Week End Wrap UpWeek End Wrap Up

June 7, 2010

Staff Meetings

Staff Meetings held on 6/1 & 6/7Presentations and minutes updated and

in staff meeting notebooks on each unitIf unable to attend meetings, please

review informationPresentations can also be accessed

from email accompanying this wrap up

June Practice Changes

  New 0/30/60  nursing responsibilities for timely transfer to OR

All IV pumps and epidural pump d/c'd before patient leaves LDR; red caps (found in plastic cylinder with blue dots)

EFM - unplug and move with patient specifics for when patient gets back to OR for "0" and "30" sections noted on powerpoint

slides (posted on unit, Staff Meeting Minutes for June 2010, and in body of this weekend wrap up email)

New C/S orders Orders in Chief resident's drawer & used for all C/S patients Pilot for 30 days—will reevaluate and modify as needed  SCD's applied and IN USE during C/S (on "30" and "60" procedures) SCD pumps in each OR under table Using "knee length" NOT "thigh length" sleeves Medium and Large in stock (not sure par stock level yet so let me know if trouble getting

sleeves or pumps) No need for TED hose with any SCD use

Thanks much for taking time to review and comment! —Kathy

34 to 34.6 wk late preterm newborn

34 to 34.6 week newborns need to transfer to the PCN within 30-60 minutes after birth

These infants require close observation due to increased risk of respiratory, thermo and nutritional instability

Babies 35 to 37 weeks may stay with Mom in L&D if RN remains in room until Mom's transfer

RN may transfer 35-37 week infant to PCN before Mom's transfer if she feels it's necessary .

When PCN closed, charge RNs trouble shoot newborn placement—NICU, PCN RN able to be in room, open PCN, etc

Questions, let us know

Weekly Pain Reassessment Audits

May 17 35 doses narcotic/33 xs reassessed w/i 1 hr 94%

May 31 105 doses narcotic/88 xs reassessed w/i 1 hr 84%

June 7 55 doses narcotic/42 xs reassessed w/i 1 hr 76%

Wrong direction—pain reassessments are done within 1 hour of narcotic administration

Pain Reassessment Audits (cont.)

Best Practice post narcotic administration assessment/documentation of patient response within 60 minutes

Documentation of reassessment noted in new column on flowsheet (separate from documentation at time of administration

UWMC minimum standard for pain reassessment—90 %

Best MIC compliance fiscal year 2010—82%

Problem times: night shift & shift changes

ORCA News

ORCA Implementation October 19

ORCA Training August 16-September 30 Staff prescheduled Make every effort to make scheduled day work If not to attend on given date, notify scheduling team

Have you had your computer assessment? If not check in with your RN3 and/or any manager

When opening patient list in ORCA—should have 5S, 6S, 6El and Nbn; if anything else, let your ORCA team know:

User Name" (first thing you type in top box; e.g., "gwall") Address of computer being used (lower right corner on blue screen look for # like

"128.95.136.15") Will help sort whether an ongoing problem with computer's location or a user-specific

problem

Thanks—ORCA design team, Natalie and Terri

Patient Safety

Situation: Patient ordered medication Medication similar in name and action, written on MAR Medication administered to patient before error recognized

Situation: Patient ordered drug at 50mg dosage Patient received drug x 2 days On 3rd day, RN stated name and dosage of drug at time of

administration, patient stated takes 25mg not 50mg

Assessment: medication errors

Plan: Verify names and dosage of medications with orders and patient before administration

Referral Process Changes

Improved referral intake process

Team created streamlined process which reduces number of activities for each role, eliminates rework, and improves communication among team, and with referring providers—wow!

CHARGE NURSE ROLE IN REFERRAL PROCESS Twice/day TEAM STEPPS – Identify L&D status by assigning

color Charge RN responsible for keeping color code tool up to date

Referral Process Changes (cont.)

GREEN – Attending will accept all referrals

YELLOW – Attending needs to call/talk with Charge RN before accepting referrals; Action: Chief & Charge RN trouble shoot patient flow issues with goal of returning to GREEN

RED – Attending comes to L&D and runs board with Chief, Charge RN; contact Nurse Manager or Flow Supervisor prn

BLACK – No referrals can be accepted; assemble management team Gigi or Debi, Karen Odle (Director of Perinatal Services), Flow Supervisor and Medical Director (if needed)

Referral Process Changes (cont.)

