Update on NS shortage - Please go back to NS flushes - smallest bags possible

Hi all. Here’s today’s update on the normal saline conservation.

The hospital is doing much better with Normal saline (we have a  4-6 week supply now).  I am sure your efforts to switch your med lines and flushes to 1/2NS have helped.

The big news now is that we are running very short on 1/2NS (3-day supply is all that is left). SO… Would those of you who switched your flushes and med lines over to 1/2NS switch BACK TO NORMAL SALINE? Use smaller bags of normal saline if possible (250 mL or 500 mL).  Thanks so much for your efforts during this unusual shortage situation.

Jill Thompson, PharmD, BCPS
Coordinator, Pediatric Clinical Pharmacy Services

Clinical Specialist, Pediatrics/Critical Care 

Adjunct Assistant Professor, South Carolina College of Pharmacy, MUSC Campus

Medical University of South Carolina

150 Ashley Ave MSC584 Charleston SC 29425

P 843-792-5850 F 843-792-0566 Pager 843-792-0590, #12767 thompsam@musc.edu

Special Pay for those who worked/stay over during the Weather Emergency

We asked and the administration listened....YAY!!!  Everyone who was called in early or stayed over in the weather emergency last week is eligible for $10/hr for the time you were required to be here but not in clinical practice (i.e. coming in early to start the shift later or having to sleep over at night or during the day).  You will receive your regular hourly rate for the clinical hours.  Please submit a time entry form to our timekeepers ASAP. You can log into kronos to see your actual clocked-in times and calculate the other hours between or around that time.

Thanks to all of you for doing a great job ensuring our patients were well cared for during the storm.

Please let me know if you have questions.

Melinda

SC RN License Renewal

IMPORTANT REMINDER: 

The universal license renewal date for all SC nurses is April 30th, 2014.  HOWEVER, MUSC has a requirement that all RNs renew no later than APRIL 1st, 2014.  This earlier date is necessary so that HR can properly conduct the required primary source verification for all 3000+ RNs across the medical center.  Please do not wait until a day or two before as the SC Board is often slow in posting the renewals on the verification website.

Those of you practicing on a compact license from another state, please take this time to check your expiration date.  You can practice with that license until it expires, but need to convert to a SC license when it is expiring if you are claiming residency here.  Please let me know if you have questions.

Thanks,

Melinda

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

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

February 28th
BLS: Shane Crawford

March 31st 
None

April 30th
BLS: Lindsay Amerman

TB: Andre Jennings

FIT: Andre Jennings

Grand Rounds Friday 2/7/14

The topic of this Friday's Grand Rounds is Pediatric Palliative Care.  Dr. Korones from The University of Rochester Medical Center, will be presenting "Pediatric Palliative Care: just what is it, anyway?" in the Storm Eye Auditorium at 8am on Friday.  It would be wonderful to send a nurse from each unit, as we often struggle with palliative care options for our patients and families.  

You've got questions? We've got ANSWERS!

By popular demand- your pressing Magnet Questions answered by MUSC Leadership!
WHY are we pursuing Magnet?
HOW much will this journey cost?
WHAT is in it for me?
WHO benefits?
HOW will I be involved?
WHAT do I need to do to prepare?


Video- Magnet Questions Answered

When the Magnet surveyors come to MUSC, they are going to want to talk to YOU, not leadership.  So celebrate our successes, read and update our Magnet Manuals, pay attention to the Magnet Board updates provided by Lauren and Kelsey.  You do a fantastic job taking care of our patients and families, and you deserve to be recognized for it.
  

Epinephrine for Anaphylaxis

Below you will find updated education for administration of Epinephrine for anaphylaxis in the Children's Hospital.  Due to many mistakes/misunderstandings with IV vs IM administration, this information will be posted by all orange tackleboxes and in each bedside chart/wall-a-roo.  Please see myself or Jill Thompson with any questions.

Need Epinephrine for ANAPHYLAXIS?

WHERE to find:	Any ORANGE TACKLEBOX – on the top shelf
HOW to DOSE:	Use the VIAL of concentrated 1:1,000 (1 mg/mL) epinephrine on top shelf. 0.01 mg/kg. Using 1:1,000 (1 mg/mL) solution, dose = 0.01 mL/kg) Max dose = 0.5 mg (0.5 mL). Dose also listed on Emergency Drug Sheet at each bedside.
HOW to PREPARE:	Use a 1-mL syringe and IM needle found in top shelf of orange tacklebox. Draw up epinephrine dose.
HOW to ADMINISTER:	Inject IM. (Never IV- even if patient has an IV line) Infant: 25 gauge, 5/8 inch IM needle Child: 25 gauge, 1 inch IM needle Adolescent: 21 gauge, 1 ½ inch IM needle Inject into anterolateral aspect of thigh. (vastus lateralis)
WHEN to REPEAT:	May repeat in 5 minutes if needed, for a maximum of 3 doses.

EROC: Please read and sign here or in binder by 2/14/14

Iceberg Identifier Sticker checkbox in McKesson
to identify patients at risk for skin breakdown

New Coding/Billing process- FYI
ICD-10 Flyer
ICD-10 Presentation

Pressure Ulcer Order Sets

VTE Prophylaxis

Specialty Bed Decision Tree
Updated- new process of ordering specialty mattresses

New Tegaderm for PIVs
Video

Any questions, please let me know.
Thanks!
Erin

Great Job PICU and 7C

Thanks again for representing pediatric critical care and the CH so well....

