Nursing Annual Report 2014

Transcription

Care and service.
Every day.
NURSING ANNUAL REPORT 2014
It gives me great pleasure to introduce the inaugural
issue of the Mercy Health Nursing Annual Report.
This report is a fascinating review of Mercy Health nursing
accomplishments in 2014. In these pages, we highlight
key initiatives, practices and outcomes from all across
our organization.
The annual report also recognizes and celebrates all that you have done. Each of you
demonstrates leadership in your commitment to patient-centered care as we come
together as one nursing organization. The new regional shared leadership structure
has led many of these successes. This is rather unbelievable, considering that we
started this journey less than a year ago.
Over the past year, I’ve seen many of you reach outside your comfort zones and grab
unexpected opportunities for “small tests of change.” These opportunities to learn and
grow — these trials to make things better for patients, families and co-workers — are
what I appreciate most. Just as we all learn and grow from each other, I’ve learned so
much from all of you. I applaud your professional commitment to a patient-centered
care delivery system and all of your accomplishments.
In 2014, Mercy Health — Fairfield Hospital was designated as a Magnet® Hospital
for nursing excellence in patient safety, patient experience, employee engagement,
transformational leadership and new knowledge and innovation. Our entire region’s
goal is to help support nursing excellence to become a Magnet Designated System.
In 2015, we continue to grow by embracing the Promise and TeamStepps. I admire the
courage shown by your adaptability and resiliency during the many recent changes
and challenges. Your leadership and collaboration through these changes have served
as a guide. Together, we make a difference for our colleagues, patients and community.
It’s been an honor and a privilege to work with you this past year. I look forward to a
future of collaboration and partnership on our journey to nursing excellence in 2015.
You have built the foundation for our future as Mercy Health nurses.
Pat Davis-Hagens
Chief Nursing Officer, Mercy Health and President and CEO
of The Jewish Hospital and Central Market
N U R S I N G A N N UA L R E P O R T 2 0 1 4
3
REGIONAL SHARED LEADERSHIP
A better experience for
patients and their caregivers
Regional Shared Leadership is an important part of our Regional Magnet Journey.
Four times a year, we get together to share ideas and processes that have been
successfully applied at each hospital. When we share across the system, we work
more efficiently, with a greater understanding and commitment to a shared goal.
The regional team listens to feedback from all levels of nursing and hospital staff.
This leads to more transparency and a more engaged staff committed to Mercy
Health’s success.
This shared involvement has had a positive impact on nursing and on our patients.
In support of clinically driven decision making, unit-based clinical councils guide
quality care using evidence-based practice. Our nurses enjoy an improved work
environment, satisfaction and retention.
Our patients benefit, too. The Mercy Health culture of excellence improves patient
safety and provides a higher quality of care for patients and their families.
We’re excited to collaborate with management to improve employee engagement,
the patient experience and patient safety. Putting the patient at the center of all care
is what we were meant to do — together.
Stephanie Matusak, BSN, RN, CNOR
Carole Baldwin, BSN, RN, CNOR
Mercy Health — Cincinnati Regional
Shared Leadership Chairs
4
M E R C Y H E A LT H
REGIONAL ADVANCE PRACTICE REGISTERED NURSE COUNCIL
Our new leadership council:
a source of professional
development
Advanced Practice Registered Nurses (APRNs) may serve as nurse practitioners,
clinical nurse specialists, nurse anesthetists or nurse midwives. All play a pivotal role
in the future of healthcare. APRNs are often primary care providers and are at the
forefront of providing care to the public.
Establishing a regional APRN leadership council allows us to advance the APRN role in
the Mercy Health organization. Our first council meeting was excellently represented
by all hospital sites, physician practices and specialty areas. The council’s goal is to
promote excellent quality patient care using the most current research-based practice.
We want to serve as an educational resource for all nurses. To achieve this goal, we’re
developing an APRN peer review process and defining the scope of practice for each
APRN specialty. We’re also creating a mentor program and support system for new
APRNs at Mercy Health.
