7/25/2014 FW: Learning Opportunities #4 - Davis, Aurora

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FW: Learning Opportunities #4
Hi CNA/ACPs,
Please read Aurora's note on 1 & 2 as they do pertain to you all. It is important to let your nurse know if
you are slammed with toiling so that they can help you get vitals done if needed (and/or toileting).
Honestly, we all get in our own bubble and if we don't know that you are drowning, then we can't help. It
is not a big deal for us to grab a set of vitals. Vanessa did a great job delegating vitals to me yesterday as
I had no clue that she had been toileting a pt on and off for the past 2 hrs!!
Thanks for all you do for the team. You have one of the most physically demanding and exhausting jobs
I've seen. RNs could NOT do their jobs without you, so thank you so very very much! I have noticed MANY
of you rounding with waters at 10, 2, and 6 with I & Os, which is so amazing. RNs constantly having to run
for waters in order to administer meds is a BIG complaint, so thanks for responding to feedback and
getting it done!
Take care,
Pam
Pamela Heinke RN, BSN, OCN
Permanent Charge Nurse
Bone Marrow Transplant & Oncology Units
From: Davis, Aurora
Sent: Thursday, June 19, 2014 2:12 PM
To: UCH-AIP 11th Onc RN
Subject: Learning Opportunities #4

All,
"O frabjous day! Callooh! Callay!" It's time for more Learning Opportunities! Rejoice, for here are more of
Aurora's Tasty Tidbits of Terrifyingly Tailor-Made Tips:
1) Change your telemetry lead stickers Q24H. Patients on telemetry should now have their white lead
stickers changed every 24 hours. This is definitely something you can delegate, though. The house wide
standard is that they will be changed on night shift. However, after a shower is an excellent time to do this
Heinke, Pamela S
Sat 6/21/2014 3:09 PM
To:UCH-AIP 11th Onc CNA/ACP <UCH-AIP11thOncCNA/ACP@uchealth.org>;
Cc:UCH-AIP 11th Onc Charge Nurse <UCH-AIP_11th_Onc_Charge_Nurse@uchealth.org>; UCH-AIP 11th Onc Relief Charge Nurses
<UCH-AIP11thOncReliefChargeNurses@uchealth.org>;
7/25/2014 RE: Learning Opportunities #4 - Davis, Aurora
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RE: Learning Opportunities #4
Aurora,
Thanks for all the updates.
Since CNAs are now changing tele batteries as part of their morning routine ever morning, why don't
we have them change out the pads at the same time. This way that care is clustered and constant too.
Don
From: Davis, Aurora
Sent: Thursday, June 19, 2014 2:12 PM
To: UCH-AIP 11th Onc RN
Subject: Learning Opportunities #4

All,
"O frabjous day! Callooh! Callay!" It's time for more Learning Opportunities! Rejoice, for here are more of
Aurora's Tasty Tidbits of Terrifyingly Tailor-Made Tips:
1) Change your telemetry lead stickers Q24H. Patients on telemetry should now have their white lead
stickers changed every 24 hours. This is definitely something you can delegate, though. The house wide
standard is that they will be changed on night shift. However, after a shower is an excellent time to do this
and is certainly appropriate; just make sure that the next shift is aware it's been done. CNAs/ACPs were
educated on this, but we've had a large new crop that might not be aware of it, so it should be discussed
when you check in with your CNAs/ACPs at the start of shift.
2) CNA prioritization should place toileting over vital signs. This feedback will be going to the CNAs,
too, but I wanted to make all you RNs aware: when the CNAs are prioritizing care, toileting comes before
vital signs. Not that vitals aren't important, but if a patient calls and needs to go to the bathroom, that
should come first. Our responsiveness to call lights score is very poor right now, and this is a big area of
concern and needs to be recognized as something that really affects patient satisfaction. (Please also
keep this in mind if the CNAs are having a rough day and are behind on vitals.)

