Reflective Thought for the Week of July 7-13, 2008
“Nothing is a waste of time if you use the experience wisely.”
-Auguste Rodin
A reminder that July's SPANC meeting will be held tomorrow (Wed) in MB206 over the lunch hours, from 11:30-14:30.
We will be working together to develop the PeriAnesthesia Handover Tool.
Be There, Or Be Square!
Tuesday, July 8, 2008
Monday, July 7, 2008
Remember this Post?!
Well, there is a new initiative amongst the Trauma General Surgeon's called ACCESS "ACute Care Emergency Surgical Services" that will enable surgeon's to have protected OR time Monday to Friday between 1600-1900. This will include cases such as Lap Appy's and Lap Chole's. Below is the latest policy for ACCESS. It begins today in the O.R. (Today was the first day I've heard about this) Any questions please refer them to Dr. Brenneman.
ACute Care Emergency Surgery Service (ACCESS)
Background
The ACCESS service is designed to create a new medical model of care for existing Emergency Department general surgery patients. The main principle of this model is based on a one week service rotation, wherein one general surgeon is responsible for managing a team solely dedicated to the care of all new ED consults, and existing ACCESS service patients.
In the recent 5 year review of Sunnybrook’s Division of General Surgery, Dr. Don Buie commented that ….“This (ACCESS) initiative has the potential to concentrate general surgical care separating it from the two primary focuses of oncology and trauma. It allows academic surgeons to plan their time more efficiently by concentrating call at specific times. Thus blocks of time without call can be more productive. It can be integrated into a trauma model as both services can be done on a weekly rotational basis. In addition it maintains the focus of individual services within their area of expertise. From an educational point of view it provides a concentrated general surgery experience for a resident assigned to this service. During the day, the remaining residents can focus on learning objectives for their assigned rotation. As trauma surgery is becoming more non-operative, there is a need to ensure that trauma surgeons keep up their skill level. The ACCESS service provides such an outlet.” Further, Dr. Buie recommended in his report that the hospital should “ensure there is dedicated operating room time so that urgent/emergent cases can be done in a timely fashion without interrupting elective bookings. This improves efficiency of patient care both for the acute service and the emergency department.”
This model of care has been recently implemented in some large AHSCs in Canada including Calgary, Montreal, and Vancouver. It has also evolved in the United States in conjunction with existing trauma surgery services at level 1 trauma centers. The reasons for Sunnybrook to implement an ACCESS service include benefits to the patient, surgical trainee, hospital, and surgeon, as outlined below:
Potential Benefits of an Acute Care General Surgery Emergency Service Model of Care
1. Benefits for the patient
· improve patient care with shorter time to GS consultation in the ED
· improve patient care by more timely access to the OR for semi-emergent surgery (eg. appendicitis, acute cholecystitis)
· improve overall patient and family experience on general surgery service, attributed to advantages of having a dedicated service managing all general surgery emergency patients
2. Benefits for the general surgery residents, medical students
· increased focus on emergency general surgery education
· improve bedside teaching with a dedicated ACCESS team for these patients
· formal teaching rounds on general surgery (non-trauma) emergencies
· easier to deal with one attending surgeon for all emergency GS patients on a dedicated ACCESS team, than to deal with multiple attending surgeons for fewer patients on each (existing) team
3. Benefits for the hospital
· improve hospital LOS for emergency general surgery patients
· improve patient flow for general surgery patients, thereby improving bed utilization and efficiency
· improve time to consultation and time to final management decision for general surgery patients in the Emergency Department
· improve patient satisfaction scores
· decrease general surgery after hours OR utilization
· easier for the general surgery ward nurses to deal with one resident/attending surgeon team for the week than to deal with multiple residents and multiple attending surgeons for the same compliment of patients
4. Benefits for the general surgeons
· compartmentalize general surgery acute care into weekly blocks
· will decrease the number of after hours general surgery operations
· helps to protect time for research
· ensures continuity of patient care in one week blocks
· financial issues (in a fee-for-service model) unclear at this point in time, but likely to be neither a gain nor a loss of income for the general surgeon as a result of this model of care.
Description of the Acute Care Emergency Surgery Service
The new ACCESS service will involve the following:
1. The patients to be INCLUDED on this new service are Emergency Department general surgery patients, and in-patient general surgery consults (see exclusions).
2. The patients to be EXCLUDED are surgical oncology patients (eg. malignant bowel obstruction, new cancer patient referrals), trauma patients (patients with any injury, regardless of whether or not they were seen by the trauma team), consults for PEGs and trachs (to be done by trauma surgeons), and post-op elective surgery patients with complications (to be managed by the original operating surgeon).
3. One week rotation for the attending general surgeon starting every Friday at 8:00am
4. The general surgeon on ACCESS will be expected to restrict other scheduled clinical work during that week in order to provide dedicated time to the ACCESS service. For example, the ACCESS surgeon will not have an elective scheduled OR list while on the ACCESS service.
5. Friday’s 8:00am sign-over is intended to allow for seamless continuity of care of general surgery patients. This may be a challenge and will require particular attention in order to achieve good outcomes. Sign-over will include both the “incoming” and the “outgoing” ACCESS attending surgeons, ACCESS team residents and medical students, and representation from C6 nursing and social work. It will occur in a reserved room on or near C6. These rounds will be focused working rounds for sign-over purposes only, and should take up to 30 minutes.
6. The general surgeon on service for the week is MRP for these general surgery patients. If a patient is admitted during an “off surgeon” night on call, the patient is to be admitted under the “off” general surgeon and transferred to the ACCESS surgeon the following morning.
7. The general surgeon’s service will round every day (7 days) on all ACCESS service patients. Particular attention to timely hospital discharge planning will be an important aspect of these rounds.
8. A nurse practitioner, patient care coordinator, or charge nurse will attend these daily rounds (weekdays) and assist with discharge planning.
9. There will be protected “ACCESS” OR time every weekday (Monday to Friday) for 3 hours to allow for overnight appes, lap choles, etc to get to the OR in a more timely fashion, thereby decreasing their length of stay. This OR time has been approved by the OR Management Committee, and will occur between 1600 – 1900 hours on weekdays for a 3 month trial period commencing July 7, 2008. If an ACCESS patient needs to go to the OR emergently during the day, the ACCESS case will bump the general surgery scheduled operating room for that day. However, the GS scheduled OR will be allowed to run until 1900 hrs on that day (in the ACCESS OR time).