As our journey continues in 2015, I’m confident that APRNs will make positive changes
and continue to be leaders in nursing.
Amanda Rumpke, MSN, ACNP, RN, CCRN
CNP Mercy Health — Fairfield Pulmonary,
Critical Care and Sleep Consultants
Chair of APRN Leadership Council
5
MERCY HEALTH — FAIRFIELD HOSPITAL
Success is a consequence,
not the goal
Congratulations on your achievements! 2014 will be marked as the “Year of the Survey,”
one of the most memorable in the 35 year history of Mercy Health — Fairfield Hospital.
It started out with that pinnacle of all surveys, the Magnet survey. The Magnet was
closely followed by the Triennial Joint Commission Survey, a CMS validation survey,
3 ODH surveys, a CARF survey, a Bariatric Center of Excellence survey and a
Commission on Cancer survey.
Many Mercy Health employees were singled out for the care that they provide, on both
the local (Daisy and Sunshine Award recipients) and national levels (Press Ganey
Nurse of the Year). Fairfield Hospital was also recognized with several awards including
the APEX Quality Award (for the Outpatient Endoscopy Center), the HealthGrades
Clinical Excellence award and the Quest Citation of Merit Award.
It was a great honor to receive these rewards and achieve this widespread success.
Patients and families will always expect the best from us. And even as we face more
challenges, we expect the best from ourselves.
But in the end, the most important thing to remember is that the goal is not awards
or recognition — it’s the care and service that we deliver.
Thank you for the care and service that each and every one of you gives each and
every day.
Ramona Cheek, MS, RN, CPHQ
Chief Nursing Officer and Site Administrator
Mercy Health — Fairfield Hospital
6
Pursuing shared goals
with Shared Leadership
What is Shared Leadership? It’s a way for hospital staff to partner with management.
It promotes shared decision-making, accountability and a better work environment.
Most importantly, it improves the quality of care.
When caregivers have a voice and are accountable for their hard work, it not only
gives the patient a better experience, but also gives employees better job satisfaction.
Research has shown that shared leadership increases patient safety, decreases length
of stay, increases patient satisfaction and increases staff engagement.
Over the years, Shared Leadership has changed Fairfield Hospital by bringing
management and staff together to discuss quality of care. It gives the staff a voice to
promote ideas to make the patient experience the best it can be. We also look for
ways to improve through education and professional development.
For example, we’ve improved control and documentation of hypoglycemic treatment.
We’ve also created “Quiet Time” rest hours in response to patient feedback.
The power of Shared Leadership shows up in a wide variety of unexpected and
meaningful ways. But the common key to success is staff involvement. Fairfield Hospital
and other Mercy Health hospitals are continuing to build awareness and educating
employees about what Shared Leadership is and how they can make a difference.
Together, staff and management have used Shared Leadership with great success in
promoting the best patient experience possible. To build on that success, our goal is to
continue learning from one another this year and far into the future.
Krista Meyer, BSN, RN, CMSRN
Lisa Wilson, BSN, RN
Mercy Health — Fairfield Hospital
Shared Leadership Co-Chairs
7
MERCY HEALTH — ANDERSON HOSPITAL
A tribute to our
excellent nurses
Mercy Health — Anderson Hospital has been on a journey. A quest to transform our
culture. A mission to elevate the professional practice of nursing. Over the years, the community has come to recognize Anderson Hospital as a leader
for excellence in nursing care. Thanks to this reputation, skilled nurses from all over
migrate to Anderson as their “home away from home.”
These nurses strive for excellence in quality, patient safety, patient experience, employee
engagement and physician satisfaction. They’re also challenged to elevate their practice,
improve their work environment and make the profession enjoyable and rewarding. The sacrifice that nurses endure for their patients and families is inspirational. Nursing is physically, emotionally and psychologically challenging. Our nurses give
of themselves every day and exemplify our mission and promise to our community. Each and every day, I’m blessed to work with the amazing nurses at Mercy Health —
Anderson Hospital. The pleasure is all mine.
