Med/Surg Education Day Decemebr 30th feel free to stop by for any topics of interest.
Saturday, December 27, 2008
Sunday, December 21, 2008
Merry Christmas Every One!
As the year ends I want to take the time to thank each of you for all that you do every shift.
The little things that make the job so much more than a job-we develop friends but we all strive to make the patients and their families lives better by what you choose to do.This nursing thing is a vocation and you each bring a little (and sometimes, alot) of yourselves to it each time you interact with a patient~Thank you for choosing our units to do that-I appreciate how tough this can be and that sometimes you leave that little bit of your self with a patient too-I hope that you come away from this year knowing that you make a difference, to me, your coworkers, but mostly to the community we serve. So no matter what happens in the year to come, please remember that our team has had it's challenges (what's life without them?) but that you each contribute to what makes our team great.
Have a Merry Christmas! ~tracy
Deana~you are important so I couldn't not post a pix of you-Thank you!
And even though I have not captured each of you in photos here please know that I appreciate that something that you bring to work each day-we couldn't do the jobs we do without each of you.
The little things that make the job so much more than a job-we develop friends but we all strive to make the patients and their families lives better by what you choose to do.This nursing thing is a vocation and you each bring a little (and sometimes, alot) of yourselves to it each time you interact with a patient~Thank you for choosing our units to do that-I appreciate how tough this can be and that sometimes you leave that little bit of your self with a patient too-I hope that you come away from this year knowing that you make a difference, to me, your coworkers, but mostly to the community we serve. So no matter what happens in the year to come, please remember that our team has had it's challenges (what's life without them?) but that you each contribute to what makes our team great.
Have a Merry Christmas! ~tracy
Nikki-welcome and we love seeing that smile!
Deana~you are important so I couldn't not post a pix of you-Thank you!
Sandi spreading the hugs to Nicole-we all need that sometimes.
Shannon-go to girl-study hard-May will be here before you know it!
Sandi-I'll make you charge material yet!
And even though I have not captured each of you in photos here please know that I appreciate that something that you bring to work each day-we couldn't do the jobs we do without each of you.
Saturday, November 29, 2008
New Fall Prevention Policy and Procedure-SEE EDUCATION BOARD IN PCU BREAKROOM TO SIGN OFF ON
You may have already seen the new yellow wrist bands on patients and signs outside patient rooms. On the Bulletin Board in the PCU break room there is a review of the new Policy and Procedure as well as a sign off/attendance sheet that you all need to sign. The Board is generally changed monthly by educational services so time is of the essence. This is all part of best practice for our patients, new to the policy is the HOMESAFEHOME Tips to Improve Home Safety that will will provide at discharge to patients so this is a slight change to our current practice but the items on the sheet are things that all of us review but there is no written education provided for discharge...problem solved. Thanks for all each of you do to give good care.
Sunday, November 9, 2008
Critical Care Online Expo
I wanted to post this awhile ago but couldn't get the links to work before the event was webcasted on November 5th but I finally got on and here is a link to a webcast/powerpoint from a national speaker AnneMarie Palatnick-her name is well known as an educator for nursing in critical care. There are many available offerings in this expo so take advantage of some great FREE education here.
http://vts.inxpo.com/scripts/InXpo.nxp?LASCmd=AI:1;F:SF!42000&EventKey=7556
Enjoy!
Tracy
http://vts.inxpo.com/scripts/InXpo.nxp?LASCmd=AI:1;F:SF!42000&EventKey=7556
Enjoy!
Tracy
Sunday, November 2, 2008
From Medscape for Nurses-Evidence Based Best Practice for ETT suctioning-Is Saline Instillation Beneficial?
Instilling Normal Saline With Suctioning: Beneficial Technique or Potentially Harmful Sacred Cow?
Margo A. Halm, RN, PhD, CNS-BC; Kathryn Krisko-Hagel, RN, MS
Am J Crit Care. 2008;17(5):469-472. ©2008 American Association of Critical-Care Nurses
Posted 10/28/2008
Introduction
Normal saline has been widely used in acute care settings during endotracheal and tracheostomy suctioning. Clinicians have held fast to this long-standing tradition because many were taught that normal saline breaks up secretions and aids in their removal (especially tenacious secretions). In this clinical review, we summarize current evidence related to the following questions: Does instilling normal saline during suctioning increase sputum yield? Alternatively, is this practice associated with adverse physiological and psychological effects?
Methods
The strategy included searching MEDLINE, CINAHL, Cochrane Library, Joanna Briggs Institute, and TRIP databases. Key words included endotracheal tubes, tracheostomies, normal saline, and suctioning. All types of evidence (nonexperimental, experimental, qualitative studies, systematic reviews) were included.
Results
In the past 2 decades, investigators have studied the physiological and psychological effects of instillation of normal saline. The impact of the instillation of normal saline on sputum recovery, oxygenation, subjective symptoms, hemodynamic alterations, and infection was measured in 14 studies[1-14] ( Table 1 ). The effects of 2, 5, or 8 mL of normal saline on physiological parameters were evaluated at intervals of 5, 10, or 20 minutes (5 minutes most common). In one study,[1] researchers investigated saline deposition by radioactively labeling normal saline with technetium (Tc 99m). Samples included anesthetized dogs and ventilator-dependent patients in general, coronary artery bypass, and neurological intensive care units (ICUs). In addition to these studies, a guideline on tracheal suctioning from the Joanna Briggs Institute[15] was retrieved.
Sputum Recovery
Sputum volume or weight was measured in 5 of the 14 studies (36%).[1-5] In 3 of those 5 studies (60%), instillation of normal saline was associated with significantly increased retrieval of sputum. The difference in sputum volume ranged from 1 to 2 g, which may not be of clinical importance. In another study,[1] radioactively labeled normal saline was noted near the bottom of the endotracheal tube within 1 minute of instillation (rather than mixing with secretions) and was then rapidly absorbed by the cardiopulmonary system, providing evidence that normal saline and secretions do not mix. Furthermore, suctioning recovered a mean of only 18.7% of normal saline instilled in humans.
Oxygenation
Arterial blood gas analysis and measurement of the nadir and recovery time of oxygen saturation (most common) or mixed venous oxygen saturation were done in 9 studies.[2-6,9,10,12,13] Results of 56% of those studies indicated that use of normal saline was significantly associated with decreased oxygenation and desaturation that worsened over time after suctioning. Oxygen saturation was a mean of 1% to 2% lower when normal saline was used, which may, in itself, not be clinically significant. However, instillation of normal saline may impair gas exchange as evidenced by continued desaturation. More clinically impressive was the 6-point decrease in mixed venous oxygen saturation that Kinloch[10] observed in patients suctioned 5 minutes after instillation of normal saline (compared with controls), as well as the doubled recovery time. These findings demonstrate the detrimental effect of normal saline on global tissue oxygenation.
Subjective Symptoms: Pain, Anxiety, Dyspnea
Subjective symptoms associated with instillation of normal saline were explored in 2 studies[8,11] (14%). Exploring the experience of being suctioned with normal saline, Jablonski[8] found that patients reported anxiety and dread, as well as increased pain. In another study, O'Neal et al[11] found increased perceived dyspnea in patients over age 60 that persisted for up to 10 minutes after suctioning, a finding that may be related to decreased pulmonary compliance with aging.
