rcs newsletter august 2010_final

8/9/2019 RCS Newsletter August 2010_final

1/9

Volume 1, Issue 6 The First Breath of News August, 2010

In the summertime....still Page 1

RESPIRATORY CAREAll the News You Can Inhale

1 Random Meanderings & Creative Cooking Corner

2 Wacky Trivial Facts (WTF)

3 Congratulations Elisa and Erika

4/5 Managing with Rhonda / Essential Education

6 Prairie Dawn

7/8 Trach/Vent Team /High Fives/Congrats to Rita

9 Congratulations to new RRTs/Anniversaries/Credits

Random Meanderingsby Terry Nuttall, Editor

Thank you to everyone who contributed tothis August newsletter, the 6th issue of

Respiratory Care, All the News You Can

Inhale. In this issue we have a new

column, called Wacky Trivial Facts by

Becky Riederer, which, if, like me, you share an interest in

trivia, I know you will enjoy.

Although I enjoy creating this newsletter, due to increaseddemands on my time in the coming months, it will unfortunately

be reduced to an every other month publication. Therefore, the

next issue will be for October. I will reevaluate this in a couple

months to see how well this publishing frequency goes.

This summer is hot, hot, hot and very humid as you know verywell. If you are like me, your air conditioner has been running

almost every day when indoors. Although I love the sun and

warmth of many of the days of this summer, hopefully the

monsoon rains and tornados do not recur again! In any event,

get out to absorb the sun's rays while they last and the many

outdoor events in the region, like State Fair!

Creative Cooking Corner

Succulent Southwestern Slow CookerChicken and Potato Soup

Weight Watchers 5 Points

3/4 pound uncooked boneless, skinless chicke

breast, cut into 1 inch cubes

2 medium sweet potatoes, peeled, cut into 1 inc

cubes

1 large onion, chopped

29 oz canned diced tomatoes, salsa-style with chilie

un-drained

14.5 oz fat-free chicken broth

1 tsp dried oregano

1/2 tsp ground cumin

1.5 cups frozen corn kernels, not thawed

Cook spaghetti according to package directions, drain and saside. Meanwhile, heat a large nonstick skillet over a medium

low heat. Add bacon and garlic; cook, stirring frequently un

the bacon is crisp, about 4 to 6 min. Remove the gar

but leave the bacon and bacon fat in the skillet.

Mix all ingredients, except corn, in a 4 quart or larger slocooker; cover and cook on low heat for 6 hours. Stir in co

and cover slow cooker; cook on high heat until chicken is n

pink in center and veggies are tender, about 30 min. mor

Yields about 1.25 cup per serving.

This recipe has been cooked and consumed by Karen Jonherself. She has personally attested to its succulence! Bo

apptit!

By

Karen Jones

our Krafty Krazy

Kook


2/9



Smart splinter remover. Just pour a drop of Elmer's Glue-Allover the splinter, let dry, and peel the dried glue off the skin.

The splinter sticks to the dried glue.

Statistics show that the majority of first time married mensleep on the right side of the bed. Divorced and re-married

men sleep on the left side of the bed.

Due to the amount of time that female elephants care fortheir young....they are only flirtatious 2 weeks out of every 4

years.

If you yelled for 8 years, 7 months and 6 days, you wouldhave produced enough sound energy to heat one cup of

coffee.

The liquid inside young coconuts can be used as substitutefor blood plasma

Apples, not caffeine, are more efficient at waking you up inthe morning.

Michael Jordan makes more money from Nike annually thanall of the Nike factory workers in Malaysia combined.

The reason firehouses have circular stairways is from thedays when the engines were pulled by horses. The horses

were stabled on the ground floor and figured out how to walk

up straight staircases.

During WWII, because a lot of players were called to duty, thePittsburgh Steelers and Philadelphia Eagles combined to

become The Steagles.

Every day, the average person swallows about a quart of

mucous.

People who ride on roller coasters have a higher chance ofhaving a blood clot in the brain.

In one hour, your heart works hard enough to produce theequivalent energy to raise almost 1 ton of weight 1 yard off the

ground.

Wacky Trivial Factsby Becky Riederer, Contributor

After 8 years your mattress doubles in weight from deadskin, dust mites, and bed bugs.

12 newborns will be given to the wrong parents daily

All blue eyed people have one common ancestor...Scientistshave tracked down a genetic mutation which took place 6-

10,000 years ago and is the cause of the eye color of all blue-

eyed humans alive on the planet today.

A raisin dropped in a glass of fresh champagne will bounceup and down continuously from the bottom of the glass to the

top.

A pencil can write 45,000 words and can make a line that is35 miles long! It will also write in zero gravity, upside down

and underwater.

