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Important message from Dr Joseph Seaman - Chief of Staff

 

Fall 2019 Edition

Download Print Version Here

I. Construction

a. ) Waldemere Tower Entrance to 2nd Floor
Waldemere Tower Staff Entrance Moving from 3rd to 2nd Floor Beginning Monday, 10/7/19:
Due to Oncology Tower Construction: 

  • The SMH ID Badge-access door on the 3rd floor of Waldemere Tower, across from the "A" elevators, will be closed.
  • The new badge-access door will open on the 2nd floor of Waldemere Towr across from the "A" elevators. 
  • Staff walking from the Waldemere Medical Plaza or the attached parking garages can enter the hospital by taking the 3rd floor "A" elevator or the garage stairwell (stairwell #21) to the 2nd floor, and then use their SMH badge to access the new entrance. Staff also can continue to use the public entrance on the first floor. 
  • Staff can access floors in Waldemere Tower via the interior, badge-access stairwell near the "A" elevators (stairwell #19).
  • The "A" elevators and stairwells in the Waldemere Garage and Waldemere Tower will remain open. 


Physician Parking and Kiosk Also to Move from 3rd to 2nd Floor: 

  • SMH physician parking will move from the 3rd to 2nd floor of Waldemere Garage on Monday, 10/7.
  • The physician kiosk will move to the 2nd floor of Waldemere Tower, near the new badge-access entrance, on Saturday, 10/5. 


We apologize for the inconvenience and thank you for your understanding as we expand and upgrade our facilities. 

b.) New Medical Care Unit on 3NW
Sarasota Memoria's Safe Work Environment Committee has implemented a number of initiatives (de-escalation training, patient protocals, BHIT team, etc.) to enhance patient, staff and physician safety.

In conjunction with these initiatives, Sarsota Memorial is opening a new dedicated nursing unit, the Medical Care Unit (MCU), on 3NW on Oct. 28, with 15 private rooms and a medical model to better supportthe needs of patients who may be at a higher risk for disruptive incidents. Attending physicians will be notified if their patient meets the criteria for placement on the MCU. 

NOTE TO PCPs: While your patient is on the MCU/3NW, the dedicated MCU physician team - including Parlane Reid, MD, Frank Burns, MD, and John Moritz, MD , along with Advanced Practice Professionals - will be Captian of the Ship and update you daily. When the patient is ready to leave the MCU, you will be contacted to resume care. 

Look for more information about the new unit in the coming days. 

II. New Product/Feature/Upgrades

a.) Physician Kiosk, upgrade (new look)
If you require immediate assistance, please call x5667 for real time help between the hours of 6 am and midnight. If it is outisde these hours, please call x6107 and someone from Clinical Systems will get back to you between 6 am and midnight.


b.) Dragon + SSO
Dragon with SCM/Allscripts - now easily works with a Single Sign On Computer (click here for login example) (click here for default device example)

c.) Product Change
SMH has begun replacing the Biopatch with the 3M CHG Gel Pad Dressing. 
The 3M CHG Dressing Replaces the use of the Biopatch with: 

  • CVCs, PICCs, Midlines, Dialysis Catheters, and Ports accessed with a Huber needle
  • The link provides training information about how to apply/remove the new dressing.
     

III. Education:

a.) Cloning in the EMR
Beware of Cloning aka Copy & Pasting within the Electronic Medical Record
EMRs make many aspects of bedside clincal care easier. Copying and pasting from day to day can be associated with misleading or incorrect information being documented. Cloning previously recorded information from a prior note into a new note is a problem in healthcare institutions that is not broadly addressed. 

  • The medical record must contain documentation showing the differences and the needs of the patient for each visit or encounter. 
  • Simply changing the date on the EHR without reflecting what occurred during the actual visit is not acceptable. 
  • The U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG) indicated that due to the growing problem of cloning, its staff would be paying close attention to EHR cloning. 


Here is a link to CMS for more information regarding the Electronic Health Record: Click Here

b.) Conditional Orders
Educational reminder that writing conditional orders, especially for medications, is not recommended and can be problematic creating a patient safety risk. The following is an example of conditional medications ordered that a patient never received. 

SITUATION:
"Aspirin 81mg daily if CT scan is stable"
"Enoxaparin 40mg injected subq every 4 hours if CT scan is stable"


These medications are written as a conditional order and were never administered to the patient who subsequently developed a DVT and bilateral pulmonary PEs. The wording of this order, "if CT scan is stable then..." was a primary factor for these medications not being given. Nurses do not determine if a CT is stable and thus would be waiting for the physician or APP to communicate this interpretation before releasing the medications to pharmacy. Fortunately, after being started on anticoagulants, the DVT/PEs resolved and the patient was stable at discharge. 

BACKGROUND: 
Conditional medication orders are usually part of an order set and include specific parameters with time limitations. This screenshot (click here) is an example of a well written conditional order. 

Conditional orders are needed in some instances and are essential with laboratory and other diagnostic test orders. Medication conditional orders can pose a unique scenario. If used inappropriately they have the potential to cause harm, either from not being activated (releaseed to Pharmacy) when the condition is met or from being activated well after the intended time period when the medication no longer fits the current clinical scenario of the patient. Other factors that contrubuted to this patient not receiving these medications are listed below.

ASSESSMENT: 

  1. It is outside the scope of nursing practice for nurses to interpret radiology results. 
  2. Medications written as a conditional order are not releasesed to pharmacy and thus there is no ability for pharmacy to recognize if a medication is not part of the patient's current medication list.
  3. A commonly used EMR filter blocks out any conditional medications that are waiting to be released to Pharmacy. Therefore, nurses and other members of the care team did not see these conditional medications ordered so were unaware the medications were not being administered.
  4. Physicians and APPs do not always view the Electronic Medication Administration Record (EMAR) document in the EMR. The EMAR document is used by nurses to document what medications are being administered to a patient and is the most accurate source of what medications the patient has taken. 


c.) Restraint Attestation: 
Both CMS Rules and Regulations regard restraint education as a high priority. Joint Commission surveys assess hospital compliance. Education for SMHCS physicians and advanced practice professionals regaring "Restraint and Seclusion" is required. Additional education is required for all staff applying restraints and monitoring. Restraint education will be assigned to all credentialed practitioners via Healthstream with an attestation of understanding. 

d.) Telephone/Voalte and Verbal Orders: 
A reminder to all members that orders submitted via test message, Voatle or email will not be accepted. Reference Telephone and Verbal Orders- Receiving and Documentation PAT.32 Sarasota Memorial Health Care System Corporate Policy. 

IV. Medical Staff Dues Assessment

Medical Staff Dues Assessment to replace Medical Staff Reappointment and CME fees
All Credentialed staff (All categories including Advanced Practice Professionals) will be assessed $150.00 annually beginning January 2020. Reference Medical Staff Bylaws dated February 2019.

The Medical Executive Committee recommended that the funds be desginated as such: $100 Medical Staff (Leadership Development and towards Credentialing and Peer Review Technology enhancements) and $50 Continuing Medical Education. Emails with invoicing instructions will be sent from Medical Staff Services in January 2020. Dues will be payable on or before April 15, 2020. 

Thank you all for protecting our patients and team members

Joseph Seaman, MD
Chief of Staff