PPG GDCH Nur 33 Nursing Care

GULF DIAGNOSTIC CENTER HOSPITAL
NURSING POLICY

Policy No: MED-NUR-P0033/12 Issue Date : July 2012 Revision No.: Original Revision Date : Next Revision : July 2014 Page 1 of 15
TITLE: Nursing Standards of Care

Department Section Distribution : Nursing : Nursing Care : Hospital Wide
Nursing Standards of Care

APPROVAL SHEET Prepared by: Name Ms. Gela Mocanu Head of Nursing Department Reviewed by: Name Prof. Dr. Emad Al Rahmani Medical Director Signature Date Signature Date
Mr. Zuher Arawi IT, QA Manager Approved by: Name Mrs. Jamal Kaddoura Co-founder & Hospital Director Signature Date
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NURSING POLICY


DOCUMENT AMENDMENT RECORD SHEET

Date Description of Change Page Effected Revision Number
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NURSING POLICY


TABLE OF CONTENTS:
SUBJECTS 1. 2. 3. 4. 5. 6. DEFINITION POLICY SCOPE RESPONSIBILITY PROCEDURE REFERENCE PAGE NO. 4 4 4 4 4-15 15
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NURSING POLICY


Department Section Distribution 1. PURPOSE : Nursing : Nursing Care : Hospital Wide
1.1. The purpose of these standards is to ensure that all patients will receive quality nursing care according to established standards, which are evidenced based and supported by a multi-disciplinary team. 1.2. Nursing policies are given where necessary to assist the nurse to find more information if required. 2. POLICY 3. 2.1. To ensure adequate Nursing Standards of Care for all patients. RESPONSIBILITY
3.1. All Medical Staffs 4. PROCEDURE 4.1. PATIENT ASSESSMENT 4.1.1. Complete physical assessment will be performed on all new admissions and transfers to the ward within 1 hour of admission and the first 2 hours of each shift and prn. 4.1.2. All sections of the nursing assessment form including psychosocial, cultural, spiritual assessment and initial discharge planning will be completed within 24 hours following admission. 4.1.3. All entries in the nursing assessment form will be completed, dated and timed,along with name, signature and staff number of the nurse who completed the section. Information or sections not completed require reason of no completion. 4.1.4. Risk assessment form, patient and family education form, and oral assessment form will be completed within 24 hours of admission and updated as specified on the forms. 4.1.5. The nurse will obtain and interpret an ECG rhythm strip on all patients requiring cardiac monitoring at the beginning of each shift and during any episodes of dysrhythmias or hemodynamic instability. 4.1.6. Nurses will report any clinically significant or symptomatic deviations in vital signs to the attending physician as per the MEWS score. 4.1.7. Vital signs will be recorded every four hours, as per MEWS score, or as per physician's order. 4.1.8. Temperatures will be documented with vital signs, every 4 hours on pyretic patients, within 1 hour post administration of anti-pyretic therapy and as per MEWS score. Documentation of temperature readings will include the site used. 4.1.9. An apical pulse will be checked for one minute and documented prior to the administration of digitalis 4.1.10. Intake and output will be recorded on the Intake and Output Record for
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NURSING POLICY


