Tuesday, February 23, 2010
SAQ #15
HOW DOES THE TEAM IDENTIFY, REPORT, AND MANAGE INFECTIONS? YELLOW, HIGH
Summary of Related Standard(s) 9.1 The organization has a process to detect suspected healthcare-associated infections 9.2 The process identifies who is responsible and what the reporting relationships are for infection prevention and control issues. 9.4 The organization has policies and procedures to contain and prevent the spread of infectious agents, including ventilation, isolation and other precautions, and cohorting as necessary.
Process Currently in Place - Evidence of Current Status
• ARO & respiratory screening is done in PAC. PAC follows isolation precautions if pt is known MRSA
• Results are followed up, the OR is informed, it is noted on OR schedule. EPR is checked the night before by the PAA in SDS and PACU to double check ARO status of all patients
• Isolation precautions are followed as soon as a patient is admitted to SDS pre-operatively and information is communicated on the handover tool
• Isolation precautions are followed post-operatively in PACU, SDS. At this time, MRSA and Isolated patients do not meet the admission criteria for the SSSU, as per IPAC the curtains no longer meet isolation criteria after 12 hours
• On-line P&P IP&C standards are followed
• If there is a break in communication, or a pt has not been identified in a timely manner, an e-safety report is filed and IP&C is informed immediately.
• Pt with identified isolation precautions will only be admitted to an isolation room once transferred out of PACU
· the bed management system will flag ARO's
· -manager and educator attend monthly Gen surg and Cardiac SSI meetings and relay information back to staff. Inservices have been held regarding pre-warming Gen surg patients in SDS, and correct clipping method for cardiac patients, as well as mouth care.
· All Patients are instructed by PAC to take chlorhexidine showers for 3 days prior to their surgical date
· Braden Skin Risk documentation is started in PAC
· Mandatory Hand Hygiene classes for all staff. ABHR strategically located and signs posted to encourage staff and visitors to comply with HH.
· all staff required to be N95 fit-tested q 2 yrs, as well, are req'd to pass IPAC PPE class q2
· Self surveillance for ARO: healthy workplace environment promoted.
· Flu clinics also available yearly by Occ Health
· Visitors are also requested to abstain from visiting if they are unwell. 1 visitor per patient is encouraged: visitor policy in effect.
· No food or drink at bedside, for staff and visitors.
· no hand or wrist jewelry when providing direct patient care
Improvement Strategy / Action Plan
July 2009-October 2009
1.PeriAnesthesia Handover Tool being utilized well.
2. IPAC RN's have attended staff meetings and education days to assist with education regarding PPE and HH
November 2009 - February 2010
1. Currently there are some MRSA in-patients who go to the OR, and then isolation requirements are not relayed to the PACU staff. The BMS is being introduced Nov 17 this will identify ARO flags. There are identified super users in each unit who will help the other staff learn the system
2. Hospital committee on Transfer of Accountability working on standardized SBAR tool between units. This will help also help identify ARO positive patients. TOA to be rolled out in January 2010.
3. Braden Skin Risk documentation needs to be completed in PACU will require inservicing on the importance of this tool
March 2010 - onward
1. Reassess to see if the BMS is identifying all ARO patients
2. Reassess to see how the TOA guide is working at identifying ARO pts at handover
3. Reassess to see if PACU is completing the BSR doc
SAQ #14
DOES THE TEAM EDUCATE CLIENTS AND FAMILIES ABOUT PREVENTING INFECTIONS? GREEN, HIGH
Summary of Related Standard(s) 7.1 The organization provides clients and families with information and education about preventing infections .7.2 The information and education provided to clients and families about IPAC covers hand hygiene and respiratory etiquette 7.3 Information provided to clients and families is documented in the client record.7.4 Families and visitors have access to hand hygiene resources and personal protective equipment if necessary.7.5 Staff, service providers, and volunteers encourage clients, families, and visitors to follow effective hand hygiene behaviour.
Process Currently in Place - Evidence of Current Status
• PAC provides chlorhexidine soap to pts with pre-op instructions.
• Staff educates families and patients on HH and PPE when needed
• Hand hygiene posters and sanitizer available at POC and upon entrance to hospital and units
Improvement Strategy / Action Plan
Reassess in June
Summary of Related Standard(s) 7.1 The organization provides clients and families with information and education about preventing infections .7.2 The information and education provided to clients and families about IPAC covers hand hygiene and respiratory etiquette 7.3 Information provided to clients and families is documented in the client record.7.4 Families and visitors have access to hand hygiene resources and personal protective equipment if necessary.7.5 Staff, service providers, and volunteers encourage clients, families, and visitors to follow effective hand hygiene behaviour.
Process Currently in Place - Evidence of Current Status
• PAC provides chlorhexidine soap to pts with pre-op instructions.
• Staff educates families and patients on HH and PPE when needed
• Hand hygiene posters and sanitizer available at POC and upon entrance to hospital and units
Improvement Strategy / Action Plan
Reassess in June
SAQ #13
DOES THE TEAM EDUCATE CLIENTS AND FAMILIES ABOUT THEIR ROLE IN PROMOTING SAFETY? YELLOW, HIGH
Summary of Related Standard(s) 15.3 REQUIRED ORGANIZATIONAL PRACTICE: The team educates its clients and families in writing/verbally about the client and family’s role in promoting safety.
Process Currently in Place - Evidence of Current Status
• There is a patient handbook available in PAC
• Patients and families are given verbal information regarding Hand Hygiene and PPE
• Written materials complements verbal information regarding discharge instructions
• Availability of a responsible adult to drive a patient home and care for the pt for the first post-op night is a condition of discharge from OPP. Pt’s sign an agreement, this is for their safety.
• Patients and their family and friends are instructed that the patient should be the only person pushing the PCA button
Improvement Strategy / Action Plan
Nov-Feb
1. Signs on doors to SDS indicating no food or drinks
2. ABHR on walls at every entrance, as well as notices regarding signs and symptoms of flu
SAQ #12
HOW DOES THE TEAM HANDLE SENTINEL EVENTS, NEAR MISSES, AND ADVERSE EVENTS? YELLOW, HIGH
Summary of Related Standard(s) 15.5 The team identifies, reports, records, and monitors sentinel events, near misses, and adverse events.15.6 The team follows the organization’s policy and process to disclose adverse events to clients and families.
Process Currently in Place - Evidence of Current Status
• E-safety reports
• No blame culture encourages staff to file reports
• Quality and Risk Management will f/u with patient/family for an adverse/sentinel event
• Staff debriefing sessions after adverse events
• Development of the PeriAnesthesia Handover tool
Improvement Strategy / Action Plan
Reassess in June
Summary of Related Standard(s) 15.5 The team identifies, reports, records, and monitors sentinel events, near misses, and adverse events.15.6 The team follows the organization’s policy and process to disclose adverse events to clients and families.
Process Currently in Place - Evidence of Current Status
• E-safety reports
• No blame culture encourages staff to file reports
• Quality and Risk Management will f/u with patient/family for an adverse/sentinel event
• Staff debriefing sessions after adverse events
• Development of the PeriAnesthesia Handover tool
Improvement Strategy / Action Plan
Reassess in June
SAQ #11
HOW ARE MEDICATION ERRORS AND INCIDENTS HANDLED BY THE TEAM? YELLOW, HIGH
Summary of Related Standard(s) 10.7 The team documents all incidents involving medications, and uses this information to make improvements.
Process Currently in Place - Evidence of Current Status
• E-safety reports are filed as soon as possible for near misses and adverse events. They are also trended.
• MD informed if necessary
• No blame policy
Improvement Strategy / Action Plan
E-safety reporting changes were relayed to staff.
The changes should make the reporting more user-friendly.
Monday, February 1, 2010
SAQ#10
HOW ARE MEDICATIONS MANAGED IN THE SURGICAL CARE AREA? GREEN, HIGH
Summary of Related Standard(s) 10.1 The team identifies who is responsible for prescribing/storing/handling/and disposing of medications, as well as recording medication information in the client record.10.6 The team follows the organization’s policies on storing/ disposing of medications safely and securely.10.2 Before dispensing medication, a qualified team member reviews each prescription for completeness/accuracy.10.3 A qualified team member fills the prescription and dispenses the medication in a timely/accurate way.10.4 The team responds to requests for medication and medication information after hours and in emergencies.10.5 The team has a process to evaluate client requests to bring in or self-administer their own medication.
