ChildrensHospitalofPittsburghofUPMC

NursingStandardsofCare

ChildrensHospitalofPittsburghofUPMCexplicatestheethicalconductandpracticesofournurses
usingourP.R.I.D.E.values.ThenursesofChildrensHospitalofPittsburghprovidepatientandfamily
centeredcareandthereforeputPatientsandFamiliesFirst.Thecoreofpatientandfamilycentered
careistoguaranteeopportunityforinformationsharing,collaboration,qualitycare,patientsafety,and
empathyforthefundamentalhumanneedsduringhospitalization.

ItisourResponsibilitytovaluecorporateandindividualintegrity,dotherightthingandensurefiscal
accountability.AllnursesatChildrensHospitalareheldtostandardsthatareinaccordancewiththe
AmericanNurseAssociation(ANA)CodeofEthics.TheANAcodeofEthicsprovidesaprofessionalguide
tonursesofalldisciplinesanddegreesnationally.TheCodeofEthicsencompassesvaluesthatallnurses
shouldpracticewithgoodintent,confidentiality,andtocontinuetoseeknewknowledgetoimprove
oneselfandonespractice(ANACodeofEthic,2008,p.xi).

Thenursingdivision,asfrontlinecaregiversmustpracticeusingInnovationandinnovativeideas.The
nursesofChildrensHospitalareadaptabletochangeanddeveloppoliciesandplanofpatientcare
basedonevidencebasedbestpractice.

DignityandRespectistheguidingvitalityofourorganization.AllemployeesofChildrensHospitalof
Pittsburghareexpectedtoconducttheirinteractionswithotherswithdignityandrespect.TheUPMC
CenterforInclusionvaluescourteousandkindmanners,aculturethatembracesdifferences,
compassion,empathy,collaborativeculture,andacceptingtheideasandopinionsofothers(web
referencehttp://www.upmc.com/about/communitycommitment/inclusion/Pages/default.aspx).

Nursingisrecognizedasoneofthemostrespectedprofessions.ThenursesofChildrensHospitalof
PittsburghareheldtoastandardofExcellence.Thenursesstrivetoexceedpersonalbestsand
expectationswhilefurtheringdiversity.Aboveall,theChildrensHospitalofPittsburghnursepractices
withbenevolenceandanethicallysoundstandardofpractice.

StandardISafety

Thepatientcanexpectanenvironmentthatissafe,clean,andquiettoprovideoptimalhealing.
Thepatientsprivacywillberespected.

1. Orientthepatientandfamilytotheirsurroundingsthrougha2wayexchangeofinformation.
2. Eachpatientwillhaveanidentificationnameband.
3. Provideappropriateequipmentandsuppliesandensurepatientshavethemeanstocallfor
assistancewhenneeded.
4. ThepatientwillbeprotectedfrominfectionandcrosscontaminationaccordingtoInfection
ControlandHandHygienepolicies.
5. Asthepatientsconditionornursinginterventionswarrant,thebedwillbekeptinthelowest
positionwiththewheelslockedandthesiderailsintheuprightposition.
6. Childrenunderthreeyearsofagewillbeplacedinacriborhightopcrib.Childrenthreeyears
andoldermaybeadmittedtoaregularsizehospitalbed.
7. SafeSleepGuidelineswillbefollowedforallinfantslessthanoneyearofage.
8. PatientsidentifiedassuicideriskwillbeassignedaPatientCareSitter.

9. Eachpatientwillbeevaluatedforfallrisk.
10. Allergieswillbeassessedanddocumentedintheelectronicmedicalrecord.
11. Ifrestraintsarenecessaryforthepatientssafety,theywillbeappliedaccordingtohospital
policy.
12. Medicationswillbeadministeredusingthe5RightsofMedicationAdministrationandtwo
patientidentifiers(nameandbirthdate).
13. Safetymeasureswillbefollowedbyallpersonnelduringtransport.
a. Patientsundertheageof18years,withpermissiontoleavetheunitfornonmedical
reasons,mustbeaccompaniedbyaguardian/volunteer/staffmember.
b. Patientsmustsignoutwithtimeanddestinationwhenleavingtheunit
14. PatientsandfamilieswillbeeducatedonConditionHelpasameansofactivatingarapid
responseteamtoaddressmedicalconcerns.
15. AllPointofCaretestingproceduresandqualitycontrolmeasureswillbeconductedaccordingto
hospitalpolicy.
16. AllvisitorswillbescreenedthroughtheVisitorManagementSystemandwillconduct
themselvesaccordingtotheVisitorCodeofConduct.

