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UMMC Nursing Newsletter

June 2012 Volume 1, Issue 5

Important Changes to Medication Administration Practices What Nurses Need to Know…

With a focus on improving quality and timeliness of care delivered in hospitals, the Centers for Medicare & Medicaid Services (CMS) has recently published new standards for the timely administration of certain critical medications in the hospital setting.

What is a Time Critical Medication?

Time Critical medications are ones that must be administered within 30 minutes before or after the scheduled administration time. Time critical medications include rapid, short-acting, and ultra short-acting insulins, oral hypoglycemics, and scheduled doses of analgesics (opioids and non-opioids—with the exception of transdermal products.

Examples of each Medication type include: (the list is NOT all-inclusive)

Ultra Short-acting Insulins • Humalog or Lispro • Novolog or Aspart • Apidra or glulisine

Rapid or Short-acting Insulins • Humulin R • Novolin • Velosulin (insulin pumps)

Opioid analgesics may include: • Morphine • Fentanyl • Codiene • Oxycodone • Hydromorphone • Hydrocodone

Oral Hypoglycemics may include: • Metformin • Glyburide or Glimepiride • Avandia or Actos • Acarbose or Miglitol • Natinglinide ot Starlix

Non-opioid analgesics

• Acetaminophen (Tylenol) • Ibuprofen • Naproxen • Toradol

So, What About Non– Time Critical Scheduled Medications?

For additional Information, see policy MM-005—Medication Administration Policy

Frequency of dose

Daily, Weekly, or Monthly

> Daily < every 4

hours

One Time Dose

On-Call dose & PRN

STAT NOW Routine

Time due window

Within 2 hours of scheduled

time

Within 1 hour of Scheduled

time

Within 2 hours of order

Within 60 minutes of indicated

need

ASAP, and within 1 hour of

identified need

Within 2 hours of

order

Next Standard Admin

time

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What’s New @ UMMC? The New Shock Trauma Tower welcomed the building’s first inhabitants

on June 5th !

• Multi-Trauma IMC moved into the 3rd floor of the new tower into a bright & airy new unit.

• Multi-Trauma ICU relocated to the North wing of the current STC on June 12th, and the 5th floor Trauma South wing closed for construction.

• STC ORs opened for business on June 18th

As with all of the Trauma floors, these areas remain secured units and access will be limited to entry by badge or intercom.

Scope of Practice question or concern? Email: scopeofpractice@umm.edu

Welch Allyn Flexi-port ® Blood Pressure Cuffs • New Disposable Blood Pressure Cuffs will be coming to all areas for all patient monitors, manual BP cuffs, and portable BP machines • Same sizes as current cuffs are available— neonatal cuffs will still require a different tubing than other sizes • Tubing rotates for ease of patient movement

• Be sure to place the Flexiport valve connector on the side of the cuff facing away from patient to avoid pressure on chest wall from the connector.

Roll out Begins

June 25th!

MicroClave ® Add-on Tubing Has begun replacing all tubing add-on sets (6 sets are affected) that currently have a Smart-Site valve.

So far, it looks like the MicroClave valves are having a positive impact on our CLABSI rates!

B-D Safety Filter Needles We have consolidated all of our filter needle orders to an 18 gauge, 1 1/2 inch blunt needle (PMM# 172442) to

reduce staff injuries and standardize product. Look for them in a supply room near you!

LaserBand ® Patient ID Bands

In response to concerns with smearing ink and poor adhesive quality on our current ID bands, we will be converting to LaserBand ® on July 10 & 11th . These bands are already in use in several clinical areas with great customer feedback! More info to come!

There is a NEW LOOK for the Nursing Intranet page!

There are updated links and additional side links to improve the organization if the Nursing page. We have removed links that were not functioning correctly, and added resources to improve navigation. If you have trouble finding anything– there is a crosswalk posted on the Home Page.

