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Required Elements for Titration Orders

Titration orders are generally defined as those in which the medication dose is either progressively increased or decreased in response to the patient’s status. Organizations are required to define, by policy, if titration orders are deemed acceptable for use. The elements of performance found in the Medication Management (MM) chapter at MM.04.01.01 outline the policy requirements.

Goals when developing requirements for safe administration:
• Compliance with manufacturer’s Instructions For Use (IFU) for safe administration
• Consistent administration practices among nurses and other practitioners
• Ensure the patient response is achieved/sustained
• Nursing not placed in a position of making dosing/administration decisions that may conflict with their scope of practice
• Documentation accurately reflects order changes, patient assessments, etc.

Resources:

Understanding Egress Clutter

Fire is a concern in a health care setting because patients are often unable to move to safety by themselves. A means of egress is an exit path that occupants may use to safely exit a building or to move between specific areas in a building during a fire or other emergency.
A means of egress includes corridors, stairways, and doors and is an essential part of the fire protection and emergency evacuation plan.

Management of hallway egress is critical in ensuring a safe facility for patients, visitors, and staff. All staff has a role in managing hallway egress.

Appropriate Selection and Use of Hospital Approved Disinfectants

It is important that all staff and faculty understand and use hospital approved disinfectants appropriately to prevent transmission of pathogens.

  • Ensure product is not expired before using
  • If the surface is heavily soiled, use the first wipe to clean and a second wipe to disinfect
  • Treated surface to remain wet for contact time
  • Wear Gloves
  • Discard in regular trash. Do not flush down the toilet.
  • Allow the surface to air dry
  • Keep lids closed when not in use

Generalized Sequence for Donning/Doffing Personal Protective Equipment (PPE)

 

OSHA requires organizations to provide personal protective equipment (PPE) in the sizes and locations where potential exposures to bloodborne pathogens or other infectious organisms may occur.

Following standard precautions, faculty and staff need to be able to determine the type of PPE required depending on the circumstance and type of anticipated exposure. For some epidemiologically significant organisms (e.g. CRE, MRSA, Hepatitis A, etc.) the medical center’s isolation policy outlines the specific PPE required.

Common errors with PPE include:

  • Putting on gloves that are too small or too large increases the risk of tearing or leaking;
  • Not wearing face protection during aerosolizing procedures;
  • Reusing PPE, including tucking mask under the chin or hanging off the ear for later use;
  • Touching face or other equipment/environmental surface not necessary during patient care (e.g. personal phone) with contaminated gloves;
  • Not wearing an isolation gown correctly (e.g. hanging off shoulders, not tied, etc.) and;
  • While removing an isolation gown, creating opportunities for self-contamination.

*Combination of PPE will affect the sequence. Please refer to the CDC for additional details on donning and doffing. Key messages include:

  • Perform hand hygiene before and after PPE use
  • Don PPE before entering an isolation room
  • Change gloves after use on each patient
  • Keep gloved hands away from the face
  • Do not reuse PPE and discard in an appropriate receptacle

Proper selection and use of PPE is essential to your safety and can prevent the transmission of organisms within the healthcare environment.