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!