Isolation Precautions

Melissa has posted educational posters about our 3 West Isolation Precautions/Procedures in the education room and the staff restroom. Here's what you need to know!

• Proper Identification of the Pt: Do they have a hx of MRSA/VRE? Is there Gram + cocci (GPCs) in clusters reported from the lab? Notify Infection Prevention @ ext. 2336 when pt identified.
• Proper Room Set Up: Equipment tag In Use, tape the nurse server closed (but use the linen bag as usual). Make sure there is disposable equipment in the room such as a thermometer, stethoscope, and BP cuff.
• Proper Education: Provide pt, family, and visitors with written information (found in Meditech under policies -> infection prevention, available in English and Spanish). Remind other staff (transporters, PT, OT, RT, etc.) as needed. Remind physicians of standards if you notice them not adhering to them (like taking the chart in the room).
• Proper Attire: Use shoe covers as needed. Make sure the isolation cart is well-stocked. Use MAR paper covers.
• Proper Discharge Procedure: Dispose of everything, strip bed linens, leave isolation signs on the door for EVS. Restock the isolation cart for the next pt.
• For all equipment like Dash monitors, walkers, O2 tanks, etc., clean with Tergo wipes (or spray/blue microfiber cloths for C. diff) between pt use.
  

Melissa is putting together a "tool box" to place on the nurse server for things that are usually accessed in the nurse server drawers. It will be minimally stocked with the basics like alcohol wipes and tele stickers, since most things will need to be disposed at discharge.

Infection Prevention Reminders

The flu in the news is a good reason to remember the basics when it comes to infection prevention.

• Wash your hands, wash your hands, wash your hands. It's the #1 way to prevent the spread of communicable disease.
  
• Cover your cough. All patients who have an active cough or upper respiratory symptoms must wear a surgical mask. The patient must also perform hand hygiene each time they sneeze or blow their nose.

The Infection Prevention department is keeping abreast on the developments with the H1N1 flu. If you have any questions or concerns, feel free to contact Beth @ ext. 2229 or Leslee @ ext. 2336.

Evaluations

As you may remember from a staff meeting a while back, the SQR (Service Quality Review) is being replaced by the SEE (Service Excellence Evaluation). The gist is that your annual performance evaluation looks at how well you meet your personal goals and how you contribute to organizational goals. This in turn is tied to whether or not you receive an annual pay increase (or if you happen to be at the top of your pay grade, you receive a topout bonus).

The SEE can be completed on Performance Manager, just like the current SQR set-up. After June 1, all evaluations will use the SEE tool. After October 31st of this year, all employees will be evaluated from that date until January 31, 2010.

Annual salary increases will continue as scheduled up until October 31, 2009. All increases after that date will be moved to January 31, 2010 and will be prorated accordingly. Everyone who is eligible for a topout bonus (employees at the top of their pay grade) will receive their bonus around February 19, 2010. Employees who receive a written reprimand or letter of final warning between 6/1/09 and 1/31/10, or do not meet Encore values will not be eligible for a pay increase or bonus.

Job Requirements

As of July 1, 2009, you must keep up to date on the following or you will not be allowed to work:

• On Performance Manager: Fire Safety, Hazardous Materials, Emergency Preparedness, Hand Hygiene, Bloodborne Pathogens, Understanding TB, and Infection Control.
• Employee Health: Documentation of immunity to measles/mumps/rubella, PPD & N95 mask fit test, proof of immunity to Hep B (or sign waiver declining vaccine).

These requirements must be fulfilled by June 30, 2009 or you cannot work. You will be sent a letter 90 days before the due date reminding you if you are due for employee health requirements. Directors will get a list of those not in compliance on a monthly basis.

To schedule an appointment with Employee Health, call ext. 2108. If you have questions about Performance Manager, talk to Kate in HR @ ext. 2426. Don't forget, there is a link to Performance Manager on the lower right hand side of the blog!

Campaign to Improve Blood Transfusion Outcomes

BCH is looking to improve outcomes in patients undergoing blood transfusion. We know there are risks involved, but what do we really know?

• 1 or 2 of every 100 blood transfusions result in some form of transfusion reaction
• The chances of acquiring an infection increases by 50% with each unit of allogenic blood transfused
• 1 in 350 transfusions is associated with transfusion-related circulatory overload (TACO), which can lead to respiratory problems, HTN, and lung disease.
• 300-500 deaths occur each year from transfusion-related acute lung injury (TRALI).

