Clinical Coaching

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Staff Name

• ID Number

• Unit

Professional Practice

• Knowledgeable about PPM

  Yes

  No

  N/A

• Knowledgeable about Nursing Mission, Vision, and Values

  Yes

  No

  N/A

• Knowledgeable about Shared Governance Structure

  Yes

  No

  N/A

• Can Identify Unit Members in Councils

  Yes

  No

  N/A

Preceptorship and Mentorship

• Rounded on all new staff twice per week

  Yes

  No

  N/A

• Ensured preceptor and preceptee are following the checklists and competencies

  Yes

  No

  N/A

• Provided reflection template if there's any issue to be reflected upon

  Yes

  No

  N/A

• Observed the new staff in clinical procedures/equipment operation, state the procedure/equipment

  Yes

  No

  N/A

• Asked the new staff about medication knowledge

  Yes

  No

  N/A

• Asked the new staff to deliver a report on one patient and asked questions about diseases and conditions

  Yes

  No

  N/A

• Preceptor is communicating effectively and shadowing and guiding the preceptee

  Yes

  No

  N/A

• Preceptor and preceptee on same schedule

  Yes

  No

  N/A

• New staff is moving on track

  Yes

  No

  N/A

• New staff can access policies and is knowledgeable about SGH policies

  Yes

  No

  N/A

• Followedup on the process of mentorship, specify status

  Yes

  No

  N/A

• Followedup on interns, attendance, evaluation, and case presentation

  Yes

  No

  N/A

• Verified completion of competencies for new and current staff

  Yes

  No

  N/A

• Verified placement of certificates in personnel files

  Yes

  No

  N/A

Pain

• Assessment for inpatients is every 3 hours

  Yes

  No

  N/A

• Assessment for outpatients is during every visit

  Yes

  No

  N/A

• Documentation on flowsheet and pain flowsheet are correct as per policy

  Yes

  No

  N/A

• Reassessment is done as per policy

  Yes

  No

  N/A

Restraints

• Restraint is the last resort

  Yes

  No

  N/A

• Documentation of order, form, and monitoring show correct procedure

  Yes

  No

  N/A

Medication Safety

Medication Knowledge

• Action Plan

  Yes

  No

  N/A

• Medication Preparation

  Yes

  No

  N/A

• Action Plan

  Yes

  No

  N/A

• Medication Administration

  Yes

  No

  N/A

• Action Plan

  Yes

  No

  N/A

• Documentation

  Yes

  No

  N/A

• Action Plan

  Yes

  No

  N/A

Pressure Injury

• Document on Braden and Braden QD (patient identification, date, time, correct scores, and initials)

  Yes

  No

  N/A

• Use Braden for age above 9 and Braden QD for age 08 years old

  Yes

  No

  N/A

• Document and apply pressure injury preventive measures based on subscores (INJURY Bundle), dated, timed, checked, initials

  Yes

  No

  N/A

• Pillow under head

  Yes

  No

  N/A

• Pillows to elevate hands by gravity

  Yes

  No

  N/A

• Pillows under lower extremities to keep the heels floating (in air, not touching surfaces)

  Yes

  No

  N/A

• Positioning/draw sheet available under patient and used to lift and not drag, no overuse of underpads

  Yes

  No

  N/A

• Nurses are using the positioning clock, depending on the mentioned hour, see the patient position, another scenario is to observe nurses while positioning patients (hand washing and PPEs, patient identification, patient communication, bed at waist level, side rails down to the side of nurse, use positioning sheet, lifting not sliding of patient, use pillows for lateral position and for head, upper and lower extremities, cover patient, side rails up, bed in lowest position, call bell within reach, removal of PPEs, hand hygiene, and documentation), repositioning is done every 2 hours

  Yes

  No

  N/A

• If patient is on chair, he/she instructed to shift weight every 15 minutes and standup every 1 hour with/without assistance as per patient condition

  Yes

  No

  N/A

• If patient is incontinent, make sure that the nurses are using the appropriate technique for cleaning and patting dry, only one underpad under buttocks, no additional towel or linen under the patient to absorb the urine or stool because these will create friction, apply barrier cream as needed if available