Hemodynamic Alterations
Hemodynamic effects were investigated in 3 studies[4,9,12] (21%). Results of 1 of these studies[12] demonstrated that instillation of normal saline was associated with increased heart rate 4 to 5 minutes after suctioning; however, no effect on blood pressure or respiratory rate was uncovered. The increased stimulation of the cough reflex associated with instillation of normal saline may have other detrimental effects such as increased mean arterial pressure and intracranial pressure.[15,16]
Infection
Risk of infection was investigated in 2 studies[7,14] (14%). Hagler and Traver[7] found sputum cultures that showed growth due to the dislodgment of bacterial colonies. Up to 5 times as many colonies were dislodged when normal saline was instilled, and therefore this practice may contribute significantly to lower airway contamination. Newer evidence from a randomized controlled trial[14] suggests that instillation of normal saline was associated with a lower incidence of ventilator-associated pneumonia. It is unclear from this abstract whether the researchers controlled for other standard interventions to avoid ventilator-associated pneumonia[17,18] such as oral care, aspiration of subglottic secretions, maintenance of cuff pressure on the endotracheal tube, and prophylaxis of peptic ulcer and deep vein thrombosis.
Recommendation Based on Current Evidence
Collectively, these studies provide class III evidence of the adverse physiological and psychological effects of instillation of normal saline, and therefore, support against the routine use of normal saline with suctioning ( Table 2 ). Normal saline and mucus do not mix. Therefore, normal saline does not thin or mobilize secretions. Rather, ensuring adequate hydration is one way that nurses can facilitate removal of secretions.[15] The best-known interventions for managing thick tenacious secretions and preventing mucus plugs in ventilator-dependent patients are hydration, adequate humidification, use of mucolytic agents, and effective mobilization.[16,18,20]
In addition to an unappreciable increase in sputum recovery, use of normal saline adversely affects arterial and global tissue oxygenation and dislodges bacterial colonies, thus contributing to lower airway contamination. Because no solid scientifically based benefits for routine use of normal saline have been shown, it is highly recommended that this potentially harmful "sacred cow" be abandoned. Instead, treatment considerations should center on ways to prevent the development of thick, tenacious secretions.[20]
Normal saline may be indicated in situations where it is necessary to elicit a cough,[4,18] and normal saline may be useful for clearing the catheter after suctioning to avoid reintroducing pathogens into the airway.[21] Good handwashing is essential to reduce infection when opening vials of normal saline because increased contamination has been documented when clinicians use the nongloved thumb to twist off the tops of the vials.[22]
Despite these recommendations, organizational change toward best suctioning practices has not been without challenges. In a recent multisite study,[23] three large institutions had policies that recommended instilling normal saline for thick secretions. Suctioning surveys[23,24] also indicate that 2 to 3 times as many respiratory therapists as nurses report continued use of normal saline—a finding that is not so surprising given that the American Association of Respiratory Care's guideline[25] has not been updated since 1993 (and still advocates that normal saline dilutes and mobilizes secretions).
Promisingly, among nursing circles, researchers in the United Kingdom reported that although observed suctioning practices were contrary to many research recommendations,[26] educational interventions proved effective in advancing the knowledge and translation of research-based suctioning practices of critical care nurses at the bedside.[27]
Others have also reported high compliance rates of nurses with evidence-based guidelines recommending avoidance of normal saline.[28] More studies are needed to document clinical adherence to evidence-based guidelines so that we can better connect processes of care to outcomes for patients.
I think that this evidence says it all-No Saline!
And here is the link to the same article-
http://www.medscape.com/viewarticle/581620_print
Margo A. Halm, RN, PhD, CNS-BC; Kathryn Krisko-Hagel, RN, MS
Am J Crit Care. 2008;17(5):469-472. ©2008 American Association of Critical-Care Nurses
Posted 10/28/2008
Introduction
Normal saline has been widely used in acute care settings during endotracheal and tracheostomy suctioning. Clinicians have held fast to this long-standing tradition because many were taught that normal saline breaks up secretions and aids in their removal (especially tenacious secretions). In this clinical review, we summarize current evidence related to the following questions: Does instilling normal saline during suctioning increase sputum yield? Alternatively, is this practice associated with adverse physiological and psychological effects?
Methods
The strategy included searching MEDLINE, CINAHL, Cochrane Library, Joanna Briggs Institute, and TRIP databases. Key words included endotracheal tubes, tracheostomies, normal saline, and suctioning. All types of evidence (nonexperimental, experimental, qualitative studies, systematic reviews) were included.
Results
In the past 2 decades, investigators have studied the physiological and psychological effects of instillation of normal saline. The impact of the instillation of normal saline on sputum recovery, oxygenation, subjective symptoms, hemodynamic alterations, and infection was measured in 14 studies[1-14] ( Table 1 ). The effects of 2, 5, or 8 mL of normal saline on physiological parameters were evaluated at intervals of 5, 10, or 20 minutes (5 minutes most common). In one study,[1] researchers investigated saline deposition by radioactively labeling normal saline with technetium (Tc 99m). Samples included anesthetized dogs and ventilator-dependent patients in general, coronary artery bypass, and neurological intensive care units (ICUs). In addition to these studies, a guideline on tracheal suctioning from the Joanna Briggs Institute[15] was retrieved.
Sputum Recovery
Sputum volume or weight was measured in 5 of the 14 studies (36%).[1-5] In 3 of those 5 studies (60%), instillation of normal saline was associated with significantly increased retrieval of sputum. The difference in sputum volume ranged from 1 to 2 g, which may not be of clinical importance. In another study,[1] radioactively labeled normal saline was noted near the bottom of the endotracheal tube within 1 minute of instillation (rather than mixing with secretions) and was then rapidly absorbed by the cardiopulmonary system, providing evidence that normal saline and secretions do not mix. Furthermore, suctioning recovered a mean of only 18.7% of normal saline instilled in humans.
Oxygenation
Arterial blood gas analysis and measurement of the nadir and recovery time of oxygen saturation (most common) or mixed venous oxygen saturation were done in 9 studies.[2-6,9,10,12,13] Results of 56% of those studies indicated that use of normal saline was significantly associated with decreased oxygenation and desaturation that worsened over time after suctioning. Oxygen saturation was a mean of 1% to 2% lower when normal saline was used, which may, in itself, not be clinically significant. However, instillation of normal saline may impair gas exchange as evidenced by continued desaturation. More clinically impressive was the 6-point decrease in mixed venous oxygen saturation that Kinloch[10] observed in patients suctioned 5 minutes after instillation of normal saline (compared with controls), as well as the doubled recovery time. These findings demonstrate the detrimental effect of normal saline on global tissue oxygenation.
Subjective Symptoms: Pain, Anxiety, Dyspnea
Subjective symptoms associated with instillation of normal saline were explored in 2 studies[8,11] (14%). Exploring the experience of being suctioned with normal saline, Jablonski[8] found that patients reported anxiety and dread, as well as increased pain. In another study, O'Neal et al[11] found increased perceived dyspnea in patients over age 60 that persisted for up to 10 minutes after suctioning, a finding that may be related to decreased pulmonary compliance with aging.
