11-039 NEWSLETTER Nurses Notes_Nurses Notes 2/8/11 4:01 PM Page 1
Nurses Notes
A quarterly newsletter for nurses at Decatur Memorial Hospital
Vol. 21, No. 1
Neuro grand rounds
celebrates five years
February 2011
Current Practices in
Healthcare Seminar
By Bonnie Matthews, RN
“Current Practices in Healthcare” is
By Gail Fyke, Clinical
being offered again, twice actually—on
Nurse Specialist,
Wednesday, April 20, 8 am to noon;
Med/Surg Units
and repeated Monday, April 25, noon
to 4 pm—and gives participants four
Neurosurgeon Oliver
(4) contact hours—free! (You only
Dold, MD, was recog-
need to attend one session!)
Stay tuned for speakers and topics.
nized during a luncheon
Friday, Jan. 28 for his
dedication and commit-
Critical Care classes
ment to continuing education for our staff
through Neuro Grand
By Errika Long, RN, MSN, Critical
Rounds. DeAnn Rose,
Care Educator
RN CNRN, was the
speaker for the first
The critical care education curriculum
rounds held in November
offers several classes pertinent to the
2005. Since that date,
advancement of critical care nurses.
there have been approxi-
Some topics covered include—
mately 55 case studies
■ Advanced Arrhythmias
reviewed and at least 50
■ Advanced Drugs
different nurses have
■ Sepsis Identification and Treatment
presented from various
departments. The
Rehabilitation staff have
Photo by Laura Bratten
DeAnn Rose, pictured here with Dr. Dold, was the
first speaker for Neuro grand rounds.
■ Advanced Assessment
■ Therapeutic Hypothermia
■ Hemodynamics
■ Rapid Response
consistently attended
rounds and contributed their expertise
of an interesting neuro case, contact
■ Code Blue certification
during many of the cases. Neuro Grand
Barb Weis, ext. 5113, Kristi Garner, ext.
■ Open Heart recovery
Rounds is held the fourth Friday of
5101, or Gail Fyke, ext. 5408. Thank
every month in classroom A at 0730.
you Dr. Dold for your support and edu-
and are scheduled in NetLearning. For
All are welcome to attend. If you are
cation of our team here at DMH.
details, contact Errika Long, ext. 2914,
interested in presenting or if you know
Classes are open to any DMH nurse
or elong@dmhhs.org.
11-039 NEWSLETTER Nurses Notes_Nurses Notes 2/8/11 4:01 PM Page 2
Congratulations
CorNer
Katrina Norman, RN, BSN has com-
Crash Cart Committee
reconvenes, sets goal
streamlined to follow DMH and
By Bonnie Matthews, RN
pleted the national certification for her
American Heart Association (ACLS)
specialty field. She is now a CGRN –
Did you know there was even such a
certified gastroenterology registered
committee?
nurse. Way to go!
Additionally, the committee identified
The crash cart committee reconvened
in December 2010, with the goal of get-
Home Health nurses
become shutter bugs
By Sandra Bosomworth, LPN
guidelines.
ting all of the “forms” associated with
other concerns to streamline such as—
■ what service line the committee
should fit under;
the crash cart (ie. drug tray list, cart
■ discussion of “Code Blue External;”
contents, etc.) updated, revised, and put
■ crash cart locations throughout the
onto the DMH Intranet for easier access
hospital.
and consistency between units.
As updates or changes are imple-
During this process, members identi-
mented, your nursing supervisor, or
DMH Home
fied medications on the tray that were
Crash Cart committee representative will
Health Care
in need of review by the Cardiology
provide information to all nursing staff
committee. Some of the present medica-
on your unit.
nurses
now
tions will be removed and the contents
have
digital
cameras
to photograph wounds of consenting
patients in their homes.
The images are then uploaded into
a document called “The Wound
Addendum.”
This program improves accuracy of
wound documentation, as well as
allowing the WOCN to assess all of the
wound images to ensure the correct
protocol is being used.
This feedback will serve as a valuable tool for ongoing education in the
area of proper wound documentation.
