May Education Newsletter | Cardiovascular Intensive Care Unit

May 28, 2024

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1. All 5N-5S Stepdown transfers will use asynchronous handoff in place of a standard called report starting Monday, May 13th, please see below for the changes to workflow and handover process.
2. Upcoming Education: Critical Care Journal Club discussing the new DanGer Shock RCT is Tuesday, May 14th at 1830, RSVP to ajagoda@abiomed.com if you're interested in attending
3. The LAST live competency event is May 30th! If you do not attend- you will need to complete case studies for CVICU-focused competencies
4. Next Bedside Open Chest Sim!! is May 29th from 0800-1300! If you are interested in attending and off work, reach out to Jo and I'll give you the information!
5. WASH YO HANDS (the end.)
6. Promethazine (Phenergan) is no longer given in IV Push injections. See SBAR below for more information on route and administration steps.
7. MAC and PSI kits are changing, they are now CHG-impregnated (amazing!!) and the kits are more inclusive. See below for a picture of additions.

Asynchronous Handover PDSA Cycle #2

Continuing on May 13th, all dayshift patients transferring from 5N-5S will no longer call report.

What changes?
1. You need to wrench the IP Body System tab into your eStar home page.

2. The SBAR handoff provides all subjective information for the report (key events, important changes, day-to-day points 'two assist out of bed' and explains problems for the shift ' started Lasix for diuresis"

** To decrease the load that the sending RN has to do, the request from the study team is that 5N nurses complete a small line in the SBAR handoff (sticky note) each shift at the end of your shift**

3. 5N will report a 'rolling call' to the MR on 5S before transferring the patient.

PLEASE know that this is a process we are fighting to make work for you all, and I'm going to place the QR code below so you can provide feedback, and let them know what isn't working or what needs to change.

May 29th- Bedside Open Chest Sim
Multidisciplinary, interactive sim: Limited availability, email JoAnna if you would like to attend!!

Every time you go in and out of a room, please make sure you foam in/out and wash your hands when they're visibly soiled!

Promethazine is no longer given IV Push

Promethazine Injection: Change from IV Push to Infusion at VUH

Caroline Jackson, PharmD

Bob Lobo, PharmD, FCCP, BCPS

Situation:

In December 2023, FDA updated the labeling of promethazine injection to require dilution prior to intravenous infusion to reduce the risk of severe tissue injury.

Background:

Promethazine injection has a boxed warning for severe tissue injury, including gangrene, due to chemical irritation and tissue injury that can occur from extravasation, infiltration, or intra-arterial injection.

FDA recommends that promethazine injection be administered by deep IM injection instead of the IV route. If promethazine must be administered intravenously, it now requires dilution and administration by IV infusion.

Assessment:

Promethazine injection is a LAST RESORT for the treatment of nausea/vomiting. The routine dose is 6.25 mg and the maximum IV dose used at VUMC is 12.5 mg.

Each dose will require dilution in 50 mL NS and be infused over 20 minutes.

Recommendation:

Due to required dilution of promethazine IV injections with normal saline, promethazine orders for IV administration will need to be prepared as an admixture in the pharmacy and will not stocked in Omnicell cabinets.

Orders will be limited to a “once” order but can be reordered if necessary.

A go-live date for this change is scheduled for early June 2024 at VUH.

MAC and PSI Kits updates:

these central line kits are getting upgraded to include many loose items physicians frequently need when inserting. Over the next 2-3 weeks they will be placed in our supply cell and will go into line carts. A big win- the lines are now CHG-impregnated.

During Time-Out, it will be important to confirm allergies, if your patient has a CHG allergy, a non-CHG-impregnated line will need to be used!

CVICU INQUIRER | March 2024
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