UMMC Nursing Newsletter by UMMS

November 2012 Volume 1, Issue 10

UMMC Nursing Newsletter Fall Prevention Program Update: The Fall Prevention Bundle has been launched! A total of 16 training sessions provided training for 32 champions from all 35 adult units including acute care, IMCs, ICUs and the Adult ED. How are we going to measure success of the program? • Ideally, we will see a reduction in falls– most importantly– reduced falls with injury. • Unit compliance with program components will be audited beginning in December. We will utilize a Survey Monkey tool for data collection. Falls Champions will audit other units (not their own) to assess compliance and look for trends. • Review of post-fall huddle forms— goal is to have 100% compliance with post-fall huddles— discussion of what went wrong and sharing lessons learned is an essential component of process improvement! • Individual unit data will be reviewed on a monthly basis. Direct feedback regarding inconsistent compliance will be discussed with unit managers and falls champions. Reporting to senior leadership will be provided.

No day is without falls, but Wednesday had the most in October

If a fall occurs, remember the key actions : • A new Fall Risk Assessment needs to be done after every fall. • Incorporate communication of fall events into shift change/report & fax post-fall huddle forms to Luiza Lima at 8-8258 Total Falls with Injuries Per 1,000 Patient Days ‐ 1.0

Rate per 1,000

0.71 0.59 0.49

0.52

0.5

Better 0.0 July ‐ Sept 11

Oct ‐Dec 11 Actual Rate per 1000

Jan ‐ Mar 12

UMMC target for falls with injury is 0.50. As you can see in the attached graph– we have a long way to go! WE NEED YOUR HELP!!

April‐ June 12

NDNQI Median

Remind your patients: Call, Don’t Fall! 1

What’s New @ UMMC? Trauma Units Relocation th

New Lab Label Date Format A change has been made to the lab label date format to standardize the date format in all clinical systems.

Neurotrauma ICU has relocated to the 4 Floor Middle of the Trauma Building. The ICU will be a 12 bed unit occupying patient beds numbered 1-4 and 21-24 in the Middle unit and beds 17-20 in the South/Tower unit. The draw date and birthdate are doors. You may reach the unit at 8-3737. changing from Select Truama ICU has relocated to the 6th the European Floor South (Tower) unit of the new Shock format of Trauma Building. The ICU will be a 12 bed dd/mm/yy unit occupying patient beds numbered 5-16 to the in the South/Tower unit. You may reach the American format unit at 8-7624 “mm/dd/yyyy”

Security Tips With the arrival of autumn and the return to standard time, it is dark later in the morning and earlier in the evening. Here are a few things to keep in mind to stay safe, particularly as you travel to and from the Medical Center. General Safety • Walk in pairs or groups whenever possible, particularly in the evening. • Be aware of your surroundings. If a path or area seems unsafe, avoid it; take the long way around. • Escorts or valet services from Guest Services and Security are available. • If you are in danger or see any dangerous activity outside the Medical Center, dial 911. Cell Phone Security Cell phones have a great deal of street value to thieves. Don’t make it easy for them to steal your phone or any personal information you have stored on it. • Stay off your cell phone in public places • Password-protect your phone • Save your cell phone's serial number • Don't store secrets in your phone. • Activate the phone’s tracking device Further Information The Security Department is available to meet with anyone needing additional information. We care about your safety and security. If your team or unit wants a crime prevention session, contact Security Director Stephen Moyer or Assistant Director Maurice Davis at 410 328 9020.

DID YOU KNOW? Hypo/Hyperthermia Blankets CAUTION! Most service calls of malfunction are due to improper filling of machine. Over-filling will cause water to leak. Fill with distilled water only and just until GREEN BAND on float is fully visible. Correct Level— Green Indicator exposed at surface

Clinical Practice Council Updates: Safety Discussion and Follow-up • Lifepak 20 follow-up: Education and Lifepak 20 Resources will be presented to CEC for an inpatient educational roll-out plan. • Low beds with charging issue- yellow blinking means bed is not fully charge and bed alarm might not function or inaccurate weights. • UMMC Lab RIE (Specimen Labeling)- Procedure for Specimen Labeling now available in Lippincott . To find: Under Categories click on “UMMC Specific” and Laboratory.

Policy revisions completed: • Ultrasound Guided PIV Placement now on the intranet. • Power Injectable CVC – CT Scan technician responsibility to check whether it is power rated. • Therapeutic Support Surfaces/Vacuum Assisted Closure (VAC) Devices. • Surgical Prevention- Preop CHG – Patients going to OR should have a preop baths with CHG cloths the night before and morning of surgery. (Not order driven, once placed in the warmer it’s good for 48 hours). TENP Updates: Blood Bands – new and improved Typenex bands currently being piloted in Stoler. More to Come! Temporary Substitution for Heparinized ABG syringes Arterial Line ABG syringes are on back order. The substitute product has heparin is in a solid white form.

