SJWH-NICU Staff Relief Process

 

• Staff meal breaks will be coordinated by Team Lead of respective neighborhood, to assure maximum patient coverage
  
• Wireless Cisco phones will be handed off to support staff member for restroom and meal breaks
  
• During meal breaks, "support staff" member to modify their patients' B850 monitors to receive their fellow TM's patient alarms by selecting Data & Pages, then Other Patients, then selecting the patients they are covering, select "Auto View Always", and select "Receive Alarms"
  
• Upon fellow TM's return, wireless Cisco phone is returned, and B850 monitors are modified to disable remote alarm viewing

SJWH-NICU Shift Start and Shift End Processes

 

Shift Start

0645/1845: Report to 3^rd floor Staff Lounge for huddle

• Clock-in at Unit Time Clock
  
• Staff lockers available for secured storage
  
• Huddle information relayed
  
• Neighborhood designation received
  

Report to Neighborhood assigned and view NICU Assignment Sheet

Obtain Cisco phone and Sonitor Locator badge per Assignment Sheet (may not be from "off-going" nurse)

Obtain report on each assigned pt. following Kardex "Patient Hand-Off"

Perform Chart Check

Update dry-erase board in each assigned room, greet visitors if present

Proceed with assignment

 

Shift End

Relay any supply needs to PST to assure work carts, giraffe drawers, and milk refrigerators are stocked for on-coming shift

Complete all charting, outstanding tasks, and outstanding orders

If visitors are present, assure their needs are met prior to shift report

Transfer devices to assigned TMs

Complete report following Kardex "Patient Hand-Off"

Perform Chart Check

Return to 3^rd floor Staff Lounge for belongings and Time Clock

 

 

 

 

SJWH-NICU Transfer Process

• Patients from 2^nd floor will be transferred to 3^rd floor when Level 2 criteria is met, and staffing and vacancy allows
  
• Patients from 3^rd floor will be transferred to 2^nd floor when Level 3 criteria is imminent or met (must be transferred before HFV is initiated)
  
• If possible, schedule transfers to occur prior to shift change, to allow following shift staffing to accommodate census change
  
• Transfer Team will consist of Bedside RN and PST (Resource RN and Delivery RN to assist if able)
  
• If pt. is receiving oxygen therapy, RT will join transfer team
  
• Giraffe shuttle will be utilized for pt. transfers (if giraffe due to be changed within 4 days, transfer pt to clean Giraffe from receiving floor at this time)
  
• Bedside RN to obtain patient's medications from Pyxis bin and place in giraffe drawer for transfer
  
• Bedside RN to obtain patient's chart and room folder contents for transfer
  
• PST to obtain HM and/or formula from existing refrigerator and place in giraffe drawer for transfer
  
• Bedside RN to disassociate transferring pt. from existing monitor in I-View
  
• Transferring floor's HUC to transfer pt.in Cerner (automatically "dirtying" room in Teletracker)
  
• RN to discharge pt. from B850 monitor and remove PDM and install in Transport Pro monitor
  
• Transfer PDM from Transport Pro monitor to "discharged" monitor
  
• Transfer Team transports pt. via southernmost elevators to receiving floor
  
• Once in vacant room, install patient's PDM into receiving monitor, and place "receiving" monitor's PDM in Transport Pro
  
• Transfer team to admit pt. into monitor via Admit/Discharge menu on B850
  
• Transferring Bedside RN to give report to Receiving RN following Kardex "Patient Hand-Off"
  
• Receiving RN to associate pt. with "receiving" monitor in I-View
  
• Receiving floor's CN to update device assignments in West-Call and Emergin
  
• 2^nd floor CN to update NICU Patient Tracking log
  
• Transferring PST to update Visitation Tracking Log on both floors
  
• Housekeeping will clean vacated room
  
• PST will clean equipment in vacated room
  

Patients to remain on 2^nd floor

All CPAP, SIMV, HFOV, HFJV

RDS/TTN

PPHN/Hydrops

Perinatal depression / Resuscitation @ delivery

CHD

Surgical diagnoses

Non-viable live births (X beds)

Congenital birth defects

R/O Seizures

UAC/UVC/Peripheral arterial lines

Vasoactive/Sedation drips

Chest tubes

Exchange transfusions

Suspected NEC or pneumatosis

External ventricular drains

 