3) Blue return to pharmacy bags are to be used for meds that don't scan properly in EPIC. These are
the little dark blue plastic bags in the return to pharmacy bin in the central pod on AIP2 (and perhaps
elsewhere on the units). These bags should only be used if you have a med that won't scan properly in
EPIC. In that case, attach a patient label to the used med container or the bag and tube it directly to the
Alvarez, Donald
Thu 6/19/2014 3:23 PM
To:Davis, Aurora <Aurora.Davis@uchealth.org>;
7/25/2014 RE: Learning Opportunities #4 - Davis, Aurora
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RE: Learning Opportunities #4
Ok, got it. Yes we probably should start linking all lines so we don't forget, and also so we understand
which line is which in the LDA drop down, so we do it properly.
I am clear now the 4th rail. Thanks.
Dana Ayer, RN, MSN, OCN
Relief Charge Nurse
Supply & Equipment Liaison 11th Floor
I 131 Radiation Room Liaison 11th Floor
Medical & Surgical Oncology, Hematology, Bone Marrow Transplantation
Dana.Ayer@uchealth.org
720 848-4275
From: Davis, Aurora
Sent: Monday, June 30, 2014 12:25 PM
To: Ayer, Dana
Subject: RE: Learning Opportunities #4

Hi, Dana.
Infusions are only REQUIRED to be linked for OBS patients. However, since everyone keeps forgetting, I've
started encouraging everyone to link their lines every time. That way, it becomes a habit, and you never
forget.
The 4th side rail is considered a restraint. The only times you can put it up without an order are 1) when
the patient requests it his/herself or 2) when the patient is on a special surface that puts them at risk for
falling out of bed without it. However, at the moment, all the special surfaces that would allow 4th rail use
are not being used d/t fall issues. So the second option is moot.
Does that help?
Aurora
Aurora Davis, RN, BA, BSN, OCN
Relief Charge Nurse, Oncology/BMT Unit
Co-Chair, Pain Champions Committee
University of Colorado Hospital
Aurora.Davis@uchealth.org
Ayer, Dana
Mon 6/30/2014 12:32 PM
To:Davis, Aurora <Aurora.Davis@uchealth.org>;
7/25/2014 RE: Learning Opportunities #4 - Davis, Aurora
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From: Ayer, Dana
Sent: Monday, June 30, 2014 12:16 PM
To: Davis, Aurora
Subject: RE: Learning Opportunities #4

Aurora,
Thanks for the info.
A couple things:
#4B I know you stated it in black & white (Calibri 12 bolded to be precise) , but all infusions must be
linked for us to charge/get reimbursed? Not just the OBS patients? This blew me away. Is this new?
#7 Are we still allowed the option to put a 4 th rail up for a patient who cannot get out of bed but whose
leg moves and can fall over the edge--without obtaining a restraint order? I have lost track. At one point
we could.
Thanks,
Dana :)


From: Davis, Aurora
Sent: Thursday, June 19, 2014 2:12 PM
To: UCH-AIP 11th Onc RN
Subject: Learning Opportunities #4

All,
"O frabjous day! Callooh! Callay!" It's time for more Learning Opportunities! Rejoice, for here are more of
Aurora's Tasty Tidbits of Terrifyingly Tailor-Made Tips:
1) Change your telemetry lead stickers Q24H. Patients on telemetry should now have their white lead
stickers changed every 24 hours. This is definitely something you can delegate, though. The house wide
standard is that they will be changed on night shift. However, after a shower is an excellent time to do this
and is certainly appropriate; just make sure that the next shift is aware it's been done. CNAs/ACPs were
educated on this, but we've had a large new crop that might not be aware of it, so it should be discussed
when you check in with your CNAs/ACPs at the start of shift.
2) CNA prioritization should place toileting over vital signs. This feedback will be going to the CNAs,
too, but I wanted to make all you RNs aware: when the CNAs are prioritizing care, toileting comes before
vital signs. Not that vitals aren't important, but if a patient calls and needs to go to the bathroom, that
should come first. Our responsiveness to call lights score is very poor right now, and this is a big area of
concern and needs to be recognized as something that really affects patient satisfaction. (Please also
keep this in mind if the CNAs are having a rough day and are behind on vitals.)

3) Blue return to pharmacy bags are to be used for meds that don't scan properly in EPIC. These are
the little dark blue plastic bags in the return to pharmacy bin in the central pod on AIP2 (and perhaps