The tongues of chameleons are faster than a fighter jet,Giraffes have no vocal chords, Owls are the only bird that can

see the color blue, Crocodiles are color-blind, Dolphins sleep

with one eye open, and a tarantula can survive for more than

two years without food.

The holes in crackers are called "docking" holes. The holesare placed in the dough to stop overly large air pockets from

forming in the cracker while baking.

Becky Riederer, RRT is very generous to share her world

of intriguing fun facts in this newest newsletter column,

WTF, which we hope will expand your knowledge of the

more esoteric but fascinating things of the world. Enjoy!


3/9



Congratulations to Two Beautiful Newlyweds,

Elisa Grunwaldt and Erika Koldeway!

On Friday, July 16, 2010,Elisa Ojala joined Josh Grunwaldt

in marriage

On Saturday July 17, 2010, Erika Babe joined

Tom Koldeway in marriage

We all wish you both a lifetime of happiness!


4/9



Service Pillar

Through a discussion with a parent regarding someconcerns I have had the opportunity to explore treatment

needs and best practices around care of children with SMA

and their families. After speaking with physicians and staff I

think we have an opportunity to explore the evidence and

establish what the best practices surrounding care of

children with SMA should be. If you are interested in

working on this please let me know. I attended training on

how to update the RCS webpage on the intranet. I will be

talking with staff to find out what they think would be

valuable to have on the department page. If you have ideas

please let me know.

Quality Pillar

The unannounced Joint Commission Survey happened andit went very well. Chas did a great job during the asthma

patient tracer on W11. Some overall opportunities to

improve are; need to date and time all documentation,

proper cleaning of soiled equipment is to spray with

Cavispray and then wait 3 minutes to wipe down.

Observations were made by the surveyor that hospital staff

did not always wait 3 minutes after spraying to wipe down. If

you want to see an executive summary of the visit you can

view it on the intranet under Joint Commission; Joint

Commission Accreditation Reports and Letters; then you will

find the full survey executive report.

Growth Pillar

NPCU opened on July 1st. We will continue to monitorrespiratory needs in this area. At this time we are not able

to increase staff to cover this area but as the NICU expandswe will need to have data to support respiratory needs to

plan for staffing when expansion happens.

I hope you enjoy the rest of the summer. As the saying

goes, Dont cry because it's over, smile because it

happened.

By the time you read this it should be close to State Fair time.I hope you will have the opportunity to enjoy the fair with your

family. This is my favorite time of the year. I spend about 60-

75 hours at the fair over the 10 day period (Yeah I know it is

excessive but I cant help it).

Congratulations to Erika Babe who won a T-shirt for being thewinner of the trivia questions in the May Newsletter!

Here are the updates for the August issue:

People Pillar

EOS overview sessions and will be hosting focus groups tohelp identify what our priority areas to work on over the next

year should be. Thank you to everyone who attended and

provided feedback! I believe we have a great team and we

need to celebrate our successes as well as work to improve

some things. We continue to recruit for vacant positions.

Finance Pillar

In process of working with finance to update the RCS ChargeMaster, planning for 2011 budget, and establishing department

productivity measures based on paid hours and unit of service.

I should be receiving data next week and will be able to share

more with staff who are interested at that time. During these

tough economic times we are all watching where we spend

money and how we can save money. This is no different at thedepartment or organization level. We need to look for ways to

reduce waste, evaluate current supplies kept on hand to see if

there are ways we can reduce inventory on some items, and

improve efficiencies within our department. If you have any

ideas please let me know.

Managing With

Rhondaby Rhonda Duerst

Managing with Rhonda, cont'


5/9



Essential Education

by Heather Knez

Based on feedback prior to the EOS, we have implementedseveral changes and extensions to the orientation plan. We heard

the feedback loud and clear by just going around and asking staff

what they thought, so we took that into consideration and made

the changes. Once the new tower was opened, we had to have

more critical care trained staff, but we learned a hard lesson that

the orientation into that population was just moving too fast. It took

a lot of time, brainstorming and planning, but we think we have a

system that will work. Let me share it with you

The first 2 weeks of the orientation consists of education/handson with acute care items only. The will be precepting with me for

these two weeks. This does not include protocol. This does

include EDRT since that person will be covering the EDRT pager.

We also do include trauma into this level so they can start getting

experience in that area. However, the trauma bit is all about to

change, so that wont be covered with every new employee in the

future.

Next, they precept for 4 weeks in acute care with their designatedpreceptor. They now follow this with 1 week of protocol

education/pt. assessment followed by 3 weeks of precepting with

their designated preceptor. Laurie Smrz helps out with the asthma

protocol. Once this is complete, they are to have all of their

competencies for acute care and protocol complete and then they

staff on their own in acute care with or without protocol for 12

weeks. This 3 month time frame will give them plenty of time to

learn to ropes and get some time management techniques down.