patients who are nil by mouth, on diuretics (if recent or increased dosage), receiving IVF; with urinary catheter, Intercostal drains, Renal/Cardiac admitting diagnosis. 4.1.11. The necessity of all lines and drains will be addressed on each shift. This includes all IV lines, Foley catheters, and surgical drains. 4.2. The patient can expect that his/her health data will be analyzed and used to guide the planning of care. 4.2.1. Patient problems will be identified within 1 hour of admission and documented with the assessment and plan of care. 4.2.2. A plan of care will be formulated, reviewed and revised as necessary at a minimum of once per shift, and when the patient's condition changes. 4.3. The patients physiological, behavioral and self-reporting indicators of pain will be assessed, documented and treated according to their individual needs. This will be done: 4.3.1. Immediately upon admission to the ward/unit 4.3.2. With vital sign assessment and upon discharge from the unit 4.3.3. When patient complains of pain or as per Non verbal Pain Scale 4.3.4. Before analgesia administration 4.3.5. Following analgesia administration within: 4.3.5.1 60 minutes post oral / rectal analgesia. 4.3.5.2 30 minutes post intramuscular / subcutaneous transdermal administration. 4.3.5.3 30 minutes post intravenous administration 4.3.6. The appropriate pain assessment tool will be used and reassessed for effectiveness of analgesia as per policy 4.4. Planning of Patient Care 4.4.1. The patient can expect that a written plan of care is documented, implemented and evaluated in a systematic way. 4.4.1.1 Nursing care will be planned according to the individual patients holistic care requirements. 4.4.1.2 Implementation of the plan of care will be reflected in the nursing Documentation. 4.4.1.3 The plan of care will be evaluated for achieving desired outcomes on current /potential problems and revised as needed. This will be done by the nurse as per Policy every shift and updated as necessary in the patients chart according to changes in the patients health status. 4.4.2. The patient can expect that the nursing plan of care is coordinated, developed and implemented in collaboration with the multi-disciplinary team. 4.4.2.1 The plan of care will be implemented in collaboration with the multidisciplinary team on an ongoing basis through team conferences, clinical rounds and/or multi-disciplinary referrals as appropriate. 4.4.3. The patient can expect that the plan of care promotes continuity of care by:
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NURSING POLICY


4.4.3.1 Encouraging the same nurse to have the same patient assignment as much as possible, staffing permitting (taking into account the competency, emotional and intellectual needs of the nursing staff). 4.4.3.2 Including the patient / family in the care planning process. 4.4.3.3 Keeping the plan of care updated and reflective of current patient problems. 4.4.3.4 Including specific information related to the patient / family educational needs as appropriate (documented as Patient and Family Education (PFE) form). 4.4.3.5 When leaving the unit during the shift, the nurse will give a complete handover of his/her assigned patient to another nurse competent to manage all aspects of their assigned patients care. 4.4.4 Planning for care includes a succinct change-of-shift report which is communicated from nurse to nurse. At the change-of-shift report, pertinent patient information is provided to ensure a smooth shift transition. Change-of-shift reports include: 4.4.4.1 Patient diagnosis, past medical history, current events, length of stay and surgery or intervention date, if applicable 4.4.4.2 Review of focus charting, plan of care, outstanding procedures and referrals. 4.4.4.3 A review of the patients medication administration record including IV infusions and calculation of doses and rates. 4.4.4.4 An update regarding family members, to include: who visited, the information that was shared and their level of coping. 4.4.4.5 Update regarding process of discharge planning. 4.4.4.6 Charge Nurse / Shift in charge is to receive the change of shift reports at the end of each shift. 4.4.5 Psychosocial/Cultural/Religious Needs of The Patient 4.4.5.1 The patient/family can expect support of their psychosocial/cultural/religious wellbeing using the following interventions: 4.4.5.1.1 Utilizing translation services when necessary to enhance communication. 4.4.5.1.2 Maintaining privacy during the delivery of care. 4.4.5.1.3 Explaining tests and procedures before performing them. 4.4.5.1.4 Providing an environment that allows the patient/family to practice their Religious/cultural beliefs. 4.4.5.1.5 Encouraging family participation in the care of the patient, as appropriate.
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NURSING POLICY