Process Currently in Place - Evidence of Current Status
• N/A in PAC, other than Patient Medication Record and Allergy record initiated
• PACU, SDS and SSSU follow specific pre and post op orders
• College Of Nurses standards of practice guidelines are followed
• Night cupboard is available to access necessary medications
• Medication fridges
• Narcotic cupboard with regular scheduled counts
• McKessin narcotic cart will be implemented in near future
• Regular stocked drugs in all areas dependant on the need
• Emergency medication trays available on arrest cart
• Designated pharmacist
• Independent Double check for heparin and insulin, PCA's and Epidurals
Improvement Strategy / Action Plan
Jan 2010-March2010
1. McKessin cabinets now implemented and staff using them as narcotic cupboard
2. symbiq pumps implemented in all areas infusing medications
Summary of Related Standard(s) 10.1 The team identifies who is responsible for prescribing/storing/handling/and disposing of medications, as well as recording medication information in the client record.10.6 The team follows the organization’s policies on storing/ disposing of medications safely and securely.10.2 Before dispensing medication, a qualified team member reviews each prescription for completeness/accuracy.10.3 A qualified team member fills the prescription and dispenses the medication in a timely/accurate way.10.4 The team responds to requests for medication and medication information after hours and in emergencies.10.5 The team has a process to evaluate client requests to bring in or self-administer their own medication.
Process Currently in Place - Evidence of Current Status
• N/A in PAC, other than Patient Medication Record and Allergy record initiated
• PACU, SDS and SSSU follow specific pre and post op orders
• College Of Nurses standards of practice guidelines are followed
• Night cupboard is available to access necessary medications
• Medication fridges
• Narcotic cupboard with regular scheduled counts
• McKessin narcotic cart will be implemented in near future
• Regular stocked drugs in all areas dependant on the need
• Emergency medication trays available on arrest cart
• Designated pharmacist
• Independent Double check for heparin and insulin, PCA's and Epidurals
Improvement Strategy / Action Plan
Jan 2010-March2010
1. McKessin cabinets now implemented and staff using them as narcotic cupboard
2. symbiq pumps implemented in all areas infusing medications
SAQ#9
IS HAND HYGIENE IMPORTANT TO THE TEAM? GREEN, HIGH
Summary of Related Standard(s) 6.1 REQUIRED ORGANIZATIONAL PRACTICE: The organization delivers education and training for staff/service providers/and volunteers on hand hygiene.6.4 The organization’s staff, service providers and volunteers have access to alcohol-based hand rubs at the point-of-care and service delivery.6.5 REQUIRED ORGANIZATIONAL PRACTICE: The organization evaluates compliance with hand hygiene practices.
Process Currently in Place - Evidence of Current Status
• HH session on PEP day May 8th with goal to achieve 100% compliance
• Hand hygiene audits have been done by IP&C
• HH e-learning module
• Waterless, alcohol based hand rub at every unit entrance, work station, bedside. POC
• HH posters at strategic locations
• P&P on intranet
Improvement Strategy / Action Plan
July 2009-ongoing
1. ongoing auditing by OHS
2. staff awareness of compliance percentages
Summary of Related Standard(s) 6.1 REQUIRED ORGANIZATIONAL PRACTICE: The organization delivers education and training for staff/service providers/and volunteers on hand hygiene.6.4 The organization’s staff, service providers and volunteers have access to alcohol-based hand rubs at the point-of-care and service delivery.6.5 REQUIRED ORGANIZATIONAL PRACTICE: The organization evaluates compliance with hand hygiene practices.
Process Currently in Place - Evidence of Current Status
• HH session on PEP day May 8th with goal to achieve 100% compliance
• Hand hygiene audits have been done by IP&C
• HH e-learning module
• Waterless, alcohol based hand rub at every unit entrance, work station, bedside. POC
• HH posters at strategic locations
• P&P on intranet
Improvement Strategy / Action Plan
July 2009-ongoing
1. ongoing auditing by OHS
2. staff awareness of compliance percentages
SAQ#8
IS THERE A TEAM FOCUS ON IMPROVING SAFETY? YELLOW, HIGH
Summary of Related Standard(s) 15.1 The team is trained to identify, reduce, and manage safety risks 15.2 Staff and service providers participate in regular safety briefings to share information about potential safety problems, reduce the risk of error, and improve the quality of service
Process Currently in Place - Evidence of Current Status
• Safety Walkabouts done by senior leadership identify key issues to be addressed in PACU and SDS
• E-safety reporting: trends are shared with staff
• Inservices regarding issues and practices (also posted on Blog)
• WHIMS and Fire Safety
• Code Orange simulation exercise and pandemic planning
• E-learning modules
Improvement Strategy / Action Plan
Nov 2009-ongoing: review in February
1. Shelly and Dale represent PACU Safety Committee
2. Stania and Pam have volunteered to be Mground Reps for Safety committee
Summary of Related Standard(s) 15.1 The team is trained to identify, reduce, and manage safety risks 15.2 Staff and service providers participate in regular safety briefings to share information about potential safety problems, reduce the risk of error, and improve the quality of service
Process Currently in Place - Evidence of Current Status
• Safety Walkabouts done by senior leadership identify key issues to be addressed in PACU and SDS
• E-safety reporting: trends are shared with staff
• Inservices regarding issues and practices (also posted on Blog)
• WHIMS and Fire Safety
• Code Orange simulation exercise and pandemic planning
• E-learning modules
Improvement Strategy / Action Plan
Nov 2009-ongoing: review in February
1. Shelly and Dale represent PACU Safety Committee
2. Stania and Pam have volunteered to be Mground Reps for Safety committee
SAQ#7
HOW DOES THE TEAM CARE FOR THE CLIENT FOLLOWING THE PROCEDURE? GREEN, HIGH
Summary of Related Standard(s) 9.1 One or more designated team members observe the client during the transfer from the operating room to the Post-Anesthesia Care Unit (PACU).9.2 the team continues to monitor and provide bedside care to clients as they recover from anaesthetic.9.3 the team applies standardized criteria when determining whether a client is fit for discharge
Process Currently in Place - Evidence of Current Status
• Anesthesiologist and OR nurse transfer patient from the OR to PACU and report is received from Anesthesiologist
• PACU staff have critical care training and in-depth orientation to the PACU patient
• A new handover tool provides a concise and comprehensive report about the client’s surgical journey. This includes PAC/SDS med-surg history, operation and highlights and a PACU report to phase 2 recovery areas
• Verbal report PRN
• Opthalmology patients return direct to SDS post-op, if there are concerns, report is given by Anesthesia Assistant or the OR nurse.
• Emergency and crash cart available
• PACU staffed 1:2 nurse: patient ration unless patient requirement dictates otherwise ie: critical care vented pt, isolated patient
• SDS staffed 1:3-5 nurse: patient ratio as per OPANA guidelines
• Aldrete scoring system is utilized and part of the PACU discharge policy
• PADDS scoring system is part of the SDS policy
• Pain number scoring system is used throughout PeriAnesthesia departments
• PONV reported in documentation and on Handover. Pain flow sheet has an algorithm in dealing with this issue for patients on PCA/Epidural infusions
Improvement Strategy / Action Plan
Nov 2009-June 2010
1. Ophthalmology task force
2. Develop care pathways for SDS and SSSU for newer procedures
Summary of Related Standard(s) 9.1 One or more designated team members observe the client during the transfer from the operating room to the Post-Anesthesia Care Unit (PACU).9.2 the team continues to monitor and provide bedside care to clients as they recover from anaesthetic.9.3 the team applies standardized criteria when determining whether a client is fit for discharge
Process Currently in Place - Evidence of Current Status
• Anesthesiologist and OR nurse transfer patient from the OR to PACU and report is received from Anesthesiologist
• PACU staff have critical care training and in-depth orientation to the PACU patient
• A new handover tool provides a concise and comprehensive report about the client’s surgical journey. This includes PAC/SDS med-surg history, operation and highlights and a PACU report to phase 2 recovery areas
• Verbal report PRN
• Opthalmology patients return direct to SDS post-op, if there are concerns, report is given by Anesthesia Assistant or the OR nurse.
• Emergency and crash cart available
• PACU staffed 1:2 nurse: patient ration unless patient requirement dictates otherwise ie: critical care vented pt, isolated patient
• SDS staffed 1:3-5 nurse: patient ratio as per OPANA guidelines
• Aldrete scoring system is utilized and part of the PACU discharge policy
• PADDS scoring system is part of the SDS policy
• Pain number scoring system is used throughout PeriAnesthesia departments
• PONV reported in documentation and on Handover. Pain flow sheet has an algorithm in dealing with this issue for patients on PCA/Epidural infusions
Improvement Strategy / Action Plan
Nov 2009-June 2010
1. Ophthalmology task force
2. Develop care pathways for SDS and SSSU for newer procedures
SAQ #6
DOES THE TEAM RECONCILE THE CLIENT’S MEDICATIONS AT TRANSITION OR END OF SERVICE? YELLOW, HIGH
Summary of Related Standard(s): 11.4 REQUIRED ORGANIZATIONAL PRACTICE: The team reconciles medications with the client at referral or transfer, and communicates information about the client’s medications to the next provider of service within or outside the organization.
