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UMMC Nursing Newsletter

September 2012

Volume 1, Issue 8

IV Infusion Pump Update

Background/Situation:

The UMMC contract with Alaris/Carefusion for IV pumps and disposables has expired. UMMC is in

need of additional pumps to accommodate: (1) increased beds in new Shock Trauma tower, and (2) a

general increase in acuity of patients throughout the Medical Center requiring multiple infusions.

There are 2 major concerns regarding the reliability of the Alaris pump – (1) continued IUI connector

problems, and (2) recent recall of pumps when the motor stalls during infusion.

Current Status:

An interdisciplinary infusion pump steering committee was established. Members include nursing

staff from all divisions, pharmacy representatives, clinical engineering- biomed and equipment

distribution staff, IT, corporate contracting, anesthesia, and capital equipment repre-

sentation.

Three vendors were identified (Alaris, Hospira, & Baxter) as having the ability to

meet our needs. Vendor demonstrations were held with staff allowing hands on time

for individual manipulation of pumps, and an opportunity for questions regarding

individual practice areas. The following recommendations were made:

There is no interest in piloting the Alaris pump (since the functionality is not

different from current pumps).

There is an interest to pilot both Hospira Simbiq and the Baxter Sigma Spec-

trum.

Associated Factors:

Other UMMS hospitals are interested in IV pump evaluations. There are varying degrees of readi-

ness, but there is some urgency to make a vendor decision by the end of the calendar year. If possible,

the UMMS goal is to leverage volume purchases to allow best financial outcome

Because UMMC pumps are nearly 10 years old, there is significant cost related

to pump repairs and management of IUI issues.

Future goal is full electronic integration of pumps from an IT perspective, in-

cluding: asset management (pump tracking), wireless library upgrades, Pharmacy

communication & E-MAR integration – all of which are potentially available – but

require upgrades to our wireless network to support best use of the technology

Next Step: Pump Pilot:

Two Pilot Trial Options

Option 1: Full Clinical Trial on unit for 2 weeks. Units would include: MICU, SICU,

Trauma, Acute Care, Pediatrics, Perioperative Areas, Cancer Center. Full library upload

required.

Option 2: Laboratory Style Clinical Trial where preset scenarios are worked through by

nurses. No library upload required.

After a decision is made when the pilot is completed, more information will be available on next

steps.

Baxter

Hospira

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What’s New @ UMMC?

When does that Council meet? Also available at http://intra.umm.edu/ummc/nursing-

pcs-governance-councils/index.htm for the most up-to-date information

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Clinical Practice Council Updates: Safety Discussion—New Task Force

After multiple issues were discussed regarding

the wrong date of birth or wrong first names on

Patient's Name Bands or in the Medical Record, a

Task Force is now formed to look at the process

for Patient Identification on Admission.

Falls Committee Report

Ready to launch a Falls Prevention Initiative.

With this program, a “Falls Prevention Bun-

dle” will be rolled out as a package which will

include a Falls Tracking Board for every unit.

The Falls Committee is looking for Unit Fall

Champions at this time. Education for this initia-

tive is scheduled for September 21st.

Mislabeled Lab Specimens Report

Mislabled lab specimens is a patient safety

issue and an expensive problem.

The RIE project found that there were incon-

sistencies in practice for lab drawing from unit

to unit. There was no current standard of prac-

tice or handoff shift to shift in place.

The SICU, MICU, and CSICU participated in

this project because they were identified as the

biggest offenders at UMMC. Using the proc-

ess that RIE developed, by the end of 90 days,

labeling errors decreased to maybe 1 or 2 a

month.

Skin Care Committee Report

Summary: UMMC outperforms the bench-

mark for NDNQI but the incidences of Stage

II are trending up throughout the hospital.

Bed Trials Report: The Lynette beds are cur-

rently being trialed on 3 units, NTCC, CSICU,

and MICU. It will be a week long trial.