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Clinical Practice Council Updates: Reminders & Updates Misidentified and Unlabeled Specimens A Rapid Improvement Event was recently conducted by Lab and Nursing staff which generated a great improvement in the number of “defective” specimens arriving in the lab. CPC will be working with the RIE participants to develop a policy for Specimen Handling that addresses this issue. More Information to come!

NG Tube EBP Update The group is now beginning to work on creating the guidelines themselves… Thanks for all of the hard work!

Blood Product Tubing Did you know that you can use the same set of tubing to infuse more than 1 unit of blood products? It is acceptable to infuse more than one blood product through the same tubing as long as tubing is flushed with saline between products – no more than 2-4 products and no longer than a 4 hour hang time per tubing. Examples include: 1 unit of reds + 1 unit of platelets, or 2 units of reds, or several units of platelets – or multiple units of FFP.

Blood Product Returns The 30 minute rule as a measure of amount of time a product can be out of the blood bank prior to re-issue is an Urban Myth!

30 minutes is too long! The measure of product re-issuability is the temperature of the product when it is returned - usually 15 minutes is enough time for the product to cool to the point that it is not able to be re-issued (and therefore wasted) From the time a product leaves the blood bank - it must be completely infused within 4 hours- if a patient’s transfusion is delayed (due to medica-tion infusion, temperature, or urgent trip off the unit) it may be better to hold the product and infuse when able (within the 4 hour window) than to return it to blood bank where it must be wasted if temperature does not meet requirement.

Policy Updates EOC-021– Care of Patients Under Legal or Correctional Restrictions The policy for the care of inmates in currently under revision due to the closure of 11D.

Patient Safety Reports Glucometer availability Over the Memorial Day holiday, there was a shortage of backup glucometers to replace broken ones in clinical units. There are 2 important messages: • Please ensure that your unit sends malfunctioning

meters to the Point of Care lab for replacements in a timely manner.

• POC team has generated a list of areas that have meters and are closed on weekends in the event that this mad rush reoccurs.

Care of Inmates When caring for an inmate in forensic restraints (shackles) the guard from the correctional facility should always have keys for patient repositioning, transportation to testing areas, or for emergencies. If there is a situation where keys are required, and the on-duty correctional officer does not have them, you should contact Security Supervisor.

TENP updates Carefusion AirLife Nebulizer kits

We have begun a transition to a new vendor for high flow nebulizer kits– ones that you would use for humidification of high flow O2.

Rationale– we learned that the water bottles we have been using with our current nebulizers are intended for IRRIGATION and not for INHALATION, and as such contain a preservative that we do not want to use for respiratory care.

The Nebulizer High Flow kits (PMM#360143) come with both the nebulizer and the bottle of sterile water (for inhalation) The new kit is engineered so that you cannot accidently add the wrong kind of bottle. If only the water needs to be replaced, there are Nebulizer Replacement Water bottles (PMM# 360760) are available for use without replacing the entire system.

Omni-Stat Pilot in Adult ED

The Adult Ed will begin piloting a new hemostatic agent for the controlling bleeding in a variety of patients, but has established effectiveness with patients who are have diseases or are on medications that alter the normal

coagulation pathways. We will be piloting nosebleed pads and granules. If you receive a patient from the ED with the product in place– there will be instructions for management.

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Meetings Canceled for May 2012 Certification Support Subgroup Charge Nurse Subgroup Medication Oversight Council Nurse Coordinating Council Nursing Research Council Patient Education On-Demand Subgroup Want to know more or get involved? Want to stay up-to-date or get involved and don’t know where to start? Check out the intranet: http://intra.umm.edu/ummc/nursing-pcs-governance-councils/ for Governance Structure and council documents.

Clinical Education Council

• Seeking nominations for CEC Chair Elect position for FY13 and PCS orientation instructors.

• Unit hand washing compliance data reviewed. Michael Ann Preas and Maureen Archibald led discussion on use of education toolkits available and strategies used by high compli-ance units to reach 100%.