Physicians will eventually be able to
view the wound images as they can be
sent via encrypted email.
Patients and staff are excited about
this new technology!
Heart attack program gets gold seal
“With Joint Commission certification,
By Anne Davis, Marketing
we are making a significant investment
DMH has earned The Joint Commis-
in quality on a day-to-day basis from
sion’s Gold Seal of Approval for its
the top down. Joint Commission certifi-
Acute Myocardial Infarction (heart
cation provides us a framework to take
attack) program by demonstrating com-
our organization to the next level and
pliance with The Joint Commission’s
helps create a culture of excellence,”
national standards for health care quali-
says DMH President and CEO Ken
ty and safety in disease-specific care.
Smithmier.
™
The certification award recognizes
The Joint Commission’s Disease-
Decatur Memorial Hospital’s dedication
Specific Care Certification Program,
to continuous compliance with The Joint
launched in 2002, is designed to evalu-
Commission’s state-of-the-art standards.
ate clinical programs across the contin-
DMH underwent a rigorous on-site
uum of care. Certification requirements
survey in November 2010. Joint
address three core areas: compliance
Commission evaluated DMH for compli-
with consensus-based national stan-
ance with standards of care specific to
dards; effective use of evidence-based
the needs of patients who have had
clinical practice guidelines to manage
heart attacks, including compliance
and optimize care; and an organized
with evidence based practice guidelines,
approach to performance measurement
coordination of care, patient education
and improvement activities.
and leadership.
Page 2
11-039 NEWSLETTER Nurses Notes_Nurses Notes 2/8/11 4:01 PM Page 3
The return of Whooping Cough
By Sandra Shoop, RN, BSN
of symptom onset. The same specimen
of reported pertussis cases has been
Infection Control
can be used for both culture and PCR.
increasing since the 1980s. There is
Specimen collection is of utmost impor-
now increased awareness and improved
Whooping cough is a very contagious
tance. Appropriated technique and han-
recognition as well as greater access to
respiratory disease. Also known as per-
dling of specimen are necessary for
laboratory diagnostics. Public Health
tussis, it is caused by bacteria called
accurate
Departments are
Bordatella pertussis, which release tox-
results. Swab
conducting
ins that cause inflammation of the upper
should be plat-
increased surveil-
respiratory system lining. Found only in
ed or placed
lance. Pertussis
humans, it spreads from person to per-
into transport
vaccine is effec-
son by droplets, usually by coughing
medium imme-
tive at preventing
and sneezing in close proximity to oth-
diately after
the disease, but
ers who then inhale the droplets.
collection.
no vaccine is 100
Pertussis can cause serious disease in
Early treat-
percent. If pertus-
infants, children, and adults. The disease
ment is very
sis is circulating
usually starts with cold-like symptoms:
important. It
in the community
■ runny nose
may make
there is a chance
■ low grade fever (fever is generally
your infection
that even a fully
less severe, can
vaccinated person
help interrupt
can catch this
disease trans-
extremely conta-
the first 2 weeks of the disease.
mission and is
gious disease,
Antibiotics may shorten the period of
necessary for
however the
communicability.
stopping the
infection is usual-
spread of per-
ly less severe.
minimal throughout the course)
■ possibly a mild cough
Pertussis is most contagious during
After one- to two weeks, severe
coughing may begin. Infants may have
tussis. Treatment started three weeks or
The best prevention is vaccination.
minimal cough, but may have periods of
more after symptoms onset is unlikely to
The vaccination for infants and children,
apnea. Infants are at higher risk for
help. Recovery from pertussis is gradual.
called DTaP, is part of the routine child-
complications. Over half of infants under
The cough becomes less severe and less
hood immunizations. Five DTaP shots
12 months with pertussis require hospi-
common, but may return with other res-
are given prior to kindergarten.
talization. Violent coughing spasms fol-
piratory infections for many months
Protection fades with time and there are
lowed by a loud “whoop” on inspiration
after a pertussis infection.
now boosters available for pre-teens,
are characteristic, but not always pres-
Positive pertussis tests are reported to
teens and adults known as (Tdap).
