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

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RE: Learning Opportunities #4, revised
Looks great to meJ

Kyle Rose Hammond, RN, BSN, OCN
Clinical Nurse Educator
Bone Marrow Transplant and Oncology Units
Kyle.Hammond@UCHealth.org
720-848-0422

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From: Davis, Aurora
Sent: Tuesday, June 10, 2014 3:22 PM
To: Wenger, Barbara; Buffington, Annsley J; Hammond, Kyle R
Subject: Learning Opportunities #4, revised

Ladies, here's the revised version per your comments. Good to go?


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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. Patients on telemetry should now have their white lead
stickers changed every 24 hours. This is definitely something you can delegate, though. The house wide
Hammond, Kyle R
Thu 6/12/2014 3:40 PM
To:Davis, Aurora <Aurora.Davis@uchealth.org>; Wenger, Barbara <Barbara.Wenger@uchealth.org>; Buffington, Annsley J
<Annsley.Buffington@uchealth.org>;
7/26/2014 RE: Learning Opportunities #4, revised - Davis, Aurora
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standard is that they will be changed on night shift. However, after a shower is an excellent time to do this
and is certainly appropriate; just make sure that the next shift is aware it's been done. CNAs/ACPs were
educated on this, but we've had a large new crop that might not be aware of it, so it should be discussed
when you check in with your CNAs/ACPs at the start of shift.

2) 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.)

3) 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.

4) 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.

4A) 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!

4B) 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.

5) 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
7/26/2014 RE: Learning Opportunities #4, revised - Davis, Aurora
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buttons, open doors, etc. When transporting a patient on precautions, place a clean sheet over the top of
them.

6) 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.

7) 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 doesnot 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.

8) 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