Shout out to 7/26 Night Shift!

I wanted to say a big thanks to our staff who worked this past Saturday night.  There were 5 potential admissions to the PICU between 7pm and midnight.  Great job to Patricia Prause for leading the PICU crew.  7C staff (Mary Carla London) took one for the team and floated Michelle Liechty up to PICU.  Patricia reports Michelle was a tremendous help in picking up an assignment and going bedside to bedside to offer help to others.  Patrice Nock showed ultimate adaptability by having 4 different patients during the shift.  Sheri Fannin had everyone's back getting admission charting and nursing tasks completed.  Gregg Hawks kept a great attitude and flexibility in changing assignments and helping move patients in and out of the unit.  Jennifer Bussey held down the fort with her busy 1:1 patient.  Kudos to Dr. McSwain for the fastest PICC line placement ever and keeping the resident on track.  This is just one of the many examples of our excellent team work in pediatric critical care.  The units have continued to be very busy this week and everyone has done a great job and stayed positive!

So proud to be on your team!

Melinda

Employee of the Quarter Nominations for April-June 2014

Please submit your nominations for Employee of the Quarter for each of the units for the past quarter - April - June 2014.  We will celebrate winners for the last two quarters in early August.

 

7C Nominations Link:

https://www.surveymonkey.com/s/3HMTLSJ 

PICU Link:

https://www.surveymonkey.com/s/3PCZQLK

Returning controlled substances

Please remember that you cannot place any controlled substance in the pharmacy return bin.  They must be returned using the secured Acudose return drawer.  Also, there are many more controlled substances besides narcotics and sedatives.  Many of the ADHD and seizure medications are controlled substances.  If you are uncertain, please look it up before just placing in the return bin.

I don't want the narc man to come take us all away.

Thanks so much!

Melinda

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

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!

SUPER AND END-USERS

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.

ABG

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!!

Melinda

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!!

Thanks,

Melinda

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!

Melinda