cooperation of workers in the acceptance of the work to be done. Principles underlying patient assignment: 1-assignment must be made by the first lines manager (head nurse, nurse in-charge). 2-It is based on nursing needs of patients and the approximate time required in order to fulfill those needs. 3-It is planned for at least one week to assure continuity of care. 4-It is considers the capabilities of staff, skill level, and experience. 5-It considers all indirect unit activities. 6-It considers that each task is the responsibility of one nurse. Characteristics of a good assignment: 1-It is definite and clearly understood. 2-It is related to the previous experiences of the workers. 3-It should be written. 4-It should be interesting for the workers. 5-It should be given in such away that workers are guided in their activities and difficulties are minimized. Methods of patient care assignment: The Traditional Methods: 1. Case method. 2. Functional method. 3. Team method. 4. Primary nursing method. 5. Modular nursing The Alternative Method: 1-The case method: - In this method one professional nurse assumes total responsibility for providing complete care for one or more patients while she is on duty, with no guarantee of having the same patients the next day. *The head nurse supervises and evaluates all the care given on her unit. The case method stresses adherence to physicians' orders. Advantages:  Individualized care.  Patient satisfaction.  Facilitates close relationship of nurses with patient and families. Disadvantages:  This method will increase workload when there is a shortage in the staff (i.e. It will force the work regardless of the patients' needs and personnel abilities).  Little continuity of care - exist from shift to shift except in following procedures.  Difficult for the head nurse to supervise.  More equipment and supplies are needed patients. 2-Functional nursing: - This is the oldest nursing practice modality. It can best be described as a task-oriented method in which particular nursing function is assigned to each staff member. One registered nurse is responsible for administering medications, one for treatments. One licensed practical nurse is assigned to admission and discharge.Another gives bed baths. nurses' aide makes beds, passes meal trays, and so on. - No nurse is responsible for giving total care to any one patient. The method divides the task to be done, with each person being responsible to the nurse manager. - This method is efficient and may be best system when the nurse manager is confronted with a large patient load and a shortage of professional nurses. Advantages:  Efficient when there is a shortage in the staff or there is limited number of professional nurses.  Each staff nurse is likely to become skillful in performing the one or two tasks which leads to increasing speed and efficiency.  Less equipment needed.  Less cost.  Useful in emergency situations, Disadvantages:  The segmentation of patient care among several nurses will result in neglecting. The humanity of the patient and the individual needs of the patient will be lost in an effort to get the work done.  Lack of communication among the different persons who care for the patient.   When responsibility for a patient’s care is divided among several nurses, it is easy for each to deny responsibility for care omissions and mistakes. 3-Team method: - It is a method that binds professional, technical, and ancillary nursing personnel into small teams. It combines the superior knowledge and skills of the professional workers with technical or ancillary workers. - Assignment of patients is made to a team consisting of a registered nurse as a team leader, other registered staff nurse, practical nurses, and aides as team members. - The team leader has the responsibility for coordinating the total care of a block of patients and is the leadership figure. - The intent of team nursing is to provide patient centered care. The patients' nursing care needs are identified and met through nursing diagnosis and prescription. Ward clerks and unit managers perform the non-nursing functions of the unit. - The process requires planning to meet the objective of taking nursing personnel to the bedside so that they can focus upon the nursing care of patients. - Implementing team nursing requires study of the literature on team planning and the development of apriority to motivate the team to work together cooperatively to achieve a maximum level of care. - Through the team plan the contributions of all members in improving patient care are recognized. Priority is given to strengthening members' weaknesses. - patient centered care requires effective supervision and recognition that personnel are the means by which the objectives are met in a cooperative effort between team leaders and team members. - Through supervision, the team leader identifies nursing care goals, identifies team members' needs, focuses on fulfilling goals, motivates team members to grow as workers and citizens, and guides team members to help set and meet high standards of patient care. Advantages:  Availability of professional nurses' skills for a large number of patients.  Continuous supervision of less trained personnel, thus providing better patient care.  Increase in number and duration of professional nurse-patient interaction For nursing personnel:  Help in developing leadership skills.  Great opportunity of initiative and shared responsibility.  Maximal use of individual abilities.  Reduction of time spent in performing non-nursing activities. Disadvantages: The team method of assignment cannot be used effectively in such a unit until the personnel were trained for the roles of team leader and team members through some sort of in-service education program. Importance of interns' cooperation in assignment: -Interns are motivated by giving the assignment in such a way that staff are guided in their activities and difficulties are minimized. -Promotes competence and development of the staff interns through work assignment rotation. -Praise the good work of interns in front of the rest of the staff Shift report  Shift report Shift report Objectives:  Define shift report  List 3 purpose of patient care assignment  Differentiate between different kinds of shift report  Develop a shift report for one shift in the unit Outlines:  Definition of shift report  Purpose of shift report  Importance of shift report  Kinds of report  Cases that should be included in shift report.  