MICU Staff MeetingAugust 2008

TEAMDATE

Ashley Greer / Julie Foss / Lauren Mallard / Stephanie Ray
Lindsey Holdren / Tameka Lindsley / Neader Williams / Stephanie Jinnette
Enqu Kent / Robin DaSilva / David Kornguth / Christine Rowan
Kara Gordon / Shaun Couch / Tracy Harris / Keith Ursery
Jittaun Caldwell / Wendi McDonald / Valerie Sauve’ / Tonya Borton
Tanya Copley / Meggie Cruze / Amanda Williams / Candice Scharklet
Anna Samuel / Jane McLaughlin / Linda Malone / Jen Adams
Terri Elkins / Stephanie Cantwell / Michaela Toney / Candice Marable
Monica Catlett / Clint Houston / Erin Moyers / Vanessa Fenton
Tara Harris / Ashley Culver / Stephanie Wilson / Jennifer Davis
Nathan Riley / Sajid Howard / Melissa Johnson / Shannon Lalka
Darlene McCormick / Priscilla Beach / Hannah Maloney / Fawn Holsombeck
Crystal Scalf / Neely Lambert / Glenda Wilson / Samantha Mathis
Katie Andrews / Christina Twine / Bennett Andrews / Maria Ramirez
Stephanie Bertrand / Juanita Taylor / Martha Reeves / Amy Eakes
Sameia Ejigu / Any Baker / Karl Dierking / Christa Roessler
Aaron Higgins / Aven McNab / Gretchen Woodrich / Cliff Huffman
David Janiszewski
Category / Agenda Process / Meeting Notes
Pillar / What / Who / Notes/Timeline / Outcomes
Quality/People / Feedback from Charge Nurses / Julie /
  1. There is becoming an issue w/ staff – nurses, care partners – leaving the floor without informing the CN. The CN’s need to know who is on or off the floor so that if there is a STAT or some other people are going on field trips they will know who is covering for whom.
  2. If leaving work area to go to another part of the unit, please make sure that you have someone who is watching out for your patients – alarms, call lights, safety – there have been 3 bell alarms going off for extended periods of time and we should be responding immediately to alarms, especially red (3 bell) ones.
  3. Equipment and room readiness – please be diligent at keeping MICU equipment on the unit – IV poles, Total Care Sport beds. If assigned to an empty room it is that nurse’s responsibility for making sure that the room is prepared for an admission – Ambu bag, lead wires, electrodes, BP cuff, O2 flow meter, suction head and canisters.
  4. Our monitors have many different pieces; in an effort to keep all of the pieces together and functioning, please have an MICU nurse or CP disconnect the patient from all of our equipment for Patient Transport or the OR – the staff from these areas may not know what can go or stay or what can be discarded
  5. In an effort to hardwire Elevate tactics within the Leadership Team I had a discussion with the CN’s about this. We discussed the fact the CN report seems to be a walking report when Julie is around and a sitting report when she is not. There are two different camps on this issue: there are some that say CN walking rounds encourages staff nurse bedside report and the other camp states that there is no direct correlation between the two. The CN’s asked that I bring this issue to staff meeting to get your perception:
CN reports – the CN’s have several reports that they have to complete:
Every Sunday night shift and Monday day shift – Pain and Fall Risk assessments
Every shift – restraint documentation
Once a week on Friday’s V.S. and EKG strips are included in a survey readiness audit that they complete
The intent of all of these audits is that if there is not 100% compliance that the CN gets with you and you get the documentation completed so the report that is turned in is 100%. There has been some drifting of doing the 6:00 documentation, especially VS and restraints until after report is given. This practice either means the CN must stay late to complete or ask the CN on the next shift to do the audit – however both of these options ignore the intent of the audit because all of the staff is gone by the time the audit is completed and the next shift can not fix the holes from the previous shift.
End of shift reminder – for AM labs do not wait until 5 or 5:30 to do them, they can be done ~ 3 or 3:30 and that will give you time if there is an access issue. 6 o’clock is a very busy time – one hint would be to start thinking about and finding meds ~ 5:15 – 5:30 that will give the pharmacy time to get missing meds to you and not get you as far behind / MICU Leadership Team wants to give a ‘shout out’ to all staff nurses for more consistent performance of report at the bedside – this is an evidence-based practice that is really for the patients’ safety, not for Julie’s benefit.
Staff perception of CN walking report:
Gives a visual of the pts for the CN’s
Distracting
Doesn’t do anything for us
Doesn’t bother me
Helps the MR because of visibility and accessibility
No impact
Does encourage bedside report
Does not encourage bedside report
Visibility
Doesn’t make a difference
Not of value
6:00 Clock VS and restraint documentation needs to be completed prior to shift report
Quality / Hourly Rounding / Julie / Hourly rounding is an evidence based practice that was conducted in multiple locations. The results of this study demonstrated the following:
Decreased call light usage
Decreased nosocomial pressure ulcer development
Decreased falls
Pain better managed
Improved patient satisfaction
The CN’s will be including this topic during their staff rounding during the month of September. We need to make sure that we are getting answers to the following questions (even on pts who can not answer) – 4 P’s
∆Is the patient having any pain/discomfort?
∆Does the pt have to go to the bathroom? Potty
∆Does the pt need help to change position?
∆Are the items the pt is using within reach? Proximity – call light, phone, OTB table, tissue, etc
As Dixie and I round on patients we will be asking them if these things are happening w/o them having to put on the call light. While you are checking on your ICU patients every hour, the Level II patients need to be included / Call light audit to assess reasons patients in the MICU are putting on their lights – 9/2 – 9/8.
For one week only
Log sheet at each of the 3 nurses station
Anyone can complete
Includes date, time, room, and reason
Quality / Smash C. Diff / Julie / Review of the plan developed during UB in response to the unit’s outbreak of C. Diff
The plan includes:
If the pt is having diarrhea and the MD’s have ordered a stool for C. Diff then this pt needs to be placed on contact isolation for r/o C. Diff until the test results come back if they are negative then we can take the pt off of contact isolation
There are TWO signs to use w/ a pt who has or is a r/o C. Diff – the contact isolation sign and a new sign that the MICU is piloting – “Wash hands with soap and water only” – please make sure that both signs are on this pt’s door
Family/visitors – the spread of C. Diff by visitors is so minimal Dr. Talbot did not feel like we need to spend a lot of energy on this. However, it is good practice as sick as our patients are that we encourage all visitors to wash their hands before and after the visit.
Everyone needs to hold everyone else accountable for wearing gowns and gloves in a contact isolation room, including physicians.
Given the inconvenient location of our sinks, Dr. Talbot’s recommendation was to remove gown and gloves, wash hands at sink w/ soap and water and then leave the room
Shared items – the Doppler, the Ultrasound machine, the Smooth Moves lifts – must be cleaned with a beach wipe after use
All isolation rooms need a terminal clean
Julie and Infection Control to address the issues related to ES cleaning / C. Diff signs – located at station 1 (7206) – vertical file cabinet, top drawer clear at the back
Please return signs to these area so that we can use them for others
If you get push back from physicians there are 2 things that you need to do: 1) do a Veritas report; 2) contact either Dr. Wheeler or Dr. Talbot and let them handle it
Why with a terminal clean is the floor not stripped and waxed?
Next UB – talk about room stocking
Growth / CCT/new MICU / Julie / A blown up floor plan and two sheets for providing feedback on our new MICU have been placed on the unit. The floor plan and one feedback sheet is on the wall in the middle hallway. Butcher paper in the large break room.
I am changing the feedback sheets weekly and sharing your feedback w/ Brent.
Pilot of a supply cart for the patient rooms in the new unit. Currently the cart is located in 7207. Please use it instead of the unicell so that you can make a determination that this will meet your needs – it is the only supply area in your pts’ rooms.
Right now we are using a punch code access but are negotiating to get a proximity access – like your garage access cards / We need for you to identify processes that are broken so we can see if the process is something we can fix so that we are not taking broken processes w/ us to the new unit.
Code for access is on top of the cart
Quality / HED/documentation changes / Julie / Two changes one happened on 8/25 – with readmissions the admission history in Star Panel will come with autopopulated sections – like past history, religious/cultural etc. You will need to verify that these are correct.
Upcoming change – in quick assessment when you download VS all of the VS, including SvO2 and RR are going to be located together – thanks Hannah! / Date implemented 8/25
Possible implementation week of 9/8
People / Clock in and out location / Julie / Reminder that in our MICU Time Clock policy that it states that you should be clocking in and out via the clock on 7S. The only times you should be using MCN or Light Hall is if you are attending a class or inservice over there.
Quality / Peep Valve / Julie / Peep Valves are being added to our intubation boxes and Difficult Airway bag – another Hannah suggestion – Thanks!
People / MedicalCenter Staff Advisory Council / Julie / The new president of this council has sent out an email asking for unit/department representation / Julie to communicate frequency of meetings
Interested volunteers let Julie know.

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