Policy revisions completed:

PROE-009 Blood Product Recall (minimal

change)

COP-011 Fertility Counseling for Cancer Pa-

tients (minimal change)

COP- 030 Power Injectable CVC (minimal

change)

New Policies Coming Soon

COP-035—Enteral Tube Placement & Man-

agement— Multidisciplinary work group has

made major revisions to what was for-

merly called Enteral Nutrition Guidelines and

added important standards of practice to im-

prove patient safety. CPC approved. Needs to

go through PISC and MEC for final approval.

COP-036 - Ultrasound Guided Peripheral IV

Insertion. CPC approved. Needs to go through

PISC and MEC for final approval.

Product Pilots:

Pilot of new typenex band planned in Stoler-

new band will include bar code for blood bank

use & will also include pt DOB

See also page 1 for Pump Trial information.

Are you performing your safety checks?

Mandatory checks should include:

Intro of oncoming staff to patient & family.

Review of Patient ID – name & DOB

Check infusions for dose, rate, & exp date.

Review all wounds, lines, & drains.

Review PRN meds for last dose &

effectiveness.

Review eMAR to ensure all medications were

given on previous shift.

Review monitor alarm parameters (if

indicated)

How to heat up a contact isolation food tray:

Infection Control stated that food can been reheated

from any Isolation Room as long as the following

steps occur:

Clean hands, gown and glove to

enter room.

When leaving room:

remove gloves, clean hands

Put one glove on so you will have a

clean hand and a dirty hand

Take the plate from the food tray with the

gloved hand

Open door to nutrition and microwave with

clean hand, reheat food

Wipe down the microwave with the same

wipes you would use to clean equipment.

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Newsletter Updates

If you have news or updates, then please send

your information by the 7th of each month to:

amurter@umm.edu or tfronczek@umm.edu

Newsletter Editorial Board

Allison Murter

Christine Provance

Susan Carey

Trisha Fronczek

Greg Raymond

Congratulations Newly Certified RNs!

Deborah A. Smith, RN-BC, Ambulatory

Care Nursing ; SCN I University of Mary-

land Center for Diabetes and Endocrinol-

ogy

From the Surgical ICU (SICU):

Alexander Halstead RN, BSN, CCRN

Leann Greise RN, BSN, CCRN

Ranae Zurawski RN, BSN, CCRN

Morgan Johnson RN, BSN, CCRN

Send your certification news to:

certification@umm.edu

Clinical Information Council (CIC)

Reviewed FY13 Goals and Objectives. Objec-

tives of council have large impact on Nurse

Sensitive Quality Indicator Data.

Audit found that RNs feel order clean-up is

providers duty. Sharing data with various

groups for additional feedback (one being

Staff Nurse Council).

Enhancements to Nursing

Quality Dashboard have been

widely accepted.

Governance Council Updates: Nurse Coordinating Council (NCC)

Advanced Practice Nursing Council is changing its name to Advanced Practice

Council

Council leaders will evaluate council leadership roles (i.e. Chair, Co-Chair, Chair-

Elect, Facilitator, Clinical Nurse Specialist, etc.) in attempts to define roles and in-

crease structure and accountability.

Reviewed 2012 RN Survey data and FY12 Q3 Pressure Ulcers data.

Watched inspirational video http://youtu.be/qp0HIF3SfI4?t=1m54s and asked council leaders to

think about their "why" for their councils and their "why" for themselves.

Patient & Family Education Council

Anne Williams presented the JHH EBP model

criteria to appraise the articles that will be

used for group EBP project.

Members worked in pairs on the appraising of

selected articles and presented the reasons for

the rating and grading selection to the rest of

the group.

Determined the composition of the EBP pro-

ject group.

Clinical Education Council

UMSON has developed an on-line preceptor

training course for RNs orienting students.

(free of charge)

CEC requested volunteers from this council to

evaluate this course for applicability as a pre-

requisite course for UMMC preceptors of new

RN hires.

Lynn Howe and Tom Emberson presented the

HealthStream® Competency Management

Center. Council discussed pros and cons of

purchase as an electronic tool for preceptors/

managers to manage new hire orientation.

