COPE Health Scholars Patient Care Station Packet PDF

This document is proprietary and confidential to COPE Heath Solutions and is protected under the copyright laws of the United States and other countries as an unpublished work. Any other reliance or disclosure in whole or in part of this information without the expressed written permission of COPE Health Solutions is prohibited. COPE HEALTH SCHOLARS PATIENT CARE STATION PACKET Copyright © 2019 COPE Health Solutions. All rights reserved Table of Contents Table of Contents...................................................................................................................................................... 2 Introduction............................................................................................................................................................... 2 COMPETENCY 1: COMMUNICATION & SERVICE EXCELLENCE..................................................................................... 3 COMPETENCY 2: ENGAGEMENT & PROFESSIONAL BOUNDARIES.............................................................................. 7 COMPETENCY 3: PROPER BODY MECHANICS.......................................................................................................... 9 COMPETENCY 4: INFECTION PREVENTION AND PPE............................................................................................... 11 COMPETENCY 5: HIPAA AND PHI.......................................................................................................................... 13 COMPETENCY 6: MANDATORY REPORTING............................................................................................................. 15 SKILL A: AMBULATING A PATIENT........................................................................................................................... 16 SKILL B: POSITIONING A PATIENT........................................................................................................................... 19 SKILL C: MAKING AN UNOCCUPIED BED................................................................................................................. 21 SKILL D: MAKING AN OCCUPIED BED...................................................................................................................... 22 SKILL E: CHANGING A PATIENT.............................................................................................................................. 24 SKILL F: BATHING A PATIENT................................................................................................................................. 26 SKILL G: TRANSFER FROM BED TO WHEELCHAIR................................................................................................... 28 SKILL H: TRANSFER FROM BED TO GURNEY/STRETCHER....................................................................................... 30 SKILL I: FEEDING A PATIENT................................................................................................................................... 32 SKILL J: VITAL SIGNS............................................................................................................................................. 35 Introduction The purpose of the patient care station packet is to provide the Scholar trainee with an outline of the competencies and skills they will apply as a part of the patient care team. The skills are simple step by step processes. It is encouraged that trainees see this packet as a tool kit of skills to be integrated together with real life scenarios which will require additional thoughtful problem solving and critical thinking skills. Sections to look out for: Process Key Tips 1. This section contains the step-by-step Scholars should remember to do these things instructions Restrictions IMPORTANT  Scholars may never do these things  These sections contain important reminders about policy and consequences. Copyright © 2019 COPE Health Solutions. All rights reserved. 2|Page COMPETENCY 1: COMMUNICATION & SERVICE EXCELLENCE Communication Communication is critical in health care, both within the patient care team and to the patient. When communicating it is important to be aware of various aspects and strategies of communication. Verbal Communication Strategies When addressing patients, family, or staff, be sure to speak clearly and avoid the use of any slang. Ask questions if staff instructions are unclear and ask patients about their preferences to allow them ownership of their care.  Assess for and be aware of:  Primary language  Ability to hear  Ability to speak  Make allowances for any difficulties that the patient might have. Non-Verbal Communication Strategies Body language can convey as much as the words you speak. Show staff that you are an engaged member of the care team, and show patients that you are empathic and committed to ensuring their quality of care.  Stand near the patient and make eye contact. Listen attentively.  If appropriate, sit down when speaking to the patient.  Use reassuring gestures, such as nodding your head to encourage the patient to continue talking.  Do not talk to the patient as you are walking out of the room; finish all conversations politely. Rounding is a frequent activity scholars participate in and it is a prime time to build rapport and seek feedback. Our goal is to deliver excellent care but this requires factoring in the patient’s perception and experience of the services they are receiving. Ultimately, feedback on service is evaluated and reported out through Centers of Medicare and Medicaid, such as HCAHPS. These surveys are designed to collect data on the patient’s perception of care and provide crucial data to key stakeholders throughout the delivery system. Please review the tables below for suggested questions and phrases/words to avoid. Rounding Questions “Are the nurses answering your questions?” “Please share with us how we could improve your stay.” “Tell us about your stay.” “Did your doctor/nurse reduce communication barriers when discussing your care?” “Was our staff attentive to your needs?” Phrasing and Key Words to Avoid The questions below are out of bounds because they coach the patient by utilizing the same survey question format and words like “always” and “on a scale.” Examples of phrases and questions to avoid:  “Did the nurses always answer your questions?”  “On a scale of 0 to 10, how would you rate your experience?”  “Is there a way we could always….?”  “Did your doctor/nurse explain things in a way you could understand?”  “Overall, how would you rate the care you received from your doctors/nurses?” Copyright © 2019 COPE Health Solutions. All rights reserved. 3|Page Key Tips Include A.I.D.E.T. in every patient interaction. Apply S.K.A.H.I. when entering all patient care rooms. Patient Identification If you are performing or assisting with an approved task, identify that you are assisting the correct patient by doing at least two the following: 1. Check the white board in the main nurses’ station for patient information  Including, but not limited to: room #, patient’s name/initials, nurse’s name 2. Use an open-ended question  Example: ask for the patient’s full name, DOB, or medical record number 3. Check the patient identification wristband  Confirm patient’s name and/or DOB 4. Ask the patient’s nurse 5. Check the patient chart  For paper charts, check the outside cover of the patient’s chart to confirm the patient’s name and room/bed #.  In an ambulatory setting, ask two open-ended questions and compare to order sheet, visit summary, or registration list as appropriate. Copyright © 2019 COPE Health Solutions. All rights reserved. 