Update 12/1/22

When in the best of times remember they will end and when in the worst of times remember they will end !    These are difficult days but your teamwork and ability to handle these record numbers amazes me.  I’m so very proud of y’all !!!   A source who is really great at predicting the cycle of infection for flu season etc is estimating the end around the middle of February.  Thank you to all of you who have signed up for extra shifts, this will be very helpful.  If anyone wants full shifts or a few hours please let us know!

1)      At 330 every shift the house sup will be calling to see how many “probable admits” we have.   This will help accuracy in the daily meeting.  If there are 6 rooms available in the house and we will probably need 3 then the main ED has an idea that they might get 3.  Any nurse can tell the HS the number if the CN is occupied.

2)      TSQ lab testing – we now have 2 Sophia machines that have the ability to test antigen flu and covid at the same time.   While the PCR is a more accurate test, we only have 2-3 channels in that instrument and the test takes 47 min each.  With our current volume the backlog could be hours.   The triage nurse ordering protocols should communicate with the lab to optimize the instruments by ordering accordingly.    Some of the doctors are not wanting swabs ordered as much as others is another factor to keep in mind.   If a family of 3 all come in with the same s/s during peak it may be prudent to test the sickest one only; of course, I have this conversation with the family and physician first.   Also, remember that the antigen test in particular is only as good as the swab / sample you get – be sure to obtain in the right manner.

The Sophia can tests the antigen covid and flu at the same time regardless of if you order one of them or both.  There isn’t a combo order for this they must both be put in:   “Flu A/B Ag Rapid” and “SARS Antigen”

I’m sure you all know by now that the PCR triple (Covid/Flu/RSV) is “SARS-CoV-2/Flu/RSV PCR”    While TSQ only has a couple of these slots in the instrument GST has numerous, that is why we added the antigen to the TSQ location.

3)      We are looking at options for a winter party in January….let us know if you have any great ideas !

4)      While I acknowledge that ideally we are not holding admitted patients long… please remember to put them in hospital beds, order food (when applicable), chart some kind of interaction with them hourly, and keep their VS updated appropriately per their condition

5)      We suspended our patient call back process for a bit during this volume.   It is a great addition to the patient experience and I really have enjoyed doing the calls more than I expected.   When volumes get back to an avg 55/day for a consecutive week we will resume these.

6)      The Soft Holiday schedule is out on the website:  www.nwthsfed.com

Email: nwfedstaff@gmail.com

Password: nwfedstaff

7)      Pain reassessment !

8)      Recently we had a ticket placed on the doppler.  Biomed picked it up and took it not realizing we did not have a backup.   It is probably a good idea to place the information that we don’t have a spare on the ticket so that they can pursue getting us a backup while it is being repaired.  I had not thought about this prior to now.

9)      Daniel’s last shift is Sunday !  He is going to work at Pantex; he will remain prn.   We are glad to have Tony with us in radiology now 😊.    Drew will be going to the cath lab as of 1/1/23 ☹.   There will be several other new faces to look for:  Erin, Amber, Mandi, Rachel, and a new traveler will be here Monday.  

Thanks for all you do !

Update 9/8/2022

Update 9/8/2022

1.       Joint Commission is due to come back for a visit at any time.  Please remember to toss all cardboard out and watch PHI on WOWs.

2.       TeleDoc Surge Plan:  Hours will be 8am to 10pm only.  We will not be using the TeleDoc option after 10pm.  GST will soon have an ipad of their own to utilize the TeleDoc system.  Please consider using the TeleDoc at 20:00 if you feel that there are more patients then the midlevel can see before they leave.

Step by step instructions on how to use this system can be found at www.nwthsfed.com.

Account Email login: nwfedstaff@gmail.com

Password: nwfedstaff

There is a blue tab labeled TeleDoc Surge Plan.

3.       Please check your work email every shift so that you are the most up-to-date with current processes, certifications expiring, and events.  As our census increases, you may need to come in a few minutes early.

4.       The glucometer must be checked each morning.  This has been missed at TSQ numerous times.

5.       Please place a ticket for anything not working properly including the patient dashboard screens, WOWs, and other equipment so that we can have everything functioning properly.  This will also ensure we have evidence of equipment that needs repair multiple times and may need to be replaced.

6.       Our census the last few weeks has increased and we must be placing the protocol orders in Cerner to start the process for the patient.  Please review the FED Protocol Orders on the website WWW.nwthsfed.com, on policy tech through the NWTHS intranet, or see the FED Protocol Orders that have been place on each WOW under the plastic sheet.

7.       Patient observation:  Patient observation officially started this last Monday, September 6, 2022 at TSQ!  Please review the email sent out about observation patients.

8.       The House Supervisor needs to be notified by the staff by 3pm or 3am if we are short a RN or tech for the oncoming shift.  If GST does not have a 3rd nurse or TSQ does not have a 11a-11p nurse we can use a tech in place of the nurse.  Please call the House Supervisor cell phone at 806-673-6016 or please call extension 1600.

9.       AMA patients:  The physician needs to be notified that the patient would like to leave and risks and benefits need to be discussed.  Please be sure you are charting that the physician or the nurse has gone over or attempted to go over the risks and benefits of leaving AMA.  Patients have every right to leave at any time.

10.   Remember that a translator must be used for any patient that does not speak English.  This must be documented in the chart.  Family cannot be used as a translator as it is not consistent with our policy.

11.   Patient discharge:  When placing your discharge note or vital signs please include a pain reassessment.

12.Welcome Back!!!

Audra Woodard FT nights RN from main starting 10/9

Lisa Rodriguez PT days RN starting 10/9

We are happy to announce that we are opening a 3rd FED!!!!  There will be more information to come.  It will be located at Western and Amarillo Blvd.

Please let Andrea or myself know if any of you have any questions.

 Thank you so much!

 Melissa

Observation patients

As of 9/6/22 we will start keeping observation patients at TSQ.   Please read the attached policy…it is in final review but not active yet.  Between the policy and some information below, I hope it answers many of the questions you may have but please ask me anything not covered!  I value your input and thought into details that we may have missed or that will make this a better experience for you and the patients!

·        In the policy you will note that the TSQ FED physician and staff will agree that observation at the FED is the best thing for the patient and can be done safely.   If the GST Dr wants to send a patient to TSQ for obs but there are 18 patients, the GST Dr would be requested to send them to the hospital.  If there are 18 pts at TSQ but 16 of them have houses for discharge, physician/staff might make a different decision. 

·        Gail wrote a great welcome letter to explain some things about a patient’s stay in obs at TSQ.  Also, in the back right corner of the supply room there are obs packets with non-skid socks, toothbrush etc.  Please provide these to obs patients.

·        I included a pic below that shows a lot of people AMA related to refusing admission.   I am unsure if they just want to go home or if they don’t want to go to the hospital…I am hoping we can capture some of this (obs) population and convince them to stay with us.

·        Of course an obs patient can leave AMA; I’m not advocating forcing anyone to stay.  However, to bill for observation the patient is supposed to be here for 8 hours past the first “treatment”.   This consists of protocol orders or orders placed by the physician.  TRIAGE DOESN’T COUNT in the 8 hours.

·        It is likely the physician will evaluate if a patient is ready to go, stay long, or transition to full admit at around 16-18 hours but have a conversation and find out that plan.