Process Currently in Place - Evidence of Current Status
• Reconciliation in PAC on 'Medication Record'
• Pamphlet instructs patient to bring meds in pre-op
-in SDS pre-op the pt is asked if there has been any changes in their meds since their PAC appt, and also which meds they took on the morning of their surgery date
-medications are also listed by the pt on the anesthetic questionnaire
• OPP and SSSU patients are instructed on use of newly ordered meds and when to resume pre- op meds and pt's are sent home with a prescription
· PACU checks post-op surgeons orders
Improvement Strategy / Action Plan
Nov 2009-Feb 2010
1. PACU to complete MAR for patients staying overnight
Summary of Related Standard(s): 11.4 REQUIRED ORGANIZATIONAL PRACTICE: The team reconciles medications with the client at referral or transfer, and communicates information about the client’s medications to the next provider of service within or outside the organization.
Process Currently in Place - Evidence of Current Status
• Reconciliation in PAC on 'Medication Record'
• Pamphlet instructs patient to bring meds in pre-op
-in SDS pre-op the pt is asked if there has been any changes in their meds since their PAC appt, and also which meds they took on the morning of their surgery date
-medications are also listed by the pt on the anesthetic questionnaire
• OPP and SSSU patients are instructed on use of newly ordered meds and when to resume pre- op meds and pt's are sent home with a prescription
· PACU checks post-op surgeons orders
Improvement Strategy / Action Plan
Nov 2009-Feb 2010
1. PACU to complete MAR for patients staying overnight
SAQ #5
DOES THE ANAESTHETIST CONDUCT A PRE-ANAESTHETIC ASSESSMENT? YELLOW, HIGH
Summary of Related Standard(s) 7.12 the anaesthetist conducts a pre-anaesthetic assessment prior to the commencement of the procedure.
Process Currently in Place - Evidence of Current Status
· In PAC patients are triaged by the nurse into appointment type. Ie: telephone consult by nurse, PAC appt with nurse, PAC appt with nurse and GP, PAC appt with nurse and anesthetist
· Pre-op, anesthesia does an assessment in the OR holding area/induction room/Block area
· In -patients who are having surgery are s/b the anesthesia resident on-call the night before
· in the ED, pt's are assessed by anesthesia if surgery is required.
Improvement Strategy / Action Plan
July 2009-October 2009
Due to the Schulich construction, holding area no longer available pre-op, however anesthesia still conducting pre-anesthetic assessment outside OR room Reassess process in February
Jan 2010-March2010
Implementation of Surgical Safety Checklist includes anesthesiologists involvement
Summary of Related Standard(s) 7.12 the anaesthetist conducts a pre-anaesthetic assessment prior to the commencement of the procedure.
Process Currently in Place - Evidence of Current Status
· In PAC patients are triaged by the nurse into appointment type. Ie: telephone consult by nurse, PAC appt with nurse, PAC appt with nurse and GP, PAC appt with nurse and anesthetist
· Pre-op, anesthesia does an assessment in the OR holding area/induction room/Block area
· In -patients who are having surgery are s/b the anesthesia resident on-call the night before
· in the ED, pt's are assessed by anesthesia if surgery is required.
Improvement Strategy / Action Plan
July 2009-October 2009
Due to the Schulich construction, holding area no longer available pre-op, however anesthesia still conducting pre-anesthetic assessment outside OR room Reassess process in February
Jan 2010-March2010
Implementation of Surgical Safety Checklist includes anesthesiologists involvement
SAQ #4
WHAT INFORMATION IS USED TO DECIDE ON THE RANGE OF THE TEAM’S SERVICES? GREEN, LOW
Summary of Related Standard(s):
1.1 The team collects information about its clients and the community.
1.3 The team’s scope of services is aligned with the organization’s strategic direction.
1.5 The team regularly reviews its services and makes changes as needed.
Process Currently in Place - Evidence of Current Status
• Historical utilization reports from Canadian Institute for Health Information
• WTS (Wait Time Strategy)
• Service specific information-clients are from specific internal programmes ie: Schulich, oncology, opthalmology, gyne, plastics, trauma, medical imaging
• CCAC, PT/OT, nursing arrangements in PAC/SSSU-for clients who need additional support in the community
• PAC redesign project
• New SSSU, and ongoing expansion of its’ services from 6-8 beds
Improvement Strategy / Action Plan
1. Develop PAC policy (Carol, Ramona, Pam)
2. Develop nurse/telephone process (Pam, Ramona)
3. Update SSSU policy (Carol, Ramona)
4. Expansion of SSSU to 11 beds (Carol, SSSU staff)
Summary of Related Standard(s):
1.1 The team collects information about its clients and the community.
1.3 The team’s scope of services is aligned with the organization’s strategic direction.
1.5 The team regularly reviews its services and makes changes as needed.
Process Currently in Place - Evidence of Current Status
• Historical utilization reports from Canadian Institute for Health Information
• WTS (Wait Time Strategy)
• Service specific information-clients are from specific internal programmes ie: Schulich, oncology, opthalmology, gyne, plastics, trauma, medical imaging
• CCAC, PT/OT, nursing arrangements in PAC/SSSU-for clients who need additional support in the community
• PAC redesign project
• New SSSU, and ongoing expansion of its’ services from 6-8 beds
Improvement Strategy / Action Plan
1. Develop PAC policy (Carol, Ramona, Pam)
2. Develop nurse/telephone process (Pam, Ramona)
3. Update SSSU policy (Carol, Ramona)
4. Expansion of SSSU to 11 beds (Carol, SSSU staff)
SAQ #3
DOES THE TEAM ASSESS THE CLIENT’S MEDICATIONS AT ADMISSION? GREEN FLAG, HIGH PRIORITY
Summary of Related Standard(s): 7.10 7.11 REQUIRED ORGANIZATIONAL PRACTICE: The team reconciles the client’s medications upon admission to the organization, with the involvement of the client.
Process Currently in Place - Evidence of Current Status
• Patients are instructed to bring their medications to PAC and SDS with them in their original containers
• Patients have written instructions in ‘Day of Surgery’ booklet on which medications to take on the morning of surgery
• Medications are listed on the anesthetic questionnaire
• Transcribed by RN onto Patient Medication Form and checked for accuracy with patients.
Improvement Strategy / Action Plan
November 2009 - February 2010
1. Same Day Surgery PAC : are they able to reconcile pt's medication on inpatient medication record document? Does one need to be developed for outpatients?'
Summary of Related Standard(s): 7.10 7.11 REQUIRED ORGANIZATIONAL PRACTICE: The team reconciles the client’s medications upon admission to the organization, with the involvement of the client.
Process Currently in Place - Evidence of Current Status
• Patients are instructed to bring their medications to PAC and SDS with them in their original containers
• Patients have written instructions in ‘Day of Surgery’ booklet on which medications to take on the morning of surgery
• Medications are listed on the anesthetic questionnaire
• Transcribed by RN onto Patient Medication Form and checked for accuracy with patients.
Improvement Strategy / Action Plan
November 2009 - February 2010
1. Same Day Surgery PAC : are they able to reconcile pt's medication on inpatient medication record document? Does one need to be developed for outpatients?'
SAQ #2
BEFORE PROVIDING SERVICES, IS THE CLIENT’S INFORMED CONSENT OBTAINED? GREEN FLAG, HIGH PRIORITY
Summary of Related Standard(s) 8.1, 8.2, 8.3, 8.4, 8.6
Process Currently in Place - Evidence of Current Status
· Surgeon obtains informed consent in the office. The original consent is placed in the chart at end of PAC appointment
· Verified on Day of Surgery and also during the PAC appointment
· APPLE PIE and TIME OUT done by OR staff includes anesthesia
Improvement Strategy / Action Plan
November 2009 - February 2010
1. Surgical checklist
2. Block checklist being implemented in Regional block area
Communication / Staff Training / Education Plan
· Delia participated in Grand Rounds outlining Block area responsibility with regards to safety checklist
· PILOT done in Nov/Dec in Block area.
Summary of Related Standard(s) 8.1, 8.2, 8.3, 8.4, 8.6
Process Currently in Place - Evidence of Current Status
· Surgeon obtains informed consent in the office. The original consent is placed in the chart at end of PAC appointment
· Verified on Day of Surgery and also during the PAC appointment
· APPLE PIE and TIME OUT done by OR staff includes anesthesia
Improvement Strategy / Action Plan
November 2009 - February 2010
1. Surgical checklist
2. Block checklist being implemented in Regional block area
Communication / Staff Training / Education Plan
· Delia participated in Grand Rounds outlining Block area responsibility with regards to safety checklist
· PILOT done in Nov/Dec in Block area.