They have just mastered Level 1 and Level 2 with acute care and

protocol.

Now, after having staffed for 12 weeks, they start the nelevel, Level 3, which is the first part of critical care. During th

Level 3, they will be with me for 2 weeks, learning an

precepting on Bipap, LTV and trach pts. They do spend a fe

hours with Carole and Lori during the first week. All of th

education is complete the first week and we precept all of th

second week. Now they are ready to go with their designate

preceptors for the next 4 weeksNow they begin the final level, Level 4. In this level, they leathe rest of critical care including all of the vents and such

There is 1 week of education/hands on and then they prece

with me during the 2nd

week. Now, they are ready to go wi

their designated preceptor for the next 8 weeks. So, let's brea

this down..

Initial Ed/hands on 2 weeks

Precept with designated preceptor 4 weeks

Protocol education 1 week

Precept protocol 3 weeks

Staff on their own for 12 weeks

W5 education 1 week

Precept with me for 1 week

Go with designated preceptor for next 4 weeks

Critical care ed 1 week

Precept with me for 1 week

Go with designated preceptor for next 8 weeks

The time and money associated with getting a new employecompetent and ready to care for sick kids priceless

So, total, there are 38 weeks in the orientation process to get

new employee ready for critical care. Keep in mind that th

does NOT include NICU.

Also, before an employee may progress into the next levethey must have their competencies complete for that level an

pass a written exam with a score of at least 80%.

Currently, we have just started this system with the critical ca

portion with Amy Mailandt and Ted Box. They just finished wit

me on W5 with some pts. on W4 and now they will b

precepting for the next 4 weeks in that area before they learn t

rest of the equipment and aspects of critical care. The fir

rotation of this whole orientation has started with Joe Winn an

Joe Oberlander .

So, give it some time and hopefully you all will like how thnew employees turn out competency wise.

Essential Education, cont'


6/9



Children's Triathlon

Both Stew Couillard and Khris OBrien were in the Tri-ing forChildrens Triathlon on Sunday July 25th. Stew of course won the day

with an overall time of 1:23:10 compared to Khriss time of 1:41:59. For

the run portion, Stew dominated and beat Khris by more than 15

minutes for that leg alone. But Khris is very proud that she beat Stew in

the bike portion, beating his time by 38 seconds. This is a wonderful

event with various levels to challenge everyone from the novice to

expert; even children can participate. Proceeds from registration andpledges benefit Childrens Hospital of Wisconsin. Other Childrens

Hospital employees which participated included Shari Parry -W5 RN,

Cathy Walters -W5 ICM, Eileen Sherburne-C8 APN. As many of you

know Khris is very passionate about the camaraderie and sense of

accomplishment obtained by participating in Triathlons. Khris said, I

honestly believe that anyone & everyone can do it! It would be great if

next year we have more folks from the department participate. If you

have ever thought about it, this is the event for you!

Optimizing NAVA Levels

Setting the original settings on NAVA can be confusing. A good placeto start is to look at the NAVA preview screen while the patient is in a

traditional mode. This will only give you an estimate though and doesnt

take into account the synergistic way the ventilator and the diaphragm

work together. Often, the patient's diaphragm will be working very hard

simply because it is not in sync with the ventilator.

I would recommend starting about 0.3 below what the estimate

recommends. If the patient tolerates it, leave the patient on this setting

for a few minutes and then go to the trend screen. Gradually increase

the NAVA level in increments of 0.1 to 0.2 while watching the Peak

Insp. Pressures (PIP), the Edi measurement and the Tidal Volumes

(TV). Leave at each setting for a few minutes until you get trend data.

You will usually see an increase in the PIP & the TV while the Edi is

decreasing. When you get to the point where the Edi, PIP and TV level

off in other words, you increase the NAVA level and only get minimal

changes in PIP and VT, you have reached your optimal NAVA level.

The trends screen is great because you can move your curser back to

the point where the inflection points leveled off and see

exactly what setting you were on.

One other thing that I have noticed if the patient has a

group of lower Edi signals followed by a few higher Ed

signals (which will translate into higher PIPs), the NAVA

level is probably not high enough for all their breaths. It

almost seems like they take catch-up breaths. Try

increasing your NAVA level in small increments to see if

the large swings in Edi can be minimized. Clean Hands Video Contest

The Clean for Kids (C4K) practice group is looking forcreative videos to promote the importance of proper hand

hygiene with these topics:

Using soap and water or alcohol-based hand

sanitizer.

Reminding others to clean their hands.

Preventing infections with proper hand hygiene.

Its a great way to create awareness and get your creativeflair recognized. It can be an individual or team effort. The

contest will run through the month of August. You will be

able to vote for the best video in September. First, second

and third prizes will be awarded. For more information

including rules and to see a sample video (Khris is in it!)

search for C4K on the intranet.