4|Page AIDET & SKAHI A.I.D.E.T. A.I.D.E.T. is a guideline for communicating with our patients and visitors. It is an evidence-based set of service principles that, when used consistently, has been proven to support excellent service delivery. Include AIDET in every patient interaction. Acknowledge What: When you enter the patient’s room, acknowledge the patient by name. Make eye contact. Demonstrate a positive and friendly attitude. Smile! Ask the patient how they would like to be addressed. Tell the patient how you would like to be addressed. Why: Help the patient feel important, heard, and acknowledged. Introduce What: Introduce yourself (name and position). Tell the patient what you are there to do. Why: Help the patient feel confident that both you and the staff are the best choice for their care. Duration What: Share with the patient how long your interaction will take. Why: Help the patient feel more in-control by knowing how long they will spend with you. Explanation What: Before proceeding, explain what you will do, why, and if they may experience any pain. Continue to narrate your actions step-by-step throughout the interaction. Actively solicit and answer questions. Why: Help the patient feel more in-control by knowing what is happening when, and why. This will bring more ease to the patient and develop trust. Thank What: Thank the patient for entrusting you with their care. Thank family/visitors for being there to support the patient. Be sure the patient’s room is in the condition you would want it, with everything clean and within reach. Perform hand hygiene (hand sanitizer or soap and water, if required by precautions) when leaving the room. Why: Because the patient has trusted us with their care and has the choice to return to us and recommend us to others. S.K.A.H.I. Apply S.K.A.H.I. when entering all patient care rooms. Signs Assess the outside of the room for signs Knock Always knock before entering the room Assess Assess the patient’s immediate surroundings and the room for cues to understand their state (personal belongings, positioning, monitor connections, etc.) Hand Hygiene Gel in with hand sanitizer or wash your hands with soap and water Identify Ensure that you know the patient you are interacting with and use two patient identifiers prior to performing any task Copyright © 2019 COPE Health Solutions. All rights reserved. 5|Page S.K.A.H.I. goes hand in hand with A.I.D.E.T. Signs Assess the outside of the room for signs Knock Knock before entering the room. Acknowledge Acknowledge the patient by name. Smile! Ask how they would like to be addressed. Introduce Introduce yourself by name and position. Let them know what you are there to do. Assess Assess the patient’s surroundings for cues to understand their state. Hand Hygiene Perform hand hygiene (hand sanitizer or soap and water). Identify Use at least two patient identifiers before beginning any task. Duration Share with the patient how long your interaction will take. Explanation Explain what you will do, why, and if s/he may experience any pain. Continue to narrate your actions step-by-step throughout the interaction. Actively solicit and answer questions. Thank Thank the patient for entrusting you with his/her care. Leave patient’s room clean and orderly, with the call light within reach. Perform hand hygiene (hand sanitizer or soap and water) when leaving the room. Assisting Patients  Before assisting a patient, check with the RN if there are any precautions affecting the patient’s mobility or how the patient should be assisted. (i.e. ability/willingness to cooperate, clinical condition, bariatric condition, etc.)  Check for any catheters such as Foley catheter, Intravenous (IV) or any other tubes or pieces of equipment that may interfere with normal movement.  Prior to assisting the patient, explain what will happen and how you will be assisting.  While assisting the patient, narrate all actions. It is important the patient feels aware of what is happening and is as comfortable as possible  Engage with the patient regardless of their ability to respond and level of consciousness.  During any task, engage in conversation and connect with the patient. Utilize service excellence skills to make the patient’s stay as comfortable and positive as possible  Do not place any items on the floor. If you drop something on the floor, dispose of it in the appropriate bin (e.g. waste, linen, etc.), and provide a new/clean item to the patient/visitor  Be neutral when others are upset, in conflict, or angry General process: Prepare the Begin patient and the interaction environment Conclude Begin and Gather items Curtain narrate task (AIDET) Brakes (SKAHI/AIDET) Side Rails Bed position Copyright © 2019 COPE Health Solutions. All rights reserved. 6|Page COMPETENCY 2: ENGAGEMENT & PROFESSIONAL BOUNDARIES Key Term(s)1 Definition Therapeutic A relationship that allows the application of professional knowledge, skills, abilities and Relationship experiences towards meeting the needs of the patient. Professional Effective and appropriate interaction between professionals and those they serve. Boundary Space between Scholar’s scope of service and the patient’s lived experience. Brief excursions across professional lines of behavior that may be inadvertent, Boundary thoughtless or even purposeful, while attempting to meet a special therapeutic need of Crossings the patient. *Boundary crossing is a clinically therapeutic skill outside of Scholar scope* Boundary Occurs when there is excessive personal disclosure, secrecy or a reversal of roles Violations between the Scholar and of the patient. The action of understanding, being aware of, and being sensitive to the feelings, Empathy thoughts, and experience of another without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner. The act or capacity of entering into or sharing the feelings or interests of another. Sympathy Feeling pity or sorrow for another. Staff Engagement Goals  Maintain a professional boundary  Preserve a mentor/mentee relationship o Allows for professional development of Scholar o Ensures that working relationships are not misread or confused with friendship or other personal relationships Patient Engagement Goals  Maintain a professional boundary (space between Scholar scope of service and the patient’s lived experience)  Develop a therapeutic relationship o Protects patient’s dignity, autonomy, and privacy o Allows for the development of trust and respect o Allows for the Scholar to act in best interest of patient as directed by staff  Responding with empathy o Active Listening  Make a conscious effort to hear what another is saying – not just the words but the true message o Give patients your undivided attention 1 https://www.ncsbn.org/ProfessionalBoundaries_Complete.pdf Copyright © 2019 COPE Health Solutions. All rights reserved. 7|Page  Demonstrates care and concern  Builds trust o Respond with empathy  Acceptance of where they are and understanding of what they want for themselves, not a plan to fix it all Boundaries Boundaries are critical for sustaining empathy and collaborating with the patient care team to deliver care.  Physical o Be aware of staff/patients who seem agitated and maintain a safe distance o Be aware of actions that can be mistaken to be romantic or sexual in nature o Ex: Scholars should also never go to secluded locations with staff or patients  Emotional o Do not solve problems for patients. Your role is to elevate problems that are presented to you, but not to solve problems independently o Recognize how your own feelings or lived experience impacts your relationships with staff/patients and be aware of issues of transference and countertransference o Do not keep secrets with or for a patient o Do not take on responsibility for a patient’s emotional well being o Do not show favoritism  Personal and Informational o Kindly decline a request to connect via social media to prevent unwanted boundary crossings o Avoid socializing outside of work time o Don’t give/receive personal gifts o Be careful about information you disclose about yourself  Ex: don’t give out addresses, phone numbers, health information, social details, etc. Key Tips Clarify and verify what is said Explain rights and responsibilities of patient Explain roles, boundaries, limitations of relationship Escalate concerns to the RN or Charge Nurse and COPE Health Solutions staff member Engage staff to address patient’s needs Restrictions Scholars may not:  Form a personal relationship or step past professional boundaries  Give out personal information  Do or accept special favors (including receiving, giving, or lending money) Copyright © 2019 COPE Health Solutions. All rights reserved. 