PATIENT CARE SERVICES POLICY AND PROCEDURE

Transcription

1 PATIENT CARE SERVICES POLICY AND PROCEDURE Title: Transportation of Patients Within a CHN Facility Section: Provision of Care, Treatment, and Services Department of Origin: Patient Care Services Effective Date: September 21, 2000 Last Review / Revision Date: 5/18/12 CNO Signatures: Gerganoff, Martha CSM, Finch, Deb CSJ, Gold, Sue CHVI, Knapheide, Deb HCH I. POLICY STATEMENT It is the Policy of CHN that safe transport practices will be adhered to within its facilities. When it is necessary to move patients within and between departments, patient transport will occur in a manner that maintains safety, and supports the protection of the patient s identity and information. It is the expectation that patient transportation will be coordinated by a Registered Nurse to ensure that the patient is accompanied by personnel with the appropriate competencies in order to provide the needed level of assessment, monitoring, and interventions. It is also expected that patients will be transported with the equipment that is necessary to continue care and monitoring during transport. Patients should never be left unattended during transport. It is expected that hand off communication will occur between the person receiving the patient, and the person that is delivering the patient. II. III. PURPOSE This policy specifies the requirement for safe patient transport, and provides guidelines for transporting patients within CHN facilities. DEFINITIONS Safe Transport Practices refers to the practice of ensuring that the right personnel, appropriate equipment and monitoring devices, and necessary communication and documentation are utilized to move the patient safely from one point to another. Safe Hand off is a key component of safe patient transportation, and involves the use of SBAR communication to convey pertinent patient information. Hold down the control key and click here to see the hand off communication policy Interdepartmental Transports: includes transports to other departments within the facility for tests or procedures, and transport to a different unit for care. Boarding Pass or Ticket to Ride: Two-way communication tool that documents the patient s condition, relevant information and safety alerts; and used during transport of the patient. IV. ROLES AND RESPONSIBILITIES All associates that are involved in the transport of a patient within the hospital are responsible for ensuring that safe patient transport practices occur. Registered Nurse: Coordinates the patient transportation. The nurse is responsible for determining the number and skill level of associates needed to facilitate a safe patient transport. This decision is based on the patient s condition, and required care and monitoring equipment (See Appendix A) Page 1 of 6

2 It is the responsibility of the RN that is transporting the patient, and the RN assuming care of the patient in the receiving department, to maintain appropriate patient assessment and nursing care documentation in the medical record while the patient is in his/her care. Respiratory Care Practitioner (RCP) will accompany patients who are intubated, or who require airway support during transport unless an anesthesiologist or Certified Registered Nurse Anesthetist accompanies the patient. Transportation department Personnel and other non licensed associates: May transport patients that do not require RN or RCP personnel in attendance (See Appendix A). V. SPECIAL CONSIDERATIONS Transporting patients with oxygen: When transporting patients with oxygen, the cylinders must be transported on an appropriate carrying device or must be secured with an appropriate strap or other appropriate securing device. Care must be taken to minimize the risk of the cylinder being dropped, dragged, or slid across the floor. When patients with oxygen are being transported by a non- licensed associate, a licensed associate must complete the following prior to the patient leaving the unit: Verification of oxygen flow rate Verification of cylinder contents Sign the Boarding Pass / Ticket to Ride *NOTE: Only tanks with 1500 PSI or greater should be used in a patient transport. The verification and signature must occur at the following points: 1. Patient Pick-up: The transporter will ask the RN taking care of the patient to verify the oxygen flow rate, the oxygen content in the cylinder, and to sign the boarding pass / ticket to ride before the patient leaves the unit. 2. Patient Delivery to the receiving department: A Patient Care Services associate will verify the flow rate and the cylinder content, and will sign their name on the Boarding Pass/Ticket to ride. The verification and signature may only be conducted by associates whose scope of practice allows them to verify and sign off on oxygen. 3. Patient Pick-up for return to unit: A Patient Care Services associate will verify the flow rate and cylinder content and will sign their name on the Boarding Pass / Ticket to Ride. The verification and signature may only be conducted by associates whose scope of practice allows them to verify and sign off on oxygen. Page 2 of 6

3 VI. PROCESS PROCESS Preparation for Transport 1. Identify patient using two Patient Identifiers (DOB & Patient s full name), prior to any transport 2. Inform patient, and family if appropriate, of transport plans, reason for transport, and any newly assigned room number. 3. Coordinate with the receiving department or unit. Discuss the patient s condition and any special needs. 4. Gather the patient s medical record including the current Medication Administration Record (MAR). 5. Assemble all required equipment or monitoring devices determined necessary for the individual patient s transport. Prior to leaving the unit 1. Transportation department associates will inform the patient s nurse or the unit clerk, when they are ready to take the patient. 2. The Boarding Pass / Ticket to Ride must be completed unless the patient is accompanied by a nurse. Upon arrival to the intended destination: 1. Complete hand off communication to the receiving unit/department Upon return to the originating unit: Transportation Department associates will inform the patient s nurse or the unit clerk that the patient has been returned to their room. The completed Boarding Pass / Ticket to Ride will be provided to the receiving KEY POINTS 1 Assures proper identification of patient. 2. Reduces fears and confusion about changing environments 3. Helps to prevent unnecessary or premature transports, and facilitates a safe transport. 4. These must accompany the patient on all transports. 5. All necessary equipment required to provide ongoing monitoring and care of the patient during transport, will accompany the patient. NOTE: if a patient is being continuously monitored prior to transport, they must be transported on a monitor. This should include at a minimum, verification of the patient identification by the person receiving and the person delivering the patient; and a discussion of pertinent patient information. Note: The receiving procedural department may request the attendance of a nurse to assess and remain with the patient at any time that they believe the patient s condition warrants the presence of a nurse. Page 3 of 6

