Editor: Jody Schipper, MSN, RN
Professional Development Coordinator
Deadline for article submission is the 5th of each month
Busy, busy, busy! Several causes are championed this month, including:
||Breast Cancer Awareness Month
Get screened! The American Cancer Society suggests that you:
• Perform breast self-exams monthly.
• Have a clinical breast exam with your health care provider regularly
(the frequency depends on your age).
• Have a mammogram yearly, if you are a woman over the age of 40.
Remember, breast cancer does not affect only women. Men: be aware and report any breast changes to your health care provider immediately.
Fire Safety Month
Fire extinguisher training has been conducted throughout the month. There are still a couple classes left. Click here for more information. Sign up for a time in Net Learning.
Stay safe at home:
• Install a smoke alarm on every level of your home.
• Check the smoke alarm batteries regularly (ie: when you set your clocks for daylight savings time).
• Have an escape route planned, and practice it.
• Designate a meeting spot if your family is forced to evacuate the home.
• Talk with your family about your fire safety plan
||Health Literacy Month
As health care providers, it is our job to make sure our patients understand the information we have given them. A great way to do this, is the use of Teach-back. Ask the patient to repeat back to you, in their own words, the information you have given them. This helps to identify any areas of misunderstanding.
When you visit your own health care provider, make a list of important questions you want to ask. The Agency for Healthcare Research and Quality suggests that all patients should ask the following questions when considering testing and treatment options:
|1. What is the test for?
2. How many times have you done this procedure?
3. When will I get the results?
4. Why do I need this treatment?
5. Are there any alternatives?
6. What are the possible complications?
7. Which hospital is best for my needs?
8. How do you spell the name of that drug?
9. Are there any side effects?
10. Will this medicine interact with medicines that I’m already taking?
American Cancer Society. Click here.
Agency for Healthcare Research and Quality.
Printing Blitz Certificates
If you attended the 2011 Quality Blitz and completed the self-study packet, you are eligible for continuing education credit. You can print a certificate of completion directly from your Net Learning Transcript. Click here for instructions.
Kim Prinsen, RN, BSN, Clinical Director Ambulatory Surgery Center and Allen Pain Clinic
All Pain Consults for Dr. Afzal and Dr. Hawkins should be called to Pain Clinic Answering Service 24 hours per day. The contact number is 319-291-2851.
The answering service will be responsible for tracking the calls and getting the consult request to the physicians during business hours as well as after business hours.
If you need any clarification, please contact me at 319-833-5858.
NDNQI Survey Time
Erika Leonard, Chair, Professional Life Council
Allen Hospital will once again have the opportunity to participate in the National Database of Nursing Quality Indicators (NDNQI) RN survey. The survey period opened October 3, 2011 and the deadline for participation is midnight Sunday night, October 23, 2011. Click here for instructions for completing the survey.
The survey is administered according to NDNQI guidelines. It is open to all RNs that spend 50% or more of their time providing direct care and have been employed on the unit for at least 3 months. The following units are eligible to participate in this survey:
2 Heart-Cath Lab
Ambulatory Surgery Center
Specialty Nursing Services – Wound Clinic, Infusion, Diabetes
Please contact Erika or a representative from the Professional Life Council if you have any questions. Thank you!
Open Nursing Leadership Council
Monday, October 24, 2011 at 1200-1330
Meeting Room 1
The council invites RNs to take their lunch break with us to learn about the work of the councils and provide an opportunity to ask questions.
Identifying Patients with Language Barriers
Allen Health Literacy Committee
If your patient has specific communication needs, please communicate that information in the patient chart. Enter the language barrier as an active problem in the patient problem list. This will allow the signal to carry forward with subsequent admissions. Click here to learn how.
Career Ladder Recognitions
Betty Marshall, Career Ladder Committee
Congratulations to the following nurses who have either achieved or maintained career ladder status.
