October 2012 Volume 1, Issue 9
UMMC Nursing Newsletter Flu is Here…Are You Ready? As flu sits on our doorstep, we have an opportunity to position ourselves to protect staff, patients and visitors for acquiring seasonal influenza. Successful flu strategies require a multi-pronged approach targeted at immunity, assessment and transmission prevention.
Flu Vaccine is a priority at UMMC and is mandatory for all staff. Not only will the vaccine likely prevent the flu, even if you are exposed, it will also prevent you from transmitting flu to our patients and fellow healthcare workers. However, if staff develop fever with respiratory symptoms, they should stay home until fever has resolved.
If onset of fever and respiratory/flu like symptoms occurs at work: • • •
Stop patient care activities Don a mask Consult with their supervisor and Employee Health Services
Early assessment of our patients (and their visitors) both in inpatient and outpatient areas assists us in instituting early measures to prevent flu transmission. All inpatients should be evaluated upon admission for fever, respiratory symptoms (and other potentially infectious symptoms) and should be placed in droplet-contact precautions if flu or other respiratory viral illness is suspected. Provide masks for symptomatic patients outside of their rooms. Equip strategic areas (emergency rooms, entries to facility, waiting rooms, outpatient areas, and cafeterias) in hospital with easily accessible tissues, alcohol sanitizer, trash receptacle and masks. Staff, patients and visitors should be reminded to use cough etiquette: • Cough into tissue or sleeve and away from others • Dispose used tissues immediately after use • Clean hands • Post alerts and reminders in strategic areas (such as in waiting rooms, outpatient areas, elevators and cafeterias)
How is flu transmitted? Influenza viruses are primarily transmitted through large-particle respiratory droplet transmission (e.g., when an infected person coughs or sneezes near a susceptible person). Transmission via largeparticle droplets requires close contact between source and recipient persons, because droplets generally travel only short distances (approximately 6 feet or less) through the air. Indirect contact transmission via hand transfer of influenza virus from virus-contaminated surfaces or objects to mucosal surfaces of the face (e.g., nose, mouth) may also occur. Airborne transmission should be used during aerosol-generating procedures (like suctioning) since transmission may occur via small particle aerosols. Staff needs to: • Use appropriate respiratory protection: N95 or PAPR with eyeshield • Aerosol generating procedures done in negative pressure room
Preventing transmission is everyone’s responsibility. How often have you cared for a patient and a couple days later realized that the patient had flu or other transmissible infection? Routine hand hygiene prior to and following contact with each patient and their environment is vital in providing safe patient care and for the prevention of disease transmission. 1
What’s New @ UMMC? Infection Prevention staff will be submitting columns monthly on various Infection Prevention tips and information. Please feel free to email us any comments, questions or suggestions you may have at our email address @ InfectionControl@umm.edu Thank you for all your efforts in providing a safe environment for our patients,
THANK YOU …
to the countless individuals who helped us fulfill our mission of patient care through the challenges posed by Hurricane Sandy!
Your efforts to support each other and care for our patients is appreciated
New Monthly Feature: Updates and Education from our Labs Laboratory tests should be consolidated prior to ordering Encourage Providers to place all orders for lab draws at the same time: ο When ordering at the same time, the computer system is able to “bundle” tests to be performed using the same specimen draw to minimize the amount of blood drawn from a patient This will work only if all tests are ordered at the same time by the same prescriber ο Review all lab labels prior to drawing the patient’s blood. Bundled tests allow for less blood to be drawn from the patient. ο Remember: One tube of blood is needed for each label TEST YOUR SKILLS! 1. What is the best way of preventing mis-identification of patient specimens? a. Check each label against the patient ID/armband before performing specimen collection b. Label all specimens at the bedside! c. Never leave the patient’s room with unlabeled specimens d. All of the above 2. What are the 2 identifiers that hospital policy requires staff to use when identifying a specimen? a. Room Number and DOB b. Name and DOB c. Name and Social Security Number
IDENTIFY, IDENTIFY, IDENTIFY... ο Label all specimens at the bedside ο Double check ALL labels with the patient’s ID band/armband at the bedside TWICE as NICE!!! ο Per hospital policy, use 2 patient identifiers (Name, DOB) ο If the specimen is incorrectly identified, then the lab must reject the specimen For further information use the link to access the "Blood Draw Instruction" module. http://www.umm.edu/cernertraining/elearning/preLabSpecimen/BloodDrawEducationModule/ BloodDrawEducationModule.htm The module can also be accessed from the Intranet under Departments and Services then Laboratory, then Professional Services Manual then Blood Draw Instructions.
Answers: 1 –d, 2– b
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 For the latest UMMC Nursing information, check out the intranet site:
http://intra.umm.edu/ummc/nursing/index.htm 2
Clinical Practice Council Updates: Safety Discussion Patient identification in regards to specimen identification and patient leaving units without armbands are found to be common concerns on units. Group being formed to address patient identification issues. We will request a Nursing Leadership Champion to head the group. Discussion Bedside Report is mandated for all units!
