Nursing

SHARPS INJURY

Effective Date: 
Wed, 12/01/2004
Reviewed: 
Wed, 08/24/2011
Revised: 
Tue, 06/14/2016

 

 

Injured Employee

Should there be a staff sharps injury, or splash or spill onto a staff member, said injured employee is referred to UrgencyMED for care. UrgencyMED is the Workers’ Compensation health care provider for the University of California Santa Cruz and provides competent care for injuries while being able to protect patient (staff) confidentiality. Injured employee immediately follows these steps:

SCHOOL/WORK ABSENCE VERIFICATION OF VISIT

Effective Date: 
Wed, 12/01/2004
Reviewed: 
Sun, 08/21/2011
Revised: 
Mon, 05/25/2015
Policy: 

The UC Santa Cruz Academic Senate passed a policy in 2007 which states that instructors will not routinely require verification of illness/injury for students missing class.

 

The Student Health Center does not routinely provide verification notes for students.  A patient handout (No Note Policy) explaining this policy is located in the EMR references under patient support forms and is routinely provided to students presenting for verification notes.  SHC staff will use their discretion in providing documentation verifying dates of illness/injury and functional impairments as appropriate.

NEBULIZER TREATMENT

Reviewed: 
Tue, 08/23/2011
Revised: 
Fri, 08/26/2011

SUBJECT: NEBULIZER TREATMENT

PERSONNEL: RN, LVN, MA upon orders of clinician

EQUIPMENT:

  • DeVilbiss Compressor,
  • Nebulizer Tubing
  • Medications as ordered by the Clinician: Albuterol Sulfate Inhalation Solution 0.083% and/or Ipratropium Bromide Inhalation Solution 0.02%
  • Fluids to rinse mouth

PROCEDURE:
MACHINE PREPARATION:

ELECTROCARDIOGRAM PROCEDURE

Effective Date: 
Thu, 08/04/2011
Reviewed: 
Tue, 08/23/2011
Revised: 
Wed, 04/20/2016
Policy: 

SUBJECT: Electrocardiogram Procedure

PERSONNEL: RN, LVN, MA

EQUIPMENT: WelchAllyn Schiller AT-1 3-Channel Electrocardiograph

Procedure: 

MACHINE PREPARATION:
Connect the power cord to wall outlet. Can be used by back up built in battery unit if necessary. (Fully charged batteries will last 2 hours on battery use)

PATIENT PREPARATION:
Assure patient there is no danger or pain involved. Have the patient remove clothing above the waist and don in a cloth gown opening to the front. Make the patient comfortable lying down on the exam table. Expose the arms and legs. If necessary shave the electrode areas before cleaning the exposed skin with alcohol for proper electrode adhesion.

Limb Sensor Application
Place the sensors on a smooth fleshy area of the upper arms and lower legs. Attach the limb leads.
Chest Sensor Application
Place the 6 Chest sensors on the patient’s chest as follows:
V1 Fourth intercostal space at right border of the sternum
V2 Fourth intercostal space at left border of the sternum
V3 Midway between position V2 and position V4
V4 At the mid-clavicular line in the fifth intercostal space
V5 At the anterior axillary line on the same horizontal level as V4
V6 At the mid-axillary line on the same horizontal level as V4 and V5
Attach the chest leads.

RECORDING THE EKG:
Follow the AT-1 user Guide instructions:

  • Press on to switch unit on.
  • Wait 10 seconds for unit to stabilize.
  • Press AUTO to record and print.
  • Press MAN PRINT to record a manual Rhythm Strip for 30 seconds, which is equal to 6 printed squares of ECG paper. Press stop to stop the printout. Press stop again to transport the paper to the start position.
  • Consult with appropriate clinical staff before disconnecting leads and allowing patient dress.

