All -



Are any of your facilities using medication carts to deliver doses to
your patients?  If so, are narcotics also kept there?   Is there a
special cart that is used in order to store narcotics?



Thanks for any help!



Susan



Susan D. Gerhardt, MSN, RN

Administrative Director

Surgical Trauma ICU and Neurosurgical ICU

University Hospital

4502 Medical Drive

San Antonio, TX  78229

Office:  210-358-2596

Fax:  210-358-4723

susan.gerhardt@...
















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[Non-text portions of this message have been removed]

Does anyone have a sepsis bundle/protocol/orderset/competency they would be
willing to share?

A question has been raised in my organization about permitting nurses to remove
surgical drains from the neck. Our current policy states that neck drains are to
be removed by physicians. This is being challenged at one of our hospitals. I
have been unable to find any literature that either supports or discourages this
practice and I receive varying opinions when I ask subject matter experts. Some
feel that it is OK to remove a neck drain as the risk of complication is similar
to removing a jugular line. Others state it is not OK because of the
complications associated with removing neck drains.

I have read some information about drain removal, but location of drains is not
specified.

Can you please provide me with any evidence or opinion to support or preclude
drain removal from the neck? I am also looking for community practice regarding
neck drain removal.
Thank you.
Mary K. Keenan, MSN, MHA, RN
Clinical Practice Documentation Specialist
Clinical Delivery
Banner Health
Phone: 602-747-7451




[Non-text portions of this message have been removed]

We used to use Comfort Baths by Sage. It got expensive because staff would also
use them as wet wipes to clean up stool and anything else they'd find. Staff
still used basins as well.

A few months ago, we switched to CHG cloths through Sage and got rid of both the
Comfort Baths and basins. Staff are over 85% compliant in use. This took a lot
of education to get them there but the research is certainly out there as to how
dirty basins are.

We use the Comfort Shields for stool and have seen a dramatic decrease in
incontinence associated dermatitis.

Susie Kampfert MSN RN CCRN
ICU Nurse Manager
Metro Health Hospital
Wyoming, MI

Danna,
We have Meditech also but I think it is still the Magic platform. We
built the reconciliation form in Meditech and print it out on discharge.
At that time we use the form to populate our Logicare (Patient Education
system that we use for all patient education)discharge instructions.
After populating and printing out the discharge teaching information, a
copy comes out to place on the chart with the last sheet being a home
medication list. This last sheet is sent to Medical Records separate
from the record and is faxed to the primary care physician office
(batched faxes to the appropriate PCP for the entire day of discharges)
since most of the PCP's use the hospitalist to see in-patients.
According to MR, the faxed sheet is then placed in the medical record.

Since we started having Medical Records do the fax, we are 100% with our
process (any problems with the fax are flagged immediately with the fax
machine).

Hope this helps.


Joyce Chambers, RN, CCRN
Director, Critical Care
Conway Regional Health System
(501)450-2172
jchambers@...

Comfort Baths. They have shampoo caps  and perineal wipes also.


Gail McWilliams RN,MS,CEN
Interim Director
Institute of Nursing Science
University of Maryland
Shore Health System
505 Byrn Street
Cambridge,MD 21613
O: 410-822-1000 x8152
F: 410-228-6921
Cell: 410-310-2866

My staff uses Sage and loves it. The bathing cloths are kept in a
warmer.   In particular, we use the Chlorohexidiene bathing system in
the ICUs and ambulatory Surgery where patients do not have access to a
shower...and can bath prior to surgery with chlorohexidine.  The company
has some interesting research which shows decreased MRSA and VRE
transmission in the ICUs.  The research is NOT multi center, multi
product, but does show promise.  None of the companies I looked at had
heated peri cleaning boxes; the peri cleaning systems I saw are multi
use and come in large containers.