8|Page COMPETENCY 3: PROPER BODY MECHANICS Key Term(s) Definition The proper way to move a body part in relation to another, or one Body Mechanics body in relation to another so as to minimize the risk of injury or strain Areas of the body where the bone is close to the surface of the skin Bony Prominences and greatest risk area for developing pressure sores resulting in wounds Patient is lying in bed in a supine position with the head of the bed Fowler’s Position elevated to 45 - 60º Semi-Fowler’s Patient is lying in bed in a supine position with the head of the bed Position elevated at approximately 30º High-Fowler’s Patient is lying in bed in a supine position with the head of the bed Position elevated upright at 90 º Proper Body Mechanics  Maintain a neutral spine at all times to ensure proper alignment and body mechanics.  Keep a low center of gravity by flexing the hips and knees instead of bending at the waist: this distributes weight evenly between the upper and lower body and maintains balance.  Create a wide base of support by spreading your feet shoulder width apart. This provides lateral stability and lowers your body’s center of gravity.  Keep your body’s center of gravity directly over the base of support by moving your feet to maintain proper body alignment. Point your toes in the direction of the intended movement. Do not twist or bend at the waist.  Lift with your legs, not your back.  Pushing is preferable to pulling.  When assisting a patient in bed, adjust the bed height to just below waist level of the shortest patient care team member. o If height discrepancy is large, identify a different care giver to assist or use a step stool if there is not another caregiver to assist. The Log Roll Technique 1. Adjust the bed so that it is flat and at a height that allows for Proper Body Mechanics a. Raise the rails at the head of the bed at minimum when adjusting the bed. 2. Remove pillow(s) from under/around the patient. 3. Have the patient cross their arms and legs to assist in moving the patient as one unit. a. If the patient is rolling onto their left side, the right arm and leg should be on top, and vice versa. 4. Raise all rails on the side the patient will be turning to and lower the rails on the other side so the patient care team member can assist the patient to turn. Copyright © 2019 COPE Health Solutions. All rights reserved. 9|Page 5. Place one hand under the patient’s scapula (shoulder blade) and one under the iliac crest (hip bone). 6. Place your dominant foot forward and bend with your legs to lower you center of gravity bringing it closer to the patient’s center of gravity. 7. Ask the patient to reach over to the railing they will be turning towards. 8. On the count of three, shift your weight from your back foot to your front foot. Rotate your hands from an underhand to overhand placement while shifting your weight, guiding the patient over to their side. 9. Your partner will then replace your hold to provide support while the patient is on their side. The Swivel Technique 1. Adjust the bed height in order to allow for Proper Body Mechanics. 2. Raise the head of the bed so the patient is in Fowler’s position. a. If the patient has a stronger side, always transfer toward the stronger side. b. If the patient only needs minimal assistance, encourage him/her to roll over gradually and bring one leg over the side of the bed at a time. Place one hand on the patient’s back to help him/her sit the rest of the way up. Let the patient rest between each movement. 3. Ask the patient to cross their arms and legs. a. If the patient is able to assist with the swivel, ask them to use their hands and own body weight to facilitate movement. 4. Place one hand on the patient’s scapula (shoulder blade) and the other hand “over & under” the patient’s knee. 5. Swing the patient’s legs off the edge of the bed while guiding the back. Key Tips Always ask for assistance if you are physically unable to perform a task on your own. Staff will be able to set up and operate a mechanical lift to transfer the patient. Have the patient help themselves as much as possible to reduce the work of the patient care team member When adjusting patient placement, support the patient’s boney prominences and move the patient as one unit Handle patients as close to their center of mass (hips area) as possible Restrictions  Scholars are not allowed to operate mechanical lifts  Never have a patient put their arms around your neck during a transfer  Never pull/push on a patient’s arm or shoulder Copyright © 2019 COPE Health Solutions. All rights reserved. 10 | P a g e COMPETENCY 4: INFECTION PREVENTION AND PPE Key Term(s) Definition When disease is known or suspected to be infectious and workers require protection Infection Prevention from the disease. Support to help prevent the spread of infectious diseases through infection control measures in healthcare settings. Personal Protective Equipment used to reduce exposure to, and protect against, infectious materials. Equipment (PPE) Includes gloves, gown, masks, goggles, face masks. Any method that removes or destroys microorganisms on hands. Hand Hygiene Effective Hand hygiene is the # 1 strategy for preventing infection. Personal Protective Equipment (PPE) Assess the outside of the room for isolation signage and follow instructions according to the type of isolation. DONNING PPE: 1. Perform hand-hygiene 2. Unfold gown and insert arms into the sleeves. 3. Tie the band around your waist securely. 4. Place the mask over your nose and mouth and secure the mask. a. Bend the top of the mask over the bridge of your nose so that it is in a comfortable position. 5. Put on goggles, if applicable. 6. Put on appropriately sized gloves, with the ends of the gown sleeves tucked inside. DOFFING PPE: 1. Carefully remove your gloves, ensuring that you do not touch the outside of the gloves. 2. Remove the goggles (if applicable). 3. Remove the gown from around your neck. 4. Roll the gown towards your waist. Make sure you do not touch the outside of the gown. Continue to roll the gown until it is in a ball. 5. Discard the gown in the appropriate dispenser. 6. Remove your mask. 7. Perform hand-hygiene. Perform hand-hygiene as needed throughout the donning and doffing processes. Copyright © 2019 COPE Health Solutions. All rights reserved. 11 | P a g e Hand Hygiene PROPER HAND-HYGIENE2: 1. Hand Rub (foam or gel) a. Apply to palm of one hand (the amount used depends on specific hand rub product). b. Rub hands together, covering all surfaces, focusing in particular on the fingertips and fingernails, until dry. Use enough rub to require at least 20 seconds to dry. 2. Handwashing a. Wet hands with water b. Apply soap c. Rub hands together for at least 20 seconds, covering all surfaces, focusing on fingertips and fingernails d. Rinse under running water and dry with disposable towel e. Use the towel to turn off the faucet Key Tips Items may not be removed from an isolation room unless appropriate precautions are followed or if the patient is transferred to another room/floor or if the patient is being discharged. Always check your clothing for any bodily fluids when entering and exiting patient rooms, especially isolation rooms. Carefully assess the outside of each room prior to entering Restrictions  Health Scholars are never allowed to enter airborne isolation rooms  Junior Health Scholars cannot enter any isolation rooms 2 https://www.cdc.gov/handhygiene/training/interactiveEducation/frame.htm Copyright © 2019 COPE Health Solutions. All rights reserved. 