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February 24, 2023
Strip of the Month: Sinus Rhythm First Degree AV Block
Top 6:
1. MAR Display Text for Oral Chemotherapy Meds Go-Live Feb. 27
2. New Product: Dual Caps
3. Behavioral Activity Rating Scale (BARS) for Inpatients Go-Live Mar. 1
4. Epic Updates
5. Bed Replacement Project Update
6. Contact the Integrative Nurse Fellows By Phone
News of Note:
Nursing Informatics Council Receives Daisy Team Award
Chekesha Carter, BSN, RN & Andrea Nicholson, MSN, RN Recognized
as Extraordinary DAISY Award Leaders
Professional Development Opportunity: Register for Med-Surg Competency Day
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Strip of the Month
Sinus Rhythm First Degree AV Block
Click to enlarge image.
First-degree atrioventricular (AV) block is a condition of abnormally slow conduction through the AV node. It is defined by ECG changes that include a PR interval of greater than 0.20 without disruption of atrial to ventricular conduction. This condition is generally asymptomatic and discovered only on routine ECG. National Library of Medicine. – National Library of Medicine
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Top 6
1. MAR Display Text for Oral Chemotherapy Meds Go-Live Feb. 27
All oral chemotherapy meds used to treat malignant indications will display red text on the inpatient MAR saying the medication must be administered by a chemo-certified nurse. No red text will show if it is not used to treat malignancy.
Text will display on inpatient MARs; Heme/Onc Clinic will be excluded.
The following oral chemotherapy meds that may be given for non-malignant indications will include an order indication question: mercaptopurine, hydroxyurea, methotrexate, cyclophosphamide
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2. New Product: Dual Caps
In-services will start Monday, February 27 through Wednesday, March 1 for the new dual caps. The DualCap System is a disinfecting cap system that contains a sponge saturated with 70% isopropyl alcohol to protect and disinfect connectors between uses.
Dark blue caps
- Replaces the blue dead-end caps and any other products previously used at the end of IV tubings.
- Attaches to the male luer connectors at the end of IV tubings.
- Failure to place a sterile cap on the end of a reusable intravenous (IV) administration set with the tubing left hanging exposes the tip of the set to potential contaminants; and can lead to infection if the nonsterile IV set is reconnected to the patient’s IV access.
- The action of inserting the male luer tip of the administration set into an injection port higher on the same set, referred to as “looping,” is never appropriate.
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3. Behavioral Activity Rating Scale (BARS) for Inpatients Go-Live Mar. 1
To reduce workplace violence and promote earlier recognition of agitation, inpatient nurses will begin to complete the BARS scale on all patients 18 years and older.
In the ICU, this will be done every 4 hours. In medical/surgical and IMCU areas, the nurse will complete the BARS once per shift, and if abnormal, a worklist task will prompt the medical/surgical or IMCU RN to recheck the patient every 4 hours until they are normal (score of 4).
There are actions for the nurse to take listed next to each number on the rating scale when you hover over the information row on the Storyboard. The scale is easy to use and takes just seconds to complete. The nurse will complete the BARS just below the vital sign section of the flowsheet. The BARS appears directly below the RIKER scale in the ICU.
Click to enlarge image.
The nurse will complete the BARS just below the vital sign section of the flowsheet. In the ICU the BARS appears directly below the RIKER scale.
RNs and CNAs can add BARS to their Patient List, and an abnormal score will be red.
Click to enlarge image.
If your patient scores a 6 or 7 on the BARS, indicating moderate or severe agitation, a banner will appear on the Summary Tab for the MD, RN & CNA. With a score of 6 or 7, Public Safety should be notified immediately by the RN or designee by calling x4-4444.
Click to enlarge image.
The BARS will appear on the worklist.
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4. Epic Updates
Heparin Infusion Protocol Changes
- BMC has recently updated Heparin Protocols based on PTT. We now have three options for PTT order sets.
- The Anticoagulation Therapy in Adult Medication Guideline, EPIC orders, and Lexicomp have all been updated.
- The two changes are pictured in the order sets and are:
- Lab frequencies
- Additional option-Heparin Infusion Standard
- This change DOES NOT AFFECT any anti-Xa Heparin protocols or the flat rate Heparin protocol.
Click to enlarge image.
Please get in touch with your nurse educator if you have any questions.
72-Hour Look Back for Recent Administration of Medication on MAR Now Live
Recently we had an issue with the functionality that should have shown the last dose and cumulative dose of Tylenol given from all orders. With the fix that went live on February 22, we also implemented this functionality on all medications on the MAR. You can see recent administrations given in the last 72 hours from any order for this medication.
The 72-hour look back will reduce the chance of giving a medication too close because it includes one-time orders from other areas. Too close warnings are triggered for administrations from within a single order.
In the example below, the bottom Captopril order is a one-time order already given that falls to the bottom of the MAR – on the new order of Captopril, you can see in the highlighted area that the previous administration is shown.
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As a reminder, when you open the MAR entry, you should also utilize the following actions displays to keep you informed on the medication order and next dose due.
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Small Task Day Epic Changes
The following changes will go live on Monday, February 27. If there are any issues, please place a Service Now ticket.
- On the Post Procedure flowsheet and Post Procedure site assessment section: The option of Dressing removed has been added to the Site dressing row
- On the Daily cares flowsheet and Interpreter used section: in the type of Interpreter row, the option Proprio has been replaced by Video
Click to enlarge image.