  Yes

  No

  N/A

• Staff aren't applying diaper with indwelling urinary catheter

  Yes

  No

  N/A

• Air mattress is used for high risk patients

  Yes

  No

  N/A

• Assess nutrition, check if dietitian is consulted as needed

  Yes

  No

  N/A

• Inspect skin under medical devices and from head to toe for 1 patient, reemphasize for the staff to do it for all patients

  Yes

  No

  N/A

• Make sure staff are changing the position of medical devices

  Yes

  No

  N/A

• Make sure staff are applying lotion after shower for the patient to moisturize the skin

  Yes

  No

  N/A

• Check if physical therapy is consulted as needed

  Yes

  No

  N/A

• Staff are applying pressure injury treatment protocol, routinely cleaning site with normal saline solution

  Yes

  No

  N/A

Fall

• Apply Morse for greater than 18 and Humpty Dumpty for less than or equal to 18 years old

  Yes

  No

  N/A

On admission to the facility, on any transfer from one unit to another within the facility, following OR, any change of status, post fall, and on daily basis, do fall risk assessment and apply the preventive measures

Exempted areas from risk assessment: Adult Intensive Care Unit, Pediatric Intensive Care Unit, Stroke Unit, Neonatal Intensive Care Unit, Nursery, Newborn department, Intermediate care unit, One day surgery, Long Term Care Unit , Operating Room, Recovery room, Interventional units, including by not limited to cardiac cath, Kidney Dialysis, endoscopy, and interventional radiology

• Document on fall risk assessment tool (patient identification, date, time, correct scores, initials)

  Yes

  No

  N/A

• Document fall prevention measures (date, time, check mark, and initials)

  Yes

  No

  N/A

• Implement Hourly Round every 1 hour during the day and every 2 hours during the night for all patients with documentation on flowsheet

  Yes

  No

  N/A

• Implement ALERT Bundle for moderate and high risk patients for adults and at risk for peds

  Yes

  No

  N/A

• For outpatient meeting criteria, assess fall risk

  Yes

  No

  N/A

• Apply accordingly the preventive measures

  Yes

  No

  N/A

• Form dated, timed, patient identification present, completed

  Yes

  No

  N/A

• For all exempt areas, apply and document preventive measures

  Yes

  No

  N/A

• Used correct procedure for IV site preparation

  Yes

  No

  N/A

• Applied transparent dressing

  Yes

  No

  N/A

• Labeled the IV dressing completely

  Yes

  No

  N/A

• Saline Lock flushed as per policy

  Yes

  No

  N/A

• Documented as per policy

  Yes

  No

  N/A

Indwelling Urinary Cath

• Routine care done with soap and water twice per day, after stool, and as needed

  Yes

  No

  N/A

• CAUTI bundle applied as per form (see below)

  Yes

  No

  N/A

• Urine samples taken aseptically

  Yes

  No

  N/A

Before insertion

• Use the catheter for appropriate indications only

  Yes

  No

  N/A

• Use the smallest catheter size

  Yes

  No

  N/A

• Perform perineal care with soap and water followed by Betadine solution directly prior to insertion

  Yes

  No

  N/A

• If failed attempt, use a new separate catheter

  Yes

  No

  N/A

Maintenance

• Hand hygiene and applying clean gloves before catheter handling

  Yes

  No

  N/A

• Maintain a closed system at all times

  Yes

  No

  N/A

• Secure catheter at all times

  Yes

  No

  N/A

• Keep drainage bag below bladder level, drainage bag and spigot not touching the floor

  Yes

  No

  N/A

• Assess catheter necessity on daily basis

  Yes

  No

  N/A

• Perform indwelling catheter care with soap and water on a fixed interval twice per day, after each bowel movement and once needed

  Yes

  No

  N/A

• Timely drainage bag emptying every 4 hours and when twothird full

  Yes

  No

  N/A

• Free tubing of kinks, loops, and obstructions

  Yes

  No

  N/A

• Obtain urine samples aseptically, either during insertion or from the sampling port

