Week End Wrap Up

May 10, 2010

Babies need your help

GBS Status document GBS status on triage form

AND newborn resuscitation record mom GBS+, include antibiotic type, #

of doses and time of last dose Medication History

Document on triage form—include methadone dosage

Blood Type accurate documentation

Referral Patients

S (Situation) How can we improve referral patients’ information flow?

B (Background) Information flow between us and our customers fragmented and incomplete

A (Assessment) Patient care suffers when referring providers aren’t identified and communicated with as important care team members Staff experience wasted time looking for necessary information

R (Recommendation) Rapid Process Improvement Team Action Planning for Right Information for Right People at Right Time

Group of interdisciplinary and interdepartmental staff members

participating in brief, intense process to identify key process problems, prioritize solutions, and develop an action plan to be implemented immediately following weeklong workshop

FRONT-LINE STAFF-driven project

Referral Patients (cont.)

What Will You See?

Team Members (with clipboards!) collecting information, e.g. talking to staff, following a referral patients’ information flow and documenting processes and outcomes of info flow

Staff Surveys to collect your perspective and input on referral info flow

An action plan implemented by June 1st: Working smarter, not harder!

Evaluations and reports by end of June, July and August—Goalto sustain new processes

Referral Patients (cont.)

Some Team Members: Cindy Bennett, RN; Edith Cheng, MD; Laura Cieslek, MD; Enedina Dumas, RN; Mary Heilman, RN ;William Kuang, PSS; Derek Pappas, CDS

Excited to address age-old problem with focused process structured to produce positive change!

Please support process by commenting on staff survey in Staff Lounge, or answering some quick questions at following Catalyst survey link: URL: https://catalysttools.washington.edu/webq/survey/gjurich/103724

Thank you for your support of your team members and your participation!

Disaster Drill, May 18

May 18 UWMC will participate in regional disaster drill UWMC role is to evacuate—3 “patient” volunteers come to unit to be “evacuated” Timeline: May 17th 2030 flow meeting - evacuation paperwork distributed to charge nurses

during night shift charge nurses complete UWMC Charge nurse evacuation assessment form inpt nurses complete Patient Evacuation and Tracking form for *at least* 1 patient

each May 18th change of shift: night to day on May 18th - all paperwork passed on to charge

RN - charge RN ensures location for volunteer patients 0830-0930 - placement of volunteer "patients" on unit, 2-3 per unit - charge nurse

supports volunteers, identifies bathrooms, inquires re needs, etc 1015 - overhead announcements "This is a drill. Code Internal Triage, Level 2,

Response. Section meetings start in 15 minutes at 1030. Code Internal Triage, Level 2, Response. This is a drill."

1030 Disaster exercise flow meeting - VERY short! - charge RNs turn in evacuation paperwork - reminder to charge nurses about process for sending patients to holding areas and that patient movement starting

1400 Conclusion of exercise 1500 "hot wash" - immediate post drill debriefing in T739. All participants welcome

now or May 19th 08-09 join UWMC Emergency Management Committee for second drill debrief ISIS conference room, first floor Surgery Pavilion

Blood Services Tube Labeling

Issue: ongoing problems with correct labeling PSBC specimens and requisitions

Consequence: PSN reports, cancelled specimens and mother and baby blood redraws

PROCESS ENSURE that U # and name not cut off on label Generally Primary nurse completes PSBC requisition

and specimen label: date, time of blood draw & signatur

Then 2nd RN comes to patient room & verifies pt's name, U #, DOB, AND that date and time on label and requisition match and primary RN signature on both

Then, second RN signs both

Blood Services Tube Labeling (cont.)

In emergency if primary nurse unable, second nurse fills out label, requisition and signs both

Then primary nurse does double check of correct/matching date and time on both tube label and requisition and 2nd RN signature on both

Then, primary nurse signs both

"STOP" sign posted by tube stop requiring triple check: U# clear and complete on label Date and time the same and on specimen label and requisition Same two signatures on specimen label and requisition

Do this triple check prior to tubing sample to TSS—it could save patient another poke and you another blood draw!

Other ideas welcome—let us know!

Blood Services Tube Labeling (cont.)

Have double checked that all required info on your blood bank tube and paperwork are correct, complete and legible?

Employee Health TB rounds

Employee Health will round on inpatient units for staff TB testing on5/20 Thursday starting at 0630 and will make complete sweep through cascade and Pacific towers

If you need a TB test and are working, plan to get it done next Thursday

Fiscal Year 10 Pain Reassessment Audits

  Total narcotics doses given # Reassessements wi 1 hr Percent

July 167 128 77%

Aug 51 38 75%

Sept 58 46 79%

Quarter 1 276 212 77%

Oct 66 53 80%

Nov 96 75 78%

Dec 133 107 80%

Quarter 2 295 235 80%

Jan 103 78 76%

Feb 78 51 65%

Mar 113 88 78%

Quarter 3 294 217 74%

Apr 169 139 82%

May     #DIV/0!

June     #DIV/0!

Quarter 4      

Fiscal Year 10 Pain Reassessment Audits (cont.)

