Sitters for SUICIDAL PATIENTS

ATTENTION 7C & PICU PCTs:

We now have to start tracking anytime that you are a sitter for a suicidal patient.  From now on, if you are a SITTER for a SUICIDAL PATIENT, then please turn in a time entry form with the shift date that you were a suicidal sitter, along with the unit that you floated to be a sitter for a suicidal patient. 

Please let me know if you have any questions.

Amanda

2-7327

Staff Recognition!!

Kudos to both Karen Loury and Shane Crawford for being recognized this week in the patient discharge callback comments! Thank you for taking great care of our patients.

--Amelia--

Airway Clearance Sheets

Reminder: Please place completed airway clearance sheets (pink sheets) in the mailbox in the break room labeled "Airway Clearance".  Though RT's document on these forms and should be placing them here, when patients are transferred or discharged the form may be lost or thrown away when we clean the bedside.  Jill Thompson is collecting data based on the use of these sheets, so please do her a favor and look for it when transferring your patient.  If you notice them piling at your bedside, feel free to remind RT where they should go :)  Secretaries and PCTs, please be aware of these pink sheets- they should not go in the chart and should not be thrown away.  Let me know if you are having any issues with this.  Thanks!
Erin

New Sedation Scale (SBS) / Withdrawal Assessment Tool (WAT-1)

PICU: On Monday I introduced our new sedation scale and withdrawal assessment tool.  Both forms can be found on the intranet --> order forms--> children's hospital--> PICU under Service Specific Orders.  I have placed printed copies of each behind the charge nurse desk and will also have Donna put them on the PICU portal.  I will continue to arrive early to go over these scales with nightshift, but in case I miss a few of you, I will explain the new scales here.

The State Behavioral Scale (SBS) will take the place of our current Sedation/Agitation assessment in McKesson.  This scale is to be used on every patient receiving chemical sedation.  Assessments are documented every 4 hour hours and are not to be confused with Pain assessments.  The form is self-explanatory and objective- you score the patient based on occurrences of the actions described.

The Withdrawal Assessment Tool (WAT-1) will be used on any patient who has received opioid and/or benzos for at least 5 days.  You will begin using this tool with the first sedation wean.  The idea is to get a baseline immediately before weaning drips, so you can compare symptoms associated with withdrawal to symptoms present prior to the wean.  This tool is also self-explanatory- the patient receives a "point" for each symptom they exhibit.  Some assessments are performed prior to stimulating the patient, others noted during stimulation (turning, suctioning, etc), and the last assessment, "time to gain calm state" is assessed once you are finished stimulating the patient.  This assessment is also performed every 4 hours.

The goal is to become familiar with these scales because we will be using them to determine infusion rates/PRN boluses in the near future when we roll out the nurse-driven sedation protocol.    Please let me know if you have any questions.  Thanks!

Erin  

Patient Satisfaction Comments for the Week

Great job to Tammy Major and Jessie Green who were recognized by parents on this week's patient satisfaction comments!  So thankful to you both!

Melinda

Kudos for the 7C Staff from Dr. Tecklenburg

Please see the wonderful note I received from Dr. T regarding 7C.  I am so proud of the adaptability and commitment to all patients that you show at all times.  Fred also sent this to John Sanders and Debbie Browning! 

"Melinda, the 7-C staff deserve another round of kudos for “can do”.  With absolute no complaints, they admitted a 17 yo with new onset acute pyschosis on Saturday PM, administered Haldol and benzo’s to get him under control, used a sitter, and in general, displayed their continued excellent work ethic and concern for patient care.  Many units would have voiced legitimate concerns for possible safety issues ( both for the patient and staff - I don’t think any of our inpatient units are necessarily equipped to deal with psychotic patients), but the staff made do with what we were dealt ( no inpatient psych beds at the time and uncertainty re diagnosis at outside hospital)."  Fred

Meeting Minutes have been posted!

Meeting minutes have been posted from the PICU Staff Meeting last week, as well as the PICU Operations meetings that were held in March and in April. 

Meeting minutes are posted on the right side of the blog, to the right of this post.  Please let me know if you have any trouble finding the minutes.

