Group 1 Section 1 Final Manual

Created November 1, 2013 Edited November 20, 2013

UNIT RESOURCE MANUAL

Produced by

Ashley Pham, Ting Ting Nie, Qiaohong Li, Ana Escobar, Chris Carantonis, Teo Kesic

2 Created November 1, 2013 Edited November 20, 2013

TABLE OF CONTENTS

CONFIDENTIALITY PROTOCOL ...................................................................................................... 3 Privacy .................................................................................................................................................... 4

Storage of Records Procedures .............................................................................................................. 4

Release of Information ............................................................................................................................ 4

Patient Consent ....................................................................................................................................... 4

HOSPITAL FORMS ................................................................................................................................ 5 COMMUNITY AGENCY REFERRAL FORM ........................................................................................ 6

KARDEX FORM ................................................................................................................................... 10

DOCTORS ORDER SHEET ................................................................................................................. 12

ADMISSION FORM.............................................................................................................................. 13

PATIENT HISTORY FORM .................................................................................................................. 14

MULTI-DAY MEDICAL ADMINISTRATION FORM .......................................................................... 18

SINGLE DAY MEDICAL ADMINISTRATION RECORD .................................................................... 19

PRE-OPERATIVE FORM ..................................................................................................................... 20

RESPONSIBILITIES OF THE CLINICAL SECRETARY .............................................................. 22 RESPONSIBILITIES OF THE MEDICAL ADMINISTRATION ASSISTANTS THROUGHOUT THE

HOSPITAL ............................................................................................................................................ 23

POSTING INSTRUCTIONS ................................................................................................................. 24 CODES FOR EMERGENCIES ............................................................................................................. 25

DESCRIPTION OF THE CODES ........................................................................................................ 26

CARDIOPULMONARY EMERGENCIES ............................................................................................ 27

H1N1 PROTOCOL ............................................................................................................................... 27

TRAINING SESSION ............................................................................................................................ 28 OVERVIEW OF NUTRITION WORKSHOP ........................................................................................ 29

AGENDA ............................................................................................................................................... 30

EMAIL FOR REGISTRATION FOR THE EVENT ............................................................................... 31

REGISTRATION FORM AND FLYER ................................................................................................. 32

REMINDER EMAIL .............................................................................................................................. 33

APPENDIX .............................................................................................................................................. 34 Appendix 1 ............................................................................................................................................ 35

Appendix 2 ............................................................................................................................................ 36

Appendix 3 ............................................................................................................................................ 37

Appendix 4 ............................................................................................................................................ 38

Appendix 5 ............................................................................................................................................ 39

Appendix 6 ............................................................................................................................................ 40

Works Cited ............................................................................................................................................. 41


CONFIDENTIALITY PROTOCOL


Privacy

Privacy does not disappear in a hospital setting health cards must be kept private and confidential at all

times. The Health Card is for health care purposes only. Patients should show their health cards every

time they are at the clinic or hospital.

Any Medical Administrative Assistant that oversees the health records of patients must ensure that they

are kept secure, private and only are released with a written consent from the patient, because clients’

health records are extremely confidential and private. The records are considered to be owned by the

facility that the patients go to and the patient. The facility owns the hard copy of the records and the

patient’s own the information within them. The owners of the facilities must make sure to form their

policies and rules around the privacy of these records.

(Administrative and Clinical Procedures for the Canadian Health Professional, 3rd Edition, Valerie D.

Thompson, Chapter 2, page 54-55, Chapter 10, Page 305, and Chapter 13 423-429)

Storage of Records Procedures

Records have to be kept for 10 years in a private, organized, and secure location. If a patient asks for his

or her files, they should be faxed and not emailed for security reasons. Access to records is limited to

only those that are caring for the patient by having a written consent by the patient. Records now should

keep a hard and electronic copy for redundancy. Hospitals should make sure to have a disaster recovery

plan implemented to recover records in case of disasters.

Release of Information

When handling personal information, administration assistants must be careful to whom they can release

information. Certain facilities may allow you to give basic information about a client to their families if

they request it; other facilities may not. In general, do not give out any information without permission

from the patient and/or doctor. If the assistants feel that the situation is out of their hands, they simply

need to pass the call on to the patient’s nurse. All of these rules apply to face-to-face conversations as

well.

(Administrative and Clinical Procedures for the Canadian Health Professional, 3rd Edition, Valerie D.

Thompson, Chapter 14, Page 464)

Patient Consent

It is required that the hospital have written permission from the patient/client in regards to releasing of

any and all personal information to anyone that asks for their documents.


HOSPITAL FORMS


COMMUNITY AGENCY REFERRAL FORM

Community Care Access Centre

Patient’s LAST Name: ___________________ Patient’s First name:______________________

Date:

Please complete the form thoroughly and PLEASE print clearly. Each referring agency or institution

should be decided on how the physician will be the most appropriate for the completed form.