ent. Other traditional symptoms of per-
the Public Health Department and are
Adults who have not had Tdap should
tussis include vomiting or extreme
followed up by them. They may recom-
get one dose of Tdap in place of one
fatigue after coughing fits. Cough may
mend prophylactic antibiotics to all close
tetanus booster. It is especially important
be more frequent at night.
contacts (household members) and
for caregivers and families of new
exposed healthcare providers who have
infants to be vaccinated. Infected people
signs and symptoms, history of expo-
been face to face with an unmasked
should wear masks to reduce spread,
sure, physical examination, as well as
patient or had contact with respiratory
and infants should be kept away from
laboratory testing. The gold standard is
secretions.
infected people. Pertussis is still out
Diagnosis of pertussis is based on
a nasopharyngeal swab or aspirate for
culture or PCR ideally within two weeks
Despite the fact that pertussis is a
vaccine preventable disease, the number
Page 3
there, so be sure to protect yourself,
your family, and your patients.
11-039 NEWSLETTER Nurses Notes_Nurses Notes 2/8/11 4:01 PM Page 4
Home Care’s
new Wound
Management
Program
By Susan Currie, RN, CWOCN
The new wound management
program used in Home Care has
enabled wound nurses to monitor
wounds on a weekly or biweekly
basis.
Formerly known as “enterostomal
therapists,” wound/ostomy nurses at
DMH divide their time between the
hospital and Home Care. Wound
Manager allows comparative photos,
measurements and descriptive documentation as well as current and previous treatments to be viewed easily
and quickly.
Additionally, communication notes
can be sent to Home Care staff.
Standard protocols for wound care
were developed before launching this
program, but non-standard protocol
orders can also be implemented. It is
especially beneficial to be able to
access these records from the hospital
and Home Care; this allows us to better assist Home Care staff on days
scheduled at the hospital or to follow
up with Home Care patients who are
Nurses making an impact
By Stacey Taylor, RN, Education
Yet another successful instance was
a patient on 6400/Transitional Care
Your efforts are impacting patient out-
who had an average blood glucose of
comes in a positive way! As a nurse
222.9 during the first five days of
you strive to deliver the best care with
admission. The glycemic protocol was
the best possible outcomes for your
initiated and the average blood glucose
patients. We understand the risks ele-
over 4 days of the protocol was 138.
vated blood sugars have on our patients
What an impact!
include poor wound healing, increase
The glycemic protocol, is taking a
risk of infection, higher risk of compli-
proactive approach to glucose control
cations and increased morbidity. The
with correction/nutritional dosing. This
new glycemic protocol was introduced
insulin delivery takes into consideration
on 5100/Surgical Nursing Unit in
what the patient’s blood sugar is imme-
October of 2010.
diately prior to a meal combined with
Each month since a new nursing
what a patient nutritionally consumes
unit has begun using the protocol on
by mouth (carbohydrate servings).
select patients of hospitalists. The
Rapid acting insulin is the administeres
results are impressive. With a goal of
as one injection once the patient has
the patient’s blood sugar averaging
eaten, just after a meal. A basal insulin
<180, we have been successful 81.3
(Lantus) may be used in addition to
percent of the time. This is a statistical-
cover basic metabolic needs. In realizing
ly significant 9.1 percent increase over
how quickly blood sugars change, we
baseline data. An example of your
are closing the gap between taking the
success; An ICU patient started on an
patient’s blood sugar and their meal,
insulin drip with an average blood
now taking blood sugars directly prior
sugar of 135.8, transitioned to regular
to eating and delivering insulin immedi-
sliding scale for 3 days with the aver-
ately after they eat. This timing is cru-
age blood glucose of 215.2. The
cial to better glucoase control for our
glycemic protocol was then initiated.
patients.
During the five days on the protocol the
Keep up the good work!
average blood glucose was 154.4.
You ARE making a difference.
Awesome!
hospitalized.
