7/26/2014 RE: Learning Opportunities #3 - Davis, Aurora

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RE: Learning Opportunities #3
Hi Aurora,
I agree, love the use of great words (and humor). I've read through this and agree with Kyle's comment
regarding the frequently missed initials on the evaluator line. Thanks so much for sending these helpful
reminders/educational points out to staff!
Annsley J Buffington RN, BSN, OCN
Clinical Nurse Educator
Oncology, Bone Marrow Transplant, Gyn-Onc
720-848-4940
Annsley.Buffington@uchealth.org

The Department of Professional Resources improves lives by empowering healthcare professionals to
influence quality care through education, discovery and navigation of change.


From: Hammond, Kyle R
Sent: Tuesday, May 13, 2014 12:34 PM
To: Davis, Aurora; Buffington, Annsley J
Cc: Wenger, Barbara
Subject: RE: Learning Opportunities #3

Loved the humorJ The only think I would like for you to add is that Sabine has stated compliance of faxing has
been much better, however, people are forgetting to initial in the evaluator line

Kyle Rose Hammond, RN, BSN, OCN
Clinical Nurse Educator
Bone Marrow Transplant and Oncology Units
Kyle.Hammond@UCHealth.org
720-848-0422

The Department of Professional Resources improves lives by empowering healthcare professionals
to influence quality care through education, discovery and navigation of change.
Buffington, Annsley J
Tue 5/13/2014 9:09 PM
To:Hammond, Kyle R <Kyle.Hammond@uchealth.org>; Davis, Aurora <Aurora.Davis@uchealth.org>;
Cc:Wenger, Barbara <Barbara.Wenger@uchealth.org>;
7/26/2014 RE: Learning Opportunities #3 - Davis, Aurora
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From: Davis, Aurora
Sent: Saturday, May 10, 2014 4:38 PM
To: Buffington, Annsley J; Hammond, Kyle R
Cc: Wenger, Barbara
Subject: Learning Opportunities #3

Ladies,

Here's my next Learning Opportunities email for your review.

Thanks!
Aurora

--------------------------------------------------------------------------------
Rockstars,

What? More learning opportunities?!? Oh, the fun never stops on BMT and OMG. There's always
something new to learn. Here is Round #3 of Aurora's Ambitiously Annoying and Alliterative Admonitions.

1) Don't give BMT cell premeds until you know when cells are to be given. These premeds are usually
timed for 0900, but they should not be given until 30 minutes before the stem cells are to be infused (per
the admin instructions). As the nurse giving the cells, its your job to call the stem cell lab and find out
what time cells are going to be infused. When in doubt, talk to the charge nurse; they'll help you figure it
out. (This also goes for the pre-hydration, which needs to be timed for 2 hours before the cell infusion
begins.)

2) When you complete the yellow form 24H post stem cell infusion and fax it to the stem cell lab,
you must document that you are the evaluator and whether or not the patient had a reaction. If the
patient had no reaction, check the box next to "no adverse reaction in 24 hours", otherwise you
should indicate what kind of reaction the patient had and how it was treated. Even if the form is to be
faxed tomorrow, if the patient reacts on your shift, you should still mark it down on the yellow form so that
the RN faxing the form doesn't have to play detective. Side Note: the form doesn't have to be faxed
precisely 24 hours after infusion, there's a little leeway so that you can complete the form appropriately.
As long as you fax it by the end of your shift, you're good to go.

3) We should not be using most dialysis caths on the floor, but Marhurker dialysis caths are an
7/26/2014 RE: Learning Opportunities #3 - Davis, Aurora
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exception. Most of the time, we CANNOT use dialysis cathethers on the floor. Only dialysis nurses can
access dialysis caths, change their dressings, or generally do anything with them. There is one exception:
Marhurker dialysis caths. These are noticably different looking from "regular" dialysis caths in that, in
addition to the two yellow Tego caps, there is a third lumen on the line. The third lumen is longer, thinner,
and does not have a yellow Tego cap on the end. We can use this lumen just like we would a regular
central line (FYI, it is not a power lumen). Your provider can place flushing orders for the central lumen just
like they would for any other central line. When they order the flushing order set, they just need to choose
"Marhurker dialysis catheter" as their line type. Remember, if the line has a yellow Tego cap, don't touch
it!

