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Week End Wrap Up


Week End Wrap Up March 8, 2010 – PowerPoint PPT presentation

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Title: Week End Wrap Up

Week End Wrap Up
  • March 8, 2010

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
  • 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

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
  • 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

  • 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
  • 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

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

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
  • 1 sodium bicarbonate 50mEq vial
  • 1 60mL syringe
  • 1 vented spike/vented clave device
  • Shortage should be resolved by the end of the
  • Will keep you apprised of any updates
  • Please contact me if you have questions
  • Thank you, Deborah A. Frieze, PharmD, BCOP

  • NST's missing random pieces of information such
  • 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
  • Thank you thank you thank you for all that you do
    to take good care of our patientsAna

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

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.

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

Infant Security Alert
  • LOCATION Tacoma General Hospital, Mother Baby
  • 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.

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
  • 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)

Sound Transit Husky Stadium Construction
  • 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
  • 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

Sound Transit Husky Stadium Construction
  • 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
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