7C was a Gold Hand Hygiene winner for all of MUSC over last quarter.

PICU continues to lead the hospital with the fewest number of contaminated blood culture specimens.

Keep up the great work!

2014 Emergency Preparedness Teams

It's that time of year again to update our Emergency Preparedness (aka Disaster or Hurricane) Teams.  I will be posting a sign up sheet in both units.  Team A comes in and stays during the emergency/storm/etc. and Team B must be prepared to come in after the event to relieve Team A.  The last few years we have had difficulty getting enough staff for Team A.  If that happens again this year, I will just place staff on a team and then we will flip the assignments the next year.  If you have a spouse who is also a designated report in person (like police, fire or other healthcare professionals) and have dependents who will not otherwise be cared for, you will need to send me a note.  However, you must all be on one team or the other.

Thanks so much for your cooperation!

Melinda

Important information on a critical IV fluid shortage!!!!

Please read the email below.  We have a very critical shortage of Normal Saline.  Please pay attention to NS infusions and whenever possible (like piggy bag flush lines) hang .45NS instead.  I will send out any updates as I receive them and will be monitoring this situation closely.

Melinda

From: Kokko, Heather
Sent: Thursday, January 23, 2014 10:56 PM
Subject: critical shortage of IV fluids

Colleagues,

MUSC is one of many healthcare providers experiencing a critical shortage of intravenous solutions. Volume bags of 0.9 % normal saline (1000cc, 500cc, & 250cc) are not available from our main manufacturer (Baxter) until at least mid-February.  Total supply of 1000cc bags of 0.9% normal saline are currently stocked for only 5 days.  We are working closely with the industry to obtain more stock.

As you know, normal saline is used all over the hospital and has many uses.  Additionally, nurses have a major influence over prescribing patterns and usage of this type of supportive care.  It is imperative that your staff are aware of this serious shortage and work with physicians and other prescribers to conserve stock.  Please inform your staff as soon as possible to avoid wastage and implement conservation measures.  Please encourage conversion when possible so we may be able to avoid later more strict conservation measures.

According to Baxter executives, the current nationwide disruption is a direct result of changes in their production combined with a much greater that expected clinical need.  Supply Chain Management is in constant communication with senior management at Baxter and actively pursuing all available options to increase our inventories to safer levels.

While alternative supply sources are investigated, MUSC practitioners are working to provide possible:

·      I.V. solution conservation measures, and

·      Alternatives (such as Plasmalyte, Lactated Ringers, and pre-filled syringes).

During this time, all health providers are asked to:

·      conserve and limit normal saline (N.S.),

·      employ use of alternative I.V. products such as Ringers Lactate, 0.45% NS and D5W, especially for low rate infusion when possible,

·      consider using oral hydration when possible,

·      avoid use of N.S. irrigation solutions,

·      consider using commercial dialysis solutions.

Thank you for understanding and helping to provide quality patient care under dynamically changing conditions.  We will continue to monitor the shortage situation and update you as necessary.  Additional restrictions may become necessary as this situation unfolds.

Heather Easterling Kokko, PharmD, MBA
Director, Department of Pharmacy Services
  Medical University of South Carolina Medical Center
Director, Health System Pharmacy Administration Residency
Clinical Associate Dean for Medical Center Affairs
 South Carolina College of Pharmacy
(843) 792-5691 (office)
(843) 792-2360 (fax)
kokko@musc.edu

New Med cart in PICU

PICU- Pharmacy replaced our old ugly med cart with a fancy new one today.  It is thinner and taller, so some things had to be moved to other places.  Anything locked in the narc box is now on the bottom shelf of the med cart, along with the doppler, train of four and lidocaine.  Insulin needles are now behind the syringes on the left shelf.  Med cups are now in the drawer by the fridge.  The CODE for the med cart is 2580#, and it must remained locked at all times.  This code will also be posted in the Charge binder for future reference.  Press * to lock the med cart when finished. Please familiarize yourself with the new cart.  Pharmacy made the switch to standardize the carts throughout the CH, which will expedite the med delivery process since the drawers can be prepared ahead of time. 
7C- Pharmacy is working on a plan for our unit, more info to come.  Thanks everyone!

You Rock, Kate Santos Seay!

Kudos to Kate Santos Seay who spent two full hours in a patient's room last week (in a lovely blue isolation gown no less) trying to get a patient to take his po medicine.  Kate first went to the gift shop to buy M&Ms so he could practice swallowing the candy.  When she just seemed to be making some progress, the MDs changed the medication order to something not so nasty tasting.  Despite the changed order, her efforts were much appreciated by the patient's family.  Thank you Kate for always going above and beyond and setting a great example for EXCELLENCE in care!

Thank you Carrie Smith!!!

I just wanted to manage up our PICU Unit Secretary, Carrie Smith.  Our phone battery charger was broken and thought to be beyond repair.  After finding out the cost for a new unit was $190, Carrie took out the tool box and managed to repair the charger herself.  All the little things Carrie does each day to help manage our incidental unit costs are helping us reach our financial goals.

New Specialty Bed Order and Return Protocol - Please Read