Presiding: Present: Excused: Guest: Recording: Approval of Minutes Nurse Pharmacy Committee January 23, 2012 1300-1400 Out Patient Conference Room - MHE, RN;, Director of Pharmacy, PharmD; Renee Edsall, RN; Martha Clark, RN; Gail Shorter, RN; Lisa Cook, RN; Melanie Donaway, RN; Denise Chodnicki Pharmacy; Mandy Bounds, RN; Holly Frase, RN; Marla Best, RN; Ruth Thompson Pharmacy Wynne Aroom, RN; Jeannie Brower, RN Janet Wilson, RN Jennifer Kaminskas The minutes of the previous meeting were approved after changes. Attachment EP7EOb, Nurse Pharmacy Committee Minutes 1-23- 12 Approved Guest TX 23 Policy Janet Wilson is the new CCU/ GU faculty member working in Professional Practice. The other new CCU/ GU faculty member is Josh Barnes who comes to SHS from Chester River. informed the group that CMS statement released stated that the 30 minute before and after rule for medication administration can be removed. Holly Frase brought a question to the committee from Mary Beth Daniels and Telemetry staff regarding administration times for Lasix, the group was asked to consider time change for the administration of Lasix due to a higher risk of falls when given at 6am. Discussion was had by the group regarding possible time changes. The morning dosage was recommended to change to from 0600 to 0800, but the evening dosage was suggested to the same at 1800. The group recommended TX 23 policy going to Global Leadership and to unit based councils for input, before any final decisions are to be made. Janet Wilson will send the TX 23 policy out to the Global group prior to their next meeting asking for input regarding time changes for administration of Lasix. The group will take the possible Janet Wilson
Page 2 of 7 Gail Shorter brought up the possibility of giving Lasix at 0800 and 1600. changes to TX 23 to their unit based councils and report back at the next meeting. IV Push Medications discussed the different medications that can and cannot be used as IV push medications (handout at last meeting). Certain drugs are appropriate on certain units but not on others. The group explained how the discussion about the push list came about to those not at the last meeting. The question posed to the group for review was should we take the current IV push list and expand it, rate it so we can suggest where the medication is appropriate to be administered. Gail Shorter would like the group to review Morphine in combination with other drugs for conscious sedation. Mary Cook would like IV cardiac drugs to also be on the list. asked the group to come back to the next meeting with ideas for expanding the IV push list and suggestions for appropriate areas for administration. will work on placing both Gail Shorter s and Mary Cook s medications on the list and will bring it
Page 3 of 7 to the next meeting. Medication Administration Policy discussed the distributed handout, the Medication Administration Process policy, which she originally wrote to be very restrictive. She has now dummied it down to try not saying the medications had to be administered separately. The policy will be very vague, but Evidence Based Practice should still be followed. Susan wrote the addendum to follow section 2.12. Susan would like all comments on the policy to be sent via email to her by the afternoon of February 3, 2012. If there are no comments, the policy will go as is. Susan discussed another handout distributed to the group last meeting about which oral medications should not be crushed. She would like to include it as an addendum to the policy. Pharmacy will add the do not crush list to each of the medications from the pharmacy. Martha Clark mentioned during the mock Joint Commission Survey, the surveyor was concerned over SHS s strict policies and thought SHS s nursing staff may have a hard time keeping within the time frames within each policy. Martha would like the TX 23 policy to be based on policy and not any time frame. Susan suggested having the policy read to be administered within a reasonable time. Discussion about removing 1.3 from the policy. Changing the routine and will put language in about time critical. Ruth Ann and Susan will take this to the Directors Meeting regarding routine change. comments on Medication Administration policy and the do not crush list should be in to by 2/3/12. to email the handout to Renee Edsall and Mandy Bounds. Pharmacy will add the do not crush list to the medications from the pharmacy. and will discuss the routine at the next Directors Council. and will work on the wording around routine and Susan Siford and Susan
