No Float Reward

To honor our long term employees in pediatric critical care, we will implement a no float policy effective 1/1/14.  This will be a unit benefit for all nursing staff who have worked on our units for at least 10 years.    My hope is that this small, but heartfelt gesture will demonstrate our appreciation for their loyalty, dedication, and clinical expertise.  Unfortunately, we cannot include the ancillary staff because we typically staff with only one PCT and one unit secretary.

Please join me in saying thanks to the staff who have been the foundation of our success for so many years.

Happy New Year,

Melinda

Nutritional and Vaccine Screenings

Please remember that all patients must be screen for pneumococcal and influenza vaccines.  While we do not typically administer the vaccinations while patients are in the PICU, we still MUST do the screening.  We have missed two patients in the past few months.  This information is monitored as we need to be 100% compliant to meet the Joint Commission standards.  Please take a moment to remind yourself what the screening looks like, where it is in McKesson, and how you need to complete it.

We have also been non-compliant with getting the nutritional screening done on admission.  Please remember to complete all sections of the admission assessment within the first 24 hours of admission.

Thanks,

Melinda

Season's Greetings

I just want to take a moment to thank each of you for making 2013 a successful year for our Pediatric Critical Care team, patients, and families.  We have made great strides in our CAUTI prevention and continue to be hospital leaders in CLABSI, VAP, and falls prevention.  Patient Satisfaction and hand hygiene scores are at or above goal for both units as well.

Your unwavering commitment and passion for this difficult work saves lives and touches hearts each day.  In my long career I have not witnessed the level of teamwork and professionalism that we have in both units.  Despite a tragic summer and an early respiratory season with high acuity and some very sad situations, you remain steadfast in our mission to provide the best care.  You should all be proud of the high quality and compassionate care you give each and every shift.  The children and the families of South Carolina are blessed to have you.

Merry Christmas and Happy New Year from your very proud and thankful nurse manager!

Cheers,

Melinda

Pulse Ox/BP cuffs

Please be sure to rotate your pulse ox and BP cuff sites at least daily.  They get gross/smelly and cause skin breakdown.  Pulse Ox probes also cause burns if left on the same site for a prolonged period of time.  Let me know if you have any questions, thanks.

Erin

Magnet Updates

The following are a ton of updates from the past two magnet meetings. Please read through and let me know if you have questions! I am hoping to continue to use the blog as an informal way to pass along some of the information from my meetings to you all! Enjoy! –Kelsey

Johnson and Johnson Gala

-       28 RNs from MUSC in attendance

-       3 of the top 4 videos came from MUSC and the winner was from 9E with a video about falls prevention

Nursing Excellence

-       Joint Commission Diabetes Center: keep up the good work! We help with this with our diabetes admissions!

RN III

-       Nurse alliance is looking into a new system for this…

o   Hopefully will not be based on points but rather, yes- something is completed, or, no- its not

o   Hopefully non-exempt employees will be able to become RN IIIs with a pay raise

-       Evidence Based Practice Workshop- if interested in RN III highly recommend doing this class where you can get your research project completed

o   One MUSC RN made a poster with the project she did and was able to go to New Orleans to present it

Back to School

-       38 RNs have taken advantage of tuition discounts at University of Phenoix- don’t forget there are 5 schools offering discounts to MUSC

-       We currently have several Nurses going back to school! (Sheri Fannin, Julie Taylor, Erin O’Donnell, Alli McCraw)

Certification

-       Last spring we had set a goal as a unit to have 5% certified

-       Currently we have 3 nurses including Melinda (Jason Williams, Patricia Prause)  

-       I am going to take the test in January so let me know if you want to study together! (FYI over TEN PC RNs are certified- only one did not pass on their first try)

AACN

-       Highly recommend membership- you get discount on certification exams, free CEs, opportunities to attend conferences, and a newsletter that has some interesting articles in it! (I will leave my copy in the break-room for you to take a look at)

-       *With the certification discount- I think there are some rules about when the discount will apply after becoming a member-FYI*

Christmas Party Details - Please RSVP

Documenting Transfer Delays

Hey guys.  We are still working on meeting the hospital's goal of getting transfers out of the PICU to the floors within 1 hour.  I have developed a chart to track any potential delays so that we can gather data to determine where and why the delays are occurring.  Once we know this, we can make an effective action plan.  The chart is in the charge book in PICU.  For the time being, charge RNs, please record all transfers out by noting the patient name, MRN, transfer date, unit transferred to, and any reason for the transfer taking longer than 1 hour after a bed was assigned and noted as clean.

I apologize for asking you to do one more thing, but this is the only way to know if the delay is on our end or the receiving end.  I don't want to keep harping on you guys if the other units are creating the delays.

Thanks so much for your help!

