Saturday, July 29, 2023
Saturday, July 15, 2023
FDA approves first over-the-counter birth control pill in US
The U.S. Food and Drug Administration on Thursday approved the first over-the-counter contraceptive pill, paving the way for millions of women in the country to purchase birth control without prescription.
The approval comes as more states ban abortion following a ruling by the Supreme Court last year that overturned the Roe v. Wade decision to legalize the procedure nationwide.
The daily contraceptive Opill, sold by Perrigo, was first approved for prescription use in 1973, and the over-the-counter approval allows people to obtain it without first seeing a healthcare provider.
Perrigo will next week share its pricing plan for the pill, which will be available in stores and online in the first quarter of next year.
"Today marks an important step in the drive toward meaningful access to essential healthcare for Americans," Health and Human Services Secretary Xavier Becerra said in a statement.
The approval will help women overcome barriers to obtaining contraceptives such as the cost and time of a healthcare provider visit, transportation and finding childcare during the appointment.
Opill, also known as a "minipill", uses progestin, a form of the progesterone hormone which plays a role in the menstrual cycle and pregnancy. It does not contain the hormone estrogen unlike combination contraceptive drugs.
Women should take a progestin-only pill within the same three hours every day to avoid pregnancy. Combination pills that contain both estrogen and progestin do not have such a limitation.
"I jokingly refer to it as a mini step in the right direction. It does have its drawbacks. If women don't take it at precisely the same time every day, they have to start all over again (from the next menstrual cycle)," said Dr. Jeffrey Singer, a senior fellow at libertarian think tank Cato Institute.
The most common side effects of the pill include irregular bleeding, headaches and dizziness. The FDA advises it should not be taken by those who have or have had breast cancer.
The National Catholic Bioethics Center and other groups have opposed making Opill available without prescription, saying physicians should be involved in health decisions, especially for teenagers, along with parental supervision, to avoid harm.
A panel of the FDA's advisers had in May voted unanimously in favor of Opill's OTC sale, with advisers saying that more women were likely to be harmed by an unplanned or unwanted pregnancy than the drug's side effects.
Perrigo gained the daily-use pill first through its $2.13 billion acquisition of Paris-based HRA Pharma in 2021.
Shares of the company were up 2% in noon trading.
(Reporting by Manas Mishra and Sriparna Roy in Bengaluru; Editing by Arun Koyyur)
Friday, July 14, 2023
Heart health in the extreme heat
Copy from : https://lookinside.kaiserpermanente.org/heart-health-in-the-extreme-heat/ As a cardiologist in the Central Valley, Malini Nadadur, MD, sees first-hand the connection between extreme heart and cardiac events. “The temperatures are much hotter here because we’re inland,” she said. “That can really up the effects of cardiovascular risk on our patients.”
Kaiser Permanente cardiac care specialists treat a broad range of heart conditions, frequently performing life-saving procedures for our patients. Read on to learn more on the topic, including self-care.
Who is most susceptible to extreme heat, and why?
With summer underway, experts are predicting hotter than normal temperatures across most of the country. According to the Environmental Protection Agency, the interaction between heat and cardiovascular disease contributes to about a quarter of heat-related deaths. Those with pre-existing conditions, such as cardiovascular disease or a prior heart attack, are most at risk because their bodies’ reserve is less.
What is the body’s response?
The body sheds heat in two major ways: radiation and evaporation. On hot days, your body has to work harder to regulate temperature, which puts a bigger burden on your cardiovascular system. The most common result is heat exhaustion or heat stroke, but the more extreme cases are heart attacks, heart arrhythmias ( irregular heart rhythm), or heart failure.
Those with cardiovascular disorders may have medications such as beta blockers and diuretics that potentially hinder that ability to effectively manage heat.
How hot is too hot?
There is no exact temperature because it depends on many factors. If you feel overly hot, your body is telling you to get out of the heat. That said, during prolonged days of extreme heat, more people are admitted to the hospitals with heart attacks and other cardiovascular conditions.
How should we head off a heat and heart health crisis?
First, always listen to your body. If it says you are hot, you need to take action. Be aware how long you are in the heat and how much you are exerting yourself.
Keep your temperature low by getting out of the sunlight and somewhere cool. Lower your temperature with cool showers or baths.
Stay hydrated. Once you start feeling the heat, drink an 8-ounce glass of water every 20 minutes. If you are thirsty, that’s your body signaling that you are already becoming dehydrated, and that strains your cardiovascular system. Avoid alcohol or drinks with excessive amounts of caffeine or sugar.
Dress in light-colored and loose-fitting clothing. Wear a hat, sunglasses, and sunscreen when outdoors.
Watch the symptoms of heat stress. The first is typically a headache. Watch also for dry mouth, dizziness, decreased urine, fatigue, confusion, and heart palpitations. Chest pain is the sign of a heart attack.
If you’re having these symptoms and things don’t feel right, be proactive in seeking medical help immediately.
How can we exercise in spells of extreme heat?
You can still stay fit when temperatures rise. Examples include setting up an air-conditioned home gym, swimming indoors or outdoors with a sun covering, or walking in an indoor mall or a superstore. The more you know and listen to your body, the more confident you can feel in staying healthy in the heat.
Tuesday, July 11, 2023
A bulge in the aorta: Specialty cardiac care saves lives
July 10, 2023 copy from :
https://mykp.kp.org/en/news/ncal/A-bulge-in-the-aorta-specialty-cardiac-care-saves-lives.html
A bulge in the aorta: Specialty cardiac care saves lives
Dr. Matthew Solomon, founder and director of the Kaiser Permanente Northern California Center for Thoracic Aortic Disease, helps us understand thoracic aortic aneurysms.
In 2016, Kaiser Permanente cardiologist Matthew Solomon, MD, PhD, assembled a special team to treat thoracic aortic aneurysms, a little understood but potentially deadly bulge in a part of the aorta that runs through the chest. Groundbreaking research he led and published last fall helped define treatment criteria nationwide. Today his team manages nearly 12,000 Kaiser Permanente members with the condition, and cardiac surgeons perform about 300 life-saving surgeries each year.
