Recertification BPA and Order - UnityPoint Health | Know ...
-826135-39635400Provider FocusOctober 2015-7715254699002015-16 Influenza Campaign 002015-16 Influenza Campaign UnityPoint Health – Des Moines____________________________________________________Who is at risk for contracting influenza? 30911804318000Everyone! Although older adults (>65 years old) and younger children (<1 year old) are at a greater risk.Did you know? At UPHDM for the 2014-2015 season, a total of 255 individuals were hospitalized with the influenza virus and 18 patients died. Is influenza season already underway? This past summer, six patients were hospitalized at UPHDM with influenza. This resulted in 26 hospital days and one death. Influenza season in the U.S. occurs in the fall and winter; however, individuals can contract influenza year-round.What can you do to protect yourself from influenza? The best way to prevent influenza is to get vaccinated every year. Practice proper respiratory hygiene and cough etiquette. If you do become sick, stay home from work. An infected individual is contagious one day before symptoms show and for up to seven days post diagnosis. Is the influenza vaccine completely protective? While still the best prevention, vaccine effectiveness is variable due to: Vaccine match: When the vaccine does match circulating virus, it is 70% -to 90% effective in healthy adults. Patient variation: May be less effective in persons with chronic conditions. How is UPHDM protecting patients, families and staff from influenza?Annual vaccination is available at no cost for staff and eligible employed physicians (>98% of our staff received the vaccine last year!)If unable to be vaccinated, staff must wear a mask when influenza is active in the community. Visitor restrictions activated when/if indicated during peak activity in the community.BOTTOM LINE: Get Vaccinated! Encourage your patients to be vaccinated!_____________________________________________________Clinical Informatics UpdatesChanges to Urinary Catheter orders (CAUTI)Urinary tract infections are one of the most common healthcare-associated infections with 70%-80% of these attributable to an indwelling urethral catheter. Minimizing the duration of an indwelling catheter is one of the primary strategies for prevention. The addition of the Nursing Urinary Catheter Removal Protocol, along with changes to orders, documentation and clinical decision support tools related to indwelling catheters are being implemented to aid in these prevention efforts. *Note: If the patient has a Urology Consult or is under the care of a Urologist, there must be a “Discontinue Indwelling Urinary Catheter” ordered for the Nurse to Discontinue the Catheter. If either the “Insert, Care & Maintenance DO NOT Remove Indwelling Catheter per Nursing Protocol” or “Care & Maintenance, DO NOT Remove Indwelling Catheter without Provider Order” order panel are ordered, there must be a “Discontinue Indwelling Urinary Catheter” ordered for the Nurse to remove the Catheter. The Nursing Catheter Removal Protocol is for the Adult population only. Pediatrics and Newborn are excluded. The current orders on any of the Pediatric/Newborn Order Sets that currently have a Catheter Orders today will be replaced with the “Insert , Care & Maintenance DO NOT Remove Indwelling Catheter per Nursing Protocol” panel and “Care and Maintenance, DO NOT Remove Indwelling Catheter without Provider Order” panel. Example of orders to place foley catheter:Example of orders to care for an existing foley catheter:Once you select the order, you will be asked for an indication for catheterization from a dropdown list. For additional information, there are three tip sheets available:Nursing Urinary Catheter Removal Protocol Order Entry for Providers Nursing Catheter Removal ProtocolCAUTI Nursing DocumentationEnsure your voice is heard regarding order setsIf you receive an e-mail regarding order sets, please respond with any concerns/feedback. This is important as the Order Set Committee (OSC) will need your feedback to ensure we have the orders you need available. It is especially helpful if you have evidentiary support for any changes, as all changes should be evidence-based.How OSC works:Order set changes are brought to OSC from affiliates through the enhancement processOrder sets go out for a two-week review (feedback is needed before this two weeks is over)Order sets come back to OSC for discussion and approval/denialOrder sets that are approved are sent to the build teamCompleted order