Shift report Definition: A shift report is a day, evening & night nursing summaries of pertinent information about patient's conditions and activities related to their care. Or It is a system of communication prepared by individuals delegated to bring or send information to others. or A report is oral, written, or computer –based communication intended to convey specific information to others should be concise Importance of shift report o To convey information based on factual materials o To prepare personnel for their daily woke according to the patients' condition. o To provide continuity of nursing care. o Provides a mean of communication between physicians and another professionals contributing to patient care. o Furnish documentary evidence of the course of patient illness and treatment during hospitalization. o Assist in protecting the legal interests of the hospital, physicians & nurses. o Serve as abases of analysis, study &evaluation of quality of care rendered to the patient. o Provide clinical data for research and education. o Serve as abases for planning individual patient care.  Shift report o Provide continuity of patient care on subsequent admissions. o Save duplication of effort and eliminates the need for investigation to learn the facts in a situation. Kinds of report:  Oral report (ISPAR )  Written report 1. Oral report They are given when information is immediate use and not for permanency. To be effective report should include information exchanged in the following manner: 1. Patient data must be pertinent, accurate and current. 2. The environment must be comfortable and without distraction. 3. Time and duration should be acceptable to all involved. 4. All personnel should feel involved and accountable. 5. Information should be personalized by patient name. 6. Important points are emphasized. (I. S. B. A. R) Definition:- A I S B A R: is an easy to use, structure form of communication that enables information to be transferred accurately between individuals.  Shift report " I S B A R " communication Tool STAGE NAME AIM OF EACH STAGE EXAMPLE I Introduce & To introduce yourself by stating the Identify yourself identify role you have played in this patient, (name /role /location) s care. to clearly and accurately patient details(full name identify and locate the patient /MRN/diagnosis/gender) S Situation To explain the patient presenting State if the situation is condition. urgent. identify current symptoms and clinical needs B Bach ground To hand over the patient’s medical Diagnosis/other health and social background relevant to issues / lab results / this admission. allergies /medication A Assessment & To succinctly describe the patient’s Provide an interpretation or Actions general condition, clinically and summary of what you think behaviorally, during your shift. To is going on. state what you have done for the patient on your shift. R Recommendation To explain the treatment plan for State a clear request with a & Read back this patient. time frame. To clearly hand over accountability and responsibility for ongoing care tasks.  Shift report Example- : Mrs. Singh is an 80-year-old female with a Left Cerebrovascular Accident (CVA) who has been in a long term care facility for the past10 years. She is immobile and has to be transferred with the mechanical lift. Her nutritional needs are met with 6 cans of Is source via G tube @ 50 mls /hour. You are assigned to Mrs. Singh on the evening shift and you provided hygiene care and repositioned her. Mrs. Singh's routine medications were administered at 1800hr. Her G feed (1 can Isosource) is also in progress. At 2000hr, when you approach Mrs. Singh's bed, you hear her coughing, respirations are noisy and her face is flushed. Her vital signs are T39, 110 bpm, R 32 /min, BP 150/90 and SP02-86% on room air. Situation -Hi my name is ………. I’m calling from ………… - I’m calling about ……….. Background - - - Assessment What is your assessment of the situation? provide details of any changes in patient status that support your assessment Recommendation What are your Recommendations? Do you think we should: (State what you would like to see done)  Shift report 2. Written report Are written summaries of pertinent information about patient conditions and activities related to their care? In written report there are two copies made, one remains in the unit, and the other is send to the nursing office. Effective written report should be: o Clear, concise, complete and objective. o well organized to be easily understood o Identifying data are included, the date, time and people concerned. o No space, signature beside mistakes. o the signature of the person who wrote it The written shift report should have information about 1. unit :  Specialty of unit, bed number, patient census, date. 2. patient:  Patient name, diagnosis, post-operative days 3. Signature and position of the person who is in charge. Cases that should be include in the shift report o All actually ill and postoperative patients. 1. Case with arrhythmias.  Time of arrhythmias occurs, duration frequency……. 2. Cases on ventilator.  On ventilator attached with ETT  Shift report 3. Comatosed patient. 4. Patient needs special preparation for the next day. 5. naso gastric tube cases:  reason for intubation(feeding or section) patent place amount of discharge 6. catheter cases:  Record amount of urine output and if there is any abnormality. 7. cases with dressing: only if cases removed sutures 8. specials IV cases : total IV/hrs, time started, type and amount of solution started amount received, place patency , e.g total IV infusion 5000ml 24hrs @ 10 am received 2000 G5% followed by 500 ml Ringer, received 300 ml & still running patent and in place total intake 2300 ml. 9. Admission, transfer, discharge, death and their number should be record. 