10. OR cases – the ACCESS attending surgeon must be in the OR at all times with the resident team. This must be an efficient operating room. All pre-op ACCESS patients must be ready for the OR when the OR calls for the patient. The OR booking sheet should indicate “ACCESS” surgical case.
11. ED consults to the ACCESS team. The ACCESS team will commit to a maximum 30 minute response time (measured from the time the consult is called to the time the patient is first seen by the ACCESS team), and a 2 hour time from consult to final decision regarding disposition.
12. If any ACCESS patient becomes chronic, the MRP stays with the ACCESS team. It is felt that the ACCESS team is best suited to deal with placement of these patients.
13. The residents on this new service rotate for one to two month blocks. This will create a new resident team at Sunnybrook and ideally will include a senior resident, junior residents and medical students.
14. The attending surgeon for the week will rotate as per a predetermined schedule. This schedule will be created 3 months in advance, and will include a 6 month period. (for example, create the July-Dec 2008 schedule in April 2008).
15. ACCESS patient follow-up is with the surgeon who did the operation. If no surgery, then the surgeon on service at the time of hospital discharge will arrange follow-up.
16. A one page outcome measures and quality improvement data collection sheet will be completed by the attending ACCESS surgeon daily in a prospective fashion. This data will be entered into a database by general surgery administrative staff.
17. Discharge summaries are the responsibility of the ACCESS surgeon on service at the time of hospital discharge (ie. the MRP).
18. All general surgeons at Sunnybrook will be expected to participate in the ACCESS service rotation in an equitable distribution. However, the trauma general surgeons have the option of only taking part in the “off surgeon” on call nights, because they already have a 1 in 5 trauma on call commitment, and in addition 3 of them also have ICU weeks on call.
Weekly On Call Surgeon Schedule
10-on and 4-off schedule
Surgeon A = ACCESS surgeon of the week
“off surgeon” is done by either the same surgeon or different surgeons for that particular week. “Off” call is from 7:00pm to 7:00am on weekdays and 5:00pm to 8:00am on Saturday night.
Well, there is a new initiative amongst the Trauma General Surgeon's called ACCESS "ACute Care Emergency Surgical Services" that will enable surgeon's to have protected OR time Monday to Friday between 1600-1900. This will include cases such as Lap Appy's and Lap Chole's. Below is the latest policy for ACCESS. It begins today in the O.R. (Today was the first day I've heard about this) Any questions please refer them to Dr. Brenneman.
ACute Care Emergency Surgery Service (ACCESS)
Background
The ACCESS service is designed to create a new medical model of care for existing Emergency Department general surgery patients. The main principle of this model is based on a one week service rotation, wherein one general surgeon is responsible for managing a team solely dedicated to the care of all new ED consults, and existing ACCESS service patients.
In the recent 5 year review of Sunnybrook’s Division of General Surgery, Dr. Don Buie commented that ….“This (ACCESS) initiative has the potential to concentrate general surgical care separating it from the two primary focuses of oncology and trauma. It allows academic surgeons to plan their time more efficiently by concentrating call at specific times. Thus blocks of time without call can be more productive. It can be integrated into a trauma model as both services can be done on a weekly rotational basis. In addition it maintains the focus of individual services within their area of expertise. From an educational point of view it provides a concentrated general surgery experience for a resident assigned to this service. During the day, the remaining residents can focus on learning objectives for their assigned rotation. As trauma surgery is becoming more non-operative, there is a need to ensure that trauma surgeons keep up their skill level. The ACCESS service provides such an outlet.” Further, Dr. Buie recommended in his report that the hospital should “ensure there is dedicated operating room time so that urgent/emergent cases can be done in a timely fashion without interrupting elective bookings. This improves efficiency of patient care both for the acute service and the emergency department.”
This model of care has been recently implemented in some large AHSCs in Canada including Calgary, Montreal, and Vancouver. It has also evolved in the United States in conjunction with existing trauma surgery services at level 1 trauma centers. The reasons for Sunnybrook to implement an ACCESS service include benefits to the patient, surgical trainee, hospital, and surgeon, as outlined below:
Potential Benefits of an Acute Care General Surgery Emergency Service Model of Care
1. Benefits for the patient
· improve patient care with shorter time to GS consultation in the ED
· improve patient care by more timely access to the OR for semi-emergent surgery (eg. appendicitis, acute cholecystitis)
· improve overall patient and family experience on general surgery service, attributed to advantages of having a dedicated service managing all general surgery emergency patients
2. Benefits for the general surgery residents, medical students
· increased focus on emergency general surgery education
· improve bedside teaching with a dedicated ACCESS team for these patients
· formal teaching rounds on general surgery (non-trauma) emergencies
· easier to deal with one attending surgeon for all emergency GS patients on a dedicated ACCESS team, than to deal with multiple attending surgeons for fewer patients on each (existing) team
3. Benefits for the hospital
· improve hospital LOS for emergency general surgery patients
· improve patient flow for general surgery patients, thereby improving bed utilization and efficiency
· improve time to consultation and time to final management decision for general surgery patients in the Emergency Department
· improve patient satisfaction scores
· decrease general surgery after hours OR utilization
· easier for the general surgery ward nurses to deal with one resident/attending surgeon team for the week than to deal with multiple residents and multiple attending surgeons for the same compliment of patients
4. Benefits for the general surgeons
· compartmentalize general surgery acute care into weekly blocks
· will decrease the number of after hours general surgery operations
· helps to protect time for research
· ensures continuity of patient care in one week blocks
· financial issues (in a fee-for-service model) unclear at this point in time, but likely to be neither a gain nor a loss of income for the general surgeon as a result of this model of care.
Description of the Acute Care Emergency Surgery Service
The new ACCESS service will involve the following:
1. The patients to be INCLUDED on this new service are Emergency Department general surgery patients, and in-patient general surgery consults (see exclusions).
2. The patients to be EXCLUDED are surgical oncology patients (eg. malignant bowel obstruction, new cancer patient referrals), trauma patients (patients with any injury, regardless of whether or not they were seen by the trauma team), consults for PEGs and trachs (to be done by trauma surgeons), and post-op elective surgery patients with complications (to be managed by the original operating surgeon).