StandardIINursingCare

Thepatientwillreceivenursingcarebasedontheprinciplesofpatientandfamilycenteredcareand
utilizinganassessmentofthepatientsandfamilysneedsbytheregisterednurse.

1. Patientswillbeadmittedtopatientcareareasaccordingtotheirphysicalandpsychosocial
needs,unitadmissioncriteria,andbedavailability.
2. Thepatientandfamilywillbeorientedtotheunitandmembersofthehealthcareteamupon
arrival.
a. Thenursingstaffwillquestiontheaccompanyingadultregardinglegalguardianshipof
thepatient,whoprovidescareathome,andanyculturalandspiritualneeds.
b. Eachpatientwillhaveanursingassessmenttoidentifyspecificcareneedsatthetimeof
admissiontotheunit,outpatientarea,priortoandfollowinganyinvasiveprocedure,
upontransfer,immediatelypriortodischarge,andasthepatientsconditionwarrants.
c. Thefrequencyofthepatientreassessmentwillbebasedonunitroutines,documented
patientacuity,diagnosis,andcaresetting.
d. Height(incentimeters)willbeobtainedonallpatientsuponadmissionandasordered
byaphysician.
e. Weight(inkilograms)willbeobtainedonallpatientsuponadmission,attimeoftransfer
fromanotherunit(unlesspatientconditionwarrantsotherwise),andaccordingtopolicy
andunitroutineswithaminimumofweekly.
f. Allinfantsaremeasuredsupine,onaflatsurface,usinganinfantometerandtwo
caregivertechnique.
g. OccipitalFrontalCircumference(OFC)willbemeasuredonallpatientslessthan36
monthsofageuponadmission,attimeoftransferfromanotherunit,andasorderedby
aphysician.
3. Treatments,medications,andIVsorderedbythephysicianwillbeinstitutedaccordingto
nursingpoliciesandprocedures.
4. Vitalsignswillbecompletedasperunitroutine,physicianorder,oraspatientcondition
warrantswithaminimumofevery8hours.

5. Thepatientwillhavetheirneedsforpersonalhygienemetappropriatetotheircondition.
a. Patientswillbebathed/showeredaccordingtounitspecificguidelinesandata
minimumofeveryotherday.
b. Patientswillbereminded/assistedwithoralcareataminimumoftwiceaday.
c. Patientsscheduledforsurgerywillbebathedwithin12hourspriortosurgery.
6. Activitiesofdailylivingwillincludepromotionofnormalgrowthanddevelopment,socialization
andplay.
7. Identifiedpatientneedsandsubsequentnursinginterventionswillbeevaluatedand
documentedinthePatientPlanofCare,basedontheprinciplesofpatientandfamilycentered
care.
a. Patientswillreceivecommunicationfromnursingstaffbasedupontheirlevelof
development
i.
Speakwithchildrenateyelevel
ii. Speakdirectlytothechildoradolescent
iii. Behonest
iv. Givechild/adolescentchoiceswhenappropriate
b. Thechildandfamilywillparticipateinthedevelopmentofapersonalplanofcarethat
includesdescriptionsoftheirnormalroutinesandtheirpreferencesandconcerns
includinganyethnicorculturalneeds.
c. NursingwillinvolveChildLife,MusicTherapy,SocialServices,andothersupportstaffas
needed.

StandardIIIPlanofCare

Thepatientandtheirfamilywillhavetheopportunitytoplayaroleindevelopingandimplementinga
patientspecificplanofcare.

1. Onadmissionaplanofcarewillbedevelopedusingtheadmissionhistoryinformation.The
familyshouldbeinvolvedinprovidingpatienthistory.Thenursewillusetheinformationto
constructandapplyanappropriateplanofcaretoensurepatientsafetyandreachdischarge
goals.
2. Otherdisciplineswillcollaborateinformingpatientgoalsasneeded.
3. Onashifttoshift/dailybasis,theplanofcarewillbeupdatedtoreflectchangesandpatient
progress.
4. Theplanofcarewillworktowardsacommongoalofasafe/comfortabledischarge.Theplanof
carewillberesolvedattimeofdischargeorappropriateeducationwillbeprovidedto
family/caregiverstocontinuesafecareathomeandtooptimizepatientshealth.

StandardIVEducation

Thepatientsandfamilieswillbeprovidedthenecessaryeducationtoenhancetheirknowledge,skills,
andaffordthemwiththeempowermenttomaintainwellnessgoalsintheirhome.

