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

OHS Audit Tool

We have a new OHS audit tool that needs to be filled out. There is a now section that we need to fill out PRE-op. Any questions can be directed to Melissa.

RN Recognition

Don't forget...RN recognition packets are due this Tuesday, March 31!

Class Offering - Documentation and Legal Issues

"Thorough Documentation: The Best Evidence of Care"

April 8, 11:30 am to 1 pm

Gene Wilson

BCH will hosting a speaker who is an expert at legal issues in nursing documentation. This class will provide nurses with an overview of legal implications of documentation and practice. Our speaker will help you identify "pitfalls" in documentation and practice, list four elements that establish professional negligence, and discuss liability issues in practice and documentation.

Any questions can be directed to Emily W. at ext. 2379.

New PCEA pumps coming!

Broadway will be receiving new PCEA pumps soon that are already in use at the Foothills campus. They are touted as "more user friendly" than the current pumps. Training sessions will be held to allow you to familiarize yourself with the new equipment:

• Monday, April 13, 7-11 am in Gene Wilson B
• Wednesday, April 15th, 2-6 pm in Homer Ball

If you are interested in or designated to be a "super-user", the training session for that will be Monday, April 17, 8-10 am in Gene Wilson A.

Contact Emily W (Nursing Education Coordinator) at ext. 2379 if you have any questions.

Diabetes Education Classes for Pts

Starting in April, BCH will hold a bi-weekly Diabetes update class. These classes are informal, taught by a Certified Diabetes Educator. They are open to patients, families, and healthcare providers. Registration is not required and you may attend as many classes as you want. The classes will be held throughout the year on the 2nd and 4th Mondays of each month. The upcoming schedule is as follows:

• April 13th and 27th, 1-4 pm in Homer Ball
• May 11th and 18th, 1-4 pm in Homer Ball
• June 8th, 4-8 pm in Gene Wilson A
• June 22nd, 1-4 pm in Homer Ball
• July 13th, 4-8 pm in Gene Wilson A
• July 27th, 1-4 pm in Homer Ball
• August 10th, 4-8 pm in Gene Wilson A
• August 24th, 1-4 pm in Homer Ball

Fall and winter classes will be held the 2nd and 4th Monday per month at the Broadway campus. Please encourage your patients to attend these classes. If you have any questions, please Mox or call the Nursing Education Coordinator, Emily W., at ext. 2379.

From Infection Prevention Land...

If a pt is placed in Clostridium difficile precautions due to a positive C. diff toxin assay (different from a C. diff culture), they will remain in precautions for the remainder of their stay. A patient can only be removed from precautions during their stay if they have a negative C. diff culture. The catch? The C. diff cultures are not done in-house, they are sent to the lab at Mayo Clinic and usually take about 7 days. We cannot use a negative C. diff toxin assay to remove someone from precautions.

C. diff yucky equipment and other stuff is cleaned with the blue microfiber cloths and Sanimaster spray. The blue microfiber cloth literally picks up the C. diff spores (can you say "shamwow!"?) Use Tergo wipes for non-C. diff cleaning. Speaking of Tergo wipes...did you know that there have been a few instances in which mold was seen growing under the lid? Ew. We can prevent this by rinsing out the canister (after it has expired) with water and drying it with a blue microfiber cloth. Then refill as usual. Don't forget to write the expiration date...90 days from the fill date. Beth can answer your questions about any of this at ext. 2339.

Policy Update: Reporting Critical Labs and Tests

• When notified of a critical lab or test, record it in the pt record. Record the date and time info was received, and read back the information to verify.
• Report this information immediately to the pt's primary RN.
• RN must notify MD in a timely manner as dictated by nursing judgment, but within 2 hrs. Do not leave the critical value on an answering machine or give to the answering service. It is OK to relay the critical value to office staff. Ask the person receiving the result to "read back" the result to ensure that it was heard correctly. Document the date, time, and the name of the person the message was given to. A call back from the MD is expected within 30 min.
• For EKGs, MD is to be notified stat if the machine reading says AMI, VF, or VT. (Did I really just write that? You can thank Captain Obvious for this one.)
• Critical diagnostic imaging results will be communicated from radiologist to MD. Exams ordered stat will be called right away, those ordered with "call report" will be called within 2 hrs. If you are concerned about a critical result when a test is ordered in Meditech, be sure to enter "notify physician of results" in the comments section.

Reference: Guideline: Reporting of Critical Test & Results, # 2.120

Policy Update: Med Reconciliation

This is a really good policy to review in light of TJC's upcoming visit. Here are the key points...

• Med Rec happens upon admission, transfer to another level of care (including surgery), at discharge, and before outpatient procedures. Form 17 must be used when transferring levels of care and at discharge.
  
• Upon admission, the RN, pharmacist, mid-level provider, or physician will complete the Home Medication Admission Orders form. Consult the pt's PCP, home pharmacy, and/or family in order to obtain the most accurate list. Fill out the form completely, including immunization history, allergies, herbals/supplements, etc. Any discrepencies must be clarified. This whole process must be completed within 24 hrs of admission.
  
• If additional medication history becomes available after the form has been scanned to pharmacy, the med history may be updated by completing an additional Home Medication Admission Orders form. The MD still need to complete and sign the additional form.
• Herbal medications and supplements can be ordered on the Physician Orders form. Since BCH does not supply herbals, pts must bring the ones ordered by the MD from home. The herbals must be then given to pharmacy for identification. The pt would then be allowed to take them per Patient Own Med policy.
• When a pt is transferred to surgery, all previous orders are cancelled. New orders must be written post-op.
• Upon discharge, the home medication list must be reviewed with the Form 17 for DC.

Reference: Medication Reconciliation, # 2.122

Policy Update: Med Admin Unanticpated Events

This isn't really anything new, but it was reviewed this past January. Here are the highlights, please refer to the policy for full text.

An unanticipated event is considered a medication error or adverse drug event (reaction).

A med error is defined as:

• A med given that was not ordered
• Wrong dose or extra dose given
• Omission of a dose without a reasonable explanation documented on MAR
• Drug given in wrong form, wrong route, or wrong patient
• Drug given at wrong time. Exceptions for surgery or procedures must be documented. A 2 hour window is OK for most standard meds. Antibiotics need to be given within 30 minutes of scheduled time.
  
• Any circumstance that pharmacy and nursing believe is a med error.

An adverse drug event is an undesirable or unexpected result from a drug that requires discontinuation of the drug, modification of a dose, prolonged hospitalization, or providing supportive treatment.

If one of the above occurs, notify charge nurse and attending MD. Also notify for medication refusals by the patient.

Document:

• Acutal drug, dose, route, etc. of drug given in error on the MAR.
• When a drug is not given (and why) or refused.
• In the patient record - the event, the outcome, and who was notified.
  
• File an Occurrence Report, but do not chart that an Occurrence Report was filed.