·        A PATIENT CAN NOT STAY PAST TWO MIDNIGHTS…so conceivably some patients must be discharged or be transitioned to a full admit at around 24 hours.  For example, if a patient receives their first care at 2350 then before the next night at 2359 they must be discharged or be fully admitted and slotted to go to main or another facility.   They don’t have to be out of the building and can stay longer as an “admit” but the accepting physician at a hospital is now the one in charge. 

·        The FED Dr will have two sign-ons.  One is what they use to place the observation order and the other is the regular FED one.  The regular one is what they will use to place obs orders so that they do not have to log out and in constantly between ED and obs patients.   The physicians have received special credentialing to be approved for this; if we have a new locums at TSQ they likely will not be able to obs

·        You will continue to chart in Cerner Firstnet as always for the observation patients.   There are not any “admission” special assessments or different elements to capture but a couple of things to look out for.    ER doctors almost never write prn orders; if an observation patient has a prn order it must be followed exactly or be changed by the physician (or RBVO etc).  For example, if Tylenol is prn for “pain 4-6” and the patient has a pain level of 2 OR you want to give it for fever…it can’t be given and the order must be changed.    If the doctor writes for morphine for pain “7-10” and the patient has a pain of 8 but wants the Tylenol “pain 4-6”…..that is actually ok and it is written into policy that the patient can pick the lower pain level med just not the higher level.  

·        If a patient has an order for a cardiac monitor or oxygen, be sure and chart that it is on.   We will always need to associate monitors and scan pumps on obs patients.  

·        One RN will assume primary responsibility for a patient.  Either the CN or acting CN will assign the patient or two partners will come to a mutual agreement on assignments.  The nurse assigned should chart the “bedside report given to X RN” etc and the oncoming do the same.  This doesn’t mean that the other nurse doesn’t help but it ensures that there is one person making sure they receive the antibiotic or breathing treatment and so on.

·        There should be some type of hourly charting about the patient condition or activity

·        FOOD:   NW has a “diet liberalization” policy which means that they let patients chose items they would normally eat at home unless there is a specific order for NPO or a special diet.   Family are welcome to bring food, we have drinks and snacks, and the Jason’s deli process.    If you don’t know about ordering from Jason’s Deli, please ask another staff member.   There is a book at each location with instructions and menus.  For some reason the JD on Coulter can’t find our charge name so we always order from the other one.  The receipt with a patient sticker should go in this book.   If you suspect you will have a patient for breakfast and lunch or lunch and dinner, place both orders for delivery at one time and place it in the patient fridge as we have to order a minimum of $25 each time for delivery.

·        It is an expectation that obs patients will be placed in the hospital beds.  I have a ticket for a second one to be brought to TSQ.   Please don’t forget family…roll in a stretcher for them if they stay the night.  I’ve ordered 3 recliners as well.

·        The dr should only order necessary home meds.   The pharmacy is increasing our medications that are typically home meds in the pyxis to assist with this.  We are not going to allow for patients to take meds they bring from home…the policy to do this is for the pharmacist to have a “facetime” with tiger text then they would confirm what the meds are and stickers would have to be printed for the meds.  This is too complicated and time consuming for nursing to make this a standard practice so we will just opt out of the brought from home med option.   HOWEVER, if there is a rare, or trial, or chem med, or other situation where it simply can not be missed, there is a policy to follow in policy tech for on how to have the pharmacist approve home meds.  While I would always refer you to policy tech for the most recent version, I attached policy MM 008 Patient’s Own Medications

·        The house sup will be a great resource and can contact case managers to assist with unusual situations.

What questions do you have or what do I need to clarify…I highly doubt I covered everything!

Thank you, I’m so proud to work with each of you and the amazing team we are building!

Andrea

CAT tourniquet

Greetings team! In TNCC you will learn about a CAT tourniquet and application. This is your best tool to use asap for prolific bleeding in an extremity. We had trouble locating one at TSQ so we wanted to review locations. We have placed them in three locations…on the code cart by Tx11, in the top drawer of the specialty cart, and one in the pharmacy room on the hook. We will order more and have one on the code cart in triage.

Update on the CAT tourniquets at GST.

One tourniquet is placed in the med room:

And the other tourniquet is on the code cart behind nurse’s desk:

Patient call back information

Next week we will start doing patient call backs; all the other UHS FEDs and main ERs are required to do this and it is an expectation that we start.   I believe it will be good for our patient satisfaction and to get real time feedback on our successes and opportunities.  We will start at TSQ and do some together, eventually we will call back the UHS goal of 50-60% and be doing them at GST as well.    It sounds daunting but really shouldn’t take long and all the staff in the building will help!  I have attached the process.   The night shift CN (which is Gail right now 😊) will print out the list and highlight the ones to be called using the criteria in “step 3”.    Gail, if you will show the other night shift staff how to do this as you work with them that would be great.  Until then the day shift can do it if Gail doesn’t work the night before…I’ll help!

Below is how you print out the list:

1)      Highlight the XXX All Beds - Nrs tab

2)      Click on the paper icon as circled below

3)      Pick the “Activity (EMTALA) Log”

4)      Parameters as below (ex is TSQ, of course GST would pick GST options)

5)      Nights:  Print the patient list and highlight the patients to call back using the step 3 criteria:

                                                               i.      Patient with a discharge LOS> 4 hours

                                                             ii.      FED Observation status patients

                                                           iii.      Discharged Diagnosed patients that are high risk HF, CHF, Renal, asthma etc

                                                           iv.      Pediatric patients

                                                             v.      Patient older than 75 years

                                                           vi.      AMAs

                                                          vii.      LWBS

6)      Days:   Determine how many staff are available to do call backs and divide up the list, non-clinical will need to be assigned the ones that had simple problems and probably won’t want to talk to a nurse/Dr.  Melissa and I get a report with phone numbers daily but can’t get everyone access to it.  We can print it or email it.  Also, the phone numbers can be looked up prior to each call.  I can show anyone how to do that.

7)      The daily log (see attached) -  The metrics that we have to keep on each call which goes into a dashboard that I send monthly to corporate consists of these items:

After making a call you can indicate if they had any issues or wanted to talk with someone medical for question 1; for question 2 you can ask them for a reply about was their visit “great, good, or poor” or if they didn’t answer the phone.   There is an area on the log for comments (good or bad) that I will keep track of.

 1) Indicate one: 2) Service (one response):

No Issues Call back requested Poor Good Great No Answer x 3

Melissa and I will be helping with this process daily, especially until all have done it and it is running smoothly.   We will indicate when we will start it at GST some time later.

Happy to answer questions or if you have thoughts on how to do this better I would love to know 😊

New luer lock vials from Nephron

Please click on the link to review the instructions for use with luer lock syringe.

New Luer Lock Vials

Good things!

1)   First of all, thank you all for your amazing teamwork, the countless hours of cleaning, and innumerable emails of information you read in order to prepare for the Joint Commission.   We did very well and you all amazed me with your responses to the auditor…you did so great!   There were 2 minor building findings at TSQ that were fixed in front of the auditor and there weren’t any findings for the building at GS.   The clinical findings were a child and an adult chart for moderate sedation were audited and neither had take home education information about sedation.   It is required for education material to include the procedure AND a different one about sedation.   We will cover this again in more detail.   The oldest patient at NW (the main building itself) had enough findings that TJC will have to return in 30-45 days to see progress about those findings.