Hemodynamic Alterations
Hemodynamic effects were investigated in 3 studies[4,9,12] (21%). Results of 1 of these studies[12] demonstrated that instillation of normal saline was associated with increased heart rate 4 to 5 minutes after suctioning; however, no effect on blood pressure or respiratory rate was uncovered. The increased stimulation of the cough reflex associated with instillation of normal saline may have other detrimental effects such as increased mean arterial pressure and intracranial pressure.[15,16]
Infection
Risk of infection was investigated in 2 studies[7,14] (14%). Hagler and Traver[7] found sputum cultures that showed growth due to the dislodgment of bacterial colonies. Up to 5 times as many colonies were dislodged when normal saline was instilled, and therefore this practice may contribute significantly to lower airway contamination. Newer evidence from a randomized controlled trial[14] suggests that instillation of normal saline was associated with a lower incidence of ventilator-associated pneumonia. It is unclear from this abstract whether the researchers controlled for other standard interventions to avoid ventilator-associated pneumonia[17,18] such as oral care, aspiration of subglottic secretions, maintenance of cuff pressure on the endotracheal tube, and prophylaxis of peptic ulcer and deep vein thrombosis.
Recommendation Based on Current Evidence
Collectively, these studies provide class III evidence of the adverse physiological and psychological effects of instillation of normal saline, and therefore, support against the routine use of normal saline with suctioning ( Table 2 ). Normal saline and mucus do not mix. Therefore, normal saline does not thin or mobilize secretions. Rather, ensuring adequate hydration is one way that nurses can facilitate removal of secretions.[15] The best-known interventions for managing thick tenacious secretions and preventing mucus plugs in ventilator-dependent patients are hydration, adequate humidification, use of mucolytic agents, and effective mobilization.[16,18,20]
In addition to an unappreciable increase in sputum recovery, use of normal saline adversely affects arterial and global tissue oxygenation and dislodges bacterial colonies, thus contributing to lower airway contamination. Because no solid scientifically based benefits for routine use of normal saline have been shown, it is highly recommended that this potentially harmful "sacred cow" be abandoned. Instead, treatment considerations should center on ways to prevent the development of thick, tenacious secretions.[20]
Normal saline may be indicated in situations where it is necessary to elicit a cough,[4,18] and normal saline may be useful for clearing the catheter after suctioning to avoid reintroducing pathogens into the airway.[21] Good handwashing is essential to reduce infection when opening vials of normal saline because increased contamination has been documented when clinicians use the nongloved thumb to twist off the tops of the vials.[22]
Despite these recommendations, organizational change toward best suctioning practices has not been without challenges. In a recent multisite study,[23] three large institutions had policies that recommended instilling normal saline for thick secretions. Suctioning surveys[23,24] also indicate that 2 to 3 times as many respiratory therapists as nurses report continued use of normal saline—a finding that is not so surprising given that the American Association of Respiratory Care's guideline[25] has not been updated since 1993 (and still advocates that normal saline dilutes and mobilizes secretions).
Promisingly, among nursing circles, researchers in the United Kingdom reported that although observed suctioning practices were contrary to many research recommendations,[26] educational interventions proved effective in advancing the knowledge and translation of research-based suctioning practices of critical care nurses at the bedside.[27]
Others have also reported high compliance rates of nurses with evidence-based guidelines recommending avoidance of normal saline.[28] More studies are needed to document clinical adherence to evidence-based guidelines so that we can better connect processes of care to outcomes for patients.
I think that this evidence says it all-No Saline!
And here is the link to the same article-
http://www.medscape.com/viewarticle/581620_print
Thursday, October 23, 2008
Put down the Penlights...Neuro assessment
Changes in behavior are an early sign of neurologic compromise. They are not specific to neurologic problems, but they are the earliest sign. Keep a close eye on the patient for problems with speech and disorientation. Many nurses start assessing neurologic function by pulling out their penlight and checking the patient's pupils. This is very stimulating to your neuro patient and is not the first thing that is going to change.
If your patient is alert and oriented and you are just trying to follow him to see if his condition is getting worse, the first thing that is going to change is his behavior. Behavior is the highest level of function. Next the patient will have changes in his speech. Speech patterns and the ability to perform speech tell you a lot about the patient's neurologic function. The third level down is content of arousability, and this is what is referred to as orientation. The forth level is arousability; whether or not the patient wakes up when you walk into the room or you have to touch him or use painful stimuli.
If your patient is already unconscious, assess systolic blood pressure as an indicator of intracranial pressure. As intracranial pressure increases, systolic pressure has to increase to continue to perfuse the brain. The very lowest level is the pupil reflex. Changes in pupils do not tell you much about the patient. Pupil changes indicate a very small lesion that is right around the optic nerve or a huge lesion that is causing the patient to herniate.
Check speech first. Put down the penlights and watch the patient's behavior changes.
Best wishes,David W. Woodruff, MSN, RN-BC, MSN, CENPresident, Ed4Nurses, Inc.www.Ed4Nurses.com www.dwoodruff.com
If your patient is alert and oriented and you are just trying to follow him to see if his condition is getting worse, the first thing that is going to change is his behavior. Behavior is the highest level of function. Next the patient will have changes in his speech. Speech patterns and the ability to perform speech tell you a lot about the patient's neurologic function. The third level down is content of arousability, and this is what is referred to as orientation. The forth level is arousability; whether or not the patient wakes up when you walk into the room or you have to touch him or use painful stimuli.
If your patient is already unconscious, assess systolic blood pressure as an indicator of intracranial pressure. As intracranial pressure increases, systolic pressure has to increase to continue to perfuse the brain. The very lowest level is the pupil reflex. Changes in pupils do not tell you much about the patient. Pupil changes indicate a very small lesion that is right around the optic nerve or a huge lesion that is causing the patient to herniate.
Check speech first. Put down the penlights and watch the patient's behavior changes.
Best wishes,David W. Woodruff, MSN, RN-BC, MSN, CENPresident, Ed4Nurses, Inc.www.Ed4Nurses.com www.dwoodruff.com
Friday, October 10, 2008
Amiodarone Competency~for RN's
You will find in your mailboxes a competency for Amiodarone. Each RN needs to complete the quiz and return it to Vilma's mailbox outside the office and while you are there sign the Attendance sheet posted there also.
Wednesday, October 8, 2008
AHRQ and You-Evidences Based Best Practice Handbook
You just never know what you find when you are surfing the net these days but looky here a handbook developed from the Agency for Healthcare Research and Quality (AHRQ) for nurses. Sponsored by the Robert Wood Johnson Foundation this is a virtual (literally) treasure trove of best practices from the nurses point of view and get this...researched as best practice, not just "we do it that way because that's how we've always done it" reasons.
The whole book can be accessed.....online-for nothing...and you can order your own 3 volume printed copy or a researchable CD if you so desire but why when this will be updated periodically long before the printed stuff will be available.
http://www.ahrq.gov/qual/nurseshdbk/
What a treat! Take a gander around and see what we can improve on to keep our patients safe and well cared for.
We all have a hand in this so read on McDuff !! :)
Tracy
The whole book can be accessed.....online-for nothing...and you can order your own 3 volume printed copy or a researchable CD if you so desire but why when this will be updated periodically long before the printed stuff will be available.
http://www.ahrq.gov/qual/nurseshdbk/
What a treat! Take a gander around and see what we can improve on to keep our patients safe and well cared for.
We all have a hand in this so read on McDuff !! :)
Tracy
Wednesday, October 1, 2008
And they're on their own..
The new grads are off orientation and are all doing great! We also had a great weekend at ACLS and I am happy to say that Susan Plissey passed without a speck of nerves showing, Dorothy, Jen and I all recerted successfully! The next ACLS is December 6 & 7th. The new grads will be scheduled in the spring class(es) once the dates are annouced I'll post them here.
Just a couple pix of the preceptors with their new grads...
