Download Our Lady`s Hospice, Harold`s Cross

Agency Orientation to Extended Care Unit:
Introduction
Mary Aikenhead had pursued her vocation by opening the doors to care for the poor
and the dying of Dublin in 1879. Today we continue that legacy of care to those who
can no longer remain at home (Extended Care Unit / ECU). The emphasis of care is
also on those who may remain at home with the support of a reablement programme
(Community Reablement Unit / CRU).
Our Mission Statement:
‘Our Lady’s Hospice founded in 1879 by the Sisters of Charity strives through a
team approach and in an atmosphere of loving care to promote wholeness of
body, mind and spirit.’
We strive to provide healthcare services that foster our core values:
Dignity
Compassion
Justice
Quality
Advocacy
Emergency Response:
Dial extension 633 (this is an emergency-only extension located at reception), give
your name, department/location and nature of problem e.g location of fire or serious
injury requiring urgent or immediate attention.
Staff panic alarm are available for use by staff members while on duty on all ward
areas and should be worn at all times.
Matron’s Office Cover:
Support service available 24 hours through matron’s office. To contact please call
extension/bleep 827.
Health And Safety:
It is the duty of all Agency Nurses to:
 Read, understand and cooperate with a Department Safety Statement.
 Read and understand all relevant OLH, Nursing, Organisational and Drug
Safety Policies.
 Seek clarification of any issues that they do not understand within all
relevant OLH Policies relating to the ward areas.
 Report any unsafe condition, practice, substance, equipment or situation as
soon as reasonably practicable to the CNM2 or Person in charge
 Properly use any resources made available to them.
 Report any accident/incident or near miss to the CNM2 or Person in charge as
soon as possible.
 Ensure they receive initial training in Manual Handling and attend 2yearly refreshers therafter
Extended Care Unit (ECU), which is in the original Hospice building offers
Gerontological expertise and care to frail older people and people with chronic illness.
The philosophy of the Extended Care Unit is:
‘Founded on the belief that each person in our care is a unique human being who
is complex, interdependent, physical, psychological, spiritual and has social
needs. It is the philosophy of Extended Care that each patient is an individual
entitled to appropriate multi-disciplinary care and where possible freedom of
choice in that care.’
Within ECU there are six long stay wards and the Community Reablement Unit
(CRU) and they are as follows:
1. St Camillus Ward, home to 10 male residents.
Clinical Nurse Manager II - Mary T Carroll
Clinical Nurse Manager I - Catriona Whitty
2. St Charles’ & St Paul’s Ward, home to 22 male and female residents
Clinical Nurse Manager II - Nora O’Connor
Clinical Nurse Manager I - Jenny Sullivan
Taiwo Ogunyemi
Happiness Aku
3. St Mary’s & St Joseph’s Ward, 10 female ward.
Clinical Nurse Manager II Clinical Nurse Manager I - Patricia Lardner
4. St Patrick’s – Nursing Development Unit, home to 14 residents.
Clinical Nurse Manager II - Chris Dalton
Clinical Nurse Manager 1 – Helen Lowry
5. St Michael’s Ward, is situated in Anna Gaynor House and is home to 25
male and female residents.
Clinical Nurse Manager II - Aurie O’Sullivan
Clinical Nurse Manager I - Eleanor Cunnane
Mary Cunningham
6. St Benedict’s Ward, is also situated in Anna Gaynor House , home to 25
male and female residents.
A/Clinical Nurse Manager II - Catriona Whitty
Clinical Nurse Manager I
- May Wright
Mildred Advincula
Priorities of Care:
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Provide assistance with residents’ Activities of Daily Living in a patient
centered approach
Assessments, implementation and evaluation of care needs of individual
patients.
