June 2012 Volume 1, Issue 5
UMMC Nursing Newsletter Important Changes to Medication Administration Practices What Nurses Need to Know… With a focus on improving quality and timeliness of care delivered in hospitals, the Centers for Medicare & Medicaid Services (CMS) has recently published new standards for the timely administration of certain critical medications in the hospital setting.
What is a Time Critical Medication? Time Critical medications are ones that must be administered within 30 minutes before or after the scheduled administration time. Time critical medications include rapid, short-acting, and ultra short-acting insulins, oral hypoglycemics, and scheduled doses of analgesics (opioids and nonopioids—with the exception of transdermal products.
Examples of each Medication type include: (the list is NOT all-inclusive) Oral Hypoglycemics may include:
Ultra Short-acting Insulins
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• Humalog or Lispro • Novolog or Aspart • Apidra or glulisine
Rapid or Short-acting Insulins • • •
Humulin R Novolin Velosulin (insulin pumps)
Opioid analgesics may include: • • • • • •
Morphine Fentanyl Codiene Oxycodone Hydromorphone Hydrocodone
Metformin Glyburide or Glimepiride Avandia or Actos Acarbose or Miglitol Natinglinide ot Starlix
Non-opioid analgesics • • • •
Acetaminophen (Tylenol) Ibuprofen Naproxen Toradol
So, What About Non– Time Critical Scheduled Medications? Frequency Daily, of dose Weekly, or Monthly Time due window
Within 2 hours of scheduled time
> Daily < every 4 hours
One Time Dose
On-Call dose & PRN
STAT
Within Within 60 ASAP, and Within 1 hour of 2 hours minutes of within 1 hour of Scheduled of order indicated identified need time need
NOW
Routine
Within 2 hours of order
Next Standard Admin time
For additional Information, see policy MM-005—Medication Administration Policy 1
What’s New @ UMMC? The New Shock Trauma Tower welcomed the building’s first inhabitants on June 5th ! • • •
Multi-Trauma IMC moved into the 3rd floor of the new tower into a bright & airy new unit. Multi-Trauma ICU relocated to the North wing of the current STC on June 12th, and the 5th floor Trauma South wing closed for construction. STC ORs opened for business on June 18th
As with all of the Trauma floors, these areas remain secured units and access will be limited to entry by badge or intercom.
Welch Allyn Flexi-port ® Blood Pressure Cuffs
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• New Disposable Blood Pressure Cuffs will be coming to Roll out all areas for all patient monitors, manual BP cuffs, and portable Begins BP machines June 25th! • Same sizes as current cuffs are available— neonatal cuffs will still require a different tubing than other sizes • Tubing rotates for ease of patient movement Be sure to place the Flexiport valve connector on the side of the cuff facing away from patient to avoid pressure on chest wall from the connector.
MicroClave ® Add-on Tubing Has begun replacing all tubing add-on sets (6 sets are affected) that currently have a Smart-Site valve. So far, it looks like the MicroClave valves are having a positive impact on our CLABSI rates!
B-D Safety Filter Needles We have consolidated all of our filter needle orders to an 18 gauge, 1 1/2 inch blunt needle (PMM# 172442) to reduce staff injuries and standardize product. Look for them in a supply room near you!
LaserBand ® Patient ID Bands In response to concerns with smearing ink and poor adhesive quality on our current ID bands, we will be converting to LaserBand ® on July 10 & 11th . These bands are already in use in several clinical areas with great customer feedback! More info to come!
There is a NEW LOOK for the Nursing Intranet page! There are updated links and additional side links to improve the organization if the Nursing page. We have removed links that were not functioning correctly, and added resources to improve navigation. If you have trouble finding anything– there is a crosswalk posted on the Home Page.
Scope of Practice question or concern?