3. One week rotation for the attending general surgeon starting every Friday at 8:00am
4. The general surgeon on ACCESS will be expected to restrict other scheduled clinical work during that week in order to provide dedicated time to the ACCESS service. For example, the ACCESS surgeon will not have an elective scheduled OR list while on the ACCESS service.
5. Friday’s 8:00am sign-over is intended to allow for seamless continuity of care of general surgery patients. This may be a challenge and will require particular attention in order to achieve good outcomes. Sign-over will include both the “incoming” and the “outgoing” ACCESS attending surgeons, ACCESS team residents and medical students, and representation from C6 nursing and social work. It will occur in a reserved room on or near C6. These rounds will be focused working rounds for sign-over purposes only, and should take up to 30 minutes.
6. The general surgeon on service for the week is MRP for these general surgery patients. If a patient is admitted during an “off surgeon” night on call, the patient is to be admitted under the “off” general surgeon and transferred to the ACCESS surgeon the following morning.
7. The general surgeon’s service will round every day (7 days) on all ACCESS service patients. Particular attention to timely hospital discharge planning will be an important aspect of these rounds.
8. A nurse practitioner, patient care coordinator, or charge nurse will attend these daily rounds (weekdays) and assist with discharge planning.
9. There will be protected “ACCESS” OR time every weekday (Monday to Friday) for 3 hours to allow for overnight appes, lap choles, etc to get to the OR in a more timely fashion, thereby decreasing their length of stay. This OR time has been approved by the OR Management Committee, and will occur between 1600 – 1900 hours on weekdays for a 3 month trial period commencing July 7, 2008. If an ACCESS patient needs to go to the OR emergently during the day, the ACCESS case will bump the general surgery scheduled operating room for that day. However, the GS scheduled OR will be allowed to run until 1900 hrs on that day (in the ACCESS OR time).
10. OR cases – the ACCESS attending surgeon must be in the OR at all times with the resident team. This must be an efficient operating room. All pre-op ACCESS patients must be ready for the OR when the OR calls for the patient. The OR booking sheet should indicate “ACCESS” surgical case.
11. ED consults to the ACCESS team. The ACCESS team will commit to a maximum 30 minute response time (measured from the time the consult is called to the time the patient is first seen by the ACCESS team), and a 2 hour time from consult to final decision regarding disposition.
12. If any ACCESS patient becomes chronic, the MRP stays with the ACCESS team. It is felt that the ACCESS team is best suited to deal with placement of these patients.
13. The residents on this new service rotate for one to two month blocks. This will create a new resident team at Sunnybrook and ideally will include a senior resident, junior residents and medical students.
14. The attending surgeon for the week will rotate as per a predetermined schedule. This schedule will be created 3 months in advance, and will include a 6 month period. (for example, create the July-Dec 2008 schedule in April 2008).
15. ACCESS patient follow-up is with the surgeon who did the operation. If no surgery, then the surgeon on service at the time of hospital discharge will arrange follow-up.
16. A one page outcome measures and quality improvement data collection sheet will be completed by the attending ACCESS surgeon daily in a prospective fashion. This data will be entered into a database by general surgery administrative staff.
17. Discharge summaries are the responsibility of the ACCESS surgeon on service at the time of hospital discharge (ie. the MRP).
18. All general surgeons at Sunnybrook will be expected to participate in the ACCESS service rotation in an equitable distribution. However, the trauma general surgeons have the option of only taking part in the “off surgeon” on call nights, because they already have a 1 in 5 trauma on call commitment, and in addition 3 of them also have ICU weeks on call.
Weekly On Call Surgeon Schedule
10-on and 4-off schedule
Surgeon A = ACCESS surgeon of the week
“off surgeon” is done by either the same surgeon or different surgeons for that particular week. “Off” call is from 7:00pm to 7:00am on weekdays and 5:00pm to 8:00am on Saturday night.
Friday, July 4, 2008
Approved Minutes from May 30th
PACU STAFF MEETING
Friday May 30, 2008 – 0900
Present: Carol Deriet, Ramona Hackett, Delia Muresan, Eric Staines, Cathy Bendayan, Julie King, Clyde Vivares, Vicky Lloyd, Shelley Warwick, Dale Peterson, Hong Ling Wu
Recorder: Joan Munro
Team Leader Role Profile: Carol Deriet distributed copies of the Team Leader role profile to be reviewed by the staff. Carol will put a sheet on the window for everyone to sign after reading the role profile. The Team Leader position will be posted once the schedule has been voted on.
New Schedule: The new schedule will be in effect by September, 2008. According to NAPAN standards, there must be two nurses to recover a patient in PACU which means two nurses must be scheduled for weekends. The workload and acuity of patients has increased over the past year. Having two nurses will provide a safe environment for patients and staff. If PACU is quiet for a period of time, the second PACU nurse should be involved in other duties, i.e. stocking or committee work. Carol Deriet will support these activities, rather than having the second PACU nurse pulled to another area by the shift manager.
TWO MASTER SCHEDULES HAVE BEEN DISTRIBUTED. PLEASE VOTE FOR MASTER #1 OR #2 AND PLACE YOUR BALLOT IN BALLOT BOX AT NURSING STATION.
OPANA: Sunnybrook staff have not been involved with OPANA in recent years, and Carol Deriet encourages PACU staff to become involved. Carol has committed to a poster presentation at the OPANA conference in October. The focus will be development of a hand-over tool to improve communication between departments. Carol welcomes any suggestions or involvement in this SPANC project.
PACU Absenteeism Policy: Copies of the policy were distributed to the staff, and will also be emailed to all staff members, to serve as information for new staff, and a reminder to all staff.
Safety Walkabout: Carol discussed the focus issues of the safety walk-about that was recently conducted. The full report will be emailed to all staff.
Handover of patients from OR to PACU: Action - Carol and Ramona are working on a tool, including questions to ask anaesthesia. The draft will be sent to PACU staff for comments and suggestions.