Amanda

Conflict of Interest Statement - Due for everyone by 4/30

Please go to the link below and complete your annual conflict of interest statement.  Everyone must complete this by 4/30.  It only takes about 3 minutes.

http://academicdepartments.musc.edu/coi

Thanks so much, Melinda

Isolation Compliance

Hi Everyone,
In February's EROC I posted information regarding isolation compliance for staff and visitors.  I know this is new for us, but please encourage visitors of patients on isolation to wear gowns, gloves and masks when appropriate.  This is especially important for visitors who are in and out (often in PICU) because they could easily spread infection throughout the hospital.  For parents staying in the room with our patients overnight, they do not need to sleep in their gown/gloves, but please encourage them to change clothes before exiting the room the next morning.  The dept of Infection Control has sent the Educators a reminder to encourage and empower staff to educate visitors.  They will begin auditing compliance on each unit shortly.  This is the link to the education rolled out in February and the video the Infection Control Dept created:

Isolation Compliance

We do a great job of encouraging each other, MDs and consulting teams to be compliant, so please extend this education to families and other visitors.  Any questions, concerns, or ideas, don't hesitate to let me know.  Thanks!
Erin

Congratulations to 7C for recognition in Preventing Falls!

Congratulations to the 7C Staff who received the WOOF (without one fall) award for having the fewest falls for any acute care unit at MUSC during the 2012 calendar year.

Super proud of all of you!!!

Melinda

Noncompliance with correct phone numbers for discharge callbacks

Please, please, please when discharging a patient, ask the parents for the best contact number and write that number on the discharge paperwork.  We are less than 70% compliant with this!!!  We are trying to improve our patient satisfaction and offer a follow up phone call to the families to give them the opportunity to ask questions.  We now have a centralized call center that does the discharge phone calls for us.  It is imperitive that we put the correct number so the families have been contacted.  Also please make a note if the contact is a FOSTER Parent.  They have had situations where the biolgical family was called post discharge instead of the foster parent  (you can image the joy of that conversation!).

Thanks for your help!  You guys do great work and I want you to be able to be recognized for it.

Melinda

Emergent Transfers - Need your help with a patient safety issue

PICU and 7C,

We are working on making CH safer for all of our patients.  Recently, we have had some patients either freshly admitted to the floors or who have been on the floor for a while who are in need of urgent or emergent transfer to the PICU.  In either of these cases, a MET or MAYDAY (if appropriate) should be called.  If you are getting patients quickly transferred without a MET call, please do a PSN.  We are trying to track what is going on and if we are improving.  Also, if you get a patient transfer within 2 hours of being admitted to a lower level of care, please do a PSN on that and include whether or not a MET/Mayday was called.

I hate to ask you to do one more thing, but we are trying to improve our triage and patient placement process.

Thanks so much for your help!

Melinda

Shout Out to Julie Taylor, RN from a grateful PICU family!

Please see the note below from the peds surgery clinic manager....Way to go Julie Taylor!  Representing us well!!!  We are so happy to have you on the PICU team!

"I had the opportunity to round on Carter Dear (MR2683996) in Peds Surgery clinic today.  Dr. Hebra performed surgery on him back in March, he was inpatient in our PICU and I think the 7^th floor.  They credit Dr. Hebra with saving his life and think the world of him.  They feel like the care we provided was outstanding and specifically mentioned Julie (the ICU nurse), Pete (the surgery resident), and a nurse on the 7^th floor who runs track (they couldn’t remember her name).

Thanks, Amy"

D/C Callback Comments for 7C - Week of 4/4-4/10

Please see the discharge callback comments for 7C from earlier this month.  Great job Team 7C.  Keep up the good work!

"everything was great"

"excellent care from the staff very impressed, happy with the care she received"

"all the nurses were great!"

So proud!!

Melinda

PICU Employee of the Quarter - Sheri Fannin

Congratulations to the PICU Employee of the Quarter, Sheri Fannin!  Sheri was nominated by her PICU peers for her clinical expertise and strong patient/family advocacy skills.  Also, Sheri has been an excellent preceptor and resource to new staff.  She is a helpful teammate and encourages her peers.  We are so thankful to have Sheri on our PICU team!

Changes in Write Offs for State Health Insurance Plan Holders receiving treatment at MUSC

Please see Dr. Cawley's note that was sent in an email late yesterday.  I apologize that I was not able to pass this information on to all of you in person before the email went out.  I only learned of this in a meeting that ended at 5pm yesterday.  Other than this change, I we have not heard of any other cost saving initiatives that will affect staff this week.  I will continue to update you as I am updated.

Thanks, Melinda

Dear Medical Center and Medical University Employees,

With reductions in Medicare and Medicaid reimbursements being phased in as part of health care reform, all health care institutions are working diligently to reduce costs as much as possible while continuing to deliver high quality patient care. The Medical University of South Carolina (MUSC) is also focused on streamlining its operations and is faced with making some difficult choices to ensure its future viability.

