Nursing News
Several Nursing Standards of Practice and Protocols have been reviewed over the past several months. It is important to regularly review standards and protocols to update your nursing practice.
NAME | CHANGE in PRACTICE NW=Northwell Policy/Practice (P/P) |
PATIENT CARE SERVICES (PCS) – STANDARDS OF PRACTICE | |
1. Bar Code Medication Administration[BCMA] 3/18 *previous name: Bedside Medication Administration (BMV) | Transitioning to NW P/P. When administering more than one parenteral medication (IVP/SQ/IM), only one medication can be scanned and administered at a time (step 9). SAVE/FILE 1st parenteral medication à then SCAN & Administer 2nd parenteral medication. |
2. Blood Glucose Monitoring Schedule (Accu-Chek and Insulin Coverage) 4/18 | Blood glucose ordered QID will be performed before meals and at bedtime, unless otherwise specified by physician; ordered BID will be performed before breakfast and before dinner, unless otherwise specified by physician. TABLE of Insulin Types/Onset/ Peak/Duration. Reviewed also by B. McGrinder RPh. |
3. Central Venous Catheter (CVC) Dressing Change Using the BIOPATCH® 4/18 | Transition to NW P/P. Biopatch® used for Central Catheters dressings. There are 2 sizes. Includes dialysis catheters. Vascular Access Team are experts. |
4. Hypothermia/Hyperthermia Blanket 4/18 | Updated machines. 3 modes with temperature monitoring. Step on prevention of rectal thermistor probe skin protection and prevention of medical device pressure ulcer. |
5. IV Push (IVP) Medication Administration 4/18 a. Medical Surgical IVP Chart 2/18 [Lexicomp]. Update IVP module and test. | Transition to NW P/P. This is the Basic Policy for all areas in IV Push Medication Administration. Each service area develops a list of approved medications for IVP and validates their RNs. Future: Work in progress with NW template that includes monitoring requirements pre/post administration. |
6. Medication Administration 4/18 a. Cosyntropin (cortosyn) b. Intravenous Immunoglobulin IVIG (octagam® 10%) c. Narcan (naloxone) d. Remicade (infliximab) Infusion | a. Ordered by Hospitalists to r/o Addison’s dx. Blood work obtained prior to and 1hr post IVP. b. Dose of drug using ACTUAL (kg) weight (not ideal weight); Weight obtained at beginning of order/delete end of infusion weight. NW Alaris Library & drug bottle/dose updated. c. Narcotic Overdose vs Respiratory Depression Reversal Protocol and for Continuous Infusion. Approved P&T. d. p.2. Correct rate at 30 minutes = 80mL/hr x 15 minutes |
7. Rapid Response Team (RRT) 4/18 | Updated SIRS criteria 2/18 and Hypercritical Lab Notification* 3/18 where an RRT may be called. Update Form 1612 (NEPS). *Refer to policy #12-next page. |
8.Stockings, Elastic & Compression; Intermittent Pneumatic Compression Calf Sleeves (IPC); Foot Pump Pads (AV Foot Pumps) 3/18 | Transitioning to NW P/P. Phelps Patient Care Protocols combined to one policy. Includes measurement guidelines. Value Analysis: Transitioning to better grade of anti-embolism stockings-due in June. |
9. Surgical Skin Preparation 4/18 | Transitioning to NW P/P. Surgical skin prep is performed PRIOR to pt arrival to ASU/Surgical Center. See p. 1. No rings/jewelry including piercings (no taping)-ring/jewelry will be cut off. Directions for clippers, indications for CHG-Chloraprep wipes, & Skin Prep Body Diagrams included. **Required each unit education/training & confirmation signature using Posters/Newletters/Competency/ Handouts etc. Refer to unit based education councils/annual competency. |
10. Ultrasound-Guided Short Peripheral Catheter Placement 4/18 | Larger catheter placed under ultrasound by Vascular Access Team. Alternative to Midline/PICC. |
11. Urinary Catheterization and Indwelling Catheters 3/18 | Transitioning to NW P/P. Yes, this is long policy with an Attachment for each procedure—Insertion of catheter; Male/Female; ISC. Includes step for Urinary Thermal Probe pg 7 #4. (Sepsis/Critical pt). Based on NW Infection Control Policy: Catheter Associated Urinary Tract Infection (CAUTI) Guidelines. |
LABORATORY POLICY/ ADMINISTRATIVE POLICY | |
12. Hypercritical Value Notification 3/20/18 | NEW Policy: To decrease the time between the standard critical value notification and patient evaluation and/or treatment for test results requiring immediate intervention. If Hospitalist Team Leader/MD is unable to be contacted/attend to the patient bedside, Lab will then call the nursing unit and inform them that they are calling an RRT to the patient bedside for immediate evaluation. Glucose < 30mg/dL; Hemoglobin < 5.0 g/dL: Potassium < 2.0 mmol/L; Potassium > 7.0 mmol/L |
NURSING CLINICAL PROTOCOLS | |
13. Skin Integrity Protocol #323 3/18 | Updated by D. Reynolds, RN-BC, CWOCN. Assessment/Risk Factor: Medical device related injury e.g., rectal tube or probe, nasal bridge and nares. Change term: Stage 1, 2, 3, 4 and update descriptions. |
14. Post-Operative Management Protocol #352 3/18 | Reviewed. Minor revisions/updates. |
NORTHWELL SYSTEM POLICIES – In final approval process | |
15. Bar Code Medication Administration | |
16. Alaris Pump, Clinical Use | |
17. Blood Component Administration | |
18. Pre-Operative Infection Prevention Guidelines: Pre-Procedure Showers/Bath & Staphylococcus aureus Decolonization | |
19. Dysphagia Screening | |
