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Archive for May, 2011

Documenting PSA

When doing Procedural Sedation & Analgesia (formerly known as conscious sedation) at Sinai, the documentation is as follows:

1. Take the PSA physician checklist out of the bin. There is one bin in the med room on the adult side, and another bin next to the attending chair on the peds side. or print it out

http://mssmem.com/?p=1673

2. Perform your PSA, using the checklist.

3. Have the BA scan the checklist into the chart.

4. Go into the patient chart in Epic.

4.1 Click on “Procedures.”

4.2 Click on “New Procedures.”

4.3 Click on “PSA/Conscious Sedation.”

4.4 Click on “The PSA physician checklist has been scanned into the chart.”

4.5 Click accept.

See attached picture. Note that the physician flowsheet is different than the nursing flowsheet, which is in Copies; this is for nurses to fill out.

Written by reuben

May 25th, 2011 at 11:01 pm

Posted in Analgesia & PSA

Detox / rehab programs

Written by reuben

May 23rd, 2011 at 2:49 am

Posted in Social Work

GNYHA Stop Sepsis Collaborative

Severe Sepsis Invasive Protocol

Severe Sepsis Non-invasive Protocol



Mount Sinai is participating in the Greater New York Hospital Association Stop Sepsis collaborative. The goal is to improve recognition and treatment of patients with severe sepsis.

Every patient who presents to the ED is screened by nursing for sepsis using seven criteria: Suspected infection; Temp > 100.4 or < 96.5 or rigors; HR > 90; RR > 20; Alteration of mental status; O2 Sat < 90%; and SBP < 90.

If a patient meets three of these seven criteria, a set of labs (including blood gas for lactate) is drawn and a “best practice alert” is triggered in Epic, notifying subsequent providers that the patient is sepsis screen positive.

If a patient is sepsis screen positive, the clinician should determine if the patient has severe sepsis as defined by MAP < 65 after 2 liters of IVNS or a lactate > 4. If the patient has severe sepsis, the clinician should initiate aggressive sepsis care using either the invasive protocol or the non-invasive protocol.

Thanks and contact Reuben Strayer with any questions or concerns.

Written by reuben

May 14th, 2011 at 6:35 pm

Posted in Sepsis

HIV anonymous test procedure & results in EPIC

with one comment

Dear Carolyn & Winston,

We now have special forms: Stat Laboratory-ANONYMOUS TESTING NEEDLESTICK SOURCE PATIENT REQUISITION

to use in Occupational exposure situations where the source patient is unable to give HIV consent.
Each pre-printed form is used for one source patient. It has 3 special pre-printed code labels. The labels are used by the needlestick coordinator(NSC)/nursing administrator:

1. For the BBFE worksheet p.1
2. For the BBFE worksheet p.2
3. Affix to the green top blood specimen tube-for the rapid HIV test.

The NSC puts this code label on top of the specimen tube labeled with the source person’s name. The NSC knows which code is linked to the specific source patient.

The green top tube goes to the lab with the pre-printed green form with the date & time written in by NSC.

All the source patients have the same name: Stick, Needle
All the source patients have the same MRN 3592458
All the source patients have the same DOB 11/11/1900
All the source patients have the same location 444

Different anonymous code: NS ____ anony

This enables the provider of the exposed person ability to look up in EPIC one patient name: Stick, Needle. The provider does not need to know the source patient name or memorize the MRN. They only need to know source patient name: Stick, Needle.
Results also in SCC.

The ED/EHS provider will be informed of the date, time & code of the source in order to look up the rapid HIV test result.

We need to educate the ED staff regarding this process.
Carolyn, as the ED education link, how do we start this?

I am meeting today with Winston Charles ( at 3:30pm Friday) He is the education link with the Nursing Administrators.

Thank you,

Sandy

Alexandra (Sandy) Derevnuk, MEd, FNP-C
Department of Infection Control
Needlestick/BBFE Coordinator
212-659-9469/Beeper 4475 or 4118
FAX 212-849-2582

Written by reuben

May 13th, 2011 at 6:45 pm

Posted in Epic,Needlestick

Sickle Cell Pain Crisis Admissions

For sickle cell pain crisis admissions, the chronic pain service wishes to be called instead of the hematology fellow. They will come down 24/7 to write analgesia orders. The resident/fellow covering this service carries a cell phone:

(646) 592-0084

If a sickle cell patient has another reason for admission (e.g. medically ill with an infection, chest crisis, hemolytic crisis, etc.) the case should be discussed with the heme fellow.

Written by reuben

May 12th, 2011 at 9:35 pm

CT consent Risks

Written by phil

May 11th, 2011 at 8:30 pm

Posted in Radiology

MSH PSA Physician Checklist

This checklist should be filled out and scanned into the chart whenever procedural sedation and analgesia is used. What counts as PSA? Well it’s at the bottom of page 1:

PSA is being performed when, in a non-intubated patient, benzodiazepines and opioids are used in combination in sufficient doses to depress level of consciousness, or when ketamine is used in dissociative dose (>1 mg/kg IV), or when propofol or etomidate is used in any dose. Use of barbiturates to facilitate painless procedures (e.g. imaging studies) is also considered PSA.

This is the old checklist without ASA Class and Mallampati. We were asked to include ASA Class and Mallampati.

Written by reuben

May 9th, 2011 at 3:50 am

Posted in Analgesia & PSA

Dr. Himmel Admits

The procedure is very straightforward and well established. Dr. Himmel is intimately involved with the Vascular Service. He directs the Vascular Clinic. He has considerable clinical acumen and when he makes a determination that a patient requires admission to the Vascular Service the patient should be admitted to the faculty member on call for the faculty practice. I regularly admit patients that Dr. Himmel has determined require admission to the Vascular Service.

I will address this issue with the Vascular team and Dr. Divino will instruct the General Surgery house staff.

In the future if the ED staff are having any difficulty with the disposition of these patients, do not hesitate to contact me directly. My page # is 917-205-0504 and my cell # is 646-300-4239.

Thank you for bringing this matter to my attention,

Peter Faries

Peter L. Faries, MD, FACS
Franz W Sichel Professor of Surgery
Chief, Division of Vascular Surgery
Mount Sinai School of Medicine
Telephone: (212) 241-5386
Facsimile: (212) 534-4079

Written by reuben

May 6th, 2011 at 4:54 pm