Transcript Practice Update

April CCU Unit Meeting
Congratulations and Thank You
• Sarah Porter and Heather Sponseller: March
graduates with their BSN
• Julie Robinson: CCRN
• Tammie Albrecht, Beth Chenevey, Chris
Kestner, and Beth Scafate our CPOE
superusers
• CCU nurses caring for our hypothermia
patient: LifeBanc donor (liver)
• Welcome back: Cindie Berbari and Peggy
Stone
Thank you: Patient Comments
• Delores Judy called to say thank you to all staff who gave
“wonderful care and was VERY impressed with our Unit, was
never disappointed even once”
• Nurses were wonderful, they took good care of me and my
family!
• All of the staff were wonderful especially Brandy
• Sara was the best nurse!
• I saw a lot of handwashing
• While in CCU learned a lot about the heart and how it works,
which told me the nurses are very skilled!
• Nurse Christy (porter) 7p-7a exceptional!!!! Kept us informed
and very friendly and helpful
Telemetry Batteries
• Please use NEW batteries on all admissions (PAR
level has been increased)
• Check batteries when running strips and change
when only one “battery bar” is lit on central monitor.
(Batteries may also be checked on telemetry itself by
pressing the “checkmark” on the telemetry unit)
• On discharge, place batteries in recycle container
(POD soiled utility room)
• When patients leave the floor, it is the expectation
the monitor be placed in “standby”
Practice Update
• Review April Policy Updates
 See April summary
 Revision call out: foley management/care – foley care changed to
daily; added use of castille soap PRIOR to insertion
• Angiomax
 Rep will be here week of 4/30
 Do NOT pull sheaths until 2 hrs after angiomax has been discontinued!
(3 hrs for renal patients – cr cl <30 – also must check ACT with these
patients) . Longer hold times and potential complication will result if
sheaths pulled without following the above!
• TAP (Turning & Positioning) Update
 In stock; please ask PCS
 Email Rhonda when patient placed on TAP or if you have a candidate
• New Palliative Care Liaison: Denise Rollyson will be
rounding on units
Practice Update
• PMX56-203 Clinical trial:
 Study drug binds to heparin stopping its anticoagulation effect;
doe not affect coagulation cascade
 Target population: staged PCI’s
 ACT’s have decreased from >200 to <130 within 3 minutes of
the study drug
 Effects: hypotension/mild flushing (benadryl prior to infusing is
helping)
 CCU take-aways:
• Vital monitoring important especially if patient had hypotension in the
lab during the infusion
• There will be a few orders for specific labs
• Close observation of groin as with any PCI patient
• Will be seeing more closure devices
• Observe for signs/symptoms of allergic reactions
Practice update
• Unit Meetings
– Must attend meetings
– Must read and sign in employee lounge – book
– Quia post test for those who do not attend live
meeting.
– Too much information to depend upon word of
mouth
• Video on Demand
– CCU & CPC show 52.5% of all videos in entire
hospital.
Echo “enhancers”
• Becoming the standard for echo studies
• Definity shortage for the next several weeks
• “Optison” will be used during this time
Stress room nurse will come up to unit and
administer
CCU to document as with definity
If stress room nurse is not available, definity will
be administered (see attached handout)
Sleep-Rest Project
• You are making a difference! – Improvement in HCAPS noise patient
satisfaction
• Continue with “Lights out” 10pm – 6am and awareness of our
conversations on all shifts- press ganey reports
• Review of hospital vital sign policy (wording is “approximately every
4 hrs for step down and approximately every 2 hrs for ICU”)
• Assessments (per CCU shared decision making)
 Patients should not automatically have head-to-toe assessment at
3am
 5am is acceptable if patient has been here >24 hrs, no drips infusing
that could effect BP, no procedure site assessment required
 Goal: provide 5 hrs of uninterrupted rest
CENTRAL SERVICE
TIP OF THE MONTH
•BSC( bedside commodes) will be delivered to your unit upon
requisition from Cerner
•After patient usage is complete, it is a nursing responsibility to
empty BSC of contents, clean the insert & then place in hall by
dirty utility room for pick up.
•CS staff will pick up on rounds (only the empty BSC)
•Our supply for all Aultman Hospital
BSC: 120- regular size, 10- Xtra Large & 6- 1000lb BSC LG.
