We have had the joy of inventory this week. Since I stepped down from my supervisor role, I found counting supplies quite enjoyable! We organized as we went, so the rooms are easier to navigate and the supplies are tidy. We'll see how long that lasts...
Unfortunately, I was unable to follow SH this week. My after work schedule was packed with kid stuff.
Luckily, I have another project to keep me busy. I'm working on my Surgical Portfolio Change Project. I have collected preference cards from each service line for the cases performed most often. I'm working on a brief synopsis for each and trying to collect pictures of the table set-up and the room organization for each. Once I have all of the raw materials, I will put the pieces together to form a portfolio for use by staff members that are unfamiliar with these assigned cases. I look forward to hearing their feedback, so I can further modify the book so the cases will be easier to understand, perform, and set-up. My hope, is for the staff and physicians to feel more comfortable with the care of our patients.
Saturday, October 17, 2009
Sunday, October 11, 2009
Busy Busy Week!
Wow! We had a huge week at work and SH had so much for us to do after 3 PM.
Peer Review is moving along. It was amazing to hear about things many of us would consider minor that can really make a big impact when you don't take care of them. One Nurse will be reported to the Board for changing her documetation for only one patient because she didn't come and talk to the review board personally and take responsibility for her mistake. Since she refuses to discuss the small problem, the review committee feels she could falsify other documents to cover other mistakes instead of learning and moving on!
Why did she change her documentation? Because she misread a feeding order and fed a patient q3 instead of q4 hours.
Oh, the Horror! Geez! A simple phone call to the doctor, explaining the error, and all could've been well after a short butt-chewing. Ummm, the next feeding could've been skipped to satisfy a tight fluid restriction, or whatever was needed, but to be disciplined and possibly lose your license over something so small?
The real issue is her need to Cover it up! to not respond to any of the inquiries on the local level! to not take responsibility for her actions! Because of these bigger issues, she is Dangerous!
We also discussed the composition of the local peer review board. It is made up of experienced, veteran nurses from many different areas and floors of the hospital. Each unit uses different technology and has slightly different floor specific policies. Members of different units may not have the full picture without the discussion by the nurses familiar with these policies. They all rely on each other to decide which peers are within the appropriate scope of their practice and which ones are out of line. It is terrific that a group reviews these issues, instead of one individual. If the nurse under review handles it with the review board, it usually doesn't go any further. The nurse is given suggestions, information, and tips on how to handle the situation in the future to make her actions fit the situation properly, and how to make her documentation clear so there isn't any question that she did the right thing, etc. If the nurse is deemed dangerous, the board is consulted.
We discussed H.C.A.P.S. in detail comparing our hospital with our main competitors on the national level based on the new standards. We are highly rated for a facility our size, but there are always areas that we can improve. I wish we could narrow our competition to hospitals our size that handle the multitude of complicated cases we handle. Our rating would be on top, I'm sure! Unfortunately, we are compared to outpatient facilities, ambulatory surgical centers, problem-focused clinics and smaller hospitals that don't have our acuity. It must be easier to score high when you only handle one type of client that isn't deathly ill to begin with! It would be easy to standardize care, navigate through the facility, and keep your patients and doctors happy.
SH also invited me to attend the N.T.O.N.E. meeting. This is the North Texas Organization for Nurse Executives meeting. It was held at Medical City on Thursday. We had 2 powerful Nurse Speakers. They delivered the 2 most front-line nursing focused seminars I can remember hearing. I was expecting to hear executive nurses telling other executive nurses how to be executive nurses. I was thrilled to hear these presenters focused on the front line nurses on the floor.
The first focused on actual care givers at the bedside and how the executives are losing touch with them. Data in this area is hard to find because there is no standard collection tool that everyone uses. There is a lot of raw data that needs to be interpreted, but since it isn't standardized, the interpretation can be questioned. Bottom line was, the bedside nurses don't feel in touch with the system. They feel like they are doing all of the work, more and more mandates are being handed down by the upper echelon, and they are spending all of their time charting and very little time actually providing patient care. She encouraged everyone present keep the front-line nurses involved in the system changes so they will feel empowered by the changes, use the changes, and feel supported, instead of feeling more pressure to perform more "meaningless" tasks.
The second focused on Medication Administration and how interruptions caused mistakes. Several hospitals have implemented a "medication interruption free zone" and use vests or sashes while preparing/delivering medications. Medication errors have been reduced by 80% in several facilities because everyone works to not interrupt the nurses wearing their sashes. They only wear them for med. administration, but the difference is great! New technology doesn't have to be expensive, a simple SASH worn during medication administration can be extremely cost effective when compared to the cost of an ERROR!