Prairie DawnBy Khris O'Brien

Praire Dawn, cont'

continued next column

I want my

Coffee,extra

strong

please


7/9



Trach/Vent Team News

Lori Leiser

Imagine your child with a trach, nobody really wants to imaginethat but lets just try, your child is laying in the crib, you walk into

the room hear water sloshing in the circuit. You immediately

become angry because the railing is up high enough for the water

to accumulate close to your child as you attempt to put the railing

down it goes up a little further causing water to make it to your

child. You as a parent of a trach child would you really want this

to happen to your child?

We noticed a change in practice recently. Trach/vent patient'stubing always used to go through bed railings which would allow

the tubing to come to the patient at about waist level. This would

prevent pulling on the trach from the vent tubing or the trach

collars to sit comfortably on the patients chin and chest area. This

also allowed water to accumulate at the lowest hanging section of

the tubing away from the patient.

Since weve become part of critical care the tubing now has to goover the railing. What we have noticed and find alarming is that

the tubing over the railing allows for a low spot to be much closer

to the patient because it now between the railing and the patient.

This is alarming as water can now accidently get dumped into the

trach. I have heard of it happening to a patient and have seen the

water accumulate closer to the patient.

If this happens complete an incident report and submit it so wecan determine if the practice needs to be changed back to placing

tubing through the railing.

Thanks, Trach/Vent TeamJust a couple more hours sleep, alright?


8/9



Honoree

Name

Submitted

byComments

Deb BoettcherElizabeth

Gallagher

Deb helped me to transfer my patient at the end of a shift who was not even on her list. Also,

she is always willing to help out and is a great teacher. Thanks, Deb

Elizabeth

Zettler

Anthony

Martinez

Thanks Liz for staying over your shift to help nights in the NPCU. I greatly appreciate your

willingness to help out.

Terry Nuttall Jason Ousey

Terry was assigned to W3 and came upstairs to cover the W4 unit so I could work on shift

change, day charge RT was late so Terry covered the unit for over 30 min and admitted a

patient for me. Thank You Terry

Theodore

Block

Joseph

OberlanderOutstanding work using some swimming goggles to make treatment more bearable. Genuis!!!!

Joseph

OberlanderCarla Riehl

Joe stayed an extra 3 hours after the end of his shift to gain more Asthma Protocol experience

and helped with additional Pentamidine treatments. Thanks Joe!

Respiratory Care ServicesHigh Fives

Con ratulations to All!

Congratulations toRita Tyeptaner for the

birth of her beautiful 7 lbbaby boy, Samuel James

on Thursday, July 22,2010 at 5:38 PM


9/9



C R E D I T S

Thank you very much to everyone who has contributedmaterial, support and ideas to this newsletter. It is your

contributions that make this possible. Karen Jones

Rita Tyeptaner

Christa Rogers

Grace Flanagan

Elisa Grunwaldt

Rhonda Duerst

Becky Riederer

Heather Knez

Lori Leiser

Khris O'Brien

CALENDAR EVENTS

Admit You're Happy Month

Family Fun Month

National Eye Exam Month

Peach Month

Romance Awareness Month

National Picnic Month

Week 1: National Simplify Your LIfe Week

Week 2: National Smile Week

Week 3: Friendship Week

Week 4: Be Kind to Humankind Week

National Mustard Day: August 7

Book Lover's Day: August 9

Lazy Day: August 10

National S'mores Day: August 10

Son and Daughter Day: August 11

Middle Child's Day: August 12

Left Hander's Day: August 13

V-J Day: August 14-15

Relaxation Day: August 15

National Tell a Joke Day: August 16

Bad Poetry Day: August 18

Kiss and Make Up Day: August 25

Women's Equality Day: August 26

Global Forgiveness Day: August 27

Congratulations

For Your Successful

Efforts in Achieving

Your RRT!

Elisa Grunwaldt

Rita Tyeptaner

Erika Koldeway

Hilary Ledbetter

Christa Rogers

Beata Czarniak

Becky Riederer

Todd Schleef

Apologies if I missed anyone. These are intended to be those

newly registered since the last newsletter.

Employee Anniversary Date Number Years

Christa Rogers 7/14/2008 2

Todd Schleef 7/14/2008 2

Rita Tyeptaner 7/14/2008 2

Matthew Roche 7/14/2008 2

Angela

Delle-Grazie7/14/2008 2

Hillary Ledbetter 7/18/2005 5

Jason Ousey 7/23/2001 9

Stew Couillard 8/02/1985 25

Jackie Schreier 8/07/2006 4

Elisa Grunwaldt 8/07/2006 4

Jamie Wingert 8/13/2007 3

rcs newsletter august 2010_final

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