4) Heme/BMT patients may need their labs replaced more than once a day. If a patient has multiple
labs a day, its important to note whether or not their electrolye levels have dropped below the parameters
for replacement. If so, you can always check with the NP/PA to see if you should replace them again.
Particularly with patients who are chronically low, they may need to be "topped off" during your shift.

5) Check your admin instructions on your insulin scale to see whether you should be dosing for
"receiving calories" or "receiving no calories". This can get a little tricky if a patient is not on a simple
ADA diet. For example, if the patient is only receiving clear liquids, they should be dosed according to the
"receiving no calories" table. This is noted in the admin instructions for lispro on your MAR. If a patient is
receiving a tube feed, they should be dosed according to "receiving calories", again, per the order. If
you're ever uncertain which table you should be using, you can check with another RN, your charge nurse,
or even call the glucose management pager number. They're very friendly and a great resource if you have
questions about your patients with diabetes.

6) If you have a patient on suicide precautions, you need to be documenting suicide risk assessments
every six hours. Yes, the security guard takes care of the every 15 minute safety check documentation.
However, as the RN, you must document the suicide risk assessment. It must be done every six hours and
the rows can be added in under the "restraint" tab. Remember, suicide precautions are a form of isolation
that DOES count as a restraint. Because of this, there are special rules that must be followed and
documentation that must be done. Refer to the Suicide Precautions Policy if you have more questions--I
always look it up whenever I take care of a patient on these precautions.

7) Salt and soda should be given to all chemo patients, including teaching regarding the dangers of
mucositis and how to perform proper mouth care. When you chart the patient's oral assessment, take
the time to ask them about mouth care. Are they doing their swish and spit? Are they brushing their teeth?
Check the bathroom, make sure they have a good supply of salt/soda, cups, and spoons. With oral care,
the old adage holds true: an ounce of prevention is worth a pound of cure. Don't assume it was done on
admission, either; admission day is very busy, and it can easily be missed.

8) Update your Alaris pumps to the current month. Ah, an oldie but goodie. When you're programming
your pump, take a quick look at the top of the screen and make sure that the data set is the current month.
I don't think I've seen a month in the last twelve where there wasn't a new data set released, so if the
month listed doesn't match the current month, you're probably out of date. Guardrails are meant to help us
dose our patients correctly when we program the pump, but they don't do us much good if they're not
updated with the best and newest information. Just turn your pump off all the way, turn it back on, and
push "yes" when the pump asks if this is a new patient. You should be all set.

9) ALL transplant patients need an incentive spirometer. This is part of the order set for all active
7/26/2014 RE: Learning Opportunities #3 - Davis, Aurora
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transplant patients. They should have an IS, be instructed in its use, and be encouraged to use it routinely.
Is your patient up and exercising regularly? Fantastic! But remember, this is a doctor's order, so its your
responsibility to make sure its carried out anyway. Again, it can be missed on a busy admission day, so
look around your patient's room when you do your morning assessment, make sure the IS is there,
and chat briefly with them about how to use it.

10) Fall risk assessment signs should be updated every shift. Guys, this is really the fall champions'
area, so I'm not going to dwell on it, but let me just say this. I had a patient recently whose fall sign hadn't
been updated for an entire week. You should be educating your patient on their fall risk every shift! If their
risk level hasn't changed, that's wonderful, but you still need to talk to your patient about it, let them know
that you're staying the course with interventions or what's changed, and update the date/initials on the
sign to indicate that you've talked about it today.

11) You have to check BP/HR every hour on IL2 patients, NOT a full set of vitals. Only BP/HR are
hourly. Full vital signs--BP/HR, temp, pulse ox, and RR--need to be checked Q4H, per unit standard. Don't
make more work for yourself! Coordinate with your CNA/ACP regarding when they'll get the full set and
when to just get BP/HR.

Questions? Comments? As always, these tips are to help you, so if you want to know more about
something, please feel free to ask.

Always available and appropriately approachable,
Aurora


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