Reason for Referral:

Application Checklist (include if available):

Care protocols attached

Communication to the individual’s family physician of referral for palliative care services

Copy of completed Do Not Resuscitate Confirmation Form

Diagnostic imaging (X-ray, Ultrasound, CT scan, MRI)

Recent chest x-ray

Infection control management

Recent consultation notes

Recent laboratory results

Pathology reports

Type of Service requested Urgency of response Pages require

Community Care Access Centre 1 to 2 Days

1 to 2 Weeks

Pages 1-5

Community Palliative Care Physician

Referral: Consultant care or Primary care

1 to 2 Days

1 to 2 Weeks

Pages 1-4

Victorian Order on Nurse 1 to 2 Days

1 to 2 Weeks

Future

Pages 1-5

Clinic (Specify):

1 to 2 Days

1 to 2 Weeks

Pages 1-5

Other (specify): 1 to 2 Days

1 to 2 Weeks

Future

Pages 1-5

Page 1

http://www.ccac-ont.ca/Upload/toronto/General/Palliative_CRF_Nov2010.pdf




Patient’s LAST Name: __________________Patient’s First name:_______________________

Home Address:

Apt: Entry Code: City, Province, Postal Code:

Circle any applicable:

Lives alone Young Children Home Smoking in home Pets in Home (specify):

Home Phone Number: Alternative Phone Number:

Date of Birth (mm/dd/yyyy): Gender:

Faith/Religion:

Health Card Number:

Version Code:

Primary Languages:

Translator (name, phone #):

Current Location:

Home Nursing Home Other:

Hospital: Anticipated discharge Date:

Primary Diagnosis: Date of Diagnosis

Other relevant Diagnosis or Symptoms:

If cancer diagnosis: metastatic spread: Yes No Describe:

If cancer diagnosis: ongoing treatment: Yes No Describe:

Individual aware of: Diagnosis:

Yes No Prognosis:

Yes No Does not Wish to know:

Yes No

Family aware of: Diagnosis:

Yes No Prognosis:

Yes No Does not Wish to know:

Yes No

If family is not aware, individual has given consent

to inform Family of:

Diagnosis Yes No

Prognosis

Yes No

Anticipated prognosis < 1 month < 3 months < 6 months < 12 months Uncertain

Determined by (name and phone number):

Functional Status:

Palliative Performance 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

Resuscitation status Do not Resuscitate Yes No Unknown

Discussed with Individual Yes No Family Members Yes No

Page 2





Patient’s LAST Name: ___________________Patient’s First name:_______________________

Family/Informal Caregiver:

Provide Power Of Attorney for Personal Care if known: _______________________________

Name Relationship Home Phone Business/Cell Phone

Please list all Providers and Services currently involved: (if Known)

Additional list attached

Name Phone Fax

Family Physician

CCAC

Community Nurse

Hospice

Other

Page 3





Patient’s LAST Name: __________________Patient’s First name:_______________________

Co-Morbidities:

Check Here if documentation is attached

Year Diagnosis Year Diagnosis

Infection Control:

MRSA/VRE (+)

C-DIFF (+)

Other (specify precaution):

Allergies

Yes, If yes, please specify:

No

Unknown

Pharmacy (name and phone number): ____________________________________________

Current medications: (Include complementary alternative & over-the-counter medications)

Medication list attached

Drug Dose Route Interval Drug Does Route Interval

Details of social situation, including any needs or concern of the family:

Page 4



KARDEX FORM

Administrative and Clinical Procedures for the Canadian Health Professional, 3rd Edition, Valerie D. Thompson, Chapter 16, pages 519-

520

Date Date

Routine: pre-op post-op other FP Glucose Times

Extra teaching Tubes / drains

Emotional support: routine extra (explain below): routine extra (explain below) Hemovac Remove (ed) on

Family conferece/teaching Abd Penrose Drain Shorten Out

Other Sump Pump

NG (Levine) Tube

NUTRITION Gomco Suction to low intermittent

NPO

Diet SAFETY MANAGEMENT

Feeding Tube side rails X1 X2

Intermittent Continuous Call bell

Solution: mealtimes HS Night rounds - special consideration

Other Restraints type

LEVELS FOR ACTIVIES OF DAILY LIVING Other

General Assistance Level: HYGIENE

Independent Assist X1 X2 Shower Bath

Toileting: Self Assist X1 X2 Mouth Care foot Care

Bath: Self Assist by nurse Other:

Diet Self Assist by nurse

CLINICAL PARAMETERS ELIMINATION - bowel

No vital signs Vital signs Temp only BID BR Commode bedpan only

Q shift bid tid other Ostomy Care Nurse Patient

Print v/s flow sheet q shift

Wight q am ac breakfast: qd q2d Other Enema Suppository

Glasgow Coma Scale Yes No

Print flow sheet q shift Other

Blood Glucose Monitoring Yes No ELIMINATION - Urinary

Intake / Output Yes No Catheter: Insert/Remove

Print 1 & 0 Flow sheet q shift Foley - #

Lab Values For Regular Monitoring 3-way

Blood sugar INR APTT Suprapubic

Other Condom cath

INTRAVENOUS MONITORING (circle solution) Irrigation:

2/3& 1/3 N/S; 5% D/W; 0.45NaC1/W; 0.45NaCI Strain all urine

Primary Line Other REST AND ACTIVITY

1 @ cc/hr Turn q2h Other

2/3 & 1/3; N/S; 5% D/W; 0.45NaC1/W; 0.45NaCI ROM Active Passive Assist

Other Skin Care decubitus ulcer

2 @ cc/hr Rx

Secondary Line with meds note times of med administration pressure mattress sheep skin