Vince Baccari

RHJ VAMC

Charleston, SC

Hello,
Would anyone have actual examples of orders that outline telemetry initiation
and discontinuation?
If so, please send directly to my email, feredaa@... or to my work email
anne_fereday@....
Thank you in advance for any information.
Anne

Thanks for all of the great information!  I appreciate all of the effort!!

~Danna Caillouet,RN,CCRN

Hello All,
I am on a mission to eradicate bedpans in my institution.  I am looking for a
new patient bathing system.  Anyone have one that they love?  We have the Sage
cloths in our "Hurricane" stash and the staff are not too crazy about them.

I heard about one recently that dispenses the packs of cloths from a vendor type
machine already warm???

What are the names of the systems you are using?

Thanks,
Danna Caillouet,RN,CCRN
Clinical Director of Critical Care
Thibodaux Regional Medical Center

Hello All,

We are having a challenge complying with the patient safety goal requirements
for communicating the list of discharge medications to the next care provider. 
Interhospital transfers and Nursing Homes are not the issue. We are having
issues when discharging to home and communicating to the PCP, esp. if the PCP
was not the admitting or attending MD for that visit.

We use Meditech Client Server with the Iatrics PDI application for med. rec. and
discharge instructions.  We have gotten responses from other listservs that
require several copies of the discharge meds to be made and then sending it to
the PCP in more than one fashion.  This seems tedious and unreliable.

Anyone have a consistent reliable process for ensuring that this occurs?

Thanks,
Danna Caillouet,RN,CCRN
Clinical Director of Critical Care
Thibodaux Regional Medical Center

We use reusable ones. Clean after each patient with Dispatch wipes. Have not
trended this as means of spreading infection.

Sincerely,
Sharon

We are at 100% on admission and we only do true DISCHARGES - which is rare. It
was easier for all units to do it for every patient admitted to their area-- so
when we transfer a patient, the receiving unit does it.
We had trouble initially, but once I made it the respobsibility of our techs
(there is one on per shift) that fixed it.  It was just not going to be a
priority with the RN's.

--- On Thu, 8/20/09, dcaillouet1 <danna.caillouet@...> wrote:


From: dcaillouet1 <danna.caillouet@...>
Subject: [NIHMBL] Re: MRSA Swab
To: NIHMBL@yahoogroups.com
Date: Thursday, August 20, 2009, 8:58 AM


 



Good Morning Drew,

> 1) What is your compliance rates with MRSA swabs upon ICU admission and ICU
discharge?

We are only swabbing on admit and have 100% compliance due to strict daily
audits of admit to the facility.
>
> 2) What interventions have helped to improve compliance with these two
actions?
>
Strict chart audits on all admits,

Danna Caillouet,RN, CCRN
Clinical Director of Critical Care
Thibodaux Regional Medical Center



















[Non-text portions of this message have been removed]

We looked into this, but just way too expensive for us.

--- On Thu, 8/20/09, Rowinski, Elaine <elaine.rowinski@...> wrote:


From: Rowinski, Elaine <elaine.rowinski@...>
Subject: [NIHMBL] RE: EKG Leads
To: "'NIHMBL@yahoogroups.com'" <NIHMBL@yahoogroups.com>
Date: Thursday, August 20, 2009, 5:52 AM


 



We do not use reusable and I have never used at any hospital I worked in.
Elaine Rowinski, RN, MPS, CCRN, CEN
Critical Care Educator
NYU Langone Medical Center
545 First Avenue
New York, New York 10016
(212) 263-7270
Beeper-1395



















[Non-text portions of this message have been removed]

You will see decrease in infection with disposables

Sent from my Verizon Wireless BlackBerry

-----Original Message-----
From: "Rowinski, Elaine" <elaine.rowinski@...>

Date: Thu, 20 Aug 2009 06:52:01
To: 'NIHMBL@yahoogroups.com'<NIHMBL@yahoogroups.com>
Subject: [NIHMBL] RE: EKG Leads


We do not use reusable and I have never used at any hospital I worked in.
Elaine Rowinski, RN, MPS, CCRN, CEN
Critical Care Educator
NYU Langone Medical Center
545 First Avenue
New York, New York 10016
(212) 263-7270
Beeper-1395






[Non-text portions of this message have been removed]

Good Morning Drew,

> 1) What is your compliance rates with MRSA swabs upon ICU admission and ICU
discharge?