4 RN. If the patient was accompanied by a nurse, the accompanying nurse will provide a verbal hand off report to the receiving nurse. **Also see Appendix A Attached** VII. DOCUMENTATION Document mode of transport, time and place of transport, and any special requirements (e.g. equipment, nurse or RT in attendance, etc.) VIII. REFERENCES 1. Cairo, J.M. & Pilbeam, S.P. (2010). Appendix 2-1: National Fire Protection Association (NFPA) and Compressed Gas Association (CGA) Recommendations for Compressed-Gas Cylinders. Mosby s Respiratory Care Equipment, (8 th ed., pp ). St. Louis, MO: Mosby Elsevier. 2. Pope, B.B. (2003). Provide safe passage for patients. Nursing Management, 34(9), Warren J, Fromm RE Jr., Orr RA, et al. (2004). Guidelines for the inter- and intrahospital transport of critically ill patients. Critical Care Medicine, 32(1), IX. APPROVALS /Department CSM Medical Executive CSJ Medical Executive HCH Medical Executive Transportation Dept CSM CSJ Med/Surg Departments CSM CSJ CHC Respiratory Therapy Dept CSM CSJ CHC/Cardio-Pulmonary Patient and Community Services Division Policy and Procedure CHN Nursing Leadership Council Original Approval 8/28/00 9/11/00 8/29/00 9/6/00 9/6/00 9/5/00 9/14/00 9/18/00 9/6/00 9/7/00 8/31/00 8/28/00 8/28/00 9/5/00 Page 4 of 6 nd 1 st 2 Review Review 3/20/02 3/12/02 2/28/02 2/28/02 9/18/00 3/14/02 3/26/12 Patient Care Services Policy 5/18/12(e) rd th 3 4 Review Review 03/06 6/28/07 4/14/03 08/05 6/28/07 4/14/03 07/05 7/24/07 4/14/03 09/05 4/14/03 4/14/03 4/14/03 5/11/06 5 th Review

5 and Procedure Policy Coordinating 9/21/00 5/23/02 4/27/03 5/25/06 8/23/07 Page 5 of 6

6 APPENDIX A Guidelines for Determining Patient Transport Requirements The RN as the coordinator of the patient transport is expected to use nursing assessment and judgment to determine the needs of each patient that is being transported within the facility, and to determine the number and skill level of persons that are required to accompany the patient. Patients that are being continuously monitored prior to transport will be transported on a cardiac monitor, and will be accompanied by an associate that is trained to recognize basic and lethal cardiac rhythms, and who is able to operate and troubleshoot the monitor. Patients who are intubated, or who require airway support, will be accompanied by a Respiratory therapist, Anesthesiologist, or Certified Registered Nurse Anesthetist when being transported within the facility. Patients that Require an RN to Accompany on Transport 1. Any Patient that is being transferred to a higher level of care 2. All critical care status patients 3. Post procedure cath lab patients 4. Any patient with an abnormal breathing pattern, respirations 8 or less and / or oxygen saturation less than 90% [88% for patients with chronic lung disease whose baseline is less than 90%] 5. Any patient on high flow oxygen by any modality greater than 6 L/min or FIO2 equal to or greater than 35% 6. Any patient who has demonstrated difficulty in managing secretions, with or without a tracheostomy. 7. Any patient who has experienced seizure activity within the previous 12 hours 8. Any patient experiencing hemodynamic instability- abnormal pulse and/or blood pressure 9. Any patient receiving continuous IV vasoactive or antiarrhythmic medications 10. Any patient experiencing a life-threatening cardiac rhythm within the previous 24 hours 11. Any patient experiencing chest pain at the time of transport 12. Patients that received moderate sedation and are not fully recovered 13. Patients who have received pain medication and have a sedation index of 3 or 4 and/or a respiratory rate of 8 or less for adults 14. Any patient receiving blood products 15. Any patient receiving chemotherapy at the time of transport 16. Patients with continuous insulin drip 17. Patients with finger stick blood glucose level of less than 50 or greater than Suicidal patients or those that are petitioned 19. Patients that are demonstrating acute signs and symptoms of drug or alcohol withdrawal 20. Patients with Chest tubes 21. Any patient that the RN determines is in need of a nurse to accompany them on transport based on assessment. Page 6 of 6