Skin Care Committee Report The cap is not ported – users will need to release • Hospital Beds- new beds in pilot process – air bubble onto a gauze pad. Stryker, Linkair, Linnet. • NDNQI Report – Survey on 11/14 and 11/15 Hourly Caring Rounds: November 19th (send an email to Joan for your unit reps). Check out the intranet site for all the information • Bathing Practices and Infection Prevention you need to know: New bathing product was discussed and a http://intra.umm.edu/ummc/nursing/hourlypilot will begin soon.

LOW Bed Safety Issue Ensure your patient’s low bed is fully charged! How can you tell the bed it not fully charged? • The orange/yellow AC light is illuminated. • Light illuminated means the battery is not fully charged & will not charge properly while the patient is in the bed.

Key reasons to order a LOW bed: Thinking of SITTER to prevent a fall? Try low bed first Bed alarm is not effective because patient gets up faster than you can respond High fall risk plus anticoagulated or low platelet patient who does not use call light 100% of time Short, arthritic patient difficult to transfer safely Rehab patient who needs to be without sitter or restraint for 24 hours—extra cushion of protection! 3

Governance Council Updates: • •

•

• • •

Nurse Coordinating Council (NCC) Discussed significant issues with patient identification and following up with leadership to see how the NCC can be a leader in change. As part of the Magnet model, NCC matched strategic priorities to components of model, structural empowerment and transformational leadership, where: ο Governance councils = structural empowerment ο DON/VP “Champion” = transformational leadership Reviewed FY13 Nursing Strategic Priorities Governance Council Crosswalk and made changes as needed. Nursing Research Council Grant obtained to screen and monitor for pain • with non-communicating patients in multiple settings. The study will be on the MICU, MIMC ( 10W), SICU, NeuroTrauma ICU/ IMC, Multi-Trauma ICU/IMU and Trauma • Select IMC. This study offers opportunities for nurses throughout the hospital to participate in multiple activities for research in• volvement & professional development. Kristin Seidl presented a comparison of the Knowledge to Action (KTA) vs. Johns Hopkins EBP Model. Council decided to develop tools to enhance the JHH EBP model instead of introducing a new model.

Clinical Information Council Ongoing confusion around bolus infusion and continuous infusions. Clinicians do not understand how to order properly (involves "duration" and "duration units"). Audits demonstrate that order management continues to be a problem . Next meeting to brainstorm barriers to order management. Feedback offered related to the change in medication rescheduling by nursing. Identified that not all nurses knew that if a medication was not given, the name of the provider notified had to be documented. (Use comment section on eMAR.)

Clinical Education Council HealthStream Competency Center remains in contract negotiation. Discussed the volume of current training that is taking place on the units. Rollout and coordination of all education efforts could be improved. Discussed options to streamline the process. Feedback solicited on the ENP course. Survey sent to group in identify if topics should remain in class, go online, become unit education with handouts or be dropped. Results to be presented in November to CEC. • 2013 Marathon education dates revised based on requests from CEC. • Marathon Topic deadlines: January 1st and August 1st. • Train the Trainer sessions (12) will be posted for February and September. • Education Marathons will be in March/April and October/November. • ACCU Check Fair: March 18-23 (6am-10am each day).

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 Susan Carey Christine Provance Greg Raymond Trisha Fronczek

Congratulations Newly Certified RNs! • •

Brigitte A Fechter, RN - BMT, Oncology Certified Nurse (OCN) Erica Caudill, RN—Pediatrics, Certified Pediatric Nurse (CPN) \

Send your certification news to: certification@umm.edu 4

Governance Council Updates: • • •

Professional Advancement Council Updates Requested nominations for a new Co-Chair because Brian Burke transitioned from the role of Co-Chair to Council Facilitator. PAC is beginning to use a standing agenda item to capture names of staff who have been mentored or coached on portfolio development by the PAC membership. Request was sent to Nurse Managers through DON/VP group for feedback on support provided by PAC members, on barriers to the model and on additional support that would be helpful to nursing leadership to support participation in the model. Charge Nurse Council

• Charge Nurse Checklist: the Council continues to work on an electronic checklist • for unit huddles. The goal is to have it completed and ready for implementation by 1/1/13 with nursing governance approval. • Safety: The Council discussed safety concerns on the unit. Hostility in the workplace, violence from visitors and weapons found on individuals within the hospital. Information around active shooter policy was discussed. • The Charge Nurse Workshop: additions will include cultural diversity and the active • shooter policy. • In November, the Council will review and discuss the following article: “Nurturing Charge Nurses for Future Leadership Roles”. •

Meetings Canceled for October 2012 Staff Nurse Council Medication Oversight Council

Patient & Family Education Council The council continues their work on an EBP project. Read below to watch their progress! The council received a summary of the work to date on the project, which includes definition of the PICO question, development of literature search terms appropriate to the project, and a literature to develop a comprehensive list of over 300 possible references. Using the algorithm approach, Ann Rigdon did a preliminary title review which reduced the list to approximately 80 items. The council agreed to an approach of having each article reviewed independently by two reviewers, one experienced and one inexperienced. Abstract reviews and then a complete “Hopkins Model” review of any article deemed appropriate will be completed by the reviewers. A summary of their independent findings will be brought to the next meeting.

