Nursing Committee Updates
Quality, Safety and Care Improvement Committee Update
We recently welcomed new members Nancy Foley-Barry, RN, nursing director for Surgical Specialties; Kim Smelstor, RN, nursing director of Ambulatory OB/GYN and program director of Ambulatory Nursing Quality and Safety; Linda Kraiger, RN, Float Pool nurse educator; and Jan Hogan, RN, Care Coordination.
The committee has discussed various types of IV poles that are available throughout the institution. Some have been identified as more effective with Alaris pumps than others. When Alaris pumps were first purchased, IV poles were replaced with white wide-based poles, and all other poles were to be removed from the bedside. However, currently, there is no central supply or tracking system for IV poles. If a nonfunctioning IV pole is identified on a unit, please call Central Transport for removal.
The committee has discussed planning a visit to the Institute for Healthcare Improvement (IHI) in Cambridge to learn and observe how to operationalize a brainstorming session in the committee work.
The QSCI committee meets the second Tuesday of every month. If you have any issues or concerns, contact co-chairs Stephanie Capello, RN, or Martha Doherty, RN.
Nursing Practice Committee
Advancing knowledge of the stages of practice development throughout the organization is a goal of the Practice Committee, with committee members acting as resources in this endeavor.
Patricia Hooper Kyriakidis, PhD, RN, consultant to the committee, is preparing members for this role. Using narratives, she is presenting the stages of practice development from advanced beginner to expert and how skills appear at the different stages. This material is being presented over several meetings to orient new members and build on the knowledge of the entire committee. Working in small groups, members have the opportunity to use this knowledge by listening to narratives and practicing by identifying the various skills and distinguishing the stages.
The committee has identified unit-based practice committee/councils that are in place on many units. Unit-based practice councils are configured in a variety of ways and tend to focus on best practices, new initiatives, policy and procedure reviews. Establishing a connection between unit-based committees/councils and creating opportunities for two-way communication between the unit-based councils and this committee has been a topic of discussion. Our goal is to offer recommendations on how this can best occur.
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 provided feedback to medicine and nursing regarding the PAML. The committee discussed various ways for nurses to notify physicians, including editing and paging options, and suggested doing a small pilot if possible.
The topic of pharmaceutical waste was visited several times by the committee, which includes the introduction of new “waste buckets” to properly dispose of medicines. Disposal of drugs has become a highly regulated area. Various options to make it easier for the nurse to identify the proper waste buckets, including eMAR icons, an Omnicell message and posters, have been utilized in a pilot study in progress on Tower 15CD, CWN-8 and Shapiro 9 and 10.
There will be a new icon in eMAR for transdermal medications. Now, eMAR will allow duration times, identify site of application and prompt removal time. Users will also be able to document early removal (for a test, fallen off), but will be required to obtain an order for a new patch.
The committee continues to provide feedback on a monthly basis on eMAR Picker and Discharge Module. Printing a draft copy, providing times of last dose meds, and new sections being added are some of the ongoing refinements under discussion.
The committee has received a brief demonstration of the Windows 7 operating system and has discussed most appropriate ways to notify and educate staff. Feedback was given after viewing a demonstration of the new online vacation request process.
Committee co-chairs Heidi Smith-Doucette, RN, and Gary Zina, RN, are available to answer questions.
Patient and Family Education Update
The Patient and Family Education Committee met with Eileen Molina, MS, RN, nursing director of Tower 5AB, to discuss her work with the Palliative Care Innovation Unit. She presented the extensive work that was done and reviewed the Palliative Care Resource guide that was compiled. Many of these same documents and resources can be found on the Patient Education Website under the Palliative Care button. The Patient Education Committee has continued to review and add many important Palliative Care Resources to the website, making them easily accessible to all nurses. Please visit the website and review what is now available to you at the click of a button.
If you have suggestions for our website, please contact co-chairs Katie Fillipon, RN, or Deb Moody, RN.
Standards, Policies and Procedures Committee
The Standards, Policies and Procedures Committee, composed of nurses in a variety of roles throughout BWH, meets monthly to review and update current nursing policies. Sometimes there are minor updates to the policies, and at other times the changes are more extensive. Significant changes in these policies are communicated to nursing staff with the “New to You” email.
The following policies and forms were reviewed and updated by this committee.
The Lab Reference Sheet was reviewed over several months to ensure that the information was accurate to current practice, and that nursing staff have access to the correct version of the form. The lab reference sheet, which is ordered through Standard Register, will be updated on a regular basis to reflect changes in normal lab values. Unit coordinators on the patient care units will place a copy of the Lab Reference Sheet in every medical record.
The new Consent for Procedure form went into effect May 1, 2012. Changes include consent for blood transfusion during the patient’s entire hospitalization. An important change includes a “patient refusal for blood” section on this form that should be checked prior to administering blood.
Point of Care (POC) testing was reviewed to ensure regulatory compliance. Of note, the employee performing the POC and writing the information on the flow sheet MUST initial next to the result and initial/sign at the bottom of the flow sheet. It is not necessary, however, to write the source of bedside blood glucose (arterial, venous or finger stick).
In reviewing Med-23 Medication Administration via Small-Bore Feeding Tube, a discussion developed around medication crushing devices. Most units have devices that utilized individual small plastic bags to crush the medications. Infection Control wants to ensure that we no longer utilize mortar and pestles due to the risk of both bacterial and chemical contamination.
If you have questions, comments or concerns, please email co-chairs Cindy Jodoin, RN, and Diane Miller, RN.
Quadramed Corner
by Sharon Donnelly, MBA, RN, Dorothy Bradley, MSN, RN, and Brian Laneau, RN
Did you know there are four ways to capture the overall nursing workload of your unit in Quadramed? They are Classification, ADT workload (admissions, discharges and transfers), Other workload, and 1+ hour events/procedures.
Classification compliance is at 98 percent for the hospital year to date. Keep up the good work, and let’s continue to strive for 100% of all patients classified every day!
ADT workload is captured every time a patient is confirmed in or out of your unit through BICS. Your unit is assigned 90 minutes of workload for each of these events.
Other Workload is incurred when a staff member who is assigned patients is called to care for or assist with care for a patient not on the unit the staff member is working on. Some examples of this include when a nurse travels from CWN to the Tower to assess a patient, when a burn nurse consults on a wound patient on another unit, or when a chemo nurse travels to another unit to assist with chemo orders. If these or similar activities occur on your unit, please contact your nursing director to review your unit’s process for capturing this information in Quadramed.
1+ hour events/procedures are intended to capture the increase in the overall workload of a unit when a member of the nursing staff is consumed with care for one patient for one consecutive hour or longer and unable to address his or her other patients’ care needs, thus creating additional workload for the other staff members.
Every 1+hour event/procedure that is documented in Quadramed is reviewed on a weekly basis. Those that do not meet the guidelines (at right) or for which additional information is required to ensure reliability, are sent to unit leadership for follow up.
Thank you to everyone for your continued hard work to ensure that we are able to accurately capture our patients nursing care needs.
Guidelines Include:
- The caregiver must have an assignment of two or more patients unless an additional nurse or PCA is required to care for a single patient assignment
- Events/procedures must last one hour or longer consecutively
- Documentation of events/procedures in Quadramed should occur retrospectively and should include accurate start and end dates and times as well as supporting documentation on the flow sheet or in the synthesis note
- Events/procedures cannot overlap (a nurse or PCA cannot perform two or more procedures during the same time period)
- The only event/procedure that nurses are not responsible for entering in Quadramed is 1:1 safety observation by non-RN, as this is entered by the Operations Supervisor from the information provided on the unit assignment sheet