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.

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

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

Did you know?

1. 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

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.

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

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

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