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"Quiet, please!"
Please remember to use your "hospital voice" on the nursing units. Voices carry down the hallways and confidientiality is jeopardized. Plus, our patients need quiet so they can rest! |
Five Things You Need to Know About Pressure Ulcers
(Michael J. Halls MD, Director Wound Care Center, SGH)
- The term "Decubitus Ulcer" is no longer used. The word Decubitus is non-descriptive as to location or etiology and has been abandoned by the wound community. These injuries at an anatomic location are caused by pressure and confusion is lessened by naming them as such.
- The primary treatment for established pressure ulcers is complete pressure relief and removal of dead tissue. Sacral pressure ulcers are almost exclusively caused by head of bed elevation in susceptible patients. To limit the pressure and shear in the area ALWAYS elevate the foot of the bed when the head is elevated.
- Wound cultures are of limited value and positive cultures are NOT a reason for antibiotics. For septic patients cultures can guide therapy until debridement is carried out.
- MRI exam is NOT indicated to diagnose underlying osteomyelitis or the need for long-term antibiotics. Bone culture is the only proven correlate to bone infection or the indication for prolonged antibiotics.
- The treatment of any pressure ulcers which BEGIN in the hospital is the financial responsibility of the hospital. Ulcers present on admission need to be documented to avoid problems.
Sharp Grossmont Hospital has experienced in- and outpatient wound teams to help with the prevention and management of all pressure ulcers.
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Sharp Healthcare System Insulin U-500 P&P and Order Set Cerner
Situation: A patient may state that they take Regular insulin at home when actually they use U-500 insulin. At home a majority of patients use a U-100 insulin syringe to administer U-500 insulin. This may mislead staff when the patient cites the U-100 syringe scale rather than the actual units of U-500 insulin as the insulin dose (i.e. 20 units on a U-100 syringe when the actual dose is 5X that amount or 100 units of U-500).
Background Information: Occasionally a patient can develop such resistance to the effect of insulin that daily doses of several hundred units are required. Use of standard insulin (U-100) becomes problematic when the total daily dose of insulin exceeds 200 units/day. The volume of insulin required becomes so large that it is painful for the patient to inject and absorption becomes unpredictable, resulting in poor glycemic control.
Assessment: Humulin R U-500 (highly concentrated) insulin is 5X more concentrated than standard insulin and is especially useful for the treatment of patients with marked insulin resistance, as the large dose required can be delivered in a more reasonable volume for subcutaneous use.
Recommendation: A SHC system P&P and Cerner order set has been developed specifically for U-500 insulin use in the hospital setting.
- Independent verification of this subcutaneous insulin is required.
- Use of U-500 order set is required. No sliding scales.
- AC meals or one time dose.
- Patient is prohibited from self-dosing this home medication per hospital policy.
- Medication must be sent home or to pharmacy for storage.
- Automatic consult with the pharmacist and the diabetic nurse specialist when U-500 is ordered. A Pharmacist will confirm home dose and enter in Cerner under "Document Medications by History".
- To avoid confusion it is critical that the inpatient prescription describes the dose both in units and volume.
- The dose(s) will be prepared in the pharmacy in a 0.5mL or 1mL syringe
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TED Hose Changes
Based on current evidence, the Evidence Based Medicine Council and the Grossmont Clinical Outcomes committee support the removal of Compression Stockings (TED Hose) from the Stroke PowerPlan.
All other plans that currently have TED Hose orders will have the orders unchecked (as in the picture above). They will remain available to order, but a clinician will be required to check them if desired for the patient.
Individual TED Hose orders will still be available outside the PowerPlan as will the supply orders if you need replacements from central supply. |
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Sharp Grossmont Medical Staff
5555 Grossmont Center Drive
La Mesa, California 91942 |
