Copy - MA Students Cohort 14 Skills Day

Medical Assistant Students - Cohort 14 Skills Day

October 1, 2025

Where have you been currently working?

Tell us about you!

Why you want to become an MA at VUMC?

Orientation Etiquette

Actively Participate

Please put cell phones away and on silent

The Ambulatory setting

VUMC Vanderbilt University Medical Center

Vanderbilt Stallworth Rehabilitation Hospital (VSRH)

Who Are We?

Vanderbilt University Hospital (VUH)

Vanderbilt Wilson County Hospital

Monroe Carell Jr. Children's Hospital at Vanderbilt (Monroe Carell)

Vanderbilt Bedford Hospital

Vanderbilt Adult Ambulatory Division

Vanderbilt Psychiatric Hospital (VPH)

Vanderbilt Tullahoma-Harton Hospital

Old name: Vanderbilt Medical Group (VMG)

The Ambulatory Setting

Future site in Brentwood!

Over 400 Clinics and Growing!

CLINICS: Throughout Nashville and Middle Tennessee, as well as in Alabama, Kentucky, and other states. VISITS: 3.2 million clinic appointments occurred last year!

Vanderbilt Adult Ambulatory Operations

SPECIALTIES:

• Heart and Vascular Institute
• Lung Institute
• Ingram Cancer Center
• Primary Care Clinics
• Neurosciences
• Orthopaedics
• Dermatology
• Digestive Diseases
• Center for Women's Health

• Interventional Pain
• Weight Loss
• Surgical Specialties
• Eye Institute
• Eskind Diabetes
• Transplant
• and MORE!

Professionalism and ma student requirements

Objectives

• Understand expectations in Attendance and Punctuality Policy
• Understand professional attire for clinic setting
• Understand proper use of cell phones in clinic setting
• Demonstrate CREDO behavior
• Demonstrate correct usage of AIDET
• Demonstrate SBAR reporting
• Understand requirements of Student Clinical weeks

Professionalism

Attendance and Punctuality

• Regular and timely attendance is an expectation for all.

• Follow departmental notification procedures if you will be late, ill, or absent for any reason.

• VUMC follows a progressive disciplinary process.
• An occurence acrues for each absence.

• If absence lasts consecutive days = one occurence

Attendance and Punctuality

Absent, Ill or Late:

• Call Tiffany AA in Staffing Operations
• Janice Gabbard, Director
• Amanda Houser, Asst Nurse Mgr
• Carrie Greene, Asst Nurse Mgr
• 615-936-0199
• floatvmgadmin@vumc.org

• If you have been hired to a clinic, follow that clinic specific call in procedure

Clocking In and Out

YOU PUNCH IN AND OUT 4 TIMES EVERY DAY

• Punching in at start of day
• You cannot punch in earlier than 7 minutes before your scheduled start time
• For 0800 start time, punch in between 0753-0800
• Punch out for lunch
• 30 minute lunch time
• Punch in after meal
• Punch out at end of day

YOU MAY NOT PUNCH IN or OUT ON YOUR PHONE!!!!!

Clocking In and Out

Clocking In and Out

CC03470

4000 - ISV

Keeping in Touch

Check your email at least daily! Your VUMC email is the only way to stay connected and receive important information.

Dress and Appearance

• Professional attire (scrubs)

• Clean / not wrinkled / fit appropriately

• No offensive writing / pictures
• Plain or Vanderbilt logo

• Shoes closed toe

• No slippers, sandals or flip flops

• Clean hair, beard, moustache

• Pulled back / off face

• Finger nails - VUMC policy: IP 10-10.07 (Hand hygiene Policy IV. B.)

• Anyone with direct patient care: Artificial nails prohibited
• Artificial nails include: acrylic nails, all overlays, tips, bondings, extensions, tapes, inlays, and wraps.

Cell Phone Usage

• Cell phones are NOT to be used in patient care areas.
• No texting
• No picture taking
• No TikTok
• No streaming

• Personal cell phone use can be disrespectful, and can be perceived by patient as a HIPPA violation.

• If you need to take a phone call, let your coworkers know and step out of the clinical area.

HR VIOLATION TO CLOCK IN/OUT ON YOUR CELL PHONE!

