Reminder

Hi Everyone,

This is a reminder that there will be a SPANC meeting next Wednesday between the hours of 11:30-14:30. This is a Brown Bag Lunch Hour drop-in, and I'd like to encourage everyone to try to make it. I know that you will be spending your valuable lunch hour at a meeting, but I'm hoping that these times will better accommodate those nurses who want to be a part of Sunnybrook Peri-Anesthesia Nursing Council.

We have some great ideas to get this Nursing Council up and running with some definite goals in mind. An agenda will be organized for next Wednesday, anyone with agenda items they would like to discuss, please either leave a comment here at the end of this post, or email me.

There is an RSVP at the top right of this blog, can you please respond so that we have an idea of how many people will attend.

Thanks, and have a great weekend!

Great Job SDS!

The following email was forwarded from Carol:

To Whom it May Concern:

My husband, John Eason, was at Sunnybrook Health Sciences Unit on Wed. May 7th for Same Day Surgery to have a tumour removed from his bladder at 9:30 a.m. He was very nervous about the procedure and we would like to take this opportunity to thank everyone for his excellent care. The staff’s good sense of humour helps to put patients at ease. When Christopher and Chris came to move the bed upstairs to the operating area they began with introducing themselves as well as explaining the next step in the day. Small gestures like this do make a difference. It also seemed apparent that the staff on duty that day enjoyed their jobs and demonstrated that they understood the patient’s needs.
Please keep up the great work.

Thank you.

John and Jill E.
Great work Same Day Surgery!

In-Patient Allergy Policy and Documentation Tool Implementation

From Frances Flint, Director of Nursing Practice and Informatics:

Implementation of the Allergy Policy and documentation tool, the Inpatient Allergy Record is scheduled for the week of June 2, 2008. The policy has been approved by NAC, PAC and MAC and is now posted on the intranet. The link is http://mysb.ca/data/1/rec_docs/6990_I_A_2150.pdf

The Inpatient Allergy Record is available through print shop PR # 999968. Please note the instructions on the reverse side of the form. Please inform the PAA’s of the new form and add it to your pre-admission packages.
The Inpatient Allergy Record should be placed in front of the physician order sheet of the health record. In due course the physician order sheet will be changed to indicate completion of the new Inpatient Allergy Record.

Over the past few months we have had more CrCU, B5ICU and D4ICU patients staying for extended periods in PACU. Patients who are intubated (and are expected to remain intubated,) have central lines, or chest tubes inserted in the OR MUST have a post-op CXR done to check placement of these invasive lines. It is a safety issue, hospital protocol, and the expected standard of care. Please refer to Central Line Insertion and Chest Tube Insertion. Management of the patient who remains intubated and/or ventilated is an advanced nursing competency, and as a PACU RN there is a professional responsibility and accountability to ensure that the skill is maintained in a competent and safe manner. If anesthesia does not order a CXR post op, please remind them that it is necessary, and insist upon it! Let them know that you will page them once the CXR has been taken. Also, if you know that a patient is going to remain intubated for an extended period of time, it is prudent to have an order for an NG Tube (if the patient does not have a basal skull fracture.) A good time to insert this would be prior to the CXR being taken.

Trauma patients whether intubated or not, with spines not cleared, should have a neck collar on, and should still be nursed with the HOB up 30 degrees, by placing the patient in Reverse Trendelberg (head higher than the feet.) For Head injured patients, this helps with ICP, but for all intubated patients, it helps with lung expansion, and prevention of aspiration. ALL patients whose spines have not been cleared in the ER, must have their spines cleared radiographically AND clinically before C-T-L Precautions can be discontinued. It is very important to continue to reposition your patient by logrolling q2h. Think about it: patients have been on a backboard from the field, to ER, to the OR. Pressure Ulcers can, AND DO already start at this time. TIP: A long wedge can be made by rolling together 3-4 flannel blankets. One flannel is helpful under the head to maintain C-spine alignment. Please note that if your patient is awake and able to answer questions appropriately, spines can be cleared by paging the appropriate service. Orthopedics and Neurosurgey take weekly turns being the Spinal On-call. You can find this information in the Trauma notes.

