nk6h, perinatal practice council minutes november 2011.pdf ... · 1 perinatal practice council...

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Perinatal Practice Council Meeting November 13, 2011

Present: Sue Vos, Wendy Lajkowicz, Charlene Miranda-Wood, Johannah Morelos Carrera, Kay Yamasaki, Florame Kadalim, Rebecca Hankins, Nancy Ryan, Laurie Turner, Caroline See

Call to Order @ 0812 Subject Presenting

Person Discussion Follow-up

Review of November Agenda

Wendy Lajkowicz Kay Yamasaki moved to approve, Rebecca Hankins second the motion

Review October Minutes and Action Items

Sue Vos Johannah Morelos Carrera moved to approve the October Minutes, Nancy Ryan second the motion Johannah Morelos Carrera: NICU has no formal training for venipunctures of newborns but they have a self-learning module that their staff is required to take. Charlene Miranda-Wood will review their module and may utilize NICU’s module (with their permission) and format for our unit since it impacts NICU staffing when they are called to our unit for this procedure. Hand washing information is located on the SharePoint via the Epidemiology site. Wendy Lajkowicz: Sterile side pouches for cesarean sections patients are in the cesarean section packets since blood and fluids are always soaked underneath the patient and on the floor. MD’s need to wait for the gel on the patient to dry completely so the pouch can adhere better. Staff RN’s have indicated that they have been told by Scrub Techs that blotting

Charlene Miranda-Wood will email the policy assignments to the Perinatal Practice Council. Charlene Miranda-Wood will talk to the Scrub Techs that our cesarean section patients need to be blotted after they are sterile prepped. Wendy Lajkowicz or Sue Vos will talk to Jane Migliaccio to see how she wants to handle the issue of NICU speed dial on DH48. Charlene Miranda-Wood will contact Risk Management regarding the practice versus the rules in obtaining Attending Signature on consent forms prior to moving patients to the OR.

NK6h, Perinatal Practice Council Minutes November 2011.pdf

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no longer needs to be done. Charlene Miranda-Wood: Spoke with the Panda Warmer vendor. We would need to make sure we are doing everything correctly for weighing first. Should not matter if there are items left in the warmer since the scale is zeroed before weighing. Georgie Torres educated the MD’s on how to input the feeding option at discharge in Quest. Charlene Miranda-Wood did not specifically speak to Morgan Swank and Megan Stephenson regarding wearing facemasks during deliveries. When she observed a delivery, no one had a mask on. Attending wasn’t wearing one either. Will take to OB Advisory. Wendy Lajkowicz contacted Quest to ensure all numbers are printed centered on the label. DH48 needs to have NICU speed dial button on their phones – this needs to be rechecked. Perhaps during construction, lines were crossed. Charlene Miranda-Wood & Johannah Morales Carrera: ER policy/wording regarding consents. Residents without the signature of an attending have been obtaining consents. Went to Nancy Hove and have not heard back. Per Pat Osuji, Manager of Perioperative Services. They do not move patient without obtaining Attending signature. Per Deborah Jones, OR Educator – they have the same issue. Technically patients

Charlene will discuss with Dr. Afshan Hameed to obtain a definition of duration of labor. Still in progress.


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are not to be moved without attending signature. Patients have been moved without signature, but before MD’s scrub, they have them sign the consent form. This is to not stop ‘through put’ of the patient. We are still working on it. Nancy Ryan moved to approve, Rebecca Hankins second the motion.

Follow-Up POD’s Communication

Wendy Lajkowicz Last month communication wasn’t sent out. This months’ communication will include October and November. Kay Yamasaki will put the communication together in Linda Stiles’ absence.

Support Services -Lactation Consultant

Charlene Miranda-Wood

Patty Carlton is working with her son to put the number patients on Dashboard. For now, will just announce how many patients these % reflect. Dashboard - Pumping initiation rates October 50% patients pump (6 patients). Three patients were pumping 6-12 hours, 1 patient 12-24 hours, 1 patient 24+ hours. Reasons: one patient was in CCU, one patient on Magnesium sulfate with elevated pressures, one patient the RN was just too busy. Percentage pumping 12 hours after delivery – 50%. We are doing well. We need to look at what we are we doing differently for the ‘green’ months >80% versus ‘yellow’ months 50-79%. May need to look at the number of pumps we have, especially with the number of patients we are now seeing.

