L&D Newsletter

December 2015

Team Health OB Hospitalists

Our first few days with the Team Health Hospitalists have been very successful! We are learning new things every day, and I feel confident that by the time our permanent physicians start in March, we will have it all figured out.


Here are a few reminders:


  • The private physicians have been given a contract to sign if they desire, to allow Team Health to work with them (when specified by them), and cover for precipitous deliveries and emergencies. Right now, there is no way for us to know who has signed a contract and who has not, so we will follow a few basic rules.
  • The Team Health physicians are all board-certified OB/GYN physicians that have worked with the hospitalist model in the past. They DO NOT have a private practice. They only work their scheduled shifts in the hospital.
  • They will generally work 24 hour shifts. They are required to be in the hospital at all times during this shift. They may be sleeping, in the cafeteria/physician lounge, rounding on FP, etc, but you will be able to contact them at any time during their shift.
  • They will carry a spectralink (4576) and hand this off when giving report to the oncoming hospitalist.
  • The Team Health OB Hospitalist will be entering ALL of their own orders. There are both patient safety and legal considerations surrounding this. The physician will be in-house 100% of the time, and the ONLY time that an RN should enter an eVerbal order is when this physician is in the middle of a procedure (delivery, etc) or an emergency. PLEASE DO NOT enter eVerbal orders for the OB Hospitalists. We will be auditing charts to ensure compliance with this.
    • The process for unassigned patients will be:
      • Dr. Brooks and the medical director for Team Health are still in discussions, however, until further notice, all unassigned patients will be admitted under the TeamHealth physician that is here in-house when the patient arrives, and will be cared for by the Hospitalist.
      • The TeamHealth Hospitalist will invite the FP residents to participate. The FP residents will not be allowed to input orders for the TeamHealth docs for now (they don't have any contractual relationship). The Family Practice residents CANNOT enter orders when they are being supervised by the hospitalist until we get the contractual relationship worked out.
      • As nurses, we should not contact the residents directly about a new, unassigned patient. We should contact the OB Hospitalist directly (ext. 4576), and they will bring in the residents for teaching opportunities.
      • Any continuity patients for the residents should be treated as PRIVATE patients, however they cannot be managed by the residents alone - they need an attending in house. In this case - Dr. Brooks must be in house. You should call her to arrange this.
    • Some private, community OBs may decide that they want to sign out coverage to a hospitalist for a night or weekend. This is perfectly fine. Please just communicate with your physicians so that you know who is covering at any given time.
    • It will be up to the individual physician to sign and return contracts to Team Health. When they do, the Physician can ask Team Health to cover if desired. We DO NOT ever ask Team Health about a private patient unless the private MD has indicated that they signed out to Team Health. The only exception to this is for emergencies: precip deliveries, stand by, or maternal /fetal compromise. If this is the case, call the hospitalist to cover immediately and make sure someone is notifying the private physician.

Education

GNOSIS 2nd Quarter Modules

· CM Module #46,47, 48 and EFM Core Modules 1-4 and SBAR if you have not completed it since July 1st 2015. These are due to be completed by December 31st, 2015.

GNOSIS Modules that were due by September 30, 2015 are CM Module: #43, 44 and 45 and CORE MODULE : Obstetric Hemorrhage. If you have not completed these, they are due immediately.

Mandatory PiL’s

· “Management of Pharmaceutical Waste” – must be completed by January 13th, 2015

This is the pre education for the new pharmaceutical waste management system that will be implemented around the system in the new year

· November Bundle for PiL- was due last month, if you did not complete it please do so now, it contains new and important information on band changes within lines, tubes, wounds, and drains, PCA and PCEA documentation, CHG Bathing, and Nursing Discharge Instructions. Please complete it if you have not do so already.

Chart Audits and PCM/Fetalink tips

I am attaching some great tips from the audits that Kathy has been doing, as well as some refreshers on finalizing and disassociating your strip when you finish. Kathy will also post on the unit for you to see, but please open the attachments in this email.


A few highlights:

  • Patient Hand-off/Transfer summary form: You give report on 2 patients, so you should be documenting hand-off on two patients.
  • 72% of charts had hand off forms between L&D and FP on Mom's chart, but only 9.1% of charts had Hand-Off forms on the Baby's chart.
  • Physician communication: Pedi notification should be charted in the Physician communication ad hoc form, as opposed to a SOAP note. This is a technicality, however, it makes things much easier for anyone reading a chart (management, auditors, lawyers!!)
  • Lots of great numbers around skin to skin and breastfeeding documentation.


Make sure you open the attachment and look at all of the details.

Breastfeeding

Our exclusive breastfeeding rates for November went down again. :-( We know that you all have been doing a great job with initiating skin to skin and breastfeeding! We appreciate this so much! The Family Place staff has placed all pacifiers in the Pyxis and are working hard with the Lactation Consultants to decrease formula usage.


The management team is working with the breastfeeding committee to come up with some scripting to our patients around breastfeeding. There are lots of new, exciting things coming up. We are developing some tools to help tell our patients about the benefits of breastfeeding. When we have it all set, we will share it all with you.


Some things coming in the future (don't worry too much about this right now, we will let you know when we are implementing these!!):


  • Formula for medical indication only
  • Pediatrician order needed for formula
  • Nursing escalation plan for when formula is requested or medical need
  • Flyers distributed in OB physician offices


Thank you for all of your dedication to making breastfeeding a priority for our patients!!

Weekend tasks

This is just a friendly reminder that stocking/refrigerator temp checks/linen should be taken care of on the weekend if it needs to be done. We shouldn't have instances where linen is waiting 3 days to be put away. This also does not have to be just a tech job - if the tech is busy, and nursing staff is not, please assist and take care of the tasks that need to be done.


Thanks!!



Patient Parking

Please remember that our parking lots and garage is owned by a separate company, and NOT Memorial Hermann. We cannot validate or pay for parking for our patients. Some staff have been referring patients to Patient Relations for parking assistance, however they cannot offer paid parking either. Please refrain from directing patients to Patient Relations for parking concerns. Thanks!

Equipment

Happy Holidays!! *Don't forget to send Sara an email acknowledging this newsletter for credit*