- On the I&O flowsheet and Suprapubic catheter LDA section. A new row Suprapubic catheter flush (ml) has been added to the flowsheet. The amount documented in this flush row will calculate into the I&O tallies
- IPOC Summary Report
- The social work last note has been added to the Interdisciplinary Plan Of Care (IPOCC) summary report
- The Interval H&P label was added to the H&P section of the IPOC report – both Notes can be found here
- ICU Nursing Notes dot phrase: a new smart phase has been made public so all users can add to their notes.
- Vitals Summary Report: O2 Device, O2 flowrate (L/Min), and FIO2 (%) columns will now always display on this report. Currently, there are two O2 device rows because these two different rows are used in different areas. These rows will be combined soon.
Click to enlarge image.
- Nursing summary reports: Within all the nursing summary reports, the Getting to know me sticky notes will now display under the Orders to be Acknowledged section
Click to enlarge image.
- Maternity: On the OB Daily Cares flowsheet & Activity section, a new row named 1st time OOB after surgery has been added. This is a time entry field. The row information offers additional details about this documentation.
Click to enlarge image.
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5. Bed Replacement Project Update
The pilot of Styker beds has expanded. In addition to the 10 ICU beds in MICUB, there are now 11 Med/Surg beds on 7W and 6 ICU beds in the SICU. In mid-March, these Stryker beds will be replaced with Hill-Rom's latest ICU and Med/Surg beds.
Your feedback is critical to the decision to select the right bed. The project team needs your opinion on these beds' overall usability, fall preventability, and patient features. Your feedback will help drive this critical patient care decision.
A survey has been created to collect your feedback. If you have not completed the survey, please click on this link: complete this evaluation form: https://form.jotform.com/bmcnursing/bed-evaluation-form
Reminder - The goals of this initiative include the following:
- Replace our aging beds (15+ years)
- Positively impact two quality care measures: prevention of skin breakdown & falls
- Streamline ordering process: with a planned transition to order beds in Epic
- Reduce our monthly rental costs
- Reduce movement of patients off beds & mattresses
The project team, the wound nurses, and our patients - thank you for your feedback. There are available paper copies of the evaluation forms on all three units. Please submit a paper evaluation if you cannot complete the survey online.
Pictured are the 2 Stryker beds that are currently being piloted on MICUB, SICU, and 7West:
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6. Contact the Integrative Nurse Fellows By Phone
You can now contact the Integrative Nurse Fellows directly by phone! Call or text 857-303-2947 Monday-Thursday from 7:00 a.m. – 5:00 p.m. Text messaging is preferred as we often deliver therapies to patients in a quiet environment. An Integrative Fellow will be in most days, so call or text any questions you have regarding the integrative therapies BMC has to offer patients and nurses. We are here to help!
Integrative Nursing Order Set
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Click to enlarge image.
- Order mode will be: “Per protocol: no cosign required”
- This is used for nursing interventions
- Fill in the ordering provider by utilizing the search button
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News of Note
Nursing Informatics Council Receives Daisy Team Award
Watch this 3-min video.
Last week, CNO Nancy Gaden presented the Nursing Informatics Council (NIC) with the DAISY Team Award. This award recognizes that while an idea to achieve better patient and family outcomes may start with one individual, it takes a team to implement it successfully. We celebrate NIC and all its members who exemplify BMC's mission and values excellence, compassion, integrity, and innovation to improve the lives of our patients, families, and staff. Congratulations NIC! Bravo!!
Chekesha Carter, BSN, RN & Andrea Nicholson, MSN, RN Recognized as Extraordinary DAISY Award Leaders
Our heartfelt congratulations to our DAISY Leadership Award recipients!
- Chekesha Carter, BSN, RN, Director of Nursing, Greater Roslindale Medical and Dental Center
- Andrea Nicholson, MSN, RN, Director of Nursing, Menino 7 East
Chekesha and Andrea were presented the award by CNO Nancy Gaden among their nursing management colleagues last week. Here’s what their nominators said about them:
“Kesha is a phenomenal nurse, leader, and person. She cares deeply for her staff, patients, and all who she encounters. She goes above and beyond for her patients, even making house calls to provide exceptional care for high-risk patients. She is always available to her staff to help with whatever issues they might face, whether they be professional or personal. She often steps onto the floor and performs patient care when more hands are needed to assist and has built a wonderful rapport with our patients; even the ones that are most difficult to reach. She patiently and tactfully works to aid them in whatever way they need. She’s a shining model for all nurses and provides encouragement for young black nurses and other nurses of color to reach for leadership positions and always continue to learn! I'm a staff nurse who recently transitioned from Roslindale CHC to the OR. it wouldn't be possible without the encouragement of Kesha.”
“Andrea has been an integral part of this organization for over 30 years, she went through all odds to become the Nurse Director she is today (from transporter to phlebotomist, to nursing assistant, to staff nurse, and to charge nurse). She is the epitome of handwork and excellence—A-Never Say Die Personality! That to me is a huge challenge to overcome and should be a motivation for the younger generation of nurses. She is a brave, very compassionate, team-building, and diligent individual. Andrea radiates positive energy, a proactive and problem-solving attitude, and is very approachable. She inspires everyone around her, and her exploits in this organization have boosted the morale of many. For example, she encourages housekeepers to train as nursing assistants and empowers them to further their education in their nursing careers—what others see as trash, Andrea sees as a treasure. It is on record that Andrea has made a valuable impact in the Nursing division.”
Congratulations to these nursing leaders who provide a haven of safety for staff, both physically and emotionally. They create a setting where compassion is valued and staff, in turn, treat patients and their families with deep humanity. We cannot express our gratitude to the many inspiring nurses who you have led and mentored under your leadership! Strong work!!
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Professional Development Opportunity
Register for Med-Surg Competency Day
Download PDF
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