  Yes

  No

  N/A

• Irrigate when absolutely indicated ONLY when ordered by a urology physician, following urological surgeries

  Yes

  No

  N/A

Tracheostomy Care

• Tracheostomy assessment is done every 4 hours

  Yes

  No

  N/A

• Tracheostomy care is done every 8 hours

  Yes

  No

  N/A

• Tracheostomy care procedure followed (inner cannula and stoma care, aseptic technique, normal saline solution, 3 bowls, sterile cotton tipped applicator, brush, and gauze, diluted hydrogen peroxide used only in case of crust and dried secretions for adults)

  Yes

  No

  N/A

• Ties clean, if need to change, 2 personnel available and attention for safety not to cut the tube, balloon, and skin, use bandage scissor

  Yes

  No

  N/A

• Tracheostomy dressing applied as per policy

  Yes

  No

  N/A

• Emergency Equipment present at bedside (suction, ambubag, and obturator)

  Yes

  No

  N/A

• Documentation done

  Yes

  No

  N/A

NG and OG

• Tube is Marked with a permanent marker

  Yes

  No

  N/A

• CXR is the verification way for placement of NG/OG after below manual methods (aspirate and respiratory distress)

  Yes

  No

  N/A

• Mark and aspirate color, (look also for respiratory distress S&S) are used as subsequent checking measures before feeding and medication administration (1 method is needed, use the mark)

  Yes

  No

  N/A

• Tube is secured well

  Yes

  No

  N/A

Suctioning

• Follow suctioning procedure using aseptic technique

  Yes

  No

  N/A

• Routine Normal Saline Instillation isn't used

  Yes

  No

  N/A

• Closed suctioning applied, open suctioning only in emergencies for intubated patients

  Yes

  No

  N/A

• Suction canister and tubing changed as per policy

  Yes

  No

  N/A

• Suction tubings are irrigated by normal saline solution

  Yes

  No

  N/A

• Ambubag and oxygen are available at bedside

  Yes

  No

  N/A

• Level of ETT checked and documented every 4 hours

  Yes

  No

  N/A

EKG

• Patient Identification and Verification

  Yes

  No

  N/A

• Correct Placement of Leads

  Yes

  No

  N/A

• Correct Labeling and Documentation

  Yes

  No

  N/A

COVID

• Hand Hygiene before and after any contact with the patient and environment

  Yes

  No

  N/A

• Face Mask on at all times

  Yes

  No

  N/A

• Correct Process/Order of Donning PPEs as per your policy

  Yes

  No

  N/A

• Correct Process /Order of Doffing PPEs as per your policy

  Yes

  No

  N/A

• Correct Process of Collecting Swab as per your policy

  Yes

  No

  N/A

Chest Tube

• Chest Tube Monitored every 4 hours

  Yes

  No

  N/A

• Troubleshooting done

  Yes

  No

  N/A

Vital Signs

• Vital Signs are taken routinely as per policy

  Yes

  No

  N/A

• For General Wards

  Yes

  No

  N/A

• For Outpatients

  Yes

  No

  N/A

• For Critical Care

  Yes

  No

  N/A

• For ER

  Yes

  No

  N/A

• For Neonatal Well Baby (Nursery)

  Yes

  No

  N/A

• Staff verbalize normal values of vital signs

  Yes

  No

  N/A

Clinical Alarms

• Clinical Alarms On and Audible

  Yes

  No

  N/A

ESR

• Blood Transfusion practice and documentation as per policy

  Yes

  No

  N/A

• Conscious Sedation certification with competency assessment are uptodate

  Yes

  No

  N/A

• High Alert Drugs practice as per policy

  Yes

  No

  N/A

• LASA practice as per policy

  Yes

  No

  N/A

• Staff know about VTE

  Yes

  No

  N/A

• Patient Identification as per policy

  Yes

  No

  N/A

• Surgical Checklist and Preop preprocedure verification complete

  Yes

  No

  N/A

• Staff familiar with system of reporting of errors

  Yes

  No

  N/A

• Staff familiar with fire safety

  Yes

  No

  N/A

CVAD

• CVAD is inserted by a competent medical staff only (check credentials and privileges)