• Marathon numbers: 2139 RN’s and 474 UAP’s completed for March/April 2012. Congrats to the trainers for their hard work!

Governance Council Updates:

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

Congratulations to Newly Certified RNs!

• Alicia Scott-Darden BSN, RN-BC, Psychiatry Department

• Alison Carder RN, CEN, Adult ED

• Andrea Ball, RN, CEN, CCRN, TRU Send your newly certified credentials to certification@umm.edu and be recognized here!

Staff Nurse Council Updates

• SNC members provided feedback on the success of Nurses’ Week 2012 events, and made recommendations for improvements for 2013.

• Council met with Infection Prevention Practitioners to discuss the safety impli-cation of pre-spiking IV fluids. This information/rationale can be found in the Management of Intravenous Catheters, Fluids and Infusion Policy SP&CI-014.

• During safety discussion, council member discussed Arrest vs. Rapid Response Team notification.

Clinical Information Council (CIC) • PAL Revisions—Increased usability with removal of unused and additions of new columns, addi-

tion of a weight column, and task columns partitioned to 12 hour blocks. • Quality Dashboard Enhancements-more interactive features, different views for different types of

care providers for example the RN view will show the status of certain nursing documentation such as POC, fall risk, etc in a column. Incomplete documentation can be completed by clicking on an icon which will directly route to the form that needs to be completed or modified.

• Powerusers Group (PUG) - will be disbanding. Various members will be added to CIC. CIC is exploring changing leadership positions to 2 year terms in order to accommodate and maintaining consistent leadership throughout implementations.

Charge Nurse Committee • Discussed opportunities for charge RNs to impact Nurse Sensitive Quality Indicators by using

hourly rounding, staff huddles, and charge nurse report as tools to communicate issues such as falls, patient satisfaction, pressure ulcer rates, CLABSI & CAUTI. Partnering with unlicensed assistive staff such as PCTs and CNAs is essential.

• Charge Nurse Workshop on May 25th had 35 attendees. Positive feedback was received! • Goals for FY13 include improving scores on communication by nurses, charge RN orientation,

developing electronic charge RN report tool, updating charge RN reference manual.

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On-Demand Contest Join the Patient-Family Education Council and the On-Demand Subgroup in two contests. The winning units will receive a free breakfast. The contest runs from April 1st to June 30th, and there will be TWO winning units. 1. The inpatient unit with highest total "On-

Demand" Usage rate. 2. The inpatient unit with the highest combined

usage of PAIN and FALL PREVENTION videos (#306, #107 & #348).

GO TEAM!

Graduate Nurse Advisory Committee (GNAC) Updates

• New Employee Orientation (NEO) dates have changed; moved ENP and other new grad courses accordingly, beginning with August cohort; July staying the same.

• ZERO new graduates have taken end of year (12 month) program evaluation. Need to encourage new grads to take these sur-veys at the end of their residency.

• Will ask UHC if they can open survey 6 weeks prior and 6 weeks post year-end to have nice 12 week window.

Patient & Family Education Council Updates • Reviewed previous work by a CNL group that focused on assessing patient’s learning styles.

Council would like to develop a model for teaching & look at what effective teaching looks like. June meeting to work on PICO for this EBP project.

• Members to review UMMC Nursing’s 2009-2013 Strategic Goals and come prepared to work on FY13 Objectives.

• Council members to review ANA’s module on health literacy.

Professional Advancement Council Updates • Members reviewed the Nursing Strategic Plan

for 2009-2013 and were charged with becom-ing familiar with the plan and the PAC's role in meeting the priorities.

• Considering next steps for staff and leader-ship education, using the framework of the "Coaching Skills for Development & Support of Application for Promotion" 3-part work-shop in which PAC members participated.

