• Only large volume specimens greater than 100ml collected by Procedure Service will be included in this initial pilot 
• A courier with a Penn Medicine identification badge may approach you and ask for assistance with retrieving specimens from a patient room 
  • Couriers cannot enter a patient’s room, so will need a unit staff member to help. 
  •  The courier will know the patient’s last name, room number, and the number of specimens to be retrieved.
• Specimens will be contained in a bin. Please pick up the bin and bring it outside of the room, where the courier will scan the barcodes and assume custody of the specimens. 
• If you are personally not in a position to retrieve the bin for the courier, please refer them to the unit secretary or charge nurse. 
• For procedures not yielding any specimens >100 ml, the Procedure Service will ask the covering team via SecureChat to send the specimens to Founders 7 Central lab by tube. 

• CL blood draws must have a new order to draw via central line DAILY (NOT a nursing communication) 
• CL Blood draw must be performed by staff who have completed the central line blood draw competency (limited to charge nurses)
• Document CL blood draw under "lab work drawn" in LDA
• Ports must be accessed every 7 days by a nurse who completed competency (Joan or Maria). Otherwise contact via onc phone for access/de-access.

• ABP must be documented every 2 hours (even if aline is in for blood draws only)

• Ensure A-line wave form is labeled "art line" so it communicates with NK and can data validate in EMR

• Aline should always be connect and alarms on- if dislodged we need to know! Patient can bleed out within minutes

• Change aline set up every 4 days

Please reference the policy for your "how to" as it is very well defined.

• Coumadin (warfarin)

• Voriconazole

• Synthroid (Levothyroxine)

• Doxycycline

• Levaquin (levofloxacin)

• Dilantin (Phenytoin)

Keys changes:

• ONLY objective data

• Removed strengths and opportunities

Send to:

• HUPPAV9Campus@pennmedicine.upenn.edu

• HUPPAV9Center@pennmedicine.upenn.edu

• Silver10-providers@uphs.upenn.edu

  
  

If you would like to recognize staff for their hard work please do so in a different forum, i.e. sending a virtual high fives. Remember to continue to encrypt the email. If you have clinical concerns, please escalate to your charge nurse and leadership team.

Please ensure follow up to covering APP if Narcan is not ordered or cannot be located in the patient server. Once the medication arrives and is delivered to the patient server, please document via a 'MAR Note' so all nursing team members are aware that it is intended to leave with the patient at time of discharge.

If you find your patient does not have a trach/airway card, please notify the Charge RN, unit leadership member, or Unit Secretary to help. We stock established and laryngectomy cards and can obtain open or percutaneous trach cards from the perioperative areas.

• Intermittent feeds- prior to every feed

• Continuous- every 4 hours unless the patient is at goal rate provider may decrease checks

• If patient is symptomatic (nausea/vomiting)

A residual is significant if it is greater than 500 mL. In surgical patients, a residual of greater than 250 mL may be considered significant.

-q4 hour BP/HR

-Ideally run through a midline or CL, if neither is available, ideally run through a #22 PIV, assess and document on IV every 4 hours, avoid using hand or AC for IVs

-If patient can take pills, generally run at 1mg/min for 6 hours and then 0.5mg/min for an additional 6 hours, if you patient is exceeding this timeframe, discuss with provider. Do not discontinue the drip without an order even if the patient returns to SR. Discuss with provider.

·Titrate per order based on chest pain- BP goal as well since nitro can cause hypotension

· Document chest pain under chest pain assessment (see attached). NOT under pain. Include vitals at time of chest pain assessment per formulary guidelines

You can use the search function ( Ctrl F) to look up products by description, manufacturer number and Pennfor # (formerly known as Lawson #).

This tool (catalog) can be used to enhance your ordering experience and can be helpful in selecting the right products etc.

• Anastrazole

• Bicalutamide

• CycloSPORINE

• Degarelix

• Fulvestrant

• Ganciclovir

• Goserelin

• Histrelin

• Letrozole (Not on Formulary)

• Leuprolide

• Mycophenolate

• Tacrolimus

• Triptorelin

B. Braun utilizes a technology called “DUPLEX” which requires the nurse to “SNAP” the bag twice in order to break the seal on the two chambers to assure the medication is mixed correctly.

Ensure to snap the bag TWICE! Otherwise patient will not receive the medication dose.

Key points:

• Patients walking independently must alert nurse via call bell prior to walking

• SOME patients excluded from independent walking (please review list in its entirety)

  • Connected to EPM (even if it is off!)

