Practice Committee
The Nursing Practice Committee welcomed Jackie Somerville, PhD, RN, senior vice president for Patient Care Services and chief nursing officer, to their January meeting. Dr. Somerville shared with the members her belief that practice is shaped by those who practice and stated her commitment to build on the work that has begun at BWH.
In February, committee members had the privilege of hearing from a member about her perceptions of the nursing care her husband received while he was a patient at BWH. As she described the care he received, she spoke about the characteristics of excellent practice that she experienced as a family member. For example, she described how “(nurses) went out of their way to make him comfortable,” and to “let me be the wife;” how the nurses “introduced themselves and explained the daily plan and schedule;” how they were “protective of privacy;”and helped him to “feel safe” and “trust staff.” Further, she described the “great teaching” he received and, how he “did not feel rushed and found it easy to ask questions.” They were “professional and sincere.” As part of the discussion, committee members identified the importance of ethical comportment (how nurses conduct themselves in the clinical setting); that teaching these skills is different from teaching technical skills; and, the value of role modeling and positive reinforcement. The members recommended that we learn more about patients’ and families’ perceptions of nursing care, including extending an invitation to a patient or family member for additional learning on how they feel known and cared for.
If you have questions, contact committee co-chairs Mary Beth Mondello, CNRN, MSN,NP-C; and Alice O’Brien, MS, RN.
Patient and Family Education Committee
The Patient and Family Education Committee has focused its attention on documentation of patient and family education. We have received much feedback from nurses that there is simply not enough room on the flow sheet to document patient education adequately and that requiring the additional step of placing the information in the progress note runs the risk that it will be left out by the time the nurse is able to write his/her notes for the shift. Another issue is that it is difficult to see at a glance how much education the patient has received since admission. As an interim measure, the committee has recommended some revisions to the patient education area of the flow sheet.
The committee is also working with the Acute Care Documentation team to develop an electronic tool that will have the ability to record all patient education in one place in the medical record; easily access this location off the daily flow sheet; accommodate an education progress note in that same area; and give staff access to all previous education documentation at a glance. Please contact Committee Co-Chairs Cynthia Loring, RN, and Deb Moody, RN, with questions.
Standards, Policies and Procedures Committee
Ongoing efforts to help reduce central line infections continue. To support this goal, language has been added to all the related IV Therapy policies to reflect the use of the biopatch, a chlorhexadine impregnated disc that is placed over the insertion site, under the line. There are different thicknesses based on the size of the line or huber needle. Please see policies IVT-01, IVT-19 and IVT-25 for further information. Biopatches are not to be applied to arterial lines. Don’t forget to scrub the hub!
ONC-01 has a new title: Administration of Antineoplastic Agents (Chemotherapy and others), to Patients on Non-Oncology Floors. This reflects that many medications have other uses, such as for sickle cell or rheumatoid arthritis. Also oncology patients, due to their condition, may be on non-oncology units. The Hematology/Oncology nurse director is to be notified 24 hours in advance of chemotherapy orders administration by the physician (beeper # 32831). The director will then coordinate administration as there is no longer a chemo-resource nurse. There is a revised reference grid, which will also include precautions.
Of particular interest to those in critical care is a new policy, ICU-46, that has been crafted on Therapeutic repositioning. This policy was created from the work of the critical care pressure ulcer committee and national guidelines. It provides grids to assess risk of turning the patient and interventions for these risk groups. The fundamentals of thorough basic nursing care is reflected in this policy.
As always, please utilize the “New to You: Time to Review” email for policy changes that impact your practice. Contact co-chairs Cindy Jodoin, RN, and Sharon Swan, RN, with questions or concerns.
Quality, Safety and Care Improvement Committee
The Quality, Safety and Care Improvement Committee is actively providing input on a number of key care practices. The committee heard program updates on restraint and skin integrity management.
The restraint prevalence data was reviewed reflecting continued reduction in the intermediate care units with the ICUs holding their gains. The revised restraint form and the 2011 strategic plan was presented and feedback provided. The pressure ulcer prevalence data suggested a strong improvement especially in the ICUs, since the last survey. The committee was involved in the development of a pressure ulcer documentation tool which was implemented in MICU and will be spread to other ICUs. Susan Kilroy, RN, MS, CWS, is now managing the pressure ulcer program since the recent retirement of Lucy Feild, PhD, RN.
The committee offered recommendations on how to better communicate to nurses when medication is pulled from the Omnicell. Possible solutions included direct notification located at the Omnicell.
The committee is also involved in the work for streamlining the process for communicating critical test results and will improve the current “sticker” process. The complex issue is still being discussed and analyzed for the best solution.
The QSCI committee meets the second Tuesday of every month. Please direct concerns to co-chairs Martha Doherty, RN, and Stephanie Capello, RN.
Informatics and Clinical Innovations Committee
The Informatics and Clinical Innovations Committee continues to advocate for clinical systems projects that support the work of the nurse at the bedside and promote patient and staff safety. Our projects include:
eMAR Updates/Enhancements
The committee validated how pain scales are used in eMAR today. They made suggestions on how and what information should flow to the new ACD electronic flow sheet.
Currently, blood factor products do not pass from order entry to eMAR. Solutions to this are being investigated. As an interim plan, the committee suggested an improved pop-up message in eMAR that will instruct the nurse to transcribe blood factors to a blue paper med sheet.
In eMAR, the rate field information on the documentation screen is inconsistent. The committee voted to remove the field from the eMAR documentation screen. In the future, the rate will be automatically calculated on the new ACD electronic flow sheet.
When PCA/epidurals are documented as “stopped” in eMAR, the total dose information is inconsistently recorded. The committee validated the need to add a pop-up message if the PCA/epidural is stopped to prompt the nurse to document the total dose administered since the pump was last cleared.
Technology Updates
Thermal printers for prescriptions were removed in January. Prescriptions can now be printed from the central printers.
The PAML screen was changed to a more user-friendly format. A comment screen option will be added to clarify any differences.
Laboratory Order Communication Project
Update on ACD Timeline & Citrix
ACD pilots will begin on 11ABCD, 12B and 3BC in February/March 2012. A training space is now open on Tower 7C, and a training program is being created.
Citrix is a system that will allow faster log on time (less than 10 seconds) and should be available when the ACD pilot occurs.
Pharmacy
If you have questions or concerns, contact co-chairs Heidi Smith Doucette, CNRN, or Carol Booth, MSN, RN, PCCN.