Nursing Notes Summer dd by liaoqinmei


									A quarterly publication for United Hospital Nurses

The voice of one                                                                 Table of contents
                                                                                 02   First Touch connection
Marie Stuewe, RN, United MNA Co-Chair
                                                                                 02   Get to know...
You’ve done the second quarter self-     many times a shift do you open a        02   Chem Dep assessments
study packet for nurses, and you’ve      Slim Pak? What does that repetitive
seen and used the new carpojects in      motion over time do to the joints       02   Passport to Excellence
giving medications that come in the      involved? That weekend I opened         03   Patient safety: suicide prevention
Slim Paks. There is a story behind       at least 30 each shift. The ED is not
that change, one that involves one       the only unit where a lot of these      03   Guatemala trip
RN raising the concern about the         medications are used; to name a few,    03   Patient passport
difficulty in opening the Slim Pak       they are also used in the Recovery
                                                                                 04   Searching for best evidence
and the long-term effects of the         Room, Post Surgical and Oncology.
repetitive motions used to open it.                                              04   Enterostomal therapy
                                         The following week I talked with
I work in the Emergency Department       Pharmacy and sent an e-mail to ED       05   Venous access devices
(ED) every other weekend, and on         Leadership, Pharmacy, and United’s      05   Professional development fair
the weekend of Dec. 13, 2005, I          Safety director, Allina
once again noticed nurses opening        Employee Occupational Health,           06   Diabetes updates and reminders
the Slim Paks using a tourniquet, a      Allina ergonomist and our MNA           07   Evidence-based guidelines: BP
glove, even their teeth. They were       business agent voicing my concern
hard to open. The use of foam for        and observations.                       07   Celebrations
hand hygiene can cause a build up of                                             08   Congratulations on Excellian
silicone on the hands making them        On Jan. 4, 2006 I participated in
slippery when trying to open the         a meeting with representatives
Slim Paks. Now think of nurses who       from the above areas and three
have a degenerative joint disease in     representatives from Hospira,
their fingers, hands or wrists and how   manufacturer of the Slim Pak and
painful these must be to open. How
                                         (Continued on Page 6)

summer 2007
First Touch connection                                                             Get to know...
Cynde Leas, RN, BSN, Medicine Unit 4400
                                                                                   Naomi English, RN, Float Pool
Lolma Olson introduced First              I included the patient care associate
Touch at United in August 2006.           (PCA) who was working with this          I started
My unit was one of the first to start     patient in my First Hello. I held the    my nursing
implementing her three-step process,      patients hand, told her the PCA          education at
which consists of the First Hello,        would be with her for the whole day      Onondaga
Retouch and Goodbye. Since that           one-on-one, and would be keeping         Community
time, I have noticed changes within       her company. The PCA had not had         College in
my own personal practice and within       the First Touch training, but because    Syracuse, NY,
the department. The patients seem         it is so simple and includes many of     and finished
to know and use the names of staff        the basic things we already do I was     up at Cornell University. I
much more frequently. I think this        able to explain the process to him.      moved to Minnesota to attend
is due to the development of more         Our shift went very smoothly. The        graduate school; I have a master
personal relationships. In my own         patient enjoyed holding hands (not       of public health degree with
experience, I enjoy taking the extra      mine, but the PCAs) and was very         a focus in occupational health
few minutes at the beginning of my        calm and cooperative for us. It is       nursing. Most of my career has
shift to connect with my patients.        possible she was just tired from her     been devoted to critical care
This reminds me to slow down and          busy night, but I took care of her for   nursing. I also managed an
show my patients that I care about        three shifts during her stay and never   occupational health clinic as
them on a personal level.                 had any difficulties.                    a federal occupational health
                                                                                   nurse for several years. Research
Recently we had a patient with            I went into nursing because I enjoy
                                                                                   matters tremendously to me
dementia who was combative,               dealing with people, and when I
                                                                                   because nurses are, I believe, at
known to throw things and very            use First Touch I develop a personal
                                                                                   the intersection of science and
uncooperative. I heard in report that     connection with my patients. This
                                                                                   caring. We must provide the best
she had a difficult night. When I went    makes me feel better and shifts the
                                                                                   care we can in a field that is
in to do my First Hello, I did not know   relationship from nurse taking care of
                                                                                   continually advancing. Research
how much she would comprehend.            patient, to nurse and patient working
                                                                                   enables us to keep our practice
Although she never made eye               together to improve health. First
                                                                                   current so that our patients can
contact with me, she did answer           Touch is now just an automatic part
                                                                                   have the best outcomes.
most of my questions appropriately.       of my nursing practice.

