Peak & trough
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This document provides guidelines for obtaining peak and trough levels for the antibiotics vancomycin and gentamicin. It states that vancomycin is time-dependent and doses should not be held for trough levels, while gentamicin is concentration-dependent and monitored by peak levels. Specific instructions are given for timing of peak and trough draws in relation to infusion times and doses. Blood should not be drawn from the line used for infusion.
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Dress code
Dress codewcmc This document outlines the dress code policy for associates at a Medical Center. It states that a professional appearance is expected at all times, including neat, clean, well-groomed attire. Scrubs or business casual is permitted, with guidelines around colors and logos. Identification badges must be worn visibly. Shoes should be closed-toe and appropriate for the job. Piercings are limited and male associates cannot wear earrings. Nails and hair must also meet professional standards.
Suicide precautions 
Suicide precautions wcmc The document outlines suicide precaution protocols, including two levels of precautions - Level I and Level II. Level II precautions involve one-to-one observation and restrictions of potentially dangerous items. Level I allows for some independence but requires close staff monitoring. Nursing responsibilities are described for assessing and caring for suicidal patients, with the goal of ensuring safety and identifying support systems. Additional protocols are specified for involuntary 72-hour holds.
Social work services
Social work serviceswcmc Upon admission, nursing staff assesses patients and families for needs. Social services receives automatic referrals for situations like suspected abuse, significant home care deficits, restraint use at home, psychiatric admissions, or readmissions within 30 days. Once the referral is made, social services sees the patient after completing current referrals. Financial concerns are referred to the business office rather than social services. Social worker notes are documented electronically and in patient charts. For psychiatric admissions, social services can refer patients to resources like HRA, Compass, or Clearview and assists with arranging transfers once patients are medically stable and agree to admission.
Rounding 
Rounding wcmc This document outlines an hourly rounding policy to provide excellent patient care and service. It states that all patients will be rounded on every hour from 6am to 10pm and every two hours from 10pm to 6am, with CSAs rounding on odd hours and nurses on even hours. During rounds, associates will check on patient well-being, monitor comfort and pain, assist with repositioning and bathroom needs, and ensure access to necessary items. The document provides examples of scripts for nurse and CSA introductions and emphasizes knocking, introductions, addressing needs, and reminding patients that someone will return within the hour.
Restraints 
Restraints wcmc The use of restraints at WCMC increased significantly over the previous year. Restraints are primarily used in the CCU and are only applied after alternative methods have been tried or considered. Only trained staff can apply restraints and they must be documented thoroughly. Alternative methods and guidelines for different types of restraints are also outlined.
Preparing for surgery
Preparing for surgerywcmc The document provides instructions for preparing a patient and their chart for surgery. Key steps include obtaining consent forms, completing pre-operative assessments and checklists, ensuring test results and medications are documented, labeling the chart and sending labels to the operating room. Important patient preparations include hygiene, ID bands, NPO status if required, and removing personal items. A time out is conducted immediately before and after the procedure to verify patient, site, procedure, history and test results.
Pharmacy 
Pharmacy wcmc Instruct patients and families on taking home or keeping medications in the hospital pharmacy. Document which family member takes medications home. If medications go to the pharmacy, they are bagged, sealed, labeled and receipt placed in patient chart. Controlled medications are counted by two nurses and secured. Medications are documented on an inventory form with date, time and list. Standing orders may be used if specified by physician.
Peritoneal dialysis 
Peritoneal dialysis wcmc Peritoneal dialysis can be performed manually in the hospital or using cycler equipment at home as directed by a physician. Licensed nursing associates carry out peritoneal dialysis according to a physician's orders regarding fluid type and number of exchanges. Any changes to orders are immediately communicated to pharmacy. Nursing staff reinforce aseptic technique and infection prevention education. Intake and output are determined by weighing bags unless direct measurement is ordered.
Pca 
Pca wcmc This document provides instructions for patient-controlled analgesia (PCA) medication administration and documentation. It lists common PCA medications and outlines requirements for verifying PCA syringe counts at shift changes and documenting amounts. It also describes PCA settings like the 4-hour medication limit and lockout time between doses. Procedures are provided for charting PCA medication as effective or ineffective, discontinuing orders, loading new syringes, and changing PCA medications.
Pain management 
Pain management wcmc This document outlines the pain management policy of WCMC. It states that all patients will have their pain assessed initially and frequently reassessed to ensure optimal pain relief. Patients will receive education on pain treatment and have their response to treatment assessed. Staff are responsible for informing patients of their right to pain management. Various pain assessment scales are used for different patient populations.
Organ tissue donation 
Organ tissue donation wcmc The Arkansas Regional Organ Recovery Agency (ARORA) determines if patients who die at the hospital are suitable for organ or tissue donation. For all patient deaths and imminent deaths, ARORA must be contacted within one hour to assess suitability. If deemed suitable, ARORA will discuss donation with the family following strict procedures to obtain consent and manage the donor according to federal law.
Medication reconciliation
Medication reconciliationwcmc Medication reconciliation is the process of comparing a patient's medication list to a physician's orders to minimize errors. It occurs at admission, transfer, discharge, and after surgery. Nurses document the patient's home medications and ED medications. Physicians then reconcile all current and home medications within 24 hours, noting any changes. Discharge reconciliation reviews chronic, new, and active medications to prevent duplication or interactions and provide a complete list for continued care.