1 Other

2 ISOLATION Sate Started:

Tubind & site change q 72 hrs. Date Type

Reason

Dates Change Site: Location Date last hospitalized

PRN Adaptor-site Change Site: Location Location:

Flush-(minimum once/shift) VRE swab + - C Difficille + -

Times: VRSA swad + - MRSA + -

IV PRN adaptor d/c Date Infection control notified Date:

ROOM #

Page 1

Administrative and Clinical Procedures for the Canadian Health Professional, 3rd Edition, Valerie D. Thompson, Chapter 16, pages 519-520

PATIENT DATA PROFILE (Kardex) LONDON GENERAL HOSPITAL

TEACHING AND EMOTIONAL SUPPORT PROCEDURES / TRATMENTS / DIRECT CARE

MRP / hospitalist FAMILY DOCTOR NURSE PRACTITIONER

NAME HOSPITAL #

PROVISIONAL DIAGNOSIS SECONDAY DIAGNOSIS (other problems) DISCHARGE DIAGNOSIS


KARDEX FORM

Administrative and Clinical Procedures for the Canadian Health Professional, 3rd Edition, Valerie D.

Thompson, Chapter 16, pages 519-520

OXYGENATION LAB

Yes No

Mask N/P

Litres- DIAGNOSTIC TESTS

Blood nTransfusions ordered/given

1

2

SUCTIONING 3

Type

Frequency STAT blood Work & Tests

Dressing Change/Check

Location: Frequency: Swabs and Cultures

Simple

Complex:

Abdominal Assessment:

Clip/suture removal cast Physician (s)

Comments: Pastoral Care

Pain Management Home Care Liaison Nurse

CSM (cirdulation/sensation, movement) Social Worker

Other Physio

Discharge Planning Dietary

Destination OT

Transportation Transport # Other

Medications Level of Nursing Care:

Teaching Presciption #1 nurseX 1 hr

Ability to fill Ability to pay #1 nurseX1-4 hr

Follow -UP #2 nurseX 1 hr

Patient aware Private room ordered

Notification of Discharge Advance Directives

Patient Caregiver code No code

Family Doctor Consultants Details

Community supports organ donation Yes No

Home Care

Mental Health Equipment MESSAGES / Other Orders:

Oxygen Home IV antibiotics

Wait-Listed for Facility Date:

Facility 1

2

NAME ROOM # HOSPITAL NUMBER

Page 2

Date ROUTINE AND DAILY TESTS Done

PATIENT DATA PROFILE (Kardex) LONDON GENERAL HOSPITAL

No allergiesALLERGIES:

Constant care

home care support worker

POST OPERATIVE ASSESSMENTS/CARE

Physio/Nurse DB&C

Oximetry

Chest Assessment

Spirometer

Aerosol Rx

Trach cannulae care

CONSULTATIONS (reason/date seen/ to be seen)

Date PROCEDURES / DIRECT CARE ORDERS


DOCTORS ORDER SHEET

Please Fax to Pharmacy & note date/time

AGE WT (Kg)

DATE TIME PHYSICIANS – PRINTED NAME SIGNATURE PLEASE CHECK IF

PATIENT

IS A NEW

ADMISSION

WT (Kg)

DATE TIME PHYSICIANS – PRINTED NAME SIGNATURE

WT (Kg)

DATE TIME PHYSICIANS – PRINTED NAME SIGNATURE


Thompson, Chapter 16, Page 533


ADMISSION FORM

http://img.docstoccdn.com/thumb/orig/10031116.png

Patient ID #

Registration Clerk Initials

YYYY MM DD

SS#

Company Group Name

and Address:

Admitted & surgery same day (ASD):

Ward: Semiprivate:

X Date

Street Address: City/Town/Village: Postal Code:

Surname:

Personal Information

Previous Admission Date:

First Name: Middle Name:

Age:Sex: M / F Marital Status

Birth Date:

Telephone (Home):

Emergency contact:

Health Information

Telephone (work): Telphone (Cell):

Relation: Telphone No.:

Accommodation:

Attending Physician: Attending Physician:

Information (Semiprivate & Private):

Health Number:

Certificate Number: Group No.

Other Health Insurance:

I authorize the release of any previous results or images in the event it is needed to help with the diagnosis and plan of care for further treatment. I permit a copy of this authorization to be used in

place of the original. I understand and acknowledge that I am personally responsible for the services rendered at this facility. We will bill your insurance carrier as a courtesy. In the event of non-

payment, I understand I will be responsible for any outstanding balances.

Patient signature or guardian for the minor patient

DS-Short Stay Unit:

Family Doctor:

Admitting Information

Telephone No.:

Admitting Diagnosis: Surgery/Procedure:

Discharge Diagnosis:

LOS: Inpatient:

Day Surgery:

Surgical Ambulatory Care:

Private:


PATIENT HISTORY FORM

http://superhouseplanswallpaper.blogspot.ca/2012/11/patient-history-form.html

Date

LAST name First Name M.I.

Birthdate

(mm/dd/yyyy) Age Sex F M

Drug Allergies No

Yes

Dosage

1

2

3

4

5

6

7

8

9

10

Page 1Physician initials _____

How long have you been

taking this medicine?

