UMMC Nursing Newsletter

September 2012 Volume 1, Issue 8

UMMC Nursing Newsletter IV Infusion Pump Update Background/Situation: The UMMC contract with Alaris/Carefusion for IV pumps and disposables has expired. UMMC is in need of additional pumps to accommodate: (1) increased beds in new Shock Trauma tower, and (2) a general increase in acuity of patients throughout the Medical Center requiring multiple infusions.

There are 2 major concerns regarding the reliability of the Alaris pump – (1) continued IUI connector problems, and (2) recent recall of pumps when the motor stalls during infusion.

Current Status:  An interdisciplinary infusion pump steering committee was established. Members include nursing staff from all divisions, pharmacy representatives, clinical engineering- biomed and equipment distribution staff, IT, corporate contracting, anesthesia, and capital equipment representation.  Three vendors were identified (Alaris, Hospira, & Baxter) as having the ability to meet our needs. Vendor demonstrations were held with staff allowing hands on time for individual manipulation of pumps, and an opportunity for questions regarding individual practice areas. The following recommendations were made:  There is no interest in piloting the Alaris pump (since the functionality is not different from current pumps).  There is an interest to pilot both Hospira Simbiq and the Baxter Sigma SpecBaxter trum.

Associated Factors:  Other UMMS hospitals are interested in IV pump evaluations. There are varying degrees of readiness, but there is some urgency to make a vendor decision by the end of the calendar year. If possible, the UMMS goal is to leverage volume purchases to allow best financial outcome  Because UMMC pumps are nearly 10 years old, there is significant cost related to pump repairs and management of IUI issues.  Future goal is full electronic integration of pumps from an IT perspective, including: asset management (pump tracking), wireless library upgrades, Pharmacy communication & E-MAR integration – all of which are potentially available – but require upgrades to our wireless network to support best use of the technology Hospira Next Step: Pump Pilot:  Two Pilot Trial Options  Option 1: Full Clinical Trial on unit for 2 weeks. Units would include: MICU, SICU, Trauma, Acute Care, Pediatrics, Perioperative Areas, Cancer Center. Full library upload required.  Option 2: Laboratory Style Clinical Trial where preset scenarios are worked through by nurses. No library upload required.

After a decision is made when the pilot is completed, more information will be available on next steps.

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What’s New @ UMMC? When does that Council meet? Also available at http://intra.umm.edu/ummc/nursingpcs-governance-councils/index.htm for the most up-to-date information

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Clinical Practice Council Updates: Safety Discussion—New Task Force After multiple issues were discussed regarding the wrong date of birth or wrong first names on Patient's Name Bands or in the Medical Record, a Task Force is now formed to look at the process for Patient Identification on Admission.

Falls Committee Report  Ready to launch a Falls Prevention Initiative.  With this program, a “Falls Prevention Bundle” will be rolled out as a package which will include a Falls Tracking Board for every unit.  The Falls Committee is looking for Unit Fall Champions at this time. Education for this initiative is scheduled for September 21st.

Policy revisions completed:

 PROE-009 Blood Product Recall (minimal change)

 COP-011 Fertility Counseling for Cancer Patients (minimal change)

 COP- 030 Power Injectable CVC (minimal change) New Policies Coming Soon

 COP-035—Enteral Tube Placement & Man-

agement— Multidisciplinary work group has Mislabeled Lab Specimens Report made major revisions to what was for Mislabled lab specimens is a patient safety merly called Enteral Nutrition Guidelines and issue and an expensive problem. added important standards of practice to im The RIE project found that there were inconprove patient safety. CPC approved. Needs to sistencies in practice for lab drawing from unit go through PISC and MEC for final approval. to unit. There was no current standard of prac COP-036 - Ultrasound Guided Peripheral IV tice or handoff shift to shift in place.

Insertion. CPC approved. Needs to go through  The SICU, MICU, and CSICU participated in PISC and MEC for final approval. this project because they were identified as the biggest offenders at UMMC. Using the procProduct Pilots: ess that RIE developed, by the end of 90 days,  Pilot of new typenex band planned in Stolerlabeling errors decreased to maybe 1 or 2 a new band will include bar code for blood bank month. use & will also include pt DOB  See also page 1 for Pump Trial information.

Skin Care Committee Report  Summary: UMMC outperforms the benchmark for NDNQI but the incidences of Stage II are trending up throughout the hospital.

How to heat up a contact isolation food tray: Infection Control stated that food can been reheated  Bed Trials Report: The Lynette beds are currently being trialed on 3 units, NTCC, CSICU, from any Isolation Room as long as the following steps occur: and MICU. It will be a week long trial.  Clean hands, gown and glove to Are you performing your safety checks? enter room.

