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December 21, 2006

Upcoming Product Changes

PLEASE FIND ATTACHED UPCOMING PRODUCT CHANGES:
<<MEMO ABDOMINAL PADS.doc>> > > <<MEMO Patient Bags.doc>> > > <<MEMO Mortuary Bags.doc>>


abdominal pads
mortuary bags
patient bags


Change to Physiotherapy on-cal pager

Please note that the new Physiotherapy on-call pager number is 53996
effective immediately!

For clarification this replaces the pager 54078, and is the number to be
used in case of evening call backs and weekend communication.




December 16, 2006

Respiratory Therapy Conference Las Vegas

 

vegas.jpg

   

The AARC Conference is packing up today in Las Vegas. We will have a recap of events and any ground shattering breakthroughs once the haze has settled: Until then, here is an EXCLUSIVE photo of a new mode of ventilation developed here in Canada, NAVA [Neurally Adjusted Ventilatory Assist]  Dr. Christer Sinderby with a demonstration of NAVA in operation at the Maquet Booth at the Las Vegas Conference. (©2006-2007 Peter Daugulis )

  

For some background info you may check out the following link

December 7, 2006

Blood Stream Infections_QI presentation

 

 

 

 
 

Realignment of SLT

 

One of the most difficult roles of a leader is to make organizational decisions that effect individuals who have made significant contributions to the organization. However, I have recently been engaged in discussions with Senior Leadership Team members regarding the current SLT structure to look for opportunities to align the work, clarify accountabilities, and to reallocate costs to support other SLT .... 

 
 

 

December 5, 2006

Announcement of New Program Director -Acute and Access Services, PHC

 

I am pleased to announce Bonita Elliott as the Program Director - Acute (ED, ICU, RT, Trauma) and Access Services, effective January 8, 2007.

Bonita obtained her nursing diploma from Royal Columbian Hospital in 1972.  She later went on the secure her Bachelor of Science in Nursing, with Distinction, from the University of Victoria in 1996.  Throughout her career, Bonita has continued to both upgrade her current qualifications and improve and augment her skills.

Bonita has over 30 years experience in critical care nursing and has spent the last 16 years in leadership roles.  In these roles, Bonita has been instrumental in implementing major quality care and operational initiatives.   Since joining PHC in 2003, Bonita has been the Operations Leader of the SPH ICU.  In addition to providing operational leadership to the ICU, she has provided leadership and team support to various quality improvement and safety initiatives such as the ICU Ventilator Associated Pneumonia project, the ICU/ED collaboration on Early Goal Directed Sepsis Management, Adverse Drug Events, and the implementation of the ICU Outreach team.  As well, Bonita is currently co-chair of the Regional Critical Care Council and has made valuable contributions in the development of Service Delivery Models for Integrated Critical Care in the region, and the Interqual Critical Care Level of Need Report.

Bonita's experience and leadership will be a valuable contribution to the program leadership teams and PHC as we continue to work collaboratively to provide strategic and operational support to our clinical programs and staff/physicians.

I wish to thank the members of the selection committee for their participation in this process.

Please join me in welcoming Bonita to her new role with Providence Health Care.

SECURITY CONTACT INFORMATION

SECURITY CONTACT INFORMATION
ST. PAUL'S HOSPITAL



All Codes Emergencies
Dial "888".
Follow the Codes procedures.

Security/First Aid Radio Inter/Connect (24/7)*
6-9164
First Aid Pager (Back-up to Radio Inter/Connect)*
5-4050
Security Pager (Back-up to Radio Inter/Connect)*
5-4821
ER Security Booth (24/7)
6-8323




*Radio Inter/Connect allows PHC staff to talk to a Paladin Security Officer, via a hand held portable radio 24/7. There is a small break between communications, due to the fact that you are talking from a phone line to a portable radio (Walkie-Talkie)

December 4, 2006

Culturally Responsive Healthcare at PHC

Join Us!

