Clinical care standards support a consistent approach to how care is provided across the health authority.

Clinical care standards

Clinical care standards are posted on FH Pulse (our intranet) and can only be accessed through the Fraser Health network with your Windows user account. 

Even if your student experience doesn’t require you to know the standards of care for your individual experience, it will be helpful to understand what others may be referring to.

48/6 model of care (for nursing students)

The 48/6 refers to a model of care in the acute care setting that provides an integrated approach to screen and assess every admitted adult patient in six areas of care:

  • Nutrition and hydration
  • Cognitive function
  • Medication management
  • Pain
  • Mobility
  • Bowel/bladder function

Based on the assessment, all members of the health care team will then develop and implement a personalized, documented care plan within 48 hours of the decision to admit.

This model offers a consistent, standardized, holistic approach to care with a specific focus on pre-hospital function, specific clinical documentation, and core tools for improved communication and measurement.

Benefits of 48/6

This model was developed to address issues and concerns early and improve patient outcomes.

Evidence suggests that implementation of the 48/6 model of care would contribute to:

  • Improved management of pain
  • Increased detection of and treatment of delirium
  • Prevented adverse medication related events
  • Decreased length of stay and hospital acquired urinary tract infection rates
  • Timely and appropriate referral for diagnostic and treatment recommendations
  • Timely information flow between clinical programs/patient care areas

Tools

Student and instructors/faculty in Fraser Health practice settings will need to use the following three standardized documentation tools during their clinical placement to reduce variation and redundancy in care, and facilitate interprofessional collaboration.

Standardized 48/6 Tool 
(see toolkit for examples) 

Timing 

Purpose 

Pre-admission Screening Questionnaire "Before you came to the hospital..."

After the screening tool, and ideally in the first 24 hours

To assess areas of concern/risk identified in the screening tool

48/6 core tools assessment algorithm

After the screening tool, and ideally in the first 24 hours

To assess areas of concern/risk identified in the screening tool

Interprofessional care and discharge plan

48 hours of admission to acute care

To document and communicate:

  1. Interventions/ actions required to address areas of concern/risk after screening and assessment are completed.
  2. Discharge needs and goals.

A toolkit is available on FH Pulse (must be logged into a Fraser Health network). It includes a tool for health care providers to assess skills, knowledge and ability to apply the core 48/6 assessment tools. Also included are sample interprofessional care and discharge plans.

Glucose meter (for nursing and lab technician students)

All nursing and laboratory students and instructors are required to complete the glucose meter training.

  1. Complete the online Accu-chek® Inform II Glucose Meter/Glucometer module on Learning Hub including the quiz.
  2. Complete the Accu-Chek® Inform II Glucose Meter - Training Checklist
  3. Read the Skills - Blood Glucose Meter – Accu-chek® Inform II procedure.
  4. Maintain records of all completed glucose meter training orientation/annual renewal (Certificate of Completion and Training Checklist).
  5. A generic operator ID to students and faculty/instructors will provided to students and instructors once training is complete.  The ID is not for wide circulation; it is only for use by students and faculty/instructors practicing in Fraser Health. The ID is changed every year on April 1 to make sure annual competency is achieved. 

Note: Fraser Health staff will not be able to provide glucose meter training for students.

Hourly nursing rounds (for nursing students)

All nursing students practicing within Fraser Health acute care will be required to follow the care standard to visualize their patient each hour following the Intentional hourly nursing rounding clinical protocol (must be logged into a Fraser Health network). Documentation of this practice is within the nursing patient flow sheet. 

Intentional hourly nursing rounding utilizes a standardized approach to assessment and management of the following four key areas every hour, 24 hours a day. 

Pain

Peri-needs

  • Verbal assessment: e.g. “Do you need to use the toilet?”
  • Non-verbal assessment: observe non-verbal cues (e.g. agitation, restlessness), assist to the toilet.
  • Care dependent patients: change incontinence briefs/pads and provide peri-care as needed.

Positioning

  • Assess need to turn, reposition, and/or mobilize.
  • Assess skin condition and provide skin care as needed.  

Possessions

  • Are the call bell, mobility aid, and personal items within reach?
  • Provide fluids as indicated (note: NPO or fluid restriction status).
  • Ask “Do you need anything before I go?”

Prior to leaving the patient room, the nurse also asks “Is there anything else you need before I leave the room?”