To:

Name of Drug

Please list any medications that you are now taking.

Current Medications

Include non-prescription medications & vitamins or supplements:

How did you hear about us?

Describe your syptoms:

Please list the names of other practitioners you have seen for this problem:

Psychiatric Hospitalizations (include where, when, & for what reason):

Have you ever had ECT?

Have you had psychotherapy?




Diabetes Heart murmur Crohn’s disease

High blood pressure Pneumonia Colitis

High cholesterol Pulmonary embolism Anemia

Hypothyroidism Asthma Jundice

Goiter Emphysema Hepatitis

Cancer Type: Stroke Stomach or peptic ulcer

Leukemia Epilepsy (seizures) Rheumatic fever

Psoriasis Cataracts Tuberculosis

Angina Kidney disease HIV/AIDS

Heart problems Kidney stones

High school Some college

College graduate Advanced degree

Marital status: Never married Divorced Widowed

Married Separated Common Law

Yes No

If not: Retired Disable

Sick Leave Matential Leave

Religion:

If Living

Age, Health & Psychiatric Age at Death Cause

Father

Mother

Children

Page 2

Do you receive disability or

SSI? Yes/No

If yes, for what disability & how long?

Family History

EXTENDED FAMILY PSYCHIATRIC PROBLEMS PAST & PRESENT:

If Deceased

Maternal Relatives:

Paternal Relatives:

Physician initials _____

What is your current or past occupation?

Were there problems with your birth? (specify)

Have you ever had legal problems? (specify)

Hours Worked

Are you currently working?

Personal History

Where were your born & raised?

What is your highest education?

Have you ever had:

Past Medical History

Other Medical conditions please list:




General NERVOUS SYSTEM PSYCHIATRIC

KIDNEY/URINE/

BLADDER

Recent weight

gain; how

much____ Headaches Depression

Frequent or

painful

urination

Recent weight

loss: how

much____ Dizziness Excessive worries Blood in urine

Fatigue

Fainting or loss of

consciousness

Difficulty falling

asleep

Weakness

Numbness or

tingling

Difficulty staying

asleep Women Only:

Fever Memory loss

Difficulties with

sexual arousal

Abnormal Pap

smear

Night sweats Poor appetite Irregular periods

Food cravings

Beeding

between

Muscle/Joints/Bo

nes

STOMACH AND

INTESTINES Frequent crying PMS

Numbness Nausea Sensitivity THROAT

Joint pain Heartburn Thoughts of suicide Sore throats

Muscle weakness Stomach pain Stress Hoarseness

Joint swelling,

Where? Vomiting Irritability

Difficulty in

swallowing

Yellow jaundice Poor concentration Pain in jaw

Increasing

constipation Racing thoughts

HEART &

LUNGS

EARS Persistent diarrhea Hallucinations Chest pain

Ringing in ears Blood in stools Rapid speech Palpitations

Loss of hearing Black stools Guilty thoughts Shortness of

Paranoia Fainting

EYES SKIN Mood swings

Swollen legs or

feet

Pain Redness Anxiety Cough

Redness Rash Risky behavior

Other Please

List:

Loss of vision Nodules/bumps BLOOD

Double or

blurred vision Hair loss Anemia

Dryness

Color changes of

hands or feet Clots

Y/N At what age?

Y/N

Page 3

Have you reached

Do you have regular

Systems Review

In the past month, have you had any of the following problems?

Physician initials _____

WOMENS REPRODUCTIVE HISTORY:

Age of first period:

# Pregnancies:

# Miscarriages:

# Abortions:




Y/N

Y/N

Marijuana Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Y/N

Page 4Physician initials _____

Patient Singautre Date:

Morphine

Demerol

Dilaudid

LSD

PCP

Mushroom

MDMA

Glue

Gasoline

Aerosols

Paint Thinner

HEROIN

STREET OR ILLICIT METHADONE

OTHER OPIOIDS:

HALLUCINOGENS:

INHALANTS:

Nitrous oxide

Tylenol #2 & #3

Xanax

Diazepam

"Roofies"

SEDATIVES/HYPNOTICS/BARBITURATES:

Dexedrine

BENZODIAZEPINES/TRANQUILIZERS:

AMPHETAMINES:

STIMULANTS:

CANNABIS:

ALCOHOL

Methamphetamine

Ritalin

Benzedrine

How many years

did you use this?

When did you

last used this?

Do you currently

used this?

Drug Category (circle which one you

have used)

Cocaine

Age when you

first used it

How much & how

often did you use

Hashish


MULTI-DAY MEDICAL ADMINISTRATION FORM


Thompson, Chapter 15, pages 488

Start/

RecordedStop Date

Patinent's Name:

MR #:

DOB:

Physican:

Schedule Medical Admission Record

Medication

dose, route, frequencyHour Due


SINGLE DAY MEDICAL ADMINISTRATION RECORD

SCHEDULED MEDICATION ADMINISTRATION RECORD

From To LAST NAME, First Name

ALLERGIES: Address, City, Province

Diagnosis MR # Doctor

Hour 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6

Initial

Initial

Initial

Initial

Initial

Initial

Room # Bed # MAR Checked by Page 1


Thompson, Chapter 15, pages 487


PRE-OPERATIVE FORM

Page 1


Thompson, Chapter 15, pages 490-491

Language Spoken: English Other: Nickname/Preferred Name .

