Welcome to 4 West

Children’s Healthcare of Atlanta at Egleston

404-785-6281
4th Floor of Tower 2, Butterfly Elevators
Welcome
 We are so glad to have you as a new member of our
team. We hope that you will enjoy working on this
unit! We want to make this a rewarding experience
for you, so please seek help when needed. Your
involvement on this unit is very important to the
team!
 This power point is intended to give you some
information that may be helpful to you during your
orientation. Please review prior to starting
orientation on the unit.
 General Pediatric Care Unit
 The primary patient population on 4W consists of
Gastrointestinal and Respiratory illnesses.
 We are a 17 bed unit with all private rooms. The
nurse to patient ratio is 1:4-5.
 The average length of stay for our patients is 24
hours to several months depending on the illness.
 Our care team consists of nurses, patient care techs
or specialists, and unit secretaries. We also work
closely with our interdisciplinary team- Respiratory
Therapy, Social Work, Nutrition, Case
Management, Child Life, and Chaplaincy.
 Organizational Structure
Linda Cole, Senior VP of Nursing and CNO
Mary Beth Bova, MS RN CNA- VP Nursing and Patient
Care Services
Bonnie Miller -Director General Patient Care Services
Lisa Hensley, BSN RN CPN- Manager 4W/TICU
404-785-1793
Alison Phillips, RN CPN- Assistant Nurse Manager
404-785-0879
Erica Towery, BSN RN CPN- Assistant Nurse Manager
404-785-0889
Kimberly Enns, MS RN CPNP- Clinical Educator
Office: 404-785-0887; Cell: 770-287-2353
Deborah Bowens, Business Operations Coordinator
404-785-0077
General Patient Care (GPC) Patient
Populations
 4W: GI & CF with Cepacia(overflow for Pulm and
Gen Peds)
 4E: Surgical/Ortho
 5W: Pulmonology/CF & Endocrine (0verflow Gen
Peds)
 5E: Neurology & General Pediatrics
 TICU: Trach/Vent dependant, BiPAP/CPAP,
Pulmonology requiring closer observation
Orientation
 There are 2 hospital based portions of orientation to
attend prior to coming to the unit: New Employee
Orientation and Patient Care Provider Orientation.
 You will also attend your Epic Training (computer based
charting system) and CPR, if needed.
 You will complete the first day of unit based orientation
with the educator followed by shadowing on the unit.
Please wear scrubs and bring a copy of your license
and CPR card. Make every effort to complete
mandatory CBTs prior to your first day.
 During your orientation you will have a few main
preceptors to guide you as you progress. The length of
orientation will vary according to your experience level.
Your educator will contact you and your preceptors
frequently to ensure that you are having a rewarding
experience.
Interworkings of 4W
 All staff must clock in on arrival to the floor through
the API Time System, either on the phone or on the
computer. You will use the orientation code throughout
your unit orientation (see next slide).
 Change of Shift Report begins at 0645 and 1845, no later
than 0700 and 1900. We use an SBAR approach when
giving report and you will be at a computer.
 You must clock out at the end of your shift. Attendance
and Tardiness is monitored carefully.
 Pay day occurs every other Friday. Direct deposit is
available through HR. You are responsible for checking
your clocking in TIME for accuracy.
 To access email, Careforce and People IQ from home, go
to www.choa.org/staff. You must download Citrix on
your computer in order to have access to RCAP.
TIME tips and reminders
 You can check TIME from home by logging into RCAP
(www.choa.org/staff ) > Careforce > TIME. You can not clock
in and out from home 
 When clocking in on the phone, use the orientation code
(104). When on the computer, enter ORF when clocking.
 Other clocking codes: For classes: (101) or TRI; For meetings:
(04) or AD. If you forget to clock in or out, do “Add Clocking.”
You must have 2 entries: Start Time and Finish Time. You
also must notify Deborah Bowens.
 For Holiday or PTO time: “Add Calendar” and enter time for
each day
 Edit a clocking or calendar entry: Click on drop down arrow
to the right of the transaction, make your changes, add note
and save.
 To check status of time entered, view My Transaction
Requests from the TIME home page.
