APRIL 2012

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 

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In the 1939 movie The Wizard of Oz, Dorothy seems to be afraid of anything that may be in the woods in the Land of Oz. 

She only sings about three animals though….lions, tigers and bears.  Is that because she doesn’t know of any other ferocious animals lurking in the dark forest?  Is it because those are the most common animals seen and talked about in Oz?  Or is it because she thinks lions, tigers and bears do the most damage? 

Here at Allen, when we talk about multidrug-resistant organisms (MDROs), we too, talk about only three… “MRSA, VRE, C. diff.  Oh my!”   

Why only three?  It is certainly not because they are the most “ferocious” or because they are the only ones we know about.  It is because they are the most common MDROs found at Allen Hospital, representing the larger problem of antibiotic resistance in general.  There are several other MRDOs, however, associated with healthcare-acquired infections (HAIs) that are creeping across the country.  Here at Allen Hospital, the Microbiology Laboratory, the Pharmacy and the Infection Control Department are all watching for these.  Please know that there are processes in place to identify these resistant organisms.  If a patient is identified as having one of these multidrug-resistant organisms, your unit will be called to alert the physician and to isolate the patient.  

If you have any questions regarding specific culture results, feel free to contact the Microbiology Laboratory or Infection Control.     

Documentation of Possible UTI Symptoms
CAUTI Committee

New Process for Documentation of Urine Cultures

When a urine culture is ordered, you must chart symptoms/reasons why it is being ordered.  This is to be charted under the GU Assessment of the Adult Assessment.   Please place a Note under GU: Other indicating why the urine culture was ordered. 

Why? 

Here at Allen Hospital, the Infection Control Department reviews EVERY positive urine culture on inpatients to determine whether it is a Catheter-Associated UTI (CAUTI) or (if no indwelling catheter) a hospital-acquired infection (HAI). 

There are VERY specific criteria to categorize an infection as a CAUTI or HAI.  Unfortunately, sometimes it is very difficult to find the criteria in the chart. Here is an example of our criteria from the CDC: 

Patient had an indwelling urinary catheter in place at the time of specimen collection
and
at least 1 of the following signs or symptoms with no other recognized cause:
fever (>38°C), suprapubic tenderness, or costovertebral angle pain or tenderness
and
Positive urine culture (more specific criteria)

Patient had indwelling urinary catheter removed within the 48 hours prior to specimen collection
and
at least 1 of the following signs or symptoms with no other recognized cause:
fever (>38°C), urgency, frequency, dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness
and
Positive urine culture (more specific criteria)

In the past, it has been VERY difficult to find these symptoms in CareCast.  Many times, patients do not have fevers, so we look at these other symptoms to determine whether it was a CAUTI and to figure out why a urine culture was ordered.    This new documentation process should help with answering the question of why a urine culture was ordered. 

Thank you! 

Upcoming Classes

April
4/16 Nonviolent Crisis Intervention
4/17 Nonviolent Crisis Intervention – Refresher
4/18 BLS Renewal
4/20 Identifying Cardiac Dysrhythmias (session 1 of 4)
4/24 Respirator Fit Testing
4/25 Care of the Patient on a Ventilator Outside of Critical Care

May
5/2 Care of the Patient on a Ventilator outside of Critical Care
5/3 BLS Renewal
5/8 Respirator Fit Testing
5/9 Perioperative Fire Safety
5/15 Nonviolent Crisis Intervention - Refresher
5/16 Nonviolent Crisis Intervention
5/17 Hemodynamics 101
5/23 Patient Centered Communication
5/24 BLS Renewal
5/30 ACLS/PALS
5/31 ACLS/PALS 

Career Ladder Recognitions
 
Congratulations to the following nurses who have either achieved or maintained career ladder status.

Maintained Career Ladder 3
Marty Dunlop, Surgery

Increased to Career Ladder 4
Holly Dorn, 3 Surgical 
Jane Schwartz, DHC Logan

Maintained Career Ladder 4
Aleshia Bloker, Cardiac/Pulmonary Rehab 
Becky Dumler, DHC Logan
Dana Clasen, PACU
Sarah Gauthier, Surgery

Career Ladder Nurses: Save The Date

The annual recognition dinner for Career Ladder Nurses will be held the evening of Thursday, May 10th at Allen College.  Please congratulate Allen's Career Ladder Nurses for their hard work and achievement!

Career Ladder Nurses be sure to save the date!

