December 2010 Editor: Jody Schipper, MSN, RN   Professional Development Coordinator   Phone: 235-3782   Email: schippjm@ihs.org   Deadline for article submission is the 5th of each month

Nursing Recognition Dinner

The Nursing Recognition Dinner was held Monday, December 6^th at the Barrett Forum. Chaplain Butch Lewellin delivered the message. After a fantastic meal provided by Allen Catering, the recipients were honored with a slide-show and presented with an award from the Nursing Recognition Committee and John Knox, President and CEO. 

The award winners are as pictured: 

Back row: Mario Parecki, Cath Lab; Bob Quario, 3 Surgical; Amanda Wagner,OB; Christine Clarkson, ICU; Jody Schipper, Professional Development and Tara Wait, Occupational Health. 

The middle row:  Shawn Buhrow, UMP ASC; Barb Oldenburger, Home Health; Sandy Jorgenson, 4 Tower; Jane Schwartz, DDC; Janet Baker, Pediatrics; Aleshia Bloker, Cardiac Rehab and Ron Schlatter, ED. 

The front row:  Mindy Wilson, 3 Heart; Heather Hemann, Resource; Bobbie Masker, Ambulatory; Stephanie Chapman, 4 Ortho and Kathy Busching Surgery. 

Not pictured are: Leah Angel, Mental Health; Jenna Schneider, 3 Medical and Dennis Preuss, Infusion Services.

DHC Nurses Were a Hit at National Conference

The Buzz recently featured Allen Digestive Health Center’s Brenda Collins, Lisa Sparks, and Barb Burkle who presented “GI Jeopardy” at the 37th annual Society of Gastroenterology Nurses and Associates (SGNA) national conference. Click here for the full article from June.

They have recently received the evaluation summary completed by the 125 or so attendees. They received RAVE reviews! Nearly 100% of respondents rated their presentation as either a 5 (excellent) or a 4 (good), with over 90% choosing excellent! Here are some quotes from the written comment section:

“Best class of the conference. Educational and fun.”
“Very fun, interactive, and informative.”
 “Super fun class! Very informative, would go again, best one so far.”
“Very fun, loved the interactive format.”

Click here to read the full review.  GREAT JOB!!!!

Employee Health Creates Mobile Immunization Cart
Jennifer Boevers, RN, MSN, Employee Health Nurse

Employee Health has recently put together a mobile cart which travels to each unit on specified date(s) and time(s) offering immunizations and TB testing. The cart offers the convenience of getting this type of thing done right on the unit with no need to make a special trip to Occupational Health. Employee Health will be working with unit managers to arrange the dates and times for your unit. Watch for us on your unit!

The first two mobile immunization cart visits are complete and Employee Health is excited to announce its success! Kudos to Ambulatory Services and 4 Ortho for helping make the cart visits for their units a success!  

UPCOMING CLASSES

December:
12/16   BLS Renewal
12/16   Care of the Actively Dying (Iowa Hospice)
12/20   Stroke Education

January:
1/4       Nursing Care for Telemetry Patients
1/5       Difficult Conversations (Iowa Hospice)
1/6       BLS Renewal
1/7       Nonviolent Crisis Intervention
1/18     BLS Instructor Renewal
1/19     Nonviolent Crisis Intervention-Refresher
1/20     BLS Renewal
1/27     Nursing Care for Telemetry Patients
1/31     BLS Instructor Renewal

Career Ladder Recognition
Congrats for the following nurses for achieving or maintaining Career Ladder status!

Maintain CL3
Amy Terrill, Cardiac Rehab
Nancy Goeller, PACU

Maintain CL4
Shawn Buhrow, UMP ASC
Sarah Scott, 3 Surgical
Sarah Eiklenborg, OB
Erika Leonard, Cardiac Rehab
Julie Schroeder, Cath Lab
Heather Loy, PACU
Judy Vauthier, UMP ASC
Amy Varzavand, OR

New CL4
Kala Miller, 4 Tower (increased from CL3 to CL4)
Leslie Michael, ED

Welcome New Nurses

From L to R: Annie Schoonover, RN, ED and Allison Martin, RN, 3 Heart

 

From L to R: Grant Larsen, RN, ED and Krista McCrady, RN, ED

ASC Nurse Appointed to IQ4 Optime Team

Right Information Right Process Right People Right Time

Susan is married to Allen’s Director of Security, Keith Rogers, and has two children ages 13 and 10. She enjoys kickboxing and attending her children’s activities, which include volleyball and swimming.

