Asthma Day Camp
July 27 to 31
9:00 a.m. to 3:00 p.m.
Monterey Park School
For info, call Respiratory Care, 755-0782.
City of Salinas National Night Out
3:00 to 8:00 p.m.
Labor of Love
3:30 to 7:30 p.m.
Legs For Life
September 16 and 17
4:00 to 8:30 p.m.
DRC Rooms A, B and C
American Heart Association Heart Walk
8:00 a.m. to 12:00 p.m.
Mazda Raceway Laguna Seca
Unless noted, call Health Promotion at 759-1890 for more information.
The Faces of eMAR-BMV
As we all know, planning, preparing, training and transitioning to the eMAR-BMV was an immense project—one of the most comprehensive and significant changes ever to impact nursing at SVMHS. The two-year project was an interdisciplinary initiative to enhance the safety of patient medication administration by adopting advanced technologies. It was an effort where the nursing discipline tapped into their professionalism, dedication, skill and ingenuity to make the transformation a success. And it was a shinning example of what can be accomplished through collaboration—between staff nurses and nursing administrators, among nurses throughout SVMHS, and with several key departments including Information Technology (IT), Engineering and Pharmacy.
“So many of our nurses took on leadership roles by serving on committees and participating in the many steps that culminated in the launch of eMAR-BMV in May,” says Lisa Paulo, RN, MSN-MPA, Senior Administrative Director, Patient Care Services. “A key to the success of these efforts was empowering nurses to identify issues and create solutions. Lilia Meraz-Gottfried, RN, MSN, staff nurse in ICU/CCU played a major role as the eMAR-BMV nurse project leader since May 2008. In September 2008, Maria Elena ‘Emmy’ Ferber, RN III, Float Pool, joined the eMAR-BMV project and began a comprehensive introduction of Work Stations on Wheels (WOWs) and C5 Tablets to all units.”
One issue that Lilia and bedside nurses on the CIDR team brought forward to nursing administrators was the need to add staff nurses on units during the two-week training and transition process. “They wanted to ensure that staff nurses could focus on learning and yet know that their patients were getting the best of care,” adds Lisa. “The nurses appreciated that they were empowered to arrange for additional staff and resources to make the process manageable for each unit.”
The Respiratory Therapy (RT) Department’s staff of 40 also underwent extensive training to use the C5 Tablets and the WOWs for administering respiratory medications. “We’ve been charting with PDAs for a while, but the MAR was on paper,” says Elvie Hall, RRT. “Because we see patients on all units, having the eMAR-BMV available makes it much more efficient and safe for our patients. The new process minimizes the likelihood for human error. The learning was a dynamic process and Emmy Ferber, RN, our designated educator, was very helpful and willing to accommodate any adjustments we needed. Overall, it’s a great new tool for improving safety for our patients.”
The successful launch of eMAR-BMV would not have been possible without the collaboration and skill of the IT, Pharmacy and Engineering Departments. While there are so many people in these departments who worked diligently to make this happen, there are three that we’d like to recognize in this issue of SVMHS Nurse—Michael Casillas, Pharmacy Medication Distribution Supervisor, Aaron Burnsides, System Administrator, IT, and Brent Kemp, Assistant Chief Engineer.
Michael was the liaison between Pharmacy and nursing. He joined the eMAR-BMV team last October and attended specialized training at Meditech in Boston. One of his typical duties is to manage the PYXIS machines on the nursing units. “Michael helped us optimize use of the PYXIS,” says Lilia. “During training and testing, he suggested a variety of ways to improve processes and pointed out several features that enhance patient safety. On the PYXIS screen, we can view medications by certain time periods or, using the MY PATIENT feature, we can see meds only for the patients under our care. The PCCs who trained nurses on the units said that nurses found these features to be especially helpful.”