Information supported
by AAMI, JCAHO and
Aultman Hospital
Policy
•Proper cleaning of BSC insert is Bleach 1:10 solution
•After each patient use , the BSC must be emptied, rinsed and
wipe off the handles with Sani Wipe while the BSC remains in
room.
•Dirty BSC’s “must not” be placed in halls, they should be placed
into patient room until the patient no longer needs them. (they can be
stored in the patient bathroom over the commode, just remove the insert container place on floor)
Orientation Update
• Nurse Aide orientations complete
• RN orientations complete as of 5/5
• Beginning ICU orientations for our current step
down nurses
• March Mentoring Meeting: reviewed CCU
universal procedure cart with TTVP
insertion/management focus
• Congratulations: Heidi Clay and Amy Mutchler’s
preceptor applications were reviewed/approved
by the CCU preceptor committee
Education Update
• Level classes have begun! Reminders are being sent out
prior to classes
• 2012 unit based competency modules will be posted on
QUIA shortly (3 nurses reviewing for “time”)
• 2012 clinical goals from 2011 competency have been
forwarded to all RN staff
• Competency meetings will begin in AUGUST!
• Information regarding 2012 support staff education coming
soon
• Currently 4 items on QUIA (will be removed within next 2
weeks by 5/11): imprivata, advanced directive update x2,
and the new Falls policy. Several still need to complete!
• Education/Competency questions?
Quality
CCU Bar Code Scanning 2012
100%
90%
80%
70%
60%
Goal 90%
Patients Scanned
50%
Medications Scanned
40%
30%
20%
10%
0%
Jan
Feb
Mar
Apr
May
June
Jul
Aug
Sept
Oct
Nov
Dec
Quality
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“Getting to Zero” Hospital Campaign
CCU with ZERO CAUTI, VAP, central line
infections for Jan - March.
MisID’d specimens: 0 (March) with 1 YTD
Falls: 1 (March) with 10 YTD
Never Events
CAUTI Prevention Initiative
• Put date on foley bag when catheter inserted
• Place nurse communication “task” at 48 hrs and
then daily for re-assessment of appropriateness
• If admitted with a foley – please ask for a culture
• Castille soap and water prior to
insertion and daily (new policy
Audits reveal
change)!
compliance with
date on foley bag 0100%
Quality
HCAHPS Patient Satisfaction Results- Feb 2012
Top Box
CCU
Benchmark*
Percentile Rank
help quickly of Staff) N=7
N=1776
Goal > 90th percentile
Communication with Nurses
- Courtesy/Respect
- Listen carefully
- Explain clearly
Communication with Doctors
- Courtesy/Respect
- Listen carefully
- Explain clearly
Received help quickly (Response of staff)
- Call button help as soon as I wanted
95%
78%
99*
95%
81%
99*
92%
65%
99*
90%
71%
99*
100%
62%
99*
- Help toileting as soon as I wanted
Pain
- Pain well controlled
- Staff did everything they could to help
Explain medications
- Tell you what medicine was for
- Explain side effects
Quality
HCAHPS Patient Satisfaction Results- Feb 2012
Cleanliness
- Room & Bathroom kept clean
Quiet
- Area around room quiet at night
Discharge
- Discussed help needed at home
CCU
N=7
Benchmark*
N=1776
Top Box
Percentile Rank
Goal > 90th percentile
86%
73%
94*
86%
57%
99*
100%
84%
99*
86%
69%
97*
100%
71%
99*
- Written info. About symptoms or problems to
watch for
Overall Rating
- Rate hospital 0-10
Recommend Aultman
Quality Outcomes
• Employee lunchroom
– Quality bulletin board to demonstrate results of
HCAPS, etc.
– Comparison to rest of hospital
– Quality scorecard with unit based outcomes
Press Ganey: Patient Comments
Areas of Opportunity
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Questions on Press Ganey that we are not doing well on:
– Did the nurse tell you what your new medication is for?
– Did the staff describe to you the side affects of your medications?
Nurses wear too much jewelry – germ carriers
Room across from the nurses station – noisy and “party time” – “I knew everything
they did on the weekend – remind nurses patients need to sleep”
“nurses were loud during the night”
“what happened to the dress code?” “Perfume was too strong”
“Care was good except for 1 night shift nurse who was not concerned about
anything except telling how good she was and how smart she was”
“It was at the end of her shift and she seemed bothered by having to do anything
for a new patient”
Environmental Audits
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Multiple patient information exposed
Pill cutters need cleaned
Unlocked supply carts
Nourishment under sink in nutrition room
dirty with unlabeled food
• Multi dose insulin vials not dated
• Unsecured O2 tank
• DO NOT USE THE GREEN STICKERS ANY
MORE ON ANYTHING!!!!