Melinda

Tuition Reimbursement Deadline for 2013

2013 Tuition Reimbursement Payments: FINAL DEADLINE for Calendar Year Tuition Assistance Request to Payroll Department will be Friday, December 13, 2013, which  will be paid on Wednesday, December 24, 2013 pay date.

EPIC Demo

For those interested in what EPIC will look like, the team is rolling out mini-demos to introduce workflows through the system.  This demo begins with information about where we are in the EPIC build and what is to come.  If you only want to see the demo, fast forward to about 22 minutes.  More of these to come! 

https://tegr.it/y/1bkeb

Erin

Train of Four

Just to clarify- Train of Four's should be done on completely paralyzed patients only. If your patient is moving, breathing or coughing AT ALL, there is no need to deliver a painful shock to them. The purpose of the train of four is to determine whether or not the paralytic dose is appropriate, it has nothing to do with sedation. On the other hand, if the patient's TOF is 0/4 at 40 (max) try repositioning the electrodes to be sure they are placed correctly over the ulnar artery- the distal lead should be placed at the wrist crease in a straight line from the base of the pinky, and the proximal lead should be placed 1 to 2 cm along the same plane. If the TOF remains 0/4 at 40, the MD should be notified. In many cases, the paralytic dose needs to be decreased to a therapeutic level, or a paralytic holiday should be given. Please let me know if you have any questions.




Thanks,

Erin

Certifications that are due to expire within the next 30/60/90 days

Please check this list for your name to see if you have any required certifications that are due to expire within the next 30/60/90 days.

December 31st
BLS: Kylie Weddington

January 31st
BLS: Kelly Grommersch
          Mary Carla London
          Amy Russell

 RES FIT: Lindsay Amerman           Shane Crawford
                 Emily Dorman                 Jessie Green
                 Kelly Grommersch          Mary Carla London
                 Karen Loury                     Kelli Masters
                 Lisa McCormick              Anna Mechem
                 Lauren Mercede               Amy Russell
                 Kate Santos                      Philip Schlabs
                 Kate Siegfried                  Amanda Smith
                 Trellar Terry                     Julianne Walsh
                 Kylie Weddington

February 28th
BLS: Shane Crawford
         Julianne Walsh

Patient Transfer Times

- Mandatory for everyone to read and reply that you have read on the blog

Please remember that we have set times for transfers in and out of the PICU and to both 7C and PICU from the PED.

From any floor to PICU:  patient must be arrived within 30 minutes of the bed being ready (and we should always be ready unless we are full or a patient just left and the bed is not clean).

From PICU out to any floor:  One hour

From PED to PICU or 7C:  One hour

This may seem like an unimportant issue.  However, failure to comply with this process impedes bed flow and can increase our cost and decrease our productivity.  In the past week, WE HAD 15 TRANSFERS OUT OF PICU AND ONLY 5 OF THEM LEFT IN A TIMELY MANNER.  This is absolutely unacceptable and I will be tracking each transfer and any delays will have to be explained or disciplinary action will occur.  I had mistakenly assumed we were just putting in for beds in the morning before we knew the patients were leaving for sure, but that is not the case.  The CULs have been waiting to put in the beds until the orders are written.  Then, once we have a bed, the staff is still not getting the patients out within one hour.  We now have to be part of an IMPROVE process to ensure better compliance.

RNs, please do not put in a bed request until you have orders written by the resident and know for sure the patient is going.  With the diabetics, the transition orders are written at the same time as transfer orders, but do not put in the request until you know the patient has tolerated the transition and is truly ready to leave.

Please remember the clock does not start ticking until the bed is available and ready.  There are few reasons we should not be meeting this policy.

Please let me know if you have questions.

Thanks, Melinda

PICU patients going to OR

Effective immediately- Anesthesia will now pick up patients in PICU and receive bedside report then take patients down to the OR.  We will no longer take our patients to the front desk.  This will ensure a thorough report is given and the patient is handed off safely.  To expedite this process, please complete the pre-op checklist as soon as possible (nightshift for those scheduled in the AM).  Let me know if you have any questions.

Erin

Evidence-Based Practice Workshop

Center for Evidence-Based Practice & Center for Professional Excellence Present

Evidence-Based Practice Nurse Scholars Course:

a project-based workshop for nurses on integrating evidence into practice

COURSE DESCRIPTION: The Evidence-Based Practice (EBP) Nurse Scholars Course at the Medical University of South Carolina (MUSC) is designed to teach EBP skills that will enable staff to conduct extensive evaluations of existing literature to improve patient care. The program provides a comprehensive overview of EBP. During the course, EBP Scholars will choose a policy or practice change requiring EBP evaluation, and focus on reviewing the evidence for the policy or practice update.