Magnet Discussion • Magnet Redesignation: Application Due: Summer 2013. Lots of work currently being done to create the draft of the on-line application- We are looking for your Great Stories! • If you are asked to share any of your “great” stories for the Magnet Redesignation Application, please submit as soon as possible after being asked.
5 Key elements must be addressed: 1. Introduction of patient/family to oncoming staff Infection Control Updates 2. Review of Patient ID– Name & DOB 3. Check infusions for dose, rate, expiration date CLABSI: • Data looks fabulous to date. 4. Review Wounds, lines, and drains Do not let your unit let up on 5. Review PRN meds for last dose given & the CLABSI initiative! effectiveness of drug • Currently, Infection Control is Announcements looking at care and maintenance of IJ central A list of New Additions to UMMC’s Hazardous line dressings. Keeping dressings on neck lines Medications was distributed. dry & intact is a nursing challenge! We are • New guidelines require the use of PPE for looking at a new dressing product that may proHandling (NIOSH 2012) vide more support and remain sealed. More to CPC has a responsibility to support the achievecome! ment of the goals outlined in the 2013 Nursing CAUTI: Strategic Plan including: • Rates are significantly above the benchmark, • CLABSI, CAUTI reduction we have more work to do! • Pressure Ulcer rate reduction • Currently, Infection • Reduce Fall Rates Control is looking at the frequency of urine • Hand Hygiene Compliance cultures, catheter • Core Measures Compliance utilization, and how • Understanding issues with Nurse Impairment to drive early catheter removal. • Establishing Standards for new category of Pain Report Observation Patients • Improve HCAHPS scores > 50th percentile • Improve Pt Satisfaction with Pain Management • Increase use of actual PRN post-analgesia pain • Implementation of Hourly Caring Rounds scores whenever possible (75 to 90%) and de• Participation in Magnet Application crease use of “asleep” option. Risk Management Report • Obtain movement related to pain scores when
• #1 Reported Incident: Blood Transfusion • #2 Reported Incident: Specimen labeling errors • IV Infiltration/Extravasation– under reported event report should be completed.
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screening for pain with vital signs as well as obtaining pre & post analgesic pain scores for 100% of the time. Use patient self report to determine if pain interferes with patient’s hospital ADLs for 100% of the time
If staff on your unit cannot access the incident reporting system, have staff get password to access the incident reporting system during business Policy revisions approved by MEC for October: hours. Help is not available 24/7 either through • COP-030 Power Injectable CVC email or call. An email to the Risk Management Help Desk for a password reset will get a response • COP-0236 Ultrasound Placement of PIVs within 24 hours. 3
Governance Council Updates: •
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Nurse Coordinating Council (NCC) FY13 Nursing Strategic Priorities were shared with the council. Councils will have an important responsibility for reaching FY13 goals. Priority will have a Director/ VP “owner” of the process that will assist council leaders in moving work forward to achieve Nursing Goals. NCC thought these topics should be added to the Nursing Strategic Priorities, including: pressure ulcer prevention; nurse impairment; safe patient handling; large volume pumps; and safe administration of hazardous medications (i.e. physical harm from exposure) Discussed adding EPIC as a standing agenda item to each meeting. Nursing Research Council (NRC) Workgroup to develop guidelines for working on a poster presentation using current poster template. Jamie Tumulty presented Alarm Identification and Response Simulation Study. Needed: Study team members, preferably ICU nurses, who are willing to mentor new graduate nurses through the study to assure scheduled testing occurs as planned. New Translation of Evidence into Practice models were presented by Krisitn Siedl and Badia Faddoul. The models presented were Rogers Diffusion of Innovation, Strauss’ Knowledge to Action (KTA), and Greenhalgh’s models. Next steps: Kristin Seidl to compare Straus’s Knowledge to Action (KTA) and the Johns Hopkins EBP Model at next meeting. Decision to be made by FY13Q2 end.
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Clinical Education Council Discussed the August marathon— timely completion was difficult due to numerous vacations. Plans to adjust schedule for the 2013 marathon in September/October Request for Heatlhstream representative to attend meeting and discuss all programming available to UMMC nurses. Healthstream Competency Center purchase is in contract negotiations. Gastic tube management policy revisions presented. Enteral nutrition incorporated into policy. More to come on training and rollout. Request for Risk Management representatives to attend next meeting for feedback on online event reporting system. Patricia Wilson discussed UMMC’s new strategy for CNA to PCT training. New ENP scheduled discussed. Concerns with class schedule fit with new hiring practices.