Mandatory checks should include:  When leaving room:  Intro of oncoming staff to patient & family.  remove gloves, clean hands  Review of Patient ID – name & DOB  Put one glove on so you will have a  Check infusions for dose, rate, & exp date. clean hand and a dirty hand  Review all wounds, lines, & drains.  Take the plate from the food tray with the  Review PRN meds for last dose & gloved hand effectiveness.  Open door to nutrition and microwave with  Review eMAR to ensure all medications were clean hand, reheat food given on previous shift.  Wipe down the microwave with the same  Review monitor alarm parameters (if wipes you would use to clean equipment. indicated) 3

Governance Council Updates:    

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Nurse Coordinating Council (NCC) Advanced Practice Nursing Council is changing its name to Advanced Practice Council Council leaders will evaluate council leadership roles (i.e. Chair, Co-Chair, ChairElect, Facilitator, Clinical Nurse Specialist, etc.) in attempts to define roles and increase structure and accountability.

Reviewed 2012 RN Survey data and FY12 Q3 Pressure Ulcers data.

Watched inspirational video http://youtu.be/qp0HIF3SfI4?t=1m54s and asked council leaders to think about their "why" for their councils and their "why" for themselves.

Clinical Information Council (CIC) Reviewed FY13 Goals and Objectives. Objec-  tives of council have large impact on Nurse Sensitive Quality Indicator Data.

Audit found that RNs feel order clean-up is  providers duty. Sharing data with various groups for additional feedback (one being Staff Nurse Council).

Enhancements to Nursing  Quality Dashboard have been widely accepted.

Patient & Family Education Council  Anne Williams presented the JHH EBP model criteria to appraise the articles that will be used for group EBP project.  Members worked in pairs on the appraising of selected articles and presented the reasons for the rating and grading selection to the rest of the group.  Determined the composition of the EBP project group.

Congratulations Newly Certified RNs!

Deborah A. Smith, RN-BC, Ambulatory Care Nursing ; SCN I University of Maryland Center for Diabetes and Endocrinol ogy From the Surgical ICU (SICU):

Nursing Research Council (NRC) Reviewed and made suggests to new Nursing Research Intranet Page. http://intra.umm.edu/ ummc/nursing-pcs-governance-councils/ nrc.htm Group discussed adopting a Conceptual Framework. One need is to strengthen communication. Feedback is to be reviewed.

Discussed need to adopt a translation of EBP to practice model. Kristin Seidl to present models at the September meeting.

Clinical Education Council UMSON has developed an on-line preceptor training course for RNs orienting students. (free of charge) CEC requested volunteers from this council to evaluate this course for applicability as a prerequisite course for UMMC preceptors of new RN hires.

Lynn Howe and Tom Emberson presented the HealthStream® Competency Management Center. Council discussed pros and cons of purchase as an electronic tool for preceptors/ managers to manage new hire orientation.

Council endorsed and supported the follow up with administration.

IV/Subcutaneous Prostycyclins information presented and discussed. Volunteers to develop an education plan for next meeting.

Alexander Halstead RN, BSN, CCRN Newsletter Updates If you have news or updates, then please send Leann Greise RN, BSN, CCRN your information by the 7th of each month to: Ranae Zurawski RN, BSN, CCRN amurter@umm.edu or tfronczek@umm.edu Morgan Johnson RN, BSN, CCRN 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: Professional Advancement Council Updates Last Cycle  Members were asked to encourwithout new age staff to participate in the appliBSN cation cycle starting October requirements 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.  Monthly PAM tip from PAC membership: When thinking towards promotion, start with a project with which you have a passion.  Membership discussed the need to break down barriers of the perception of SCNs needing to be pulled away from the bedside.

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Meetings Canceled for August 2012 Medication Process Improvement Group Magnet Champion Group Medication Oversight Council—now meets quarterly Certification Subgroup—now every other month GNAC—now quarterly

Charge Nurse Council Council was educated on the Patients Leaving Units (PLU) Guidelines by Anne Naunton. Take homes: staff needs to educate patients on admission; charge nurses need to review the guidelines and expectations with staff in order to better prepare them; for additional in-servicing contact Anne at anaunton@umm.edu Safety issues discussed were incivility in the workplace & hand hygiene. On the topic of incivility, the council encourages charge nurses to continue to work with relationship building, treating others with respect and reporting incivility to leadership. Hand hygiene is of paramount importance! Those units having compliance issues should identify and document those individuals who do not complete hand hygiene. Leadership should be notified.

FY13 goals were reviewed, approved and forwarded to the Professional Advancement Council for integration.

The agenda for the Oct 19th Charge Nurse Workshop is being finalized. Topics will be on healthstream for review. Next year’s workshop will include social diversity, generational differences/ priorities, & managing families of various cultures.

