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March 2012 Volume 1, Issue 2

UMMC Nursing Newsletter Tips on Clear Communication with Patients & Families Facts What is “health literacy”? The degree to which individuals have the capacity to obtain, process, and understand basic health information & services needed to make appropriate health decisions. About 1/2 of the US adult population has difficulty using text (write & read) to accomplish everyday tasks. Writing literacy skills: 29% basic & 14% below basic = 43%! Ability of the average American to use numbers: 33% basic ability & 22% below basic = 55%! How Can Nurses Improve Communication Skills? Listening is just as • Make eye contact when talking to patients & families. important as speaking • Use your spoken & body language carefully - may convey the wrong message. • Use plain language & probe for understanding. • Limit information to 2 or 3 important points at a time. • Use “teach back” and “show back” techniques, • Use pictures, charts, and diagrams to enhance the communication process. • When using interpreters, talk directly to the patient , not to the interpreter Tips to Using Teach Back or Show Back Techniques to Evaluate Comprehension When finished with patient teaching, have the patient: ♦ Paraphrase instructions; ♦ Observe patient demonstration and provide feedback; ♦ Reassure patient that others have difficulty with information; ♦ Encourage patient to teach family or friends in your presence; ♦ Ask open-ended questions that assess application of new knowledge.

Scripted Huddle for Unit Teaching “In order to better assist & prepare our patients, clear communication about diagnosis & plan of care are very important. Always utilize the ‘Ask Me 3’ concept:


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What is the patient’s main problem? What does the patient need to do? Why is it important? Make sure the patient teaches back or shows back understanding. Adjust your teaching style to the patient’s learning style.” 1

March 28th new oral care products

What’s New @ UMMC? UMMC Strategies to prevent VAP UMMC customized q4 hour oral care kits (for intubated patients). Protocol summary on each q 4 hour kit. • Sani-stor holder: stores patient yankauer. Use holder and yankauer for 24 hours—replace daily. • Plak-vac holder: stores patients suction toothbrush. Use holder & suction toothbrush for 24 hours—replace daily.

**See Oral Care Fast Facts and Vendor handouts for more information.

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From March Marathon Education: Product Replacements at UMMC MicroClave neutral displacement connector can be used on all peripheral and central venous catheters for the administration of IV fluids or medication. The MicroClave design offers protection against bacterial contamination and helped lower our BSI rates! Gripper Plus Power P.A.C. Needle allows for higher pressure and flow rates for power injections with PORT-A-CATH® POWER P.A.C. systems. SEPP – replaces alcohol pad for PIV insertion. 0.67 ml can cover 5 x 8 cm area FREPP—in blood culture kits and dressing kits. 1.5 ml can cover 10 x 13 cm area Chloraprep 3 ml “lollipop” - for line insertions & other procedures- contains most volume, and is most expensive! 3ml can cover 15 x 15 cm area



Sterile NS flush syringe—for use on sterile field only. • Do not store with non-sterile flushes or substitute for nonsterile flushes—they cost more! 7mm Biopatch® 7mm to be used for large bore catheter dressings that are expected to remain for > 3 days. (ie: Hemodialysis catheters, if indicated) 4mm Biopatch® - included in central line dressing kits for standard bore lines


Medipore + pad (island dressing) - available outside of dressing kit for use as gauze & tape dressing on weepy or oozing catheters.

Clinical Practice Reminder: Calculating the rate of Argatroban Infusions (Argatroban is an alternative anticoagulant for patients diagnosed with HIT) Starting the Argatroban Infusion via Alaris Smart Pump: • Perform an independent double check with 2nd RN when hanging a new bag, changing the dose, & change of shift. • Maximum infusion dose of argatroban is 10 mcg/kg/min Ordered mcg/kg/min x Patient’s Weight in kg x 60 min/hr = rate mL/hr Medication Concentration in mcg/mL

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Use the patient’s dosing weight for calculations. Do not use the daily wt. Calculate the drug rate(mL/hr) based on the order dose (mcg/kg/min): When communicating with team members: • Always discuss medication dosage, NOT the rate.