CREDO Behavior

• Framework for how VUMC employees treat our patients, visitors, and each other.

• CREDO behavior is an EXPECTATION for all employees.

• Treat others the way you would like to be treated!

• Be friendly and courteous to patients / coworkers / providers.

• Be present.

• Make eye contact.

• If your back is to the patient during documentation,
• Please turn around and address the patient.

On Stage vs Off Stage Behavior

The Disney Company originated the idea of being 'On Stage' whenever in a customer-facing role.

• Onstage:
• The customer (patient) can see you and/or hear you.
• You are a part of their experience - both good and bad.

• Offstage:
• Customer (patient) cannot see you or hear you.
• You are NOT part of their experience.

AIDET Communication

• Introduce yourself as a professional.

• Allows us to communicate effectively, reduce patient anxiety, and increase patient confidence.

(47 seconds)

SBAR Communication

Communicate with provider, RN/LPN, outside facilities, and peers. SBAR structures your communication to ensure you have included all needed information.

• S = Situation - A concise statement of the problem.

• B = Background - Pertinent information related to current situation.
• History? Recent hospitalizations / office visits?

• A = Assessment - Vital signs, complaints, pain
• MAs and LPNs relay information

• R = Recommendation - What result do you want from this communication?

Preceptor

• Preceptor is responsible to validate the MA Student's exposure to skills on

their Student Checklist

• When MA Student is assigned to a preceptor, they are to have ONE ASSIGNMENT

• YOU ARE NOT TO BE WORKING ON YOUR OWN!

• Follow preceptor wherever they go -within reason :)

• You must advocate for yourself. Don't miss out on a good learning opportunity because you are waiting for preceptor to tell you/ask you if you want to see something.

• ASK them to show you!
• ASK questions!
• Be proactive!

02

Vital signs & intake

Vital Signs

Objectives

• Underatand all components of patient intake
• Understand normal adult vital signs
• Demonstrate 2 step BP
• Understand how to perform Orthostatic Blood Pressures
• Understand differences in special populations

Before Obtaining Vital Signs:

• Hand hygiene before all patient contact.
• Confirm selected site and device are appropriate for your patient.
• Explain procedure to the patient.
• Assist patient to a comfortable position.

NORMAL ADULT vital sigNS report anything outside of range

O2

BP

RespiratoryRate

Temperature

Blood Pressure

Oxygen Saturation

Heart Rate/Pulse

96.8° F - 99.7° F

95 - 100 %

90/60 mmHg -120/80 mmHg

12 - 20 breaths per minute

60 - 100 beats per minute

Vital Signs

• Normal or expected vital signs can vary depending on clinic and medical specialty.

• Know the expectations specific to your population.

• Change in vital signs may indicate a patient concern.

• Elevate to RN or provider

Normal Adult Oral Temperatureapproximately 96.8-99.7

Temperature can be affected by:

• Gender
• Women may have higher body temperatures.
• Age
• Older people may have lower body temperatures.
• Circadian rhythms
• Body temperatures increase later in the day (afternoon).
• Environment
• Air conditioning, heat, clothing, outside temperatures all affect body temperature.

https://point-of-care.elsevierperformancemanager.com/skills/672/quick-sheet?skillId=GN_17_1A&virtualname=vuebl-tnnashville

https://www.health.harvard.edu/blog/time-to-redefine-normal-body-temperature-2020031319173

Common Modes of Temperature Measurement

Oral

Tympanic

Temporal

PULSE (Heart Rate)

SYSTOLE: Pumping / contraction of heart DIASTOLE: Filling / heart at rest

Normal adult heart rate 60-100

(1:41 minutes)

Radial Pulse (Heart Rate)

Allow patient to relax for several minutes:

• Patient in a sitting position.
• Bend elbow to 90 degrees.
• Support the lower arm.

• Place 2-3 fingers over groove along the radial (thumb) side of patient wrist.

• Lightly press until pulse is easily palpable.

• Count rate (number) for 30 seconds and multiply by 2.
• If pulse is irregular, count rate for full 60 seconds.

• Document findings.