Why is it important to treat a thoracic aortic aneurysm?
The aorta is the largest blood vessel in the body. It is the highway that carries blood to all the vital organs and tissues. If the aorta gets too large, or has other high-risk features, it can tear or rupture, which can be a life-threatening event. When that happens, the risk of death increases by 1% every hour. So, intervening before that occurs, with medications, lifestyle changes or preventive surgery, is critical to save lives.
How would someone know they have a thoracic aortic aneurysm that needs emergency care?
Our goal is to prevent an acute, life-threatening aortic event — called an aortic dissection — from happening. But many patients remain undiagnosed because aortic aneurysms usually do not cause any symptoms while growing. However, if one grows too large, an aortic dissection can occur, which usually presents as a painful ripping and tearing sensation in the chest that can radiate to the back. It is typically quite severe and painful, and nearly always brings patients to the emergency room. We have skilled surgeons throughout Northern California who can perform emergency surgery.
How do you diagnose someone who has a thoracic aortic aneurysm if they are not in the emergency room seeking care?
There is currently no screening for thoracic aneurysms. Most aneurysms are found incidentally when a patient has imaging done for something else. Once identified, we obtain all the necessary imaging, and have a robust and systematic checklist that we go through with every patient to identify additional risk factors. If we find an aneurysm 5.5 centimeters or larger, the patient is a candidate for surgery no matter what, and sometimes also when the aorta is smaller than that, if a high-risk condition is identified.Each patient’s care plan is individualized. For most patients, we monitor and treat the patient long-term with serial imaging, medications to control blood pressure, and lifestyle changes. If surgery is needed, we have a team of outstanding aortic surgeons who work at our medical centers in San Francisco, Santa Clara, and Sacramento.
Why is it important to screen family members of someone who has been diagnosed with a thoracic aortic aneurysm?
We know aortic aneurysms can run in families, and when they do, they tend to be more aggressive. So, once a person is identified, it is critical to get their family members screened. It can be a true a life saver. We’ve had patients who had an aneurysm that is just mild or moderately enlarged. But then we do our detective work, sometimes we find someone in that family who has a severely enlarged aneurysm requiring urgent surgery, which otherwise might have gone undetected and could have been fatal.
What does long-term monitoring look like if you don’t need surgery?
Most patients do fall into this category. They are put on a care pathway that includes serial imaging with echocardiograms and CT or MRI scans to monitor the aorta, intensive blood pressure management, activity restrictions that include avoiding heavy weightlifting and contact sports, and for most patients, avoiding high intensity aerobic activity, in addition to lifestyle changes such as quitting smoking.
What makes Kaiser Permanente a leader in care for thoracic aortic aneurysm?
We knew early on that our program is unique because our integrated system allows us to perform incredible health management of large populations of people for specialty conditions like this, conduct comprehensive and systematic risk assessment, and make individualized recommendations for care based on input from a broad, multi-disciplinary team of experts. All our patients are followed closely by a multi-disciplinary team of cardiologists, nurses, medical assistants, cardiovascular geneticists, and cardiac and vascular surgeons, and we have a system to track patients that other systems cannot match. Having that kind of multi-specialty care and structural support is incredibly satisfying, and great for our patients.
To learn more about Kaiser Permanente specialty care, visit kp.org.
Share
The Spread of Bloodborne Pathogens
Hand with cut.
Amount of exposure
A large splash to broken skin is
more likely to result in infection than
a small splash to the eyes, nose,
or mouth.
Hand with needle.
Route of exposure
A needlestick or a sharp object injury is more likely to result in infection than a splash to the eyes, nose, or mouth.
Bloodbag.
Amount of virus (in the infectious material)
Blood with a large amount of a pathogen is more likely to cause infection than blood with a low
viral count.
The Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard helps facilities create their exposure control plan. This plan is for all staff. It outlines possible exposures in each job and what type of personal protective equipment (PPE) is needed.
cybersecurity test
Select the best answer: A person does not want information about their room number, how they are feeling, and their religion to be shared. Which right under the Privacy Rule allows them to keep this information private?
Your Answer
The right to access protected health information (PHI)
Correct Answer
The right to decide if they want to be in the directory
Feedback
Most facilities have a directory with the names of all people staying in the facility for care. If a person decides not to be in the directory, then they have that right.
Question 2 of 5 Correct
Select the best answer: The HIPAA Privacy Rule requires healthcare providers to provide a Notice of Privacy Practices (NPP) the first time they provide a service. What else does the Privacy Rule require providers to do?
Your Answer
Update the NPP when the law or policies change.
Feedback
The HIPAA Privacy Rule requires the provider to update the NPP when the law or policies change.
Question 3 of 5 Correct
Select the best answer: The HIPAA Privacy Rule requires healthcare facilities to protect health information. What is protected health information (PHI)?
Your Answer
Any data that identifies a person
Feedback
PHI is any data that identifies someone. Examples of PHI include name, address, phone number, and the medical record.
Question 4 of 5 Correct
Fill in the blank: A person is given a Notice of Privacy Practices (NPP). The NPP should include information about ______________.
Your Answer
The facility's duty to protect privacy
Feedback
An NPP includes the facility's duty to protect privacy, how the facility will protect privacy, and other information.
Question 5 of 5 Correct
Fill in the blank: A person finds a mistake in their medical record. The right to _____________ allows them to request a change to records that are used to make medical decisions.
Your Answer
Amend protected health information (PHI)
Feedback
The Notice of Privacy Practices (NPP) tells how to make a request to amend PHI. A person has the right to change information in their medical record.