It can be confusing or disturbing
to patients and/or families when they
CAreS Dollars available for CAreS behavior
perceive a communication issue
Employees can
value. A carbon copy
between different parts of the same
now recognize a
stays with the direc-
organization. This is one small way
co-worker who
tor (who sends it to
the continuity of care takes place!
exhibits CARES
Education) and the
values by present-
original is given to
ing that co-worker
you. You can then present it to your co-
with a CARES Dollar. CARES Dollars are
worker. The CARES Dollars recognition
available from your department director
program was created in response to this
who signs the dollar to validate its
summer’s employee survey.
Page 4
11-039 NEWSLETTER Nurses Notes_Nurses Notes 2/8/11 4:01 PM Page 5
Learning to recognize Sepsis
By Errika Long, RN, MSN,
Critical Care Educator
Sepsis is a potentially lifethreatening condition in which
the immune system’s reaction
to an infection may injure
body tissues.
Anyone with an infection
may be at risk for developing
sepsis, but certain factors may
increase this risk. The most
susceptible population includes
the elderly and newborns, individuals with compromised
immune systems (i.e. patients
Sepsis is diagnosed when a patient
was 48 percent. Now that we have
with chronic illnesses, organ trans-
has two or more of the SIRS criteria
adopted the nationally recognized
plants, HIV or receiving immunosup-
PLUS a known or suspected infection.
treatment for sepsis called “Early
pressive therapy), hospitalized
Severe sepsis is sepsis that is com-
Goal Directed Therapy” (EGDT),
patients, and people who have inva-
plicated by organ dysfunction,
we have decreased the mortality
sive devices, such as central lines,
hypotension or poor perfusion, and is
rate to 25 percent! A whopping
Foley catheters, or ET tubes.
considered the most common cause
48 percent reduction!
Sepsis typically begins with the
Systemic Inflammatory Response
of death in the non-coronary ICU.
Signs of organ dysfunction
As nurses, we must be able to
identify the earliest signs of sepsis
Syndrome (SIRS), which is the body’s
include—
in order to prevent the spread of
response to an insult that results in
■ mental status change
severe infection. Early recognition
the activation of the immune
■ decreased UOP
allows for appropriate treatment
response. This response is the body’s
■ hypoxia
using EGDT thus decreasing the
way of attempting to maintain home-
■ coagulopathy
likelihood of septic shock and life-
ostasis.
■ hyperglycemia in the absence of
threatening organ failure.
SIRS is diagnosed when a patient
diabetes
If you have a patient presenting
has two or more of the following
■ abnormal heart function
with the signs and symptoms of SIRS
signs and symptoms;
■ poor perfusion (causing elevated
and may have an active infection,
■ body temperature < 96 or > 101 F
serum lactate levels)
please contact the physician ASAP.
■ heart rate > 90 bpm
Septic shock is severe sepsis char-
■ respiratory rate > 20/min
acterized by persistent hypotension
■ WBC count < 4 or > 12
that does not improve even after ade-
■ PaCO2 < 32 mmHg
quate fluid resuscitation.
There are several factors that can
The nationwide mortality rate of
Your prompt response may save a
life.
References:
Dellacroce, H (2009) Surviving
trigger the SIRS criteria, including
patients who develop sepsis is 50
Sepsis: The role of the nurse.
infection, trauma, burns, MI or other
percent. Here at DMH, the baseline
Mayo Clinic (2009) Sepsis
inflammatory processes.
mortality rate of patients with sepsis
Page 5
11-039 NEWSLETTER Nurses Notes_Nurses Notes 2/8/11 4:01 PM Page 6
What’s new with Clinical Practice Council?
By Errika Long, RN, MSN,
Chairman, Clinical Practice Council
Council representative.
New methods for decreasing central
patients with insulin individually, based
on their personal history and nutritional
line associated bloodstream infections
intake measured by carb counting. Only
Recently, the Clinical Practice Council
are being reviewed. There is a new DMH
patients being cared for by the
has been discussing several topics
committee for stopping Bloodstream
Hospitalists are being trialed on the pro-
related to clinical nursing.
Infections (BSI). If you are interested in
tocol at this time. Nursing education in-
becoming a champion on your unit,
services are currently being provided.
