Clinical Staffing Resource Center

Transcription

1 Clinical Staffing Resource Center Quarterly Staff Meeting August 2013 (click a navigation link below) Power Point Presentation Staff Meeting Minutes

2 Quarterly Staff Meeting August 2013

3 Welcome and Introduction Meet and greet Team introduction

4 Educational Updates Cerner Lab Conversion Go live September 14 th Associated 2 hour downtime in HED when this is implemented

5 Diagnostic Laboratory Changes Simultaneous implementation of two projects: Cerner Laboratory Information System (LIS) will replace the current GE (LIS) Abbott Diagnostics automated chemistry line will replace the current Beckman instruments

6 Benefits of Conversion Improved specimen tracking Direct order interface with HEO and VOOM Accurate record of ordering providers Addresses ICD10 requirements Improved Chemistry turn around time Reduced downtime Decreased manual processing Improved electronic reporting to State and other regulatory agencies Smaller sample amount required

7 Date of Conversion September 14 from 10am-12pm Routinely lab test needed by noon should be ordered and performed by the 10am downtime when possible We will need to follow downtime procedures for all orders during this two hour window The lab will remain operational and test results sent to StarPanel Any pre-existing repeating lab orders will be discontinued in HEO/wiz and VOOM and will need to be reentered On Site Support from Systems Support (inpatient areas) and Operations Systems Engineers for (outpatient areas)

8 Changes for Point of Care Blood Glucose GEM & Hemoglobin A1C Testing Please have the nursing staff Scan the Account number not the MR number

9 Reference Range Changes Some Chemistry reference ranges will change as a result of new instrumentation and test methods. The new reference ranges will be reported with each test in StarPanel beginning September 14 th and will also be available in Pediatric reference ranges will be more extensive.

10 Future Related Lab Projects Glucometer replacement Lab ready labels on inpatient areas

11 Problem List- Educational Updates

12 On Tue., Sept. 9th, staff in VUH will see a new CARE PLAN Tab that should better guide the process from assessment to problem identification to prioritization to plan of care based on our new Nursing Documentation framework and Saba Care Categories. Some Care Categories will match existing Body Systems or other categories you already use (eg. Cardiac, Renal, Skin). Other categories will be new but will fill significant gaps in our current assessment options (eg. Coping, Role Relationships). The crosswalk below shows relationships of new categories to current ones on Assessments/Interventions tab. Care Plan Tab CARDIAC GI NEURO/COGNITIVE RESPIRATORY RENAL/UR SKIN INTEGRITY SAFETY RISK Activity Fluid Life cycle Medication Metabolic Nutrition Physical Reg Self Care Sensory Tissue Perfusion Health Behavior Role Relationship Coping Self Concept PEDS Assmnt Tab CARDIOVASCULAR GASTROINTESTINAL NEURO PEDS PULMONARY RENAL/URINARY SKIN FALLS RISK/SAFETY Musculoskeletal NA NA NA NA NutR by Nursing NA Act Daily Living NA NA NA NA NA NA

13 The new PLAN Tab looks like this with Plan of Care section at the top, Problem Assessment in the middle, and Care Categories in ALL CAPS must be assessed each shift and with change in Caregiver or Pt. Condition

14 Priority Problems at the bottom. Note that UPPER CASE Font still indicates categories to be assessed every shift while Mixed Case categories are assessed when warranted by patient condition/family situation. Care Categories in Mixed Case are assessed on admission and as indicated by patient condition Behavioral categories include options to address Role Relationship issues (eg. Caregiver Strain, Ineffective Parenting) and Coping issues (eg. Family, Coping, Grieving, Dying Process)

15 1. Standard Met is replaced with WNL (aka Within Normal Limits) at the top of each Problem Assessment Dropdown. 2. WNL reflects absence of a problem in the list 3. When the Care Category is NOT WNL, select a Problem that best describes the variance from normal. 4. Once you have identified all Problems, you would then determine which 2-4 are Priority Problems for your shift and would document those as usual, including identifying a Short Term Goal for your shift. Problem options when Care Category is not WNL

16 Problem Definitions are available for reference under Links at top of HED and Care Organizer screens. An example of the definitions for Activity Problems is shown above. Note that more generic Activity Problems are shown in Bold Face while more specific problems are shown in regular font. Use more specific problems when possible.

17 Educational Updates LMS Demo Policy Updates and Educational Summaries Mosby Updates

18 Educational Updates New Glucometer- October 29th Advantages of this new meter include: Requires smaller specimen sample Immediate, wireless uploading of results to StarPanel Cleaning materials do not degrade meter Staff training: all staff that perform blood glucose monitoring will need to attend one 60 minute hands-on training session in October. The schedule for these sessions is being finalized. Details and registration information will be forthcoming as soon as it is available. A variety of locations (including VUH, Children s, VPH, and OHO) and times will be available. (Note: off-site clinics will be scheduled after the initial training sessions are completed). Training on the new system will create a Fall 2014 certification due date for all testers.