OR Activity varies from day to day: Action – There are some engineering graduate students working on an OR Calming project, to adjust OR bookings to be more equal from day to day. This will take time to implement, as it will impact doctors’ office hours. Patient Flow staff are more involved with OR and PACU. There is a bed huddle every day at the OR desk at 1330hrs to discuss the following days OR activity and potential bed issues. If M-Ground ORs are not using the SSSU beds, they become available for appropriate M2 patients, but M2 cannot pre-book SSSU beds at this time. The PACU holding area will open next week, Monday to Friday, 1300 – 2100.
Inadequate labeling of narcotics: Action – The PACU nurse will no longer accept narcotics from anaesthesia. Anaesthesia can give the narcotic and document it should the patient require analgesic directly on admission to PACU. If the nurse is to give narcotics, (s)he must draw own medication.
Communication: Action – Ramona posts information on her blog. SPANC opens communication within peri-anesthesia services.
Physician care of critically ill patients in PACU: Action – Carol will be meeting with OR Executive, CrCU physicians and Dr. Keith Rose to establish a policy. In the meantime, CrCU and PACU are working together for the benefit of the patients. Please forward any suggestions to Carol. Meeting is set up for July 10 with OR Management and CrCU management.
Near Misses: Action – There is a new on-line safety report for incidences and near misses. The staff reaction is that the process is long and time consuming and discourages staff from completing reports. Carol will pass this information to Cynthia Bailey.
Intimidating behavior from physicians and other units: Action – All incidents of intimidation or disrespectful attitude should be reported to Carol, who will follow-up with the individuals involved.
Nurse Safety Concerns on M-Ground: The nurses can’t see the patients well, and suggested a change in the configuration of the beds. Julie King will send an email to all staff with proposed new lay-out and ask for feed-back. Carol will investigate implementation of a new bed lay-out.
Friday May 30, 2008 – 0900
Present: Carol Deriet, Ramona Hackett, Delia Muresan, Eric Staines, Cathy Bendayan, Julie King, Clyde Vivares, Vicky Lloyd, Shelley Warwick, Dale Peterson, Hong Ling Wu
Recorder: Joan Munro
Team Leader Role Profile: Carol Deriet distributed copies of the Team Leader role profile to be reviewed by the staff. Carol will put a sheet on the window for everyone to sign after reading the role profile. The Team Leader position will be posted once the schedule has been voted on.
New Schedule: The new schedule will be in effect by September, 2008. According to NAPAN standards, there must be two nurses to recover a patient in PACU which means two nurses must be scheduled for weekends. The workload and acuity of patients has increased over the past year. Having two nurses will provide a safe environment for patients and staff. If PACU is quiet for a period of time, the second PACU nurse should be involved in other duties, i.e. stocking or committee work. Carol Deriet will support these activities, rather than having the second PACU nurse pulled to another area by the shift manager.
TWO MASTER SCHEDULES HAVE BEEN DISTRIBUTED. PLEASE VOTE FOR MASTER #1 OR #2 AND PLACE YOUR BALLOT IN BALLOT BOX AT NURSING STATION.
OPANA: Sunnybrook staff have not been involved with OPANA in recent years, and Carol Deriet encourages PACU staff to become involved. Carol has committed to a poster presentation at the OPANA conference in October. The focus will be development of a hand-over tool to improve communication between departments. Carol welcomes any suggestions or involvement in this SPANC project.
PACU Absenteeism Policy: Copies of the policy were distributed to the staff, and will also be emailed to all staff members, to serve as information for new staff, and a reminder to all staff.
Safety Walkabout: Carol discussed the focus issues of the safety walk-about that was recently conducted. The full report will be emailed to all staff.
Handover of patients from OR to PACU: Action - Carol and Ramona are working on a tool, including questions to ask anaesthesia. The draft will be sent to PACU staff for comments and suggestions.
OR Activity varies from day to day: Action – There are some engineering graduate students working on an OR Calming project, to adjust OR bookings to be more equal from day to day. This will take time to implement, as it will impact doctors’ office hours. Patient Flow staff are more involved with OR and PACU. There is a bed huddle every day at the OR desk at 1330hrs to discuss the following days OR activity and potential bed issues. If M-Ground ORs are not using the SSSU beds, they become available for appropriate M2 patients, but M2 cannot pre-book SSSU beds at this time. The PACU holding area will open next week, Monday to Friday, 1300 – 2100.
Inadequate labeling of narcotics: Action – The PACU nurse will no longer accept narcotics from anaesthesia. Anaesthesia can give the narcotic and document it should the patient require analgesic directly on admission to PACU. If the nurse is to give narcotics, (s)he must draw own medication.
Communication: Action – Ramona posts information on her blog. SPANC opens communication within peri-anesthesia services.
Physician care of critically ill patients in PACU: Action – Carol will be meeting with OR Executive, CrCU physicians and Dr. Keith Rose to establish a policy. In the meantime, CrCU and PACU are working together for the benefit of the patients. Please forward any suggestions to Carol. Meeting is set up for July 10 with OR Management and CrCU management.
Near Misses: Action – There is a new on-line safety report for incidences and near misses. The staff reaction is that the process is long and time consuming and discourages staff from completing reports. Carol will pass this information to Cynthia Bailey.
Intimidating behavior from physicians and other units: Action – All incidents of intimidation or disrespectful attitude should be reported to Carol, who will follow-up with the individuals involved.
Nurse Safety Concerns on M-Ground: The nurses can’t see the patients well, and suggested a change in the configuration of the beds. Julie King will send an email to all staff with proposed new lay-out and ask for feed-back. Carol will investigate implementation of a new bed lay-out.
Good Job!
The following is from a Thank You card received in PACU:
To The Recovery Room
"First off I'm sorry if I have forgot someone, but there are only two names I remember but I know enough people were involved with saving my life. I just wanted to thank you from the bottom of my heart, I was probably a pain in the ass too, so thank youo for putting upn with me. I really remember Betty being there for me and for always's letting me use the swab to wet my mouth, I was just dying of thirst, ha ha. But Thank you very much for putting up with me I am not the nicest person when I'm in that state apparently. You guys deal with that everyday and I admire you for that.
Thank you very much
God Bless,
Conrad P.
Thursday, July 3, 2008
FYI---Biochemistry Update
Hello All,
We are making some process improvements in Biochemistry as a result of new instrumentation. We are happy to report that this will translate to decreased blood collection for some of the routine chemistry tests.
