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To work with our partner physicians in the community to improve the health and welfare of the children we serve by enhancing their lifestyles when healthy and improving their outcomes when ill.
This is a big deal!!
Below I have copied a memo from Dr. Paul Hintze, vice president of medical affairs, regarding legibility of signatures. SJMMC and SJMCH are currently being audited by The Joint Commission because we were cited in a recent survey for lack of legible signatures in the chart. This is a patient safety issue. Please write legibly, print you name legibly next to your signature and remember to time, date and sign every order and note in the chart.
Memo from Dr. Hintze:
We need your help!
During the recent Joint Commission survey, SJMMC was cited for lack of signature legibility. We are now required to audit records and determine the percentage of illegible signatures. The Joint Commission minimum standard is 90 percent of legible signatures. If we are below 80 percent, we may lose accreditation!
Whenever you make a chart entry, please either leave a legible signature or print your name below your signature. Using an identifying stamp is also acceptable.
This is a patient safety issue. The Joint Commission is concerned because they know that unless the secretaries and nurses on the divisions know whom to contact when questions arise, miscommunications can occur leading to patient harm.
Also, we continue to struggle with timing of chart entries. Each entry must be dated, timed and signed with a legible signature.
Thanks for your help keeping our patients safe!
1. Go live dates:
- July 19, 2009 – St. John’s Mercy Hospital, Washington, Mo.
- Aug. 30, 2009 – SJMMC and SJMCH Phase One. This includes Computerized Physician Order Entry (CPOE), electronic medication reconciliation, Admission-Discharge-Transfer (ADT) function, radiology, pharmacy, surgery and ED functions, core nursing documentation including height, weight, allergies, history, discharge instructions, medication administration.
- Oct. 25, 2009 – SJMMC and SJMCH Phase Two. This includes all physician documentation outside the ED and all advanced clinical documentation including nursing and ancillary assessments, flow sheets, care planning, patient education, etc.
2. Training Dates:
- May 18, 2009 – Training schedule published and class registration begins.
- July 13 through Aug. 22, 2009 – Physician training for Phase One go-live.
- Sept. 14 through Oct. 17, 2009 – Physician training for Phase Two go-live.
I have had many calls and e-mails about Epic implementation and training. I have taken to the Epic implementation and training team questions about training specific to pediatric and newborn care. Although many training details still need to be worked out, we have identified these general principles for training pediatricians:
- Pediatricians who wish to admit and provide all care for their own patients will need the full 10 hours of Epic in-patient training. This is reduced to eight hours if you have previous Epic experience through SJMMG or another facility using Epic. This applies to pediatric hospitalists, specialists and those community primary care pediatricians who admit and follow their own in-patients. We will offer some pediatric-specific training times.
- Any community primary care pediatrician may opt for “newborn only” training. This will be an abbreviated training session designed to teach the pediatricians how to document newborn visits only. As many of you do already, those who elect to take “newborn only” Epic training will be expected to admit in-patients to the pediatric hospitalists. Allowance will be made in this abbreviated training for those of you who have Epic experience in the office or with another hospital.
- Some of you may opt to take no in-patient Epic training. In that case, all of your patients – newborn and in-patients – will be cared for by the pediatric hospitalists. Many of you are already using the hospitalists in this manner with excellent satisfaction on the part of you and your patients.
- All details regarding training opportunities, sign up, etc., will be coming in a few weeks
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The Full Term Nursery is beginning the process of routinely performing Car Seat Challenges on all infants born before 37-weeks gestation and infants who weigh less than 5 pounds. Nurses will soon begin receiving education on this topic. In the meantime, if you would like your patient to receive a car seat challenge, please write an order in the medical record. It is recommended that the order be written at the first physician exam in order to give the nursery staff times to schedule the test before the day of discharge.
- At this time, the Full Term Nursery will provide care for infants requiring intensive or double phototherapy. The infant should be otherwise healthy and without major medical concern other than hyperbilirubinemia. Infants requiring this level of phototherapy will be housed in the Full Term Nursery (rather than with the mother in her postpartum room). These infants were previously cared for in the Special Care Nursery, which has now been assumed by NICU.
- Effective Sunday, May 17, the “pre-op parties” currently offered by Women and Children’s Education will be discontinued. These were poorly attended so resources will be re-allocated to programs for which there is a stronger demand.
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Pediatric Pharmacy Update
The following article, written by SJMCH Pediatric Pharmacist Nausheen Hasan, Pharm D., and Medication Safety Coordinator Emmylou Frost, RN, appeared in the St. Louis Post-Dispatch health section on Thursday, April 23:
Pediatric-trained pharmacists
help reduce medication errors
Headlines about children receiving near fatal overdoses of certain drugs due to medication error, like the incident involving actor Dennis Quaid's infant twins, understandably concern parents when their children need to be hospitalized.
Children are at higher risk for medication errors than adult patients, however the frequency is unknown. Medication dosages for pediatric patients are usually based on the child's weight. Because pediatric patients vary in size, weight
and organ system maturity, most pediatric drug dosages must be calculated and customized for each patient.
And helping to reduce any misinterpretation in handwriting and calculation errors is the computerized prescriber order entry. It has been associated with the largest reduction in hospital medication errors by assisting with medication choice and appropriate dose for the weight of the patient.
There are other approaches to reducing medication errors in a pediatric population including standardized protocols, pediatric-trained pharmacists and teams devoted to medication safety.
Pediatric-trained clinical pharmacists have been shown to help decrease medication error rates in pediatric inpatient populations by participating in patient rounds and having an active voice at the point of medication transcription.
Pediatric in-patient pharmacists have an active voice at the point when medication orders are being written. We can help with orders by telling the physicians doses, routes, frequency and any pertinent information to that order. This helps avoid any questions that may come at the point of filling
that medication order, which occurs in the pharmacy.
In addition to having pediatric pharmacists, it is important to have medications for children prepared and sent from a pediatric-specific pharmacy. Doses from these pharmacies may be made for a specific patient or in a generic
amount that is appropriate for most children. Hospitals can also provide added safety by using what is known as "oral use only" syringes.
It is important as parents or caregivers to remember that you are an important member of your child's health care team. Always inform physicians, nurses and pharmacists of your child's allergies or any medications taken at home. Never
hesitate to ask what your child is getting, how much and the reason for receiving the medication.
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