Thank you to all who attended the Wound Update on Monday...if you missed it there will be more at the skills fair in November also. Remember the new regs go into effect today so let the providers know if there are any pressure ulcers on your patients so they can assess and document them in their admission work. Thanks for all you do!
Saturday, September 20, 2008
Wound Ulcer Staging and New Standards for Documentation
Inservice: September 29th every hour on the hour in McCain B with Rhonda Bossie starting at 0700 with the last session starting at 1600.
Starting October 1st there are new CMS regulations going into effect that will effect repayment on pressure ulcers. The long and short of it is that if a pressure ulcer isn't documented at the time of admission(POA or present on admission) by the provider then payment is not guarenteed for the care of this ulcer. i.e. patient A admitted for CHF and hyperglycemia and has a stage II on his heel if the provider doesn't dictate or document the ulcers presence and the ulcer either gets worse or we have treatments to administer (lets say we order an air mattress) it's won't be reimbursed. Since the doctors rely heavily on our documentation of these items we need to be certain that the admitting provider is aware of these as soon as possible to ensure that money is captured by the coding folks.
Here are the staging guidelines for review.
http://www.medicaledu.com/staging.htm
and let's be measuring these-I have found that the white boards are helpful for communication of this info to any provider (wound/ostomy nurses and MD's) in addition to our coworkers who may be changing the dressing after you.
Rhonda will be reviewing some of this info also but I figured having it here too will be a resource for you also. And some of you have already attended the webcast Sept. 9th. This is not a repeat presentation of that information.
So attend 1 session with Rhonda on September 29th for one hour-it starts at 0700 until 1600-if you aren't working that day you have some latitude on what time to attend and if you are working we will do our best to get everyone there.
Questions and answers from the presentation on Sept. 9th; some of you had some questions and I poised them to Rhonda after the session I attended.
Q: Are the physicians being trained?
A: Yes at their monthly meeting this month.
Q: Can we take pcitures of wounds to document them?
A: Not at this time-there is alot of training necessary for this plus obtaining cameras for each unit and only specific formats are allowed by Medical records.
Q: Are we going to purchase/use the "Solutions Algorithms" mentioned in the webinar?
A: Not at this time but the Wound/Ostomy Affiliate group is working on standardized treatments based on the products we use in the system.
One more time: September 29th for an hour in McCain B-Wound updates with Rhonda Bossie.
Thanks for reading!
Tracy
Starting October 1st there are new CMS regulations going into effect that will effect repayment on pressure ulcers. The long and short of it is that if a pressure ulcer isn't documented at the time of admission(POA or present on admission) by the provider then payment is not guarenteed for the care of this ulcer. i.e. patient A admitted for CHF and hyperglycemia and has a stage II on his heel if the provider doesn't dictate or document the ulcers presence and the ulcer either gets worse or we have treatments to administer (lets say we order an air mattress) it's won't be reimbursed. Since the doctors rely heavily on our documentation of these items we need to be certain that the admitting provider is aware of these as soon as possible to ensure that money is captured by the coding folks.
Here are the staging guidelines for review.
http://www.medicaledu.com/staging.htm
and let's be measuring these-I have found that the white boards are helpful for communication of this info to any provider (wound/ostomy nurses and MD's) in addition to our coworkers who may be changing the dressing after you.
Rhonda will be reviewing some of this info also but I figured having it here too will be a resource for you also. And some of you have already attended the webcast Sept. 9th. This is not a repeat presentation of that information.
So attend 1 session with Rhonda on September 29th for one hour-it starts at 0700 until 1600-if you aren't working that day you have some latitude on what time to attend and if you are working we will do our best to get everyone there.
Questions and answers from the presentation on Sept. 9th; some of you had some questions and I poised them to Rhonda after the session I attended.
Q: Are the physicians being trained?
A: Yes at their monthly meeting this month.
Q: Can we take pcitures of wounds to document them?
A: Not at this time-there is alot of training necessary for this plus obtaining cameras for each unit and only specific formats are allowed by Medical records.
Q: Are we going to purchase/use the "Solutions Algorithms" mentioned in the webinar?
A: Not at this time but the Wound/Ostomy Affiliate group is working on standardized treatments based on the products we use in the system.
One more time: September 29th for an hour in McCain B-Wound updates with Rhonda Bossie.
Thanks for reading!
Tracy
Friday, September 5, 2008
Back to School time SCIP= Core Measures=Best Practice
Surgical Care Improvement Project
What does this mean to us-well similar to Core Measures it provices a framework of researched best practices only instead of it being about CHF, MI & Pneumonia that Cores target these are specific to pre and post op measures. You may have already seen them as part of ordersets-for instance stopping antibiotics after a set number of doses or VTE prophylaxis/screening. Other measures that we already know work were researched by other studies and are integrated into these measures-like all the respiratory measures SCU staff will recognize as IHI's 100,000 Lives Campaign; having the HOB greater than 30 degrees in a ventilated patient and Ulcer prophylaxis.
Here is a link to all the SCIP measures-and yes this is monitored and reported since repayment is contingent on our completing each step in the process and like Cores if we miss one measure of the whole surgical experience then we fail the whole"bundle" and payment.
http://www.premierinc.com/quality-safety/tools-services/safety/topics/scip/downloads/scip-final-10-14-05.pdf
One to note especially for SCU staff who commonly recover the big bowel cases is #7 :
Colorectal surgery patients with immediate postoperative normothermia.
Translation: We have 15 minutes to get the postop colorectal patients temp above 96.8.
Everyone is working hard to meet this measure, but even I was unaware that this was the standard until we had already missed one-unfortunate since it decreases the patients risk negative post op issues but now that I know I want you all to be in to make our patients safer also.
Please take the time to read through the measures on the link so that you ar aware also and we can all help each other to facilitate giving our patients the best care research says works.
Thanks for all you are doing for Cores-I went to the meeting on Friday and we were 100% for all measures in June-YEAH US!!!
So if we can do it for Cores-SCIP should be a breeze with a little attention to detail.
Saturday, August 30, 2008
Silver Coated ET tubes decrease VAP rates
Who is getting ready for some changes soon??? ;)
***AND***
Latest JAMA article to decrease VAP in ICU
http://www.medscape.com/viewarticle/579239
Dr. Jimenez is back from a recent mission trip.
***AND***
Latest JAMA article to decrease VAP in ICU
http://www.medscape.com/viewarticle/579239
Dr. Jimenez is back from a recent mission trip.
Thursday, July 10, 2008
More KUDOS!!!
Woo-Who! Look at this guys. Great Job!
Also for the month of June, SCU did 100% of their chart reviews.
Vilma
_____________________________________________
PYXIS Inventory 2nd Quarter
Due Date SCU Days Delinquent
4/2/2008- 4/9/2008 0
4/16/2008 - 4/23/2008 0
4/30/2008 - 5/7/2008 0
5/14/2008 - 5/21/2008 0
5/21/2008 - 5/28/2008 0
6/4/2008 - 6/11/2008 0
6/18/2008 - 6/25/2008 0
Due Date PCU Days Delinquent
4/2/2008 - 4/9/2008 0
4/16/2008 -4/18/2008 2 LATE
4/23/2008 - 4/30/2008 0
5/7/2008 - 5/14/2008 0
5/21/2008 - 5/28/2008 0
6/4/2008 - 6/11/2008 0
6/18/2008 - 6/18/2008 0
6/25/2008 0
Also for the month of June, SCU did 100% of their chart reviews.
