The Daily Apple™© Volume 1, Number 3

The Daily Apple™© Volume 1, Number 3

From Dr. Mike & Infinity Health Solutions

www.ihealsolutions.com

December 12, 2012 PGY 40 Day #165

BLUEBERRIES ARE GOOD FOR YOU TOO!

What Can You Do To Optimize Your Acute Care?
Take Ownership for Self or Family Member in Conjunction with YOUR Trusted Physician

In The Daily Apple™© Volume 1, Number 1, I promised to “use The Stress Management Workbook, to help maintain order and perspective in what has become an extraordinarily complex and fragmented “business of medicine”. Recently, I have been contacted by Friends and Family who have required acute care for one reason or another. That leads me to fast forward to Acute and Hospital care for this edition.  Specifically, let’s look at what you can do to optimize your care, or your family member’s care, if acute, or hospital care is necessary.  For this purpose; to get family on the same page with Doctors, Nurses and other Caregivers, I have developed the Stompp™*IT** daily rounds checklist.  This comprehensive checklist will help you to help yourself or your loved one get the best possible care from 3^rd parties.  If you wish to use it, contact me via dr.mike@ihealsolutions.com so terms and conditions of use can be clarified.  Without a condition of use agreement, you do NOT have permission to use the form for any reason.  I will respond to email requests for use ASAP.  If you have comments about the form, please feel free to contact me through this blog, or email.

STOMPPIT™© V122012: StepWisely®™© Infinity Health Solutions & MFM

MFM@IHS part of the StepWisely® System for Mission Adhesion & Team Development   WWW.IHEALSOLUTIONS.COM

Stompp™*IT** daily rounds checklist PILOT #6 December 2012 Patient-Family V1: Patients & Families are Part of the Team!

STRATEGIC TARGETED OPERATIONS MANAGEMENT for patient protection*

daily rounds checklist: care coordination and integration tool**

goal: OPTIMAL PATIENT CARE through teamwork (“get everybody on the same page”)

Base data

patient name: sticker

admit date:                                                            today’s date:

admit service:                                           consulting serviceS:

Primary Diagnosis/problem:              reason for admission:                                                                                                              reason in ICU:

Primary service:                                      referring physician:

primary family contact:                    power of attorney:

             CODE STATUS:                                             ADVANCED DIRECTIVES ON THE CHART:

        updated problem list to include:1.  ____________ 2.  __________  3. __________

4.  __________  5.  __________  6.  __________  7.  __________  8.  __________  9.  _______________

              meets admission/discharge criteria for ICU

TARGETS:  SEE SEPARATE GUIDELINES, PROTOCOLS, BUNDLES, INITIATIVES & PACKS** FOR DETAILS & use qi/pi data sheet to list need for new guidelines.

                FAMILY INTEGRITY PROTECTION & PRESERVATION GUIDELINES

1.        ARE WE DOING EVERYTHING POSSIBLE TO HELP THE FAMILY DEAL WITH THE PATIENT’S ILLNESS?

COMFORTABLE? PHYSICAL, EMOTIONAL, FINANCIAL, ISSUES, ETC., FAMILY LEADER, CONFERENCES? DISCHARGE PLANNING? LONG TERM CARE CONSIDERATIONS?  OPTIMAL PATIENT SUPPORT NETWORK ESTABLISHED?

PATIENT INTEGRITY PROTECTION & PRESERVATION GUIDELINES

POPS™ (Patient + Organ Specific Preservation Strategies)

1. ARE WE DOING EVERYTHING POSSIBLE TO OPTIMIZE THE PATIENT’S OUTCOME?

2. ARE WE PROVIDING CARE ACCORDING TO PATIENT’S WISHES?

3. DO WE KNOW/HAVE PATIENT WISHES IN WRITING?  (When in doubt err on the side of life!)

4. ADVANCED DIRECTIVES?

ALL GENERAL PATIENT PROPHYLAXIS GUIDELINES: NOSOCOMIAL COMPLICATION PROPHYLAXIS AND ENVIRONMENTAL CONTROL

1.        ARE WE DOING EVERYTHING POSSIBLE TO PREVENT HOSPITAL, ILLNESS AND TREATMENT ASSOCIATED COMPLICATIONS?

                ID: SEPSIS, LINES, HARDWARE, VAP, UTI, GEN IMMUNIZATION & IMMUNE BOOST.   SPECIFIC: Line Holidays? Line Changes? Dental Care & Oral Hygeine? Abx & prophylaxis end points? Handwashing? Pro Biotics for CDAD prophylaxis?