Currently you have been collecting an extra SST (yellow top) tube for Troponin and CK-MB, in addition to any routine chemistry orders that require an SST tube (calcium, liver etc.). On Monday, June 30, 2008 it will no longer be necessary to draw an additional tube for Troponin and CK-MB; these orders will print out on the same label as the other chemistry tests that would require an SST tube.
Please let the nursing staff know that they should pay attention to how many and type of tubes that are required as indicated on the barcode label that prints out after order entry to avoid unnecessary extra tubes being collected. At this point it is only Troponin and CK-MB that is changing, we will keep you updated as further improvements are in the pipeline.
Please let me know if you require further information or clarification.
We are making some process improvements in Biochemistry as a result of new instrumentation. We are happy to report that this will translate to decreased blood collection for some of the routine chemistry tests.
Currently you have been collecting an extra SST (yellow top) tube for Troponin and CK-MB, in addition to any routine chemistry orders that require an SST tube (calcium, liver etc.). On Monday, June 30, 2008 it will no longer be necessary to draw an additional tube for Troponin and CK-MB; these orders will print out on the same label as the other chemistry tests that would require an SST tube.Please let the nursing staff know that they should pay attention to how many and type of tubes that are required as indicated on the barcode label that prints out after order entry to avoid unnecessary extra tubes being collected. At this point it is only Troponin and CK-MB that is changing, we will keep you updated as further improvements are in the pipeline.
Please let me know if you require further information or clarification.
Tammie Taylor MLT
Supervisor Biochemistry Department of Clinical Pathology
Great Work!
By Email (carol.deriet@sunnybrook.ca)
July 3, 2008
Sunnybrook Health Sciences Centre
Short-Stay Unit
Attention: Ms. Carol Deriet
Dear Ms. Deriet:
Re: Recognition of Excellent Care
I was an outpatient at Sunnybrook on July 2, 2008, and would like to express my gratitude to the entire staff of the same day surgery unit. They were at all times caring, attentive, gentle and respectful. Without minimizing everyone's efforts in making my stay as comfortable and stress-free as possible, I do want to emphasize the superlative care provided to me by Kristen Gifford between 7:40 p.m. and 9:00 p.m. that evening.
Ms. Gifford was patient and kind, and even while assisting me with some very intimate tasks, always left me with my sense of dignity intact. She willingly explained the medical reasons behind my physical discomfort, and equally willingly repeated them to my husband. She was at all times empathetic and unhurried in the care she provided. She was a godsend, and I feel very lucky to have landed in her care. I told her how much I appreciated all she did for me, but I would have felt remiss if I did not more officially express my gratitude.
Sincerely,
Elisabeth Colson
July 3, 2008
Sunnybrook Health Sciences Centre
Short-Stay Unit
Attention: Ms. Carol Deriet
Dear Ms. Deriet:
Re: Recognition of Excellent Care
I was an outpatient at Sunnybrook on July 2, 2008, and would like to express my gratitude to the entire staff of the same day surgery unit. They were at all times caring, attentive, gentle and respectful. Without minimizing everyone's efforts in making my stay as comfortable and stress-free as possible, I do want to emphasize the superlative care provided to me by Kristen Gifford between 7:40 p.m. and 9:00 p.m. that evening.
Ms. Gifford was patient and kind, and even while assisting me with some very intimate tasks, always left me with my sense of dignity intact. She willingly explained the medical reasons behind my physical discomfort, and equally willingly repeated them to my husband. She was at all times empathetic and unhurried in the care she provided. She was a godsend, and I feel very lucky to have landed in her care. I told her how much I appreciated all she did for me, but I would have felt remiss if I did not more officially express my gratitude.
Sincerely,
Elisabeth Colson
Tuesday, June 17, 2008
HOW TO STAY YOUNG
We all need to read this one over and over until it becomes part of who we are! 1. Try everything twice. On Madams tombstone (of Whelan's and Madam) she said she wanted this epitaph: Tried everything twice...loved it both times!
2. Keep only cheerful friends.The grouches pull you down. (Keep this in mind if you are one of those grouches)
3. Keep learning: Learn more about the computer, crafts, gardening, whatever. Never let the brain get idle. 'An idle mind is the devil's workshop.' And the devil's name is Alzhei mer's!
4. Enjoy the simple things.
5. Laugh often, long and loud. Laugh until you gasp for breath. And if you have a friend who makes you laugh, spend lots and lots of time with HIM/HER.
6. The tears happen: Endure, grieve, and move on. The only person who is with us our entire life is ourselves. LIVE while you are alive.
7. Surround yourself with what you love: Whether it's family, pets, keepsakes, music, plants, hobbies, whatever. Your home is your refuge.
8. Cherish your health: If it is good, preserve it. If it is unstable, improve it. If it is beyond what you can improve, get help.
9. Don't take guilt trips. Take a trip to the mall, even to the next county, to a foreign country, but NOT to where the guilt is.
10. Tell the people you love that you love them at every opportunity.I love you, my special friend.
11. Forgive now those who made you cry You might not get a second time. But if you have to forgive them more than twice let them go they aren’t worth it.
12. Lost time can never be found.
13. Be kinder than necessary, for everyone you meet is fighting some kind of battle.
Monday, June 16, 2008
OPANA/NAPANc
I am working on an in service for this Friday that will highlight the 2008 1st Edition of the NAPAN Standards. FYI, membership with OPANA automatically entitles you to membership with NAPANc (National Association of PeriAnesthsia Nurses of Canada.)
"NAPAN(c) is a growing volunteer organization of over 800 R.N.'s in 8 jurisdictions with contacts in the remaining provinces and territories. JOIN US as we work together for the bright future of PeriAnesthesia Nursing. Membership in your jurisdiction entitles you to NAPAN(c) membership."
"OntarioOPANA- OPANA's Standards Committee is currently working on a 6th version of their Provincial Standards, which will be in print by the end of 2008! Please watch for this new publication on our website.
Please visit OPANA for more information on upcoming events. The Ontarion rep for NAPAN(c) is Virginia Casey. For those of you who aren’t familiar with OPANA, they are a vast group of nurses spread across a very large province. Their executive consists of their President, President-elect, and Past President as well as their secretary and treasurer. As well there are eight provincial area directors and Advisory Council.
