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Phoebe NORTH Orientation Packet First Things First You will need a MicroProx Tag which will allow you to enter the facility and multiple areas within the hospital. It is a sticker which you can attach to the back of your employee badge. Either Melissa or Gloria can direct you to the Maintenance departmentyou will need to call beforehand to see if someone is available to assign one to you that day. The office is located on the 1st Floor near the Morgue. You will need to have a personal Pin Code to get into the locked Controlled Substance drawer of the Anesthesia carts. This code and your badge need to be programmed into the new cart system in order for you to have access. Ask Mary for your assigned code or call the Help Desk at 312-6333 for access issues. You may need to get an Accudose ID at Phoebe North to access the Accudose machine. These are set by Pharmacy. It will prompt you to choose a password the first time you use the Accudose machine. These machines are similar to the Omnicell at Phoebe Main. You can get most medications from this machine located in the PreOp and PACU area of the OR instead of going downstairs to Pharmacy. Tour of Facility *Please initial when each area has been visited/identified/oriented to* ___ Surgicare/ “Outpatient Services” ___ Endoscopy (In-room “mini” cart & larger supply/drug cart, Code Cart) ___ PreOp (Accudose machine, Supplies, Blanket Warmer, Regional Block Cart, Code Cart) ___ PACU (Accudose machine, Bins for Completed Paperwork, Code Cart, Pediatric Code Cart, Reintubation/Airway Cart) ___ Radiology (Location & Anesthesia Machine) ___ OR rooms (Anesthesia machine, 2 Carts, Phone list, fire extinguisher) ___ OR Front Desk (Electronic Schedule, Intercom System, Next Day Schedule, Weekly Schedule Notebook) ___ Anesthesia Supply Room (*please orient with an Anesthesia Tech) ___ Old Doctor’s Dictation Room (Location of Serious/Rapid Response Cart- similar to drips found in the Heart Room at Main) (items include: (Albumin, Hespan, emergency drugs to make drips, central line kit, I.O. kit, etc.) ___ Anesthesia Office (where anesthesiologists screen charts, computer for anesthetists) ___ Pharmacy (Procedures, Paperwork) Tour of Facility (cont.) ___ Nurses Lounge ___ Doctor’s Lounge (*Anesthesia Communication Board, Posted Schedule) ___ Offices of Tammy (OR Director) & Deese (in charge of ordering Supplies) ___ Cafeteria (Location & Hours) ___ Locker Rooms ___ ICU (on “Stand-by” for the majority of the time/patients needing ICU care will be stabilized & transferred to Main) Items that need to be Located & Checked-off __ Code Cart (red) in Pre-Op __ Code Cart (red) in PACU as well as Pediatric Code Cart in PACU __ Code Cart (red) in Endo __ Glidescope in Anesthesia Work Room __ Fluid Warmers/Level 1 Infuser outside of OR 5 in open storage area __ Spinal Cart (black) in OR Supply Room __ Regional Block Cart (black) in PreOp __ Malignant Hyperthermia Cart (black) outside OR 1 __ Rapid Response/Emergency Cart (black) in Old Doc’s Dictation Room __ Pediatric Cart (sea green) between OR 1 and OR 3 __ Difficult Airway Cart (yellow) outside OR 2 __ Reintubation/Airway Cart (blue) in PACU __ Fire Extinguishers (between OR 8 and OR 9/outside OR 4) __ Emergency Gas Shut-Off Valves (multiple throughout OR hallways) __ Anesthesia Communication Board/Posted Schedule in Doctor’s Lounge __ A-line set-up in Yellow Bin in Anesthesia Work Room __ Central Line Kits in Anesthesia Work Room/Old Doc’s Dictation Room (both open with MicroProx Tag) Items that need to be Located & Checked-off (cont.) __ Bougies/Stethoscopes/Ambu’s- should all be on the Anesthesia Machine __ Pacemaker/ICD Magnets- one should be on every Anesthesia cart; typically on the underside of the top shelf of the Anesthesia cart __ “Extra Supplies” Cart in hallway outside OR 5 (extra blades, LMAs, pillows, etc.) __ Time-Clocks (outside Emergency Center, Outside Locker Rooms, near Employee Parking Lot, across from Pharmacy) Pharmacy Hours Mon-Fri 6:30am-9pm Sat-Sun 8am-6pm Pharmacy Procedures Pick up Narcotic Bag daily or use the Accudose machine to withdraw medications Phenylephrine syringes will be assigned (2) per Narcotic