Discuss dosage in mcg/kg/min


Clinical Practice Council Updates: REMINDERS & UPDATES:

Patient Safety Reports

Gastric Residual Volume - Algorithm

Bed Malfunction—sparks due to frayed cord . Patient immediately moved to a new bed—bed sent to biomed for repairs—there have been 5 similar issues reported in the past 6 months.

changed-maximum increased to 500 ml if patient has no other symptoms of feeding intolerance or GI distress. --- Evidence presented group approved& recommended review/approval by GI providers.

Blood Transfusion Product Request Form Errors– there has been a high rate of errors on form– education included in Marathon… will monitor for improvement.

NG Tube Placement Verification Standards - reviewed EBP, Best Practice

Portable X-Ray Help- radiology staff is requesting assistance when performing portable films– there is a risk of dislodgement of patient tubes and drains—as well as risk for staff injury when attempting to perform x-rays alone.

Elevator Doors Closing Too Soon? Nursing leadership and facilities are working to identify a solution to the problem of doors closing during transports…. Stay tuned for more info.

Rapid Response Team Saves the Day!

Standards established by multiple experts, reviewed UMMC risk data regarding adverse events - Work Group started to set Clinical Practice Standards for UMMC

This project is a fantastic example of interdepartmental collaboration— Nursing, Nutrition, Radiology, and Risk Management staff are working on establishing a plan to allow us to utilize Best Practice Standards in a meaningful & realistic way.

Our Rapid Response team is getting some good exercise responding to calls in many areas- they have been able to prevent transfers to ICUs in many of the patient situations & are being much appreciated by all members of the team!


TENP Updates


Patients Leaving Unit Guidelines - new addition to Pt Rights & Responsibilities policy -reviewed - policy sets guidelines to encourage pts to remain on the unit & creates a document requiring acknowledgment of risk when leaving while undergoing treatment. - to be implemented April 1 Antibiotic Lock policy- new- instillation of antibiotics into line in attempt to preserve central access when alternatives are limited. approved by P&T, but still needs to go thru PISC & MEC.

Perflutren policy- revised- patient monitoring standards have been relaxed by FDAour policy changed to match manufacturer recommendations. 3


Announcing the merger of Critical Care Value Analysis (CCVA) with Med/Surg Value Analysis and TENP. This merger will allow a more streamlined approach to review products used in the care of our patients. Oral Care Kits—new Plak-Vac kits being deployed 3/28 to all ICUs to help us comply with the Oral Care Protocol and reduce Ventilatorassociated pneumonia. LaserBand pilot was a resounding success! staff feedback has been excellent & we will be replacing Endur-ID with the new LaserBand ID bracelets soon!

Falls Committee Updates Skin Care Committee Updates Committee will conduct a PI project on fall • The first NDNQI pressure ulcer prevalence prevention awareness through a kit (in develsurvey occurred on February 22 and 23. This opment phase) distributed to acute care and survey will happen on a quarterly basis insome IMC units. stead of annually. Next dates: Committee will develop post-fall management • May 23-24, 2012 to include EBP, Cerner order set, policy revi• August 22-23, 2012 sion, and staff education. • November 14-15, 2012 Low bed volumes average about 45/day, so Nasogastric Tube Placement Survey we are renting about 15, in addition to the Nutrition colleagues have agreed to assist us in 30 UMMC-owned measuring our enteric access catheter volumes & beds. current verification processes in our units.

Nurse Coordinating Council Update:

Thank you to our Nutrition team for helping us to achieve a collaborative EBP goal!

♦ Discussed opportunities to improve the collaboration between councils. ♦ NCC will set aside time to provide opportunity for council leaders to request feedback and share ideas. ♦ Group is reviewing all council objectives in relation to the Annual Operating Plan. Plan is to create equal sharing and joint efforts towards change.

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Data Corner

Nursing Research Director, Pat Woltz, provided an update on current studies. There are 6 ongoing studies and 2 in development at UMMC.

♦ Fall rates are increased in our Acute Care areas. ♦ Pressure ulcer data collection will increase from one to four times a year (all staging will be completed by WOCNs). ♦ Data reports are being adjusted to show eight quarters of data as required by Magnet. ♦ CLABSI Rates are looking good! ♦ CAUTI Rates are in need of improvementGET THOSE FOLEYS OUT!!!! ♦ Hand Hygiene scores still have room for improvement!! REMEMBER: Observations are done upon ENTRY and EXIT!! Certification Committee Update: Remember UMMC Certified Nurses’ Day Was March 16th!

