CRC minutes - 1.13.22
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Arizona Western College *
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BIO-299
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Medicine
Date
Jan 9, 2024
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9
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Cardiopulmonary Resuscitation Committee (CRC) Veterans Affairs Medical Center (VAMC) –
Tomah, Wisconsin ATTENDANCE: P = Present A = Absent E = Excused X = Alternate N=Not Required MEMBERS DEC 16 DEC 30 JAN 13 FEB 2 FEB 10 MAR APR MAY JUNE JULY AUG SEP OCT NOV DEC Chair –
Acute Care Provider or Designee A P P Co-Chair –
Deputy Associate Chief of Staff-MS P P P Committee Administrative Support –
MS E P P Fire Department Chief or Designee A A P Urgent Care Nurse Manager or Designee A P P Performance Improvement Representative P P P Education Instructor P P P Respiratory Therapist P P P Police Department Representative A P P Nurse of the Day (NOD) or Designee P P P AdHoc Members - - - Associate Chief of Staff-MS P - - Topic Discussions/Conclusions Recommend
ations/Action Responsibl
e Person Follow-
up Date 1. Date, Time, and place of Meeting January 13th, 2022 9:00am –
10:00am via TEAMS
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Topic Discussions/Conclusions Recommend
ations/Action Responsibl
e Person Follow-
up Date 2. Review/ Acceptance of Previous Minutes: None –
minutes not completed on time for this meeting 3. Old Business: None 4. Agenda Items AGENDA Cardiopulmonary Resuscitation Committee (CRC) 1. Date and Time of Meeting: January 13th, 2022 9a-10a 2. Place of Meeting:
TEAMS: 1 872-701-0185, ID - 857 612 207# 3.
Review Previous Minutes: none available for this meeting
4.
Agenda Items:
4.1.
Review Emergency Response Reports
–
TEAM to discuss all Emergency Responses to give reports to the group. type of emergenc
y Patient info date of emergenc
y assigned reviewer Committee review date with ambulance run report 1 ME
Gene Schmidt
10/13/2021
Adam Reinart 1/13/2022
yes
2 RR
Daniel Gallagher
10/17/2021
Angella Pierce
1/13/2022
yes
3 RR
Richard Bennett
10/23/2021
Marcie Fulford
1/13/2022
no
4 RR
Mahlon Libbey
10/28/2021
Leanne Arne
1/13/2022
no
5 RR
Richard Bennett
10/31/2021
Nancy Delzer
1/13/2022
yes
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Topic Discussions/Conclusions Recommend
ations/Action Responsibl
e Person Follow-
up Date 6 BE
Victor Fahl
11/6/2021
Marissa Hoffman
1/13/2022
no
7 ME
Rudolph Paulson
11/15/2021
Kate Hanson
1/13/2022
no
8 ME
Ronald Weise
11/16/2021
Dr. Simon
1/13/2022
no
5. Discussion on AMBU bag set up
–
Christopher Fox/Adam Reinart. 6. Next Meeting: January 27
th
, 2022 via TEAMS 4.1 reports Case #1 –
Mr. Gene
Schmidt (10/13/21). Nature of Emergency: Medical Emergency called for Shortness of Breath, Tachypnea. Group Discussion: Upon NOD arrival MOD in room. Veteran sitting upright in bed with 15LPM NRBM on, vitals machine on, Veteran using accessory muscles. Veteran stating "Need air" when asked if he was in pain. Veteran alert to self and place only. Vitals monitored to include respiratory rate. IV Fluids capped. 1812: Emergency called overhead and paged,1816: FD on scene, 1816: Sufficient staff called. 1819: 911 ambulance called, 1825: Tomah Ambulance on campus, 1843: Tomah Ambulance left with Veteran. All responders wore proper PPE. No delay or deficiencies noted. Paramedics from Tomah Health wear facility required level of PPE (they only had mask and gloves on even after informed Veteran COVID +). Dr. Simon did inquire with Tomah ambulance service on the PPE, there is no mandate to wear PPE for their EMT crew. This was reported to the Department of Health at the State level. Dr. Simon to have a discussion with Acting Acute care Nurse Manager. Nursing documentation needs to be better, taking forward to the Nursing Professional Practice Council (NPC) thru Angella Krueger. Discussed taking it down to the individual on their documentation processes or the Nurse Manager to have that discussion with her staff. Items that went well: Response of team. Items that did not go well: All appeared to go well. 1. Inquiry with Tomah ambulance service on the use of PPE for their staff. 2. to have a discussion with Acting Acute care Nurse Manager. Dr. Simon Dr. Simon 2/10/22 2/10/22
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Topic Discussions/Conclusions Recommend
ations/Action Responsibl
e Person Follow-
up Date Equipment not available or not functioning properly:
NA Case #2 Daniel Gallagher (10/17/21). Nature of Emergency: Rapid Response for Hypoxia. Group Discussion: No EKG at event, Documentation was sparse. Nothing led into the event. Veteran was a DNR however there was no DNR bracelet on Veteran nor available for the transfer. Veteran returned 2 days later to VA. EKG machines were on order and all buildings now have them readily available. Per report Veteran had an emesis shortly before his oxygen saturation decreased, oxygen saturation at lowest was 74% RA. RN denied him eating any breakfast this am. Stated that he has been having ice chips, that he was complaining of not feeling well, and that previous RN reported to her that he has been coughing. Reported to her that he also has been reporting a sore throat and coughed up some blood that was thought to be from him coughing so hard. Vitals monitored. MOD arrived and instructed staff to call for emergent ambulance. Veteran transferred out via Tomah Ambulance. Transfer to Tomah Health. All responders wore the proper PPE. No delays noted. Items that went well
: 1. Per MOD - NOD having the laptop. 2. Per Floor Staff - Response was timely. Items that did not go well: Per RNs -More education on transferring Veterans out. Didn't have the transfer out envelop, DNR band cut (no new band in drawer), no IV start kits in SPD. Equipment not available or not functioning properly: EKG machine not readily accessible. EKG machines were on order and all buildings now have them readily available. To have the state DNR bracelets in the Veterans drawer, that can be put on when Veteran needing to be transferred out. NA NA Case #3 Richard Bennett (10/23/21) –
Deferred until 2/2/22 meeting as time ran out –
assigned reviewer not able to review prior to meeting. Nature of Emergency: Group Discussion: Items that went well: Items that did not go well: Equipment not available or not functioning properly:
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Topic Discussions/Conclusions Recommend
ations/Action Responsibl
e Person Follow-
up Date Case #4 Mahlon Libbey (10/28/21). Nature of Emergency: Rapid response called for a fall. Group Discussion: Upon NOD arrival Veteran was lying by a wheelchair on his left side. Veteran was alert and oriented, he denied any pain. Veteran stated that he just fell. Denied hitting his head and denied losing consciousness. Veteran assisted back into the wheelchair. Veteran stated he is here for his first PT appointment. MOD assessed Veteran, stated that he was able to participate in his PT appointment at 1030. HR 93 SPO2 95% RA. 5 out of 7 responders did not wear proper PPE. No delays of deficiencies were noted. Items that went well: No issues with event. MOD did full assessment Items that did not go well: NA Equipment not available or not functioning properly: NA
NA NA NA Case #5 Richard Bennett (10/31/21) Nature of Emergency: Rapid Response called for a veteran who had an EKG that read tachycardia with a heart rate of 130's. Group Discussion: Dr. Kim properly documented the transfer note adequately. Nursing (early warning signs) documentation needs to better relay the timeline of events. The EKG machine needs to be on building 401, due to the frequency of cardiac events recently. Suggestions made to revise the Early warning sign template for either a Medical Emergency (ME) or a Rapid Response (RR) to be selected using a drop-down box to select either ME or RR. The EKG machines were on order and now located on all buildings. Veteran did not outwardly appear to be in distress. 150ml bolus of NS given, B/p recheck was 107 systolic, heart rate remained in 130's. EMS arrived 2330 and transported veteran to TMH ER for further workup. 3 out of the 4 responders wore proper PPE. Items that went well: EKG machine needs to be on building 401 Adam Reinart to assist with Early warning sign template update note in the future. Nancy Delzer Adam Reinart 1/13/22 2/10/22
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Topic Discussions/Conclusions Recommend
ations/Action Responsibl
e Person Follow-
up Date Staff remained calm, Elie! placed an 18 gage IV which was excellent in this case as the veteran became very hypotensive and required IV fluid bolus. Staff followed protocol. If I had to describe in one word how this Rapid Response went that word would be FLAWLESS. Everyone did a great job! Items that did not go well: NA Equipment not available or not functioning properly: NA
Case #6 Victor Fahl –
Behavioral Emergency –
not reviewed by CRC Nature of Emergency: Behavioral Emergency. Group Discussion
: Behavioral Emergencies (BE) are not reviewed by CRC committee. MOD does respond to these BH cases.