1. TheadmittingRNwillprovideeducationtothepatientandfamilyastotheirunitsurroundings,
confidentialitycode,MooseontheLoosemenuandorderingprocess,telephonenumbersand
television/ondemandservices.

2. Parentsandfamilieswillbeeducatedonageappropriatesafetyconcernsincludingbutnot
limitedtosafesleepenvironment,fallandinjuryprevention,medicationsafety,anddiagnosis
specificeducation.
3. Medicationreconciliationwillbecompletedforeachpatient.Theprocessformedication
reconciliationwillinclude:
a. Medicationsreviewedwithpatientandfamilyonadmission
b. Newmedicationverifiedandorderedduringhospitalization.
c. Newmedicationeducationprovidedtopatientsandfamiliesregardingdosing,
frequency,reasonformedicationandpotentialsideeffects.
d. Ondischarge,medicationeducationshouldoccurwitheachresponsiblefamilymember
toensuresafeadministrationinthehome.
e. Thepatientshouldnotbedischargedwithoutcompletemedicationreconciliation.
f. LogicareandLodgnetwillbeusedtoprovidestandardizededucationinformation.
4. Patientandfamilyteachingwillbeconductedatadevelopmentallyappropriateleveland
environmentconducivetolearning.Patientsandfamiliesshouldprovideaverbalunderstanding
oftheteachingandwhenappropriateprovideareturndemonstration.
5. WrittendischargeinstructionsshouldbeproducedthroughLogicareandreadtofamiliesbythe
dischargingnurse.Parentsandguardiansareaskedtosigntovalidatethattheyreceived
dischargeeducationandunderstoodtheteaching.
6. NurseswilldocumentteachingusingtheDailyAssessmentofLearningandDischargeform.
StandardVPatientandFamilyCenteredCommunication

Thepatientandtheirfamilywillhavetheinformationtheyneedtoparticipateandcollaboratewith
thehealthcareteaminawaythatismeaningfulforthem.

1. AdmissioneducationprovidedbytheadmittingRNtoinformthepatientandfamilyof
hospitalpoliciesandservicesoutlinedintheHandbookforFamiliesandtheunitspecific
Logicare.
2. UseofthebedsideWhiteBoardtointroduceandtrackcaregiversandmedical/ancillary
teammembers.
3. UseofthebedsideWhiteBoardtodocumentmedicalmilestones,progress,questionsand
dischargecriteria.
4. ParticipationinNursingBedsideShiftReport
5. ParticipationinFamilyCenteredRounds
6. Accesstoappropriateresourceswillbeofferedtofacilitatecommunication.These
resourcesincludelanguagetranslationeitherinpersonorCyracombluephones,deaftalk,
Brailleitems,pictureboardsandwritteninformationbasedonpatientandfamilyneeds.
StandardVIHandoff
Nursinghandoffoccursanytimeapatientistransferredfromonelicensedcareprovidertoanother.

1. ChildrensHospitalofPittsburghmaintainsthreeMuststoensureasafeandaccurate
handoff:
a. Mustbeaverbalconversation
b. MustbeuniversalEveryprofessionalatChildrensHospitalperformsCHPCares
handoff
c. Mustnotbesubstituted.
2. CHPCaresStandardizedHandoffwillprovideinformationregarding
CWhoistheChild?

HHistoryofChild,patient

PPlan

CaresWhatdoI(thehandoffgiver)carethatyouneedtoknow,andwhatdoyou(the
handoffreceiver)carethatyouneedtoknow.
3. Nursingbedsideshiftreportwilloccurinthepatientsroomatthebedside.

StandardVIISatisfaction

Thepatient,parent,orguardianwillreceivetheopportunitytoprovidefeedbackontheirperceptions
ofthecareprovidedduringtheirpatientcareexperience.

1. Allstaffwillintroducethemselvestothepatient/family,identifyingtheirroleandpurpose.
2. Thenursingstaffwillencourageinputfromthepatient/familyregardingtheircareandhome
routines.
3. Thenursewillserveasthepatientsadvocateorcontactthepatientrepresentativeasneeded.
4. Nursingleadershipwillbeavailabletothepatientandfamilytoenhancepatientsatisfaction.
5. Therewillbeanattempttocontactthepatientand/orfamilyafterdischargeforaroutinefollow
upphonecallorquestionnaire.
StandardVIIIComfort/PainManagement

Thepatientspainwillbeassessedbyobtainingapainhistoryuponadmission,addressingpain
throughoutthepatientsstay,andintegratingpainmanagementaspartofthedischargeplanning
process.

