For all clinical staff who are responsible for administration of medication. How to avoid medication errors… the 6 rights and link to associated policy.
Intrauterine Pressure Catheter and Amnioinfusion
Access the module for IUPC and amnioinfusion.
Intraosseous Insertion and Maintenance
Required every 2 years; competency includes self-learning package and quiz (80% required). ACLS and/or neonatal resuscitation program; if you perform intraosseous insertions using training equipment while being monitored by a trainer following the skill checklist (must be completed, signed and stored in personnel file and entered in QHR).
You are responsible to seek out additional educational opportunities, refer to Elsevier Clinical Skills to maintain competency. You should only perform a skill if and when you feel knowledgeable, safe and capable.
Intraosseous Insertion and Maintenance Self-learning-Competency Package
Induction of Labour
Access the module for induction/augmentation of labour with Oxytocin. Practice quiz below.
Quiz
- If the FHR has been normal upon auscultation, you only need to apply the EFM at the time you begin the oxytocin induction. True or False
Answer
True
- ) It may take ____ to ____ minutes to see a response once the oxytocin is adjusted down or off due to tachysystole (half life of oxytocin).
Answer
6 to 8
- ) A Bishop score of 7 is adequate to start an oxytocin induction. True or False
Answer
False
- Many of the medications given in labour are compatible with oxytocin. A port line may be used as long as long as the line is clearly marked as oxytocin. True or False
Answer
False
- The PCP leaves an order to start the oxytocin as per protocol. You mix 30 units Syntocinon in 500 mLs N/S. The patient is a grandmultip. The infusion should be started at ____ mU/min, which equals _____ mLs/hr. You will adjust the rate by _____ mU/min (= to _____ mLs/hr) every _____minutes until the contractions are adequate.
Answer
The PCP leaves an order to start the oxytocin as per protocol. You mix 30 units Syntocinon in 500 mLs N/S. The patient is a grandmultip. The infusion should be started at .3 mU/min, which equals .3 mLs/hr. You will adjust the rate by 1 mU/min (= to 1 mLs/hr) every 30 minutes until the contractions are adequate.
- Before starting the infusion, what risks should the PCP discuss with the patient?
Answer
Failed induction resulting in C/S, chance of operative vaginal delivery, tachysystole, with and without
FHR changes, chorioamnionitis, prolapsed cord with ARM, preterm infant being delivered if dates are
off, uterine rupture & water intoxication.
- The labour floor is really busy and you cannot find a nurse to do your independent double nurse check when mixing the syntocinon. You feel it is OK to mix and infuse the medication as the drug monograph states a double check is only required when possible. True or False
Answer
False
- It takes _______ to _____ minutes to achieve a uterine steady state with oxytocin.
Answer
30 to 40
- A patient had her cervidil removed at 1200. It is now 1220 and the PCP wants the oxytocin initiated. What is the period of time that must lapse between cervidil removal and initiation of the infusion?
Answer
30 minutes
- A patient is having contractions every 2-3 minutes, lasting 20 seconds, palpating mild. Do you increase the oxytocin? Why or why not?
Answer
As they contractions are only lasting 20 seconds, the rate may be turned up (ineffective contractions) as
long as the FHR is normal and there is adequate resting tone between contractions. However, it is also
OK to wait to see if the contractions lengthen and if not, turn the rate up at the next 30 minute mark.
- Written consent by the patient is required to initiate an induction. True or False
Answer
True
- During an induction/augmentation, BP must be monitored every _____ and pulse every _____.
Answer
During an induction/augmentation, BP must be monitored every hour and pulse ever 15 minutes.
- An accurate I&O is not necessary until the patient has been on oxytocin for greater than 24 hours as this is when water intoxication may occur. True or False
Answer
False
- After initiating an oxytocin infusion, the patient is able to ambulate once…
Answer
…. the rate of infusion has been constant for 1 hour and the FHR is normal
- A patient is on 20 mu/min of oxytocin, with contractions every 2-3 minutes, lasting 60 seconds, palpating moderate. SROM occurs. Should the oxytocin be turned down? Why or why not?
Answer
Consideration should be given to decreasing the rate of infusion as the patient has adequate
contractions. A ROM generally will cause an increase in contractions. If the patient does not have
adequate contractions, the rate may be left as is. Monitor the contractions carefully to ensure
tachysystole does not occur.