Will take this issue of enough pumps to Lactation who will address Jane Migliaccio. We have 5 yellow Symphony Pumps. Wendy Lajkowicz will send a recommendation to Jane Migliaccio on behalf of the Perinatal Practice Council since it’s becoming a patient dissatisfaction issue. Will ask Jane Migliaccio to see if the secretaries can keep track of the pumps.


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Halos were placed on the pump machines; however, it was alarming frequently, so they were taken off. Trackers can only track where the item/person is located. Perhaps we need a log to document which patient has the pump? We currently have a list if the pump is taken off the unit.

Policy and Procedures Venipuncture Policy, Neonatal - Charlene Miranda-Wood & Johannah Morelos Carrera Reference to Mosby. Policy begins with an Alert, then Overview of why and where these recommendations come from. Some verbiage of the steps has been modified to apply for our unit. There is a Quick Sheet for reference. Blood Culture in Newborn – Charlene Miranda-Wood & Johannah Morelos Carrera Policy/Guidelines refer to Mosby. Rewritten to apply for our unit. We will need a par for stocking of blood culture bottles for the NBN. Perhaps we can form a ‘blood culture team’ to make kits for all supplies to be together for easy access. Rebecca Hankins moved to approve, Kay Yamasaki second the motion Epidural Intrathecal Anesthesia, Care of the Intrapartum Patient - Charlene Miranda-Wood & Johannah Carrera Morelos Policy/Guidelines refer to Mosby. Epidural pump update – BP every 5 minutes for 15 min with fetal monitoring, more frequently, if indicated. Anesthesia Resident responsible to notify RN their requirement for IV bolus prior to labor epidural procedure. Independent double check vs. double check with RN and anesthesia.

Wendy Lajkowicz will contact Jane Migliaccio to see who will be responsible to put together NBN blood culture kits -Baby RN or NBN RN vs. Scrub Tech.


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The yellow-colored tubing identifies epidurals. PI Report -Hand washing

See Infection Control section below.

PI Report -SOFT/Baby Friendly Hospital Initiative

Johannah Morelos Carrera

We are currently in the Development Phase – We are waiting for tools and guidelines – A UPS issue that the package was returned to sender. Practice Rooming in and encouraging breastfeeding on demand. Not to feed baby every 3-4 hours but should be based on baby’s feeding ques. Should have no routine delays for mother-baby contact. If mother requests for baby to be taken by RN, documented that teaching and counseling was done with the patient. If patient desires to bottle feed, document that teaching was done. WIC form was given to Maura Williams, Patient Education.

PI Report -Women’s & Children Bereavement


Conference on January 12th hosted by UCI – OC Palliative Conference in Building 53. Register online with nominal fee of $20, 6.5 hours with continental breakfast and lunch. One of many presenters: Betty Ferrell, LNAC (End of life).

PI Report -Quality Measures


Hand washing–see Infection Control Section below. Lactation–see above section. 3rd and 4th degree lacerations - haven’t met recently. Will obtained information. Cesarean Section infection-see Infection Control Section below.

Committee Reports -OB Advisory

Johannah Morelos Carrera

Dr. Tamara Hatfield stated that she spoke to her superiors of the responsibility of which level residents are responsible for caring for specific

Charlene Miranda-Wood will look at which drugs (i.e., Versed) RN’s can push.