Hope this information helps!

Another New Staff Member!

As you all know, we have been on a MAJOR hiring spree this year! Please help me to welcome our newest PACU employee, Hongling Wu. Hongling comes to us from the ICU at Humber River Regional Hospital.

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Since we do have such a large number of new staff members in all areas, I would like to take this opportunity to point all all of you in the direction of Professional Specialty Organizations relating to PeriAnesthesia. ASPAN is the American Society of PeriAnesthesia Nurses. International membership costs $100, but it is well worth the price. You will receive Journals and Newsletters in the mail, plus discounts on seminars, conferences and educational material. Check it out Here.

OPANA is the Ontario PeriAnesthesia Nurses Association. "This is the province of Ontario's only non-profit professional nursing association serving nurses who practice patient care, including Pre-Anesthetic care, in all areas of health care where all types of anesthetics are administered.
These areas include, but are not limited to:
Pre-Admission Clinics
Ambulatory Clinics
Post Anesthetic Care Units (PACU)
Day Surgery Units
Free Standing Dental and Plastic Surgery Clinics
Endoscopy Units
Cystoscopy Units
Labour and Delivery Units
Any other area of health care where local, general or regional anesthetics or sedation are given to patients undergoing a wide variety of treatments or surgery.
The purpose of OPANA is to lead the provinces' perianesthesia nurses through perianesthesia nursing education, practice standards and research. This is accomplished through communication, networking, knowledge exchange, evidence-based research activities and incorporating them ultimately into Practice Standards."

"All OPANA members are members of NAPAN© and a portion of the membership fees goes towards supporting this national association.
OPANA is working towards developing a certification exam in collaboration with associated professional groups (i.e., CNA, NAPAN(c))."

January 1 until December 31 of the year of application. Members who join OPANA throughout the year or at the time of registration for the annual conference, are considered to be members of OPANA for that calendar year only. It is through membership, that OPANA's members can receive membership discounts for the conference.

Membership costs $40 and there is a reduced rate if you are also a member of the RNAO. Click Here for more info!

If you haven't had the chance to catch up on the latest issue of Nursing Voice, or you would like to read some back issues, you can find the link Here.

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I know PEP Day was a while ago, but there is still some outstanding info. The Complaint Free Bracelets will be arriving soon. Apparently they were sent by mule. (Was that a complaint?!)

Also, CONGRATULATIONS TO ALL P.E.P. DAY DOOR PRIZE WINNERS!!!

1) $100 gift certificate to Civello Spa Jean Ford SD
2) $100 gift certificate to Civello Spa Erin Stainer PACU
3) $50 gift certificate to Yorkdale Rowena Supat OR, SB
4) $50 gift certificate to Yorkdale Marie McEachnie OR, SB
5) $50 gift certificate to Want Boutique Zera Ratensi PAC
6) $50 gift certificate to Want Boutique Valerie Cramer OR, HOAC
7) Gift package from Bacardi Andrea Clarke PAC
8) Gift package from Bacardi Jane Gannon OR, HOAC
9) Gift package from Bacardi Tatyana Milenkovic, OR, HOAC
10) Gift package from Bacardi Irina Zaslavsky, OR, HOAC
11) Gift package from Vichy Michelle Sparkes, OR, HOAC
12) Gift package from Vichy Bente Willis, PAC
13) Gift package from Vichy Michelle Bertrand, OR, SB
14) Gift package from Vichy Cristal Hurst, OR, HOAC
15) Garden Gift Basket Stephanie Taylor, porter, HOAC
16) Adidas Bag Becky Wong, OR, SB
17) Adidas Bag Maria DaSilva, PAC
18) 3M gift basket Biddy Chang, OR, SB
19) J.C. Creations necklace Robyn Fosbury, PACU
20) $50 gift certificate to Bon Appetit Marilyn Gunn, SB, OR
21) $50 gift certificate to Bon Appetit nurse speaker L. Mahoney, PACU
22) $50 gift certificate to Bon Appetit nurse speaker M. Gunn, SB, OR
23) $50 gift certificate to Bon Appetit nurse speaker G. Groetzch, HOAC


