A Message from Sue Eckert - Washington Hospital Center

Wednesday, May 8, 2013 Vol. 3 No. 10
A Message from Sue Eckert
Dear Nursing Colleagues:
I am always impressed by the amazing hard work, compassion, caring and
dedication among the nurses at MedStar Washington Hospital Center. This
week—Nurses Week—is a wonderful time to say once again that what you do
every day is extraordinary.
It’s also a perfect time to thank those who helped shape our professionalism and
practice: our mentors.
Like many of us, I came to nursing because I had a family member who was a
nurse and who loved it. My mom had a wonderful, 45-year career as a staff nurse
in pediatrics and as a med-surg nurse, and her stories inspired me to think of
nursing for my own career. Nursing appealed to my sense of altruism and our
family’s belief that it is important to give back to the world.
From my first year at Massachusetts General Hospital back in my hometown of Boston, I had other mentors
who showed me how to be the best possible nurse.
For example, when I came to MedStar Washington Hospital Center in 1979, my preceptor—Nancy Barton,
who still works on 4G SICU – taught me that knowing why I was doing something was more important than
just doing a task. She helped me learn that all patients, even the unconscious or dying, need a nurse to touch
and care for them.
Donna Canfield, a former senior nursing director here, taught me to always practice with integrity and do the
right thing. And Sandy Marshall, the former Chief Nursing Officer here, taught me how to ensure that
nursing is always at the table and has a voice in all matters related to patient care.
As we celebrate Nurses Week, I want to thank all of you for what you do every day. Your work is deeply
appreciated.
I also want to give a special thanks to those who helped us get here. Because they were more than just
nurses...they inspired us to be our best. This week, share your stories about the mentors who shaped your
practice. It is just one more way to honor the job we all do.
Sue

HOT TOPICS
Happy Nurses Week!
Don’t miss out on the remaining events for Nurses Week.
Thursday, May 9
• Boot Camp: 11 a.m. to 1 p.m., 4B45 Conference Room. Wear comfortable shoes and clothes. Bring
energy!
• The Professional Workshop: 10 a.m. to noon, and 1 to 4 p.m., 3NW Conference Room. Join a
professional organization. Lifelong learning, certifications and degree programs.
• NICHE Rodeo: Presented by Elizbieta Kmiecik
• A Day of Accolades: Candy Gram thank you notes delivered today.
Friday, May 10
• Guest Speakers: 11 a.m. to 1 p.m., True Auditorium. Paul Clements, PhD, APRN-BC,
CGS, DF_IAFN, and Cathy Riesenberg, PhD, FNP-BC lead discussions on: Vulnerability
Risk Assessment, Workplace Violence. Strategies for dealing with the aggressive patient.
Submitted Wednesday, May 8, 2013
Medicine Physicians and Nurse Practitioners
Contact List
Attached is an updated chart on how to contact our medicine physicians and NPs.
Submitted Wednesday, May 8, 2013

HOT TOPICS
New MedStar Health Advertising Campaign
On Sunday, April 28, MedStar Health launched a multi-media (TV, radio, print and online) campaign
promoting our healthcare system as the most accessible in the region. As the largest healthcare provider in
Maryland and the Washington, D.C., region, MedStar's 10 hospitals, the MedStar Health Research Institute
and a comprehensive scope of health-related organizations are recognized regionally and nationally for
excellence in medical care. View the television ads — four 30-second commercials; two for the D.C. market
and two for the Baltimore market — at www.MedStarHealth.org/CloseToYou.
Submitted Wednesday, May 8, 2013
Wireless Network Upgrades Continue on May 10
and 17
The wireless network upgrade will continue on May 10 and 17, from 11:30 a.m. until noon. During this time,
MedConnect and other systems will be available from desktop computers, such as the ones on each nursing
unit. However, WOWs, MC75s and other devices that work through wireless network access will not be
accessible for this 30-minute period. Please make a note of these dates.
Chinese Nurses Visit MedStar Washington
Hospital Center
Submitted Wednesday, May 8, 2013
On April 25, MedStar Washington Hospital Center and Washington Cancer Institute hosted chief nursing
officers from nine of the largest cancer hospitals in China, as well as the editor of the Chinese Journal of Nursing
Education and a nursing professor from Fujian Medical University. These nurses were attending the annual
Oncology Nursing Society Congress and interested in touring an American hospital and cancer center. The
nurses toured 2NW and 3NE and Washington Cancer Institute (WCI), followed by a reception where David
Perry, MD, and Carolyn Mitchell, nursing director of WCI, welcomed them to the United States and our
institution. Comparisons of cancer care between the two countries were discussed, as well as nursing
education and professional development of oncology nurses.
Submitted Wednesday, May 8, 2013