                NON INFECTIOUS: DVT-PE, ASHD. EYE, SKIN, DELERIUM, GLUCOSE, FALL,                                  MALNUTRITION, DECUBITUS ULCER, GI BLEEDING, GENERAL DEBILITY

SPECIFIC: RESTRAINTS, INSULIN, KINETICS, ROOM (LIGHT, NOISE, TEMP CONTROL), ALCOHOL & WERNICKE- KORSAKOFF ENCEPHALOPATHY

SPECIFIC ORGAN PROTECTION & PRESERVATION AND TREATMENT OPTIMIZATION GUIDELINES: (GENERIC AND DISEASE SPECIFIC)

TOPS™ = Tartets for Specific Organ Preservation

1.       ARE WE DOING EVERYTHING POSSIBLE TO OPTIMIZE PRIMARY, SECONDARY AND TERTIARY DISEASE PREVENTION?

                             (DETAILS ON NEXT PAGE)

SPECIFIC ORGAN PROTECTION & PRESERVATION AND TREATMENT OPTIMIZATION GUIDELINES: (GENERIC AND DISEASE SPECIFIC)

ARE WE DOING EVERYTHING POSSIBLE TO OPTIMIZE PRIMARY, SECONDARY AND TERTIARY DISEASE PREVENTION?

       

□   CNS (BRAIN & SPINAL CORD):  PERFUSION & BP CONTROL? ^Na+?

      ^ Mg++? TEMP CONTROL?  H/H = 10/30? EUGLYCEMIA? EUVOLEMIA?

      □EYE PROTECTION

□   HEART: PERFUSION? BETA BLOCKER?  HEART RATE CONTROL? ASPIRIN? OTHER ANTICOAGULATION? CATH? H/H = 10/30?

□   LUNG: PERFUSION? ASNJMB Guidelines?  VENT: Smallest tidal volume and lowest pressures? Weaning vent? Minimize ABG draws? Sedation Holiday? VAP prophylaxis? TOF?

□   KIDNEY: PERFUSION? High Cardiac Filling Pressures?  Euvolemia +?

□   GUT:  PERFUSION? Abdominal hypertension?

□   LIVER: PERFUSION?

□   MUSCULOSKELETAL: PERFUSION? KINETICS?

□   SKIN:  PERFUSION? KINETICS

□   ENDOCRINE:

            

DOCUMENTATION IN RECORD: Diagnoses and Problems listed in PRIORITY order?  PROGRESS NOTES? Procedure notes include DX?  Separate Procedure note for each procedure?  ORDERS?  BILLING: Proper documentation to reflect charges?

QUALITY AND PERFORMANCE IMPROVEMENT ISSUES:  Q & PI Documentation on separate encounter form?                     

TODAY’S TARGETS & PLANS:                                       today’s date:

NAMES/SIGNATURES:

SICU RESIDENT:  _________________________  SICU ATTENDING:  _________________

PATIENT, or FAMILY REPRESENTATIVE/MPOA:  _________________________________

PRIMARY NURSE:  __________________  CHARGE NURSE:  ________________________

DIETICIAN: __________  OCCUPATIONAL, PHYSICAL AND SPEECH THERAPISTS:

TEAM PHARMACIST:  ___________________________TEAM RT: ____________________

PRIMARY ATTENDING:  _______________  CONSULTANT ATTENDING:  ____________

NOTES:

STOMPPIT™© V122012: StepWisely®™© Infinity Health Solutions & MFM

MFM@IHS part of the StepWisely® System for Mission Adhesion & Team Development   WWW.IHEALSOLUTIONS.COM