Transcript Week End Wrap Up

Week End Wrap Up
May 24, 2010
Staff Meetings
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Tuesday, June 1, 2010
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BB667 (OB Conference Rooms)
1500-1930 & 1900-2300
Monday, June 7, 2010
Two locations
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SCC 252
1100-1530 & 1500-1930
BB667
1900-2300
Staff Meeting Agenda
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Announcements
Practice changes/timelines
Mother Baby Updates (Purple
Crying, Documentation)
Holidays (8-hours versus 12-hours)
Scheduling issues
MIC Idea Summit presentation
Mandatories/LMS demo
Referral Process Changes
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Improved referral intake process completed today
Team created streamlined process which reduces number
of activities for each role, eliminates rework, and improves
communication among team, and with referring
providers—wow!
CHARGE NURSE ROLE IN REFERRAL PROCESS
 Twice/day TEAM STEPPS – Identify L&D status by
assigning color
 Charge RN responsible for keeping color code tool up
to date
Referral Process Changes (cont.)
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GREEN – Attending will accept all referrals 
YELLOW – Attending needs to call/talk with Charge RN
before accepting referrals; Action: Chief & Charge RN
trouble shoot patient flow issues with goal of returning
to GREEN 
RED – Attending comes to L&D and runs board with
Chief, Charge RN; contact Nurse Manager or Flow
Supervisor prn
BLACK – No referrals can be accepted; assemble
management team Gigi or Debi, Karen Odle (Director
of Perinatal Services), Flow Supervisor and Medical
Director (if needed)
Referral Process Changes (cont.)
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Charge RN responsible for alerting Attending and Chief
of changes in unit status by sending text message –
only text color (your phone # is on their card)
Attending will accept all transfers if Green was status
indicated at TEAM STEPPS unless Charge RN texted
change
Attending will call Charge RN to notify transfer is
coming and ETA
Charge RN responsible for texting Chief Resident and
Generalist of new transfer (no longer responsibility of
Attending to notify Chief)
Include in text: G/P, GA, diagnosis and ETA
Referral Process Changes (cont.)
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Circulating RN in OR monitoring Med-Con
pager in OR; she will call Med-Con to alert
that Attending can call after C-Section; if
call an emergency, will transfer to Charge
RN to take info
Referring Provider is transferred to front
desk person (PSS/Float/RN/Tech) after
Attending has accepted patient
Front desk now collects all info on referral
patient
EFM Alert Acknowledgment
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RN acknowledging EFM alert needs to call RN
caring for patient to make sure they can follow up
SITUATIONS
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Acknowledging paper end alert and not letting RN
know; paper missing for 1-2 hours at night.
Baby off monitor and alert acknowledged; RN not
notified; patient off monitor too long
Especially important in busy shifts at higher
census when "juggling many patients"
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Teri
34 to 34.6 wk late preterm newborn
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34 to 34.6 week newborns need to transfer to the
PCN within 30-60 minutes after birth
These infants require close observation due to
increased risk of respiratory, thermo and
nutritional instability
Babies 35 to 37 weeks may stay with Mom in L&D
if RN remains in room until Mom's transfer
RN may transfer 35-37 week infant to PCN before
Mom's transfer if she feels it's necessary .
When PCN is closed, charge RNs trouble shoot
newborn placement as they have been—NICU,
PCN RN able to be in the room, open PCN, etc
Any questions, let us know
Bedside Safety Checks
Make a Difference
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Hospital wide evaluation of value of checks reported via PSN:
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During safety checks, noted patient did not have ID band. Ordered FFP not infused until ID verified
Patient on protonix gtt . Found levophed gtt running. Pt previously on levo gtt but titrated off last night, or
so everyone thought. RN recommendation – “Double check gtts including before end of shift”
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During bedside safety check, noted ketamine gtt connected to wrong IV fluids and no name band
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An hour after shift change patient found to have bag of heparin infusing in place of NS. Resulting PTT
>200. RN recommendation - “Observe closely 5R of drug admin. Do bedside safety checks religiously”
Patients and families also like safety check as evidenced by a complimentary letter:
"I wanted to share some feedback from recent hospitalization of my sister-in-law…..…(my
brother) and his wife, were extremely impressed with the nursing care. The nurses were fun,
responsive, informative, caring, attentive……... use of the white board is flawless. We always
knew the names of folks… …my brother and his wife really liked the bedside shift reports.
They said it happened all the time. …My brother was also impressed with how everyone
checked the name band the first time they came in.
Bedside Safety checks are expectation at shift change. To do them correctly both on-coming
and off-going RN enter room and review: ID, Medications, PCA (Epidurals, Lines) Allergies,
Check O2 and Thank you. (IMPACT)
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On-coming RN should be doing the patient check “fresh eyes”. Off-going RN should be doing
verification in ORCA “tired eyes”
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Thank you for your continued work to keep our patients safe--Neil Francoeur, RN. Patient Safety Officer
Heparin IV bags
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Pharmacy currently unable to obtain premixed
bags of heparin 25,000unit/250ml used for
heparin protocol
Until manufacturer able to re-supply, have
taken following steps:
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Removed premixed heparin bags from Pyxis
Make heparin 25,000unit/D5W 250ml in
pharmacy
Done in "batches" with multiple check points to
assure appropriate compounding
Labeled with "Heparin, High Alert" Stickers (stopsign like) to call-out they are heparin bags
Low Molecular Weight Heparin
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UW Medicine Pharmacy & Therapeutics Committee in
consultation with experts in thrombosis and anticoagulation
reviewed data with Low Molecular Weight Heparin (LMWH),
and determined dalteparin (Fragmin) was most cost effective
agent for institutions
To achieve desired patient and financial outcomes following
steps will be implemented June 1, 2010:
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1. Pharmacy will auto-substitute dalteparin 5000 units daily for
VTE prophylaxis orders for enoxaparin 30mg daily, 30 mg every
12 hours, and 40 mg daily
2. A new LMWH order form (UH2933) has been developed for use
in VTE treatment, bridge therapy and acute coronary syndromes
Please order form UH2933 from Materials Management in
anticipation of June 1st implementation date.
