Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine Division Directors Meeting Yamins 208 Conference Room October 6, 2010 Attendees: MD s Anu Vasudevan Riki Kverega David Feinstein Raj Doshi Cindy Ku Kenny Leng Amy Anastasi Phil Hess Vimal Akhouri Pete Panzica Steve Pratt CRNA s Judi Connell Rebecca Peyev Trish O Connor Trish Demiglio Beth Coolidge Donna Greene Joanne Grzybinski Excused: Mark Heuther, Matt Basile, Rob Leckie Anu Vasudevan called the meeting to order at 17:05. Action Item Summary of Discussion/Decision Follow-Up Action Responsible Person Due Date 1. one Medical Vendor provided a brief overview of To set up PAT lab testing Passport system showing the one page pre-op criteria sheet. Anu Vasudevan Everyone needs to have a user ID and Set up Alerts via one medical Jan 2012 password which were e-mailed by Dr. passport Vasudevan. Data is initially created by patient, and edited by RNs We can look at patients by date. When you request to Print - any alert will show up just before printing To add an alert or an event - click on EMR (to left of patients info)- this will 1
show up in Passport any time patient comes to the OR in the future and print as a separate sheet with the Passport We need to setup criteria with PAT for lab testing. Additional information was requested for anesthesia to include: airway exam 2. Meditech Raj Doshi gave an overview of the BIDN on-line medical record Anesthesia currently has Read Only access through BIDMC portal Access can be set up as an App on the BIDMC Portal 3 password attempts will lock you out If the patient can be found on BIDMC OMR all the info will be there To discuss with Stephen O Halloran ( BIDN-IT) Dr. Feinstein is already talking to Stephen Ohalloran. TBD Primarily shows labs, ECG; only few notes on first screen - will want option 1 by Name, Number is easiest to find your patient; no space between last name and first name when you find patient, will have all their admissions - the most recent admission will have cumulative data right arrow will accept highlighted choice P will allow to Print 2
We would like to add difficult airway info so that it would transfer into the BIDMC OMR 3. Or Supplies We are aware of the shortage of pumps - Ed Plant is fixing broken ones Level 1 - when setting it up, Step 2 you have to pull knob on left OUT to appropriately set the tube in Recommend trying to set it up Always check to make sure the Luer Lock cap between 2 tubes is tight. Please familiarize with the level 1 set up ( anesthesia work room) BIDN anesthesia Ongoing training. New Monitors set up today ( 11/29/11)!!:) New monitors will be ordered in the future. 4. Airway Cart Airway cart is used hospital-wide not just anesthesia. A lock tab will be put on the cart to alert that cart has been used. CRNA to check airway cart each morning to ensure that lock tab is not broken. To do: create equipment list; create log with date, usage signature, etc. Trish O Connor and Judi Connell Done ( up and running) Medications have been added - atomizer-no air source required *** ADD MEDICATIONS Anu put in There is a separate FOB with light source in the bottom drawer just for anesthesia use Pharmacy restocks the cart. Don t forget to BILL patient for medications you used patient label 3
on form to pharmacy 5.Glidescope Please leave Glidescope like you found it - i.e. CLEAN Bring used stylettes to Danny in back to be cleaned CRNAs are to check that the Glidescope is ready to use every morning with the stylette loaded in ETT, No. 3 sleeve x2 in the bin and extra stylettes present none 6. Impediments to OR start time Labs: Patients come in to PAT for labs on the way up to OR. Any patients that need to have labs drawn will have to come in before day of surgery to have them drawn; phone preops shouldn t have labs drawn; T&S valid only 3 days (this should be changing after December) OR Start Time: 7:30 start - patients come in at 6am to pre-op holding. Dr. Panzica suggested doing a timeline of patient flow expectations (faculty hour project) with all services (surgery, anesthesia, nursing). We will start this to track when patient is changed, ready for anesthesia, consent in place, etc. Physician Assistant: Only one for all surgeons and doesn t come in early enough to get consents. Anu will 1.Push for on time starts everyday 2. Present start times in surgical review meeting 3. Work with PAT re patient arrival time 4. Streamline holding area work 5. Work with administration for PA obtaining ortho consents (Especially in block patients. 1. All BIDN anesthesia providers 3, 4: All ideas and suggestions are welcome. Surgeon arrives late: Dr. Vasudevan will work with surgeons and communicate arrival time problems 2, 5: Done (presented start times data at surgical review and identified surgery related delay reasons) Please ask for PA if consent is missing especially for Block patients. 4