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gestational aged patients. Epidural pumps, PCEA training 12 RN’s Dosage concern: medication officer concerned that it’s too high or patients are still feeling pain. Dr. Portnoy gave ranges and Dr. Engwall feels too high since 40 ml should be the maximum/hr. Anesthesia met, and a range was determined: basal 0-10ml, demand 4-10ml, lockout 5-10 min, max 20-35ml. Continue to document concerns as Dr. Portnoy has a stack of concerns to address. Our RN’s need to make sure they document in our QS system when anesthesia is paged. When epidural is requested, HUSC calls it to OR to get the patient in SIS. Discussion with Dr. Hameed regarding wanting RN’s to be reinforced in using OB Emergency Team 6123 number. Dr. Portnoy does not mind if called even if it was a false call. Will not be punitive. Will be doing pager drills once/month and ensure that everyone knows the script. Spinal headaches – concern report or IR needs to be done for these patients so this issue can be addressed. L&D OR will be up and running soon – no date was given. Anticipate the L&D OR to be ready by April 2012. Transport – backup number available in case of cesarean section if attending is in the OR. There

Charlene Miranda-Wood will find out where spinal headaches are to be documented. Will L&D RN’s be able to input the system when we move back to the L&D OR’s or will it still need to be called to the OR? Charlene Miranda-Wood will add the Concern Report form to the Perinatal Website.


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is a back up attending available Monday-Friday. HUSC will receive a list. On weekends, it is the MD on call for Fountain Valley. Jane Migliaccio will be working on finding a storage area for the IUD’s. A grant is available for IUD placement for patients. Normally $300-$500. Residents are responsible for documentation. No involvement from pharmacy. Baby bands – if baby goes to NICU, 1st band should be handwritten with mom’s first and last name, mother’s PF and baby gender. The second band can wait until the stickers are printed. The band to keep at discharge should be the one with the label print out. Meetings 3rd Wednesday/month from 1230-1400.

Committee Reports -Nursing Standards

Charlene Now called ‘Nursing Practice Council’ Newly formed Nothing to report

Committee Reports -Medication Safety


Anesthesia Patient with birth plan and reported feeling her incision during the procedure after several attempts at placing spinal was done, then patient was put under general – suggestions for improvement: recommend for patient to bring birth plan to her OB visits for discussion, limiting number of attempts at procedures by one provider, necessity of good SBAR reporting of marginal epidurals so appropriate decisions on their care for cesarean section can be better made, better communicate with patient and

Follow up with Lynn Zuniga about what specific teaching is done in clinic. Johannah Carrera Morelos to follow-up on epidural Fentanyl bags not being charged in Quest when an RN retrieves it from the Pyxis for her colleague. Linda Chiu, Pharmacy to be


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family, especially educating the mother support system on why they are asked to leave if general anesthesia is used. Controlled Substance During cassette exchange tech found Ambien in another patient’s cassette and not returned to the narcotic vault. – Reinforce where it should narcotics need to be returned. Ambien should have been returned it to the Pyxis. Diagnosis/Treatment LD power outage Fall/Injury Staff hit head on metal bar in front of the window on DH46 when placing patient belongings on visitor bench. Hospital Operation x2 OB Emergency reports to be placed in Jane Migliaccio’s office/under her door. Lab Results -NICU blood draw and RN sent specimen to lab @ 0012, RN called for results. Facilities contacted and it was documented it was received in the laboratory @ 0013. Lab stated it received @ 3am. -MD added on labs for specimen in lab. Lab indicated they had specimen and it can be added but the person who logged it in went home and did not relay it to laboratory co-workers. Found specimen in the machine. -Unlabeled lab with transmittal sent. Reinforce

contacted to see if baby’s name on Pyxis can be a different color to help prevent override medications to be pulled out under its name.


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double check. Medications -A second dose of PCN was infused in amnioinfusion line – No adverse effects on patient. New amnioinfusion tubing available now, which have no additional ports. -RN removed Codeine 30 mg and charted for 60 mg in DH46 – will relay in POD communication to reinforce the 7 medication rights. -RN removed Morphing 4 mg (two 2mg/ml vials) on override with no MD order and no charting was done. Verbal order by the RN should have been entered if Stat, emergency or MD in a procedure so the RN could have charted. -Fentanyl epidural removed from Pyxis – not charged -RN removed Morphine 2 mg override under baby boy name, should be taken out under mom’s name. Suggestion: Perhaps have baby’s name a different color on the Pyxis Other Treatment -Called for a Stat and did not use OB Emergency Team number – currently working on resolving this issue. Dr. Afshan Hameed will discuss with residents -RN touched patient abdomen and patients states that the RN punched her. Overall, patient reported she received good care.