SAQ #1
PeriAnesthesia Accreditation 2010
Self-Assessment Questions (in order of priorities)
1. DOES THE TEAM HAVE SPECIFIC WAYS TO MONITOR ACTIVITIES THAT ARE HIGH-RISK, E.G. CRITICAL TESTS, OR MEDICATION ADMINISTRATION? RED FLAG, HIGH PRIORITY
SUMMARY OF RELATED STANDARD(S): 15.4 REQUIRED ORGANIZATIONAL PRACTICE: The team uses verification processes and other checking systems for high-risk activities.
PROCESS CURRENTLY IN PLACE:
• Independent Double Check (IDC) for high risk meds insulin and heparin, PCA's and Epidurals
• E-safety reports on near misses and adverse events
• Equipment alarms. Equipment is sent to biomed if it is not working. PCA and Epidural pumps are regularly checked by biomed.-new pain pumps to be implemented possibly in March 2009 -will require in servicing
· SMART pumps being rolled out December 2009
· Block Safety Checklist
· McKessin cabinets for narcotics on MGround and M2 PACU
IMPROVEMENT STRATEGY / ACTION PLAN
July 2009- October 2009
-IDC implemented over the summer
-E-safety reports are encouraged to be completed.
-ongoing equipment repairs are done through Biomed
November 2009 - February 2010
1. McKessin cabinet rollout Nov 17th. Super users: Ramona, Carly, Deborah K
2. Symbiq SMART pumps rolled out in December. Super users: Ramona, Carly, Carrie, Debbie Mulgrave, Sirkka
3. Block safety checklist to be implemented in Jan 2010. Ramona, Carol, Delia
4. Novo glucose meters will be rolled out in January
March 2010 - onward
1. New pain pump rollout? Will need volunteer super users.
Plan for spreading improvement to related services / areas?
With units moving on Mground, SSSU RN's will need to be in serviced on McKessin cabinets
Self-Assessment Questions (in order of priorities)
1. DOES THE TEAM HAVE SPECIFIC WAYS TO MONITOR ACTIVITIES THAT ARE HIGH-RISK, E.G. CRITICAL TESTS, OR MEDICATION ADMINISTRATION? RED FLAG, HIGH PRIORITY
SUMMARY OF RELATED STANDARD(S): 15.4 REQUIRED ORGANIZATIONAL PRACTICE: The team uses verification processes and other checking systems for high-risk activities.
PROCESS CURRENTLY IN PLACE:
• Independent Double Check (IDC) for high risk meds insulin and heparin, PCA's and Epidurals
• E-safety reports on near misses and adverse events
• Equipment alarms. Equipment is sent to biomed if it is not working. PCA and Epidural pumps are regularly checked by biomed.-new pain pumps to be implemented possibly in March 2009 -will require in servicing
· SMART pumps being rolled out December 2009
· Block Safety Checklist
· McKessin cabinets for narcotics on MGround and M2 PACU
IMPROVEMENT STRATEGY / ACTION PLAN
July 2009- October 2009
-IDC implemented over the summer
-E-safety reports are encouraged to be completed.
-ongoing equipment repairs are done through Biomed
November 2009 - February 2010
1. McKessin cabinet rollout Nov 17th. Super users: Ramona, Carly, Deborah K
2. Symbiq SMART pumps rolled out in December. Super users: Ramona, Carly, Carrie, Debbie Mulgrave, Sirkka
3. Block safety checklist to be implemented in Jan 2010. Ramona, Carol, Delia
4. Novo glucose meters will be rolled out in January
March 2010 - onward
1. New pain pump rollout? Will need volunteer super users.
Plan for spreading improvement to related services / areas?
With units moving on Mground, SSSU RN's will need to be in serviced on McKessin cabinets
Monday, January 11, 2010
Inhaled Anesthetics (Health & Wellbeing: Anesthesiology)
Happy New Year!
It's been a while and I thought I would upate our blog. I hope you find this interesting!
Inhaled Anesthetics (Health & Wellbeing: Anesthesiology)
It's been a while and I thought I would upate our blog. I hope you find this interesting!
Inhaled Anesthetics (Health & Wellbeing: Anesthesiology)
Friday, December 4, 2009
Wednesday, November 4, 2009
Code Blog: Tales of a Nurse
The following is a post taken from the Blog called Code Blog:Tales of a Nurse
Grand Rounds Volume 6, Number 6
October 27, 2009 Welcome to Grand Rounds! This is volume 6, number 6…. and the 6th time I am hosting… during the week of Halloween. Does anyone else find that creepy coincidentally satanic fascinating?!
For this edition, I thought we could go out Trick or Treating on Medblogger Lane. I’m sure we will find some colorful stories along the way…
The first house we come to seems amiable enough. The porch light is on and when the door is answered, some good old fashioned chocolate is put into my Trick or Treat bag! Even though she is diabetic, apparently Amy at Diabetes Mine prefers to give out the real stuff instead of the sugar-free kind. The reason may surprise you.
The next house also has the porch light on, but no one answers the door when I ring the bell. Finally I notice a note that says I should just take some candy from the bowl. Not Nurse Ratched is horribly sick with H1N1 and doesn’t want to spread any germs. Read her first-hand account of what it’s like to be knocked out by this flu.
Dr. Bates from Suture for a Living is at the next house. She has some great candy but it was kind of a pain to get. She said that the candy was password-protected and that I had to prove that I had a professional responsibility to eat the candy, and would not eat it out of mere curiosity. Take a gander at what happens when HIPAA is peering over your shoulder when you go looking around where you shouldn’t.
The next house was just crazy. When I arrived, they would only open the gate to let me in if I was wearing a face mask. Laika from MedLibLog wasn’t taking any chances after watching this very descriptive video that shows how the flu virus is transmitted and starts taking over the cells in your body. When I finally got past the gate, Dr. Val from Better Health informed me that she would love to give me some candy, but unfortunately the Big Candy Store down the block ordered it all up and now there wasn’t any left. So I wouldn’t feel as though I wasted a trip (and a mask!), Dr. Anonymous sat me down and told me all about the candy H1N1 flu, including busting some myths about the vaccine and informing me of when it might be available. On my way to the next place, I passed someone dressed up as a shark. That reminded me of Dr. Auerbach’s post at Healthline.com about shark attacks – why they attack and steps we can take to avoid being attacked. I was especially amused at reading this: “…it is important to note that any shark, including the seemingly docile nurse shark, will bite a human if sufficiently provoked.” I’m sure there are a few doctors out there who learned that the hard way.
I finally arrived at the Medblogger Lane Haunted House. It was with much trepidation that I walked through the front door…
…and had to stifle a scream as I entered the room! A mad scientist was performing various experiments on poor unsuspecting subjects. You would think that a little playful squirt of lime would result in no harm, but Dr. Charles explains how it could end up badly. The adjacent hallway was dark and a little spongy. It seemed strangely reminiscent of a certain screening exam. The Clinical Cases & Images Blog gives us the quick and easy Cliff Notes version of colorectal screening guidelines. Allergy Notes describes the scary effects of sulfite hypersensitivity. In another room Sharp Brains had specimens in jars and was performing tests to find out if caffeine had a sustained lifetime benefit or harm.
The last room had people who have had very scary things happen to them. Trauma Junkie described a typical day in the life for a patient with Cystic Fibrosis and shares his newfound wisdom about how sometimes the patient teaches the practitioner. Chris at Life in the Fast Lane relates a story with a very important lesson: sometimes we need to dig a little deeper and ask a few more questions before the medical mystery can be solved. And Robin at Survive the Journey describes what it’s like to parent a child who has Cushing’s Disease, from diagnosis and management to terrifying flare-ups and hospitalizations.
After all that, I was ready to get back to some more trick or treating! The next house I came upon was giving out gift certificates to iTunes! I thought that was perfect because I could use it to check out some of the Anatomy software apps on Dr. Penna’s list. As I was leaving, I overheard a conversation about a laptop being stolen from Blue Cross Blue Shield and the potential damage that could result. Dr. Joseph Kim from Non-Clinical Jobs lets us know what to do in case we find ourselves in this predicament.
I finally arrived at a huge scary house… you know, the kind that is decked to the nines in Halloween decorations… the one that makes your heart go just a little faster as you’re walking up to the porch. I rang the bell, said “Trick or Treat!” and waited. And waited some more. Surely a house as big and fancy as this would have great candy, right?! Finally a piece of paper was slipped under the door. It asked if I had any conditions that would be exacerbated by procuring and ingesting sweet edibles. It further stipulated that I needed to meet a minimum threshold of candy before they would provide me with any more! What was this? Some kind of confectionery deductible? I concluded that I had unwittingly arrived at the House of Insurance.
Instead of filling out the forms that had piled up outside, I decided to sneak in the back door to see if I could find out anything interesting, and boy did I ever…
Insure Blog was trying to figure out how Washington would handle 14 million new patients finding themselves on Medicaid if the Baucus health care bill is enacted. Louise at the Colorado Health Insurance Insider was pondering the composition of hospital boards of directors – are they comprised of objective participants, or is there some significant conflict of interest going on? And in the corner was a group led by Leslie at Getting Closer to Myself discussing the merits of marrying for love… or insurance coverage.