4.4.5.1.6 Allowing the patient the use of personal items, such as head coverings for women, which do not interfere with medical or nursing procedures or hospital valuable policy. 4.4.6 Physical Needs of the Patient 4.4.6.1 The patient can expect assessment and supportive treatment and care of physiological function for the following body systems: neurological, cardiovascular, respiratory, integumentary/musculoskeletal, gastro-intestinal, and genitor urinary/reproductive. 4.4.6.1.1 Neurological 4.4.6.1.1.1 A GCS will be completed on patients with an acute neurological pathology, those who have undergone neurosurgery or neurological interventional procedures as per physician orders or: 4.4.6.1.1.1.1 Every 1 hour for a minimum of 6 hours post admission or procedure 4.4.6.1.1.1.2 Then, if stable, it is completed every 2 hours for 12 hours then every 4 hours for 12 hours, then every 8 hours and prn. 4.4.6.1.1.1.3 If not stable, the timings of the GCS will not change and the Physician will be notified. 4.4.6.1.1.2 The nurse will immediately notify the Physician if: 4.4.6.1.1.2.1 There is a new development of agitation or abnormal behavior 4.4.6.1.1.2.2 Any drop of more that two points in the GCS 4.4.6.1.1.2.3 Development of severe or increasing headache or persistent vomiting 4.4.6.1.1.2.4 New or evolving neurological symptoms or signs. 4.4.6.1.1.3 Suspected spinal injuries will be immobilized and spinal precautions will be implemented until clear authorization to mobilize is documented in the medical records by the physician. Verbal orders are not acceptable for spinal clearance and C-spine precautions are to continue until a written order is received from the physician. 4.4.6.1.1.4 Any patient with a C-collar (hard collar) will have collar released every 2 hours for care of the neck and pressure area assessment. C-spine alignment will be maintained during release of collar and this procedure requires a minimum of two competent persons. 4.4.6.1.1.5 For acute patients who have or are at risk of raised intra-cranial pressure, care will be provided that prevents
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NURSING POLICY


elevations in Intra-Cranial Pressure (ICP) and/or promotes ICP reduction including: 4.4.6.1.1.5.1 Maintain head and neck alignment. 4.4.6.1.1.5.2 Maintain head of bed elevation at 30 degrees 4.4.6.1.1.5.3 Avoid hip flexion greater then 30 degrees (consider reverse trendelenburg). 4.4.6.1.1.5.4 Avoid positions that may increase intraabdominal or intrathoracic pressures such as prone or semiprone. 4.4.6.1.1.5.5 Minimize stimulation and lighting; avoid prolonged periods of stimulation. 4.4.6.1.1.6 Beds containing air mattresses will not be used for patients with suspected or diagnosed spinal trauma. 4.4.6.1.1.7 The nurse will attempt to minimize injury to the seizing patient by such measures as padding the side rails, placing a pillow under head, and clearing the area of potentially harmful materials. The nurse will never attempt to place anything into the patient's mouth. 4.4.6.1.1.8 Oxygen therapy may be required if the seizure is prolonged e.g. longer than 5 minutes. All witnessed seizures will be reported to the Physician. 4.4.6.1.1.9 Patients at risk for neurovascular compromise will have a neurovascular assessment completed with the vital signs and documented in the patient chart. Documentation will include color, warmth, movement, sensation & the presence of pulses distal to the injury. 4.4.6.1.2 Cardiovascular 4.4.6.1.2.1 A 12 Lead ECG will be carried out on all patients who require cardiac investigations as deemed necessary by the treating physician or as part of the nurses assessment when deemed necessary. 4.4.6.1.2.2 All monitored alarm limits will be assessed and documented at the beginning of each shift and as patient condition changes. 4.4.6.1.2.3 High/low alarm limits will be set to a maximum of 20% above and below the patients current reading. 4.4.6.1.2.4 All monitor alarms will be on and audible at all times. 4.4.6.1.2.5 Alarms will be addressed immediately by the nurse and corrective action taken accordingly. 4.4.6.1.2.6 ECG electrodes will be changed every 24 hours and prn.
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NURSING POLICY