19 Educational Updates MRI Questionnaire

20 Educational Updates My Health at Vandy Look up your medical records including OHC. health-portal/

21 My Health at Vandy Enter My Health at Vandy in the Search Box Click here

22 My Health at Vandy Click here Click here

23 My Health at Vandy Enter info to create an account When you are at a clinic or OHC, ask to be given full access. You will be able to look at your records on line from any computer, any where. You will be able to see your immunization statue for OHC.

24 Educational Updates Nurse Alerts Get notices about continuing education, Nurse s week, Nurse wellness, Nursing News from Marilyn Dubree, and many other items. p?site=vanderbilt-nursing&doc=40188

25 Nurse Alerts On Main VUMC webpage, click on Nursing

26 Nurse Alerts Click here Scroll to the bottom of the page

27 Nurse Alerts 1. Click here 2. Click here 3. Fill in form and submit

28 Educational Updates Virtual Clinical Workstation White board set up

29 Virtual Clinical Workstation Setting up the Whiteboard 1. Click on Star browse icon 2. Click on Customize

30 Virtual Clinical Workstation Click on Preferences

31 Virtual Clinical Workstation Make sure the answer is yes Click on PtLists and Inpt.wboard

32 Virtual Clinical Workstation Click and drag Inpt. Whiteboard to Favorites Click on Dashboards Click on Inpt.Whiteboard

33 Virtual Clinical Workstation Inpatient Whiteboard Click Select which beds to show. Select your assigned patients Select your unit

34 Education Updates VandySafe- Due 12/15/13

35 New Critical Care Classes CC Technologies Will be offered twice a year No CEUs offered Register in the LMS November 5 th & 6 th 7:30am 11:00am CRRT Update LIDCO Super User Training Cardiac Pacemakers/ Implantable Devices November 5 th & 6 th 12:00pm 3:30 pm Therapeutic Hypothermia RotoProne Super User Training 12 Lead Electrocardiography/ ST Segment Monitoring Link to Information:

36 Expectations Compliance Occupational Health and TB skin tests Credo Floating

37 Medical Center Updates How did we get here? Evolve to Excel (E2E)

38 Schedule Changes Meeting the Medical Center s needs while continuing to offer flexibility. Data shows us: Number Staff Needed per/day of week 10 month history VUH VMG VPH VCH Total Sunday Daily Totals Number Staff Needed per/day of week 10 month history VUH VPH VCH Total Sunday Monday Monday Tuesday Tuesday Wednesda Wednesday y Thursday Thursday Friday Friday Saturday Saturday Nightly Totals

39 Schedule Data More detailed data Jan-May 2013 Adult Inpatient

40 Schedule Process Effective with the next open schedule window- September 29 nd to October 6 th There will be new Process Groups Acute Care 7a-7p Critical Care 7a-7p Acute Care 7p-7a Critical Care 7p-7a Out-patient (non-benefited RN s, LPN s, and MA s) Pediatrics 7a-7p Pediatrics 7p-7a

41 Schedule Process Using the collected data, there will be a limited amount of shifts per group and per shift. This will help us better meet the Medical Center s needs Know your window opening time- 6amdelaying in signing up for your shifts may limit your available selection.

42 Questions??? Closing

43 Minutes Clinical Staffing Resource Center Q Staff Meeting or Unit Meeting or Other DATE August 26, 27, 28 NEXT MEETING TBD Director: Lou Kaelin TIME Varied by day TIME Varies by day Ast. Mgrs- Kellie Boucher, Dara Dixon LOCATION VUH 7T3 Conference Room LOCATION Light Hall Educ- Jennifer Anderson, Natalie Bishop Attendees: Meeting Record Topic Presenter Content Next Steps Pillar (select which pillar(s) represented) Welcome and Introduced CSRC team attending the meeting People Introduction Cerner Lab Upgrade Lou Kaelin Jennifer Anderson Meet and greet those around you. Cerner Lab upgrade: downtime planned for two hours on 9/14 on the go live date. This is hospital wide. You will now use the patient's account number rather than the MR number. There will be new lab ranges with the system please watch for these. (since meeting this project is now delayed- more to come) People Priority Problem List LMS Priority Problems: Phase II- problem list. Starts 9/9 in VUH going to new priority problem tabs in HED. This transition has already occurred in VCH. Pick only 2-4 problems (less is more in this case) LMS: Use the Chrome browser when working in the LMS for the best performance. The CWS link will launch the LMS in Chrome. Jennifer tries to push out all of the policies to your to-do list, but you can also add these yourself. Make sure you complete the acknowledgment for the policy to show it is complete. You only need to review the policies that apply to your role. Green means good and blue means to-do, but you may find a lot of old assignments are showing in blue. They are working to clean up the system but it will take a while to complete. Don't go back

