Functional Mobility Assessment

Hospitalized patients at IU Health often suffer from mobility regression, which can negatively
impact length of stay, risk for pressure injury and falls, and discharge disposition. Consistent
patient mobilization during hospitalization is necessary to achieve positive patient outcomes
and avoid unnecessary healthcare cost (Hoyer, 2018).
Current state assessment of the IU Health Mobility Protocol identified a lack of functional
assessment tool availability and heavy reliance on nursing clinical judgement to determine
safe mobility activities. Establishing standardized communication and goal alignment between
mobility stakeholders can better support a team approach and collaboration amongst
disciplines. Implementation of a standardized mobility functional assessment into the IU
Health Mobility Protocol algorithm has potential to provide common language for all staff and
aid in congruence of the mobility plan across entities.
The AM-PAC 6-Clicks is a 6-item assessment tool developed in collaboration between Boston
University and Cleveland Clinic to quantify functional mobility limitations. The 6-Clicks tool
was identified to have the best supporting evidence and closely aligns with the protocol goal
to provide an algorithm for nursing that is easy to follow, while delineating decision making.

Improving Documentation to Avoid a Long Term Acute Care Hospital (LTACH) Peer to Peer

Update in Indiana Parental Consent Law

Indiana law regarding who can provide medical consent for a minor defines “parent” as one who has legal custody of a child.

Riley Maternity and Newborn Health Project - Part 1

Riley Maternity and Newborn Health (RMNH) project has been scheduled to open Fall 2021.

Patient Blood Management Program

Beginning in January 2021, updated transfusion guideline dissemination, broad-scale education, and roll-out of transfusion analytics will occur across the system. The initial phase will focus on Red Blood Cell (RBC) transfusions. After a review of baseline data and benchmarks from over 300 hospitals nationally, the PBMC has set system goals for 3 well-established RBC transfusion metrics in 2021: Increase the number of units transfused at a hemoglobin below 7 g/dL, decrease the number of units transfused at a hemoglobin above 8 g/dL, and increase the number of single-unit RBC transfusions. The PBMC is excited to move forward on this work and the positive outcomes it can bring to our patients. Your support and engagement will be key to the success of this important patient safety and quality initiative.

New Dysphagia Diet Orders

We would like to alert physicians practicing downtown to be aware of this change so they can adjust dysphagia diet orders appropriately for patients that transfer for other IU Health facilities to downtown between now and March 12.

ED Sepsis Order Set Changes In Cerner

Emergency Medicine Clinical Council Approved Updates and Additions to the ED Sepsis Order Set.

Physician/Nurse Education - Inpatient Order Entry for All IV and PO Fluoroquinolones

Inpatient Order Entry for All IV and PO Fluoroquinolones

Inpatient Order Entry for All IV and PO Fluoroquinolones

• Published literature supports the requirement of clinical indication at time of order entry to increase appropriate antimicrobial use.
• Indication at time of order entry is also recommended by the National Quality Partners (NPQ) and CDC.
• The FDA recommends reserving the use of fluoroquinolones for specific indications “…when patients have no alternative treatment options because of the risk of disabling and potentially serious adverse reactions (Eg, tendinitis and tendon rupture, peripheral neuropathy, CNS effects)”.
• ID Clinical Council endorses required indications for fluoroquinolone antibiotics to prompt provider and clinician assessment of antibiotic appropriateness.

Minor Consent

Indiana Minors may consent for pregnancy related services at the age of 16 as long as a reasonable effort to contact the minor’s parent or guardian has been initiated.

I-PASS at Riley

A handoff is considered a shift in responsibility from one person to another. This shift in responsibility can be about any subject, including but not limited to patient handoffs.

Policy Change: Use of Mother's Own Milk (MOM) with THC

Changes in the policy Lactation: Drugs of Abuse, Narcotics and use of Human Milk and the use of MOM with THC.

i-STAT Cartridges - Recall

On January 15, 2020, the sole source vendor for our i-STAT Point of Care (POC) testing system announced the conclusion
of an FDA evaluation, in which it was determined that three i-STAT "test modules" or cartridges (namely the CHEM8+,
CG4+, and G3+ cartridges) have lost FDA clearance due to an unapproved change in their design a several years ago.

BD PosiFlush Syringes

Providers are reporting issues using the BD PosiFlush Syringes accurately. BD PosiFlush syringes require its seal to be broken prior to use. This document contain instructions for breaking the seal for these syringes.

INSPECT

Providers must review the INSPECT report for each patient during every visit prior to prescribing an opioid or benzodiazepine.

C-Difficile Testing: Yes or No?

Apheresis Ports

Provide clinical practice update to inpatient RNs trained in accessing ports to not attempt to access new Bard Apheresis Port. Recommendations: * Note the difference in shape from Power Ports upon palpation as demonstrated in pictures below, denoting difference in accessing this port. * Must get x-ray prior to accessing port to verify type of port to access. * Contact Apheresis if you suspect patient has PowerFlow Port. Issues: * Seen at least twice within the last few months on inpatient units at the Adult AHC. * Need to make sure RN aware not to access or attempt to access Bard port used for apheresis.

Functional Mobility Assessment

Current state assessment of the IU Health Mobility Protocol identified a lack of functional
assessment tool availability and heavy reliance on nursing clinical judgement to determine
safe mobility activities. Establishing standardized communication and goal alignment between
mobility stakeholders can better support a team approach and collaboration amongst
disciplines. Implementation of a standardized mobility functional assessment into the IU
Health Mobility Protocol algorithm has potential to provide common language for all staff and
aid in congruence of the mobility plan across entities.

How to Access and Register for the IU Health Clinical Nest Mobile APP

The Antibiotic (ABX) Stewardship Committee has developed an app to help physician with abx questions (pathways, use, etc.). Currently, it has been rolled out to the downtown only (with hopes to push the app system-wide in the near future). This document contains instructions on how to access and register for the IU Health Clinical Nest Mobile APP.