Nursing Committee Updates
Quality, Safety, and Care Improvement Committee
Under executive sponsors Jackie Somerville, PhD, RN, senior vice president of Patient Care Services and chief nursing officer, and Stan Ashley, MD, chief medical officer, the Quality, Safety, and Care Improvement Committee will work collaboratively with the Division of Infectious Diseases to reenergize the BWH hand hygiene program. Although hand hygiene rates continue to be high, the goal is to reach 100 percent compliance. Hand Hygiene audits continue to take place monthly, and detailed reports are being sent to leadership on the patient care units. Unit champions are being recruited to help raise staff awareness and compliance, so stay tuned for more on this topic.
The need for an improved and increased supply of recliner chairs for patient use in the Tower has been identified. The committee is actively involved in selecting the most appropriate chairs. A work group has been established to assist with equipment trials and purchasing. Trials will begin in mid-February on 8AB, 10BA, 11BD and 15CD.
The committee provided feedback on information related to the upcoming pharmaceutical waste program. New EPA requirements on medication waste will require disposal of medications in specific hazardous and nonhazardous waste bins that will be located on each unit. Staff will be expected to dispose all medication waste in the appropriate designated bin.
The QSCI committee meets the second Tuesday of every month. If you have questions or concerns, please contact co-chairs Stephanie Capello, RN, or Marty Doherty, RN.
Practice Committee
The Practice Committee is experiencing a period of transition with 10 members completing their term of appointment last December and 12 new members beginning their term in January. Members completed a survey asking for their recommendations on how to best orient new members. Among the recommendations was using a “buddy” as a way to guide new members through the work of the committee and their role as members. At December’s meeting, we acknowledged and celebrated the members who have completed their terms and thanked them for their past contributions and continued support toward preserving and extending excellent practice at BWH.
Also in December, members listened to an audio clip of a patient telling his story about his inpatient hospitalization at BWH. This particular patient spoke about how important it was for him to have the same nurses caring for him because it eased his worry and made him feel safe. The committee discussed continuity as a way of knowing the patient and about how developing a care team helps achieve this and can be part of the plan of care. Hearing the voice of the patient and family is an important goal for the next year, and the committee will continue to seek opportunities to hear from patients and families directly about how they felt known and cared for by their nurses.
If you have questions, contact committee co-chairs Suzanne Fernandes, RN, and Alice O’Brien, RN.
The Informatics and Clinical Innovations Committee
The Informatics and Clinical Innovations Committee continues to advocate for clinical systems projects to support the work of the nurse at the bedside and promote patient and staff safety.
The committee discussed implementation of a plan to increase compliance with documentation regarding Influenza and Pneumococcal vaccines. There will be a HealthStream course to highlight the changes, which will include the nurse being able to see the reason a vaccine was not given on the current or previous admission. Current paper forms should be dated 2/11 on the bottom of the sheet. Any vaccine documented in eMAR since 2005 can be viewed from the “Reports” Tab in eMAR under vaccine information.
eMAR:
The committee discussed the process to adjust medication administration times if the current dose is given late, with the consensus indicating collaboration between nursing and pharmacy, as opposed to an automatic adjustment in eMAR. The committee also provided feedback on new functionality in eMAR that will prompt the nurse to remove a transdermal patch as well as document the location of the patch application. Planning is also ongoing for nurses to request PRN sliding scale, blood and platelets orders from an eMAR screen, instead of faxing a request to the blood bank. There is a plan to trial this new process on Tower 6A and 6C this spring.
Discharge Module:
Ongoing discussions and feedback were provided regarding the new module. The overall impression is strongly positive, but many had concerns about paper waste. Feedback was offered on ways to reduce the number of pages printed, and concerns were discussed about the last dose of medications.
Restraints:
New policy language is coming to be proactive in complying with The Joint Commission standards. Nursing practice concerning restraints should not be affected. Contact committee co-chairs Heidi Smith-Doucette, CNRN, and Gary Zina, RN, with questions.
Patient Family Education Committee
The Patient Family Education Committee has focused on the new discharge module, which went live in November. As part of our goal for the year, we are looking at our discharge process and how it affects patient and family success at home. The first step is looking at our current tools. Committee members took the month of December to talk with patients and families about the new discharge process and solicit feedback, which we shared with Lauren Selvitella, RN, from the discharge module team, at our meeting in January. We plan to continue this work in the months to come.
