New nursing practices are transforming bedside care at Catholic Medical Center.
With each patient's medical records now stored and available electronically, CMC's nursing clinical documentation system incorporates evidence-based guidelines into the diagnosis and care of patients. When a patient is admitted to the hospital, the medical staff selects an evidence-based guideline based on the patient's diagnosis or diagnoses.
"This provides our nursing staff with a 'road map' or guideline for care" explains Elizabeth Hale Campoli, RN. "We treat each patient as an individual, but it is always best practice to have evidence-based guidelines to assist us with care and decision-making for our patients."
New technology is also assisting nurses in making good patient care decisions at the bedside. At CMC, nurses have been using a smart pump to ensure the delivery of accurate doses of prescribed medications.
Each smart pump is pre-configured with medications most frequently prescribed for patients and within dosing parameters determined by the pharmacy and therapeutics committee. Depending on the dosage amount selected by the nurse, the smart pump delivers the medication or provides a soft stop or hard stop caution. For example, if a physician ordered morphine at 4 milligrams an hour for a patient, but a nurse enters in 400 milligrams an hour, the smart pump delivers a hard stop and will not allow that level of dosing.
"With a soft stop, the smart pump asks me to recheck the order and review my patient's diagnosis to ensure that I do want to administer a dosage that is a little higher than normal" says Hale Campoli. "We require the nurse in this situation to have another nurse confirm the dosage and enter this into the machine. This is an excellent tool for ensuring patient safety."
The smart pump also allows patient profiles to be built into the system, so medications can be organized into groupings frequently used by specific patient populations. With CMC's recent association with the Norris Cotton Cancer Center, the hospital is treating an increased number of oncology patients and is developing an oncology-specific profile. When a nurse chooses the smart pump's oncology profile, only medications specific to this group of patients will be listed, reducing the potential for error in selecting the wrong medication. CMC smart pumps also include a neonatal profile and a profile for high risk, lower volume patient populations.
Recognizing the critical importance of safe medication delivery, CMC is completing a medication quiet zone pilot program in the hospital's ICU and one of its medical surgical units. When nurses are in the posted medication quiet zone, they are not to be disturbed or interrupted unless one of their patients is in need of immediate care.
"We recognize that medication preparation and delivery is a sacred task that a nurse is performing and should not be interrupted" adds Hale Campoli. "Nurses have said they feel much safer in their medication preparation process in the medication quiet zone, and patients receive their medications more quickly:' The program will soon be rolled out hospital-wide.
Changes in point-of-care glucose testing are also transforming patient care. Because insulin is considered one of the five highest risk medications in the inpatient setting, and glucose results from bedside testing would often be used to adjust insulin dosing, test limitations need to be eliminated to deliver the highest level of patient safety with the latest technologies.
CMC is completing a pilot program that includes a new glucose meter that will provide greater sensitivity of testing, reduction in risk of infection and elimination of interference by medications based on maltose, a type of sugar. The new meter connects electronically to CMC's laboratory information system, so patients' results are transmitted quickly and accurately to their medical record.
"By using this new meter we will be improving patient safety, testing sensitivity and information access" notes Roberta Provencal, a medical technologist in CMC's lab.
For more information on these new nursing practices, contact ASK-A-NURSE at 603-626-2626.