  • Morse fall score >45

  • Orthostasis in the last 24 hours

Other Fall prevention reminders:

• We have seen an influx in unassisted falls in the bathroom- always remain with your patient if they are a falls risk or impulsive

• Place falls risk band on ALL fall risk patients- especially new admissions

Type of Wound:

Location:

LDA? Y/N

Measurements?

Photo?

Safety Net?

Present on Admission?

2 RN Skin Check on Admission?

Have you started any wound care?

Remember

• The sites must remain covered for 48 hours post pull

• After 48 hours leave open to air unless draining- If draining apply dressing and change Daily

• Date All dressings and pass off in report

• For Chest Tubes in place policy states change daily (once 48 hours post op)

  • Night Shift expectation

Due to space constraints, we are not stocking gloves and Purell but recognize these are important to have for cleaning our glucometers. Grab gloves from a patient server and hit a Purell station.

We are looking for feedback as a pilot unit- please let us know how it's going!

• Key Goals of the New Process:

  • The primary objective is to streamline the report/handoff process and reduce delays in getting patients to dialysis for their scheduled treatments.

  • The dialysis nurse will review patient information for those scheduled for dialysis, without needing to call for a full report.

  • Secure chat will be used for reminders and clarifying questions.

• Important Reminders:

·         HD Checklist Completion:

o   Sending RN will need to complete the HD checklist before sending patient(s) to HD.

o   RNs and Unit Secretaries can review the HD schedule in Snapboard in PennChart (see attached tip sheet).

• The checklist is similar to an OR checklist, providing reminders to ensure all necessary steps are completed prior to sending patients for their treatment.

·         Unusual Patient Circumstances:

o   If there are any unusual circumstances (e.g., patient behavior, restraints, medication monitoring parameters), sending nurse should relay this information to the HD Charge RN via secure chat (Dialysis Charge Nurse – HUP).

1) Can You Find?

2) Check Your Charts!

3) Check Your File! (Complete all overdue KL Modules)

4) Did You Know?

In the recent triennial survey at Penn Presbyterian Medical Center (PPMC), this was a major focus and we are at risk too!

1. Line the basin with a patient belonging bag for each bath

2. Fill the basin with warm water and washcloths

3. Wet skin with washcloth

4. Apply CHG directly to washcloth- Do not dilute it- and wash skin

5. Use a new wet wash cloth to wipe/rinse

6. Dry

7. Discard the used pt belonging bag

8. Document chg bath :)

All patients are expected to be bathed using this method. It was developed to ensure use of clean basins and hygienic bathing

1. Always dispose of your mask when leaving a room where the patient is on droplet precautions. (Perform hand hygiene, too!) 

2. If you are choosing to mask in contact precaution areas, dispose of the mask upon doffing. 

3. Staff are allowed to use the same mask between patients on standard precautions and protective precautions. 

4. Masks are single-use. If you touch or readjust your mask, it should be discarded.

Protective Precautions:

1. For our transplant patients, I want to make sure that our units are aligned. 

2. In Epic, we should be using the protective precaution order instead of droplet precautions for transplant patients. This is outlined in our Infection Control & Isolation Policy.

3. Continue to display the "masking required" sign outside of a transplant patient room. The protective precaution order does not have an icon that automatically displays.

4. Rationale for change: when droplet precautions are ordered, it is assumed that the patient has a respiratory infection. When this is the case, masks should always be discarded to protect staff, other patients, and visitors. Using incorrect signage puts us at risk of regulatory scrutiny.

• Gloves should be worn for patient care and discarded afterwards. Never wear the same pair of gloves for two patients, or between two patient rooms.

• Perform hand hygiene before and after glove use.

• Gloves should not be worn in the hallways when transporting patients or clean supplies. Gloves may be appropriate while handling Sani-Cloths during equipment disinfection, or transporting a blood or urine sample. In all cases, gloves should be removed as soon as the activity requiring them is finished, and hand hygiene should be performed.

• If gloves are observed being worn in the hallway, we are exposing ourselves to regulatory scrutiny:

  • Wearing gloves in the hallway may indicate you have performed patient care, and did not perform hand hygiene afterwards.

  • Entering another room with the same gloves would be a clear example of noncompliance with hand hygiene.

  • Gloves in the hallway will call attention to you! Unless you are performing a task that requires gloves, discard them and perform hand hygiene.

Mask Use (other PPE)

• Surgical masks are no longer being conserved (like with COVID). A new mask must be used for each patient.

• Don a new mask in each room (that requires droplet isolation or masking for other reasons) and discard it upon exit, immediately followed by hand hygiene.