Congratulations to ASC’s Susan Rogers on her appointment to Iowa Health System’s IQ4 project. Susan was chosen by IHS to work on Optime, the OR charting component of the Epic system. Susan has vast IT experience, having worked with ORSOS implementation and maintenance for several years. Prior to her 11 years of informatics experience, Susan worked in the OR and in OB. She has been with Allen since 1992.

The first step in the IQ4 journey for Susan was to obtain Epic certification. Certification is required by Epic for all members of the build team. The certification process involved attending a 3 week course in Verona, Wisconsin. Throughout the course, she was required to complete a fundamental project, a comprehensive project, and a comprehensive exam, with a minimum score of 85% on each. Susan was recently notified that she has passed with flying colors!

The next step for Susan included moving her office to Cedar Rapids. She will commute to Cedar Rapids four days a week throughout the IQ4 project implementation. There the team member from various IHS affiliates work toward standardizing and validating OR workflow.

Trinity Fort Dodge will be the first affiliate to go live in September 2011.  Allen will be the fifth affiliate, with a scheduled implementation date of December 2012. All senior affiliates will be live by the end of 2013.

Congrats Susan!



Pharmacy Corner
Linsey Schuldt, PharmD

New formulary additions/changes:

Sevelarmer Carbonate (Renvela®)				Sevelamer carbonate (Renvela®) is indicated for the control of serum phosphorus in patients with chronic kidney disease who are on dialysis.  The manufacturer of Renvela® also markets sevelamer HCl (Renagel®) and has announced that they will end production of that product.  Possible advantages with Renvela® include fewer GI adverse reactions and less chance for acidosis.  As soon as pharmacy supplies of Renagel are depleted, all orders for Renagel® will be filled with Renvela® at the same dose and schedule.
Dabigatran etexilate  (Pradaxa®)				Dabigatran etexilate is a direct thrombin inhibitor indicated to reduce the  risk of stroke and systemic embolism in patients with non-valvular atrial fibrillation.  Dabigatran is an effective alternative to warfarin with superior outcomes and similar bleeding rates.  The advantages of dabigatran over warfarin include its lack of monitoring requirements, few medication and no food interactions, and dose adjustments only in response to changes in renal function.  Bleeding rates are similar to warfarin with a lower intracranial hemorrhage rate but higher GI bleeding rate.  Dabigatran should be stopped 1 to 2 days before invasive procedures.  It should be discontinued for longer times before major surgery, spinal puncture and in patients with a CrCl < 50ml/min.  The dose is 150mg PO bid.  Dabigatran is restricted to its approved indication only.
Hydroxocobalamin				Hydroxocobalamin is a hydroxylated active form of vitamin B12 that is used in the treatment of cyanide poisoning.  It has a high affinity for cyanide ions and once bound, is rapidly excreted through the kidney.  It is included in a kit (Cyanokit®) along with transfer spikes and IV tubing.  The dose is 5gm IV over 15min to 2hrs depending on the severity of symptoms.  A 5gm dose may be repeated.  Adverse reactions seem to be mild and self-limiting.  The Cyanokit® will replace the currently available cyanide antidote kit
Phenytoin to Fosphenytoin				Current policy states that fosphenytoin will be substituted for all doses of IV phenytoin greater than 200mg due to increased solubility and safety.  This substitution will now be expanded to include all doses of phenytoin.  Problems due to phenytoin crystallization in PICC lines and elaborate flushing procedures will be avoided by exclusive use of fosphenytoin.  Dosing guidelines are the same for each product.
Pediatric Liquid Medications				For pediatric patients less than 2 years of age, orders for oral liquid medications will be prepared by pharmacy and dispensed in the exact dose ordered.  Exceptions to this policy will include bulk oral antibiotic suspensions and orders for liquid acetaminophen and ibuprofen

ASC Nurse Earns CAPA Certification

Connie Towlerton, RN, CAPA, Ambulatory Surgery Center Connie enjoys gourmet cooking and scrapbooking. She has been with Allen since 1992; having worked in medical, ambulatory, emergency, endoscopy, and Infusion Services. Connie has been at ASC for over 6 years and also currently works at the Allen Pain Clinic.

