Clinical Staffing Resource Center

Quarterly Staff Meeting August 2013

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Power Point Presentation

Staff Meeting Minutes

Quarterly Staff Meeting

August 2013

Welcome and Introduction

• Meet and greet • Team introduction

Educational Updates

• Cerner Lab Conversion – Go live September 14th – Associated 2 hour downtime in HED when

this is implemented

Diagnostic Laboratory Changes

Simultaneous implementation of two projects:

Cerner Laboratory Information System (LIS) will replace the current GE (LIS)

Abbott Diagnostics automated chemistry

line will replace the current Beckman instruments

Benefits of Conversion

• Improved specimen tracking • Direct order interface with HEO and VOOM • Accurate record of ordering providers • Addresses ICD10 requirements • Improved Chemistry turn around time • Reduced downtime • Decreased manual processing • Improved electronic reporting to State and other

regulatory agencies • Smaller sample amount required

Date of Conversion September 14 from 10am-12pm

• Routinely lab test needed by noon should be ordered and performed by the 10am downtime when possible

• We will need to follow downtime procedures for all orders during this two hour window

• The lab will remain operational and test results sent to StarPanel

• Any pre-existing repeating lab orders will be discontinued in HEO/wiz and VOOM and will need to be reentered

• On Site Support from Systems Support (inpatient areas) and Operations Systems Engineers for (outpatient areas)

Changes for Point of Care Blood Glucose GEM & Hemoglobin A1C Testing

Please have the nursing staff Scan the Account number not the MR number

Reference Range Changes

Some Chemistry reference ranges will change as a result of new instrumentation and test methods. The new reference ranges will be reported with each test in StarPanel beginning September 14th and will also be available in www.lab.vu.com. Pediatric reference ranges will be more extensive.

Future Related Lab Projects

• Glucometer replacement • Lab ready labels on inpatient areas

Educational Updates

• Problem List-

On Tue., Sept. 9th, staff in VUH will see a new CARE PLAN Tab that should better guide the process from assessment to problem identification to prioritization to plan of care based on our new Nursing Documentation framework and Saba Care Categories. Some Care Categories will match existing Body Systems or other categories you already use (eg. Cardiac, Renal, Skin). Other categories will be new but will fill significant gaps in our current assessment options (eg. Coping, Role Relationships). The cross-walk below shows relationships of new categories to current ones on Assessments/Interventions tab.

Care Plan Tab CARDIAC GI NEURO/COGNITIVE RESPIRATORY RENAL/UR SKIN INTEGRITY SAFETY RISK Activity Fluid Life cycle Medication Metabolic Nutrition Physical Reg Self Care Sensory Tissue Perfusion Health Behavior Role Relationship Coping Self Concept

PEDS Assmnt Tab CARDIOVASCULAR GASTROINTESTINAL NEURO PEDS PULMONARY RENAL/URINARY SKIN FALLS RISK/SAFETY Musculoskeletal NA NA NA NA NutR by Nursing NA Act Daily Living NA NA NA NA NA NA

Care Categories in ALL CAPS must be assessed each shift and with change in Caregiver or Pt. Condition

The new PLAN Tab looks like this with Plan of Care section at the top, Problem Assessment in the middle, and …

Care Categories in Mixed Case are assessed on admission and as indicated by patient condition

… Priority Problems at the bottom. Note that UPPER CASE Font still indicates categories to be assessed every shift while Mixed Case categories are assessed when warranted by patient condition/family situation.

Behavioral categories include options to address Role Relationship issues (eg. Caregiver Strain, Ineffective Parenting) and Coping issues (eg. Family, Coping, Grieving, Dying Process)

Problem options when Care Category is not WNL

1. “Standard Met” is replaced with WNL (aka Within Normal Limits) at the top of each Problem Assessment Dropdown.

2. WNL reflects absence of a “problem” in the list

3. When the Care Category is NOT WNL, select a Problem that best describes the variance from “normal”. 4. Once you have identified all Problems, you would then determine which 2-4 are Priority Problems for your

shift and would document those as usual, including identifying a Short Term Goal for your shift.

Problem Definitions are available for reference under Links at top of HED and Care Organizer screens. An example of the definitions for Activity Problems is shown above. Note that more generic Activity Problems are shown in Bold Face while more specific problems are shown in regular font. Use more specific problems when possible.

Educational Updates

• LMS – Demo – Policy Updates and Educational Summaries – Mosby Updates

Educational Updates

• New Glucometer- October 29th • Advantages of this new meter include: • Requires smaller specimen sample • Immediate, wireless uploading of results to StarPanel • Cleaning materials do not degrade meter

• Staff training: all staff that perform blood glucose monitoring will need to attend one 60 minute hands-on training session in October. The schedule for these sessions is being finalized. Details and registration information will be forthcoming as soon as it is available. A variety of locations (including VUH, Children’s, VPH, and OHO) and times will be available. (Note: off-site clinics will be scheduled after the initial training sessions are completed). Training on the new system will create a Fall 2014 certification due date for all testers.

Educational Updates

• MRI Questionnaire

Educational Updates

• My Health at Vandy – Look up your medical records including OHC.