Surgery:

Allergies:

alert confused agitated unconscious relaxed apprehensive

Other:

Yes No

Lab Work

NOT

APPLICABLE ON ON CHART

CALL TO

OR

1 CBC ………………………………………………………………..

2 Urinalysis ……………………………………………………..

3 Electrolytes ………………………………………………...

4 HCG ………………………………………………………………

5 Gr & Reserve Serum …………………………………….

6 C & T# units ………………………………………….

7 Glucose/BUN/Creatnine …………………………….

8 FBS @ …………………………………………………….

9 Addressograph ……………………………………………

10 Other .

Other Documentation

NOT

APPLICABLE ON ON CHART

CALL TO

OR

1 Consent ………………………………………………………..

2 History / Physical ………………………………………...

3 Medical Consult …………………………………………..

4 Surgical Consult …………………………………………...

5 Anaesthetic Consult …………………………………...

6 Chest X-Ray / Other ……………………………

7 Pre-op Prep (Type )………………………..

8 Pre-anaesthetic Questionnaire .

9 Addressograph ……………………………………………….

10 Face Sheet ……………………………………………………

11 Arm Band on Patient …………………………………….

12 Other .

Surgery Date: Time: .

Mental Status: (Circle as appropriate)

PRELIMINRY PRE-OP PREPARATION

Any change in health history since pre-admit/ admission assessment?


PRE-OPERATIVE FORM

Page 2

Administrative and Clinical Procedures for the Canadian Health Professional, 3rd Edition, Valerie D. Thompson, Chapter 15, pages 490-491

IMMEDIATE PRE-OP

PREPARATION NOT APPLICABLE PRESENT REMOVED

Contact Lenses/Glasses Type

Heating Aid Locked up

Prosthesis (Type) Home

Valuables Caps

Nail Polish Loose

Make Up Dentrues Top Bottom

Medic Alert Tag

Dental work

PRESENT REMOVED

Given

Held

Not Order

Order Sheet

MAR

Anaesthetic Record

NPO No Yes @

Voided No Yes @

Catheterized No Yes @

I.V. Therapy No Yes

Blood Infusing No Yes

Oxygen No Yes

To OR Via Surgilift @ hrs. Initials

Stretcher @ hrs. Initials

Crib @ hrs. Initials

Walking @ hrs. Initials

Carried by Paretns @ hrs. Initials

Bed @ hrs. Initials

Initials

Initials

Signed Off:

Pre-op Medication

Received in OR @

Doctor Please See/ Call @ .

Recovery room: Lab Work top Be Done SPECIFY: .

Type cc/hr

@ cc/hr

@ l itres/min or %


RESPONSIBILITIES OF THE CLINICAL SECRETARY


RESPONSIBILITIES OF THE MEDICAL ADMINISTRATION ASSISTANTS THROUGHOUT

THE HOSPITAL

Daily:

Prepare patient documents and files

Manage phone calls, meetings and appointments

Maintain office environment

Handle patient and other hospital staff questions

Transfer files and phone calls from department to department

Deal with billing, i.e. OHIP and insurance

Back up medical files

Deal with hospital staff and doctors

Weekly: Please also see Daily.

Deal with drug reps

Order office supplies

Possibly assist doctors with medical research

Calculate hours for payroll


Monthly: Please also see Daily and Weekly.

Print medical reports, audits



POSTING INSTRUCTIONS


CODES FOR EMERGENCIES

http://www.stjoes.ca/default.asp?action=article&ID=1185

Name of Code IncidentCode Red Fire

Code Blue Cardiac Arrest

Code Green Internal Evacuation

Code Yellow Missing Patient

Code Black Bomb Threat

Code White Violent situation

Code Brown Chemical Spill

Code Orange External Disaster

Code Purple Hostage/Abduction

Code Grey Loss of essential services


DESCRIPTION OF THE CODES


Code DescriptionIn case of a fire:

Call 911

Activate the fire alarm closest to you

Get patients and staff members to a safe

location

Close all doors to confine the fire and

smoke

If safe to do so, use a fire extinguisher to

tame the fire

In case of cardiac event:

Page for the nearest doctor or nurse

Start CPR right away

In Case of Evacuation:

Call 911

Evacuate all patients, employees and

volunteers to a safe location

Use stairs and not elevators

File out of the building as claimly and

quickly as possible

Code Red

Code Blue

Code Green

Code DescriptionIn case of a missing person and

location is unknown:

Call security

Be aware of all patients in the unit

Make sure to be informed about patients

leaving the unit

In case of a bomb threat:

CALL POLICE

Staff should NOT handle any packages

that are suspicious looking

Stay calm

Try and get as much information if it is a

caller giving a bomb treat

In case of Violent or threaten

behaviour:

Call security

Page a code white in the location the

Keep staff and patient safe and aware of

the situation

Code White

Code Yellow

Code Black

Code DescriptionIn Case of Chemical Spill:

Follow procedures and polices set by the

Containment and Chemical Team

Respond to the situation quickly, safely,

effective and efficiently

In case of an External Disaster:

Follow protocol issued by the

Emergency Prepared Team

Be flexible with any disasters that may

occur

In case of a Hostage Crisis:

CALL POLICE

Stay calm and co-operate with the

perpetrators

Observe and gather as much information

In case of loss or interruption of vital and

critical services

E.X. hydro, ventilation

Code Purple

Code Grey

Code Brown

Code Orange


CARDIOPULMONARY EMERGENCIES

When there is a cardiopulmonary emergency anywhere in the hospital, follow the directions below to

save lives and to prevent any loss of life or injuries due to the situation.

