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Staff Meeting. Welcome!. Wins. *Thomas was the aide that night. An amazing nurse/aide. Wonderful personality. *Cara was outstanding!!. Discharge Info. Transport vitals.
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Staff Meeting Welcome!
Wins • *Thomas was the aide that night. An amazing nurse/aide. Wonderful personality. • *Cara was outstanding!!
Transport vitals • (A set of vital signs need to be taken and documented either on paper documentation or in powerchart within in 15 minutes of patient leaving for transport to anywhere.) • Post op vitals April- 83% May- 89% I know a lot of work is going on with these. With the things they have in place I expect to see them increase over the next two weeks. We will keep our eye on it and if there are concerns we will discuss with Margaret immediately. WE will need a 93% for the next two months to meet the 90% requirement. ( This is still in process. There is discussion on any leeway time on timeframe for q 15min. and q 1hr vital sign, i.e.- 5 minute leeway either way on q 15min. vital signs and 15 minutes on q 1hr vital signs. We will keep you updated with any decision.)
Upcoming Evaluations:Just a heads up • June evals • New Evaluation rating system: 1, 2, 3, 4 • Emphasis on meeting department goals • More to come later
You are KEY to Procedure Charges • Help capture Lost Revenue: • Key examples of procedure that can and should be billable: • $$ Fluid resuscitation • $$ Recovery from moderate sedation (IR patients) • $$ Insertion of NG and DHT tubes • These charges are all captured through Summary of Clinical Course: • Explanation of charges ( why documentation is so important!): • **Fluid Resuscitation: $488 (Q day) • **DHT or NG tube placement: $ 115 • **Bladder irrigation/lavage, simple (Q day): $110 • Chemo Admin-IV push: $95.50 • Chemo Admin-up to 1 hr: $163.90 REMEMBER ! • Chemo-Admin- esaddl hr: $66.00 *Document, document!, document! • Near Code Stabilization (1-2 hours): $372 Charge will post when document is SIGNED
Fluid resuscitation:Charge Criteria • Any patient requiring fluid resuscitation or replacement at a rate greater than or equal to 250 ml/hour or rapid infusion over 2 hours or less of 1Litre of fluid (including albumin)as evidenced by at least one of the following: • A decrease in urine output • A decrease from baseline in blood pressure • An increase from baseline in heart rate • Decreased CVP • Increased output (gastric (emesis, diarrhea, gastric tube) urine, blood, drains) • Positive blood cultures with/without fever
Documentation to support reason for fluid replacement charge • Q1 hour urine output • Q1 hour vital signs (BP, temp, O2 sats, HR) • Q2 hour IV site assessments
Powerchart Enhancements:Mostly affects RN’s • Go live July 30th • Mandatory training via Educat available June 27th. MUST be completed by July 30th (access denied after this date!!) • Classroom training on request • We will have Superusers Feature sneak preview: • Enhanced view (like I view)-easier to navigate • Message center to contact providers • I & O second generation • Medication hx
Body Substance Precaution Patients • Reminder to wipe down the Dynamaps etc. with Clorox wipes when in these rooms or when leaving a c.diff room or patient with other body substance precautions
Falls Agreement: Go Live May 31 • Go Live
Falls Agreement • Stresses patient & family involvement- Partnering with us to keep patients safe • Steps: • Current policy still intact with yellow door signs and safety briefings • Hourly rounding while awake, offer 3 P’s but also use language like: • “I’m here to help you to the restroom. I’d like you to try to go so we can keep you safe by avoiding the need to RUSH to the restroom. Waiting until you have to go urgently can lead to falls.” • Patients are not to be left alone in the bathroom without someone being nearby. Safety trumps privacy- you must use a measure of judgment. • Signage in room with clip to hang the patient agreement on once it’s signed. • Signage in bathrooms where indicated. • Patient falls prevention agreement. Go over this with the patient and family. Do not just give to the patient to read it. This can be done at the same time as the speak up materials are done. Have the patient or family sign the form, (explain it’s not a legal document nor in their medical record but done to keep them safe). Place agreement on the clip by the room poster or somewhere the patient can see it. • Any fall requires a PSN report and your recommendations for preventing this patient from falling again need to go on there and to the next shift and beyond. Please call Risk Management if there is ever a fall with injury. Their phone number is on the last page of the PSN. • Be aware falls tend to happen at hand-off times, new arrivals (before you really know a patient such as before the admission assessment is done), discharge day (don’t relax your vigilance on that day) and if call lights are not answered promptly. Answer all lights, not just your own patients.
Blood Draws • Turn off fluids • Lab getting too many unusable samples
HCH duties • Remember to wipe down Dynamaps with Clorox wipes on c.diff patients
JP Drains • Please be sure to strip JP drains, EVEN if there is no volume to empty
Jacho Pain Audit Issues • SCU: need a PAIN champion • Quality Improvement Project has just begun to look at a pain assessment tool to use in ICU cluster What tool to use? 3 month turnaround to ID a new tool. Sue Childress emailed today @ Sloan Kettering to ID their tool, if possible
