Pillar: People
MUSC received National HAI Award for Outstanding Performance and Leadership in CLABSI Prevention
PICU Received Honorable Mention in CLABSI Prevention.
Three PICU nurses were nominated for Nurse of the Year, this is a huge honor! There were only 11 finalists total for Nurse of the Year for the overall hospital.
Reminder: there is a Survey Monkey on the blog; please vote for the unit based nurse of the Year.
March was Child Life Month – Thanks to Megan DeBolt, our Child Life Specialist!
iStat Usage
Pillar: Finance
With closure of the OR lab it is no longer more cost effective to send blood gases to the lab. We will resume bedside POCT with the iStat.
Cost per patient day Update
Pillar: Finance
Data for March is not available at this time, data will be sent out via email.
Staffing Update
Pillar: People
New RNs to start on 7C and PICU in April and May:
7C: Michelle Liechty, RN II started on April 8, 2013. Michelle is a former tech on 7B and currently works in the OR at East Cooper.
PICU: Ashley Gardner, RN II will start on May 6, 2013. Ashley is a former PCICU nurse and currently works in IR at MUSC.
Patient Satisfaction Update
Pillar: Service
Declining scores for both areas: 7C was in the 99th percentile but is now in the 1st percentile.
Many surveys have not been returned which leads to a small “n.”
7C and PICU are trialing giving out thank you cards with discharge paperwork to patients – the card has as label that informs the family and patient that a survey will be coming in the mail and that their feedback is greatly appreciated.
Dr. Evans found a study in the British Medical Journal on response rates to post-discharge questionnaires. As a reminder, “frequent flyers” do not receive patient satisfaction surveys.
Dr. Webb asked if a questionnaire was allowed for physician feedback or a survey that is specifically given by the PICU and 7C – Amelia will follow up to find out if this is allowed. Typically, this is not allowed since that is not the benchmark that other hospitals use to measure themselves across the country.
Infection Control Update
Pillar: Quality
No CLABSI, VAP OR CAUTI for March
38 months CLABSI free
One CAUTI for April, the first CAUTI this fiscal year. This is an improvement from former years; the average in years prior has been 3 – 6 a year.
Patricia Prause is working on updating annual infection prevention modules in CATTS for the PICU and 7C, CAUTI information will be added to the modules.
Education Update
Pillar: Quality
Bedside safety checklists are going well on PICU & 7C. Very few mistakes have been found, any true safety concerns have been addressed. Trach patients have been a focus on 7C checklist, the use of the trach checklist is very helpful. The bedside safety checklist is done at shift change.
On April 9, a CCRN (critical care registered nurse) certification review course began in the PICU; study sessions will be once a week for the next few months.
CPN (certified pediatric nurse) review courses will begin on 7C in the coming weeks.
Competencies are being readdressed on the units; nurses now have a voice on what they would like their competencies to be. One of the competencies that the nurses do not feel comfortable with is hypothermia protocol. Erin asked the physicians about the hypothermia protocol. Dr. Tecklenburg stated that the hypothermia protocol was never officially incorporated, however; Dr. Evans stated that it is important for the nurses to be familiar and to use the hypothermia protocol. The protocol is only used in certain post-cardiac arrest patients. There will be an official order set and a guideline set for the hypothermia protocol – this competency will be addressed in the fourth quarter. The PICU attending will be responsible for deciding which patients will go on the protocol.
In the future, the PICU would like to apply for a Beacon Award which is a nursing excellence award that the American Association of Critical Care Nurses presents to units. MICU, NSICU, STICU are all beacon units at MUSC. The goal is to apply for this award within the next three years.
Erin has started attending an evidence-based practice class at MUSC, Erin is looking for a quality improvement project to change a process in the unit, and she will do the research and work on implementing a change in the unit. Suggestions: using data from VPS system, routine use of Zantac in patients. Any suggestions – please email to Erin.
Trauma Update
Pillar: Quality
Activation paging guidelines were rolled out on April 9. The guidelines allow the trauma page to address the patient’s age, level of trauma, type of injury: stabbed, gunshot wound, motorcycle crash, etc. Someone from the Peds E/D calls the paging operator and gives this information to the operator; the operator uses a template to send the trauma page. PICU Charge Nurses receive all trauma pages on the Mayday pager.