Bag. You may ask for more if needed. PHENYLEPHRINE SYRINGES ARE NOT LOCATED IN YOUR CART’S DRUG DRAWER. If you need to make a Phenylephrine drip, there are 10 mg vials in the Anesthesia WORK ROOM that the Anesthesia Tech can get for you to prepare your own drip or call Pharmacy to make the drip for you. RNs can get 200mL or 250mL NS bags from the Accudose or elsewhere in the OR. OFIRIMEV 1Gram is located in the Accudose machine or Pharmacy Routinely supplied in daily Narcotic Bag: Propofol, Versed, Fentanyl, Dilaudid, Phenylephrine. ***Any other controlled substances (ex: Morphine, Phenergan) need to be requested daily. Pharmacy Procedures (cont.) IMPORTANT: ***If you or a nurse DISPENSE a medication from the Accudose machine, the patient is charged. ***Please DO NOT doublecharge the patient by marking the same medication on the Pharmacy Drug Billing sheet. o Accudose= PT ALREADY CHARGED o Pharmacy Drug Billing Sheet= ALL OTHER MEDS USED ***If you or a nurse pull a medication from the Accudose and YOU NEED TO RETURN IT (unused)= FILL OUT AN ORANGE SHEET IN ORDER TO CREDIT THE PATIENT BACK. Pharmacy needs these ORANGE Sheets ASAP. o ORANGE Sheets are located on the side of the Accudose machine If you check out a Narcotic Bag, YOU ARE RESPOSIBLE for those items. Another Anesthetist CANNOT turn in your Narcotic Bag. You are to sign back in your bag at the end of your shift. There is an EMERGENCY ONCALL Box in the case that Pharmacy is closed. It is located in the locked metallic closet in the PreOp area near the patient bathroom. You need to swipe your MicroProx Tag on the side of the closet for it to unlock. o YELLOW zip-tie on the box means it is not used. o If you use the ONCALL BOX= Please date/initial & reseal the box with a BLUE zip-tie, and notify Pharmacy ASAP. Pharmacy Procedures (cont.) We are NOT to use multi-dose drug vials on more than one patient per Pharmacy. Please discard these vials at the end of the day. Some common multi-dose vials at North are: Labetalol, Atropine, Decadron, Lidocaine Please DISPOSE of EMPTY vaporizer bottles. This is opposite of the practice at Phoebe Main. There is a New Pharmacy Drug Billing Sheet. Please write in any medications that are not listed. **Please charge by the amp or syringe (according to the unit listed) **For multi-dose vials, write in the milligrams used. ENDOSCOPY Code Cart Outside the Room Procedure Nurse will bring patient to the Room. You are to drop off patient in the same room for recovery after giving report to a Recovery Nurse. Top Copy/”Original” Anesthesia Record will stay in the Patient’s Chart. Pharmacy copy and Anesthesia Billing copy of the record will go back to appropriate bins in PACU along with the Pharmacy Billing Sheet. An Anesthesia Tech will restock the larger supply & drug cart in Endo. This cart stays directly outside of the room. It is the Anesthetist’s responsibility to restock the smaller “in-room” cart. Other Info Post-it notes are located on every Anesthesia cart. They can be used to make notes for the Anesthesia Tech of supplies that need to be restocked in between cases. Electronic board in front of the OR desk is the most up-to-date schedule with Add-ons listed there first in ORANGE. Some LMAs are reusable- please put these in the red blade bin on side of your cart where the dirty blades also belong. Please circle your name & write the time you went to lunch or who you are feeding on the board next to the daily schedule. Drugs or supplies that are on Back-order are updated on the Anesthesia Communication Board by the Anesthesia Tech. Suction on the Anesthesia Machine is NOT to be shared during the Procedure for any reason. Anesthetists need to VERBALIZE that the Anesthesia Checklist has been completed prior to the start of the case. A Time-Out will be done in PreOp, repeated when the patient rolls into the OR, and a final time-out prior to incision. Check if any of your drugs need to be restocked PRIOR to the start of your case. Especially if it is an Emergency drug & especially if the Anesthesia Tech has gone home for the day. Document the name of the person intubating your patient, whether it is a student or an anesthesiologist. If the person intubating is not