Week End Wrap Up June 7 2010 Week

Week End Wrap Up June 7, 2010 Week End Wrap Up

Staff Meetings l Staff Meetings held on 6/1 & 6/7 l Presentations and minutes updated and in staff meeting notebooks on each unit l If unable to attend meetings, please review information l Presentations can also be accessed from email accompanying this wrap up

June Practice Changes l New 0/30/60 nursing responsibilities for timely transfer to OR l l New C/S orders l l l l All IV pumps and epidural pump d/c'd before patient leaves LDR; red caps (found in plastic cylinder with blue dots) EFM - unplug and move with patient specifics for when patient gets back to OR for "0" and "30" sections noted on powerpoint slides (posted on unit, Staff Meeting Minutes for June 2010, and in body of this weekend wrap up email) Orders in Chief resident's drawer & used for all C/S patients Pilot for 30 days—will reevaluate and modify as needed SCD's applied and IN USE during C/S (on "30" and "60" procedures) SCD pumps in each OR under table Using "knee length" NOT "thigh length" sleeves Medium and Large in stock (not sure par stock level yet so let me know if trouble getting sleeves or pumps) No need for TED hose with any SCD use Thanks much for taking time to review and comment! —Kathy

34 to 34. 6 wk late preterm newborn l l l 34 to 34. 6 week newborns need to transfer to the PCN within 30 -60 minutes after birth These infants require close observation due to increased risk of respiratory, thermo and nutritional instability Babies 35 to 37 weeks may stay with Mom in L&D if RN remains in room until Mom's transfer RN may transfer 35 -37 week infant to PCN before Mom's transfer if she feels it's necessary. When PCN closed, charge RNs trouble shoot newborn placement—NICU, PCN RN able to be in room, open PCN, etc Questions, let us know

Weekly Pain Reassessment Audits l May 17 l l l May 31 l l l 105 doses narcotic/88 xs reassessed w/i 1 hr 84% June 7 l l l 35 doses narcotic/33 xs reassessed w/i 1 hr 94% 55 doses narcotic/42 xs reassessed w/i 1 hr 76% Wrong direction—pain reassessments are done within 1 hour of narcotic administration

Pain Reassessment Audits (cont. ) ¡ Best Practice post narcotic administration assessment/documentation of patient response within 60 minutes ¡ Documentation of reassessment noted in new column on flowsheet (separate from documentation at time of administration ¡ UWMC minimum standard for pain reassessment — 90 % ¡ Best MIC compliance fiscal year 2010— 82% ¡ Problem times: night shift & shift changes

ORCA News l ORCA Implementation October 19 l ORCA Training August 16 -September 30 l l Have you had your computer assessment? l l If not check in with your RN 3 and/or any manager When opening patient list in ORCA—should have 5 S, 6 El and Nbn; if anything else, let your ORCA team know: l l Staff prescheduled Make every effort to make scheduled day work If not to attend on given date, notify scheduling team User Name" (first thing you type in top box; e. g. , "gwall") Address of computer being used (lower right corner on blue screen look for # like "128. 95. 136. 15") Will help sort whether an ongoing problem with computer's location or a user-specific problem Thanks—ORCA design team, Natalie and Terri

Patient Safety l Situation: l l Patient ordered medication Medication similar in name and action, written on MAR Medication administered to patient before error recognized Situation: l l l Patient ordered drug at 50 mg dosage Patient received drug x 2 days On 3 rd day, RN stated name and dosage of drug at time of administration, patient stated takes 25 mg not 50 mg l Assessment: medication errors l Plan: Verify names and dosage of medications with orders and patient before administration

Referral Process Changes l Improved referral intake process l Team created streamlined process which reduces number of activities for each role, eliminates rework, and improves communication among team, and with referring providers—wow! l CHARGE NURSE ROLE IN REFERRAL PROCESS l Twice/day TEAM STEPPS – Identify L&D status by assigning color l Charge RN responsible for keeping color code tool up to date

Referral Process Changes (cont. ) l GREEN – Attending will accept all referrals l YELLOW – Attending needs to call/talk with Charge RN before accepting referrals; Action: Chief & Charge RN trouble shoot patient flow issues with goal of returning to GREEN l RED – Attending comes to L&D and runs board with Chief, Charge RN; contact Nurse Manager or Flow Supervisor prn l BLACK – No referrals can be accepted; assemble management team Gigi or Debi, Karen Odle (Director of Perinatal Services), Flow Supervisor and Medical Director (if needed)

