Transcript Adult ED Staff Meeting - Vanderbilt University Medical Center

Adult ED Staff Meeting
December 16, 2010
Quality Data
-Jackie Ashburn
December 16, 2010
Antibiotic Stop Times
• First IV antibiotic per
patient.
• Documentation in
Nursing assessment or
Order Tracker
• Lost of $128.00 per
medication/ Drips.
Month
Lost Revenue/ week
Aug-10
$7,680.00
Sep-10
$7,552.00
Oct-10
$8,320.00
Nov-10
$5,632.00
Urine Contamination
Non contaminated Urines
90.00%
85.00%
 Up is Good
Goal is 85%
Remember:
Percentage
goal 85%
Give wipes
Instructions are key
Never assume they know (
including men)
Instruct to collect mid stream.
80.00%
75.00%
70.00%
Don’ts:
Use bedpans or urinals ( They are
not sterile
Never use a sample that is greater
than 30 minutes old
65.00%
60.00%
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov09 09 09 10 10 10 10 10 10 10 10 10 10 10
Oct- Nov- Dec- Jan- Feb- Mar- Apr- May- Jun- Jul- Aug- Sep- Oct- Nov09 09 09 10 10 10 10 10 10 10 10 10 10 10
Series1 71.0080.00 81% 85.0083.0080.0080.00 85% 75.0072.0079.0083.00 75% 73.00
Blood Cultures
Blood Cultures Reported as Possible
Contamination
10.0%
9.2%
8.6%
8.0%
7.00%
7.0%
6.3%
6.0%6.0%
5.9%
6.0%
5.20%
5.0%
3.80%
4.0%
3.70%
3.30%
3.00%
2.75%
2.64%
2.50%
2.18%
2.07%
1.88%
3.0%
2.0%
1.0%
Nov-10
Oct-10
Sep-10
Aug-10
Jul-10
Jun.10
May.10
Apr.10
Mar.10
Feb.10
Jan.10
Dec.09
Nov.09
Oct.09
Sept.09
Aug.09
0.0%
July. 09
% of Blood Culture Contamination per Total
9.0%
Jun. 09
Sterile procedure
 Can not draw from IV
lines
Unless MD order to
indentify line infection
 Remember to scrub site
and do not touch after.
 Any difficulty document

Hand Washing Audits
• October 2010
• November 2010
Hand washing Audits
December 2010
EDIS
-Elizabeth Banks
December 16, 2010
VPH to Inpatient Transfer Process
• VPH patient to ED for treatment visit
– Patient remains a VPH patient in Medipac (admission,
discharge, transfer system)
– This is for insurance purposes
• If VPH patient admitted to VUH
–
–
–
–
Patient must be discharged from VPH
Readmitted to VUH in obs or inpatient status
New case number is generated for patient
Process in place to replay as many orders as possible
VPH to Inpatient Transfer Process
• Admitting Liaison starts process by notifying ED
charge nurse with this page: “Bed name (MRN): Please
notify Primary Nurse to play back order for VPH patient after
Admitting Liaison completes the discharge process.”
• Admitting Liaison will archive orders in
HEO/WIZ.
• Once process is completed, Admitting Liaison
will notify Charge Nurse that HEO/WIZ orders
can be played back
VPH to Inpatient Transfer Process:
– All documentation in Order Tracker should be
completed prior to the transfer process
– When patient is discharged from VPH, all orders
that appear in Order Tracker for that VPH case
number will no longer be present in Order
Tracker
– Orders can be viewed in StarPanel under ED
Orders (this shows which orders completed, not
completed)
VPH to Inpatient Transfer Process:
Key Features
– All archived orders that are re-played will
come across to Order Tracker as new orders
– One time Stat orders will not archive and
playback because these orders are
considered as past orders
– If the One time order is not yet completed,
re-enter order in HEO/WIZ so that you can
document the order as “done” in Order
Tracker
Magnet
-Dawn Hawley
December 16, 2010
YOU ARE MAGNET
• Evidence Based Practice
• Team Support and Leadership
• Encouragement and Education
• Community Involvement
• Commitment to Professionalism
ANCC – New Magnet Vision
To be the fount of knowledge and
expertise of nursing care
globally. Will be solidly
grounded in core magnet
principles, flexible, and
constantly striving for discovery
and innovation. Lead the
reformation of healthcare, the
discipline of nursing and care of
the patient, family and
community.