CARDIOPULMONARY EMERGENCY DIRECTIONS:

1. Page a Code Blue to the location of the emergency so that any available nearby doctors

and nurses can assist with the emergency.

2. Assess what type of cardiopulmonary emergency it is.

3. Perform the relevant lifesaving procedure(s).

4. Notify the proper departments and ensure proper communication protocol is followed.

5. Complete mandatory training for all staff in First Aid, CPR & AED.

H1N1 PROTOCOL

As a big hospital, it is very critical that the administration assistants don’t spread disease around to the

rest of the population. Below are directions to take appropriate measures to prevent exposure from any

viruses spreading to other patients and staff.

H1N1 PROTOCOL DIRECTIONS:

1. Reduce likely sources of infection by putting off surgeries and visits for patients that may

be infected with H1N1, deny visits to patients from outside family that may be infected as

well. Staffs that are ill should stay at home and not go to work.

2. Make workplace preventative from ergonomics by installing partitions to reduce airborne

transmission from/to each other; have ventilation inside the facility to use for airborne

treatments. Make sure in the labs that they use hazmat suits; have proper ventilation in

ambulances, and make sure hands free soap and water dispensers are placed in

abundance.

3. Make sure all staff has a flu shot or the most up to date vaccine against H1N1. Any

patients that may have H1N1 should be isolated. Make sure proper hygiene/cough

etiquette is followed. Make sure to use precautions for patients and staff if there is any

indication they may be infected at hospital entrances. Make sure to clean frequently

touched surfaces.

4. Make sure to use appropriate Personal Protective Equipment.

http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm


TRAINING SESSION


OVERVIEW OF NUTRITION WORKSHOP

This workshop will be about nutrition that people can do for themselves and to patients. The presenters

will give examples of different nutritional needs for everyone from expectant mothers to people who

have diabetes.

Participants will learn that one patient’s diet will be different from another patient, so they will have to

make sure that all allergies and food restrictions are placed in the patients’ files, so they are given the

proper meals if they are staying for a long time period at the hospital.

The workshop will be held on the first Friday, of December, every year, from 8 am to 4:30 pm.

Breakfast and lunch are provided, and they are also for training purposes. This year, the workshop is on

December 6th

.

There will be only 100 spots available, so please register as soon as you can. The workshop[ will start in

a conference room at the Best Western Lamplighter Inn on 591 Wellingtons Rd, and as the day goes on,

the participants will go to the room they are assigned to.

The equipment that will be required for this training will be as follows (was follow):

Computer or laptop to play the PowerPoint

Projector

Various tubes for the hands on sessions

o Levine/N-G tube

o G-tubes

o J-tubes

o PEG tube

Human mannequin to practice the insertions of the tubes

For full schedule of the workshop, please see attached schedule of the event. Below is a summary of

what the event will be about:

Discuss what each meal needs to have each day

Discuss meal plans for various of people

o Women who are pregnant or who just gave birth

o People who have diet restrictions due to diabetes and allergies

o People who want to gain or lose weight

o People who are having bowel movements, acute stomach problems

Hands on activities for insertions of feeding tubes for patients who need help feeding another

way

Administrative and Clinical Procedures for the Canadian Health Professional, 3rd Edition, Valerie D. Thompson, Chapter 18, pages 577 to 589


AGENDA

The day will be divided into various sessions. Below is the outline for the day:

8:30 a.m. to 9 a.m. is the Breakfast session and introduction to the training

9 to 10 a.m., participants will learn how each age group is different from one another through

genetics, activities and their gender.

10:05 to 11:30 a.m., participants will learn about the different restricted diets that some of their

patients may needs after their diagnosis.

11:30am to 12: 30 pm lunch workshop and break

12:30 pm -4 pm, participants will be divided into 4 groups. This will be the hands-on portion of the

workshop. Participants will have a choice of which activity they will like to start with and will have

a chance to do each session. Each session should be about 45 minutes long and there will be a 10 to

15 minute break between session 2 and session 3.