sets go into ProductionIf we don’t receive feedback from you, we will assume that you are in agreement with the changes.Accepting order set changesYou may be aware that there are many order set changes as workgroups complete their review of all order sets. As any changes are implemented, when you use an order set, you may see a pop up window explaining that you need to accept the changes. To do this: Go into your inbasket in Epic There will be a folder titledClick into this folder. You will see your user order sets that have changes From here, you can do two things: Highlight the row (which will open a reading pane), review the changes in red and click the button to update your user order setHighlight the row, and click the button to modify your user order setRecertification BPA and Order Medicare requires recertification of the need for an inpatient stay every 20 days. In order to comply with their regulation, an order and a recertification reminder (BPA) have been created. There is a tip sheet available in Epic with additional information.Sleep Apnea BannerA pink sleep apnea banner has been added to various summary and index reports in the Summary activity. It will appear for patients who are either diagnosed with Sleep Apnea or are screened as at risk prior to surgery.Diagnosis CalculatorThe Diagnosis Calculator for inpatient/ED providers went live 9/13/15 as approved by the CMIO’s. This is a tool to assist with ICD-10 specificity. A tip sheet is available in Epic. Chart Review TabsTough-to-find documents will now appear in more clinically-relevant tabs in Chart Review.? The below notes have been moved out of the Notes tab beginning 9/7/15. Documents scanned prior to 9/7/15 will continue to appear in Notes tab.?Document TypePrior to 9/7/15Beginning 9/7/15Anesthesia RecordNotes tabProcedures & Surgeries tabsOperative ReportNotes tabProcedures & Surgeries tabsTransfusion RecordNotes tabLabs & Procedures tabsReferral AttachmentNotes tabOther Orders & Referrals tabsMedication RecordNotes tabOther Orders & Meds tabs_____________________________________________________Welcome to New Physicians and Providers143055107268Lindsey Koele-Schmidt, MD, Neonatology - Blank Children’s HospitalDr. Koele-Schmidt joins us after completing her neonatal-perinatal fellowship at University of Texas Health Science Center at San Antonio. She also completed her pediatrics residency at University of Texas Health Science Center and attended medical school at the University of Iowa Carver College of Medicine. She will be working in the Blank Children’s Neonatal Intensive Care Unit, joining Drs. Alabsi, Azuero, Bzdega, Harrell, Rice, Riley and Yuille. As you see Dr. Koele-Schmidt around, please welcome her to the Blank Children’s family! 00Lindsey Koele-Schmidt, MD, Neonatology - Blank Children’s HospitalDr. Koele-Schmidt joins us after completing her neonatal-perinatal fellowship at University of Texas Health Science Center at San Antonio. She also completed her pediatrics residency at University of Texas Health Science Center and attended medical school at the University of Iowa Carver College of Medicine. She will be working in the Blank Children’s Neonatal Intensive Care Unit, joining Drs. Alabsi, Azuero, Bzdega, Harrell, Rice, Riley and Yuille. As you see Dr. Koele-Schmidt around, please welcome her to the Blank Children’s family! -280670965200015381297363Brandon McNew, MD, Pediatric Hematology and Oncology – Blank Children’s HospitalDr. McNew joins us after completing his fellowship at the University of Iowa in Iowa City, Iowa. His research during fellowship focused on exploring the effects of environmental factors on genes that cause leukemia. Dr. McNew completed his residency in pediatrics at the Helen Devos Children’s Hospital in Grand Rapids, Michigan, and attended medical school at Michigan State University in East Lansing, Michigan. His clinical interests are leukemia and lymphoma, brain tumors, complex solid tumors, long-term survivorship and immune thrombocytopenia. Dr. McNew joins the pediatric hematology and oncology team with Drs. Woods-Swafford, Fustino, Rokes, Schwalm and Stephenson. Phone number is 515-241-8912.00Brandon McNew, MD, Pediatric Hematology and Oncology – Blank Children’s HospitalDr. McNew joins us after completing his fellowship at the University of Iowa in Iowa City, Iowa. His research during fellowship focused on exploring the effects of environmental factors on genes that cause leukemia. Dr. McNew completed his residency in pediatrics at the Helen Devos Children’s Hospital in Grand Rapids, Michigan, and attended medical school at Michigan State University in East Lansing, Michigan. His clinical interests are leukemia and lymphoma, brain tumors, complex solid tumors, long-term survivorship and immune thrombocytopenia. Dr. McNew joins the pediatric hematology and oncology team with Drs. Woods-Swafford, Fustino, Rokes, Schwalm and Stephenson. Phone number is 515-241-8912.