Ye Olde Magnet Faire
Timeline
Month
Goals
July/August 2009
• Work launched
• Document writing
January 2010
• Magnet Champions Education
October 1, 2010
• Document submitted
• Preparation for site visit
NOW
•
•
•
•
February/March 2011
• Probable site visit
Continued work with Champions
Education
Practice
Continue Magnet work
5 Magnet Model Essential Elements
1. Transformational Leadership
2. Structural Empowerment
3. Exemplary Professional
Nursing Practice
4. New Knowledge, Innovations
& Improvements
5. Empirical Quality Results
Transformational Leadership
• Identification of/understanding of nursing leader
roles
• Nursing Strategic and Quality Initiatives
• How do you as a leader gain/use staff input for
decisions & examples?
• How do you as a leader value, encourage,
recognize/reward & implement staff ideas
(innovation)
* Key – Staff as Transformational Leaders
Structural Empowerment
VUMC Nursing Shared Governance Model
Structural Empowerment
How does SG work in your area & EXAMPLES
Structures that support:
•
•
•
•
Professional Engagement
Professional Development
Community Involvement
Recognition of Nursing
The Vanderbilt Reputation
• Ranked in Top 10 in 2009 US News &
World Report in 3 Specialty Areas
• Ranked in Top 25 in ALL Pediatric Specialty
Areas (US News & World Report, 2009)
• One of “Fortunes” Best Companies to Work
For (Fortune, 2009)
• Of 371 Magnet Status Organizations,
Vanderbilt is one of only two in TN (ANCC,
2010)
Exemplary Professional Practice
Vanderbilt Nursing Professional Practice Model
Exemplary Professional Practice
• How is the PPM implemented in your area?
o Staff Satisfaction Data
• How do you deliver care?
• Staffing, Scheduling & Budgeting
• Interdisciplinary Collaboration
Exemplary Professional Practicecontinued
• Performance Evaluations/Peer Reviews/Goals
• Ethics, Privacy & Confidentiality
• Diversity & Workplace Advocacy
Exemplary Professional Practicecontinued
Culture of Safety
(Proactive – Improve - Outcomes)
•
Staff and Patients
•
Nursing Sensitive Quality Indicators
o Total falls vs falls with injuries
o Pressure Ulcers
o Restraints
o All infections
o Peds IV infiltrations
o Handwashing
o Medication Reconciliation
o Others
Exemplary Professional Practicecontinued
Quality Monitoring and Improvement
(Outcomes, Outcomes, Outcomes)
• Patient Satisfaction
• How nurses coordinate care
New Knowledge, Innovations and
Improvements
• Research
• Evidence-Based Practice
• Innovation
Magnet Champions
Adult Emergency Department:
Hawley, Dawn
Bransford, Bill
Knipp, Kory
Hamilton, Mary
Brusch, Joan
Vanderveldt, Gina
Grubbs, Ali
Brumley, Laren
Sims, Matt
Locklayer, Anthony
Kossler, Rebecca
Beckstead, Chris
Wilson, Cathy
Vanderbilt Nurses are the Elite
• In 2009, 19,545
applications were
received.
• 1350 people were
hired.