Passport to Excellence                                                             Chem dep
Cynde Leas, RN, BSN, Medicine Unit 4400                                            assessments
The Passport to Nursing Excellence        Nurses received a passport as part       To request a chemical
event during this year’s National         of the Nurses’ Week gift packet          dependency consult for a
Nurses’ Week celebration featured a       to assist in developing a plan for       patient, use Excellian to order
cruise ship theme. Thirty two nurses      advancing their nursing practice.        an IP Consult to Substance
served as tour guides for the eight       More than 250 nurses attended the        Abuse Counselor #207507.
“ports of call,” which included:          event and took advantage of the          This order is different than the
                                          opportunity to network with their        nursing order Substance Abuse
• Nursing around the globe                nursing colleagues.                      Assessment. Teresa Eakman is
• Educational advancement                                                          the new chemical dependency
  in nursing                              The event demonstrated not only          counselor/assessor at Hospital.
• Nursing research and evidence-          excellence in nursing but the            Contact Eakman, at 651-241-5284
  based practice                          strong commitment of United              or
• Quality indicators in nursing           Hospital nurses to the professional      with any questions.
• Advanced practice roles in nursing      development of their nursing
• Expanded roles in nursing               colleagues.
• Nurses as teachers
• Certification in specialty nursing                                                                 nursing notes 2
Patient safety: suicide prevention
Christine Fenske RN, CNS, Behavioral Health Services

The Joint Commission has a new              may be at risk for suicide through          assessment should be communicated
National Patient Safety Goal. Goal          information from family, referral           to the patient’s physician to
15a requires that all patients who          sources or other care providers,            determine the need for a psychiatric
are at risk for suicide be identified.      for example, the patient should be          evaluation and more intensive
Patients will be assessed for suicidal      assessed. Finally, if a patient voices      monitoring, such as a one-on-one
and self harm thoughts when they            thoughts of suicide he or she should        attendant. The assessment should be
meet certain conditions.                    be assessed.                                completed each waking shift.

For nurses, this means that if              A placeholder on the ED Triage              To document monitoring by the one-
a patient’s primary problem or              Navigator and the Med Surg and ICU          on-one attendant add the “Patient
complaint is emotional or behavioral,       admission and daily flow sheets will        Monitoring” group and choose
or an encounter due to a suicide            remind nurses of the criteria and cue       “1 staff: 1 patient continuous.” More
attempt, the patient should be              nurses to add the “Danger to Self”          information is available in the current
assessed for suicidal or self harm          row to the flow sheet. After ensuring       nurse learning packet. Contact me at
thoughts. If it is learned that a patient   the patient’s safety, the results of this   ext. 15278 with any questions.

Guatemala trip brought cultural appreciation
Cynde Leas, RN, BSN, Medicine Unit 4400

Remember the first week in February         weaving. It is back-breaking work           Global Education who enriched our
when the temperature was below              that demands strength in your arms          understanding of the Guatemalan
zero and the wind chill 20 below?           and hands. We worked outside, tied          way of life. We experienced so
I was enjoying the balmy weather            to trees in the most beautiful, lush,       much, including a visit to a hospital,
in Guatemala with 16 other nurses           relaxing environment. Even though           helping out at the diabetic clinic,
from Augsburg College. We had               the women did not speak English, we         sorting coffee beans, going on
an awesome experience immersing             formed relationships with them. After       home visits, participating in a Mayan
ourselves with the Guatemalan               attempting to weave our own cloth,          ceremony, shopping the market in
people, culture and traditions.             we gained a deep appreciation for           Chichicastenanago, exploring ancient
                                            the time, effort and talent required        Mayan ruins in Tikal and talking with
San Lucas was our home for most of          to produce some of these amazing            health promoters, midwives, city
our stay and this is where we met the       works of art.                               officials and Guatemalan people in
women who shared their knowledge,                                                       their homes. The poverty contrasted
expertise and patience with us              Throughout our stay we had a                with the happy, smiling faces of the
about their traditional back-strap          cultural guide from the Center for          children. It was the trip of a lifetime.