SPONSORS FOR PEP DAY:

Sherry Mullen & Kristy Walker (Covidien), $750 for lunch
Mark Hunks (J & J Dupuy), $350 for lunch
Sue Heyland (Cardinal Health), $100 for lunch
Jason Pearson (ConMed), prizes 20-23
Larry Pyykko (GE Healthcare), “Believe in the Power of Nursing” booklets
Wendy Gilmore, motivational speaker, prizes 1- 4 & loot bag items
Alexandra Leeksma, “A Complaint Free World” package
Carol Deriet & Helen Vandoremalen, coffee break & dessert



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Great Work!

WOW! The nurses in SSSU must be gushing with all the kind words they've received from their patients! Here is another letter:

Hello Carol,

This quick note is intended to provide feedback regarding your staff in the Short Stay unit at Sunnybrook hospital. I had out-patient surgery on Friday May 9, 2008 however I was unable to go home that evening because my blood pressure was too low and I was experiencing severe dizziness. I was admitted into the Short Stay unit where your staff went above and beyond to help me through the initial recovery. In particular Maggie was available to assist me "on demand" in getting in/out of bed to use the washroom, she allowed my husband to stay well beyond visitor hours and allowed him to re-enter the hospital at 10pm so he could bring me a special meal to accommodate my food allergy. She also tried on several attempts to reach my doctor to inform him that I was staying in the hospital overnight. I was released the next morning and am still recovering at home but I wanted to send a quick note to thank you and your staff for not only providing me with much needed help during the first 12 hours after my surgery but also for making my brief stay in the hospital as comfortable as possible. Thankfully my experience with hospitals has been minimal so far but I am happy to see that Sunnybrook has staff that is accommodating and attentive.

Once again, thank you.

Sincerely,

Katerina M

Happy Nurses Week from the Provincial Chief Nursing Officer

Ministry of Health and Long-Term Care
The Nursing Secretariat
12th Floor
56 Wellesley Street West
Toronto ON M5S 1S3
Tel.: 416 327-9689
Fax: 416 327-1878
Website: http://nursingsecretariat.on.ca

May 12, 2008
Dear Nurses,
Re: National Nursing Week – Think you know nursing? Take a closer look…
Nursing week is a time of celebration and acknowledgement of the significant contributions that nurses make to enrich the lives of patients, families, communities, and the health care system. As the Provincial Chief Nursing Officer, I am very aware of the deep commitment and professional knowledge of nurses across the province. I would like to take this opportunity to offer my sincere appreciation and personal greetings to all nurses in recognition of your enduring effort to promote the profession of nursing and support the delivery of quality care to Ontarians.
Every day, nurses demonstrate leadership and dedication to patients and family members experiencing alterations in health status. Using knowledge and expertise to promote the health of patients, clients and residents, nurses provide holistic and compassionate care and play an integral role in positively impacting both the quality and safety of care delivery.
I wish you great success and enjoyment of the various nursing events that your organization has planned for the week. Most of all, I wish that during Nursing Week and always, you will take some time to celebrate yourselves and your colleagues for the truly remarkable work that you do.
Sincerely,
Vanessa Burkoski
Provincial Chief Nursing Officer

Great Job SSSU!

The following letters were received from a past patients.

Letter #1

Attention SSSU PCM CAROL DERIET

Just a note to say how wonderful the nursing care was when I was in the short stay unit on Fri. Apr. 25. There was 4 nurses Fri afternoon-Debbi & Debbie and Maggie & Martha overnight. I found them to be kind, pleasant, considerate and most helpful.

