Wednesday, July 16, 2014

Shortage of Bacitracin Zinc

Hello all,

Bacitracin Zinc is on a national back order.  Potential release dates are towards the end of August/early September.  We are able to order plain bacitracin packets.  Please make your unit aware that we will be dispensing plain bacitracin in place of the bacitracin zinc until the shortage is resolved.

Thank you,
Kate Seningen, PharmD
Children’s Hospital Pharmacy Coordinator
Phone:  (843) 792-2185
Pager:  11741

Tuesday, July 8, 2014

And now there are 6 certified RNs on 7C!!

Congratulations to Kate Siegfried, CPN!  
We are so very proud of you.

Helpful Epic Hints from PICU SuperUser ABG!


1.  Today through Saturday July 12 0700-1900, there are representatives from Elsevier in the hospital who are here to help with the CLINICAL PRACTICE GUIDELINES (CPGs), PLAN OF CARE, PATIENT EDUCATION, ASSESSMENT DOCUMENTATION, and INTERVENTION documentation.  It was very helpful to have someone explain the care plan documentation process again and what we should be doing with that mixed up thing.  If you have time, they can be reached at Simon Pager number 12792.  The Super User of the day should really try to get the rep to come teach you so that you can help others that cannot meet with the rep (i.e., night shift).  Am I a pro now?  No, but it helped some.  They stated that we should only be spending about 2 minutes on the Care Plan.  Laugh now.  

2.  Nursing Notation:  Still some questions coming up related to Nurse's Notes.  There are three good ways to chart these, depending on what's going on with the patient. 

    A.  Team Chat:  found in the Overview Report.  This is the "yellow sticky note" and is fairly informal documentation.  You can use it to pass on things about the patient to the MDs, RNs, treatment team.   

    B.  Care Plan:  We definitely should not be using the NOTES Activity to chart nursing notes (I verified this with several EPIC CTs today).  Use the CARE PLAN.  I know this seems like a strange place to document but according to the Epic CTs, this is similar to the "MISC" notes section we used in McKesson.
Let's say your patient leaves the floor to go to CT or wherever and you want to document that you took the respiratory bag, the code drug box, the ambu bag/O2 tank and the transport monitor on the road trip.  You do this in the Care Plan Activity.  Go to the General Care Plan (for us the newborn/infant/pediatric General Care Plan) and expand it to show the Plan of Care Review goal (green dot).  Click on Document.   You can then free-hand a note in that bottom section or use smart text. 
You should also use this same procedure to document (at the end of your shift) that you reviewed the Care Plan (according to the Elselvier rep today).  They want us to write a note at the end of the shift that "synthesizes" or kind of sums up the documentation that you did for each care plan goal (basically 1-2 sentences on the outcome of the shift care).  

Finally, when you chart a note within the Care Plan and are finished with it, you can then go to the NOTES ACTIVITY, choose the PLAN OF CARE tab up top and you will see your note in the list. 

    C.  On most cells in the Doc Flowsheets, if you highlight the cell that you'd like to write a note on then right click the mouse, NEW NOTE will appear.  Choose this and you can write a short note related to that whatever in entered into that cell (it gives you more characters that the "comments" field).  You might remember that this is where you can "Insert Data" into your note if you'd like.  When you are finished writing this note, it also will appear in NOTES ACTIVITY, but instead of the Plan of Care tab like the previous type of note, it will appear in the NURSING tab up top.   

3.  Charge Nurses:  Epic people are working on a solution for you to be able to filter our OR patients out of the gigantic OR schedule.  I know it was "fixed" last week, but it was broken again today.  I will update you when I know more.

4.  Observations and Treatments:  we all know it's been difficult to go ALL OVER THE PLACE to chart the things that were in Observations and Treatments section of McKesson.  This issue has been raised to the Epic folks, let's hope we get it all back under one roof for ease of charting.  If you've compiled a list where everything is located and would like to share, send it to me and I will put it all together.   

5. Until we are able to document WAT (Withdrawal Assessment Tool) scoring and SBS (State Behavioral Scale) in Epic, we should be documenting these scores on paper.  I have made several copies of each sheet and placed them in the appropriate place on the file folder wall thingy behind the charge nurse desk. 

6. I submitted another request for them to add a ROW under the ETCO2 or some other way under the Oxygen Therapy heading for nurses to document Nitric Oxide easily on the Pediatric VS complex flowsheet. 

7.  At the end of your shift, please remember to unassign yourself from the treatment team.  You can do it by right clicking and "end my assignment".  I also happened upon another option that may work automatically the end your assignment at the end of the shift.  Go to the Overview report for your patient.  Click on the TREATMENT TEAM hyperlink.  In the middle of the page, there is a heading that says Treatment Team and then two boxes that say Search for a Provider and Search for a Provider Team.  If you click the green plus sign beside Add Me, you will see a box appear that says New Provider with your name and a start/stop date and time for your shift.  Try this and see if your assignment ends at the end of your shift.  Don't know if it'll work but we'll see.....

:) Cheers.


Melinda would like to add one more thing brought up by Gregg today.....

Please remember to go into LDAs to D/C any LDA that is no longer applicable.  For example, if you extubate to 2LNC, you need to end the ET tube as airway.  This is also critical to do for central lines, foleys, and PIVs as they will continue to carry over if not discontinued.  Moreover, it will eventually distort our line days data collection for VPS and our infection rates.

Thanks so much for all your hard work and patience.  Thanks ABG for this great list of hints!!


Monday, July 7, 2014

More Certified RNs!!

Congratulations to two more 7C staff who have recently earned CPN certification:

Mary Carla London
Amy Russell

I am so very proud of you both!  7C has now exceeded our certification goal with more to come!!