 Clocking In/Out on the Phone
 Clocking IN or OUT
• Working on another unit
 Dial 5-TIME (5-8463)
– Dial 5-TIME (5-8463)
 Enter your ID number + #
– Enter your ID number + #
 Enter your PIN number + #
– Enter your PIN number + #
 Press “1” to badge in/out
– Press “1” to badge in/out
 Answer questions about badging and
about lunch – Answer questions about badging
and about lunch
 Press # until you hear the chime
– Press “3” to enter facility/cost
• Going to a Class or Meeting center info
– Dial 5-TIME (5-8463) – Enter facility number (10)
– Enter your ID number + # – Enter cost center number
– Enter your PIN number + # – Press # until you hear the chime
– Press “1” to badge in/out
API and TIMECall Contacts:
– Answer question about badging and
• Deborah Bowens(Business
about lunch
Operations Coordinator): 5-0077,
– Press “4” to enter a special code deborah.bowens@choa.org
– Code “101” for class, or “04” for meeting • Dawn Taylor (ANM, Scheduler):
– Press # until you hear the chime 5-1997, dawn.taylor@choa.org
 PTO vs Holiday Time
 Paid Time Off (Policy 3.11)
 For eligible employees working at
least 40 hours per pay period
 Accrued based on hours worked
and years of employment
 Hours may be carried over from
year to year
 Hours are capped when 300 hours
are reached
 Can be used for vacation,
maternity leave, sick days
 Cash in and donation available
 Can use PTO hours after 60 days
of employment
 Holiday Time (Policy 3.24)
 For eligible employees working at
least 40 hours per pay period
 Accrued based on 7 CHOA
approved holidays and 2 personal
days
 Full-time employees receive 8
hours per holiday, and part-time
employees receive 4 hours per
holiday
 You do not have to work the actual
holiday to receive your hours. If
you work the holiday, you will
receive holiday pay.
 If you call out on your assigned
holiday, you will not receive
holiday time
 Holiday hours are not carried over
to the next year
Resources
 A team leader is assigned on each unit and they may or
may not have a lesser patient assignment. They are
responsible for coordinating admissions and discharges,
staffing decisions, and making assignments. They also
act as a resource for the team when available.
 On night shifts and weekend shifts there is a GPC
floating night preceptor. They are available between
4W, TICU, 5W and 5E.
 The House Supervisor is another resource to you. They
float throughout the hospital and can help with
difficult patient/family situations, policy clarification or
general problem solving.
 There is also a Leadership Point Person on call at all
times.
Documentation and VS
 You will receive Epic training so that you will know the basics
of patient documentation. Timely and accurate
documentation is a very important part of patient care.
Medication administration should also be documented in a
timely manner.
 Routine vital signs are considered a full set every 4 hours
(temperature, blood pressure, heart rate, and respiratory
rate). Exceptions must be documented and communicated.
 Strict Intake and Output is obtained per MD order and is
recommended for all patients with IV fluids, supplemental
feeds, failure to thrive, patients on diuretics, infants, or when
nurse or MD deem necessary. On admission, instruct
families importance of saving diapers.
 Heights and weights are critical elements of assessment and
are required for all patients. Head circumference is required
for all patients < 24 months or when diagnosis warrants.
Creating Your My List in Epic-
We recommend including these sections at a minimum in your “My List”
 Room
 Name/Age/Sex
 Weight
 Height
 Admission Comments
 Eg Gen Peds Team
 Unacknowledged Orders
 PEWS
 ASSIGNED NURSE
 RN Review
 Falls
 Restraints- Last Medical
 Primary Nurse
 Associate Nurse
Scheduling
 We are on a tracked schedule which rotates every
six weeks, or FLEX schedule which self schedules
between 4W and TICU, days and nights.
 The scheduling system is API, which connects
directly with our API Time System.
 You will meet with Dawn Taylor early in orientation
to discuss your tracked schedule/FLEX schedule
and requested time off.
Staff Forums and Required Education
 Staff forums are held quarterly. Webinar is available but
you must attend at least one in person. If you are unable
to attend in person or via webinar, you will need to read
the minutes and answer the questions to the quiz.
 You will receive a Friday Newsletter each week via email
that contains important information about system
updates, unit updates, and mandatory education. There
is a mandatory education log kept at the bottom of each
newsletter. Please refer to this list to make sure you are
keeping up with your requirements! The list contains all
the dates for the staff forums and other unit
requirements.