-31940520002500152419276955Priscilla Putzier, DO, Pediatric Emergency Medicine – Blank Children’s Hospital.Dr. Putzier joins us after completing her fellowship in pediatric emergency medicine at the University of Arkansas for Medical Sciences. She completed her pediatrics residency at Blank Children’s Hospital and attended medical school at the Kansas City University of Medicine and Biosciences. Dr. Putzier will be working in the Blank Children’s Hospital Emergency Department, joining Drs. Anderson-Suddarth, Chande, Espelund, Groen, Holland, Holm, Jasper, Jensen and Thornton. 00Priscilla Putzier, DO, Pediatric Emergency Medicine – Blank Children’s Hospital.Dr. Putzier joins us after completing her fellowship in pediatric emergency medicine at the University of Arkansas for Medical Sciences. She completed her pediatrics residency at Blank Children’s Hospital and attended medical school at the Kansas City University of Medicine and Biosciences. Dr. Putzier will be working in the Blank Children’s Hospital Emergency Department, joining Drs. Anderson-Suddarth, Chande, Espelund, Groen, Holland, Holm, Jasper, Jensen and Thornton. -32131021526500853440-2540Anne Sayre, MD UnityPoint Clinic OB/GYN – Lakeview Dr. Sayre completed her undergraduate education at the University of Illinois - Champaign. She then completed her medical degree at University of Iowa and OB/GYN Residency at the Medical College of Wisconsin – Milwaukee. She is Board Certified through the American Board of Obstetrics and Gynecology.? Kate’s clinical interests include obstetrics and high-risk obstetrics as well as infertility. When she isn’t at the clinic, you will be able to find her with her family, including husband and daughters, ages 3 and 1, reading novels, writing, boating/waterskiing and surfing social media.00Anne Sayre, MD UnityPoint Clinic OB/GYN – Lakeview Dr. Sayre completed her undergraduate education at the University of Illinois - Champaign. She then completed her medical degree at University of Iowa and OB/GYN Residency at the Medical College of Wisconsin – Milwaukee. She is Board Certified through the American Board of Obstetrics and Gynecology.? Kate’s clinical interests include obstetrics and high-risk obstetrics as well as infertility. When she isn’t at the clinic, you will be able to find her with her family, including husband and daughters, ages 3 and 1, reading novels, writing, boating/waterskiing and surfing social media.85217053956Nick Vellema, PA-C, UnityPoint Clinic – Merle Hay Family Medicine – Urgent CareNick completed his medical degree at the University of Iowa. He then completed his advanced degree at Des Moines University. He is board certified by the National Commission of Certification of Physician Assistants.Nick’s clinical interests include cardiology, family medicine, pediatrics and urgent care. When he isn’t at the clinic, you will be able to find him running, fishing, woodworking, sports and world history.00Nick Vellema, PA-C, UnityPoint Clinic – Merle Hay Family Medicine – Urgent CareNick completed his medical degree at the University of Iowa. He then completed his advanced degree at Des Moines University. He is board certified by the National Commission of Certification of Physician Assistants.Nick’s clinical interests include cardiology, family medicine, pediatrics and urgent care. When he isn’t at the clinic, you will be able to find him running, fishing, woodworking, sports and world history.8521701905Dr. David P. Newton, Iowa Digestive Disease CenterDr. Newton is a fellowship trained gastroenterologist with a special interest in hepatology.Dr. Newton was born and raised in North Platte, Nebraska. Following undergraduate studies at Michigan State University, Dr. Newton received his medical degree from the University Of Nebraska College Of Medicine. He completed his Internal Medicine Residency at the University of Alabama at Birmingham and his Gastroenterology fellowship at the University Of Nebraska College Of Medicine in Omaha, Nebraska00Dr. David P. Newton, Iowa Digestive Disease CenterDr. Newton is a fellowship trained gastroenterologist with a special