Email Discussion Group: JCAHO 2006 National Patient Safety Goals

This month's email group discussion is courtesy of CLD editorial board member Ken Gorski, RN, RCIS, FSICP.
This month's email group discussion is courtesy of CLD editorial board member Ken Gorski, RN, RCIS, FSICP.
NPSG #2 does not specifically say that reports to a receiving hospital unit has to be Nurse-to-Nurse; what it says is that the institution is responsible to implement a standardized approach to hand off communication, with an opportunity to ask and respond to questions. NPSG #2 only mentions that there be a timeliness of RECEIPT by the responsible licensed caregiver. NPSG #2 does not state the individual giving report has to be a nurse, nor does it say that the have to even be licensed. NPSG#2, below, can be found on the JCAHO website at: http://www.jointcommission.org/PatientSafety/NationalPatientSafetyGoals/06_npsg_facts.htm Goal 2: Improve the effectiveness of communication among caregivers. 2A: For verbal or telephone orders or for telephonic reporting of critical test results, verify the complete order or test result by having the person receiving the order or test result "read-back" the complete order or test result. [Ambulatory, Assisted Living, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Lab, Long Term Care, Office Based Surgery] 2B: Standardize a list of abbreviations, acronyms and symbols that are not to be used throughout the organization. [Ambulatory, Assisted Living, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Lab, Long Term Care, Office Based Surgery] 2C: Measure, assess and, if appropriate, take action to improve the timeliness of reporting, and the timeliness of receipt by the responsible licensed caregiver, of critical test results and values. [Ambulatory, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Lab, Office Based Surgery] 2D: All values defined as critical by the laboratory are reported to a responsible licensed caregiver within time frames established by the laboratory (defined in cooperation with nursing and medical staff). When the patient's responsible licensed caregiver is not available within the time frames, there is a mechanism to report the critical information to an alternative responsible caregiver. [Lab] 2E: Implement a standardized approach to hand off communications, including an opportunity to ask and respond to questions. [Ambulatory, Assisted Living, Behavioral Health Care, Critical Access Hospital, Disease-Specific Care, Home Care, Hospital, Lab, Long Term Care, Office Based Surgery] Because of NPSG #2, the nursing units at my institution are requesting RN-to-RN report only. How are other institutions handling floor report and NPSG#2? Do any of your hospitals allow non-RN cath lab staff give report to the CCU or floor? Kenneth A. Gorski, RN, RCIS, FSICP Assistant Manager Sones Cardiac Catheterization Laboratories The Cleveland Clinic Foundation Email: gorskik @ ccf.org _______________________________________________________ Great question. It reemphasizes how similar the issues are that we deal with from day to day. I had to address this same issue a year or two ago, and it was decided that non-RN cath lab staff can and will give report to RNs in non-critical care nursing units. However, for units like the CCU or other intensive care units, our hospital developed a policy requiring that the same level of nursing care be maintained as a patient moves throughout the hospital. For example, if the patient in the CCU is receiving critical care nursing and a cardiac cath or angioplasty is ordered for that patient, the critical care nursing must follow and remain with the patient throughout the procedure. Here's an excerpt from our hospital policy: "To insure continuity of care during the procedure, the transporting Critical Care RN may transfer the care of the patient to anesthesia personnel or another Critical Care RN. The transporting Critical Care RN will give a patient report to anesthesia personnel or the Critical Care RN accepting care of the patient." I do not have CCRN nurses for all cases and so the CCU nurses are often required to stay with their patients during their cardiac cath procedure. Therefore, giving report to the CCU staff is not an issue for me. David Strelow System Director, Cardiac Catheterization Laboratories Mid America Heart Institute Saint Luke’s Health System Kansas City, MO Great question. Currently, we have RT(R) or