AFTER THE RECORDING:
The person performing the ECG:

  1. Mounts ECG recording onto the adhesive side of the mounitng sheet (kept on cart) and place the rhythm strip on to the back side of the sheet using double stick tape.
  2. On the front of the mounting sheet document patient name, SID#, age, sex, height, weight, BP, pulse, medications, date performed, ordering clinician's name, and operator's initials.
  3. Also place patient label or write patient name and SID# on back of sheet.
  4. Stamps ECG for clinician to determine “Keep” or “Send Out”. All ECGs will be logged, sent out, & tracked by Health Information Management (HIM) (see details below).
  5. Route to Charge Nurse or Clinician as below.
  • We do not routinely send out all ECGs for review by an outside specialist. It is the clinician’s discretion to have any questionable ECG mailed to a specialist for second opinion depending on the acuity of the situation.

If a clinician ordered the ECG for diagnostic purpose, have the ordering clinician review the ECG and decide if it is to be sent to the specialist.
1. Send to Specialist
a. Have clinician initial it and mark “Send Out”
b. Route to HIM to log, scan into the electronic medical record as Preliminary, and mail to specialist.
2. Receiving back from Specialist
a. HIM receives the reviewed ECG via the mail, logs, date stamps, and routes to the charge nurse.
b. The Charge Nurse routes to clinician for review.
c. The Clinician Initials the ECG & routes to HIM to be logged & scanned into the EMR as Final.
3. Does NOT need to be sent to Specialist
a. The clinician signs, dates, and marks “Keep” on the original ECG.
b. The ECG is routed to HIM to log and scan as Final.

ECGs ordered within a Clinician visit, whether normal or abnormal, must be reviewed by the ordering clinician.

If the ECG is done for Routine Testing as part of a physical  without an ordering clinician, prior to be being seen (i.e. Pre-SCUBA Physical):

           Normal sinus rhythm:
           1. The Charge Nurse signs, dates and marks the ECG as “Keep”.
           2. Routes to HIM to log and scan as Final.

           Abnormal Results: If the machine reports anything other than “normal sinus rhythm”or the nurse/MA has  any clinical concerns, the ECG will be reviewed by the DOC or Medical Director prior to the patient leaving.

           Abnormal ECGs (including Psychiatry patients) performed by an MA outside a clinician visit must be reveiwed   by the Charge Nurse, who will consult with the DOC to determine patient disposition.

           Abnormal ECGs performed by an MA as part of a clinician visit must be reveiwed by the ordering clinician, who will determine patient disposition.

The clinican reviewing the abnormal ECG determines whether to "Keep" or "Send Out" the ECG.
 

All ECGs ordered by CAPS are considered "Diagnostic".  Normal results are forwarded to the Medical Director for review (non-urgent).  All abnormal results are reviewed  by the Medical Director or the DOC in his absence prior to the student leaving.

Normal sinus rhythm:

1. The Charge Nurse signs, dates and marks the ECG as “Keep”.
2. Routes to HIM to log and scan as Final.

Abnormal Results: If the machine reports anything other than
“normal sinus rhythm”or the nurse/MA has any clinical concerns, the ECG will be reviewed by the DOC or Medical Director prior to the patient leaving.

Abnormal ECGs (including Psychiatry patients) performed by an MA outside a clinician visit must be reveiwed by the Charge Nurse, who will consult with the DOC to determine patient disposition.

Abnormal ECGs performed by an MA as part of a clinician visit must be reveiwed by the ordering clinician, who will determine patient disposition.

The clinican reviewing the abnormal ECG determines whether to "Keep" or "Send Out" the ECG.
         1. Send to Specialist

a. Have clinician initial it and mark “Send Out”
b. Route to HIM to log, scan into the electronic medical record as Preliminary, and mail to specialist.

2. Receiving back from Specialist

a. HIM receives the reviewed ECG via the mail, logs, date stamps, and routes to the charge nurse.
b. The Charge Nurse routes to clinician for review.
c. The Clinician initials the ECG & routes it to HIM to be logged & scanned into the EMR as Final.

3. Does NOT need to be sent to Specialist

a. The clinician initials, dates, and marks as “Keep” on the original ECG.
b. The ECG is routed to HIM to log and scan as Final.