By this time it was getting late and I decided to head home. I spotted a big bonfire along the way and decided to stop by to see what was going on. Several people were gathered around the fire sharing experiences and information. Jolie Bookspan at the Fitness Fixer described several ways to treat knee pain that do not involve scalpels. Jenni at ChronicBabe informed us about fibromyalgia and contributed a list of resources that provided education on how to live and even thrive with the disease. Jeffrey at Nuts for Healthcare explained that fibromyalgia remains controversial in the medical community; however, while drug companies have been accused of fear-mongering to a desperate population for a handsome profit, recent neurological research has begun to unravel the biological manifestations of the disease in the hope to pinpoint a cause.
Novel Patient proudly described how she painstakingly stood up against her chronic illness and disappointing new diagnosis. Rachel at talesofmy30’s divulged her secret for learning to love her body after enduring disordered eating patterns and a type 2 diabetes diagnosis. Stacey at ACP Internist spoke about a possible reason as to why medical students are not going into primary care. David Harlow at HealthBlawg gave a detailed account of his experience at the Connected Health Symposium 2009 conference held last week in Boston. To finish the evening, Barbara at In Sickness and In Health shared with us a story she told her father while he was ill in the hospital.
That’s all for this edition of Grand Rounds. Next week, Grand Rounds will be held at nonclinicaljobs.com.
Have a safe and happy Halloween everyone!
Grand Rounds Volume 6, Number 6
October 27, 2009 Welcome to Grand Rounds! This is volume 6, number 6…. and the 6th time I am hosting… during the week of Halloween. Does anyone else find that creepy coincidentally satanic fascinating?!
For this edition, I thought we could go out Trick or Treating on Medblogger Lane. I’m sure we will find some colorful stories along the way…
The first house we come to seems amiable enough. The porch light is on and when the door is answered, some good old fashioned chocolate is put into my Trick or Treat bag! Even though she is diabetic, apparently Amy at Diabetes Mine prefers to give out the real stuff instead of the sugar-free kind. The reason may surprise you.
The next house also has the porch light on, but no one answers the door when I ring the bell. Finally I notice a note that says I should just take some candy from the bowl. Not Nurse Ratched is horribly sick with H1N1 and doesn’t want to spread any germs. Read her first-hand account of what it’s like to be knocked out by this flu.
Dr. Bates from Suture for a Living is at the next house. She has some great candy but it was kind of a pain to get. She said that the candy was password-protected and that I had to prove that I had a professional responsibility to eat the candy, and would not eat it out of mere curiosity. Take a gander at what happens when HIPAA is peering over your shoulder when you go looking around where you shouldn’t.
The next house was just crazy. When I arrived, they would only open the gate to let me in if I was wearing a face mask. Laika from MedLibLog wasn’t taking any chances after watching this very descriptive video that shows how the flu virus is transmitted and starts taking over the cells in your body. When I finally got past the gate, Dr. Val from Better Health informed me that she would love to give me some candy, but unfortunately the Big Candy Store down the block ordered it all up and now there wasn’t any left. So I wouldn’t feel as though I wasted a trip (and a mask!), Dr. Anonymous sat me down and told me all about the candy H1N1 flu, including busting some myths about the vaccine and informing me of when it might be available. On my way to the next place, I passed someone dressed up as a shark. That reminded me of Dr. Auerbach’s post at Healthline.com about shark attacks – why they attack and steps we can take to avoid being attacked. I was especially amused at reading this: “…it is important to note that any shark, including the seemingly docile nurse shark, will bite a human if sufficiently provoked.” I’m sure there are a few doctors out there who learned that the hard way.
I finally arrived at the Medblogger Lane Haunted House. It was with much trepidation that I walked through the front door…
…and had to stifle a scream as I entered the room! A mad scientist was performing various experiments on poor unsuspecting subjects. You would think that a little playful squirt of lime would result in no harm, but Dr. Charles explains how it could end up badly. The adjacent hallway was dark and a little spongy. It seemed strangely reminiscent of a certain screening exam. The Clinical Cases & Images Blog gives us the quick and easy Cliff Notes version of colorectal screening guidelines. Allergy Notes describes the scary effects of sulfite hypersensitivity. In another room Sharp Brains had specimens in jars and was performing tests to find out if caffeine had a sustained lifetime benefit or harm.
The last room had people who have had very scary things happen to them. Trauma Junkie described a typical day in the life for a patient with Cystic Fibrosis and shares his newfound wisdom about how sometimes the patient teaches the practitioner. Chris at Life in the Fast Lane relates a story with a very important lesson: sometimes we need to dig a little deeper and ask a few more questions before the medical mystery can be solved. And Robin at Survive the Journey describes what it’s like to parent a child who has Cushing’s Disease, from diagnosis and management to terrifying flare-ups and hospitalizations.
After all that, I was ready to get back to some more trick or treating! The next house I came upon was giving out gift certificates to iTunes! I thought that was perfect because I could use it to check out some of the Anatomy software apps on Dr. Penna’s list. As I was leaving, I overheard a conversation about a laptop being stolen from Blue Cross Blue Shield and the potential damage that could result. Dr. Joseph Kim from Non-Clinical Jobs lets us know what to do in case we find ourselves in this predicament.
I finally arrived at a huge scary house… you know, the kind that is decked to the nines in Halloween decorations… the one that makes your heart go just a little faster as you’re walking up to the porch. I rang the bell, said “Trick or Treat!” and waited. And waited some more. Surely a house as big and fancy as this would have great candy, right?! Finally a piece of paper was slipped under the door. It asked if I had any conditions that would be exacerbated by procuring and ingesting sweet edibles. It further stipulated that I needed to meet a minimum threshold of candy before they would provide me with any more! What was this? Some kind of confectionery deductible? I concluded that I had unwittingly arrived at the House of Insurance.
Instead of filling out the forms that had piled up outside, I decided to sneak in the back door to see if I could find out anything interesting, and boy did I ever…
Insure Blog was trying to figure out how Washington would handle 14 million new patients finding themselves on Medicaid if the Baucus health care bill is enacted. Louise at the Colorado Health Insurance Insider was pondering the composition of hospital boards of directors – are they comprised of objective participants, or is there some significant conflict of interest going on? And in the corner was a group led by Leslie at Getting Closer to Myself discussing the merits of marrying for love… or insurance coverage.
By this time it was getting late and I decided to head home. I spotted a big bonfire along the way and decided to stop by to see what was going on. Several people were gathered around the fire sharing experiences and information. Jolie Bookspan at the Fitness Fixer described several ways to treat knee pain that do not involve scalpels. Jenni at ChronicBabe informed us about fibromyalgia and contributed a list of resources that provided education on how to live and even thrive with the disease. Jeffrey at Nuts for Healthcare explained that fibromyalgia remains controversial in the medical community; however, while drug companies have been accused of fear-mongering to a desperate population for a handsome profit, recent neurological research has begun to unravel the biological manifestations of the disease in the hope to pinpoint a cause.
Novel Patient proudly described how she painstakingly stood up against her chronic illness and disappointing new diagnosis. Rachel at talesofmy30’s divulged her secret for learning to love her body after enduring disordered eating patterns and a type 2 diabetes diagnosis. Stacey at ACP Internist spoke about a possible reason as to why medical students are not going into primary care. David Harlow at HealthBlawg gave a detailed account of his experience at the Connected Health Symposium 2009 conference held last week in Boston. To finish the evening, Barbara at In Sickness and In Health shared with us a story she told her father while he was ill in the hospital.
That’s all for this edition of Grand Rounds. Next week, Grand Rounds will be held at nonclinicaljobs.com.
Have a safe and happy Halloween everyone!
Thursday, September 10, 2009
Sunnybrook performs minimally invasive, beating-heart bypass surgery
Dr. Moussa came to PAC today to present an in service on his Minimally Invasive, Beating Heart Bypass today. He has so far done 8 procedures here at Sunnybrook, and is one of 2 surgeons in Ontario performing this procedure!
Thursday, August 27, 2009
Updates
I came across this site this morning that I thought might be of interest: Safety Share
Many new initiatives are going on around the hospital, many geared towards patient safety. Policies currently being worked on: Conscious Sedation, Transfer of Accountability, Procedures Performed on Correct Side of Patient(being updated!) As well, there is a Surgical Safety Checklist being developed-an initiative recommended by the WHO. For the Regional Block area, there is a mini checklist being developed.
SPANC has two new co-chairs: Sandi Weir and Lan Zhou. They are looking for committed PeriAnesthesia nurses to meet once a month. They need suggestions on unit initiatives.
There is an Environmental Sustainability Committee and Laurie R has already placed a Recycling bin in the PACU with instructions regarding the types of paper and plastics that can go in the one bin. Bins will be coming to PAC, SDS, SSSU soon.