Katherine J. Edrington, DNP, MBA, MSN-NEL, RN, CENP
Vice President of Nursing & Site Administrator
Mercy Health — Anderson Hospital
8
The power to make
powerful changes
The process of pursuing Magnet status has been invaluable. First of all, the Shared
Leadership structure that we’re establishing is the right thing to do for our patients.
It makes us accountable for keeping the patient and family at the center of care.
Second it gives staff direction and support.
Our staff is now empowered to make changes at the bedside that improve quality
of patient care and caregiver satisfaction and reduce patient harm. A few examples:
We initiated insulin dosage controls in the EMR. We actively seek and encourage family
involvement. And we promote evidence-based practices through research projects.
So not only can we share ideas, but we can also watch those ideas be put to use and
see the changes. This endeavor has truly changed the culture of our hospital to one
of partnership, accountability, empowerment and ownership.
Agnes R. Hudak, MSN, RN, CCRN
Melissa Fritz, RN
Mercy Health — Anderson Hospital
9
THE JEWISH HOSPITAL — MERCY HEALTH
Patient-centered care
is front and center
At The Jewish Hospital — Mercy Health, we spent 2014 building a strong patientcentered environment. It’s now the basis for all of our priorities and the focus for
overcoming challenges. We saw many changes throughout the year. Weekly Unit Based Leadership Rounds
allow staff to share information, receive real-time patient care data and develop
real-time solutions. Our Patient Family Advisory guides us in caring for our patients. A multidisciplinary Shared Leadership Council and Committees form a link between
direct care staff and management. The ICU Unit Based Council unlocked the waiting
room doors, allowing open family visits. With the renovation of our Cath Lab, we
will offer the lowest radiation exposure during procedures in the city. And open
collaboration allowed us to perform our first Robotic-Assisted hip surgery using
the MAKO robot.
These efforts resulted in positive outcomes for patients — and national recognition for
the hospital. We had a very successful Joint Commission Survey and were asked to
submit our Nurse Driven Foley Removal protocol to the Joint Commission’s Best
Practice Library. We also received the Joint Commission’s Disease Specific Certification
in The Blood Cancer Center and in Orthopaedics for Total Hips and Total Knees. Nursing is a leader here for patient safety and the patient experience. Our PACU and
Orthopaedics nurses were invited to present at this year’s NAON Conference and
several of our nurses became certified this year in many different specialties. We look forward to growing and strengthening our patient-centered culture through
our Shared Leadership Council and by living our Promise through TeamStepps. With this focus, The Jewish Hospital is leading the way for an excellent work
environment and a positive patient healing environment.
Vanessa Vonderhaar-Picard, MSN, MEd, RN, CNML
Vice President, Chief Nursing Officer
The Jewish Hospital — Mercy Health
10
Leaders at all levels
At The Jewish Hospital — Mercy Health, we believe that no matter what position you’re
in, you can be a leader. So our Shared Leadership Council crosses over all departments
and specialties, giving everyone the chance to influence decisions. Leaders at the point
of patient care partner with leaders in management to make decisions that impact the
patient’s experience, patient harms and employee engagement.
We’re proud of this group’s accomplishments. Here are a few committee highlights:
•
Evidence-Based Practice introduced a falls education contract.
•
Informatics made changes to EPIC and implemented Awarix.
•
Research had one IRB-approved study and is collecting data.
•
Awards and Recognition hosted its first nursing certification luncheon.
•
Quality and Peer Review helped reduce hospital acquired C-Diff.
•
Professional Development promoted the Professional Recognition Program,
which several nurses completed.
•
Patient Family Advisory Council and Education enhanced the education we give
to our patients.
•
Unit Based Councils are making decisions that impact their work flow and patient care.
This year, we’re embracing the Promise and TeamStepps concepts to better
communicate our emerging patient-centered environment.
We consider our Shared Leadership Council and committees our biggest success in 2014.
The concept supports leaders at every level of the organization. Shared Leadership is the
avenue for decision-making that truly puts the patient at the center of care.
