Transcript place “backward” on door frame after calling IV Team

May-June CCU Unit Meeting
Copies of these slides along with handouts distributed at
the unit meeting are located in the 2012 CCU Unit Meeting
Book (you will find the book in the staff lounge).
Current Trends in Operations
• Daily census
• Working smarter
• The future in care delivery
At the unit meeting Rachel discussed the
above three trends and their impact. These
trends are occurring throughout the hospital
as well as hospitals in our area. Additional
communication coming from the hospital in
the near future.
Congratulations to…
• Completion of the May Fundamentals of Critical Care
Course (FCCS): Jenna Burin, Andrea Dugan, Caitlin Greaves
• Certification: Lauren Ellis (CCRN)
• Illuminate Patient Call Back Recognition (this employees
were specifically called out by name from our patients):
 Dawn Cox
 Cayla Troyer
 Ken Lee
 Mike Klemens
 Nikki Kraynick
 Jenna Burin
 “Heather”
 Rachel Kuhn
Policy Change
• Tornados and Mass Notification (handout distributed – includes more
detail)
 Code Gray = severe weather/tornado
 Mass Notification Process: please update your contact information to HR for
disaster notification
 Policy change from Joplin, Mo. “lessons”
 Continue to encourage visitors to stay within the facility
 Changes:
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
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No longer phases for tornado preparation
“Code Gray” repeated every 15 minutes for PA until cleared
Event of direct impact: “Code Gray Tornado Impact, take immediate shelter”
Employees to pull down all shades, move beds/visitors away from window, toward room
interior
 Turn bed so patient faces hallway with headboard toward the window/cover patient
 Place patient shoes with patient in bed
 Store loose “projectiles”
New emergency reference
flip chart distributed for
review in unit mtg – these
are located on each POD –
in cupboard with resource
Books.
Quality
•
•
•
•
•
“Getting to Zero” Hospital Campaign
CCU with ZERO CAUTI, VAP, central line infections
for Jan - May.
MisID’d specimens: 1 YTD
Falls: 3 (May) with 16 YTD
100% CHG wipes (2 applications)
for May
ZAP VAP hospital campaign is coming (May oral
care dropped to 88%)
CCU Bar Code Scanning 2012
Patients Scanned
Medications Scanned
100%
90%
80%
70%
60%
Goal 90% 50%
40%
30%
20%
10%
0%
Jan
Feb
Mar
Apr
May
June
Jul
Aug
Sept
Oct
Nov
Dec
Clinical Practice
• Angiomax
 Cannot pull sheath until 2 hrs
after angiomax has been
discontinued and not upon
return to room as with
Gpiib/iiia meds (often bag is
being ordered to complete in
CCU)
 Cath lab to communicate if
renal dose of angiomax given!
(cr cl <30): must wait 3 hrs
and check ACT prior to pull
 If above not done: longer
hold times and potential for
vascular complications!
• Isolation Identification
 If positive culture received, place patient
in isolation and notify physician
 Patient labels, face sheet, and arm
band will NOT print the isolation
code until the next admission (we
need to call to place if NEW positive
culture – admitting does not
automatically do. This gap has been
brought to infection control’s
attention!
 Plain white ID band – write isolation
category in RED ink
 Place appropriate color coded
signage on door (yellow – airborne;
blue – droplet; green – stringent
contact)
 Place isolation cart outside room
 If two-letter code on ID band/label/face
sheet on admission, place patient in
isolation and notifiy procedure areas
PRIOR to the procedure!
Low Volume/High Risk Patients
• Invitation extended at January unit meeting regarding forming a “core”
hypothermia team.
• Please review invitation (handout also distributed at January unit
meeting).
• While some nurses expressed interest, it has been communicated that
others did not know/understand.
• Please accept my apologies if there was confusion.
• Challenge: maintaining competency and achieving patient outcomes
• Similar challenge with recent FDA mandate regarding CRRT software –
requiring 2 hrs of retraining.
 43 CCU nurses currently trained for a population that is less in numbers than
the hypothermia/cardiac arrest population
 Recommendations from centers of excellence/CRRT programs include
competency and implement a safety/quality monitoring plan for CRRT care
 Thoughts/feedback
IV Team Requisition – place
“backward” on door frame after
calling IV Team (refer to email)
Handout distributed
Communications
• Check email weekly (minimum)
• Attend monthly unit meeting
Goal: provide
timely/accurate
communication
to staff.
