East Cluster Meeting Minutes, December 3, 2008

Attendees: David Butler, Nicole Trombley, Cheryl Rogers, Barb Meier, Marty Levine, Sheila Collins, Mark Christianson

Flow Nurse Support

MA/LPNs not taking breaks and they should: 15 minutes/half day. The group unanimously agreed breaks should be taken.

Docs reviewing the AVS with patients saves the MA/LPNs time and the patients like it.

Docs should ALWAYS enlist the help of the MA/LPNs when the following are needed: urine collection, nephrolithiasis strainer, stool culture, sputum collection. Docs have sometimes simply sent patients to lab to get these things and the lab technicians will send them right back.

Immunization management in the cluster needs to be done well and we discussed several key points about immunizations.

1) Consent forms for shots must be completed in the cluster (not CORE)

2) Consent forms must have patient labels affixed to both sides within the cluster

3) Vaccine information sheets (VIS) are the responsibility of CORE to provide patients, but patients often want them from the cluster and the cluster should be prepared to provide them

4) As part of preparation for the start of the half day, the MA/LPNs should prepare immunization consent forms for all patients and have them ready in the exam rooms upon completion of rooming

5) The CORE uses the vaccine consent form to tell them what shots are ordered. The CORE does not routinely check the orders in Epic placed by the physician. Though the physician may put immunizations in the note and orders to properly document what has happened at the visit, it is not important to do this to ensure that vaccines are administered. Because vaccines have standing orders by default, docs don't have to order them.

6) MA/LPNs can find the process of determining a catch up schedule for children immunization onerous. MA/LPNs do not have the confidence that they can do this work and seek out other nurses for help. This can create a bottleneck situation. It might be preferable to develop MA/LPN skills/confidence with catch up immunizations to make this easier.

7) FYI -- the CORE now gives out stuffed animals to children after shots.