Email: scopeofpractice@umm.edu 2
Clinical Practice Council Updates: Reminders & Updates
Patient Safety Reports
Misidentified and Unlabeled Specimens A Rapid Improvement Event was recently conducted by Lab and Nursing staff which generated a great improvement in the number of “defective” specimens arriving in the lab. CPC will be working with the RIE participants to develop a policy for Specimen Handling that addresses this issue. More Information to come!
Glucometer availability Over the Memorial Day holiday, there was a shortage of backup glucometers to replace broken ones in clinical units. There are 2 important messages: • Please ensure that your unit sends malfunctioning meters to the Point of Care lab for replacements in a timely manner. • POC team has generated a list of areas that have meters and are closed on weekends in the event that this mad rush reoccurs.
NG Tube EBP Update The group is now beginning to work on creating the guidelines themselves… Thanks for all of the hard work!
Care of Inmates
Blood Product Tubing Did you know that you can use the same set of tubing to infuse more than 1 unit of blood products? It is acceptable to infuse more than one blood product through the same tubing as long as tubing is flushed with saline between products – no more than 2-4 products and no longer than a 4 hour hang time per tubing. Examples include: 1 unit of reds + 1 unit of platelets, or 2 units of reds, or several units of platelets – or multiple units of FFP.
When caring for an inmate in forensic restraints (shackles) the guard from the correctional facility should always have keys for patient repositioning, transportation to testing areas, or for emergencies. If there is a situation where keys are required, and the on-duty correctional officer does not have them, you should contact Security Supervisor.
TENP updates Carefusion AirLife Nebulizer kits We have begun a transition to a new vendor for high flow nebulizer kits– ones that you would use for humidification of high flow O2. Rationale– we learned that the water bottles we have been using with our current nebulizers are intended for IRRIGATION and not for INHALATION, and as such contain a preservative that we do not want to use for respiratory care. The Nebulizer High Flow kits (PMM#360143) come with both the nebulizer and the bottle of sterile water (for inhalation) The new kit is engineered so that you cannot accidently add the wrong kind of bottle. If only the water needs to be replaced, there are Nebulizer Replacement Water bottles (PMM# 360760) are available for use without replacing the entire system.
Blood Product Returns The 30 minute rule as a measure of amount of time a product can be out of the blood bank prior to re-issue is an Urban Myth! 30 minutes is too long! The measure of product reissuability is the temperature of the product when it is returned - usually 15 minutes is enough time for the product to cool to the point that it is not able to be re-issued (and therefore wasted) From the time a product leaves the blood bank it must be completely infused within 4 hours- if a patient’s transfusion is delayed (due to medica- Omni-Stat Pilot in Adult ED tion infusion, temperature, or urgent trip off the The Adult Ed will begin piloting a new unit) it may be better to hold the product and hemostatic agent for the controlling infuse when able (within the 4 hour window) bleeding in a variety of patients, but has than to return it to blood bank where it must be established effectiveness with patients wasted if temperature does not meet requirement. who are have diseases or are on medications that alter the normal Policy Updates coagulation pathways. EOC-021– Care of Patients Under Legal We will be piloting nosebleed pads and granules. If or Correctional Restrictions you receive a patient from the ED with the product in The policy for the care of inmates in currently place– there will be instructions for management. under revision due to the closure of 11D. 3
Governance Council Updates: Staff Nurse Council Updates • • •
SNC members provided feedback on the success of Nurses’ Week 2012 events, and made recommendations for improvements for 2013. Council met with Infection Prevention Practitioners to discuss the safety implication of pre-spiking IV fluids. This information/rationale can be found in the Management of Intravenous Catheters, Fluids and Infusion Policy SP&CI-014. During safety discussion, council member discussed Arrest vs. Rapid Response Team notification.