HOT TOPICS
ECHO Lab Now Providing Weekend Coverage
To eliminate barriers to patient discharge and reduce length of stay, the ECHO lab has expanded its hours on
weekends. Effective May 4, the lab will be open from 7 a.m. to 1 p.m. on Saturdays and Sundays. The expansion
will be re-evaluated based on utilization by the third week of May to determine hours of operation for June.
Operationally, the ordering process for inpatients will not change. Maggie Curry, chief NP, Cardiology Ward
Service, and her team will continue to assist the ECHO team in prioritizing requests. Nursing units should
contact the ECHO Lab (at ext.7-6700) between 8 and 10 a.m. and provide the names of patients requiring an
ECHO study to facilitate a hospital discharge. The phone (ext. 7-6700) will be forwarded and covered by the
EKG department. Note: If a patient pending discharge is identified after 10 a.m., please contact Jean
Manansala, RN, at jean.manansala@medstar.net or David Zwerski at david.p.zwerski@medstar.net.
Farmers Market at the Hospital Center
Submitted Wednesday, May 8, 2013
The Hospital Center has joined with Children’s National Medical Center to host a farmers market every
Wednesday from 1 to 3 p.m. from May 1 until October 30, near the picnic tables behind the East Building
(near the parking lot for gamma knife patients).
The market is open to everyone—associates, patients and visitors, and matches SNAP/EBT, WIC, and Senior
FMNP (up to $10 per visit: for example, $10 in SNAP/EBT, buys $20 of fruits, vegetables, eggs, or meat).
Submitted Wednesday, May 8, 2013

PHARMACY
FDA Recommendation for Lower Doses of
Zolpidem (Ambien)
In January, the FDA announced it was requiring the manufacturers of the zolpidem-containing products
Ambien, Ambien CR, Edluar and Zolpimist to lower the doses for women, and to recommend in their labeling a
lower dose for men. These drugs used to treat insomnia can cause impairment of driving performance as well
as an increased risk of falls. As a result, the Pharmacy and Therapeutics Committee has recommended that
initial doses be limited to 5 mg. The 10 mg option will be removed from the preprinted order sets. This will be
phased in during the next two weeks. In addition, the order “may repeat 1x” will also be removed. If the first
dose is not effective, the prescriber should be contacted to re-evaluate the patient. Questions may be referred
to the Pharmacy at ext. 7-6646.
EDUCATION/RESEARCH
Submitted Wednesday, May 8, 2013
Nursing Evidence Based Practice Grand Rounds:
High-Alert Medication Safety
What is the research on safety with intravenous high-alert medications? Read the research and come to discuss
on Wednesday, May 15, from 8 to 9 a.m., or noon to 1 p.m., in 3NW Conference Room. BYO lunch or snack.
You can practice evaluating research studies using our evaluation guides on the Nursing Research website, or
see attachments for the grade summary of findings and for individual evidence table. EBP Grand Rounds are
approved for one contact hour by the Maryland Nurses Association. No registration necessary. For more
information, email patricia.r.mccartney@medstar.net.
• Porat N, Bitan Y, Shefi D, Donchin Y and Rozenbaum H (2009). Use of color-coded labels for
intravenous high-risk medications and lines to improve patient safety Quality & Safety Health Care
18(6), 505-509. Link to the Full Text:
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=medl&AN=1995
5466
• Dennison R. (2007). A medication safety education program to reduce the risk of harm caused by
medication errors. The Journal of Continuing Education in Nursing, 38(4), 176-184. Link to the Full