Monday, July 10, 2023
- Bloodborne pathogen
Bacteria or virus in the human blood and body fluids that can cause disease
- Disinfection
- The process of cleaning something to remove all germs, with exception of spores
Exposure
Coming in contact with or not having protection from something
Hand hygiene
Washing hands with soap and water or with alcohol-based rubs to prevent the spread of germs or bacteria
Infection control breach
When there is a break in following established infection control procedures that prevent the spread of germs
Mucous membranes
The moist, inner tissue of the eyes, nose, or mouth
Non-critical items
Medical equipment that comes in contact with intact skin
Other potentially infectious materials (OPIM)
Human body fluids that can spread infection from one person to another through direct or indirect contact
Source person
The person involved in the exposure to the healthcare worker
Standard precautions
Guidelines developed for healthcare workers to help prevent and reduce the spread of bacteria
Sterilization
The process of making something free of germs and spores
What is a bloodborne pathogen?
Those other fluids are called other potentially infectious materials (OPIM).
HIPPA
This module will review the following:
- The Privacy Rule
- The required Notice of Privacy Practices
- Specific rights of people that are protected by the Privacy Rule
If there is reason to believe that information can be used to identify someone, it should be protected.
Notice of Privacy Practices
Notice of Privacy Practices
All people receive a Notice of Privacy Practices (NPP). It tells them how the facility uses or shares their PHI with others. The NPP describes the facility’s duty to protect privacy. It explains their rights as people being cared for by the facility. If they have questions or wish to make a complaint, the NPP also includes contact information for the person who can help
In certain circumstances, people have the right to ask to whom their PHI has been disclosed. This is their right to an accounting of disclosures. People can request a report on when and why their health information was shared. The facility provides a written report of disclosures. The report includes the following:
When the facility shared the PHI
Who received the PHI
What PHI the facility shared
Why the facility shared the PHI
This request is related to the use and release of health information that was not for care, payment, or facility operations.
People can request a report for up to the last six years. The facility provides the report within 60 days of the request. The NPP describes the steps to request a report. The NPP also includes the name of the person to contact to request a report. The facility provides the first report within a year for free. They can charge for additional reports within the same 12-month period.
Confidential communication
Paper documents with a shield and lock on top of them.
People can tell a facility how to contact them. This is the right to confidential communication. A person may not want their family to know about a health issue.
The individual tells the facility how to communicate with them. The facility needs to use the number or address the individual requests.
Filing a complaint
If a person believes their rights have been denied or their health data is not safe, they can:
File a complaint with their provider or health insurer.
File a complaint with the Office for Civil Rights.
The NPP explains whom to contact so that complaints can be addressed quickly. It is important that healthcare workers learn what is in the NPP. It will state who is responsible for handling privacy complaints at the facility.
To ensure appropriate use of Neutral Spine Precautions for patient mobility.
Description
To ensure appropriate use of Neutral Spine Precautions for patient mobility.
Behavioral Criteria
It is expected that all staff will gather all necessary equipment, perform effective hand hygiene, don appropriate personal protective equipment, identify patients using two appropriate patient identifiers, and explain procedures to patients and family members, as appropriate, before beginning any skill or procedure.
Nurse has reviewed appropriate reference procedure/protocol for this skill/equipment and verbalizes understanding.
Identifies components of Neutral Spine Principles (NSP); including keeping shoulders, hips and knees in line during all activities and positioning
No bending over/stooping, no bending sideways or backwards
No reaching arms behind / across body;
No arching or bridging back
No twisting / turning shoulders to reach or look behind body
No raising knees higher than hips when sitting / standing
Keep legs in symmetrical position when resting or still.
Limit sitting time to no more than 30 minutes or per provider order
No lifting anything heavier than your walker or approximately 3 pounds, or per provider order
No walking without your walker until cleared by provider
Ensure patient demonstrates adherence to Neutral Spine Principles in all daily activities.
Notifies RN of any abnormalities
Documents Patient's tolerance and distance ambulated in the electronic health record.
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
White, C. C. IV, et al. (2014). EMS spinal precautions and the use of the long backboard: Resource document to the position statement of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma. Prehospital Emergency Care, 18, 306–314. Accessed April 2020 via the Web at https://tandfonline.com/doi/pdf/10.3109/10903127.2014.884197?needAccess=true (Level VII)
The Royal Melbourne Hospital. (2015). “TRM08.04 management of the patient with spinal precautions” [Online]. Accessed April 2020 via the Web at https://www.thermh.org.au/sites/default/files/media/documents/clinical/TRM0804_0.pdf (Level VII)
CNA Care of the patient undergoing Bariatric Surgery
CNA Care of the patient undergoing Bariatric Surgery
Additional Ratings
Description
Assists the professional nursing staff in caring for patient undergoing bariatric surgery
Behavioral Criteria
Recognizes the increased potential for postoperative complications in bariatric surgery patients
Monitors food and fluid intake
Ensures compliance with small feedings
Encourages modification in eating habits
Reports noncompliance in food and fluid intake
Provides routine post-op care and reports any abnormal finding to the nursing staff
Attends sensitivity training in order to empathize with the patient
Provides emotional support patient and family
Anticipates patient's special need related to inability to move independently
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Musculoskeletal Injury Prevention Plan and Policy (MIPP)
Care and Management of the Bariatric Patient
Thiele, T., & Osterreicher, A. (2011). Caring for your bariatric patient: A resource guide to the literature on care of the morbidly obese. Bariatric Nursing & Surgical Patient Care, 6(1), 43-48
Grindel, M., & Grindel, C. (2006). Nursing care of the person having bariatric surgery. MEDSURG Nursing, 15(3), 129-146
Muir, M., Heese, G., McLean, D., Bodnar, S., & Rock, B. (2007). Handling of the bariatric patient in critical care: A case study of lessons learned. Critical Care Nursing Clinics Of North America, 19(2), 223-240
CNA Cardiac (Monitoring)
CNA Cardiac (Monitoring)
Additional Ratings
Description
Cares for patient with continuous cardiac monitoring
Behavioral Criteria
Placing Electrodes on Patient:
Prep skin: select a flat, non-muscular area, Clean skin , Remove hair using clippers ( do not use a razor)
Apply electrodes- 5 lead
White "Right" (Directly below the clavicle and near the Right shoulder)
Black- "Smoke over fire" (Directly below the clavicle and near the Left shoulder) )
Red- "Fire under Smoke" (Left Lower abdomen)
Green- (Right Lower abdomen)
Brown- ( On the 4th intercostal space at the right sternal border)
Changes electrodes daily or more often, if needed to prevent irritation
Assist in changing batteries when directed by nurse
Report abnormal findings or alarms to nurse
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Cardiac Telemetry Monitoring
Toolbox: How to Guides to Technology Systems & Devices
Critical Care Nursing Clinics of North America. (2006). Practice Standards for ECG Monitoring in Hospital Settings: Executive summary and Guide for Implementation
Heart Lung. (1991). Electrode Site Preparation Techniques: A Follow Up Study.