Clinical Education Council • •
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Meetings Canceled for May 2012
Certification Support Subgroup Seeking nominations for CEC Chair Elect Charge Nurse Subgroup position for FY13 and PCS orientation Medication Oversight Council instructors. Nurse Coordinating Council Unit hand washing compliance data reviewed. Nursing Research Council Michael Ann Preas and Maureen Archibald Patient Education On-Demand Subgroup led discussion on use of education toolkits Want to know more or get involved? available and strategies used by high compli- Want to stay up-to-date or get involved and don’t ance units to reach 100%. know where to start? Check out the intranet: Marathon numbers: 2139 RN’s and 474 http://intra.umm.edu/ummc/nursing-pcsUAP’s completed for March/April 2012. governance-councils/ for Governance Structure Congrats to the trainers for their hard work! and council documents. Clinical Information Council (CIC) PAL Revisions—Increased usability with removal of unused and additions of new columns, addition of a weight column, and task columns partitioned to 12 hour blocks. Quality Dashboard Enhancements-more interactive features, different views for different types of care providers for example the RN view will show the status of certain nursing documentation such as POC, fall risk, etc in a column. Incomplete documentation can be completed by clicking on an icon which will directly route to the form that needs to be completed or modified. Powerusers Group (PUG) - will be disbanding. Various members will be added to CIC. CIC is exploring changing leadership positions to 2 year terms in order to accommodate and maintaining consistent leadership throughout implementations. Charge Nurse Committee Discussed opportunities for charge RNs to impact Nurse Sensitive Quality Indicators by using hourly rounding, staff huddles, and charge nurse report as tools to communicate issues such as falls, patient satisfaction, pressure ulcer rates, CLABSI & CAUTI. Partnering with unlicensed assistive staff such as PCTs and CNAs is essential. Charge Nurse Workshop on May 25th had 35 attendees. Positive feedback was received! Goals for FY13 include improving scores on communication by nurses, charge RN orientation, developing electronic charge RN report tool, updating charge RN reference manual. Congratulations to Newly Certified RNs!
Newsletter Updates If you have news or updates, then please send your information by the 7th of each month to: amurter@umm.edu or tfronczek@umm.edu Newsletter Editorial Board Allison Murter Christine Provance Susan Carey Trisha Fronczek 4
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Alicia Scott-Darden BSN, RNBC, Psychiatry Department Alison Carder RN, CEN, Adult ED Andrea Ball, RN, CEN, CCRN, TRU
Send your newly certified credentials to certification@umm.edu and be recognized here!
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Patient & Family Education Council Updates Reviewed previous work by a CNL group that focused on assessing patient’s learning styles. Council would like to develop a model for teaching & look at what effective teaching looks like. June meeting to work on PICO for this EBP project. Members to review UMMC Nursing’s 2009-2013 Strategic Goals and come prepared to work on FY13 Objectives. Council members to review ANA’s module on health literacy.
Graduate Nurse Advisory Committee (GNAC) Professional Advancement Council Updates Updates • Members reviewed the Nursing Strategic Plan • New Employee Orientation (NEO) dates have for 2009-2013 and were charged with becomchanged; moved ENP and other new grad ing familiar with the plan and the PAC's role courses accordingly, beginning with August in meeting the priorities. cohort; July staying the same. • Considering next steps for staff and leader• ZERO new graduates have taken end of ship education, using the framework of the year (12 month) program evaluation. Need "Coaching Skills for Development & Support to encourage new grads to take these surof Application for Promotion" 3-part workveys at the end of their residency. shop in which PAC members participated. • Will ask UHC if they can open survey 6 • Effective July 1, 2012 is the change in BSN weeks prior and 6 weeks post year-end to requirements for promotion to SCNI, have nice 12 week window. Student Nurse Resident (SNR) Program at UMMC This summer there are 45 nursing students participating in the 10 week UMMC Student Nurse Residency Program. These residents come from eight Schools of Nursing all over the East coast are working clinically with a preceptor on inpatient units throughout the hospital. In relation to their nursing programs, the student nurse residency program occurs after completion of junior year and prior to at least their last semester. During education sessions, they will be learning about pain, substance abuse, healthy work environments and will experience an end of life care simulation. Please join us in welcoming the residents and hope they gain valuable experiences at UMMC. Pictured are 2011 Student Nurse Residents and 2012 new graduate hires Jasmine Noronha, Mike Murray and Kristen Dizon.