interest in hepatology.Dr. Newton was born and raised in North Platte, Nebraska. Following undergraduate studies at Michigan State University, Dr. Newton received his medical degree from the University Of Nebraska College Of Medicine. He completed his Internal Medicine Residency at the University of Alabama at Birmingham and his Gastroenterology fellowship at the University Of Nebraska College Of Medicine in Omaha, Nebraska85217010160Dr. Michael J. Page, Iowa Digestive Disease CenterDr. Page is certified by the American Board of Colon & Rectal Surgery and American Board of Surgery. The addition of Dr. Page to our practice allows Iowa Digestive Disease Center to offer our patients a full complement of colorectal care – including medical management, diagnostics and surgical procedures. Dr. Page offers a broad array of colorectal surgical services focusing on the following conditions:Colorectal CancerInflammatory Bowel DiseaseHemorrhoids & FissuresFecal IncontinenceAnal/Rectal Conditions 00Dr. Michael J. Page, Iowa Digestive Disease CenterDr. Page is certified by the American Board of Colon & Rectal Surgery and American Board of Surgery. The addition of Dr. Page to our practice allows Iowa Digestive Disease Center to offer our patients a full complement of colorectal care – including medical management, diagnostics and surgical procedures. Dr. Page offers a broad array of colorectal surgical services focusing on the following conditions:Colorectal CancerInflammatory Bowel DiseaseHemorrhoids & FissuresFecal IncontinenceAnal/Rectal Conditions _________________________________________________Blank Children’s Hospital: NICU Annual ReportThe Blank NICU Annual Report can be found here__________________________________________________Update on the Clinical Trials Office at UnityPointWe are here to assist with your research!We are located on the 2nd floor of the Education and Research Center on the IMMC campus.We provide resources for: IRB submission, budget/contract, consenting, data collection, monitoring visits, investigational drug dispensing, and more.We are approached daily about new and exciting clinical investigations - from interested physicians, sponsors and contract research organizations.Here are a few of our current and upcoming projects:Bacteremia, Dr. HarveyVenous Thromboembolism, Dr. LovellDrug-Coated Balloon and Vascular Stent, Dr. Fry and Dr. ScottCardiac Resynchronization Therapy, Dr. PalakurthyMultiple Sclerosis, Dr. JanusFunctional Constipation in Pediatrics, Dr. ManiniKidney Transplant, Dr. ShadurStroke, Dr. HansenMigraine, Dr. RankinKidney Transplant Rejection, Dr. ChaudhryLupus Nephritis, Dr. BelzUltimately, with your help, we bring new medicines and devices to the people of Iowa!We are always looking for investigators to help carry out the mission of providing the best care to our patients. Give us a call or e-mail if you are interested! Clinical Trials Office: 241-6727E-mail: joan.pruisner@, Research Pharmacist and Study CoordinatorResearch…the Pathway to Improved Health Care_____________________________________________________Cardiac Telemetry MonitoringOccasionally we have patients placed on floors where they do not have the appropriate level of cardiac monitoring. Proper ordering of cardiac monitoring is important for Patient safetyPatient experienceEfficient use of resources in regard to eliminating the time and work involved in having to transfer a patient who ends up in the wrong areaKey things to consider:Completing an option for telemetry on the bed request order tells admitting where to place the patient. It is important to note that ED nurses do not see the cardiac monitoring order when a patient is admitted to inpatient. They will not be aware of the type of monitoring needed unless the bed request order indicates this.Specifically ordering admission to a certain floor does not eliminate the need to order cardiac monitoring.Cardiac monitoring cannot be discontinued in the medical record when there is not an original cardiac monitoring order places.The Bed Request order does not = a telemetry order. When admitting a patient from the ED or transferring a patient from one floor to another, there is a need for botha bed request order AND a cardiac monitoring orderWhen ordering cardiac telemetry there are three options for patient placement:Continuous Cardiac Monitoring Patients requiring ICU placementTelemetry (Full) Patients monitored on a floor where nurses have expertise in reading rhythms and cardiac drugs can be given intravenously by