MHW
ORIENTATION
CONTENTS
PES: Night MHW Check off Sheet…
The following guidelines
supplement the orientation checklist. The basic idea is to begin with simple
things and safety but not to rigidly adhere to the guideline
First Day
¨
Orientation
Checklist
¨
Sempervirens
and Building Tour; Kitchen
¨
RN: Team Work, MAB:
Milieu and Safety; Using the Treatment Plan and Writing Progress [PIR] Notes;
Abbreviations
¨
Suicide
Precautions
¨
Fire
¨
Seclusion and
Restraints
Second Day
¨
Admission and
Discharge
¨
Auditing
Guidelines for the Mental Health Worker
¨
Legal Holds;
W&I Code; LPS Act
¨
Public, Phone
and Confidentiality, Visitors
¨
HCMH and
Community Mental Services. Crisis Unit
¨
Common
Psychiatric and Related Signs/Symptoms: Hallucinations, Delusions, Paranoia;
Acting Out; Mania, Depression, Suicidality; Substance
Intoxication and Withdrawal; Codes
¨
Medications
Nurse: Medications: S/S Indicating PRN; Side Effects
Policies to Review
|
Admission |
Fall / slip |
Postural support |
|
Blood pressure / vital
signs |
Infection control |
Search policy |
|
Bomb threat |
Intake and output |
Seclusion |
|
Charting, rules |
Linen |
Seizures |
|
Child abuse, suspected |
Minors |
Self-harm |
|
Community meetings |
Night rounds |
Treatment plan |
|
Dentures, care of |
Nursing documentation |
Unusual occurrence |
|
Discharge of patient |
Obstructed airway |
visitors |
|
Duty to warn / Tarasoff |
Patient belongings |
Fire, disaster - separate
manual |
¨
¨
Do a round, introduce your self to patients who are awake.
Note that rounds are every hour; every 30 min for S/P I, every 15 min for S/P
II. Safety – unsafe objects, patient’s doors open,
locked doors locked; seclusion and restraints; spills etc.
¨
Check with
you team nurse to review
special concerns for the shift
Review your patient's charts for
problems, behaviors, goals, interventions in the treatment plan […one of the most important documents in
the chart. Thoroughly familiarize yourself with the structure of the plans and
the planning process.] Read progress notes - doctor/social worker/nursing.
All shifts chart on at least one problem; plan to chart to all
problems for which information becomes available, especially the main
psychiatric problems such as danger to self, depression, psychosis – these are
the problems that are the focus of treatment and show medical necessity. Due to
frequent unavailability of charts it may be useful to make a copy of the
treatment plans for your assigned patients
Introduce your self to your
patients; tell them that you are available to assist with
needs, to talk to them… Occasionally a patient is on an hourly request
protocol: this is discussed and determined by all staff as a team. It is
important to respect all patients at all times… especially while setting
limits; it is usually more effective to state why something is or is not done
rather than enforcing a rule as a rule. Except medical and safety concerns it
is good to be flexible but always check with the CN. Be aware that patients see
you as being in a position of power, that many patients are intimidated and
scared… be reassuring
Observe patients behaviors,
activities and speech and take notes for charting and safety
during your rounds and throughout the shift, report anything unsafe or dangerous
to the charge nurse immediately. The treatment plan tells you what behaviors to
look for
1:1 for communication,
assessment, and charting with your patients between 9 AM and
¨
¨ 9 AM: Vital Signs: Phones on; linen cart out; encourage patients out of bed, attend groups
¨
¨ Staff
Lunch
¨ Lunch at
¨ Visiting: No regular visiting hours this shift. Off hour visits per MD order and
at CN discretion. It is important to be courteous to all visitors at all times.
Ask all visitors whether they have cigarettes, matches, lighters, sharp
objects, keys, anything unsafe
– explain why first and ask them to leave them including women’s handbags at
the nursing station during the visit; visitors sign in; anything brought in for
the patients must be assessed for safety and logged in before giving it to the
patients
¨
Complete assignments: letters A – P on the
assignment sheet; prepare coffee for next shift, clean staff lounge, TV room,
table, garbage can, showers
and disinfect; clean utility room, complete laundry, take dirty linen to 3rd
floor; clean dining room – tables and counter; treatment and property rooms;
garbage cans at nursing station and in treatment and property rooms
¨
¨ 3:30 PM: Do a round,
introduce your self to patients. Note that rounds are every hour; every 30
min for S/P I, every 15 min for S/P II. Safety – unsafe
objects, patient’s doors open, locked doors locked; seclusion and
restraints; spills etc.
