Pilot for Feeding Tube Labeling and Placement Checks in PICU

In response to two sentinel events in the adult hospital, I have been part of a group reviewing our policy for confirming the placement of feeding tubes both at the initial time of placement and on an ongoing basis (q shift, before initiating feedings, or before giving medications).

The PICU will be doing a pilot for the CH on how to label feeding tubes.  I have placed a roll of stickers at the charge nurse desk (see photo below).  After placing a feeding tube and confirming placement via Xray, this label needs to be placed on the distal (farthest from the nare) end of the feeding tube.  You need to measure in cm the distance from where the tube enters the nare to the bottom edge of this label and record the distance on the label.  Then during your assessment each shift, the tube should be measured again to ensure it has remain in place (externally – it still may have moved internally and you would assess that in your usual way).

Please let me know if you have questions or concerns.  Feedback is needed to see if the labels remain intact and are easy to use.

Thanks so much,

Melinda

J. Melinda Rauton Biller, MSN, MSW, RN, CCRN

Nurse Manager

Pediatric Intensive Care Unit

Pediatric Intermediate Care Unit (7C)

MUSC Children’s Hospital

165 Ashley Avenue

Charleston, SC 29425

843-792-8639

billerm@musc.edu

Greetings from a Yankee:)

Hi Y'all!

I am just getting used to saying that!  I just started at MUSC last week as your new Nursing Professional Development Facilitator (NPDF) in the PICU and 7C.  I look forward to joining a great team!  I just wanted to introduce myself and tell you all a little about me:

I have been a nurse for about 14 years now, having worked at the Children's Hospital of Philadelphia (CHOP) in the PICU for over 9 years and then in the NICU and staff development at Penn Medicine:  The Chester County Hospital.  I finished my MSN from Drexel in 2009 and also have my certification in pediatric critical care and high risk neonatal nursing.  I love the ICU, and taking care of critical children!  I am a true OCD ICU nurse, I love my labels and sharpies.  This would put me into a tailspin!

I also worked part time as an adjunct clinical faculty in mother/baby and pediatrics.  I have worked all shifts including nights and weekend program.  I am a true night shifter so I am usually here pretty early so I can see what it going on and chat with staff.  I also consider myself a bit of a nerd, I love to read critical care journals and see what is going on in nursing globally. 

My family and I just moved here from outside Philadelphia.  My husband, Chris works for the Boeing company and was transferred in August.  We love the weather and our hoping for less snow days this year (we had 13 days last year)!  We just moved into Mount Pleasant with our three girls, Reese is 8, Addison is 5, and Harper is 2 1/2.  Harper was born with a genetic eye condition called aniridia, so she is legally blind.  She does really well and is transitioning to her new environment nicely! 

For now, my office is on 7C (in the back by the staff entrance), but I will be moving up to the 8th floor soon.  Please feel free to stop by and introduce yourself, I would love to meet you or hear any ideas or concerns you may have:)

Jaime

Jaime O'Donnell
phone 843-792-7002
pager 1761

FYI - What to do with a dislodged Gtube

G tube Education Highlight:

What to do if a g tube becomes dislodged:

If the g tube is NEW, <6 b="" initial="" placement="" since="" surgical="" weeks=""> : Call the pediatric surgery resident on call ASAP. Do not replace the tube, do not insert anything into the tract unless you are instructed to do so by a surgeon.  If the tube is replaced by the surgeon, do not use the tube until a g tube contrast study is obtained.

If the g tube is OLD, >6 weeks since initial surgical placement:  Attempt to replace the g tube or place a red rubber/foley in the tract and call surgery. If the tube is replaced easily and you are able to aspirate gastric contacts you may resume using the tube.

Kiften Carroll, NP-C

Medical Univeristy of South Carolina

Department of Surgery, Division of Pediatric Surgery

843-792-3851

New RN III's!

Please join me in congratulating our newest RN III's!

7C
Kelly Lynch and Lindsay Amerman

PICU
Sheri Fannin
Anna Durstine 
Kelsey Strawn

All have worked very hard this year, demonstrating leadership and initiative to complete their projects.  We are very proud of you ladies!  -Erin

Leadership Changes

PICU and 7C Teams,

Many of you have heard from me personally or through the grapevine that I have accepted a position as Clinical Operations Project Manager for the design and construction of the new MUSC Children’s Hospital and Women’s Pavilion.  First, my sincere apologies if you did not hear the news from me.  I started telling our team members last Monday and then, unexpectedly, had to take some time off to be with my father who has been very ill and in the CVICU at Roper.  It was very important to me to be able to meet with each of you, and I am saddened that did not happen.

For the past 6 years (3 for 7C), I have had the privilege of working with the most incredible group of clinicians.  Your stellar clinical skills and extraordinary patient/family advocacy have inspired me each day.  I could not have asked for a more dedicated, passionate, and compassionate care team.  I have always felt I was the luckiest nurse manager at MUSC because of your amazing success, quality outcomes, and commitment to patient safety.  I could not be more proud to be associated with each of you.  For all these reasons, I could never imagine leaving our pediatric critical care team.  I’ve considered myself to be a “lifer” in this role.  However, I was recruited for the position of Clinical Project Manager, and after much consideration, could not pass up this once in a lifetime opportunity.  My entire career at MUSC has been built on the fundamentals of patient and family-centered care and staff engagement.  Now I have the opportunity to help build a structure that supports those ideals.  It gives me chills to think of how even more amazing your care will be when we have a space that supports our mission.

We have a saying, “Once a PICU nurse, always a PICU nurse”.  The same is true for intermediate care.  I do not ever plan to leave MUSC and will always remain in close contact with our units (not just for the build).  I will continue to serve in the nurse manager role (and have already started the Project Manager role) until a new manager is hired.  We will still have PICU and 7C together and I am hopeful this will be an opportunity to revisit having an assistant nurse manager.  You will all be given the chance for input in the hiring process, and I will certainly be available to assist/mentor the new manager in the transition phase.  This is such a bittersweet change for me, and I am so very thankful to know I have your continued support.  You all have made me a better leader and a better person.

With much love and the highest respect,

Melinda

Congratulations, Sheri Fannin, BSN

Please join me in congratulating Sheri Fannin on earning her BSN degree.  We are so very proud of you!

Melinda

Katherine Baldwin Wins the MUSC Daisy Award

Please join me in congratulating Katherine Baldwin for being selected as a Daisy Award recipient for MUSC.  This award recognizes extraordinary nurses and Katherine certainly fits the bill.  She has been a critical member of the PICU team for 9 years and is a role model for family-centered care and patient advocacy.  Katherine's husband, son, and parents surprised her this morning, making the ceremony even more meaningful.

Congratulations, Katherine!  We are so very proud of you and thankful to have you as a part of our pediatric critical care team.  Thanks also to Kelsey Strawn for writing a beautiful nomination letter.

Melinda

Important Info Regarding Product Replacement/New EVD drainage/monitoring set

Due to a manufacturer's recall, we will have a replacement EVD drainage set starting Monday, October 6th.  A clinical rep for the replacement product will be here on Friday, October 3rd at 11am to do inservices for PICU and 7C.  If you cannot attend, below is a link to a video for how to set up, level, and use the replacement drainage system.  We will also leave written materials in the unit from the sales rep.




http://www.medtronic.com/for-healthcare-professionals/products-therapies/video/mns-duetvid/index.htm?TB_iframe=true&height=412&width=480

Thanks,

Melinda

Way to go Lauren!

Congratulations to Lauren Mercede Sailor who recently became CPN certified!  We are so proud of you.  We now have 9 certified RNs on 7C.  That is almost 50% of the RN staff.