Council endorsed and supported the follow up

with administration.

IV/Subcutaneous Prostycyclins information

presented and discussed. Volunteers to de-

velop an education plan for next meeting.

Nursing Research Council (NRC)

Reviewed and made suggests to new Nursing

Research Intranet Page. http://intra.umm.edu/

ummc/nursing-pcs-governance-councils/

nrc.htm

Group discussed adopting a Conceptual

Framework. One need is to strengthen com-

munication. Feedback is to be reviewed.

Discussed need to adopt a translation of EBP

to practice model. Kristin Seidl to present

models at the September meeting.

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Governance Council Updates: Meetings Canceled for

August 2012

Medication Process Improvement

Group

Magnet Champion Group

Medication Oversight Council—now

meets quarterly

Certification Subgroup—now every

other month

GNAC—now

quarterly

Professional Advancement Council Up-

dates

Members were asked to encour-

age staff to participate in the appli-

cation cycle starting October

2012. The October cycle is the last

cycle where staff are eligible for pro-

motion without a previous BSN or cur-

rent enrollment in a BSN program.

Monthly PAM tip from PAC membership: When

thinking towards promotion, start with a project with

which you have a passion.

Membership discussed the need to break down barri-

ers of the perception of SCNs needing to be pulled

away from the bedside.

Charge Nurse Council

Council was educated on the Patients Leaving Units (PLU) Guidelines by Anne Naunton. Take

homes: staff needs to educate patients on admission; charge nurses need to review the guidelines

and expectations with staff in order to better prepare them; for additional in-servicing contact

Anne at anaunton@umm.edu

Safety issues discussed were incivility in the workplace & hand hygiene. On the topic of incivil-

ity, the council encourages charge nurses to continue to work with relationship building, treating

others with respect and reporting incivility to leadership. Hand hygiene is of paramount impor-

tance! Those units having compliance issues should identify and document those individuals who

do not complete hand hygiene. Leadership should be notified.

FY13 goals were reviewed, approved and forwarded to the Professional Advancement Council for

integration.

The agenda for the Oct 19th Charge Nurse Workshop is being finalized. Topics will be on health-

stream for review. Next year’s workshop will include social diversity, generational differences/

priorities, & managing families of various cultures.

Staff Nurse Council

Kerry Sobol sought feedback on the Patient Family Handbook, which is due for revisions. Mem-

bers to review the book and for any needed corrections, as well as, any missing information.

Council provided feedback the effectiveness and safety implications of an auxiliary label to be

placed on tube feeds of patients on Insulin drips. The label is bright orange, sticks out, and helps

to identify the drip is Insulin. Council agreed that MEADE should consider re-conceiving the

sticker and its use by having pharmacy place the sticker directly on the Insulin drip

The council discussed the complexities of a case involving an anonymous letter regarding a medi-

cal center nurse; including, the rights of the individual, the safety of patients, and the ability to

provide a compassionate work environment

Effective Sept 11th: New Labels for IV Infusions requiring Refrigeration

Pharmacy is transitioning to new labels for IV infusions that require refrigeration. Beginning

Sept 11th, some mini-bags will have the new labels that are white with blue stripes down

the right and left sides.

Blue stripes indicate that the medication should be stored in the refrigerator. "Refrigerate"

also appears on the label. The reason for the switch is to facilitate the use of barcode scanning

technology to verify the correct product.

Last Cycle

without new

BSN

requirements

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Recall: Alaris Pump Channels

There has been a recall of Alaris Pump Channels that have an issue with

the motor stalling during infusions. This does not affect the "brain"

only the attached channels.

Please check your pumps and look for the Serial number beginning with

numbers 133....UMMC has approximately 50 of these modules. If

you have one of the affected channels - please remove affected chan-

nels from use immediately & notify SOSC @ 8-5174 for pick up.

Upcoming Courses

"Managing Diabetes for the Beside Nurse" is on October 3 from 8 am to 12 pm a

"Looking Good in Print: How to Develop Your CV & Portfolio" on October 10 with two session

at 7:30 am and 12 pm have open seats. Each 1 hour only.