4.4.6.1.2.7 A physicians written order and signed patient consent must be obtained prior to the transfusion of blood / blood products as per policy 4.4.6.1.3 Respiratory 4.4.6.1.3 .1 Lung sounds will be auscultated on all patients at the beginning of the morning and afternoon shifts. On night shift, lung sounds will be auscultated only if the patient is awake, or unstable. 4.4.6.1.3.2 The nurse will closely monitor the patient receiving oxygen by pulse oximetry and clinical assessment such as respiratory rate and depth, presence of cyanosis, and mental status. 4.4.6.1.3.3 Oxygen flow rate via face mask will be greater than six (6) liters per minute. These patients may use nasal cannula to permit mouth care and/or eating/drinking. 4.4.6.1.3.4 Oxygen flow rate by nasal cannula will not exceed six (6) liters / min. 4.4.6.1.3.5 At least once per shift the nurse will assess the patient for possible skin breakdown where tubing may cause pressure and apply protective measures such as padding. (e.g. over ears and bridge of nose) 4.4.6.1.3.6 Oxygen is to be started if SpO2 is less than 95% at room air and Physician needs to be notified. 4.4.6.1.4 Integumentary/Musculoskeletal 4.4.6.1.4.1 A head to toe skin assessment will be carried out on all patients every shift and will be documented in the Nurses Notes. Particular attention will be paid to vulnerable areas, such as bony prominences. 4.4.6.1.4.2 Immobile patients will be turned or repositioned at least every 2 hours, including night shift. If this is not done, reasons will be documented. 4.4.6.1.4.3 A 30 turn to either side is required to avoid positioning directly on the trochanter, unless medically contraindicated. 4.4.6.1.4.4 Reddened areas and bony prominences will not be massaged. 4.4.6.1.4.5 Pillows or foam wedges will be used to avoid contact between bony prominences. 4.4.6.1.4.6 Devices, such as pillows or foam wedges will be used to relieve pressure on the heels and bony prominences of the feet. Heels should be floating in air. 4.4.6.1.4.7 Shearing forces will be reduced by maintaining the head of the bed at no more than 30. 4.4.6.1.4.8 Friction will be reduced by the use of transfer sheets to move patients.
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NURSING POLICY


4.4.6.1.4.9 Rehabilitation or physiotherapy services will be consulted when devices are required to reduce pressure, friction and shear. 4.4.6.1.4.10 The nurse will protect and promote skin integrity by: 4.4.6.1.4.10.1 Ensuring hydration through adequate fluid intake. 4.4.6.1.4.10.2 Showering when possible. 4.4.6.1.4.10.3 Avoiding hot water and use a pH balanced, nonsensitizing skin cleanser. 4.4.6.1.4.10.4 Minimizing friction and shear 4.4.6.1.4.10.5 The application of a non-sensitizing, pH balanced, lubricating moisturizers and creams with minimal alcohol content. 4.4.6.1.4.10.6 Using protective barriers (e.g. Extra-thin hydrocolloid, or transparent film) or protective padding to reduce friction injuries. 4.4.6.1.4.11 Minimize skin exposure to excess moisture. (e.g. urine, faeces, perspiration, wound exudate, saliva etc). 4.4.6.1.4.12 When moisture cannot be controlled use absorbent pads, dressings or briefs that draw moisture away from the skin. Replace pads and linen when damp. 4.4.6.1.4.13 for Wound Care 4.4.6.1.4.13.1 Open wounds will be irrigated with the above solutions ONLY using a 30cc syringe and a 19g angiocath/cannula. 4.4.6.1.4.13.2 Physician or wound management team orders will be followed for the type and frequency of dressing as per policy 4.4.6.1.5 Gastro-Intestinal 4.4.6.1.5.1 Naso/Oro Gastric Tube [N/OGT] placement will be checked following initial insertion, at the beginning of each shift and prior to use. 4.4.6.1.5.2 If there is any doubt that tube is not in the stomach or the patient becomes acutely breathless or develops difficulty in breathing during administration of feed /medications, stop administration and notify physician. 4.4.6.1.5.3 Confirmation of tube placement will be made by: 4.4.6.1.5.3.1 Auscultation over the epigastric region whilst rapidly injecting 10-20ml of air AND 4.4.6.1.5.3.2 Aspirating 20 mLs of stomach contents AND testing with pH indicator strip. A pH measurement of less than 5.0 requires an X-ray ordered and read by the physician in order to confirm the placement of the tube. 4.4.6.1.5.4 The patients head of bed will be elevated to 30 degrees for all feeds via N/OGT or PEG whether the feed is intermittent of continuous
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NURSING POLICY