“Aaron, part of the core eMAR-BMV group, was our link to the IT world,” says Emmy. “eMAR-BMV increased our reliance on technology so there was a lot to learn and he made it a smooth process.” Aaron has worked on eMAR-BMV since December 2008. He worked with IT staff and vendors to ensure that the C5 Tablets and WOWs would work well in our environment. “His role was huge and increased beyond the devices to looking at the whole infrastructure,” Emmy says. “It was a wonderful collaboration.” When there were issues, often, Aaron and Emmy went to the unit to show solidarity between nursing and IT and did trouble shooting on the spot. They became the face of the WOWs and motions C5 tablets.
Brent joined the project team in October and was instrumental in creating the Medication Sanctuary areas. On Level II, he and his team removed the old charting counters and medication drawers and crafted an alcove where the WOWs could be used and recharged, and modified patient rooms in ICU to accommodate the WOWs. “What was so phenomenal is that he and others in Engineering were involved in the seismic-retrofit/construction projects during that period and yet they made time to make these important changes happen for nursing,” says Lilia. Nurses identified what was needed and he assisted with cabinet design and had them built for the Sanctuaries and suggested ways to improve efficiency. “Brent worked collaboratively with nursing every step of the way to ensure the best outcomes."
Providing patients with the right medications, at the right time and in the correct dose is essential to patient safety and a key element of a nurse’s professional practice. The eMAR-BMV, implemented at SVMHS in May, gives nurses a new set of tools to help ensure safe medication administration. Some of the many patient safety features resulting from the two-year eMAR-BMV project include bar coding, display of lab values for nursing and dedicated medication areas called Medication Sanctuaries.
Bar Coding—Stripes for Safety
The cornerstone of the medication safety aspects of eMAR-BMV is the ability to scan bar coding on medications,” says Terry Pettitt, Pharm D, Senior Pharmacy Specialist at SVMHS. “Scanning both the medications and the patient’s ID band provides an automated double check that helps prevent medications from being administered incorrectly.” The system alerts the nurse if there are any discrepancies so he or she can investigate further. “This has made a real difference in my nursing practice,” says Nancy Groebli, RN III, BSN on MSCV3. “I scan the bar code on the patient’s ID band using the WOW and it pulls up the patient’s profile with orders already reviewed by the Pharmacy. If there’s an issue of any kind, the system alerts me to it so I can check into it until I’m sure that everything is correct. It adds an extra measure of safety for our patients.”
Medication Sanctuary—A safe haven for medication administration
A special area—called a Medication Sanctuary (MS)—strategically located on each floor, is just one example of nurse-led initiatives to improve patient safety. Everything needed for medication administration was relocated to the Medication Sanctuary including the PYXIS automatic dispensing machine, refrigerators, locking medication cabinets and related supplies. “Work flow is smoother because we have everything at our fingertips,” says Cristine Torres, RN II, PCC, MSCV3. “This gives me more time to spend with my patients. I think it has been very well received by nurses on our unit and throughout SVMHS.”
Lab value display enhances patient safety
eMAR-BMV includes a feature that allows the nurse to view specific lab values associated with certain medications such as anticoagulants, diuretics and insulin. When the medication or IV bag is scanned, the nurse sees a pop-up that displays previous and current lab values including the appropriate value range. Any values that are out of range are shown in red. “When I’m administering a diuretic, for example, the patient’s potassium level shows on the screen,” says Rosangel Carmona, RN, ONS. “If it’s low, this is an alert to me from the system to investigate further. There was a lot to learn with the eMAR-BMV, but the benefits to patient safety go way beyond any challenges we’ve had.”
The success of the eMAR-BMV training, roll-out and acceptance is largely due to the involvement of staff nurses throughout the process. The power of the nursing profession truly shined as staff nurses drew on their experience and skill to help their peers learn to use this important patient safety technology. Thank you to all of our nurses who dedicated themselves to this project as teachers, unit super-users and roll-out super-users. In this issue of SVMHS Nurse, we highlight two from the Float Pool—Kim Stewart, RN, andAmanda Dziurda, RN, BSN.