As part of MUSC Health, the MUSC Medical Center has long waived balances on hospital bills for deductibles, copayments, and coinsurance for active state employees and their dependents who are insured under the Standard State Health Plan, which is administered by Blue Cross Blue Shield of SC.  The MUSC Medical Center has been the only institution to apply these waivers and the waivers annually cost our clinical enterprise more than $9.4 million. 

Unfortunately, in today’s health care economic climate, MUSC Medical Center has no choice but to discontinue this practice. Effective June 1, 2013, MUSC will no longer waive hospital balances for state employees, including our own employees, who are insured by the Standard State Health Plan.

MUSC and MUSC Medical Center are working with leaders in Columbia to explore novel ways MUSC can collaborate with the state health plan to lower costs and improve the health of all state employees, including our own.

MUSC has a long history of providing exemplary health care to the citizens of South Carolina.  The implementation of this difficult decision allows MUSC Health to decrease losses and be better positioned to meet the challenges of a quickly evolving health care system.  We look forward to serving the health care needs of you and your family for many years to come.

Sincerely,

Patrick J. Cawley, MD, MHM, FACHE
CEO/Executive Director, MUSC Medical Center
Vice President for Clinical Operations, MUSC

Handwashing!

PICU received the silver level for hand hygiene compliance >90%.  Keep up the good work, and let's get gold next time! 
7C- We feel that maybe our secret shoppers are missing when we wash our hands in the patients' rooms.  There are now hand gel bottles outside of EVERY patient room, so please be sure to wash your hands BEFORE entering the room.  Thanks for your help with this!
Erin

Immunization Schedule

A few questions have come up regarding immunizations and when they should be given.  The CDC has a great webpage that makes it easy to determine which vaccines are given and when:

http://www.cdc.gov/vaccines/parents/index.html

The schedules can be found on the right side of the webpage.

If vaccines are ordered for your patient, please do not assume they are to be given at discharge, and check with the team.  Refer to this post in the future by typing  "immunization" in the search box of this blog.  Any questions, please let me know!
-Erin

Reminder: Certifications to Expire on April 30, 2013

The following employees have certifications that will expire on April 30, 2013.  If you have not already done so, please make arrangements to be renew your certification by the end of the month.  Please remember to make a copy of your certification card and put a copy in Amanda's box.

BLS
Lisa McCormick
Brooke Nitterhouse
Madeline Ward

PALS
Trellar Terry

Thank You JENNIFER LARKINS!

I'd like to give a shout out to Jennifer Larkins for diligently working on the schedule to make sure all PICU staff (who aren't on vacation or maternity leave) are able to go to the Prismaflex classes.  Scheduling is tough enough as it is, and to get all staff to a class only offered on 2 days is AMAZING.  We really appreciate all that you do! 
-Erin

Pulse Ox / BP sites

Please remember to change your patients' pulse ox sites Q shift.  Not doing so can cause skin breakdown, ouch!  For those patients with BP cuffs on at all times, please change extremities at least Q shift, and if this isn't possible, at least take it off, wipe it down and let the extremity air out a bit.  We know how smelly they can get.  Thanks everyone!
Erin

Nurse of the Year Nominations for 7C and PICU - Deadline is April 18th

Please use the following link to nominate a 7C RN for Nurse of the Year....

http://www.surveymonkey.com/s/XFC8KXS

Please use the following link to nominate a PICU RN for Nurse of the Year....

http://www.surveymonkey.com/s/X3FJQQG


Thanks so much for recognizing your peers!  Winners will be announced during Nurses Week, May 6-11th.

Employees with Incomplete CATTS Lessons

Reminder: CATTS lessons are due in a little less than three months on June 30, 2013. 

Please check the list below to see if you have incomplete lessons.  The number next to your name is the numbers of lessons that are incomplete.