Congratulations to Connie Towlerton, who recently earned certification in Ambulatory Peri-Anesthesia Nursing (CAPA). The certification process is quite intense. Connie has been studying for 8 months and took two pre-exams online to prepare. She traveled to Des Moines to take the 3 hour, computer-based exam. The test was divided into three domains: Safety, Patient Advocacy, and General Knowledge. Benefits of Certification Connie reports there was a heavy focus on sedation and anesthesia drugs, reversal agents, pre and post op care, and endoscopy. “The entire process has given me a more well-rounded understanding of all operative phases. I pick up on things and am more aware of patient cues than I was before” says Connie. The American Board of Perianesthesia Nursing Certification, Inc. (ABPANC) oversees the CAPA certification. “Expectations of nurses are higher than ever before. ABPANC helps perianesthesia nurses meet these expectations by administering a certification process that validates knowledge gained through professional education and experience, ultimately promoting quality patient care” (ABPANC, 2010) Reference: American Board of Perianesthesia Nursing Certification, Inc. Retrieved from http://www.cpancapa.org/index.html

Be Aware of MHU Restricted Items Jessica Hallett, RN, MHU Nurse Manager Did you know that we restrict over 30 items to ensure the safety of the MHU patients. Please click here to read the items that are not allowed in the patient's room and print the pdf for your future reference.

Don’t forget to attend Stroke Education!

If you have not yet attended a Stroke Education class, you still have time. There are two classes being offered on December 20, 2010. Click here for more information.

Remember: Attendance is required for RNs in 3 Heart, 3 Medical, 3 Surgical, 4 Ortho, 4 Tower, ED, ICU, and Resource.

Register in Net Learning.

Discourage Sharing of Medications
Patient Safety Committee

We recently had a situation where a patient was discharged with an order for Lisinopril. During discharge education, the patient declined a prescription stating he would take his wife’s Lisinopril. The patient was subsequently readmitted with complications from taking his Lisinopril incorrectly.

Please remember to talk with your patients about the dangers of sharing medications. Do not allow a patient to leave without an accurate prescription for the ordered medication.





Code Walk
Steve Cusher, Environmental Safety Officer

Please review SOP 1-C-30-16: REVIEW OF MISSING PATIENTS/CODE WALK which is located on the Allen Intranet. 

Key points of this policy are:
1. All patients leaving a unit must be accompanied by an Allen associate.
2. If you find an unattended patient that is off the unit, you should approach and redirect them back to their unit.
3. If a patient leaves your area without notification, you should: 
     * Search your area
     * Notify your supervisor
     * Call 3600 and call a CODE WALK. Provide the following information:
               - location
               - age
               - gender
               - clothing description
4. When you hear a CODE WALK announced, all staff must search immediate areas and monitor exits until ALL CLEAR announced. 

Linda Benson, RN, CL 4, ICU Linda enjoys reading, spending time with her grandsons, and Hawkeye football and basketball games!				Rhonda Stonewall, RN, OB Rhonda enjoys playing volleyball and has played on an indoor and outdoor league for many years.
Theresa Pierce, RN, 4 Ortho Theresa enjoys spending time with her family, especially her 3 grandchildren! She also likes to spend time horseback riding.				Elisia Heidt-Penrod, 4 Ortho nurse manager, and Irene Murphy, Unit Coordinator, hard at work.
Christa Glaser, 4 Ortho nurse, and Wendy Lamos, social worker, coordinating a complex discharge. Christa is speaking with the discharging physician and Wendy is relaying information to the home health referral coordinator.

More on HCAHPS Scores…. This month: The Discharge Domain
Jody Schipper, MSN, RN, Professional Development Coordinator

This month the Buzz will continue its focus on HCAHPS scores. We have covered the Communication with Nurses and Communication Regarding Medications domains. We will now focus on the Discharge domain.