 Shared Leadership
 This is our Shared Decision Making Model. All staff
are encouraged to become involved.
 Also pictured is our Professional Practice Model here
at Children’s.
System Councils Campus Councils Unit Councils

 System Shared  Campus Shared  Unit Councils

Leadership Council Leadership Councils
 Department
 Professional  Nurse Engagement Councils
Development Councils
Council
 Quality-Patient
 Clinical Practice Safety Councils
Council
 Patient-Family
Experience Councils
Huddle Board
 A central place:
 to view our system and unit based goals
 to track how we are doing as a unit
 display unit based council
updates/information
 to huddle each shift and discuss/document
patient care, acuity and updates.
Model of Care
 Relationship Based Care is the Model of Care at
Children’s Healthcare of Atlanta.
 It is based on 3 main relationships: Relationship to
Patient, Relationship to Co-workers and Relationship to
Self.
 We practice the WE CARE behaviors each shift:
 W: Who I am? “I will be caring for you today.”
 E: Explain your role in their care
 C: Call pt and parent by their preferred name
 A: Advocate for the pt and Ask Why
 R: Review POC while sitting at the bedside, have pt/family
create a “goal for the day”
 E: Everyone is involved in this patient’s care
Commitment to Co-workers
As your co-worker and with our shared organizational goal of excellent
patient care, I commit to the following:
 I will accept responsibility for establishing and maintaining healthy
interpersonal relationships with you and every member of this team.
 I will talk to you promptly if I am having a problem with you. The only
time I will discuss it with another person is when I need advice or help
in deciding how to communicate with you appropriately.
 I will establish and maintain a relationship of functional trust with you
and every member of this team. My relationships with each of you will
be equally respectful, regardless of job titles, or level of educational
preparation.
 I will not engage in the “3 Bs” (Bickering, Back-biting, and Blaming). I
will practice the “3Cs” (Caring, Committing, and Collaborating) in my
relationship with you and ask you to do the same with me.
Commitment to Co-Workers (cont.)
 I will not complain about another team member and ask you
not to as well. If I hear you doing so, I will ask you to talk to that
person.
 I will accept you as you are today, forgiving past problems and
ask you to do the same with me.
 I will be committed to finding solutions to problems rather
than complaining about them or blaming someone for them
and ask you to do the same.
 I will affirm your contribution to the quality of our work.
 I will remember that neither of us is perfect and that human
errors are opportunities not for shame or guilt, but for
forgiveness and growth.
~Compiled by Marie Manthey, Relationship Based Care
Primary Nursing
 Our care delivery system is Primary Nursing.
 Ideally, the admitting nurse signs up to be the primary
nurse for that patient. They have the most accurate
information/history and are the first to establish a
relationship with the patient and family
 To sign up in Epic you right click on the patient’s name
and choose “Assign Me.”
 You should also put this on the assignment board and
the patient board. You should not be assigned to more
than 2 primary patients and 2 associate patients at a
time.
 Primary and Associate Nursing is the first thing taken
into account when making the assignment.
 A primary nurse should establish a relationship with
the patient and family, add pertinent info to the RN
sticky note on the kardex, and manage their care on a
consistent basis.
Patient Acuity
Level 2 Level 3 Level 4 Level 5
ADLS ADLS per ADLs/Alone ADLS frequent Same except
self/parent with Requiring staff (Q 1-2hrs) requiring 2 or
assistance (>3 to do routine Alone more staff
times/shift) care requiring due to size
PO/Bolus feeds Interventions
Routine VS Interventions Q Interventions Q 1 hr
4hrs Q 2-3 hours
PEWS 0-4 PEWS 0-4 PEWS 5 PEWS 6
# IV 1-2 IV meds 3-5 IV meds 6-8 IV meds 9 or more IV
Meds/ Continuous meds OR
12 hr Ex. Doubles IVFs in PIV Infusing
shift (Q1 hr check) IVIG, blood
products,
Ex. Triples Ampho,
Remicade,
etc.
Patient Acuity (cont.)
 Other factors that may affect the level:
 PO Meds: only if you have to make more than 7 trips in
12 hours to administer them and it is difficult to
administer PO
 Procedures: may temporarily raise the level during a
procedure or for multiple procedures, then would fall
back to base level once completed
 Education: For teaching lasting 30 min or more, raise
by one. Would fall back to base level once complete.
