Blood Culture Bottle Shortage Restrictions and Recommendations

Effective immediately

Go-live to stop the 2nd blood culture orders is July 22, 2024.

We are experiencing an ongoing national and critical shortage of all Blood Culture Bottles (Pedi & Adult) that is anticipated to last through the end of 2024. Our supplier has asked that we reduce utilization by 50%. Restrictions to ordering processes are vital to ensure we do not exhaust our blood culture bottle supply.

Restrictions:

  • *Blood Culture collections are restricted to 1 set (1 anaerobic and 1 lytic), in place of 2 sets.

  • *Hard stop for all Blood Cultures ordered within 48 hours of a prior culture.

  • *No future orders for all Blood Cultures

Recommendations:

  • Prevent contaminations and thoroughly disinfect & ensure proper fill volumes are collected

    • UMC is well poised for this bc our contamination rate is extremely low, regularly <2%

    • Phlebotomists and Nurses who collect blood are cultures are well trained and demonstrate a very high competence in blood culture drawing techniques

  • Blood Culture bottle fill volumes are evaluated monthly and all areas are compliant with appropriate fill volumes, which drastically reduces false negative cultures

  • Body fluids other than blood should NOT be placed in blood culture bottles for culture

  • Peripheral collections are strongly encouraged – Only draw from a line if you are trying to determine if the line is infected

  • Do NOT collect blood cultures before an order is placed

  • Do NOT discard a bottle to ‘try again’ and get a better fill

  • In addition, blood cultures are NOT recommended in the following scenarios:

    • Patient with elevated WBC & no other signs/symptoms of sepsis

    • Patient with fever but no chills, leukocytosis or other signs of sepsis

    • Stable patient with prosthetic joint infection

    • Stable patient with post operative infection, planned for I&D w/OR cultures

    • Patient with repeatedly negative blood cultures in past week

    • Patient with UTI infection

    • Patient with non-severe pneumonia

    • Patient with non-severe cellulitis

    • Daily cultures to document blood stream infection clearance

For special circumstances or requests, please call:

Marisol Martinez, Clinical Laboratory Director @ 806-775-8399 or

Jayton Zachary, Clinical Laboratory Asst. Director @ 806-775-8381 or

The Microbiology Department @ 806-775-8375

*IT Tickets have been placed for these changes to be implemented as soon as possible

Dietary Supplement for Stage 3 & 4 Pressure Injuries

Estimated Go-Live Date: July 24, 2024

Juven is a therapeutic dietary supplement that supports wound healing. National Pressure Injury Advisory Panel (NPIAP) guidelines recommend providing additional nutrients (i.e., arginine, glutamine, HMB, multi-vitamin) for the prevention and treatment of pressure injuries as a standard of care.

A dietary supplement order for for Juven BID will be added to the Stage 3 & 4 Pressure Injury Standing Delegation Order which is initiated on patients with Stage 3 or 4 pressure injuries by nursing staff.

Juven is mixed with water or juice for oral administration. Can be mixed with soft foods (i.e., applesauce or ice cream) for patients with fluid restriction concerns or patient preference. Ability to administer via feeding tube as well.

Scan QR code to learn more about Juven.

For reference material or any questions/concerns, contact:

Hanna Cunningham MSN, RN, CWOCN

Wound Care & Ostomy Services Supervisor

806-775-8873

hannah.cunningham@umchealthsystem.com

Influenza Vaccination Update

Go-Live: August 1, 2024

The 2024-25 flu vaccine is moving from a quadrivalent to a trivalent immunization.  To consolidate and ensure proper ordering and documentation, all influenza orders will only be available in a new care set called "Vaccinations Influenza w/chg".  The new set will be available beginning 8/1/2024.  You will no longer find influenza vaccines in the age-specific vaccination care sets.

Changes to the Request Medical Records from Outside Facility Order

Go-Live: June 12, 2024

Summary

On 6/12, additional fields will be added to the Request Medical Records from Outside Facility Order. These changes have been made for providers who are waiting on information that is needed for clinical decision-making and want to be notified when it comes in, regardless of the hour. These fields will let the HUCs know they can contact the provider as soon as the records arrive and include a field for provider contact information.

Key Points

The two (2) new fields within the order include:

  • “Notify provider if records received outside of normal business hours”

  • “Provider to contact name/number”

Old Order

New Order

Cerner Oracle Code Upgrade

(All Cerner Applications)

Tuesday, June 4th, 10:00 pm- 4:00 am

During this time, Cerner will be available. There will NOT be a downtime; however, there will be brief interruptions in service during the following time periods:

10:15 pm – 11:00 pm

  • Radiology Imaging

    • No new or modified radiology orders will cross to CHRS Radiology PACS.

    • No new reports will be available in PowerChart.

    • ONRAD will fax radiology reports during this time

  • RapidComm blood gas, Glucometer, iStat, and Sofia results will not populate in PowerChart.

  • Quest results will not populate into PowerChart, and orders will not send to Quest.

  • Orchard Orders and Results will not post for TTU Student Health.

  • South Plains Rehab-Encompass, Lubbock Heart Hospital, and Montford orders will not populate into Cerner, and results will not pass to the vendors.

  • Telemetry strips will not show in Clinical Notes.

  • ePrescribing

    • Prescriptions will queue up and be sent once the interfaces are back up.