To liase with other members of the multidisciplinary team
To keep accurate and legible records/documentations
Implement appropriate practices in line with the policies of Our Lady’s
Hospice Limited e.g. Drug Administration Policy, Infection Control
Respect the dignity and confidentiality of each patient at all times and
serve as an advocate
Medical Conditions Affecting ECU Patients
 Dementia
 Stroke
 Parkinson’s Disease
 Bipolar Affective Disorder
 Multiple Sclerosis
 Diabetes Mellitus
 Syringomyelia
 Hypertension / Hypotension
 History of Falls
 Osteoarthritis
 Renal Impairment
 Diverticular Disease
 Depression
 Motor Neuron Disease
Common Medications Used:
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Analgesics – paracetamol/codeine/morphine
Prophylaxis for MI/Stroke – Nu-Seals 75 ( aspirin), Plavix,
Hypertension – Adalat, Zestril, Tritace, Tenormin, Meldopa, Istin, Inderal,
Isoptin, Emcor, Dilzem, Coversyl, Betaloc, Atecor, Aldomet, Adalat
Angina – Atecor, Dilzem, Imdur, Inderal, Isoptiin, Istin, Nitrolingual spray,
Tildiem, tenormin, transiderm-Nitro patch
Diuretics– Fruco, Frumil
Laxatives
Anxiety disorders– Ativan, Anxicalm, Calmax, Citrol
Epilepsy/Seizures – Epanutin, Epilim, Neurontin, Tegretol
Senior Members of the Multidisciplinary Team:
Director of Nursing:
Assistant Director of Nursing
Practice Development Nurse
Admin Sister
Night Sisters
Resource Nurse
Clinical Nurse Manager(s)
Medical Team
Medical Director
Medical Officer
Occupational Therapy
Physiotherapy
Social Worker
Pharmacist
Chaplain
RC
C of I
Sr Helena McGilly (ext/bleep 825)
Linda Kearns (ext/bleep 826)
Rowena Cueto (ext 827/793, bleep 174)
Ana Cuerpo
(ext 827/793, bleep 827)
Mary Tierney (bleep 368)
Marie Whitty
Sr Rose O’Rourke (bleep 389)
as listed above
Dr Dennis Donohoe
Dr George Robles
Dr Sheila Parumal
Carol Reynolds
Andreya Kelly
Margaret Healy
Kathleen Keaveney
Miriam Sanfey
Sheila Sullivan
Gabrielle Corbette
Sheron Toolan
Roisin Adams
Fr John Craven
Sr Rita Keegan
Liz Coyle
Rev Canon Neil McEndoo
7. St Anne’s Community Reablement Unit, Which is a pilot programme for
the country, offers a step up intermediate programme
package of care specific to elderly people to which
will enable them to continue living at home. CRU
facilitates 24 patients who each in turn have a
multi-disciplinary review and intensive therapy.
Liaison Nurse
- Cecilia O’Malley
Clinical Nurse Manager II - Karen McElwaine
Clinical Nurse Manager I - Marguerite Crowe
Kay Byrne
Medical Director
- Dr. Dennis Donohoe
Consultant Geriatrician
- Dr. Miriam Casey (SJH)
Specialist Registrar
- Dr. Joe Browne (SJH)
SHO
- Dr. George Robles / Dr Sarah Dowling
Social Worker
- Aine Flynn
Physiotherapist
- Mary Weakliam
Emily Adamson
Occupational Therapist
Pharmacist
Dietician
Unit Secretary
David White
Sheila Ryan
- Gill McHugh
Aoife Synnott
- Aine frewen
- Michael Maher
- Avril Halligan
Medical Conditions Affecting CRU Patients
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Parkinson
History of Falls
Asthma
Hypertension / Hypotension
Depression
Aneamia
Bronchitis
Stroke
Osteoarthritis
Osteoporosis
Fracture
Rheumatoid Arthritis
PTB
Renal Impairment
Diverticulities
TIA
Common Medications Used:
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Analgesia – Solpadeine, Solpadol, Panadol, Lyrica, Dicolfenac, Dona,
Neurontin
Bisophossonates – alendronate, Actonel, forsteo inj, Bonvera
Vitamin Supplement – calcichew, One-Alpha, Centrum, Galfer, Folic Acid
Proton Pump Inhibitor – Zoton, Nexium
Diuretic – Fruco, Lasix
Cardiac – Nu-seal Aspirin 75, Plavix, Zanidip, Ramipril, Emcor, Warfarin,
Coversyl, Digoxin
Laxatives – Lactulose, Senokot, Milpar, Movicol
Antidepressant – Cipramil, Lormetazepam, Sertraline
Sedatives – Zopliclone, Zolpiderm
Cholesterol – Pravastin, Lipitor
All Reablement clients are for full treatment / resuscitation
Our Lady’s Hospice, Harold’s Cross: Drug Administration Guidelines
General Principles and Responsibilities:
 The prescription or medications order should be verified that it is correct, prior
to the administration of any product. Clarification of any questions regarding
the medication order should be conducted at this time with the appropriate
health care professional.