• https://www.myhealthatvanderbilt.com/my

health-portal/

My Health at Vandy

Enter “My Health at Vandy” in the Search Box

Click here

My Health at Vandy

Click here Click here

My Health at Vandy

Enter info to create an account

When you are at a clinic or OHC, ask to be given full access. You will be able to look at your records on line from any computer, any where. You will be able to see your immunization statue for OHC.

Educational Updates

• Nurse Alerts – Get email notices about continuing education, Nurse’s

week, Nurse wellness, Nursing News from Marilyn Dubree, and many other items.

• http://www.mc.vanderbilt.edu/root/vumc.php?site=vanderbilt-nursing&doc=40188

Nurse Alerts • On Main VUMC webpage, click on “Nursing”

Nurse Alerts

Click here

Scroll to the bottom of the page

Nurse Alerts 1. Click here

2. Click here

3. Fill in form and submit

Educational Updates

• Virtual Clinical Workstation – White board set up

Virtual Clinical Workstation

Setting up the Whiteboard

1. Click on Star browse icon 2. Click on “Customize”

• Click on “Preferences”

Virtual Clinical Workstation

Virtual Clinical Workstation

•Make sure the answer is “yes”

•Click on “PtLists” and “Inpt.wboard”

Virtual Clinical Workstation

•Click on “Dashboards”

•Click on “Inpt.Whiteboard”

•Click and drag “Inpt. Whiteboard” to “Favorites”

Virtual Clinical Workstation Inpatient Whiteboard

Select your unit Click “Select which beds to show”. Select your assigned patients

Education Updates

• VandySafe- Due 12/15/13

New Critical Care Classes

CC Technologies • Will be offered twice a year • No CEUs offered • Register in the LMS

November 5th & 6th November 5th & 6th 7:30am – 11:00am 12:00pm – 3:30 pm

CRRT Update Therapeutic Hypothermia

LIDCO Super User Training RotoProne Super User Training

Cardiac Pacemakers/ Implantable Devices

12 Lead Electrocardiography/ ST Segment Monitoring

Link to Information:

http://www.mc.vanderbilt.edu/root/vumc.php?site=nepd&doc=43702#CCRT

Expectations

• Compliance – Occupational Health and TB skin tests

• Credo • Floating

Medical Center Updates

• How did we get here? • Evolve to Excel (E2E)

Schedule Changes

• Meeting the Medical Center’s needs while continuing to offer flexibility.

• Data shows us:

Number Staff Needed per/day of week 10

month history VUH VMG VPH VCH Total

Number Staff Needed per/day of week 10

month history VUH VPH VCH Total Sunday

Dai

ly T

otal

s 20.19 0.00 0.03 1.52 24.62 Sunday

Nig

htly

Tot

als 15.80 0.08 0.29 19.73

Monday 29.74 34.54 0.03 0.70 66.84 Monday 19.52 0.00 0.81 23.09 Tuesday 30.62 35.69 0.03 0.76 68.95 Tuesday 18.19 0.05 0.71 21.44

Wednesday 29.61 34.78 0.03 0.82 68.18 Wednesday 17.98 0.07 0.49 20.98

Thursday 33.74 34.36 0.00 0.52 71.78 Thursday 18.05 0.00 0.41 21.29 Friday 35.21 33.79 0.02 0.89 72.02 Friday 18.05 0.04 0.68 30.19 Saturday 20.62 0.00 0.02 1.65 25.28 Saturday 18.57 0.02 0.18 20.46

Schedule Data

• More detailed data Jan-May 2013 • Adult Inpatient

Schedule Process

• Effective with the next open schedule window- September 29nd to October 6th

• There will be new Process Groups – Acute Care 7a-7p – Critical Care 7a-7p – Acute Care 7p-7a – Critical Care 7p-7a – Out-patient (non-benefited RN’s, LPN’s, and MA’s) – Pediatrics 7a-7p – Pediatrics 7p-7a

Schedule Process

• Using the collected data, there will be a limited amount of shifts per group and per shift.

• This will help us better meet the Medical Center’s needs

• Know your window opening time- 6am- delaying in signing up for your shifts may limit your available selection.

Closing

• Questions???

Minutes

Clinical Staffing Resource Center Q3 2013 Staff Meeting or Unit Meeting or Other DATE August 26, 27, 28 NEXT MEETING TBD Director: Lou Kaelin

Ast. Mgrs- Kellie Boucher, Dara Dixon Educ- Jennifer Anderson, Natalie Bishop

TIME Varied by day TIME Varies by day LOCATION VUH 7T3 Conference Room LOCATION Light Hall Attendees:

Meeting Record

Topic Presenter Content Next Steps Pillar (select which pillar(s)

represented) Welcome and Introduction

Lou Kaelin

Introduced CSRC team attending the meeting Meet and greet those around you.

