Adult ED Staff Meeting

1. Adult ED Staff Meeting December 16, 2010

2. Quality Data-Jackie Ashburn December 16, 2010

3. Antibiotic Stop Times • First IV antibiotic per patient. • Documentation in Nursing assessment or Order Tracker • Lost of $128.00 per medication/ Drips.

4. Urine Contamination Up is Good Goal is 85% Remember: Give wipes Instructions are key Never assume they know ( including men) Instruct to collect mid stream. Don’ts: Use bedpans or urinals ( They are not sterile Never use a sample that is greater than 30 minutes old

5. Blood Cultures Sterile procedure Can not draw from IV lines Unless MD order to indentify line infection Remember to scrub site and do not touch after. Any difficulty document

6. October 2010 November 2010 Hand Washing Audits

7. Hand washing AuditsDecember 2010

8. EDIS-Elizabeth Banks December 16, 2010

9. VPH to Inpatient Transfer Process • VPH patient to ED for treatment visit • Patient remains a VPH patient in Medipac (admission, discharge, transfer system) • This is for insurance purposes • If VPH patient admitted to VUH • Patient must be discharged from VPH • Readmitted to VUH in obs or inpatient status • New case number is generated for patient • Process in place to replay as many orders as possible

10. VPH to Inpatient Transfer Process • Admitting Liaison starts process by notifying ED charge nurse with this page: “Bed name (MRN): Please notify Primary Nurse to play back order for VPH patient after Admitting Liaison completes the discharge process.” • Admitting Liaison will archive orders in HEO/WIZ. • Once process is completed, Admitting Liaison will notify Charge Nurse that HEO/WIZ orders can be played back

11. VPH to Inpatient Transfer Process: • All documentation in Order Tracker should be completed prior to the transfer process • When patient is discharged from VPH, all orders that appear in Order Tracker for that VPH case number will no longer be present in Order Tracker • Orders can be viewed in StarPanel under ED Orders (this shows which orders completed, not completed)

12. VPH to Inpatient Transfer Process: Key Features • All archived orders that are re-played will come across to Order Tracker as new orders • One time Stat orders will not archive and playback because these orders are considered as past orders • If the One time order is not yet completed, re-enter order in HEO/WIZ so that you can document the order as “done” in Order Tracker

13. Magnet-Dawn Hawley December 16, 2010

14. YOU ARE MAGNET• Evidence Based Practice• Team Support and Leadership• Encouragement and Education• Community Involvement• Commitment to Professionalism

15. ANCC – New Magnet VisionTo be the fount of knowledge andexpertise of nursing careglobally. Will be solidlygrounded in core magnetprinciples, flexible, andconstantly striving for discoveryand innovation. Lead thereformation of healthcare, thediscipline of nursing and care ofthe patient, family andcommunity.

16. Ye Olde Magnet Faire

17. Timeline

18. 5 Magnet Model Essential Elements1. Transformational Leadership2. Structural Empowerment3. Exemplary ProfessionalNursing Practice4. New Knowledge, Innovations& Improvements5. Empirical Quality Results

19. Transformational Leadership • Identification of/understanding of nursing leader roles • Nursing Strategic and Quality Initiatives • How do you as a leader gain/use staff input for decisions & examples? • How do you as a leader value, encourage, recognize/reward & implement staff ideas (innovation) * Key – Staff as Transformational Leaders

20. Structural Empowerment VUMC Nursing Shared Governance Model

21. Structural Empowerment How does SG work in your area & EXAMPLES • Structures that support: • Professional Engagement • Professional Development • Community Involvement • Recognition of Nursing

22. The Vanderbilt Reputation• Ranked in Top 10 in 2009 US News &World Report in 3 Specialty Areas• Ranked in Top 25 in ALL Pediatric SpecialtyAreas (US News & World Report, 2009)• One of “Fortunes” Best Companies to WorkFor (Fortune, 2009)• Of 371 Magnet Status Organizations,Vanderbilt is one of only two in TN (ANCC,2010)

23. Exemplary Professional PracticeVanderbilt Nursing Professional Practice Model

24. Exemplary Professional Practice • How is the PPM implemented in your area? • Staff Satisfaction Data • How do you deliver care? • Staffing, Scheduling & Budgeting • Interdisciplinary Collaboration

25. Exemplary Professional Practice-continued • Performance Evaluations/Peer Reviews/Goals • Ethics, Privacy & Confidentiality • Diversity & Workplace Advocacy

