April Staff Meeting 2pm

Kim Byrum Chappell Mechanical Assist Coordinator

 Ventricular  Assist  Device

 End stage Heart Failure  BTT (Bridge to Transplant) – Vanderbilt  Under the watchful eye of the Transplant Coordinators  DT (Destination Therapy) – St. Thomas. These patients will live with this device until death. They are not transplant candidates.

 Pulsatile  Continuous Flow  Axial Flow  Centrifugal Flow

 Currently 8 patients are followed by Vanderbilt  St Thomas also implants VAD’s and those patients could show up at our doorstep  The current VAD you would encounter in the ER is CONTINUOUS FLOW VAD called the Heart Mate II (HMII) made by Thoratec, Inc. (Axial Flow)

 Will most likely not be able to palpate peripheral pulses  Most likely unable to obtain SBP/DBP  Most reliable/accurate measurement is by Doppler  Document under Manual MAP

 VAD patients will be on anticoagulants –  Coumadin  Aspirin  Rare – Persantine, Plavix,  More rare/rumor – Dabigatran: there has been discussion around this Afib approved drug but it has not been used here…..no antidote.

 Pump – inside the patient (sounds like humming)  Driveline – white tube; exits somewhere in the abdominal area  System Controller – the brains  Battery or Power Base Unit – the power

 Will bring a back up system controller & batteries in case of a failure; typically in a black bag. Must remain with patient at all times, for all tests/procedures, transport, etc.  Do not unplug cables to silence any alarm.  Do not unplug both power cables at the same time.

 VAD pager #  Thoratec supplied items:  Clinical Operations and Patient Management book  HMII Information and Emergency Assistance Guide pamphlet  HMII LVAD Pocket Guide to alarms for Clinicians  Outpatient Emergency Response Program CD  Thoratec Thoratec.com

 If they are speaking to you, if they are warm, pink & with brisk capillary refill they are perfusing.  It’s a patient with a pump, not a pump with a patient – so treat the patient.  Can auscultate the pump  Floors trained in VAD patients: 5N & 7N  You can’t always tell a VAD patient at first glance

David Pipes and Mike Malone

Crisis Intervention Training

 A new Joint Commission Sentinel Event Alert warns that health care facilities today are being confronted with steadily increasing rates of crime, including assault, rape and murder.Sentinel Event Alert  A report from the Substance Abuse and Mental Health Services Administration notes that drug- and alcohol-related incidents in the ER rose from about 1.6 million in 2005 to nearly 2 million in From 2006 to 2008, those visits resulting in violence increased from 16,277 to 21,406. Just last year, more than half of 3,465 emergency nurses reported in an anonymous, online survey conducted by the Emergency Nurses Association being assaulted at work  Health care facilities should be places of healing, not harm. But, unfortunately, health care settings are not immune from the types of violence that are found in the other areas of our lives," says Mark R. Chassin, M.D., M.P.P., M.P.H., president, The Joint Commission. "The recommendations in this Alert give health care institutions and caregivers specific strategies to take action that will keep everyone safer  Source:

 There are well over one hundred thousand Handle With Care practitioners working with adults and children in some of the most challenging environments in the United States, Puerto Rico and Europe.

 Every verbal and physical component of Handle With Care training has been carefully integrated with the next, creating a system that is beautifully simple and coherent.  Those who complete HWC training will have the verbal and physical tools to effectively to de- escalate a crisis before it begins.  When a crisis presents a clear physical threat, they will be able to make "real time real speed “interventions with confidence.

Verbal Intervention (De-escalation) o The Solid Object Relationship Model (SORM) o The Tension/ Tension Reduction Cycle (T/TRC) o The HWC Role-Play Workshop

 The Solid Object Relationship Model (SORM) Illustrates how staff can develop and utilize their relationship skills with a youth to reduce tension.  Emphasize the importance of staff maintaining an “affect neutral” posture 2. Understand the underlying dynamics of establishing a therapeutic relationship 3. Understand the testing process and begin to identify our personal stressors (“buttons”) 4. Participants examine their own reactions in critical situation

 The Tension / Tension Reduction Cycle Model (T/TRC) Theoretical model used to illustrate the dynamics of escalating and de-escalating tension as it applies to the youth in crisis, intervening staff and other youth and staff exposed to the crisis 1. How tension contributes to inappropriate behavior in youth and staff 2. Identify responses and behaviors that indicate tension levels are rising 3. Understand how the T/T Reduction Cycle relates to observations of self, staff and youth 4. Understand when verbal and/or physical interventions become necessary 5. Understand when to withdraw from an intervention

Physical Intervention o The Personal Defense System o The Primary Restraint Technique (PRT)® o The Modified PRT for Smaller Children o Team Restraint

Personal Defense - Escape Techniques from: 1. Same side wrist grab 2. Two on one wrist grab 3. Two on two wrist grab 4. Cross hand grab 5. Front choke / lapel Grabs 6. Rear choke 7. Hair pull 8. Bite 9. Arm bar choke from behind Use of Personal Space 1. Spatial considerations and strategies 2. The Non-Defensive Posture Personal Defense - Blocking Techniques 1. Straight punch / straight incoming assault 2. Hook punch / blunt weapon / thrown object 3. Kicking assault

The Primary Restraint Technique (PRT) & Takedown Interfacing the PRT with the entire Personal Defense System Two Person Escort / Two Person Team Restraint & Takedown The HWC Speed Cuff System (optional) One Person PRT (standing & neutral position) Two Person PRT (standing & neutral position) Two and Four Person Team Restraint, Takedown & Transport S Specialized Intervention Strategies Breaking up fights Managing pregnant women Managing small children Therapeutic use of seclusion and mechanical restraints (optional)

Ten Minute KiaNexius Training:

EDUCATION UPDATE  Mandatory May Inservice  Annual Competencies  Philips End Tidal CO2 Monitoring (next slide)

Philips End Tidal CO2 Monitoring By Cathy Wilson

MANAGER UPDATE  Hand Hygiene- overall for March 74%, down from Feb. 75%  Service Center Committee  Equipment: dinamap / A Pod Trauma Monitor  Staffing Variance  RNs- 2 FTE vacancies / 1 PTE (multiple interview completed)  Paramedics- 3 FTE vacancies  MHT- position filled  Care Partners- 3 FTE vacancies (multiple interview in progress)

 CONGRATS Vanderbilt list at top 100 Hospitals  CONGRATS on 2011 Healthgrade.com Award  Uniform Trial- going well so far, only a couple issues (4/1-9/1/2011)  Welcome to all new Nurse Residents  New Social Worker: Lauren Goley Sat-Mon 7p-7a  Time and Attendance / Deadlines / s  Spindle

 Kudos  QUESTIONS???  As always my door is open to anyone who would like to come and talk, please come talk to me I encourage you to!