Best Practice post narcotic administration assessment/documentation of patient response within 60 minutes

Documentation of reassessment noted in new column on flowsheet (separate from documentation at time of administration

UWMC minimum standard for pain reassessment—90 %

Best MIC compliance fiscal year 2010—82%

Problem times: night shift & shift changes

OB Glucose Tolerance Testing

Please place new labels on Clinical Lab Request for Blood requisitions when sending glucose tolerance test specimens

Improves patient safety through reporting of abnormal tests

Environmental Services

Effective immediately, please use only 598-6181 Environmental Services phone number for any service request (including terminal cleans) 24 hours per day, 7 days per week

We hope one number for all services all hours will simplify communication and improve service

  Currently, we have nine discharge-only custodians during the following

times: 5 custodians    1:00pm to 9:30pm 2 custodians    4:45pm to 1:15am 2 custodians    11:00pm to 7:30am

 

Sincerely, Myriam RiveraProgram Operations ManagerEnvironmental Services

FOB Tip

Room use refers to actual time spent in active care for things we cannot otherwise charge

For example, EFM after an NST, toco for ctx, serial BP's, checking pt for medication reactions

If chargeable item like IV infusion or NST alone, you don't mark it

*EXCUDES WAIT TIME* Very important; if pt waiting for lab results, or to see

physician and is not receiving active care do not mark this

New 5S Room Stock Coming

Long closets next to “gas/suction” cupboard getting shelving to help with needed supply space due to loss of storage room coming this November

Invisible lock will be used to ensure that cupboard locks whenever door closed

Fitting the shelves will occur over the next several weeks; please help the construction team find empty rooms

Will begin to work on redesigning supply system once critical mass of rooms ready

Breast Pumps

Breast Pump kits are opened for mom’s having difficulty with breastfeeding or having to pump for a preemie

Kits retail for over $50 and need to conserve our resources

If patient tells you "Maria " told them they could get a pump - referring to WIC clinician in MICC

If Maria promises a pump it is usually a hand pump that comes from her or one of Lactation Consultants that have access to WIC supplies

Many of our clients have WIC in other locations and have similar options!

Carry on the good work of supporting our breastfeeding moms!

Alaris Pump Update

Finishing this week

Nursing assistance essential to ensure all PCU’s are turned on and profile selected, (especially those in patient rooms), and in directing CE team to any PCU’s stored outside patient rooms

Once pumps updated, each pump must be turned off, turned back on, and say YES to “new patient” before it will reflect updates

How do I know my pump has been updated? Date updated version approved or released incorporated into dataset name which appears on pump (upper left corner)

For this update dataset name is: UWMC_05012010

If you power down your pump, select new patient, and do not see updated dataset name, contact clinical engineering.

No Changes to Drug Library apply to MIC

New car seats with bases are here

Cost is $40

Paperwork to accompany patient to cashier and provide receipt to patient now available

Will no longer provide free car seats

Sample of new car seat now on car seat kiosk by odd hallway

Car Seats

SHIFTS IN DEMOGRAPHIC CHARACTERISTICS OF U.S. MOTHERS IN PAST TWO DECADES

Demography of American Motherhood compares data about women who gave birth in 2008 with data about those who gave birth in 1990 and results from nationwide survey about parenthood

Report, (by Pew Research) organized as follows First section is an overview Second section presents trends in U.S. birth patterns from 1990 to

2008, focusing on changes in characteristics of mothers of newborns; includes subsections on trends in age of mothers of newborns, their race and ethnicity, their marital status, and their educational attainment. Analysis in section based largely on data from National Center for Health Statistics and from U.S. Census Bureau.

Third section analyzes results of nationwide Pew Research Center survey that asked respondents about reasons for having children or intentions to have children, ideal family size, and attitudes toward several social trends that affect U.S. birth patterns. Details on methodology and data analysis included.

The report is available at http://pewsocialtrends.org/assets/pdf/754-new-demography-of-motherhood.pdf.

Acceptable Receipts for CE Reimbursement

Guidelines in order of most preferred type of receipt: Receipt from vendor with date, amt, method of payment:

May be original receipt, letter from vendor acknowledging receipt, receipt emailed from vendor, or receipt printed from online purchase

Must be clear who purchaser is (nurse name), vendor name, date of transaction, amount of transaction and form of payment

Credit card statement that itemizes purchase (black out all but relevant charge)

If personal check form of payment, photocopy of cancelled check or bank statement itemizing check accepted

Travel Office will NOT accept photocopy of original check prior to being processed and posted or carbon or photocopy of carbon from personal check

Perjury Statement accepted as receipt of last resort

Traffic Concerns

University District Street Fair Saturday, 5/15 & Sunday 5/16

Sunday, May 16th, 28th Annual Nordstrom Beat the Bridge event

For information on University District Street Fair: http://www.udistrictchamber.org/StreetFair/index.html

For more information on Beat the Bridge event: http://www.beatthebridge.org/site/PageServer

These events will bring additional traffic volumes and pedestrians to UW Husky Stadium area as early as 5:30 AM. MontLake Bridge will close to all traffic at 7:30 am.

All weekend scheduled staff members are advised to use alternate routes to & from the UW Medical Center

Please provide additional time to your travel plans. 

Back in the 1500s:

Most people got married in June because they took their yearly bath in May, and they still smelled pretty good by June...

However, since they were starting to smell . .. . brides carried a bouquet of flowers to hide the body odor.

Hence the custom today of carrying a bouquet when getting married!