Many new initiatives are going on around the hospital, many geared towards patient safety. Policies currently being worked on: Conscious Sedation, Transfer of Accountability, Procedures Performed on Correct Side of Patient(being updated!) As well, there is a Surgical Safety Checklist being developed-an initiative recommended by the WHO. For the Regional Block area, there is a mini checklist being developed.
SPANC has two new co-chairs: Sandi Weir and Lan Zhou. They are looking for committed PeriAnesthesia nurses to meet once a month. They need suggestions on unit initiatives.
There is an Environmental Sustainability Committee and Laurie R has already placed a Recycling bin in the PACU with instructions regarding the types of paper and plastics that can go in the one bin. Bins will be coming to PAC, SDS, SSSU soon.
Tuesday, August 11, 2009
On Colonoscopies...
Thought I'd add a little humour...
ABOUT THE WRITER Dave Barry is a Pulitzer Prize-winning humor columnist for the Miami Herald.
Colonoscopy Journal: I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy.
A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis.
Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner.
I nodded thoughtfully, but I didn't really hear anything he said, because my brain was shrieking, 'HE'S GOING TO STICK A TUBE 17,000 FEET UP YOUR BEHIND!'
I left Andy's office with some written instructions, and a prescription for a product called 'MoviPrep,' which comes in a box large enough to hold a microwave oven. I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of America's enemies.
I spent the next several days productively sitting around being nervous.
Then, on the day before my colonoscopy, I began my preparation. In accordance with my instructions, I didn't eat any solid food that day; all I had was chicken broth, which is basically water, only with less flavor.
Then, in the evening, I took the MoviPrep. You mix two packets of powder together in a one-liter plastic jug, then you fill it with lukewarm water. (For those unfamiliar with the metric system, a liter is about 32 gallons). Then you have to drink the whole jug. This takes about an hour, because MoviPrep tastes - and here I am being kind - like a mixture of goat spit and urinal cleanser, with just a hint of lemon.
The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, 'a loose, watery bowel movement may result.'
This is kind of like saying that after you jump off your roof, you may experience contact with the ground.
MoviPrep is a nuclear laxative. I don't want to be too graphic, here, but, have you ever seen a space-shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet.
After an action-packed evening, I finally got to sleep.
The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, 'What if I spurt on Andy?' How do you apologize to a friend for something like that? Flowers would not be enough.
At the clinic I had to sign many forms acknowledging that I understood and totally agreed with whatever the heck the forms said. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actually naked..
Then a nurse named Eddie put a little needle in a vein in my left hand. Ordinarily I would have fainted, but Eddie was very good, and I was already lying down. Eddie also told me that some people put vodka in their MoviPrep. At first I was ticked off that I hadn't thought of this, but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode. You would have no choice but to burn your house.
When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthesiologist. I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere. I was seriously nervous at this point.
Andy had me roll over on my left side, and the anesthesiologist began hooking something up to the needle in my hand.
There was music playing in the room, and I realized that the song was 'Dancing Queen' by ABBA. I remarked to Andy that, of all the songs that could be playing during this particular procedure, 'Dancing Queen' had to be the least appropriate.
'You want me to turn it up?' said Andy, from somewhere behind me.
'Ha ha,' I said. And then it was time, the moment I had been dreading for more than a decade. If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like.
I have no idea. Really. I slept through it. One moment, ABBA was yelling 'Dancing Queen, feel the beat of the tambourine,' and the next moment, I was back in the other room, waking up in a very mellow mood.
Andy was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that It was all over, and that my colon had passed with flying colors. I have never been prouder of an internal organ.
On the subject of Colonoscopies... Colonoscopies are no joke, but these comments during the exam were quite humorous..... A physician claimed that the following are actual comments made by his patients (predominately male) while he was performing their colonoscopies:
1. 'Take it easy, Doc. You're boldly going where no man has gone before!'
2. 'Find Amelia Earhart yet?'
3. 'Can you hear me NOW?'
4. 'Are we there yet? Are we there yet? Are we there yet?'
5. 'You know, in Arkansas , we're now legally married.'
6. 'Any sign of the trapped miners, Chief?'
7. 'You put your left hand in, you take your left hand out...'
8. 'Hey! Now I know how a Muppet feels!'
9. 'If your hand doesn't fit, you must quit!'
10. 'Hey Doc, let me know if you find my dignity.'
And the best one of all: 11. 'Could you write a note for my wife saying that my head is not up there?'
ABOUT THE WRITER Dave Barry is a Pulitzer Prize-winning humor columnist for the Miami Herald.
Colonoscopy Journal: I called my friend Andy Sable, a gastroenterologist, to make an appointment for a colonoscopy.
A few days later, in his office, Andy showed me a color diagram of the colon, a lengthy organ that appears to go all over the place, at one point passing briefly through Minneapolis.
Then Andy explained the colonoscopy procedure to me in a thorough, reassuring and patient manner.
I nodded thoughtfully, but I didn't really hear anything he said, because my brain was shrieking, 'HE'S GOING TO STICK A TUBE 17,000 FEET UP YOUR BEHIND!'
I left Andy's office with some written instructions, and a prescription for a product called 'MoviPrep,' which comes in a box large enough to hold a microwave oven. I will discuss MoviPrep in detail later; for now suffice it to say that we must never allow it to fall into the hands of America's enemies.
I spent the next several days productively sitting around being nervous.
Then, on the day before my colonoscopy, I began my preparation. In accordance with my instructions, I didn't eat any solid food that day; all I had was chicken broth, which is basically water, only with less flavor.
Then, in the evening, I took the MoviPrep. You mix two packets of powder together in a one-liter plastic jug, then you fill it with lukewarm water. (For those unfamiliar with the metric system, a liter is about 32 gallons). Then you have to drink the whole jug. This takes about an hour, because MoviPrep tastes - and here I am being kind - like a mixture of goat spit and urinal cleanser, with just a hint of lemon.
The instructions for MoviPrep, clearly written by somebody with a great sense of humor, state that after you drink it, 'a loose, watery bowel movement may result.'
This is kind of like saying that after you jump off your roof, you may experience contact with the ground.
MoviPrep is a nuclear laxative. I don't want to be too graphic, here, but, have you ever seen a space-shuttle launch? This is pretty much the MoviPrep experience, with you as the shuttle. There are times when you wish the commode had a seat belt. You spend several hours pretty much confined to the bathroom, spurting violently. You eliminate everything. And then, when you figure you must be totally empty, you have to drink another liter of MoviPrep, at which point, as far as I can tell, your bowels travel into the future and start eliminating food that you have not even eaten yet.
After an action-packed evening, I finally got to sleep.
The next morning my wife drove me to the clinic. I was very nervous. Not only was I worried about the procedure, but I had been experiencing occasional return bouts of MoviPrep spurtage. I was thinking, 'What if I spurt on Andy?' How do you apologize to a friend for something like that? Flowers would not be enough.
At the clinic I had to sign many forms acknowledging that I understood and totally agreed with whatever the heck the forms said. Then they led me to a room full of other colonoscopy people, where I went inside a little curtained space and took off my clothes and put on one of those hospital garments designed by sadist perverts, the kind that, when you put it on, makes you feel even more naked than when you are actually naked..
Then a nurse named Eddie put a little needle in a vein in my left hand. Ordinarily I would have fainted, but Eddie was very good, and I was already lying down. Eddie also told me that some people put vodka in their MoviPrep. At first I was ticked off that I hadn't thought of this, but then I pondered what would happen if you got yourself too tipsy to make it to the bathroom, so you were staggering around in full Fire Hose Mode. You would have no choice but to burn your house.
When everything was ready, Eddie wheeled me into the procedure room, where Andy was waiting with a nurse and an anesthesiologist. I did not see the 17,000-foot tube, but I knew Andy had it hidden around there somewhere. I was seriously nervous at this point.
Andy had me roll over on my left side, and the anesthesiologist began hooking something up to the needle in my hand.
There was music playing in the room, and I realized that the song was 'Dancing Queen' by ABBA. I remarked to Andy that, of all the songs that could be playing during this particular procedure, 'Dancing Queen' had to be the least appropriate.
'You want me to turn it up?' said Andy, from somewhere behind me.
'Ha ha,' I said. And then it was time, the moment I had been dreading for more than a decade. If you are squeamish, prepare yourself, because I am going to tell you, in explicit detail, exactly what it was like.
I have no idea. Really. I slept through it. One moment, ABBA was yelling 'Dancing Queen, feel the beat of the tambourine,' and the next moment, I was back in the other room, waking up in a very mellow mood.
Andy was looking down at me and asking me how I felt. I felt excellent. I felt even more excellent when Andy told me that It was all over, and that my colon had passed with flying colors. I have never been prouder of an internal organ.
