April CCU Unit Meeting

1. April CCU Unit Meeting

2. Congratulations and Thank You • Sarah Porter and Heather Sponseller: March graduates with their BSN • Julie Robinson: CCRN • Tammie Albrecht, Beth Chenevey, Chris Kestner, and Beth Scafate our CPOE superusers • CCU nurses caring for our hypothermia patient: LifeBanc donor (liver) • Welcome back: Cindie Berbari and Peggy Stone

3. Thank you: Patient Comments • Delores Judy called to say thank you to all staff who gave “wonderful care and was VERY impressed with our Unit, was never disappointed even once” • Nurses were wonderful, they took good care of me and my family! • All of the staff were wonderful especially Brandy • Sara was the best nurse! • I saw a lot of handwashing • While in CCU learned a lot about the heart and how it works, which told me the nurses are very skilled! • Nurse Christy (porter) 7p-7a exceptional!!!! Kept us informed and very friendly and helpful

4. Telemetry Batteries • Please use NEW batteries on all admissions (PAR level has been increased) • Check batteries when running strips and change when only one “battery bar” is lit on central monitor. (Batteries may also be checked on telemetry itself by pressing the “checkmark” on the telemetry unit) • On discharge, place batteries in recycle container (POD soiled utility room) • When patients leave the floor, it is the expectation the monitor be placed in “standby”

5. Practice Update • Review April Policy Updates • See April summary • Revision call out: foley management/care – foley care changed to daily; added use of castille soap PRIOR to insertion • Angiomax • Rep will be here week of 4/30 • Do NOT pull sheaths until 2 hrs after angiomax has been discontinued! (3 hrs for renal patients – crcl <30 – also must check ACT with these patients) . Longer hold times and potential complication will result if sheaths pulled without following the above! • TAP (Turning & Positioning) Update • In stock; please ask PCS • Email Rhonda when patient placed on TAP or if you have a candidate • New Palliative Care Liaison: Denise Rollyson will be rounding on units

6. Practice Update • PMX56-203 Clinical trial: • Study drug binds to heparin stopping its anticoagulation effect; doe not affect coagulation cascade • Target population: staged PCI’s • ACT’s have decreased from >200 to <130 within 3 minutes of the study drug • Effects: hypotension/mild flushing (benadryl prior to infusing is helping) • CCU take-aways: • Vital monitoring important especially if patient had hypotension in the lab during the infusion • There will be a few orders for specific labs • Close observation of groin as with any PCI patient • Will be seeing more closure devices • Observe for signs/symptoms of allergic reactions

7. Practice update • Unit Meetings • Must attend meetings • Must read and sign in employee lounge – book • Quia post test for those who do not attend live meeting. • Too much information to depend upon word of mouth • Video on Demand • CCU & CPC show 52.5% of all videos in entire hospital.

8. Echo “enhancers” • Becoming the standard for echo studies • Definity shortage for the next several weeks • “Optison” will be used during this time • Stress room nurse will come up to unit and administer • CCU to document as with definity • If stress room nurse is not available, definity will be administered (see attached handout)

9. Sleep-Rest Project • You are making a difference! – Improvement in HCAPS noise patient satisfaction • Continue with “Lights out” 10pm – 6am and awareness of our conversations on all shifts- press ganey reports • Review of hospital vital sign policy (wording is “approximately every 4 hrs for step down and approximately every 2 hrs for ICU”) • Assessments (per CCU shared decision making) • Patients should not automatically have head-to-toe assessment at 3am • 5am is acceptable if patient has been here >24 hrs, no drips infusing that could effect BP, no procedure site assessment required • Goal: provide 5 hrs of uninterrupted rest

10. CENTRAL SERVICE TIP OF THE MONTH BSC( bedside commodes) will be delivered to your unit upon requisition from Cerner After patient usage is complete, it is a nursing responsibility to empty BSC of contents, clean the insert & then place in hall by dirty utility room for pick up. CS staff will pick up on rounds (only the empty BSC) Our supply for all Aultman Hospital BSC: 120- regular size, 10- Xtra Large & 6- 1000lb BSC LG. Proper cleaning of BSC insert is Bleach 1:10 solution After each patient use , the BSC must be emptied, rinsed and wipe off the handles with Sani Wipe while the BSC remains in room. Dirty BSC’s “must not” be placed in halls, they should be placed into patient room until the patient no longer needs them. (they can be stored in the patient bathroom over the commode, just remove the insert container place on floor) Information supported by AAMI, JCAHO and Aultman Hospital Policy

11. Orientation Update • Nurse Aide orientations complete • RN orientations complete as of 5/5 • Beginning ICU orientations for our current step down nurses • March Mentoring Meeting: reviewed CCU universal procedure cart with TTVP insertion/management focus • Congratulations: Heidi Clay and Amy Mutchler’s preceptor applications were reviewed/approved by the CCU preceptor committee

12. Education Update • Level classes have begun! Reminders are being sent out prior to classes • 2012 unit based competency modules will be posted on QUIA shortly (3 nurses reviewing for “time”) • 2012 clinical goals from 2011 competency have been forwarded to all RN staff • Competency meetings will begin in AUGUST! • Information regarding 2012 support staff education coming soon • Currently 4 items on QUIA (will be removed within next 2 weeks by 5/11): imprivata, advanced directive update x2, and the new Falls policy. Several still need to complete! • Education/Competency questions?