Nasogastric tube insertion

Jejunstomy tube insertion

Gastrostomy tube insertion

Percutaneous endoscopic gastrostomy tube insertion

4: 00 pm to 4:30 will be a debrief with everyone discussing what can be changed, what they learned

from today, if they would like to come back next year and if they would recommend it to anyone

else. Administrative and Clinical Procedures for the Canadian Health Professional, 3rd Edition, Valerie D. Thompson, Chapter 18, pages 577 to 589

# Activity Start Time Duration End Time

1 Registration 8:30 AM 30 minutes 9:00 AM

2 Breakfast and Introduction 9:00 AM 30 minutes 9:30 AM

3 Meal Plan 9:30 AM 30 Minutes 10:00 AM

4 Break 10:00 AM 5 Minutes 10:05 AM

5 Meal Plan 10:05 AM 40 Minutes 10:45 AM

6 Break 10:45 AM 5 Minutes 10:50 AM

7 Meal Plan 10:50 AM 2 hours 11:30 AM

8 Lunch 11:30 AM 50 Minutes 12:30 PM

9 Session 1 12:30 PM 45 Minutes 1:25 PM


11 Break 2:15 PM 10 minutes 2:25 PM



14 Debrief 4:00 PM 30 minutes 4:30 PM

Agenda


EMAIL FOR REGISTRATION FOR THE EVENT

To: Hospital Staff

From: Board Members

CC: CEO, President

Re: Annual Nutrition Workshop

Good Day,

As many of you may know, the Hospital holds an Annual Nutrition Workshop every year for all staff

members at the hospital, including doctors and nurses. This workshop is to help staff members become

aware of the variety of meal plans that patient and even staff can be on. The more aware staff members

are with these plans, the more patients will become healthier and longer living.

When: December 6, 2013

Time: 8:30 am to 4:30 pm

Where: Best Western Lamplighter Inn on Wellington Street

Registration Deadline: November 30, 2013

Fee: $50

Payment to: London General Hospital

Each participant that is involved will get breakfast, lunch and a certificate for participating in the event.

Attached is an agenda of the event and a registration form. Please fill out the registration form and

return it with the fee by November 30, 2013. If you have any questions or would like more information

about the event, feel free to contact us at 519-685-9987 or at nutrition @lgh.on.ca.

Thank you and we hope to see you at the event.

Sincerely,

Ashley Pham

Nutrition Office Assistant


REGISTRATION FORM AND FLYER

Date of Event December 06 2013 Time 8 am to 4:30 pm

Registration Last

Name

Registration

First Name

Profession Title

Address City & Province Postal Code

Phone Number Cell Phone #

Work Phone # E-mail

1st Choice 2nd Choice 3rd Choice 4th Choice

Nasogastric tube

insertion

Jejunstomy tube

insertion

Gastrostomy

tube insertion

Percutaneous

endoscopic

gastrostomy tube

insertion

Registration Form for Nutrition Workshop

Choices for session, Please Rate from 1 to 4 for each topic. 1 = 1st choice, 4 = last choice


REMINDER EMAIL

To: Hospital Staff

From: Board Members

Re: Reminder for Annual Nutrition Workshop

Good Day,

This is a reminder this upcoming Friday December 6th

, 2013 is the Annual Nutrition Workshop. If you

were unable to register for the event this year, we are glad to say that we are offering it again on

December 5, 2014.

Again, the upcoming Nutrition Workshop is on December 6th

, 2013. Please come at 8:30 am for

registration and Breakfast starts right at 8 am.

Feel free to contact us if there is any concern, or questions. See you bright and early!

Sincerely,

Ashley Pham

Nutrition Office Assistant


APPENDIX


Appendix 1

Minutes of Meeting

Location: Fanshawe College, F3009

Date: November 1, 2013

Time: 1:30 pm to 3:00 pm

Purpose: To discuss contract, meetings, and divide work

Recorder: Ashley Pham

Attendees:


CC:


Discussion

Topic 1

Action Items Who When

Contract Ashley Pham

Ting Ting Nie

Qiaohong Li

Ana Escobar

Chris Carantonis

Teo Kesic

November 1, 2013

Topic 2


Divide Work Ashley Pham

Ting Ting Nie

Qiaohong Li

Ana Escobar

Chris Carantonis

Teo Kesic

November 1, 2013

Next Meeting


Time: 11 am – 12 pm

Location: Fanshawe College

Room Number: TBA


Appendix 2

Minutes of Meeting


Date: November 6, 2013 from 11 am to 12:00 pm

Purpose: Update

Recorder: Christos .R. Carantonis

Attendees: Ashley Pham, Ting Ting Nie, Qiaohong Li, Ana Escobar, Chris Carantonis, Teo Kesic

CC: Ashley Pham, Ting Ting Nie, Qiaohong Li, Ana Escobar, Chris Carantonis, Teo Kesic

Review for Previous Actions

Action Items Who When Status?

Forms Ana, Qiaohong,

Ashley

Nov 1 Half Way

Confidentiality Protocol Teo Nov 1 Started

Responsibilities of the Clinical

secretary

Ting Ting Nov 1 Not yet started

Posting Instructions Chris Nov 1 Not yet started

Training Ashley Nov 1 Started

Logo Qiaohong Nov 1 Done!