2)   New Staff:   Welcome Tiffany Dominguez who is now orienting on the unit, she is a PT night RN;   Catherine Monzingo is coming back PT days !!!!;    Kelsey Baker accepted a position as PT night RN but has not started yet.  Amanda Johnson has accepted the FT Float RN position but is still training Chad how to be the stroke coordinator and will arrive in a couple of weeks on the unit.     I know nights have been a bit difficult…help is on the way!

3)   Dr Poage put a “tool box” and a fancy ring cutter that might actually cut a ring in each pyxis.

4)   WHAT IS GOING ON AT GEORGIA STREET TODAY ?????  WE HAVE HAD 6 POSITIVE REVIEWS ON GOOGLE TODAY ALONE…. IS SOMEONE STANDING IN THE MEDIAN BY THE LIGHT PASSING OUT THOSE QR CARDS TO ALL THE CARS ?    THANK YOU AND PLEASE KEEP IT UP !    The UHS expectation is for us to get 30 reviews per month at each location.

Protocol Orders

Greeting! A bit of a change to protocol orders, Dr Poage and I discussed this and are in agreement…

Prior instructions were that protocol orders are for when all the rooms are full or a provider is unable to see a patient expeditiously.  We are changing this to a more robust front end process where they are ordered by the triage nurse (or RN if only 2 on duty) in order to get ahead and assist with throughput and more prompt care of patients.   Obviously we would not want the triage nurse detaining a patient to place protocol orders when the provider is in the room waiting; use your best judgement about this but know you are empowered to order them following the approved guidelines.  Only RNs can place protocol orders.

This is especially important for getting that UA and an hcg on patients with N/V, abdominal pain, flank pain…this should be the standard and a priority.   For example, a female with abdominal pain is an ectopic until ruled out otherwise.  If the chief complaint indicates, as just mentioned, or if you suspect imaging is a probability,  order and obtain a UA and / or hcg as appropriate.   This is should be for all females of “child bearing years” which can be a variable range – taking a good history in this area will be important.

Also, if there are three nurses on duty, it is an expectation that one is assigned to triage.  The CN will do this when there is one; otherwise, the three on duty should determine who it will be and they will reside in the front to expedite triage and protocol orders.

Thank you and let me know if you have questions or problems!  

Andrea

Update 7/7/22

3 out of 3 perfect sepsis bundles for the FEDs last week!  Way to go Elhardt, Hatfield, Newson, Soria, Farhat, and Biskup !

With Chad leaving we now have a day RN position open.   It is our standard practice to offer this internally before posting and to offer it to the requestor with the most FED seniority.  Reply to this email and let me know if you are wanting to move to days.   Also be aware this is not a fast process - we will have to fill your night position and have them off orientation or a plan to manage the shifts prior to being able to move you to days.   Please let me know by 7/13/22.

Thank you!

Andrea

Update 7/1/22

Hey there !  Volumes have been low low and then high high…very unpredictably erratic.   Thank you for your patience and flexibility with this!

1)     STARTING WEDNESDAY 7/6/22 AT 11am we will call the NW dedicated AMR ambulance “NW1” directly for transfers from 11a – 11p at 806-282-5713.    You can call the truck for emergent transfers as well but if they don’t answer or if you want to call dispatch directly this would still be fine to do.  We do not want to cause any delays because of this process but it is an attempt to optimize use of NW1.     Attached is the set of questions that dispatch asks and you can just go down the list answering the questions for NW1.  They will have this same form.

If there is a non-emergent transfer that becomes ready at 1030 we can wait until 1100 and call the truck for the transfer.  If there is a 1050 pm transfer the truck may call it in for you but it would be expected that another AMR will take the transport as they would be on OT if they took it.   Please send me and Melissa an email if you experience any issues with making contact with NW1 etc.    If they get two calls in close proximity they will take one then come do the other as long as neither are emergent.  If they are on a transport and we call with an emergent one, they may ask us to call dispatch directly.

2)     Employee Performance Reviews will be from July 5 – 19.  Melissa and / or I will do our best to meet with you all 1:1.   Please help us with this; approach us about doing this at work or if you are off and not doing anything you can text us and drop by where we are to get it done.  Thank you!

3)     HOW DOES THE MARQUIS “WAIT TIME  x  minutes” GET CALCULATED ?    I want to review this as you may not know how that time is determined.   This is a rolling average of how long it takes us to complete the initial triage or red plus.  If we complete one at 0205 that takes 20 min (anything over 12) and we don’t get another patient arrival then that will become the only number used for the average for the next 2 hours.  You may not have anyone in the FED but the sign out front will say there is a 20 min wait time.  Of course this is a metric corporate follows because patients are less likely to come in with longer wait times.   Y’all are really great at getting patients back and taking care of them quickly and the sign should reflect that so please be aware of this and get the triage / red plus complete asap.

4)        I have 5 Daisy Awards to hand out to FED staff – way to go !!!  I’ll give them out then let you know who they were later 😊

5)  Staffing – Chad had his last day this week and will start as the Stroke Coordinator next week ! Congrats and best wishes !   Amanda Johnson was the stroke coordinator and decided to go back to the bedside so starting 7/17 she will be an ED Float FT NT RN between the FEDs and main…what a great resource.   Also, we have a new employee who did orientation last week and will soon start on the unit, welcome Tiffany Dominguez.  We needed to add to our list of Tiffanies !    The travelers finished up last week and were a big help in difficult times and greatly appreciated.

6)  Please be diligent in upholding EOC issues.  Last week we rounded with a corporate audit and found copious amounts of paper not in sleeves and exposed tape.  Tape can be behind something just not on the front.   ALSO, another finding were some nutrition items that were expired.   These recently arrived so I believe that they arrived expired!  Therefore, we have to look at all nutrition and medical supplies we put up to make sure we are putting things on the shelf that are in date.  Thank you

7)  IT IS THE 1ST OF THE MONTH AND ALL THE CART CHECKS AND FACILITY WIDE EXPIRATIONS ARE DUE AS NOTED IN THE BACK OF THE DAILY AND MONTHLY LOG FOLDER.  CHARGE NURSES AND ACTING CNs FOR EACH SHIFT, PLEASE LEAD YOUR SHIFT IN GETTING THESE ITEMS ACCOMPLISHED. 

8)  A couple of months ago some of you participated in an employee engagement survey, thank you for your entries.   Of course there were some opportunity areas and I’ll be working on these and sharing later.  I smiled with the top categories and wanted to share them with you.  When I interview new staff I almost always mention that the most underrated part of a job is how important the people you work with are in creating a positive environment.   Our top categories on the survey (on a 1-5 scale) were:  4.37 Teamwork, 4.31 Employee Relations, and 4.24 Quality.    I’m really happy that you like working with each other and gave one another a great teamwork score.   Great teamwork and quality are very closely related.  Tell your teammates they are awesome today !

9)  Reminder – don’t leave an O2 bottle in the portable single carrier, it isn’t for storage, only transport.  If an O2 bottle is below 500psi, you change the tag to empty and put it in the empty rack.