People

Cerner Lab Upgrade Priority Problem List LMS

Jennifer Anderson

Cerner Lab upgrade: downtime planned for two hours on 9/14 on the go live date. This is hospital wide. You will now use the patient's account number rather than the MR number. There will be new lab ranges with the system please watch for these. (since meeting this project is now delayed- more to come) Priority Problems: Phase II- problem list. Starts 9/9 in VUH going to new priority problem tabs in HED. This transition has already occurred in VCH. Pick only 2-4 problems (less is more in this case) LMS: Use the Chrome browser when working in the LMS for the best performance. The CWS link will launch the LMS in Chrome. Jennifer tries to push out all of the policies to your to-do list, but you can also add these yourself. Make sure you complete the acknowledgment for the policy to show it is complete. You only need to review the policies that apply to your role. Green means good and blue means to-do, but you may find a lot of old assignments are showing in blue. They are working to clean up the system but it will take a while to complete. Don't go back

People

Minutes

Glucometer MRI Questionnaire My Health at Vandy Nurse Alerts Virtual Clinical Workstation VandySafe

Natalie Bishop

and do the very old work. Glucometer: New meter is coming 10/29. Training dates to be announced. If current glucose expires between 8/23 and 10/29, you will not renew, you will be extended until the new training is available. MRI Questionnaire: Some Pediatric staff are being asked to complete the Occupational Health questionnaire prior to taking a patient to MRI. You will have to sign off in MRI that you have completed the questionnaire and they will also give you some literature to complete your training. If you have implanted medal (screws, plates, hip, etc) you will not be able to take patients to MRI. My Health at Vandy: See power point on how to sign up for this important tool. After you have it fully activated, you can review your own clinical data and monitor if you have any Occupational Health requirements that may be due such as TB skin test. You can also message your physician. Nurse Alerts: See power point on how to sign up for Nurse Alerts. There are a variety of subjects to choose from and an excellent way to stay up to date on a variety of educational opportunities for continued learning. Virtual Clinical Workstation: See power point to understand how to set up preferences so that you can move from computer to computer and have your same patient information. VandySafe: Due 12/15. Please log into VandySafe and complete the required lessons. All of our staff are considered direct patient care. Only a few areas require glutaraldehyde for cleaning instruments and only trained

Minutes

Critical Care Technology Class

staff who work with radiation implants should complete the radiation training. New info on hazard communications this year. You cannot test out; you must complete the full lesson, video and test. If you have a question about what you need call an Jennifer or Natalie Critical Care Technology Classes: This was discussed at the staff meetings but unfortunately since the meeting we have been placed on hold at this time.

Expectations Dara Dixon Kellie Boucher

Compliance: Make sure you monitor all your compliance dates i.e. TB, POCT, N-95. You should not let things become past due. Please use your resources (emails, MyHealthatVandy, etc) to ensure you have reminders. Credo: Please continue to use your best Credo behaviors showing our positive attitudes and how we come across to others. Floating: Recently we were contacted by a unit about conversations from a few of our staff when they were asked about floating to specific units. These staff talked negatively about these units. While we know everyone has units they favor over others, we must support the units as they now are having staff float among their partner units. Please help make this a positive for all staff.

People

Medical Center News

Lou Kaelin How did we get here? In response to substantial revenue reductions from Medicaid and Medicare, federal cuts supporting research, sequestration and other federal legislation. The Medical Center stared cost reduction efforts over 18 months ago. This work must continue as we work to find budget savings of over $250 million over the next two years. We are not alone; every academic medical center across the country is having this same reality check. Vanderbilt is actually one of the top medical centers leading the work on how to reduce costs.

Minutes

Evolve to Excel (E2E): E2E is Vanderbilt’s strategic change initiative. This is a system-wide workflow re-engineering process which focuses on improving function and enhancing revenue in some areas while preserving the vast majority of our mission-critical programs. This includes a review of staffing ratios, education, leadership structure, along with many other components. The entire E3E implementation will take 9 to 12 months. System-wide operational improvement will be achieved through workforce realignment via several steps including: natural workforce attrition, offering early retirement for some MC staff, re-engineering workflow to reduce the need to fill vacated position, eliminating some occupied positions in administrative support as opposed to areas that would affect direct patient care. The Medical Center is undertaking these steps to further strengthen the organization. This will be a better place. To be successful, these efforts require the active engagement and energetic support of our entire Medical Center over the coming year.

Scheduling Changes**

Lou Kaelin See Power Point for data used. Scheduling Changes: With the next scheduling window that opens September 29th, we will have a new process that will place each staff member into a group based on their primary areas. i.e. Critical Care Days, Med/Surg Nights (step down staff will be grouped with Med/Surg), Outpatient, etc. There will be a limited amount of shifts available on each day based on the data collected over the last year on what the Medical Center's needs have been. This should make us better positioned to meet the MC's needs while still offering some flexibility for staff. It will be competitive so we do recommend that you are ready to schedule when the window opens at 6am. This should decrease cancellations by better matching the needs. You will schedule only to your plan initially in the first window. We will then open a second window for additional shifts where you can sign up for more shifts. You will still have the flexibility to call the day ahead to be added to the availability list for a shift.

Growth and Finance

Minutes

Approved: _____Lou Kaelin_____________________________________________________ ________9/11/13________________ Lou Kaelin MSN, RN, Director Date Clinical Staffing Resource Center