¨
Check with
you team nurse to review
special concerns for the shift
Review your patient's charts for the
problems, behaviors, goals and interventions in the treatment plan. [The treatment plan is one of the most
important documents in the chart. Thoroughly familiarize yourself with the
structure of the plans and the planning process.] Also read progress notes
- doctor/social worker/nursing. Plan to chart to all problems for which information becomes available, especially the
main psychiatric problems such as danger to self, depression, psychosis – these
are the problems that are the focus of treatment and show medical necessity. PM
shift also charts on problems not addressed in the previous two shifts
Introduce your self to your
patients; tell them that you are available to assist with
needs, to talk to them… Occasionally a patient is on an hourly request
protocol: this is discussed and determined by all staff as a team. It is
important to respect all patients at all times… especially while setting
limits. Be aware that patients see you as being in a position of power, that
many patients are intimidated and scared… be reassuring
Observe patients behaviors,
activities and speech and take notes for charting and safety during
your rounds and throughout the shift, report anything unsafe or dangerous to
the charge nurse immediately. The treatment plan tells you what behaviors to
look for
1:1 for communication,
assessment, and charting with your patients between 4 and
¨ 4 – 4:30 PM: Get ready for dinner – make
coffee; check supplies of regular and decaf coffee, sugar,
creamer, diabetic creamer and sweetener, stir-sticks, fruit, candy, diabetic
snacks - pretzels, Gatorade – ask the nurses how much they need, cups… call
kitchen at 311 to get supplies that are low (janitor for cups)
¨ Dinner at
No sharing food; all food/fluids in dining room; monitor special diets; get
meals for patients unable to attend; disruptive clients may eat in the SALLI
port; monitor silverware
¨ Lunch
break - take this at some point if not scheduled. Inform charge nurse whenever you plan to
leave the unit
¨ Visiting 6 - 7:30: it is important to be courteous
to all visitors at all times. Ask all visitors whether they have cigarettes,
matches, lighters, sharp objects, keys, anything unsafe – explain why first and ask them to
leave them including women’s handbags at the nursing station during
the visit; visitors sign in; anything brought in for the patients must first be
assessed for safety and logged in before giving it to the patients
Get snacks. This is
a good time to check which patients have money for snacks; ask those patients
what they want from the vending machines and get their requests; observe
dietary restrictions and two item per patient limit.
Also a good time to prepare coffee and to distribute the snack prepared by the
kitchen for snacks for everyone – the kitchen staff prepares the snacks but
mental health workers distribute them
¨
¨
¨ 9 – 11 PM: Complete assignments i.e. the letters A – P on
the assignment sheet, especially: clean staff lounge prepare coffee for next
shift; clean TV room, table and garbage can; clean showers and spray with
disinfectant; clean utility room, complete laundry, take dirty linen up to
third floor; clean dining room – tables and counter, take snacks out; treatment
and property rooms; garbage cans at nursing station and in treatment and
property rooms
¨
Make night rounds sheet with suicide
levels and risk factors, NPO
¨
Rounds for days / pm
¨
Census board; physicians and ward
clerks census sheet
¨
Assignment sheet
¨
Acuity
¨
Chart till 0000 hours in all charts
¨
Chart audits: dates and times, all
problems correctly stated and addressed… and signed including continuation, TPR,
admission and other [e.g. 5250] paperwork complete, all papers in place and
dated… Blue slips for deficiencies
¨
Change date on patient information
board
¨
Patients are in correct rooms and beds
and match patient information board; look for unusual / unsafe items in all
rooms – shoes with laces, too much supplies etc… LOOK everywhere
¨
Patients on S/P II are checked Q 30
min; be especially aware of patients with med/sleep concerns e.g. sleep apnea
and patients with C-PAP machines
¨
Unit safety check including restraint
room and bed; restraint key works?
¨
Are patient telephones off?
¨
Check patio for property / unsafe
items; check / lock SALLI port door
Assignments and Duties
¨
Check
your assignments = your patients and tasks [letters A – P.]
Responsibilities include:
Check with you team nurse to review special concerns for the shift and any special do’s and don’ts
Review your patient's charts for the problems, behaviors, goals and
interventions in the treatment plan.
[The treatment plan is one of the most important documents in the chart.