 The Five Rights of Medication Administration should be applied to each
patient encounter. The five rights are:
1. Right medication.
2. Right patient / client, the nurse should be certain of the identity of the
person.
3. Right dose.
4. Correct form of the medication, route and administration method
as prescribed.
5. Right time.
 The expiry date of the medication should be checked prior to administration.
Expired medications should not be administered.
 All MDA drugs and drugs for parenteral administration, must be checked by a
second nurse. Oral medication (except MDA drugs) may be administered by a
single nurse.
 The preparation and administration, of a medical product must be performed
by the same nurse. The principles of aseptic technique and appropriate
precautions should be observed during the preparation and administration of
the medical product.
 The assessment and evaluation of administered medication should encompass
the following observations: vital signs, laboratory values, effectiveness
method and of administered medical product; medication allergies, side
effects, adverse reactions, toxicity, interactions and contraindications.
 The administered medical product and the patient / client response should be
adequately documented.
 Educational information should be provided to patients / clients as appropriate
and as required.
 It is appropriate to exercise professional judgement to withhold a medical
product if indicated. Consult a peer, medical practitioner, pharmacist or nurse
manager as applicable.
 Transcribing of medication orders (by the nurse) should not occur in any
setting where health care is provided. This is the responsibility of a medical
practitioner.
 A medical product prescription provided by fax, by a medical practitioner for
a patient / client under his supervision should be signed by the practitioner.
The nurse will sign date and time of the administration on the fax prescription
sheet, which will be photocopied, and the two copies inserted in the patients
notes. The prescription will be written into the patient’s drug chart if
subsequently administration are required.
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The only acceptable time a verbal or telephone order should be taken from a
medical practitioner is in an emergency situation, where there is an immediate
unplanned patient / client need.
Guidelines for MDA Dugs : An Overview
1. MDA Drugs
 MDA drugs are controlled drugs, classified in five schedules, under the
Misuse of Drugs Act, 1977 (No. 12) and the Misuse of Drugs Act, 1984 (No
18), (DP 06)
 MDA CD2 drugs are the most relevant to nursing practice, and include most
opoid drugs.
 It is the nurse’s responsibility to become familiar with and to follow Our
Lady’s Hospice Policies, Procedures and Guidelines in relation to the safe
acquisition, storage, checking procedure and administration of MDA drugs.
2. Pharmacy Ordering Procedure
 A requisition must be signed (in duplicate), in the Controlled Drugs Register,
by the CNM / nurse in charge, (DP 02)
 The requisition is signed by a pharmacist to indicate that the drugs have been
supplied.
 A Registered Nurse must go to the pharmacy to order and collect MDA drugs,
(DP 02).
3. Safe Storage of MDA Drugs
 On return, the order is checked with another Registered Nurse, and stored into
the suitably locked cupboard to which access is restricted (DP 03)
 Controlled drugs (MDA’s) must be stored in an (MDA cabinet), Misuse of
Drugs (Safe Custody) Regulation 1982. It must be a locked cabinet, within a
locked cabinet, the keys of which are kept on the person of a Registered Nurse
only (DP 03).
 At no time can MDA drugs be stored on the regular drugs trolley, (DP 03)
 A discrepancy in the count must be reported to the Clinical Nurse Manager, to
the Pharmacist and to Nursing Administration immediately, (DP 03)
 If / when new patients bring in own medications, including MDA drugs;
where possible, these are sent home. Otherwise, they are clearly labelled and
stored (in a separate locked press) away from the ward stock drugs until the
patient is going home, (DP 03).
4. Checking of MDA C2 Drugs
 The Controlled Drugs Register is updated, each time an MDA drug is
administered and signed by both the administering RGN and the checking
RGN, (DP 07 & DP 08).
 A stock balance check will be carried out on all MDA drugs; at each
individual transaction, & twice daily in all units, (ECU, RRU, CRU & PCU)
in Our Lady’s Hospice complex, by two Registered General Nurse, (DP 06,
DP 07, DP 08).
5. Administration of MDA CD2 Drugs
 Two Registered Nurses / Registered Nurse & Medical Practitioner, must check
the MDA C2 drug, one of whom must administer the drug immediately, (DP
07 & DP 08).