Medication administration
Medication administrationwcmc The document outlines the proper procedures for medication administration including verifying the right patient, right dose, right route and time as well as documenting appropriately, noting exceptions for medication scheduling, and steps to take in the event of a medication error including immediately notifying the attending physician and charge nurse.
Iv therapy 
Iv therapy wcmc This document provides guidelines for IV maintenance therapy and insertion. It outlines that IV bags should be changed every 24 hours, tubing every 96 hours, and sites every 96 hours. When choosing sites, start with hand veins and avoid interfering with blood draws. Lidocaine can be used with a doctor's order for difficult insertions or anxious patients. Proper documentation and disposal is also covered. Tips for successful insertion include slowing down, looking for flash instead of pop, and threading carefully after flash.
Isolation 
Isolation wcmc Documentation of isolation precautions is required for insurance reimbursement and includes the type of isolation initiated, patient education, and daily observation of precautions. Isolation can be documented in the problem list, nursing activities, MedAct, or education sections. Proper hand hygiene and use of personal protective equipment are essential to prevent the spread of infection when a patient is in isolation.
Insulin drips
Insulin dripswcmc Diabetic ketoacidosis is a severe insulin deficiency that causes the body to break down fat instead of glucose for energy, putting patients at risk for complications without insulin replacement. The document outlines guidelines for monitoring and treating patients with diabetic ketoacidosis via insulin drips, including defining diagnostic criteria, assigning patients to units based on stability, and delineating responsibilities of physicians, nurses, and other staff in titrating insulin drips and monitoring patients' blood glucose and response to treatment.
Hemodialysis 
Hemodialysis wcmc This document outlines guidelines for providing hemodialysis treatment, including: only using the access arm for dialysis and applying direct pressure for bleeding; using catheters only for dialysis unless otherwise ordered; postponing routine meds before/after dialysis unless ordered; avoiding IM meds/IVs for 3 hours after; weighing patients daily and prohibiting access arm procedures; and observing patients during and after treatment for adverse reactions.
Haldol drips 
Haldol drips wcmc Haldol is an antipsychotic that can be administered intravenously via a controlled drip to treat acute delirium in emergency situations. The drip must be regulated using an IV pump and vital signs are closely monitored every 15 minutes during titration and then hourly. Only haloperidol lactate can be used intravenously and patients require daily ECGs while on the drip due to cardiac risks. Nurses follow standing orders for the usual starting dose of 4mg/hr, titrating up to 15mg/hr maximum based on response measured by the Richmond Agitation-Sedation Scale.
Epidural 
Epidural wcmc Anesthesiologists order epidural infusions which are prepared by pharmacy and administered by nurses trained in epidural infusion pumps. Nurses maintain and modify infusion rates as ordered, can administer bolus doses up to 10ml, and must change tubing every 72 hours and solutions every 24 hours. Blood thinners are not used or given when a patient has an epidural in place due to risk of bleeding. Nurses should address any side effects by following protocols before contacting anesthesia.
Enteral feeding 
Enteral feeding wcmc Enteral tube feeding is used to maintain or improve nutrition in patients unable to take food orally. Enteral nutrition is preferred over parenteral nutrition because it is safer for the patient and has less risk of infection. Ready to hang bottles are used with a pump set and flushed daily to maintain tube patency and hydration. Tubing and feeding sets are changed every 24 hours and residuals are checked every 4-6 hours during continuous feedings.
Peak & trough
- 1. Peak & Trough Vancomycin is a glycopeptide antibiotic. It is a time dependent killer. The level has to stay above a minimum concentration for a length of time for the medication to be effective. Thus, Vancomycin doses should not be held while waiting for a trough level. Vancomycin peak levels are not routinely monitored, however if ordered by the MD, the peak should be drawn 1 hour after medication dose is complete. Exception – if the ordered dose of Vancomycin is 2 grams or more then obtain the peak 2 hours after the infusion is complete.
- 2. Peak & Trough (cont) Collect trough immediately prior to dose Blood must NOT be drawn from the line it was infusing in Blood is drawn from a different port, it is NOT drawn from the port it was infused in Do not draw a trough level while Vancomycin is infusing Do not wait for trough results before hanging antibiotic unless a specific order to wait for result is ordered by MD Administer antibiotic at prescribed rate so levels are accurate
- 3. Peak & Trough (continued) Gentamicin Gentamicin is an aminoglycoside antibiotic. It works differently. It is a concentration dependent killer. This means the higher the peak concentration, the larger the kill of microorganisms. Gentamicin can kill microorganisms after the concentration has decreased (this is called a post-antibiotic effect). Patients on Gentamicin are monitored to ensure that levels are adequate for therapy and to detect elevated levels that may be associated with a greater risk of ototoxicity and nephrotoxicity.
- 4. Peak & Trough (continued) Blood must NOT be drawn from the line it was infusing in Blood is drawn from a different port, it is NOT drawn from the port it was infused in Do not wait for trough results before hanging antibiotic unless specific order to wait for result is ordered by MD Administer antibiotic at prescribed rate so that peak levels will be accurate If dose is received to infuse over 30 minutes, collect peak 30 minutes after dose completion EXCEPTION – If the dose is ordered to infuse over 60 minutes, then the peak is drawn 15 minutes after the infusion is complete