4.4.6.1.5.5 Bowel function will be monitored and documented on each shift and a bowel protocol will be implemented as required according to physicians order. 4.4.6.1.5.6 For Percutaneous Drains: 4.4.6.1.5.6.1 Percutaneous drains will be secured firmly. 4.4.6.1.5.6.2 Accurately measure and record drainage output on intake and output record at the end of every shift or when emptied or removed. 4.4.6.1.5.6.3 The nurse will report any significant changes in the character or volume of fluid, leaking of fluid or bleeding at site of drain to the nurse in charge. 4.4.6.1.5.6.4 The nurse will notify the Physician if total drainage is greater than 300mls over 6 hours. 4.4.6.1.5.7 Urinary/Fecal Ostomy 4.4.6.1.5.7.1 The nurse will report excessive bleeding from stoma (a small amount of bleeding during cleaning is normal), discoloration, signs of necrosis, retraction below skin level or herniation of 2.5 cms (or greater) more than usual to the nurse in charge. 4.4.6.1.6 Genito-Urinary/Reproductive 4.4.6.1.6.1 Urinary catheter and perineal care are performed with soap and water during the daily bed bath and every 8 hours and prn. 4.4.6.1.6.2 Urinary drainage bags will be emptied using an aseptic technique at the end of each shift [and prn] and recorded on intake and output sheet. 4.4.6.1.6.2 Silastic and Foleys urinary catheters will only be changed if there is evidence of obstruction by encrustation or mucus, symptomatic infection, or leakage around the catheter. Changes are documented in the multidisciplinary notes. 4.4.6.1.6.3 Urinary catheter tubing will be secured to the leg with an elastic cuff. 4.4.6.1.7 Pre & Post-Operative Care 4.4.6.1.7.1 Pre-op checklist will be completed prior to transfer to OT. 4.4.6.1.7.2 The nurse will initiate incentive spirometry to prevent postoperative pneumonia in patients with underlying respiratory disease. This will be initiated pre-operatively if possible. Post-operatively, the patient will be assisted to undertake the exercise every hour while patient is awake for 24 48 hours post operatively or longer if required. Patient education will be documented in the Patient and Family Education form (PFE).
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NURSING POLICY


4.4.6.1.7.3 A concise and appropriate handover will be given to the OT by the nurse transporting the patient and will include ongoing infusions, abnormal vital signs, allergies and latest capillary blood glucose level if applicable 4.4.6.1.7.4 The ward nurse will go to the Recovery Room to collect the patient and receive handover from the staff. 4.4.6.1.7.5 The ward Nurse will check and assess the following in the Recovery Room prior to transport back to the ward: Operation performed, type of anaesthesia given, any medication or blood given, post operative wound dressing and drainage, presence and/or quality of pain, presence of analgesia, level of consciousness and post operative orders. 4.4.6.1.7.6 Provide safe transportation for return to ward as per escort policy 4.4.6.1.7.7 Assess for pain and give analgesic as required as per Patient Pain Assessment Policy. 4.4.6.1.7.8 Contacts the Physician if analgesia does not relieve pain in the allotted times. 4.4.6.1.7.9 Observations/vital signs will be completed and documented as follows: 15 minute interval x 2 (started on arrival to the ward), every 30 minutes x 2, every 1 hour x 2, every 2 hours x 2 and every 4 hours. 4.4.6.1.7.10 Deep breathing and coughing will be taught and encouraged and analgesia provided, if required. Patient education to be documented in the Patient and Family Education form (PFE). 4.4.6.1.7.11 Fluid intake and urine output will be monitored and documented every 2 hours for the first 8 hours. 4.4.6.1.7.12 The physician will be notified if the patient has not urinated 8 hours post-op. 4.4.6.1.7.13 Patients will be supported and encouraged to mobilize as soon as possible or as per physicians orders 4.4.6.1.7.14 Patients will be kept NPO until there is a Physicians order to feed the patient. 4.4.6.1.7.15 Oral care will be given to patients at least every 4 hours while NPO. 5. INFECTION CONTROL 5.1. The patient can expect that infection control and prevention measures are implemented 5.1.1 Suction liners and tubing will be changed every 24 hours and when required. 5.1.2 Irrigation bottles will be changed every 24 hours and dated and timed. 5.1.3 All disposable products used directly for the patient will be either discarded or transferred with the patient.
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NURSING POLICY