10)              Lots of HealthStream due !

11)              The safety message this week was about hallway clutter – remember that items must be stored on only one side of the hallway.

12)              For a short period we were stocking rabies vac in the pyxis but pharmacy has removed it. 

Thanks for all you do, let me know if you need anything.  Speaking of, many items are on back order and we are short on some critical items.  I know CS is working on finding sources.

Andrea

Update 6/3/2022

Greetings Team hope all is well !   Please read, nothing new just reminders.

1)     Next staff meeting (2nd Tuesday of each month) – June 14th 0645 or 1845.  We will have the Zoom option this time as well, I’ll email the link when I get it.

2)     LWBS (left without being seen) AKA LWOT (Left without treatment) – we had a patient not be seen by a provider for an hour so they left, the next day they went to main and had some significant findings… that’s the “why” of our need to get every patient seen by a provider.   The triage nurse has a lot of influence on “encouraging” throughput with the mid-level and providing creative ways for encounters.  Getting patients back to rooms quickly and providing frequent updates will help as well…thank you for your efforts in this, we have improved significantly !

***I have to give corporate an explanation for every LWBS, the only way I will know why is reading the notes you leave in Cerner, please include efforts you made to get them seen, thanks!***

3)     Techs and CNs work together at GS to utilize the double rooms; it is an expectation that we will utilize these rather than have 3’s in the lobby.

4)     The Joint Commission is at another facility this week in Amarillo, we think they may be at NW in the next week or two.  Please be diligent to keep up with all the EOC details.

a.     One struggle we have is pain reassessment even if they say zero the first time, they will look for a reassessment.  If they have any pain at all, even a 1, and no pain med is given they will want to see some comment about repositioning for pain, ice, distraction etc

b.     No door stops, heaters, fans allowed

c.      No sharps, meds, phi on WOWs…please get rid of the lidocaine 😊

d.     Carts are to remain locked

e.     Nails must be short and only paint is allowed

f.       Please fill out engineering tickets for any water damaged or stained tiles.

g.     It’s ok to ask for clarification on what an auditor is asking or to ask a peer for assistance

5)     The master key at GS was lost, Danny brought us a new one.  IF THE LIGHT ON THE BACK DOOR IS RED USE THIS KEY TO TURN ON THE ALARM…THE GREEN LIGHT SHOULD SHOW

6)     AMBULANCE – Their cell phone is 806-316-1055

a.     NW1 will call TSQ at 11a every day when they come on duty and check in to see if we have any transfers we haven’t called in, look at the TSQ and GS board

b.     For example if you get a room # at 1040 and it’s non-emergent, it would be best to wait until we get the 11a call stating they are on duty to call this in to dispatch and utilize NW1.  If it’s at GS we can tell the truck to head that way rather than arrive at TSQ. 

c.      Even if you say no to all the questions like “are they having difficulty breathing”, the patient will not just be a “transfer” but will require a priority truck based on a chief complaint like altered mental status, chest pain, etc.    They will send the closest truck for this type of transport.   Remember that while we wait on a room assignment, before we call dispatch, we can have the ambulance move to the other facility so that it will be the closest truck.    Please let me know if you have any difficulties with this, call me or send me an email.  ***Note, for true emergencies, we want the closest truck, I wouldn’t want any delays to move NW1!***

d.     The hospital case manager(s) will on occasion be calling TSQ to check for NW1 availability for unfunded transfers.  I printed out a log on 8.5 x 14 paper that is with the binders, a binder this size has been ordered.  This log is not for all trucks but for keeping track of these.  The TSQ CN should assist with calling these in to dispatch; the case manager should provide all needed information to make this simple.  AMR has requested that we have one source calling in to use the truck. (GS will continue to call in theirs of course)

7)     Kudos to Rhonda and Denise for working on the schedule – they are working diligently to balance meeting the needs of the unit while getting a schedule that will work well for you.  Thank you for your understanding and flexibility during the piecing of this puzzle !

8)     The CT construction is almost complete – the portable should be leaving 6/8.  The good news is that we have a handle and a badge reader on that east door and can use it.  Please be sure it gets closed appropriately for safety reasons.

9)     Hand Hygiene Audits – we have to do 150 audits per month at each location.  That sounds daunting but you could stand there and in a few minutes watch several people come in and out of rooms…each one is a “handwashing opportunity” and can be audited.  There are forms for this at each site.  I would expect us to have a 40-70% positive rate to be realistic.

10)                        REMINDER – I have to scan in the daily sheets and send them to corporate weekly.  If you don’t know what I’m referring to ask someone to show you.  There are many blank nights, ask day shift at shift change if you are unsure about what this is.  In the same book is the monthly check of carts and supplies, this is to be completed by the 7th of the month.  We label and pile up expired items to take them back to CS…the educators use these as needed.

11)                        Mandatory reporting – this can seem confusing or complicated.  I won’t pretend to cover every situation but a review on some:   Minors and geriatric (<18 or >64) are mandatory reporting to CPS or APS respectively for neglect, abuse, assault.  For 18-64 yo adults – they get to determine if they want APD notified for assaults, sexual abuse, domestic violence, to include knife wounds.   High velocity projectiles like gun shot wounds, even if self-inflicted, are always mandatory reportable.  Animal bites are mandatory as well

12)                         

13)                        New nurse in the ED ?  you may not know that the BON of Texas has special education requirements:

·        Two contact hours related to forensic evidence collection for those who work in an emergency room setting

·        Two contact hours related to older adults and geriatric populations for those who work with patients from these populations (such as in assisted living homes)

·        Two contact hours of education related to nursing jurisprudence and nursing ethics before the end of every third two-year licensing period for all nurses

14)                        Both FEDs have new QR code cards, please be diligent to pass these out; we also have a lot of folders in the cabinets in both triage areas.

15)                        We have several new people!  We are so happy to have them, welcome Lauren, Chris, Kerry, Katrina is back, Kim is back, Shay isn’t new of course but will be returning from maternity leave  😊.

16)                        Congrats to Marisela and her new baby boy!

I hope everyone gets a chance to travel or do some fun things this summer, we will work with you to help make this happen, thanks for all you do !

Andrea

Update 5/20/22

1)      Monday 5/23 Doug Matney will be visiting both sites.  He is the UHS VP over operations for the FEDs and Urgent Cares.  The tentative schedule is 1030 at GS and 1230 at TSQ.   I would be grateful if the Sun night and Monday morning crews would sweep the building for EOC issues.  We should be in good shape, quality came over today and there were a couple of things to review:

a.       Rarely used items are bagged as a method to indicate clean and to assist in remaining clean.  We do a great job of this but should also include the bladder scanner and the warmer in the OB rooms

b.       You can expect to be asked several fire related questions like RACE, PASS, where is the nearest extinguisher to where you are now.  Also, what is your fire retardant system? “overhead sprinklers and an alarm”.   If you had to evacuate, where would you go and can do you know where the posted evacuation routes on the walls are ?

c.       What is the process for cleaning otoscope heads ?  “after every use”   Process for cleaning VS machine?  “after every use”

d.       All the steps to follow for an SI patient ?   policy allows for no sitter if low or moderate risk but at the FEDs we do a 1:1 sitter for all levels, to prepare a room we do an environment checklist form; however, in the back of each 1:1 book is a risk assessment for each room that will guide you in what all is considered a risk;  the sitter must be qualified, how can you check this ?  At the FEDs, the RNs, techs, lab, and radiology employees all complete the electronic training (HealthStream)   A manager, educator, House Sup can check on qualifications

e.       We have restraints in the supply room – we all need to review this policy and if you are asked questions about restraints you can open the policy on the intranet in policy tech and answer those questions.

f.        Two common high level findings are blood on the glucometer and blood on the railing of beds

2)      In the med room at GS, the supply shelfing unit on the left is only attached to the wall.  When bags of supplies are hung on it, it is too heavy and pulls away from the wall so please discontinue doing this.  The rack on the right is standing on the floor and can manage the extra weight.