12 | P a g e COMPETENCY 5: HIPAA AND PHI Key Term(s) Definition Health Insurance Portability and Accountability Act. HIPAA US law designed to provide privacy standards to protect patients' medical records and other health information provided to health plans, doctors, hospitals and other health care providers. Protected Health Any information about a person’s physical health, mental health, provided care and Information (PHI) payment for that care HIPAA HIPAA RULES: Rules were established to protect the privacy and security of health information and provide individuals with certain rights to their health information  Privacy Rule o Sets standards for when protected health information (PHI) may be used and disclosed  Security Rule o Requires safeguards to ensure only those who should have access to PHI will have access  Breach Notification Rule o Requires covered entities to notify affected individuals and the Dept. of Health and Human Services (HHS) SOCIAL MEDIA AND HIPAA: NEVER POST OR REPOST Regardless of a patient posting every last detail about his/her medical issues and treatments, no medical professional, staff, volunteer or student should repost, retweet or "regram" this information on their personal pages  Never post information on personal social media pages as the voice or representative of the hospital, practice or business  No Pictures or Videos o Taking and/or transmitting an image or video of a patient with an electronic device is strictly prohibited  Avoid ‘Friending’ o Do not “friend” and connect with patients on social media Copyright © 2019 COPE Health Solutions. All rights reserved. 13 | P a g e PHI  Written PHI – Patient Chart and Patient Lab/X-ray Reports o Ensure that PHI is not left on copy machines or desk tops. o Pick up any dropped wrist bands or medical papers off floor immediately and return to appropriate staff member. o Do NOT dispose of any PHI, even if directed by staff member.  Electronic PHI – Electronic Medical Record o Ensure that computer monitors are covered or shielded from the public eye. o Never delete any computer data, even if directed by a staff member.  Oral PHI – Verbal Communication  Do not talk about PHI in hallways, elevators, parking lots, or public areas. You never know if the person next to you may think you are referencing their relative, neighbor, or friend IMPORTANT If a patient chart is unavailable (lost/stolen/misplaced/destroyed) or inaccurate/falsified:  The institution may be imposed serious federal or state fines  The employee (or Scholar) may be terminated or held accountable  The patient may receive unsafe or inappropriate medical care Restrictions Scholars are prohibited from:  Deleting/entering any electronic data into/from a patient’s record  Taking any PHI with them from the program site  Discarding any PHI, even into the appropriate locked bin or shredding box Copyright © 2019 COPE Health Solutions. All rights reserved. 14 | P a g e COMPETENCY 6: MANDATORY REPORTING Key Term(s) Definition An unexpected or unanticipated event that needs to be reported to the facility and Program Manager Incident Examples: patient fall, walking into an isolation room without proper PPE, patient complaint, patient injury (including but not limited to skin tears, bedsores, bruises), etc. A type of incident – any physical or emotional harm that occurs to the participant while Injury serving shifts in the facility Examples: slipping on the floor/stairs, needle stick, traumatic encounter, etc. A type of incident - any exposure of PHI to unauthorized persons. Breach Examples: Finding a pile of patient records in the lobby of the Emergency Room Process REPORTING AN INCIDENT 1. Tell the Charge Nurse a. Immediately after the incident occurs, inform the charge nurse of the unit where you are stationed 2. Page the onsite Program Manager prior to leaving site a. Pager number: (888) 248-2914 REPORTING AN INJURY 1. Tell the charge nurse a. Immediately after the incident occurs, inform the charge nurse of the unit where you are stationed 2. Get treated a. Go to Employee Health or the Emergency Department after hours or in case of serious injury. 3. Page the onsite Program Manager prior to leaving site b. Pager number: (888) 248-2914 IMPORTANT  If reporting procedure is not followed, Scholars may be released from the program  Scholars who are injured while performing duties will be treated by the facility for first aid only *Scholars are financially responsible for any treatment administered onsite beyond basic first aid * Copyright © 2019 COPE Health Solutions. All rights reserved. 15 | P a g e SKILL A: AMBULATING A PATIENT Supplies Requirements  Non-skid shoes or socks RN/PT  RN/PT approval and direction  Assistive devices, i.e. canes,  Appropriate rail adjustment walkers (optional) Key Term(s) Definition Ambulate To walk from place to place A designation assigned to a patient whose stability is of concern in order to prevent falls Fall Risk from occurring Process PREPARE 1. Assess the outside of the room for any signage indicating patient as fall risk 2. Introduce yourself to the patient and confirm that you are comfortable to assist with proceeding with ambulating 3. Gather necessary supplies a. Provide appropriate assistive device (i.e. walker, cane, etc.) as instructed by the patient’s RN 4. Perform hand hygiene and apply gloves to assist patient out of bed 5. Assess a. Ask the patient when he/she last walked b. Check to see if they are designated as a “Fall Risk” patient i. Fall Risk wristband ii. Signs outside room c. Ensure the patient is wearing non-skid shoes or socks d. Identify catheters or monitor leads connected to the patient e. Ensure the wheels on the bed are locked 6. Adjust the bed height in order to allow for Proper Body Mechanics (page 8) HELPING A PATIENT OUT OF BED 1. Raise the head of the bed so the patient is in Fowler’s position 2. Utilize Swivel Technique (page 9) to guide the patient so they are sitting on the side of the bed 3. While supporting the patient, lower the bed (further, if necessary) and ask the patient to move to the edge of the bed until his/her feet are firmly planted on the ground. HELPING A PATIENT STAND UP Copyright © 2019 COPE Health Solutions. All rights reserved. 16 | P a g e 1. Ensure the patient’s feet are under their knees. 2. Stand in front of the patient and place one foot between the patient’s feet. 3. Flex your knees slightly maintaining your base of support. 4. Ask the patient to place their hands on the bed to help push up. Place your hands on the patient’s lower back (lumbar area). 5. Count to three and slowly stand up with the patient. AMBULATION 1. Walk next to the patient and slightly behind, ensuring that the patient is steady and will not fall. The patient requires your full attention and watchful care a. Hands can be placed on patient’s lower back (lumbar area) and on/under their arm to better the support the patient. 2. If the patient has I.V. lines or a catheter, ask the nurse for assistance in getting the patient unhooked, out of the bed, and properly set up for ambulation a. Do not touch or adjust the I.V. pump settings or tubing connections b. Have the patient use the I.V. pole for support on one side while you support the other side 3. Remove gloves before exiting the room 4. When returning the patient to the bed, ensure proper bed settings as directed by the RN 5. Once the patient is safely in bed, report the following items to the patient’s RN: a. Distance walked b. Patient’s tolerance to mobility Providing an Assisted Fall 1. If the patient indicates that s/he is becoming faint/dizzy, call out for assistance and guide the patient to the nearest resting location (chair, bed, wheelchair, etc.). 2. If the patient indicates that s/he is going to fall, call out for assistance and guide the patient down to the floor: a. Keep a tight core and neutral spine. b. Place your arms underneath the patient’s axillae and bend at the knees to help the patient to the floor. c. Call out for help as you guide the patient to the floor (bend at the knees), holding on to his/her core to direct their fall. Do not try to stop the fall by attempting to hold the patient up. d. Ensure that the patient’s head and neck are protected. e. Do not leave the patient unattended. Stay with the patient until assistance comes. i. Do not attempt to bring the patient back up or to reposition them once fallen. f. Patient falls are incidents. If this situation occurs in your presence, please follow proper reporting protocol. Copyright © 2019 COPE Health Solutions. All rights reserved. 