Brad Bailey, RN
Connie Wendle, RN
The Jewish Hospital — Mercy Health
Shared Leadership Chairs
11
MERCY HEALTH — WEST HOSPITAL
A year of transformation
and growth
Words can’t describe the incredible cultural transformation that has happened in our
first year. Our interventional cardiac, maternity and robotic programs got off to a good
start and our inpatient and outpatient programs continue to grow.
The staff has grown too, learning new technology in a state-of-the-art facility and in
freestanding emergency departments. Staff and physicians also learned how to work
with new team members, which included defining the “West” way. We’ll continue to
grow in our key service areas of cardiovascular, orthopaedic and surgical services,
women’s services, oncology and emergency services.
While keeping up with the growth has been a challenge, seeing the successes of the
staff and physicians has been a truly gratifying experience.
Our patients are noticing the difference; several patient experience metrics are
pointing up. The West Side community hasn’t had access to many of these new
services so close to home and the response has been humbling.
As we start into 2015, I want to recognize the remarkable teamwork, dedication,
and perseverance of the entire team. With your partnership, we can continue on this
successful journey.
Stephanie Meade, MBA, MSN, RN, NEA-BC
Mercy Health — West Hospital
12
Discovering the best
possible care — together
One idea is at the center of our Shared Leadership efforts at Mercy Health — West
Hospital: patient safety. And one practice is especially effective at improving patient
safety: collaboration.
Teamwork between disciplines is the heart of Shared Leadership and it has transformed
West Hospital in a short amount of time. The program promotes collaboration,
continuing education and evidenced-based initiatives to improve the care that we
deliver. Nurses, therapists, lab technicians, pharmacists, patients and families are all
involved in the decision-making processes to improve the quality of care.
Nurses play an especially important role. Their unique position means that they’re not
just involved with decision-making and improving care — they’re at the forefront.
Nurses are part of the team that evaluates evidenced-based literature, compares it
to current practice and recommends changes that need to be made. They’re helping
to work on a pilot project with tablets for patient and family education which will
integrate into the electronic medical record. And they work with the Patient and
Family Advisory Committee, which brings caregivers, managers, patients and their
families to the table to discuss quality, safe, patient-centered care.
Together, nurses and staff members from many ancillary departments work to provide
the best healthcare possible. We’d like to recognize those who serve our faith-based
ministry and promote the education of our staff to make this possibility a reality.
Lisa Clapp, BSN, RN
Mercy Health — West Hospital
Shared Leadership Chair
13
MERCY HEALTH — CLERMONT HOSPITAL
Leaders in service and care
I’m extremely proud of the accomplishments our nurses have made in 2014 and
their commitment to the care of our patients at Mercy Health — Clermont Hospital.
Our nurses are transforming how we deliver patient care based on a Synergy Model.
This model focuses first and foremost on the patient and is integrated across the
continuum of care.
We’ve started our Magnet journey this year; the process empowers nurses to become
leaders in patient care by partnering with physicians, other healthcare providers and
families. These skilled professionals continue to create a culture of safety, quality,
professionalism and respect.
The past year saw many accomplishments. Our new Behavioral Health Institute fills
an area of great need. It offers an integrated treatment program across the care
continuum: Crisis and Emergency Screening, Acute Care Services, Partial Hospitalization
Program (PHP), Intensive Outpatient Program (IOP) and Outpatient Clinic.
Meanwhile, our nurse driven protocols, developed in partnership with our physicians,
were recognized as a QUEST finalist in providing high quality, high value healthcare.
We have a lot to be excited about and we have more to accomplish. We will focus
on improving staffing, patient flow, patient satisfaction and continuing our Magnet
journey. Most of all, we’ll focus on Mercy’s Mission, Vision and Promise — “This is what
we were meant to do.”
Gayle Heintzelman, MEd, RN
Mercy Health — Clermont Hospital
14
Having a voice.
Having an impact.
