Present: See Attendance Sheet Chair: Kathy Zopf-Herling, MSN, RN- BC and Lindsay Pritchett, BSN, RN, CMSRN Date: February 18, 2014 Time 7:00 AM to 11:00 AM Location: Building 606 Training Room A Absent: Recorder: Mary Louise DeMarco, MSN, RN- BC and Sandy Craft BSN, RN Guest: Sandy Garrison, Director Cardiovascular Disease Management Review and Approval of Minutes reviewed in handout. Jen made a motion to Minutes approved. Minutes (Lindsay and approve the minutes and Margaret seconded the group) motion. Unit Rounding Prep and Council Goals (Lindsay) Rounding today.continue same topics this month? New topics? o Plan of care? Mary Ellen feels the ICU needs assistance with the new Care Plan. Follow up us not being done. Nicole states that the dates are confusing. Donna feels that they are redundant and some of the staff are repeating the same thing each day. Documentation is not being dated and not always entered in reverse chronological order. Donna also noted that when there are multiple goals, it is difficult to associate the interventions and outcomes with the goals. Donna also noted that goals need to be identified shift to shift however Kathy stated Bev is putting together a tip sheet to send to staff. Send out clarification of how to document in the care plan: Date reverse chronological Problems not repeated (Resolved Date) Utilize the Care Plan for another month and will review next month. NI team will review options to Bev Drake SIC 1
that the goals could be identified daily. Donna discuss next month at SIC. suggested a checkbox to note that the goal was met. SIC members discussed the possibility of having a form similar to the Patient Education Form for the Care Plans. Mary Ellen requested Lindsay demonstrate the easiest way to view the care plan in Soarian Clinicals. SIC members note they are not reviewing Care Plan in shift report. Lindsay demonstrated the Care Plan in the Shift Summary. Lindsay confirms that the purpose is not to keep repeating the same thing but to use the checkbox for I have reviewed/revised the Care Plan even if there are no changes. Lindsay demonstrated viewing the Care Plan in the Multidisciplinary Rounds form. One of the comments from the Joint Commission was that the Care Plan needs to include multidisciplinary input and documentation. Donna feels the Care Plans are labor intensive. Nicole notes that it is a free for all without consistency in the documentation methods. Mary Ellen suggests that the boxes for text entry be smaller. SIC members agreed that there is too much scrolling to see what was entered in the other boxes. Kathy noted that CCH did not get cited by the Joint Commission for the care plans. To summarize issues related to the new care 2
plan form: Large box format with multiple problems how do you tell which item in the next box goes with which item in the problem needs box. Kathy demonstrated a sample problem list in the care plan format. Anne suggested a potential format with columns. Anne and Kathy recommended that the most recent text is entered at the top. It is difficult to address the current item when in chronological order, particularly for longer stays or multiple goals. Kathy suggested we look at the Care Plan module. The SIC members did not feel that this would be a timely solution to the current issues. While investigating, Anne suggested trying to set up the form like the patient education form. It was noted that in the Patient Education format, the care plan topics could not remain on the multidisciplinary form. Staff need to be reminded to evaluate progress toward goals each shift and sometimes may have new goal but do not need to write everything over each shift. SIC members request education and structure re care plan documentation. Discussed the need to prevent redundancy. Documentation of education as an intervention still needs to be documented on the patient 3
education form. Kathy suggested, entering Education as per education form. High Level education needs should go on the Plan of Care but specifics of education should go on the patient education form. Kelly Buchmann questioned if the goals could be erased when they have been met since the information is available in the Soarian Clinicals revision history. Kathy recommended the goals remain so the progression of the goals can be viewed by the multidisciplinary team. Feedback from group, Updates and General Announcements: JCAHO update (KZH) Kathy reviewed the JCAHO findings on page 13 of SIC Meeting Handouts. o One of the direct findings is ED patients not receiving education document for patients receiving moderate sedation. This is available in ExitCare and will be corrected. o Alert for Critical Test Results needs to be documented. Nurses are closing the alert that states this is documented elsewhere without documenting or checking for documentation. o Non responsive for pain reassessment 98 and 99 are being used when the grimace scale should be used for patients who are non verbal. It is ok to use sleeping. PACU nurses noted that in recovery the numbers can be inconsistent because of the effects of Athena to send Kathy screen shot of Critical Care Alert options and Kathy will send out tip. Send out tip re use of the Grimace scale versus non-responsive for pain reassessment. Athena/Kathy Kathy 4
anesthesia and it will look like the pain has increased after receiving the pain medication. Kathy recommended that nurses use non responsive carefully and remember to use the Grimace scale when appropriate. o Plan of Care as discussed above. The surveyors were very complimentary re the cleanliness of the hospital and the caring and cooperation of the staff. Provider Doc Update (KZH) and Clinician Navigator issue Kathy demonstrated the use of Clinical Navigator view of Clinical Summary for physician documentation. PEDS, MICA and Intensivists are now live. Training for the remaining physicians is scheduled for 3/3 to 4/15. All members of a group are required to attend training before any member of the group can go live. o Kathy notes a bug has been discovered in Staff to send Soarian feedback if this the Clinical Summary that will not grant message is seen. access to view any of the new provider documentation that an NP or PA initiated. You will see a message that you are not authorized to view documents and can only review the records in EDM. This is now resolved. o Lindsay noted that she cannot print the new progress notes from the Clinical Navigator but can from the Medical Record. Kathy demonstrated how to print 5