Charge RN responsible for alerting Attending and Chief of changes in unit status by sending text message – only text color (your phone # is on their card)

Goal is try to be GREEN all the time

Attending will accept all transfers if Green was status indicated at TEAM STEPPS unless Charge RN texted change

Attending will call Charge RN to notify transfer is coming and ETA

Charge RN responsible for texting Chief Resident and Generalist of new transfer (no longer responsibility of Attending to notify Chief) Include in text: G/P, GA, diagnosis and ETA

Referral Process Changes (cont.)

Circulating RN in OR monitoring Med-Con pager in OR; she will call Med-Con to alert that Attending can call after C-Section; if call an emergency, will transfer to Charge RN to take info

Referring Provider transferred to front desk person (PSS/Float/RN/Tech) after Attending accepts patient

Front desk now collects info on referral patient

OB Flex Room

Moved LR, L&D med kits and suture from over-counter cabinet into top (locked) drawer of admit/delivery cart

Non-sharps from drawer moved to lower drawers

Plan to remove hasp and lock when able and correctly label drawers

Environmental Services cleans clear surfaces—refrain from storage on counter tops

L&D Supply Changes

Pacifiers will be removed from bins

Will be adding curved syringes and 10 ml oral syringes

Will have par level of 2 breast pumps the pump room

Foley Catheters

Continue to find latex catheters on unit

Place ONLY latex free (silicone) foley catheter

Remove any latex catheters (if they sneak in), from rooms, OR, etc and give to OB tech to return to Materials Management

In ORs silicone catheters in costructs

Thank you for your help in this matter!

SCDs

"SCDs" now used in ORs are reprocessed

Reprocessed means that they are returned to MM and go through a process to clean (similar to BP Cuffs)

Please don’t throw away Put in dirty utility rooms on dirty

equipment carts

D50 Emergency Syringes

Nationwide shortage of D50w emergency syringes

Necessary for D50w vials be used during shortage

Will be loading D50w vials into PYXIS

Thanks, Baxi

IMPACT in MIC

Recent staff findings:Errors on baby bands identified Insulin bag had 2 shift changes that missed

bag expiration (not changed at 24 hrs)Look for review and recommendations

for Mother Baby report and assignments posted soon on units; be sure to provide input

Saturday, June 12, UW Commencement begins at Noon

Saturday, June 12, 2010, UW Commencement ceremony scheduled for 12:00 PM (Noon) at Husky Stadium 

Event will bring traffic congestion to University District from as early as 9:00 AM All weekend scheduled staff advised to plan additional time for traveling to UWMC   Listed below is additional parking information for scheduled staff, patients and their visitors.

E20 Permit Holders: Friday, June 11, 2010, E20 Husky Stadium parking closes at 5:00 PM UW Commuter Services has arrangements for vehicles to be moved to alternate parking

location after 5:00 PM All permit holders arriving at E20 after 5:00pm need to contact UW Police at 543-9331

for access to E20 or be directed to relocate vehicle

E20 & E21 Night permit holder for Friday night, June 11th Night permits assigned to E20 & E21 will park in E21 parking lot until 7:00 AM Saturday

Morning Vehicles remaining after 7:00 AM will be moved by UW Commuter Services to alternate

parking lot in preparation for commencement ceremony.  If vehicle is relocated, please contact UW Police at 206-543-9331. 

Saturday, June 12, UW Commencement begins at Noon (cont.)

UWMC staff working Saturday, June 12th: Staff scheduled to work on Saturday, June 12th will park at Surgery Pavilion Parking Garage.  Staff required to show valid parking permit and UWMC ID Badge for access UWMC Parking Staff at entrance to garage to provide assistance and answer questions. Overflow staff parking available at: S1 Parking Garage - Middle and Lower levels Triangle Garage - Parking at Triangle Garage restricted for PATIENTS & VISITORS ONLY.

NO Staff parking allowed in Triangle garage  PATIENT & VISITOR PARKING  On Saturday, Patients and visitors will have following options for parking at UWMC Triangle garage - upper level of parking garage reserved for patient/visitor parking Surgery Pavilion Garage available for overflow patient & visitor parking Valet Services at Main Entrance - OPEN at main entrance from 8am - 6pm on Saturday. Valet Services also available on upper level of Triangle garage

If you have any questions, please give me a call at 206-598-5275 or email me at Larryk@UW.edu –will be onsite on Saturday during event

NE 45 St Viaduct Closes 6/14 - 9/10

Dear UW Bicyclists, Walkers and U-PASS Members-

Monday, June 14, to Friday, Sept 10, NE 45th St Viaduct closed in both directions between 20th Ave NE and Montlake Blvd NE.