CLASS MEETING TIMES: This 12-week, project-based workshop will be held on Thursdays from 1-2:30 pm from Feb 13th – May 15th. (NOTE: There will be a 2 week break. No sessions will be held March 20th or April 17th).

COURSE OBJECTIVES: Upon completion of this course, participants will be able to:

1. Distinguish EBP from research and quality improvement.

2. Discuss the 5 steps used to implement EBP in a clinical environment.

3. Explore search engines used to identify appropriate EBP articles and reviews.

4. Develop skills in evaluating the evidence and synthesizing the findings.

5. Develop expertise in summarizing evidence specific to a nursing policy/practice.

6. Determine appropriate measures to evaluate the effectiveness of EBP implementation.

7. Disseminate evidence to support a specific nursing policy or practice update.

REQUIREMENTS AND CREDIT: 18 hours of nursing CE credit have been applied for. Participants will need to attend at least 10 of the 12 sessions, and complete an evidence-based summary for their selected nursing policy or practice change in order to receive credit. Participants will be able to use these projects for RN III certification.

THE BENEFIT: Past course participants have used their course projects to change the way care is delivered at MUSC through updating current policies and education material, and developing standing orders and protocols. Several have developed poster abstracts and presented their work at national conferences. The work from this course will lead to opportunities for scholarly publications.

CONTACT FOR QUESTIONS AND TO REQUEST AN APPLICATION: Please contact Andrea Coyle (coyla@musc.edu, 792.7769) or Elizabeth Crabtree (crabtr@musc.edu, 792.4348) with any questions, or to request an application. Application deadline is January 6th. Selected applicants will be notified of their acceptance by January 20th.

Nursing contact hours provided. The Center for Education and Best Practice of MUSC Health is an approved provider of nursing continuing education by the South Carolina Nurses Association, an accredited provider by the American Nurses Credentialing Center's Commission on Accreditation



Safety Reminders

Please remember to check your alarms during shift change: the high, low and critical alarms should all be checked Q shift. A patient was desating without critically alarming (the loud beep that needs to be physically silenced) because it was set abnormally low. If you need assistance with this, please let me know.


When caring for trached patients, checking the trach box is part of your bedside safety check. Last week a trached patient in PICU was missing several emergency supplies, including the smaller sized back-up trach. With respiratory season upon us in full swing, please get in the habit of checking these things. Each trached patient should have a designated BOX (pink basin) marked TRACH SUPPLIES, and this box should not be used for anything else. Feel free to ask the charge RN or PCT to gather your trach supplies and box if you are busy with your patients.

7C- Please remember that Bedside Shift Report should be done at the bedside. The 7C nurse's station is busy in the morning with RNs, MDs, and other team members, so the bedside is the best place to give and receive a clear, thorough report. This allows you to immediately perform your safety checks and also allows the charge RNs to give and receive report without others speaking around them.

A HUGE shout-out to both units for your hard work this month. It has been very busy, and many of you have been open and flexible with assignments and shifts. Thank you for your positivity! It is vital during busy times, and does not go unnoticed. If you notice a staff member going above and beyond, please remember to recognize them. Tell myself or Melinda, nominate them for employee of the quarter, or a DAISY award. We work with some pretty great people who deserve to be recognized for it :)

Any questions/comments, please let me know.

-Erin

    

STAFF MEETINGS

We will be having STAFF MEETINGS on:
Thursday November 21 and Friday November 22 at 0730 on 7C
Monday November 25 and Tuesday November 26 at 0730 in PICU
Please plan to attend. 

EROC Updates. Please sign here or in binder by Friday November 22.

Compliance: Patient Information on computers: I will do my best to speak to everyone about this. It is very important to log out of McKesson and Oasis if you are leaving your computer. Audits are being done by the compliance team and anyone found to be non-compliant will be reported for disciplinary action. It is unfortunate that it has come to punishment, but HIPPA regulations require us to keep patient information private. In EROC we were told that minimizing the screen is “ok” but logging off or locking the screen are better options. Those found with minimized screens will not be reported, but may be asked to log off/lock in the future. If you are at the bedside (PICU) you do not need to log off, but remember to do so before leaving the bedside to get supplies, meds, or see your other patient. Please let me know if you have any questions or concerns, I really don’t want any of you getting in trouble for this. You take excellent care of our patients and deserve recognition for your dedication, not punishment for simple mistakes. End of rant.


Pre-Op Checklist

Power Point

Quick Tips

CAUTI Updates: We have had 3 CAUTIs already this year. I am planning a CAUTI Bundle class for next week, stay tuned.

3M Tegaderm

Shortage of Heparin Tubex: We rarely use these, but please be aware of the change in case the wrong vials are mistakenly placed in our accudose. Check your concentration.

Pediatric Trauma and Injury Prevention Symposium

FYI- this conference was great last year, and this year it is here!  Let myself or Melinda know if you're interested, we can definitely offer education time for this.