• Elevate findings if appropriate.

https://point-of-care.elsevierperformancemanager.com/skills/19221/quick-sheet?skillId=AM_067&virtualname=vuebl-tnnashville

RESPIRATIONS

Inspiration - air in; diaphragm and thoracic muscle contractExhalation - air out; diaphragm and thoracic muscles relax

Normal rate 12-20

Respirations

Wait several minutes after patient has entered room:

• Ask patient to NOT speak during the procedure.

• Observe breathing pattern.
• Normal breathing is regular and unlabored.

• Count respirations by watching rise and fall of chest.

• If breathing regular - count for 30 seconds and multiply by 2.

• If breathing irregular or RR < 12 or > 20 - count for 60 seconds.

• Document RR, include depth of respirations (shallow, normal or deep).

• Elevate findings if appropriate.

BLOOD PRESSURE

Systole: Peak pressure exterted as ventricles contract and eject blood Diastole: Minimum pressure exerted between cardiac contractions (heart at rest)

Normal adult BP 120/80

Cuff size is key to an accurate BP reading: TOO BIG = FALSE LOW BP TOO SMALL = FALSE HIGH BP

Taking a Blood Pressure Measurement

Is the patient ready to have Blood Pressure taken?

Is patient in proper position for Blood Pressure Reading?

Placing BP Cuff

YES

NO

+ info

+ info

+ info

Please hover on + info boxes

Taking a Blood Pressure Measurement

• Perform hand hygiene and don clean gloves.

• Position patient.

• Place BP cuff above antecubital fossa.

• Place stethoscope diaphragm over brachial artery and below the lower edge of the BP cuff

• Do not let diaphragm touch cuff or clothing.

• Quickly inflate cuff to desired mm HG.

• Slowly release pressure valve to allow needle to fall at a rate of 2-3 mm HG per second.

• Observe the point on the manometer at which the first Korotkoff sound is heard (Systolic BP).

• Continue to deflate cuff gradually.

• Observe for point at which all Korotkoff sounds disappear (Diastolic BP).

Please hover on + info boxes

Targeted BP / Two Step BP

Estimating patient systolic BP with palpation

1. Locate the radial pulse with fingertips of nondominant hand.
2. Palpate the pulse while inflating the BP cuff.
3. Note number mm Hg when pulse disappears.
4. Deflate the cuff fully.
5. Wait 1-2 minutes.
6. Reinflate cuff to 20-30 mm Hg above the number where the pulse disappeared
7. Obtain BP per protocol.

practice 2-step Blood Pressure

Orthostatic Hypotension Blood Pressure

Measure Blood Pressure and Pulse 3 times1. Patient to lay supine for 5-10 minutes, then:

• Obtain Blood Pressure / Pulse.

2. Change patient to sitting position.

• Wait 1-3 minutes.

• Obtain Blood Pressure / Pulse.

3. Change to standing position.

• Wait 1-3 minutes.

• Obtain Blood Pressure / Pulse.

With each change in position ask/observe for:

• Weakness
• Dizziness
• Pallor
• Diaphorresis
• Vision changes.

Oxygen Saturation (SpO2)

• Place probe on patient finger.
• Do NOT place on thumb.
• Do NOT place on same extremity as electronic BP cuff.
• May warm site if cold.
• Remove dark nail polish - light must shine through.

• Align light source and photodetector sensor directly opposite of each other.

• Observe pulse waveform until it reaches a constant value.

• Read the SpO2 on the digital display.

• Document reading in patient’s record.

• Elevate results if appropriate.

• Disinfect device after every patient.

Normal 95-100% for healthy adult

SPECIAL POPULATIONS

Blood Pressure Ranges in Pregnancy

Accepted blood pressure threshold for a pregnant patient is less than 140/90.

Normal threshhold for adults is 120/80.

BARIATRIC PATIENTSSeverely Obese -Things to Consider...

• Blood Pressure measurement can be inaccurate due to poorly fitting BP cuff.

(Leblanc et al., 2013).

• BP measurement at the wrist should be considered if a correctly fitting upper arm cuff cannot be applied.

• Wrist BP must be taken while cuff is held at the level of the heart.

(Irving et al., 2016).