- When the patient is ambulating in the halls, you can document on the labour record that she is ambulating as a reason why the FHR/Contraction pattern was not checked. True or False
Answer
False
- The most common sign of a uterine rupture is ____________, followed by….
Answer
The most common sign of a uterine rupture is Abnormal FHR, followed by… Abnormal uterine pain, vaginal bleeding or hematuria, elevated presentation of fetal presentation upon PV, easier abdominal palpation of fetal part.
- What important safety feature should you inform your patient about regarding the oxytocin infusion on the pump?
Answer
That the oxytocin line should never be disconnected from the pump before being disconnected from her, unless she has already delivered her baby.
Immunization & Anaphylaxis
Access the self-learning modules for immunization providers and anaphylaxis.
** Developed for the primary purpose of supporting staff working in the community setting; however, relevance for review of this package in Acute Care and PCH settings, as long as the learner recognizes that additional facility-based anaphylaxis protocols more suited to those settings may also exist and should be followed where appropriate.
Manitoba Health Seasonal Influenza, Pneumococcal and COVID-19
Manitoba Health School-based Immunization Program Training Module
Immunization Provider Self-learning package
Anaphylaxis Management Post Immunization Self learning Package
- New content and practice changes included
- Anaphylaxis Overview
Demonstration and Competency Checklist
- Located in the Immunization Provider Module
- If you are new to immunization connect with your local PHN, Educator (or designate within your facility/program) to arrange an orientation and supervised immunization experience which will be based on the information in this module. The Critical Elements Checklist for Immunizations (found at the end module) is to be completed by the PHN Lead/Educator/Site Designate.
- Upon satisfactory completion of the Critical Elements Checklist, you and the PHN/Educator/Program Designate both need to sign the Acknowledgment of Competency located on the second page of the Critical Elements Checklist. The PHN/Educator/Program Designate
- Designate will forward the completed form to the applicable Manager.
- The Manager/Educator/Program Designate should submit the list of staff competency completions to
Home Oxygen Concentrator Program
10 min video on eligibility and information for referrals.
Orientation | Home Care
10 min video on the process of discharge from the hospital to community with home care services.
Harm Reduction
Access the self-learning module on harm reduction supply distribution. Practice quiz below
Practice Quiz:
- Harm reduction is a pragmatic response that focuses on keeping people safe by minimizing death, preventing disease and injury associated with higher risk behavior, while recognizing that the behavior may continue despite the risks. True or False?
Answer
True
- Safer sex practices, safer drug use practices and other harm reduction tools are the most effective methods of preventing STBBI transmission. ? is not an achievable goal (or desired one) for most people and therefore, ? tools are the best strategy.
Answer
Abstinence
harm reduction
- Safer sex practices includes which of the following?
a. using latex or polyurethane condoms and sex dams
b. using gloves for all sex involving hands or fingers
c. lubrication should be used to prevent damage to mucous membranes
d. All of the above
Answer
d. All of the above
- When should someone have STBBI screening completed?
a. every 6-12 months
b. after every risky encounter
c. more regularly when engaged in ongoing risk such as injection drug use
d. All of the above
Answer
d. All of the above
- A “window period” is described as?
Answer
The time between exposure to an infection, and when a test is able to detect the infection. The length of a window period can vary depending on the infection.
- All drug use supplies can transmit HIV and Hep C infections if shared with an HIV-positive or Hep C-positive person. Drug use supplies that can transmit infections include:
a. needles/syringes,
b. water, filters,
c. cookers/spoons,
d. snorters/pipes and barrels
e. All of the above
Answer
e. All of the above
- For clients who choose to smoke or snort their drugs: what should you recommended clients do to their pipes or tubing?
a. clean pipes or tubing with alcohol swabs between each use
b. never share pipes or tubes
c. All of the above
Answer
c. All of the above
- Arrange in order of least risk to most risk
a. huffing
b. smoking
c. sharing supplies
d. snorting
e. no use
f. injecting
g. swallowing
Answer
a. no use
b. swallowing
c. huffing
d. smoking
e. snorting
f. injecting
g. sharing supplies
- What are signs of an overdose from stimulants?
a. fast heart rate, fever, blue lips, pale skin
b. foaming at the mouth, vomiting, seizures, twitching or body shakes
c. chest pains, going unconscious
d. All of the above
Answer
d. All of the above
- What are signs of an overdose from depressants?
a. breathing slows or stops (less than 18/min), heart rate slows or stops
b. seizures, twitching or body shakes, vomiting, blue lips or skin, low body temperature
c. confused or very hard to rouse, going unconscious or sleeping deeply/snoring and can’t be woken
d. All of the above
Answer
d. All of the above
- ________________ ? is a drug that can be administered when a person has overdosed on an opiate to prevent death. Clients given ________________ ? should be monitored for 30-60 minutes, as once the ________________ ? wears off, they may experience overdose again.