Reviewed these
three staff
communication
expectation.
QUIA monthly (and complete review of slides/quiz
if not present at unit meeting)
• Check vestibule announcements daily
NEW – date posted and quick “header” of
important communication
This will alert you to an email you need to review
and important communication we need to provide
Communication
• CMS requirement to report all deaths that occur
while a patient is in restraints or within 24 hrs of
restraint discontinuation.
• Quality Department has difficulty finding restraint
discontinuation documentation when a patient is
extubated.
• Please document discontinuation of restraints
(outlined in restraint policy).
• Discontinuation of the restraint order will dc your
nursing task for restraint documentation.
Communications
(previous emails have already been sent to staff)
• Print “daily” EKG requisitions and place on
board for EKG tech (no change from pre-CPOE)
• Bed tracking process: all discharges to be
entered using employee ID (resources in all
PODS)
• Please add “CBN” to white boards on PODS –
this is a hospital wide request
Process Updates
• Monitor Tech
 Hospital is developing a policy/procedure
 Patients are NOT to be removed from the monitor to take a bath
and placed in “standby”
 Only a physician can order a telemetry to be removed to shower
 Monitor Tech’s are required to call staff when patient off
monitor, hospital policy PLEASE BE KIND AND PROMPT WHEN
THEY CALL YOU!
• POD Team Leader
 Shared decision making approved initial goals and role focus
(teamwork, safety, quality)
 Education for POD team leaders and all staff coming (JulyAugust)
 Shift POD huddles will be mandatory
What’s new….
• CareFusion Go Live: June 12th (Details discussed at unit meeting)
• Telemetry replacements: we are now at 56 telemetries. PROCESS
for storing and regular checks – will be forwarded to you via email!
• Change in code blue documentation form (handout distributed;
education was posted on QUIA – please complete if you have not
already)
• Disposable lead trial for OHS patients (see handout) – starts June
17th : these leads are to be applied after the FIRST CHG application
(afternoon shift)
• CHG wipes (recent OHS delay due to IV infiltrate)
 Evening before/morning of (after 7am if second case)
 Performed by the RN (not patient or support staff)
 3 packs per application not 2 (patient’s back has been added to make
the CHG application a full-body prep = 6 wipes)
CPOE CCU Accomplishments
• Thank you, Alexis!
• Metformin is now on post intervention, CRT, and
cath powerplans to hold for 48 hrs (will appear
on EMAR)
• Actual orders for caths, pacers, PCI’s are now part
of the power plan and will NOT have to be
entered separately so cath lab now physically
receives the procedure order
• Working on a stress test power plan
• Working on angiomax/integrellin process
CPOE
• Shift report is to be given using the computer
• Discharge scripts, orders (home health,
equipment) are now printing on discharge!
• Do not forget to check “paper” chart for
discharge items (pacer book, ID cards,
prescriptions)
• See handout for Depart process
CPOE: Physician Communication
• Physician orders
–
–
–
–
Must take over orders over phone from physicians if asked
Always do what is best for the patient
Not acceptable to refuse to take phone orders
Nurse permitted to complete discharge med reconciliation
over the phone, but the physician must stay on the phone.
– Admission meds – physician must complete the med req,
however they can give verbal orders for medications. If
they do not want to stay on the phone to complete the
med orders, you will need to write these meds onto
physician order sheet and fax to pharmacy.
2012 Unit Initiatives Progress Report
• Building Relationships
– Physician Relationships
• Rounding
• Co-management
– Staff Teamwork
• Pod resource project
• Shared decision
– Department Relationships
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•
•
•
Heart cath lab
Cvsicu
Critical Care Council
Staffing department
At the January unit meeting:
building relationships,
accountability, and
communication were
presented as the 3 key
initiatives we would be
working on this year.
Updates were provided for
each of these areas at the
June unit meeting. If you
have questions or would like
further detail, please see
Rachel or Rhonda.
Accountability
• Monthly Quality Audits
– Bar Code / Med Scanning
– VAP Compliance
– Intake and Output Chart Audits
– Core Measure Compliance / Follow up
– Attendance
– Clarification of Roles, more to come
Communication
• Monthly Unit meetings
– Quia
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•
•
•
CPOE training
Emails
Pod Resource notebooks
Pod Huddles
Questions?
Remember : For those unit meetings
not attended, the expectation is to
complete the QUIA quiz