Please register in Healthstream, if interested.

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From the September 10, 2012 Clinical Practice Update: Placement of Post-pyloric Feeding Tubes

(Cortrak tubes) in Adult Patients

August Hand Hygiene Data Highlights

· The overall hand hygiene rate for UMMC went down slightly from 85% to 83%. This is the

fist time we have seen a decrease in the rate since the implementation of an intense moni-

toring program in March 2012. · There were not any units that were able to achieve 100% compliance this month.

· Four units that were able to achieve the UMMC target of at least 90% overall:

o Med Surg Progressive Care Unit (C5E)- 98%

o Cardiac Stepdown (Weinberg 6C and Gudelsky 6E)- 95%

o Cardiac Surgery ICU (Weinberg 6AB)- 95%

o Gudelsky 8- 90%

· One unit demonstrated a 20% improvement in their rates since July

o Gudelsky 9 West

· The most improved discipline is Phlebotomy! They improved from 50% in July to 92%

in August (42% improvement)!

· The discipline receiving the highest hand hygiene rating is Social Work at 100%, followed by

Rehabilitative Therapy at 94%.

· Unit based staff achieving 100% compliance included (need at

least 10 observations):

o Nursing on PCU, C5E, C5W, MTCC, and STCC

o Patient Care Techs on Cardiac Step-down (Weinberg 6 C

and Gudelsky 6 East), C4E, and C6W o Nutrition and Food Services on CSICU, C5E

o Physicians on 13 E/W

o Transporters on C4E

August

Data

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Announcements Save the Date!!!

Oral Systemic Link

October 29

Pediatric Nursing Symposium

November 2nd all day

Trends & Topics in Periop

November 10th all day

UMSON: Environmental Excellence in Health

Care: Innovations and Collaborations Date: November 14th 7:30 a.m.-4 p.m.

Will explore how facilities are working across de-

partments and with community partners, product

and service providers, and regulatory agencies to

develop, implement, and assess environmental sus-

tainability programs.

For more information visit:

http://nursing.umaryland.edu/events/

environmental/index.php

Trends and Topics in Periop

The Cutting Edge of Surgery

November 10th 8:30-4:30 pm

UMB Campus Center Ballroom

For more information visit:

http://periop2012.eventbrite.com/

Registration is now OPEN!

The Oral Systemic Link: Creating Collaborative Initiatives

Collaboration and interprofessionalism are hallmarks of innova-

tive health care delivery. Join us for the first national conference

highlighting dental hygiene and nursing collaborations! This con-

ference will address the issues of interprofessional collaboration,

institutional and policy challenges, and shared goals in providing optimal patient care. The symbiosis

of oral and systemic health provides the perfect backdrop for interprofessional learning.

Date: Monday October 29, 2012

Location: UMB

Register and learn more at: http://nursing.umaryland.edu/oral-systemic

UMSON Graduate Open House

Thursday: Sept 27th 5-7 pm

Master's Degree Specialties Adult/Gerontological Nurse Practitioner

Community/Public Health Nursing

Health Services Leadership and Management

Nurse Anesthesia

Nursing Informatics (Entirely Online)

Pediatric Nurse Practitioner - Primary Care

Pediatric Nurse practitioner - Acute Care

Trauma, Critical Care, & Emergency Nursing: Clinical Nurse Specialist & Acute Care Nurse

Practitioner

RSVP two days prior to the event to: openhouse@son.umaryland.edu or call 410-706-0501.

Certificates:

Global Health

Environmental Health

Teaching in Nursing & Health Professions

Doctoral Degrees

Doctor of Philosophy (PhD)

Doctor of Nursing Practice (DNP) (Primarily

Online)

Pediatric Nursing Education Symposium:

Fall into Enlightenment

Date: November 2nd 8:30am-5:30pm

Location: UMMC Audito-

rium

See Flyer Page 6 for more

information