5.1.4 All medication vials and infusion solutions will be dated, initialed, and utilized for no more than 24 hours and then discarded (exception: Insulin and Heparin vials which are good for one month). 5.1.5 Non-disposable equipment is cleaned between patient use and PRN. 5.1.6 Hand washing and/or hand disinfection with alcohol based gel will be performed before and after patient procedures, between patients and upon entering and leaving the ward. 5.1.7 Isolation barriers will be initiated according to policies 5.1.8 Standard precautions will be applied to all patients. 5.1.9 Patients/visitors will be instructed regarding infection control measures. 5.1.10 Peripheral vascular access device (PVAD) will be checked for phlebitis and infiltration within 30 minutes of insertion and then every 2 hours if solutions are being infused and every 4 hours if no solutions are being infused. 5.1.11 IV tubing and burettes that are continuously used are changed every 96 hours and dated, timed and initialed. 5.1.12 IV tubing and burettes that are NOT continuously used are changed every 24 hours and dated, timed and initialed. 5.1.13 At any time IV tubing, secondary sets and add-on devices are disconnected from the cannula they must be immediately discarded. 5.1.14 Peripheral IVs will be re-sited every 96 hours and prn. If it is difficult to start an IV on the patient, the IV may be kept longer with a Physician's order provided the site is free of complications, with documentation in the multidisciplinary notes. 5.1.15 Blood and blood product IV tubing will be changed every 24 hours and dated, timed and initialed. 5.1.16 TPN IV tubing will be changed every 24 hours and dated, timed and initialed. 5.1.17 A transparent, occlusive dressing will be used for all invasive line insertion sites. The catheter hub and tubing connection will be left exposed. Transparent dressings will be changed when damp, loosened, or soiled. 5.1.18 Gauze dressings will be used for invasive lines which are leaking from the site 5.1.19 All unused lines will be Normal Saline locked and will be capped with extension tubing with positive pressure valve. Closure cap will be changed each time the line is accessed. 5.1.20 All CVC dressings will be assessed at least every 4 hours. 5.1.21 CVC's will be checked for phlebitis and infiltration within 30 minutes of insertion and then every 2 hours. 6. SAFETY 6.1 The patient can expect that their safety needs are addressed
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NURSING POLICY


