TJC (JCAHO) expected soon!

The hospital is expecting surveyors from The Joint Commission starting Monday, June 22 or the following week of June 29. The unit is looking "survey ready", so please do your part to keep it in tip-top shape. Now would also be a good time to review your red booklets.

N95 mask fittings/PPD walk-in clinics

Don't forget that having your mask fit test and PPD completed in a timely manner is part of your job requirements. If you're due or past-due for these tests, you can come to one of these clinics without an appointment:

Monday, June 22
Foothills Chairman's Room
12-1:30 pm

Wednesday, June 24
Alcove outside Gene Wilson
12:30-2:30 pm

Diabetes Teaching Supply Kit

Beginning Monday, June 22, all nursing units will be stocked with a "ready to go" Diabetes Supply Boxes. Wahoo! Inside each box, you will find tote bags filled with items that your may need for education.

The contents are available in English and Spanish, and they will include:

• Educational video
• Comprehensive diabetes reference guide
• Meal planning guide and carb counter
• Pedometer
• Glucometer and instructions
• Schedule of support groups and meetings

Patients may take these tote bags and their contents home. They are free of charge for patients who begin their diabetes education with us. The boxes are restocked by the flow nurses.

If you have any questions, please contact Emily W. @ ext. 2379.

O2 tanks

Storage for oxygen cylinders is in the respiratory closet. If you have an O2 tank that is low or empty and needs replacement, purchasing will only switch it out if the tank is in the storage area. Tanks that are in wheeled carriers in the hallways and patient rooms will not be switched out because purchasing considers them "in use".

Patient belongings

Patient belongings should be charted and described specifically upon admission. For instance, instead of simply documenting "clothes", write "blue jeans", "wool sweater", "fur coat", etc. Do the same with jewelery, but you need to be general with this as we cannot determine what is a diamond or 14 karat gold. An example would be "ring with white stone", "gold pendant necklace", etc. Specific documentation can protect the hospital from litigation if a patient claims that the hospital misplaced their fur coat. If you have any questions, please see Peggy.

Assignments with 4-5 pts in a shift

If you are assigned to 4-5 pts for a shift, write your name and date on a sheet found in the purple binder (you know, the "old schedule" binder). You will find this sheet behind the LOL list.

Guidelines for H1N1 flu

The CO Dept. of Health has issued updated guidelines for caring for pts with suspected or confirmed H1N1 flu.

These pts can be placed in Droplet Precautions (not negative pressure room) with the use of standard precautions UNLESS a procedure is being done that would cause secretions to be aerosolized (intubation, bronchoscopy, nebulizer treatments). If aerosolization may occur, staff should wear the N95 mask.

3W MDRO Precautions

As stated in an earlier post, 3W will be implementing formal isolation procedures for our pts with infections requiring protective isolation. May 18th is the day that these procedures will become official, so now is a good time to familiarize yourself with what you need to do.

• Isolation carts: The contents of the carts have all been standardized. A contents list is secured to the top of all carts. In the list you will find the ordering number for each item, should you need to replenish the stock. The staff discharging the pt is responsible for restocking the cart.
• Nurse servers: These must be closed and secured with "caution" tape whenever a pt is placed in isolation. Two old IV trays have been converted to stock items that are normally found in the nurse server. These supplies are additionally bagged in biohazard bags. Only bring into the room whatever supplies you actually need. Remember that everything that comes out of the room must be cleaned or disposed.
• Linen bags: You may still use these as usual. Clean linen should only be brought into the room on an as-needed basis.
• Room equipment: If a piece of equipment is not needed, remove it from the room before the pt arrives. Equipment that can be removed from the room (such as IV poles) will be tagged with the "Clean/In Use" tag. Items that stay in the room are not tagged. The person removing the equipment from the room is the one responsible for cleaning it. Keep walkers in the room until discharge; when they are no longer needed, clean them and store in the PT office. O2 tanks will be tagged; clean appropriately when removing from an isolation room. Equipment that is tagged and can be removed from the room will stay with the pt for their entire hospitalization.
• Tergo wipes: Keep an eye on these. If you find any with mold growing on them, place them in a garbage bag and place outside of Melissa's office. We should be checking the bin of Tergo wipes once a week or so to monitor for mold. Alert Melissa if you have any issues.

Please contact Melissa if you have any questions. More information will be coming soon!

Showers for OHS pts

Per Peggy, OT is not required to do the first shower with our open heart pts. It is a good opportunity for the primary RN to assess the pt and begin teaching. RNs should check to make sure that all dressings are removed, PICCS/peripheral IVs are covered, and pacer wires are insulated before the shower. Any moisture at invasive sites promotes to growth of bacteria. Peggy is working on a new post-chest tube-removal dressing that would allow the patient to shower the same day as chest tub-removal. For now, pts must wait 24 hours after the tubes are removed before showering.

Need a good laugh?

Check out this "educational" video about AV node blocks..thanks to Michelle Mo for the link!

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.