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On-Demand Contest Join the Patient-Family Education Council and the On-Demand Subgroup in two contests. The winning units will receive a free breakfast. The contest runs from April 1st to June 30th, and there will be TWO winning units. 1. The inpatient unit with highest total "OnDemand" Usage rate. 2. The inpatient unit with the highest combined usage of PAIN and FALL PREVENTION videos (#306, #107 & Continuing Education Funds #348). We are 1/2 way through 2012. Have you utilized the continuing education benefit? Make it a priority before it GO TEAM! is too late! FTE $500; PTE $250.
Magnet Champion Group Updates Magnet Re-designation is rapidly approaching. Champions are gathering stories and exemplars from their units. Please send community involvement examples to Anne Naunton anaunton@umm.edu Discussed the Professional Review Processlikes, dislikes and implementation. Group to look at feedback and see how to best aid units implementation progress.
What is stopping you? 5
TPN Update CAPS hare rearranged the adult TPN ingredient sequence. The new arrangement TPN label will match the order of ingredients on the TPN Power Form. This consistent ordering of ingredients promotes medication safety by simplifying the double check between the original order and the compounded TPN bag. From the Clinical Practice Update: STOP-BANG Obstructive Sleep Apnea (OSA) Screening Tool Assessment, May 24, 2012 What? The STOP questionnaire used to assess for OSA will be replaced with the STOPBANG questionnaire (Preoperative Checklist and Special Procedure form) Why? OSA is undiagnosed in an estimated 70- 80% of patients; few will have had a sleep study Failure to recognize is a major factor in post-op complications Research and clinical guidelines recommend preoperative screening for OSA Polysomnography is the gold standard for diagnosis (The American Academy of Sleep Medicine) If this is not possible, a patient questionnaire can be used to identify potential OSA The STOP-BANG questionnaire has been recommended for preoperative screening When? Change to PowerChart and FirstNet effective on June 5, 2012
National Furosemide Shortage affects UMMC supplies The national furosemide shortage has depleted UMMC supplies of 2 ml and 4 ml vials. Currently, UMMC pharmacies are dispensing 10 ml vials as replacement. The furosemide concentration remains the same, however, the volume is larger. Further information to come on the shortage and furosemide dispensing as available. Hospira Carpuject Overfills The FDA recently published an alert concerning the overfill of several drugs in Carpuject pre-filled syringes manufactured by Hospira The FDA is not issuing a recall, and relies on health professionals to make sure the drugs are dispensed and administered correctly. Nurses should visibly inspect and confirm that the Carpuject pre-filled cartridge contains the labeled fill volume before administering to patients. Please inspect the following syringes for potential overfill: â&#x20AC;˘ Meperidine 25 mg ; Meperidine 50 mg; Diazepam 5 mg; Hydromorphone 1 mg â&#x20AC;˘ Hydromorphone 2 mg; Lorazepam 2 mg; Morphine 10 mg; Naloxone 0.4 mg Any syringes with overfill should be returned to the satellite pharmacy for your unit.
EZ-Wider Bariatric Chair-Bed is Available The EZ-Wider bariatric chair-bed is currently available to units upon request. Please contact your wound ostomy nurse to place a request one if needed. Beds are delivered to units within an average of 4 hours and can accommodate patients up to 1,000 lbs. 6
Successful Trends in Nursing Practice Conference The 2012 Trends in Nursing Practice Conference, “Interprofessional Civility in Healthcare: Awareness, Impact, & Outcomes,” held on May 1, 2012, highlighted a relevant and pertinent topic in contemporary nursing. Over 185 participants engaged in a full day of learning about interprofessional civility in health care and its impact on the safety and health of health-care providers and the patients they serve. There were concrete tools for enhancing interprofessional communication and teamwork, successful accounts from those who studied and changed their hospital-wide culture, and preparation tools for engaging in civil interactions while finding inner peace. Attendees were provided with informative and practical information that all staff can easily integrate in their practice.