Shared Leadership at Mercy Health — Clermont Hospital has taken on a new form
with our ongoing Magnet journey. Our nurses have always worked together to find
ways to improve patient care, employee satisfaction and retention, giving a voice to
those who work the closest with patients on a daily basis. The new structure has
those advantages — plus new levels of accountability.
Shared Leadership gives everyone the opportunity to get involved. Ancillary
departments, dietary, maintenance, off-site outpatient services — all employees at
Clermont Hospital have the chance to have a voice in making positive changes.
Recognition plays a big part in this journey. Staff has the chance to publicly thank
fellow co-workers for great teamwork, for going above expected standards and for
making positive differences in patient care. Patients have noticed the positive effects.
Comments like “this is the best care I’ve ever received,” “the people who work here
are so nice” and “everyone is always smiling” are starting to become common.
Shared Leadership can be very rewarding for those who participate. It’s an untapped
resource just waiting to fill employees with the power of positive reinforcement and
the great satisfaction of seeing changes in practice that they had a voice in setting.
Mercy Health — Clermont Hospital’s journey is just beginning. Shared Leadership has
planted the seed with the start of our Magnet journey. Now the entire team needs to
nourish it. The Shared Leadership committee is very excited to see what will bloom at
Mercy Health — Clermont Hospital once this journey really takes off.
Jennifer Brandenburg, BSN, RN
Jill Ortega, RN
Mercy Health — Clermont Hospital
15
Transformational
leadership
Transformational leaders stimulate and inspire others
to achieve extraordinary outcomes and develop
their own leadership capacity. They help people grow.
They respond to others’ needs. They align everyone’s
goals and objectives with the larger organization.
Mercy Health nurses are Transformational Leaders.
Advisory council involves
patients and families
In 2014, The Jewish Hospital — Mercy Health started the first Patient Family Advisory
Council (PFAC). Alice Wanninger, Director of Volunteer Services and Community
Outreach and Sherry Varney, ICU Nurse Manager, pioneered this collaboration and
have mentored other Mercy Health hospitals to do the same. Community members and
hospital representatives are getting together to improve quality, safety, patient
experience and education.
Through the PFAC, we foster an atmosphere of active listening, compassion and
respect for patient choices. It’s part of our goal to develop ongoing partnerships
with our community. By involving patients and families as integral members of the
healthcare team, the council builds a united commitment to excellence.
Highlights from the year included Conversation Project material added in My Chart,
a change in directional signage for visitors and an updated welcome education folder.
Presenting proof of the
benefits of collaboration
Mercy Health — Anderson Hospital was selected to
present at the National Client Conference for Press Ganey
in 2014. Our topic: improving the patient experience in
the emergency department. During our presentation we
showed how our workflow initiatives improved length
of stay and overall patient experience.
Collaboration with inpatient units allowed us to address throughput, discharge
and satisfaction barriers. A Kaizen Team at Anderson started with measures like a
discharge checklist and a medication explanation to be used by the inpatient
team. Length of stay dropped below 300 minutes and inpatient scores rose. The ongoing success of this program is an excellent example of how collaboration
between the ED and inpatient units can meet the needs of patients.
19
Transforming a community ICU
In 2013, Mercy Health — Mt. Airy Hospital and Mercy Health — Western Hills Hospital
joined to form Mercy Health — West Hospital. They implemented a new interventional
cardiac program. Historically, a large percent of the hospitals’ critically ill patients were
transferred to tertiary care centers or academic medical centers. The new facility planned
to treat these higher acuity level patients. To do so, the critical care leadership team
developed a comprehensive plan to care for these patients. The team proposed a rapid
cycle critical care team built on interdisciplinary collaboration. Here are some results:
2013 – 2014 RISE IN CMI
hospital opening
1.75
collaborative started
1.5
1.25
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HOSPITAL RATING BY DISCHARGE MONTH
100
0 Rating
1 Rating
Top Box Percentage
80
2 Rating
3 Rating
60
4 Rating
5 Rating
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6 Rating
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7 Rating:
4.7% 2014 YTD
8 Rating:
13.6% 2014 YTD
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9-10 Rating:
73.6% 2014 YTD
ICU nurse receives
national recognition
Lisa Walker, BSN, RN, was one of three national finalists for the
Press Ganey Nurse of the Year Award. As a night shift ICU clinical
coordinator, Lisa is a long-term and very valued employee of Mercy
Health — Fairfield Hospital. For 14 years, she has dedicated herself
to providing the best care for our patients and their families.