Diversity Services & Dr. Rod Andrew & IMGs present:
A Four - Part Lecture / Discussion Series For all PHC staff
Culturally Responsive Healthcare at PHC
    Find out how culture impacts patients' health definitions, practices, beliefs and needs
    Get practice clues from local & internationally educated doctors
    Pick up some useful print resource materials
A late lunch will be provided
Lecture Dates and Titles

Nov. 21
Cultural Awareness in the Hospital Setting: Dr. Rod Andrew

Nov. 28
Comparing Medical Systems: An Internationally Trained Physician from Eastern Europe Speaks

Dec.   5
Comparing Medical Systems: An Internationally Trained Physician from the Far East Speaks

Dec. 12
Comparing Medical Systems: An Internationally Trained Physician from The Middle East Speaks

Location:    Hurlburt Auditorium
Time:        1:15 pm to 2:15 pm

Pneumococcal Infections

In recent weeks St. Paul's Hospital has seen an unusually high number of patients with severe pneumonia and blood stream infections (Invasive Pneumococcal Disease). Some of these patients have also been transferred to Mount Saint Joseph. Most of those affected are from the Downtown Eastside (DTES) and have compromised immune systems due to pre-existing health issues. Fortunately, this illness responds positively to appropriate antibiotic medications such as penicillin. To reduce the number of further infections, PHC is working with Vancouver Coastal Health to extend vaccination programs in the DTES, hospital emergency rooms and inpatient units. A PHC Response Team has been assembled to coordinate planning associated with this health issue. In the meantime, we expect that staff and physicians at St. Paul's and Mount Saint Joseph will be treating more patients with invasive pneumococcal disease. At this time there is no evidence of patient-to-patient or patient-to-staff transmission.

Staff at St. Paul's and Mount Saint Joseph are advised as follows:
Use standard precautions at all times. These include wearing gloves, gowns and, during procedures likely to cause splashes or sprays of blood, body fluids or secretions (i.e., intubation), face protection such as masks, goggles or face shield.
Staff who are immune-suppressed can receive the pneumococcal vaccine from their family physician. (Public health officers say that other staff immunization is not necessary.)
Practice good personal hygiene techniques such as thorough hand washing.

It is important that staff stay healthy, and it is encouraging that many staff have already had their flu shots. If you have not had a flu shot, please be advised that there is a flu clinic at St. Paul's Hospital on Tuesday, November 28, 2006 from 7:30 am to 1:30 pm in Dining Room 1 and 2.  After that date flu shots will be available upon request. To arrange for a flu shot, please call:

St. Paul's Hospital - 68455 or 68454
Mount Saint Joseph Hospital - 78540


What are pneumococcal infections?

What are pneumococcal infections?
Pneumococcal infections are caused by the bacteria Streptococcus pneumoniae, which can cause infections such as pneumonia, bacteremia, meningitis, and otitis media. Severe infections are usually seen in patients who are at risk, such as persons over 65 years of age, residents of extended care and intermediate care facilities, and persons with impaired immunity or chronic illness. Over the past few months, however, there have been a higher than expected number of patients being admitted to St. Paul's Hospital with severe pneumonia and bloodstream infections. The increase in illness has been noted in persons with addresses in the Downtown EastSide (DTES) Vancouver, homeless, persons living with HIV, and history of drug misuse.

How is pneumococcal infection transmitted?
These bacteria can spread from the nose and throat of one person to another by close direct contact like kissing, coughing, or sneezing and through saliva when people share food, cups, water bottles, toothbrushes, etc. Currently, there is no evidence of nosocomial spread.

What Infection Control Precautions are required for patients with pneumococcal infection?
Standard Precautions are adequate to prevent the spread of this organism from the patient to patient and from patient to staff.
Standard Precautions:
Hand washing.
Appropriate use of Personal Protective Equipment (PPE) for contact with all blood and body fluids except sweat and tears.
Proper handling of needles and sharps.

When should I wash my hands?
Hands should be washed before and after every patient contact, as well as after touching potentially contaminated items in the environment (e.g., respiratory equipment). Hand washing with an alcohol hand gel (e.g., MicrosanTM) is appropriate for use if hands are not visibly soiled, but remember to let them air dry. Conventional handwashing with antiseptic soap and water is recommended for hands that are grossly soiled.

Standard Precautions: What PPE do I need?
Gloves - for direct to anticipated direct contact with all blood and body fluids (i.e., providing suctioning).
Gown or plastic apron - protection against splashes and sprays (i.e., intubation).
Face Protection - masks, goggles, face shield - during procedures that are likely to cause splashes or sprays of blood, body fluids or secretions (i.e., intubation).