• Effective July 1, 2012 is the change in BSN requirements for promotion to SCNI,

Student Nurse Resident (SNR) Program at UMMC

This summer there are 45 nursing students participating in the 10 week UMMC Student Nurse Residency Program. These residents come from eight Schools of Nursing all over the East coast are working clinically with a preceptor on inpatient units throughout the hospital. In relation to their nursing programs, the student nurse residency program occurs after completion of junior year and prior to at least their last semester. During education sessions, they will be learning about pain, substance abuse, healthy work environments and will experience an end of life care simu-lation. Please join us in welcoming the residents and hope they gain valu-able experiences at UMMC. Pictured are 2011 Student Nurse Residents and 2012 new graduate hires Jasmine Noronha, Mike Murray and Kristen Dizon.

Magnet Champion Group Updates • Magnet Re-designation is rapidly approach-

ing. Champions are gathering stories and exemplars from their units. Please send community involvement examples to Anne Naunton anaunton@umm.edu

• Discussed the Professional Review Process-likes, dislikes and implementation. Group to look at feedback and see how to best aid units implementation progress.

Continuing Education Funds We are 1/2 way through 2012. Have you utilized the continuing education benefit? Make it a priority before it is too late! FTE $500; PTE $250.

What is stopping you?

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TPN Update CAPS hare rearranged the adult TPN ingredient sequence. The new arrangement TPN label will match the order of ingredients on the TPN Power Form. This consistent ordering of ingredients promotes medication safety by simplifying the double check between the original order and the compounded TPN bag.

From the Clinical Practice Update: STOP-BANG Obstructive Sleep Apnea (OSA) Screening Tool Assessment, May 24, 2012

What? The STOP questionnaire used to assess for OSA will be replaced with the STOP-BANG questionnaire (Preoperative Checklist and Special Procedure form) Why? � OSA is undiagnosed in an estimated 70- 80% of patients; few will have had a sleep study � Failure to recognize is a major factor in post-op complications � Research and clinical guidelines recommend preoperative screening for OSA � Polysomnography is the gold standard for diagnosis (The American Academy of Sleep Medicine) � If this is not possible, a patient questionnaire can be used to identify potential OSA � The STOP-BANG questionnaire has been recommended for preoperative screening When? Change to PowerChart and FirstNet effective on June 5, 2012

National Furosemide Shortage affects UMMC supplies

The national furosemide shortage has depleted UMMC supplies of 2 ml and 4 ml vials. Currently, UMMC pharmacies are dispensing 10 ml vials as replacement. The furosemide concentration remains the same, however, the volume is larger. Further information to come on the shortage and furosemide dispensing as available.

Hospira Carpuject Overfills The FDA recently published an alert concerning the overfill of several drugs in Carpuject pre-filled syringes manufactured by Hospira The FDA is not issuing a recall, and relies on health professionals to make sure the drugs are dispensed and administered correctly. Nurses should visibly inspect and confirm that the Carpuject pre-filled cartridge contains the labeled fill volume before ad-ministering to patients. Please inspect the following syringes for potential overfill: • Meperidine 25 mg ; Meperidine 50 mg; Diazepam 5 mg; Hydromorphone 1 mg • Hydromorphone 2 mg; Lorazepam 2 mg; Morphine 10 mg; Naloxone 0.4 mg Any syringes with overfill should be returned to the satellite pharmacy for your unit.

EZ-Wider Bariatric Chair-Bed is Available The EZ-Wider bariatric chair-bed is currently available to units upon request. Please contact your wound ostomy nurse to place a request one if needed. Beds are delivered to units within an average of 4 hours and can accommodate patients up to 1,000 lbs.

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Successful Trends in Nursing Practice Conference

The 2012 Trends in Nursing Practice Conference, “Interprofessional Civility in Healthcare: Awareness, Impact, & Outcomes,” held on May 1, 2012, highlighted a relevant and pertinent topic in contemporary nursing. Over 185 participants engaged in a full day of learning about interprofessional civility in health care and its impact on the safety and health of health-care providers and the patients they serve. There were concrete tools for enhancing interprofessional communication and teamwork, successful accounts from those who studied and changed their hospital-wide culture, and preparation tools for engaging in civil interactions while finding inner peace. Attendees were provided with informative and practical information that all staff can easily integrate in their practice.