10. Patient with any change in general condition, time of complain occurrence, action done, medication given.  Shift report Sift report No of beds: Unit: Pt census: Date: Room No, Bed NO (DX) Summary of Pt condition Pt. name No of admission: No of transfer: No of discharge: No of death:  Shift report Example Today 26/4/2014 you are Head nurse in ICU. Pt census @ beginning of the shift 9, number of beds 12The most critical ill patient in your unit is Ragab Esmail suffer from MCA with brain edema,roomNo2and bedNo1pt attached to monitor &ventilator o percent 80% Pt with IV cannula in RT, FA patent 2 and in place Total IV infusion 2000/24 hrs received @ 10.00 am and with cath no abnormality total output 100cc@ 8.00am and @ 1:00pm total output 600cc V/S were T:37c P: 120b/m R:16c/m and BP:140/100mmHg@11:00 am and at the end of the shift S were T:37c P: 90b/m R:16c/m and BP:140/100mmHg and at 11.00 go to operating room. while @ 11:00am Ahmed Hassan who suffer from splenectomy secondary to MCA who admitted @ 23-4-2014 and make exploration in this day in bed No 1, room No 2 transfer to general surgical with IV cannula in RT, FA patent and in place with stable condition and V/S were T:37c P: 80b/m R:16c/m and BP:120/90mmHg Kardex  Kardex Objectives:  Define kardex  List 3 benefits \ uses of Kardex  Discuss basic information for Kardex  Enumerate different types of abbreviations used in kardex  Develop a kardex form  Apply one kardex for one patient Outlines:  Definition of kardex  Benefits \ uses of Kardex  Basic information for Kardex  Updating Kardex  Kardex form  Kardex Definition: Kardex is an administrative tool, used to provide a concise source of patient care information kept at the nurses' station in a Kardex book. OR Kardex is a desktop file system that give brief overview of each patient and is update evert shift Benefits \ uses of Kardex: 1- Developing the assignment for the nursing staff. 2- Writing the shift report. 3- Evaluating progress in patient’s conditions as reflecting in the provided nursing care. 4- Directing and supervising nursing staff. 5- Aid in evaluating nursing staff performance. Basic information for Kardex : 1- Demographic patient data:  Name, age, sex, occupation, weight on admission.  Date of admission and operation.  Treating and notifying doctor.  Vital signs on admission.  Frequency of vital signs. 2- Patients’ diagnosis. 3- daily living activities such as: - diet and fluid - activities , bath ,allergy 4- Special nursing information.  Kardex 5- diagnostic test (type, date taken & date received of test) 6- medication(date-type–dose-route &frequency of medication) Updating Kardex done through: - Shift reports. -Patient record. -Patient –centered conference. -Physicians round. Kardex form: Diagnosis: Age: sex: Date of admission: occupation: Date of operation: treating Dr: V/s on admission: Dr to be notified: T: P: R: BP: Wt: Freq Tq: Pq: Rq: BPq: Wtq: Diet: Bath: Fluid: Allergy: Activity: Elimination: urine: Stool: Special in formation: Hosp No: Room No: Pt name: Bed No:  Kardex Investigations Medications Type Date Date Date Type Dose Route Frequency taken received  Kardex How to fill in Kardex: The following abbreviations used in writing Kardex: Post- op Postoperative Pre-op Preoperative V/S Vital Signs T Temperature P Pulse R Respiration Bl.pr/ BP Blood pressure Wt Weight Kg Kilogram Ht Height NA Not Applicable/Not Freq Frequency Available q Every hr/hrs Hour/Hours Min Minute Sec. Second No. Number Pt. Patient Rt. Right Lt. Left For diet ( according to pt's case & diagnosis): N Normal NPO Nothing per Oral/Mouth NGT Nasogastric Tube Breast feeding (amount \ hr). Hi- Vit High Vitamin Battelle feeding (amount \ hr). Hi-Cal High Caloric Hi \low protein Low fats  Kardex For activity ( according to pt's case & diagnosis): Amb. Ambulatory Lim. Limited mobility C.B.R Complete Bed Ridden Wh/ch Wheel Chair For Bath: S/C Self Care P/B Partial Bath C/BB Complete Bed Bath For allergy: -Diet (name) -Medication(name) -Dust , smoke. -NKA No Known Allergy For Elimination: -Urine: N Normal Cath. Catheter UOP Urine out pot -Stool: N Normal Diarrhea, constipation, or Melina………… etc For Investigations:(according to pt. records) Abd. Abdomen/Abdominal U/S Ultra Sound CBC Complete Blood Count RBCs Red Blood Cells WBCs White Blood Cells Hb Hemoglobin Pt/Pc Prothrombin ECG Electrocardiogram time/Concentration  Kardex S. K serum Potassium EEG Electroencephalogram S. Ca serum calcium ABG Arterial Blood Gases S. Na serum sodium Chest X- rays For Medication: (as Dr. ordered on pt records) Normal saline or Na Cl Sodium chloride CC Cubique Cent miter ml Milliliter L Liter mg. Milligram Liq Liquide Sol Solution Amp. Ampoule Tab. Tablete Caps. Capsules -Route of administration: O Oral IV Intraveineuse IM Intramusculaire SC Subcutaneous Syr. Syrup Ung Ointment gtts. Drops (eye, ear, or Supp. Suppository nose ) -Frequency of médications:- 1-For oral given types: Bid Two times a day Tid Three times a day Qid Four times a day OD Once Daily PRN As needed 2-For parentéral given types: q 24 hrs Once a day q 12 hrs Twice daily  Kardex q 8 hrs Three times a day q 6 hrs Four times a day Other Abbreviations: AM/ am Morning Pm/ pm After noon Fr Fracture OR Operating Room DR Delivery Room ER Emergency Room Ortho. Orthopedics ENT Ear Nose and Throght GB Gall Bladder GIT Gastro Intestinal Tract GE Gastroenteritis HB Heart Blok G. Edema General edema PROM Premature rupture of membrane ROM Range of motion LL Lower Limb O2 Oxygène Amt. Amount Examples for special information: (according to the case) -Check I.V cannula for place & patency q 2 hrs as scheduled ( 8,00 am - 10, 00 -12.00 pm……….. etc ). -Check urinary cath. for place & patency q 2 hrs as scheduled (8,00am- 10,00- 12,00……………. etc) -Check NGT for place & patency q 2 hrs as scheduled ( 8,00 am -10, 00 - 12.00 pm……….. etc ). -Check cardiac monitor connections q shift. -Check oxygène connections q shift.  Kardex -Monitor Intake & Output q shift. -Nebulizer setting q 4 hrs as scheduled ( 8,00 am -10, 00 -12.00 pm………. etc ) -Daily ECG @ 9,00 am. -Daily dressing @ 10,00 am. -Change pt. position q 2 hrs as scheduled ( 8,00-10,00- 12,00…… etc ). -Encourage early ambulation -Import health teaching about diet , Exercise , Hygiene, baby care,…etc. -Maintain clear& calm environment.  