CNA Baseline Urinary Elimination
CNA Baseline Urinary Elimination
Additional Ratings
Description
Assists professional nursing staff in caring for patients with urinary elimination needs
Behavioral Criteria
Observes urinary elimination including frequency, odor, volume, amount and color
Obtains urine specimens as directed (non sterile)
Measures continuous bladder irrigation output as delegated by nurse
Secures urinary catheter and maintains closed urinary drainage systems
Maintains drainage bag below bladder, not touch floor, ensure tubing free of kinks.
Apply initial Purewick to famales as delegated by nurse, then change Purewick as needed or once a shift. Keep suction between 40-60 mmHg degrees.
Apply initial Condom catheter as delegated by nurse, then change as needed
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Care of the Patient with an indwelling cahteter
Craven, H. (2009). Core curriculum for medical-surgical nursing . (4ed.). New Jersey: Academy Of Medical Surgical Nursing
DiGiulio, M., Jackson, D., & Keogh, J. (2007). Medical-surgical Nursing Demystified. McGraw-Hill Professional
Cayir, G., Beji, N., & Yalcin, O. (2007). Effectiveness of nursing care after surgery for stress urinary incontinence. Urologic Nursing, 27(1), 25-33
CNA Baseline Tubes & Drains
CNA Baseline Tubes & Drains
Additional Ratings
Description
Assists the professional nursing staff in caring for patient with tubes, drains, and pouches
Behavioral Criteria
- Empties Jackson Pratt (JP) and Hemovac drains
- Measures and Documents in Electronic Health Record (EHR)
- output from JP,
- Hemovac,
- nasal gastric (NG),
- colostomy, ileostomy, and/or
- urinary drainage bags,
Reports abnormal finding to nursing staff
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Patient safety Attendants (PSA)
Carter,P. (2007). Lippincott's essentials for nursing assistants: a humanistic approach to caregiving. Philadephia: Lippincott Williams & Wilkins
Hegner, B., Acello, B., Caldwell, E. (2008). Nursing assistant: a nursing process approach. Clifton Park, NY: Thomson Delmar Learning
Frazer, C. (2012). Managing chest tubes. Med-Surg Matters, 21(1), 1
Doenges, M. E., Moorhouse, M., & Geissler-Murr, A. (2008). Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care. F.A. Davis Company
CNA Baseline Tubes & Drains
CNA Baseline Tubes & Drains
Additional Ratings
Description
Assists the professional nursing staff in caring for patient with tubes, drains, and pouches
Behavioral Criteria
Empties Jackson Pratt (JP) and Hemovac drains
Measures and Documents in Electronic Health Record (EHR) output from JP, Hemovac, nasal gastric (NG), colostomy, ileostomy, and/or urinary drainage bags,
Reports abnormal finding to nursing staff
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Patient safety Attendants (PSA)
Carter,P. (2007). Lippincott's essentials for nursing assistants: a humanistic approach to caregiving. Philadephia: Lippincott Williams & Wilkins
Hegner, B., Acello, B., Caldwell, E. (2008). Nursing assistant: a nursing process approach. Clifton Park, NY: Thomson Delmar Learning
Frazer, C. (2012). Managing chest tubes. Med-Surg Matters, 21(1), 1
Doenges, M. E., Moorhouse, M., & Geissler-Murr, A. (2008). Nursing Diagnosis Manual: Planning, Individualizing, and Documenting Client Care. F.A. Davis Company
CNA Baseline Postoperative/Post Procedure Care
CNA Baseline Postoperative/Post Procedure Care
Additional Ratings
Description
Assists the professional nursing staff in caring for the post-op patient
Behavioral Criteria
Assist the patient out of bed to chair
Encourages coughing and deep breathing exercises
Encourages use of incentive spirometer
Assists patient to ambulate
Reports complaints of pain to nursing staff
Reports patient's tolerance for increase in activity to nursing staff
Reports significant decrease in urine output to nursing staff
Applies sequential compression stocking as ordered
Takes vital signs and documents in Electronic Health Record
Reports changes in condition to nursing staff
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Prevention of Respiratory Complications with ICOUGH
Carter,P. (2007). Lippincott's essentials for nursing assistants: a humanistic approach to caregiving. Philadephia: Lippincott Williams & Wilkins
Hegner, B., Acello, B., Caldwell, E. (2008). Nursing assistant: a nursing process approach. Clifton Park, NY: Thomson Delmar Learning
DiGiulio, M., Jackson, D., & Keogh, J. (2007). Medical-surgical Nursing Demystified. McGraw-Hill Professional
CNA Baseline Patient Hygiene
CNA Baseline Patient Hygiene
Additional Ratings
Description
Provides Bathing/shower, oral hygiene , perineal and catheter care and linen change
Behavioral Criteria
Assists with bed bath or assisted bath
Assists patients with Medicated baths who have Central lines (includes PICC, Dialysis catheters and Mediports)
Daily bed linen change (Top sheet, bottom/draw sheet, Pillow cases)
Assist patient with medicated bath who is scheduled for surgery
Assists patient with ADL, as permitted with focus on improved self care
At a minimum, peri care/Foley Catheter care to be completed twice daily
Cleans incontinent patients
Changes wet or soiled linens
Assists patient to brush teeth and/or clean dentures after each meal and bedtime
Document care or refusal in the EHR
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Management of Patient Hygiene
Nose to Toes Pre-Operative Decolonization Procedure
Campbell, L., Gilbert, M. A., & Laustsen, G. R. (2010). Clinical Coach for Nursing Excellence. F. A. Davis Co
King, P., & Crawford, D. (2009). Healthcare assistants in the children's intensive care unit. Pediatric Nursing, 21(1), 48-51