Intermittent IV Infusion Order Changes in PowerChart

Changes to Intermittent IV Infusion orders began on Monday June 11, 2012 with Acetylcysteine IV being the first medication changed. Others to change in the following weeks.

• A small number of intermittent infusion orders were built as continuous infusions to overcome technical limitations in PowerChart.

• These select intermittent infusion or-ders will be fixed so that they will now function as medication orders identical to the remainder of the intermittent infusion orders currently built.

• These changes will help alleviate the problems with free-text infusion rates and short duration times.

• Medications affected will include: – Acetylcysteine IV – 7.5% sodium chloride/acetate – Banana bags – Thymoglobulin via peripheral IV

Intermittent infusions will be entered as medications & the

order detail fields will be similar to those of standard medications.

The frequency & infuse over times will populate appropriately.

On the EMAR, it appears as a task with a specific date & time. It will

appropriately go to an overdue status, & still be available for

charting even if the medication is received late.

Ultrasound Guided IV Insertion Classes Scheduled

The IV insertion using ultrasound class registration is now in health stream, open to select cost centers that have the appropriate machines.

Please note the requirements for this course. It is an advanced skill and does require manager recommendation, excellence in inserting IVs without ultrasound, and the ability to take time to use the skill to assist others. For staff who meet the criteria please encourage them to undertake this advanced skill. If you have any questions or concerns as to these please contact Jennifer Miceli at jmiceli@umm.edu

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Announcements Save the Date!!!

UMSON Summer Institute in Nursing Informatics (SINI)

Wednesday, July 18-Friday, July 20 All Day

End of Life Workshop September 18th and 25th

All Day

ANCC Magnet Conference October 10-12, 2012

22ndn Annual Summer Institute in Nursing Informatics (SINI) Conference

July 18th—July 20th at the University of Maryland School of Nursing

§ Three full-day format. § Focus on posters and abstracts § One expert-level working track with

interactive and participatory format for the full SINI.

For details & registration, visit the conference website: http://nursing.umaryland.edu/sini

AHNA Classes: Holistic Nursing at UMMC HEALING TOUCH: An Energy Therapy to Support Holistic Care ( 1 PAM hour; CE pending) • Discuss Healing Touch as an energy healing modality, its benefits, a typical session, and the client

experience • Describe the Healing Touch Program’s educational program and organizational support • Practice sensing energy and a healing touch technique

Mon Jun 11 0645 Weinberg 6 Conference Room Mon Jun 11 1745 Weinberg 6 Conference Room

For more information contact AHNA Chapter Leaders: dsmith2@umm.edu, csalmond@umm.edu

NEW: Diversity and Inclusion Forum Series Including a summary of research findings, panel discussion, and audience interaction, the first forum will focus on generational differences and similarities in communication, work ethic and work-life balance. All staff are invited and encouraged to register for the forums through Healthstream.

Forum Date: Thursday, June 21, from 2 to 3 p.m

Location: T1R15, across from the UMMC Auditorium Topic: Generational Differences in the Workplace

Moderator: Jean Tucker Mann.

2 Day End of Life Nursing Care Workshop The workshop, Clinical Applications of Death & Dying and Fundamentals of Death & Dying, is scheduled for September 18th and 25th. Although participants may register for one session, attending both sessions will best ensure an understanding of all aspects of end-of-life care. Please register in Healthstream- for questions contact Erica Bergstein ebergstein@umm.edu

June Nursing Grand Rounds: Date: June 19th Time: 2:00—3:30 pm Location: UMMC Auditorium Topic: Dealing with Delirium: From Problem to Research to Practice Speaker: Tiffany Blacklock,MS, RN ACNP Bre Wallizer, BSN, RN CCRN and LaToya Stubbs, BS