Patient Passport now more user friendly
Linda Gfrerer, RN, MS, Education Services

The Patient Passport, the form                RN from the sending unit to                  has been added in addition to
that travels with the patient during          complete the front side of the form .        "Tolerated Well" and "Could Not
transport from the sending unit to            It is not within the scope of the HUC        Complete Procedure Well."
the procedural/ treatment area, has           role to complete the form.                 • The font of the form has been
been revised and is now more user-          • "Verified Allergy Band on Patient"           enlarged, and the color has been
friendly. The revised forms are printed       has been added with a check box              changed to a lighter color both
on lighter blue paper with larger text,       on the sending unit side of the form.        making the form easier to use.
and the forms have information on           • The procedural/treatment areas
front and back.                               complete the back side of the form.        Audits on use of the Patient
                                            • A blank with "Procedure                    Passport will take place July through
Revisions and Reminders:                      Completed; Not Tolerated Well"             September 2007.
• It is the responsibility of the LPN/                                                                           nursing notes 3
Tips on searching for best evidence
Pamela Barnard, MSLS, AHIP-Senior Knowledge Consultant, Allina Library Services

Conducting a search for the best           hand navigation, choose “Clinical         no clinical queries as in PubMed,
evidence to answer a specific nursing      Queries.”                                 several limits in CINAHL can help get
care question or verify a current                                                    to best practices. Examples:
practice can be tricky. Knowing the        From this page, you can limit
best search strategy and the best          a search by the Clinical Study            • Publication Type =
databases to use, as well as how           category, Systematic Reviews or             Systematic Reviews
far to go if you are not finding the       more. These apply a predeveloped          • Publication Type =
answers to your questions, can all         search strategy called a “hedge”            Practice Guidelines
take time and persistence that may         against your subject in order to pull     • Special Interest =
be in short supply in the busy patient     up the strongest evidence (often a          Evidence-based Practice
care environment.                          study using a randomized controlled
                                           trial methodology) on your question.      These options may be accessed
Strategies and resources are               Hedges work best for broad                under the Refine Search tab in
available to limit searches quickly to     questions and not as well for specific    EBSCO/CINAHL. Call or e-mail
best practices. One special feature        nursing intervention questions. Since     Allina Library Services for more
is called Clinical Queries in the          they are in PubMed/MEDLINE and            information at 612-863-4312 or
PubMed/MEDLINE database. You               not the CINAHL (nursing) database,
can access this feature at                 they will work with more clinical Under the left             medicine topics. Although there are

Spotlight on enterostomal therapy
Anita Carteaux, RN, WOC Clinician

The nursing specialty of enterostomal      patients and other health care            identify and match conditions and
therapy (ET) has undergone                 professionals on managing ostomies        treatments. We work in consultation
substantive change since its               and fistulas. Most of all she wanted      with physicians and nurses to
beginnings in the 1950s. Its focus         to assure patients that they could live   develop individualized care plans,
has expanded from management of            full lives with an ostomy.                obtain and apply the best products
people with ostomies and fistulas                                                    for each patient situation and assist
to include caring for people with          The first school of enterostomal          in the transition from acute care to
incontinence, pressure ulcers and all      therapy started in 1961 at The            home care or another care center.
types of wounds.                           Cleveland Clinic. Today, there are
                                           seven programs located across the         Satisfaction is guaranteed as a WOC
The world’s first enterostomal             United States, including St. Paul.        nurse...
therapist was a patient, Ohio native       The three-to-six month programs           • Colleagues look to us for
Norma Gill, who had an ostomy              are for nurses who have completed           additional nursing expertise in
performed at The Cleveland Clinic by       a four-year baccalaureate program.          situations that can be difficult
surgeon Rupert Turnbull Jr., MD, in        Credits may be earned toward a            • Patients and their families
the early 1950s. After she recovered,      master’s degree.                            have often experienced multiple
Gill expressed an interest in caring for                                               medical crises and are grateful
patients with ostomies and fistulae.       There are approximately 4,000               for the added resources of
                                           nurse professionals practicing WOC          specialty nurses
Working with Turnbull, she laid            Nursing (wound, ostomy, continence)       • Outcomes are easily measured
the foundation for enterostomal            worldwide.                                • We always have a network of
nursing and set her goals to provide                                                   partners in our pursuit of
empathic care to patients with             A typical day for a WOC nurse at
                                                                                       improved quality of life
stomas and fistulae, to develop            United is unpredictable. In addition
                                                                                       for patients.
ideas for more effective and efficient     to being clinical practitioners, we
ostomy products and to educate             are educators for staff, patients and
                                           their families. We are called upon to
                                                                                                             nursing notes 4
Management of venous access devices
Linda Phalen, RN, ACM, IV Resource

