UNC Hospitals Medicine Service Overview

1. UNC Hospitals Medicine Service Overview Physician Orientation July 15, 2009

2. Medicine Service Units • Acute Care Units: • 8 BedTower- Primary services MdA, MdU, MdW. Deborah Erickson, NM • 6 BedTower/AACU- Primary services MdG, MdK. Hazel Cochran, NM • 6 West- Primary services MdH. Kimberly Wood, NM • 3 West- Primary services MdB, Fam Prac. Pam Ball, NM

3. Medicine Service Units • Medicine Step-Down • Medicine Progressive Care Unit (MPCU) Megan O’Connor, NM • Medicine ICU • Lewis McKenzie, NM • Dialysis- Wanda Bandy, NM • ADU- Admission-Discharge Unit • Janie Dail, NM

4. Current Initiatives • Carolina Care- Hospital-wide patient satisfaction improvement initiative. Utilizes scripting, rounding, and data-driven action plans to improve patient satisfaction scores • BCBS, Cigna, CMS have already included pt satisfaction into contracts • How can you help?- • Update patients on plan of care using white boards. • No overhead paging • Do not promise things we cannot deliver • Update the Rounds Report • Manage expectations for discharge • Manage up

5. Current Initiatives cont’d • Clinical Care Triads- Hospital-wide initiative focused on improving through-put and decreasing length of stay • Care Coordinator, Physician Service Leader, and Nurse Manager meet weekly to improve flow on each service

6. Regulatory Agencies • JCAHO, CMS, DHSR • Periodic reviews/inspections on-site • Stressful time for Nursing • How can you help? • No food/drink on unit • Keep charts/ COWs out of hallways • Make sure Restraint orders are up to date

7. Elopement • Patient is deemed Elopement Risk based on Nursing Assessment • No Physician order required • Patients will wear purple gowns, have PNA

8. Restraints • HIGHLY Regulated by DHSR • Order MUST be renewed electronically EVERY 24 hrs with NO gaps in coverage • Med-Surg vs Behavioral Restraints

9. “Sitters” or Personal Nursing Assistants • No Physician ordering allowed per policy • Confused patients or those at risk for falls will be assessed by staff. No sitter is ever guaranteed for these patients • PNA policy gives coverage to these patients: • Suicide • Elopement • Behavioral Restraints • 4 Point Restraints • Involuntary Commitments

10. Rapid Response/ Code Blue • Nurses will independently call RRT or Code Blue if they deem necessary • Policy includes specific criteria for activation • Notify primary nurse, charge nurse AND house sup when you have decided to transfer patient to another level of care

11. Lab Draws • Nurse draws from Central Lines • If STAT labs are needed, contact primary nurse to ensure availability • All other labs should be entered as Lab Draw • Hourly Phlebotomy rounds

12. Isolation • Contact Precaution policy requires EVERYONE to wear yellow gown upon entering the room • 6BT, 8BT, MPCU, and MICU have negative pressure rooms for Airborne Isolation • Please indicate in initial orders the suspected organism

13. Procedures • Consent MUST be on chart (signed, dated, timed, witnessed) before procedure • General consent does not cover procedures or blood administration. Must have separate blood consent form • It is helpful if you can order a diet following a procedure so that patients can eat ASAP

14. Admission • If ED writes skeleton orders, admitting team must see patient and write full order set within an hour • Remember to document wounds and decubitus ulcers upon admission • Pay close attention to call parameters when writing admission orders

15. Discharge • Manage patient’s expectations regarding discharge timing • Please check with Nurse before amending D/C summary • Brief D/C summary must be signed before nurse can begin his/her d/c • The morning of d/c: Please free-text a note “Anticipate discharge” so that charge nurse/ house sup can make decisions based on anticipated bed availability. Should also be on rounds report

16. Dialysis • Notify Renal Service as soon as you are aware your pt is a dialysis pt • ONLY HD staff and Nephrologists may access HD catheters. The only exception to this policy would be in the event of a life-threatening medical emergency where rapid vascular access is required for resuscitation • Any pt with an IV access will have antibiotics delivered via that access by the staff on their nursing unit- Not via the HD machine • Please schedule diagnostic tests for HD patients on their Non-Dialysis days. • On day of discharge please notify the Dialysis Unit if you would like for your pt to receive their treatment on the 1st shift to expedite their d/c

17. Final Thoughts • Please answer your pager, it could be an emergency. If staff are not text paging frequently enough or appropriately, please notify manager with specifics. • Nurses will relay any patient requests to you via text page. • Please always be professional and respectful in dealing with patients and staff. Please contact Nurse Manager if you feel you have not been treated appropriately. We are all on the same team!!!