7/26/2014 FW: Learning Opportunities #4 - Davis, Aurora

https://outlook.office365.com/owa/#viewmodel=ReadMessageItem&ItemID=AAMkADJmODRkNzU1LWY2MDAtNGYwYS1hZDViLWQ2ZWI2ZDg0NDEyMwBG 1/4
FW: Learning Opportunities #4
Havent looked through it all yet, but do know there may be a change with CHG

Barbara Wenger MS, RN, AOCNS, CRNI
Oncology/ BMT CNS
University of Colorado Hospital
Phone: 720-848-4596
Pager: 303-266-2131


The Department of Professional Resources improves lives by empowering healthcare professionals
to influence quality care through education, discovery and navigation of change



From: Buffington, Annsley J
Sent: Friday, June 06, 2014 10:45 AM
To: Davis, Aurora; Hammond, Kyle R
Cc: Wenger, Barbara
Subject: RE: Learning Opportunities #4

Thanks Aurora for putting this together! See below for a few additional comments.

Annsley J Buffington RN, BSN, OCN
Clinical Nurse Educator
Oncology, Bone Marrow Transplant, Gyn-Onc
720-848-4940
Annsley.Buffington@uchealth.org

The Department of Professional Resources improves lives by empowering healthcare professionals to
influence quality care through education, discovery and navigation of change.

Wenger, Barbara
Fri 6/6/2014 10:50 AM
To:Davis, Aurora <Aurora.Davis@uchealth.org>;
7/26/2014 FW: Learning Opportunities #4 - Davis, Aurora
https://outlook.office365.com/owa/#viewmodel=ReadMessageItem&ItemID=AAMkADJmODRkNzU1LWY2MDAtNGYwYS1hZDViLWQ2ZWI2ZDg0NDEyMwBG 2/4
From: Davis, Aurora
Sent: Friday, June 6, 2014 9:43 AM
To: Hammond, Kyle R; Buffington, Annsley J
Cc: Wenger, Barbara
Subject: Learning Opportunities #4

Ladies, here's the next round of tips for your perusal. Thanks!

----------------------------------------------------------------------------
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. CNAs/ACPs were educated on this, but we just hired many
more who might not be aware. but I'm not sure how well it was communicated to RNs (we did send an
email out to everyone and posted the practice change on sharepoint). Patients on telemetry should now
have their white lead stickers changed every 24 hours preferably on night shift. (This was decided on at
NEC so to be consistent housewide, this should probably be mentioed) Changing stickers after showers
certainly makes sense; however, this would just need to be communicated to the next shift. This is
definitely something you can delegate, though. After the shower is an excellent time to do this, btw.

2) Chlorhexidine wipes for central lines daily. Remember we're supposed to be wiping around and down
our central lines daily with chlorhexidine wipes. While this is something you can delegate to ACPs/CNAs,
you still need to be making sure that it gets done. Also, something new that I learned: we should still be
doing these wipes even on days when we change the central line dressing. Also, the ACPs/CNAs should
not be charting this task under your "IV Asmt" tab. It goes under "Interventions-->Self Care Assistance--
>Skin Care-->CHG wipes". (Dont mention any of this yet.. we are working on standardizing
documentation for CHG wipes with CAUTI, CLABSI and Burn care so this may change in the near future.)

3) 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.)

4) 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
central pharmacy; that way, pharmacy has all the info they need to investigate. If you're just trying to
return an unused med to pharmacy, use the return to pharmacy bins located in the med rooms immediately
next to all the patient specific bins.
7/26/2014 FW: Learning Opportunities #4 - Davis, Aurora
https://outlook.office365.com/owa/#viewmodel=ReadMessageItem&ItemID=AAMkADJmODRkNzU1LWY2MDAtNGYwYS1hZDViLWQ2ZWI2ZDg0NDEyMwBG 3/4

5) Overdue infusion alerts on an OBS patient mean that you have to re-verify that the patient's IVF is
still flowing at the correct rate and through the same linked line. This alert will appear Q4H on all OBS
patients with running infusions. Every four hours you have to scan the patient, scan the med, change the
drop down box to "rate/dose verify", then click accept. The message will then disappear for another four
hours. (If the IVF or other infusion has been stopped, then you need to chart the time that the fluid was
stopped and the message will disappear unless you restart the IVF.) Verifying the fluid is required in order
for us to get paid for it!

