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