Kardex Example of filled Kardex: Diagnosis: Appendicitis for ( Appendectomy) Age: 35yrs Sex: ♂ Date of admission: 3-3-2010 Occupation: Teacher Date of operation: 4-3-2010 ( 2nd day post.op) Treating Dr: Adel Hassan V/s on admission: Dr to be notified: M. Ali T: 37.2 Co P: 80b/m R:19 c/m BP: 110/80 Mm/Hg WT: -- -Freq: Tq: 2Hrs Pq: 2Hrs Rq:2Hrs BP: 2Hrs WT: -- -Diet: NPO Bath: p/b -Fluid: I.VFluid( 3000cc\24hrs,31gtts/min). Allergy: NKA Cath.300cc -Activity: Lim. urine: Elimination: @1.00 pm Stool: N Special information: -Check I.V cannula for place & patency q 2 hrs as scheduled ( 8,00 am -10, 00 -12.00 pm……….. etc ). -Check urinary cath. for place & patency q 2 hrs as scheduled (8,00am-10,00- 12,00……………. etc) -Daily dressing @ 10 am -Change position q 2 hrs as scheduled ( 8,00-10,00- 12,00……….. etc ). -Encourage early ambulation -Import health teaching about diet , Exercise , Hygiene,………… etc. Hosp No.: 3220 Room No: 1 Pt name: Ali Sayed Bed No: 3  Kardex Investigations Medications Type Date Date Date Type Dose Route Frequency taken receive -C.B.C Glucose 5% 500 cc I.V q24 hrs -Abd. u/s N.saline 0.9% 500cc I.V q 8 hrs -Chest X- Ringer's 500cc I.V q12 hrs 3/3/2010 3/3/2010 5/3/2010 ray lactates Zantac 75 mg O BID Ketoprek 75mg I.M PRN Objectives  Define time schedule  Enumerate 3 objective of time schedule  List 6 polices of time schedule  Apply time schedule principles in developing a time schedule  Develop a time schedule for one unit for one month and one week  Choose one system of time schedule systems  Differentiate between approaches of time schedule  Differentiate between patterns of time schedule  Compare between systems of time schedule Outlines Introduction Definition Objectives Principles Polices Systems of time planning Time planning Approaches Forms of Scheduling Schedule Pattern Introduction Scheduling personnel is a complex, time –consuming, and frequently perplexing task. However it must be done. Appropriate work scheduling is a prerequisite for successful nursing operations, because pattering of working/ non-working hours directly affects employee productivity, work satisfaction, and job tenure Definition Planning pattern of on-off duty hours for employee in a particular unit for a given period of times OR Distribution of hours to be worked by each person during each 24 hours, 7 days a week, per a month OR distribution of hours to be worked by each person during each 24 hours, seven days a week, i.e., assigning personnel specific days and specific hours of work. Objective of time planning: 1. To provide adequate staffing to meet patient care needs according to the philosophy and policy of the organization during a 24hrs period. 2. To utilize experience and skills to the best advantage. 3. To organize work in the unit. 4. Prevent confusion by avoiding periods of understaffing and overstaffing. 5. To maintain staff morale (Equity of treatment to all employees). 6. To match accurately units needs with staff abilities and number. 7. To define responsibilities of personnel. Principles of time planning: 1) It should be planned to meet needs of each time period and balance the needs of patients and personnel. 2) There must be an equitable distribution of the desirable as well as undesirable hours of duty. 3) Scheduling policies must be identified at the time of employment 4) An employee must be assured that his assigned time on duty will not change unless an extreme emergency arises and only with his permission. 5) All staff members should be assigned similar duty hours as much as possible, and days off should be equitable for all personnel. 6) There should no accumulation of days off. 7) There should be a professional nurse on duty at all times during the24- hour period. 8) Draw up a long-term plan to maintain morale (e.g. made out for a monthly period). 9) Special requests should be granted if reasonable 10) Changes in the time schedule should be kept to a minimum. 11) There should be an overlapping of each shift to provide time for shift reports. 12) There should be a day apart between head nurse and assistant head nurse days off. 13) The head nurse is rarely off duty on Saturday, which is the beginning of the week. 14) A day off is given before and after a night shift. 15) The head nurse has to be sure that the unit is adequately staffed when inexperienced staff is working 16) If time for students is planning by the head nurse, certain points should be considered: A-It should be planned cooperatively with instructor. B-Remember time off is given when there are no classes. C- Keep students well supported by graduate staff. D- Allow for slight over-lapping of each shift. Scheduling Policies: 1) The person, by title, who is responsible for preparing employees' time schedules. 2) The total on-duty hours required for each employee per day, week, or month.) 3) The day that starts the work week (Saturday? Monday? ) 4) The beginning and ending hour for each work shift. 5) The amount of time allowed for work and meal breaks. 6) The number of shifts to which each employee must rotate. 7) The number of weekends per month that an employee must work 8) The conditions under which an employee may be "floated" to another unit 9) The minimum time interval between work shift (8, 12 hours). 10) The procedure to be used by employees in requesting OFF duty time for specific holidays as :( Vocation time, Emergency time, Sick days). 11) The restriction on vacation scheduling during feast. 12) The required minimum of days off in sequence. Systems of time planning: Centralized Scheduling: All work hours for nursing staff are planned in a central office by staff scheduler  Unbiased  Save head nurse-time  Provide overall picture of staffing situation  Eliminate contact between head nurse, staff. Decentralized Scheduling: It planned at unit level by head nurse  Staff has personalized attention.  