EDUCATION/RESEARCH
Text:
http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&D=med4&AN=1770
8117
PATIENT CARE/PRODUCTS
Submitted Wednesday, May 8, 2013
Feeding Pump Conversion Go-Live May 15
The Hospital Center will be converting to a new Kangaroo Enteral Feeding Pump on May 15. Product
representatives will provide roving educational in-services during the morning and evening shifts on May 12,
13 and 14. (For additional educational material, see attachments or go to www.kangaroopumptrianing.com.)
On the morning of May 15, new pumps and associated bags will be brought to each unit and the old products
removed.
Back-Order Alert
Submitted Wednesday, May 8, 2013
The empty evac bottles used for paracentesis have been on a long-term manufacturer back-order. Arrival of
this item is expected in September. Until further notice, please order a Thoracentesis Kit (Arrow AK-01000)
and use the drainage bag inside the kit for drainage.
Submitted Wednesday, May 8, 2013

PATIENT CARE/PRODUCTS
Rubbermaid Representatives on Units Next Week
Rubbermaid representatives will add brackets on the new Rubbermaid WOW carts next Monday and Tuesday,
May 13-14. It should only take a couple of minutes per cart, so there should be minimal disruption to
workflow.
Submitted Wednesday, May 8, 2013
Clarification Regarding Labeling of IV Tubing
There has been some confusion about writing the date on the IV tubing change label. It is not necessary to
write any date on the IV tubing label. The color and the printed day should alert the nurse as to when the
tubing needs to be changed next.
If you do choose to write the date on the label, write the date of the day it next needs to be changed. An
illustration is attached. Contact your unit educator or clinical specialist with questions.
Submitted Wednesday, May 8, 2013
Supply Interruptions of Integra’s Cranial Access
Kit
The hospital has had supply interruptions with Integra’s Cranial Access Kit (Lawson # 56109) over the past few
months and is now using a substitute item from Codman (manufacturer # 82-6614). If there are no
complaints about this item, we may make this a permanent change.
Submitted Wednesday, May 8, 2013

KUDOS
Congratulations! CLABSI rates for March are
down!
• ICUs’ rates: 1.2
• Non-ICUs’ rates: 0.8.
Keep up the great work!
--Nursing CLABSI Committee
Submitted Wednesday, May 8, 2013
Nurse Presents Poster at International Meeting
Kristina Hildago, RN, ARNP, presented a case study at the International Society for Heart and Lung
Transplantation in Montreal, Canada on April 24 about one of our LVAD patients.
A Nurse with a Big Heart
Submitted Wednesday, May 8, 2013
On Friday, May 3, Cardiovascular Recovery Room Nurse Natalie Suttles, RN was honored for excellence by the
National Capital Area Chapter of Mended Hearts. Neal Gregory, president of the local chapter spoke about
Natalie, a 13-year Hospital Center nurse, “You are someone who personifies the best in nursing,” he said. “You
are a role model for patients and family interaction. You often call and check on your patients on your day off.
You stand up for your patients.” Natalie, who was surprised by the award, which her department planned, said,
“I love working in the CVRR, I love the management, and I love the people I work with.”
Submitted Wednesday, May 8, 2013

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FullTimeNocturnist:
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HospitalistNP’s
SarahSabo#0744
MichelleMelenwick#2277
AnneNyman#6550
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JudyCunningham#(TBD)
HospitalistOfficeCoordinator:
LisaLane:2028770393

TherehasbeenconfusionregardingwritingthedateonIVtubing
labels.
ItisnotnecessarytowriteanydateontheIVtubinglabel. Thecolor
andtheprinteddayshouldalertthenurseastowhenthetubing
needstobechangednext. g
Ifyoudochoosetowritethedateonthelabel,writethedateofthe
dayitnextneedstobechanged.
dayitnextneedstobechanged.

