Email Discussion Group

To join the Email Discussion Group, please email cathlabdigest@hotmail.com Pictures in this month's Email Discussion Group are from St. Mary's Medical Center in San Francisco, CA. Topics Under Discussion: Incentives for certification Observing OR nurse asks for advice Question 1: Incentives for Certification I am gathering data to present to my hospital supervisors and would like to hear from as many people as possible. The hospital I work for does not give bonuses or an increase in pay for RNs or RTs who go on to get their RCIS, CCRN, CORN, etc. There are no incentives to gain these certifications. I feel that those who have obtained the skills and knowledge to pass these exams and meet a national standard show that they are dedicated to the care they give and want to excel in their practice. The other two hospitals in the area do give compensation for those who have achieved these goals. What type of compensation at your facility does one get? Thank you, Kevin, RN, RCIS, ldrich3@comcast.net Grade or bonus We have a grade difference for technicians who get their RCIS and a bonus system for RNs who do so. pam_ragland@bshsi.com Nothing at our facility Our hospital does not give any bonus for passing the RCIS, CCRN, etc. Annie Ruppert RN, San Diego, CA, Annie.Ruppert@sharp.com Zero additional pay We do not give additional pay for ACLS, or any other certification. Patti, PatriciaACoblentz@ProvenaHealth.com More certs reduce liability insurance We offer an hourly differential for any advanced level certification or Registry, i.e.; ARRT’s CV exam, RCIS, CCRN and ACLS. This not only increases knowledge bases but also reduces liability insurance for our area of the hospital. Steve Gressmire, Cardiology Services Manager, Northwest Mississippi Regional Medical Center, Clarksdale, MS, Steve.Gressmire@nwmrmc.hma-corp.com Some facilities yes; some no The answer from New Orleans is mixed. I know of several RCIS who have received raises after passing the exam, and also several who haven’t. I, unfortunately, was one who did not receive a raise/bonus. Alex Holmes, RCIS, RT If required for position, no Our hospital reimburses for initial certification upon submission of proof of passing grade, plus will reimburse for recertification. However, we are required to remain employed at the facility for the time period of the certification or must return the $$. Also, if a certification is a requirement of the position, there is no reimbursement. So if your CVTs are required to be RCIS, then there is no reimbursement. I work for a public hospital, but most places I have been have virtually the same rules. Monica C. Simpson, RN, MSN, CCRN, CCNS, Cardiovascular Clinical Nurse Specialist, Broward General Medical Center, Fort Lauderdale, FL, mcsimpson@nbhd.org No financial incentive At this time, RNs do get paid slightly more than techs. We do not receive any financial incentive for additional degrees. Tracijo Capua, Cath Lab Coordinator, Flagler Hospital St. Augustine, cathlab@flaglerhospital.org Union/non-union important When it comes to compensating staff for the RCIS, we pay non-union members a $2.50 increase per hour. The nursing staff, on the other hand, receive nothing at this time. The reason is they are under a union contract and they do not address it in the contract. I believe the CCRN is covered under the clinical ladder. Scott Fylling, Manager of Cardiac Cath/Special Procedures, Scott.Fylling@bhsnet.org For techs, yes; RNs have ladder We hire techs and RCVTs (RCISs). If the techs pass their register, then they get an increase in their hourly rate. The nurses that are in the lab have a clinical ladder that they can climb for increases in hourly rate based on their skill level. charlene@shentel.net Pride plays a role All techs and nurses are paid on the same scale regardless of further education or credentials. Most have extra credentials just as a matter of pride. Bob Cole, Ft. Smith, AR, BCole@ftsm.mercy.net Only years of experience count Emory University Healthcare does not give any incentives for the RCIS credential nor the ARRT CI credential. The RNs have been given significant salary adjustments that supposedly parallel the salary shifts with our regional competitors. Whether they obtain the RCIS has no bearing on the salaries. HR and administration only looks at how many years of experience the person has as a nurse with a cutoff at 14 years. As for technologists, the cutoff for salary incentives is ten years of experience in cath labs. Radiologic technologists only are required to have their basic ARRT radiography credential. Each employee is brought on board based on years of experience, which places most candidates at the bottom end of the scale. There is no recognition by the system for any advanced credential. Paramedics with a state EMT-P credential are being hired with credit for their full years of