February Meetings Canceled Advanced Practice Nursing Council On Demand Subgroup Competency Management Subgroup Nursing Research Council Update

The work groups (EBP Workshop Re-Design, "We Discover", Incorporation of EBP into Orientation, and Internet/Intranet Re-Design) presented their recommendations to the council for feedback and approval. Work groups will meet in March to develop and implement recommendations approved by the council. Nursing Grand Rounds Tuesday, March 20th 2-3pm Topic: "Rapid Response Team” Location: UMMC Auditorium Presented by: Margie Stickles

Celebrate being a UMMC Certified Nurse! March is National Nutrition Month! Please join the Departments of Clinical Nutrition and Food & Hospitality Services for a series of fun, tasty and educational events. The full list is available from the home page of the intranet or at this link: UMMS will be hosting a Virtual Food Drive to benefit the Maryland Food Bank. Check out the intranet for further details. 4

Power Users Group Updates: As you are aware, there have been ongoing performance issues with our clinical systems since the Cerner & Citrix upgrade on 2/26/12. Your feedback is needed to better understand the implications & severity of the performance issues. Patient safety is our utmost priority. Please complete the Cerner performance survey to let us evaluate short term strategies to optimize workflow and provide safe patient care.

Staff Nurse Council Updates

Since all councils include a regular agenda item related to patient safety, Lisa recommended that we include a column in News & Views related to what we learn from safety rounds. This is a great way for everyone to have a sense of what is going on.

Rose Jose, Pharmacy Operations Manager for Redwood and Weinberg, and Gary Stewart, Assistant Director for Ambulatory Operations, attended the meeting to partner with council members on customer service opportunities.

Patients Leaving Units Guidelines have been developed

Implementation is April 1, 2012. Graduate Nurse Advisory Committee Updates •

New Employee Orientation (NEO) decreased from 2 days to 1.5 days, and Patient Care Services (PCS) Orientation changed from 1 day to a half day. New schedule is Monday (NEO) and Tuesday (NEO morning + PCS afternoon).

Applied Nursing Practicum is now called “Essentials of Nursing Practice” as it covers topics pertaining to UMMC culture and initiatives imperative to discuss with new UMMC RN hires. This class now begins on the Wednesday of an orientation week. Offered 8 times a year, based on need.

UHC/AACN NRP Meeting: March 6-9 in Florida; out of 75 national submissions, and 23 spaces, two abstracts from UMMC new grads accepted for poster presentations: • Peds ED: Kathy Tran (mentor Michele Scala): “Will the combination of a comprehensive isolation procedure and continued education improve nursing compliance with initiating isolation precautions from triage?” • Transplant/PCU: Ayyub Hanif, Veronica Rosales, Victoria Johnson, Angela Lewis (mentor Mary Herster): “What is the recommended interval between glucose testing and insulin administration • in an acute care setting?”

FYI: New Professional Advancement Model Manuals and CDs are available at CPPD Office.


Professional Advancement Council Updates

Patient & Family Education Council Updates

During the January PAM cycle, there were 10 candidates that achieved a promotion to either SCN I or SCN II after review and recommendations by the review team. Way to go UMMC nurses! PAC members completed the first phase of education and training through the "Coaching for Development" workshop, with a focus on coaching and mentoring of staff looking for advancement within the PAM.