FORMS AND HANDOUTS

See Forms & Handouts section for the following associated forms:

DISABILITY RESOURCE CENTER

Effective Date: 
Sat, 12/04/2004
Reviewed: 
Tue, 08/23/2011
Revised: 
Fri, 08/26/2011

Nurses may initiate or assist students in receiving help from the DRC for temporary disabilities by documenting information noted below for the student to take to DRC. In the event of questions or serious mobility issues, the nurse should call and discuss with DRC prior to sending student there. Students with permanent disabilities usually have already been in contact with DRC and will have to provide documentation of prior medical evaluation.


Disability Resource Center (DRC) Requests

DEPO-PROVERA ADMINISTRATION

Effective Date: 
Mon, 01/02/2012
Revised: 
Wed, 01/14/2015
Policy: 

This policy clarifies the procedure for giving the injectable contraceptive Depo-Provera (Depo, DMPA).     The policy clarifies the procedure for patients who are late receiving their repeat Depo-Provera injections, allowing the nurse to provide on-going contraception by using the "quick start" algorithm (attached below).  This algorithm guides the nurse to assist women in need of on-going contraception who present after the standard 14 week (98 day) guideline for repeat injection.

Patient makes an appointment for Depo injection or is seen as a COPE RN visit. Nurse may administer Depo Provera in AIT, Same Day Clinic or by Nurse appointments

Equipment:

Injectable Contraceptive-Depo-Provera Patient Information Handout, HC266
Depo-Provera in a vial or pre-filled syringe containing 150mg DMPA per ml
21 or 23 gauge safety needle
A signed order from a Clinician at CSHC or per RN Standardized Procedure through the COPE or quick contraceptive refill procedure

 

Procedure: 

First Injection:

Assure that a signed order from a clinician at SHC is appropriately entered into the PNC medical record, or meets the criteria for COPE as per the UCSC RN Standardized Procedures.

A urine pregnancy test is done prior to the initial injection.  If it is positive, proceed with pregnancy test visit.  If it is negative, proceed with Depo injection process.

Patient reads Injectable Contraceptive handout and is given the opportunity to ask any questions or clarify any concerns.

The first dose of Depo-Provera is given according to the Quick Start Algorithm.

Following standardized nursing practice, nurse gives IM injection and documents in the EMR.

DMPA 150mg/1 ml is given in a single injection deeply in the gluteus maximus or deltoid muscle using a 21 or 23g needle.

Patient waits 15 minutes after injection and prior to leaving to be observed for possible local site allergic reaction.

Nurse instructs patient to use a back-up contraceptive method for one week and to schedule follow-up appointment for the next injection every 12 weeks.  If Depo initial injection was initiated via COPE, the follow-up injections require a clinician order.  The Nurse assists the student in arranging a clinican appointment if indicated for on-going orders.

Follow-up Injections:

Nurse reviews side effects and patient concerns with attention to change in periods. A pregnancy test will be repeated prior to the second injection. If negative, the nurse will administer the second injection.

Obtain weight and blood pressure.  If weight is up more than 10% or BP is >130/>90, refer for clinician evaluation.

Discuss STI risk and/or testing.  Order STI testing as indicated.  Review STI risk reduction as indicated.

Follow-up injections less than 14 weeks (98 days) from previous injection:

Give Depo-Provera per protocol.  No urine pregnancy testing is necessary after the second visit if seen within 14 weeks of prior injection.

Patient waits 15 minutes after injection to observe for allergic reaction.

Follow-Up injection More than 14 weeks (98 days) from previous injection:

With history of unprotected intercourse after 14 weeks, offer emergency contraception if appropriate. 

Obtain a urine pregnancy test if indicated.  If negative, reassure the patient that the hormone injection will not harm an unrecognized pregnancy.  If the student still wishes to proceed, give the Depo.

Instruct the patient to use a back-up method of birth control for 1 week following the injection. 

Schedule and emphasize a return visit in 3 weeks for repeat pregnancy test.

Create a reminder/future callback in EMR to call patient in 3 weeks to return for pregnancy test.