 

 

 

 

 

 

 

 

 

 

 

 

Patients eligible for transfer after transitioning

R/O Sepsis

Less than 2 Kg

NAS

Hypoglycemia

Temp Instability

Hyperbilirubinemia

Poor PO feeders

 

 

 

SJWH-NICU Admission Process

• LDR/OR calls NICU 2^nd floor CN (#827141) when NICU team needed
  
• CN notifies delivery team:
  
  • Sends message to delivery team (Del. RN & Resource RT) via nurse call system (enter room # and brief description if known, and not previously relayed)
    
  • Calls on-call Neo/NNP
    
  • Sends "Delivery Team down" message to Resource RN
    
• CN accesses OBTV to expedite admission
  
• DT notifies CN of respiratory support, etc. to have at bedside (confirming admission)
  
• CN notifies PST for support
  
• HUC initiates admission of patient into Cerner, generates MR#
  
• PST obtains "admission-ready" chart, containing patient labels if available
  
• PST to facilitate entrance of team into unit and follows team for support
  
• DT enters unit via southernmost entrance (neighborhood "2 Purple")
  
• HUC enters pt information into census log and master record
  
• CN generates "wee id", obtains posey, verifies pt bands and assures "Newborn Identification" sheet is completed
  
• Neo/NNP completes orders and communicates to Resource RN, Delivery RN, and/or Charge RN, which faxes completed orders to HUC (stamp "Faxed" and document date, time, & initials)
  
• HUC enters orders once fax received
  
• PST prints facesheet and barcode labels from neighborhood, if not printed before arrival of DT
  
• PST prepares PKU slip and adds pt to PKU tracking list
  
• Resource RN, Delivery RN, and Charge RN (and Bedside RN, if available) execute admission assessment, orders, and charting
  
• Del. RN orders cord blood work-up and sends to blood bank
  
• PST cleans and prepares transporter/giraffe shuttle for next use, returns to station (TBD)
  
• CN adds pt to NICU pt tracking list

B850 Monitors

For those of you who have had monitor training, what do you think should be our practice regarding bed-to-bed viewing?  There is an option to only have the alarms breakthrough, therefore only when the other patients alarm, the monitor of the room that you are in will split-screen with a view of the alarming patient's display and corresponding alarms.  We need to determine what is best practice for our new unit.  Until further notice, only bradys will be coming to our Cisco phones.  Therefore, we would see if one of our babies are desatting, when we are not at our desks in view of all the monitors. 

What supplies do we carry over?

Scott Van Allen from Materials Management has printed me a "par inventory worksheet" to determine par levels for our new unit.  I wanted to get everyone's opinion on a few items.  Does anyone use the blood tubing to the left with the chamber with the little white ball in it?  I'm pretty sure we only use the standard blood tubing for all blood products.  And the iv kit on the right to start an iv?  Also, what are you thoughts regarding bili-masks?  Do we need both kinds?  I personally like the white wrap-around ones.  Again, I need feedback on this one.

Flow of NICU Admissions

I apologize for my lack of computer graphic-ing abilities?!  From what we have discussed in meetings, here's a starting point, as is the "NICU Admission" post.  Please share your thoughts.

NICU Admissions

• A Resource RN will be assigned each shift to the 2^nd floor, if staffing permits.
• If "new admit" is able to be assumed into existing assignment, Resource RN, Delivery RN, and/or Charge RN will aid in completing the admission process with the Bedside RN with open, existing assignment.
• If "new admit" will not be able to be assumed into existing assignment, Resource RN will admit patient into a vacant room, or into the "micropreemie/high acuity" neighborhood if criteria met, and continue patient care for remainder of shift.
• Resource RN duties may be assumed as follows, if needed to continue patient care of two admitted patients.
  

Resource Order:

1. 2^nd floor Resource RN
2. Delivery RN (3^rd floor Charge RN to attend deliveries)
3. 3^rd floor Charge RN (2^nd floor Charge RN to attend deliveries and charge duties of both floors )
   
    

• If "new admit" fits criteria for admission into "micropreemie/high acuity" neighborhood, placement in that neighborhood must be assured. Stable, existing occupants, not meeting "micropreemie/high acuity" criteria, will be transferred out, to meet placement/staffing needs. SBAR, OBTraceVue, and open communication between NICU/LDR/HROB will facilitate proper "micropreemie/high acuity" placement.
• Resource RN will facilitate admissions, until patient assignment is assumed.

