Transcript Top Ten things you need to know - Vanderbilt University Medical

April Staff Meeting
4/14/2011
@ 2pm
Kim Byrum Chappell
Mechanical Assist Coordinator
TOP TEN THINGS YOU NEED TO KNOW…
#1: VAD STANDS FOR:
 Ventricular
 Assist
 Device
#2: WHY ARE THEY USED?
End stage Heart Failure
 BTT (Bridge to Transplant) – Vanderbilt

 Under
the watchful eye of the Transplant
Coordinators

DT (Destination Therapy) – St. Thomas. These
patients will live with this device until death.
They are not transplant candidates.
#3: TYPES OF VAD’S
 Pulsatile
 Continuous
 Axial
Flow
Flow
 Centrifugal Flow
#4: VAD’S IN THE NASHVILLE COMMUNITY



Currently 8 patients are followed by Vanderbilt
St Thomas also implants VAD’s and those patients
could show up at our doorstep
The current VAD you would encounter in the ER
is CONTINUOUS FLOW VAD called the Heart
Mate II (HMII) made by Thoratec, Inc. (Axial
Flow)
#5: CONTINUOUS FLOW = NO PULSATILITY
Will most likely not be able to palpate
peripheral pulses
 Most likely unable to obtain SBP/DBP
 Most reliable/accurate measurement is by
Doppler
 Document under Manual MAP

#6: MEDICATIONS

VAD patients will be on anticoagulants –
Coumadin
Aspirin
 Rare
– Persantine, Plavix,
 More rare/rumor – Dabigatran: there has been
discussion around this Afib approved drug but it has not
been used here…..no antidote.
#7: COMPONENTS
Pump – inside the patient (sounds like
humming)
 Driveline – white tube; exits somewhere in the
abdominal area
 System Controller – the brains
 Battery or Power Base Unit – the power

#8: PATIENTS KNOW THEIR “STUFF”
Will bring a back up system controller &
batteries in case of a failure; typically in a black
bag. Must remain with patient at all times, for
all tests/procedures, transport, etc.
 Do not unplug cables to silence any alarm.
 Do not unplug both power cables at the same
time.

#9. RESOURCES
VAD pager #835-9109
 Thoratec supplied items:

 Clinical
Operations and Patient Management book
 HMII Information and Emergency Assistance Guide
pamphlet
 HMII LVAD Pocket Guide to alarms for Clinicians
 Outpatient Emergency Response Program CD
 Thoratec eUniversity @ Thoratec.com
#10: REMEMBER…..
If they are speaking to you, if they are warm,
pink & with brisk capillary refill they are
perfusing.
 It’s a patient with a pump, not a pump with a
patient – so treat the patient.
 Can auscultate the pump
 Floors trained in VAD patients: 5N & 7N
 You can’t always tell a VAD patient at first
glance

HANDLES WITH CARE
David Pipes
and
Mike Malone
HANDLE WITH CARE
Crisis Intervention Training
HANDLE WITH CARE

A new Joint Commission Sentinel Event Alert warns that health care facilities
today are being confronted with steadily increasing rates of crime, including
assault, rape and murder.

A report from the Substance Abuse and Mental Health Services Administration
notes that drug- and alcohol-related incidents in the ER rose from about 1.6
million in 2005 to nearly 2 million in 2008. From 2006 to 2008, those visits
resulting in violence increased from 16,277 to 21,406. Just last year, more
than half of 3,465 emergency nurses reported in an anonymous, online survey
conducted by the Emergency Nurses Association being assaulted at work

Health care facilities should be places of healing, not harm. But,
unfortunately, health care settings are not immune from the types of violence
that are found in the other areas of our lives," says Mark R. Chassin, M.D.,
M.P.P., M.P.H., president, The Joint Commission. "The recommendations in
this Alert give health care institutions and caregivers specific strategies to
take action that will keep everyone safer

Source: http://www.campussafetymagazine.com/
HANDLE WITH CARE
 There
are well over one hundred
thousand Handle With Care
practitioners working with adults
and children in some of the most
challenging environments in the
United States, Puerto Rico and
Europe.
HANDLE WITH CARE