push or infusionIMMC - N3 and N4 ILH - 3N at ILH Remote Telemetry Patients are monitored from another site by scope techs. Nurses on the floor are not trained to interpret rhythms and cardiac meds cannot be given intravenously.IMMC –Powell 3, 4, 5 Younker 5, 8, North 5 (Powell 4 can administer IV push Labetalol)ILH - 2N and 3EMWH – 3W and 4WSee the algorithm below that has been developed using American Heart Association guidelines to provide assistance when determining the type of monitoring needed for common cardiac admissions.Atrial Fibrillation-Rapid ventricular response (RVR)Requiring continuous IV infusion or new onset? Yes- Full TelemetryNo-Remote Telemetry Cerebral Vascular Accident (CVA)Receiving IV blood pressure medications except for Labetolol?Yes- Full TelemetryNo-Remote TelemetryPowell 4 can push LabetololSyncopeIs syncope related to an arrhythmia, pauses, runs of ectopy?Yes- Full TelemetryNo-Remote TelemetryHeart FailureNew onset, acute exacerbation or readmission within 30 daysYes- Full TelemetryNo-Remote TelemetryChest PainElevated troponin, positive/suspicious EKG or highly suspicious cardiac etiology?Yes- Full TelemetryNo-Remote TelemetryHypertensionRequiring continuous or IV push medication for BP control or hypertensive crisis?Yes- Full TelemetryNo-Remote TelemetryPermanent pacemakerAdmitting diagnosis cardiac or pacemaker related? Yes- Full TelemetryNo-Remote Telemetry_____________________________________________________Save The Date: Hawaii41More info is available at: desmoines/hawaii____________________________________________________Annual DNV Primary Stroke Center Certification Survey > Last year 795,000 people in the US suffered a stroke> Stroke is the #1 cause of disability and the 5th cause of death in the USWe at UPH-DM are doing our part to change those statistics - evidenced this week through our 5th annual DNV Primary Stroke Center certification survey. Under new guidelines, effective July 1st, this organizational endeavor was successfully led by Lyndsey Schwanz, Stroke Coordinator, with Laura Juel, Director of Neurosciences, Kelley Blackburn, Process Improvement Coordinator, and Dr Cal Hansen, Medical Director. Improving stroke care occurs because this great leadership and the remarkable teamwork of so many here at UPH-DM. This week I have been privileged to observe the results through interviews, group and performance improvement discussions, and project presentations. The surveyor’s closing summary began with, “You have a magnificent program in place!”?Two areas for improvement in meeting the new standards were noted. These related to elements of documentation and pt assessment.Four areas of noteworthy accomplishments were highlighted:The new patient education program “Healthwise” - The same patient information about Stroke care and prevention is now available for teaching by hospital staff, physician clinic staff and for review by the patient and family following discharge.? Staff Stroke Education using the Sim Lab and real actors (examples: Mock Stroke Alerts and Dysphagia Assessment)RN’s accompanying Speech Pathologists to barium swallow tests to visualize and better understand the risks related to hidden swallowing issues following StrokeThe use of our new bionic leg to improve the stroke rehab phaseSincere thanks to those who contributed to the recent survey, and also to each of you whose daily efforts prevent strokes and assist patients and families in their recovery following stroke. -66802029273500_____________________________________________________Knowledge Improves Quality: ProcalcitoninLevels & SepsisBy Annie Bell MSN, APNSeptember is international sepsis awareness month and the UPHDM Sepsis Action Team has planned for multiple sepsis awareness activities. We hope you will have taken advantage of these. One of our main presentations this year focuses on the use of procalcitonin, a blood test, in the care of patients with suspected or known sepsis. If you were unable to attend the Internal Medicine Grand Rounds – “Procalcitonin: What Is the Role of this Biomarker” by Dr. Trevor Van Schooneveld presentation on Wednesday, Sept. 2, you’re in luck. The following review of the procalcitonin literature was submitted by Ms. Annie Bell, Senior Clinical Science Liaison with Thermo Fisher Scientifi. Thank you very much, Ms. Bell.What is Procalcitonin (PCT)?PCT is the prohormone of calcitonin. Calcitonin is produced predominantly in the thyroid gland. PCT is usually present in very small quantities in the bloodstream. However, during