Nursing Committee Updates
Informatics and Clinical Innovations Committee
Check out LMR, New BWHPikeNotes.org
PikeNotes has been redesigned. Take a look at the new features that include better overall display of what is available, improved search features for the entire site and filtered searches for forms, policies and manuals, etc.
Have you tried using LMR (Longitudinal Medical Record)? LMR is an excellent resource for staff to obtain information on patient histories. To access LMR from the start button: start > partners applications > LMR web; from the pod monitor, highlight patient > click on EMAR > click on LMR.
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The Informatics and Clinical Innovations Committee continues to work on improving clinical systems technologies that impact the clinical nurse at the bedside. Projects include:
Critical Lab Notification: new process to improve communication between the MD and nurse for notification of critical labs. The new system will automatically alert the covering physician of the patient’s critical lab value.
Nursing Handoff Tool: HIP (BWH Health Information Technology Program) has funded the evaluation of a Web-based tool to support nursing hand-off shift report. The idea for this work originated with Marc Boomhower, a Tower 16AB staff nurse. A focus group discussion took place covering methods of current shift report and feedback on what should be included in a Web-based electronic hand-off tool. The committee communicated the need for the tool to eliminate redundancy and improve RN efficiency during hand off. The group also made recommendations for a prototype hand-off tool. Prototype testing by the committee will follow.
Lab Order Communications Project: A pilot of Phase I will take place on Tower 11ABCD and Tower 3C in late July. Phase 1 features new Web-based lab ordering screens in BICS/OE and a re-sorting of all lab orders on the eMAR and BICS take off screens. Pending a successful pilot, these changes will roll out to all units that use BICS OE on Aug. 11. The pilot and “go live” for Phase II, in which the lab order is automatically sent to the lab eliminating paper requisitions, is to be determined.
eMAR Changes: eMAR is coming to oncology! eMAR with chemotherapy will be piloted from July 7-21 on Tower 6D. A phased rollout of eMAR to all of the oncology pods will then begin Sept. 21, and it will be completed in the Tower by the end of November. Recently, other enhancements added to eMAR include alerts regarding the use of the “not given” option, improved rules for PRN medications and pop of physician instructions at administration.
Ceiling Lifts: a focus group was conducted with the committee on ceiling lifts. The group gave feedback on the positives (saves nurses from injury, helpful in getting patients out of bed, turning, etc.) as well as negatives (leaving pad under skin-potential for skin issues/no defined protocol, running out of slings, etc.) The group made recommendations such as using a different sling material that does not cause patients to slide and increasing the number of portable lifts for floors without ceiling lifts until they receive permanent ones.
Acute Care Documentation Project (ACD): the ACD project utilizing Metavision software is well underway. Two accelerated design sessions, utilizing ongoing nursing staff representation, have taken place reviewing the clinical content of the nursing flow sheet/nursing assessment form and validation of our current workflow analysis. This is in preparation as we move from paper documentation to electronic documentation. The Informatics group gave feedback on what notifications should show on the Metavision electronic flow sheet. (See story on page 13.)
If you have any questions/concerns regarding this committee or its projects, please contact co-chairs Heidi Smith Doucette, CNRN, or Carol Booth, MSN, RN.
Quality, Safety, and Care Improvement Committee
The Quality, Safety and Care Improvement Committee has focused on a number of quality and safety initiatives over the last few months. The committee’s hand hygiene campaign is spreading the word on the importance of hand hygiene through activities geared to raise awareness of staff and visitors. Environmental surveys, an informational table, recognition of nursing units with hand hygiene compliance rates of 90 percent or greater and promotional items with current unit hand hygiene compliance rates are some of the activities targeted to help reach the nursing department goal of hand hygiene rates of 90 percent. As the campaign moves forward, the committee hopes to include hand hygiene information on the BWH Web site for patient and family access in the patient safety folder.
The committee also served as a focus group to explore current shift-to-shift hand-off processes and to identify data elements that would be contained in a Web-based tool for nursing hand offs. This focus group work is part of a research project funded by the BW/F Healthcare Information Technology Innovation Program (HIP). The project is building on the shift-to-shift hand-off tool developed by Marc Boomhower, BSN, RN, staff nurse on Tower 16AB, and supported by Mary Anne Murphy Kenyon, RN, ONC, MPH, MS, nurse manager Tower 16AB. The Web-based prototype tool is being developed and will be trialed sometime this fall on Tower 16AB.
If you have questions, contact committee co-chairs Stephanie Capello, RN, and Mary Antonelli, MSN, RN.
Standards, Policy and Procedure
The guidelines for the use of palliative sedation in the non ICU setting have been updated. These guidelines feature the use of medications to induce sedation and to control severe distress in the imminently dying patient that have not been controlled despite aggressive measures. These means are for symptom management, not to hasten death. The patient must be suffering from a severe, unrecoverable illness at its fatal point and have orders for no form of resuscitation, including medications like vasopressors to support blood pressure. These orders have been known as CMO, (comfort measures only) but the more current term is “intensive comfort measures.” These measures include the use of the medications Midazolam and Pentobarbital, which are usually only seen in the ICUs but under these circumstances only can be utilized on patient care units after consulting with Pain & Palliative Care. You will find these guidelines under the “Guideline” section in the Nursing Clinical Practice Manual and under the DAG section (at the very bottom of the DAG list) on BWHPikeNotes.org. The appropriate policies will be hyperlinked to aid you in providing relief for your dying patient. Please review these guidelines and their location.
If you have questions, contact committee co-chairs Cindy Jodoin, MHA, BSN, RN, and Sharon Swan, BSN, RN, CCRN.
Nursing Practice Committee
The Nursing Practice Committee continues to focus on how the characteristics uncovered in the practice of excellent nurses at BWH appear at different stages of practice from beginner to expert. These characteristics (knowing the patient and family, making clinical judgments specific to the individual patient, caring practices, providing care in an individualized way and leading others to act on the patient’s behalf) show up in practice differently at each stage of development. How nurses develop these characteristics determines whether and how long it takes to go to the expert stage. The committee will advise on how to preserve and extend these characteristics in order to make excellent practice possible for all nurses and patients.
In addition, the committee was asked to advise on the Department of Nursing’s State of the Department address given in May, and the committee celebrated the selection of Sharon Levine, a committee member, as the 2009 Essence of Nursing recipient.
If you have any questions, contact committee co-chairs Mary Beth Mondello, CNRN, and Alice O’Brien, MS, RN.
Patient and Family Education Committee
The Patient and Family Education Committee continues to work to improve the accessibility and quality of educational resources available through the Patient and Family Education Web site on BWPikeNotes.org. Most recently added to the Web site was Krames on Demand. In order to access the Web site, you need only to go to the start button, then Partners Applications, Clinical References and then BWH Patient Education. On the Web site, you will see Krames on Demand. This is an excellent resource that houses hundreds of patient education teaching sheets that are available to all.
The BWH Patient and Family Education Web site also has available teaching sheets for “drains and tubes.” This is where you will find catheter care teaching sheets. We encourage all to view the site. It holds important teaching information for all areas.
The Care Channel is also now available to all patients via the TV set to provide comfort and relaxation to the patients and family. It is on Channel 11.
If you have any questions, contact committee co-chairs Cindy Loring, RNC, CNS, and Deb Moody, BSN, RN.