Answer
Naxolone
- Good vein care includes:
a. using a tourniquet to ensure that needle goes into a viable vein.
b. rotating injection sites to minimize scarring and infection.
c. saving a vein for medical care
d. use of ascorbic acid for better vein health when using heroin and crack
e. All of the above
Answer
e. All of the above
- If the client is using a new dealer, after detox, or if talk of “bad” drugs on the street, it is important to education the client to inject a smaller than normal dose of the drug prior to injecting a full dose. This is called:
a. flavour
b. bite
c. taste
d. All of above
Answer
c. taste
- Health care providers, such as _______________ ?, can provide referrals and/or linkages to agencies that can assist and provide support with behaviour changes i.e. AFM, mental health services.
Answer
public health nurses
- Can you think of other agencies that can assist and provide support?
Formalin Spill Training
All staff that handle, use or ship Formalin should complete this training. Enter your personal information at the end of thee training before submitting to ensure accurate record keeping.
Access the training presentation
Fire Safety | Community Staff
Fire Safety Quiz
Carefully read each question and match or circle the letter of the correct answer.
- What does the letter “C” in the acronym RACE stand for?
a. Consider leaving the area
b. Confine – close all windows and doors to the room/ area where the fire is located
c. Chemical – check for chemicals in the area that might burn
d. Control – extinguish the fire with a fire extinguisher if it is safe to do so
Answer
b. Confine – close all windows and doors to the room/ area where the fire is located
- When you use a fire extinguisher, use a sweeping motion to:
a. Keep the fire extinguisher power flowing
b. Block the travel of smoke
c. We never use a sweeping motion
d. Completely cover the entire base of the fire
Answer
d. Completely cover the entire base of the fire
- Common causes of fires in offices, clinics, and client homes include:
a. Cooking – if food is left unattended while cooking
b. Arson
c. Improper storage and materials handling
d. All of the above
Answer
d. All of the above
- What is the acronym to remember when you use a fire extinguisher?
a. PASS
b. RACE
c. PULL
d. REACT
Answer
a. PASS
- How do chemical reactions start a fire?
a. Chemical reactions cannot start a fire
b. Chemical substances self-ignite resulting in fire
c. Chemical substances can react and produce heat and start a fire
Answer
c. Chemical substances can react and produce heat and start a fire
- What are symptoms of carbon monoxide poisoning?
a. Headache, dizziness
b. Flu like symptoms, nausea/ vomiting
c. Confusion/ tiredness
d. All of the above
Answer
d. All of the above
- Which three things are needed to create a fire? (circle all that apply)
a. Heat
b. Electrical wire
c. Fuel
d. Oxygen
e. Carbon monoxide
Answer
a, c & d
- What should you do if a carbon monoxide detector is going off and someone is experiencing poisoning symptoms?
a. Evacuate and call 911
b. Turn the alarm off
c. Open all the windows and doors and turn off all fuel burning appliances
d. Nothing because they must have a cold
Answer
a. Evacuate and call 911
- What acronym should you remember and follow when you discover a fire?
a. REACT
b. RACE
c. PASS
d. RUN
Answer
b. RACE
- Which of the following are reasons why you should not try to fight a fire?
a. If you do not have the correct type of fire extinguisher
b. If your instincts tell you not to
c. If there is a risk of inhaling toxic smoke
d. All of the above
Answer
d. All of the above
- What should you do after the fire is extinguished? Choose the best answer.
a. Throw the used fire extinguisher on fire
b. Back away and keep watch for fire rekindling
c. Turn around and carefully exit
d. Turn on fans to clear the smoke
Answer
b. Back away and keep watch for fire rekindling
- What actions would you consider to be the best choice for reduction of arson potential?
a. Minimize clutter and surplus material
b. Screen visitors for matches and lighters
c. Check your fire extinguisher regularly
d. Lock every door and keep public spaces free of clutter
Answer
d. Lock every door and keep public spaces free of clutter