• Mask use is no longer a requirement in most inpatient areas. Wearing a mask may expose you to regulatory scrutiny:

  • A mask may indicate that you working while ill, leading a surveyor to ask.

  • A mask pulled down around the chin may indicate you are reusing that mask for multiple patients.

  • Masks in hallways may indicate you are going room to room with the same mask. 

  • Masks worn in common areas should be discarded, and hand hygiene performed immediately after.

• N95 usage in the inpatient setting is an exception. Staff may choose to preserve their N-95 masks to use on the same patient, by the same clinician during the same day. This is not recommended for surgical masks.  

1. Breaking the Seal: Twist the catheter hub to break the seal, then re-seat it for smooth insertion.

2. Flash vs. Feel: Look for flashback to confirm vein access. You might not feel a “pop,” so go slowly.

3. Threading: When you see flashback:

• Stop pushing down

• Drop the angle

• Advance slightly (~1 mm)

• Hold the needle steady and use the push-tab to thread the catheter.

Please continue to use the attached resources and track training via the QR code. 

Location:  

LDA added? Y/N 

Measurements? Y/N 

Provider notified? Y/N  

Safety Net? Y/N     

What wound care was started?

** Be sure to attach the patient and photo to Secure Chat message

Escalate any issues to leadership. Thanks!

• Can select primary wound type, including surgical, PI, infiltration, etc. Will cascade with secondary wound type if applicable

• Surgical incisions are now documented under wounds

• Moisture damage is now termed "Irritant Contact Dermatitis"

• Can link NPWT to LDA

•Date the bra with a sharpie on the strap

Bra should be worn for roughly 20 hours a day with a 4-hour bra break (usually at night between 11p-3a but can vary based on patient preference)

DOCUMENT your interventions! The bra is part of your incisional care

Educate the patient on…

•How to clean their incision at home- return demonstration!

•Wear bra for 4-6 weeks or up to 12 weeks after surgery

•Continue “bra breaks” at home

•Change bra at least every 48 hours or when soiled

• PennChart Nursing Handoff Tool is going live on 9 Center starting the week of 1/5 with the goal to have everyone using it by the end of the following week (1/16)

• Goal: streamline nursing report, standardize communication, and centralize key patient highlights

• When writing handoff, change your title from “Cardiac Surgery” to “Nursing” so nurses can view/edit across shifts

• We will use two dot-phrase templates:

  
  

  • .9CENTERPATIENTHIGHLIGHTS → Plan of care / patient highlights

  • .9CENTERHANDOFF → Physical assessment / review of systems

  
  

• Outgoing nurse updates handoff with changes from their shift

• Most updates will be edits to select sections, not full rewrites

• Please complete updates before oncoming nurse arrives

• Oncoming nurses can print handoff at sign-in and be ready for verbal report

• Nursing handoff is not part of the medical record, but pulls key chart data (weights, meds, LDAs, etc.)

• Shared responsibility: keep handoff accurate—this is our source of truth for patient care

• Any feedback on the dot phrases? If so please comment below!

Please remember to use clinical judgment. If the patient is symptomatic, escalate to APP and the patient should remain in bed.

For patients on continuous pulse oximetry, remember there should be clinical rationale to support continuous monitoring and we should dc continuous monitoring as soon as patient stabilizes/O2 is weaned.

SPO2 Probe Off continues to be our top Nihon Kohden alarm, at 10,000-12,000 alarms per month!

There is no change to the active ingredient, concentration, or any other aspects of the product except for the container. Due to the reduced beyond use date the product will need to be dispensed from central pharmacies.

·  Alyssa presented her residency project on alarm fatigue​

·  HCAPHS scores and the transition with Aramark. We will see if scores and reviews improve ​

·  Welcome folders in patient's rooms! There is info on SSI, patient education,  and discharge instructions! HOT TIP: put it in front of the TV when they first get here!​

·  Nursing Certification- March 19th is Certification day​

o        You can get reimbursed for test fees​

o        PCCN (Adult) – Direct Care Eligibility Pathway - AACN​

·   We had a lengthy, open discussion on unit involvement. There will be a survey sent to staff in the next few weeks on barriers, knowledge, and how to get involved

Thank you to everyone for joining todays meeting and your input!

See you next month on 3/19!

-Remember to demonstrate and have the patient return demonstrate

-perfect opportunity to try this is a few days before discharge

- If patient has a Prevena, still practice the process!

https://padlet.com/f12hup/substance-use-disorder-hup-nursing-jii5y31klqp7bdfe

2.                  Nurse's Week is the first week of May this year. We discussed some ideas for activities on the unit and are open to ideas and suggestions. If anyone would like to help plan or know a business would donate food/gift cards/etc to the floor, please reach out!