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-An aide was verbally abused by patient’s husband and aide returned to unit crying. Transfusion Pt complained of rash and itching after PRBC’s infused. FFP also given with no reaction – determined that it was not a transfusion reaction since it was not reported as a transfusion reaction. Protocol needs to be reinforced when a patient demonstrates signs and symptoms of a potential allergic reaction.

Infection Control Kathleen Quan Staff cannot wear buttons that are larger than the small pins as it is against the dress code. Flu Vaccination Campaign – We are looking for 100% participation. Participation is either receiving the flu vaccination or signing a flu vaccine declination. If not done, then those staff members will be called off on December 1st. Hand Hygiene Dashboard on Epidemiology SharePoint Stats – 423 observations over 80% T2/46&48. No CLABSI, CAUTI for L&D unit. Gail Devaney was asked about our unit switching over to the SIS system for our cesarean section procedures, which is required by State Law. We are working hard to get there. Data is currently manually being extracted for the CDC. We need a push to have SIS training and completed. Cut time, close time, EBL, total labor time information currently on our QS system. There is additional information that is needed. Epidemiology needs to be able to

Charlene Miranda-Wood and Johannah Morales Carrera will contact Jane Migliaccio regarding training staff for SIS.


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access all the required information from one system which is why it is important for everyone to be trained on the SIS

Educator Report -Safety Report

Charlene Miranda- Wood

Journal Club can be accessed via UC Learning. Search “Journal Club*”– Journal Club Perinatal – November Journal Club: Visual Stimulation of Newborn Submit for registration – read article then take the test online and will be immediately graded on line. Email with then be sent to completed online evaluation and then email a completion link showing you received credit. Transcripts will be updated once/month. December Journal Club: Oxytocin

Educator Report -Workshops & Education Opportunities


Service Engine Training in January/February via Grunigan Library for PPC and any staff interested. Librarian is not available on Thursdays. Linda Murphy. Library offers PubMed and other training through UC Learning Center. Hot Topics - December 6th Adoption piece, OC vs. LA County Law. Lactation/Breastfeeding from Virginia Bernal Second stage labor support from Johannah Carrera Morelos Healing relationships Surprise piece at the end In the future to collaborate with NICU to have NICU/Perinatal Hot Topics During rounds appreciation tool Leslie Hitzfield did a good assessment and

An email will be sent to staff asking if they want to contribute $1 to the cost of the Perinatal brick for the new hospital garden.


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obtained information Lourdes de Griese ensured everyone was covered. Stork Bytes – do we want to continue this? Will take it back to Jane Migliaccio. Employment brick for the new hospital – should our Perinatal unit have a brick designated in the new hospital garden? Cost is $250. We need to submit whether we want to commit to having one representing out unit. Practice Council voted to commit.

Quite Time Suggestion from 2:00pm-4:00pm on DH46 and DH48.

Will discuss at December meeting

Nurse Manager/Charge Nurse/Director Report

Not Present

As Offered Charlene Miranda-Wood

Thursday, December 15th - Next PPC Meeting @ Charlene Miranda-Wood’s Home. Address will be emailed to Practice Council Members.

Johannah Morales Carrera

Additional SIS trainers for night shift – Meera Narasimalu and Grace Kang Password 123456 to play on the SIS. Use own password in OR when doing actual documentation.

Wendy Lajkowicz Congratulations to Sue Vos for her new Clin IV position

Congratulations to Meera Narasimalu and Grace Kang who received the Supervisor positions, night and day shift, respectively

Johannah Morales Carrera

NRP Instructors needed. Laurie Turner interested

Johannah Hot Topics registration – need to register


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Morales Carrera through UC Learning to get into Hot Topics class. Wendy Lajkowicz will assist with access.


Johannah Carrera Morelos almost finished on PCEA training.

Adjourned @ 1155


nk6h, perinatal practice council minutes november 2011.pdf ... · 1 perinatal practice council...

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