On the subject of Colonoscopies... Colonoscopies are no joke, but these comments during the exam were quite humorous..... A physician claimed that the following are actual comments made by his patients (predominately male) while he was performing their colonoscopies:
1. 'Take it easy, Doc. You're boldly going where no man has gone before!'
2. 'Find Amelia Earhart yet?'
3. 'Can you hear me NOW?'
4. 'Are we there yet? Are we there yet? Are we there yet?'
5. 'You know, in Arkansas , we're now legally married.'
6. 'Any sign of the trapped miners, Chief?'
7. 'You put your left hand in, you take your left hand out...'
8. 'Hey! Now I know how a Muppet feels!'
9. 'If your hand doesn't fit, you must quit!'
10. 'Hey Doc, let me know if you find my dignity.'
And the best one of all: 11. 'Could you write a note for my wife saying that my head is not up there?'
Wednesday, July 22, 2009
Automated Dispensing Cabinets
We are currently working with pharmacy to get the McKessin cabinets up and running. I found this article on Medscape and thought I would share it on the blog. Happy reading!
From Topics in Advanced Practice Nursing eJournal > Commentary
Automated Dispensing Cabinets: Getting It Right in the Age of Automation
Barbara L. Olson, MS, RN-BC, FISMP
Just as the brand name Kleenex® is commonly used for facial tissues, automated dispensing cabinets (ADCs) are often recognized by manufacturer or product names such as AcuDose®, Omnicell®, and Pyxis®. Currently, 83% of US hospitals report that they use ADCs, indicating widespread acceptance of touchscreen-activated drug storage vaults.[1] Generally welcome additions to busy clinical settings, ADCs provide ready availability of medications (a key component of acute care) while streamlining the process of drug charging.
But ADCs are more than automated teller machines for drugs. These unit-based medication repositories incorporate sophisticated software and electronic interfaces to synthesize high-risk steps in the medication use process. Today's cabinets reflect design advances as well as an appreciation for how specific technologies, such as barcode scanning and clinical decision support, can improve medication safety. Over the years, ADCs have been adapted to facilitate compliance with emerging regulatory requirements such as pharmacy review of medication orders and safe practice recommendations.
Promoting Medication Safety
The "5 rights" of medication administration, a set of objectives well-known to nurses and other frontline clinicians, are often used to describe medication safety goals. When used to their greatest potential, ADCs can increase the reliability of the "5 rights": the right drug, the right dose, the right patient, the right route, and the right time. The mirror image of each medication right is a wrong -- wrong drug, wrong dose, wrong patient, wrong route, and wrong time -- representing a risk point that a strong system design can help to avert.
However, sophisticated, accessible drug storage systems alone do not guarantee safety. Selection, design, implementation, and monitoring of ADCs are also important to mitigate the risk associated with medication use.
In 2008, the Institute for Safe Medication Practices published Guidance on the Interdisciplinary Safe Use of Automated Dispensing Cabinets to help organizations and individuals understand and adopt practices that maximize the safety of ADCs.[2] Twelve distinct core processes that promote safest practices and secure handling of drugs are addressed in this document. While these guidelines do not represent standards of care, they do provide organizations and frontline users with measures for each stage of ADC implementation, from deciding how the technology will be used to staff education and long-term monitoring.
The ISMP guidance document, coupled with other relevant literature and reports of error and near-miss events associated with ADC use, inform the recommendations provided below. These quick-read recommendations are by no means inclusive, but may serve to bridge understanding between executive decision makers, medication safety experts, and frontline clinicians during high-stakes decision processes that involve resource allocation, work-flow, and patient safety. Teams charged with ADC implementation or re-evaluation as well as those interested in defining pharmacy-specific processes to enhance ADC safety are advised to consult ISMP's complete document.[2]
Wrong Drug/Wrong Dose Errors
Wrong drug and wrong dose errors are the most common errors associated with ADC use. Look-alike drug names and drug packages are variables that can lead to wrong-drug/wrong-container selection errors. Morphine and hydromorphone (Dilaudid®), for example, are 2 different opioid analgesics that top the list of the most frequently confused drugs.[3] Alprazolam and lorazepam are another pair of look-alike, sound-alike drugs that are frequently confused.
Environmental factors (such as distraction and lighting) influence how well humans perform tasks involving product selection. Patient information at the point of dispensing, such as allergies and potential contraindications, allow a final cognitive check (matching prescribed drug, dispensed drug, and indication for use) to occur.
Consider this comment, made by a seasoned nurse who responded to a post entitled "Meds & Mindfulness" on Medscape's On Your Meds blog in April 2009:
I have been an RN since 1974 and have worked in many settings. I am currently on a geriatric psychiatric unit and I just wanted to share that my morning med pass is just about the most unnerving thing I have ever done. The area where 2 of us prepare our meds is a small hallway through which people must pass to reach our unit tube system. Folks squeeze by often as we work. On the other end of our small area is our Pixis (sic) machine, which the pharmacy tech comes to stock during the time we are setting up our meds...... Interruption is the name of the game.
This nurse's observations highlight several of the well-known risk points in the medication use process that contribute to wrong drug/wrong dose errors.
Recommendations to Prevent Wrong Drug/Wrong Dose Errors With Automated Dispensing Cabinet Use
System Level Recommendations
System-level considerations that may diminish the risk of wrong drug and wrong dose errors when drugs are retrieved from ADCs include:
-Evaluate unit geography when planning for ADC installation or upgrades;
Minimize the potential for ADC users who stock and remove drugs, to be distracted while working at the ADC;
-Match ADC stock to unit needs meticulously, using unit-dose packaging whenever possible. Overstocking medications predisposes to wrong-dose errors, specifically overdoses, while stocking drugs that are not routinely used predisposes to wrong drug errors;
-Store drugs with look-alike, sound-alike names in different locations within ADCs. Consult published lists such as the ISMP's list of frequently confused drug names to determine which medications stored in each of the facility's ADCs pose the greatest potential to be mixed up in the selection process;
-Examine interdisciplinary workflow issues and eliminate scheduling conflicts so that routine drug stocking and retrieval activities do not overlap;
-Establish procedures for medication administration that avoid distractions related to other duties, especially in settings where nurses care for multiple patients.[4,5] Drug selection is a high-stakes activity, one that may be compared to safety-sensitive tasks that occur during pre-flight activities in the aviation industry. System leaders should evaluate expectations, especially those that involve multi-tasking, to ensure that staff members are not routinely disrupted at high-stakes junctures in medication administration. (If you wouldn't want the captain of your airliner to greet passengers while simultaneously performing pre-flight checks, you should advocate for processes that allow nurse to similar attention to detail during drug selection);
-Maximize the use of barcode technology with ADCs to make sure that the correct products (intended drug in the correct dose units or container size) are stocked in each clinical setting.[6] Bar-code product verification at point of retrieval (or point of administration) further diminishes the likelihood of wrong drug or wrong dose errors. When barcode verification is not possible, high alert drugs should be verified both by the person stocking the ADC and a unit-based nurse;
-Ensure that patient medication administration records (MAR) are accessible to practitioners while they are removing medications from an ADC. To make this a practice norm, select workstations that can be positioned near the ADC. When purchasing hardware (such as wheeled workstations), weigh cost-benefits of integrated patient information repositories in light of nursing time and patient safety. (The process used to deliver food to your table at the average chain restaurant should not be more reliable -- and less cumbersome -- than the process used to bring ordered medications to your bedside in a community hospital);
-The ADC should display drug information in a nonambiguous fashion, matching information provided on the MAR;
-Require pharmacy review of medication orders (which includes measures such as checking the order against known allergies; reviewing appropriateness of the prescribed dose; and evaluating potential for drug-drug interactions) prior to removal of medications, except in emergency situations.[6] Once pharmacy review has occurred, a readily identifiable flag/symbol should signal "go" to frontline clinicians;
-Use computerized alerts, ideally pop-ups that require a confirmation, when medications with high potential for mix-up (look-alike, sound-alike medications) in a given setting are selected. Bring the possibility of drug product confusion to the attention of the clinician at the point of retrieval, especially for other high alert drugs that have look-alike, sound-like qualities. For example, to minimize morphine and hydromorphone confusion risk, the ADC screen may prompt, "This is DILAUDID. Is that correct?" whenever hydromorphone is selected[7];
-Monitor how well ADCs, as configured, support care goals established by frontline providers and expected by patients and other stakeholders. This may be accomplished through proactive order set/clinical pathway review and retrospective review of medication overrides. Investigate causes of ADC overrides, considering the possibility of production pressure, especially in settings where turnover goals may compete with meticulous adherence to safest medication practices;
-Teach front line clinicians, especially those who participate in unit-based practice councils and multidisciplinary committees, the principles that inform safest use of ADCs, especially those that relate to medication stocking and availability. Solicit their input proactively to prepare for anticipated practice changes involving medication use and medication storage;
-Consider providing unit-based practice councils and multidisciplinary teams in specialty units to review ADC metrics (such as results of override reports). With this knowledge, it will be possible to identify deviations from targeted benchmarks, identify barriers to compliance, and champion safest practices;
-Ensure that knowledge of high alert medications and look-alike/sound-alike drugs (particular to a given clinical setting) are included in orientation and initial competency validation measures of individuals who dispense, stock, or administer medications; and
-Create a culture in which concerns voiced by frontline clinicians are seen as valuable. Develop a visible "rapid response" when ADC near-misses or discrepancies are reported.