BUTLER-WILLIAMS, C., JAMES, J., COX, H., & HUNT, J. (2010). The hidden contribution of the health care assistant: A survey-based exploration of support to their role in caring for the acutely ill patient in the general ward setting. Journal Of Nursing Management, 18(7), 789-795
Conway, J., & Kearin, M. (2007). The contribution of the Patient Support Assistant to direct patient care: An exploration of nursing and PSA role perceptions. Contemporary Nurse: A Journal For The Australian Nursing Profession, 24(2), 175-188
CNA Baseline Patient Hygiene
CNA Baseline Patient Hygiene
Additional Ratings
Description
Provides Bathing/shower, oral hygiene , perineal and catheter care and linen change
Behavioral Criteria
Assists with bed bath or assisted bath
Assists patients with Medicated baths who have Central lines (includes PICC, Dialysis catheters and Mediports)
Daily bed linen change (Top sheet, bottom/draw sheet, Pillow cases)
Assist patient with medicated bath who is scheduled for surgery
Assists patient with ADL, as permitted with focus on improved self care
At a minimum, peri care/Foley Catheter care to be completed twice daily
Cleans incontinent patients
Changes wet or soiled linens
Assists patient to brush teeth and/or clean dentures after each meal and bedtime
Document care or refusal in the EHR
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Management of Patient Hygiene
Nose to Toes Pre-Operative Decolonization Procedure
Campbell, L., Gilbert, M. A., & Laustsen, G. R. (2010). Clinical Coach for Nursing Excellence. F. A. Davis Co
King, P., & Crawford, D. (2009). Healthcare assistants in the children's intensive care unit. Pediatric Nursing, 21(1), 48-51
BUTLER-WILLIAMS, C., JAMES, J., COX, H., & HUNT, J. (2010). The hidden contribution of the health care assistant: A survey-based exploration of support to their role in caring for the acutely ill patient in the general ward setting. Journal Of Nursing Management, 18(7), 789-795
Conway, J., & Kearin, M. (2007). The contribution of the Patient Support Assistant to direct patient care: An exploration of nursing and PSA role perceptions. Contemporary Nurse: A Journal For The Australian Nursing Profession, 24(2), 175-188
CNA Baseline Patient Experience, including age related/cultural/religious considerations
CNA Baseline Patient Experience, including age related/cultural/religious considerations
Additional Ratings
Description
Builds patient trust and confidence through effective communication and visible demonstration of staff teamwork Interacts with patient in a manner that is appropriate for developmental or chronological age to provide safe and effective care and communication Identifies cultural and religious needs of patient for individualized care
Behavioral Criteria
General Considerations for Patient Centered Care:
Receives report from off-going staff; ensures all members of patient team have received report, using ISBAR and bedside handoff
Reviews and updates goals with patient using communication board in room.
Maximizes perception of time spent with patients by speaking slowly with courtesy and respect, using eye contact, and giving patients time to ask questions or voice concerns
Uses plain language; presents information in an appropriate and clear manner with an understanding of age-specific guidelines, cultural considerations, and culturally appropriate language; asks specifically about preferences and needs
Displays respect and understanding for patient’s values and practices; makes effort to learn about patient needs and preferences, especially concerning healthcare treatment and ways of communicating/interacting
Listens attentively; responds appropriately to patient/family requests, questions, and concerns; shows compassion and empathy
Explains all tasks to be performed with/on patient so that patient understands what is happening and why and what is expected of him/her.
Asks patient to describe using own words what has been taught about his/her health and care, i.e. activities, diet, medication and side effects, restrictions, etc.
Engages and includes family members; recognizes their importance in patient’s care
Stop to check on patient and respond to requests when a call bell is lit; participates in Purposeful Rounding schedule with healthcare team to anticipate patient needs.
General Considerations for Age-Specific Care:
Note: Chronological age may not reflect developmental age, especially in special needs patient population. Plan of care should be tailored to reflect specific needs of each patient.
Recognizes vital signs, labs that are out of normal range for age of the patient. Responds as required
Chooses equipment and supplies appropriate to patient’s age/size.
General Considerations for Cultural and Religious Practices:
Asks patient about any cultural or religious beliefs or practices that will affect the patient’s hospital stay, including practices the patient would like to continue, and communicates information to healthcare team
Contacts spiritual advisors, as indicated by patient
Asks patient about food preferences
Asks patient about preferred language, whom to include in conversations and teaching and communication practices that should be avoided (eye contact, touching)
Utilizes hospital's interpreting services whenever needed
Asks open ended-questions, allowing ample time to answer
Assures patient of healthcare team’s desire to understand patient’s needs and concerns
Identifies resources to seek information about patient behavior related to their culture or religion
Documentation reflects considerations and individualized interventions.
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
References:
Borenstein, K. MSN, RN, CCRN (Oct 2011). Bedside Report: A change project could result in improved patient and nurse satisfaction.” Advance for Nurses, Vol. 8, Issue 9, 24.