an inflammatory process such as an aggressive systemic bacterial infection, other cells within the body begin to produce PCT, which will dramatically increase the serum PCT level.1,10 Elevated circulating levels of PCT are important markers in response to microbial infections and a powerful tool in the early detection of sepsis.1When does Procalcitonin rise?Following stimulus by a bacterial endotoxin or trauma, PCT plasma concentrations:2,3? Rise 3 – 6 hours after bacterial invasion? Are significant after 6 hours? Exhibit peak values between 12 – 48 hours? Have an observed half-life of 24 hoursThis rapid and sustained response to bacterially induced systemic inflammation is an important hallmark of PCT as a marker of sepsis risk.What does the test result mean?Normal serum PCT levels for healthy adults (and infants older than 72h) are less than 0.05 ng/mL. 4-6, 10Low levels of PCT in a seriously ill patient represent a low risk of sepsis or progression to severe sepsis and/or septic shock, but don’t exclude it. Low concentrations may indicate a localized infection that hasn’t yet become systemic or a systemic infection that’s less than 6 hours old. It may also indicate that the patient’s symptoms are likely due to another cause, such as transplant rejection, a viral infection, or trauma (postsurgery or otherwise).Serum PCT level of 0.05 to 2 ng/mL4-6Sepsis should be considered as well as a localized infectionSerum PCT level of greater than 2 ng/mL4-6, 10There is high risk for progression to severe sepsis and/or septic shock. Moderate elevations may be due to a noninfectious condition or the early stages of infection and, along with other findings, should be reviewed carefully.What are the limitations of procalcitonin?False positive and false negative results can occur with any test and clinical context should guide interpretation of PCT results._Situations where the PCT elevations may be due to a non-bacterial cause:6-9Newborns (<48-72 hours; after 72 interpret levels as usual)Massive stress (severe trauma, surgery, cardiac shock, burns)In absence of infection PCT levels trend down after inciting eventTreatment with agents which stimulate cytokines (OKT3, anti-lymphocyte globulins, alemtuzumab, IL-2, granulocyte transfusion)Malaria and some fungal infectionsProlonged, severe cardiogenic shock or organ perfusion abnormalitiesSome forms of vasculitis and acute graft vs. host diseaseParaneoplastic syndromes due to medullary thyroid and small cell lung cancerSignificantly compromised renal function, especially ESRD/hemodialysisAdditional Information: University of Nebraska Medical Center Procalcitonin Guidance ReferenceReferences:1. Müller B, et al., Ubiquitous expression of the calcitonin-i gene in multiple tissues in response to sepsis. J Clin Endocrinol Metab 2001Jan;86(1):396-404.2. Brunkhorst FM, et al., Kinetics of procalcitonin in iatrogenic sepsis. Intens Care Med. 1998;24:888-892.3. Meisner M, Procalcitonin: Experience with a new diagnostic tool for bacterial infection and systemic inflammation. J Lab Med 1999;23(5):263-272.4. Harbarth S, et al., Diagnostic value of procalcitonin,interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis. Am JRespir Crit Care Med 2001;164:396-402.5. Müller B, et al., Procalcitonin for Diagnosis and Monitoring of Therapy of Bacterial Infections Crit Care Med 2000;28(4):977-983.6. Meisner M, Procalcitonin – Biochemistry and Clinical Diagnosis – 1st edition – Bremen: UNI-MED, 2010 ISBN 978-3-8374-1241-3.7. Meisner M, et al., Postoperative plasma concentrations of procalcitonin after different types of surgery, Intensive Care Med 1998;24:680-684.8. Chiesa C, et al., Reliability of procalcitonin concentrations for the diagnosis of sepsis in critically ill neonates, Clinical Infectious Diseases1998;26:664-72.9. Reith HB, Procalcitonin in early detection of postoperative complications, Dig Surg 1998;15:260-265.10. Dalton D, et al., The predictive value to procalcitonin in sepsis. Nursing Made Easy! 2014: 12(1): 52-53.Quality in Motion: RL Solutions Monthly Featured FormsBy Janice McCullough, Clinical QualityWatch for the Monthly Featured Form, this month’s reportable events found under 2 more RL Solutions Event forms.. Infection Prevention: Recent Practice ChangesBy Julie Gibbons, Infection PreventionPeripheral IVsPeripheral IVs are no longer routinely replaced. This practice change is supported by the literature and is per Mosby Skills, the UPH-DM nursing procedure manual. This will not affect Blank Children’s Hospital patients, as