Core Measures
• Pneumonia
– Make sure to complete the vaccine assessment
– Check and clear items from Task List
– Give vaccine at discharge
– Any patient with Asthma/pneumonia any age – at risk for vaccine
• SCIP
– Post op antibiotic ordered
– Lopressor needs to be ordered to be given prior to surgery
– Remove foley in am as ordered and pt should void
• Heart Failure
– 60 minutes of education in PER in cerner – document
– Print correct home going instructions & check box pt understands inst.
– Discharge med req needs to be correct
– Follow up appointment must be recorded in Depart process
• AMI - 100% nice job!!!
Communications
• CareInfusion “Go Live” (new IV pumps) – June
12th; education for new pumps to begin midMay. Details to be communicated when
available.
• Physician phone books: no longer being
printed – go to Aultman Intranet and enter
the physicians name in the search window.
Communications
• Pod Resource / Team Leader Phone numbers
– 39181, 39182, 39183, 39184, 39180
– Pod desk phones will transfer after 2 rings
– Make sure to transfer phone to Lead with pod
closing.
• Nurse aide Phones per Pod
– 39171, 39172, 39173, 39174, 39175
– Transfer to other nurse aide phone when split
– Transfer to lead phone when pod closed.
Communications
• Please do not question why patients are being transferred
from another unit.
– Reports that nurses are questioning appropriateness of
transfer – family heard the conversation and complained.
– Please do not complain to the lead nurse regarding
discharges and admissions. We must accommodate
patients needs. Ask for help!!!
– Shortage on SD beds in hospital, so our census is up and
we are getting some non-cardiac admits.
– Professionalism at all costs with other employees,
physicians and families!!!
Signed Consents
• Make sure that signed consents are
written EXACTLY as written by
physician or APN in the Dr. Orders
section.
CPOE
• CCU superusers continue to assist us in
identifying/following up with CPOE issues
• Cardiac division is meeting on a regular basis with
the CERNER team and have submitted CPOE
related problems
• Thank you for your patience as keeping up with
the multiple communications has been
challenging
• We will focus on the top 3 concerns for the
month over the next several unit meetings
CPOE – Unit “hot spots”
• Check for “planned” states of your powerplans
 Missed pre procedure orders!
• Eyeglass
 “signing off” of the orders – review carefully
 Nursing must call all consults and document “provider notification”
• Depart process
 After printing patient’s discharge instructions, please remember to
“SIGN” the depart process. Chart is ‘incomplete’ if not “signed”
 Please use handouts for depart from the “departmental” folder.
Handouts under the “ALL” folder have not been reviewed/approved.
Many blanks are on these handouts.
• DNR-Comfort Care/arrest paper orders: recommended to continue
to fill out as patient gets a copy – the only paper item an EMS squad
will accept!
• CPOE questions?
OBSERVATION PATIENTS
• Make sure to contact physician if patient
status not indicated on orders
• Must chart when patient leaves the floor and
arrives in cerner!!!!
• Any orders, admission powerplans, etc…
disappears when patient transfers to admit
status. Must enter the actual date of arrival to
be able to see these items.
Pod Resource / Team Leader
• Shared Decision Making Committee voted to
continue
• Task Force of peers determining the job
description, and qualities of a good PR
• New Name – Team Leader
• Team building exercises will be coming.
• Precepting done with new hires – so more
employees to help with better staffing.
Gallup Survey
• The official staff survey coming in summer
• We need 100% of all employees to complete
and is truly anonymous!!!
• I will be sending out a survey to gain
information, based upon last years results
• Important for peers to offer support to each
other.
• Top items – needed equipment to do job &
employees committed to quality.
Changes in Patient Condition
• During Day call the APN if patient has CVC
consult first!! They are on floor
• Call the lead with changes in Patient condition
such as: chest pain with EKG changes, pt going
to lab, worsening condition, groin issues
Equipment
• 3 new hypothermia machines
• 2 new SVO2 monitors
– When HCL brings up a patient with one, they will
take one to the lab to replace. We will not need
to switch out equipment on patients.
• 2 new telemetries, still missing 3 – new
process coming for storage to gain visibility for
them after discharge.