Copeland, L., Desmond, J. (2000). Communicating with Today’s Patient: Essentials to Save Time, Decrease Risk, and Increase Patient Compliance. New Jersey: Jossey-Bass
Shelton, Patrick J. (2000). Measuring and Improving Patient Satisfaction. New York: Aspen Publishing
N.A. (2005). Improving Patient Safety through Informed Consent for Patients with Limited Health Literacy. National Quality Forum. Retrieved from: http://www.ethics.va.gov/ETHICS/docs/infocus/InFocus_20060401_Teach_Back.pdf
N.A. (Nov/Dec 2005). Case Study: Improving Medication Compliance – One hospital targets patient education, medication compliance, and medication reconciliation. The Joint Commission Benchmark, Vol. 7, No. 6, 4-10.
CNA Baseline Oxygen Therapy
CNA Baseline Oxygen Therapy
Additional Ratings
Description
Assists the professional nursing staff in the caring for patient with oxygen therapy
Behavioral Criteria
Recognizes abnormal respiratory patterns and reports to the nursing staff
Encourages the patient to cough and breathe deeply
Maintains nasal cannula and simple face mask
Obtains and reports pulse ox
Recognizes hypoxia and abnormal respirations
Assists patients with oxygen therapy safely for turning and moving
Safe transport of patient- ensures portable oxygen tank is full (greater than or equal to 1500 PSI) switches wall oxygen to portable tank at arrival of transporter
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Patient Care- Oxygen Administration in the Adult Patient
Hegner, B., Acello, B., Caldwell, E. (2008). Nursing assistant: a nursing process approach. Clifton Park, NY: Thomson Delmar Learning
Craven, H. (2009). Core curriculum for medical-surgical nursing . (4ed.). New Jersey: Academy Of Medical Surgical Nursing
Woodrow, P. (2007). Caring for patients receiving oxygen therapy. Nursing Older People, 19(1), 31-36
McGloin, S. (2008). Administration of oxygen therapy. Nursing Standard, 22(21), 46-48
CNA Baseline Nutrition Feeding
CNA Baseline Nutrition Feeding
Additional Ratings
Description
Participates in meeting the nutritional needs of patients with feeding difficulty
Behavioral Criteria
Assists or feeds patient who is unable to feed self
Observes for coughing, choking and reports observations to nurse
Arranges food in relation to numbers on a clock if patient is visually impaired
Records calorie count
Reinforces swallowing precautions
Documents Percent taken of meals in Electronic Health Record.
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Plan for Provision of Nursing Care
Carter,P. (2007). Lippincott's essentials for nursing assistants: a humanistic approach to caregiving. Philadephia: Lippincott Williams & Wilkins
Hegner, B., Acello, B., Caldwell, E. (2008). Nursing assistant: a nursing process approach. Clifton Park, NY: Thomson Delmar Learning
Simmons, S. (2007). Quality improvement for feeding assistance care in nursing homes. Journal Of The American Medical Directors Association, 8(3), S12-7
CNA Baseline Lab Specimen Collection and Labeling
CNA Baseline Lab Specimen Collection and Labeling
Additional Ratings
Description
Demonstrates appropriate technique when acquiring lab specimens
Behavioral Criteria
Identifies patient using two patient identifiers and verifies orders for sample
Utilizes computerized barcode labeling system to collect & label specimens at bedside
Uses appropriate specimen collection receptacle
During down times, labels specimen at the bedside, in the presence of the patient, including time and date of collection, own initials, and source of specimen, if non-blood
Prepares/transports specimen to appropriate place, ensuring specimen is in labeled, sealed biohazard container/bag with appropriate paperwork
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure) Speciment Collection utilizing Soft ID
Toolbox: How to Guides to Technology Systems & Devices
Becton, Dickinson and Company. (2004). "Midstream clean catch urine procedure" [Online]. Accessed April 2020 via the Web at http://legacy.bd.com/resource.aspx?IDX=11181
Craven, R. F., et al. (2017). Fundamentals of nursing: Human health and function (8th ed.). Philadelphia, PA:Wolters Kluwer
MedlinePlus. (2017). "Clean catch urine sample" [Online]. Accessed April 2020 via the Web at http://www.nlm.nih.gov/medlineplus/ency/article/007487.htm
Sharma, L. (2018). Evidence summary. Fecal specimen: Collection and assessment. The JBI EBP Database. AN: JBI211
CNA Baseline Infection Control
CNA Baseline Infection Control
Additional Ratings
Rater
Huang, Judy C
Not Yet Rated
Peer
Nurse, Nurse
Not Yet Rated
Description
Adheres to infection control practices
Behavioral Criteria
Demonstrates knowledge of medical asepsis and contamination
Demonstrates appropriate hand washing
Implements Standard Precautions to reduce the risk of pathogens
Utilizes personal protective equipment
Wears gloves when touching blood, body fluids, secretions, excretions and contaminated items
Changes gloves between tasks and procedures
Handles used equipment per organization policy
Transports and handles linen that is soiled as per organization policy
Prevents injuries when handling and cleaning sharp instruments after procedures
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Infection MRSA, C-Diff
Infection Control Flip Guide
Rowley, S., Clare, S., Ruffell, A., & Beer, J. (2010). High impact actions: fighting infection. Nursing Management - UK, 17(6), 14-19
Lewis, K., & Thompson, J. (2009). Health care professionals' perceptions and knowledge of infection control practices in a community hospital. Health Care Manager, 28(3), 230-239
Hegner, B., Acello, B., Caldwell, E. (2008). Nursing assistant : a nursing process approach. Clifton Park
If certain equipment is NOT used in practice area, please indicate this exception(s) in Comment section.
CNA Baseline Equipment General Use
Additional Ratings
Description
Safely and appropriately demonstrates use of all features listed for each piece of equipment (see Resources).
Behavioral Criteria
If certain equipment is NOT used in practice area, please indicate this exception(s) in Comment section.
Vital sign Machine
AED/Defibrillator
Ambu bag
Bladder scanner
Low Air Loss Pump for Patient bed
Vertical and horizontal patient transfer devices (hovermat, z-slider)
Powered Air Purifier Respirator (PAPR)
Safe Patient Handling Equipment- (Sara Steady, Sara Plus, Sky lift, etc.)
