Category Archives: Policies

Trauma updates – T-PODs, Tourniquets and QuikClot

We are now stocking a few new items in the trauma room wall racks near bed 3 behind the nursing station.

 

T-POD/Pelvic binders

We have both the T-POD as well as pean clamps for sheet binding if preferred.  For those unfamiliar with T-POD application, here is a video tutorial for review.  In addition I have a trainer and will happy to inservice anyone interested.
YouTube Preview Image
Tourniquets
 
Tourniquets are also now available.  Pretty self explanatory but Here and Here are a couple of videos regarding application of tourniquets.  I’ve also attached a scan of the product insert with instructions. 
QuiKClot Combat Gauze
 
QuikClot is a kaolin impregnated gauze pad that allows for topical hemostasis by activating factor VII.  It is clay based and unlike prior formulations of quikclot does not result in exothermic reaction and has not been found to be associated w/ allergic reaction.  It can be used in any situation in which you encounter difficult to control bleeding, eg. proximal injuries you are unable to tourniquet, avulsion injuries, oozing from vascular access sites including shunts, oozing from scalp wounds, etc.  If hemorrhage control is unsuccessful after application, leave the initial pad in place and apply another to minimize disrupting existing clot.  The gauze can be left in place for 24 hours but once dried should be soaked with saline prior to removal.

Revised massive transfusion protocol and emergency release blood product delivery forms

The revised massive transfusion and emergency release forms for uncrossmatched product are now stocked in the trauma room and available for download from the GUIDELINES page.

With the revised MTP form, the delivery schedule has now been replaced by a fixed ratio of 5U PRBCs, 4U FFP, and 1U single donor platelets.  2 Pooled cryoprecipitate (equivalent to 10U of cryo) will be added to every 3rd delivery of product.  You may also request FEIBA, Kcentra, or other blood product as needed.

In addition, in situations in which a patient is not rapidly exsanguinating and you don’t expect you will need multiple deliveries, you can also obtain smaller quantities of uncrossmatched blood product just as quickly with the emergency release form.   As a reminder, 1U of single donor/apheresis platelets is equivalent to ~5U of pooled platelets.

In both cases, call 4-2028 and send a runner with the signed forms affixed with a patient label to the blood bank to pick up the product.

MASSIVE TRANSFUSION FORM - 7.19.17
EMERGENCY BLOOD PRODUCT RELEASE - 7.19.17

Hand & Extremity Cellulitis

The observation unit will accept patients with hand cellulitis after they’ve been seen by the covering consult service in the AED. They’ll also accept cellulitis cases that crosses joints where there is a concern about septic arthritis – as long as orthopedics sees the patients in the AED and documents their impressions.

 

Humipak

What is the Humipak? 

  • It is a plastic bag to be used when returning reusable instrument trays for cleaning.

What kits do you need to use them for?

  • All reusable kits, all of which should have the Humipaks included on top of the blue sheets.

How to use them:

Use the kit and complete your procedure successfully

  • Place all tools back on the tray
  • Wrap the tray in the blue sheet
  • Place in the Humipak
  • Add 1 cup of water
  • Seal the bag

 

Subject: ATTENDING INTAKE UNIT

From Department of Internal Medicine:

Starting tomorrow, Tuesday May 30th at 7-8PM an attending intake unit will start to expedite ED admissions (or further assessments) to medicine. This will consist of attendings who will evaluate and admit patients without house staff. They will work from 7PM to 7am on nights. In the am they will sign out admitted patients to the MTAR who will give them teams. We will show everyone the flow on Tuesday. However, in order for this to work, it is imperative that all admitted patients to medicine (except MICU, CCU or A4 ) go through the MTAR. The MTARs will than assign teams starting at about 8 PM when the shift  starts. The MTAR will assign cases to the attending intake  as well. This will decrease the number of admissions that the MTAR and night floats will be admitting. Therefore, having the MTAR assign all admissions after 8 PM (irrespective of whether the teams have capped or NOT) is mandatory. A4 admissions will be called directly to the resident on A4 or TR once the team has capped or after 2 PM. MICU and CCU will continue to function as at present.

 

Addendum from ED Admin:
There is no change to the current admission process on the part of the ED provider.  The change is related to the way medicine will assign admitted patients to their service.

Trauma Ultrasound

For Ultrasound in Trauma –

  • Place patient Baxter number, provider user ID and attending user ID
  • Complete POCUS study
  • Place order in Epic
  • Open Q-path
  • Find Baxter ID and replace with patient MRN
  • Document Study

E-Prescribing now mandated 100% of the time and other tips on filling prescriptions at Elmhurst.

As a summary of the below corporate email –

1) E-Prescribe 100% of your discharge prescriptions.

2) You can E-Prescribe to the Elmhurst pharmacy which is open 8am-4pm M-Fri (closed weekends and holidays)

3) If a patient cannot fill a prescription from a community pharmacy after-hours; E-prescribe the medication to the Main Pharmacy then call them and let them know the script has been sent to their queue  and ask them fill at least the minimum needed prescription for a safe discharge.   The AOD can then be contacted to pick up the script.

——

 

As of today our e-prescribing waiver has expired, which means that all prescriptions must be transmitted to pharmacy electronically.

Electronic prescriptions for non-insured patients may be send to the facility’s Outpatient Pharmacy, which is open from  8:00 a.m. to 4:00 p.m., Mon – Friday (closed on weekends and holidays). During off hours, e-Rxs need to be transmitted to community drugstores and patients need to be advised accordingly. In urgent situations (when a patient is uninsured, must have his prescription filled and cannot access a community drugstore), the Main Pharmacy pharmacist can process the prescription from 4:00 to 11:30 p.m. provided:

  1. An e-Rx is transmitted to the facility’s Outpatient Pharmacy
  2. A phone call is made to alert the pharmacist that a prescription was send to his queue
  3. Arrangements are made for picking-up and signing off the medications internally (via the AOD) as Main Pharmacy is not equipped to handle patients  and patient’s bags cannot be sent via the pneumatic tube.

 

Effective tomorrow, in order to comply with NYS law, we’ll have to discontinue the OPD med cart (see attached) and also remove from Pyxis  the percocet packaged for outpatient use.

 

Please share this info with appropriate staff

Alcohol levels in Trauma

ETOH level is needed for all Trauma Admissions (Activated and Non-Activated). 
 
a.       The ETOH level needs to be drawn on all activated trauma patients (Red and Yellow) at the time of ED arrival.
b.      For Non-Activated patients getting admitted with any Traumatic Injury, it needs to be added to the first specimen sent to lab, at the time decision to admit the patient is made. These patients can be in any area of the ER
c.       It must be drawn on all >=15 year old patients (even if it’s likely to be irrelevant).
 
Please see attached SBIRT policy, which clearly states:
 
Alcohol levels will be drawn for all activated trauma patients (>=15 years of age).  Alcohol level will be added to the serum specimens drawn upon ED arrival on non-activated trauma patients admitted to the hospital.
 

Psychiatry Consults

Providers – please be sure to place an order for psych consults.

This should be done whenever a psych consult is going to come to the ED to see a patient.

Dr. DePena-Nowak and Dr.Givre will be monitoring the time is takes from calling for the consults to transfer to CPEP.  We will be working together to improve communication and patient care between the ED and CPEP.   Let me know when you have any issues.

Dr.Givre