Hand Hygiene Data for October The overall hand hygiene compliance rate remained consistent at 85%. There are 3 units that were able to achieve 100% compliance overall: Neuro Trauma Critical Care (2nd month in a row!!!) Neurocare ICU & Surgical IMC Keep up the great work!!! Nine additional units also met the UMMC target of at least 90% compliance: • Medical Surgical Progressive Care Unit -98% • Multi Trauma Critical Care- 93% • Cardiac Surgery ICU - 96% • Gudelsky 6 West- 92% • Cardiac Surgery step-down - 95% • Gudelsky 4 East- 92% • Gudelsky 5 West- 95% • Weinberg 5- 90% • Neuro Trauma IMC- 90% * Of special note, the Division of Neuroscience achieved >90 % compliance for the month! EPIC Project Launch Set UMMC is committed to making our electronic record meet the end users and patients’ needs. Beginning in January 2013, UMMC will launch its journey to convert from a Cerner to Epic product. Conversion date is set for March 2014. Watch for details as the project goes full steam ahead. 5

Lab Series Part 2: Blood Collection

Find this badge tag: Order of Collection – can contaminate other specimens from needle piercing Blood Draw Order at 1. Blood Culture Tube(s) the CPPD Satellite • Medium in them to grown bacteria over a 24 hour period Office 2. Light Blue Coagulation Tube • Must fill to fill line (right under cap) – partial tubes will be rejected • Adults require 2.7 mls of whole blood • Pediatrics require 1.8 mls of whole blood 3. Plain Top Red (no additive) 4. Gold Top (with gel) • Less than full tube takes longer for results to be reported d/t automation amount needs 5. Light Green Top (with Heparin) Must be filled to top 6. Dark Green Top (with Heparin) • Must be on ice to send to Lab for Lactate only 7. Lavender or Pink Top (with EDTA) • Must be filled to top LAB QUESTION OF THE MONTH: 8. Gray Top (with Oxalate) A gold top must be drawn before a pink top? • For send out labs 1. True • Must be filled to top 2. False

Causes of Hemolysis • Shaking specimen instead of inverting—must invert all specimens 5 to 10 times • Dropping specimen • Drawing sample to fast or too slow Issues that occur from not following Order of Draw • Microbiology specimen may be contaminated • Anticoagulation contamination may occur Special IV Note: If an IV is running: Contamination with IV Fluids – will affect different parameters depending on the fluid; may also dilute results. • Draw from other extremity • If the other extremity is not an option, then draw from the extremity with the IV but draw specimen from below the IV site • If neither is possible consult with a prescriber about turning off the IV fluids for 3-5 minutes. This gives enough time for the fluid in the veins to equilibrate.

TEST YOURSELF: Which is NOT a cause of hemolysis? 1. Inverting the tube 5 to 10 times 2. Vigorously shaking the specimen 3. Fast pulling of a plunger when performing a syringe draw

What is special about a blue top tube? 1. It has a pretty blue top 2. It has anticoagulant in it 3. It must be filled to the line or rejected 4. Both 2 and 3

For further information use the link to access the "Blood Draw Instruction" module. http://www.umm.edu/cernertraining/elearning/preLabSpecimen/ BloodDrawEducationModule/BloodDrawEducationModule.htm Laboratory staff will be submitting columns monthly on various tips and information. Please feel free to email them any comments, questions or suggestions you may have to: dmacfarlane@umm.edu