44 Minutes and do the very old work. Glucometer MRI Questionnaire My Health at Vandy Nurse Alerts Virtual Clinical Workstation VandySafe Natalie Bishop Glucometer: New meter is coming 10/29. Training dates to be announced. If current glucose expires between 8/23 and 10/29, you will not renew, you will be extended until the new training is available. MRI Questionnaire: Some Pediatric staff are being asked to complete the Occupational Health questionnaire prior to taking a patient to MRI. You will have to sign off in MRI that you have completed the questionnaire and they will also give you some literature to complete your training. If you have implanted medal (screws, plates, hip, etc) you will not be able to take patients to MRI. My Health at Vandy: See power point on how to sign up for this important tool. After you have it fully activated, you can review your own clinical data and monitor if you have any Occupational Health requirements that may be due such as TB skin test. You can also message your physician. Nurse Alerts: See power point on how to sign up for Nurse Alerts. There are a variety of subjects to choose from and an excellent way to stay up to date on a variety of educational opportunities for continued learning. Virtual Clinical Workstation: See power point to understand how to set up preferences so that you can move from computer to computer and have your same patient information. VandySafe: Due 12/15. Please log into VandySafe and complete the required lessons. All of our staff are considered direct patient care. Only a few areas require glutaraldehyde for cleaning instruments and only trained

45 Minutes Critical Care Technology Class Expectations Dara Dixon staff who work with radiation implants should complete the radiation training. New info on hazard communications this year. You cannot test out; you must complete the full lesson, video and test. If you have a question about what you need call an Jennifer or Natalie Critical Care Technology Classes: This was discussed at the staff meetings but unfortunately since the meeting we have been placed on hold at this time. Compliance: Make sure you monitor all your compliance dates i.e. TB, POCT, N-95. You should not let things become past due. Please use your resources ( s, MyHealthatVandy, etc) to ensure you have reminders. People Kellie Boucher Credo: Please continue to use your best Credo behaviors showing our positive attitudes and how we come across to others. Medical Center News Lou Kaelin Floating: Recently we were contacted by a unit about conversations from a few of our staff when they were asked about floating to specific units. These staff talked negatively about these units. While we know everyone has units they favor over others, we must support the units as they now are having staff float among their partner units. Please help make this a positive for all staff. How did we get here? In response to substantial revenue reductions from Medicaid and Medicare, federal cuts supporting research, sequestration and other federal legislation. The Medical Center stared cost reduction efforts over 18 months ago. This work must continue as we work to find budget savings of over $250 million over the next two years. We are not alone; every academic medical center across the country is having this same reality check. Vanderbilt is actually one of the top medical centers leading the work on how to reduce costs.

46 Minutes Evolve to Excel (E2E): E2E is Vanderbilt s strategic change initiative. This is a system-wide workflow re-engineering process which focuses on improving function and enhancing revenue in some areas while preserving the vast majority of our mission-critical programs. This includes a review of staffing ratios, education, leadership structure, along with many other components. The entire E3E implementation will take 9 to 12 months. System-wide operational improvement will be achieved through workforce realignment via several steps including: natural workforce attrition, offering early retirement for some MC staff, re-engineering workflow to reduce the need to fill vacated position, eliminating some occupied positions in administrative support as opposed to areas that would affect direct patient care. The Medical Center is undertaking these steps to further strengthen the organization. This will be a better place. To be successful, these efforts require the active engagement and energetic support of our entire Medical Center over the coming year. Scheduling Changes** Lou Kaelin See Power Point for data used. Scheduling Changes: With the next scheduling window that opens September 29th, we will have a new process that will place each staff member into a group based on their primary areas. i.e. Critical Care Days, Med/Surg Nights (step down staff will be grouped with Med/Surg), Outpatient, etc. There will be a limited amount of shifts available on each day based on the data collected over the last year on what the Medical Center's needs have been. This should make us better positioned to meet the MC's needs while still offering some flexibility for staff. It will be competitive so we do recommend that you are ready to schedule when the window opens at 6am. This should decrease cancellations by better matching the needs. You will schedule only to your plan initially in the first window. We will then open a second window for additional shifts where you can sign up for more shifts. You will still have the flexibility to call the day ahead to be added to the availability list for a shift. Growth and Finance

47 Minutes Approved: Lou Kaelin Lou Kaelin MSN, RN, Director Clinical Staffing Resource Center Date 9/11/13