Discussion

Topic 1


Protocol Ashley Pham, Ting Ting Nie, Qiaohong

Li, Ana Escobar, Chris Carantonis, Teo

Kesic

November

6, 2013

Topic 2



Secretary

Ashley Pham, Ting Ting Nie, Qiaohong Li,

Ana Escobar, Chris Carantonis, Teo Kesic November

6, 2013

Topic 3


Posting Instructions Ashley Pham, Ting Ting Nie,

Qiaohong Li, Ana Escobar, Chris

Carantonis, Teo Kesic

November

6, 2013

Topic 4


Forms

Admission Sheet & Patient History – Qiaohong

MAR & Pre-op Checklist -- Ana

Ashley Pham, Ting Ting Nie,

Qiaohong Li, Ana Escobar,

Chris Carantonis, Teo Kesic

November

6, 2013

Next Meeting

Date: November 13, 2013 at 11in F3007 at Fanshawe College


Appendix 3

Minutes of Meeting


Date: November 7, 2013 at 10 am to 12 pm

Purpose: Update

Recorder: Qiaohong Li

Attendees: Ashley Pham, Ana Escobar, Chris Carantonis, Ting Ting Nie , Qiaohong Li ,Teo Kesic




Forms Ana, Qiaohong, Ashley, Ting Ting Nov 6 Almost done

Confidentiality Protocol Teo Nov 6 Started


secretary

Ting Ting Nov 6 Done!

Posting Instructions Chris Nov 6 Codes started

Training Ashley Nov 6 Just have to do

PowerPoint


Discussion

Topic 1


Protocol Ashley Pham, Ting Ting Nie, Qiaohong


Kesic

November 7,

2013

Topic 2


Training Ashley Pham, Ting Ting Nie, Qiaohong


Kesic

November 7,

2013

Topic 3


Posting Instructions Ashley Pham, Ting Ting Nie, Qiaohong


Kesic

November 7,

2013

Topic 4


Forms

Ashley Pham, Ting Ting Nie, Qiaohong


Kesic

November 7,

2013

Next Meeting

Date: November 13, 2013, Time: 11 am – 12 pm, Location: Fanshawe College, Room Number: TBA


Appendix 4

Minutes of Meeting



Time: 11 a.m. to 12:00 p.m.

Purpose: Update & discuss formatting

Recorder: Ting Ting Nie

Attendees: Ashley Pham, Ana Escobar, Chris Carantonis, Ting Ting Nie , Qiaohong Li ,

Regrets: Teo Kesic





Ashley, Ting Ting

Nov 7 Done!

Confidentiality Protocol Teo Nov 7 Done!


secretary

Ting Ting Nov 7 Done!

Posting Instructions Chris Nov 7 Codes- Done!

Others need to start

Training Ashley Nov 7 Done!


Discussion

Topic 1


Logo and formatting Ashley Pham, Ting Ting Nie,

Qiaohong Li, Ana Escobar,

Chris Carantonis, Teo Kesic

November 13

Topic 2


Posting Instructions Ashley Pham, Ting Ting Nie,

Qiaohong Li

Ana Escobar, Chris

Carantonis, Teo Kesic

November 13

Next Meeting

Date: November 20, 2013 Time: 11 am – 12 pm Location: Fanshawe College Room Number: TBA


Appendix 5

Minutes of Meeting



Time: 11 a.m. to 12:00 p.m.

Purpose: Discuss Printing

Recorder: Ana Escobar

Attendees:

Ashley Pham, Ana Escobar, Chris Carantonis, Ting Ting Nie , Qiaohong Li ,Teo Kesic

CC:





Ashley, Ting Ting

Nov

13

Done!

Confidentiality Protocol Teo Nov

13

Done!


secretary

Ting Ting Nov

13

Done!

Posting Instructions Chris Nov

13

Done!

Training Ashley Nov

13

Done!

Logo Qiaohong Nov

13

Done!

Discussion

Topic 1


Where to print Ashley Pham, Ting Ting

Nie, Qiaohong Li, Ana

Escobar,Chris Carantonis

Teo Kesic

November 20, 2013


Appendix 6


Works Cited

Centers for Disease Control and Prevention (2010). “ Interim Guidance on Infection Control Measure

for 2009 H1N1 Influenza in Healthcare settings, Including Protection of Healthcare Personals”

http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm

Diet.com (2013). “High-Fiber Diet”. http://www.diet.com/g/highfiber-diet

Health Canada (2012). “Canada Food Guide.” Food and Nutrition.

http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/order-commander/index-eng.php

St. Joseph’s Healthcare Hamilton (2012). “What are Hospital Emergency Codes?”


Thompson V.D. (2014). “Health and the Individual” Toronto: Pearson. 54-55.

Administrative and Clinical Procedures for the Canadian Health Professional.

Thompson V.D. (2014). “Health – Care Plans” Toronto: Pearson. 305.


Thompson V.D. (2014). “Health Information Management” Toronto: Pearson. 423-429.


Thompson V.D. (2014). “The Hospital Setting” Toronto: Pearson. 464.


Thompson V.D. (2014). “Hospital Documents and Procedures” Toronto: Pearson. 480, 488.


Thompson V.D. (2014). “Hospital Documents and Procedures” Toronto: Pearson. 490-491.


Thompson V.D. (2014). “Order Entry” Toronto: Pearson. 511, 519-520,533.


Thompson V.D. (2014). “Orders Related to Nutrition” Toronto: Pearson. 577-589.


Toronto Central Palliative Care Network (2010). “Palliative Care Common Referral From.”


Web MD (2011). “Sample Meal Plan for Diabetes.” Diabetes Health Center.

http://diabetes.webmd.com/sample-meal-plan

Web MD (2013). “High Protein Diet for Weight Loss” Weight Loss & Diet Plans.

http://www.webmd.com/diet/guide/high-protein-diet-weight-loss?page=2

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