  Yes

  No

  N/A

• CVAD is handled (care, maintenance, and blood sampling) only by a competent staff nurse

  Yes

  No

  N/A

• CVAD is inserted based on the appropriate indications as stated on the checklist

  Yes

  No

  N/A

• Dailydiscussion with physician the need to discontinue the central venous access device as soon as it's no longer needed

  Yes

  No

  N/A

• CVAD assessed for line securement, integrity of dressing and signs of infection by Staff Nurse every 4 hours and documented on nursing flow sheet

  Yes

  No

  N/A

• Insertion checklist filled during insrtion and the bundle compliance checklist completed once per shift in the first 2 hours of the shift

  Yes

  No

  N/A

• During an emergency situation there was a breach in aseptic technique, nonadherence should be documented in patient’s chart by the inserting physician, and a new CVC shall be replaced within a maximum of 48 hours

• During central line insertion and dressing change, the number of people in patient’s room shall be minimized to avoid distraction and possible contamination

  Yes

  No

  N/A

• The physician and his/her assistant put on a mask, a cap, a sterile gown, and sterile gloves

  Yes

  No

  N/A

• All other personnel shall wear disposable gown, clean gloves, cap and facemask

  Yes

  No

  N/A

• A sterile drape be put covering the patient from head to toe

  Yes

  No

  N/A

• The nurse shall alert, document, and stop the procedure if breaches in aseptic technique is witnessed.​

  Yes

  No

  N/A

• Continuously used tubing, secondary sets & addon devices (ie. Needleless connectors, multiple lumen extensions, medication filters) must be changed every 96 hours, or immediately if contamination or breach in system integrity is suspected

  Yes

  No

  N/A

• Lipid and all Parenteral Nutrition (PN) solutions, filter, adapters & tubing is changed every 24 hours

  Yes

  No

  N/A

• IV tubes used for propofol infusions is changed every 6 hours with syringe/bag change

  Yes

  No

  N/A

• Blood & blood products every 4 hours

  Yes

  No

  N/A

• IV solutions changed at least every 24 hours and with tubing change

  Yes

  No

  N/A

• All IV tubing labeled by date/time applied and date/time to be changed. Date applies to those needing few hours to be changed such as propofol

  Yes

  No

  N/A

• A chlorhexidine impregnated semipermeable transparent dressings is applied for CVAD and changed every 7 days and when needed

  Yes

  No

  N/A

• Only in the absence of CHG dressing, a semipermeable transparent dressing can be used

  Yes

  No

  N/A

• Gauze dressing is ONLY used in case of diaphoresis or blood oozing from the catheter site. Gauze dressing is converted to a semipermeable transparent dressing as soon as diaphoresis or blood oozing stops

  Yes

  No

  N/A

• Dressing must be applied and changed by staff nurses only under strict aseptic techniques

  Yes

  No

  N/A

• Do not combine dressing types

  Yes

  No

  N/A

• Using a low infusion rate of 1 to 2 ml of normal saline for neonates and pediatric patients and 2 to 3 ml of normal saline for adult patients requiring frequent medication administration through locked or intermittently used catheters

  Yes

  No

  N/A

• Flush/lock protocol is followed for all patients with CVAD. Refer to Educator Advice for this

  Yes

  No

  N/A

• Flush using gentle pulsatile technique (pushpause, pushpause) for both saline flush and heparin saline flush

  Yes

  No

  N/A

• Needleless connectors or multiple lumen extensions is applied to all lumens of CVC (except the port used for hemodynamic monitoring), PICC, and IVAD

  Yes

  No

  N/A

• CVAD ports locked with heparin upon physician order is labeled “locked with heparin”

  Yes

  No

  N/A

• Occluded CVAD port is labeled as “occluded” to prevent manipulation of CVAD port and the physician is notified