Closure will alter Metro Route 25 and impact pedestrian and bicycle routes to and from campus, so plan new route and allow more time if necessary

More about project at: Seattle Department of Transportation Web site: www.seattle.gov/transportation/45th-bridge.htm , and University Week: uwnews.org/uweek/article.aspx?id=57864

Detailed information on changes to Metro Route 25 can be found at the King County Metro Web site: metro.kingcounty.gov/up/scvchange.html

Thank you for walking, biking, ridesharing, and taking the bus to campus

U-PASSupass@u.washington.edu

Paternal Prenatal and Postpartum Depression

“Overall meta-analytic rate of paternal depression between first trimester and 1 year postpartum . . . suggests paternal prenatal and postpartum depression represents significant public health concern," state authors of article published in May 19, 2010, issue of JAMA

Meta-analysis presents findings of depression in expecting and new fathers to: (1) estimate paternal depression between first trimester and 1 year postpartum; (2) describe differences across time period (3) examine association between paternal and maternal depression (4) estimate prevalence of maternal prenatal and postpartum depression identified in

paternal depression studies (5) identify how published rates of paternal depression affected by methodological

factors such as measurement method, study location, and sample risk status

Studies for meta-analysis drawn from relevant reviews; a search of MEDLINE, PsychINFO, Dissertation Abstracts International, EMBASE, and Google Scholar; and reference lists of retrieved articles

Initial analysis included all journal articles, dissertations, and book chapters produced between January 1980 and October 2009 that assessed paternal depression during pregnancy, first postpartum year, or both

Paternal Prenatal and PostpartumDepression (cont.)

Studies that reported an estimated # of cases among identified fathers selected Primary outcome was point prevalence rate of paternal depression Secondary outcomes included rates of depression in female partners and correlations

between paternal and maternal depressive symptoms Research also examined following determinants of primary and secondary outcomes:

period of measurement, risk status of sample, and case identification method (interview vs. rating scale)

Study location also coded

The authors found that Overall rate of paternal depression between 1st trimester and 1 year pp was 10.4%

(compared with recent national data on base rates of depression in men at 4.8%) Considerable variability between different time periods, with 3- to 6-month pp showing

highest rate of paternal depression and first 3 pp months showing lowest rate U.S. studies reported average rate of paternal depression at 14.1% and international

studies reported average rate of 8.2% Interview-based case definition methods associated with lower overall prevalence

estimates Overall estimate of maternal-paternal depressive symptom correlation was significant

Paternal Prenatal and PostpartumDepression (cont.)

“Observation that expecting and new fathers disproportionately experience depression suggests that more efforts should be made to improve screening and referral," conclude authors. “Correlation between paternal and maternal depression also suggests . . . that prevention and intervention efforts for depression in parents might be focused on couple and family rather than individual," they add

Paulson JF, Bazemore SD. 2010. Prenatal and postpartum depression in fathers and its association with maternal depression: A meta-analysis. JAMA, The Journal of the American Medical Association 303(19):1961-1969. Abstract available at http://jama.ama-assn.org/cgi/content/short/303/19/1961. Readers: More information is available from the following MCH Library resources: - Depression During and After Pregnancy: Knowledge Path at http://mchlibrary.info/KnowledgePaths/kp_postpartum.html - Fatherhood: Resource Brief at http://mchlibrary.info/guides/fatherhood.html

Surveillance for Guillain-Barre Syndrome After Receipt of Influenza A (H1N1)

Preliminary Results: Surveillance for Guillain-Barre Syndrome After Receipt of Influenza A (H1N1) 2009 Monovalent Vaccine --- United States, 2009—2010

Guillain-Barre syndrome is uncommon peripheral neuropathy causing paralysis and in severe cases respiratory failure and death

Incidence of Guillain-Barre Syndrome associated with H1N1 vaccine in 2009 US data

Vaccine considered safe Incidence:~.8/1,000,000 vaccines given Half of those may have had symptoms of Guillain-Barre Syndrome prior to

vaccination

For more information go to: Preliminary Results: Surveillance for Guillain-Barre Syndrome After Receipt of Influenza A (H1N1) 2009 Monovalent Vaccine --- United States, 2009—2010 Wed, 02 Jun 2010 16:30:00 -0500

Compensatory Time

Unused overtime compensatory time paid off by June 30, 2010

Accrued holiday compensatory time may remain unpaid until September 30, 2010

  Please refer to the University website for more

information about comp time:   http://www.washington.edu/admin/hr/ocpsp/flsa-ot/ot.html

  Questions may be directed to Department Human

Resources Consultant