Week End Wrap Up

1
Week End Wrap Up

• March 8, 2010

2
Time Change This Weekend

• Clocks "spring" forward one hour, tonight,
  Sunday, March 14, 2010, at 0200
• UWMC Payroll policy states (located in UWMC
  Payroll/Personnel Policies, --credited hours when
  semi-annual time change occurs)
• Standard time changes to daylight savings time
  (Spring) are credited with normal shift hours
• no overtime paid until actual work hours exceed
  original scheduled shift length of 8 or more
  hours
• for example, employee scheduled to work 2300 to
  0730 not eligible to receive overtime pay until
  at least 0900, then would qualify for .50 OT
• Mirtha T. Johnson, CPP
• Director Payroll Services, UW Medicine
  Health System

3
Pain Reassessment

• Pain Audits resumed
• Expectation to reassess after narcotic
  administration within 60 minutes
• Hospital expectation that this occurs 85 of time
• At this moment in March we reassess 80
• Most frequent lapses night shift and shift
  change
• Please remember to provide recent narcotic
  administration in shift report so appropriate
  follow up can occur
• Professional nursing practice ensures that pain
  reassessment occurs within 60 minutes of narcotic
  administration

4
CT SCAN

• CT Scan requires patient have 20 Gauge or larger
  IV catheter at antecubital space (or higher)
• Address IV access issues prior to administering
  contrast fluid
• Situation
• recent patient scheduled for CT Scan (non urgent)
• Given contrast fluid to drink
• Clock startsmust have scan within 5 hours of
  contrast
• IV access 22 gauge at level of wrist
• CT calls and asks about IV in the next hour
• Patient difficult IV access
• Required 12 sticks IJ finally inserted to get
  patient to CT before time lapse relative to
  drinking contrast
• Ensure/Plan acceptable IV status for CT

5
PCT Phones

• 2 new phones for HA/PCTs on 5 South
• Please make a note of
• 8-8503
• 8-8504

6
Sodium Bicarbonate 50mEq

• Manufacturer backorder on Sodium bicarbonate
  50mEq emergency syringes
• Pharmacy stock very low, however have 50mEq vials
• Remaining emergency syringe stock being saved for
  placement in code carts
• Pyxis machines will be stocked with kit
  containing
• 1 sodium bicarbonate 50mEq vial
• 1 60mL syringe
• 1 vented spike/vented clave device
• Shortage should be resolved by the end of the
  month
• Will keep you apprised of any updates
• Please contact me if you have questions
• Thank you, Deborah A. Frieze, PharmD, BCOP

7
NST

• NST's missing random pieces of information such
  as
• EDD, vital signs, gestational age, times of NST,
  RN resident signatures and resident signature
• If paperwork is not complete cannot bill for NST
• R2 or chief needs to sign off on each NST before
  patient is discharged and then NST is placed in
  box for attending signaturepatient safety issue
  that assures residents aware of pts status
• Dr. Cheng will speak with residents to ensure
  they do their part
• For 5 missing info there were 20 that were
  complete
• Thank you thank you thank you for all that you do
  to take good care of our patientsAna

8
Verbal Orders

• Audits finding quite a few orders unsigned and no
  stickers on unsigned orders
• Please remind your staff including PSS staff to
  place stickers on unsigned verbal orders
• Tom Staiger sent following to residents about
  verbal orders
•  Colleagues
• Historically there has not been mandate at UWMC
  requiring authentication of verbal orders, have
  been considered authenticated unless contramanded
• However, both The Joint Commission and Centers
  for Medicare Medicaid Services (CMS) have
  deemed that current practice needs to change such
  that all verbal ordersmust now be authenticated
  within 48 hours

9
Verbal Orders

• Accordingly, every service has been asked to
  formulate a plan to ensureverbal orders
  (including telephone orders) are authenticated
  within 48hours. 
• Answers to some frequently asked questions
  regarding this process
• 1) Is it legal and appropriate to sign
  verbal/telephone order placed by someone else on
  service? A) Yes, at present.  In 21012 rules
  will change to require verbal orders to be signed
  by originating physician/practitioner.
• 2) Is person signing VO considered legally /
  medically liable for that order?A)Depends on
  whether order has been carried out by time it is
  signed.  In most cases order will have been
  carried out by time it is co-signed.  Liability
  would typically belong to person who gaveorder.