  Yes

  No

  N/A

• Ensure that CVC is well fixated either through sutures or sutureless fixation device to prevent tube manipulation and dislodgement

  Yes

  No

  N/A

• Clean the skin with chlorhexidine swabs using a backandforth motion (vertical and horizontal) for at least 30 seconds

  Yes

  No

  N/A

• If the patient is sensitive to chlorhexidine or less than two months of age, use povidoneiodine. Allow the area to dry completely. If you use povidoneiodine solution; begin at the catheter insertion site and move outward in concentric circles and then allow the solution to remain on the skin until it dries completely (for at least 2 minutes)

Bundle Compliance Checklist to be Completed Once every Shift in the First 2 hours

• Date

  Date

• Shift

  Yes

  No

  N/A

• Daily catheter necessity discussed with the physician in the morning round

  Yes

  No

  N/A

• Document the name of the physician

  Yes

  No

  N/A

• Assess site every 4 hours and document on nursing flow sheet

  Yes

  No

  N/A

• Hand hygiene and applying clean gloves before catheter handling

  Yes

  No

  N/A

• Immediately replace dressings that are wet, soiled, or dislodged

  Yes

  No

  N/A

• Routinely change the transparent dressing every 7 days and when needed & gauze dressing once indicated for oozing sites or diaphoretic patient every 48 hours

  Yes

  No

  N/A

• Hub decontamination using 70% alcohol or 70% alcohol with CHG antiseptic swabs is performed before each hub access for at least 15 seconds

  Yes

  No

  N/A

• Chlorhexidine 2% is used for cleaning the insertion site during dressing changes for patients > 2 months of age

  Yes

  No

  N/A

• and with Povidone Iodine for babies < 2 months of age

  Yes

  No

  N/A

• Change administrations sets for continuous infusions every 96 hours and intermittently used sets every 24 hours

  Yes

  No

  N/A

• Registered Nurse Initials

  Yes

  No

  N/A

CVAD Removal

• Obtained a physician order for the removal of CVAD

  Yes

  No

  N/A

• Gathered and preparerd the equipments:Fluidimpermeable pad, sterile 2"x2" gauze pads and tape,gown mask with face shield or mask and goggles as needed sterile sutures removal set or streile scissors and sterile forceps, CHG or povidone if contraindicated and adhesive remover (optional)

• Confirmed the patient identity using ate least two patient identifiers

  Yes

  No

  N/A

• Provided privacy

  Yes

  No

  N/A

• Provided the patient with the necessary information that addresses the removal of CVAD

  Yes

  No

  N/A

• Performed hand hygiene

  Yes

  No

  N/A

• Physician wore full PPE

  Yes

  No

  N/A

• Placed the patient in supine or slight trendlenburg if not contraindicated

  Yes

  No

  N/A

• Raised the bed to the waist level to avoid back strain

  Yes

  No

  N/A

• Placed a fluid impermeable pad under the patient, close to the catheter exit site

• Dicontinued IV fluid administration and clamped the IV tubings

  Yes

  No

  N/A

• Removed and discarded the old dressing

  Yes

  No

  N/A

• Physician disinfected the area with chlorhexidine sponge using a vigorous side to side motion(vertical and horizontal)for at least 30 seconds and left it to air dry. If the patient is allergic or less than two months of age use betadine in a circular motion and allow to air dry

  Yes

  No

  N/A

• Physician removed the sutures

  Yes

  No

  N/A

• If possible, instructed the patient to breath deeply as the physician gently pull the line as the patient exhale

  Yes

  No

  N/A

• Physician applied firm pressure for 3 to 5 minutes until bleeding stops

  Yes

  No

  N/A

• Covered the exit site with gauze dressing

  Yes

  No

  N/A

• Dressing was removed after 12 to 24 hours have passed

  Yes

  No

  N/A

• Monitored the patient heart rate, respiratory rate and oxygen saturation after removal

  Yes

  No

  N/A

• Tip wasn't sent to the culture except if clinically indicated

  Yes

  No

  N/A

• Instructed the patient to remain flat or reclined position if able for 30 minutes after removal