Meet staff needs  More easily, less complicated. Self-Scheduling: It allows nurses on the unit to assign themselves on the schedule while assuming total responsibility for coverage of the unit and maintains an appropriate level of competency. Takes advantages of centralized and decentralized schedule Time Planning Approaches:  The Manual Approach: One or several person prepares a schedule for a special time for a group of personal on one nursing division, several divisions.  The Computer-Assisted approach: It enables the user to develop a plan that considers more variables than would be possible for hand calculations. The head nurse gives data to the computer and by a computer it self make schedule to nurses by a special program found in it. Types of scheduling working hours:- 11. Blocking scheduling: For a unit is planned in a “block” Means that the work schedule be worked by staff are blocked together. Of week, i.e. days to Block scheduling is done for 3-6 weeks at a time. For example if you’ve request block scheduling for your next travel nursing assignment, your schedule could look like this: Monday – Off Tuesday – Off Wednesday – Off Thursday – Off Friday – On Saturday – On Sunday. Advantages: It can be calculated easily. 2. Has flexibility in that the next block of time does not Necessarily need to follow the pattern of the preceding block. Disadvantage: This type of scheduling does not provide for maximum level of care seven days a week.  Week SA S M T W Th F 1 M M M M M M O 2 M M M M O M M 3 E E E E O N N 4 E E O E E E E 5 N N N N N O M Cyclical staffing pattern: It is a technique for assigning days and time off in a pattern that repeats itself regularly while taking in consideration the need for the proper number and mixes of personnel, Continuity of care. Cyclic time scheduling is done for “six To eight weeks’. Advantages: 1. This type of scheduling is desirable to many nurses since they can calculate even month in advance when they will be on – duty and off. 2. This type also provide for coverage of professional nurses and allow each employee to have at least one full weekend off every 4 weeks cycle and it never has the nurse working more than five consecutive days. 3. Also there are never less than 2RNs on duty, there are never more than 2 persons [RN and LPN considered together] off on the same day. 4. There is never a day without at least one LPN on duty. Disadvantages: Because it repeats without change, the only schedules That need careful attention are those in which Exception occur, as in a week containing a holiday.  Week SA S M T W Th F 1 M M M E E N O 2 E E N O M M M 3 N N O M M E E 4 M M M E E O N 5 E E E N N O M Scheduling patterns of working hours: There are many patterns: Eight hours shift This is a traditional pattern that uses 8 hours shifts for time planning for the 24 hours period. The pattern may be as such: Morning: 7am to 3:30pm. Evening: 3pm to 11:30am. Night: 11pm to 7:30am Ten hours shift This pattern allows staff to work 10 hours a day for 4 days a week and three days off. This is a 6 week cyclical pattern that has advantages over the 8 hours/day. Shifts developed for the 10 hours day. Example:- Morning: 7am to 5:30pm. Evening: 1pm to 11:30am. Night: 9pm to 7:30am.  Twelve hours shift This pattern consists of working 12 hours a day with 2 days off prior to a change of shift. The shift hours are : Usually 7 am to 7.30 pm and 7 pm to 7.30 pm was introduced due to inadequate staffing, but it proved to be appropriate in ICU and modified ICU Irregular hours shift each week and the Nurses work a number of hours hours of work may vary depending on patient care requirements or service demands Nurse may work 10 hours, 12 hours or irregular length shift. This system is implemented for the services of highly trained clinical nurse specialist or for nurses in in-service training supervision programs. It can be useful in increasing productivity but it is often costly because it ends up increasing the number of required staff  Incident report: Outlines:- 1. Definitions (incident,incident report). 2. Purpose of incidence report. 3. Principles of written incidence report. 4. Types of incident reporting in health care. 5. Components of incident report. 6. Benefits of incidence report. 7. When should the incidence report be faild. Objectives 8. At the end of this lecture the students will be able to 9. Define (incident & incident report) 10. Mentione the Purpose of incidence report. 11. Discus the Principles of written incidence report. 12. Enumerate type of incidence. 13. Mention component & benefits of incident report 14. Know when should the Incidence report be faild. Introduction: It is an important administrative tool for use in studying the cause of accident or incident in the hospital by providing information which will lead to effective preventive measures and in case of legal actions. Definition: incident 1. Any happening which is not consistent with routineg operation of the hospital or the routine care of a patient. It may be an incident or a situation which might result in an accident, e.g., error in medication and admission of the treatment, etc. 2. An incident is an unexpected event that affects patient or staff safety. 3. Definition of incidence report: is a form that is filled out in order to record details of an unusual event that occurs at the facility, such as an injury to a patient. The process of writing incident data:- are related to  physical injuries  medical errors,  equipment failure  administration,  patient care, or others In short, anything that endangers a patient’s or staff’s safety is called an incident in the medical system. Purpose of Incident Reports:- 1. Incident reports provide valuable information to hospital administration facilities. 2. They capture data required to highlight necessary measures to improve the overall safety and quality of the hospital. 3. To document the exact detail of an accident or unusual incident that occurred in a health-care institution. 4. To be used in the future when dealing with liability issues stemming from the incident. 5. Helps in the evaluation of nursing care to ensure safe care to all patients. 6. An accurate incident report serves multiple purposes.