6.1.1 An identification bracelet will be placed on the patient upon arrival to the unit with accuracy verified and then checked per shift for placement. The identification bracelet may need to be replaced and/or re-sited due to edema, or procedures prn. 6.1.2 A falls prevention/ risk assessment will be performed daily. It will be placed on the patient that is identified as high risk of fall. Appropriate interventions are followed as specified on the risk assessment form. 6.1.3 All bedside emergency equipment will be checked at the beginning of each shift. This check will ensure all equipment is present and functioning. 61.4 Medications, hazardous supplies and cleaning materials will be kept under lock and key. 6.1.5 Call bells will be within patient reach at all times. 6.1.6 Crash carts are maintained on each unit and checked as per policy 6.1.7 All equipment that is donated or brought into the hospital will be cleared by Biomedical as per policy. 6.1.8 Blood products will be double checked by two registered nurses before administration. Vital signs will be documented before initiating infusion, during and after the transfusion as per blood and blood product infusion procedure. 6.1.9 Patients will be observed at least once per hour by a member of the nursing staff. 6.1.10 Patients requiring physical restraints will be assessed and evaluated as per policy 6.1.11 All patients being transported will be assessed against set criteria to determine the type of escort required. 6.1.12 The escorting nurse will ensure that the appropriate documentation has been completed, and will accompany the patient. 6.1.13 Transfers within the UAE will be according to policy 7. COMFORT 7.1 The patient can expect that comfort, rest and pain alleviation needs are supported 7.1.1 A bath and linen change will be done at least once per day unless contraindicated by patient's clinical condition. 7.1.2 Lip and mouth care will be given as per oral assessment tool. 7.1.3 Male patients will be offered a shave each morning or as per patient/family request; documentation will reflect if the patient or family has refused a shave. Cultural norms and values will be adhered to.
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NURSING POLICY


8. PATIENT EDUCATION / DISCHARGE PLANNING 8.1 The patient/family can expect education that supports their transition towards selfcare, and adaptation to their health/illness condition 8.1.1 The nurse will collaborate with other services as appropriate. 8.1.2 The nurse will assess barriers to learning and level of learning achieved by the patient. 8.1.3 The nurse will document all teaching performed. 8.1.4 Appropriate patient and family education materials will be provided. 8.2 The patient/family can expect that an individualized discharge plan of care is assessed, established and implemented 8.2.1 A Nursing Discharge Summary will be completed on all patients prior to transfer or discharge. 8.2.2 Discharge planning will be initiated within 24 hours of admission and documented on the Initial Assessment Form. 8.2.3 Discharge planning will demonstrate a multidisciplinary collaboration with necessary referrals 8.2.4 All patient and family education will be documented on the Patient and Family Education Form. 8.2.5 Patients may be transferred to transit area prior to discharge 8.2.6 If the patient is leaving against medical advice, the registered nurse inquires why the patient requests to leave the hospital, notifies the MRP and document this in the patients record as per policy. 9. REFERENCES 9.1 5 Million Lives Campaign. Getting Started Kit: Prevent Central Line Infections How to Guide. Cambridge, MA: Institute for Healthcare Improvement; 2008. www.ihi.org Accessed 19 February, 2009 9.2 Brain Trauma Foundation, (2007) "Guidelines for the management of TBI: American, Association of Neurological Surgeons (AANS), Congress of Neurological Surgeons, (CNS), AANS/CNS Joint Section on Neurotrauma and Critical Care". Journal of Neurotrauma; Volume 24, Supplement 1, 2007. 9.3 Buchanan S, Coltart L, Cowie K, Davidson R, Don C, Elder F, Gravill P, Guild C, Manson L, McGibbon G, Nardi A, Rait C, Wood A. (2007). Caring for the patient with a tracheostomy - Best Practice Statement. NHS Quality Improvement Scotland. March http://www.nhshealthquality.org/nhsqis/files/TRACHEOREV_BPS_MAR07.pdf -Accessed 09 February, 2009 9.4 Centre for Disease Control (CDC), [2003]. Guidelines for Preventing Health Care Associated Pneumonia. CDC: U.S.A. 9.5 Centre for Disease Control (CDC), [2011]. Guidelines for Preventing of Intravascular Catheter Related Infections. CDC: U.S.A.
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PPG GDCH Nur 33 Nursing Care

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PPG GDCH Nur 33 Nursing Care

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GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

DOCUMENT AMENDMENT RECORD SHEET

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

GULF DIAGNOSTIC CENTER HOSPITAL

TITLE: Nursing Standards of Care

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