Urology Consults
Jessica Lovrien, MSN, RN, Clinical Nurse Specialist of Clinical Informatics

When a physician writes an order for a Urology consult, please clarify with the physician which Urology practice they are referring to. With the addition of the Allen Urology Center, we now have two different Urology practices that provide care at Allen Hospital.

Please clarify which practice should be consulted prior to making the consult:

Allen Urology Center
Karam Pathan, M.D.

Northern Iowa Urological Associates
Stephen Mong, M.D.
Anand Inamdar, M.D.
Paul Richardson, M.D.

Allen Celebrates Donate Life Month
Jody Schipper, MSN, RN, Professional Development Coordinator

April is Donate Life Month. Several exciting events have already occurred this month, and there are still more to come.

On April 2, Allen hosted a flag-raising ceremony in which the Iowa Donor Network flag was raised on the flagpole at the front entrance of the hospital. The purpose is to increase awareness of the critical need for organ, tissue, and eye donation.

On April 3, Frank Descourouez, Donation Services Coordinator for the Iowa Donor Network, presented a CEU on Organ, Tissue, and Eye Donation. Allen’s own Melanie Smith provided a recipient testimonial when she recounted her experience as a cornea transplant recipient. Melanie’s experience has made her passionate about increasing public awareness.

Coming up on April 16, we are celebrating HealthCare Decision Day in the Allen Café. We are featuring the following:
• Advance Directives (living will and durable power of attorney for healthcare)
• Organ, Tissue, and Eye Donation
• Blood Typing and Donation

Also on April 16, staff are encouraged to wear blue or green to show support for the Iowa Donor Network.

Melanie’s Story
In late 2002, as a freshman in college, Melanie began to have severe pain in her eye, watering, redness, swelling, and horrible light sensitivity. Despite an initial treatment of eye drops from her ophthalmologist, her symptoms continued to worsen. She was referred to the University of Iowa where she was diagnosed with acanthamoeba keratitis. The Centers for Disease Control (CDC) define acanthamoeba keratitis as a rare eye infection that can result in permanent vision loss. It occurs when a single-cell living organism infects the outer layer of the eye, known as the cornea (CDC, 2011). After her diagnosis, she received a treatment regimen of multiple eye drops (include chlorhexidine drops) several times a day. Despite this, her condition continued to deteriorate, and she was declared legally blind in January 2003.

In February 2003, she received news that a cornea was available for transplant. On February 13, 2003, she received the gift of sight from a woman she had never met. Her donor was a 51 year old woman who had died from breast cancer. Melanie becomes emotional when discussing her donor, saying "I can only live each day to make her proud. Every day I strive to have even half as much compassion and courage that she did for the gift of sight she gave me.  There isn't a day that goes by that I don't think about the decision she made in her last moments of life so someone like me could see once again."

Organ Donation Committee
The Allen Organ Donation Committee was created with Melanie’s help. She had already been working as a spokesperson for the Iowa Lions Eye Bank. When she began working at Allen, she saw an opportunity to do more.

Committee members include:
• Melanie Smith, 2 Heart
• Tami Jones, Clinical Director ED/ICU
• Alisha Engel, Nurse Manager, ICU
• Sue Gable, ED
• Lyndsey Beattie, Surgery
• Linda Benson, ICU
• Melanie Tagtow, Social Services
• Dr. Hill, ED
• Lauryl Stockness, Spiritual Care
• Erin Iverson, Foundation
• Angie Fuller, Foundation
• Sheila Markham, Nurse Manager, ED
• Erica Steinlage, House Supervisor
• Maggie Pietryga, House Supervisor/4 Tower
• Jody Schipper, Professional Development

Facts about Organ and Tissue Donation
Many people believe you must be young and healthy to donate. However, anyone can be considered for organ/tissue donation regardless of age. Even individuals with some types of cancer can donate, as in Melanie’s case.

One tissue donor can help more than 50 people. One eye donor can help more than 10. There are currently 626 Iowans awaiting a transplant of some sort, and 113,537 individuals waiting nationally (IDN, 2012).

What can be donated?

Make sure to attend HealthCare Decision Day April 16 to learn more. Wear blue or green on April 16 to show your support!

At home:
Have the conversation! Make sure your loved ones know your wishes. Make sure you know the wishes of your loved ones.

Kudos to Melanie and the Organ Donation Committee for their efforts to increase awareness about the need for organ, tissue, and eye donation!

References:
Centers for Disease Control and Prevention (CDC). (2011). Retrieved from http://www.cdc.gov/parasites/acanthamoeba/gen_info/acanthamoeba_keratitis.html

Iowa Donor Network (IDN). (2012). Retrieved from http://www.iowadonornetwork.org/