Let’s recap….what are HCAHPS Scores?
As discussed in recent issues, HCAHPS stands for Hospital Consumer Assessment of Healthcare Providers and Systems. It is a national, standardized, publicly reported survey of patients’ perceptions of their hospital experience (HCAHPS Fact Sheet, 2010).

Our patients tell us how well we meet their needs through the HCAHPS reports. The Discharge domain includes a screening item, followed by two questions to which the patient answers “yes” or “no”. Our goal is to achieve the highest number of “yes” responses possible. The screening item relates to where the patient will reside following discharge. They choose from “own home”, “another home” or “another facility”. The follow-up questions are:
    1. Did staff talk with you about needing help at home when you left the hospital?
    2. Did staff provide information regarding symptoms and/or problems to watch
        for at home?

How are we doing?
The table below shows a comparison of house-wide data for quarters 2 and 3. We have improved significantly in the 3rd quarter. Way to go!

HCAHPS scores for Discharge domain

Question	2nd Quarter 2010 Percent of patients answering “yes”	3rd Quarter 2010 Percent of patients answering “yes”
Staff talk about help when you left	77%	83%
Information provided regarding symptoms/problems to look for	84%	87%
Total average	80%	85%

Now, let's look at a breakdown by unit:

3^rd Quarter 2010

Unit	Number of respondents	Staff talk about help when you left Percent of patients answering “yes”	Info re symptoms or problems to look for Percent of patients answering “yes”
2 Heart	0	No data	No data
3 Heart	45	79%	92%
3 Medical	32	80%	79%
3 Surgical	18	87%	86%
4 Ortho	16	100%	85%
4 Tower	22	76%	81%
ICU	4	100%	100%
OB	10	90%	100%

What are the nurses saying?
4 Ortho has impressive survey responses, showing a heavy focus on discharge planning. 100% of respondents reported that staff talked with them about help needed at home after discharge. Elisia Heidt-Penrod, nurse manager 4 Ortho, reports it is a team effort. Nursing, case management, and social services are all heavily involved in discharge planning. 4 Ortho nurse, Theresa Pierce, says “we review everything several times throughout the stay. We talk about medications, name brand versus the generic name. We also discuss the importance of using Ted hose and incentive spirometry. I will demonstrate correct use and have the patient do a return demonstration to ensure they will do it correctly at home.”

ICU has shown 100% “yes” responses to both survey questions. ICU nurse Linda Benson says the discharge education process starts early in the stay. “We conduct daily Caregraph rounding at the patient bedside. It includes the primary nurse, head nurse, case manager, social worker, dietician, pharmacist, chaplain, and clinical nurse specialist. An important aspect of the care conference is the discharge plan. We specifically consider if they have family support, if they have stairs at home, if they understand how to care for themselves, and so on.” Linda continues “We try to identify complicated discharges right away. For example if they have multiple health conditions or will be unable to drive, we try to get a plan in place to meet those needs.” The patients appreciate the extra time spent by nursing to make that personal connection. Linda reports it is not uncommon for patients to return for a visit after discharge. The nurses enjoy that as well.

OB also has strong numbers, showing 100% “yes” responses in the “symptoms or problems to watch for” category. OB nurse Rhonda Stonewall agrees that discharge planning and education must start early in the patient stay. “We start talking about discharge plans during the admission process. We have a teaching sheet which helps us make sure the patient knows how to take care of not only themselves after delivery, but also for their baby. Throughout the stay, we do hands on teaching with return demonstration of things like the newborn bath. At discharge, we have preprinted instructions for both mom and baby. For mom, the information covers such things as when to make their follow-up appointment, how to take home medications, birth control, breastfeeding information, and signs and symptoms of complications. For baby, the information covers when to make follow-up appointments, how often to feed, proper carseat use, and warning signs.” Rhonda continues that it is important to evaluate the family unit as a whole and adjust the teaching methods to best meet the needs of the patient. “We have teen moms that need additional support, I also try to include any older siblings in the teaching process. I want to make sure everyone is going home to a good environment” says Rhonda.

Way to go!
Another great example of Allen staff going above and beyond in the constant pursuit of ideal care!

Reference:
HCAHPS Fact Sheet (July 2010).
http://www.hcahpsonline.org/files/HCAHPS%20Fact%20Sheet%202010.pdf