Venous access devices come in              Peripherally inserted central catheters    Midlines, peripheral IVs inserted into
different sizes, lengths, number of        (PICC) are inserted into a peripheral      an antecubital vein by IV Resource
lumens, power versus not powered,          vein by a trained RN and advanced          or CMT, extend just distal of the
location, flushes and more. This article   to the SVC. The tip must be in the         shoulder. The purpose of the midline
shares information about commonly          SVC or SVC/RA junction to be a             is to provide a bridge in Critical
asked questions.                           central catheter and referred to as        Care Units until a central line can
                                           a PICC. (If the tip location is in the     be placed or for the patients on the
An IV is referred to as a central line     subclavian or brachialcephalic it is not   sepsis protocol for fluid resuscitation
when the tip lies in the superior vena     a central line but a peripheral IV that    in noncritical care units. The duration
cava (SVC) or the right atrium. When       is a midclavicular. TPN solutions and      for the midline is 48 hours. These are
listening to the X-ray report, you may     chemotherapy intended for central          preferred over standard peripheral
hear the radiologist refer to the tip      line infusions may not be delivered        IVs because the length and insertion
location in the SVC, RA or junction        through a midclavicular catheter.          technique makes them more stable
of the SVC/RA; all are considered          PICCs may be used to draw labs, but        with less risk of infiltration. A blood
acceptable locations. The SVC is           always flush with 20 ml of normal          return must be present to use a
approximately 2 to 3 inches long           saline following any blood draws           midline. It is identified by a bright
and the blood flow through this vein       and 200 units of heparin to prevent        green sticker at the insertion site that
is approximately 2000ml/minute.            clotting. It is important to secure all    reads MIDLINE. Midlines may not be
The subclavian, brachialcephalic or        IV tubing with PICC lines to prevent       used for TPN, chemo or lab draws.
innominate veins are not considered        pulling on the catheter and accidental     Midlines are flushed with 100 units of
to be central line locations. The          removal of the line.                       heparin if not in use.
blood flow is less than that within
the SVC, and due to the curvature of       PICCs can be open-ended or                 If unsure what line the patient has,
these vessels they carry a high risk       closed-ended. Open-ended PICCs             refer to the DOC Flowsheet. If the
of thrombus formation. Therefore           are inserted at United by both             patient has a PICC catheter, always
these locations are not considered         IV Resource and Interventional             know where your tip is located. Refer
acceptable tip placements without          Radiology. Closed-ended PICCs are          to the chest X-ray reports to verify
contacting the ordering physician.         the Groshongs, which have a valve          tip placement. Patients admitted with
                                           at the distal end that prevents the        PICC catheters require a chest X-ray
Triple lumens are central lines            backflow of blood into the catheter.       to have a record of tip location. Notify
inserted by an MD or MDA. They are         Groshongs do not require a clamp           IV Resource about the admission so
placed in the subclavian or jugular        or heparin flushes, only saline flushes    that these patients can be followed
veins with the tip in the SVC/RA.          every 24 hours. Groshongs are not CT       for BioPatch dressing changes.
They are flushed with 100 units of         compatible. Open-ended PICCs are
heparin every 24 hours and after           flushed every 12 hours with normal         IV Resource is available to assist you
intermittent use.                          saline and heparin.                        with concerns or question that you
                                                                                      may have concerning IV lines.