Page 4 of 7 and the critical timing. Siford IV Spreadsheet Renee Edsall spoke to Jo Anne Thomson and the IV spreadsheet is on hold right now by Clinical Applications group. Other projects are currently taking precedence. Diabetic Flow Sheet spoke on the Diabetic Flow Sheet pilot. The pilot has been stopped as of 1/20/12 due to a potential patient safety issue lab. Until Mike D Arcangelo, Ruth Ann, Lisa Lyons, Renee Edsall, and Wynne Aroom meet the pilot will remain on hold. 2 East at MHE is the only unit impacted and will go back to using the paper flow sheet., Mike D Arcangelo, Lisa Lyons, Renee Edsall, and Wynne Aroom to meet. DGH Clinical Pharmacy Pilot Results discussed handout distributed to group. Explained page 4, orders on the floor for DGH- Tele, ICU, and 2 East. Data has been compiled on DGH patients on Kevin s shift and MHE patients from the same time frame beginning 10/4/11 to 12/31/11 that met the qualifications and criteria. The step removed was the nurse calling the Pharm D. Adjustments being made were done very rarely. DGH nurses are very pleased with the changes. Staff pharmacists are liking it as well. Kevin will email handouts to Renee and Mandy. Kevin will take this pilot to Pharmacy and Therapeutics (P&T) meeting. Would like to start this in either April or May 2012 at MHE. will email handouts to Renee Edsall and Mandy Bounds. to take pilot to P&T. The surveyors from the mock Joint Commission Survey would like any nurse driven protocol to have a copy placed on the chart for reference. Ruth Ann explained that this will be discussed in the Joint Commission Task Force meeting for a final decision on
Page 5 of 7 the recommendation Kevin would like a list of protocols that are nurse driven created. Will bring it to next months meeting. will put together a list of nurse driven protocols for next months meeting. New Patient Personal Medications Policy Susan distributed a new administrative policy for patient personal medications. She would like the group to get back to her by email prior to the next meeting with any changes or suggestions. The group will email any suggestions to prior to the next meeting. Jennifer will attach it to the agenda email for the next meeting. Jennifer to attach to email to group prior to next meeting. Jennifer Kaminskas Heparin Pre-printed Order Sheet Kevin reviewed the distributed handout for Heparin pre-printed order sheets. Kevin explained how the use of this sheet as a part of the heparin protocol would minimize unnecessary calls to the clinical pharmacist and delays in therapeutic heparin adjustments. Kevin will forward this form to so she can take it to Forms Committee for approval on February 6, 2012. will email it to Jennifer Kaminskas, Renee Edsall, and Mandy Bounds. Proposal supported by committee to forward Heparin preprinted order sheet to. to take Heparin form to Forms Committee. Gail and Janet informed the group of the new bags of premix Heparin started being used which confused the nursing staff. Wanted to know if pharmacy could put something on the homepage of the intranet to inform staff of shortages or changes in medication dosages. Susan will check with Kim Quigley. will check with Kim Quigley about putting pharmacy updates on the intranet. Ruth Ann wanted the group to understand that the drug shortage is not a pharmacy issue, it is a nationwide issue.
Page 6 of 7 ICU Electrolyte Protocol Update Kevin discussed ICU electrolyte protocol distributed to the group. Susan asked Kevin for pre-printed sheets. Kevin would like to take this to P&T in February 2012. Medications Brought From Home Bag Susan and Ruth Ann will speak with Jim Robertson about getting rid of the smaller personal property bag and replacing it with the one the group liked best. and to meet with Jim Robertson about a new personal property bag. and Susan Siford Marla Best questioned what Short Stay does with the personal medications. Susan will speak with Susan Walbridge regarding what happens to the personal medications while the patient is in Short Stay and to make sure patient is not self medicating. will speak with Susan Walbridge regarding personal medications. Medical Surgical Pharmacy Task Force Membership Ruth Ann explained this task force will be set up like the ICU group. The task force will cover all pharmacy issues, BMV, and medication issues. Group agreed to have someone representing each unit. Members: Becky Wright- 2 East DGH Luann Satchell- Birthing Center Holly Frase- ICU Janet Wilson- CCU/GU Lisa Cook- 2 East MHE Ruth Ann will re-send request for staff from each unit to be on the task force. Lisa would like the group to also discuss the Computers on Wheels (COWs). to e-mail managers for staff representation on task force. Open Discussion Janet Wilson- If there is an ER bracelet, does it count as a BMV scan. The group explained that it is all the same. Lisa Cook- Concerned with double orders of medications.
Page 7 of 7 Melanie Donaway- Wanted to know why Propofol was not in a pharmacy protocol. Susan recommended having Kim Marks build in a line for Propofol preferred so staff would not have to anywhere else to find it. Next Meeting February 27, 2012 1300-1400 MHE OCCR Marla Best- Wanted to know if there was a way to alert staff in the Pyxis for an allergy. Susan said there was not one except for what is already there. Mandy Bounds- had some concerns for pharmacy that Susan Siford said she would handle.