The ECMO Teams billing department closely monitors our documentation so patients can be billed appropriately.
This is why our charting must paint the correct picture of ECMO therapy. What you need to document:
1. You must document "Start/Stop ECMO Therapy", "ECMO Circuit", and "$ ECMO Therapy Type" at the beginning of each shift.
2. Document Therapy start/stop of the therapy as closely to the cannulation and decannulation times as possible.
Charting Education? What's the requirement
What are the requirements for Charting Education in CVICU?
Learning Assessments is a requirement on admission and should be completed within the first 24 HOURS after patient admission! (If your patient cannot answer the questions, it can be completed VIA Surrogate of a family member).
Education should be documented EVERY SHIFT! This helps us to identify knowledge gaps of our patients and family members. Blood Administration education is REQUIRED prior to the first transfusion done during hospital admission.
How is charting education being adjusted to fit within your work flow?
Within the 'all doc' tab, a daily reminder will populate within the flowsheet that will take you to the admission requirement to complete, or allow for a comment as to why the information cannot be completed by the patient or a family member.
Withn the blood administration navigator, a link will autopopulate to chart education when the blood administration is started!
Product Update: INVOS NIRS Monitors
The NIRS Monitors we know and love are getting an update! These products are utilized on patients with peripheral devices, and ECMO populations. Updates will allow us to easily track our patients baseline and note any deviations Changes:
1. You set a baseline for each sensor (Left/Right)
2. Graph trends will flag events and alarm if the patient goes 20% below the baseline
3. All alarms come with guided directions to troubleshoot
** The CVICU Website has been updated and includes the product information on these new NIRS Monitors**
This week on VHVI APP Grand Rounds: Zoom in to listen to one of Vanderbilt's Heart Transplant NP's Rachel Fowler Speak on how Congenital Heart Disease Patient Transplants care is evolving and how this can change practice in the CVICU!
Nasal Decolonization: Why is it Important?
As a part of the CLABSI reduction bundle: Patients should be receiving nasal decolonization with 10% povidone-iodine solution TWO times a day for FIVE days.
This is reflected by an order in eStar that states" Intranasal aseptic application completed" or "contraindicated" This auto-populates on your work list, and you need to be completing the nasal swabs AND charting it!
This is ONLY contraindicated in patients who are receiving Mupirocin instead.
We are currently only completing nasal decolonization at a rate of 20-40% our goal is 100%
Hemolyzed Labs: Why is it happening?
Myth: labs are not hemolyzing because they sit in the lab too long! When you see a delay in labs being reported as hemolyzed, this is because the lab technicians actually have to run the labs TWICE to confirm that they're hemolyzed.
How can you prevent Lab Hemolysis?
Avoid drawing blood from a PIV unless it is an emergent situation
Fill the tubes to the correct amount to ensure there is enough blood/additive ratio
Make sure the transport tube is padded. Tubes can reach up to 6 G-Force while in the pneumatic tube system!!
Supply Shortage on Pharmacy Supplies: Leuerlock Syringe Adapter
These syringes are glued to every phenylephrine and epinephrine push dose syringe by the pharmacy. While CVICU does not use this product, the ED does. Place these where filters are held by the omnicells and we can intermittently send these syringes back to the pharmacy!
Medication Questions? Ask your local drug thug or provider.
Back By Popular Demand: Spiels on Wheels!
After feedback from the unit, CVICU Education Council in collaboration will be bringing back education at the bedside via Speils on Wheels!
These rolling 5 minute inservice will be offered daily Monday-Friday on both Day shift AND Night shift starting February 1st! Topics will change month to month, and we welcome any and all feedback you have on wanted topics.
Our Topic for February is going to be LVAD
What You Really Need to Know.
Fast.
ECMO Charges should be charted every shift. Remembering Start/Stop ECMO Therapy, ECMO Circuit, and $ ECMO Therapy Type
Education needs to be charted every shift. Blood Education needs to be documented prior to the first blood administration of the admission.
New NIRS monitors are coming to the CVICU
Listen in to Grand Rounds this week to hear about Congenital heart transplants
Nasal decolonization is required one every CVICU patient, twice a day, for 5 days. Unless they are on Mupirocin
Labs are hemolyzing, make sure to not draw from PIVs and fill tubes appropriately
Save the Leuer lock Syringes from Epi pushes and send them back to pharmacy
Spiels on Wheels is back! Look for this to start the first week of February