  Yes

  No

  N/A

• Discarded used supply

  Yes

  No

  N/A

• Performed hand hygiene

  Yes

  No

  N/A

• Documented the procedure

  Yes

  No

  N/A

Norepinephrine Administration

• Defined Norepinephrine :Norepinephrine is both a neurotransmitter and a hormone. It is a vasoconstrictor that predominantly stimulate alpha 1 receptors to cause peripheral vasoconstriction and increase blood pressure

  Yes

  No

  N/A

• Stated the preferred and recommended route for administration of Norepinephrine (CVAD)

  Yes

  No

  N/A

• Stated when are we allowed to use peripheral IV access for Norepinephrine administration(only rapidly hemodynamically deteriorating patients requiring emergent stabilization awaiting the insertion of CVAD)

  Yes

  No

  N/A

• IV access in nonrestricted uper limbs only, hand, wrists and lower extremities are not used

  Yes

  No

  N/A

• Obtained a large vein 18 to 20 gauge angiocath

  Yes

  No

  N/A

• Established blood return before initiating the infusion

  Yes

  No

  N/A

• Selected the lowest drug concentration 4mg in 250 D5W in infusion pump

  Yes

  No

  N/A

• Infusing Norepinephrine at a rate of ≤ 0.4 mcg/Kg/min can be infused peripherally for less than or equal to 24 hours

  Yes

  No

  N/A

• IV access is dedicated only for Norepinephrine infusion,no other infusion are being administered in the same line

  Yes

  No

  N/A

• Second IV access is present for emergencies

  Yes

  No

  N/A

• Assessed the IV site for signs of phelebitis or extravasation every 2hours

  Yes

  No

  N/A

• Noninvasive blood pressure measurement is obtained from the arm contralateral to that in which Norepinephrine is being infused

  Yes

  No

  N/A

• Measuring Noninvasive blood pressure at a minimum of 10 to 15 minutes interval during drug titration

  Yes

  No

  N/A

• Monitoring the noninvasive blood pressure and titrating norepinephrine to reach a desired mean arterial pressure (MAP)

  Yes

  No

  N/A

• Abe to obtain the MAP either from the monitor/calculation

  Yes

  No

  N/A

• Stated when a consult a privileged physician for CVAD insertion should be done If Norepinephrine up titration using lowest standard drug concentration reached ≥ 0.4 mcg/Kg/min OR There is a need for the addition of another vasoactive drug

  Yes

  No

  N/A

• Rotating IV site every 24 hours if CVAD is still not obtained except if the patient is identified as “difficult to canulate”

  Yes

  No

  N/A

• Monitoring for signs of swelling at insertion site, redness or blanching, blister formation, unexplained reduced IV flow rate, lack of blood return, and ulceration

  Yes

  No

  N/A

• Stated the management in case of extravasation: Immediately Discontinue IV Access Alert Medical Team Initiate Extravasation Management as Ordered

  Yes

  No

  N/A

Patient Identification

• Application of one ID band for all inpatients, ER patients , patients in OPD and day surgery undergoing procedures

  Yes

  No

  N/A

• Application of 3 ID bands for in hospital born babies, containing the correct data as mentioned in the policy

  Yes

  No

  N/A

• Performing Patient Identification by asking at least 2 identifiers

  Yes

  No

  N/A

• No use of room/bed number as identifiers

  Yes

  No

  N/A

• Performing Patient Identification before any interaction with the patient as mentioned in the policy

  Yes

  No

  N/A

• Application of 2 ID bands at the hospital entry point for Born before arrival patients

  Yes

  No

  N/A

• Knowing the correct action to take in case of patient found without ID band

  Yes

  No

  N/A

• Knowing how to identify unknown/unattended/unconscious patients

  Yes

  No

  N/A

• Knowing what data should the tag applied on ankle of deceased patient contain

  Yes

  No

  N/A

• Staff are familiar with Name Alert, and the actions to be taken if present to avoid errors

  Yes

  No

  N/A