 

Key Points: 

Pregnancy tests are required prior to the first two injections and as needed if delay of greater than 98 days since prior injection.

Planned pregnancies are associated with improved health for both women and babies.  Every attempt should be made to provide appropriate contraception to avoid unintended pregnancy.  This guideline has been modified to facilitate on-going use of injectable contraception for women who fail to return as scheduled for repeat Depo-Provera injections. 

In addition, this protocol has been revised to remove the requirement that a woman sign a special consent to use this type of contraception.

In accordance with World Health Organization guidance, this protocol removes warnings about loss of bone mineral density in women using Depo Provera.  Longitudinal research suggests that this loss of bone mineral density is transient, returning to baseline when women stop using Depo.  The research also indicates that women using this form of contraception do not have more bone fractures than women who don't use this contraceptive.

RED CART, AED, AND OXYGEN TANK

Effective Date: 
Wed, 12/01/2004
Reviewed: 
Mon, 08/22/2011
Revised: 
Wed, 05/13/2015

SUBJECT: MEDICAL EMERGENCY RESPONSE EQUIPMENT: Daily Checks

PERSONNEL: RN, LVN, MA

EQUIPMENT: RED CART, LIFEPAK 1000 AED (Auotmatic External Debrillator),  Zoll AED Plus, Oxygen tanks, Emergency Response Bags, Suction Machine

AED CHECK: (located West Wing Floor 1 Same Day Care Clinic, West Wing Floor 2 Hallway, East Wing Pharmacy)

HOURS OF WORK

Effective Date: 
Sat, 04/01/2006
Reviewed: 
Fri, 08/19/2011
Revised: 
Fri, 08/26/2011
Policy: 

Work assignments and hours of work are set by supervisors based on the operational needs of the Student Health Center. Providing health care to patients is a team based activity, and lateness in arriving or early departure may mean colleagues and coworkers are without important support and collaboration in discharging their duties and providing health services. Because of this, staff are expected to make every effort to be in their work area and available to carry out their work function at the assigned time.

Procedure: 

Departmental hours of operation are set by supervisors in collaboration with the Management Team and approved by the Executive Director. Departmental hours are determined by considering the operational needs of the unit in the overall context of the multi-department process of providing health services to students.

Departmental hours and hours of work for individual staff members are clearly communicated to the staff member by his/her supervisor. Any change or modification that requires union notice or approval is made in accordance with the specific collective bargaining agreement covering the employee involved, or with reasonable notice and according to university policy for unrepresented staff.

Repeated lateness or unavailability of a staff member in his/her work area during hours of work is considered a performance issue and will be addressed by the supervisor in accord with policies and procedures appropriate to the staff member’s position and bargaining unit.

Key Points: 
  • Departmental hours of operation are set by supervisors based on the operational needs of the health center, in collaboration with the Management Team, and approved by the Executive Director.
  • Departmental hours and hours of work for individual staff members are clearly communicated to the staff member by his/her supervisor.
  • Because providing health care to patients is a team based activity, staff are expected to make every effort to be in their work area and available to carry out their work function at their assigned time

WORKERS COMPENSATION FOR UCSC EMPLOYEES

Effective Date: 
Sun, 09/15/1996
Reviewed: 
Sun, 08/21/2011
Revised: 
Thu, 04/27/2017
Policy: 

The SHC adheres to UCSC Risk Services policies on workers compensation for UCSC employess.  UCSC Employees presenting to the SHC for work related illness or injury will be provided first aid, comfort and information on accessing services at the UCSC designated provider of occupational health services off campus. UCSC Risk Services is responsible for training UCSC supervisors to assist and authorize their employees with occupational illness or injury to proceed with a timely evaluation at UrgencyMED or Dominican Hospital ER (DSCH) depending on the acuity and time of day. In cases where UCSC employees present to the Student Health Center seeking care of occupational illness or injury the following procedure will be followed:

Procedure: 
  • If UCSC employees present to the Student Health Center for non-emergent care of occupational illness or injury the reception staff will provide information (see Workers Comp reference found in EMR - References - Infrequent P&Ps) on campus procedures for Workers Compensation care.  Unless there is an apparent emergency or need for immediate attention, the employee will be re-directed back to their supervisor for care at the UCSC contracted Occupational Health provider (see UCSC Risk Services link)  Assistance with transportation, if necessary, will be offered via arranging for taxi service and provision of taxi voucher. In some cases, the employee’s supervisor may choose to provide transportation.
  • If the employee presents with an obvious emergency, or if the employee feels unable to travel to the Occupational Health provider for care, the employee will be signed into Same Day Clinic and evaluated by the Triage nurse. If there is any question regarding the safety of the employee traveling for care the employee should be signed into Same Day Clinic for evaluation by the Triage nurse.
  • If a student with UCSHIP or Cruz Care presents with a simple illness or injury and no further follow up will be needed and no labs, supplies or medication is required, the student can be seen at the Student Health Center. (Rationale: If it is an illness and injury visit only, there is no charge to the student, the SHS absorbs this cost and does not bill insurance.)"
The Triage nurse will assess the patient and proceed as follows:
 
  • Emergent cases or cases in which immediate care is needed:
    These patients are seen by the Same Day Clinic clinical staff. After stabilizing the patient ambulance or other transport to DSCH ER is arranged as appropriate. In less emergent cases such as active bleeding from minor wounds or chemical burns to eye immediate care is provided before arranging appropriate transport to the contracted Occupational Health provider or DSCH ER for further evaluation and treatment.  A "Doctors First Report of Injury" form will be completed by the treating clinician (see attached weblink)
  • Other cases, including minor problems requiring only First Aid (see definition below):
    Patients who are evaluated by the triage nurse and then found to need only information, referral or first aid may be cared for by nursing staff. Patient may be discharged directly to follow up at the contracted Occupational Health provider.
First Aid:Definition of First Aid chart reprinted from UCSC Risk Management website:
http://risk.ucsc.edu/all-pdf/wc-handbook.pdf

“First aid means any one-time treatment of minor scratches, cuts, burns, splinters or other minor work injury."

  • All follow-up care is to be rendered through SCOHC or the patient’s designated medical provider for workers compensation care. All follow-up instructions should direct patients to the contracted Occupational Health provider rather than return to the Student Health Center.
Documentation of clinical care:
  • Refer to Workers Comp Process located in Internal References in EMR that details procedures.
  • Use workers compensation template in EMR for documentation of assistance and first aid
  • Triage nurses will make an entry in the medical record for any patient evaluated, particularly if providing first aid care.
  • When workers compensation patients are seen by a clinician at the Student Health Center the Doctor’s First Report is to be completed by treating clinician, and a SHC referral form advising receiving or follow up facility of care provided at Student Health Center.
 
Workers Compensation paperwork for all employees seen by the Student Health Center.
  • Receptionist
1. Checks the patient in to Triage using UC Same Day visit type and Workers Comp reason code
2.  Assists the patient in contacting their supervisor
3. Attaches a copy of the "SHC Workers' comp Checklist and a printed copy of the web link Workers Comp. – Injury Reporting & Medical Treatment to their red out guide.
4. Places paperwork and chart in red outguide folder
 
 
  • Nurse/Clinician

1.  If first aid was all that was required the employee is then sent back to their supervisor.

                                         OR

 If any treatment beyond first aid is needed emergently Student Health Services provides this service and fill out Worker’s Comp – First Report of Injury located in Web links (print hard copy and submit as indicated on top of form). A copy of this form should be scanned in to the EMR. 

2. If not already done, assist the employee in contacting their supervisor to facilitate the next steps with Occupational Health (see link to Risk Services). If the employee is unable to contact their supervisor due to an emergent medical condition SHS will alert the employee’s supervisor.

3.  If a student with UCSHIP or Cruz Care presents with a simple illness or injury and no further follow up will be needed and no labs, supplies or medication is required, the student can be seen at the Student Health Center. (Rationale: If it is an illness and injury visit only, there is no charge to the student, the SHS absorbs this cost and does not bill insurance.)