17 | P a g e Image Disclaimer: The image above shows an example of one way a fall can be assisted. The goal of an assisted fall is to help ease the patient gently to the floor while keeping both the caregiver and the patient safe during the process. Restrictions Do not ambulate a patient if:  The patient has not walked since being admitted to current floor.  The patient has not walked in more than 12 hours.  The patient is designated as a “Fall Risk” patient.  You feel that you would be unable to provide support in the event of a fall.  The patient needs to be walked to the restroom. Staff MUST be present to ambulate the patient.  Alternatives if walking is restricted: urinal, bedpan, or bedside commode Copyright © 2019 COPE Health Solutions. All rights reserved. 18 | P a g e SKILL B: POSITIONING A PATIENT Supplies Requirements  2-3 pillows RN  RN approval and direction  Foam cushion  Clinical staff member presence  Friction-reducing device  Flat bed Process PREPARE 1. Check-in with the RN for approval and direction a. If the patient is on tube feeding or has other limitations, check with the RN to ensure that tube feeding/IVs/etc. are properly adjusted before adjusting the bed. 2. Gather necessary supplies 3. Perform hand hygiene and apply gloves 4. Identify a. Catheters or monitor leads connected to the patient b. Ensure the wheels on the bed are locked 5. Adjust the bed so that it is flat and at a height that allows for Proper Body Mechanics (page 8) RE-POSITIONING A PATIENT UP IN BED 6. When sliding a patient up in bed, the bed should be flat or in a slight Trendelenburg position, with the side rails down. Use a friction-reducing device if possible. 7. Place a pillow at the headboard as needed to protect the patient 8. Position yourself at mid-torso of the patient and position your feet so they point towards the head of the bed. Keep the knees slightly bent. 9. Roll up the blue pad/chuck/draw sheet toward the patient and grasp with an underhand grip 10. On the count of three, slide the patient upwards carefully using proper body mechanics. Perform two movements if necessary or find more staff. 11. If the patient can help, ask him/her to pull up by the rails and push with his/her legs 12. Remember that the movement is to slide the patient, NOT to lift, with follow-through from your lower body RE-POSITIONING A PATIENT ON THEIR SIDE 1. To position a patient on his/her side, ask the patient or provide assistance and perform the log roll, to help them turn on their side toward the raised guard rails. The rail can be lowered on the side where you are working on. Copyright © 2019 COPE Health Solutions. All rights reserved. 19 | P a g e 2. Never allow weight to rest directly on the greater trochanter of the femur (hip). Place the patient so that his/her weight is resting on his/her buttock. Place pillow (folded) or foam wedge under the chuck/draw sheet to maintain the position. 3. Place a pillow between the knees and ankles to minimize the pressure exerted when one limb lies atop the other. 4. When positioning a patient, suspend the patient’s feet so the bony prominence on the heels is not under pressure. Use a pillow length-wise or foam cushion under the calves to suspend the heels. 5. Lower the bed to the lowest height and raise the head of the bed to the patient’s desired position. Key Tips Positioning may change based on the weight of the patient or already existing bed sores Follow direction of a nurse regarding patients that have existing pressure ulcers so to avoid shearing force. If required, nursing staff will use a mechanical lift or lift team, Health Scholar will only assist With every repositioning, look for reddened skin or skin tears, if identified, alert the RN assigned and follow proper reporting procedures. If there is no extra pillow, you can place the pillow length wise to cover the knees and ankle or you can take an extra sheet, fold it, and place it under the ankles Restraints = ____ bed rails raised Restrictions  Scholars are not allowed to operate any lift equipment  Scholars may not apply/release and/or tighten/loosen restraints Copyright © 2019 COPE Health Solutions. All rights reserved. 20 | P a g e SKILL C: MAKING AN UNOCCUPIED BED Supplies Requirements Clinical  Fitted sheet Staff  Clinical staff approval and direction  Blue pad/Chuck(s)  Flat bed  Draw sheet  Flat sheet  Pillow case(s)  Lightweight blanket  Heavy blanket (optional) Process PREPARE 1. Gather necessary supplies 2. Perform hand hygiene and apply gloves 3. Assess a. Ensure the wheels on the bed are locked 4. Adjust the bed so that it is flat and at a height that allows for Proper Body Mechanics (page 8) MAKE AN UNOCCUPIED BED 5. Remove all soiled linens on the bed, watching for any belongings/sharps that may have fallen into the linens (glasses, false teeth, phones). 6. Discard the soiled linens into the proper hamper. Do not throw the linen on the floor. 7. Wipe the bed/pillow down with Sani wipes, and ensure that the bed/pillow stays wet for at least 2 minutes (or according to the instructions on the label for the wipes being utilized). Allow bed/pillow to dry completely. 8. Remove gloves and perform hand hygiene. 9. Place new linen on the bed: a. Place fitted sheet on bed. b. Place blue pad/Chuck(s) and/or draw sheet (if necessary) across center of bed. c. Place top sheet so that center of sheet will be in center of mattress. d. Place blanket in the same manner as top sheet and tuck both under the mattress at foot of bed. e. Accordion fold covers down to end of bed. f. Put clean pillow cases on pillows. 10. Lower the bed to the lowest height, raise the head of the bed and assist the patient back into bed. Copyright © 2019 COPE Health Solutions. All rights reserved. 21 | P a g e SKILL D: MAKING AN OCCUPIED BED Supplies Requirements Clinical  Fitted sheet Staff  Clinical staff approval and direction  Blue pad/Chuck(s)  Clinical staff member presence  Draw sheet  Flat bed  Flat sheet  Appropriate rail adjustment  Pillow case(s)  Lightweight blanket  Heavy blanket (optional)  Patient gown Process PREPARE 1. Check-in with the RN for approval and direction 2. Gather necessary supplies 3. Perform hand hygiene and apply gloves 4. Draw the curtains to maintain patient privacy 5. Assess a. Identify catheters or monitor leads connected to the patient b. Ensure the wheels on the bed are locked 6. Adjust the bed so that it is flat and at a height that allows for Proper Body Mechanics (page 8) MAKING AN OCCUPIED BED 7. Adjust the bed rails appropriately. a. Raise the rails on the side the patient will be turning to and lower the rails on the other side so the caregiver can assist the patient to turn. 8. Carefully remove pillows around/under the patient. 9. Turn the patient toward the side of the bed with the raised side rails using the Log Roll Technique (page 8). 10. Roll all of the soiled linen toward the patient’s back, in the middle of the bed. a. If there is a disposable Chuck(s), roll it in first and separate from the other linens. 11. Place clean linen on half of the bed, rolling up the other half and tucking it under the soiled linens that were previously rolled in. a. Ensure that the clean linen is tucked nicely and pulled tightly to avoid linen folds. Copyright © 2019 COPE Health Solutions. All rights reserved. 22 | P a g e 12. Untie/clip the back of the patient’s gown (if applicable). 13. Guide the patient over to lay on their back again and warn them of the linen “bump”. 14. Replace the soiled gown with a new gown. 15. Adjust the bed rails appropriately. a. Raise the rails on the side the patient will be turning to and lower the rails on the other side so the caregiver can assist the patient to turn. 16. Turn the patient toward the side of the bed with the raised side rails. 17. Tie/Clip the back of the patient’s gown (if applicable). 18. Remove the soiled items and place them in the appropriate bin – trash for disposable items and the soiled linen bin for linens. 19. Pull the clean linen out from under the patient and pull tight so that the patient does not have to lie on any linen folds. 