I hope they will continue to serve for many years to come.

Please pass my thanks on to them! Sincerely, Joseph G.

Letter #2

Dear Dr. McLellan,

I would like to take this opportunity to share my very positive experience that I recently had with Sunnybrook and Dr. Marks in connections with my ACL replacement surgery. It was my first time to have surgery or any medical procedure for that matter and I must say the whole operation was very professional and efficient/ While it is not possible for me to remember all of the names of those that were involved in my surgery I would like to say that the medical and support staff that assisted me were all first class professionals. This includes my initial contact and visit with Dr. Marks' and his office, the pre-op session a week before mu surgery, the pre-surgery prep and the post surgery recovery. It is hard to tell what actually went on while I was in the operating room as I was knocked out-but all indications are that it was a big success!

Please pass this note on to all the departments involved as I would like to thank them for the excellent medical care they provided to me.

Yours truly,

Daniel C.

Nursing week, PEP day, Herbal Products, and a new staff member.

Most of you have probably seen this joke before, but it's funny the second time around too!

You know you are a Nurse when...

1) the front of your scrubs reads “Nurses…here to save your butt, not kiss it!”
2) you occasionally park in the space with the “physicians only” sign… and knock it over.
3) you believe some patients are alive only because it’s illegal to kill them.
4) you recognize that you can’t cure stupid.
5) you own at least three pens with the names of prescription medications on them.
6) you believe there’s a special place for the inventor of the call light.
7) you believe that saying “it can’t get any worse” causes it to get worse just to show you it can.
8 ) you wash your hands BEFORE you go to the bathroom.
9) you believe that any job where you can drive to work in your pajamas is a cool one.
10) you consider a tongue depressor an eating utensil.
11) eating microwave popcorn out of a clean bedpan is perfectly natural.
12) you have been exposed to so many x-rays that you consider it a form of birth control.
13) you have heard a patient with a nose ring, a brow ring, and twelve earrings say “I’m afraid of shots.”
14) you have placed a bet on someone’s blood alcohol level.
15) you have told a confused patient that your name is that of a coworker and to call if they need help.
16) your bladder can expand to the size of a Winnebago’s water tank.
17) you have seen more penises than any prostitute could dream of.
1 you believe that not all patients are annoying…some are unconscious.
19) your family and friends refuse to watch medical sitcoms with you because you spend the whole time correcting everyone and pointing out upside down x-rays.
20) you don’t get excited about blood, unless it’s your own.
21) you have sworn to have “do not resuscitate” tattooed on your chest. Soon.
22) discussing dismemberment over a gourmet meal is perfectly normal to you.
23) your idea of fine dining is anywhere you can sit down to eat.
24) your idea of a good time is a cardiac arrest at shift change.
25) you believe in the aerial spraying of Prozac.
26) you believe that “shallow gene pool” should be a recognized diagnosis.
27) you believe that the government should require permits to reproduce.
2 you believe that unspeakable evils will befall anyone who utters the phrase, “Wow, it’s really quiet, isn’t it?
29) you have wanted to write a book entitled, “Suicide: getting it right the first time.”
30) you have ever had a patient look you straight in the eye and say “I have no idea how that got stuck in there.”
31) you have had to leave a patient’s room before you begin to laugh uncontrollably.

HAVE A GREAT WEEK!

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It has been a while since I've posted anything, but I have lots of updates and new information to share from the ASPAN Conference. It will take me a while, but I will pass on as much info as I can. I did leave a copy of the AANA Journal (American Association of Nurse
Anesthesia) in the Block Binder along with some pamphlets about Nurse Anesthesia for anyone who might be interested in this role.

Thanks to all who came to the PEP retreat, feedback was very good, and I thought I would share the evaluations with you.