CAUTI: According to the CDC, urinary tract infections are the most common type of health care associated infections, accounting for more than 30 percent of all health care associated infections reported by acute care hospitals. Catheter Associated Urinary Tract Infections (CAUTI) has been associated with increased morbidity, mortality, hospital cost, and length of stay. Many CAUTI’s can be prevented with recommended infection control practices. Intact Red Recommended strategies for the prevention of CAUTI include: Seal means • Insert catheters for appropriate indications closed system • Urinary retention / obstruction • Severely ill/ immobility • Lack of bladder control • Patient request for end of life issues • Perioperative- selected surgical procedures • Assisting with pressure ulcer healing for incontinent patients • Leave catheters in place only as long as they are needed (review the catheter need daily) • Ensure that individuals who insert urinary catheters are trained to insert and maintain the catheters • Insert catheters using aseptic technique and sterile equipment • Properly secure the device to the patient using a leg strap or securement device. • Following aseptic insertion, maintain a closed drainage system (do not break the tamper evident seal on the catheter) • Maintain unobstructed urine flow (keep the bag off the ground and below the bladder, no dependent loops in the catheter tubing.) Keep the Pee Below the Knee • Practice hand hygiene and standard precautions according to the CDC guidelines The pressure to remove the catheter as early as possible has often caused anxiety among nursing staff: would removing the catheter the catheter leads to incontinence, skin breakdown, or an increase in workload? Nurses have a direct role in CAUTI prevention, because many of the preventative interventions fall within the Nursing scope of practice. Although the patient may be ill enough to have the catheter early in the admission, the nurse can recognize when the patient no longer needs that catheter and communicate that to the healthcare provider who can direct catheter removal.

New Foley Kits are coming soon! Foley kits with Securement Device and Castille soap and perineal wipes for patients who need perineal wash prior to insertion using povidone iodine solution.

As nurses we have the potential to evoke change and improve patient care at the bedside. Remaining vigilant to removing urinary catheters when feasible and reminding the physicians to asses the need for catheter and performing meticulous care while these devices are in place can play a significant role in decreasing complication and infections related to urinary catheters. Infection Control question from staff: “Can I use so much hand gel that it becomes ineffective or dangerous to me?” According to the World Health Organization (WHO) there has been no reported or likely resistance to alcohol-based hand rubs. When used appropriately, hand gels have been proven to decrease the spread of multi-drug resistant bacteria. There is a common misconception that the hands should be washed after every 4-5 applications of the hand gel. There is no reason to do this, other than personal preference (your hands feel like they need washing because they are sticky). There is no evidence that suggests that that health care staff are adversely affected by repeated use of alcohol hand gel to clean their hands. For more information, please refer to www.cdc.gov or www.who.org .

Infection Control staff will be submitting columns monthly on various tips and information. Please feel free to email any comments, questions or suggestions you may have to: InfectionControl@umm.edu 7

Announcements Save the Date!!!

Flu Vaccine deadline is December 6th. Make sure you do your part to keep yourself, your patients and your loved ones safe!

Infusing EBP Concepts into Nursing Curricula January 8, 2013 Pediatric CCRN Review Course March 18 and 19, 2013 UMMC Certification Breakfast March 19, 2013

University of Maryland School of Nursing (UMSON) Doctor of Nursing Practice FAQs Beginning with the Fall 2014 admitting class: Which advanced practice roles will be available in the Post-BSN/Post-CNL to DNP Program? The program will be available in all six advanced practice specialty areas • Adult and Gerontological Primary Nurse Practitioner • Pediatric Nurse Practitioner (Acute or Primary) • Family Nurse Practitioner • Adult and Gerontological Acute Care Nurse Practitioner/Acute and Critical Care Clinical Nurse Specialist • Psychiatric/Mental Health Nurse Practitioner • Nurse Anesthesia. The plans of study will be posted for each specialty on the UMSON website. Which master’s specialties will remain at UMSON? • Community Health • Nursing Informatics • Health Services Leadership and Management • Master of Science for Clinical Nurse Leaders To read more visit: http://nursing.umaryland.edu/academic-programs/grad/doctoral-degree/dnp/faq Evidence-based Practice: Infusing EBP Concepts Into Nursing Curricula Date: Tuesday, January 8, 2013 Time: 9:00am - 4:00pm Location: UMSON Speaker: Bernadette Mazurek Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN Associate Vice President for Health Promotion, University Chief Wellness Officer, Dean and Professor, College of Nursing Professor, College of Medicine: Department of Pediatrics, Department of Psychiatry The Ohio State University RSVP: For more information http:// nursing.umaryland.edu/calendar/event/4536

• • • • • • •

December CPPD Courses: Cardiac Rhythm Interpretation Dec. 11 & 13 Critical Care Nursing: Dec. 3,4 & 10, 11 Critical Thinking: Dec. 5 (am and pm sessions) Fundamental Critical Care Support: Dec 13 & 14 Phlebotomy: Dec. 19 Preceptor Boot Camp: Dec. 4 We Discover Series: Dec. 19

Register in Healthstream! Call 8-6257 for assistance. December Nursing Grand Rounds Date & Time: December 18, 2012 2-3 pm Location: UMMC Auditorium Topic: Targeted Therapies for the Treatment of Chronic Pain Presenter: Susan G. Dorsey, PhD RN FAAN, University of Maryland School of Nursing