20. Guide the patient back onto their back. 21. Change the pillow case(s) and place them around/under the patient as instructed by the RN or CNA/PCA. 22. Change the top linens on the patient’s bed, being careful to maintain privacy. 23. Return the bed to the appropriate height. Key Tips During the log roll, check the patient for reddened skin/bed sores. When applicable, wipe the bed/pillow down with Sani wipes, and ensure that the bed/pillow stays wet for at least 2 minutes (or according to the instructions on the label for the wipes being utilized). Copyright © 2019 COPE Health Solutions. All rights reserved. 23 | P a g e SKILL E: CHANGING A PATIENT Supplies Requirements (a) Fracture bed pan RN  RN approval and direction (b) Regular bed pan  Clinical staff member presence (c) Measuring hat  Flat bed (d) Commode (e) Urinal (f) Chuck(s) (g) Adult brief (h) Adult wipes (a) (b) (c) (d) (e) (f) (g) (h) Process PREPARE 1. Check-in with the RN for approval and direction 2. Gather necessary supplies 3. Perform hand hygiene and apply gloves 4. Draw the curtains to maintain patient privacy. 5. Assess a. Identify catheters or monitor leads connected to the patient b. Ensure the wheels on the bed are locked 6. Adjust the bed so that it is flat and at a height that allows for Proper Body Mechanics (page 8) ASSISTING A PATIENT WITH A BEDPAN/URINAL Copyright © 2019 COPE Health Solutions. All rights reserved. 24 | P a g e 7. Place a blue pad/Chuck(s) under patient using the log roll technique, if not already present. a. Bedpan: Log roll to place bed pan under the patient or ask the patient, if able, to lift their hips and slide the pan under the patient. i. Log Roll Technique when using a bedpan: 1. Use appropriate bed pan (fracture or regular) as instructed by the clinical staff. 2. Align the pan so that contents dispelled will be caught in the pan. 3. Raise the head of the bed to semi-fowlers while the patient is using the bed pan and provide her/him some privacy. 4. Once complete, lower the head of the bed to turn the patient and remove the bed pan. 5. Always have a nurse examine the contents before flushing them down the toilet. 6. If asked to measure the contents, please use a measuring cylinder/cup. Regular Bed Pan Fracture Bed Pan b. Urinal: Give patient the urinal or assist in holding, if needed 1. Ask the person to put the urinal between his legs. 2. Spread the person's legs if he cannot do it himself. 3. If the person is male and needs extra help, place his penis into the opening at the top of the urinal. 4. Position the urinal and hold it gently while the person urinates. 8. If the gown is soiled, replace with a fresh gown. 9. Remove any soiled items and place them in the appropriate soiled linens bin. Key Tips During the log roll, check the patient for reddened skin/bed sores. Notify the patient’s nurse if there is any visible blood in urine or stool. Before assisting a patient with toileting, ask nurse if the contents needs to be set aside for measurement or assessment. Copyright © 2019 COPE Health Solutions. All rights reserved. 25 | P a g e SKILL F: BATHING A PATIENT Supplies Requirements Wash cloths/wipes RN  RN approval and direction Towels  Clinical staff member presence Gown  Appropriate rail adjustment Wash basin Cleansing solution Lotion (optional) Deodorant (optional) Key Tips Be sure to keep the patient covered as much as possible during the bathing process, to (1) protect the patient’s privacy and (2) keep the patient from getting cold. Thoroughly dry the skin after rinsing so the patient doesn’t get cold. Elderly patients have very fragile skin which often tears or bruises easily. Be careful and gentle when washing and drying. Provide opportunity for patient involvement throughout the bathing process. Change the wash cloths/wipes at any time during the bath if it is necessary, however, it is a must to change the cloths/wipes after cleaning the anal area. If the patient has a urinary catheter, the clinical staff will perform catheter care and provide further instructions during the bathing process. Process PREPARE 1. Check-in with the RN for approval and direction 2. Gather necessary supplies a. For wash wipes only: Heat up in designated warmer according to the instructions provided on the package. 3. Perform hand hygiene and apply gloves 4. Draw the curtains to maintain patient privacy 5. Assess a. Identify catheters or monitor leads connected to the patient b. Ensure the wheels on the bed are locked 6. Adjust the bed so that it is flat and at a height that allows for Proper Body Mechanics (page 8) BATHING A PATIENT Copyright © 2019 COPE Health Solutions. All rights reserved. 26 | P a g e 7. Fill wash basin with warm water and cleansing solution, and place small wash cloths in the basin. a. Have the patient test the water with their hand before you proceed. FLAT 8. Replace the patient’s soiled gown with a bath towel(s) prior to starting the bath. a. Cover the patient with a towel and pull the gown out from under the towel. b. Keep the patient covered with bath towel(s) throughout the bathing process to ensure privacy and warmth. c. If the towel does not provide sufficient coverage, a clean blanket may be used instead. 9. Wash and Dry a. Face – wash and rinse the face as necessary b. Arms - support the arm while washing the axillary region and apply deodorant i. Be careful when cleaning the area around an IV. Ask an RN to unhook the IV if needed. c. Chest – wash under breasts and in-between folds d. ★Groin – wipe front to back, with a new side of the of the cloth/wipe each time e. ★Legs i. If possible, have the patient flex their leg at the knee and wipe the back of each leg. f. Feet i. Wash thoroughly between toes and note skin condition. ii. Apply lotion to feet and legs, if requested. LOG ROLL g. Tuck the towel/blanket in between the patient’s legs, and have patient cross their arms so the towel/blanket does not fall off during the log roll. h. ★Back - wipe back from neck to buttocks/back thighs i. ★Anal Area – wipe front to back (avoid contaminating the perineum) 10. Change bed linens (if needed) FLAT 11. Remove the bath blanket and provide a clean gown. 12. Remove all items that were used for the bath from the patient’s room and discard used linen in appropriate bin. 13. Return the bed to patient’s desired position. ★Required times to change wash cloths during bathing process Key Tips During the log roll, check the patient for reddened skin/bed sores Copyright © 2019 COPE Health Solutions. All rights reserved. 27 | P a g e SKILL G: TRANSFER FROM BED TO WHEELCHAIR Supplies Requirements  Wheelchair (wheels that lock) RN  RN approval and direction  Non-slip shoes, slippers or socks Process PREPARE 1. Check-in with the RN for approval and direction 2. Gather necessary supplies a. Apply gloves. Wipe down the wheelchair with Sani Wipes (using gloves) and allow two minutes to dry. Discard gloves. 3. Perform hand hygiene and apply gloves (for non-discharge transfers) 4. Assess a. Identify catheters or monitor leads connected to the patient b. Ensure the wheels on the bed are locked 5. Adjust the bed height in order to allow for Proper Body Mechanics (page 8) TRANSFER BED TO WHEELCHAIR 6. Place the wheelchair parallel and close to the foot of the bed, facing the head of the bed. There should NOT be a gap between the bed and the wheelchair. 7. Lock the wheels of the wheelchair. Raise the wheelchair foot rests and swing them out to avoid interfering with the transfer. 8. Make sure that the bed and wheelchair are locked, and all catheters and wires are out of the way or secured. 9. Utilize Swivel Technique (page 9) to guide the patient so they are sitting on the side of the bed 10. Make sure the patient is stable. If possible, have the patient scoot forward so s/he can place his/her feet flat on the floor. Wait a few moments and ask to make sure the patient is not feeling dizzy, weak or light-headed. STAND PIVOT 11. Stand in front of the patient and place one foot between the patient’s feet. 12. Flex your knees slightly maintaining your base of support. 13. Ask the patient to place their arms on the bed to help push up. Place your hands on the patient’s lower back (lumbar area). 