NICU Designation –Cardiopulmonary 11/11/2020 Brooke ......2020/11/11  · q Infant Flow q Pulse Oximetry q Flow Meters q High Flow, Low Flow, Micro q Updraft/Nebulizer q Surfactant

NICU Designation – Cardiopulmonary 11/11/2020

Brooke Jeter, MBA, BS, RRT

q Baylor Scott & White All Saints Medical Center NICU Respiratory Team

q Education Break Down

q Competencies

q Mock Simulation/Codes

q Policies & Guidelines

q Projects

q Scanning Errors on Capillary Blood Gases

q Retinopathy of Prematurity

Objectives

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BSW-All Saints Medical Center NICU Respiratory Therapists **

MASTER LIST** Buch

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CertificationsBLS X X X X X X X X X X X X X X XACLS X X X X X X X X X X X X X X XNRP X X X X X X X X X X X X X X XLicensure X X X X X X X X X X X X X X XDegree A.A.S B.S. B.S. B.S. B.S. A.A.S. B.S. A.A.S A.A.S B.S. B.S. B.S. A.A.S A.A.S A.A.SValidationsAirway Management X X X X X X X X X X X X X X XMicroFlow Nasal Cannula X X X X X X X X X X X X X X XLow Flow Nasal Cannula X X X X X X X X X X X X X X XHigh Flow Nasal Cannula X X X X X X X X X X X X X X XT-Piece Resuscitator X X X X X X X X X X X X X X XPositive Pressure Ventilation - Self Inflating Bag X X X X X X X X X X X X X X XPositive Pressure Ventilation - Flow Inflating Bag X X X X X X X X X X X X X X XBubble CPAP X X X X X X X X X X X X X X XInfant Flow/SIPAP X X X X X X X X X X X X X X XCrossvent 2+ X X X X X X X X X X X X X X XConventional Ventilator - Draeger V500 X X X X X X X X X X X X X X XHigh Frequency Oscillatory Ventilation X X X X X X X X X X X X X X XHigh Frequency Jet Ventilation X X X X X X X X X X X X X X XNitric Oxide X X X X X X X X X X X X X X XPulse Oximetry X X X X X X X X X X X X X X XMDI Administration X X X X X X X X X X X X X X XNebulizer X X X X X X X X X X X X X X XSurfactant Administration X X X X X X X X X X X X X X XChest Physiotherapy X X X X X X X X X X X X X X XInline Suction & Maintenance X X X X X X X X X X X X X X XTwo-Person Sterile Suctioning X X X X X X X X X X X X X X XIntubation Assistance X X X X X X X X X X X X X X XExtubation X X X X X X X X X X X X X X XNeonatal 15 Lead EKG X X X X X X X X X X X X X X XHigh Risk Delivery X X X X X X X X X X X X X X XInitials Cardiopulmonary Manager - Brooke Jeter, MBA, BS, RRT BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJCardiopulmonary Educator - Monica Davis, BS, RRT-NPS MD MD MD MD MD MD MD MD MD MD MD MD MD MD MDMedical Director - Randall Grubbs, MD RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG

2018

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BSW-All Saints Medical Center NICU Respiratory Therapists

2018 Bold

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Annual Compentencies & Education LegendI-Stat Education (February 2018) X NA NA = Completed PreviosulyDisposable Largynscope Blade & Handle (March 2018) X X X X X X X X X X X X X X X X X X X X X = Completed in 2018Optiflow - HighFlow NC (March 2018) X X X X X X X X X X X X X NA X No longer employeedBCPAP (March 2018) X X X X X X X X X X X X NA X NA = Not employeed during trainingAerogen (March 2018) X X X X X X X X X X X X NA X No Longer working in the NICUCrossVent 2i+ (April 2018) X X X X X NA X X X X NA X X X X X X NA XNEO-PIP (June 2018) X X X X X X X X NA X X X X X NA XDraeger V500 (June 2018) X X X X X X X X X NA NA X X X NA X NA X NA XEKG Placement Training (October 2018) NA NA X NA X NA XNEO-PIP (Novemeber 2018) NA NA X X X NA X X NA X X X XInitials Cardiopulmonary Manager - Brooke Jeter, MBA, BS, RRT BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJCardiopulmonary Educator - Monica Davis, BS, RRT-NPS MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MDMedical Director - Randall Grubbs, MD RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG

2019

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BSW-All Saints Medical Center NICU Respiratory Therapists

2019 Barin

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Validations LegendNitric Oxide NA X X X NA X X X X X NA NA = Completed Previosuly3M Tape Inservice (Recalled) X X X X X X NA X X X X X NA X X X X X X X = Completed in 2019Mosby's No longer employeedIncentive Spirometry X X X X X X X X X X X X X X X X X X X X NA = Not employeed during trainingCough Assist X X X X X X X X X X X X X X X X X X X X No Longer working in the NICUiStat and Siemens X X X X X X X X X X X X X X X X X X X XInservicesEpic Training X NA X X X X X X X X X X X X X X X X X XEPIC Super-User Training NA X X XInitials Cardiopulmonary Manager - Brooke Jeter, MBA, BS, RRT BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJCardiopulmonary Educator - Monica Davis, BS, RRT-NPS MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MDMedical Director - Randall Grubbs, MD RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG

2020

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BSW-All Saints Medical Center NICU Respiratory Therapists 2020

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Validations LegendNeonatal 15-Lead EKG Refresher (January 2020) X X X X X X X NA X X X NA = Completed PreviosulyPulse Oximetry (July 2020) X NA NA X NA X NA NA X NA X NA X NA NA X X X = Completed in 2020Micro Flowmeter (July 2020) X NA NA X NA X NA NA X NA X NA X NA NA X X No longer employeedUpdraft (July 2020) X NA NA X NA X NA NA X NA X NA X NA NA X X ● Has not been assigned CPT (July 2020) X NA NA X NA X NA NA X NA X NA X NA NA X XSuctioning 2 person sterile (July 2020) X NA NA X NA X NA NA X NA X NA X NA NA X XExtubation (july 2020) X NA NA X NA X NA NA X NA X NA X NA NA X X

Inhaled Nitric Oxide Therapy for Neonates (Respiratory Therapy) X X X X X X X X X X X X XMechanical Ventilation: High-Frequency Oscillatory Ventilation for Neonates (RT) X X X X X X X X X X X X XSurfactant Replacement Therapy for Neonates (Respiratory Therapy) X X X X X X X X X X X X X XIntubation Education X ● X X X ● X ● ● ● X ● X ● X

UBER Premie (Feburary 2020) X X X XROP X X X X X X X X X X X X X X X X XNellcor 7/13, 7/14 X XLISA ( Less Invasive Surfactant Adminstration)Initials Cardiopulmonary Manager - Brooke Jeter, MBA, BS, RRT BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJ BJCardiopulmonary Educator - Monica Davis, BS, RRT-NPS MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MD MDMedical Director - Randall Grubbs, MD RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG RG

Mosby's

Inservice

q All NICU RRT’s have a personal education development folder that includes:

q Licensureq Initial competenciesq Yearly competenciesq Educational transcripts

q Mosby lessonsq In-services

Competencies

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q Neonatal 15 Lead EKG

q Ventilator(s)q Draeger V500, High Frequency Oscillatory Ventilator, High Frequency Jet

Ventilator, Crossvent 2+, iNO

q Positive Pressure Manual Ventilation

q T-Piece Resuscitator

q I-Stat

q Bubble CPAP

q Infant Flow

q Pulse Oximetry

q Flow Metersq High Flow, Low Flow, Micro

q Updraft/Nebulizer

q Surfactant

q Meter Dose Inhaler

q Intubation Assist/Extubation

q High Risk Delivery

q Airway Managementq In-line Suction, 2-person suction (sterile technique)