Absorbing Assignments:

1. Resource RN
2. Delivery RN
3. 3^rd floor Charge RN
4. Bedside RN, if becomes available (i.e. discharges)

  

        

SJWH-NICU Wayfinding

In early May, I had an opportunity to meet with Carmen Zeno from our Security department.  Unsure of what additional support her department would be able to offer us, I devised the following plan to secure our unit.  Please share your thoughts.

SJWH-NICU Wayfinding

2^nd and 3^rd floor elevators will open to a secured vestibule.  Entrance into NICU through either floor will be dependent on the following steps:

1. Visitors will pick up phone located in vestibule that rings directly to HUC/Reception Desk
2. HUC/Charge RN will answer phone and request patient identification (Baby’s last name)
3. HUC/Charge RN will instruct caller to wait briefly, that someone will be there shortly to allow them in
4. HUC/Charge RN will notify PCT/PST/RN “greeter” of visitor and patient identification, then send a message via nurse-call to notify the bedside nurse of upcoming visitors
5. “Greeter” will have a list with all patient’s names, ID band numbers, and room # (this list may have 3 boxes next to each patient, to track 3 visitor limit)

Patient	Band #	Room #	Band Holder	Visitor 1	Visitor 2
Smith, Boy-Lisa	12345 BTE	2101

6. “Greeter” will open secured unit entrance and verify band holder’s band, then allow the entrance of a maximum of 3 visitors (band holder plus 2)
7. Checks will be entered in the boxes to account for number of visitors
8. Visitors will be directed towards the patient’s room
9. Bedside RN will have received notification via nurse call
10. If “Greeter” receives notice of visitors for a “visitor-occupied” room, “greeter” would contact the bedside RN or go to patient room him/herself to inform band holder of secondary visitors
11.  Band holder would then select to exchange visitors, or allow secondary visitors to continue waiting
12. “Greeter” will either:
1. monitor visitor exchange (assuring there will be at least one band holder in patient room during any visitation, and maximum of 3 visitors per room)
2. inform secondary visitors of existing visitor capacity, and that they will be able to exchange shortly

Let's get the ball rolling...

Today we met with Ideacom, the vendor for our West-Call nurse call system.  This was their second demo on the system.  NICU had the first hour, Mom/Baby, Imaging, and Gyn had the second hour.  Each nicu patient room will have two wall stations.



Red Staff Emergency button will notify the Nurse and RT assigned to the room, as well as the Charge Nurse on that floor.  This could take the place of our current "RESPIRATORY" call.
Code Blue Button will notify the 2nd floor Charge Nurse, Delivery Nurse, Float RT, Floor RT, and the Neo or NNP.



Red and Blue buttons will elicit the same responses as the unit above.  The Green Button will alarm at the front desk.  Anyone who answers that green "nurse call" button call will be able to speak into the room via the speaker.  Currently, the thought is to avoid speaking through that wall speaker, which is located right behind the baby's giraffe, and would add unnecessary noise.  The outlet on the left, under the red button, is where the vents plug into, alarming us of vent disconnect or malfunctions.  The outlet on the right, under the blue button is where the pillow speaker plugs into.  Currently, the thought is to solely use the pillow speaker as a remote control for the tv. 

 



This is the master station that will be housed at the HUC/Reception desk.  Assignments will be entered at this unit, linking the caregivers, with phones and badge locators.  These assignments may be entered up to 4 hours before shift change.  AHCA requires that these are manned at all times, therefore, the HUC may not step away without being relieved.

Good night all!  I'll post more tomorrow, when my eyes aren't rolling backwards :) Monica

Welcome Committee Members!

In an effort to maximize the delivery of information to all of the committee members, day and night shifters alike, and taking into account that it is 2011, I decided to create a blog.  I hope this blog becomes an avenue for all of you to obtain information and provide feedback,without pulling you away from your assignments, or your homes.  Please check-in on a regular basis, and don't hesitate to ask questions or provide constructive criticism.  Ideally, I will be able to post educational material on this platform, that will serve as a resource, as we transition into our new unit and workflow.  Again, let me express my gratitude to all of you for wanting to take part in the advancement of our unit!  See you soon :)