Professional development fair held June 13
Susan Loushin, RN, MA, and Linda Gfrerer, RN, MS

United Hospital Education Services         Specialty Nursing Certification            • Katie Krisko-Hagel, MS, RN
sponsored a fair for RNs to talk           • Christie Frid, RN, OCN                   • Donna Schumacher, RN, CRNA
to college representatives about           • Kathy Forbes, BS, RN, C
advanced nursing degrees and               • Sarah Gustafson, RN, C                   If you were unable to attend and
to colleagues about specialty              • M.J. Lee-Vanhouten, LSW, RN,             would like information contact:
nursing certifications. During panel         C, CDE                                   Advanced Nursing Degrees:
discussions, RNs shared stories            • Cheri Talsness, BS, RN, CIC              • Linda Gfrerer, MS, RN, ext. 18227
about their journeys toward specialty      Advanced Nursing Degrees                       Specialty Nursing Certification:
certification and advanced nursing         • Ann Berndtson, MA, RN, ONC               • Susan Loushin, MA, RN, ext. 18240
degrees. Panel members included:           • Naomi English, BS, RN, MPH
                                                                                                               nursing notes 5
Diabetes update and reminders
Lisa Schipp, RN, Diabetes Resource Team

Admission screening                        Newly diagnosed patients                    accurate pump function). A consult
As you may or may not know,                When patients are new to diabetes,          must be sent to us through the
almost half of United patients have        please request a diabetes educator          nursing screening order.
diabetes. When using the admission         consult. Patients who are being
screening tool to assess if a diabetes     missed are those who are diagnosed          IV insulin drips
consult is needed, remember                in the hospital or their treatment (i.e.,   Five type of insulin drips may be
that just having diabetes is not a         steroids) requires home management          ordered:
qualifying criteria. In Excellian, the     of their blood sugars. If you are           • DKA
diabetes education activity needs to       unsure about the situation, diabetes        • ICU
be activated upon admission.               educators are happy to help sort out        • Medial
                                           problems or questions.                      • Surgical
To perform this process:                                                               • Cardiothoracic surgery
• click (add title)                        Insulin pumps
                                           To find your needed forms/orders            DKA orders are now an Excellian
• search for template 433-diabetes
                                           through Excellian, go to order sets         order set. All others are on the
• select appropriate topics for your
                                           and select #33038 continuous self-          AKN under Allina drug protocols,
  patient (e.g., insulin or oral agents)
                                           administered SQ Insulin pump. Go to         United protocols. Copy and paste
• click accept
                                           links on the header and then select         these protocols into a note and
Please use this activity to teach and      Allina protocols, custom document.          enter orders appropriately. Please
assess patients’ diabetes educational      This will give you the worksheet that       remember to obtain the order for,
needs. Consults are done through the       the patient fills out everyday and the      and give long-acting insulin (such
order entry activity. It is very helpful   agreement. These items are signed           as Lantus), at least one hour before
if the reason the patient needs to         by the patient and the nurse and            discontinuing insulin drip.
be seen is written in the comments         put in the paper chart for scanning
                                                                                       Equipment reminders
section. Please do not complete the        after discharge. The remainder of the
                                                                                       As insulin drip use increases, there
order as this does not allow the order     process remains the same. You still
                                                                                       is an increased need for IV insulin
to print to our office or show up on       need to obtain the information on
                                                                                       boluses. Luer lock insulin syringes
our list as a consult.                     basal rates and bolus information and
                                                                                       are available through Materials
                                           the physician must write the orders.
Tip sheets are available to help with                                                  Management. Purple lancing devices
                                           These patients need to bring in their
this process. Request them from any                                                    are a much kinder option for patients,
                                           own supplies. Remember to obtain
diabetes educator or call 18780.                                                       especially for frequent bolus sugar
                                           a blood sugar two hours after a site
                                           change (to ensure insulin flow and