New Career Ladder 3
Sue Haase, Digestive Health Tower Park
Janice Songstad, UMP ASC
Maintained Career Ladder 4
Joy Hershey, ICU
Cheryl Wallace, Surgery
10/17 Fire Extinguisher Training
10/18 Hemodynamics 101
10/18 Fire Extinguisher Training
10/19 Hemodynamics 101
10/25 Respiratory Fit Testing
10/26 Identifying Cardiac Dysrhythmias
10/27 BLS Renewal
10/28 Nonviolent Crisis Intervention - Refresher
11/1 Hemodynamics 102
11/2 Nonviolent Crisis Intervention
11/3 Hemodynamics 102
11/3 BLS Renewal
11/8 Respiratory Fit Testing
11/15 BLS Renewal
11/16 Nonviolent Crisis Intervention – Refresher
11/22 Care of the Patient with an Intra-Aortic Balloon Pump
11/29 Care of the Patient on a Ventilator outside of Critical Care
Welcome New Nurses
Front Row (L to R): Katie Slocum, 3 Surgical; Kelly Humfeld, 3 Heart; Nicole Collins, Resource
Back Row (L to R): Hillary Mumma, 4 Tower; Lori Larson, 3 Medical; Saja Puthiyottil, 3 Heart;
Sara King, MHU
Linsey Schuldt, PharmD
Conditional Orders: The P&T committee sought clarification from the Medical Executive Committee on the process for handling “Start if OK with Dr._____” conditional orders. The P&T was informed that this type of order is not acceptable. Upon the receipt of an “If OK with Dr.___” order, the Pharmacy will contact the physician and clarify whether the medication in the conditional order should be ordered or not. If it is not to be ordered at that time, it is the physician’s responsibility to directly contact the other physician on whether the medication should be ordered.
New medication on formulary: Rivaroxaban (Xarelto®). Rivaroxaban is an oral reversible Xa receptor inhibitor recently approved for the prevention of deep vein thrombosis and pulmonary embolism in patients undergoing hip or knee replacement. Rivaroxaban is dosed at 10mg po daily with or without food to start at least 6-10 hours after the end of surgery once hemostasis has been established. Duration of therapy is 35 days for hip replacement and 12 days for knee replacement. In studies, Rivaroxaban was more effective than daily 40mg enoxaparin with a similar safety profile. Cost for 10mg of rivaroxaban is roughly 1/3 that of enoxaparin.
Neonatal Probiotics: Probiotics (Lactobacillus acidophilus and Bifidobacterium infantis) for the prevention of necrotizing enterocolitis (NEC) in infants have been approved. NEC is an acquired gastrointestinal emergency which is reported to affect up to 10% of infants weighing less than 1500 grams. Nationally, NEC is a leading cause of death in the NICU setting with a case fatality rate of 15 to 30% and 20 to 40% of cases requiring surgical intervention. Studies have shown the use of probiotics leads to a decreased incidence of death or NEC. The probiotics are added to feedings twice daily for 6 weeks. These products must be compounded and the Pharmacy is investigating whether to compound the probiotic preparations in house or to contract it out to a compounding pharmacy.
Range orders: Reminder that range orders are no longer acceptable. This includes all medications (both IV and PO) as well as frequencies. Order sets have recently been updated to remove range doses and schedules. If there are old order sets on file on your floor, please print new ones from the Intranet.
Screen your Patients for Influenza Vaccine Status
Tammy Spier, RN, MS, Director Quality Improvement
Effective with October 1, 2011 Discharges:
All patients 50 years and older with a diagnosis of Pneumonia must be screened for Influenza vaccine status. If no contraindications, the patient is to receive Influenza vaccination prior to discharge. Use the Pneumococcal/Flu standing order. This is one of the publicly reported measures for Pneumonia inpatients.
Mary Clark, RN, CL 4
Ambulatory Surgery Center
Mary enjoys UNI volleyball and football games.
She has worked at the ASC since 1999. “I was honored to take part in this trial” she says.