OPANA hosted their 22nd annual conference in Toronto last October 20-21. Our largest conference ever, with an outstanding attendance of 370 PeriAnesthesia Nurses from all over Ontario and as far away as Alberta and Manitoba! Topics included Pandemic Preparation, Anesthesia Care Team and Nursing in the Year 2020.
The conference planning committee is well under way planning another exciting conference for October 18-19, 2008. Watch for the conference updates on our website.
Also, please visit our OPANA Blog and blog on. PeriAnesthesia nurses from across the province have already started to discuss topics, share ideas, policies and practises. JOIN IN !!"
"NAPAN(c) is a growing volunteer organization of over 800 R.N.'s in 8 jurisdictions with contacts in the remaining provinces and territories. JOIN US as we work together for the bright future of PeriAnesthesia Nursing. Membership in your jurisdiction entitles you to NAPAN(c) membership."
"OntarioOPANA- OPANA's Standards Committee is currently working on a 6th version of their Provincial Standards, which will be in print by the end of 2008! Please watch for this new publication on our website.
Please visit OPANA for more information on upcoming events. The Ontarion rep for NAPAN(c) is Virginia Casey. For those of you who aren’t familiar with OPANA, they are a vast group of nurses spread across a very large province. Their executive consists of their President, President-elect, and Past President as well as their secretary and treasurer. As well there are eight provincial area directors and Advisory Council.
OPANA hosted their 22nd annual conference in Toronto last October 20-21. Our largest conference ever, with an outstanding attendance of 370 PeriAnesthesia Nurses from all over Ontario and as far away as Alberta and Manitoba! Topics included Pandemic Preparation, Anesthesia Care Team and Nursing in the Year 2020.
The conference planning committee is well under way planning another exciting conference for October 18-19, 2008. Watch for the conference updates on our website.
Also, please visit our OPANA Blog and blog on. PeriAnesthesia nurses from across the province have already started to discuss topics, share ideas, policies and practises. JOIN IN !!"
Tuesday, June 10, 2008
Odds & Ends
Want to practice your cardiac rhythms? A recommended site from Delia in PACU.
Cathy PACU/SDS also wanted to remind staff that if at all possible to please hide the little round blue wheeled chairs. Last week, we had a near-miss with a visitor who tried to sit down on one and it wheeled away on her. Luckily, she wasn't hurt.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Cathy PACU/SDS also wanted to remind staff that if at all possible to please hide the little round blue wheeled chairs. Last week, we had a near-miss with a visitor who tried to sit down on one and it wheeled away on her. Luckily, she wasn't hurt.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Same Day Surgery, Cardiac Pre-Op Patients
The following information pertains to the CV Surgery Improvement Task Force. Their goal is to drastically reduce the incidence of Surgical Site Infection, most notably Deep Sternal SSI’s, and CABG SSI’s. FYI: Deep Sternal SSI rates for Jan/Feb 2008 was 2.09% (the benchmark is 0.76%) Surgeries are followed up to one year, post-procedure.
FOLLOW UP TO LAST WEEK’S IN SERVICE IN THE NEW CARDIAC SURGERY PRE-OP PROTOCOL
1. The PSP’s are to find out from the RN’s exactly which area to clip. Only patients who are have CABG (Bypass surgery) are required to have their legs and forearms clipped. (They still require that their chest and groins are clipped.) In the new orders, the surgeon will mark specifically which areas he wants clipped.
2. All other CV surgery patients only need their chest and groins clipped.
3. Chests are to be clipped from nipple to nipple, and neck to navel.
4. Position the clipper at a flat to 15 - 30 degree angle on the patient’s skin
5. Stretch the skin taut
6. Clip hair using short strokes against the direction of hair growth
Final skin prep
7. Use medical tape (paper tape) to remove hair clippings from surface of skin
8. Thoroughly cleanse clipped area using appropriate available products
9. Instruct patient to wash the chest area with one or two cloths to get all the hair off, and the groins areas with separate cloths, the legs with separate cloths, and the forearms with separate cloths (if legs and forearms have been clipped.) o
10. These disposable cloths have antiseptic solution on them. Patient is to allow solution to air dry.
PREOPERATIVE HAIR REMOVAL (CLIPPING) CHECKLIST
(From the 3M Learning Package)
REQUIRED SUPPLIES
¨ Charged clipper body
¨ Packaged clipper blade(s)
¨ Gloves
¨ Waste bag
¨ Under pads
¨ Medical tape
PRE-PROCEDURE CHECK
¨ Verify clipping area(s) with nurse
¨ Identify patient
¨ Ensure adequate light and privacy
¨ Uncover only the area to be clipped
¨ Protect bedding with under pads
¨ Put on gloves
CLIPPING PROCEDURE
Prior to clipping
¨ Make sure ON/OFF switch is in OFF position
¨ Attach disposable blade
Clipping process
¨ Switch to ON position
¨ Position the clipper at a flat to 15 - 30 degree angle on the patient’s skin
¨ Stretch the skin taut
¨ Clip hair using short strokes against the direction of hair growth
End of procedure
¨ Turn clipper to OFF position
¨ Remove clipper blade according to manufacturer’s instructions
¨ Clean clipper body and return to charger
Final skin prep
¨ Use medical tape to remove hair clippings from surface of skin
¨ Thoroughly cleanse clipped area using appropriate available products
ADMISSION ORDERS FOR CARDIAC SURGERY PATIENTS
1. These orders are going through their final look at the document committee and it is hoped that they will be passed, and in print by next month. Most of the orders refer to Inpatients from CCU and D6 who are going to surgery, but there are orders that will affect SDS.
2. If patients go through PAC, they will get their usual pre-op blood work and ECG and whatever other tests have been ordered by anesthesia.
3. The new orders for SDS indicated that patients are to rinse and spit with Chlorhexidine gluconate mouthwash 0.12% 10 ml pre-op. It was decided that SDS patients will not be asked to rinse and spit with this mouthwash at home, as they might get it mixed up with their chlorhexidine body wash. Patients are to swish the mouthwash for 20 seconds.