    • If a prescription needs to be sent immediately, please print, or call in the prescription.

  • Teletracking will not show new, updated, or transferred patients.

  • EasyID will not show new, updated, or transferred patients.

  • IDX will not show new, updated, or transferred patients.

  • Hill-Rom

    • New patients nor transferred patients will appear on the dashboard.

    • Bed alarm automation will not be functional for new admits or newly identified fall-risk patients. Staff will need to use the downtime procedures of manually turning on/off bed alarms.

** By 11:30 pm, all patients and orders will be released, and the above systems will be updated. Radiology systems will receive the updates, and the reports will cross over once the orders are reconciled. **

10:00 pm – 12:30 am

  • Bridge will not be available. Charting will have to be completed on the compatibility tag.

11:00 pm – 11:45 pm

  • Scheduled reports will need to be printed manually (ex. Dietary reports)

  • Batch label printing (Meds/Labs) will be run early, but any new orders during that time will need to be printed manually. ** At 12:00am, all scheduled reports and batches for label printing will resume as scheduled **

You will be prompted to log out at least once during the upgrade. If you receive this notice, then please log out. You will be able to log right back in without issue. With the system being available during the upgrade, there is a potential for odd issues to occur. If you experience issues, we will wait until the upgrade is complete to troubleshoot. If you experience issues, please call the IT Helpdesk at 59109.

Jehovah's Witness BB Order Alert

Go-Live: May 6, 2024

Beginning May 6, 2024, Jehovah’s Witness patients will trigger an alert to fire when blood products are ordered. The alert is based on the patient’s religion of Jehovah’s Witness and when any of the following blood products are ordered:

  • BB Cryoprecipitate for pts 25 kg or GREATER

  • BB Cryoprecipitate for pts LESS than 25kg

  • BB Plasma for pts 25 kg or GREATER

  • BB Plasma for pts LESS than 25kg

  • BB Platelet for pts 25 kg or GREATER

  • BB Platelet for pts LESS than 25kg

  • BB PRBC for pts 25 kg or GREATER

  • BB PRBC for pts LESS than 25kg

  • BB Send Blood Product for pt 25 kg or GREATER

  • BB Send Blood Product for pts LESS than 25kg

  • BB Transfuse Rh Immune  Globulin

  • NICU BB Cryoprecipitate Order

  • NICU BB Plasma Order

  • NICU BB Platelet Order

  • NICU BB PRBC's Blood Order

  • NICU BB Send Blood Product

PowerChart SkyVue Workaround

For those providers who need access to Cerner SkyVue through PowerChart, a new link has been created to allow you to launch PowerChart/Surginet/FirstNet with SkyVue (the old viewer) instead of the new Cerner Image Viewer.

http://cernerweb.teamumc.com/Citrix/SkyVueProdWeb/

NOTE:

This is the same unsupported version of Cerner SkyVue and will continue to have the same issues it previously had.  However, we will make this PowerChart SkyVue link available as a temporary workaround until the Image Viewer reaches a stable state.

Reminder on NPO Diet Orders

Diet Order Key Points

  • When an NPO Diet Order is placed and “(None)” is selected, the NPO Order will begin at THAT time. The same issue will occur if T;N NPO is selected. Therefore, the patient could unintentionally be left without a meal for an extended period of time.

  • If NPO needs to begin after midnight, ensure you are selecting “T;2359 NPO After Midnight.”

  • “(None)” cannot be removed as it is a Cerner Standard.

    • Ensure the correct NPO Order Sentence is selected based on the patient’s needs.

DISCHARGE CLOSED SURGICAL SITE INSTRUCTIONS AND DISCHARGE OPEN WOUND CARE INSTRUCTIONS

Go-live: April 24, 2024

Summary of Changes

  • On 4/24, a new order called Discharge Closed Surgical Site Care Instructions will be added to all PowerPlans with the Discharge Wound Care Instructions order.

    • This new order will include the following fields: Wound Location, Wound Care Instructions, Remove Dressing in (days), Replace with, and Additional Instructions.

    • This order should be used for closed surgical site care instructions.

  • The Discharge Wound Care Instruction Order will be renamed to Discharge Open Wound Care Instructions.

    • This order should be used for care open wound care instructions.

Discharge Closed Surgical Site Care Instructions

Discharge Open Wound Care Instructions

Impacted Plans:

  • Adult Discharge Plan

  • Adult Outpatient Ophthalmology Plan - Discharge Orders

  • Adult Outpatient Surgery Plan - Discharge Orders

  • Cardio Discharge Cardiovascular Procedure Plan

  • EC OR Adult Outpatient Surgery Plan - Discharge Orders

  • EC OR Pediatric Outpatient Surgery Plan - Discharge Orders

  • GYN ONC Outpatient Surgery Plan - Discharge Orders

  • NICU Discharge Plan

  • Outpatient Endoscopy (GI) Procedure Plan - Discharge Orders

  • Outpatient Endoscopy (Pulm) Procedure Plan - Discharge Orders

  • Outpatient Endoscopy Procedure Plan - Discharge Orders

  • Outpatient Interventional Radiology Sedation Plan - Discharge Orders

  • Pediatric Discharge Plan, Pediatric

  • Outpatient Ophthalmology Plan - Discharge Orders

  • Pediatric Outpatient Surgery Plan - Discharge Orders