Referral Process Changes (cont. ) l Charge RN responsible for alerting Attending and Chief of changes in unit status by sending text message – only text color (your phone # is on their card) l Goal is try to be GREEN all the time l Attending will accept all transfers if Green was status indicated at TEAM STEPPS unless Charge RN texted change l Attending will call Charge RN to notify transfer is coming and ETA l Charge RN responsible for texting Chief Resident and Generalist of new transfer (no longer responsibility of Attending to notify Chief) Include in text: G/P, GA, diagnosis and ETA

Referral Process Changes (cont. ) l Circulating RN in OR monitoring Med-Con pager in OR; she will call Med-Con to alert that Attending can call after C-Section; if call an emergency, will transfer to Charge RN to take info l Referring Provider transferred to front desk person (PSS/Float/RN/Tech) after Attending accepts patient l Front desk now collects info on referral patient

OB Flex Room Moved LR, L&D med kits and suture from overcounter cabinet into top (locked) drawer of admit/delivery cart l Non-sharps from drawer moved to lower drawers l Plan to remove hasp and lock when able and correctly label drawers l Environmental Services cleans clear surfaces —refrain from storage on counter tops l

L&D Supply Changes l Pacifiers will be removed from bins l Will be adding curved syringes and 10 ml oral syringes l Will have par level of 2 breast pumps the pump room

Foley Catheters l Continue to find latex catheters on unit l Place ONLY latex free (silicone) foley catheter l Remove any latex catheters (if they sneak in), from rooms, OR, etc and give to OB tech to return to Materials Management l In ORs silicone catheters in costructs l Thank you for your help in this matter!

SCDs l "SCDs" now used in ORs are reprocessed l Reprocessed means that they are returned to MM and go through a process to clean (similar to BP Cuffs) l Please don’t throw away l Put in dirty utility rooms on dirty equipment carts

D 50 Emergency Syringes l Nationwide shortage of D 50 w emergency syringes l Necessary for D 50 w vials be used during shortage l Will be loading D 50 w vials into PYXIS l Thanks, Baxi

IMPACT in MIC l Recent staff findings: Errors on baby bands identified l Insulin bag had 2 shift changes that missed bag expiration (not changed at 24 hrs) l l Look for review and recommendations for Mother Baby report and assignments posted soon on units; be sure to provide input

Saturday, June 12, UW Commencement begins at Noon l l l Saturday, June 12, 2010, UW Commencement ceremony scheduled for 12: 00 PM (Noon) at Husky Stadium Event will bring traffic congestion to University District from as early as 9: 00 AM All weekend scheduled staff advised to plan additional time for traveling to UWMC Listed below is additional parking information for scheduled staff, patients and their visitors. E 20 Permit Holders: Friday, June 11, 2010, E 20 Husky Stadium parking closes at 5: 00 PM UW Commuter Services has arrangements for vehicles to be moved to alternate parking location after 5: 00 PM All permit holders arriving at E 20 after 5: 00 pm need to contact UW Police at 543 -9331 for access to E 20 or be directed to relocate vehicle E 20 & E 21 Night permit holder for Friday night, June 11 th Night permits assigned to E 20 & E 21 will park in E 21 parking lot until 7: 00 AM Saturday Morning Vehicles remaining after 7: 00 AM will be moved by UW Commuter Services to alternate parking lot in preparation for commencement ceremony. If vehicle is relocated, please contact UW Police at 206 -543 -9331.

Saturday, June 12, UW Commencement begins at Noon (cont. ) l UWMC staff working Saturday, June 12 th: l l l Staff scheduled to work on Saturday, June 12 th will park at Surgery Pavilion Parking Garage. Staff required to show valid parking permit and UWMC ID Badge for access UWMC Parking Staff at entrance to garage to provide assistance and answer questions. Overflow staff parking available at: S 1 Parking Garage - Middle and Lower levels Triangle Garage - Parking at Triangle Garage restricted for PATIENTS & VISITORS ONLY. NO Staff parking allowed in Triangle garage l l l PATIENT & VISITOR PARKING On Saturday, Patients and visitors will have following options for parking at UWMC Triangle garage - upper level of parking garage reserved for patient/visitor parking Surgery Pavilion Garage available for overflow patient & visitor parking Valet Services at Main Entrance - OPEN at main entrance from 8 am - 6 pm on Saturday. Valet Services also available on upper level of Triangle garage l If you have any questions, please give me a call at 206 -598 -5275 or email me at Larryk@UW. edu –will be onsite on Saturday during event