discuss with Penny Greenberg PA hours. Anu Vasudevan appreciates the hard work and good will extended by all the anesthesia providers. 7.Anesthesia Record Documentation Anesthesia Record is being revised. Antibiotic: Route of administration, name, dose and time (time within 30 min of incision) must be documented Beta Blocker: Hospital would like anyone on a beta blocker to receive a beta blocker within 24 hours of the perioperative period or, if not receiving a beta blocker, have a note in the record that it was not indicated Dr. Pratt questioned whether we should be responsible for charting this aspect of patient care. This will be discussed further at a later date 8. GI Dr. Leng raised issue of not being aware that GI is on the schedule for the following day when making the schedule. Dr. Vasudevan working to get the schedule incorporated on the main OR schedule. GI days are the 2nd and 4th Thursday of each month. Dorcie Mcweeny is updating anesthesia record and will be available for review soon. Whether Beta blockers need to be listed in the anesthesia chart will be revisited. ( Steve Pratt and Anu) GI schedule needs to be incorporated with the OR schedule Anu Vasudevan will circulate the revised anesthesia record ( when she receives it) for feedback and suggestions prior to Changes. Jill Sullivan from GI will have this set up in first/second week of December. Late Jan 2012 Ketamine will be 20 mg per 2cc; midazolam is in 5 mg syringes; you should pick up propofol from 5
pharmacy (they should get list of patients and will hand out 2 vials for each patient) 9. Pyxis All drugs are patient charge. Pharmacy tracks drugs ONLY by Pyxis - they don t even look at pink sheets 10. Or Super STAT New bright pink forms for OR stat lab - will have a sticker that says Super Stat Need to think about who can actually trigger this protocol (email was sent about the protocol) All labs will be done in the regular lab None Blood bank, nursing supervisor(s) and Lab services are discussing this. Anu Vasudevan Dec 2012 11. Wednesday morning lectures Anesthesia has been requested to give a Wednesday morning educational session, possibly once per month, to the nurses. This will start in January. There will be a sign up sheet in the office. Need volunteers for the talks. The talks will have CEU credits (nursing). Anu for now. Need a volunteer to be in charge of BIDN didactics 12.Call Schedule 1.Dr. Vasudevan asked if the current call system 2 consecutive weekdays was working for the staff and everyone agreed it was. Will continue this for next quarter. We will start collecting data on late days for both on call and no call attendings and CRNAs 2. A list of BIDN attendings will be 1. Will revisit the call schedule after next quarter. 2. List of BIDN attending to be in the West campus. 1. Joanne G will collect the time data. 2. Joanne has given the Needham list to Laura March 2012 6
placed on the West Campus so the on-call attending can assign someone to BIDN if needed. Mclean 3. Attending reminder - if you are in the hospital after midnight, you have the option of working the next day (post call for points) or taking the day off. You need to notify the West Campus on call attending if you are not working the next day and notify the BIDN floor manager so that coverage can be arranged. 4. CVL, intubations, arterial lines: There is a new pathway that is in process (ask if ED doctor can do the procedure); ask them to have everything ready with glove size and consent must be done before you come in 5. Epidural blood patch - forward call to CPS 6. Catheter Management: When you do catheter management make sure you fill out a blue card and write catheter management, so that we can bill. CVL and Airway management during on call hours is yet to be finalized. Please continue to liaise with the Emergency room attending when called for CVL s and Airway management. If the ER physician is unable to place the line, anesthesiologist will need to come in until further notice. CVL and Airway: Drs. Lisbon and Vasudevan The meeting was adjourned at 18:30. Next meeting date and time: TBD Respectfully submitted, 7
Anasuya Vasudevan 8