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Currents Progress continues with our efforts to strengthen our employee training program and to improve methods of training documentation. As reported in this newsletter last fall, several training-related initiatives are involved in this effort. A “hands-on” policies and procedures training session has been designed for new managers. The intent is to cover key policies and procedures that managers should be familiar with from their first day of employment. This training, consisting of two half-day sessions, will kick-off on April 17 and 25 and should include all new managers hired during the past six months. Through the efforts of the Human Resources Competency Assessment team and others, a very involved process to develop a Request for Proposals (RFP) is near completion. The RFP will be issued very soon and calls for an interactive web-based system for conducting and tracking training. This system will replace the defunct deMedici system and will offer the “annual mandatory training reviews” and an array of other training. It is anticipated that the web-based training system will be purchased and implementation will begin by this fall. Training sessions will be conducted on how to use the system and a number of system coordinators will be designated to maintain the system. Recently an RFP was issued for the purpose of providing targeted customer service and managerial training. The objectives will be to provide certain areas of the Medical Center with training in customer service skills and to enhance training for managers with a focus on retention of employees. It is expected that the contract will be awarded within six weeks and the training will take place during a one-year to 18-month time frame. Thank you very much. W. Stuart Smith Vice President for Clinical Operations and Executive Director, MUSC Medical Center   Stricter rules for writing medication orders required Director of MUSC Pharmacy Services Paul Bush is making the rounds these days, touting the contents of the bright yellow fliers and posters he’s circulating that present the new guidelines for writing medication orders. Paul Bush, director of MUSC Pharmacy Services, holds up the new guidelines for writing medication orders. “These new guidelines are designed to improve medication safety. We’re working to reduce the chances of error during the ordering stage,” Bush said to the management team during the Feb. 19 communications meeting. The guidelines detail unacceptable abbreviations and provide a list of required elements in all medication orders. Bush said that the guidelines apply to all inpatient and clinic medication orders. Health care professionals who write prescriptions are urged to review the guidelines and modify their order writing practices by March 18.  “As of that date, nurses and pharmacists will require that orders that are not written correctly be rewritten,” he said. Bush cited studies that show that 49 percent of medication errors originate in the ordering phase and many are due to orders that are illegible, incomplete or unclear. The yellow fliers detail recommendations to enhance medication safety and required elements for inpatient and clinic medication orders. “Medication orders, indeed all orders, are the basic written communication tool for patient care,” the flier states. “What an order says, or is interpreted to say, directly impacts the care of the patient. In carrying out an order, there are many ‘hand-offs’ by physicians, nurses, pharmacists and other health care professionals. If it is not written clearly, each individual who acts on the order may interpret it a different way. Most importantly, errors can occur when orders are misinterpreted.” Bush described key areas to attend to in order writing. Use of decimals with a trailing zero, such as 1.0 mg, or the absence of a leading zero (.5 mg), can result in ten-fold errors in drug strength and dosage. The guidelines stipulate that terminal and trailing zeros should never be used after a decimal and a leading zero should always precede a decimal of less than one. The flier also details dangerous abbreviations and explanations for why they are not allowed.  The use of pre-printed order forms, which are available on line, is encouraged. “It’s a big project,” he said of the re-education process. “We need every-body’s support. We’re flooding the place with yellow posters and yellow cards.”  If you don’t have one, Bush will be happy to send one to you. Call 792-5691. Environment of Care checklist helps promote survey readiness The mock Joint Commission survey being conducted the week of Feb. 26, 27, 28 is part of an overall effort to promote continuous survey readiness, according to Mary Hughes, project manager for Outcomes Management, Research and Development, and Mary Allen, Environment of Care coordinator, who both addressed the management team. Allen, promoting the use of the Environment of Care (EOC) checklist for clinical areas, encouraged managers to make sure the form they use is the most current version. “The EOC/IC checklist, first utilized in 2000, was scored by hand. Last summer, the checklist was developed into an electronic scan card and made more available by posting on the Intranet,” Allen said. After six months of using the scan card, there has been excellent compliance, according to Hughes. In 2001, compliance has improved substantially, making data collection more reliable. The change has resulted in an increase in reporting from 65 percent to 90 - 94 percent. “The idea is if you can measure it (items in environment of care), then it can help you improve,” Allen said. In addition to promoting continuous survey readiness, the effort is designed to ensure unit-based compliance with numerous EOC and infection control issues, to educate staff and to monitor and measure aspects of environment of care performance. The scan card provides a number of benefits, including a simplified listing of hot items inspectors typically assess, documented institutional safety trends and potential safety risks.  Hughes reminded managers that the scan card is available on the Intranet. Due to the sensitive nature of the electronic scan cards, please submit only the copy downloaded directly from the Intranet. Faxes and copies do not scan well. Also please remember to completely blacken the circles for each item and fill in the cost center identifier on both pages of the scan card, she added. Minor omissions or incomplete forms have an impact on the reports.  The scan cards are to be submitted to the office of Outcomes Management, room 248 North Tower, and reminders are sent out each month to help keep this on track. The next improvement is to update the scan form to have it fit all on one page. Eventually, she said, we hope to have the scan cards updated to a database that can be completed directly on the Intranet. This should facilitate data collection even further.  As part of the overall survey readiness effort, Jodell Johnson encouraged managers to replace the “Standard Precautions” signs and posters regarding hand washing with new ones if needed. New posters are available in the Infection Control office or from Infection Control Practitioners. Introduction of new employees Colleen Corish, R.N., clinical services director of Oncology and Medical/Surgical Services, introduced Lin Nicolas, Ph.D., the new administrator for Hollings Cancer Center. Joan Herbert, director of the Institute of Psychiatry (IOP), introduced Peggy Thompson, the manager for finance for IOP.