Items that went well: NA Items that did not go well: NA Equipment not available or not functioning properly: NA Nurse of the Day (NOD) office will send this case to the Behavioral Committee for their own review. Leanne Arne 1/13/22
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Page 7
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Topic Discussions/Conclusions Recommend
ations/Action Responsibl
e Person Follow-
up Date Case #7 Rudolph Paulson (11/15/2021). Nature of Emergency: Medical Emergency called for a Fall. Group Discussion
: When NOD arrived, Veteran was sitting on floor with pressure applied to facial lacerations. NOD called for sufficient staff and released many to go. MOD assessed Veteran. Veteran refused sutures. Veteran continued to hold pressure on lacerations. NOD obtained steri strips. Due to Veteran's disruptive behaviors, MOD and provider agreed that keeping the Veteran on the unit was the best choice for Veteran and staff. MOD alerted staff that she would be available to suture until 2000 if the Veteran changed his mind. He should have had sutures, however Veteran declined. All responders assisted MOD staff with Veteran to remain calm while is facial injuries could be addressed successfully. Documentation was completed fully. No delays or deficiencies noted. 10 out of the 15 responders wore proper PPE. A Rapid response should have been called in place of the Medical Emergency. Items that went well: All went well. Items that did not go well: Too many people in the room. Equipment not available or not functioning properly
: NA NA Case #8 Ronald Weise Nature of Emergency
: Medical Emergency was called at 0558 when Veteran was found unresponsive. Group Discussion
: Last well-known time was at 0400. Upon arrival of NOD staff had code cart at bedside, pads placed and CPR in progress. Ambu bag was hooked to oxygen. Upon arrival of the VA Fire, Lucas was placed for chest compression. 22ga peripheral, IV placed on left forearm. 0610 1 shock delivered (slight delay in pausing Lucas-possible lead to a shockable rhythm). 0612 No Shock advised 0614 no shock advised 0616 no shock advised 0617. 1 mg Epi at 0617 mouth was suction/oral airway placed 0618 no shock advised 0620. 1 mg epi 0620 rhythm check-no shock advised 0622 rhythm check-no shock advised 0624. 1 mg Epi 0626 rhythm check-no 1. To remind MOD staff for insertion of IO device to assist with access. 2. To inform the Acting ACN (Stephanie Greenwell) on Dr. Simon Dr. Simon 1/13/2022 1/13/2022
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Topic Discussions/Conclusions Recommend
ations/Action Responsibl
e Person Follow-
up Date shock advised. Time of death was pronounced at 0629. Timeline for IV insertion and Epi was delayed, should have used the IO instead. Rounding is to be done on the hourly basis. Documentation for hospice is done thru Cariboo system per CLC guidelines which is not a part of CPRS, the 2 systems do not work together unless the staff member saves the Cariboo data. into CPRS, but it does require to be uploaded. Dr. Simon to remind MOD staff for insertion of IO device to assist with access. Dr. Simon to inform the Acting ACN (Stephanie Greenwell) on the rounding instance to ensure hourly rounding on all units. 1 out of 5 responders did not wear proper PPE. Items that went well:
Despite a bad page being sent, all responders were able to respond timely to the event. SH staff were on point-had code cart at beside, had pads placed, and 2 rounds of CPR were completed.
Items that did not go well:
Paging Emergency to response team had issues, so staff were called out using the Radio devices. Initially was paged to the wrong building (409) which is empty.
Equipment not available or not functioning properly
: NA the rounding instance to ensure hourly rounding on all units. 5. Discussion on AMBU bag set up
During a Mock drill it was found that the current AMBU bags with HEPA filter are not working with the I-gel (does not fit properly). Discussion on if the Filter vs Peep valve are to be used in the interim until committee decides which is the best route until we can purchase the combo set up (with HEPA and PEEP valve). At the January meeting, the CRC committee advised that removing the PEEP device was the best route until the ESC committee could review/approve purchase of new device with both the HEPA filter and PEEP valve set up. CRC temporarily approved the new AMBU bag set up with PEEP device removed during the meeting held on 1/13/22, until we can get the PEEP valve and HEPA filter combination ordered. Dr. Simon for Christopher Fox 1/20/22 6. Next Meeting: January 27th, 2022 9:00am –
10:00am
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------------------------------------------------------------------------------------------------------------------- Tina Williams Recorder - Committee Chair APPROVED/DISAPPROVED __________________________________________________________________ Melissa Simon, DO Chair Attachments:
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