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
Resources
Link to clinical lift and transfer devices
References
Toolbox (Policy/Procedure)
Fall Prevention
Musculoskeletal Injury Prevention Plan and Policy (MIPP)
Safe Patient Handling
Toolbox: How to Guides to Technology Systems & Devices
CNA Baseline Duties as a Patient Safety Attendant (PSA)
CNA Baseline Duties as a Patient Safety Attendant (PSA)
Additional Ratings
Description
Standard Duties of Patient Safety Attendant (PSA)
Behavioral Criteria
Get report from off-going PSA and nurse
Complete documentation for safety observations (activity, behaviors, interventions)
Try to keep patient on normal sleep/wake cycle
Wake patients, assist with toileting/diaper changes, oral care (open window blinds)
Have patient out of bed and performing activities as much as possible during daytime hours
Provide bedtime care (offer lavender lotion/oil, give sleep hygiene)
Collect vital signs at ordered times, report data to Nurse as soon as completed
Bathe patients
Prepare patient for meals including hand washing and sitting them up in the chair if appropriate
Ensure assistive devices in place (dentures, glasses, etc.)
Help patients who can’t feed themselves
Ambulate patients or turn patients
Provide toileting regularly, do not leave patient unattended in bathroom
Provide activity for confused patients (i.e. wheeling around the unit, using items from the GREAT kit)
Prepare and accompany patient for off unit procedures
Report any changes in baseline to the nurse
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Duties as a Patient Safety Attendant
Handoff Communication
Mezey, M. (2016). Decision-making and dementia. Try this: Best practices in nursing care to older adults with dementia, D9. Accessed April 2020 via the Web at https://consultgeri.org/try-this/dementia/d9decision2016r3.pdf
The Joint Commission. (2020). Standard NPSG.07.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission. (Level VII)
World Health Organization. (2009). "WHO guidelines on hand hygiene in health care: First global patient safety challenge, clean care is safer care" [Online]. Accessed April 2020 via the Web at https://apps.who.int/iris/bitstream/handle/10665/44102/9789241597906_eng.pdf?sequence=1 (Level IV)
National Institute on Aging, National Institutes of Health. (2017). "Talking with your older patient: Communicating with a confused patient [Online]. Accessed April 2020 via the Web at https://www.nia.nih.gov/health/communicating-confused-patient
CNA Baseline Collecting and documenting vital signs and measuring weight
CNA Baseline Collecting and documenting vital signs and measuring weight
Additional Ratings
Description
Monitoring/Documenting Vital signs, pain level and patient measurements (weight, height, neck circumference)
Behavioral Criteria
Verify the identity of your patient, and explain that you are going to take their Vital Signs (Blood Pressure, pulse, temperature, oxygen saturation):
Blood Pressure:
Position of patient -sitting or lying down, Legs kept uncrossed and remain quiet (no talking)
Select the appropriate size cuff and apply it directly over the skin, above the elbow.
Does not take blood pressure on Restricted Extremity, over an intravenous line (IV), injured or painful extremity.
Obtain reading from display and document Systolic, Diastolic and Mean Arterial Pressure (MAP) in Electronic Health Record (EHR)
Notify nurse of abnormal reading
Pulse Oximetry:
Ensure patient hand is clean (no nail polish or false nails)
Place oximetry probe onto one of the patient's fingers
Obtain reading from display and document in EHR
Notify nurse of abnormal reading
Respiratory Rate:
Observe the patient as they breathe, and count each rise and fall of the chest as one respiration. Count the breaths for one minute.
Record the respiration rate in the EHR.
Notify the nurseif patient is having any difficulty with achieving regular deep breaths
Pulse:
Obtain reading from display and document in EHR
Notify nurse of abnormal reading
Temperature:
Select appropriate placement for oral, axillary, or temporal to obtain temperature
Obtain reading from display and document in EHR
Notify nurse of abnormal reading
Pain Level:
Obtain/document stated pain level from patient
Notify nurse of pain level
Weighing Patient:
Standing scale
Check that scale reads zero to ensure accurate measurement.
Assist patient onto the scale and remain close to the patient to prevent falls
Have the patient stand as still as possible for accuracy
Obtain reading from display and document in the EHR
Notify nurse if abnormal reading
Bed Scale
Zero bed prior to weighing patient
Weigh patient
Obtain reading and document in the EHR
Measuring Neck Circumference
Use paper measuring tape- place around patient's neck.
Record measurement in cm in EHR.
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in EHR accurate and complete
References
Toolbox (Policy/Procedure)
Specimen Collection Utilizing Soft Id System
Mohammad, Y., et al. (2010). "Clinical use of pulse oximetry: Pocket reference 2010" [Online]. Accessed January 2021 via the Web at https://www.networks.nhs.uk/nhs-networks/south-east-coast-respiratory-programme/documents/OximetryPG.pdf
The Joint Commission. (2021). Standard NPSG.07.01.01. Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission
World Health Organization. (2011). "Pulse oximetry training manual" [Online]. Accessed January 2021 via the Web at https://www.who.int/patientsafety/safesurgery/pulse_oximetry/who_ps_pulse_oxymetry_training_
Hanlon, P. (2015). Patient monitoring: Oximetry enhances care. RT for Decision Makers in Respiratory Care, 28(2), 15–18.
American Association of Critical-Care Nurses. (2016). "AACN practice alert: Obtaining accurate noninvasive blood pressure measurements in adults" [Online]. Accessed April 2020 via the Web at https://www.aacn.org/clinical-resources/practice-alerts/obtaining-accurate-noninvasive blood-pressure--measurements-in-adults
Kallioinen, N., et al. (2017). Sources of inaccuracy in the measurement of adult patients’ resting blood pressure in clinical settings: A systematic review. Journal of Hypertension, 35, 421–441. [Online]. Accessed April 2020 via the Web at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5278896/
Davie, A., & Amoore, J. (2010). Best practice in the measurement of body temperature. Nursing Standard, 24(42), 42–49.
