Nursing Committee Updates
Patient Family Education Committee
The Patient and Family Education Committee has been reviewing and updating the Patient Education website. We have reconnected links, updated the Nurse to Nurse button and added a Feedback button. When you next use the website, please use the feedback button if you encounter any problems or issues so we can attempt to repair any problems. We strongly encourage users to give feedback on whether they feel something is missing from the website.
The committee has also been working with Beth Baldwin, RN, and Ann Furey, RN, on the Patient and Family Education Videos. Many units in the Tower have been successfully utilizing these videos and have set up “folders” for the most watched videos. The committee has previewed a few safety videos to determine which are most appropriate for BWH viewers. We are also brainstorming ideas for future educational needs and are in the process of prioritizing the needs of nurses.
Lastly, the committee is drafting a proposal to add a patient to its membership, working closely with Center for Patients and Families in order for this to occur. If you have any suggestions, please contact co-chairs Debra Moody, RN, or Katie Fillipon, RN.
Nursing Quality, Safety and Care Improvement
The Quality, Safety and Care Improvement Committee provided feedback on the patient education video technology. Working with representatives from the patient education program, committee members reviewed and discussed proposed educational videos that could be pre-assigned to all patients admitted to BWH. The hope is that these videos will promote BWH’s commitment to patient safety while meeting several of the National Patient Safety Goals. The plan is to pilot auto-assigning educational videos to specific units and revisit the proposed idea of pre-assigning videos to all patients admitted.
The committee has discussed intravenous potassium administration and how peripheral discomfort can be minimized during infusion. Currently, additional IV fluid is administered to prevent discomfort but other alternatives are being investigated. The committee is gathering data from different areas of the hospital in order to be fully informed about current practices. A task force is being developed to look at all aspects of potassium replacement. The committee is looking to gain insight from nurses, physicians, pharmacy and the IV team.
The committee meets the second Tuesday of every month. Please feel free to contact co-chairs Stephanie Capello, RN, or Martha Doherty, RN, if you have any questions or concerns.
Informatics and Clinical Innovations Committee
The Informatics and Clinical Innovations Committee continues to advocate for clinical systems projects to support work of the nurse at the bedside and promote patient and staff safety. Recently, the committee discussed its role in integrating the Department of Nursing’s Four Pillars/Strategic Goals into the goals of the committee.
The committee took inventory on the multiple methods of nursing handoffs for shift to shift report, transfers, OR and care coordination. Methods included taped report, verbal handoff, website, BICS sign-out and SharePoint. Information was provided to physician/IT representatives looking at the phase out of the BICS signoff.
eMAR: The committee discussed terminology regarding IV and TPN documentation. Discussion also centered on a new alert message to prevent duplicate signing of medications. New changes to documentation of medication patches included being able to enter location of patch(es), removal time, and reminder prompts to remove the patch(es).
Patient Education Interactive Video System: As the system continues to roll out, the committee discussed questions regarding the suitability of particular videos. Nurses are encouraged to preview the videos before assigning them to their patients and to provide feedback by using the feedback button in the application.
Discharge Module: The committee provided feedback, and was updated, on the roll-out and training for the new module. On-site training sessions, computer-based training and the super user role was also discussed.
Acute Care Documentation: E-chart feedback and updates were provided with emphasis on timelines, eMAR integration, IV fluids/meds and flow of care. Discussion on weight and temperature scales took place, with consensus moving towards kilogram and Celsius scales. The pilot is scheduled for late spring with roll-out in fall 2012. Continued attention was given to nursing work flow and E-chart documentation.
CIWA Scale: Demonstration and feedback was provided for the roll-out of the CIWA alcohol withdrawal scale. Discussion included the use of two order set pathways (medication given based on patient score or scheduled hourly), the scale being used in eMAR and the score in E-chart.
New Changes:
Nerve Blocks: A new order set will replace free text ordering in November. CAdd Solis pump libraries will be updated, and discussion regarding education for change took place.
Labs: Drugs that require levels measured (i.e. Vancomycin) will have lab instructions in the drug order in BICS, but the MD will still be required to order labs.
Practice Committee
In October, Suzanne Fernandes officially assumed role of co-chair of the Practice Committee. She is a clinical nurse in the ICU Float Pool and has been a member of the committee since it formed three years ago.
For several meetings, the committee has focused on the development of skills around facilitating a narrative discussion. Members have had the opportunity to practice by listening to narratives and then through coaching have practiced how to probe for a better understanding of the situations presented in the narratives. As members have developed their abilities with these practice sessions, they have had the added benefit of participating in rich discussions of nursing practice.
In October, clinical nurses on the committee participated in a focus group about the nurse educator role led by Laura Mylott, PhD, RN, executive director of the Center for Nursing Excellence. In 2009, the educator role was identified by committee members as one of the supports and conditions for excellent practice. The purpose of the focus group was to gain the perspective of clinical nurses on how the role makes a difference on the unit, and seek their views on the required responsibilities of the role. This information will be added to feedback provided by other focus groups to summarize current state and inform next steps. In November, committee members in all roles participated in a focus group about sleep, led by Lichaun Ye, PhD, RN, Haley Nurse Scientist. The information obtained will help guide research development about nursing interventions that support patient sleep.
If you have questions, contact committee co-chairs Suzanne Fernandes, BSN, RN, and Alice O’Brien, MS, RN.
Standards, Policies and Procedures
The Standards, Policies and Procedures committee is comprised of nurses across the organization in a range of nursing roles. The purpose is to provide a forum to write, revise, coordinate, review and monitor standards, policies, procedures and guidelines using current evidence-based information and clinical practices.
Ensuring that the information available to BWH nurses is accurate, timely and easy to access is a committee goal. It requires review of multiple policies each month that includes discussions about how each one impacts patient care and nursing practice. Changes in policies in one department may have cascading impact on other departments. For example, BLD-07 (Procedure for Preparation and Administration of All Clotting Factor Concentrates) and eMAR-08 (Electronic Medication Administration Record Barcode Scanning) were revised to reflect changes in the prescribing and documentation of Blood Factor administrations. The Factors have been changed from Roman numeral to numeric (i.e. Factor VIII is now Factor 8) and will now be obtained from pharmacy. Like medications, the Factors will be ordered in the BICS order entry screen and displayed in eMAR. The Factors have bar codes and will be scanned and documented in eMAR, just like medications. These changes enhance patient safety.
Our committee also reviews the use of different types of media to get accurate information to nurses. While reviewing HNT-07 (Nasopharyngeal (NP) Viral Cultures & Ambulatory Practice) the availability of a brief, instructional video was discovered on YouTube. The idea of embedding the link to the YouTube video was suggested, as we realize that many nurses find videos helpful educational tools. Members reviewed the content, shared it with clinical experts and consulted with Public Affairs and IS to ask their support of embedding the link in a policy.
If you have questions, comments or concerns, please email co-chairs Cindy Jodoin, RN, and Diane Miller, RN.