We are only swabbing on admit and have 100% compliance due to strict daily
audits of admit to the facility.
>
> 2) What interventions have helped to improve compliance with these two
actions?
>
Strict chart audits on all admits,


Danna Caillouet,RN,CCRN
Clinical Director of Critical Care
Thibodaux Regional Medical Center

Hi Chris,
I looked into this for both hardwire and tele leads and found it to be cost
prohibitive in my organization.  We are looking at using disposable leads for
CABG pts only, but are having issues with compatibility of our GE hardwire
monitors.

Danna Caillouet, RN,CCRN
Clinical Director of Critical Care
Thibodaux Regional Medical Center

We do not use reusable and I have never used at any hospital I worked in.
Elaine Rowinski, RN, MPS, CCRN, CEN
Critical Care Educator
NYU Langone Medical Center
545 First Avenue
New York, New York 10016
(212) 263-7270
Beeper-1395

We use reusable. No VAP in 16 months, no CLA-BSI in 10 months. I think
bacteria can (and does) grow anywhere. Maybe we should use disposable
beds.

Roberta

P.S. I hope you need a little humor in your day today. :-)

Roberta Basol RN, MA, NE-BC
Director; Intensive/Surgical Care and Clinical Practice
ext. 54110
pager 89-0364

You need to work with the lab to track who drew the contaminated blood
cultures and have monthly reports. This lets you target education in the
right place. If an individual has more than one month with an increased
risk of contamination, it starts to become a disciplinary process. It's
not perfect but folks seem to listen more when non-compliance to policy
becomes part of their annual evaluation.


Gail McWilliams RN,MS,CEN
Interim Director
Institute of Nursing Science
University of Maryland
Shore Health System
505 Byrn Street
Cambridge,MD 21613
O: 410-822-1000 x8152
F: 410-228-6921
Cell: 410-310-2866

Hi,
 
Check out the 'patients first' website in massachusetts.
We reports our HPPD (criteria and skill mix) publicly.
 
http://www.patientsfirstma.org/staffing08a/hospitals.cfm
 
choose any of the hospitals you think will compare and the unit for your
circumstances...
 
FYI,
Drew




[Non-text portions of this message have been removed]

The numbers I gave 16-19 average nationwide, 17 for our hospital does not
include the Nurse Manager, but does include the Charge Nurse.  We have no off
tour or other supervisors. Nurse Managers are costed to the unit, but hours are
not included in HPPD.

--- On Tue, 8/18/09, White, Janice <janice.white@...> wrote:


From: White, Janice <janice.white@...>
Subject: RE: [NIHMBL] WHPPD
To: NIHMBL@yahoogroups.com
Date: Tuesday, August 18, 2009, 12:58 PM


 



Does this include management staff?

Jan White RN, BSN, CCRN

Patient Care Director CVICU
Inova Heart and Vascular Institute/Inova Fairfax Hospital
Office 703-776-3095
Fax 703-776-7228
Pager 71898 or 703-701-9413

Blessed Are Those Who Laugh at Themselves For They Shall Never Cease to
be Amused.



















[Non-text portions of this message have been removed]

We are stuggling with blood culture contamination. Has anyone done anywork in
this area that could tell us what has worked? Are you using the plastic bottles?
Designated people to draw? Only Lab draws? Thanks!
B.Wiggins, McLeod Health

Disposable EKG Leads or reusable ones? What is the verdict with spreading
INFECTION for reusable ones?