Patient intake

Intake

• Retrieve patient from waiting area

• Place ID Band on patient wrist

• Verify correct patient using two patient identifiers
• Legal Name and DOB
• Preferred name - on band also
• Compare to patient ID Band

• AIDET

• Obtain height (cm) and weight (kg)

The following videos illustrate staff interactions with a patient in a clinical setting. Notice the differences in the staff member's performance.

Intake

4:27

How did the staff member do?

Did she...

Introduce herself correctly (AIDET)?

Comply with HIPAA?

Demonstrate professional behavior?

Deliver patient-centered care?

Refrain from diagnosing the patient?

Give the patient accurate information?

Perform the blood pressure correctly?

Intake

6:18

What went well?

The staff member:

Used AIDET and CREDO behaviors

Made eye contact during intake questions

Asked questions and ensured patient was comfortble before proceeding with the next questions

Conducted professional behavior

Refrained from diagnosing the patient

Delivered patient -centered care

Performing patient Intake in estar

Patient ID Bands

• Both legal and preferred name displayed on patient ID Bands.

• Preferred name will be in smaller font and printed below legal name.

Example: Thomas Jackson

"Tom"

Scan ID Band

Choose Arrived Appt and then click 'Accept'

Choose Intake TAB

CORE INTAKE REQUIREMENTS

Right side of eStar screen - Intake Checklist Refresh frequently to see most up to date info

Left side of eStar screen - Required during intake

Fill in in Click "Close" when completed.

Review allergies / add any new allergies Click "Mark as Reviewed"

ONLY Certified MA's may do Medication Review

AS A STUDENT, YOU MAY ONLY DO THE MEDICATION REVIEW WITH YOUR CERTIFIED PRECEPTOR AND THEY MUST COSIGN!

• Do not copy or carry forward Vital Signs.

• If your clinic requires vital signs at each visit - then you must complete new vital signs at each visit as part of your intake.

• If your patient just finished an appointment at another clinic, you STILL need to perform the full intake required by your clinic, which may include vital signs.

Vital Signs

• Normal or expected vital signs can vary depending on clinic and medical specialty.

• Know the expectations specific to your population.

• Change in vital signs may indicate a patient concern.

• Immediately elevate to RN or Provider

Document "Vital Signs"

Review History: medical / surgical / family. This may have already been completed by patient in MHAV.

Review / complete Health Maintenance and document any outside of Vanderbilt care received.

In Documentation Box:

• Select action
• Example: "Add Completion"

• Insert historical data
• Completion reason - patient reported/external report
• Date
• Any comments

• Give patient forms for test results to be sent to Vanderbilt

Coming Soon To A Clinic Near You!

Infection Prevention: Isolation Requirements for the Ambulatory Setting

• Phased Roll-Out Plan

• Began May 2025
• Each PC will take 4-8 weeks

References:

Prabhavathi, K., Selvi, K. T., Poornima, K. N., & Sarvanan, A. (2014). Role of biological sex in normal cardiac function and in its disease outcome - a review. Journal of clinical and diagnostic research : JCDR, 8(8), BE01–BE4. https://doi.org/10.7860/JCDR/2014/9635.4771

Treas, L. & Wilkinson, J. (2018). Basic nursing: Thinking, doing, and caring (2nd Ed.) Philadelphia, PA: F.A. Davis. ISBN 978-0-8036-5942-1

Zhang, D., Wang, W., & Li, F. (2016). Association between resting heart rate and coronary artery disease, stroke, sudden death and noncardiovascular diseases: a meta-analysis. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 188(15), E384–E392. https://doi.org/10.1503/cmaj.160050

Blood glucose

practice accuchek

Emergency response

Updated 6/16/25

Stroke Acute Coronary Syndrome Mock Code

Stroke: Signs and Symptoms

Call For Help Immediately!