3)      We will use the “Dr Heart” and “Code Stroke” overhead paging on day and night shift.   Please be sure and place a sticker in the book.

4)      While auditing charts, it becomes apparent that there are some routine things we type or click that are the charting equivalent of “alarm fatigue”.   Please be diligent to not fall into this easy trap, examples of findings:

a.       Patient who arrives for dizzy and fall is labeled as not a fall risk

b.       Patient who arrives with an intentional overdose is labeled as not at risk for SI

c.       Patient who has to be taken in a wheelchair is charted as ambulating to room and/or is not a fall risk

5)      Melissa did chart audits on pain and reassessment has seen fantastic improvement !  Great job, keep it up 😊

6)      Please clock in to the right location:  38310 – TSQ;   48310 – GS;   6021 – orientation;   6023 education >4h;    8310 – main ED

7)      I will be doing payroll on Sunday – please send me an email or text for any omissions or corrections you have

8)      The suture carts at both location should remain locked at all time.  TSQ requires a key and GS has the code of 1,2,3,4

9)      Moderate Sedation – there are many steps that are required for a moderate sedation and Tiffany Powers put out education on this and created a laminated tip sheet.   One of the steps is to verify the provider is credentialed for sedation, obviously this is not for emergent situations like intubating or other life or limb issues.  How to do this:   go to the intranetà at the top pick the third tab over “Departments” à “Med Staff Services” à on the left below “useful links” is “Physician Privileges”.   There are 30 pages listed in alphabetical order, the search at the top right will be helpful.

10)   We have had several strokes lately and found that there have been issues with the tele-neuro.  Charge Nurses:  please huddle this every day with staff and review the process as it is a high risk / low frequency and is difficult to remember when you are in a stressful situation.   Also, remember to do NIH and swallow screen per policy…. A frequent finding is an aspirin given prior to the swallow showing completion.

11)   Schedule-gate:   Thank you to Melissa for the last 6 months of the nightmare that was the Covid staffing schedule!  Thank you to Rhonda and Denise for all your hard work on the current schedule !  The why – the hospital hasn’t made budget for a few months this year and we are having to account for productivity daily.   For the FEDs, productivity is a calculation that involves how many patients we see (not included- LWBS,AMA,Admits) and how many nursing hours are charged for the day.   Unfortunately, it doesn’t take into account that there are days 60% of our daily volume arrives in a few hours!  The UHS corporate staffing grid for the FEDs is as follows:

VOLUME                              STAFFING

< 20 ADV                             2 RN’s (24 x 7)

20 to 45 ADV                     Above + 1 PCT (24 x 7)

45 to 65 ADV                     Above + 1 RN for peak 12 hours

65 to 80 ADV                     Above + 1 PCT for peak 12 hours

80 to 95                             Above + 1 RN (24 x 7 – both shifts)

> 95                                    Above + 1 RN for peak 12 hours

Right now GS has an average of 63/day and TSQ has an average of 43/day for reference so you can see that with the change to 2/2 with a mid-shift at TSQ and 3/3 at GS we are still a bit over what the grid allows but we can still manage it and have a safer environment.  Staffing is 51% of the budget and the reason we are having to switch to 2/2 and a mid at TSQ in order to help make budget as the volume has dropped recently.  Most of the other items are fixed like utilities and supplies.  Managing our LWBS and AMAs will help the volume, these numbers were really good last month.   Providing a great patient experience in order to increase return volume, being very engaging for those phone calls that represent potential visits, and creating a great environment for EMS staff who often determine where to take patients are about the only other ways to influence volume.  

This was difficult to do on a schedule that is already out, I apologize for any inconveniences this may have caused you and appreciate your flexibility in the changes you made.    Changing it now instead of in a couple of months will help everyone plan ahead rather than managing productivity by filling the next couple of months with copious LCs.  Please check your shifts before coming to work so you show up at the right place😊 Thank you all! 

12)   Kudos to Cherri and Rhonda found expired items in the facility and then CS was replacing them with expired items…all the ones in CS stock were expired ! Good catch!   Dakota found numerous expired items at TSQ, great job!

Update 4/8/22

1)  The mock JC audit is next week.   Right now the FEDs are scheduled for Wednesday but may be earlier or later depending on their progress.   It is likely they will look at charts from Sun – Wed to make sure key elements like discharge instructions, patient education, and pain reassessment are present…for those less common events like sedation or SI they may go back as far as necessary.

SURVEY ETIQUETTE

Ø  Welcome the surveyors to the unit as soon as they appear.  Do not vanish!

Ø  Make sure to “hand off” your patients to another nurse before interviewing

Ø  Remember to answer only the questions surveyors ask you – do not volunteer information

Ø  Make eye contact with the surveyor; listen to what they are asking

Ø  If you are not sure of the answer to a question, it is OK – just ask for clarification or say that you are unsure, but know where to find the answer. You may ask to your manager for support if they are available or look at the Intranet resources.

Ø  Listen to any education the surveyor offers

Ø  Do not place blame on another department, point out weaknesses, mention past surveys, etc. . . . surveyors may view these remarks as excuses and the comments do not evoke sympathy

Ø  Always be professional and confident when you speak.

Ø  Do not argue or challenge the surveyor– the surveyors did not set the standards

Ø  Do not give the surveyors any policies, forms, etc. – the surveyor escort will obtain these items for the surveyor

Do not lie or falsify – this has serious consequences that will impact the survey process and the hospital’s accreditation status

1)     Ultrasound is doing the outpatient exams in RME 4 so we will need to keep a stretcher in that location.  I know that the other RME rooms are very full right now since we had to move items to get ready for the new CT instillation

2)     CT – you will notice the portable CT truck on the east side of the property.   A badge reader and door handle have been placed on that east door.  On your next shift, please try out your badge and make sure you have appropriate access, send me an email if you don’t.  Most patients will be able to go in a wheelchair but help CT as much as possible as this is going to be difficult.    Construction should start 4/13 and will take a bit over a month.

3)                STAFF MEETING:   Next Tuesday 4/12   0645  and  1845.   ALSO,  I am adding an extra staff meeting opportunity on Thursday 4/14 at 2pm.  There is a lot of important information and I will need to go over it with everyone.   If you are unable to attend, please review this information with me, Melissa, or a CN and send a confirmation email that you went over it as your signature.  My goal is to finish the slides and email them so you can be exposed to the content and have questions ready.