Can pneumococcal infection be prevented?
Vaccination can prevent most serious pneumoccocal infections. The pneumococcal polysaccharide vaccine is recommended for and provided free to people who are at high risk of getting serious infections. This includes:
All those 65 years or older.
Residents of extended care and intermediate care facilities.
All people with:
Asplenia (removed or impaired spleen);
Weakened immune system such as HIV disease, haematopoietic stem cell transplantation; (HSCT), solid organ transplantation, certain cancers (leukemia, lymphoma, Hodgkins's Disease);
Conditions requiring ongoing high dose oral corticosteroid therapy; or
Chronic diseases such as heart disease, lung disease, liver disease, diabetes, alcoholism, cerebral spinal fluid leak, cochlear implant.
The VCH Public Health has also initiated a vaccination campaign in the DTES at a variety of locations, and would like to expand it to include patients in the SPH and VGH Emergency Departments.

Thank you very much for your help!
More information on Standard Precautions other infection control issues is available online on the PHC intranet at HYPERLINK "http://phcmanuals.phcnet.ca/Level2.asp?L1Heading=Standard+Precautions&LibCode=ICON" http://phcmanuals.phcnet.ca/Level2.asp?L1Heading=Standard+Precautions&LibCode=ICON

PHC Infection Prevention and Control (IPAC)

Pneumococcal Infection
Fact Sheet for Health Care Workers, Physicians and House Staff

 

 

 

 

 


What are pneumococcal infections?

What are pneumococcal infections?
Pneumococcal infections are caused by the bacteria Streptococcus pneumoniae, which can cause infections such as pneumonia, bacteremia, meningitis, and otitis media. Severe infections are usually seen in patients who are at risk, such as persons over 65 years of age, residents of extended care and intermediate care facilities, and persons with impaired immunity or chronic illness. Over the past few months, however, there have been a higher than expected number of patients being admitted to St. Paul's Hospital with severe pneumonia and bloodstream infections. The increase in illness has been noted in persons with addresses in the Downtown EastSide (DTES) Vancouver, homeless, persons living with HIV, and history of drug misuse.

How is pneumococcal infection transmitted?
These bacteria can spread from the nose and throat of one person to another by close direct contact like kissing, coughing, or sneezing and through saliva when people share food, cups, water bottles, toothbrushes, etc. Currently, there is no evidence of nosocomial spread.

What Infection Control Precautions are required for patients with pneumococcal infection?
Standard Precautions are adequate to prevent the spread of this organism from the patient to patient and from patient to staff.
Standard Precautions:
Hand washing.
Appropriate use of Personal Protective Equipment (PPE) for contact with all blood and body fluids except sweat and tears.
Proper handling of needles and sharps.

When should I wash my hands?
Hands should be washed before and after every patient contact, as well as after touching potentially contaminated items in the environment (e.g., respiratory equipment). Hand washing with an alcohol hand gel (e.g., MicrosanTM) is appropriate for use if hands are not visibly soiled, but remember to let them air dry. Conventional handwashing with antiseptic soap and water is recommended for hands that are grossly soiled.

Standard Precautions: What PPE do I need?
Gloves - for direct to anticipated direct contact with all blood and body fluids (i.e., providing suctioning).
Gown or plastic apron - protection against splashes and sprays (i.e., intubation).
Face Protection - masks, goggles, face shield - during procedures that are likely to cause splashes or sprays of blood, body fluids or secretions (i.e., intubation).

Can pneumococcal infection be prevented?
Vaccination can prevent most serious pneumoccocal infections. The pneumococcal polysaccharide vaccine is recommended for and provided free to people who are at high risk of getting serious infections. This includes:
All those 65 years or older.
Residents of extended care and intermediate care facilities.
All people with:
Asplenia (removed or impaired spleen);
Weakened immune system such as HIV disease, haematopoietic stem cell transplantation; (HSCT), solid organ transplantation, certain cancers (leukemia, lymphoma, Hodgkins's Disease);
Conditions requiring ongoing high dose oral corticosteroid therapy; or
Chronic diseases such as heart disease, lung disease, liver disease, diabetes, alcoholism, cerebral spinal fluid leak, cochlear implant.
The VCH Public Health has also initiated a vaccination campaign in the DTES at a variety of locations, and would like to expand it to include patients in the SPH and VGH Emergency Departments.

