Good Question: Where Do I Find Out How to _______________?
A Clinical Standards Update
By Mary Erickson, Cindy Eshelman, Kim Lorence, Lottie Rike, and Barb Wang.
We are constantly striving to improve our nursing practice in order to provide the best outcomes for our patients and families. Continuous improvement involves changes that may be difficult to incorporate into our practice, leaving gaps in our ability to access information needed to perform our jobs at the bedside.
Children’s has made a transition to the electronic medical record. We are now in a phase where we will learn to search electronic references for Evidence-Based
Practice (EBP) standards of care, instead of relying on Children’s internal Clinical Standards manual. We should expect some anxiety until information is more readily available and we are more familiar with where to access quickly the information we need. Practice makes better, not perfect.
Why is this change necessary? Three years ago, the Clinical Standards team, working with representatives of the advanced practice registered nurses (APRNs) at Children’s, began to explore the use of nationally standardized references. Our previous process of sending standards through our committee was labor-intensive and could take months to complete updates and approvals. Standards were at risk of being outdated by the time they were approved and posted. Evidence-Based Practice standards and protocols are becoming available through electronic nursing reference companies. EBP protocols are practice approaches based on clinical consensus, trials and/or research findings. Experts across the country regularly and expediently update on-line resources. Multiple professional nursing and health care organizations develop standards to direct the best practice of care. Examples of such organizations include the American Academy of Pediatrics, the Institute for Healthcare Improvement, the Cystic Fibrosis Foundation, the American Diabetes Association, and the Association of Pediatric Oncology Nurses.
References currently used on our units comprise a variety of online and textbook resources.
Medication resources include: - Micromedex
- Lexi-Comp Pediatric Dosage Guide
- Children's Standard Dosing Reference
- Children’s Medication Resource Center (formulary information, pharmacy web page with links to Micromedex)
- Pediatric Dose Handbook
The Lab Manual is an on-line lab reference with step-by-step instructions for lab specimen collection, transport, timing, etc.
We also currently use online Clinical Standards, Policies and Procedures, and textbook manuals.
Nursing clinical standards will eventually be limited to standards that are nursing only but not considered part of basic nursing practice. The remaining clinical standards would cover those topics not available in pediatric textbooks or other available references. Outdated paper copies of deleted clinical standards would be considered obsolete.
Policies & Procedures now include some practices that were formerly clinical standards. If a process, procedure or skill is performed by multiple disciplines, it should be found in Policies and Procedures. (Example: blood product administration could be performed by nursing or anesthesia.)
Reference textbooks have been purchased for each unit. These will be useful for looking up nursing procedures not currently found in either the Clinical Standards or Policies and Procedures. (Example: Enema administration).
Mosby’s Nursing Consult is an on-line reference that is already in use at Children’s. In 2008, Mosby’s Pediatric Clinical Standards will be made available electronically.
So for the present, the best answer to the question, “Where do I find out how to _________?” is: check the Clinical Standards first. If what you are looking for is not found there, then search the on-line Policies and Procedures. If you cannot find it there, check the reference textbook on your unit until the Mosby’s Pediatric Clinical Standards product is in place and has been reviewed by a group of APRN representatives from all the nursing divisions at Children’s.
Being able to find these tools is critical to providing safe care to our patients. It is too bad that things can’t just come to a halt so that we can get the new reference system in place, and then reopen the doors and resume providing care. We all know that health care is not that way. We need to support each other and the system as we move through these changes. Remember that you can access references while in your patient’s chart by clicking on the Launch Applications icon, which saves several steps - ask your Super user to show you how.
Practice Makes Better: Five Searches To Hone Your Skills
Scenario #1: You need to administer albumin.
Option 1: Use the Pediatric Dose Handbook.
Option 2: From your patient’s chart, - Click on Launch Applications->Clinical Links->StarNet->Clinical References.
- Scroll to Micromedex
- Search Albumin
- Select Drug Summary results
- Choose “human albumin” (this is the only type of albumin Children’s stocks)
- Using the left column table of contents, scroll to select Administration and Monitoring
- If you still have questions, call pharmacy – albumin is considered a drug instead of a blood product.
Scenario #2: Your patient needs flu vaccine before discharge; it’s been awhile since you gave an IM - Ask yourself if more than one discipline might give an IM medication. Anesthesia, nursing, or physician might. Since more than one discipline could give an IM, the information you are looking for should now be in the Policy and Procedure reference
- On StarNet, click on Clinical References
- Scroll to Policy and Procedure manual.
- Within the manual, search IM medication administration.
- Policy #314.00 Medication Administration and Monitoring is a very lengthy policy. Scroll to the end to find information on IM administration.
Scenario #3: You need to instruct a family on administering ACTH injections at home.
- You will need 2 different Patient/Family Education Forms (PFEMs): ACTH For Infantile Spasm, and Injections (Intramuscular). PFEMs can now be accessed from the Clinical Reference page on StarNet.
- Scroll past External References to Patient Education.
Scenario # 4: You need to collect an RSV specimen by nasal washing/aspiration. - This is considered a lab procedure. On StarNet home page, click on Departments/Committees, then Laboratory Services.
- RSV is viral, so it is in the microbiology/virology section of the Lab Manual. Click on this section and scroll to RSV FA test for all the detailed requirements for a successful test completion – container, timing, etc.
- Scroll down to collection for the step-by-step procedure
Scenario #5: Your patient has an IV infiltrate of a vesicant medication with extravasation. - The extravasation list has a new home: it can be accessed in on the Clinical Reference Page.
- Go to Manuals and choose Medication Resource Center –Formulary Information.
- Choose Medication Safety
- Choose Medications Associated with Extravasation.
Mary Erickson, RN, CNP, is an APRN in pediatric at Children’s. Cindy Eshelman, RNC, is a clinical educator on 6th Floor. Kim Lorence, MS, RN, CPNP, is a clinical education specialist in the Center for Professional Development and Practice. Lottie Rike, RN,C, is a clinical educator on 6th Floor. Barb Wang, RN, BSN, is a staff nurse on 6th Floor. |