Vilma
_____________________________________________
PYXIS Inventory 2nd Quarter
Due Date SCU Days Delinquent
4/2/2008- 4/9/2008 0
4/16/2008 - 4/23/2008 0
4/30/2008 - 5/7/2008 0
5/14/2008 - 5/21/2008 0
5/21/2008 - 5/28/2008 0
6/4/2008 - 6/11/2008 0
6/18/2008 - 6/25/2008 0
Due Date PCU Days Delinquent
4/2/2008 - 4/9/2008 0
4/16/2008 -4/18/2008 2 LATE
4/23/2008 - 4/30/2008 0
5/7/2008 - 5/14/2008 0
5/21/2008 - 5/28/2008 0
6/4/2008 - 6/11/2008 0
6/18/2008 - 6/18/2008 0
6/25/2008 0
Wednesday, July 9, 2008
Congrats!!!
Celebrate the peers amoung us! So far Nic, Nicole (Nikki) Ouellette, Louise, and Becki have all passed their RN boards!!! Latricia (Trish) passed her boards on July 8th! Great job all of you!!Another Kudos goes out to Wendy Samaroo for passing her Basic Rhythms-as a self study I might add-so far as I know she is the first one to successfully complete this without taking the complete class! Great Job! Wendy will be transitioning to the MT role over the next few weeks so congratulate her when you see her.
Saturday, June 21, 2008
What am I?-a Rhythm Quiz
Scenario: An 83 year old woman with ischemic cardiomyopathy goes into her PCP for a routine checkup. She is receiving appropriate medical management with pharmacological agents and has no acute symptoms.
So evaluate her rhythm:
Rate- normal,brady or tachy?
Rhythm-regular,irregular, irregularly regular?
P waves-one for each QRS, less than one for each QRS, more than one for each QRS, unable to determine ?
PR interval-normal, short, prolonged, can't determine?
QRS duration-normal or wide?
ST segment-negative and less than 0.12, negative and greater than 0.12, positive and greater than 0.12?
T wave-normal or inverted?
QTc-normal or lengthened(greater than 0.47)?
Please print and return to me for competency credit for June. I will post answers after I receive everyone's answers.
Also please copy your certificate from attending Bob Pages EKG interpretation workshop and place it with your items in the competency 3 ring binders on each unit. Thanks!
Friday, June 20, 2008
No More Lead II in Critical Care Services
http://homepage.mac.com/edutainment/Menu3.html
Here is the link to Bob Page's presentation and practice 12 Leads.
Hope you all enjoyed the information and yes you can expect some competencies on EKG interpretation towards fall. I know several of you purchased Bob's book that was available at the conference and Vilma purchased a book for each unit's resource library also, please make use of them, they are tools in your practice young Padawans. Before long we'll all be Jedi masters of the EKG. 15 leads are in your reach and join me in monitoring in MCL1 my friends, the difference is amazing!
Here is the link to Bob Page's presentation and practice 12 Leads.
Hope you all enjoyed the information and yes you can expect some competencies on EKG interpretation towards fall. I know several of you purchased Bob's book that was available at the conference and Vilma purchased a book for each unit's resource library also, please make use of them, they are tools in your practice young Padawans. Before long we'll all be Jedi masters of the EKG. 15 leads are in your reach and join me in monitoring in MCL1 my friends, the difference is amazing!
Wednesday, June 18, 2008
EKG class at P I Inn and Convention Center Tomorrow!!!
Just a reminder...registration at 7:30...See you there!
Also got this cool article in my email today and thought it was sooo useful...Cardiac meds demystified.
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=770337
From Nursing 2008
Have you met a new grad yet?
Also got this cool article in my email today and thought it was sooo useful...Cardiac meds demystified.
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=770337
From Nursing 2008
Have you met a new grad yet?
Saturday, June 14, 2008
Big Week
First off-the new grads will be in the floor starting this week. Please Welcome Nick, Latricia, Nicole, Becki, and Louise as they start the venture to "Registered Nursehood".
http://www.kangarooepump.com/Epump/pageBuilder.aspx?webPageID=131032&topicID=131032
And the EKG class is happening Thursday and Friday at the Presque Inn and Convention Center (yes the Old Keddys) from 8-4 each day-registration starts at 7:30. This will be a great break from the busy floors and get some great info for our brains to enhance our bedside practice.
Thanks for all the extra people have been doing to cover each other with the recent bugs floating around. Really appreciate all you do!
Until next update..
~Tracy
Next off-the Rep will be here this week for the new Kangaroo Feeding pump-I sent out an email with a link to the companies website with a video tutorial. If you missed it here it is-please try and make it down to the McCain rooms for a hands on also."Don't let your past dictate who you are now
but let it be a part of of who you will become "
http://www.kangarooepump.com/Epump/pageBuilder.aspx?webPageID=131032&topicID=131032
And the EKG class is happening Thursday and Friday at the Presque Inn and Convention Center (yes the Old Keddys) from 8-4 each day-registration starts at 7:30. This will be a great break from the busy floors and get some great info for our brains to enhance our bedside practice.
Thanks for all the extra people have been doing to cover each other with the recent bugs floating around. Really appreciate all you do!
Until next update..
~Tracy
Thursday, May 22, 2008
Room supplies
Bag 1 supplies: Nasal cannula, oxygen extension, tubing connector, Venti mask, and 100% NRB
Bag 2 Supplies: Yankeur Suction, Suction Catheter kit, suction tubing, 80 mm oral airway,90 mm oral airway, & 100 cm oral airway
- Above you see pictures of 2 bags that will be at hand at each patient's bedside.
- If you open the supplies for a patient they are only to be used for that patient for the duration of their stay.
- Housekeeping will be wiping off the bags if they are not opened but if the seal is opened then the bag "belongs" to that patient.
- New supplies in a new bag will be replaced if the bag is opened for a prior patient.
- I expect that the suction cannister if used will be replaced in the room other wise housekeeping is only wiping down the exterior surfaces of everything.
- This is in an effort to decrease patient exposure especially given the volume of isolation patients we see on a daily basis.
Thanks for your help in keeping our patients safe.
Tracy
Wednesday, May 14, 2008
Question for you
Your diabetic patient is to receive Tenormin (Atenolol) this morning.
As her nurse you should assess which lab value:
a. Glucose
b. Potassium
c. Calcium
d. Magnesium
{courtesy of David Woodruff Med/Surg Certification Review}
Answers can be posted here or email.
As her nurse you should assess which lab value:
a. Glucose
b. Potassium
c. Calcium
d. Magnesium
{courtesy of David Woodruff Med/Surg Certification Review}
Answers can be posted here or email.
Sunday, May 11, 2008
Thursday, May 8, 2008
We appreciate all you do!
The Lady With the Lamp National Nurses Week is always May 6-12, ending on Florence Nightingale's birthday. National Nurses Week is always May 6-12, ending on Florence Nightingale's birthday. By ADVANCE staffTest your knowledge about the founder of modern day nursing with some of these lesser known facts:
Nightingale's father was a pioneer in epidemiology and tutored Florence in mathematics/statistics, an area she excelled in later in her career.
A gifted statistician in her own right, Nightingale was fond of using pie charts when presenting her statistics.
Among many studies, Nightingale did a statistical analysis of sanitation in India.
Nightingale was the first female to be elected to Royal Statistical Society.
Florence Nightingale defied her extremely wealthy family and upper class conventions in choosing to become a nurse in 1845.
Nightingale not only fought for better medical care, but also championed social issues such as reform of the British Poor Laws.
Nightingale's first published work was on a German Lutheran religious community in 1851.