 Always follow the ‘five rights’ when administering MDA drugs, (DP 04, 07 &
08).
 Check out MDA drugs and administer to each patient individually, (DP 06).
 When an MDA C2 drug is administered, the details are recorded in Controlled
Drugs Register, in the patient’s drug chart& in the nursing notes, (DP 04, DP
07 & DP 08).
 It is the nurse’s responsibility to acquire and maintain competency regarding
the safe storage, checking and administration of MDA Drugs. If in any doubt,
check with an experienced / senior colleague before you proceed.
References
Our Lady’s Hosice Policy Folder
An Bord Altranais (2000), code of Professional Conduct for each Nurse and Midwife
An Bord Altranais (2000), Scope of Nursing Practice
An Bord Altranais (2003), Guidelines to Nurses and Midwives on Medication
Management
Infection Control Guidelines
Control of infection within the Hospice is the responsibility of all personnel in
order to minimise the risk of patient and staff.
Standard Precautions apply to:
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2.
Blood
All body fluids, excretions and secretions except sweat regardless of wether
they contain visible body fluids
Non intact skin
Mucous membranes
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4.
Standard precautions are designed to reduce the risk of transmission of microorganisms for both recognised and unrecognised sources of infection and they are
as follows:
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Handwashing – the single most important measure to reduce the risk of
transmitting micro-organisms from one person to another and from one
site to another on the same patient. Handwashing thoroughly between
patient contact and after contact with blood, body fluid, secretions and
excretions and equipment or articles contaminated is an important
component of infection control. The principle of handwashing is primarily
that of the removal of dirt and micro-organism by using running water,
sudsing, vigorous friction for at least 15 seconds and thorough rinsing.
Hand wash procedures are available at most of the washing facilities
within the Hospice.
 Gloves – are worn to reduce the risk of the possibility that the hospital
personnel will transmit their own micro-organisms to patients. I t is also to
reduce the risk of hospital personnel transmitting micro-organism from
one patient to another. It is to reduce the risk of hospital personnel
becoming infected with micro-organisms that are present in the patients
bodily fluids. Use gloves when doing procedures involving contact with
bodily fluids, mucous membranes while tending to patient care, soiled
linens and cleaning up spills containing blood or bodily fluids.
Wash hands thoroughly prior to wearing and on removal of gloves
 Protective Clothing – Various types of masks, goggles and face shields
are worn alone or in combination to provide barrier protection by assessing
the risk of splashing. A mask that covers both the nose and mouth and
goggles or a face shield are worn during procedures and patient care
activities that are likely to generate splashes or sprays of blood, body
fluids, excretions or secretions. Gowns/Plastic aprons are worn to provide
barrier protection and reduce opportunities for transmission of microorganisms. They are worn to prevent contamination of clothing and protect
the skin of personnel from blood and body fluid exposure and must be
removed before leaving the patients environment and hands are washed.
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Safe Handling of Spillage – Blood should always be handled with the
personal “no touch” attitude instinctively adopted for urine and faeces.
Care should be taken to contain spills by prompt attention to disposal.
Gloves and protective clothings are to be worn. Most items to clear
spillage may be obtained from ward sluice room. Hypochlorite granules
(Titan) are available for localised spills, granules are sprinkled freely over
the spill and after two minutes a gel should form, the gel may then be
transferred to a yellow bag. Discard gloves and apron same and wash
hands thoroughly.
Sharps – Wherever possible syringes and needles should be discarded as
one unit. Needles should NOT be resheathed.
There should be sufficient numbers of sharps containers within the ward
and should be sealed when three quarters full. Gloves should be worn
during procedures.
In the event of Accidental Needle Stick Injury immediately:
1. Encourage bleeding of the wound under running water.
2. Wash the wound thoroughly under running water using hibiscrub or
betadine.
3. Cover the wound with a waterproof dressing.
4. Report the incident to the Senior person present for further management.
5. An Incident Form must be completed.
Please refer to Infection Control Manual and Policy Folders available in the
wards.
Reminder
Uniforms may not be worn to and from Our Lady’s Hospice, changing room facilities
are provided for your use.
Abbreviation’s Listings for Nurses Notes (2006 - 2007)
The following list consists of the only abbreviations to be used in nursing
documentation of Our Lady’s Hospice.