this is their current practice. Peripheral IV catheters are to be discontinued when therapy is completed. The decision to replace a peripheral IV catheter will be based on assessment and indications (e.g., condition of site, catheter patency, prescribed therapy, and patient condition), per provider order or if complications occur (e.g., infection, infiltration, occlusion, signs of phlebitis). Every peripheral IV site is assessed at least every two hours.A peripheral IV placed in an emergency situation under less than optimal conditions, should be replaced ASAP, but no later than 48 hours after insertion.Indwelling Urinary CathetersA nurse driven protocol for removal of Foley catheters will be available in Epic on September 9.When the order “insert catheter” is placed two options are available:A. Insert, Care, & Maintenance, Remove Indwelling Catheter per Nursing Protocol* Includes a link to review the removal protocol that will be followed.* The removal protocol includes a checklist to review indications for an indwellingurinary catheter. If any indication is met, the catheter will not be removed.* This option is pre-checked.B. Insert, Care, & Maintenance, DO NOT Remove Indwelling Catheter per Nursing.* If this order panel is used a “Discontinue Indwelling Catheter” order must be placed to remove the catheter.If the patient is under the care of an urologist or has a urology consult, the nurse drivenprotocol cannot be used, so an order to discontinue the catheter must be placed.An Epic tip sheet, Nursing Catheter Removal Protocol Order Entry is available.For questions, contact your Infection Prevention Team: Sandy Peno, Kevin Daniels, Carrie O’Brien and Julie GibbonsQuality in Action: Care Coordination RoundsBy Kelley Blackburn, Clinical Quality & Denise Cundy, Nursing AdministrationWhat are Care Coordination Rounds (CCRs)?Care coordination rounding is a team approach to managing and coordinating a patient’s care during their hospital stay.They are completed with the patient and family at the bedside with the patient’s care team. They provide a structure forthe deployment of care coordination and engage patients in their care. The care rounds focus on what is currentlyhappening or changing with the patients’ medical condition, concerns or questions, and plan for discharge. Rounds areNOT just discharge plan focused.Who makes up the care team?Patient & FamilyPhysician or ProviderPatient Care FacilitatorCase ManagerSocial Work BedsideNurse PharmacistAny ad hoc members that are involved in the patients care such as Respiratory Therapy,Nutrition, CNS, PT/OT or Palliative Care.What are the Benefits of Care Coordination Rounds?? Improves the quality of care that we provide. CCRs allow the health care team to have a higher level of collaboration and decrease the risk of negative outcomes. This collaboration brings everyone together on the same page, and makes sure that everyone is giving and receiving the same messages.? Enhances the patient experience by allowing patients to feel included in their care.? Improves efficiency by enhancing the ability of identify barriers to progress and decrease the duplication of services.What types of patients are we rounding on and how much time is spent?While ALL patients can benefit from care coordination rounds, currently UPH is targeting patients that are at high risk to readmit (high lace scores), pulmonary diagnoses (COPD, PNA, PE, etc…), readmissions, long length of stay, complex discharges, and other complex medical/surgical R’s are short and succinct and should take approximately 5 min for each patient.What units are currently participating in Care Coordination Rounds?? IMMC - Younker 5, Younker 7, Younker 8, North 5, North 6? ILH – 3 East, 2 North? MWH – 4 West? All adult inpatient units will be required to participate in rounding, implementation will continue phases to other units.What is the role of the Physician or Provider?The physicians in collaboration with the patients are the primary leaders of the health care team. It is essential that the physicians or providers be part of CCRs. The success of this collaboration at UPH – DM will build the desired foundation to increase our quality outcomes. This will result in improving the efficiency of care and our patients’ experience. The Patient Care Facilitator on our patients’ units will contact the physician or provider to inform them of CCR times and provide more information how to be a part of this great team! ................
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