 Social Issues: Time consuming social issues/language
barriers may cause you to raise the level by one.
SBAR Report- Situation, Background,
Assessment and Recommendation
Codes at Children’s: What’s my role?
 Code Red
 Code Orange
 Code Yellow
 Code Green
 Code Blue
 Code Purple
 Code Pink
 Code Silver
 Code White
 Tornado
 Evacuation Plan
 Code RED = Fire
 Policy Number: 5.14
 Definition: A fire or smoke is suspected or detected. In the main hospitals, an announcement
is made by Security to alert all personnel of a fire or smoke emergency and the location. This
code initiates hospital and department fire plans.
 First Response Team: security, engineering, respiratory
 Role on 4 West (if fire alarm is on another floor):
 Remain calm
 Close but do not lock all windows and doors (close patient doors and open hallway curtains)
 Keep lights on
 Clear hallways of possible obstructions
 Keep phone lines open
 Staff away from their department should remain where they are unless directed to do otherwise
 Patients in locations away from their assigned patient care units should remain in those locations until the all clear is announced or
further directions are issued
 Responsibility for directing visitors in public waiting areas (i.e., lounges, waiting rooms, cafeterias, auditoriums) is assigned in
departmental fire plans
 What to do if you discover a fire on your area: remember RACE and PASS
 Rescue anyone in immediate danger
 Activate alarm at nearest fire alarm station and dial 56161 to report to security
 Contain smoke and fire by closing doors and windows
 Extinguish fire if possible using the nearest fire extinguisher
 Pull pin
 Aim hose
 Squeeze handle
 Sweep across base of flames
 Evacuate the area if the fire cannot be extinguished.
Code ORANGE = Decontamination
 Policy Number: 4.15
 Definition: To provide guidelines for the prompt and effective decontamination
(decon) of patients that may have been exposed to hazardous materials, in
order to minimize harm to the patients and to protect the staff and facility from
secondary contamination.
 First Response Team: Decon team leader, ED charge nurse, ED physician
 Role on 4 West: this code will be more than likely contained to the ED. The ED
has all of the decon equipment and showers needed. In the policy there are
talking points to help you if any patients or visitors have questions about a
decon situation.
 In addition to the above, it is everyone’s responsibility:
 Report possible hazardous material exposures to the ED Charge Nurse
 Avoid personal contamination (remain approx. 6 feet from patient), and prevent the potential
contamination of other personnel and the facility
 Direct potentially contaminated patients to move outside immediately
 Obtain as much information as possible about the exposure or incident
Code YELLOW = Bomb Threat
 Policy Number: 2.13
 Definition: initiated when a verbal or written threat is received, a suspicious
package is discovered, or a surrounding building is under the threat of a bomb.
 First Response Team: security, administrator on call, house supervisor, patient
representative, media relations, risk management, police.
 Role on 4 West:
 If someone calls in a bomb threat:
 The receiver of the call should utilize Attachment A, “Bomb Threat Checklist” as a guide
 Attempt to keep the caller on the line as long as possible (never put the caller on hold or hang up.)
 Ask the caller to repeat the message
 Write down the exact message
 Inform the caller that the building is a pediatric facility occupied by sick children and that unnecessary death and
injuries could occur
 After the caller has hung up:
 Remain calm. Report the call to the appropriate Security Department (56161)
 Notify the department manager or director
 If directed by security to conduct a search (refer to policy), the team leader will report findings back to
security.
 If you happen to find a suspicious package, do NOT touch it. Note the color, shape,
size, any wirings and location. Report to security at 56161.
Code GREEN = Mass Casualty
 Policy Number: 4.13
 Definition: To provide guidelines for the effective response to an event that
significantly disrupts the environment of care at Children’s Healthcare of
Atlanta.
 First Response Team: lead ED physician, ED charge nurse, house supervisor
and incident command team
 Role on 4 West: the teamleader will report to the Labor Pool and provide a list
of any available staff in house that could be used in the ED.