1.
3.
4.
5.
Kangar oo ePump
Normal Operation
Enteral
F eeding Pump
“F eed Only Set” Directions
For
Use
Battery
Operation
Unplugging
the
pump
from
m t
he
AC
line
will
automati
cally
put
the
p u ump
on
battery
power.
To
recharge
the
b a t t e r y , p lu g t h e p u m p i n t o o a
a n A C w a l l o u t l e t . P u m p w i l l a u t o m a t i c
a
l
l
y b
e
g
i
n c
ha
r
g
i
n
g
.
General
Instructions
Fill
or
spike
feeding
contain
e er
prior
to
setting
up
pump.
2.
Turn
pump
on
– Press
1.
2.
1.
In
order
to
achieve
pro
p per
accuracy,
the
bottom
of
the
fe
e eding
set
bag
must
be
18
inches
above
the
top
of
the
fe
e eding
pump.
Sele
the
ct
Pow
e er
button
in
lower
right-hand
corner.
“ Keep
Settings”
or
“ Clear
Settings”
( for
day
t o d day
use
with
the
same
feeding
regimen
“ Keep
Settings”
o option
should
be
selected)
.
Load
the
Feeding
Set
per
di
a agram.
Do
not
overstretch
the
tubing.
“ i ”
p m u e P h g t n i m i r P
Press
“
Prime
Pump”
t o a access
t h he
pump
priming
options.
Press
“
Auto
Prime”
t o a automatically
prime
the
pump
set.
The
e p
ump
will
quickly
prime
the
feed
line
and
stop
the
formula
befor
e r reaching
the
end
of
the
feeding
line.
3.
Press
the
4.
Press
“
H
“ Done”
.
old
To
Pri
m me
Feed”
menu
selection
to
manually
y t
op
off
the
line.
Setting
the
Feed
Rate
Select
“
Adjust
Feed”
t then
“
Feed
Rate”
use
the
buttons
s o
n the
left
to
program
the
pump
from
1 to
400
in
increments
o f 1 m mL.
Select
“Enter”
when
desired
d r
ate
is
set.
Note
e:
the
Volume
To
B e D Delivered
“ VTBD”
Rate
is
an
Opti
i o onal
Featuu
re
Only
use
the
“ VTBD”
option
if
you
want
the
pump
to
stop
and
alarm
o once
a set
amount
of
formula
is
Select
“ Feed
VTBD
” . Use
the
buttons
on
the
left
to
program
the
VTBD
from
1 to
3000
in
increments
of
1 mL.
Sel
e ect
“Enter”
when
desired
VTBD
i s s set.
2. Select
“ Run”
. You
wil
l n notice
a small
drop
d
elivered.
Re-Priming
the
Pump
Af
f ter
the
Feed
Bag
Empties
1.
A pump
set
bag
that
has
been
emptied
will
trigger
the
Feed
Error
screen.
In
this
condition
the
pump
set
bag
can
be
refilled
to
continue
the
feeding,
but
only
after
the
pum
p s set
has
been
re-primed.
2.
Disconnect
the
feeding
lin
e f from
the
patient.
3.
Refill
the
bag.
4.
Press
“
Continue”
to
b e egin
the
pump
running.
5 5.
P r e s s “H
o
l
d
” , t
h
e
n p
r
e
s
s “ A d j u s t S e t t i n g s s”
, t h e n p r e s s “ P r i m e P u m p p”
.
6.
Press
7.
Press
1.
2.
3.
4.
“
H
“
Done”
, then
sele
e ct
scrolling
down
t h he
screen
when
running.
old
To
Prime
” to
prime
the
line.
( Do
Not
Use
Auto
Prime)
“ Run”
To
Change
Rate
or
Clear
r V
olume
Select
“Hold”
.
Select
“
Clear
Vol
Fed”
” to
clear
the
volume.
Select
“
Adjust
Settings”
to
adjust
all
settings.
Select
“
Run”
to
return
n t
o normal
operations.
Pump
sets
should
not
b e r reused
after
24
hours
of
initial
usage.

