The Franny Feed

March 2014

Department Update ~ T. Edison, RN, MSN, CEN Nursing Director

Hi Everyone! This is Joint Commission season. We have been getting the department ready for our annual inspection. Thank you to everyone for keeping the department survey ready.Remember, turn off your computer screens when not in use, keep the hallways free of clutter, throw away medication laying around, don't have food in the nursing know the drill. Few points to remember: Preferred Patient Pharmacy: Please get this done at triage. If the patient does not have a preferred pharmacy please suggest one like the one across the street. Undressing patients: All patients need to be undressed and ready for examination.Translators: Please make sure that you obtain the translator's ID number or name when utilizing them. That needs to be documented in the chart. I have attached the practice alert for you.Falls: Please screen your patient for falls and implement the appropriate interventions. Also, know we have a falls gurney that can alarm if the patient gets up out of bed.Please utilize that.New ambulance doors have finally been installed! They look great and function well! Patient Portal is now live. Patients can go online and view their own medical record. The patient must provide an email address to the registration clerk. They should soon get an email invitation to enroll.As you may have noticed, the department is also getting some much needed patching and painting as well as new bumpers for the walls. Please do not stick stuff to the wall. It will pull off the paint. If you need something on the wall see me and we will get it up. OBGYN guerney: New guerny arrives on Thursday!That is all for now.

Thanks everyone!


MD update ~ J. Sun MD Medical Director

From the Medical Director:I just wanted to bring up a patient experience that exemplifies the great teamwork that's a hallmark of the care provided by our Emergency Department!


ZB, came in code 3 at 1850. He was intubated at 1858. Dr. Melnick was amazingly proactive and helpful. RN report was given to the ICU at 2022 (and accepted on the first try!) Patient left the ED at 2051. That's 121 minutes for an ICU admission! I believe Janet was the ICU nurse (but don't quote me on that.) It was a rockstar crew in the ED, and everything went smoothly.


Thank you to everyone that evening: Nathan, Jeremy, Holli, Meagan, Lana, Alex, Kajuana, Janet, Ryan and Megan and Chris Cheng! However, I know this is just one example of MANY that occurs on a daily basis! Thank you, everyone, in the ED for your hard work!



-New Insulin Protocol: Look out for the new insulin protocol for the ED. This protocol is going to allow us to have better glycemic control for our patients with HHS and DKA. Important remember: we never use any other insulin protocol now that we have the new DKA protocol. The reference sheets are in the IV binder and we have retired the other insulin protocol.

-Restraints: don't forget to get the correct order, do the initial assessment form and 2 hour monitoring.

-Conscious Sedation: make sure you are completing the paperwork and putting it in Amy's folder where the the unit clerk sits.

-New CENs!: Megan Morrow , Alex Lipinski, Hannah Berns &, Shaina Onnagan, Kate Rider. Congrats!!

-We will be hosting four new paramedic interns in our department in April, two from City College and two from California Regional Fire Academy. Please give them a warm welcome and share your knowledge and expertise with them during their tenure with us.

-We have a new ultrasound machine for the department for ultrasound guided IV insertion on patients with difficult IV access, stay tuned for information on upcoming training classes.

Palliative Care Corner ~ M. McKigney, RN & H. Miller, RN

Surrogate Decision Makers

Recently, one of our well-known patients was admitted to the ICU for a very extended stay. She spent weeks and weeks intubated while hospital staff attempted to find someone who knew her well enough to say what her final wishes for care would have been. She had no immediate family. The staff was finally able to locate someone who knew her well and said that she would not have wanted aggressive treatment. She was eventually extubated, placed on comfort care, and passed away. Of note, this patient had ninety-two visits to the ED over a period of a few years. No one had ever noted any family, friends, or anything about wishes for end of life treatment.

Of course we are not in the habit of asking those questions, but for some of our patients, maybe we should be. We all know patients who we see over and over again, and we often see them in declining states of health. We are sometimes the very last people these patients will speak to. Patients can name anyone they chose as a Surrogate Decision Maker, they need not be family or a relative. It can be anyone they want to make decisions for them should they become unable to do so. There is a spot for nurses to document Surrogate Decision Makers in the Advance Directive Screen in AdHoc.

Quality Corner

Please remember your key Sepsis initiatives. Obtain Lactate within one hour of meeting SIRS Administer antibiotics within one hour of resulted Lactate >2. Administer 30 ml/kg of fluid resuscitation for Lactates >4. YOU MUST START AND STOP YOUR INFUSION TO GET CREDIT

Restraints: don't forget to get an order, do the initial assessment form and 2 hour monitoring. Conscious Sedation: make sure you are completing the paperwork and putting it in Amy's folder where the the unit clerk sits.

Compartment Syndrome: please review the PowerPoint attached. Please increase your level of suspicion for compartment syndrome. Any extremity injury with disporportionate amount of pain and tenderness, you should suspect compartment syndrome.

Joanne's Baby Shower @ SOMA Street Food Park

Saturday, April 26th, 12-3pm

428 11th St

San Francisco, CA

Come meet Joanne's babies! Phoebe and Quinn are ready to party ;)SOMA Street Food Park is located on 11th St across from Costco.Mike and Joanne like to start a book library for the girls. There is a list of books posted in the break room if you'd like to participate in that.