7/24/2014 Learning Opportunities - Davis, Aurora

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Learning Opportunities
All,

I've had some concerns with a few items on recent shifts that I think are a great opportunity for some
teachable moments. A few things in particular are potentially information that hasn't been passed along to
all our new hires and/or new graduate nurses. The following are some unit-wide policies that you may not
be aware of...but have unfortunately been the subject of recent PSNs.

1. All active BMT patients should have a disposable stethoscope in their room. One of our own nurses,
Lindsey Spencer, did a study several years ago showing that stethoscopes are a source of infection and
can carry contamination between patients. Individual stethoscopes for all BMT and neutropenic patients
help prevent this. This is an admitting RN responsibility, just like setting up SCDs and teaching pts about
their IS.

2. Alaris pumps need to be in the current month's dataset and the proper care area. The main screen
of your Alaris pump will always display the dataset and care area. It is the RNs responsibility to make sure
everything is updated and correct. You can do this by turning the pump completely off, then saying "yes" to
"new patient?" when you turn the pump back on. (Just remember to clear your volumes, first.) Remember,
your pump may not program correctly with out this being updated.

3. Chart maintenance should be completed on all your patients every shift. This means getting rid of
old, outdated orders, but also getting rid of space-clogging orders like those for supplies or transport.

4. A patient who is receiving tube feeds and lispro should be dosed according to the "receiving
calories" table. Check your administration instructions to be sure, but usually a patient receiving tube
feeds is considered to be receiving calories, even if they're not taking in PO intake.

5. Tubing expires at midnight on the day of the sticker. So, if tubing is stickered for Sunday, it means it
expires Sunday night at 2359. It is night shift's responsibility to change expired tubing. If a patient is not
receiving IVF, new tubing does not need to be hung, but the old tubing must still be thrown away.

6. Chemo always needs to be fully infused. If a bag has overfill, the pump should be reprogrammed to
make sure that the patient receives every last drop of chemo goodness (at the same rate as the rest of the
bag, of course). Once the bag is totally empty, the bag and chemo tubing should be taken down and
disposed of in a cytotoxic bin.

7. EPIC alerts are your best friend when it comes to avoiding med errors. I've seen several medication
errors lately where EPIC posted a BPA regarding a medication frequency, timing, dosage, etc, and the
warning was overlooked by the RN, clicked through, and the med given anyway. Remember, the computer
Davis, Aurora
Fri 3/28/2014 11:24 AM
To:UCH-AIP 11th Onc RN <UCH-AIP_11th_Onc_RN@uchealth.org>;
7/24/2014 Learning Opportunities - Davis, Aurora
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is supposed to be a failsafe: you, the RN, are responsible for checking the patient's 5 rights and making
sure that everything is correct when passing medications. EPIC may give you an error message, but YOU
need to figure out why it's giving you that message.

8. Residuals should only be checked on gastric tubes (G tubes, large NGTs). Do NOT check residuals on
tubes that are in the small bowel (J tubes) or small bore feeding tubes (8-10 fr).

9. Central line dresssings are the responsibility of the day shift RN to change on the day that they are
due. They must be changed once a week. Caps should be changed when dressings are changed. You
should be writing the date the dressing was changed on the dressing when you change it. Biopatches
should always be used with all central lines except ports.

10. Ports must be accessed and freshly heparin locked once a month. EPIC will usually show when a
port was last heparin flushed, even if the port is not currently accessed.

11. All DNARs must be ordered by an attending physician (or cosigned by an attending within 24
hours after the resident places the order). You can check who placed the order and whether its been
cosigned by clicking on the hyperlink of the pt's code status in the patient's chart.

12. If your patient has a tube feeding, and you can't figure out where to chart it, you can add
the group tube feeding to your I/Os section by clicking on "Add Row" and typing "tube feeding".
This gives you all those nice rows for tube feeding type, rate, intake, flushes, etc.

13. All active BMT patients should have an active type and screen. Keep your eyes open, as the lab
draw for these is ordered every third day from the date of admission at the time the orders were released.
It does not automatically appear with AM labs.

14. Don't forget to unclamp your secondary tubing. Unfortunately, this continues to be an issue.
Please, take a moment after you hang your meds to make certain that the chamber is dripping before you
leave the room.

Whew! I think that's it for now. Please let Annsley or Kyle know if you have questions about any of this, or
I'm always happy to help if I'm around.

Thanks,
Aurora
Aurora Davis, RN, BA, BSN, OCN
Relief Charge Nurse
Oncology and Bone Marrow Transplant Unit
University of Colorado Hospital
Aurora.Davis@uchealth.org