The Blood Utilization Steering Committee is devising ways we can all work together to update our practices in blood transfusion. Look in the Scoop and here on the blog as more information is available.

Swine Flu public info sources

• Centers for Disease Control: www.cdc.gov/swineflu - This is a great resource, with pretty much everything you'd ever want to know. You can sign up for email updates through the CDC here.
• Boulder County Public Health: http://www.bouldercounty.org/health
• Colorado Dept. of Public Health: http://www.cdphe.state.co.us/

Click on the green box on the lower right hand side of the blog to link to the Dept. of HHS and CDC. More information will be posted that is specific to BCH when it becomes available.

Are you current on your N95 mask fit test? Call Employee Health to get your fit test completed.

Legalities in Documentation Class

If you were unable to make it for this class, Emily (the nursing education coordinator) is compiling the notes so that you can take a look at them.

Reminders

• We cannot secure O2 tanks to IV poles with tape. There are several IV poles with holders for O2 floating around the unit. Come to Melissa if you have questions about this.
  
• Don't forget to chart your pt's BMs. 'Nuff said about that...
• If you need to administer a medication that requires rotation of sites, please document the site the med was given.
  
• Check the alarm limits on your pt's tele monitor. This can be dangerous if not set properly. For example, a pt was in SR, but went into afib and the alarm never sounded when the HR was 165. It was soon discovered that someone on a previous shift had changed the HR alarm limit to 180!
  

When In Doubt, Throw It Out

Pharmacy has made a change in regards to injectable narcotics. Meds that are placed in the Pyxis return bin will be taken to pharmacy and destroyed. This will decrease the likelihood that pt could receive a tampered medication. Keep this is mind and try to make sure your pt really wants the med before you take it out of the Pyxis (save $ wherever we can).

Varicella Titers

Employee Health is sending out memos for everyone to provide proof of immunity to varicella. Please wait to receive this memo before you have a blood titer drawn. The lab requisition must accompany the blood specimen in order for it to be processed correctly.

Programs for cheap meds

I recently read this article about people who are forced to skip doses or split their meds because they cannot afford the medication. Med compliance is so important, especially for our HF patients. If you have someone that might need help with the costs of meds, here a few internet sources:

• Patient Assistance Programs - www.rxhope.com
• NeedyMeds - www.needymeds.org
• Patient Assistance Programs - www.patientassistance.com
• Patient Advocate Foundation - www.patientadvocate.org
• Partnership for Prescription Assistance - www.pparx.org

On the side bar on the lower right hand side of the blog, I have a list of links to the low-cost programs from Wal-Mart, Walgreens, Target, and Costco.

New Meals On Wheels program for hospital patients

Meals on Wheels of Boulder is offering a new service for recently discharged patients from hospitals and rehab facilities. They can deliver one hot meal per day for five days, prepared for any dietary restriction. There is no restriction on income to take advantage of this service. For more information, go to www.mowboulder.com.

Skills Lab next week!

Don't forget, Skills lab will be held next Tuesday and Thursday!

STAT team

A couple of changes have been made with regards to utilization of the STAT team. The option for a phone consultation with a STAT team member instead of a bedside assessment is no longer available. The STAT team activation will remain a team approach and response.

For emergent and urgent transfers to the ICU, activation of the STAT team is highly encouraged. This is not to second-guess the abilities of the nurse or physician involved with the patient, it is to promote the smoothest hand-off possible between care providers. During these emergent transfers, hand-off communication is often poor, the receiving unit is not prepared, and patient transportation is not as safe as possible. With STAT team involvement, the following can occur: a face-to-face hand-off, assessment of any tests needed during transport (to cut down on "road trips" after ICU arrival), a nurse-escorted transfer, monitoring during transport, additional support if the situation turns into a Code Blue, and time for the receiving nurse to set up for the patient.

When transferring a patient to the ICU, don't forget to fill out a hand-off form. Of course this may be the last thing on your mind when trying to stabilize your patient, but it may be competed after the transfer. This form allows a back-up just in case any information is lost in the transfer.

If you have any questions, please direct them to Holly P. (director of ICU/ED), or Tracy N. (manager of ICU).

Meditech upgrade begins this October, Mox exits in July

As you may have read in The Scoop, our Meditech software will begin the first phase of upgrade October 1, 2009. The project has been dubbed NORMA, which stands for No One Runs Meditech Alone. The goal is to achieve a fully electronic medical record. The project is slated to take 5 years total. The federal government is requiring hospitals to have fully electronic medical records by 2014.