13. Quality

14. Quality “Getting to Zero” Hospital Campaign • CCU with ZERO CAUTI, VAP, central line infections for Jan - March. • MisID’d specimens: 0 (March) with 1 YTD • Falls: 1 (March) with 10 YTD • Never Events

15. CAUTI Prevention Initiative • Put date on foley bag when catheter inserted • Place nurse communication “task” at 48 hrs and then daily for re-assessment of appropriateness • If admitted with a foley – please ask for a culture • Castille soap and water prior to insertion and daily (new policy change)! Audits reveal compliance with date on foley bag 0-100%

16. Quality HCAHPS Patient Satisfaction Results- Feb 2012 help quickly of Staff)

17. Quality HCAHPS Patient Satisfaction Results- Feb 2012

18. Quality Outcomes • Employee lunchroom • Quality bulletin board to demonstrate results of HCAPS, etc. • Comparison to rest of hospital • Quality scorecard with unit based outcomes

19. Press Ganey: Patient CommentsAreas of Opportunity • Questions on Press Ganey that we are not doing well on: • Did the nurse tell you what your new medication is for? • Did the staff describe to you the side affects of your medications? • Nurses wear too much jewelry – germ carriers • Room across from the nurses station – noisy and “party time” – “I knew everything they did on the weekend – remind nurses patients need to sleep” • “nurses were loud during the night” • “what happened to the dress code?” “Perfume was too strong” • “Care was good except for 1 night shift nurse who was not concerned about anything except telling how good she was and how smart she was” • “It was at the end of her shift and she seemed bothered by having to do anything for a new patient”

20. Environmental Audits • Multiple patient information exposed • Pill cutters need cleaned • Unlocked supply carts • Nourishment under sink in nutrition room dirty with unlabeled food • Multi dose insulin vials not dated • Unsecured O2 tank • DO NOT USE THE GREEN STICKERS ANY MORE ON ANYTHING!!!!

21. Core Measures • Pneumonia • Make sure to complete the vaccine assessment • Check and clear items from Task List • Give vaccine at discharge • Any patient with Asthma/pneumonia any age – at risk for vaccine • SCIP • Post op antibiotic ordered • Lopressor needs to be ordered to be given prior to surgery • Remove foley in am as ordered and pt should void • Heart Failure • 60 minutes of education in PER in cerner – document • Print correct home going instructions & check box pt understands inst. • Discharge med req needs to be correct • Follow up appointment must be recorded in Depart process • AMI - 100% nice job!!!

22. Communications • CareInfusion “Go Live” (new IV pumps) – June 12th; education for new pumps to begin mid-May. Details to be communicated when available. • Physician phone books: no longer being printed – go to Aultman Intranet and enter the physicians name in the search window.

23. Communications • Pod Resource / Team Leader Phone numbers • 39181, 39182, 39183, 39184, 39180 • Pod desk phones will transfer after 2 rings • Make sure to transfer phone to Lead with pod closing. • Nurse aide Phones per Pod • 39171, 39172, 39173, 39174, 39175 • Transfer to other nurse aide phone when split • Transfer to lead phone when pod closed.

24. Communications • Please do not question why patients are being transferred from another unit. • Reports that nurses are questioning appropriateness of transfer – family heard the conversation and complained. • Please do not complain to the lead nurse regarding discharges and admissions. We must accommodate patients needs. Ask for help!!! • Shortage on SD beds in hospital, so our census is up and we are getting some non-cardiac admits. • Professionalism at all costs with other employees, physicians and families!!!

25. Signed Consents • Make sure that signed consents are written EXACTLY as written by physician or APN in the Dr. Orders section.

26. CPOE • CCU superusers continue to assist us in identifying/following up with CPOE issues • Cardiac division is meeting on a regular basis with the CERNER team and have submitted CPOE related problems • Thank you for your patience as keeping up with the multiple communications has been challenging • We will focus on the top 3 concerns for the month over the next several unit meetings

27. CPOE – Unit “hot spots” • Check for “planned” states of your powerplans • Missed pre procedure orders! • Eyeglass • “signing off” of the orders – review carefully • Nursing must call all consults and document “provider notification” • Depart process • After printing patient’s discharge instructions, please remember to “SIGN” the depart process. Chart is ‘incomplete’ if not “signed” • Please use handouts for depart from the “departmental” folder. Handouts under the “ALL” folder have not been reviewed/approved. Many blanks are on these handouts. • DNR-Comfort Care/arrest paper orders: recommended to continue to fill out as patient gets a copy – the only paper item an EMS squad will accept! • CPOE questions?

28. OBSERVATION PATIENTS • Make sure to contact physician if patient status not indicated on orders • Must chart when patient leaves the floor and arrives in cerner!!!! • Any orders, admission powerplans, etc… disappears when patient transfers to admit status. Must enter the actual date of arrival to be able to see these items.

29. Pod Resource / Team Leader • Shared Decision Making Committee voted to continue • Task Force of peers determining the job description, and qualities of a good PR • New Name – Team Leader • Team building exercises will be coming. • Precepting done with new hires – so more employees to help with better staffing.

30. Gallup Survey • The official staff survey coming in summer • We need 100% of all employees to complete and is truly anonymous!!! • I will be sending out a survey to gain information, based upon last years results • Important for peers to offer support to each other. • Top items – needed equipment to do job & employees committed to quality.

31. Changes in Patient Condition • During Day call the APN if patient has CVC consult first!! They are on floor • Call the lead with changes in Patient condition such as: chest pain with EKG changes, pt going to lab, worsening condition, groin issues

32. Equipment • 3 new hypothermia machines • 2 new SVO2 monitors • When HCL brings up a patient with one, they will take one to the lab to replace. We will not need to switch out equipment on patients. • 2 new telemetries, still missing 3 – new process coming for storage to gain visibility for them after discharge.