Week End Wrap Up

March 8, 2010

Time Change This Weekend • Clocks "spring" forward one hour, tonight, Sunday, March 14, 2010,

at 0200

• UWMC Payroll policy states (located in UWMC Payroll/Personnel Policies, --credited hours when semi-annual time change occurs):

– Standard time changes to daylight savings time (Spring) are credited with normal shift hours

– no overtime paid until actual work hours exceed original scheduled shift length of 8 or more hours

– for example, employee scheduled to work 2300 to 0730 not eligible to receive overtime pay until at least 0900, then would qualify for .50 OT

• Mirtha T. Johnson, CPP Director Payroll Services, UW Medicine Health System

Pain Reassessment

• Pain Audits resumed • Expectation to reassess after narcotic administration within 60 minutes• Hospital expectation that this occurs 85% of time• At this moment in March we reassess 80% • Most frequent lapses: night shift and shift change • Please remember to provide recent narcotic administration in shift report so

appropriate follow up can occur• Professional nursing practice ensures that pain reassessment occurs within 60

minutes of narcotic administration

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1 Hour PainReassessment

CT SCAN• CT Scan requires patient have 20 Gauge or larger IV

catheter at antecubital space (or higher) • Address IV access issues prior to administering contrast

fluid

• Situation: – recent patient scheduled for CT Scan (non urgent)– Given contrast fluid to drink – Clock starts—must have scan within 5 hours of contrast– IV access 22 gauge at level of wrist– CT calls and asks about IV in the next hour– Patient difficult IV access– Required 12 sticks; IJ finally inserted to get patient to CT before

time lapse relative to drinking contrast

• Ensure/Plan acceptable IV status for CT

PCT Phones

• 2 new phones for HA/PCTs on 5 South

• Please make a note of:– 8-8503– 8-8504

Sodium Bicarbonate 50mEq• Manufacturer backorder on Sodium bicarbonate 50mEq emergency syringes

• Pharmacy stock very low, however have 50mEq vials

• Remaining emergency syringe stock being saved for placement in code carts

• Pyxis machines will be stocked with kit containing:– 1 – sodium bicarbonate 50mEq vial– 1 – 60mL syringe– 1 – vented spike/vented clave device

• Shortage should be resolved by the end of the month

• Will keep you apprised of any updates

• Please contact me if you have questions

• Thank you, Deborah A. Frieze, PharmD, BCOP

NST• NST's missing random pieces of information such as:

– EDD, vital signs, gestational age, times of NST, RN & resident signatures and resident signature

• If paperwork is not complete cannot bill for NST

• R2 or chief needs to sign off on each NST before patient is discharged and then NST is placed in box for attending signature—patient safety issue that assures residents aware of pts status

• Dr. Cheng will speak with residents to ensure they do their part• • For 5 missing info there were 20 that were complete

• Thank you thank you thank you for all that you do to take good care of our patients—Ana

Verbal Orders• Audits finding quite a few orders unsigned and no stickers on unsigned

orders

• Please remind your staff including PSS staff to place stickers on unsigned verbal orders

• Tom Staiger sent following to residents about verbal orders

•  Colleagues:

• Historically there has not been mandate at UWMC requiring authentication of verbal orders, have been considered authenticated unless contramanded

• However, both The Joint Commission and Centers for Medicare & Medicaid Services (CMS) have deemed that current practice needs to change such that all verbal ordersmust now be authenticated within 48 hours

Verbal Orders• Accordingly, every service has been asked to formulate a plan to ensure

verbal orders (including telephone orders) are authenticated within 48hours. 

• Answers to some frequently asked questions regarding this process:

• 1) Is it legal and appropriate to sign verbal/telephone order placed by someone else on service? 

A) Yes, at present.  In 21012 rules will change to require verbal orders to be signed by originating physician/practitioner.

• 2) Is person signing VO considered legally / medically liable for that order?

A)Depends on whether order has been carried out by time it is signed.  In most cases order will have been carried out by time it is co-signed.  Liability would typically belong to person who gaveorder.