 If staff are needed to report to the ED for assignment, the Labor Pool coordinator will inform the
floor teamleader
 Unless needed by the Labor Pool, continue your current operations and patient care on 4 West
Code BLUE = Patient Arrest
 Policy Number: 20.55
 Definition: interdisciplinary team of trained individuals who are able to respond
promptly and efficiently to an impending, or actual, cardiac or respiratory arrest and
institute appropriate resuscitative measures. “Code Blue” is the term used to
activate the code team who responds to the specific situation. The Code Blue
Response Team is activated by activating the code blue button throughout clinical
areas or dialing 56161.
 First Response Team: patient’s nurse, PICU RN and RT, ED/PICU physician, ED RN,
pharmacy, house supervisor, chaplain, security
 Role on 4 West: if it is your patient that is breathless and/or pulseless and you call
the code blue, stay in the room with the patient. A Code Blue can be called for an
impending arrest when the skills of the Code Team are needed to appropriately
manage the patient to prevent an actual respiratory/cardiac arrest.
 If it is not your patient, you can help by:
 Bringing the code cart to the room
 Directing traffic in the hallways
 Answering call bells and needs of the other patients on the floor
 Being a “runner” to help get supplies as needed
 If a code is called in another GPC area, the TL typically will respond to that floor to help.
Code PURPLE = Disruptive Behavior
 Policy Number: pilot code at this time
 Definition: Facing continued high volumes of workplace violence incidents, a
multi-disciplinary team was formed to support the staff at the bedside with
resources to address challenging incidents with patients, families and visitors.
The guidelines have three levels of escalating severity, with noted triggers and
actions.
 First Response Team: security, house supervisor, social work, patient rep,
chaplain
 Role on 4 West: If you have a patient or family which is appearing to become
disruptive,
 Make the teamleader aware so they can provide increased rounding with the family
 Involve the patient rep or social work if needed
 Contact security to make frequent rounds on the floor
 Page Risk Management if threats of lawsuits are made
 Call a Code Purple if threats continue, if physical attacks seem eminent or
occur, or if staff feel threatened or unsafe.
Code PINK = Missing Patient
 Policy Number: 2.12
 Definition: In the event that a patient is missing (i.e., cannot be located on the
floor and no staff have been notified of where the patient went), security is
immediately notified, a search of the premises is performed, and a building
lock down is initiated.
 First Response Team: teamleader, house supervisor/incident commander,
security
 Role on 4 West: make sure you know where your patient is at all times. If they
are leaving the floor, they need to tell someone and sign the log at the secretary
desk. If you cannot find your patient:
 Notify security with a description immediately
 Conduct a thorough search of the unit
 Notify the house supervisor
 If a Code Pink is called, the patient’s nurse should report to the
Command Center to give a description of the patient. The unit
representatives will then search the hospital.
 Complete an ONS
Code SILVER = Shooter or Hostage
 Policy Number: 2.33
 Definition: to promote a coordinated response in situations where hostile person(s)
with weapon(s) are posing a threat to the staff, patients or visitors or has taken
hostages.
 First Response Team: security, local law enforcement
 Role on 4 West: The first employee to identify an active shooter situation should:
 Call 911 with the location of the incident and provide a description of the active shooter(s) and the type
of weapon, if known.
 Call the Security Services Department at 56161.
 Evacuate all persons from the affected area, if safe to do so.
 Upon hearing a “Code Silver” overhead page; employees shall “Shelter in Place”. DO NOT go to the
areas specified in the “Code Silver”.
 Department manager or department designee shall initiate the “Shelter in Place” procedures
 Shelter in place procedures include:
 Moving into a nearby room that can be locked; if not locked, employees will need to barricade the door with
furniture.
 Employees shall remain calm; confidently and calmly assure staff to stay within the secured area/department.
Clear people from the hallways.
 Close all blinds, turn out all lights, silence all phones, and remain quiet.
 Listen for additional overhead page announcements and follow procedures after the announcements are made.
 Wait for the “Code All Clear” overhead pages before resuming normal operations.
Code WHITE = Winter Weather
 Policy Number: 3.01
 Definition: steps Children’s will take to ensure continuity of operations and
quality of care during periods of winter weather, when hazardous driving
conditions may delay or prevent access to our facilities.
 First Response Team: Code White leadership team, department manager
 Role on 4 West:
 Employees are expected to report to work or make arrangements to have their shift covered.
 Employees who have been given the opportunity to remain at work and choose not to do so will
be assessed two occurrences if they fail to report for their next regularly scheduled shift while a
Code White is activated.