4)                We had great attendance at the RT – Vent/Cpap training and I appreciate Tiffany and Todd for that opportunity.  If you didn’t get to attend get with a CN who can walk through setting up our RT equipment

5)                The FEDs do not do many sedations and this makes it difficult to remember all the elements that must be captured.   You need to know how to verify that the physician is credentialed to perform the procedure and follow policy PC 065.  Two important pieces are that the patient must be discharged with PRINTED information about the procedure they had AND information about after care for sedation.  VS during the procedure were a finding last time.  From PC 065 for reference:

B. Intra-procedure monitoring, equipment and supply requirements for moderate sedation 1. Physiologic measurements will include baseline heart sounds, breath sounds, respiratory rate, oxygen saturation, level of consciousness (Aldrete Score), blood pressure, heart rate and rhythm and patient temperature monitoring. IV access must be maintained for patients receiving IV sedation. 2. Oxygen saturation should be monitored continuously. Oxygen will be available and used if needed based on the patient’s condition and per physician order. 3. Assessment and documentation a minimum of every 5 minutes x 30 minutes from the last dose of sedation/analgesia, and then every 15 minutes until patient meets discharge criteria (Aldrete score 8 or greater or return to baseline). Includes: heart rate, rhythm, SPO2, respiratory rate, blood pressure

6)     Many of you have had questions about the process when someone calls in:   During regular business hours M-F 8-5 or early evening you can call me or Melissa.   After hours (esp sleeping hours) or if management is unavailable you should call the CN, if there isn’t one the CN designee on duty.   The CN or RN you talk to shall notify the house sup and find out if house staff will be available to cover, place a notice on shifthound, and text those off to see if FED staff are available.   The CN/RN should text Melissa and me with results of the conversation with staff and house sup; if no alternate was located and the next shift will only have one RN please CALL us as we are unlikely to wake up to a text.

7)     The wall O2 regulator was left on all weekend and drained the cylinders down to nothing.   Please be careful about this as it could happen in any room and creates a significant safety issue.

8)     We have made great improvements in how we care for CP and Stroke patients by using “Dr. Heart to room X” and “Code Stroke to CT”.  It is an expectation that these are to be used.   They did a drill today at TSQ with the overhead and found that certain areas in the building require the person to speak quite loudly for it to be heard in an effective way.  I bet the same is true for GS.  Remember this when paging it overhead; don’t be shy !

9)     PTO cash out is going on, we all received an email

10)                        Random piece of information – recently a guidewire was left in a patient (not FED) and did not result in harm; however, they reviewed that two people, either two physicians or more likely for us the ED physician and the procedure RN should verbalize and document the removal of the guide.

11)                        When you receive a critical result call from lab or a critical VS, remember to document it appropriately.

12)                        The hospital is monitoring and making great efforts to eliminate the number of foleys used as they are traditionally a great source of infection.   ED nurses traditionally insert a prodigious amount of these; please evaluate every effort to avoid them.  We will look into stocking PureWicks and condom catheters.

13)                        The process of schedule sign ups should be covered by every preceptor in orientation.  If you have questions about it please ask a regular staff member, the CN, or management to explain it.   Many are missing their sign up days and this creates stressful situations.   We send out a shifthound message as a reminder during sign up week so let us know if you don’t receive these and we can change your settings.

14)                        THANK YOU SO MUCH TO ALL THE STAFF THAT CONTINUALLY CHECK ON EOC ISSUES AND HAVE BEEN A BIG HELP IN GETTING THE FEDS READY FOR THE AUDIT IN SO MANY WAYS!

Thanks for all you do!

Andrea and Melissa

Update 3/25/22

Greetings Team….lots of information below, please absorb !   Thanks

1)     Marisela turned 30 on Saturday 3/26!   Happy Birthday!

2)    As an FYI, UHS has 1600 items on backorder, supplies are limited in some areas or take longer than expected to get in

3) This red box is for sterile reprocessing, I believe the only item left at each location that isn’t disposable is the precipitous delivery tray and we are working on finding those items in disposable form. Lately, I have been finding scissors, ring forceps, tweezers and other disposable items in this bin. The process of sterile reprocessing is highly regulated and a frequent audit finding. Please don’t place any items in this bin other than the used precip tray and let me know if you think there are any other items that need reprocessed that I’m missing. Preceptors…train this to new staff please!

4)      Know how to shut off O2 and Air at each location:

The shutoff at GS is in the hall past Exam 1 across from the bathroom by the fire extinguisher…sorry no pic

At TSQ there are two, the one by room 10 is for Exam 1-10 and RME – take extra caution to not park a WOW in front of it as you can see that would be easy to do.  The shutoff at TSQ for Exam 11-12 and CT/Xray is in the hall on the way to the break room

5) More to come on this but we will soon send out information about following manufacturer’s instructions and frequency to clean the tono-pen.    If you see cans of air in the pyxis that’s what it is for but we will send out more info when available.

 6)    EKG packages -  once they are open, the remaining dots/pads must go in plastic bag and have 30 day exp date.  It is not sufficient to fold over the top of the packages.   CNs and preceptors please check and teach on this

 7) Pain reassessment – recent chart audit show that pain reassessment after meds and at discharge (with VS) is an area of opportunity for us.   That should be an easy fix, we will continue to audit. Thanks

 8)      NW uses O2 tips that are not disposable and remain in place.  If you see any of these that have the green plastic tips let me know and I will replace them because the green ones are single use items.   HOWEVER, SINCE WE USE THESE PERMANENT ONES, THEY MUST BE WIPED DOWN WITH EVERY PATIENT/ROOM CHANGE…BE ABLE TO SPEAK TO THIS.

9)   We all know we should do these two things, but I wanted you to be aware of the actually policy that requires 100% compliance and has progressive disciplinary action for non-compliance.    These are for patient safety.     Policy PC 093 Red Rules:   1)  Use of Two Patient Identifiers  and  2. Remaining with patients during toileting whom are at risk for falling (Morse Score of 45 or greater) or anyone requiring assistance for safe ambulating and toileting.     

********58% of falls lately in the hospital are related to high risks getting up to toilet******

10)      Please be diligent in watching for sepsis patients and never overlook a notice ! 

 11) The lac cart at GS must stay locked since it has needles, lidocaine, flushes etc in it:    the code is 1234

 12)   Doors should not be propped open.   This includes supply rooms at both locations starting immediately !   Thanks

 13)     Ambulance – minimal update…. The ambulance was called Life 30 but is now “NW1” or Northwest 1.   It continues to be available 11a – 11p 7days a week, both FEDs should be communicating with each other about utilization of the truck.  Process coming

 14) New CT coming to TSQ !    Starting 4/10 there should be a mobile CT unit being set up in the East parking lot where the sidewalk leading to the building is.  Please do not park there as of 4/9.    The CT installation process will start around 4/18 and is expected to take a couple of weeks.   IT WILL BE CHALLENGING FOR THE RAD TECHS TO HAVE TO TAKE PATIENTS TO GET CTS IN THE PORTABLE.   AS CENSUS ALLOWS, IT WOULD BE IDEAL IF A NURSE OR TECH COULD ASSIST THEM WITH THIS PROCESS

 14)  Phone Information:   Just a reminder to balance wanting to be helpful with caution with what we say.    It is appropriate to give someone their options like “we are open 24/7 and will be happy to see you or you can go to your PCP or an urgent care…whatever you think your need is” rather than “that sounds like you need to go to X”.  You can say what services we offer…yes we have a lab or no we don’t have an MRI but refrain from speculating what a doctor will and won’t do.   I always inform them that although we have these resources available, it will be up to the ED physician on what they want to order.