-  Root Cause Identification  Policy and Process Improvements  Clinical Risk Management  Continuous Quality Improvement (CQI)  Better Training and Continuous Learning Principles of written incidence report. 1. Written at the first opportunity after the incident so that the details are not blurry or forgotten. 2. Written with a pen (ink) not pencil. Information written using a pencil can be erased. 3. Details should be complete and accurate. 4. Events should be written in sequence that they occurred. Proper technical terms should be used. For example instead of using the word bottle specify that it is a urinal. 5. Identifies the witnesses. 6. Identifies the medications given before the incident (If applicable) 7. Identifies the equipment that is involved or used. 8. Signed legibly with the correct designation. 9. Events should be written in sequence that they occurred. Types of Incident Reporting in Healthcare:- An incident is an unfavorable event in health organizations. But, the nature of the incident can vary based on numerous circumstantial factors. Broadly, there are three types of incident reports: 1. Clinical Incidents A clinical incident is an unpleasant and unplanned event that causes or can cause physical harm to a patient. These incidents are harmful in nature; they can severely harm a person or damage the property. For example— Nurse administered the wrong medication to the patient. Unintended retention of a foreign object in a patient after a surgery. Blood transfusion reaction. 2. Near Miss Incidents Sometimes an error/unsafe condition is caught before it reaches the patient. Such incidents are called “near-miss” incidents. However, the problem might have diffused before the severe harm, but it is still essential to report near-miss incidents. Nearly 50 near-miss incidents occur for each injury reported. For example— A nurse notices the bedrail is not up when the patient is asleep and fixes it. A checklist call caught an incorrect medicine dispensation before administration. A patient attempts to leave the facility before discharge, but the security guard stopped him and brought him back to the ward. 3. Non Clinical Incidents Non-clinical incidents include events, incidents, and near-misses related to a failure or breach of Environmental Health and Safety( EH&S) regardless of who is injured or involved. For example— Misplaced documentation or documents were interchanged between patient files. A security mishap at a facility. 4. Workplace Incidents A work accident, occupational incident, or accident at work is a discrete occurrence that can lead to physical or mental occupational injury. The workplace incidents are related to mental as well as physical hurts. the nursing assistant jobs have the highest incidence rates. For example— Patient or next-of-kin abuses a care provider – verbally or physically – leading to unsafe work conditions. A healthcare provider suffered a needle prick while disposing of a used needle. Critical Components of Incident Report One comprehensive incident report should answer all the basic questions — who, what, where, when, and how. 5 Why's (report facts) 1. What :- describe what happened in details. 2. When :- give the date and time of incident. 3. Where :- describe the incidence location. 4. Who:- tell who did what to whom and who witnessed to the incidence. 5. Why:-did equipment fail? Did someone fail to perform the certain procedures. An incident report must cover the following aspects: 1. General Information The well-informed incident report needs basic information such as the date and time of the incident. Additionally, for future analysis, your report must include general information. 2. Location of the Incident Specifically, mention the location of the incident and the particular area within the property—for example, patient X fell in Ward no. 2 near the washroom. With the location specifications, administration staff can better investigate the reason behind the incident and fix it. 3. Concise yet Detailed Incident Description The incident description needs to be clear and meaningful — don’t use vague language, never add baseless information, and keep personal biases out. Whenever you have to add your opinion to the report, mark it as an assumption or subjective opinion. 4. Type of the Incident You should define the nature of the incident while reporting to get a clear view. We can categorize the hospital incidents into different sections such as Medication Error, Patient Fall, Equipment Damage, Abuse, Pressure Ulcer, Radiation, Surgery/Anesthesia, Laboratory related, Security, Harassment, Loss or damage to property, Patient Identification, among others 5. Information of all Parties Involved in the Incident The administration needs the name and contact details of all the parties involved in the incident. The report should capture all the relevant information required to follow up with the involved parties. 6. Witness Testimonies If there are witnesses available to the incident, it will be helpful to add their statements in your report. While writing witness statements, focus on the following attributes — specific details provided related to the incident, use quotation marks to frame their accounts, note witnesses’ location at the time of the incident, and how they are related to the incident. 7. Level of Injury In case of injury, the reporting staff must record the injury level and cause in the report. If the incident involves an in-patient at the hospital, their medical records will reflect the treatment and diagnosis of the injury. However, for others, it might be required to follow up and record their injury diagnoses. 8. Follow Up The incident report is incomplete without the follow-up action details. Each report should include remarks stating what preventive measurements and tactics you have opted to avoid such incidents in the future. Benefits of Hospital Incident Reporting: 1. Through healthcare data analysis, setting the correct key performance indicators (KPI) in your organization. 2. Preventive Measures. 3. Disease Monitoring. 4. Cost Reduction. 