First, a new computerized discharge
process is in the works which hopefully
will provide a link for written prescrip-
contact Errika, ext. 2914.
Programs for free CE credits are now
DMH is using “Tapease” in the IV
start kits. Tapease prevents gloves from
tions and medication information for the
available for nurses in the Intranet under
sticking to tape during IV insertion.
patient to review.
Education/Education Links.
Congratulations to one of Tapease’s cre-
Orientation packets for new nurses
are being revised and made unit specific.
New Peer Review topics are being
discussed that are also unit specific.
If you have a idea for a peer review
Some of the critical care education
classes are in the process of being
approved for CEs. Remember, RN/LPNs
need 20 CEs to renew your license!
The new Glycemic protocol is being
topic for your unit, please discuss it with
trialed throughout the hospital. The pro-
your supervisor or Clinical Practice
tocol is a way to provide diabetic
ators: Sue Hesse, RN.
The Clinical Practice Council meets
every third Thursday at 1 pm.
If you are interested in being
involved, please contact your supervisor
for more information!
Diabetes News
Mouth health and diabetes: Why is it important?
By Marie Stauder, RN, APN, CDE
By Marie Stauder,
RN, APN, CDE
Mark your calendar: The annual
DMH free Community Diabetes
Do I still
Program will be offered from
need to see
1—4 pm (doors open at noon)
the dentist
Tuesday, March 22 in the DMH
if I have
classroom complex.
dentures?
Pulmonologist Steve Arnold, MD,
As nurses, we know
will speak at 1 pm on Sleep Apnea, a
that the mucous mem-
common ailment to many with dia-
branes of the mouth is
betes. Dr. Magnolia Hallum will speak
the vehicle by which
on Gum Disease (the unofficial sixth
nitroglycerin’s effects of
complication of diabetes) and Kandie
increased circulation and
Dino, RPh, Director of DMH
oxygen flow to the
Pharmacy, will address medications
heart eases chest pain.
to control Diabetes.
As healthcare practitioners, we
Mouth infection, gum and or
need to advise patients that dentist
tooth disease has a systemic affect
visits every six months are not only
ary is available by calling the DMH
on our bodies resulting in elevated
important for their mouth, but for
Wellness Center at 876-4249.
blood glucose levels and initiating the
total body health.
Registration and a complete itiner-
inflammatory response.
Page 6
11-039 NEWSLETTER Nurses Notes_Nurses Notes 2/8/11 4:01 PM Page 7
The dual role of a Case Manager
Photo by Laura Bratten
DMH’s Case Management team: From left, Noreen Duncan, Katherine Shepard, Tara Schum, Janice Perkins, Megan Teschner,
Tara Tucker, Karen Bryant, Julie Kirkley, Mary Pressnall, Terri Tulak, Andrea Long, Tara Cook, Sherrie Sandgren and Lindsay
Paradee. Not pictured: Jennifer Sweatt.
By Julie Kirkley, RN
Do you know what a Case Manager
really does?
A Case Manager works closely with
for themselves at home or if they have a
clinicians to ensure the patient meets
willing and able caregiver.
established criteria sets for Medicare,
They also provide resources for our
patients and families to choose
care that certifies
from to assist them upon dis-
length of stay.
members of the health care team to help
charge if necessary. They eval-
our patients and their families find the
uate for possible financial assis-
most appropriate resources.
tance, and suggest available
There are two core components to the
Case Management role:
The most visible portion is the dis-
Medicaid and managed
resources. When the assessment is
complete, a discharge plan is formulated and re-evaluated as changes
charge planning/medical social service
occur until the time the patient is dis-
aspect. You may see a Registered Nurse
charged from the hospital.
or one of the Discharge planners in this
The second aspect of
The DMH Case
Management staff
includes Registered
Nurses, a licensed Social
Worker, a master’s prepared
Social Worker, and Discharge
Planners with offices located on
3500, 4100, 5100 and 5400.