5A) Link your lines! Especially for OBS patients. Like verifying fluid rates, the location where the fluid
infuses--i.e. the linked line--is required in order for us to get paid. If the line isn't linked, then we can't bill
for that infusion. This is true for IVF, antibiotics, even blood.

If, like me, you have a hard time remembering to link lines when your patient is OBS, then my suggestion
is to simply get in the habit of always linking your lines. If you always link, you never have to worry about
forgetting it. Plus, once you link the infusion, you don't have to link it again.

5B) What's an OBS patient? OBS means that a patient's status is "Observation". That is, the doctors don't
think they'll be here longer than 48H. Billing is different for these patients, hence the weird requirements
regarding linking lines, reverifying IVF, etc. How can you tell your patient is OBS? They'll have a brilliant
turquoise blue band along the top of their EPIC chart. (perhaps move this up above before going into OBS
specific reminders)

6) Patients on contact precautions should not be leaving their rooms wearing yellow gowns. The
yellow gowns are only for care providers, visitors, and others who are going into the room, but should not
be coming out of the room. This is a Joint Comission standard. If a patient wants to leave the room for a
walk, they need to put on a clean gown and gloves and should have someone walk with them to touch
buttons, open doors, etc. When transporting a patient on precautions, place a clean sheet over the top of
them.

7) Chart maintenance should be done every shift. This means culling out old, outdated orders or orders
that are no longer relevant. For instance, I recently took care of a patient who had 4 day old orders
regarding a ketamine drip that had been d/c'd, several old transport orders, old equipment orders, and 3
different sets of PCA monitoring orders (all identical). This could all be safely deleted to clean up the
orders section. I know sometimes its difficult to tell what things can be safely deleted and what things
can't, but use your resources. Your charge nurse or another RN can give you a second opinion about
whether something is safe to get rid of or not.

8) Only people who are totally physicially incapable of getting (or falling) out of bed should have
"yes" in the fall risk section for "not capable of bed exit". This means only quadraplegics, end of life
patients who are comatose, and those who are deeply sedated (like in the ICU). This does not include
patients who are weak, patients who are paraplegics, patients who are end of life but are still able to
move their extremities, and patients who have simply received sedating medications. Please remember: if
you are in any doubt as to whether this patient could pull themselves out of bed or fall out of bed on their
own, DO NOT USE THIS OPTION, as it automatically makes the patient a low fall risk.
7/26/2014 FW: Learning Opportunities #4 - Davis, Aurora
https://outlook.office365.com/owa/#viewmodel=ReadMessageItem&ItemID=AAMkADJmODRkNzU1LWY2MDAtNGYwYS1hZDViLWQ2ZWI2ZDg0NDEyMwBG 4/4

9) Venous blood gas levels must be checked in an ABG syringe. This is something I did not know and I
think it probably recently changed. We can no longer send venous blood gasses in the dark green with no
gel tubes. You now have to use an ABG syringe. (You can, however, still send an ionized calcium in the
dark green tubes.) The ABG syringe doesn't have a luer lock, but it does still hook up to the central line
caps so that you can draw blood directly into them.

Hopefully these tips will help you slay the Jabberwock of nursing errors. Until next time, keep those vorpal
blades sharp and, as always, beware the frumious Bandersnatch...but never beware asking me questions.

Aurora


Aurora Davis, RN, BA, BSN, OCN
Relief Charge Nurse
Oncology and Bone Marrow Transplant Unit
University of Colorado Hospital
Aurora.Davis@uchealth.org