Sincerely,

Chris


Christopher David Kowal, BS, RN, MSN, CCRN
St. Joseph's Hospital Health Center
Surgical Intensive Care Unit (SICU)
301 Prospect Avenue
Syracuse, NY 13203
(315) 448-5340

"Evidence-based practice drives
process improvement facilitating
patient & family-centered, best-practice
outcomes through provision of quality
healthcare from the collaborative
efforts of a multidisciplinary team."

Confidentiality Notice:
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intended recipient(s) and may contain confidential and privileged information.
Any unauthorized review, use, disclosure or distribution is prohibited. If you
are not the intended recipient, please contact the sender by reply e-mail and
destroy all copies of the original message.


[Non-text portions of this message have been removed]

Hi Susie,

I am an Acute Care Nurse Practitioner at Tampa General Hospital. I will be
happy to share our credentials/protocols off-line due to the complexity of
what we do. Please e-mail me directly at krduncan@...

If you have electronic order entry with physician order entry (CPOE), and your
order entry system has alerts (allergies, drug-drug interactions, etc.) and if
the nurse takes a verbal/telephone order and enters it in the computer – how is
the alert handled? Does the nurse call the physician back about the alert? Does
pharmacy? Does the nurse enter the order directly into the computer or on paper?
Our issue is that the nurse is not telling the physician about alerts, however
pharmacy does address the alerts. We have been requested to have the nurse
address the alerts. Who addresses your alerts when the physician is not entering
the order? Thanks for your help.

Roberta

Roberta Basol RN, MA, NE-BC
Director; Intensive/Surgical Care and Clinical Practice
St. Cloud Hospital, St. Cloud, MN
Magnet Designated
Beacon ICU
320-251-2700, ext. 54110
fax 320-656-7144
basolr@...

Does this include management staff?

Jan White RN, BSN, CCRN

Patient Care Director CVICU
Inova Heart and Vascular Institute/Inova Fairfax Hospital
Office 703-776-3095
Fax 703-776-7228
Pager 71898 or 703-701-9413

Blessed Are Those Who Laugh at Themselves For They Shall Never Cease to
be Amused.

We do take open hearts and are a teaching hospital.  We aim our staffing pattern
to provide an HPPD of 17 hours. The last I saw, national aerages I believe
ranged from 16-19

--- On Mon, 8/17/09, kcastela <kcastela@...> wrote:


From: kcastela <kcastela@...>
Subject: [NIHMBL] WHPPD
To: NIHMBL@yahoogroups.com
Date: Monday, August 17, 2009, 3:58 PM


 



I manage a general med-surg-trauma ICU. The only patient populations we do not
care for are immediate post open heart and neuro patients. I am requesting
information on WHPPD for similar ICUs as well as staff mix.



















[Non-text portions of this message have been removed]

Danna,
We don't have a protocol for the sedation vacation. However, the staff
routinely turns off the sedation at 0400. This allows RT to draw ABG's
and do weaning parameters by 0500 at the latest. It seems to work since
our pulmonologist will not use a weaning protocol. I do have a decision
tree for extubation of CABG pts. Let me know your info if you would like
a copy.
Thanks,
Joyce Chambers, RN, CCRN
Conway Regional Health System
jchambers@...
(501)450-2172

-----Original Message-----
From: NIHMBL@yahoogroups.com [mailto:NIHMBL@yahoogroups.com] On Behalf
Of dcaillouet1
Sent: Thursday, August 13, 2009 9:56 AM
To: NIHMBL@yahoogroups.com
Subject: [NIHMBL] Sedation Vacation/Weaning Protocol



Anyone have a sedation vacation protocol and ventilator weaning protocol
they are willing to share? Any assistance would be greatly appreciated.

Email to: danna.caillouet@...
<mailto:danna.caillouet%40thibodaux.com>

Thanks in advance,
Danna Caillouet,RN,CCRN
Clinical Director of Critical Care
Thibodaux Regional Medical Center

Hello,

I am curious to know:

1) What is your compliance rates with MRSA swabs upon ICU admission and ICU
discharge?

2) What interventions have helped to improve compliance with these two actions?

Thanks,

Drew