Staff Nurse Council Kerry Sobol sought feedback on the Patient Family Handbook, which is due for revisions. Members to review the book and for any needed corrections, as well as, any missing information.

Council provided feedback the effectiveness and safety implications of an auxiliary label to be placed on tube feeds of patients on Insulin drips. The label is bright orange, sticks out, and helps to identify the drip is Insulin. Council agreed that MEADE should consider re-conceiving the sticker and its use by having pharmacy place the sticker directly on the Insulin drip The council discussed the complexities of a case involving an anonymous letter regarding a medical center nurse; including, the rights of the individual, the safety of patients, and the ability to provide a compassionate work environment Effective Sept 11th: New Labels for IV Infusions requiring Refrigeration

Pharmacy is transitioning to new labels for IV infusions that require refrigeration. Beginning Sept 11th, some mini-bags will have the new labels that are white with blue stripes down the right and left sides.

Blue stripes indicate that the medication should be stored in the refrigerator. "Refrigerate" also appears on the label. The reason for the switch is to facilitate the use of barcode scanning technology to verify the correct product.

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Recall: Alaris Pump Channels There has been a recall of Alaris Pump Channels that have an issue with the motor stalling during infusions. This does not affect the "brain" only the attached channels.

Please check your pumps and look for the Serial number beginning with numbers 133....UMMC has approximately 50 of these modules. If you have one of the affected channels - please remove affected channels from use immediately & notify SOSC @ 8-5174 for pick up.

Upcoming Courses

 "Managing Diabetes for the Beside Nurse" is on October 3 from 8 am to 12 pm a  "Looking Good in Print: How to Develop Your CV & Portfolio" on October 10 with two session at 7:30 am and 12 pm have open seats. Each 1 hour only.

 Please register in Healthstream, if interested.

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From the September 10, 2012 Clinical Practice Update: Placement of Post-pyloric Feeding Tubes (Cortrak tubes) in Adult Patients

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August Hand Hygiene Data Highlights The overall hand hygiene rate for UMMC went down slightly from 85% to 83%. This is the fist time we have seen a decrease in the rate since the implementation of an intense monitoring program in March 2012.

There were not any units that were able to achieve 100% compliance this month.

Four units that were able to achieve the UMMC target of at least 90% overall: August o Med Surg Progressive Care Unit (C5E)- 98% Data o Cardiac Stepdown (Weinberg 6C and Gudelsky 6E)- 95% o Cardiac Surgery ICU (Weinberg 6AB)- 95% o Gudelsky 8- 90% One unit demonstrated a 20% improvement in their rates since July o Gudelsky 9 West The most improved discipline is Phlebotomy! They improved from 50% in July to 92% in August (42% improvement)!

The discipline receiving the highest hand hygiene rating is Social Work at 100%, followed by Rehabilitative Therapy at 94%.

Unit based staff achieving 100% compliance included (need at least 10 observations): o Nursing on PCU, C5E, C5W, MTCC, and STCC o Patient Care Techs on Cardiac Step-down (Weinberg 6 C and Gudelsky 6 East), C4E, and C6W o Nutrition and Food Services on CSICU, C5E o Physicians on 13 E/W o Transporters on C4E

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Announcements Trends and Topics in Periop The Cutting Edge of Surgery

Save the Date!!!

Oral Systemic Link October 29

November 10th 8:30-4:30 pm UMB Campus Center Ballroom For more information visit: http://periop2012.eventbrite.com/

Pediatric Nursing Symposium November 2nd all day Trends & Topics in Periop November 10th all day

Registration is now OPEN!

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 UMSON Graduate Open House Thursday: Sept 27th 5-7 pm Certificates: Global Health Environmental Health Teaching in Nursing & Health Professions

Master's Degree Specialties Adult/Gerontological Nurse Practitioner Community/Public Health Nursing Doctoral Degrees Health Services Leadership and Management Doctor of Philosophy (PhD) Nurse Anesthesia Doctor of Nursing Practice (DNP) (Primarily Nursing Informatics (Entirely Online) Online) Pediatric Nurse Practitioner - Primary Care Pediatric Nurse practitioner - Acute Care Trauma, Critical Care, & Emergency Nursing: Clinical Nurse Specialist & Acute Care Nurse Practitioner RSVP two days prior to the event to: openhouse@son.umaryland.edu or call 410-706-0501.

UMSON: Environmental Excellence in Health Care: Innovations and Collaborations 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

Pediatric Nursing Education Symposium: Fall into Enlightenment Date: November 2nd 8:30am-5:30pm Location: UMMC Auditorium See Flyer Page 6 for more information

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