experiences, Their starting salaries with no cath lab experience are beyond some of our ARRT-credentialed employees and beyond some of our RNs who have cath lab experience. Chuck Williams, RPA, RT(R)(CV)(CI), RCIS, Emory University Hospital, Atlanta, GA, CharlesWilliams@mail.weber.edu Annual merit increase There is no compensation here for taking the RCIS, etc., but it does increase your merit annually. Larry Sneed, BS, RCP, Coordinator, Cath Lab, lsneed@armc.com Reward w/ $1/hr We offer $1.00 per hour for attaining national recognition. Cynthia.Fielders@HCAHealthcare.com Question 2: Observing OR Nurse Asks for Advice I am the perioperative educator at my hospital. I am currently reviewing the practices in our cath lab and angio lab. I will be reporting to the Directors/physicians and trying to set a standard of practice for these areas. I have been observing procedure and practices for 2 weeks. Being an O.R. nurse, there are areas that I can help, but I also want to make sure I see this from the staff’s perspective. I have concerns with attire and questions about what procedures you consider "sterile," warranting a O.R.-type set up vs. a procedure requiring just the actual tray to be sterile and not the surroundings included; medication distribution by techs.; use of the ESU; traffic control, etc. Thanks for your consideration. MaryM, from MD Sterile for pacemakers only Our pacemaker room is maintained in an OR fashion in regards to sterile procedure. All staff wear hats, masks, gowns, shoe covers, and while the pt is being prepped, they also wear a hat and mask. We remove the mask once the pt is draped for the procedure. All doors are kept closed and the traffic is kept to a bare minimal so people are not coming in and out of the room during the procedure. The tray for the procedure is not opened until the pt is in the room and then it is done by the scrub person. The scrub required for the staff assisting and the MD is longer also. Annie Ruppert RN, San Diego, CA, Annie.Ruppert@sharp.com No, backed up w/ zero infections PLEEZZZZZZZZZZZZE……DO NOT promote a sterile environment! ALL our cardiologists feel that the arteriotomy is similar to an IV puncture. The scrub and physician do wear gown, mask, hair cover but no one else in the room. Our infection rate equals zero in my 13 years. Patti, PatriciaACoblentz@ProvenaHealth.com LHC is CLEAN procedure I feel that a LHC is not really a sterile procedure. It is a clean procedure. We do wear mask, cap, glasses for our protection. We have never had any infections due to our techniques. Larry Sneed, BS,RCP, Coordinator, Cath Lab, lsneed@armc.com EP lab has OR sterility We consider a clean procedure room: any entering the lab wear scrubs, foot and hair covers. Those at the table must also wear sterile gowns, gloves and masks. The door is kept closed at all times. EP Lab: we keep OR sterility standards for this room; it is cleaned nightly and between cases, no one enters (including reps, visitors, etc.) without being in full OR dress. pam_ragland@bshsi.com Our pacemaker room is "sterile," like in the OR. Cath lab: techs and nurses wear hats and masks, doctors do not. Go figure. Bob Cole, Ft. Smith, AR, BCole@ftsm.mercy.net Masks for pacemakers We use aseptic technique for all procedures, including masks and caps for all at the tableside. We do, however, mask all personnel for pacemaker implants. Our infection rate has been quite low. We have seen a reduction in groin infections (zero) since using the Chloraprep for groin preps. We do not use it alone for PPMs, adding a Betadine prep, and letting it dry. Louisiana law does not allow techs to administer medications. We allow only one sales rep at a time, and they are not allowed in the procedure room. Alex Holmes, RCIS, RT CDC recommendations need revisiting? Procedure rooms such as cath labs and interventional radiology suites are semi-sterile environments, not surgical sterile areas. Scrub clothes should be worn. My feeling is that the scrub clothes should be changed in the hospital and not worn home. A surgeon general told me that 20 years ago, he recommended changing clothes in the hospital because he never knew what micro-organism may be carried home to his spouse and children. With what we are possibly exposed today, I honestly feel the removal of scrub clothes is a safety measure that strengthens the need for standard precautions. Unfortunately, most hospitals require employees to arrive at work in purchased scrub attire; because employee theft of has created exuberant replacement costs. Implants suites where pacemakers and ICDs are implanted are full surgical rooms with the need for positive ventilation, etc. Also, how many of your facilities have stopped using iodine-povidine based skin cleaning solutions? Do we need to ponder the CDC recommendations? Chuck Williams RPA,RT(R)(CV)(CI), RCIS, Cardiac Cath Lab, Emory University