Thoroughly familiarize yourself with the structure of the plans and the
planning process.] Also read progress notes - doctor/social worker/nursing.
All shifts are required to chart on at least one problem; however plan to chart
to all problems for which information becomes available, especially the main
psychiatric problems such as danger to self, depression, psychosis – these are
the problems that are the focus of treatment and show medical necessity
Usually there will not be any significant
opportunity to observe patients behaviors or have a 1:1 with patients. However,
if the patient remains awake you may observe significant behaviors that should
be charted; otherwise it may at times be appropriate to say ‘unable to assess
because patient appeared to sleep.’ Chart to sleep issues and any
medical concerns that arise
¨
Sanitize bathrooms, light switches, chairs, towel and arm
rests, chairs, doorknobs
¨
Check TV room for order, cleanliness and if closets are locked.
Check / remove garbage; check / wipe tables; put away activity supplies. Staff lounge; coffee for day shift
¨
Paper towel / soap dispensers: staff
lounge, property / utility / treatment rooms, handicapped shower room. Gloves:
fill when necessary
¨
Laundry: refill water in lint catch, remove lint; restock
client supply chart; stock linen cabinets and remove linen from counter tops if
space available; tidy and remove stray items including excess empty boxes.
Washing and drying clothes; label; attempt to identify unlabeled clothes.
Laundry soap – is there enough. Yellow, red, water-soluble bags. Take linen bags
upstairs; replace
¨
Complete assignments
Miscellaneous Duties
¨ Call
kitchen with # of dinners needed--ex 311
¨ Laundry
¨ Trash
Paperwork
¨ Phone
contact records
¨ Adult/Minor
observation record
¨ Service
activity log [SAL]; 1651 = adult, 1652 = minor
Computer Operations
¨ DESKTOP
ICON: CMHC: most client info; #2 =case #, DOB; #3, 6,
7, 13, 14 also used often
¨ DESKTOP
ICON: MEDS: MediCal info; can
use this even if they aren’t in our system – see codes/password index card for
access
Admitting New Clients:
prepare as much as possible beforehand when you know for sure they’re
coming
¨ Central
log: get time they arrived
¨ Possession
to get: anything dangerous or valuable – belts, shoes, lighters, sharp objects,
hats; do pat down and/or use wand
¨ Vital
signs in evaluation form as well as info at top of first page if possible
(NOTE: Eval form is in one of the form boxes on far
wall)
¨ Name,
case number, SSN, etc on each page of eval
¨ Client
info form: if LPS, client doesn’t need to sign; copy of insurance card; get MediCal info off computer (NOTE: Client info form also in a
wall box)
¨ Pages
5 and 7 in evaluation form – be sure to sign at the bottom
¨ Notice
of Privacy Practices NOPP (NOTE: these forms are on a clipboard hanging on the
wall)
1.
Received packet, signed form? Look under CMHC
#3, top right of screen
1.
No: give packet, sign form
2.
Yes: no more to do
¨ Release
of info forms – separate forms for friends / family, physicians
Transferring Clients to
SV
¨
Copy entire chart
¨
Do Level II check on purple sheet if time
allows
¨
Communicate with SV MHW whether you started an
admit pack – to prevent duplication
¨
SV gets originals of: psychiatric evaluation,
5150, pink copy of client info form, property sheet, admission order sheet
Disposition
from aftercare plan: (a) staff MD or therapist with whom client has appt. (b)
PCP (primary care provider – physician)
Start date /
time
RN who
completed evaluation / dc’d client
Client info
form
Evaluation
packet
Dr’s
evaluation
Dr’s orders
Med Sheets
Labs
Misc. papers
(transport consents, ER paperwork, labs, property sheets, NOPP… etc)
5150
Orders to
admit to SV or aftercare plan
Check against
SAL’s completed
Indicate on sheet whether was SAL completed or not
18 copies of
log distributed to front office mailboxes; distribution list in Central Log
binder
Orders to admit
to SV or aftercare plan – copy of aftercare plan to OP nurses box in front
office
Copy of
aftercare planes to OP nurses box in front office
CYFS: (a) fax
copy of log, (b) fax copy of any minor charts
Fax any
orders from Dr. Jenkins to Dr. Jenkins; place in Dr. Jenkins ring binder
Stack for Med
Records
Copy
of log sheet; copies of each Client Info form with RAS written vertically in
red ink by Emergency Request Block
Shift
schedule sheet with SAL’s
Chart Packets