Providing palliative care and end-of-life resources to nurses who can then provide better care to our patients was raised by member Diana Cuypers, RN, of the MICU, several months ago. The Patient and Family Education Committee identified this as an area to address during 2012. In the last several weeks, we have been working on uncovering resources nurses can use to assist them in dealing with symptom management and end-of-life care challenges. This process has opened our eyes to a wealth of available resources. We have been able to add a Palliative Care / Goals of Care button to the Patient Education website to improve the accessibility of these resources. We encourage you to go to the Patient Education Website and check it out. We plan to continue to evaluate and add new information in the future. If you have any suggestions, please contact co-chairs Deb Moody, RN, or Katie Fillipon, RN.
Standards, Policies and Procedures Committee
The Standards, Policies and Procedures Committee continues to review and revise numerous policies each month. The membership of the committee is made up of nurses from throughout the organization so that policies can be thoroughly evaluated. We have recently reviewed the membership and have added staff nurses from areas that were under-represented.
The committee is constantly reviewing the best means to communicate changes in policies to nursing staff. The “New To You” emails that are sent out monthly highlight the major changes that have occurred in policies. Some of the procedures cross all areas of nursing at BWH, including the Med-28 Influenza Immunization Policy. Other procedures are interesting and promote much discussion, such as COM-03 Dog Therapy Policy. This policy outlines the program and the acceptable areas in which Dog Therapy is allowed.
Highlights of changes include:
The Laboratory Reference Sheet is placed in all patient charts; however, committee members raised concerns about keeping the information updated. These sheets will be updated regularly, and Standard Register will make smaller batches to ensure accurate information. Unit coordinators will be instructed to have the current Laboratory Reference Sheet in every chart.
Point of Care (POC) testing for Hemoccult and Gastroccult must have the QC documented for every test performed. The nurse is to write “QC acceptable” or “QC not acceptable & the actions taken” on the flow sheet with the results. All POC (including glucose monitoring) must have the initials of the provider performing the test next to the result, and the provider must sign their name and initial it at the bottom of the flow sheet.
EQU-11 Use of Anti-Embolism Stockings and EQU-25 Use of Sequential Compression Device have changed. There is no evidence that thigh-high stockings are more beneficial to preventing blood clots, so the BWH default will be for knee-high. There are still specific circumstances in which thigh-high stockings can be used. Also, there is no evidence that using both sequential compression device and stockings together provides any additional benefit, so either or should be used, not both. Please contact co-chairs Cindy Johnson, RN, or Diane Miller, RN, with questions.
IACRN Boston Chapter Seeks Members
The International Association of Clinical Research Nurses (IACRN)/Boston Chapter is looking for clinical research nurses interested in participating as members in this new local chapter.
IACRN is an international organization dedicated to promoting the role of the clinical research nurse and recognizing clinical research nursing as a specialty practice.
Membership is open to all interested research nurses in Boston and the greater New England area. The next meeting will be March 8, at 5:30 p.m., in Carrie Hall at BWH. For more information, please contact chapter president Mary Larkin, RN, at mlarkin1@partners.org or email bostoniacrn@gmail.com.
Quadramed Update
by Dorothy Bradley, RN, MSN, Sharon Donnelly, RN, MBA, and Brian Laneau, RN
The re-education of all inpatient units that utilize the Quadramed system to capture patient acuity and nursing workload was completed in late fall. As we move into the next phase of achieving and sustaining reliability, we are encouraging units to partner with the Quadramed team in identifying best practices to accomplish these goals.
One best practice is the use of unit-based Quadramed champions. Many units have instituted champions, including 5A, 7A, 7B, 8C, 8D, 10CD, 11A, 11C, 11BD,12B, SH 9E and SH 9/10.Champions function as the unit based go-to resource assisting staff with questions, difficult classifications or procedure capture and acting as a liaison to the Quadramed team.
An early adopter to this best practice was 11C. The Quadramed team congratulates the unit on achieving 100 percent patient type agreement since Oct. 1, 2011. Achieving greater than 90 percent Patient type agreement is a major factor in helping to understand the resources needed to care for our patients. The success that 11C has achieved is due in large part to their Quadramed Champion, Lauren Sweeney, RN. She has been an excellent resource for fellow nurses, utilizing and sharing her in-depth knowledge of indicators and procedures to ensure that patient acuity and nursing workload are accurately captured. The unit has also led the way with the lowest number of unclassified patients since October 2011, achieving 99 percent overall patient classification compliance. Congratulations!
If you are interested in becoming a Quadramed Champion or would like more information on how to get your unit involved, please talk to your nursing director.
For additional information on Quadramed, please visit the Quadramed Acuity SharePoint site at http://sharepoint.partners.org/bwh/quadramedacuitysite