Morning all,

Please ROUTINELY ask the charge nurse ( or bed allocator if daytime) if the site you are working in has beds when you go to admit.

It will save you phone calls/work if you need to admit to the other hospital site due to beds/services.
This has been a factor this week with gridlock at HDMH.

Then call switchboard at the site you are admitting to and ask for the orphan doc. The orphan systems are quite different at both sites so swithcboard is our coordinator/fallback!!

John

Hi everyone,

As you will have seen in the circulated MAHC memo carfentanyl is confirmed in Grey Bruce and I am sure it is here too!!

Fentanyl testing is a send out test and has a two day turnaround. I ahem talked to lab about this within the last month.
Our current drug screen does not have like almost every hospital in Ontario and beyond.

Becky Vanersel ( our LHIN ED lead) had the following to add below…
“Only thing I want to make sure you know is that carfentanyl has been in grey bruce and likely will be in our lhin shortly. Decontaminate with cold water to reduce transdermal absorption for patient, high dose narcan (8-10mg) and consider narcan infusion. Full PPE is being recommended – but at least contact precautions for staff”

I am gonna reach out to Howard Ovens at Sunnybrook to see if he has advice and /or how they are approaching this….

Stay tuned.

John

Anyone have any topics that they find interesting in the “choosing wisely” campaign that they like and want to audit??

Track performance ? Or reasons we can’t/don’t follow it??

Take a read of the closing wisely ER section if you haven’t recently. No earth shattering things but…..interesting.

Please let me know if you are interested in pursuing something!

John

Hi All,

When writing orders for admission please always use the orderset having to do with the number one reason for admission!

I am currently auditing this.

Reason being…
1) QBP is being tracked and are built into order sets. Orderset use clearly triggers a cascade of things with need to be doing as a hospital that the ministry is tracking.
2) very soon…hospital funding is gonna be tied to performance on QBP practices.

This is brought up repeatedly at MAC now and re-discussed yesterday again.

I am happy to talk to anyone to explain more if needed.

thanks
John

Please write down time that you call consultants and ask for them to see a patient as data is actively being colected on this.

If you know what time they arrive to see a patient write that on the chart too.

If you mutually agree on a time to see patient then write that on the chart.

Just a reminder.

John

HI all,

Please be aware that our drug screens do not pick up fentanyl!

Also – be aware that different isomers of fentanyl are in our community and have different metabolism times!!

I am working with the lab re: our drug testing but be aware.

Any patient that is decreased LOA with response to narcan consider observing for several hours.

Hopefully more details /specifics to come.

John

Please order salbutamol news with mg’s not amps…..

Two different strengths floating around.

We also have very, very little in terms of supply overall ( as you will have seen memo today)….

Please consider use MDI’s with aerochamber when ever possible!!

The studies suggest this is probably best practice anyways!

John