RCIS staff that monitor and give report to the floors post-procedure. We always have an RN monitoring moderate sedation and LOC during the procedure. All staff are cross-trained, but the RT(R)/RCIS staff are not able to give meds or waste meds. Julie Baran, RN, BSN Clinical Manager Adult & Pediatric Invasive Cardiology Memorial Hermann Hospital Houston, TX In Springfield, IL, at St. John's Hospital, standard of care is RN-to-RN only. Jonna Herring St. John’s Hospital Springfield, IL At Florida Hospital, we allow RT, RRT, and CVTs to call report. Larry Criswell Florida Hospital Orlando, FL You can add another hospital in the column of techs giving report to nurses on the floors. It has not been an issue and I would hope that an interpretation of the JCAHO guideline is not taken out of context. The informal survey would be a good one to publish for reference. Teresa B. Waters Director, Cardiovascular and Pulmonary Services University Hospital Augusta, Georgia At my center, only nurses are allowed to give report to nurses outside the unit. Within the unit, the CV Specialist gives report to the nurses and the nurses give report to the CV Specialists. The Department of Nursing made the nurse-to-nurse report a rule several years ago. It does present some issues, particularly for the call team. Tricia Hospital and location withheld by request We have always done nurse-to-nurse, and not just because of the new national safety goals. In California, only RNs can assess the patient and they are responsible for patient care via Title 22. CVTs are not licensed in the state and legally cannot assess the patient. We have nurses report directly to each other, just as a physician will give an order directly to the nurse, not via a secretary or a tech. I know this will differ a great deal from state to state. Paul in California At Sentara there are no nurses in the cath labs… report is nurse-to-tech on the front end and tech-to-nurse on the back, including critical care transfers to CCU. Per your original e-mail, that would include: Sentara Heart Hospital Sentara Norfolk General Hospital Sentara Leigh Hospital Sentara Bayside Hospital Sentara Careplex Hospital Sentara Virginia Beach General and Sentara Williamsburg Hospitals employ nurses who work as RNs in the lab although the Invasive Specialists operate under a system job description and are capable of giving and receiving report to the hospital units. All facilities are located in southeastern Virginia. Chris Nelson Director, Cardiac Education & Technology Sentara Healthcare In our lab, anyone who scrubs and transports can give report. All staff who are ACLS-certified can transport. In Maryland, an RT(R) can give meds in the cath lab only under direct supervision of the MD, so RNs transport with the RT(R)s just in case there is a need for Rx in transport. Marsha Holton BS, CCRN, RCIS, FSICP Washington Adventist Hospital Takoma Park, Maryland Everyone calls report (RN and tech), except for CCU patients…RN only. Barbara A. Boston Senior Director, Cardiac Services Tenet Healthcare, Hahnemann University Hospital Philadelphia, PA At Piedmont, everyone in the cath lab is cross-trained and ACLS-certified. Everyone can call report and transport. Our hospital policy states that you must be ACLS-certified to perform these functions. We try very hard here not to differentiate between allied health individuals in the lab. Bonnie Ferguson Piedmont Hospital Fuqua Heart and Vascular Center Atlanta, GA At our institution, it needs to be nurse-to-nurse, but technologists can and do provide additional information. For our peripheral cases, everyone in the room knows about the patient. All information should be, and is, shared. We have no issues with this at all. Not a matter of barriers it is just a matter of quality of care and communication. We do our best not to draw lines. It is not good for the organization nor the patient. Carol Mascioli Baptist Health Hospital Miami, FL We (BIDMC) are nurse-to-nurse, but my technologists know the same detail, and actually more about the patient, especially when it comes to peripheral cases. My technologists go to the floors to remove sheaths, hold pressure and document in the patient’s record the patient’s status post sheath removal. Are we building barriers to other allied heath professionals communicating patient care issues? Georgann Bruski, RT(R), CRT, ARRT Director Invasive Cardiology Beth Israel Deaconess