PEP DAY EVALUATIONS MAY 2TH, 2008
Evaluations collected – 58
1. Was this retreat what you expected?
Yes:48 No: 10
2. Did you enjoy it?
Yes:57 No:1
3. Were the presentations relevant to your practice?
Yes:58 No: 0
4. Did you realize anything today that might make you deal with the challenges you face each day a little easier?
Yes: 52 No:6

What did you like best? (In order of popularity)
All Aboard the Change Train-Rosita Hall
Out of Africa-Peter Chu
EVAR-Andrew Dueck
RNFA-Grace Groetzsch
A Complaint Free World-Ramona Hackett
What didn’t you like?
· IP&C – they were very rude & accusatory
Not the right venue to do this
Too much equipment thrown in the garbage
Other Comments
· Good Job – thank you
· Fun upbeat day
· Well organized
· Very Exciting day – enjoyed
· I enjoyed the whole day – by far the best
· Excellent motivational speaker
· To all educators – an excellent job
· Everything was great – no more complaining
· Vegetarians need protein – not just cheese
· Lunch need more meat or chicken no vegetables
· More social seating for lunch and coffee
What ideas do you have for next year?
· NP role
· Have a paid speaker again
· More presentations by the nurses
· Praise and recognition of staff
· Blood conservation
· Retirement
· Nurses in business
· Benchmarking
· Patient outcomes and patient flow issues

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At the ASPAN conference, I picked up an interesting pamphlet about Herbal Products and Anesthesia.

Herbal products are also known as dietary supplements, alternative therapies, complementary medicine, and homeopathic health care. There are few instructions on proper use and dosage requirements, and little information about possible side effects, toxicity and possible drug interactions. While many herbal products offer noticeable health benefits when used correctly, taking these products right up until the day of surgery may have an impact on the success of the anesthetic and/or procedure.

Herbal products should be stopped at least two weeks prior to the scheduled procedure to prevent side effects. Surgeon, anesthesiologist and nurses need to be aware of any herbal products that are being taken including over-the-counter drugs, dietary supplements, minerals, and teas.

The following are some popular herbal products and possible side effects when interacting with anesthetics:

Ephedra-used for the treatment of asthma, hay fever, and the common cold. It is primarily used as a nasal decongestant, but has also been found in diet aids to promote weight loss. the side effects are BP changes, exaggerated response to high BP meds, risk of heart attack and stroke.

Feverfew-used to treat fever, migraines, arthritis, and digestive problems. The major risk is prolonged bleeding, but also insomnia and anxiety.

Garlic- claimed to help prevent heart disease including atherosclerosis, high cholesterol, high BP, and cancer. Side effects include blood pressure changes and a risk of prolonged bleeding.

Ginger- may decrease joint pain from arthritis, and may have blood thinning and cholesterol lowering properties that may make it useful for treating heart disease. Commonly used to aid nausea, some cultures use it to treat the common cold, flu and diarrhea. Ginger is contraindicated in people suffering from gallstones as the herb promotes the release of bile from the gallbladder. Also contraindicated in people who are taking warfarin. Interactions with anesthetics include sedative effects, risk of bleeding.

Ginseng-is promoted as an adaptogen (a product that increases the body's resistance to stress,) a nourishing energy drink, an aphrodisiac, and in the management of Type II Diabetes. Side effects include insomnia and irritability, and risk of cardiac effects and blood pressure changes.

Kava-is marketed against stress, insomnia and anxiety. Mixed with anesthetics there is a risk of additive effect to medications, increased sedative effects.

St. John's Wort-used as an antidepressant, may help to decrease alcohol intake, and commonly used as an herbal tea. there are many adverse interactions with other medications, some which may prolong the effects of anesthesia. May also cause blood pressure changes.

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Last, but not least I'd like to make an announcement about another new staff member in PACU. Lindsay Richmond comes to us via CrCu. Previous to that she moved to Toronto from London, Ontario where she also worked in ICU. Welcome Lindsay!