Council discussed and provided feedback to the new Outpatient Intake form r/t patient education presented by Susanne Anderson (Clinical Information Council). Approved fact sheet on clear communication to be distributed to staff, as well as a huddle script; group also discussed potential activities related to this topic to be included in the upcoming Clinical Practice Summit in March. (see page 1 of newsletter for fact sheet and huddle scripting)

Clinical Practice Update Reminder: February 6th Hazardous Medications- DO NOT CRUSH!!! • Pharmaceuticals are potentially hazardous to those who handle the medications and to the environment when disposed of improperly. • The purpose of Special Handling Precautions is to protect employees and the environment from the hazards presented by the use, handling and disposal of Haz hazardous medications. Waste on label! • Wear appropriate Personal Protective Equipment (PPE)! Important Points to Remember: • In case of leak or spill of hazardous medication, • Isolate and mark the area; • Don proper PPE; • Use designated spill kits to clean; and • Call Safety Department at 8-8711 for large spills (>10 ml) or when in need of assistance. • When caring for a patient receiving hazardous medications, their bodily fluids are potentially hazardous, as well Clinical Practice Update Reminder: February 10th New Speech - Modified Barium Swallow Order Set built for use by Speech Language Pathologists (SLP) ♦ Order set includes 5 “on call” orders for various Varibar (barium sulfate) products ♦ SLP will document administration on the eMAR ♦ RNs/RTs should not document using these administration tasks ♦ Please consult the SLP for any concerns Coming September 1st, New Wound Management Assessment Tool UMMS is embarking on the deployment of an Enterprise Wound Management System which will be used in an inpatient, outpatient, emergency room, & cross-facility environment. This system will provide a more efficient & accurate way to improve & communicate wound assessments, objective staging, healing, & documentation. In addition, this application will support clinical trials & research initiatives, track the effectiveness of adjunctive therapies, & enhance the ability to identify secondary diagnoses present upon admission. Electrical Hazard from Damaged Cords Recently there was a fire & several instances of electrical arcing (sparking) with patient beds. Beds are especially vulnerable to cord damage; cords are frequently run over and/or ripped from wall outlets when the bed is moved without unplugging first. Immediate action needed. Staff should examine bed (& equipment) power cords before they plug them in for: • Broken, deformed, loose or missing prongs • Cuts or damaged insulation If you find any of these defects, DO NOT USE THE ITEM. Call the SOSC (8-5174) for a replacement. See URGENT NOTICE - Electrical Hazard from Damaged Cords 3/5/12 for more information. Gudelsky Building Water Restrictions Water restrictions have been lifted for patient care areas in the Gudelsky building. This was a preventative measure to protect our vulnerable patients.


Announcements Nurses Week is coming soon! Details index.htm Planning members still needed Contact: Tori Martin CAPSUM Canceled! March 29th CAPSUM. To be rescheduled for Fall 2012. Look for more details coming soon.

Save the Date!!! UMSON: Practice Based on Evidence: The Future of Nursing Thursday, April 12 & Friday April 13 8:00 am-4:15 pm

TRENDS IN NURSING PRACTICE CONFERENCE Interprofessional Civility in Healthcare: Awareness, Impact & Outcomes May 1, 2012 at the UMMC Auditorium For UMMC Trends flier, please visit the intranet:

UMB: The Global Burden of Chronic Disease Friday, April 20th 10 am-3pm Trauma Care 2012: Humanity, Compassion, Hope Tuesday, April 24th 8:00 am-4:40 pm

Register online starting March 12th @ Thank you Trends Planning Committee for bringing a top notch conference to UMMC American Holistic Nursing Association (AHNA) Chapter at UMMC!

UMMC 2012 Trends in Nursing Practice Interprofessional Civility in Healthcare: Awareness, Impact and Outcomes Tuesday, May 1st 8:00 am-4:15 pm UMSON Summer Institute in Nursing Informatics (SINI) Wednesday, July 18-Friday, July 20 All Day

Meetings are 3 times a month for your convenience. All colleagues welcome.

Energy Medicine Network Take your holistic nursing practice to the next level. March’s topic: Introduction to Holisitic Upcoming events: Nursing...Survey Results...Your Input! • Healing Touch level 1, contact • Mon, 3/12, 0745-0845 Medical Center torium • Reiki Class, March & April, • Wed, 3/15, 1745-1845 T1R15 (across from contact auditorium) • “Health and Wellness Conference” coming • Wed, 3/22, 1245-1345 Medical Center AudiSaturday April 14th. Keynote speaker Dr. torium Andrew Weil. For further information: reFor more info contact: AHNA Chapter Leaders: • Diane Smith, RN, • Cynthia Salmond, CRNP,


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University of Maryland Medical Center Nursing Newsletter