Adult ED Staff Meeting

December 16, 2010

Quality Data-Jackie Ashburn

December 16, 2010

Antibiotic Stop Times

• First IV antibiotic per patient.

• Documentation in Nursing assessment or Order Tracker

• Lost of $128.00 per medication/ Drips.

Month Lost Revenue/ week

Aug-10 $7,680.00

Sep-10 $7,552.00

Oct-10 $8,320.00

Nov-10 $5,632.00

Urine Contamination

Oct-09

Nov-09

Dec-09

Jan-10

Feb-10

Mar-10

Apr-10

May-10

Jun-10Jul-1

0

Aug-10

Sep-10

Oct-10

Nov-10

60.00%

65.00%

70.00%

75.00%

80.00%

85.00%

90.00%

Non contaminated Urines

Perc

enta

gego

al 8

5%

Up is GoodGoal is 85%Remember:

Give wipesInstructions are key

Never assume they know ( including men)Instruct to collect mid stream.

Don’ts:Use bedpans or urinals ( They are not sterileNever use a sample that is greater than 30 minutes old

Blood Cultures Sterile procedure Can not draw from IV lines

Unless MD order to indentify line infection

Remember to scrub site and do not touch after. Any difficulty document

Jun. 09

July. 09

Aug.09

Sept.0

9Oct.

09

Nov.09Dec.

09Jan

.10Feb

.10

Mar.10

Apr.10

May.10

Jun.10Jul-1

0

Aug-10Sep

-10Oct-

10

Nov-10

0.0%

1.0%

2.0%

3.0%

4.0%

5.0%

6.0%

7.0%

8.0%

9.0%

10.0%

8.6%

6.0%6.0%6.3%

5.9%

9.2%

5.2%

7.0%

3.3%

3.8%

2.5%2.6%

2.1%2.2%

2.8%3.0%

1.9%

3.7%

Blood Cultures Reported as Possible Contamination

% o

f Blo

od C

ultu

re C

onta

min

ation

per

Tot

al

Hand Washing Audits• October 2010 • November 2010

Hand washing AuditsDecember 2010

EDIS-Elizabeth Banks

December 16, 2010

VPH to Inpatient Transfer Process• VPH patient to ED for treatment visit

– Patient remains a VPH patient in Medipac (admission, discharge, transfer system)

– This is for insurance purposes • If VPH patient admitted to VUH

– Patient must be discharged from VPH– Readmitted to VUH in obs or inpatient status– New case number is generated for patient– Process in place to replay as many orders as possible

VPH to Inpatient Transfer Process• Admitting Liaison starts process by notifying ED

charge nurse with this page: “Bed name (MRN): Please notify Primary Nurse to play back order for VPH patient after Admitting Liaison completes the discharge process.”

• Admitting Liaison will archive orders in HEO/WIZ.

• Once process is completed, Admitting Liaison will notify Charge Nurse that HEO/WIZ orders can be played back

VPH to Inpatient Transfer Process:– All documentation in Order Tracker should be

completed prior to the transfer process– When patient is discharged from VPH, all orders

that appear in Order Tracker for that VPH case number will no longer be present in Order Tracker

– Orders can be viewed in StarPanel under ED Orders (this shows which orders completed, not completed)

VPH to Inpatient Transfer Process: Key Features

– All archived orders that are re-played will come across to Order Tracker as new orders

– One time Stat orders will not archive and playback because these orders are considered as past orders

– If the One time order is not yet completed, re-enter order in HEO/WIZ so that you can document the order as “done” in Order Tracker

Magnet-Dawn Hawley

December 16, 2010

YOU ARE MAGNET• Evidence Based Practice

• Team Support and Leadership• Encouragement and Education

• Community Involvement• Commitment to Professionalism

ANCC – New Magnet VisionTo be the fount of knowledge and

expertise of nursing careglobally. Will be solidly

grounded in core magnetprinciples, flexible, and

constantly striving for discoveryand innovation. Lead the

reformation of healthcare, thediscipline of nursing and care of

the patient, family andcommunity.

Ye Olde Magnet Faire

Timeline

Month GoalsJuly/August 2009 • Work launched

• Document writingJanuary 2010 • Magnet Champions EducationOctober 1, 2010 • Document submitted

• Preparation for site visitNOW • Continued work with Champions

• Education• Practice• Continue Magnet work

February/March 2011 • Probable site visit

5 Magnet Model Essential Elements1. Transformational Leadership

2. Structural Empowerment3. Exemplary Professional

Nursing Practice4. New Knowledge, Innovations

& Improvements5. Empirical Quality Results

Transformational Leadership• Identification of/understanding of nursing leader

roles

• Nursing Strategic and Quality Initiatives

• How do you as a leader gain/use staff input for decisions & examples?

• How do you as a leader value, encourage, recognize/reward & implement staff ideas (innovation)

* Key – Staff as Transformational Leaders

Structural Empowerment

VUMC Nursing Shared Governance Model

Structural Empowerment

How does SG work in your area & EXAMPLES

Structures that support:

• Professional Engagement• Professional Development• Community Involvement• Recognition of Nursing

The Vanderbilt Reputation• Ranked in Top 10 in 2009 US News &

World Report in 3 Specialty Areas• Ranked in Top 25 in ALL Pediatric Specialty

Areas (US News & World Report, 2009)• One of “Fortunes” Best Companies to Work

For (Fortune, 2009)• Of 371 Magnet Status Organizations,

Vanderbilt is one of only two in TN (ANCC,2010)

Exemplary Professional Practice

Vanderbilt Nursing Professional Practice Model

Exemplary Professional Practice

• How is the PPM implemented in your area?o Staff Satisfaction Data

• How do you deliver care?