14. Ask the patient to stand and support as much of his/her own weight as possible. At the same time, straighten your knees and hips, rising with the patient by straightening your body. 15. Pivot with the patient toward the wheelchair (shuffle), keeping your knee between both of the patient’s knees. 16. Supporting the patient as needed, tell her/him to grasp the armrest of the wheelchair with his/her hand. Copyright © 2019 COPE Health Solutions. All rights reserved. 28 | P a g e a. While moving, if the patient begins to feel faint, guide him/her back to sit on the bed or lower him/her into the wheelchair, if possible, or to the floor (whichever is closest at that time). 17. Ask the patient when he/she can feel the wheelchair. If the patient cannot position him/herself correctly, help him/her move his/her buttocks against the back of the chair. 18. Place the patient’s feet flat on the footrests, pointed straight ahead. 19. Ensure that all belongings have been collected (check outlets, drawers, etc.). 20. Remove gloves before leaving room Discharge Process 1. Confirm with the nurse that the patient is ready to be discharged and that transportation arrangements have been confirmed. 2. Obtain a wheelchair (all patients must be discharged via wheelchair to pick up location). 3. Identify the patient using two patient identifiers. 4. Make sure the patient has all of his/her belongings. a. Note that valuables (items that need to be locked up, such as wallets, money, jewelry, electronic devices, etc.) are handled by staff members only. 5. Check out with the unit secretary and patient’s nurse. 6. Carefully wheel the patient to the designated discharge location (never walk a patient to his/her vehicle in a parking structure/lot or leave hospital grounds). a. When using the elevator, be sure to wheel patient backwards into the elevator so they are facing the doors. b. When going over bumps, be sure to wheel the patient backwards so that do not fall out of the wheelchair 7. Wait with the patient until their transportation arrives - never leave a patient alone. 8. Return the wheelchair to the same department it was borrowed from and wipe clean. 9. If the patient falls or displays any medical issues at any point of the discharge process, get help or take them back to the department for assessment. Restrictions Scholars may never:  Accept tips  Help patient into car  Assist with the car or car seats  Handle/seal valuables bags  Discharge patient to any area outside of the designated patient pick-up area Copyright © 2019 COPE Health Solutions. All rights reserved. 29 | P a g e SKILL H: TRANSFER FROM BED TO GURNEY/STRETCHER Supplies Requirements  Flat Sheet RN  RN approval and direction  Transfer equipment  Clinical staff member presence  Gurney  Flat bed Process PREPARE 1. Check-in with the RN for approval and direction 2. Gather necessary supplies 3. Perform hand hygiene and apply gloves 4. Draw the curtains to maintain patient privacy 5. Identify a. Catheters or monitor leads connected to the patient b. Ensure the wheels on the bed/gurney are locked 6. Adjust the bed so that it is flat and at a height that allows for Proper Body Mechanics (page 8) TRANSFER BED TO GURNEY/STRETCHER 7. Place a flat sheet under the patient’s chuck using the Log Roll Technique (page 8). 8. Adjust the gurney to the same height as the bed or slightly lower. 9. Place the gurney parallel to the bed. 10. Lock the wheels of the gurney and the bed. 11. When moving a patient from the bed to a gurney, use one of the following techniques: a. If patient is able to assist with the transfer: i. While standing at the center of the gurney and holding it firm with your body, encourage the patient to slowly move him/herself over onto the gurney b. If patient is UNABLE to assist with the transfer: i. Place a flat sheet under the patient to facilitate the transfer. Place the flat sheet so that it covers the transfer equipment/material (slide board, z-slider, etc.). 2 PATIENT CARE TEAM MEMBERS 12. Caregiver #1 and Caregiver #2 stand on either side of the patient at the center of the bed or gurney and roll up the flat sheet with the underhand grip technique. 13. Caregiver #1 log rolls the patient toward Caregiver #2. While Caregiver #2 holds the patient, Caregiver #1 pushes the bed and gurney together and places the transferring equipment/material underneath the patient’s linens and in the middle of the gurney and the bed. Caregiver #2 lowers the patient down onto the transfer equipment. Copyright © 2019 COPE Health Solutions. All rights reserved. 30 | P a g e Caregiver #1 Caregiver #2 14. Encourage the patient to cross arms across their chest and their legs, and to then hold up his/her head. 15. In one fluid motion, Caregiver #1 pulls the flat sheet and Chuck(s) and Caregiver #2 guides the patient over in a synchronized fashion. 4 PATIENT CARE TEAM MEMBERS Additional caregiver roles during transfer: 16. Caregiver #3 stands at head of gurney: Gently lift up the flat sheet/patient’s head and guide the patient toward the bed. 17. Caregiver #4 stands at foot of gurney: Gently lift up the flat sheet/patient’s feet and guide the patient toward the bed. USING A SLIDE BOARD 18. At the side of bed: Place one hand firmly on the slide board with an overhand grip and one hand on the draw sheet with the underhand grip technique. Guide the patient across the slide board and onto the gurney in unison with the caregiver at the head of the bed. 19. At the side of the gurney: Place one hand firmly on the slide board with an overhand grip and the one hand on the draw sheet with the underhand grip technique. Pull the patient across the slide board and onto the gurney in unison with the caregiver at the head of the bed. USING OTHER TRANSFER EQUIPMENT (DRAW SHEET) 20. At the side of bed: Place both hands on the draw sheet with the underhand grip technique. Guide the patient across the and onto the bed in unison with the caregiver at the head of the bed. 21. At the side of the gurney: Place both hands on the draw sheet with the underhand grip technique. Pull the patient across and onto the bed in unison with the caregiver at the head of the bed. REMOVING TRANSFER EQUIPMENT 22. Remove the flat sheet and transfer equipment using the Log Roll Technique (page 6). Key Tips During the log roll, check the patient for reddened skin/bed sores. Maintain patient’s privacy at all times. Use proper body mechanics at all times, i.e. keep knees close to gurney, bend knees slightly to prevent back strain. Always be sure to look for any skin tears before and after transferring the patient. If observed, notify RN of any skin tears and follow proper reporting procedures Copyright © 2019 COPE Health Solutions. All rights reserved. 31 | P a g e SKILL I: FEEDING A PATIENT Supplies Requirements  Meal tray RN  RN approval and direction  Wash cloth(s)  High fowlers position  Tooth brush and paste Background Aspiration  Inhalation of secretions, fluids, or solids, usually food, into the trachea rather than into the esophagus  Associated with patients characterized by: o Dysphagia (difficulty swallowing) o Facial, oral, or neck surgery or trauma o Post-anesthesia o Reduced level of consciousness o Inability to elevate upper body  Signs of aspiration can include: o Complaints of food sticking in throat o Repetitive swallows o Throat clearing o Coughing before or after swallowing o Pocketing food inside the cheek Silent Aspiration  No clear signs of aspiration or choking  Silent aspiration is assessed through: o Chest x-rays o Temperature o Respiratory status o Multiple pneumonias o Swallowing status Process PREPARE 1. Check-in with the RN for approval and direction 2. Gather necessary supplies 3. Perform hand hygiene a. Gloves are optional, unless the patient is in an isolation room 4. Identify 5. Assess Copyright © 2019 COPE Health Solutions. All rights reserved. 32 | P a g e a. Catheters or monitor leads connected to the patient b. Ensure the wheels on the bed are locked 6. Adjust the bed height in order to allow for Proper Body Mechanics (page 8) FEEDING A PATIENT 7. Adjust the bed to upright, high Fowler’s position or sit patient up in chair unless contraindicated. Ask the patient if he /she is comfortable and sitting high enough. 