 
Workers Compensation for Student Health Center staff
Occupational illness or injury in SHC staff is handled in the same way as it is for other university employees. Supervisors, upon notification of the illness or injury, will complete an Accident Report, Claim Form, and Authorization for Treatment. Staff members will leave work and travel to the contracted Occupational Health provider to seek care. A Student Health Center Opportunity for Improvement report should also be completed.
 
Needle stick injuries to Student Health Center staff present a special case. Any needle stick injury with possible Blood Borne Pathogen exposure must be referred to the contracted Occupational Health provider for evaluation and management using the following procedure, as detailed in the Infection Control Manual and on Student Health Center form HC: 1051 "Bloodborne Pathogen (BBP) Exposure Plan & Checklist":
 
1. After immediate cleansing of the injured area, the employee reports the injury to supervisor and Patient Care Coordinator or Medical Director.
2. The incident is evaluated by the Patient Care Coordinator or DOC to determine whether a source patient for the needle stick can be identified
3. The supervisor of the exposed employee completes the on-line UC Accident Form, Claim Form, and Authorization for Treatment (see UCSC Risk Services link attached) , and the exposed employee goes to the contracted Occupational Health Provider for evaluation and care of the needle stick injury.
4. If a source patient has been identified, the clinician caring for the source patient is notified of the need to complete a source evaluation packet (see appendix) for
o contacting the source and obtaining consent for testing,
o ordering appropriate tests as described in the packet
o notifying the contracted Occupational Health Provider physician caring for the exposed employee regarding the plan for testing the source
o providing results and followup to the source patient, and
o communicating test results to the contracted Occupational Health provider physician caring for the exposed employee.
If the source clinician is not available, the DOC or Medical Director will assume these responsibilities
5. The supervisor will make an entry in the Sharps Injury Log, and the exposed employee and/or supervisor will complete an opportunity for improvement report to prompt further evaluation of the needle stick occurrence.

WORKERS COMPENSATION FOR NON-UCSC EMPLOYEES

Effective Date: 
Sun, 09/15/1996
Reviewed: 
Mon, 08/22/2011
Revised: 
Fri, 08/26/2011
Policy: 

The SHC adheres to UCSC Risk Services policy on workers compensation. The SHC does not provide workers compensation care for UCSC employees. (see Worker's Comp Process for UCSC employees located in internal references in EMR)  Occasionally, UCSC students eligible for SHC services and employed off campus (non UCSC employment) will present to the SHC for work related injury or illness assistance.

Many employers have a contracted Workers Compensation occupational health clinic where employees should preferably have their initial assessment.  The SHC will assist the UCSC student in contacting their employer to determine the appropriate care provider for their work-related injury. 

It is always appropriate to give immediate first aid to injured workers and not delay care while the employer is being contacted for further information. 
 
If the employer identifies another provider for injured workers, the role of the Health Center is to facilitate the transfer of care to the designated provider. If a student chooses to decline their employer designated workers compensation provider, they will be informed that they may be responsible for more costs stemming from the work related injury or illness.  After informing the student of their options and potential costs, the student may be seen for medical evaluation at the SHC like any other eligible student seen for non work related injury or illness. Students may prefer the convenience of care at the SHC even if it results in more out of pocket costs than if they had gone through their employer's workers compensation process and designated provider.
Procedure: 

 

When an eligible UCSC student presents with a non-UCSC work-related injury, the clinician or designee contacts the employer for direction on which facility is authorized to provider workers compensation evaluations. If the employer is unavailable and or the patient condition is acute, care is initiated at the SHC and not delayed while awaiting response from the employer.
 
If the employer authorizes treatment at the Student Health center, care is delivered. The clinician completes a Doctor’s First Report of Occupational Injury or Illness and distributes the report according to the instructions at the top of the form.  A copy is scanned into the EMR.
 
If care is initiated at the Health Center and follow up care is to be continued by the employer’s Workers Compensation provider, the clinician completes a Doctor’s First Report of Occupational Injury or Illness and distributes according to the instructions at the top of the form.
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