26. Exemplary Professional Practice-continued Culture of Safety (Proactive – Improve - Outcomes) • Staff and Patients • Nursing Sensitive Quality Indicators • Total falls vs falls with injuries • Pressure Ulcers • Restraints • All infections • Peds IV infiltrations • Handwashing • Medication Reconciliation • Others

27. Exemplary Professional Practice-continued Quality Monitoring and Improvement (Outcomes, Outcomes, Outcomes) • Patient Satisfaction • How nurses coordinate care

28. New Knowledge, Innovations and Improvements • Research • Evidence-Based Practice • Innovation

29. Magnet ChampionsAdult Emergency Department:Hawley, Dawn Bransford, Bill Knipp, Kory Hamilton, Mary Brusch, Joan Vanderveldt, Gina Grubbs, Ali Brumley, Laren Sims, Matt Locklayer, Anthony Kossler, Rebecca Beckstead, Chris Wilson, Cathy

30. Vanderbilt Nurses are the Elite• In 2009, 19,545applications werereceived.• 1350 people werehired.

33. PRC-Marsha Price December 16, 2010

34. 14 - Now I would like to ask you some questions about the DOCTOR or DOCTORS who treated (you/your family member) in the emergency room. Overall, would you rate the quality of doctor care as:

35. 19 - Would you rate the overall teamwork between the doctors, nurses, and staff as:

36. 27 - Would you say the likelihood of your recommending [+hospname+] to friends and relatives for emergency services is:

37. 29 - (30525402) Overall, would you rate the quality of care provided as:

38. Stroke Update-Ali Grubbs December 16, 2010

39. IV tPA: High Alert Medication • IV tPA is now a high-alert medication at VUMC which means that staff should follow safety strategies and defined procedures during all steps in the medication use process in order to minimize risk. • Being a High Alert medication means that IV tPA bears a heightened risk of causing significant patient harm when used in error. **Review the Policy: High Alert and Look-Alike Sound-Alike Medications CL 30-06.26 https://mcapps.mc.vanderbilt.edu/E-Manual/Hpolicy.nsf/AllDocs/DA7AB99D84815A4C862577AF00747227

40. IV tPA: High Alert Medication • Administration of IV tPA as a high alert drug involves: • Primary nurse verifies drug indication corresponds to patient diagnosis and appropriate monitoring has been reviewed • Two licensed staff will verify the following prior to administration of IV tPA: • Drug and dose based on patient weight • Amount of waste • Amount of bolus to be administered over one minute

41. IV tPA: High Alert Medication • Amount of IV infusion via infusion pump to be administered over one hour • Primary nurse will verify waste amount withdrawn from vial followed by bolus dose withdrawn from vial followed by infusion dose administered via infusion pump • Primary nurse will document waste amount and name of second licensed staff member who witnessed waste, bolus dose amount and time administered and infusion dose amount and time initiated in EMR. 

42. TWiG Working Group-Kevin High December 16, 2010

43. TWiG Working Group

44. Requirements • Must be off orientation and actively assigned to trauma (may be staff, charge nurse or paramedic) • Willing and able to participate in this process; answer email/inquiries promptly • Attend meetings set up by the group (on/off campus)

45. Projects • Develop Room Checklist/Standards • Outline Orientation Contents • Standardize Practice within Bay • Outline Core Requisites to work in Bay

46. Domestic Violence

47. Know the Facts • Domestic Violence is any pattern of behaviors that attempts to control an intimate partner or family member by the use of fear, manipulation, isolation, intimidation, physical, sexual, and/or verbal abuse. • Tennessee consistently remains in the top 10 states for domestic violence related homicides. Currently, we are number 5. • One in four women will experience some form of abuse in her life. • In America, every day three women are murdered by the man who says he loves her (American Bar Association Commission onDomestic Violence). • The sole purpose of domestic violence is power and control. • Typically, this control starts out slowly, and increases over time.

48. Weaver Domestic Violence Center • Weaver Center is the largest domestic violence shelter in Tennessee. • We provided 15,753 bednights of shelter last year to 233 women and 187 children fleeing domestic violence. • Staff answered 3,791 calls on our 24-hour crisis line.

49. How can you help? • Call the YWCA Crisis and Information line at 242.1199 or 1.800.334.4628. • The Crisis and Information Line is available for anyone whether they are in immediate crisis or seeking to offer assistance or support to someone who is in danger. • Call the YWCA crisis line to get support on how to talk to a friend or family member regarding safety planning.

50. Susan French Director of Outreach Services 983.5150 Susan.french@ywcanashville.com