Most famous for her care of soldiers during the Crimean War, Nightingale entered Turkey in 1854 with 38 nurses she personally trained.
In Nightingale's first winter at Scutari in the Crimea, the death toll rose with more than 4,077 soldiers dying.
Nightingale's first evidence-based practice research involved collecting evidence that poor living conditions were the cause of most soldier deaths during the Crimean War.
The Times of London is widely considered responsible for labeling Nightingale "the lady with the lamp."
The U.S. government consulted Nightingale on setting up military hospitals during the Civil War.
As a woman, Nightingale could not serve on the British Royal Commission on the Health of the Army even though she played a critical role in its formation.
What is now the Florence Nightingale School of Nursing and Midwifery, part of King's College London, was established by her to train nurses in 1860.
Notes on Nursing also sold well as a popular book in the 1860s.
In 1867, poet Henry Longfellow's poem "Santa Filomena" further ensured Nightingale's image with the lines, "Lo! In that hour of misery A lady with a lamp I see Pass through the glimmering gloom."
In the 1870s, Nightingale trained Linda Richards, the first formally trained American nurse.
Nightingale died in 1910, but her family declined to have her buried in Westminster Abbey with kings, queens and other English nobility. She is buried in the churchyard at St. Margaret's Church, East Wellow, Hampshire, England.
Nightingale's maternal grandfather was the British abolitionist Will Smith.
Nightingale is named after her birthplace, Florence, Grand Duchy of Tuscany (Italy).
To read more about Florence Nightingale and her continuing influence on nurses, see this selection of editor's picks from the ADVANCE for Nurses archives:
Led by the LampThe Nightingale Initiative for Global Health has created the Nightingale Declaration, designed to bring health to the forefront of world consciousness.For Florence Dee Jones composes and performs a song about nursing's heroine.
Copyright ©2008 Merion Publications
Tuesday, May 6, 2008
Multi-Lead Medics 12 Lead ECG Interpetation Workshop
You will notice that on June 19th or 20th you are each scheduled for an 8 hour EKG class. This an interpretation class that will be from 7:30 until 4pm at Presque Isle Inn and Convention Center. Bob Page is the presenter and he is nationally known author on this topic. This should be an excellent presentation and I hope you all bring alot of information back to your practices.
I have placed one copy of the Seminar Workbook on each unit for you to peruse prior to the presentation if you wish but they will be passed out at each session, so don't feel like you have to copy it unless you really want to have a copy ahead of time.
Vilma and I sincerely hope that this is a beneficial conference for all of you.
Tracy
I have placed one copy of the Seminar Workbook on each unit for you to peruse prior to the presentation if you wish but they will be passed out at each session, so don't feel like you have to copy it unless you really want to have a copy ahead of time.
Vilma and I sincerely hope that this is a beneficial conference for all of you.
Tracy
Tuesday, April 22, 2008
Chart Review/Performance Improvement
In the FYI section-please welcome Mark Morrow back to PCU, he will be providing his compassionate care on PCU days in the near future.
Congrats go to Susan Plissey for passing her RN boards-she is finishing up orientation with Nicole on PCU nights and will be on her own around the first of May.
Bunny Estabrook is the proud grandmother of the Little Miss PI runner up.
Welcome to Robert Garrett a new CNA on PCU-he joins us from AHC and has already proven to be "johnny on the spot" with a lift so far.
Congrats go to Susan Plissey for passing her RN boards-she is finishing up orientation with Nicole on PCU nights and will be on her own around the first of May.
Bunny Estabrook is the proud grandmother of the Little Miss PI runner up.
Welcome to Robert Garrett a new CNA on PCU-he joins us from AHC and has already proven to be "johnny on the spot" with a lift so far.
We are missing Blossom Cyr's can do attitude on PCU and we wish her the best with getting her new business venture off the ground and will still she her as a casual staff on weekends.
New travelers for both areas on nights are Amanda Dobson, Robert Pina and Bill Bourke have joined the force in time to cover vacations-welcome them and help them with things as they arise.
Heather Michaud will be returning to SCU in the next few weeks-be sure to give her an understanding smile as she rejoins the fold as a mother of 3!
Thank you to Louanne Langley for all the organizing she has done with what remains in paper-we all appreciate having the needed paper in the files when we reach for it.
Carrie Haas has been working hard at the SCU orientation materials and checkoff lists. I know I appreciate the time she has taken with this project as well as Judy Morrill for serving as our tireless typist:) We love you Judy!
And drumroll please...as promised here are the actual numbers for our Performance Improvement Measures for Chart Reviews the First Quarter.
SCU - overall 86%
PCU- overall 91%
SCU started the year with a bang-Each nurse completed 2 reviews each for 100% compliance, February we dropped to 83% and March was down again to 75%. I can't stress enough how we all impact these items.
PCU for January and February was 86% and improved to 100% for March-these numbers demonstrate that we are capable of achieving greatness; please strive to be the best by doing your part.
Of all of the measures we monitor the most telling is the Critical Lab Reporting. SCU was 89% for the 1st quarter (100-100-67%) And PCU was 84% (75-25-34%) This is a no argument area our expectation is 100%. We have to document each critical result that we obtain. The process is clear. Whichever department that has the result {be that radiology with a positive CT finding to the lab with a high BUN or nuclear with a positive stress test} is to call the unit with this result, the registered nurse will read back the results[RBV] to whomever is calling. Document the result in Ad Hoc in Powerchart in the Provider Notification form clicking the critical result reporting button, sign the form. Page the provider, who understands that criticals have a 1 hour time limit to be reported-this includes the lab running time so often we have 30 minutes to relay the information. When the provider returns the page open the Provider Notification form from the FORMS tab and by right clicking on it to modify it and document actions taken/MD response.
Please know that I fully appreciate the time it takes to get the job done and all your efforts are not ignored. However we still have a way to go to get where we have to be, so your attention to these items shows on reviews.
Next week employee surveys will commence and you will be asked to go to the designated area to complete one starting April 28th.
O.K. how is this working as a mode of communication? I need some feedback....
Until next time.....
Tracy
Thursday, April 17, 2008
Chart Reviews and Coumadin dosing
A few of you have raised a question on the timing of coumadin dosing. I have checked and doubled checked to be certain and according to Dr. Tewksbury and Cheri Fitzpatrick in the lab we will NOT affect lab results if we administer Coumadin at 1600 instead of 2000. 1600 is the default time set in order sentences so it will eliminate the retiming issues that we have had since we went live with Powerchart. So although this will be a change for us to adminster coumadin on day shift instead of nights rest assured we will not disrupt the lab results and most patients usually dose at this time at home so it will be more continuitity of care for them.
Chart reviews~yes, RN's are still expected to complete 2 charts per month. Our most recent quarter results are still lacking. With our decrease in the number of RN's it really shows if only one of us is not completing their share.
I will post the actual numbers but it was staggering the effect that just one person not completing them has on our statisitics. Thank you to those of you that are completing them-keep up the good work!
Tracy
Chart reviews~yes, RN's are still expected to complete 2 charts per month. Our most recent quarter results are still lacking. With our decrease in the number of RN's it really shows if only one of us is not completing their share.
I will post the actual numbers but it was staggering the effect that just one person not completing them has on our statisitics. Thank you to those of you that are completing them-keep up the good work!
Tracy
Wednesday, April 2, 2008
Did you know?
- For bystanders-AHA reccomends that calling 911 and doing chest compressions enhances survival rates - no mouth to mouth necessary-very interesting!