In addition, Discharge Planners
role. He or she assesses the patient’s
Case Management is uti-
needs in several aspects upon the initial
lization review. This clinical
stations on 3500, 4100,
interview with the patient. This can
component is performed by our
and 5100.
include assessing patients’ ability to care
registered nurses in tandem with our
Page 7
are located in the nurses
11-039 NEWSLETTER Nurses Notes_Nurses Notes 2/8/11 4:01 PM Page 8
Editorial Board:
Editors:
Bonnie Matthews, PACU, x3203
Renee Ferre, Nursing Float Pool, x3500
Photogr aphers:
Patty Brumett, Lung Center, x4212
Anne Minks, Heart Ctr/Cardiac Rehab, x2749
Layout/Desig n:
Laura Bratten, Publications, x3235
Free CEU/CMEs for DMH employees
The countdown begins…
By Stacey Taylor, RN,
the following user name
Education
and password:
User Name: decatur
RNs, you have
Password: staff
15 months left
Please note:
Contributors:
to complete
the user name
Sandra Bosomworth, Home Health, x4600
20 hours of
and password
Rebecca Dunakey, Endoscopy, x6030
continuing
are case-sensi-
Gail Fyke, CNS, x5408
education for
tive and must
Lisa Harmon, Wound Therapy
your two-year
be entered as
Sue Hesse, Family Birth Center, x3416
license renew-
shown. You
Joyce Highley, Pediatrics, x3100
al. The Illinois
can access this
Cindy Jenkins, Regulatory Compliance, x4371
Nurse Practice
link on the
Julie Kirkley, Case Management
Act now
DMH Intranet.
Shirley Kroll, Surgery, ext. 6000
requires
On the Intranet
Errika Long, Critical Care Educationm x 2914
Registered Nurses to achieve 20 hours
home page, select the Education tab on
Pam McMillen, Women’s Health, x4373
of continuing education per two-year
the left, then select Education links. In
Tracy Newlin, Education, x2910
renewal for licensure. This cycle began
this section you will also find other on-
DeAnn Rose, 5100/Surgical Nsg, x5100
in 2010 and the 20 hours will be
line opportunities for continuing educa-
John Saylor, Clinical Informatics
required for renewal in 2012. This
tion, such as the “free CE of the
Brenda Schwass, CVU, x5400
change also affects LPNs with their
Month”.
Sandra Shoop, Infection Control, x2508
renewal date in 2013.
Julie Sims, Orthopaedic Unit, x3500
In November, the DMH
Reminder:
With any contin-
Stacey Taylor, Education, x2904
Medical Staff bought a sub-
uing education
Vickie Weikle, Transitional Care, x6400
scription to
certificates you
Marilyn White, 4100/Medical Nsg, x4100
CEUlectures.org, a clinical
resource with more than 130 lectures
Mission Statement:
To communicate, recognize and promote
the Nursing Profession within Decatur
Memorial Hospital in our service to
Decatur and the surrounding community.
Nurses Notes
Vol. 21, No. 1
February 2011
Nurses Notes
is published for nurses at Decatur Memorial
Hospital. All contents are copyrighted. Articles appearing in Nurses Notes may
be used with permission. For copies of this or any of our other publications,
call or write the DMH Publications department, 2300 N. Edward St., Decatur,
Ill., 62526, 217/876-3235.
covering 18 clinical and surgical specialties. CEUlectures.org/decatur is pro-
11-039
the certificate to the
Education Department to
be posted on your
vided to you at no cost. Each lecture is
NetLearning transcript. You will need to
approximately one hour in length. An
keep the original certificate for your
exam follows each lecture; when suc-
records. There are many opportunities
cessfully completed, you will be award-
to earn free relevant continuing educa-
ed a “certificate of participation,” which
tion hours. If you complete just one
is approved for appropriate credit
continuing education hour a month you
awards. The lectures are presented in
will have more than enough when it is
the traditional “Grand Rounds” format
time to renew your license.
and are available to you on an unlimited basis, 24/7. The website is userfriendly and easy to navigate. Go to
www.CEUlectures.org/decatur and insert
© Copyright Decatur Memorial Hospital 2011
earn, send a copy of