A. fib: Atrial Fibrillation
A.D.L’s: Activities of daily living
ADON: Assistant Director of Nursing
A.I.D.S.: Acquired Immune Deficiency Syndrome
ABGs: Arterial Blood Gases
AGH: Anna Gaynor House
AMNCH: Adelaide & Meath Hospitals incorporating the National Children’s Hospital
APTT: Activated Partial Thromboplastin Time
B.B.T.: Berg Balance Test
B.D.: Bis Die (twice daily)
B.O. : Bowel Open
B.P.: Blood Pressure
C&S: Culture and sensitivity
C.A.B.G: Coronary Artery Bypass Graft
C.C.F: Congestive Cardiac Failure
C.N.M. 1, 2, 3: Clinical Nurse Manager
C.O.P.D: Chronic obstructive pulmonary disease
C.S.U.: Catheter specimen of urine
C.X.R.: Chest X Ray
CA: Care Assistant
CRU: Community Rehabilitation Unit
CT: Computed Tomography Imaging
DON: Director of Nursing
Dx: Diagnosis
E.C.G.: Electrocardiograph
E.M.S.: Eldery Mobility Scale
ECU: Extended Care Unit
ESR: Erythrocyte Sedimentation Rate
F.O.B.: Faecal Occult Blood
G.I: Gastrointestinal
G.U.: Genitourinary
GP: General Practitioner
H.D.L.: High Density Lipids
H.I.V: Human Immunodeficiency Virus
Hb: Haemoglobin
Hx: History
I.D.D.M.: Insulin Dependent Diabetes Mellitus
I.H.F.: Ischaemic Heart Failure
I.M.: Intramuscularly
I.N.R.: International Normalised Ratio
I.V.: Intravenously
JCMH: James Connolly Memorial Hospital
L.D.L.: Low Density Lipids
L.F.Ts: Liver Function Tests
Lfts: Liver Function tests
M.M.S.E.: Mini Mental Score exam
M.N.D.: Motor Neuron Disease
M.S.U. : Mid Stream Urine specimen
M.S.W.: Medical Social Worker
MDT: Multi disciplinary team
MMUH: Mater Misericordiae University Hospital
MRI: Magnetic Resonance Imaging
M.R.S.A : Methicillin Resistant Staphylococcus Aureus
N.I.D.D.M.: Non Insulin Dependent Diabetes Mellitus
N.S.A.I.D.s: Non steroidal anti inflammatory drugs
NAD: Nothing Abnormal Detected
NFR: Not for ressussitation
NPO: Nil per oral
Nocte: At night
O.A.: Osteoarthritis
O.D.: Once daily
O.T: Occupational Therapist
Obs: Observation chart
OLH: Our Lady’s Hospice
OLHSC: Our Lady’s Hospital for Sick Children
P.E.G.: Percutaneous Endoscopic Gastrostomy
P.H.N.: Public Health Nurse
P.O: Orally
P.R.: Rectally
P.R.N.: Pro re nata (when required)
P.U.D.: Peptic Ulcer Disease
P.V.: Vaginally
P.V.D.: Peripheral Vascular Disease
P: Pulse
PCU: Palliative Care Unit
Physio: Physiotherapist
Plts: Platelets
PSA: Prostatic Specific Antigen
PTO: Please turn over
Pts: Patients
PTT: Partial Thromboplastin Time
Q.D.S.: Quarter die sumendus (four times daily)
R.A.: Rheumatoid arthritis
R.R.: Respiration Rate
RGN: Registered General Nurse
RRU: Rheumatology Rehabilitation Unit
Rx: Treatment
S.C.: Subcutaneously
S.H.O.: Senior House Officer
S.L.: Sublingually
S.L.T.: Speech and Language therapy
SJH: St James Hospital
SLH: St Luke’s Hospital
SN: Staff Nurse
S.O.P.: Standard Operating Procedure
SVPH: St. Vincent’s Private Hospital
SVUH: St. Vincent’s University Hospital
T.D.S.: Ter die sumendus (three times daily)
T.I.A.: Transient Ischaemic Attack
T.U.R.P.: Transurethral resection of the prostate
Temp: Temperature
Tfts: Thyroid Function Tests
U&E: Urea and Electrolytes
U.R.T.I.: Upper Respiratory Tract Infection
U.T.I.: Urinary Tract Infection
WCC: White Cell Count