Hands-Only (Compression Only) Cardiopulmonary Resuscitation: A Call to Action for Bystander Response to Adults Who Experience Out of Hospital Sudden Cardiac Arrest
When you see an adult suddenly collapse, use Hands-Only CPR: that's CPR without mouth-to-mouth breaths. And it can help save lives.
Hands-Only CPR is CPR without mouth-to-mouth breaths. It is recommended for use by bystanders who see an adult suddenly collapse in the "out-of-hospital" setting. It consists of two steps:
Call 911 (or send someone to do that).
Begin providing high-quality chest compressions by pushing hard and fast in the center of the chest with minimal interruptions
The American Heart Association recommends conventional CPR (that is, CPR with a combination of breaths and compressions) for all infants and children, for adult victims who are found already unconscious and not breathing normally, and for any victims of drowning or collapse due to breathing problems.
Read the full Hands-Only CPR Advisory statement.
To learn more about Hands-Only CPR visit: americanheart.org/handsonlycpr
Thursday, March 13, 2008
General Updates
- Vilma and I are still working through API stuff as you are so please keep doing a paper timecard until we tell you to stop.
- While reviewing charts with our chart reviewer this week it was brought up that we should be adding a comment to every IV medication or fluid we are infusing to state that it is infusing on a pump to justify the charge.
- We should make sure that the time we are receiving the patient is not the same time as the prior caregivers time-we would be charging services at the same time(i.e. day surgery or ER)
- Please obtain a written order for patients on bariatric beds.
Reminder-staff meetings for PCU are Monday and Wed.-see times to the right.
Topics of meeting to include:
- API
- Blog
- Vacations
- Future staff meetings
Please let us know if there is anything else you need.
Our condolances to Barb Caron and her family on her recent loss of her father.
Sunday, March 9, 2008
Don't forget-Medication Reconcillation Class
Schedules are posted on each unit-about an hour long class at City Drug with Karla-yes there is a badge reader inside the entrance before you go down the stairs. Please badge in and out as usual to get credit for attending. These are the last classes that are being offered-see me if you have any questions. Thanks!
Tracy
Tracy
Thursday, March 6, 2008
Powerchart Updates for March 18
Here are the quarterlyupdates for Powerchart there are several upcoming changes and just general updates to forms-please go through these 2 pages and let me know if you find any issues-these are meant to make things easier and to clarify issues that have been raised to our attention. Thank you for taking the time.
https://webmail.emh.org/exchange/TWhitten@tamc.org/Sent%20Items/March%2018%20Powerchart%20Updates.EML/PC%20-%20Update%20for%20Quarterly%20Update%20March%2018%202008TAMC.doc/C58EA28C-18C0-4a97-9AF2-036E93DDAFB3/PC%20-%20Update%20for%20Quarterly%20Update%20March%2018%202008TAMC.doc?attach=1
Tracy
https://webmail.emh.org/exchange/TWhitten@tamc.org/Sent%20Items/March%2018%20Powerchart%20Updates.EML/PC%20-%20Update%20for%20Quarterly%20Update%20March%2018%202008TAMC.doc/C58EA28C-18C0-4a97-9AF2-036E93DDAFB3/PC%20-%20Update%20for%20Quarterly%20Update%20March%2018%202008TAMC.doc?attach=1
Tracy
Sunday, March 2, 2008
Part One of New Drugs 2008- API
Sorry for the link but I tried to add just the PDF to the blog but it wouldn't cooperate...but thought this was important since we often don't research these new drugs until we get a patient that is taking them.
http://www.nursingcenter.com/library/journalarticleprint.asp?Article_ID=770334
Things are progressing with API-how are you finding things? Vilma is working on getting everyone PC access, please remember that it takes some time for the info to "cross" from the badge reader to the computer system so if you badge is don't badge in on the PC-from what I have seen it's taken at least 20 minutes to see your badge on the PC account. Please make sure when you are badging out of "charge" in the middle of a shift that you badge yourself back in for the rest of the shift. Everyone is really doing well overall-I know it's frustrating to not "see" what you just badged show up on the reader itself but we can help you until you get PC access.
A fond and sad goodbye to Crystal Laster was given on Wednesday in the form of a pot luck that I heard was delicious. We interviewed a couple of potential candidates this past week and are hoping things pan out in that area. I did type a couple we are being proactive since we anticipate some of our staff(Becki) to graduate in the spring and we want to be prepared to have folks step into spots as that and vacations start in earnest for the summer.
If you have any ideas of what you want to see here please let me know and I will do what I can to get it here.
Have a great week!
Tracy
http://www.nursingcenter.com/library/journalarticleprint.asp?Article_ID=770334
Things are progressing with API-how are you finding things? Vilma is working on getting everyone PC access, please remember that it takes some time for the info to "cross" from the badge reader to the computer system so if you badge is don't badge in on the PC-from what I have seen it's taken at least 20 minutes to see your badge on the PC account. Please make sure when you are badging out of "charge" in the middle of a shift that you badge yourself back in for the rest of the shift. Everyone is really doing well overall-I know it's frustrating to not "see" what you just badged show up on the reader itself but we can help you until you get PC access.
A fond and sad goodbye to Crystal Laster was given on Wednesday in the form of a pot luck that I heard was delicious. We interviewed a couple of potential candidates this past week and are hoping things pan out in that area. I did type a couple we are being proactive since we anticipate some of our staff(Becki) to graduate in the spring and we want to be prepared to have folks step into spots as that and vacations start in earnest for the summer.
If you have any ideas of what you want to see here please let me know and I will do what I can to get it here.
Have a great week!
Tracy
Sunday, February 24, 2008
Pain, Potty and Position~Hourly Rounding improves patient satisfaction and decreases falls
Pain, Potty and Position-the new motto...
Bob Murphy raised this as a way to raise our patient satisfaction at Spring Fever the past couple days. So along that vein, Here is an article to support this expectation.
I know we are all about making the patient's stay a better one while making our jobs a pleasant experience at the same time. This article with research discusses the stress "bellringers" place and how hourly rounding can decrease patient and caregiver stress.
http://www.medscape.com/viewarticle/570242
This is a focus for our areas this year-increasing patient satisfaction through hourly rounding will affect our Avatar patient satisfaction scores if we remember to round on our patients and remind them that they may receive a survey in the mail after discharge that we use to make us better and that we rely on their responses to do just that, judge what we are doing well and improve on our weak areas.
Tracy
Bob Murphy raised this as a way to raise our patient satisfaction at Spring Fever the past couple days. So along that vein, Here is an article to support this expectation.
I know we are all about making the patient's stay a better one while making our jobs a pleasant experience at the same time. This article with research discusses the stress "bellringers" place and how hourly rounding can decrease patient and caregiver stress.
http://www.medscape.com/viewarticle/570242
This is a focus for our areas this year-increasing patient satisfaction through hourly rounding will affect our Avatar patient satisfaction scores if we remember to round on our patients and remind them that they may receive a survey in the mail after discharge that we use to make us better and that we rely on their responses to do just that, judge what we are doing well and improve on our weak areas.
Tracy
API starts today :)
Of course those of you at work are aware of this. Try to remember to clock/badge in and out using special codes for incentive/reward shifts as well as charge if they apply. I'm sure there will be lots of questions as things come up-please don't hesitate to ask questions. Please continue to do your paper timecard until we tell you to stop; this will just help us to double check your badged time against what you really worked in case the codes weren't entered at the time you badged.
Take a deep breath and remember It usually takes a long time to find a shorter way.