In other technology news, we will bid farewell to the Mox mail system this summer (approximately July). The Mox email system will be replaced by Microsoft Outlook 2007. All persons with an "@bch.org" email address will automatically be converted to Outlook so that the hospital will only be using one email method. With Outlook, you will have a global directory of hospital email addresses to select and send emails to (which is much easier than the current system). Outlook will also provide a calendar which will help you keep track of meetings or other important events. The calendar will also allow you to see who is busy and who is free.

Policies in Mox will be moved to an online Internet portal system called SharePoint. SharePoint will keep track of the changes in policies and alert you when changes are made. SharePoint promises to be more user-friendly when searching for policies. SharePoint will be the central location to view important announcements and access the latest edition of The Scoop.

In the meantime, you are encouraged to clean out your Mox inbox and delete whatever files you do not want. This will make the transition from Mox to Outlook much easier and less time-consuming.

Key dates:

• July 2009 - Mox replaced by MS Outlook, Mox Policies replaced by SharePoint.
• October 2009 - Meditech MAGIC, Client/Server functionality will be replaced. This includes Admissions, Lab, Pharmacy, Imaging, Order Entry, Billing, Materials Management, and everything else that works off Meditech today.
• 2010 - OR will replace their current system, PICIS, with new online clinical documentation.
• 2011 - Online Nursing documentation and medication dispensing.
• 2012 - Physician order management and clinical documentation.

More information and training will be coming up in the months ahead.

Looking for Something?

Do you remember seeing something on the blog, but aren't quite sure how to find it? Here are a couple of ways to find what you need:

• At the very top of this page is a navy blue bar. In the left-hand side of the bar, you will notice a white box, followed by a button that says "search blog". You can type in a phrase into the white box, then click "search blog". Matches to your phrase will appear.
  
• For an even easier way to find what you need, you can use the index method. Scroll down the blog page, and on the right-hand side, you will see a section titled "Subjects and Labels". I have indexed all of the postings under their appropriate label. Say you are looking for a class...click on "nursing education", and all of the class details will be shown. If you are looking for details on an upcoming meeting, click on "meetings".
  
• For classes and meetings, I will post the details about when/where/registration in a regular blog post. The date/time/place only will be posted in the side bar, in order to save space. Use the index method I explained above to search for a class.

If there is something you would like to see on the blog, please send me an email: BCH3Westblogger@gmail.com

Class Offering: Basic/Intermediate EKG

Dates: May 14th (0900-1700) in HBB, and May 15th (0900-1400) in GWA. Another session will be held September 3rd & 4th.

Cost: Free for class, $25 for workbook. You cannot clock in for this class.

Focus: Beginners, those who are "rusty" with their rhythms. 35 rhythms are covered, as well as their causes and treatment. You can attend both days of the class; those taking this class as a "refresher" can attend both days or just the second day.

Registration: Call Cardiopulmonary @ ext. 2095. If you register, but are unable to attend, please call to cancel your spot so that others can sign up.

Questions: Mox Curtis Stringer (who is teaching this class)

Class offering: Care of the Patient with Acute Coronary Syndrome

Care of the Patient with ACS will be offered on Tuesday, April 28th from 0900-1500 in the BCH conference center. Sign up through Vicki C. @ ext. 2074.

NANDA Nursing Diagnosis

Click here for a link to a list of 2007-2008 NANDA-Approved Nursing Diagnoses.

TRALI - What you need to know!

What is TRALI? It is an acronym for Transfusion-related Acute Lung Injury. If you haven't heard much about it, you will soon! Peggy has more education about it in the pipeline. In the meantime...an introduction:

"TRALI should be suspected in all cases of dyspnea and hypoxia temporally related to blood transfusion. Dyspnea due to bronchospasm associated with allergic/anaphylactic reactions can be readily identified based on the accompanying urticarial rash. Dyspnea associated with pulmonary edema after transfusion may result from TRALI or from transfusion-associated circulatory overload (TACO). Differentiation between TACO and TRALI is important from patient treatment and blood donor management perspectives. Recently an algorithm was developed to help eliminate clinicians and researchers in managing patients with respiratory symptoms associated with blood transfusion. Hydrostatic (TACO) and permeability (TRALI) pulmonary edema may coexist. Hence, evaluation by a critical care specialist may be necessary."

Reference: Blood Bulletin, July 2006. Volume 8, No. 2