Epic Questions

PICU & 7C Staff,

First, a big thanks to everyone for keeping a positive attitude as we take this Epic journey together.  Second, a shout out to our Super Users for all your hard work and determination in finding the answers to all our questions. 

We have come to realize that many of the staff have the same questions.  We are working on a Tip Sheet Summary to answer those questions and give guidance in work flow processes that seem to be of greatest concern.  ABG and I chatted this morning and thought a blog post that enable staff to post Epic questions would be a good way to ensure we are addressing most of the questions.

Please use the comment button below to post your burning Epic Questions.  We will post back answers and summarize all of the information into an overall Tip Sheet.

Thanks so much!


Wednesday, June 25, 2014

Nursing Excellence (Magnet) Updates

Sorry this is SO long but please take the time to read through it because there is a lot of really great info. J I am going to be updating the Nursing Excellence Roadmap, as related to the PICU, as well as the PICU Accomplishments document, and will put those papers in your mailbox sometime soon (let me know if there is anything you would like to see included). I am also going to send out an e-mail with the PowerPoint from the last Nursing Excellence Meeting.  This included information on nursing advancements in the past year as well as reward and recognition opportunities at MUSC. So here we go…

Important Dates:

7/1- Epic Go-Live
7/8- PICU Leadership Meeting cancelled for epic roll-out
8/1- Magnet Document will be submitted
Now- MUSC RN to BSN Fall Semester Scholarship is accepting applications.
-       Remember you must apply to both the school of nursing and the scholarship separately.
-       I have heard the application does not save as you are filling it out so make sure you have all information needed handy!
-       This is over an $1 million investment MUSC has set aside for nursing
-       With the new clinical ladder you should be able to easily use a project from advancing your degree to become and RN III (and get a pay raise)

Nursing Excellence Accomplishments:

I was so impressed at the last meeting with how far nursing has come at MUSC recently. Please read through as all of this is good to know if we are chosen for a site visit by Magnet Surveyors and you might learn something new!

-       Increased nursing participation in committees at every level giving nursing a voice in hospital wide decisions
o   New CNO Advisory Committee
o   New Nursing Reward and Recognition Committee
§  New DAISY Award Recognition- Now all nominees receive a pin and letter from our CNO and COO (anyone can nominate a nurse via the intranet so if you catch someone going above and beyond, like we do every day, please recognize them by nominating our peers)
§  Revamped Friends of Nursing Gift Fund- donations made specifically to nursing are going directly back into opportunities for nurses
o   PICU Leadership Committee
§  Meets the second Tuesday of the Month and all are welcome.
§  We have almost doubled participation the past few months.
o   Nurse Alliance
§  Is anyone interested in representing the PICU at these meetings? There are different sub committees if anyone has a specific interest.
o   There is now a nurse on the hospital-wide Communications Committee
§  Development of an MUSC app was approved.
§  E-Mail ideas to Amber Patterson. She is a bedside RN in one of the adult units who wants our input. She said after attending an information technology conference she has realized the possibilities are endless. Current ideas include- bus schedule with gps tracking, education apps for patients and families, insulin and heparin calculators, cafeteria information, etc. etc.
-       Percentage of nurses who have a BSN at MUSC is now 62% compared to only 39% statewide.
o   The Institute of Medicine’s recommendation is that 80% of RNs have a BSN by the year 2020 (?) and have related this to better patient outcomes through evidence based practice.
o   MUSC now has partnerships with 6 Universities who offer tuition assistance and has re-started the RN to BSN program at MUSC with 30 full ride scholarships available
-       Changes have been made to help nurses advance with the new Clinical Ladder
o   This year we have at least three RNs applying for RN III- Sheri, Anna, Kelsey
o   Current RN IIIs include Patricia, Natalie and Erin
-       Hospital wide increase in certification by 30%
o   We only have one new certification and lost Jason who has one so this is a very easy opportunity for us. 
o   Remember the hospital will now pay upfront for you to take it meaning no out of pocket costs anymore and once you pass you receive incentive pay (several 7C RNs recently passed the CPN and can probably answer questions about payment).
-       There is now a Nursing Annual Report and a Nursing Excellence Website
-       Increased MUSC Nursing participation and recognition at conferences at the local, state, national and international level
o   Example: Storm Eye RN enrolled in the new Evidence Based Practice class was able to present findings at local and state level was then invited to present in New Orleans and now is going to London England.
o   Erin is in the EBP class if anyone has questions
-       Using our NDNQI Benchmarks we have initiatives in place to improve practices (hospital wide)
o   Employee Satisfaction
o   Hand Hygiene
o   Bottoms Up (Skin Team- reduction in the number of stage II pressure ulcers saving the hospital millions of dollars)
o   Falls
o   Why Not Campaign- to decrease use of restraints
-       Increased participation in professional organizations
o   Sign up to be a member of the AACN if you haven’t already

I apologize again that this is so long but there is so much interesting information.
If you made it to the bottom of this message- thank you. J

Let me know if you have questions! –Kelsey

Tuesday, June 24, 2014

Important Patient Safety and Practice Change regarding Lipids!

Attention Nurses!

Starting Friday, June 27th, PNs and lipids will no longer be run as “IV Fluids” in the Alaris pump.

You can find them under “Guardrails drugs.”

For PNs, select the item with the appropriate dextrose concentration
·        There is a wildcard entry if the dextrose is not a standard concentration
·        Guardrails rate safety checks will now be based on the GIR (glucose infusion rate in mg/kg/min)

For lipids, if infused separately from PN, Guardrails safety checks will now be based on “dose” of lipids in g/kg/day.

Questions? Ask your nurse educator or PharmD!