The voice of one
Marie Stuewe, RN, United MNA Co-Chair             (Continued from Page 1)

carpoject systems. After explaining        looked at the Slim Pak and noticed          time. The new carpojects started to
my concerns and observations there         that the tamper-proof hash marks did        arrive here in late December 2006.
was a commitment to look at the            not line up with the opening. I relayed
issue with short-term and long-            this to the Hospira representative.         The voice of one and persistence
term solutions. Short-term, United         In the meantime, United engineers           do pay off. I had raised this issue
would have Kelly clamps at the Pyxis       developed the white Corian blocks
                                                                                       with Hospira in 2004 and spoke
machines to use in opening the Slim        that are near the Pyxis machines to         with their Product Quality Analyst
Paks. Hospira would take the issue         use instead of Kelly clamps.                who “thanked me for bringing this
back to their engineers to review.                                                     to their attention, that it would be
                                           Notification came from Hospira              investigated and included in their
When I shared the story with Jim           that they would need to re-tool the         product compliant analysis program.”
McGlade, United Human Resources            machines at the manufacturing plant         Nothing changed. Fast forward to
director and co-chair partner of the       to make a more ergonomically correct        December 2006.
MNA Health & Safety Committee, he          system and that it may take some                                    nursing notes 6
Evidence-based guidelines on BP
Nursing Research Council of United Hospital

Over the past year, questions have          theoretical physiology principles, as    taking a BP in these patients is
been raised across nursing units            well as published statements from        safe, expert organizations such
and departments at United Hospital          national organizations. This evidence    as the National Lymphedema
about some blood pressure practices.        is referred to as “expert opinion”       Network advise against this practice.
Questions voiced by many included,          in the world of evidence-based           Therefore, health care providers
“Is it safe to take a BP on the same        practice — a form of evidence,           should continue to take the BP
side of mastectomy surgery, and if          but the lowest form of evidence          on the unaffected extremity and
so, how many years after surgery is         because it has not been empirically      include this warning in patient
this practice acceptable?” “What is         tested in the real world.                teaching. If needed, the leg may be
the evidence around BP assessment                                                    used to assess the BP if the patient
in patients with arteriovenous              In the case of arteriovenous fistulas,   underwent a bilateral mastectomy or
fistulas?”                                  basic physiology suggests the            has a device (VAD, AV shunt, etc.) on
                                            constriction imposed by a BP cuff        the opposite side of surgery.
The Nursing Research Council                would severely impede vascular
began searching for evidence to             flow and thus, destroy the integrity     For a more detailed account of this
answer these questions. Interestingly,      of the fistula. Similarly, while no      information, refer to our Evidence-
no primary studies were found               research evidence exists, expert         Based Practice Guideline on the
that investigated the safety of             opinion errs on the conservative side    AKN, “BP Assessment in Selected
taking BP on an extremity with              and advises health care providers        Populations,” under Nursing
an arteriovenous fistula or on the          from taking BPs on the same side         Practices, Resources & Information.
same side of a mastectomy surgery.          of mastectomy surgery (despite the
Furthermore, no studies were                fact that the risk of lymphedema         Members of the Nursing Research
found that demonstrate taking               is based on the extent of surgery).      Council of United Hospital: Margo
BP on the surgical side leads to            Disrupting lymphatic distribution        Halm & Naomi English (Co-Chairs),
the development or exacerbation             with the removal of lymph nodes          Deb Axmacher, Becky Braden,
of lymphedema. More than likely,            during radical mastectomies is           Minda Demira, Norbert Erben, Debra
these studies do not exist because          what increases a woman’s risk of         Freund, Kelly Gannon, Jen Gerlach,
it would not be ethical to subject          lymphedema should constriction           Mary Goering, Barb Jacobs, Katie
some patients to this practice and          occur in the affected arm. Today,        Krisko-Hagel, Dave Larson, Stephanie
not others (the only way to detect if       modified surgeries such as sentinel      Leininger, Anna McFarlane, Kris
it is truly safe) if an appreciable level   node dissection carry a low risk of      Lindell-Madsen, Rozann Reyerson,
of harm was anticipated. Instead,           lymphedema. Nonetheless, since           Julie Sabo, Kathy Schowalter, Bette
the evidence that exists comes from         there is no evidence to show that        Sisler, Deb Steele, Linda Strom and