4. It was brought to the attention of the CV Task group that many patients are so strict with their NPO status that they do not even brush their teeth! The group was very surprised, and I think that this is something that we should include with our redesign PAC Patient Education.
5. Please remember that RN’s are responsible for ensuring that pre-op clipping sites are double checked. Two incident reports have been filed from patients having been clipped in the OR. NOTE: The incident report did not indicate where the patient came from pre-operatively.
FOLLOW UP TO LAST WEEK’S IN SERVICE IN THE NEW CARDIAC SURGERY PRE-OP PROTOCOL
1. The PSP’s are to find out from the RN’s exactly which area to clip. Only patients who are have CABG (Bypass surgery) are required to have their legs and forearms clipped. (They still require that their chest and groins are clipped.) In the new orders, the surgeon will mark specifically which areas he wants clipped.
2. All other CV surgery patients only need their chest and groins clipped.
3. Chests are to be clipped from nipple to nipple, and neck to navel.
4. Position the clipper at a flat to 15 - 30 degree angle on the patient’s skin
5. Stretch the skin taut
6. Clip hair using short strokes against the direction of hair growth
Final skin prep
7. Use medical tape (paper tape) to remove hair clippings from surface of skin
8. Thoroughly cleanse clipped area using appropriate available products
9. Instruct patient to wash the chest area with one or two cloths to get all the hair off, and the groins areas with separate cloths, the legs with separate cloths, and the forearms with separate cloths (if legs and forearms have been clipped.) o
10. These disposable cloths have antiseptic solution on them. Patient is to allow solution to air dry.
PREOPERATIVE HAIR REMOVAL (CLIPPING) CHECKLIST
(From the 3M Learning Package)
REQUIRED SUPPLIES
¨ Charged clipper body
¨ Packaged clipper blade(s)
¨ Gloves
¨ Waste bag
¨ Under pads
¨ Medical tape
PRE-PROCEDURE CHECK
¨ Verify clipping area(s) with nurse
¨ Identify patient
¨ Ensure adequate light and privacy
¨ Uncover only the area to be clipped
¨ Protect bedding with under pads
¨ Put on gloves
CLIPPING PROCEDURE
Prior to clipping
¨ Make sure ON/OFF switch is in OFF position
¨ Attach disposable blade
Clipping process
¨ Switch to ON position
¨ Position the clipper at a flat to 15 - 30 degree angle on the patient’s skin
¨ Stretch the skin taut
¨ Clip hair using short strokes against the direction of hair growth
End of procedure
¨ Turn clipper to OFF position
¨ Remove clipper blade according to manufacturer’s instructions
¨ Clean clipper body and return to charger
Final skin prep
¨ Use medical tape to remove hair clippings from surface of skin
¨ Thoroughly cleanse clipped area using appropriate available products
ADMISSION ORDERS FOR CARDIAC SURGERY PATIENTS
1. These orders are going through their final look at the document committee and it is hoped that they will be passed, and in print by next month. Most of the orders refer to Inpatients from CCU and D6 who are going to surgery, but there are orders that will affect SDS.
2. If patients go through PAC, they will get their usual pre-op blood work and ECG and whatever other tests have been ordered by anesthesia.
3. The new orders for SDS indicated that patients are to rinse and spit with Chlorhexidine gluconate mouthwash 0.12% 10 ml pre-op. It was decided that SDS patients will not be asked to rinse and spit with this mouthwash at home, as they might get it mixed up with their chlorhexidine body wash. Patients are to swish the mouthwash for 20 seconds.
4. It was brought to the attention of the CV Task group that many patients are so strict with their NPO status that they do not even brush their teeth! The group was very surprised, and I think that this is something that we should include with our redesign PAC Patient Education.
5. Please remember that RN’s are responsible for ensuring that pre-op clipping sites are double checked. Two incident reports have been filed from patients having been clipped in the OR. NOTE: The incident report did not indicate where the patient came from pre-operatively.
Thursday, June 5, 2008
Great Work!
It's never too late to post a letter of appreciation! This one was sent to Dr. Barry McClellan and is dated April 9, 2008.
"Dear Dr. McClellan,
I would like to take this opportunity to share my very positive experience that I recently had with Sunnybrook and Dr. Marks in connection with my ACL replacement surgery. It was my first time to have surgery or any medical porcedure 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 my 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 proviced to me.
Your Truly,
Mr. C."
Wednesday, June 4, 2008
Interested in Cardiac Care Nursing????
Would you like to learn more about:
v Coronary Artery Disease?
v Dysrhthmia interpretation?
v Hemodynamics?
v Acute Coronary Syndromes?
v Incorporating research and best practice into nursing care?
Why not register for the George Brown College - Cardiology Nursing I
Course Code NURS 9064?
http://coned.georgebrown.ca/owa_prod/cewskcrss.P_CrseGet?subj_code=NURS&crse_numb=9064
Where: Onsite at the Sunnybrook campus
When: classes are held 1 day/week
v 6 hrs each day for total of 36 hours
v Start mid July – end August
For more information contact:
Danielle Herold- APN – Acute Care Nursing Resource TeamExt: 89688 or Danielle.herold@sunnybrook.ca
v Coronary Artery Disease?
v Dysrhthmia interpretation?
v Hemodynamics?
v Acute Coronary Syndromes?
v Incorporating research and best practice into nursing care?
Why not register for the George Brown College - Cardiology Nursing I
Course Code NURS 9064?
http://coned.georgebrown.ca/owa_prod/cewskcrss.P_CrseGet?subj_code=NURS&crse_numb=9064
Where: Onsite at the Sunnybrook campus
When: classes are held 1 day/week
v 6 hrs each day for total of 36 hours
v Start mid July – end August
For more information contact:
Danielle Herold- APN – Acute Care Nursing Resource TeamExt: 89688 or Danielle.herold@sunnybrook.ca
Journal of the Month
The Journal of the Month has really worked out to be a 'Journal of the Season' however, this may be an article that can actually help us out. Let me know what you think. It is from the Joint Commision Journal on Quality and Patient Safety, and is about the SBAR tool.
Check it out HERE!
ARTICLE AT A GLANCE
Background: The importance of sharing a common
mental model in communication prompted efforts to
spread the use of the SBAR (Situation, Background,
Assessment, and Recommendation) tool at OSF St.