Verbal Orders• 3) It may be someone else on the team signing the order who doesn't understand

justification or know if verbal order was written correctly

• A) Once  order carried out, standard of care violation (if any) already has occurred.  Only way an authentication signer could incur additional liability would be if reason to question order with respect to patient's ongoing care needs.  Example--order was carried out but med ordered/dose, etc. possibly not right.  Authentication signer expected to follow up on whether an error was made and if so, whether we need to do anything else for pt.  Would be expected to get enough information to either be comfortable signing order or moving on to "error" scenario below

• 4) What if order was actually written incorrectly? Does someone still sign it? Call risk management?

A) Any time, concern about an error, appropriate clinical actions need to be taken and documented.  Order still signed with notation, e.g., to "see ORCA note" or "see new orders and ORCA note."  A PSN (Patient Safety Net) report should be entered and the attending notified.  If patient harm, call Risk Management.

• Thank you for assisting with new process and for all you do for our patients. If you have further questions, please contact me.  Best, Tom

Infant Security Alert• FOR INTERNAL USE AND DISPLAY ONLY• • DO NOT DISPLAY IN PUBLIC AREAS

• LOCATION: Tacoma General Hospital, Mother Baby Unit,

• In mid February, 2010, call received in Mother Baby Unit, Tacoma General Hospital, from woman asking about having car seat inspected because she was “getting a baby soon”. Woman referred to Mary Bridge Child Safety; became angry when request to come to unit to have it checked was denied. Conversation lasted about 20 minutes but not reported further.

Infant Security• On Sunday, March 7, 2010, at ~ 1830 hours, unkempt woman described as: Caucasian….25-35 years of age….approximately 5’4”….slight build…long dirty blond

hair swept up in a pony tail…carrying a filthy car seat …visited department and asked that her car seat be checked as she “was getting a baby soon”. Woman mentioned something about a 16 year old who she knew was expecting a baby soon. Woman referred to Mary Bridge Children’s Hospital again. Reported to have left department slowly looking into rooms as she exited.

• Concerns about behavior of individual stem from her not stating she was “adopting a

baby,” but “getting a baby,” she insisted on coming to unit, and suspicious behavior while on phone and during her visit

• • As further information/description available, ALERT NOTICES will be forwarded

• If suspect seen on campus, notify Security immediately

• Good reminder to remain alert and if inquiries into newborns seems slightly off, report it

• Good opportunity to review Amber Alert as well (infant security)

Sound Transit Husky Stadium Construction Alert 

• For additional information on Sound Transit Husky Stadium construction project, including project overview, impacts and special alerts click on link below or copy to your internet browser http://f2.washington.edu/cpo/projects/sound-transit  

• Sidewalk Construction along Montlake Boulevard

• Construction at UW light rail station is underway and during March 2010 there will be several construction activities along Montlake Blvd, adjacent to Husky Stadium   1) Drilling to install geotechnical monitoring devices in sidewalk on east side of Montlake Blvd. between NE Pacific Street and NE Pacific Place. Will reduce width of sidewalk to 5 feet for pedestrians/bicyclists

Sound Transit Husky Stadium Construction Alert

• 2) Contractor will demolish pedestrian island at NE Pacific Street crosswalk, install left-hand turn traffic signal southbound on Montlake Blvd, and re-stripe crosswalk.  Signal work will involve closing multiple lanes of traffic on Montlake Blvd near intersection of NE Pacific Street.  To minimize traffic disruption, some of work will take place at night (between 8 p.m. and 7 a.m.).  Work scheduled to begin on March 10, 2010. 3) Final surfacing for driveway entrance/exit at NE Pacific Street to Husky Stadium will take place in March.  To complete this work, will close lane of northbound traffic to create temporary sidewalk using concrete barriers to separate pedestrians and bicyclists from automobile traffic.  Work scheduled to begin on March 8, 2010. All above work is happening simultaneously with other work to widen sidewalk and create a safer environment for bicyclists and pedestrians.  Bicyclist can avoid congested construction area by using sidewalk on west side of Montlake Blvd. Thank you for sharing this information with your staff. Larry Kalahiki, MBA/HRMManager of Program Operations