Be patient we will get there together.
Tracy
Take a deep breath and remember It usually takes a long time to find a shorter way.
Be patient we will get there together.
Tracy
Saturday, February 23, 2008
Heart Failure Reading-Core Measures
We are deep in Heart Failure season so thought it was appropriate to review some things to meet the Core measures that affect our repayment on Heart Failure admissions.
Here are some reading links for you....
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=741530
http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Heart+Failure+Core+Measure+Set.htm
You all have been doing well with reminding caregivers and education of patients but a little review never hurts to keep us all current!
Kudos to Otie for someone out of our department noticing what we all see each day you work-Norman Roy mentioned that even though she was busy one day she took the time to review a patients needs with him. Again something we do each day but feels good to know that we are valued for our knowledge of our patients.
Dr. Hanf also recognized Wanda's efforts with a difficult end of life situation and managed her up to the family as well as to Rosalie Dwyer which went a long way to making the death experience for the family as much of a positive experience as could be expected.
Nice job Ladies!
Have a nice weekend!
Tracy
Here are some reading links for you....
http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=741530
http://www.jointcommission.org/PerformanceMeasurement/PerformanceMeasurement/Heart+Failure+Core+Measure+Set.htm
You all have been doing well with reminding caregivers and education of patients but a little review never hurts to keep us all current!
Kudos to Otie for someone out of our department noticing what we all see each day you work-Norman Roy mentioned that even though she was busy one day she took the time to review a patients needs with him. Again something we do each day but feels good to know that we are valued for our knowledge of our patients.
Dr. Hanf also recognized Wanda's efforts with a difficult end of life situation and managed her up to the family as well as to Rosalie Dwyer which went a long way to making the death experience for the family as much of a positive experience as could be expected.
Nice job Ladies!
Have a nice weekend!
Tracy
Thursday, February 21, 2008
EKG Quiz for RN's
Alrighty so here is the first competency for this year. Print off and complete for this years competency. It's not as hard as it looks. Drumroll please...
EKG Quiz
1. You’re caring for a patient with a history of mitral valve prolapse(MVP). Based on your knowledge of the heart’s anatomy, you know the mitral valve is located between the :
a. the left atrium and left ventricle
b. the left ventricle and the right ventricle
c. the right atrium and the right ventricle
d. the right ventricule and the pulmonary artery
2. A 45 year old patient is admitted to your floor for observation after undergoing cardiac catherization. His test results reveal a blockage in the circumflex artery, which supplies oxygenated blood to which area of the heart?
a. anterior wall
b. lateral wall
c. inferior wall
d. septal wall
3. Which of the following choices is responsible for slowing heart rate?
a. norepinephrine
b. vagus nerve
c. epinephrine
d. isoproterenol
4. A 65 year old patient diagnosed with angina is admitted to your telemetry unit. You begin cardiac monitoring and record a rhythm strip. Using the 8-step method of rhythm strip interpretation what should you do first?
a. Calculate the heart rate
b. Evaluate the P wave
c. Check the rhythm
d. Measure the PR interval
5. A 76 year old patient with heart failure is receiving furosemide(lasix) 40mg IV twice daily. When you look at her rhythm strip, you note prominent U waves. Which condition may have caused the U waves to appear on your patient’s rhythm?
a. hypokalemia
b. hypocalcemia
c. worsening heart failure
d. pericarditis
6. A patient with a history of paroxysmal atrial tachycardia {PAT} develops digoxin toxicity, which may cause prolongation of the PR interval, so you must monitor his cardiac rhythm closely. What’s the duration of a normal PR interval?
a. 0.06 to 0.10 second
b. 0.12 to 0.20 second
c. 0.24 to 0.30 second
d. 0.36 to 0.44 second
7. A patient is admitted to your telemetry unit with a diagnosis of sick sinus syndrome. Which medication should you keep readily available to treat symptomatic bradycardia?
a. isoproterenol( Isuprel)
b. verapamil (Calan)
c. lidocaine
d. atropine
source:ECG Interpretation made Incredibly Easy! Lippincott Williams & Wilkins, 2005there are many quick quizzes like this available @ http://www.nursing2007.com/ (click the educators button)
By popular demand the answers are as follows:
1-A 2-B 3-B 4-C 5-A 6-B 7-D {added on 3mar08}
EKG Quiz
1. You’re caring for a patient with a history of mitral valve prolapse(MVP). Based on your knowledge of the heart’s anatomy, you know the mitral valve is located between the :
a. the left atrium and left ventricle
b. the left ventricle and the right ventricle
c. the right atrium and the right ventricle
d. the right ventricule and the pulmonary artery
2. A 45 year old patient is admitted to your floor for observation after undergoing cardiac catherization. His test results reveal a blockage in the circumflex artery, which supplies oxygenated blood to which area of the heart?
a. anterior wall
b. lateral wall
c. inferior wall
d. septal wall
3. Which of the following choices is responsible for slowing heart rate?
a. norepinephrine
b. vagus nerve
c. epinephrine
d. isoproterenol
4. A 65 year old patient diagnosed with angina is admitted to your telemetry unit. You begin cardiac monitoring and record a rhythm strip. Using the 8-step method of rhythm strip interpretation what should you do first?
a. Calculate the heart rate
b. Evaluate the P wave
c. Check the rhythm
d. Measure the PR interval
5. A 76 year old patient with heart failure is receiving furosemide(lasix) 40mg IV twice daily. When you look at her rhythm strip, you note prominent U waves. Which condition may have caused the U waves to appear on your patient’s rhythm?
a. hypokalemia
b. hypocalcemia
c. worsening heart failure
d. pericarditis
6. A patient with a history of paroxysmal atrial tachycardia {PAT} develops digoxin toxicity, which may cause prolongation of the PR interval, so you must monitor his cardiac rhythm closely. What’s the duration of a normal PR interval?
a. 0.06 to 0.10 second
b. 0.12 to 0.20 second
c. 0.24 to 0.30 second
d. 0.36 to 0.44 second
7. A patient is admitted to your telemetry unit with a diagnosis of sick sinus syndrome. Which medication should you keep readily available to treat symptomatic bradycardia?
a. isoproterenol( Isuprel)
b. verapamil (Calan)
c. lidocaine
d. atropine
source:ECG Interpretation made Incredibly Easy! Lippincott Williams & Wilkins, 2005there are many quick quizzes like this available @ http://www.nursing2007.com/ (click the educators button)
By popular demand the answers are as follows:
1-A 2-B 3-B 4-C 5-A 6-B 7-D {added on 3mar08}
Welcome All !!!
Here you go-a blog just for us....I'll try to keep this as THE source for updates.
The first post is dedicated to API-hey we all like to get paid right? Vilma and I will be learning the system as you are. If you think you have forgotten to badge/clock in or out for a shift we will be able to help the process. Sunday February 24th is our first day to badge. We have some of your badges and are distributing them as we see you-you have to turn in our old badge with the cover to receive the new one.
Please let me know what kinds of things you want to see here and I will oblige as much as I can :)
Until the next time,
Tracy
The first post is dedicated to API-hey we all like to get paid right? Vilma and I will be learning the system as you are. If you think you have forgotten to badge/clock in or out for a shift we will be able to help the process. Sunday February 24th is our first day to badge. We have some of your badges and are distributing them as we see you-you have to turn in our old badge with the cover to receive the new one.
Please let me know what kinds of things you want to see here and I will oblige as much as I can :)
Until the next time,
Tracy
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