1. Allpatientswillbeprovidedwithanenvironmentconducivetorest/recovery.
a. Provisionswillbemadeforthecomfortoftheparent/guardianbyprovidingsleeping
accommodationstoencouragepatientandfamilysupport.
2. Thepatientscomfortlevelwillbeassessedandinterventions/painmanagementwillbe
providedtomeetpatientsneeds.Painassessmentwillbeindividualizedtothepatient;
developmentallyappropriatepainassessmentscaleswillbeused.
a. CRIES,FLACC,WongBakerFACESPainRatingScale,andnumericvisualanalog(110)
scalearetoolsusedforpainassessmentinchildren.

b. Inadditiontoselfreportorintheabsenceofselfreportofpain,otherpainassessment
criteriawillinclude:
i. Physiologicparameters
ii. Parentalreport/opinions
iii. Behavioralmanifestations
iv. Culturalbeliefs
v. Environmentalfactors
vi. Pastexperiences(painhistory)
c. Healthcareprofessionalswillworkwithfamiliesinacollaborativemannerinthe
continualassessmentofcomfortmeasures/painmanagementofchildren.
d. Ageappropriatenonpharmacologicadjunctivetherapieswillbeencouragedas
appropriate,includingdistraction,music,art,deepbreathing,warm/coldpacks,etc.
e. Painisconsideredthefifthvitalsignandwillbeassessedasfrequentlyasorderedvital
signsoraminimumofevery8hours.
f. Anactivepainissuewillbereassessedwithinonehourfollowinganintervention.
StandardIXPatientRights/InformedCare

Thepatient/familywillbeprovidedtheinformationnecessarytoparticipateindecisionsabouttheir
nursingcare.

1. Fullinformationwillbedisclosedinawaythatiseasytounderstandtothepatientandfamily,
concerningdiagnosis,treatment,andprognosisincludingalternativetreatmentsandpossible
complications.
2. Developmentandimplementationoftheinpatientoroutpatientplanofcare/treatmentand
dischargewillbesharedwiththepatientandfamily.
3. Thepatientwillbeprovidednecessarymedicalcarecompletedinatimelymannerandwith
effectivepainmanagementtechniquestocauseaslittlediscomfortaspossible.
4. Thenameandprofessionalstatusofthosephysicians,nurses,andstaffmemberstakingcareof
thepatient,andtheprimaryphysicianresponsibleforthepatientscarewillbesharedwiththe
patientandfamily.
5. Consentforprocedureandpatient/familyunderstandingwillbeverifiedpriortoanyprocedure.
Ifthepatientandfamilyrequirefurtherexplanationthenappropriateresourceswillbeutilized.
6. Asanadultpatient,oremancipatedminor,conveyinadvance(advancedirective)theirwishes
regardingextraordinarytreatment,orthepersontheywouldliketomakedecisionsforthem
shouldtheybecomeunabletospeakforthemselves.
7. Thepatientandfamilywillbeinformedoftheirrighttorefusedrugsorprocedures,andthe
consequencesofrefusal.
8. Thepatientandfamilywillbeinformedoftheirrighttorequestandobtainanethics
consultationwheneverthereisaperceivedethicalquestion,issue,problem,orconflictrelated
topatientcare.
StandardXConfidentiality


Thepatientcanexpectthatconfidentialityofinformationregardingtheircarewillbemaintained.

1. Respectforprivacywillbemaintainedtothefullestextentpossibleconsistentwiththecare
provided.
2. Onlyauthorizedpersonnelcaringforthepatientwillhaveaccesstothemedicalrecord.
3. Compliancebyhospitalstaffwithallstateandfederallawsandregulationsconcerningtheuse
anddisclosureofprotectedhealthinformationandaccesstodisclosuresofhealthinformation
madebythehospital.
4. Consentwillbeobtainedtotakeoruseanyphotographs,video,oranyothertypeofimagethat
couldidentifythepatientfornontreatmentpurposesincludingtherighttorescindconsentand
requestcessationoftheproductionofrecordings,films,orotherimagesbeforeuse.
StandardXICultural/SpiritualValues

Thepatientwillreceiveconsiderateandrespectfulcarethatisconsistentwiththeirculturaland
spiritualvalues.

1. Patientsculturalandspiritualbeliefswillbeconsideredwhenplanningandimplementingcare.
2. Patientandfamilyinteractionswillbeconductedinacaring,courteous,professional,and
empatheticmanner.
3. PastoralCareandotherresourceswillbeofferedtomaximizepatient/familysupportasneeds
areidentified.