There will be a Pediatric Trauma class in October 2013.
Pharmacy Update
Pillar: Quality
Bolusing of the pump: many hospitals bolus sedations through a drip line from the continuous medication drip already hanging. Pros: cost saver, not wasting large amounts of drugs, quick delivery of drugs, more accurate, guardrail limits can be used with it, central lines are accessed less frequently, no flush solution in the line. Cons: documentation, how will this be scanned into the electronic medical record? Amelia plans to work with Jill Thompson to see how this can be documented, hope to roll out quickly. There will be a cost savings analysis done on bolusing.
Nurse driven sedation protocol is being worked on by nursing leadership group, Jill Thompson, Dr. Webb, and Dr. Evans – will include Morphine and Versed only.
SBS and WATT forms will be sent to FORMS committee on Thursday, April 11. Standardized scales will be used.
Airway clearance guidelines went into effect on April 9. Education has been rolled out to nursing and respiratory therapy staff.
Protocol for Albuterol weaning pathways from PICU to the floor patients has been finalized. PICU: how to wean off continuous albuterol, Floor: wean off Albuterol for home. 7C can use either protocol since they have different acuity levels of patients. Once final approval has been given from the hospitalist group, this will be rolled out to the units.
Drug Shortages: Critical shortages of most electrolytes, we have potassium acetate in stock, severe shortage of calcium which is impacting CVVH, lessened restriction on bi-carb, Propofol shortage.
Chloral Hydrate was never approved by the FDA. Cannot be compounded anymore. Planning for a substitute. Alternatives to Chloral Hydrate are: oral Ketamine, Preceidex, and Pentabarb.
Savings on Dornase are dismal.
Alaris Pump Upgrades: everything should be in guardrails.
Text Message ISBAR
Pillar: Quality
There is new Children’s Hospital Text Paging Protocol. This will be trialed in the PICU and the NICU. *See attachment for protocol.
If you have a MET or Code, follow MET rules.
There are three different response codes: If you have something that is urgent and needs a response in ten minutes, an FYI which needs a response in an hour, or an NRR (no response required).
Use the ISBAR format for giving information.
Part of the goal is to encourage residents to think on their feet.
Education on the text paging protocol in the month of May, new text paging protocol will be trialed June 1. At the end of the trial in June, feedback will be given by the residents and the nurses.
Employee Engagement/Physician Satisfaction
Pillar: People
Surveys will be sent out in April for Physician Satisfaction Survey and in May for Employee Satisfaction Survey.
Open Forum
Pillar: Service
Revisit getting dry erase boards in each patient room in the PICU instead of using paper.
Suggestion: tape off large dry erase board with the following columns: room #, patient name, nurse, doctor and resident name. Will look into getting a new, large dry eraser board at the nurses’ station.
Respiratory Therapy
Pillar: Quality
Respiratory Therapy Update: recently had journal club, there will be a standard communication sheet for MLT (minimal leak technique), this sheet will be placed at every bedside and respiratory therapy will fill it out. If a patient fails extubation, one of the therapists will go back and look at the chart. Unplanned extubation rates will be tracked.
PSN from the weekend: there has been a continuous issue with nurses confirming respiratory therapy orders. This has been addressed with nurses, and will be emphasized again that this is not allowed on the blog and at the staff meetings in April.
VPS
Pillar: Growth
Starting in April, new data is being added in VPS: Foleys, EEGs, removal of lines, referring hospitals, etc.
Parent Mailboxes
Pillar: Quality
Parent mailboxes will be used on a case by case basis, especially for long term patients.
Family-Centered Care
Pillar: Quality
Family-centered care discussion: there is a 10-minute window on getting families back from OR, is this window necessary? Is there a reason that family can’t come to the bedside as soon as a patient is back? It is important to give family the option to come to the bedside right away or stay in the waiting room.
Post-Mortem Review
Pillar: Service
Looking into having a post-mortem review after Ops meetings. Led by an attending who is not involved with the case to review the death.
Staff Recognition
Pillar: People
Dr. Webb for caring for a patient who passed away the first weekend in April. She was very helpful in debriefing the staff after the death and they wanted to thank her.
Lisa O’Reilly for accommodating patients from the NNICU.
carrie smith
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