NE 45 St Viaduct Closes 6/14 - 9/10 l Dear UW Bicyclists, Walkers and U-PASS Members- l Monday, June 14, to Friday, Sept 10, NE 45 th St Viaduct closed in both directions between 20 th Ave NE and Montlake Blvd NE. l Closure will alter Metro Route 25 and impact pedestrian and bicycle routes to and from campus, so plan new route and allow more time if necessary l More about project at: Seattle Department of Transportation Web site: www. seattle. gov/transportation/45 th-bridge. htm , and University Week: uwnews. org/uweek/article. aspx? id=57864 l Detailed information on changes to Metro Route 25 can be found at the King County Metro Web site: metro. kingcounty. gov/up/scvchange. html l Thank you for walking, biking, ridesharing, and taking the bus to campus U-PASS upass@u. washington. edu

Paternal Prenatal and Postpartum Depression l “Overall meta-analytic rate of paternal depression between first trimester and 1 year postpartum. . . suggests paternal prenatal and postpartum depression represents significant public health concern, " state authors of article published in May 19, 2010, issue of JAMA l Meta-analysis presents findings of depression in expecting and new fathers to: l l l (1) estimate paternal depression between first trimester and 1 year postpartum; (2) describe differences across time period (3) examine association between paternal and maternal depression (4) estimate prevalence of maternal prenatal and postpartum depression identified in paternal depression studies (5) identify how published rates of paternal depression affected by methodological factors such as measurement method, study location, and sample risk status Studies for meta-analysis drawn from relevant reviews; a search of MEDLINE, Psych. INFO, Dissertation Abstracts International, EMBASE, and Google Scholar; and reference lists of retrieved articles l Initial analysis included all journal articles, dissertations, and book chapters produced between January 1980 and October 2009 that assessed paternal depression during pregnancy, first postpartum year, or both

Paternal Prenatal and Postpartum. Depression (cont. ) l Studies that reported an estimated # of cases among identified fathers selected l l l Primary outcome was point prevalence rate of paternal depression Secondary outcomes included rates of depression in female partners and correlations between paternal and maternal depressive symptoms Research also examined following determinants of primary and secondary outcomes: period of measurement, risk status of sample, and case identification method (interview vs. rating scale) Study location also coded The authors found that l l l Overall rate of paternal depression between 1 st trimester and 1 year pp was 10. 4% (compared with recent national data on base rates of depression in men at 4. 8%) Considerable variability between different time periods, with 3 - to 6 -month pp showing highest rate of paternal depression and first 3 pp months showing lowest rate U. S. studies reported average rate of paternal depression at 14. 1% and international studies reported average rate of 8. 2% Interview-based case definition methods associated with lower overall prevalence estimates Overall estimate of maternal-paternal depressive symptom correlation was significant

Paternal Prenatal and Postpartum. Depression (cont. ) l “Observation that expecting and new fathers disproportionately experience depression suggests that more efforts should be made to improve screening and referral, " conclude authors. “Correlation between paternal and maternal depression also suggests. . . that prevention and intervention efforts for depression in parents might be focused on couple and family rather than individual, " they add l Paulson JF, Bazemore SD. 2010. Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA, The Journal of the American Medical Association 303(19): 19611969. Abstract available at http: //jama. amaassn. org/cgi/content/short/303/19/1961. Readers: More information is available from the following MCH Library resources: - Depression During and After Pregnancy: Knowledge Path at http: //mchlibrary. info/Knowledge. Paths/kp_postpartum. html - Fatherhood: Resource Brief at http: //mchlibrary. info/guides/fatherhood. html

Surveillance for Guillain-Barre Syndrome After Receipt of Influenza A (H 1 N 1) l Preliminary Results: Surveillance for Guillain-Barre Syndrome After Receipt of Influenza A (H 1 N 1) 2009 Monovalent Vaccine --- United States, 2009— 2010 l Guillain-Barre syndrome is uncommon peripheral neuropathy causing paralysis and in severe cases respiratory failure and death l Incidence of Guillain-Barre Syndrome associated with H 1 N 1 vaccine in 2009 US data l l Vaccine considered safe Incidence: ~. 8/1, 000 vaccines given Half of those may have had symptoms of Guillain-Barre Syndrome prior to vaccination For more information go to: Preliminary Results: Surveillance for Guillain -Barre Syndrome After Receipt of Influenza A (H 1 N 1) 2009 Monovalent Vaccine --- United States, 2009— 2010 Wed, 02 Jun 2010 16: 30: 00 0500

Compensatory Time l Unused overtime compensatory time paid off by June 30, 2010 l Accrued holiday compensatory time may remain unpaid until September 30, 2010 Please refer to the University website for more information about comp time: http: //www. washington. edu/admin/hr/ocpsp/flsaot/ot. html l Questions may be directed to Department Human Resources Consultant l