Ultrasound Guided IV Insertion Classes Scheduled The IV insertion using ultrasound class registration is now in health stream, open to select cost centers that have the appropriate machines. Please note the requirements for this course. It is an advanced skill and does require manager recommendation, excellence in inserting IVs without ultrasound, and the ability to take time to use the skill to assist others. For staff who meet the criteria please encourage them to undertake this advanced skill. If you have any questions or concerns as to these please contact Jennifer Miceli at jmiceli@umm.edu
Intermittent IV Infusion Order Changes in PowerChart Changes to Intermittent IV Infusion orders began on Monday June 11, 2012 with Acetylcysteine IV being the first medication changed. Others to change in the following weeks. • A small number of intermittent infusion orders were built as continuous infusions to overcome technical limitations in PowerChart. • These select intermittent infusion orIntermittent infusions will be ders will be fixed so that they will now entered as medications & the function as medication orders identical order detail fields will be similar to the remainder of the intermittent to those of standard medications. infusion orders currently built. The frequency & infuse over • These changes will help alleviate the times will populate appropriately. problems with free-text infusion rates and short duration times. • Medications affected will include: – Acetylcysteine IV – 7.5% sodium chloride/acetate – Banana bags – Thymoglobulin via peripheral IV
On the EMAR, it appears as a task with a specific date & time. It will appropriately go to an overdue status, & still be available for charting even if the medication is received late.
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Announcements Save the Date!!! 22ndn Annual Summer Institute in Nursing Informatics (SINI) Conference July 18th—July 20th at the University of Maryland School of Nursing § Three full-day format. § Focus on posters and abstracts § One expert-level working track with interactive and participatory format for the full SINI. For details & registration, visit the conference website: http://nursing.umaryland.edu/sini
UMSON Summer Institute in Nursing Informatics (SINI) Wednesday, July 18-Friday, July 20 All Day End of Life Workshop September 18th and 25th All Day ANCC Magnet Conference October 10-12, 2012
AHNA Classes: Holistic Nursing at UMMC HEALING TOUCH: An Energy Therapy to Support Holistic Care ( 1 PAM hour; CE pending) • Discuss Healing Touch as an energy healing modality, its benefits, a typical session, and the client experience • Describe the Healing Touch Program’s educational program and organizational support • Practice sensing energy and a healing touch technique Mon Jun 11 0645 Weinberg 6 Conference Room Mon Jun 11 1745 Weinberg 6 Conference Room For more information contact AHNA Chapter Leaders: dsmith2@umm.edu, csalmond@umm.edu NEW: Diversity and Inclusion Forum Series Including a summary of research findings, panel discussion, and audience interaction, the first forum will focus on generational differences and similarities in communication, work ethic and work-life balance. All staff are invited and encouraged to register for the forums through Healthstream. Forum Date: Thursday, June 21, from 2 to 3 p.m Location: T1R15, across from the UMMC Auditorium Topic: Generational Differences in the Workplace Moderator: Jean Tucker Mann.
2 Day End of Life Nursing Care Workshop The workshop, Clinical Applications of Death & Dying and Fundamentals of Death & Dying, is scheduled for September 18th and 25th. Although participants may register for one session, attending both sessions will best ensure an understanding of all aspects of end-of-life care. Please register in Healthstream- for questions contact Erica Bergstein ebergstein@umm.edu
June Nursing Grand Rounds: Date: June 19th Time: 2:00—3:30 pm Location: UMMC Auditorium Topic: Dealing with Delirium: From Problem to Research to Practice Speaker: Tiffany Blacklock,MS, RN ACNP Bre Wallizer, BSN, RN CCRN and LaToya Stubbs, BS
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