3.                  We discussed the Unit Council Survey that was sent to staff last week and some of the responses/general findings. 35 people responded so far, but we would love to hear from everyone! We are open to trialing a different time/day for the monthly meeting and shortening meeting length. I really enjoyed reading your responses. Thank you for taking the time to fill out the survey! 🙂

4.                  When looking at quality data, we had 2 falls in the last month, 1 of which had an injury. Reminders to put all patients admitted to the unit on the 24 hour bed/chair alarm protocol and to complete the falls agreement.

5.                  Happy Certified Nurse's Day!

PickIt capabilities: 

• Order supplies, equipment and linen

• If you can't find an item, use the 'free text' box to place an order

• See tracking in real time 

• 2 options for delivery: the tube station or unit clerk's desk

Hypoglycemia in pump patients- treat per protocol but consider removing/suspending pump if severe or unconscious. 

FUN FACT- Continuous glucose monitors have a lag time of 5-15 minutes! Trust your fingerstick over a CGM if there is a mismatch. 

Make sure to ask patients on direct admission: "Do you wear a CGM or insulin pump?" and be sure to document. 

Some blood glucose monitors have steel tips which will need to be removed before radiology/OR visits. 

Patient Wristband not scanning (not capturing or not scanning

• need phone /patient info/medication submitted in a ticket within 24 hours if possible

CODE WRITER

• Newest SSO process requiring Full Penn Medicine Email address when attempting to close a clinical emergency document

( I.e John.smith@pennmedicine.upenn.edu)

• NOT Penn medicine username (I.e. smithj)

Correct Wi-Fi network for SCiPs

• Wi-Fi “Penn medicine” not UPHS Guest

• NEVER enter your personal Penn Medicine credentials for these networks

• If not please place an IS ticker to have an EUS team member connect to the correct Wi-Fi

Ambulating O2 Dot Phrases

• .AMBO24L and .AMBO25L dot phases have been updated to ensure proper insurance processing and alignment it’s CMS

• staff should use these dot phrases for ambulatory O2 assessment documentation

Patch Verification

• a new MAR action “Patch Verify” will be available for all patch orders to confirm transdermal patch medications are in intact and in place

• Nurses should document a patch verification once per shift. A task will populate on the brain and work list at 0800 and 2000 after med applied action has been completed on MAR

No Qshift Button in Vitals and I&O Frequency

• aim to reduce the ambiguity of the Q shift radio button in vitals and I&O

• Q shift option is removed

• Q12 radio button added

Vancomycin-resistant Enterococcus Infection flag

• The flag for VRE infection linked to order contact precautions has been removed. This was related to the earlier request of the discontinuation of the use of contact precautions for inpatients colonized with VRE

Quick tip!

Admission Documentation

When going through the workflow of admitting a patient, staff should review and document admission through the admission navigator not required documentation

Why?

• not all needed documentation is listed via required documentation Admission Navigator (sections that must be addressed through the navigator)

• Signed and Held Orders

release all orders as appropriate the setting

• Language

Confirm language and need for interpreter

• Patient belongings

Document patient belongings including medications

Document medications sent to pharmacy

Document belongings sent to security

Prior to line insertion, the patient will be decolonized (cleaned) using 2% Chlorhexidine Gluconate (CHG) wipes and 5% Povidone-Iodine nasal antiseptic solution.  These products will be paired together in one kit. Request the kit via the Pick-It app.

A central line insertion order will cause these products to populate on the patient’s MAR.  Bedside nursing should administer as close to line insertion as possible, and no more than 2 hours prior to procedure for non-emergent placements. If the patient was previously decolonized within that 24-hour period, decolonization does not need to be repeated.

This includes PICCs, HD lines, etc.

How they work- connected to a pump that inflates and deflates the sleeves in a sequential pattern every 20–60 seconds. This mimics the natural pumping action of muscles, enhancing venous return and reducing venous stasis, which helps prevent deep vein thrombosis (DVT) and other blood clots. SCDs are effective as mechanical thromboprophylaxis, especially in patients with a high risk of bleeding where anticoagulants cannot be used. They should be worn continuously while in bed and if spending extended time in the chair (ie sleeping in chair vs. bed)

Our June meeting is canceled next month so we will see you in July.

Please fill out incisional care in your RN handoff tool and discuss in report!