Amerman	Lindsay	35
Crawford	David	7
Dorman	Emily	28
Loury	Karen	35
Masters	Kelli	23
McCormick	Lisa	32
Mechem	Anna	30
Mercede	Lauren	35
Mishoe	Stephanie	19
Russell	Amy	33
Santos	Catherine	36
Schlabs	Philip	36
Siegfried	Katharyn	36
Smith	Mari	32
Taylor	Amanda	30
Terry	Trellar	36
Weddington	Kylie	30
Ball	Natalie	27
Barber	Rachel	33
Biller	Jacquelyn	28
Bryers	Kerry	30
Bussey	Jennifer	10
Crittenden	Mary	32
Daigle	Nicole	38
Fannin	Sheri	1
Kemp	Mary	37
Larkins	Jennifer	42
Lee	Donna	11
Lindsey	Marc	22
Little	Amelia	10
Major	Tammy	14
Mason	Jayme	28
Nitterhouse	Brooke	14
Odonnell	Erin	12
Oreilly	Elisabeth	20
Piede	Alicia	37
Rinehart	Mary	33
Rudolph	Sarah Jane	28
Shaw	Jennifer	38
Smith	Laura	36
Turbeville	Linette	1
Ward	Madeline	9
Williams	Jason	37
Woods	Krishna	42

Respiratory Orders - Important Information for Patient Safety - Please Read!!!!

Please DO NOT confirm respiratory therapy orders in McKesson.  By doing so, you cause the RTs to miss the order, creating a patient safety issue.  This has been a recurring problem that needs to stop IMMMEDIATELY.  This past weekend, an order to discontinue a respiratory medication was confirmed by the RN and not communicated to the RT.  Imagine if someone did that with RN orders.  It is also alarming that some of the RTs have gotten comments from the nurses that "I just confirm anything in yellow", etc.  You should not be mass confirming orders EVER.  Please be sure to read each order carefully and only confirm those that are nursing related and that you have completed.  I will be following up with the RTs to ensure this is improving.

Please let me know if you have questions.

Thanks, Melinda

EROC Due by 04/19/2013

Hi everyone,
Below are the links to last week's EROC topics.  Please review and sign here with your full name or in the unit binders by Friday, April 19, 2013. 

All Clinical Staff:

§  Update to Policy C-087: Blood Product Administration

§  New Policy C-189: Patient Safety During Patient Transport

Announcements:

• Mosby's Skills Update
• Update Magnet Criteria in Success Factors
• POCT Survey
• Promethazine Change

Thanks! Erin

SAVE $$$

Just a friendly reminder to be cost-conscious when placing supplies at your bed spaces.  Patients should not have several shampoos, lotions, oral care kits, etc at their bedsides and in their bottom drawers.  Before getting these supplies, check your bed space/drawers- odds are they already have it if they've been here for a  few days.  In these tough times, these are the little things we can do to help cut costs and save jobs.  Thanks everyone.

Congratulations PICU Team - Honorable Mention in the National Healthcare Associated Infections Prevention Awards

Re: Medical University of South Carolina Children’s Hospital PICU (031-C)

Good news!

Your team’s application has been selected to receive Honorable Mention in the program of National Awards to Recognize Achievement in Eliminating Healthcare-Associated Infections, sponsored by the U.S. Department of Health & Human Services Office of Healthcare Quality and the Critical Care Societies Collaborative — composed of the American Association of Critical-Care Nurses, American College of Chest Physicians, American Thoracic Society and Society of Critical Care Medicine.

You will receive Honorable Mention for Achievement in Eliminating Central Line Associated Bloodstream Infections. To assist you in celebrating your successes, a certificate suitable for framing will be sent to you in a few weeks.

The leadership of the Department of Health & Human Services  and the Critical Care Societies Collaborative applaud your achievement. Information on the 2013 awardees will be posted shortly at www.aacn.org/haiawards. 

I am so very proud of all of you....38 months CLABSI free!  Melinda

Evening Shift Differential

As we discussed back in January, the evening shift differential will be going away for the 1500-1900 portion of day shift.  This has now been programmed into payroll and you will see the change reflected in your April 17th pay check.  Please know that I realize this does impact many of you significantly.  I continue to hope and pray each day that we can all weather this financial storm with as few changes as possible.  I will keep you updated with any new information or changes as I learn of them.  You should all receive an email from HR outlining the evening shift differential changes in greater detail.

Please let me know if you have questions.

Melinda

Interested in becoming an RN III?

Sheri Stewart is holding 30 minute information sessions next Wednesday, April 10 at 1000 and 1030 in the 7 East conference room.  Learn about the requirements and process of becoming an RN III.  We have many qualified nurses on both units that should look into this.  As of right now, you are not required to have a BSN to apply-this may change in the future so take advantage of this opportunity!

Erin

email from a thankful NICU nurse!

I received the email below from a NICU RN who floated to PICU to care for the very sick RSV premie.  Thanks so much to Angi Kemp and Laura Smith for helping her get through a busy day!