5. Enhanced Patient Safety. When should the incidence report be faild :- Immediately after the incidence occurred:-  Memories are freshe  Evidence is in place  Immediate corrective action can be intiated to prevent others Example of incidence report  INCIDENT REPORT FORM Information about person Involved in the incident : Patient name : Department : MRN : Address : Phone Number : Information about the Incidence : Date : Time : Police notified : Location of incident : Description of Incident : Witness : Was there any injury ? if so , describe the injury (location , and any other information about result of injury … Was a medical treatment provided ? if yes , where ? *On site * urgent care *emergency room * other  Reporter information : Signature : Date report completed : Report received by : Date : The Case A 2-year-old girl was admitted to a hospital burn unit for a 10% total body surface area burn on her face, upper chest, and back. She was being treated with oral acetaminophen around the clock and nonsteroidal anti-inflammatory drugs as needed for pain and discomfort. The patient underwent dressing changes and burn inspection every third day. On these days, she was also given oxycodone, which was highly effective and allowed her to rest the whole day. One week into the hospital stay, the mother noticed the patient's breathing was very shallow after a dressing change. On examination, the patient was difficult to arouse and lethargic, and an arterial blood gas revealed CO2 retention and hypoxemia. While preparing to intubate, the physician reviewed that day's medications to identify possible causes of this sudden change in respiratory status. He discovered the patient had received oxycodone 3 times in less than 8 hours (1 dose prior to the dressing change and 2 doses after). The nurse checked the automated dispensing machine in which the oxycodone was stored and was surprised to find a higher concentration of oxycodone solution stored in place of the typical, lower concentration pediatric solution. Consequently, the dose administered to the patient was almost 5 times what was ordered. After the physician and nurse recognized the error, the patient immediately received multiple doses of naloxone. Her breathing improved quickly, and intubation was avoided. The patient was monitored in the hospital for 1 week after the incident, did well, and was safely discharged home. Root cause analysis (RCA) by the safety committee determined the higher concentration of oxycodone solution was incorrectly placed in the automated dispensing machine by a pharmacist who was working per diem. The RCA also found that the nurse did not check the concentration of the medication to be administered against the order written by the physician. After the incident, multiple checkpoints were established in the pharmacy and a new protocol was established, with a special focus on pediatric medication doses. In-service training was provided to all the pharmacists, including those who work irregular shifts (e.g., overnight).  NURSING NOTES Outlines:- 1. Definition of documentation, progress notes and nurse note.  Purpose of nurse note  Benefits of nursing notes.  Principles of nurse note  Characteristics of nurse note  Component of nurse note Objective:- 15. Define (Definition of documentation, progress notes and nurse note. 16. Mention Purpose of nurse note. 17. Discus Benefits and Principles of nurse note. 18. Enumerate Characteristics and Component of nurse note. Introduction:- A nursing note is an official health record used to document precise details about every nursing assessment, service provided, change in the patient’s condition, patient admission, and other medical or clinical-driven data. It works similar to a Doctor’s Note except that nursing notes are written by nurses already. And covering nursing notes has been practiced among hospitals and medical facilities worldwide. Definitions:- 2. Documentation:- it is anything written or electronically generated that describes the status of a client or the care or services given to the patient. Or It is the process of communicating in written form about essential fact. Records and reports are essential components of documentation. 5. Progress notes:- are the part of a medical record where healthcare professionals record details to document a patient's clinical status or achievement during the course of a hospitalization , written and signed by the physician, written every day or every few hours in acute phase.all procedures performed should be recorded,dated and signed in these notes. 7. Nurses's notes :- It eh si document that used by uniheun staff to record their dnuuil nul lideviiilcare, observation , pertinent data on medication, treatment,diet, physical and mental condition,any abnormalities in patient,etc. Purposes/uses of nursing notes:- Nurses frequently use nursing notes and documentation:- 6. Provide good way for communication between nurses and other health care providers. 7. Create an accurate descriptions of nursing assessments, changes in patient conditions, the specific care provided. 8. Provide a way for nurses to document their patient's clinical status, the results of reassessment after interventions are performed and how patients responded. 9. Record any abnormal lab or assessment results,changes in patient's condition and any changes in the plan of care. 10. Accurate data to develop a plan of care and ensure continuity of care for patients. 11. To prevent error and duplication of care and medication. 12. good resource for reaserch and education. 13. Service as evidence of care in a court of law. Benefits of Nursing Charting Notes:  Health Insurance Portability and Accountability Act (HIPAA) compliance:- One of the major benefits of having nursing charting notes is that you can increase your HIPAA compliance tenfold. 2.Legal and insurance protection: In the case that a patient finds themselves in a court of law, your notes can serve as sufficient evidence to prove medical expertise and authoritative decisions. 3.Save time:-Not only this but using nursing charting notes means that you can save time where it counts. 4.Higher medical outcomes:-Utilizing nursing charting notes also means you can increase the quality and standard of medical outcomes within your practice. 