Geijer, H., et al. (2016). Temperature measurements with a temporal scanner: Systematic review and meta-analysis. BMJ Open, 6(3), e009509. Accessed April 2020 via the Web at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4823400/
Tipton, P. H., et al. (2012). Patient safety: Consider the accuracy of height and weight measurements. Nursing, 42(5), 50–52. Accessed April 2020 via the Web at https://journals.lww.com/nursing/Fulltext/2012/05000/Consider_the_accuracy_of_height and weight
CNA Baseline Bed and Chair Alarm Safety Features Copy
CNA Baseline Bed and Chair Alarm Safety Features Copy
Additional Ratings
Description
Demonstrates competency in use of safety features of bed and chair alarms
Behavioral Criteria
Bed features
- Connect bed to power source
- Operate bed functions including, brake, side rails, CPR function, height, and head/foot adjustments
- Zero bed and utilize bed scale
- Set bed alarm appropriate for level of activity of patient
- Utilize iAwareness, when available
Chair alarm features
Connect pad (single-patient use) to chair alarm
At Mountain View Campus, connect auxiliary cord to nurse call panel
Verbalizes that bed exit alarms and chair alarms will be utilized on all patients deemed to be High Fall Risk
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Patient Safety Visual Centralized Monitoring
Fall Prevention
Musculoskeletal Injury Prevention Plan and Policy (MIPP)
Toolbox : How to Guides to Technology Systems & Devices
CNA Baseline Application of Non-Violent Restraints
CNA Baseline Application of Non-Violent Restraints
Additional Ratings
Description
Assists professional nursing staff in caring for patients in restraints
Behavioral Criteria
Implements alternative to restraints as delegated by nurse
Applies soft restraints as directed by nurse
Demonstrates securing devices using a quick release
Observes for breathing, skin redness, color, temperature and reports observations to nurse
Performs patients needs for elimination, hydration and safety are addressed while restraints are in use
Demonstrates removal of restraint as directed by nurse
Verbalizes understanding that vest restraints are used only in CCU-MV
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
Admission and Discharge
CNA Baseline Admission/Discharge/Transfer
Additional Ratings
Description
Assists the nurse in preparing for patient admission/discharge/transfer
Behavioral Criteria
Admission:
Verifies if the patient is arriving via wheelchair or stretcher
Ensures room has been cleaned and admission bed is ready
collects admission kit and arranges IV pole, patient gown, equipments for checking vital signs, suction, etc.
Places bed in appropriate position
Places call bell in reach
Greets the patient by name
Accommodates patient family
Provides for privacy
Completes and Documents personal belongings on arrival in Electronic Health Record (EHR)
Obtains and documents vital signs on arrival in EHR
Assists patient with clothing change
Orientates patient and family to room, bed and unit
Provides information about TV controls, visiting hours policy, meal times, etc.
Notifies the nurse about any abnormal findings
Discharge and Transfer:
Assist patient with clothing
Completes and Documents personal belongings in Electronic Health Record (EHR)
Evidence of Achievement
Direct observation of competency in all areas through patient care or simulation / case study; documentation in electronic health record accurate and complete
References
Toolbox (Policy/Procedure)
Patient Safety Visual Centralized Monitoring; Handoff Communication
Management of Patient Belongings and Valuables
Patient Safety Visual Centralized Monitoring
Conway, J., & Kearin, M. (2007). The contribution of the Patient Support Assistant to direct patient care: An exploration of nursing and PSA role perceptions. Contemporary Nurse: A Journal For The Australian Nursing Profession, 24(2), 175-188
Knibb W 2006 The Contribution of Assistants to Nursing: Report for the Royai College of Nursing London, Royal College of Nursing
Waldie, J. (2010). Healthcare assistant role development: a literature review. Journal Of Advanced Perioperative Care, 4(2), 61-72
Hopkins S, Hughes A, Vaughan P 2007 Primary healthcare. Healthcare assistants in general practice: Delegation and accountability Primary Healthcare 17 (1)1-10
PHI test
Congratulations, you passed this test!
Question 1 of 5 Correct
Select the best answer: Protected health information (PHI) is data about a person and the healthcare they have received. What does the HIPAA Privacy Rule say about PHI?
Your Answer
Keep PHI private from people unless the Privacy Rule allows them to see it.
Feedback
Protected health information (PHI) should be kept private from other people unless the Privacy Rule allows them to see it.
Question 2 of 5 Correct
Fill in the blank: There are a few times when covered entities (CEs) can use and disclose protected health information (PHI) without permission from the person. One example of this is when __________.
Your Answer
Other providers need to give treatment.
Feedback
There are times when other providers giving treatment to the person will need their PHI. Other examples include when others might be at risk of harm and also for the purpose of submitting claims for payment.
Question 3 of 5 Correct
Fill in the blank: A healthcare worker observes a visitor looking through a person's medical file. This breach should be reported ______________.
Your Answer
Right away
Feedback
A breach should be reported right away to a manager, the privacy officer, or the compliance hotline or other reporting portal.
Question 4 of 5 Incorrect
Select the best answer: Administrative safeguards help covered entities (CEs) know when they can share protected health information (PHI). What is a safeguard that a CE may use?
Your Answer
Put guardrails around high platforms.
Correct Answer
Have a set of rules for the CE.
Feedback
An example of an administrative safeguard for CEs is having a set of rules or policies and procedures to run the facility.
Question 5 of 5 Correct
Select the best answer: What can a healthcare worker do to make sure the person who speaks little English knows how their protected health information (PHI) will be used?
Your Answer
Provide a copy of the Notice of Privacy Practices (NPP) in their preferred language.
Feedback
Healthcare workers should provide a Notice of Privacy Practices (NPP) the first time a person receives a service. It should be provided in the person's native or preferred language.