from the Clinician Navigator. Print link is to the far right of the document displayed in Clinician Navigator. UC SPW update (ML, Anne, Pat and Lisa) Rolled out in the ED. Positive feedback from ED. ED Plan SPW education at the next 2 Tech at Desk has reminder to call Nuclear Med Unit Coordinator meetings. Tech for off hours, give oral contrast, add on lab, and ADT orders. Anne demonstrated the SPW for Unit Coordinators Advance Diet as tolerated; daily lab orders, and CPK orders are examples of what the inpatient UC might see on their SPW. Anne demonstrated changing the orders to In Progress and Complete status. Follow up appointments, DNR orders, high risk for reassessment; discharge notification are also suggestions for use on the SPW. Oakie questioned how the ED feels about the UC telling the nurse to do something. Pat Bria notes the ED Nurse is not in the computer as much and appreciates the unit coordinator letting the nurse know there is an order for contrast, for example. Anne notes this needs to be part of the education for the unit coordinators and will most likely be different on the inpatient units. Critical Care (Kathy, Pat, Sandy and Mary Ellen) Phase 1 of the Critical Care documentation went very well. The End of March is the planned go live for Phase 2 where VS will be electronically sent to the Soarian Clinicals Critical Care Module. CFS tab in Soarian with Kathy demonstrated the new Clinician Flowsheet Kathy/Anne 6
Critical Care (KZH) (CFS). There are 5 tabs. Some data is coming from the machines and some is data entry. The documentation is done in the far right column. Vital Signs/ADL tab the nurse must validate data from machines and add data then accept. Only validated data goes into the view for the patient which is seen by the providers. Eventually other areas will have access to this view. There is a working flowsheet used by the nurses. Hemodynamics, Therapies, 840 Vent/BIPAP and NIBP are sent to the Critical Care Flowsheet. Other units will most likely not have this set up until the fall. There would be flow sheets that need to be built for other units to receive the vital signs electronically. Revision Requests: Stroke risk factors in Admission and Shift Assess Approved Revision Requests to be (Sandy) Changes proposed to clinical note approved: although the clinical note is not the ideal place to put this information, needs to be used on all patients that have stroke or TIA, purpose is for education and to document the patient s individual risk factors Also proposed changes to discharge plan library document Stroke and TIA Approved Kathy suggested that it go on the MEND but that form is not used by all nurses so SIC disapproved Changes to the stroke Risk Assess and Education Approved clinical note (Sandy) Move Care plan Reviewed/Revised field to top Approved of the screen in SA. 7
Education Document PICC line home instructions Revision Request statusfor approved items (NI team) Add choice 3 5 days for lab follow ups Add Home on Hospice, Inpatient Hospice, and Assisted Living to disposition in multidisciplinary rounds charting, Add verbiage to Domestic Violence question to prevent false positives done Remove defaults on pulse sites? Add pleural as a choice for chest tube location (CVU nurses) done Surgical Infections document done Depression screening questions (Pat) involved project CPAP, Snoring questions (Sandy) Kathy showed new values in past med surg history to indicate patient history of snoring, sleep apnea and home use of BiPAP or CPAP needs workflow Pain scale used (Sandy) in progress ADL Assessment change for safe patient handling done Total Joint Education (ML) done Daily weight alert option for cannot obtain Council reviewed and approved with the following changes 9. Word immerse is not patient friendly replace with do not get the line wet. Instead of numbers one through seventeen, make subsections and put all do nots together. Donna will take this document and make the editorial changes. 8
..if no option is selected the alert will come back in 5 minutes done Monitor Tech Form done no SIC feedback Approved ACC requested safe patient handling devices added to the assistive devices finding in the ambulatory procedure form Dietician forms Ann demonstrated the new nutrition assessment, there is carry forward from the nursing admission assessment. Ann is also working on this assessment for pediatrics. The information is available on the clinical summary on the multidisciplinary tab and in the clinician navigator. Will send out instructions, downtime Network downtime scheduled for 2/26. Will pcs will be deployed and downtime send out instructions, will have access to boxes will be distributed downtime pcs and downtime boxes Armband request SF analyst is looking into the option of changing the configuration of the armband barcode Extended recovery payment is based on the procedure and observation is paid by the hour so for some procedures we were getting reimbursed twice for the observation patients so extended care was developed to prevent that issue. This will not be a status change only a change in level of care. Unit Rounding Staff went to units for rounding. If there are no staff members to work with could review some charts and speak to issues that you find. SIC members to discuss rounding issues/results at next meeting. Anne Lindsay/SIC Members Next Meeting: Tuesday, March 18 from 0700 1100 Lindsay/Kathy 9
in 606 Training Room A 10