Improving the Patient Experience at ASC
Jody Schipper, MSN, RN, Professional Development Coordinator
Great things are happening at the Ambulatory Surgery Center. The group has used Adaptive Design to implement changes to better serve our patients.
Adaptive Design Refresher
As you will remember, Adaptive Design is a problem solving methodology that examines the background, current condition, and root cause of a problem. Using an A3 tool, you then identify the target condition and countermeasures to help reach the target condition. A key feature of Adaptive Design is the involvement of front-line staff in identifying and solving problems. Those closest to the work know it best.
A problem was signaled by a Press-Ganey consultant indicating patients were dissatisfied with extended wait times in the pre-op phase of their care.
Prior to implementation, the average patient wait time in the pre-op area was 10-12 minutes. This means a patient would wait 10-12 minutes in pre-op before they were greeted by a pre-op staff member.
The specific case examined with the A3 included a patient who experienced an extended wait, 23 minutes, before being greeted by pre-op staff. The root cause analysis revealed the following:
Problem Statement: There was a delay in patient care.
Why? The patient waited 23 minutes for admit care.
Why? Nurse didn’t greet patient right away.
Why? She went through the chart first.
Why? This is her routine.
Why? No routine specified for admit.
Delays in patient care can occur in the pre-op phase for various reasons. Mary Clark, RN, UMP ASC reports that there are 13 pre-op rooms at the surgery center. On a busy day, all of these rooms could be filled. There are traditionally 4 pre-op nurses. The nurses get to each patient as soon as possible, but sometimes there is a delay.
Ideally, the patient would be greeted immediately upon arrival to the pre-op area. The benefits of greeting the patient when they arrive include:
- Decreased patient anxiety.
- Increased confidence in the staff.
- Makes the patient feel valued.
- Helps make the surgical experience more pleasant.
The group implemented the role of a pre-op lead. Communication is essential to this role. The pre-op lead communicates with the patient and family and with fellow staff members (front desk, pre-op, OR, Phase I, Phase II, head nurses, and managers).
The pre-op lead is responsible for greeting the patient upon arrival to the pre-op area. They discuss the plan for the day, have the patient gown, start the consent process, and obtain vitals if time allows. The pre-op lead then hands off the patient by saying “Your admitting nurse, Jane, will be in to finish preparing you for surgery”. “This plants a seed to the patient that we have excellent staff here to take care of them” says Mary.
The pre-op lead keeps in close contact with the OR Manager to monitor the flow of the schedule. He/she communicates with front office staff regarding bed availability and placement and serves as a staff resource for such things as consents, lab work, antibiotic administration, etc.
The pre-op lead rounds on every patient, keeping them informed of actual or expected delays in care and works to keep the patient comfortable while they wait.
The group hopes to see improvement in Press-Ganey scores for “informed regarding delays”. “Historically, this has been one of our lower scores” says Jennifer Goos, BSN, CAPA, Nurse Manager, Allen Surgery Center.
How is it going?
Mary Clark was the pilot staff person in this assignment. She worked in the role for several weeks. Now the nurses rotate in 3 week intervals. Initially the role was new, and they had to decide how they wanted it to work. Through trial and error they have refined the responsibilities of the role, and it will continue to evolve as the work continues.
“This position helps to communicate with one person…so this person can see the whole picture and keep the right staff informed” says Mary.
Since implementation, the time a patient spends in pre-op before being greeted by a pre-op staff member has dropped from 10-12 minutes to 5-7 minutes. Great job!
“This new assignment has been well received by the staff and we have found it is more efficient to field questions and problems through one person” says Jennifer.
Mary sums it up well. “I have so much pride with ASC. I feel every one of my co-workers has a special gift to offer the patients that choose to come here. We put our heart into Allen CARE. Our goal as a team is to make the patient feel like they are number 1, and I believe we do this well.”
Great job ASC!
Click here to view the actual A3.