Amanda, a nurse in the Float Pool for three years, was an evening roll-out super-user (RSU). The role of RSUs was to help staff nurses take the information they learned in class and apply it in a patient care setting. “We also helped trouble shoot issues that came up and were available as a resource to nurses on each unit as the eMAR-BMV went live,” says Amanda. They worked closely with unit super-users (USU) for the first week of the roll-out so the USUs could assist nurses on the unit after the RSU had moved on to the next department. “I planned to be a teacher before choosing nursing,” Amanda says. “So it was great to be able to combine my love of nursing and teaching. It was exciting to serve on units that I don’t typically work on and meet so many nurses. It gave me a new appreciation and a view of the big picture of nursing at SVMHS. The eMAR-BMV is a great benefit to the practice of nursing by allowing us to spend more time at the bedside with patients.”
A nurse in the Float Pool at SVMHS since 1997, Kim joined the core team of staff nurse teachers on March 1. “It was a very pleasant, yet unexpected surprise to be considered for such an awesome project,” says Kim. After serving as a teacher in the classes, she was a RSU throughout the hospital. “I enjoyed being part of an extraordinary team of people who are so passionate about their patients and their profession. This was such a huge project and many nurses went into it with some anxiety. But with each roll-out, the feedback was ‘it’s not as bad as I thought it would be.’” The teaching was very hands-on, using scenarios of different issues that might come up when administering medications using the new system. “When it came time to go live, nurses were well prepared and confident. It was rewarding to be able to be a knowledgeable resource for other nurses at SVMHS.”
Nurses working the night shift on MSCV3 came up with an idea to help a.m. shift nurses. Because there is typically more patient care activity during the morning hours than at night, these nurses now prepare all the medications that a.m. nurses need for their patients. “They work with the Pharmacy so that when the nurses come in the next morning, all the medications for their patients are ready to go,” says Molly McCarty, RN III, BSN, Float Pool, who experienced this benefit firsthand. “It’s a tremendous help and really shows the dedication of our nursing staff to excellence in patient care.”
Q:How has serving on a committee impacted your nursing practice?
A:In referring to the policy and procedure binder for ICU/CCU, I found a number of items that were no longer applicable. Iíve worked on ICU/CCU for 23 years and thought I could make the biggest difference by serving on our unitís policy and procedure committee. That led to joining the Critical Care Nursing Policy and Procedure Committee in 2000. I really enjoyed having input into the process of converting to an electronic system that was easy to search and to keep up-to-date. Serving on these committees involves a lot of research into evidence based practices as well as collaborating with our clinical partners. Itís a great opportunity to improve my nursing practice as well as be a leader, presenter, mentor and teacher. It helps me look into my own practice and set standards for improving patient safety and quality of care. —Mercedes Labindalaua, RN, BSN, CCRN, ICU/CCU
A: My first committee experience at SVMHS was serving on the Care Model Committee. Later I joined my unitís Policy and Procedure Committee and now I am on the SVMHS Nursing Policy and Procedure Committee. Agnes Lalata and I worked together on the Care Model Committee and she mentioned the Magnet Steering Committee. It sounded interesting to me so I interviewed and was accepted as a Magnet Committee member in 2007. I feel supported in doing extra projects for SVMHS and the single committee day makes participation feasible. Attending the Maria OíRourke Professional Role-Based Nursing classes and serving on various committees reinforce my viewpoint that we are creating an environment at SVMHS that values nurses, gets nurses excited about their practice and improves patient care. I am currently working on my MSN at CSU, Dominguez Hills and would love to implement studies and research to contribute to continued change and improvement at SVMHS. —Michelle Savala RN, BSN, CLC, Mother/Baby
A: I never thought about being on a committee until my director Tanya Osborne McKenzie invited me to attend a Magnet Conference and join CIDR. My former AHN Janis Magers also encouraged me and pointed out that attending conferences and serving on committees are part of professional development. Before going to the Magnet Conference, Iíd thought that conferences and committees were for nursing administrators, but now know that bedside nurses play a key role. At SVMHS, nurse administrators make it clear that they value staff nurses and our input. Itís been a great learning experience and gives me more confidence that as a bedside nurse, I can contribute in my own little way to the best patient care and safety. I am excited about coming to work every day and really enjoy my practice of nursing in this environment. —Mabel Tomimbang, RN, BSN, Ortho/Neuro/Spine