Joseph Medical Center, Bloomington, Illinois.
Case Study: An elderly patient was on warfarin sodium
(Coumadin) 2.5 mg daily. The nurse received a call
from the lab regarding an elevated international normalized
ratio (INR) but did not write down the results
(she was providing care to another patient). On the
basis of the previous lab cumulative summary, the
physician increased the warfarin dose for the patient; a
dangerously high INR resulted.
Actions Taken: The medical center initiated a collaborative
to implement the use of the SBAR communication
tool. Education was incorporated into team
resource management training and general orientation.
Tools included SBAR pocket cards for clinicians and
laminated SBAR “cheat sheets” posted at each phone.
SBAR became the communication methodology from
leadership to the microsystem in all forms of reporting.
Discussion: Staff adapted quickly to the use of SBAR,
although hesitancy was noted in providing the “recommendation”
to physicians. Medical staff were encouraged
to listen for the SBAR components and encourage staff to
share their recommendation if not initially provided.
Check it out HERE!
ARTICLE AT A GLANCE
Background: The importance of sharing a common
mental model in communication prompted efforts to
spread the use of the SBAR (Situation, Background,
Assessment, and Recommendation) tool at OSF St.
Joseph Medical Center, Bloomington, Illinois.
Case Study: An elderly patient was on warfarin sodium
(Coumadin) 2.5 mg daily. The nurse received a call
from the lab regarding an elevated international normalized
ratio (INR) but did not write down the results
(she was providing care to another patient). On the
basis of the previous lab cumulative summary, the
physician increased the warfarin dose for the patient; a
dangerously high INR resulted.
Actions Taken: The medical center initiated a collaborative
to implement the use of the SBAR communication
tool. Education was incorporated into team
resource management training and general orientation.
Tools included SBAR pocket cards for clinicians and
laminated SBAR “cheat sheets” posted at each phone.
SBAR became the communication methodology from
leadership to the microsystem in all forms of reporting.
Discussion: Staff adapted quickly to the use of SBAR,
although hesitancy was noted in providing the “recommendation”
to physicians. Medical staff were encouraged
to listen for the SBAR components and encourage staff to
share their recommendation if not initially provided.
Friday, May 30, 2008
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!
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!
Wednesday, May 28, 2008
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.
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.
Monday, May 26, 2008
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!
Thursday, May 22, 2008
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. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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."
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))."
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!
Wednesday, May 21, 2008
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.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
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
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Thursday, May 15, 2008
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
Wednesday, May 14, 2008
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
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
Tuesday, May 13, 2008
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.
Monday, May 12, 2008
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.
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!
*******************************************
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.
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
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
*****************************************
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.
*********************************************
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!
Wednesday, April 23, 2008
Earth Week (Should be Every Week!)
Visit the Earth Day Canada website at http://www.earthday.ca/pub/index.php for a list of Earth Week events in your area that you and your family can participate in. ~Bring a ‘litter-less’ lunch to work all week (no plastic or foil wrap). Continue this practice beyond Earth Week. This includes bringing reusable mugs when buying coffee and other refreshments at the coffee counters. Tim Horton’s and Second Cup offer discounts to those using their own mugs!
Impact
· Reduce your waste – In a lifetime, the average North American throws away 600 times his/her adult weight in garbage.
~ Always turn taps off tightly at work and at home.
~ At home and at work, develop the habit of defrosting frozen food in the fridge overnight instead of running water.
Impact
· Conserve water –A faucet that drips one drop per second wastes nearly 12,000 litres of water per year.
· Check for leaks in your toilets at home – a leaking toilet can waste up to 400,000 litres of water or about $730 per year.
~Avoid printing paper – try to use email instead of paper copies whenever possible. If necessary, use double-sided photocopying or printing.
~Install low-flow aerators on your faucets at home. (Aerators are small fixtures added to the water stream, reducing water flow while keeping the same pressure. Very easy to install and cost is under $10)
Impact
· Approximately 80% of office waste is paper and of that, 70% is not recycled.
· Low-flow aerators can reduce the water usage of faucets by as much as 40% from 4 gallons per minute to 2.5.
~Take public transit, ride a bike, walk or carpool with friends and co-workers to work
Install energy efficient compact fluorescent lights (CFL) at home.
~Recycle old computers and computer equipment for FREE (during Earth Week) by dropping it off at Computation – located at 280 Jane Street, between the hours of 10am and 7pm.
http://www.computation.to/recyclingEvent.html
Impact
· One city bus eliminates the emissions of 40 cars.
· Save money and use less energy - A single 18 watt CFL used instead of a 75 watt incandescent
will save about 570 kWh over its lifetime – that’s $45 in savings (at 8 cents per kWh).
~At home and at work, always turn off lights, printers, faxes, computers, etc. when they aren’t in use. At home? Unplug all electronic devices when not in use (e.g. toaster, kettle, blender, coffeemaker, battery charger, etc.). OR: You can plug your electronics into a power bar that can easily be switched off.
Impact
· Electronic devices still draw power even when they are turned off. This is called standby power.
· Over a year, electronic devices at home can draw enough standby power to run a refrigerator for a month. (who knew?!)
~In the GTA? Bring your family and friends to the Annual Trees across Toronto city-wide planting event from 10am – 12pm. Locations can be found at this website: http://www.toronto.ca/parks/treeadvocacy.htm
Impact
· Trees help reduce the effects of global warming by absorbing carbon dioxide.
· A single mature tree can absorb 48 lbs of carbon dioxide per year and release enough oxygen to support two human beings.
Tuesday, April 22, 2008
Dipute Regarding Medical Care Plans
This policy was forwarded to me today, and I thought it might be useful to know where to find it. It might come in handy when working shift or weekends?! Just to let everyone know that the attached policy was uploaded to the intranet on March 18, 2008.
Policy #: I-D-2550 can be found in the Patient Care manual, under Section I: Policies and under the sub-heading “Disputes” (Please note, that Sunnybrook P&P's can only be accessed on Sunnybrook computers.)
Policy #: I-D-2550 can be found in the Patient Care manual, under Section I: Policies and under the sub-heading “Disputes” (Please note, that Sunnybrook P&P's can only be accessed on Sunnybrook computers.)
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