Daylight Savings Time: POCT

Please dock all iStats and glucometers by 1255 AM Sunday morning (Saturday nightshift).  If possible, do not use these devices for 65 minutes (after the time change when 0200 becomes 0100).  If they must be used, do not re-dock them until after the time change so the data can be uploaded with the correct time. 
Thanks!
Erin

Certifications that are due to expire within the next 30/60/90 days

Please check this list for your name to see if you have any required certifications that are due to expire within the next 30/60/90 days.

November 30th
 PALS: Amy Russell

December 31st
BLS: Kylie Weddington

January 31st
BLS: Kelly Grommersch
          Mary Carla London
          Amy Russell

 RES FIT: Lindsay Amerman           Shane Crawford
                 Emily Dorman                 Jessie Green
                 Kelly Grommersch          Mary Carla London
                 Karen Loury                     Kelli Masters
                 Lisa McCormick              Anna Mechem
                 Lauren Mercede               Amy Russell
                 Kate Santos                      Philip Schlabs
                 Kate Siegfried                  Amanda Smith
                 Trellar Terry                     Julianne Walsh
                 Kylie Weddington

                

7C Flu Vaccines for Patients

There is a flu vaccine basket in the med fridge on 7C.  Every patient should be screened and vaccines should be ordered immediately if appropriate.  Now you can request the vaccine to be delivered to the unit and kept in the basket until an appropriate administration time. You DO NOT need to wait until discharge to administer, but if you do, discharge will no longer be held up for vaccines.
See me with questions, thanks!
Erin

EPIC Intro

Check out this presentation, an introduction to what you can expect with EPIC when it comes to admitting, discharging and transfering patients.  I will pass along any EPIC demos as they come to me so we are all prepared come July 1st. 

https://tegr.it/y/1bkeb

Erin

Pain Reassessments and High-Alert Meds

Hi everyone,
Every Wednesday morning I do chart audits in both units.  One nursing assessment I am auditing is pain assessments/reassessments- and we could use some improvement.  According to policy https://www.musc.edu/medcenter/policy/Med/C064.pdf you MUST perform a pain reassessment within one hour of pharmacologic intervention, and this must be documented by the end of your shift.  This applies to BOTH scheduled and PRN medications per policy.  In PICU, the easiest way to ensure compliance is to document a pain assessment with your hourly vital signs- then you are always covered.  7C- when you scan your pain med, you can document a pain assessment on the same screen (see me if you have questions), you just need to remember to do the follow-up assessment.  In addition to following policy, this documentation helps the team determine if current therapies are effective.
Also, as I've been auditing pain meds, I have noticed MANY high-alert meds without co-signatures.  It is the responsibility of the nurse administering the medication to be sure it gets co-signed.  Please check your documentation before leaving at the end of the shift- we all know- if it wasn't documented, it wasn't done. 
See me with questions, thanks everyone!
Erin 

Professionalism Policy Videos - Please review

Please go to the link below to review the Professionalism Videos as a part of our new policy on Professionalism at MUSC.

http://mcintranet.musc.edu/muscexcellence/Professionalismhttp://mcintranet.musc.edu/muscexcellence/Professionalism/professionalismvideo2.html/professionalismvideo2.html

Thanks, Melinda

Key Messages for Staff from October Administrators, Directors, and Managers Meeting

Please see the link below for the key messages for staff from our October all leader meeting.  I will be going over important points in the monthly staff meetings (not much new this month and I will be out of town next week) and then posting the link to the blog.


https://www.musc.edu/medcenter/MUSCexcellence/source/ADMpresentations/KEY_MSGS_STAFF/Key_Msgs_Staff_10.15.13.pdf

 Please let me know if you are not able to access this information.  I will also send it in email as a pdf.

thanks, Melinda

CH Service of Remembrance

Children’s Hospital

Service of Remembrance

Friday November 1st @ 1 PM

St. Luke’s Chapel

Reception immediately following

Sponsored by the Children's Hospital Bereavement Committee

Includes music, prayers, words of comfort, a pictorial music presentation, and family candle lighting for each child

This service provides an opportunity for families and staff members to come together and remember the children who have touched so many lives

For information please contact:

Megan DeBolt 792-2463

Selene Moniz 792-5619

Mandatory Town Halls starting November 11th

It's time for the quarterly town hall meetings starting November 11th.  Please remember it is MANDATORY for all MUHA staff to attend a town hall session or webinar.  Please see the link below for schedule times and dates.  There will also be a few CH specific town halls that will be announced soon.  You only have to attend one or the other.

This is your chance to hear what is happening at an organizational level and to ask questions of hospital administration.

Thanks so much!


http://mcintranet.musc.edu/muscexcellence/communications/townhall/townhallschedule.htm