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Hello Team,

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CTIC Unit Practice

June 8, 2016

10:00 AM CTIC Break Room

Present: A. Lanoue, M. Gaboriault, S. Martin, W. Swain, R. David, M. Buzzerio, C. Farias

Bedside cart contents – Based on our last meeting, Michelle revised the contents of the cart to make them more user friendly given current practice.  She received feedback for several staff members.  Using the newly devised content list, Sam filled a cart and is now requesting feedback.  This feedback is due by June 13 for finalization.

For precaution patients, the carts must be pulled from the rooms.  If you do not know a precaution status, check the OR schedule for clarification.  If it is still unclear, the carts need to be left outside the rooms until the final determination can be made.  This will be communicated to all staff.

Open positions – currently there are 2 open CTIC positions one each 36 hour day and night.  We will be orienting one or two new CCIs in the mid-summer through the fall.

Rounding –Staff have requested that rounding with LIPs occur at night as well.  Renee will communicate to her team the need to have these at 9pm each night.  The charge nurse in the CTIC on nights needs to ensure that this occurs and the RN staff is present.   Day time rounding is as follows: 9:30 Monday, Tuesday and Thursday.  It will be at 10:30 on Wednesday and there will be walking rounds every Friday at 8:30.  Nurses are required to be present when their patient is being presented and participation is strongly encouraged.

Collaborative projects:

Extubation: We will review the plan for meeting the 6 hour mark to wean and extubate each patient.  Obstacles in meeting this will be studied.  Michelle, Mike, Michelle and Renee will convene on this.

Early Mobility of our patients is necessary.  This is the next project.  Team leads will be Wendy, Amy, Chris, and Darryk.  We will work with PT as well to coordinate this aspect of the care.

Both project results will be presented at our July meeting.

Phones – We will be using the phones for communication amongst the staff both RN and LIPs.  We need to utilize these.  This is for patient and staff safety.  The current phones are not able to be switched out.  The alternative has a deficiency being able to hear properly.  Smarty phones are expensive and not practical.  Clips will be supplied.  The phone for a singled patient assignment can be kept in the patient room alongside the desktop computer.  This process will start on Monday.  Stacey will take the lead.  The US will ensure that the batteries are in working order, there will be a sign in list.

Other projects will be building an AF pathway so that all will be on the same page n treatment.

For now, follow up meeting will be July 13 time and place TBD.

Respectfully Submitted,

Paula Gellner, MS, RN

Dear Staff,

Although this was a short week, a lot has been going on behind the scenes.

• I met with our secretaries and unit assistants to review work flow.  The minutes of the meeting s are at the end of this email.
• Additionally, we will be having a better process for ensuring that we have properly cleaned IABPs in the CTIC.  This new process will be finalized next week and communicated.
• Please ensure that the IABP site dressings are changed as outlined in the policy 2 days for gauze dressings and 7 days for Tegaderm.
• We have a sample bedside cart on CTIC.  Please take a look this over the weekend and let us know your thoughts.  Michelle did a lot of work researching the contents that would be most helpful to have on hand.  Sam put the sample together this week.
• I am still reviewing restraint data and will need to continue with this for the next 6 months!  Remember to address this is in the plan of care , document every 2 hours and ensure that you always have a current order.
• EKG strips need to be scanned.  Please only leave valid identified strips for the US to scan.  Nothing in that is ambiguous should be left in the folder.
• There will be an ICTU staff meeting on Tuesday June 8^th at 6:30PM.  Attendance is strongly encouraged!  There will be a call in option communicated.
• Next week we will have two former nurse rejoin our teams:  Nicole Landroche on CTIC and Kristen Finocchi on ICTU!
• Donna Saul will be conducting her coffee hours as follows:
  • June 7thCTIC 1-2pm
  • June 13 ICTU 1-2pm

Respectfully Submitted,

Paula Gellner, MSRN

Manager CTIC/ICTU

Present: Sunny A., Chris C., Frank M., Sue P., Liz O., Hector R., Jordan P., Theresa C., Lucy M.

UA Role:

• Linen may not always be first priority for the day.  Please check that supplies are available for the nursing staff and fill out CSD and special order forms.
• Carry Phone only No UA s to carry a beeper.  The method for reaching the UA is through the phone only.  When you arrive at work, please put your name on the white board of the unit as well as the phone number.  If you happen to be covering two units this needs to be done on each unit.  This is for proper communication among the team.  This should be completed no later than 8am.
• Ordering – Review store room for supplies. There is a small white board in the store rooms.  If you notice low levels of a particular supplies and it is not a delivery day, the storeroom needs to be notified.  If it is a delivery day, the list will need to be reconciled against the delivery.
• Breakfast delivery and pick up needs to be timely.
• Room Carts – This may require filling more than once per day given the needs of the patients.  Empty rooms need to have carts stocked.  These rooms will have patients and should be ready and properly supplied.
• 24 Hour sheets these sheets are faxed to payroll each day.  If you float, you need to notify the unit to which you floated.  If you are working on more than one unit, you need to indicate that you are working the other units as well.  This is for charging purposes.  The previous charge nurse should be aware of the need to float a UA for a shift.

Unit Secretaries

• Faxing 24 hours sheet – This needs to be faxed daily and noted if faxed.  There is a stamp on each unit.
• Phone – please use proper identification when answering the phone
• Call lights -The nurses need to be notified when call light assistance is requested by the patient.
• Desk coverage – the Secretary desk needs to be covered during rounding time
• Communication – each handoff should consist of what has been done for the day and any outlying tasks.  Please let the RN charge know when you are not going to be at the desk.
• Breaks are no more than two 15 minute breaks during the shift and 30 minutes for lunch.  These cannot be combined.  Extended breaks will not be tolerated.

Additional discussion:

• EKG strips need to be faxed for the previous day.  Do not batch scan
• The food order needs to be placed before 2pm.  This is still not happening consistently
• There has been a lot of change over the past 6 months in the role and hours of the UA and it is essential that everyone is on board for the common goal, working together to provide for our patients.
• We will meet quarterly.  Our next meeting will be in August.  Time and date TBD.  Nursing is invited to attend

Respectfully Submitted,

Paula Gellner MS, RN

Clinical Manager CTIC, ICTU

Rhode Island Hospital

Paula.Gellner@lifespan.org

O (401) 444-5992

C (401) 533-4362