• Sudden severe headache

• Sudden change in:
• Strength
• Speech
• Vision
• Coordination

"BE FAST"

B: Balance Loss of balance, headache, dizziness

E: Eyes Blurred vision

F: FACE Facial droop or uneven smile

T: TIME Call for ambulance Immediately

S: SPEECH Difficulty with speech

A: ARMS Arm or leg weakness

Be able to answer:

• Time of symptom onset

• Patients name

• Address of Clinic

• Clinic Name
• Suite Number
• Room Number

Main VUMC Campus and One Hundred Oaks (OHO)

• Dial 1-1111 from any hard wired phone

Off Campus: Dial 911

Acute Coronary syndrome

Umbrella term for a group of conditions that suddenly reduce or block the flow of blood to the heart. #1 Cause of Death

Symptoms

Atypical: Women / Diabetics / Elderly

• Heartburn or indigestion
• Diaphoresis (sweating)
• Back pain
• Nausea / vomiting
• Dizziness
• Fatigue / weakness
• Anxiety

Common:

• Pain in chest, arms, neck or jaw
• Shortness of breath
• Sudden symptom onset

• Weakness
• Vision loss
• Difficulty speaking
• Dizziness
• Trouble walking
• Loss of balance or coordination
• Severe headache with no obvious cause

Additional Symptoms

Objectives

• Demonstrate how to properly activate emergency response based on department or clinic location
• Discuss team roles in a code situation
• Demonstrate use of available emergency equipment
• Engage in meaningful debrief

Clinic Code Demonstration # 1

Next

What went wrong here?

Clinic Code Demonstration # 2

What went right?

Turn the oxygen all the way up (15L)

• Use green wrench 'key' to turn on oxygen by turning key to the left
• Lefty Loosey
• Righty Tighty

• Turn dial to start oxygen

Attach tubing to side, increase oxygen with top dial

Attach mask tubing to oxygen!

What are the team roles in a code?

Review Team Roles In a Code

What is an adult compression to breath ratio? What about pediatrics?

If there are enough rescuers:

• 2 people should be on the bag / valve mask (Ambu bag)

• One rescuer holds the mask with 2 hands using the "E-C grip" from the top of the patient's head, and tilts chin upward with ring fingers

• Other rescuer give the breaths

Emergency Equipment

This differs per clinic! Get familiar with what your clinic has and how it works.

Zoll Monitor/Defibrillator

Zoll AED 3

Zoll R Series Review

When you turn defibrillator ON it is in AED mode

Zoll Electrodes for Defibrillator

Electrode 1: (RED)

• Roll the patient onto their side
• Place 1st electrode on patient's back
• left of their spine and under the shoulder blade

Electrode 2: (BLUE)

• CPR compression sensor (Puck)
• Place Sensor (Puck) with red cross/plus sign mid sternum at nipple line.

This AED uses the same pads for both Adults and Pediatrics.

ZOLL AED 3 for Adults

STEP 1: Turn on ZOLL AED (button upper left corner) STEP 2: Place pads on patient - look at pictures

Power

Shock

ZOLL AED 3 for Pediatric Patients

STEP 1: Turn on ZOLL AED (upper left corner) STEP 2: Press child button (bottom right corner) STEP 3: Place pads on patient

Press to activate child mode for children <55 lb or approx 8 years old

ZOLL AED 3 for Pediatric Patients ***

DO NOT use Purple CPR sensor (Puck) on patients <1 year of age! (Remove purple sensor and place it next to the patient).

practice 2 person BAg/mask breathing

Medical Emergency Equipment Checklist - ZOLL AED 3

revised 9-2024

Documentation

Provider and nurse sign Arrest Record

Arrest Record

Permanent part of patient record - scan form into eStar

Fax Arrest Record to number at bottom of form

You will also need to fill out a VERITAS

If transferring to ED, call Patient Flow Center

Debriefing

Discuss with your team after an emergency situation

Discuss emotional support

• Chaplain
• Employee Assistance Program
• Emotional support for patient, family, visitors

• What went well?
• What would you change?
• Ask questions at the debriefing – NEVER be afraid to speak up.

practice - mock code simulation

References

VUMC. Cardiopulmonary Resuscitation (CPR) policy. PolicyTech. Retrieved from https://vanderbilt.policytech.com/dotNet/documents/?docid=21641 VUMC. Resuscitation Team. Retreived from https://www.vumc.org/resuscitation-program/welcome

Interpreter services

Let's go!

The Vanderbilt Health Hub

Choose: "Clinical Operations" then "Interpreter Services"

20 Minute Video

THANK YOU!