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Flash FAX

June 9, 2009
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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