PRC
-Marsha Price
December 16, 2010
14 - Now I would like to ask you some questions about the DOCTOR or DOCTORS who
treated (you/your family member) in the emergency room. Overall, would you rate the
quality of doctor care as:
19 - Would you rate the overall teamwork between the doctors, nurses, and staff as:
27 - Would you say the likelihood of your recommending [+hospname+] to friends and
relatives for emergency services is:
29 - (30525402) Overall, would you rate the quality of care provided as:
Stroke Update
-Ali Grubbs
December 16, 2010
IV tPA: High Alert Medication
• IV tPA is now a high-alert medication at VUMC which
means that staff should follow safety strategies and
defined procedures during all steps in the medication
use process in order to minimize risk.
• Being a High Alert medication means that IV tPA bears
a heightened risk of causing significant patient harm
when used in error.
**Review the Policy: High Alert and Look-Alike Sound-Alike Medications CL 30-06.26
https://mcapps.mc.vanderbilt.edu/EManual/Hpolicy.nsf/AllDocs/DA7AB99D84815A4C862577AF00747227
IV tPA: High Alert Medication
• Administration of IV tPA as a high alert drug involves:
– Primary nurse verifies drug indication corresponds to
patient diagnosis and appropriate monitoring has been
reviewed
– Two licensed staff will verify the following prior to
administration of IV tPA:
• Drug and dose based on patient weight
• Amount of waste
• Amount of bolus to be administered over one minute
IV tPA: High Alert Medication
• Amount of IV infusion via infusion pump to be
administered over one hour
• Primary nurse will verify waste amount withdrawn from
vial followed by bolus dose withdrawn from vial
followed by infusion dose administered via infusion
pump
• Primary nurse will document waste amount and name
of second licensed staff member who witnessed waste,
bolus dose amount and time administered and infusion
dose amount and time initiated in EMR.
TWiG Working Group
-Kevin High
December 16, 2010
TWiG Working Group
Requirements
• Must be off orientation and actively assigned to
trauma (may be staff, charge nurse or
paramedic)
• Willing and able to participate in this process;
answer email/inquiries promptly
• Attend meetings set up by the group (on/off
campus)
Projects
•
•
•
•
Develop Room Checklist/Standards
Outline Orientation Contents
Standardize Practice within Bay
Outline Core Requisites to work in Bay
Domestic Violence
Know the Facts
• Domestic Violence is any pattern of behaviors that attempts to control an
intimate partner or family member by the use of fear, manipulation,
isolation, intimidation, physical, sexual, and/or verbal abuse.
• Tennessee consistently remains in the top 10 states for domestic violence
related homicides. Currently, we are number 5.
• One in four women will experience some form of abuse in her life.
• In America, every day three women are murdered by the man who says
he loves her (American Bar Association Commission on Domestic Violence).
• The sole purpose of domestic violence is power and control.
• Typically, this control starts out slowly, and increases over time.
Weaver Domestic Violence Center
• Weaver Center is the largest domestic violence shelter in Tennessee.
• We provided 15,753 bednights of shelter last year to 233 women and 187
children fleeing domestic violence.
• Staff answered 3,791 calls on our 24-hour crisis line.
How can you help?
• Call the YWCA Crisis and Information line at 242.1199 or 1.800.334.4628.
• The Crisis and Information Line is available for anyone whether they are in
immediate crisis or seeking to offer assistance or support to someone who
is in danger.
• Call the YWCA crisis line to get support on how to talk to a friend or family
member regarding safety planning.
Susan French
Director of Outreach Services
983.5150
[email protected]
A Few Reminders – Marsha Price
• If at all possible, please sign up for text paging
• Triage nurses: please let the triage attending
know if a patient elects to leave without being
seen. Triage attending will communicate a
plan and wait times to minimize our LWBS
patients
• There is a new policy with regard to the
Labeling of All Lab Specimen. They all must be
labeled with your VUNET ID.
HAPPY HOLIDAYS!!!
Meeting Evaluation – Marsha
•
•
•
•
•
5 – Excellent
4 – Very Good
3 – Average
2 – Below Average
1 - Poor
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HAPPY HOLIDAYS!!!