Staff Nurse Council Multiple safety concerns were identified requiring follow-up attention: STC PACU Stat Labs, Staff Safety and Pediatric Psych Patients, and CAFC Fetal Lab/Specimen Reporting During Civility Discussion, council members engaged in a discussion regarding the upcoming Service Employees Union representatives that would be in-house for 90 days. Discussion included Union Access, Voting Procedures, Employee Rights, and Education/Information. Kristin Seidl presented the NDNQI Nurse Satisfaction Survey Results from May 2012. Scores have remained stable over time, 8/11 Nurse Categories above benchmark, 1/11 at benchmark, 2/11 below benchmark. Council made aware of department’s goal to focus on RN-RN Interaction. Greg Raymond presented an update on the Professional Advancement Model, including work of the council, and recent requirement changes for SCN I role.
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
Congratulations Newly Certified RNs! Send your certification news to: certification@umm.edu
Newsletter Editorial Board Allison Murter, Christine Provance Susan Carey, Trisha Fronczek Greg Raymond 4
Governance Council Updates: •
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Professional Advancement Council Updates Members to encourage staff to participate in the application cycle starting October 2012. The October cycle is the last cycle where staff are eligible for promotion without a previous BSN or current enrollment in a BSN program. Clarification that the January and April cycles for PAM will be final two where staff can apply for advancement to SCN I, while enrolled in a BSN program prior to conferring of a BSN. Clarification provided on the Continuing Education Reimbursement Process and Benefit. Ongoing clarification and communication will be provided to staff through the council structure. Membership encouraged to identify their personal “why” based on video clip viewed.
Meetings Canceled for September 2012 Clinical Information Council Patient and Family Education Council
Lippincott Updates and Adds to Nursing Procedures and Skills (LNPS) NEW CONTENT 32 procedures to the new oncology category. Please note- Some of these procedures also apply to other categories. NEW PROCEDURES IN VARIOUS CATEGORIES Discharge against medical advice Endoscope reprocessing, automated reprocessor Endoscope reprocessing, manual Hemodynamic monitoring, minimally invasive Intraosseous infusion device removal Intraosseous infusion maintenance Pain assessment Steam sterilization MORE NEW VIDEO CLIPS By early 2013, they will have nearly doubled the quantity of current availability. Upcoming NDNQI Pressure Ulcer Prevalence Survey The next survey will occur on November 14 or15, 2012—ONE DAY ONLY Please identify a staff member who is working on both days to conduct the unit survey, Contact the WOC Nurse who covers your unit to identify the person responsible for completing the survey no later than November 9, 2012. You may leave a voice mail message at ext. 8-6448.
FYI New Glove Packaging reduces waste! This change will apply to many types of boxed gloves.
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From the Sept. 21st Clinical Practice Update: Following up with compliance issues noted in the Vaccine Column of the Nursing Quality Dashboard.
From the October 1st Clinical Practice Update: Changes to Medication Administration
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Announcements Trends and Topics in Periop The Cutting Edge of Surgery
Save the Date!!! Oral Systemic Link October 29th all day
November 10th 8:30-4:30 pm UMB Campus Center Ballroom
ABCs of Interventional Radiology October 31st all day
For more information visit: http://periop2012.eventbrite.com/
Pediatric Nursing Symposium November 2nd all day
Pediatric Nursing Education Symposium: Fall into Enlightenment Date: November 2nd 8:30am-5:30pm Location: UMMC Auditorium Contact professionaldevelopment@umm.edu or 410-328-6257 for a registration brochure.
Trends & Topics in Periop November 10th all day Environmental Excellence in Healthcare November 14th all day
The Oral Systemic Link: Creating Collaborative Initiatives Collaboration and interprofessionalism are hallmarks of innovative health care delivery. Join us for the first national conference highlighting dental hygiene and nursing collaborations! This conference will address the issues of interprofessional collaboration, institutional and policy challenges, and shared goals in providing optimal patient care. The symbiosis of oral and systemic health provides the perfect backdrop for interprofessional learning. Date: Monday October 29, 2012 Location: UMB Register and learn more at: http://nursing.umaryland.edu/oral-systemic ABCs of Interventional Radiology October 31st 8:30 am—4:30 pm Where: UMB Campus Center. Register via Healthstream for this FREE educational event Specialty topics including Uterine Fibroid Embolization, MRI Safety for Nursing, and Round Table discussions.
Flu Vaccine deadline is December 6th. Make sure you do your part to keep yourself, your patients and your loved ones safe! Environmental Excellence in Health Care: Innovations and Collaborations Location: UMSON Date: November 14th 7:30 a.m.-4 p.m. Will explore how facilities are working across departments and with community partners, product and service providers, and regulatory agencies to develop, implement, and assess environmental sustainability programs. For more information visit: http://nursing.umaryland.edu/events/environmental/ index.php
October Nursing Grand Rounds: Date: October 16th Time: 2-3 pm Location: Auditorium Topic: "Taking Control of Your Practice and Building A Positive Culture: The C5E Experience" Speakers: Simone Odwin-Jenkins, MBA, BSN, RN; Virginia Nganga, BSN, RN; Victoria Phelps, BSN, RN-BC; Visitacion Casal, BSN, RN 7