8. Verify that the patient name and MR# on the food tray matches the patient I.D. armband. 9. Put on gloves and wipe the tray table with Sani-wipes so that it is clean prior to putting the food tray on it. Discard soiled gloves and sanitize/wash hands. 10. Place the meal tray on the tray table. 11. Assist the patient in washing his/her hands and face. Use a warm soapy hand towel and rinse appropriately. 12. Stand or sit in a chair next to the patient while feeding the patient. 13. Allow the patient to have as much control over the meal/feeding as possible. a. If necessary, use a napkin or towel(s) to protect the patient from spills. b. Encourage the patient to assist in eating. c. Ask the patient which food he/she would like to start with first, in what order he/she would like to eat the meal. d. Be careful that the food is not too hot. Do not blow on the patient’s food to cool it. e. Feed slowly. Do not hurry the feeding process; ask the patient when he/she is ready for the next spoonful of food. f. Talk to the patient while feeding him/her to help make the meal time one of visitation and conversation. 14. When the patient is done eating, remove the food tray and towel(s). a. Leave the bed raised in high Fowlers. b. Clean the tray table. c. Provide appropriate hand, face, and items for oral care to the patient. d. Change the patient gown and bed linen if he/she spilled any food during the meal. e. Report the amount of solid food and liquids that the patient ate to the nurse. f. With RN approval, take food tray to soiled utility room. Copyright © 2019 COPE Health Solutions. All rights reserved. 33 | P a g e Key Tips Feed patient slowly and only provide bite-sized pieces Follow signs posted for aspiration precautions Ask nurse if the patient is on the ventilator or has a tracheostomy tube Obtain instructions from patient’s nurse regarding reheating food, especially for patients in isolation rooms STOP feeding the patient if you notice any signs of aspiration (difficulty swallowing, choking, or refusal to swallow his/her food), immediately notify the patient’s nurse Do not put additional food into the patient’s mouth until he/she has an empty mouth Restrictions  Never administer medication(s) to a patient  Never feed a patient with high risk of aspiration Copyright © 2019 COPE Health Solutions. All rights reserved. 34 | P a g e SKILL J: VITAL SIGNS Supplies Requirements  Automated vitals machine RN  RN approval and direction  Alcohol wipes  Fowlers position  Temperature probe cover  IV or BP Cuff Sign (optional)  Paper and pen Vital Sign Adult Normal Average/Range* Blood Pressure 120/80 mmHg Pulse 60-100 beats per minute Temperature 98.6oF +/- 1oF (oral) Respiration 12-20 breaths per minute 02 Saturation 97%-99% Scale: 0 - 10 Pain Level Report pain at or above __ to a nurse immediately *If a patient deviates from these ranges, report to their RN immediately Process PREPARE 1. Check-in with the RN for approval and direction 2. Gather necessary supplies 3. Perform hand hygiene 4. Assess a. Identify catheters or monitor leads connected to the patient b. Ensure the wheels on the bed are locked 5. Adjust the bed height in order to allow for Proper Body Mechanics (page 8) OBTAIN VITAL SIGNS 6. Thoroughly clean all components of the vitals machine. 7. Make sure patient is in an ideal position, if possible. a. Patient’s arms and legs should not be crossed. b. Patient should be on their back, in Fowler’s position. 8. Begin by asking the patient for his/her current pain level on a scale of 0-10. Copyright © 2019 COPE Health Solutions. All rights reserved. 35 | P a g e a. If patient reports there are in pain, ask if it is new pain, and the location of the pain. 9. Record the pain level. 10. Place the blood pressure cuff around the patient’s bare, upper arm (align the arrow on the cuff with the brachial artery). Make sure the BP cuff is not placed on the same arm as the IV line. 11. Place the oxygen saturation sensor on the patient’s index finger. a. Opposite extremity of the BP cuff. b. Make sure the red light is on top of the patient’s finger nail. 12. Press “Start.” 13. Make note of BP, HR, and O2 saturation. 14. Take the thermometer and place a plastic cover over the probe. Place the thermometer in the patient’s mouth with the tip under their tongue. 15. Ask the patient to close their lips gently around the thermometer and keep it there until you obtain a number on the screen. 16. Record the temperature. 17. While the machine measures the above vitals, discretely count the patient’s respiratory rate. Remember: 1 respiration = 1 inspiration + 1 expiration. 18. Record respiratory rate. 19. Record the time you took the patient’s vitals. 20. Remove blood pressure cuff. If the cuff is reusable, clean it thoroughly. 21. Report vital signs to the patient’s nurse and provide the nurse with the record sheet. Key Tips If anything is outside of the normal range, report to the patient’s nurse immediately. Do not continue to other patients. Include the room number on the vitals sheet Wipe down vitals machine with bleach wipes before/after taking vitals for a patient in an isolation room Restrictions Scholars may never:  Take vitals for a new patient admit  Interpret vital sign values to the patient or their visitors.  Chart vitals in a patient’s chart Copyright © 2019 COPE Health Solutions. All rights reserved. 36 | P a g e APPENDIX [A]: GAIT BELTS Supplies Requirements  Gait belt RN/PT  RN/PT approval and direction Key Term(s) Definition Ambulate To walk from place to place A designation assigned to a patient whose stability is of concern in order to prevent falls Fall Risk from occurring Gait Belts The gait belt is used to provide a secure point of contact when transferring/ambulating patients in order to prevent falls. ▪ Gait belts are secured around the patient’s waist, over the clothing with the buckle in the front ▪ To secure the belt: 1. Thread the belt through the teeth of the buckle 2. Put the belt through the other two openings to lock it ▪ The belt must be snug with just enough room to fit a few fingers under, so the patient care team member can hold on to the belt while transferring or ambulating the patient ▪ To use the belt: 1. Place one hand underneath the belt behind the patient’s back. The palm of your hand should rest on top of the gait belt while your fingers hook underneath 2. Your second hand can be placed underneath the patient’s arm that is closest to you 3. Ensure that you are standing to the side and behind the patient Application HELPING A PATIENT STAND UP 1. Place the gait belt around the patient and secure as instructed above 2. Stand in front of the patient and place one foot between the patient’s feet 3. Flex your knees slightly maintaining your base of support 4. Ask the patient to place their hands on the bed to help push up. Place your hands on the gait belt near the patient’s lower back (lumbar area). 5. Count to three and slowly stand up with the patient. AMBULATION 6. Place one hand on the gait belt behind the patient’s back. The palm of your hand should rest on the outside of the gait belt while your fingers hook under the belt. Your second hand may be placed underneath the patient’s arm that is closest to you. 7. Walk next to the patient and slightly behind, ensuring that the patient is steady and will not fall. The patient requires your full attention and watchful care 8. If the patient has I.V. lines or a catheter, ask the nurse for assistance in getting the patient unhooked, out of the bed, and properly set up for ambulation a. Do not touch or adjust the I.V. pump settings or tubing connections b. Have the patient use the I.V. pole for support on one side while you support the other side. 9. Remove gloves before exiting the room 10. When returning the patient to the bed, ensure proper bed settings as directed by the RN 11. Once the patient is safely in bed, report the following items to the patient’s RN: a. Distance walked b. Patient’s tolerance to mobility

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