• Staffing, Scheduling & Budgeting

• Interdisciplinary Collaboration

Exemplary Professional Practice-continued

• Performance Evaluations/Peer Reviews/Goals

• Ethics, Privacy & Confidentiality

• Diversity & Workplace Advocacy

Exemplary Professional Practice-continued

• Staff and Patients

• Nursing Sensitive Quality Indicatorso Total falls vs falls with injurieso Pressure Ulcerso Restraintso All infectionso Peds IV infiltrationso Handwashingo Medication Reconciliationo Others

Culture of Safety(Proactive – Improve - Outcomes)

Exemplary Professional Practice-continued

• Patient Satisfaction

• How nurses coordinate care

Quality Monitoring and Improvement(Outcomes, Outcomes, Outcomes)

New Knowledge, Innovations and Improvements

• Research

• Evidence-Based Practice

• Innovation

Magnet ChampionsAdult Emergency Department:

Hawley, Dawn Bransford, Bill

Knipp, Kory Hamilton, Mary Brusch, Joan

Vanderveldt, Gina Grubbs, Ali

Brumley, Laren Sims, Matt

Locklayer, Anthony Kossler, Rebecca Beckstead, Chris

Wilson, Cathy

Vanderbilt Nurses are the Elite• In 2009, 19,545applications were

received.• 1350 people were

hired.

PRC-Marsha Price

December 16, 2010

14 - Now I would like to ask you some questions about the DOCTOR or DOCTORS who treated (you/your family member) in the emergency room. Overall, would you rate the

quality of doctor care as:

19 - Would you rate the overall teamwork between the doctors, nurses, and staff as:

27 - Would you say the likelihood of your recommending [+hospname+] to friends and relatives for emergency services is:

29 - (30525402) Overall, would you rate the quality of care provided as:

Stroke Update-Ali Grubbs

December 16, 2010

IV tPA: High Alert Medication• IV tPA is now a high-alert medication at VUMC which

means that staff should follow safety strategies and defined procedures during all steps in the medication use process in order to minimize risk.

• Being a High Alert medication means that IV tPA bears a heightened risk of causing significant patient harm when used in error.

**Review the Policy: High Alert and Look-Alike Sound-Alike Medications CL 30-06.26 https://mcapps.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/DA7AB99D84815A4C862577AF00747227

IV tPA: High Alert Medication

• Administration of IV tPA as a high alert drug involves:– Primary nurse verifies drug indication corresponds to

patient diagnosis and appropriate monitoring has been reviewed

– Two licensed staff will verify the following prior to administration of IV tPA:

• Drug and dose based on patient weight• Amount of waste• Amount of bolus to be administered over one minute

IV tPA: High Alert Medication

• Amount of IV infusion via infusion pump to be administered over one hour

• Primary nurse will verify waste amount withdrawn from vial followed by bolus dose withdrawn from vial followed by infusion dose administered via infusion pump

• Primary nurse will document waste amount and name of second licensed staff member who witnessed waste, bolus dose amount and time administered and infusion dose amount and time initiated in EMR.

TWiG Working Group-Kevin High

December 16, 2010

TWiG Working Group

Requirements

• Must be off orientation and actively assigned to trauma (may be staff, charge nurse or paramedic)

• Willing and able to participate in this process; answer email/inquiries promptly

• Attend meetings set up by the group (on/off campus)

Projects• Develop Room Checklist/Standards• Outline Orientation Contents• Standardize Practice within Bay• Outline Core Requisites to work in Bay

Domestic Violence

Know the Facts• Domestic Violence is any pattern of behaviors that attempts to control an

intimate partner or family member by the use of fear, manipulation, isolation, intimidation, physical, sexual, and/or verbal abuse.

• Tennessee consistently remains in the top 10 states for domestic violence related homicides. Currently, we are number 5.

• One in four women will experience some form of abuse in her life.• In America, every day three women are murdered by the man who says

he loves her (American Bar Association Commission on Domestic Violence).• The sole purpose of domestic violence is power and control.• Typically, this control starts out slowly, and increases over time.

Weaver Domestic Violence Center

• Weaver Center is the largest domestic violence shelter in Tennessee.

• We provided 15,753 bednights of shelter last year to 233 women and 187 children fleeing domestic violence.

• Staff answered 3,791 calls on our 24-hour crisis line.

How can you help?

• Call the YWCA Crisis and Information line at 242.1199 or 1.800.334.4628.

• The Crisis and Information Line is available for anyone whether they are in immediate crisis or seeking to offer assistance or support to someone who is in danger.

• Call the YWCA crisis line to get support on how to talk to a friend or family member regarding safety planning.

Susan FrenchDirector of Outreach Services

983.5150Susan.french@ywcanashville.com

A Few Reminders – Marsha Price• If at all possible, please sign up for text paging• Triage nurses: please let the triage attending

know if a patient elects to leave without being seen. Triage attending will communicate a plan and wait times to minimize our LWBS patients

• There is a new policy with regard to the Labeling of All Lab Specimen. They all must be labeled with your VUNET ID.

HAPPY HOLIDAYS!!!

Meeting Evaluation – Marsha• 5 – Excellent• 4 – Very Good• 3 – Average• 2 – Below Average• 1 - Poor

Use the poll on our Team Member Only Website to Evaluate the Meeting. We will send you a link today.

Share any comments now.

HAPPY HOLIDAYS!!!