Every verbal and physical component of
Handle With Care training has been
carefully integrated with the next,
creating a system that is beautifully
simple and coherent.
Those who complete HWC training will
have the verbal and physical tools to
effectively to de-escalate a crisis before it
begins.
When a crisis presents a clear physical
threat, they will be able to make "real
HANDLE WITH CARE
Verbal Intervention (De-escalation)
o
o
o
The Solid Object Relationship Model
(SORM)
The Tension/ Tension Reduction Cycle
(T/TRC)
The HWC Role-Play Workshop
HANDLE WITH CARE
VERBAL INTERVENTION

The Solid Object Relationship Model (SORM)
Illustrates how staff can develop and utilize their
relationship skills with a youth to reduce tension.
1.
Emphasize the importance of staff maintaining an
“affect neutral” posture
2. Understand the underlying dynamics of establishing a
therapeutic relationship
3. Understand the testing process and begin to identify our
personal stressors (“buttons”)
4. Participants examine their own reactions in critical
situation
HANDLE WITH CARE
VERBAL INTERVENTION

The Tension / Tension Reduction Cycle Model
(T/TRC)
Theoretical model used to illustrate the dynamics of escalating
and de-escalating tension as it applies to the youth in crisis,
intervening staff and other youth and staff exposed to the
crisis
1. How tension contributes to inappropriate behavior in youth and
staff
2. Identify responses and behaviors that indicate tension levels are
rising
3. Understand how the T/T Reduction Cycle relates to observations
of self, staff and youth
4. Understand when verbal and/or physical interventions become
necessary
HANDLE WITH CARE
Physical Intervention
o
The Personal Defense System
o
The Primary Restraint Technique (PRT)®
o
The Modified PRT for Smaller Children
o
Team Restraint
HANDLE WITH CARE
Personal Defense - Escape
Techniques from:
1.
2.
3.
4.
5.
6.
7.
8.
9.
Same side wrist grab
Two on one wrist grab
Two on two wrist grab
Cross hand grab
Front choke / lapel Grabs
Rear choke
Hair pull
Bite
Arm bar choke from behind
Use of Personal Space
1. Spatial considerations
and strategies
2. The Non-Defensive
Posture
Personal Defense Blocking Techniques
1. Straight punch /
straight incoming assault
2. Hook punch / blunt
weapon / thrown object
3. Kicking assault
HANDLE WITH CARE
The Primary Restraint Technique (PRT) & Takedown
Interfacing the PRT with the entire Personal Defense System




Two Person Escort / Two Person Team Restraint & Takedown
The HWC Speed Cuff System (optional)
One Person PRT (standing & neutral position)
Two Person PRT (standing & neutral position)
Two and Four Person Team Restraint, Takedown & Transport S
Specialized Intervention Strategies




Breaking up fights
Managing pregnant women
Managing small children
Therapeutic use of seclusion and mechanical restraints (optional)
HANDLE WITH CARE
KIANEXIUS TRAINING
Ten Minute KiaNexius Training:
http://www.kainexus.com/training.html
CATHY WILSON
EDUCATION UPDATE
 Mandatory May Inservice
 Annual Competencies
 Philips End Tidal CO2 Monitoring (next slide)
Philips
End Tidal CO2
Monitoring
By Cathy Wilson
CHRIS RUCKMAN
MANAGER UPDATE
Hand Hygiene- overall for March 74%, down from Feb. 75%
 Service Center Committee
 Equipment: dinamap / A Pod Trauma Monitor
 Staffing Variance

RNs- 2 FTE vacancies / 1 PTE (multiple interview completed)
 Paramedics- 3 FTE vacancies
 MHT- position filled
 Care Partners- 3 FTE vacancies (multiple interview in progress)

CONT. MANAGER UPDATE……
CONGRATS Vanderbilt list at top 100 Hospitals
 CONGRATS on 2011 Healthgrade.com Award
 Uniform Trial- going well so far, only a couple issues (4/1-9/1/2011)
 Welcome to all new Nurse Residents
 New Social Worker: Lauren Goley Sat-Mon 7p-7a
 Time and Attendance / Deadlines / Emails
 Spindle

CONT. MANAGER UPDATE……
Kudos
 QUESTIONS???


As always my door is open to anyone who would
like to come and talk, please come talk to me I
encourage you to!