10
Verbal Orders

• 3) It may be someone else on the team signing the
  order who doesn't understand justification or
  know if verbal order was written correctly
• A) Once  order carried out, standard of care
  violation (if any) already has occurred.  Only
  way an authentication signer could incur
  additional liability would be if reason to
  question order with respect to patient's ongoing
  care needs.  Example--order was carried out but
  med ordered/dose, etc. possibly not right. 
  Authentication signer expected to follow up on
  whether an error was made and if so, whether we
  need to do anything else for pt.  Would be
  expected to get enough information to either be
  comfortable signing order or moving on to "error"
  scenario below
• 4) What if order was actually written
  incorrectly? Does someone still sign it? Call
  risk management?A) Any time, concern about an
  error, appropriate clinical actions need to be
  taken and documented.  Order still signed with
  notation, e.g., to "see ORCA note" or "see new
  orders and ORCA note."  A PSN (Patient Safety
  Net) report should be entered and the attending
  notified.  If patient harm, call Risk Management.
• Thank you for assisting with new process and for
  all you do for our patients. If you have further
  questions, please contact me.  Best, Tom

11
Infant Security Alert

• FOR INTERNAL USE AND DISPLAY ONLY
• DO NOT DISPLAY IN PUBLIC AREAS
• LOCATION Tacoma General Hospital, Mother Baby
  Unit,
• In mid February, 2010, call received in Mother
  Baby Unit, Tacoma General Hospital, from woman
  asking about having car seat inspected because
  she was getting a baby soon. Woman referred to
  Mary Bridge Child Safety became angry when
  request to come to unit to have it checked was
  denied. Conversation lasted about 20 minutes but
  not reported further.

12
Infant Security

• On Sunday, March 7, 2010, at 1830 hours,
  unkempt woman described as
• Caucasian.25-35 years of
  age.approximately 54.slight buildlong dirty
  blond hair swept up in a pony tailcarrying a
  filthy car seat visited department and asked
  that her car seat be checked as she was getting
  a baby soon. Woman mentioned something about a
  16 year old who she knew was expecting a baby
  soon. Woman referred to Mary Bridge Childrens
  Hospital again. Reported to have left department
  slowly looking into rooms as she exited.
• Concerns about behavior of individual stem from
  her not stating she was adopting a baby, but
  getting a baby, she insisted on coming to unit,
  and suspicious behavior while on phone and during
  her visit
• As further information/description available,
  ALERT NOTICES will be forwarded
• If suspect seen on campus, notify Security
  immediately
• Good reminder to remain alert and if inquiries
  into newborns seems slightly off, report it
• Good opportunity to review Amber Alert as well
  (infant security)

13
Sound Transit Husky Stadium Construction
Alert 

• For additional information on Sound Transit Husky
  Stadium construction project, including project
  overview, impacts and special alerts click on
  link below or copy to your internet
  browser http//f2.washington.edu/cpo/projects/sou
  nd-transit  
• Sidewalk Construction along Montlake Boulevard
• Construction at UW light rail station is underway
  and during March 2010 there will be several
  construction activities along Montlake Blvd,
  adjacent to Husky Stadium   1) Drilling to
  install geotechnical monitoring devices in
  sidewalk on east side of Montlake Blvd. between
  NE Pacific Street and NE Pacific Place. Will
  reduce width of sidewalk to 5 feet for
  pedestrians/bicyclists

14
Sound Transit Husky Stadium Construction
Alert

• 2) Contractor will demolish pedestrian island at
  NE Pacific Street crosswalk, install left-hand
  turn traffic signal southbound on Montlake Blvd,
  and re-stripe crosswalk.  Signal work will
  involve closing multiple lanes of traffic on
  Montlake Blvd near intersection of NE Pacific
  Street.  To minimize traffic disruption, some of
  work will take place at night (between 8 p.m. and
  7 a.m.).  Work scheduled to begin on March 10,
  2010. 3) Final surfacing for driveway
  entrance/exit at NE Pacific Street to Husky
  Stadium will take place in March.  To complete
  this work, will close lane of northbound traffic
  to create temporary sidewalk using concrete
  barriers to separate pedestrians and bicyclists
  from automobile traffic.  Work scheduled to begin
  on March 8, 2010. All above work is happening
  simultaneously with other work to widen sidewalk
  and create a safer environment for bicyclists and
  pedestrians.  Bicyclist can avoid congested
  construction area by using sidewalk on west side
  of Montlake Blvd. Thank you for sharing this
  information with your staff. Larry Kalahiki,
  MBA/HRMManager of Program Operations