Pprwrk

Policy can be changed if not appropriate or evidence based. My policy is not what I am questioning here. I am questioning the practice.

I do not know off hand, but this is not just for terminal cleaning, this is all patients being transferred out of their ICU room. Presently, all equipment in the bedside supply cart gets tossed (syringes, flushes, dressings, IV start kits, EVERYTHING. Oddly enough, I do not see anyone tossing the glove boxes.

After a patient (any patient) is transferred out of his ICU room, we throw out all supplies that were in the bedside supply cart Syringes, flushes, dressings, whatever). It 'feels' like a good idea for cleanliness, but I cannot say that I find any data to support that this is actually necessary. I was also wondering about glove boxes... Does your facility throw out glove boxes between patient admissions?

After a patient is transferred out of a room (I work in ICU), do the boxes of gloves get tossed as part of the room cleaning??

And wow, THese were all comments as 'replies' to comments left by others, and yet they were all piled onto the end of the thread. This site is very glitchy.

In a perfect world, the chain of command would be followed appropriately, and all problems addressed in a timely manner. If this is not happening, I think the rounding may help uncover this, hold people accountable, and provide opportunities for education eventually improving the system. And perhaps the rounding does not have to be a physical presence, rather a phone call to each unit's charge nurse. It's easy to get aggravated about how things 'should' be, but we must also look at how they really are, the latest evidence-based practices, and how to best incorporate them into our own facilities. The rounding is not my idea, and neither is the family initiated RRT call. We are just late to the party in initiating the programs. These are not new ideas. I have been a bedside nurse for 22 years and an ICU nurse for 18 years I am well aware of the taxing nature of the physical AND paperwork involved. Seeking feedback from other facilities, nurses, and physicians is way to identify what works and doesn't work. It can identify facilitators and barriers to the programs, along with thoughts, feelings and attitudes brought on by the very idea of the program to be compared with personal experiences by nurses who actually have the programs up and running in their facilities.

This is the 'problem' and where this, if rolled out, may have to be tailored to our resources... The ICU Charge sometimes has a patient assignment. If she doesn't, then she is responsible for charge duties and responding to codes and RRTS. If she DOES have an assignment, then the codes are assigned to another nurse, and the RRTs to yet another nurse. So, in this situation, the nurses have suggested NO physical rounding, but a phone call to each floor's charge. OR, maybe the program would simply be a follow up visit to patients recently admitted from the ER to the floors or to patients recently moved from the ICU to the floor...

How often IS it used?

I agree with the drain on resources. That's why I really want to know the first-hand failure and success stories with this approach. I know that it sounds like it could be false alarms and staff being pulled away unnecessarily.. but is that what ACTUALLY happens? As for the bedside RN being notified, the family/patient/visitor call would be promoted as something to initiate if issues were addressed with the nurse/MD

I am imagining this happening. and so are the other nurses and physicians. But I am wondering what the reality is in hospitals that already uses this approach, not just what we are afraid might happen.

Our ICU has been using the packaged CHG wipes for several years. The patients are to have a wipe-down with the packaged CHG wipes at least once a day. If the patient has been incontinent, or there is a larger mess to clean up, then washcloths with plain water are to be used... no basins. You can wet the wash cloths, and pile them on a towel. The wipes can be used to also clean off foley caths and any tube/line/wire resting on the patient and extending out from the patient. The CHG binds to the skin. Using soap washes it off and reduced its effectiveness. Soaps and lotions create a barrier on the skin that prevent the CHG from binding to the skin. If lotions are to be used, they are to be applied after the CHG, and are to be deemed CHG compatible. The CHG bathing has been shown to decrease infection rates, including c-diff. The CHG does not kill the c-diff, but nonetheless, the CHG use has decreased c-diff rates in hospitals, especially if used hospital-wide. We just went through re-evaluating our packaged CHG wipes vs. using a CHG foam to be used while bathing with other pre-packaged bath wipes (cost saving potential). We decided to stay with the wipes, as there is a specific CHG dose with the wipes, and this would not be consistent with the foam soap. Also, the foam soap could encourage basin use again.

So far, just seeing my face, getting to know me, knowing that the support is there HAS been positive for the floor nurses. Some of them feel very unsupported and crave a better relationship with the ICU, and greater sense of 'all hospital nurses as a team' instead of 'ICU vs ER vs this floor vs that floor'.

From what I am reading, the Patient/Family initiated RRT call is presented in different ways (through posters, brochures, explanation by the nurse) as something to be initiated by the concerned family/patient in situations ranging from 'something isn't right' to 'like calling 911' and also including specifics such as 'you have already addressed concern with nurse and physician but still feel like there is something wrong/problem not addressed' and even further specifics such as 'change in breathing, change in mental status' etc. It seems to depend on the facility. There are calls that turn out to be non-emergent, but from what I am reading, it has not blossomed into a general abuse of the system. HOWEVER, I have not heard from nurses first-hand about the realities of this in their facilities. As for the rounding, I have only heard from a few nurses who spoke of a facility that actually has a dedicated RRT nurse, who does rounds and acts as a resource and an extra set of hands on all inpatient units unless an RRT is called. Our ICU nurse would not have that luxury. The feedback I have gotten from our ICU nurses is that the process would take too much of the ICU nurse's time, and the floor nurses would depend on the ICU nurses too much to address problems. The floor nurses, overall, see relieved to have someone from the ICU come around to check in. I, too, am already sensing that the rounds I have done (informal, trying to get feedback), are something that the charge nurse or nurse manager should be doing. Also, I checked in at 5:30 am, but that did not prevent a RRT at 1pm. Things are constantly changing, and I am wondering how effective the program would be for patient care, aside from uncovering knowledge gaps in nursing policy/procedure in the bedside nurses, and inefficiencies in interns and residents addressing problems; uncovering systems problems, not patient condition issues.

I am looking into developing a proactive rounding aspect to our Rapid Response system. I am also looking into developing a process for patients and visitors to activate the rapid response team. The proactive rounding would have the ICU nurse/RRT nurse (we have no dedicated RRT nurse) round to each inpatient unit at least once per shift, to talk to the floor nurses and see if there are any concerns about patient conditions (not yet an RRT call, but may be heading that way) and help to address the concerns of the nurse, facilitate interventions for the patient, and get the patient on the ICU 'radar' (what this would entail as far as ICU physician follow-up or contact with the floors' medicine teams/surgeons, I do not know yet). What are YOUR experiences with proactive rounding and/or patient and visitor initiated RRT calls?? Thanks.

That sounds amazing! But the position I am asking about is Clinical Nurse EXPERT. It seems like a fill-in for the Clinical Nurse Lead that my facility does NOT have. I was going back and forth on putting in for the position, because in the world of nursing it is not a REAL title. Also, if advocating for the nursing profession, shouldn't we stand up against this type of thing? I mean, if the facility should have CNL's, and it benefits patients to have actual CNL's who have ben educated for the role, then we should rally to have the REAL CNL hired? Obviously the facility cannot hire any at this point, but still sees the value in the role, and wants it filled by someone who can focus on QA, staff support, and staff education.