June 9, 2009
OUTPATIENT TESTING CENTER—KETTERING IS MOVING: We are excited to announce
that Dayton Children’s Outpatient Testing Center—Kettering will be moving
to 4475 Far Hills Avenue, one mile north of its current location, and will
open on Wednesday, July 8, 2009. The last day of business in the current
location at Lamplighter Square will be Friday, July 3, 2009. The phone
number to the new center will be 937-641-5760. Your physician liaison will
be delivering maps and information on opening events for the new location
over the next several weeks. For more information on Dayton Children’s
Outpatient Testing Centers, contact Melanie Wilson, director of community
testing services, at 937-641-5701.
HEPARIN AND IV CATHETERS IN THE WORLD OF EPIC: As we have become more
involved with EPIC, we have found ourselves rethinking many of the
processes that we have used in the past to provide care. Humans are often
able to create work that computers will not accept. Recently we learned
that as clinicians we were occasionally writing an order for “hep-lock IV”
or for “central catheter care as needed.” In both cases, these orders
required that we access medications from the Pyxis System. EPIC, however,
won’t let you access medications without a medication order. So, we have
developed a plan.
In the future, we need you to write very specific orders whenever you are
discontinuing an IV, hep-locking an IV or ordering heparin for maintenance
of PICCs or central catheters (regardless of type). Please select
whichever of the following orders is most accurate and specific:
• Discontinue current IV fluids and discontinue IV (this will result in
the IV fluids being discontinued and the IV being removed)
• Discontinue current IV fluids and hep-lock IV (this results in the IV
fluids being discontinued and the line being flushed with heparin)
• Heparinize vascular catheter per protocol (results in protocol driven
flushes with heparin)
The orders must be written this way because in EPIC, you need an order to
discontinue IV fluids or the IV fluid order remains active in the system.
So first, you have to discontinue the IV fluids and then you either
discontinue the IV (will remove the IV from the lines/drains/airway flow
chart in clinical documentation) or hep-lock the IV.
The nurses will then implement the protocol to assure that the correct
amount and concentration of heparin is used. If the appropriate order is
not received, the nurses will contact you for either a written or verbal
order with read-back. The latter will then require authentication within
48 hours. Also, keep in mind that when you order a PICC line, topical
numbing creams, lidocaine and sedation must be ordered separately. Please
use the PICC standing orders (NUT 9057) or the CF Standing Orders (NUR
0027) when appropriate. If you have any questions, call Karen
Rittenhouse, RN, MS, in IV therapy at 937-641-8250 extension 8250.
This change is effective on June 15, 2009.
H1N1 UPDATE: Cases of infection due to H1N1 continue to surface across
the country but at a conservative rate. Significant community spread of
cases has not yet occurred—at least for Dayton. The end of the school
year will certainly have an effect in limiting the spread of this virus,
at least for the summer months. We are triaging in the emergency
department based upon the CDC definitions, and trying to isolate any
possible cases to minimize exposure in the emergency department area. We
will keep you posted.
EPIC UPDATE: Formal training for the use of EPIC on the floors will begin
in early July. The training will be driven by actual needs of the
provider groups. For example, a physician who provides occasional
consults will be offered less training than one of the inpatient
generalists. We are working on a menu of training options. You will each
have to decide exactly what you want/need to be able to do on the floors.
Stay tuned. Questions? Call Tom Murphy, MD, at 937-641-5871.
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