Thanks for all you do!

Andrea

FED Update

Greeting Team !    Here are some updates on information you need to know.  Some of it is information corporate has told us to make sure you know, some are questions you’ve had, others are related to findings of EOC or chart audits.   Please read carefully and talk with us to clarify anything needed; better to ask us now than have an auditor ask you later and you not know!

1)      Pain reassessment:   For chest pain, our pain reassessment was at 15% last audit and now we are at 40%... that’s a great improvement, let’s keep up that momentum.   All monitors should be associated with your patients; when you go to approve vital signs use that moment to scroll down a bit and enter their pain.    Our VS on discharge are improving but still have opportunities for improvement – remember to do pain as part of the discharge VS.   Communicate with the tech and new employees to make sure we are focused on compliance in this area.

2)      Suicidal patients:

a.       FED accepted practice is that SI patients will use bedside commodes or urinals.  The process of walking a patient to a bathroom presents a flight risk and  needs to be avoided.   If it is absolutely necessary (all the bedsides in use) then know that a staff member must be with the patient in the bathroom as there are numerous ligature risks like the cord to the call light and others. 

b.       At both locations, the keys for the “Quiet Room” cabinets and sliders have been placed together on one ring for ease of use:

3)      Falls – there are three elements to capture after a fall:

a)      In Cerner: at the top, you go to “Ad Hoc” then on left “Assessments” then “Post Fall Assessment”.   Cerner has numerous opportunities to chart information; however, please use this location to document a post fall assessment as it will capture all the required elements and is actually easier to use than typing out the event in a nurses note.

b)     The debriefing tool (attached and printed in a file at both locations) should be completed asap and faxed to risk management 354-1174

c)      Enter a Midas

4)      Bathroom Doors -  Do you know how to get into a locked bathroom quickly if you need to assist a patient ?   It may seem strange but the accepted practice is to place a penny on top of the hinge for each bathroom door to use for quick access.  If there is no hinge, look for it affixed to a sign close by.   Also, there is one patient bathroom at GS by Exam 1 that has a key lock where the penny won’t work.  The key for this, “Master”,  is on the main ring (see below).

5)      HealthStream – An urgent HS has been assigned that is a fulfillment of a regulatory requirement for healthcare facilities related to Covid/vaccinations, please complete this ASAP.   It is a simple 2 minute read and then attestation that you understood it.

6)      Earbuds / Airpods / Earphones create an impediment to communication with each other and patients and are not consistent with the UHS service excellence standards; therefore, FED staff will not wear them while on duty at the FEDs.

7)      If you missed the March staff meeting, I have an education piece that I need to go over with you.  Also, Kudos to our EVS staff for all they do and being a vital part of the team.  We gave them the February “unique expERience” award !

Staff will now take turns picking other team members who stand out in making the FEDs a great place; Chad will pick the next one.

Kudos also to Logan for doing the floors at GS during the bad weather; I heard Meghan was helping with TSQ floors as well;  the TSQ stock room looks amazing and is EOC compliant – I can tell there has been a lot of work there, same with GS everything looks so much better and compliance has increased.  Thank you all for pulling together and doing some amazing teamwork.  

Thanks for all you do !

Andrea & Melissa

Ambulance

So excited, this will be such a great resource !

Starting 3/1/22 we have an AMR dedicated ambulance  (Life 30)  7 days a week from 11a – 11p.  Eventually it will have the NW logo on it, something similar to the below picture.  We are working out the details and I will provide them when they are final but there are a few specific basic operation things I need you to know.

1)      This truck is dedicated to NW for 12 hours a day.  It is not a truck that would ever be used (from 11a-11p) to answer 911 calls or get sent out by Amarillo dispatch; therefore, AMR will not be determining what transfers this truck will make.   I have submitted a process where the Lifestar transfer center employee (1251) will use a set of criteria in determining how to optimize the use of this resource.  For example, if there are main hospital, GS, and TSQ transfer needs…who goes first ???  This hasn’t been finalized but I will communicate once it is approved.

2)      Lifestar will call Amarillo Dispatch to inform them that Life 30 is going on a run; this is necessary for AMR record keeping.  Therefore, even if the AMR staff are sitting right by you, you can’t just tell them to make a run.  You must follow the process and call 1251.

3)      EMERGENCIES – we can still call an emergent truck directly from Amarillo Dispatch.  For example, a STEMI comes in to TSQ but Life 30 is at GS…we can get a truck from AMR faster than Life 30 could come over; if Life 30 were at TSQ when it came in, we would use them.  We want to utilize Life 30 as much as possible in order to add to safety and patient care, not take away from it. 

4)      A cell phone has been ordered but has not arrived yet that will be specific to the truck… I’ll forward this # when I have it.

5)      THIS IS AN IMPORTANT ONE, READ CAREFULLY… we want to utilize the AMR staff in the ERs as much as possible and to the fullest extent possible; however, at this time, the scope has not been finalized.  Once the scope is finalized, the staff will have to do competencies.   We are working on this as it is very complicated; I would be happy to explain this in as much detail as you want just contact me.   However, for now, they should not function in any clinical manner but spend time learning our processes, location of supplies, walk patients back to rooms, and other non-clinical things.   Spend time getting to know them and make them feel welcome !

6)      The AMR staff will have patches on their sleeves or their tags have special colors to indicate what type of EMT they are (White – supervisor, Red – Paramedic, Yellow  - Advanced aka Intermediate, Blue – EMT (basic).   The truck will be staffed with 2 AMR EMTs, at least one of which will be a paramedic.

7)      This is a new process for NW to have this resource and I would request a high level of patience and flexibility as we work together in working out the details!  

Call with questions…Thanks for all you do !

Andrea

Behavioral Health update

TRAINING ON THIS IS TO COME THIS IS AN INITIAL FYI; HOWEVER, STARTING NOW NO SI PATIENT CAN GO POV TO BEHAVIORAL HEALTH (EVEN A MINOR WITH PARENTS)

The behavioral health patient will now receive a BH Intake assessment via telehealth with our MSE ipads.  The BH patient at the FED will receive an MSE via telehealth but it will be in the opposite direction than we used to do.  We will enter the patient information and call BH ,place them in front of the ipad and connect the call.  

All behavioral health patients must transfer to the behavioral health facility or the main ED via ambulance.  We will disposition the patient the same way we disposition our transfers to the main hospital and place the patient in the TSQ to NWT or GST to NWT row in Cerner.  Access will admit or discharge the patient from that point.

Any patient, including minors, that refuses to transport via ambulance to behavioral health or the main ED must sign an AMA form.  The RN will call report to Access and inform the staff if the patient is coming by ambulance or signed out AMA and is coming by private vehicle. The staff in Access will be responsible for monitoring if the patient arrives in a reasonable amount of time and will take the appropriate steps to keep the patient safe.

Updates 2/26/22

Greetings team!  What a great time we had at Cinergy, thank you all for coming.  If you missed it and Dr Newson’s grand entrance…well, I just have no words.   Dr Poage reserved the outdoor patio at CRUSH for our next event on April 28…more to come.