Hospital, Atlanta, GA, CharlesWilliams@mail.weber.edu Fact-finding mission results A cardiac cath is a clean procedure and should not be confused with an open procedure like PPM that must be handled as a sterile procedure. All staff, while in the room, wear some type of hair covering, mask and eye protection. A colleague of mine, Linda Szafranski, Director of Surgical Services, has just completed a fact-finding mission for the hospital. The following is a synopsis of her report given to hospital administration and staff surgeons. Unable to locate even one regulatory agency that requires hospitals to launder scrubs for OR/PACU/OB or other staff members. CDC and OSHA strictly mandate practices they feel can pose a threat to patients and/or hospital staff. Again neither of them mandate hospitals to provide or launder scrubs. AORN is the only organization that recommends that surgical staff wear hospital-laundered scrubs. This recommendation is not based on scientific evidence that can be found, but appears more likely based on old habits. Unable to find one research article linking the use of scrubs to infections of patient or a staff family member. Sterile fluid-impervious grown is your barrier to pathogens. Extreme hot water and dryer temperatures are no longer the standard for laundering scrubs. EPA states many home laundry detergents are effective in killing Gram positive and Gram negative organisms, including Staph Aureus, using warm water temperatures. Dr. Belken, who is a highly referenced epidemiologist in this area of research, points out that hospitals which already have made the change to home-laundered scrubs would have switched back years ago if there was even a shred of evidence of infection concerns due to the change in practice. The cost-savings for a hospital switching to home laundered scrubs could easily add up well over $20,000 a year. This, with the rising cost of new devices and decrease in reimbursement, means we all may be doing our own laundry soon. Personally I am old school and would prefer to pick-up and drop-off my scrubs at the hospital. Scott Fylling, Manager of Cardiac Cath/Special Procedures, Scott.Fylling@bhsnet.org Clean vs sterile Sometimes there is controversy in the cath lab regarding a clean environment and a sterile environment. We wear sterile gowns, hat, mask and shoe covers to set up a sterile table. Then the scrub person remains wearing the sterile gown, mask eyewear and hat. The circulator doesn't have to wear a hat or mask at this time. This goes for the heart caths and interventions. When it comes to pacers then we treat the room as if it was an OR room, we try to maintain sterility, doors closed, everyone wears a hat, mask, and shoe covers. We clean the room between each case, wiping the back table and procedure table with sanimaster solution and mopping the floor. charlene@shentel.net Re: Procedure room dress codes At our parent hospital, the scrub assistant has to be dressed in scrubs and in full sterile environment dress. The fellows have to be dressed the same. The attendings are dressed in sterile dress over their street clothes. At our other hospital, all scrubbed personnel have on scrub clothes and proper sterile surgical attire. Circulating staff have to have on scrub attire but not face masks at both hospitals. Chuck Williams, RPA, RT(R)(CV)(CI), RCIS, Emory University Hospital, Atlanta, GA, CharlesWilliams@mail.weber.edu CCL Staff Trained in OR Sterility I am sure everyone will tell Mary about the long-standing argument we have with physicians regarding proper attire in the cath lab. Our staff in the cath lab are required to wear full scrub attire when assisting. Circulating staff does not. We consider a cath or PCI a clean procedure. I think most cath labs open out into an unsterile environment (we don’t have inner and outer cores like an OR). Same for EP unless it is a pacer or ICD insertion. That is sterile and we have the room set up as such (all shelving and cabinets can be closed and the room is cleaned as an OR prior to those procedures). We sent our staff to the OR for training so they would understand what was needed. At another institution where I was director, we started pacer insertions in the lab and we had the OR staff give us classes on sterile technique, including what is considered a breach, etc. They also used the ESU and were properly trained and observed on its use. The important thing to remember when it comes to your accrediting body (JCAHO or others) is that when the same procedure is performed in different areas, the practice is the same! Techs are not allowed to administer medications in cath labs in Florida, that is either a nurse or physician responsibility. Monica C. Simpson, RN, MSN, CCRN, CCNS, Cardiovascular Clinical Nurse Specialist, Broward General Medical Center, Fort Lauderdale, FL, mcsimpson@nbhd.org

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