5.Greater shareability :-Finally, using nursing charting notes allows for greater shareability when it comes to referrals and additional support from other healthcare practitioners. Principles for writing Quality nurse notes:- 1. Always use a consistent format :make apoint of starting each record with a patient identification information.each entry should also include Nurse full name,the date and time of the report. 2. Keep notes timely: nurses should complete notes in real time and not wait till the end of the shift.write note within 24 hours after supervising and observation and noting care given must be done while it's fresh in your memory so no faulty information is passed along 3. Remain objective: Nurse should write down only what see and hear.avoid noting subjective comments or giving your own interpretation on patient's condition. 4. Ignor trivial information: everything included in nurses notes should directly relate to the patient's health only 5. Keep it simple: note should be designed to be quickly read,so nurses and doctors on the next shift can be caught up to speed on a patient.focus only on specific information relevant to symptoms you are charting. 6. Write clearly: when nurse do handwritten notes, make an effort to keep the handwriting clear and readable, illegible handwriting can lead to a patient to a patient receiving the wrong medication or an incorrect dosage , this can have serious or even fatal, consequences. Standard nurses notes usually include an opening note, middle notes and a closing note.in these notes nurse should note any primary or secondary problems a patient is experiencing.record things like blood pressure, heart rate and skin color that can offer insight into these issues. 7. Use standard abbreviation: write out complete terms whenever possible if nurse must use an abbreviation, stick to standard medical abbreviation familiar to other nurses or the attending physician 8. Nurses should make a record of any assessment that have administered during the shift.indicate if more tests are needed and include a probable diagnosis of their condition. 9. Always note what medication the patient has been prescribed.List all medication the patient has been given,along with dosage and how the medication was administered. 10. The nurse should be extra careful when she/he thinks they are "too busy" it is ironic that it's at your busiest hours that the importance of documenting is the most crucial. 11. Avoid general statement: it is important to be as specific as possible toavoid later misinterpretation.for example,you wrote "Dr.smith called"did you mean :You called and are waiting for a return phone call? The physician called the nurse.The nurse called and spoke to physician?abetter option is "assessment findings discussed,and no additional orders at this time". 12. Note all communication: jot down everything important you hear regarding a patient's health during conversation with family members,doctors and other nurses this will ensure that all available information on the patient has been charted.always designate communication with quotationmarks. 13. Late entries and any corrections:entered should be per policy and procedures.sign each entry correctly, including date and time. 14. No charting should be done in advanced. 15. Notes should include staff notified and steps taken:careful nursing assessment makes spotting changes in the patient's condition easier.,in all cases the notes should include the name of any staff the nurse notified about a particular situation and reports tha steps taken by the medical team. Components of nursing notes:- Nurse's notes begin with the admission of the patient to the unit and could include:-  Date and time  Statement of apparent condition of the patient.  Record of symptoms noted.  Treatment instituted   Time and type of specimen  Changes in the client's condition  The administration of tests, treatment, procedures, patient education with the results of or patient's respons.  The patient response to an intervention.  The evaluation of expected outcome.  Complaints from patients or family.  Signed by the nurse who rendered the service. Signature should include full name and professional status. What Should be Included In a Nursing Notes Template:-  Patient Demographics: An effective nursing notes template should begin with a section for patient demographics, including the patient’s name, date of birth, age, gender, medical record number, and admission date.  Chief Complaint or Reason for Visit: The template should have a dedicated section to document the patient’s chief complaint or the primary reason for their visit.  Vital Signs and Measurements: A comprehensive nursing notes template must include a section to record vital signs such as temperature, pulse, blood pressure, respiratory rate, and oxygen saturation.  Head-to-Toe Physical Assessment: The template should facilitate a thorough head-to-toe physical assessment by providing distinct sections for each body system.  Medication Administration and Response: An essential component of a nursing notes template is a section for recording administered medications, including the drug name, dosage, route, and time.  Nursing Interventions and Patient Education: The template should include a section to document nursing interventions performed,  Plan of Care and Progress Notes: A well-designed nursing notes template should have a dedicated section for documenting the patient’s plan of care, including ongoing assessments, treatments, and referrals to other healthcare professionals. Characteristics of good nursing notes:-  Accurate  Complete  Current  Complaints with standard  Organized  Objective  Factual  Free of errors and grammatical or spelling errors.  Concise manner by using abbreviations as appropriate.  Written by using permanent -ink pen, blue or black ink  Don't leave space between entries.  Never change another person's entry,even if it is incorrect.  If an error is made use the single line to cross out of the error,then date , time and sign the correction.  Chart omissions document the reason for the omission. Example of nursing notes:-  Forme of nursing note Pt name : - shift :- Diagnosis:- unit:-