Sharing Vital Sign Tips

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By Dawn Thompson, DOR, Victoria Post Acute Care, El Cajon, CA

Over the last several months, Victoria Post Acute Care [VPAC] has honed in on vital sign monitoring as part of our daily practice in both nursing and therapy. I’ve been nominated to lead our vital signs committee, and during the next few weeks I’d like to share some of the best practices and education that assisted us through COVID and landed VPAC Vital Sign Grand Champions.

We’ll start with the vital sign we’re all monitoring daily, body temperature. After 8 months of daily screening, you’ve probably noticed a pattern and can guess your morning temperature within a few tenths of a degree; you’ve established your baseline temperature.

Do you know your residents’ baseline temperature? Would you be able to identify a fever and assist in early recognition of an infection?

Regularly measured body temperature is used to establish a baseline temperature and define the threshold temperature for fever. The elderly are noted with a lower baseline body temperature and a shift of 2.4*F above baseline is a fever, even when falling below definition of a fever at 100.4*F.

At VPAC, once a baseline temperature has been established, it is then added in special instructions in the Care Profile in PCC [See photo below]. This baseline temperature can then be used to assist in identifying any potential infection or COC with our residents.

Please don’t hesitate to reach out with any questions. (DawnThompson@ensignservices.net).

 

CAPLICO Moment: Momentum Therapist Spotlight

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By Paul Emerson L. Baloy OTD, OTR/L , DOR, The Hills Post Acute Care, Santa Ana, CA

Denise Del Cano, COTA, ADOR, has dedicated her career in The Hills Post Acute. An alumnus of Santa Ana College, she earned her associate’s degree in Occupational Therapy Assistant 12 years ago and has been with the facility since then. She was promoted to Assistant Director of Rehab last year and completed the DORITO program this year. Denise did her internship here at The Hills. She was supervised by Vonda Gaier, COTA, who then became her colleague. She is a Filipino American born in Los Angeles, California, the eldest of five and a loving mother to her 16-year-old daughter, Elizabeth. Interestingly, Denise was introduced to the field of therapy when her daughter received therapy for several years. Denise saw the importance and relevance of Occupational Therapy and has been an advocate ever since.

Customer Second: Residents approach her knowing that she will listen and immediately respond to their requests. She will ask any of our facility staff how well each one is doing and how she can assist them to make their day better.

Accountability: She assists her supervisor in creating daily schedules and follows up on department needs and requests.

Passion for Learning: She is seeking ways of learning new things, being receptive to new information and understanding, and embracing the Hills Post-Acute way of doing things.

Love One Another: She genuinely cares for the staff. She will hand you a cookie or any treat to perk up your day.
Intelligent Risk Taking She will listen and learn our new way of doing things. Willing to unlearn past habits, think outside the box and develop better and efficient new systems.

Celebration: She will bring in breakfast or lunch to celebrate the day’s hard work, keeping each one’s morale in check and in good shape. She will celebrate birthdays or becoming a new member of the team.

Ownership: She demonstrates ownership by making everything personal because she believes in her heart that this is her second home and that her co-workers are her family.

Code Sepsis: Pilot Program

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Submitted by Esther Allmond, DOR, The Cove at La Jolla, CA

The Cove volunteered to be a pilot site and is now entering their 3rd month for the EPIC program: CODE SEPSIS. Dr. Pouya Afshar handpicked our facility to trial this pilot program to help prevent sepsis in-house by carefully monitoring vitals throughout the day. Throughout this time, we have gained a new appreciation and respect for taking vitals before, during and after therapy treatment sessions. Rehab has taken a more active role in vital signs at The Cove, and I just wanted to share with all of you a little bit more about EPIC, CODE SEPSIS, and our current protocol at our facility.

EPIC (Excellence in Programming and IDT Care): Programs dedicated to taking IDT action with a QAPI approach in order to provide the most excellent care possible for our patients.

CODE SEPSIS MISSION: Early identification of sepsis to improve patient outcomes.

WHY: Sepsis is the leading cause of readmissions to the hospital in 2019 (20% of Medicare readmission!). With every hour that treatment is delayed for sepsis, the mortality rate increases by 8%.

CODE SEPSIS PROTOCOL: Taking vital signs early and often for each of Dr. Afshar’s patients. Nurses take vital signs Q shift (or more often). and therapists take vital signs before each treatment session and enter it into PCC. Notify charge nurse immediately with any one of the following triggers:
1. Temp > 99.5F
2. SBP < 100
3. HR > 90

CODE ACTIVATION/METRICS:
• Clinician identifies patient meeting criteria (initiation, time stamp)
• Notify charge nurse (5 minutes)
• Verify/repeat vitals (5 minutes)
• Nurse activates code (5 minutes)
• Code team clinician contacts on call MD/NP (5 minutes)
• Response back from on call MD/NP (10 minutes)
• Total time spent: 30 minutes
• Reassess at the end of each 30-day cycle
• Duration of phase 1: 90 days

CODE SEPSIS was triggered several times in the past two months, allowing us to implement interventions in a timely manner and preventing re-hospitalization for our patients! As we close the last 30 days of Phase 1, we hope to remain consistent and vigilant in monitoring vital signs for our patients, providing the most EXCELLENT care possible for patients and improving outcomes. Please feel free to reach out to me at any time if you have any questions, comments, feedback, or interest in implementing CODE SEPSIS at your own facilities!

Huge Shout-Out to Emblem Hospice

MP Celebrate

By Doug Haney, CEO/ED, Bella Vita Health & Rehabilitation Center, Glendale, AZ

I wanted to recognize this very special “Moment of Truth-esk” gesture that the entire staff of Bella Vita experienced recently. A couple weeks back, our staff was pretty worn down and experiencing a wide range of emotions dealing with the effects felt from this coronavirus. Everyone was especially hurt when we lost several of our long, long-term residents we all called family. We loved each and every one of those we lost and needed some serious support for those who knew them well.

Out of the blue, Michael and Mitch stepped in, offering a memorial service to honor and remember those we lost over the past several months. They set everything up, even though I knew their services were widely needed during that time. I can honestly tell you we cried and held each other a lot during that time. We were grateful for Emblem’s offering and kindness when we needed it the most. One of them brought a grill on wheels (not sure whose it was, but it is pretty sweet) and cooked up burgers and hot dogs for all the staff over a four-hour period. It was hot outside, but Michael didn’t seem to mind it — it was 115 that day.

At 2 p.m. in our main dining room, staff joined together and were allowed to share special memories about their lost friends and then place a leaf with their name on a potted tree. It was good to get together to reminisce, reflect, and realize we were blessed to be a part of their lives.

On behalf of the entire Bella Vita Team, THANK YOU MITCH, MICHAEL AND EMBLEM HOSPICE. You truly made our day!