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Archive for April, 2012

High Level Disinfection for transvaginal ultrasound probes

All faculty and residents- please note this important workflow change for high level disinfection of the transvaginal ultrasound probes:

After use of the Sonosite ultrasound probe for vaginal exam, the Charge Nurse (zone phone 78740) must be notified by the examiner to facilitate disinfection of the probe prior to the next exam.

The Charge Nurse will select an ED Technician (trained in the new process) who will remove the probe and cable from the machine for transport to the East Dirty Utility Room. There a Trophon machine that uses heated vapor and a concentrate of H2O2 will be used for disinfecting process. Only those who have completed a criterion checklist and competency under the supervision of persons designated can use the Trophon machine.

The ED Technician will then:
1. Disinfect the ultrasound probe using the Trophon machine per protocol
2. After disinfection, return the ultrasound probe to its proper location on the ultrasound machine
3. Wipe down the ENTIRE ultrasound machine (everything except the vaginal probe) using germicidal wipes

Please let me know if there are any questions or issues with this process. It has been mandated by Sinai’s Infection Control team; compliance, by definition, is mandatory.

Bret P. Nelson

Written by reuben

April 26th, 2012 at 5:49 am

Posted in Ultrasound

Emergency Release Protocol for Uncrossmatched Blood Products

1. Know the patient name and MRN
2. Call the blood bank, extension 46101
3. “This is Dr. Jones calling from the emergency department, may I speak with the blood bank supervisor or most senior technologist.”

4a. “We have a bleeding emergency, we need 2 units uncrossmatched blood immediately.”

4b. “We have a bleeding emergency, we need 4 units uncrossmatched blood immediately.”

4c. “We have a massive transfusion, we need a massive transfusion pack immediately.”
a massive transfusion pack is 4 u pRBCs, 4 u FFP, 1 platelet pack, and 1 pooled cryoprecipitate

5. The blood bank will immediately send you the products via pneumatic tube (The ED specimen desk is tube station #11), along with an emergency blood release / massive transfusion protocol form. Nothing has to be done in Epic to get the products.

6. As soon as you are able, fill out the form and send the form back to the blood bank, tube station #114. Fill out either the top of the form (emergency blood release) or the bottom (massive transfusion). The areas you need to fill out are conveniently highlighted in yellow. Signature, license number, reason for transfusion, and check the order.

ED Code Blood Scrip (pdf)

Blood Bank Emergency Release Form

Blood Bank Emergency Release and Massive Transfusion Protocol v5

Written by reuben

April 23rd, 2012 at 7:45 pm

Posted in Blood Bank

New Endocavitary Probe and Glidescope Flow

Dear Doctors and PAs,

We now have an easy, 7 minute process for high level disinfection of our vaginal probe for the ultrasound machine! Because the disinfection needs to be logged by a credentialed person, the techs will be in charge of this process.

We are also going to be taking our Glidescope blades to the sterile processing department (SPD) for sterilization until further notice.

I am forwarding Dwayne’s email below so you can see the workflow message that has been sent to the techs and nurses.
________________________________
From: Raymond, Dwayne
Sent: Friday, April 13, 2012 5:39 PM
To: Gardner, Keri; Baumlin, Kevin; Vella, Adam (MSSM); Fakih, Francine
Subject: High Level Disinfection Processes

There will be no change in practice until Monday (4/16) with another notice.

Process change #1, pending a few things on Monday:

After use of the Sonosite probe for vaginal exam, the Charge Nurse must be notified, by the examiner, to facilitate disinfection of the probe prior to next exam.

Thereafter, the Charge Nurse will select an ED Technician (trained in the new process) that will remove the probe and cable from the machine for transport to the East Dirty Utility Room. There a Trophon Machine that uses heated vapor and a concentrate of H2O2 will be used for disinfecting process.

Only those who have completed a criterion checklist and competency under the supervision of persons designated can use the machine.The process takes about 7 minutes.

Process change #2, pending a few things on Monday:

The Glidescope blade and stylet used in the AED will be sent to Sterile Processing Distribution for disinfection. We will be given another set in exchange. Note, the TAT for disinfection is 1 1/2 hours.

We will need to look into the use of disposable blades for the pediatric ED in particular. There isn’t presently a exchange set for pediatrics.

Thank you/Dwayne

Written by reuben

April 16th, 2012 at 5:19 pm

Posted in Airway,Ultrasound

Glidescope Cleaning Process

Written by phil

April 16th, 2012 at 3:34 pm

Vaginal Probe Cleaning Process

After use of the Sonosite probe for vaginal exam, the Charge Nurse must be notified, by the examiner, to facilitate disinfection of the probe prior to next exam.