1)      FLEXING – when I arrived we were very short staffed and it was a widespread custom for staff to not sign up for their minimum which created a tremendous burden and I had to discontinue this.  However, our census / staffing ratios are such that we can now change this.   You should sign up for your required hours but if staffing allows, closer to the shift date or if census allows you to leave early you can request to flex off without pay in lieu of having to use PTO.  You will need to be sure and enter a PTO request on those times you want it or I will assume you don’t want it.

a.       Lately we have been asking if anyone is interested in taking off here and there to let you know it is an option.  Several have been very happy that this was an option.   Please note if we are asking if you’re interested, we welcome an honest reply. 

b.       The CNs will be evaluating staffing on a day to day basis in relation to census and peak times and may see the need to flex travelers, OT staff, or see if any FED staff are interested in flexing (in that order).   I know having 3 nurses is important and a satisfier for you all as well as management; we are more likely to get to keep this model if we manage it well.

c.       Please talk to Melissa or me with questions and concerns – I’ll come out day or night to address your concerns.

2)      Go Live date for the new lab tubes is 3/1/22.  There is a video on the New Shoes  / pes communication site about these

3)      There will be several new physician, tech, and nursing faces around in the next few weeks; make every effort to welcome new staff and help them with the transition to the FED.  Starting a new job is an anxious situation

4)      The ambulance will be coming soon!  Maybe 3/1.   We are working on getting the EMT scope of practice in the FEDs approved and defined.  Until then, show them the flow and our processes but we will have to hold off on them functioning in a clinical manner in the ED until this process is complete.

5)      Coming soon – instead of sending a patient to BH for the MSE we will do it here via ipad…sort of the reverse of our doctor doing their MSE.  See the attached.   More to come on this, we will have education.  I just wanted to bring it up and see if you have thoughts on this.  Please read the attachment.

6)      Several have asked lately about weekend requirements and if Sundays count.   The NW policy states weekends are considered Friday and Saturday for nights and Saturday and Sunday for days.  Several years ago Sunday night was included for nights and the floors would have 20 RNs on Sunday night and 3 on Saturday which necessitated the change.   The individual units can decide if Sunday nights count based on their need and Patti has always been aware that I count Sunday nights as that has been our biggest need.  

7)      Please continue to pursue EKGs in less than 8 minutes since arrival and encourage the doctors to place a time on them.  These are two fall-outs we struggle with but we have seen improvements!

8)      Kudos to Jodi, Bobbie, Denise and Dr King who had a STEMI and got them to the cath lab table in amazing time !  The CP coordinator brought them cookies last Friday

9)      The new process for checking FED carts / supplies / stocking rooms that Gail sent an email about starts 3/1… reread that and be familiar with it.

10)      INTERPRETER:   They have recently discovered the GLOBO module that they formerly thought approved someone to be an interpreter is only certifying staff as proficient in another language; therefore, at this time we do not have any official NW “interpreters”.    If you can talk 1:1 in a second language with a patient that is allowed; however, if another staff member asks you to interpret you must decline and inform them they must use GLOBO.  KNOW THIS INFORMATION FOR PRACTICE AND FOR WHEN JC ARRIVES !

11)      They are looking for a new floor person, unless he changes his mind I’m told Wilford will not be returning.   He did an amazing job for us and will be missed.  I have a new appreciation for his skill after my own terrible attempt at driving the floor cleaner!   I will keep in touch with Jessie about his progress in a replacement but please notice and rectify floor issues as you find them, thanks!

12)      Remember to direct patients to the QR Google and FB review cards when they have feedback about their visit.  Also, we put Daisy cards in each room that have a QR code.  Patients often ask about leaving good remarks on their nurse and this code will make it easy.

13)      KUDOS Gail !   She received the Daisy award of the month.  We are so proud of her and it comes as no surprise as she takes great pride in her work.  I’m sure you noticed the banner in the hall!

KUDOS to Candace who finished her FNP program! She has given notice and we will be transitioning some other staff into doing the ordering.

Thank you all for the flowers, texts, and kind words over the last week about my recent loss.  Your nice gestures have sustained me!  So happy to work with such a great team!

Thanks for all you do!

Andrea

Medication Change Effective immediately

DUPLEX Container for antibiotics Roll-out asap

Due to Medication Shortages you will note a change in several antibiotic bag- see tip sheet below for medications and how to- reach out to me if you have any questions or concerns- Tiff

Update from Gail

Hello fellow people!

As you probably have already seen things have been moved around.

Rhonda and I had the pleasure of taking on the responsibility of reorganizing.

I know change is hard but we believe that in doing this, it will be easier on the staff.

This email will be long but please read through!

At Georgia, Rhonda has reorganized the stock room and worked very hard on putting everything in 1 spot instead of 50 different places. It is also Labeled. The respiratory cart has been rearranged so that TSQ and GST respiratory carts are the same. Room 2 is set up for back up respiratory supplies, chest tubes, central line, and a few trauma things. ( this room is essentially the specialty cart that is at TSQ).  Room 3 is set up with a few respiratory things and then has ortho in it.  Rhonda, please let me know if I have left anything out.

At TSQ, the stock room has been re arranged. There is now strictly an airway section. This is so it is easy access for backup from our respiratory cart. The extra ekg and bp cords are hanging in the supply room.

If you have not already, please go through both places so you know where things have been moved to. 

At both locations there will be a few changes starting March 1st!

There are 2 lists hanging. 1 on the nutrition refrigerator and one in the stock room. If there is something that is getting low, please place it on the list. When ordered it will be crossed out. This is hopefully a way that we do not run out of things completely! Also, There will be a list on all exam rooms at both locations. When Night shift stocks, please place initials on that list. It is everyone's responsibility to stock. However, it has always been a night shift responsibility for as long as I can remember. Night shift,  if for some reason you are unable to stock just let day shift know so they can get in there before getting patients. Attached is a list of the carts. There have been nurses assigned to these carts. The first week of every month please go through the cart that is assigned to you and check expiration dates and make sure it is stocked appropriately.  The charge nurses have been assigned these carts unless there is a missing charge nurse then another nurse has been assigned. There is also a back-up person assigned. This is just in case the assigned nurse are not here or on vacation the first week of the month. There will be a binder at each nurse's station for check off.  

We will split stocking carts. Day shift is responsible for Suture Cart, Ortho Cart, OB Cart, and Code Carts ( Checking Code carts ). Night Shift: Exam Rooms, Respiratory Cart, Specialty cart (TSQ) Room 2 & 3 (GST), and Isolation Cart. (This is an everyday stocking routine).  On the carts, it is very imperative that if you use something out of the cart, (especially respiratory cart) it is your responsibly to stock it back so it will be ready to go for the next person. If there is not a supply to replace it with,  please text, call, or email Gail for TSQ or Rhonda for Georgia. Then in the check off binder at the nurse's station there will be a piece of paper that states what you are missing and your initials. Please tape on top of the cart until it is stocked. (This is an easy way to know what is missing). 

I know this is a lot of information and probably confusing. If you have questions call me or Andrea and we will be happy to go over anything you need!

Hope this helps!

Love Gail