Did you know you should be charting Impella CM Depth?
Impella Devices have CM markings on the side of the catheter. These should be assessed at minimum at shift change with oncoming and off going nurse, after any turns, and with any suspicion of migration or movement of the device. What do you document?
1. Impella Devices are added into the chart as a Mechanical Circulatory Assist device
2. CM Markings are charted under the device flowsheet
If you have an questions about this practice change reach out to JoAnna or Jess!
Its Competency Season!!
FY2022 Competencies were assigned to you on January 17th, these are due for completion no later than June 15th
See learning exchange for your required competencies, link to learning exchange is below.
Recently there has been some inconsistencies with Chlorhexidine (CHG) bathing and correct application of CHG wipes.
This process helps to prevent infections and the spread of antibiotic resistant bacteria.
Remember, CHG should be applied to EVERY CVICU patient every 24 hours. Unless they have an allergy to CHG which is verified by the patient.
Application of these wipes is one for each extremity, one for the front of the truck, and a final for the back, totaling 6 wipes. Do NOT apply CHG to the face
The What's What on Wounds
Taking care of patients skin is of paramount importance within the CVICU. Because of vasoactive medications, peripheral devices and tenuous nutrition status, ensuring that skin is taken care off take consistent commitment and careful attention.
When our patients do get pressure injuries, VUMC has a wide variety of resources to help us treat and heal pressure injuries, one of these resources being the adult wound care team.
Recently there has been updates to wound cares process:
1. For Skin Tears, skin fold management, Stage 1 and 2 Pressure injuries, Nursing staff implements an order for skin care guidelines.
(these guidelines then slate resources into the chart that give direction to wound care, wound healing and products to improve both of those processes)
These are ordered in eStar under "Adult Skin Care Guidelines"
2. At the first sighting of a wound, the nurse will put a picture into the chart to document the wound
3. With any concerning wound, nurses should upload a picture and then ask the primary to assess if the patient should have an Adult Wound Team consult.
Blood Administration Documentation
During TJC prior visit, it was identified that VUMC has education documentation deficiencies. Based on that information, some updates to eStar were made to help you document education on your patients. A few reminders of this are
1. Admission assessments INCLUDING knowledge assessment must be performed with 24 HOURS of patient admission. since our patients frequently are unable to self report, family members may fill these assessments out for our patients. If the patient has no family members, then you may defer the assessment for 24 hours
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2. PRIOR to receiving their first blood product in patient (not in the OR) a patient must be educated on the risks and side effects of blood transfusion reactions and blood transfusion procedure. there is a hyperlink in the blood flowsheet, that will take you to the education tab to document this education.
**If you are performing mass transfusion it is not the expectation that you delay patient care to document blood education, this is targeted at patients receiving routine blood products**
Since we give a large amount of blood products in the CVICU, you can document this blood education when the patient is admitted, saving you time when the patient is ordered products.
Omnicell Changes for Push Dose Pressors
'bab epi' and the sister push dose pressors have been renamed in the omnicell. When trying to pull these doses you will now be looking for
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.
When charting on Impella devices, ensure you are documenting centimeter depth and charting the device in under the title "Mechanical Circulatory Assist Device"
Competencies are up! They are due June 15th!!
Chlorhexidine bathing has become inconsistent, learn how to do it and document appropriately.
For wound management, do not consult wound care unless you have a stage 3-4 wound. for 1-2 nursing staff implements skin care guideline orders
You are REQUIRED to chart education on blood within 15 minutes of starting the product. This can only be documented if the patient has an admission learning assessment
Baby Epi is now in the omnicell labeled "diluted"
LVAD spiels and wheels is up, complete kahoot to win a gift card!