Individual Level Recommendations
Considerations for individuals that may diminish the risk of wrong drug and wrong dose errors when drugs are retrieved from ADCs include:
-Recognize that medication retrieval from ADCs is a high-risk activity, one in which human error has the potential to cause irreparable harm;
-Utilize bar-code scanning to the fullest extent possible in your practice setting. Report barriers to compliance immediately, using system-wide, near-miss reporting systems. For example, if barcode scanning is prevented by mechanical failures, battery life, or the availability of scanning equipment during high volume medication administration times -- these are reportable events;
-Upon removal of a drug from an ADC, validate that the drug name on the label of the drug-in-hand matches the drug name displayed on the patient's MAR (or prescriber's order if MAR has not been generated);
-Validate that the drug-in-hand is the ordered concentration, dose, and dosage form;
Be suspicious of any dose that would require removal of more than 3 packages/ampules/vials to administer a single dose;
-Avoid excessive use of the override function; it should be limited to true emergencies;
-Be aware that distractions undermine performance. Reduce distractions within your control when you are removing medications from ADCs. Although duties related to medication administration occupy a significant amount of nursing time, accurate performance cannot be assured simply because tasks are familiar. For example, answering cell phones while performing high-stakes activities impairs accuracy. Social exchanges with colleagues, patients, and family members should not occur at the ADC;
-Advocate for practice models that promote the least amount of distraction during medication preparation and administration. If multi-tasking while accessing medications from an ADC is a performance expectation, use professional practice councils and near-miss reporting systems to call attention to this risk;
-Become familiar with the rationale behind the system-level interventions (listed above) that promote safest use of ADCs; and
-Report deviations from ideal or standard practices as near-misses. This may seem "picky," but having a highly reliable medication use system involves meticulous attention to detail, something which requires a high degree of standardization. A system that has to undergo individual interpretation to accomplish routine tasks -- like a 9:00 am medication pass -- is error-prone. Fixing a system is difficult, but possible (in a way that fixing a lethal wrong-drug medication error is not). Here are a few things worth reporting when you notice them: A discrepancy between the way the drug name is displayed on the MAR and on the ADC screen; for example, when tall-man letters used to differentiate a known look-alike, sound-alike drug pair throughout your organization are not used on the pick list of your ADC screen; or when you find a syringe labeled "hydromorphone" in a bin labeled "morphine."
Summing Up: Seeing Beyond "The Box"
ADCs, particularly when they interface with computerized redundancies such as bar-coding and electronic MARS, give front line clinicians powerful tools to deliver reliable results. But reaping the benefits of technology involves more than selecting "the best box."
Knowledge of how automated dispensing cabinets are used by clinicians is essential for realizing the potential of these devices to improve safety, just as they have improved efficiency and charge capture for medications. Individual performance is one aspect of medication safety: how individuals perform is affected by the knowledge and competency each brings to the task at hand along with personal practice habits and choices under each individual's control. But key elements of performance are also influenced by the system in which care is delivered and by factors controlled at the organizational level.
To maximize the benefits of ADCs, organizations should identify and manage risk points that predictably occur when humans, often busy and working under stress, interface with machines to deliver high-stakes therapies. Interdisciplinary guidance, such as those published by ISMP, identify these risk-points and recommend risk-reduction strategies, enabling organizations to align work-flow and performance expectations so that the safety benefits of ADCs are fully realized.
Monday, June 29, 2009
Are Nurse Jackie and Hawthorne helping or harming nursing?
Thought I would forward this information on our Blog:
News Alert from the Center for Nursing Advocacy:
Nurse Jackie and HawthoRNe have created quite a stir in the nursing community, causing excitement about nurses being featured as lead characters on prime time television, but also concern about whether the character profiles and story lines will have a positive or negative impact on the public's understanding of who nurses are and what they do.
Center for Nursing Advocacy board members have been weighing in, and we would like to open a discussion with all of you on what has already become a source of controversy among nursing professionals. Suzanne Gordon, internationally known journalist, advocate for nurses, and a member of our Board of Directors, wrote an op-ed for the Boston Globe on the new shows, and Board chair Mary Dominiak was quoted in a Chicago Sun-Times article.
Please join the discussion at our discussion board. Our discussion board was recently reactivated after removing a deceptive thread started by an unauthorized person who posted false information about the Center's status. Now, we invite your thoughts on the following topics:
Are Nurse Jackie and HawthoRNe harming or helping nursing?
How can nurses, including nursing faculty, use Nurse Jackie and HawthoRNe to educate their peers and students about the importance of becoming advocates for the nursing profession?
We look forward to the discussion!
News Alert from the Center for Nursing Advocacy:
Nurse Jackie and HawthoRNe have created quite a stir in the nursing community, causing excitement about nurses being featured as lead characters on prime time television, but also concern about whether the character profiles and story lines will have a positive or negative impact on the public's understanding of who nurses are and what they do.
Center for Nursing Advocacy board members have been weighing in, and we would like to open a discussion with all of you on what has already become a source of controversy among nursing professionals. Suzanne Gordon, internationally known journalist, advocate for nurses, and a member of our Board of Directors, wrote an op-ed for the Boston Globe on the new shows, and Board chair Mary Dominiak was quoted in a Chicago Sun-Times article.
Please join the discussion at our discussion board. Our discussion board was recently reactivated after removing a deceptive thread started by an unauthorized person who posted false information about the Center's status. Now, we invite your thoughts on the following topics:
Are Nurse Jackie and HawthoRNe harming or helping nursing?
How can nurses, including nursing faculty, use Nurse Jackie and HawthoRNe to educate their peers and students about the importance of becoming advocates for the nursing profession?
We look forward to the discussion!
Wednesday, June 17, 2009
Nurse Jackie
Click on link above to find out more about this showtime series. Within the link are also spoilers and clips.enjoy!
Thursday, June 4, 2009
MRSA
Methicillin-resistant staphylococcus aureus (MRSA) is a micro-organism that has developed a resistance to antibiotics. MRSA is currently the most clinically significant antibiotic-resistant organism (ARO) in Canada.
MRSA is hardy. The bacteria can live up to six weeks on environmental surfaces and is easily transmitted by skin-to-skin contact and touching shared items. Through the implementation of evidence-based strategies, healthcare providers can reduce MRSA transmission and infections.
About 220,000 Canadians develop hospital-acquired infections each year and about 8,000 die from them annually. It costs more to treat MRSA infections than to prevent them. Estimated costs for treating and isolating patients with MRSA infections was $82 million in 2004 and that could reach $129 million by 2010. Total cost per infected MRSA patient averages $12,216, for prolonged hospitalization, special control measures, expensive treatments and extensive surveillance.
The five key components of evidence-based infection control practices that form the basis of successfully reducing MRSA transmission include an aggressive hand hygiene program; systematic cleaning and decontamination of the environment and equipment; precautions for contact with any patient that is infected with MRSA; selected MRSA screening surveillance cultures on admission and at other times during hospitalization if indicated; and regularly reporting of MRSA infection rates to frontline workers and hospital leadership. Participation in this intervention can help your organization meet the MRSA reporting requirements of the Canadian Council on Health Services Accreditation.
MRSA is hardy. The bacteria can live up to six weeks on environmental surfaces and is easily transmitted by skin-to-skin contact and touching shared items. Through the implementation of evidence-based strategies, healthcare providers can reduce MRSA transmission and infections.
About 220,000 Canadians develop hospital-acquired infections each year and about 8,000 die from them annually. It costs more to treat MRSA infections than to prevent them. Estimated costs for treating and isolating patients with MRSA infections was $82 million in 2004 and that could reach $129 million by 2010. Total cost per infected MRSA patient averages $12,216, for prolonged hospitalization, special control measures, expensive treatments and extensive surveillance.
The five key components of evidence-based infection control practices that form the basis of successfully reducing MRSA transmission include an aggressive hand hygiene program; systematic cleaning and decontamination of the environment and equipment; precautions for contact with any patient that is infected with MRSA; selected MRSA screening surveillance cultures on admission and at other times during hospitalization if indicated; and regularly reporting of MRSA infection rates to frontline workers and hospital leadership. Participation in this intervention can help your organization meet the MRSA reporting requirements of the Canadian Council on Health Services Accreditation.
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