Thank you very much for your help!
More information on Standard Precautions other infection control issues is available online on the PHC intranet at HYPERLINK "http://phcmanuals.phcnet.ca/Level2.asp?L1Heading=Standard+Precautions&LibCode=ICON" http://phcmanuals.phcnet.ca/Level2.asp?L1Heading=Standard+Precautions&LibCode=ICON

PHC Infection Prevention and Control (IPAC)

Pneumococcal Infection
Fact Sheet for Health Care Workers, Physicians and House Staff

 

 

 

 

 


Transducer Updates


M E M O R A N D U M
 Memorandum
DATE:
 November 28th, 2006

TO:
 ALL ICU NURSES
CC:
 

FROM:
 David MacDonald
RE:
 NEW TRANSDUCER changes


To Whom It May Concern:

This is just a reminder:

A per earlier communication, today is the day for the changeover to our new transducers.

New Edwards Life Sciences transducers - choice of:
one with an in-line VAMP
one without and in-line VAMP
now a "pull tab" instead of the previous "squeeze" function for flushing the tubing

New red pressure cables:
the connection for the new Edwards pressure tubing is different (like a telephone jack connection) and requires new cables.

There are also new transducer holders for our enjoyment!

This equipment has been standardized throughout the hospital.

 




 

CRRT/ PRISMAFLEX®

CRRT/ PRISMAFLEX®
 UPDATES November 2006

Using Prismaflex® on a new patient:

We all know about plugging the machine and allowing it to equilibrate with the room temperature for at least 20 minutes before installing a new filter and begin the priming process.  The NEW recommendation is to plug and turn the machine on and leave it for 20 minutes.   Before installing and priming a new filter, ensure that the scales have been calibrated.

Scale Calibrations:

Yes, it is still BioMed's responsibility to do the regular calibrations of all the Prismaflex® in the unit.  Our responsibility is to ensure that the scales have been calibrated recently.  
How to check:
1.  After the machine has been turned on and performed its own self-test, the first screen you will see has the therapy information.  
2.  Press on the date, which is located on the right upper screen for about 15 seconds.  
3.  The next screen will be information about the pumps and scales.  Under the scale section (lower box), look at the last column that has a heading of "PRT GR".  Under this heading will be a number.  Each number listed on this column should be less than 20, which indicates that the scales have been calibrated.  Press exit and proceed with the installation of a new filter.  
However, if you see a number 20 on this column then it means that the affected scale has not been calibrated and the machine can't be use at this time; Call biomed and asked him/her to come up and calibrate your machine.

"Time to change the Filter" reminder alarm: (It is a yellow warning light by the way)

I always thought that a filter has a 72-hour life span (unless of course if it was cut short by that dreaded clot!) and that the machine will give an advisory/reminder alarm when the filter is approaching that 72-hour time limit.  
About three weeks ago, I had a patient who was on high flow CVVHDF with a blood flow of 300 mL/min.  After 48 hours of run time, the yellow light came on and indicated that it was time to change the filter.  Surprise!
After consulting with Lisa Magee, Gambro Clinical Specialist, I found out that the machine has two ways of keeping track of the filter life span (as set by Health Canada for filter safety regulations).  One is the 72 hours time limit (that we are all aware of).  The other is the amount of blood processed by the filter which has a limit of 780 litres.  It is in the Operators Manual 2.0xx Page 185 for those of you who want to read more about this.  Most filters currently in use in the unit would probably fall into the 72 hour time limit but if you have a patient on high flow CVVHDF with a high blood flow rates (like 300 ml/min), then expect to change the filter sooner than what you are accustomed to.  Please refer to the "Advisory Set change" poster for instruction on how to get this information from the Prismaflex.  I have also attached copies of these in the teal information binder used with CRRT.  Just a reminder, when it is "time to change the set", it is NOT an URGENT procedure.  I believe you have a leeway of 8 hours or so.  Plan your day (or night) and put it on top of your priority list.

Pre filter replacement vs. Post filter replacement:   

We were all told that North Americans give replacement solutions pre filter (and in fact all our machines are defaulted to pre) and the Europeans give theirs post filter.  Apparently, there are centres in Canada that are now giving their replacement solution post filter!  It may be coming to a filter near you.  In fact, VGH in January 2007 will start using the Prismaflex® and may be using a combination of both.  Nancy F. are you reading this?!

