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|Meeting Title: |Meeting Date & Time: |Meeting Location: |
|March PNPC Meeting |March 1st, 2018 |5132 Dickson Building |
|Facilitator: |Note Taker: |Time Keeper: |
|Sally Maclean |Natalie Callan |Natalie Callan |
|Attendees: |
|Tina, Sally, Madi, Jaimlyn, MJ, Gladness, Claire, Natalie, Sara |
| |
|Regrets: |
| |
|Liz, Magan |
| |Agenda Item |Action |
| |Review of agenda/additions |Name |
| |Approval of minutes from August 24th, 2017 |Sally |
| |Appoint minute taker – Natalie |Natalie |
| |Old Business |Name |
| |OR med orders, recurring issue. Sally working on new policy – will send draft to PNPC for review, |Sally |
| |addresses OR med orders. When patient is sent to OR, all med orders are discontinued. Physician must | |
| |re-write all orders upon patient’s return to floor from OR. | |
| |“HOLD” is coming back into use, but will need to have specific guidelines as to how long etc. | |
| |NG Management |Name |
| |How do we best encourage nurses to provide proper maintenance of Double Lumen Salem Sump? Re-occurring |Sally |
| |issues on floors, how to promote best practice? | |
| |Add pigtail air flushes to MAR until practice is being done regularly; q4h 15 ml air flush, if increase | |
| |gastric output (means increase in pressure in the gut), therefore we must increase air flushes to q1h to | |
| |prevent reflux from traveling up the drainage tube. | |
| |Make sure air flushes are listed on Kardex | |
| |NRT to be champions | |
| |PNPC to create a “did you know” page on the maintenance of Salem Sump | |
| | | |
| | | |
| | | |
| |Independent Double Check Practice |Name |
| |Hit or miss, not all nurses are doing it, some aren’t doing it properly asking “so what am I checking?” | |
| |meant to be a completely independent check. |All |
| |Most are complying with the Warfarin IDC | |
| |Continue with the promotion of safety, changing attitudes towards asking questions, it’s not a sign of | |
| |incompetence but a sign of safe, accountable practice. | |
| |CVAD Troubleshooting |Name |
| |Discussion about a newly insterted port-a-cath, xray confirmed placement, port flushing well but no blood | |
| |return, cath flow inserted, once xray was read more closely, noted that there was catheter pinch off due |Sally, MJ |
| |to positioning, patient needed to be sitting with arm up in order to get blood return. Make sure to read | |
| |notes on xray findings. IR should be involved with this case because of the pressure being applied to the | |
| |catheter, greater risk of thrombus development. | |
| |Cath flow Tips – 2 doses total per 24 hours, you should have a proper order, dose, frequency etc. Often | |
| |seeing cath flow daily prn… If not result from 1st cath flow dose, let 2nd dose sit, leave CVAD alone for | |
| |12 hours and let the cath flow work. | |
| |If all else fails, sometimes you can slowly infuse low dose cath flow with a pump | |
| |Triple Lumen cath flow dosing; it’s the 2mg divided by 3 (for each lumen) | |
| |Heparinized Ports: need physician to write out order, 100 units/ml, 5ml following medication, needs to be | |
| |on med profile so that pharmacy is aware that patient is getting heparin | |
| |Canadian Vascular Access Association Meetings – Sally finds them very informative, will forward | |
| |information on next meeting for those who are interested. | |
| |CODE status |Name |
| |Unclear what some patient’s code status is, whose responsibility is it to address it? Nursing cannot write| |
| |the order, but can initiate/facilitate conversations with patients if the timing is appropriate. Ensure |All |
| |clear documentation in progress notes of these conversations and patient’s wishes. Physician must write | |
| |order. | |
| |Language around code status, NO CODE vs DNR, it’s affecting how we deliver care. We can still get | |
| |assistance if patient’s declining, even if they are “no code” and will not receive chest compressions. | |
| |Going forward, how do we make sure code status is being addressed with the right way, ? on admission | |
| |checklist, ? PPO | |
| |Natalie will bring copy of Pathways of Care form from Veterans Services to next meeting. | |
| |Difficult ethical situations, patient suffering and family wishes, can contact legal services. | |
| |Nurse Burnout |Name |
| |Recap/reflection on talk from education day about nurse burnout. Some of the information was helpful, but | |
| |some was not. Discussed ways to prevent burnout: self-care; formal and informal debriefing; EFAP Phone: |Tina, Sally |
| |1-800-461-5558 | |
| |Online: ; using break time to “escape” leave break room if there is too much negative | |
| |talk | |
| |Understaffing/overcrowding units; try to keep in mind that we are all working together as facility, so by | |
| |discharging/admitting a new patient you are making room in ER for someone, trying to think big picture. | |
| |Texting/Social Media |Name |
| |What is the appropriate way to contact colleague if a med isn’t signed off? 1st check pyxis to see if it | |
| |was signed off, 2nd call them. Do not text or use social media to contact a colleague about a patient, |Tina |
| |breach of confidentiality. | |
| |Issues with medication missing form patient profile on pyxis. Some of the mixed IV antibiotics are not | |
| |listed on med profile. Follow up with Pharmacy Tech for this issue. | |
|9. |Veraflo KCI VAC |Name |
| |New type of VAC that instills normal saline, not many have had the opportunity to use it, 2 way tubing. | |
| |Dressing changed 3x weekly. Page ET if in doubt or have questions, check the NPWT PPO and care plan. |Sally |
| |Pico – single use NPWT all in 8 dressing with battery pack, can stay on as long as 7 days, ~ 80mmHg, good | |
| |for venous leg ulcers. Battery should be at distal end of wound. | |
|10. |Sepsis Handout |Name |
| |Subtle Signs of Sepsis Poster from Lippincott Nursing Centre, download will be posted to PNPC website | |
| |nrtprofessionalpractice. |Sally, Tina |
| | | |
|Date & venue of next meeting: |
|Next meeting TBD (aiming for July/August). |
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