documented- it is assumed to be YOU. Please separate your chart appropriately in the bins near the automated door in PACU once your anesthesiologist has signed the record. Otherwise, the PACU nurse will separate the anesthesia record. There is a fire extinguisher located in EVERY OR as well as between OR 8 & 9 and outside OR 4 Most anesthesia machines at North have an automated machine check-out. If you are unfamiliar with this, ask one of the anesthetists or the Anesthesia Tech to run you through it. The trickiest part is locating where to block off the connector during the leak check in order for it to “PASS”. Please check your laryngoscope blade & check the light in the handle before the start of every case. **Sometimes the blades do not fit in the handle. **Sometimes the light is dim and the batteries need to be replaced. Know where to find new batteries within the Anesthesia Workroom. The Help-Desk at 312-6333 can assist you in any access or computer issues you are having. Operating Rooms Currently some ORs are not being used: 1, 4, 7 General rooms: 3 & 5 Ortho rooms: 8 & 9 Cysto room: 6 Eye room: 2 Phone Lists A list of frequently used extensions can be found in the anesthesia office. Room 1 Room 2 Room 3 Room 4 Room 5 Room 6 Room 7 Room 8 Room 9 42781 42782 42778 42776 42777 42775 42772 42779 42780 Phoebe North Cafeteria Hours Breakfast 7am-9am Lunch 11am-1:45pm No Dinner **It is suggested you bring your own lunch as eating opportunities may vary depending on cases and number of available anesthetists to feed. Furthermore, anesthetists may not become free until after the cafeteria has closed. On a busy day and lack of lunch relief, you are not guaranteed a 30 minute lunch break at North. Please circle your name & what time you went to lunch on the dry-erase Anesthesia Communication Board found in the Doctor’s Lounge. If you leave before 11am, PLEASE check with Main to see if you are needed to help with lunches. If you come to Main as lunch relief, you will be sent home after all lunches are given. You will NOT be used to run another room or added to the yellow sticky note list of available anesthetists. However, this is not the case if you are pulled first thing in the morning. If you are pulled to Main first thing in the morning (light day, case cancellations, call-outs, etc.), you will be added to the appropriate spot on the yellow sticky note list for the day. The appropriate spot where a North person fits in, depends on the CURRENT MATRIX. The North case schedule for the next day is reported by noon to Mary, so you will typically be notified by the afternoon if you will be pulled to Main the next day. If you are done at North for the day, PLEASE make sure your coworkers at North have all had a break. You are to ask your anesthesiologist for permission to leave & you are to notify the front desk- either Melissa or Gloria, that you are leaving the hospital. Cases should be added on by 3pm and completed by 5pm. If you leave for the day- you may be called back for an add-on case or to relieve a locum or a specific shift. Leaving the hospital at North DOES NOT qualify as “Call-Back” time. This is because you are the AVAILABLE anesthetist and we do not take call at North. See the explanations below for corresponding “available” times. WHO goes WHERE when we are running HOW many Rooms? We currently run 3 rooms at Phoebe North. The positions are Early, Late, 5pm shift. **Please see current Matrix as to where the PN people fit into the Main daily schedule of anesthetists** If we run ONE room: o The 5pm person is at North. o The late person goes to Main & is “available” to relieve the 5pm person if the late person is sent home before then. o The early person goes to Main (see the current matrix). If we run TWO rooms: o The 5pm person is at North. o The late person is at North & is “available” to relieve the 5pm person if the late person is sent home before then. o The early person goes to Main (see current matrix). If we run THREE rooms: o The 5pm person is at North. o The late person is at North & is “available” to relieve the 5pm person if the late person is sent home before then. o The early person goes to North & is “available” until 3pm for add-on cases.