Form is in PMM system and can be added to order template
Please allow 5-7 days as it is a non stocked item
Contact your clinical pharmacist if you have questions or
would like additional information
New Warfarin Order Form
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To improve safety using anticoagulants, new warfarin order form
implemented
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Form introduced at HMC and now required at UWMC to standardize
prescribing of warfarin across institutions
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Order form is UH2924
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Order form required for:
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New start warfarin
Continuation of home warfarin
Change in warfarin dose
Hold or discontinuation of warfarin
Filed in heparin section of patient chart—charts coming when we go
online with ORCA; for now will remain in orders section of chart
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Thank you for supporting use of order form to improve safety of
warfarin therapy
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Jackie Biery, Pharm.D. Medication Safety Pharmacist
May 2010
Pain Reassessment Audits
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Of charts audited in May
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172 dose of narcotics given
138 documented reassessment in 1 hour
80% reassessment work—right direction
Of charts audited week of May 17
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35 doses of narcotic given
33 had reassessment within 1 hour
94%
GREAT WORK this week (despite being very
busy!)
Fiscal Year 10
Pain Reassessment Audits (cont.)
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Best Practice post narcotic administration
assessment/documentation of patient response
within 60 minutes
Documentation of reassessment noted in new
column on flowsheet (separate from documentation
at time of administration
UWMC minimum standard for pain reassessment—
90 %
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Best MIC compliance fiscal year 2010—82%
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Problem times: night shift & shift changes
Interpreter News
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Interpreter sheet used to sign in
and out is interpreter’s worksheet
Needs to remain with interpreter
Interpreters are spread thinly with
frequent, overlapping work
Communication with individual
interpreters re unit needs, please
take time to clarify unit needs and
interpreter availability
Closet Locks on Mother Baby
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First stage toward redesigning supply
placement has begun
Several rooms now outfitted with shelves
and “invisible locks”
Will trial what to stock and process to
obtain supplies once several more rooms
ready
Will largely be PCT function and
responsibility
Stay tuned!
Compensatory Time
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Unused overtime compensatory time paid off by
June 30, 2010
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Accrued holiday compensatory time may
remain unpaid until September 30, 2010
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Please refer to the University website for more
information about comp time:
http://www.washington.edu/admin/hr/ocpsp/flsa
-ot/ot.html
Questions may be directed to Department
Human Resources Consultant
Babies need your help
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GBS Status
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Medication History
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document GBS status on triage form
AND newborn resuscitation record
mom GBS+, include antibiotic type, #
of doses and time of last dose
Document on triage form—include
methadone dosage
Blood Type accurate documentation
Glycomark
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New lab test ordered to evaluate patient's diabetic
control
Called GLYCOMARK
Lab reports it: 1,5 Anhydroglucitol.
CBGs give immediate information,
Hemoglobin A1C gives average of patient's glucose
level over last 60 to 90 days
GlycoMark level provides estimate of patient's post
meal glucose levels over past 1-2 weeks
Evidence that up to 40% of patients whose blood
glucose levels appear well controlled experience
postprandial hyperglycemia
Studies show oscillating hyperglycemia leads to more
damaging complications than constant high glucose
levels
Blood Services Tube Labeling
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Issue: ongoing problems with correct labeling
PSBC specimens and requisitions
Consequence: PSN reports, cancelled specimens
and mother and baby blood redraws
PROCESS
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ENSURE that U # and name not cut off on label
Generally Primary nurse completes PSBC requisition
and specimen label: date, time of blood draw &
signatur
Then 2nd RN comes to patient room & verifies pt's
name, U #, DOB, AND that date and time on label
and requisition match and primary RN signature on
both
Then, second RN signs both
Blood Services Tube Labeling (cont.)
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In emergency if primary nurse unable, second nurse fills out label,
requisition and signs both
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Then primary nurse does double check of correct/matching date and
time on both tube label and requisition and 2nd RN signature on both
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Then, primary nurse signs both
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"STOP" sign posted by tube stop requiring triple check:
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U# clear and complete on label
Date and time the same and on specimen label and requisition
Same two signatures on specimen label and requisition
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Do this triple check prior to tubing sample to TSS—it could save
patient another poke and you another blood draw!
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Other ideas welcome—let us know!
Blood Services Tube Labeling (cont.)
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Have you checked that all required
info on your blood bank tube label
and paperwork are correct,
complete and legible?
Back in the 1500s:
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Baths consisted of big tub filled with hot water
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Man of house had privilege of nice clean water, then
sons and other men, then women and children
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Last of all, babies
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By then water was so dirty you could actually lose
someone in it
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Hence the saying, "Don't throw the baby out with
the Bath water!"