 Multi-day event and called to report early - Employees who have been called to report to work
prior to the onset of hazardous driving conditions and choose not to do so, will be assessed two
occurrences if they fail to report for their next regularly scheduled shift and two occurrences for
each subsequent uncovered shift while the Code White is activated.
 Employees who are asked by the Director/Designee to remain on the premises in case of need
receive the current federal minimum wage while remaining available (waiting) to work. Pay Code
# 43 Winter Weather Standby.
 Meal passes will be provided.
 It is a good idea to pack a bag with extra scrubs, hygiene items, medications, pillow, blankets,
snacks and an air mattress if you have one.
Tornado Plan - Hospital
 Policy Number: 4.11
 Definition: plan of action so that staff may respond to Tornado Watches and Warnings at the hospital campuses.
 Tornado Watch: Conditions are such that a tornado may develop.
 Tornado Warning: A tornado has been sighted or indicated by radar in the immediate area
 First Response Team: security, administrator on call
 Role on 4 West:
 Tornado Watch:
 Patients should return to their rooms.
 Personnel should complete the following:
 Prepare for possible loss of utilities and gather available flashlights (med room).
 Secure blankets and sheets for protection.
 Pull blinds and drapes.
 Stay clear of windows.
 Clear hallways for possible transportation of patients.
 Tornado Warning:
 Visitors
 Upon the activation of a Tornado Warning, all visitors in common areas should be relocated to the nearest safe area: Interior rooms or hallways, away from all
windows and exterior doors.
 The charge nurse or designee of each unit will check the patient waiting areas, lounges, sleep rooms, and elevator lobbies to advise visitors to go to the nearest
safe area, and parents to go to their child’s room. Security will clear the main lobby area upon activation of a Tornado Warning.
 Patients and Staff
 Staff and patients are moved to the closest, safest area away from exterior walls and windows. On in-patient floors, this is typically in the hallway outside of the
patients’ rooms.
o Should further evacuation be necessary, the Administrator or designee will advise the departments involved as to what further evacuation plan should be
implemented, (horizontal, vertical, or evacuation of the hospital).
 If a patient cannot be moved or warning time does not allow for relocation, the following should be done:
o Close all blinds, interior room curtains and doors.
o Move the patient as far from the windows as possible.
o Locate the patient where privacy curtains may be placed between the patients and the windows. Cover patient, especially the head and torso, with a
blanket or sheet.
o Any non-patient occupants of the room should sit on the floor away from the windows. Coats, jackets, pillows, covers, etc., can be used to protect the
body from flying glass and debris.
Evacuation Plan
 Policy Number: 4.14
 Definition: response to an emergency situation requiring partial or complete
evacuation of the facility.
 First Response Team: house supervisor, security, administrator on call
 Role on 4 West:
 Assist in evacuating patients from the unit.
 The teamleader will assign someone to keep a log of patients and their locations.
 Horizontal Evacuation:
 We will move patients down the hallway to 4 East.
 If assistance is needed moving patients, request help from the Command Center.
 Vertical Evacuation:
 Evacuate the most threatened people first
 Do not use the elevators. Follow lit EXIT signs to stairwells.
 Non-ambulatory patients will be loaded into designated transport equipment.
 Pre-assigned transport teams will evacuate personnel to designated areas.
Cross Training to TICU
 During your orientation, you will be cross training
to the TICU. This is our Technology Dependent
ICU. There are 9 private rooms with a nurse to
patient ratio of 1:3.
 You will receive a document titled “What the 4W
nurse needs to know about TICU” as well as some
detailed information on the type of equipment or
patients you might see in the TICU.
 Tamra Prieur, Clinical Educator, 404-785-0898
What you can do as a new hire:
1. Be proactive in learning and networking
2. Be open to new ways of thinking and acting
3. Be active in seeking information and getting
feedback
4. Be active in building relationships
Documents you will receive:

Orientation Packet Attachments

 Job Description  Weekly Orientation
 Mandatory Summary
Requirements for the  Orientation Milestones
Year  Admission Checklist
 Initial Competency  Discharge Reminders
Checklist and  Quality and
Guidelines Environmental Room
Checks
 Omnicell Scavenger Hunt
We look forward to seeing you soon…