Melinda,

Today I floated (from the NICU) to the PICU.  It was a busy day--but a good day.  I just wanted to let you know how great the nurses were!  Angie was charge and Laura was next to me and Erin was at my bedside throughout the day--they totally took care of me!  They were so patient and so incredibly helpful-their teamwork was amazing.  It was a great day--and I'm so thankful for your great nurses! 

Thanks!

Erin Barton

Conflict of Interest - Everyone MUST do this!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Dear Colleague:

In accordance with the MUSC and MUHA Board of Trustees policy, I am writing to inform you that it is time to administer the annual conflict of interest disclosure.  As a public institution concerned with patient care, education and research, MUSC must solicit and review financial interests and outside activities in order to identify and manage any conflict of interests for those who work here.

As a reminder, the MUSC/MUHA policy requires disclosure of significant financial interests which relate to your work at MUSC at the time of employment.  Annual updates also are required, as well as interim reports that are due within 30 days of a change in a financial interest. We continue to use a secure internet-based program, to allow you to confidentially transmit information.  The URL to access the online disclosure on the conflict of interest’s web site is: http://academicdepartments.musc.edu/coi

General questions and comments may be addressed to conflicts@musc.edu.  I recognize this is a busy time of the year.  Nevertheless, I would appreciate it if you could complete the disclosure no later than April 30, 2013.

Thank you in advance for your help in complying with this important Board policy.  Your participation is essential to assuring the integrity of the institution as a whole.  Please accept my appreciation for all that you do for the Medical University and for the people of South Carolina.

Sincerely,

Raymond S. Greenberg, MD, PhD

President

30/60/90 Certification Reminders - PICU & 7C

30/60/90 day Certification Reminders for PICU AND 7C

Listed below is all certifications and competencies that will expire within the next 30/60/90 days - this list includes both PICU and 7C.  If you have any questions, please respond to this thread or let Amanda or Erin know.

April 2013
BLS
Lisa McCormick
Brooke Nitterhouse
Madeline Ward

ACLS (not required)
Kerry Bryers
Brooke Nitterhouse

PALS
Trel Terry

May 2013
BLS
Jessie Green
Lauren Mercede
Kerry Bryers
Linette Turbeville

TB
Karen Loury
Lauren Mercede
Amy Russell
Kerry Bryers

 

June 2013

BLS
Lindsay Amerman
Emily Dorman
Kate Santos
Amanda Smith
Julie Taylor
Jason Williams

PALSKate Siegfried
TB
TB vaccine will be on the unit - all of 7C and PICU to renew!

CATTS are due June 30, 2013 for all employees!

Education Updates

PICU: Please see my email re: Prismaflex training and get started on the online modules- they will take you a while and they must be completed by May.  Thanks.
We are starting CCRN study groups! Our first meeting is Monday April 8 at 730pm.  Sign up sheet is on the break-room door and see me for our first 100 questions.  We will go over rationales during our meetings.  If interested but can't make the meeting, let me know and I'll keep you in mind when scheduling our second meeting.
We need a new Unit Magnet Champion.  I will update both boards for April, but after that, I'd like a PICU RN to take over.  Lauren Mercede has offered to take over for Amelia as 7C's UMC.  Attending the meetings is much easier now- they send you a link to a video of the meeting to view at your convenience if you cannot attend.  Anyone interested?? 
7C: We are ordering a CPN book and I will get our study groups together once it arrives!  I've heard a few people are interested.  Please let me know if you are so I can schedule the meetings appropriately.
Great job with the bedside safety checks, I have found very few errors.  That being said, please make sure your patients' ID bands are ON  the patient.  Use a foam/velcro band to luggage-tag ID bands for babies (this way they stay on, and I'm not waking them up by unswaddling to check for ID bands).  Also, make sure your IVPB sets are labeled- including the NS bag. 
There have been some issues with breast milk not being recieved/fed through the MOMS system.  This is a HUGE safety issue and needs to be resolved immediately.  I have a quick-guide/cheat-sheet that I will have laminated and placed at the nurses station by the MOMS scanner to refer to when you have a breastfeeding patient.  If you are still unsure, PLEASE let me know, or on nights use 7A or NICU charge nurses as resources. 

Any questions or concerns, please let me know.  Have a great week everyone!
-Erin

Accurate Discharge Phone Numbers

Please remember to record an accurate phone number on the discharge paperwork so the family can be reached for a discharge phone call.  We have a centralized call center now and 7C has only been about 70-80% compliant with accurate phone numbers.  We really want to be able to check on our patients and get feedback about their stay.

Thanks so much!

Melinda