Kangaroo
ePum
p
Troubleshooting
Guide
Listed
below
are
some
of
f t
he
probable
causes
of
alarm
co
o nditions
and
their
corrections.
SYMPTOM
Hold Error
Flow Error
Feed
Error
Flow Error
Use > 24
Hrs
Pump Set
Dislodged
Battery Low
Rotor Error
System
Error
Menu Selections
Progr
amming & Menu
Selection Buttons
PROBABLE
CA USE
Pump in HOLDING mode for
more than 10 minutes minutes.
Occlusion in pump-patient
line.
(downstream occlusion)
Empty bag or occlusion in
bag-pump line.
(upstream
occlusion)
Pump Set in use beyond
recommended length of time time.
Pump Set not properly
loaded to pump.
Battery charge too low low.
Pump Set tubing not properly
loaded on rotor,
or some
other unusual rotor operating
condition.
Gener al error caused by
many factors.
See Manual for
error list.
Enteral
Feeding
P u ump
02048
CORRECTIONS
Status LEDs
Red=Error
Yellow=Hold/Pause
Green=Normal Operation
Power
Button
Press CONTINUE to return to HOLDING screen, or press and
hold the Power
button to turn urn off
f. . Several
options are available
from the HOLDING screen,
such as RUN
or ADJUST SETTINGS.
Check for and correct the occlusion in the line between pump and
patient. Replace Pump Set if error cannot be resolved.
Check for empty bag and refill,
or check for and correct the
occlusion in the line between the pump and feed bag.
Replace
Pump Set if error cannot be resolved.
Informational warning
arning message blinks on upper left of screen.
It is
recommended that the Pump Set be replaced.
Check black ring retainer (MISTIC) and v
alve; reload Pump Set and
restart pump to continue.
Replace Pump Set if error cannot be
resolved.
Immediately plug pump into
A/C outlet to recharge battery and to
provide power for pump.
Check that the tubing is loaded on the rotor and that it is not
damaged, torn, etc. Reload tubing or replace Pump Set.
P ower down pump and attempt restart to clear error error.
Call customer
service with screen code if error cannot be resolved.
COVIDIEN,
COVIDIEN
with logo,
Covidien logo logo,
positive results for life and Kangaroo ePump
are U.S.
and/or internationally registered tr trademarks
of Covidien AG.
©2009 Covidien.
H6202-5M-1209
15 Hampshire
Street
Mansfield,
MA
1-800-962-9888
508-261-8000
www.c .covidien.c
om

MEDSTAR WASHINGTON HOSPITAL CENTER – DEPARTMENT OF NURSING
Appraising Evidence Guide: Individual Study Evidence Table
Full APA citation for study:
Question:
Purpose,
Aims,
Research
Question,
PICO question
Why did they
do the study?
Methods:
Design, Sample, Procedures,
Outcomes
Who could be in the study? How was the
study done? What was measured?
Type of Study (Design)
• Randomized Controlled Trial
• Observational Study
Non-randomized controlled trial with
an intervention
Non-experimental cohort or casecontrol
study of an intervention
• Any Other Evidence
Descriptive, Qualitative, Case Study
Performance data (PI, QI, audits,
indicators, benchmarking)
EBP Project
Practice guidelines
Expert opinion, textbook, authority,
vendor
Methods
• Population/sampling method
Inclusion/exclusion criteria
recruitment
• Setting
• Procedures
Intervention, instruments, training,
data collectors, variables defined
• Outcomes
Findings:
Quantitative-statistics
Qualitative-themes
What did they find? Who
actually ended up in the
sample?
• Final sample, drop-outs
or attrition
• Quantitative
Key outcome data
Statistical significance
• Qualitative
Key Themes
Discussion:
Conclusions
Interpretation
Limitations
Implications
What can we be confident
in? What can we use?
• Overall conclusion to
learn based on the
findings
• Clinical significance of
findings
• Limitations
Bias
Method flaws
• Implications
To use in practice
Publication:
Are we confident in
this report?
• Based on review
of literature
• Completeness
Procedures
Outcomes
• Bias
Author, vendor,
publisher

MEDSTAR WASHINGTON HOSPITAL CENTER – DEPARTMENT OF NURSING
Appraising Evidence Guide: Individual Study Evidence Table
Full APA citation for study:
Question:
Purpose,
Aims,
Research
Question,
PICO question
Why did they
do the study?
Methods:
Design, Sample, Procedures,
Outcomes
Who could be in the study? How was the
study done? What was measured?
Findings:
Quantitative-statistics
Qualitative-themes
What did they find? Who
actually ended up in the
sample?
Discussion:
Conclusions
Interpretation
Limitations
Implications
What can we be confident
in? What can we use?
Publication:
Are we confident in
this report?