Medical Center Boston, MA At Lenox Hill in New York, only RNs give and receive report. The monitoring RN calls and gives report to the receiving RN on the inpatient. If the inpatient nurse can not take report or a bed has not been assigned yet, the holding area RN will give report to the inpatient RN. Either the Monitoring, Circulating, or Scrub RN will give report to the holding area RN when they transport the patient from the procedure room to the holding area. Ambulatory patients are discharged to home from the recovery room. Suzanne Riva, Lenox Hill Hospital New York, NY At Emory University, all staff support members are certified allied healthcare workers, and along with our registered nurses, are required to give report to the receiving nurse whether the patient returns to a regular bed or to a critical care unit. All of our staff are cross-trained. Chuck Williams, BS, RPA, RT(R)(CV)(CI), RCIS Emory University Hospital Atlanta, GA In Houston at the Methodist DeBakey Heart Center Cath Lab, we only give RN-to-RN hand-offs and call report in advance of transfers regardless of the unit. This is part of our patient safety initiative. It occasionally will slow down the lab turnarounds. Katrina Dunn Methodist Hospital, Houston, TX All monitored patients must be accompanied by an RN so that RN gives report. If the patient is returning to a med-surg floor and does not need monitoring, the RN will report and the patient may be transported with non-RNs. Sandi Kadotani Scottsdale Healthcare Scottsdale, AZ For all critical care areas, the nurse transporting the patient gives report to the nurse receiving the patient. Sometimes the nurse in the lab will call report to the unit, but the patient still must have an RN accompany the patient to their room. To all other areas (non critical care), a phone report to the nurse on the floor is acceptable with a non-RN transporting the patient. Mark Hertenstein, Manager Cardiovascular Labs McConnell Heart at Riverside Methodist Hospital Columbus, OH At WVU, RNs give report to RNs. E. Wayne Cochran Director, Cardiovascular and Interventional Services West Virginia University Hospitals Inc. Our hospital policy stipulates that the sending RN must give report to the receiving RN. The only time we don't follow that rule is within our own department, from the cath lab to the cath lab holding area, and most of the time those are non-critical patients. Martine Kinman, Clarian Health Indianapolis, IN At St. Vincent in Indianapolis, RNs call report to the receiving RN. H. Jane VanDyne, Director Cardiac Labs, St. Vincent Hospital Indianapolis, IN I am in Charleston, West Virginia at Charleston Area Medical Center. We do not allow any other staff to call report or receive reports except RNs and LPNs (receive report only). Sandy Cooke Charleston Area Medical Center Charleston, WV We allow CVTs to also give the report. It can be a radiology tech or respiratory therapist also. Charlene Cole, RN, MSHA Director Invasive Cardiology Carilion Roanoke Memorial Hospital, Roanoke, VA At the Gill Heart Institute at the University of Kentucky, we require RNs to hand-off or call report to other RNs. Kim Morton, RN, BSN, Interventional Coordinator Gill Heart Institute Cardiac Cath Lab, Lexington, KY Sacred Heart in Washington is RN to RN. Tim Ulgaldea, Sacred Heart Hospital, Spokane, WA Non-RN staff do give report to CCU. A nurse accompanies the patient to the unit and is available if there are any specific questions. Lynne Jones, Robert F. Schaper Heart Center, Tomball Regional Hospital, Tomball, TX St. Joseph Mercy Hospital in Ann Arbor, Michigan currently does a tech-to-nurse report post procedure. However, we are being asked to change this to an RN giving report but have not operationalized yet. We staff 2 techs and 1 RN for each procedure room and the tech who records is responsible for gathering up the paper work, getting the physician signature, and calling report. An RN transfers the patient to the recovery area and does a brief hands-off communication. The patient is then transferred to a PCU (monitored) bed with no further report unless there is a problem that they need to be updated on. We do approximately 4,300 coronary and PV procedures and 2,100 EP procedures annually. Jackie McAninch, RN, Service Delivery Leader, St. Joseph Mercy Hospital, Cardiac Cath Lab and Electrophysiology Laboratories Ann Arbor, MI Share your lab’s information at cathlabdigest@aol.com