ONC certifications                          Honors                                   Professional appointments
• Christie Frid, RN, 4500 recently          • Margo Halm, RN, PhD. director of       • Heather Lundberg, RN, was named
  received her ONC certification.             Nursing Research & Quality, was          clinical leader of The Breast Center
                                              recently selected as a Geriatric         and Infusion Center.
Orthopedics                                   Research Scholar at New York
• Ann Caliguire, RN, Neuro/Epilepsy,          University. She will attend a week-    This spring, because of the impact of
  has completed her second                    long research intensive in New York    preparing for Excellian, we were only
  certification. She is now certified in      to advance her research on the         able to accommodate five nursing
  both neurology and orthopedics.             impact of coronary artery bypass       student preceptorships. Four of the
                                              surgery on caregiving and quality      students were from Inver Hills/Century
Educational advancement BSN                                                          College and the fifth was a student
                                              of life.
• Angela Ikera, RN, 8940 received her                                                from the Wisconsin Indianhead
  BSN from Bethel College.                                                           Technical College (ADN program).

                                                                                                             nursing notes 7
Congratulations on Excellian implementation
Barb Knudtson, RN, Excellian and Patient Care Informatics director

Thank you to all United Hospital                by Lisa Waytulonis, RN, and MNA                 representatives participate and
nurses for your preparation and                 representative Glenda Cartney, RN.              contribute to these teams and report
enthusiastic attitude in implementing           PCEW supports workflow planning,                information back to United PCEW to
the Excellian electronic medical                practice and training. PCEW is                  ensure communication continuity.
record. Your work has been                      directly accountable to United
outstanding, and I am proud of                  Nursing Practice Care Delivery,                 If you have any questions or
the dedication United nurses have               which reviews and approves final                concerns about Excellian, please
to providing exceptional care to                nursing practice decisions. Current             talk to your department leader, Lead
patients and their families.                    chairs of United Nursing Practice               Super User and Super Users, or
                                                Care Delivery are Sue Penque, RN,               the Allina Technology Support
Now that we have been live with                 vice president of Patient Care and              Center at ext. 21900. You may also
Excellian for more than two months,             Operations, and Linda Slattengren,              contact one of United’s Excellian
it is important to know that there              RN, United MNA co-chair and current             nursing leaders:
are still many methods of support               president of the MNA.                           • Barb Knudtson, RN, at ext. 18775 or
available to you. Department Lead                                                       
Super Users and Super Users are                 Several RNs represent United                    • Liz Hoelscher, RN, workflow
very knowledgeable about the                    Hospital on various Allina Excellian              analyst, at ext. 18788 or
system and are able to bring items              user groups, including Surgical         
forward for discussion through                  Services (OpTime), Emergency                    • Lisa Waytulonis, RN, nursing
the United Patient Care Excellian               Services (ASAP/Epic ED) and                       coordinator, at ext. 18453 or
Workgroup (PCEW), co-chaired                    Epic Care Inpatient Team. The           

 Publisher: Margo Halm, RN, PhD, 651-241-8536,
 Editor: Colleen Kingsbury, senior communications consultant, 651-241-8518,
 Editorial Assistant: Janet Olariu-Tau, marketing associate, 651-241-8502,
 Editorial Board: Sue Penque, RN, MSN, Margo Halm, RN, PhD, APRN-BC, CCRN; Glenda Cartney, RN, ACM; Nancy Roberts, RN,
 Julie Sabo, RN, MN, CCRN, APRN-BC, CNS; Colleen Kingsbury.

 Nursing Notes is the official newsletter of United Hospital nurses. Nursing Notes is published quarterly by the United Nursing Care Delivery
 Board. Nursing Notes editorial board reserves the right to edit material based on content and space and to change this policy at any time.
 United Hospital, 333 N. Smith Ave., St. Paul, MN 55102
 Nursing Notes is available under United/Employee Communications/Newsletters on the AKN.
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