I was so interested to see and hear these presentations. Our Leadership team is trying so hard to keep our best interests in mind while they implement new mandates set down by JCAHO and the BNE, but as one of the front-line nurses, it's easy to think they are clueless to our needs.
I witnessed in person the focus of our executives. I heard their questions and discussions and I know they are not clueless, they are simply trying to compromise so many issues into working solutions that the bedside nurses can't realize all of the effort that has gone into each new decision.
Peer Review is moving along. It was amazing to hear about things many of us would consider minor that can really make a big impact when you don't take care of them. One Nurse will be reported to the Board for changing her documetation for only one patient because she didn't come and talk to the review board personally and take responsibility for her mistake. Since she refuses to discuss the small problem, the review committee feels she could falsify other documents to cover other mistakes instead of learning and moving on!
Why did she change her documentation? Because she misread a feeding order and fed a patient q3 instead of q4 hours.
Oh, the Horror! Geez! A simple phone call to the doctor, explaining the error, and all could've been well after a short butt-chewing. Ummm, the next feeding could've been skipped to satisfy a tight fluid restriction, or whatever was needed, but to be disciplined and possibly lose your license over something so small?
The real issue is her need to Cover it up! to not respond to any of the inquiries on the local level! to not take responsibility for her actions! Because of these bigger issues, she is Dangerous!
We also discussed the composition of the local peer review board. It is made up of experienced, veteran nurses from many different areas and floors of the hospital. Each unit uses different technology and has slightly different floor specific policies. Members of different units may not have the full picture without the discussion by the nurses familiar with these policies. They all rely on each other to decide which peers are within the appropriate scope of their practice and which ones are out of line. It is terrific that a group reviews these issues, instead of one individual. If the nurse under review handles it with the review board, it usually doesn't go any further. The nurse is given suggestions, information, and tips on how to handle the situation in the future to make her actions fit the situation properly, and how to make her documentation clear so there isn't any question that she did the right thing, etc. If the nurse is deemed dangerous, the board is consulted.
We discussed H.C.A.P.S. in detail comparing our hospital with our main competitors on the national level based on the new standards. We are highly rated for a facility our size, but there are always areas that we can improve. I wish we could narrow our competition to hospitals our size that handle the multitude of complicated cases we handle. Our rating would be on top, I'm sure! Unfortunately, we are compared to outpatient facilities, ambulatory surgical centers, problem-focused clinics and smaller hospitals that don't have our acuity. It must be easier to score high when you only handle one type of client that isn't deathly ill to begin with! It would be easy to standardize care, navigate through the facility, and keep your patients and doctors happy.
SH also invited me to attend the N.T.O.N.E. meeting. This is the North Texas Organization for Nurse Executives meeting. It was held at Medical City on Thursday. We had 2 powerful Nurse Speakers. They delivered the 2 most front-line nursing focused seminars I can remember hearing. I was expecting to hear executive nurses telling other executive nurses how to be executive nurses. I was thrilled to hear these presenters focused on the front line nurses on the floor.
The first focused on actual care givers at the bedside and how the executives are losing touch with them. Data in this area is hard to find because there is no standard collection tool that everyone uses. There is a lot of raw data that needs to be interpreted, but since it isn't standardized, the interpretation can be questioned. Bottom line was, the bedside nurses don't feel in touch with the system. They feel like they are doing all of the work, more and more mandates are being handed down by the upper echelon, and they are spending all of their time charting and very little time actually providing patient care. She encouraged everyone present keep the front-line nurses involved in the system changes so they will feel empowered by the changes, use the changes, and feel supported, instead of feeling more pressure to perform more "meaningless" tasks.
The second focused on Medication Administration and how interruptions caused mistakes. Several hospitals have implemented a "medication interruption free zone" and use vests or sashes while preparing/delivering medications. Medication errors have been reduced by 80% in several facilities because everyone works to not interrupt the nurses wearing their sashes. They only wear them for med. administration, but the difference is great! New technology doesn't have to be expensive, a simple SASH worn during medication administration can be extremely cost effective when compared to the cost of an ERROR!
I was so interested to see and hear these presentations. Our Leadership team is trying so hard to keep our best interests in mind while they implement new mandates set down by JCAHO and the BNE, but as one of the front-line nurses, it's easy to think they are clueless to our needs.
I witnessed in person the focus of our executives. I heard their questions and discussions and I know they are not clueless, they are simply trying to compromise so many issues into working solutions that the bedside nurses can't realize all of the effort that has gone into each new decision.
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