Inconsistent (and sometimes wacky) filter Ionized Calcium results:

Most of you have probably experienced this and I commend you for sending another sample before acting up on a result that you have just received.
It is currently under investigation and we need to collect more data from other hospitals and compare our current practice with theirs. Therefore, expect a change of practice in regards to the blood sampling of Ionized Calcium in the near future.


Hemodialysis Insertion Trays:

In case you are asked during a hemodialysis catheter insertion for a longer guidewire (because the one that came with the Niagara catheter kit got bent and became unusable etc. etc.) the insertion trays should come with an extra 68 cm individually packaged guide wires (the 60 cm ones is too short).  However, if it is not there, the unit keeps a stock of this guide wires and they are located in the hemodynamic red carts (and in the supplies room).  I have asked CSD (or SPD) to add the 68 cm guide wire in the Insertion trays.  





Labeling the Dialysis and Replacement Bags:

Continue with the current practice of using the red medication stickers to indicate what medication was added into the bag, and whether the bicarbonate has been added or discarded.  Distinguishing which is the dialysis and replacement bag is also encouraged.  However the practice of writing on the bag with a felt marker is not recommended (and discouraged) as the ink may leach into the solution.  Also, please don't forget to date and time the solutions were prepared.


Level II Prismaflex advanced troubleshooting Class:

I have spoken with Lisa Magee about this and she's thinking of offering this course sometime in April/May of 2007.  I highly recommend this course to all CRRT nurses.  You will receive plenty of notice when a final date has been set.




STUFF in the works:

I have just recently finished revising the following and awaiting the Physicians approval:

Calcium Infusion Nomogram  (what is new:  a bolus reminder which is part of the new orders and a bolus option in the actual nomogram for systemic I Ca++ of less than 0.90 mmol/l)


New CRRT orders for Citrate Anticoagulation  (what is new:  therapeutic dose calculation for the doctors, goal MAP and what to do should the MAP is less than goal on start up and during CRRT, a bolus order of Calcium Chloride if baseline systemic I Ca++ is less than or equal to 0.90 mmol/l)

I am currently working on revising the "CRRT preprinted orders for no anticoagulation and/or heparin anticoagulation".  I am hoping to get rid of the heparin filter nomogram altogether and convince the doctors for high flow hemofiltration with no anticoagulation.  Nancy F. I may need your help with this one.

And finally, CSICU will go live with their Prismaflex® on the first week of December (and yes they will be using CITRATE ANTICOAGULATION as well!)  GOOD LUCK to them!! For the super users in the unit (and me), expect phone calls for assistance.

That is all for now.  I apologize for this lengthy update.
If you have flex-related questions and any suggestions as to how I can support you especially the newly trained CRRT nurses, please let me know.

Thanks for your time,



Ron Bernardo
Temporary CRRT Educator







    
 

World's Aids Day

aids.jpg

Informed Consent:


Informed Consent:

Users are no longer required to fax Transfusion Medicine to inform them that consent has been obtained; you now have the ability to change the status in previously submitted orders through SCM.

MODIFICATION EFFECTIVE NOVEMBER 22nd, 2006


Highlight patient that requires consent updated & then Select the Orders Tab:

 

Scroll down & highlight the TM order that requires consent status updated:

 

Right click over order and Select ‘Modify Order' and then ‘Requested by Me'

 

Update the Consent Status field with the correct consent and then select OK:

 

Note: Users will be unable to change the consent field on orders entered before November 22nd (The changes are day forward).

 

 


Consent status For All blood product orders

MODIFICATIONS EFFECTIVE NOVEMBER 22nd, 2006

Consent forms will remain available from the Chartpacks

 


MODIFICATIONS MADE TO BLOOD PRODUCT
ORDERS REGARDING INFORMED CONSENT:

 

Consent is Mandatory: The button to the right gives the user a direct link to the Transfusion Medicine Website at the time of order entry, where Policies and Manuals can be viewed.

 

Consent Status: Is a mandatory fieldand one of the four consents must be selected: Informed Consent Present, No Consent, Emergency Consent or Refused (no change made).


Print Consent Form: Depending upon which consent status is selected, the appropriate consent form will print if the check box is checked. E.g. If informed consent is selected and the check box is checked, then the informed consent form will automatically print.

NOTE: The Refusal Consent form cannot be automatically printed upon order submission, pleas access it through SoftMed/Chartpacks.

 

For Questions or Concerns, Please Page The SCM Support Pager (54188)