List of Initial Competencies

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Policies & Guidelines

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q Bubble CPAPq Chest Physiotherapy of the Neonateq Tracheal & Nasal Pharyngeal Suctioningq Oxygen Administrationq Sipap Infant Flowq NICU Respiratory Therapist Intubationsq Neonatal Resuscitationq Infant Transportq High Frequency Jet Ventilationq Endotracheal Extubation

Policies

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q Cardiopulmonary NICU Staffing Guidelineq Manual Ventilationq High Frequency Oscillating Ventilationq Surfactant Administrationq Non-Invasive Ventilationq Nitric Oxide Deliveryq NICU Conventional Ventilatorq Guideline for the Reduction of Severe ROP in the High-Risk Infantq Electrocardiogram (EKG/ECG)

Guidelines

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Projects

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q Multidisciplinary Team

Retinopathy of Prematurity

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Executive Sponser Alvina Peterson, MHA, BSN Chair Rebecca Purdy, MS, BSN

Co-Chair Rachel McCamley, BSN, RNC-NICNeonatologist Dr. Erin Hamilton-Spence, MD IBCLC

Team Members Krystal Orr, RNBrooke Jeter, MBA, BS, RRT

Monica Davis, BSRT

q Aim Statement (Original)

q The rate of severe ROP in the very low birth weight population at BAS will be reduced from the rate of 7.9% to below the Vermont Oxford Network mean rate of 6% by utilizing “SeeMore” ROP cards, oxygen saturation alarm settings to maintain infants’ oxygen saturation levels within the desired range of 90-95%, and providing education/graphs to the NICU staff.

q Setting

q Project focused on infants weighing less than1500 grams and/or < 30 weeks gestation at birth who were admitted to the NICU at Baylor Scott & White All Saints Medical Center of Fort Worth.

Project Overview

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q Methods

q PDCA Cycle 1 (April 2019): QAPI Committee noticed a few ROP “Fallouts”, leadership and key stakeholders met to strategically create an action plan. Monica Davis & Kent Palmore extracted data from Nellcor machines to help visualize the outcomes.

q PDCA Cycle 2 (May 2019): Respiratory Therapy provided a tip sheet with reminders on gestation, FiO2 guidelines, and key pointers:

q Gestational age <30.6 and/or <1500 grams

q Only increase/decrease FiO2 by 3-5%

q Notifying NNP/MD with > 10% FiO2 increase

q Infant >34 weeks & >25% FiO2, place a new “Owl Card” with new parameters

Rapid Cycle Methodology Overview

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“SeeMore”Owl Cards” – PDCA Cycle 2

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<30.6 and/or 1500grams >34 weeks & >25% FiO2

q Methods

q PDCA Cycle 3 (May 2019 – March 2020): Ongoing education for all staff caring for NICU babies.

q PDCA Cycle 4 (April 2020): Added additional team members to the ROP Committee, naming the 2-project team leads.

q PDCA Cycle 5 (June 2020): First team meeting, Epic order set and ROP cards were not correlating, reviewed the “Owl Cards” to create a refresh, and staff education planned. Parameters were changed to match order set, Nellcor pulse oximeters were preset for SpO2 to 88%-95% with a high saturation alarm to 96% with the sat seconds counting up.

Rapid Cycle Methodology Cont’d

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q Methods

q PDCA Cycle 6 (Current): Staff education ongoing and following all trends/fallouts for purposing education rounding.

Rapid Cycle Methodology Cont’d

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Graphs

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Metrics/Measures

q Outcome Measure

q Decrease the number of scanning errors in the NICU by RRT’s

q Process Measures

q NICU RTq Check order in HERq Cross check with 2 patient identifiersq Enter MIDAS with any errors

q Education & coaching provided with any errors

q Follow lab policy

Scanning Errors on Capillary Blood Gases

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Next Steps/Lessons Learned:

q Continue to monitor miss-scanned specimens with NICU staff RRT’s

q Continue to educate NICU RRT’sq Always cross-check before scanning

the sticker with 2 patient identifiers

Education Provided:

q iSTAT Initial Certification Validationq Siemens Orientation Examq Policies

Scanning Errors on Capillary Blood Gases

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Questions?