Thereafter, the Charge Nurse will select an ED Technician (trained in the new process) that will remove the probe and cable from the machine for transport to the East Dirty Utility Room. There a Trophon Machine that uses heated vapor and a concentrate of H2O2 will be used for disinfecting process.

Only those who have completed a criterion checklist and competency under the supervision of persons designated can use the machine.The process takes about 7 minutes.

– Dwayne Raymond

Written by phil

April 16th, 2012 at 3:32 pm

Posted in Ultrasound

Parents in Radiology

Hello,
Please be aware that if appropriately shielded, parents are allowed in room with their child while they are undergoing CT scans. Occasionally techs mention some policy, which does not exist, that parents are not allowed in. According to the email below from Dr. Rosenberg, this is not true. Today I was able to complete a non contrast Head CT on a 21 month old male without sedation. This clearly would not have been possible with the mother out of the room. Be aware that there is no policy against this.
thanks,
Adam

———- Forwarded message ———-
From: Rosenberg, Henrietta
Date: Tue, Apr 3, 2012 at 9:24 PM
Subject: RE: CT
To: Adam Vella

Adam,

If the parent is appropriately shielded, there is no reason why they cannot be in the room. However, having a parent present does not ensure patient cooperation when the patient is of an age when their behavior is likely unpredictable. What age and what type of CT study are you alluding to?

Henrietta

From: Adam Vella
Sent: Tuesday, April 03, 2012 4:53 PM
To: Rosenberg, Henrietta
Subject: CT

Hello Henrietta,

I have a quick question regarding radiology policy. Frequently having a parent in the room with the patient will allow us to complete a study without sedation. If the parent is wearing lead is there some problem with this? I have had multiple radiology techs say that their policy is that parent’s can’t be in the room. Clearly this is not family centered if it is the case. Can we address this from the pediatric perspective?

Adam

Written by reuben

April 4th, 2012 at 1:56 am

Posted in Peds,Radiology

These guidelines are to be used in determining the most appropriate service to which a patient shall be admitted. Clinical circumstances may, on occasion, require the responsible ED attending to make an admission decision that overrides these guidelines.

Patients with the following primary diagnoses are to be admitted to the Surgery Service.

• Lower GI Bleeds
• Pancreatitis with gallstones or if the patient requires an lCU admission.
• Diverticulitis (with or without abscess)
• Appendicitis
• Bowel obstruction (large or small bowel)
• Bowel perforation.
• Cholecystitis
• Cholangitits / choledocholithiasis
• Liver abscess
• Post-operative complication (including DVT) within 30 days of surgery goes to service that operated on the patient.
• Animal bites (except to upper extremity distal to elbow, which goes to service covering hand)
• Frostbite / burns (except to upper extremity distal to elbow, which goes to service covering hand)
• Acutely Incarcerated Hernia
• Spontaneous primary pneumothorax. (This excludes those patients with
underlying pulmonary disease as the probable cause ofthe pneumothorax, such as
COPD, TB, PCP or other HIV-related disease)
• Perirectal abscess
• Cellulitis to be admitted on an alternating basis with medicine (except for upper
extremity cellulitis distal to the elbow, which gets admitted to the service covering hand)

Admissions Criteria Regarding Trauma Patients

Patients with traumatic injury requiring admission are to be admitted as follows: Red Trauma: Surgery (Trauma Service).*
Traumas other than Red Traumas (Yellow Traumas and non-activated traumas)
• More than one organ system injury: Trauma Service.
• Syncope with significant trauma**: Trauma Service.
• Syncope with isolated intracranial bleed**: Neurosurgery Service or Trauma
Service.
• Isolated facial trauma not requiring ICU: Service covering facial trauma.
• Isolated genitourinary trauma: Trauma Service
• Isolated upper extremity fracture: Orthopedic Service (Social goes to Medicine)
• Isolated lower extremity fracture: Orthopedic Service.
• Pelvic Fracture: Hemodynamically unstable and / or accompanied by significant
blood loss: Trauma Service. Otherwise, Orthopedic Service.
• Altered mental status (or post-concussive syndrome) after mechanism of trauma except for syncope (i.e. pedestrian struck, assault, motor vehicle crash): Trauma
service, even if trauma work up is negative.
• Rib fractures: Trauma Service
• Isolated vertebral fractures after trauma: Service covering spine.
* These patients may be discharged ONLY IF the ED attending agrees and the senior surgical resident and / or surgical attending writes a progress note that can be scanned into HMED to document this decision. They should not be downgraded to Yellow Trauma prior to discharge.
** Syncope patients with a traumatic injury should only be admitted to Medicine if they are suspected to be at risk of serious cardiac dysrhythmia or cardiac ischemia as determined the ED attending.

Trauma and General Surgey Admission Guidelines

Written by reuben

April 3rd, 2012 at 6:11 pm

Posted in Elmhurst,Surgery