UCLA Santa Monica Medical Center RESPIRATORY THERAPY STAFF MINUTES March, 2018

Transcription

1 UCLA Santa Monica Medical Center RESPIRATORY THERAPY STAFF MINUTES March, 2018 GENERAL Ellen Wilson LGBQT TRAINING MANDATORY ETHICS TRAINING MERP Ellen engaged staff and told them of the hospitals budget shortfall. She mentioned the organization is coming up with new FY19 goals. She asked staff to contribute ideas on how our department will meet those goals. We will be asking for staffs input when the goals are announced. LGBQT to training will be coming eventually. Mandatory Ethics Training is the first week of April Employees will receive an notification for their training MERP survey Calif. Dept. of Public Health (CDPH) -- probably is coming soon. This is like JC survey. They will expect you to know our policies and where to find them. Infection control Know disinfectant wipe times What you do for spores Disposal of vent tubing in the patients room Wipe down the vent They will have a Pharmacist for reviewing MERP. Know 5 patient rights for medication administration MAR Checking two patient identifiers Override of the Pyxis is for emergencies only and the emergency is documented in CareConnect as well Make sure you have orders for all of your therapy, etc. New Tracer System We will all be doing Tracers on Infection Control and other items.

2 2 Please contact Ted by phone for any of your concerns or issues This will be a learning experience, so all of our staff can be ready for their inspection and their questioning of us. Please use Suggestion/ Feedback Box, . BUT, if it s really important or a nagging issue Please call Ted at and leave me a voic C-ICARE PT EXPERIENCE &CULTURE OF SAFETY UPDATED- EMPLOYEE ENGAGEMENT SURVEY (EES)/A4 DASHBOARD PI QA A3 OUR QUALITY MEASURES AND Keep up your excellent CICARE Any questions on Patient Safe Handling please see one of our Champions below. We want to avoid any injuries to our staff. Arnold Fajardo Raymond Chang Katherine Mercado Russel Acosta Matthew Dartt 1) Have you noticed the improvement? The stats show that most months your daily average is under 500 minutes. Here are the stats for each month. It is going away in March since we are entering our slow season. 2) About 15 floats trained to ER/Peds 3) Clinic positioned filled by staff who currently have the most clinic experience and have excellent performance their and good attendance. 4) Matthew will be talking with all staff, one on one, about any issues you may have on changes you would like to see occur in our Dept. Please review our Dashboards 2nd quarter of this fiscal year 18 s, which is posted and ed. Please submit your new ideas anonymously in our suggestion box or via . We will have new organizational goals and we will notify you on what they are. Please submit ideas on how the Dept. can meet those goals.

3 3 PATIENT SAFETY HR TRACKER on Employee Items Due CODE PINK AND PURPLE REVIEW POC Please review the HR Tracker. It is posted outside of where you get your assignment entered, on the cork bulletin board. It is ed to you too! Every one of you receives an from HR on what is due, specific to you, as well!! Your managers try to remind you as well Due In April Annual Ed Due in May TB and Radiation Safety Sexual Harassment and workplace violence Should be done Code Pink (infant abduction) & Code Purple (pediatric abduction) requires a response from all floors (refer to your Department Disaster Plan) Typical abductor description: - Caucasian female 18 to 40 years old - Hand carrying the infant or child - Carrying a bag large enough to hold an infant - Covering the infant with her coat or a blanket - May be in scrubs or wearing a uniform Report suspicious activities or people to Security at x77100 (WW) or x99100 (SM), immediately. Emergencies dial #36 and/or 911. There will be a series of important inspections this year and we want to make sure to remind everyone of the following items with POC: DO a time out and focus every time you run a blood gas Compare Requisition vs Patient Label (use two identifiers) Select the correct sample type (ABG or VBG) Document Critical Value reporting correctly (Log book and put 003 before sending) Do NOT scribble or use any white out on erroneous documentation, Strike it out by placing ONE line and place your initials.

4 4 Please pay attention to the above sign!!

5 5 Don t run any blood gases if you see this sign (pictured above)!! Notify the supervisor or perform corrections immediately. (see Reyann if you need any clarifications) Please keep all POC sites clean and in order (Perform the maintenance and event logs early and completely) Absolutely NO gauze or gloves in the sharps bin! Sharps bin are for needles and syringes only.

6 6 DO NOT dispose any gloves or gauze in the biohazard or sharps bin. Only biohazard bags and blood soaked materials goes to the biohazard bin.

7 7 Complete all appropriate necessary charting such as critical reporting, rejected sample, and Allen s test. REMINDERS VENTILATOR CIRCUIT CHANGES Do not place oxygen tubing in RT baskets for our nebulizer in PTs rooms. If you remember O2, tubing is considered not clean. Please keep them outside of RT bins. Also, please chart "vent start date" during initiation of a vent, chart "vent stop date" after extubation. At one of our campuses, we recently had a PB 840 on a pediatric patient that was receiving Q4 Hypertonic Saline 7%. It had been on the patient for almost 6 weeks without being changed. The concha column was encrusted with salt crystals from the hypertonic saline. As a reminder, our departmental ventilator management policy states, suction catheters, columns and circuits are to be changed out PRN or after 30 days of continuous use. This patient s safety was jeopardized because we didn t pay attention to detail. It also can lead to ventilator operational problems

8 8 So that we help to remind each other of a circuit or column change, please remember to fill out the GREEN Column info sticker when you intubate or initiate a new ventilator on a patient. Also, document appropriately in CareConnect. VENTILATOR PROBLEMS In light of the many Severe Occlusion malfunctions we have had on our PB 980 Ventilators, we have been working closely with the Medtronic company and engineers to identify what the root cause of the ventilator malfunctions have been. After testing, we have discovered the underlying problem is a deficient internal software algorithm. This algorithm is currently being modified by Medtronic to accommodate our critical patient populations. The have recommended and provided our department with the Green Circle filters as a fix while they complete their algorithm update. (They need to follow the guidelines we have provided for both campuses on filter use.) Once Medtronic has a successful update to the algorithm, our ventilator software will be upgraded. The target date for resolution is by the end of August. In addition, the Medtronic testing also revealed that there were some clinician based user errors that have also triggered Circuit Disconnect alarms. These should not be confused with a Severe Occlusion alarms. Its import for staff to understand they are two totally separate alarms and what

9 9 was thought to be Severe Occlusion Alarms (after investigation) we re predominantly Circuit Disconnect alarms. Disconnect alarms are more indicative of errors that can be prevented by RT s if they are familiar with the details and information that the ventilator is returning to the clinician. As a result, we identified that there needed to be additional education for staff specifically on the nuances of the ventilator modes. Dan Cosa, the Medtronic clinical specialist spent 2 additional weeks with the SMH staff to help assist in clinical recognition of some of these ventilator mode nuances. This was to help us fine-tune the ventilator while on patients in an effort to mitigate the Disconnect alarms. All ventilators will now also default to VC plus instead of VC as all of the Servo- I s did prior. Since these changes have been implemented, including the green filter changes, reviewing of the ventilator and mode with staff, both campuses have seen an improvement in malfunctions. We currently have had no additional Severe Occlusion errors. Everyone is doing a great job with ventilator management. Please continue to keep up the great work. In the event you have an unusual malfunction, please notify their supervisor, Matthew or Dmitri our Equipment Manager! Any questions please ask! OPEN None