Unit Clerk, REQ #20701, PD, Varied Schedule
Provides indirect patient care in the medical surgical setting. Meets the communication needs of the patient/family, departmental staff and medical staff. Prepares and compiles records in the Medical Surgical Unit. Initiates directions from physician and nursing staff. Participates in performance improvement activities. Maintains regulatory agency requirements, nursing and hospital policies and procedures and standards.
Performs other duties as assigned or requested including observational sitter responsibilities.
Manages and operates equipment safely and correctly.
Demonstrates awareness of cultural factors: religion, food preferences, family/community relationships, healthcare understanding, attitudes and practices.
When indicated, interacts in a manner that is appropriate to the age and condition of the patient and optimizes patient safety.
For Department Secretaries:
Assists with departmental payroll activities.
Assists with departmental staffing and scheduling.
Participates in data collection for departmental QI activities.
For unit clerks on ABU and CBM:
Attends annual CPI training.
Demonstrates competency in CPI techniques.
Enters and verifies physician orders into the computer system; then transcribes orders as per unit standard with RN confirmation.
Orders routine supplies weekly; obtains special orders as required.
Logs all patients into the appropriate log book and/or the computer upon admission, transfer, discharge or expiration.
Retrieves all lab results from computer and files in patient record.
Documents and records all vital signs in the graphic section of the patient record.
Communicates appropriately and clearly to the charge nurse, co-workers, physicians, patients/families and other departments to assist in providing an interdisciplinary approach to meeting the patient's needs.
Interacts professionally. Treats patients and families with respect and dignity. Answers telephone/intercom in a polite manner and communicates information to the appropriate personnel. Maintains a good working relationship both within the department and with other departments.
Demonstrates an ability to be flexible, organized and function under stressful situations.
Prepares the medical record for new admissions. Disassembles and organizes the record for discharged patients as per Department of Health Information Management requirements. Updates and maintains all medical records on the unit with current forms, diagnostic reports and demographic data.
Transcribes patient information onto the Kardex and updates with all new orders.
High school graduate or equivalent.
Ability to read and communicate effectively in English.
Basic computer knowledge. Knowledge of medical terminology.