Her dedication in leading the ICU to improve Patient Satisfaction
Scores was recognized at this year’s conference. Lisa and her
co-worker Shelley Rice lead a patient experience committee to
improve nursing communication in the ICU. The group focused on
treating patients with courtesy and respect, listening to the patient
and explaining in a way the patient understands. Patient scores
improved in each of these areas over four consecutive quarters.
ICU NURSES LISTEN
CAREFULLY TO YOU
ICU NURSES TREAT WITH
COURTESY / RESPECT
ICU NURSES EXPLAIN IN
A WAY YOU UNDERSTAND
100
100
100
80
80
85.8
80
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All Press Ganey Database Mean
21
Outstanding service honored
It’s a tradition every year — a special mass is held at
Cathedral of St. Peter in Chains to honor outstanding
caregivers. It’s called the “White Mass” because
healthcare workers in attendance wear white. This year’s
honorees included Mercy Health — Anderson Hospital
nurse manager Molly Grooms (as an Outstanding
Caregiver) and Ted and Sally Motz (as Outstanding
Volunteers). Congratulations and warm wishes to all!
Local nurse goes
extra step for her profession
Bariatric certification is an important gauge of
professional competence. For nurses, it enhances and
promotes their specialty. For patients, it showcases their
caregiver’s knowledge and dedication to the specialty.
Angie McLearen, BSN, RN, CNOR, CBN, is a clinical coordinator for General & Bariatric
Surgery at Mercy Health — Fairfield Hospital. Based on her experience and knowledge,
she was chosen as a certification content expert by the American Society for Metabolic
and Bariatric Surgery. Experts like Angie were chosen across the U.S. to write test
questions and review the final exam. This involved thoroughly researching evidencebased practices and reviewing the exam for accuracy, redundancy, relevancy and
difficulty. With Angie’s input, the test provides a fair, well-rounded and accurate picture
of a competent and proficient bariatric nurse.
23
Structural
empowerment
Structural empowerment comes from Mercy Health’s
lifelong learning philosophy. This vision encourages
professional collaboration, academic achievement
and a higher understanding of the nursing profession.
All of our nurses are invested in better healthcare
throughout our communities. And it all starts with
being empowered.
Best practices
recognized nationally
BEDSIDE REPORTS BETWEEN ORTHOPAEDIC AND PACU NURSES
The Joint Commission maintains that bedside
communication and hand off can increase care quality and
safety. For orthopaedic patients, an interdepartmental
approach is essential for optimizing long-term outcomes.
Nursing leadership and direct care nurses began a collaborative project. Together,
they created an interactive, inclusive bedside communication hand off to improve
post-surgical care. Using the Plan-Do-Study-Act (PDSA) method, they started by
evaluating the current practice and current evidence-based literature about bedside
hand off and implementing a new process.
First, the orthopaedic nurse receives a bedside report from the PACU clinical nurses.
Together, they use “Four Eyes” to assess the patient’s status to ensure quality care
and patient safety. This assessment becomes part of a new communication tool in the
electronic health record. This patient hand off collaboration was shown to improve the
patient experience, so the best practice is being implemented throughout The Jewish
Hospital — Mercy Health. And in 2015, the team will be presenting it to the National
Orthopedic Association of Nurses and the Tri-State Nursing Excellence Consortium.
PRESS GANEY SURVEY: 5SOUTH OVERALL PAIN MANAGEMENT
100
implemented Four Eyes of communication
80
76.1
60
40
20
26
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All Press Ganey
Database Mean
Anderson Hospital nurse
changes lives for families
with Down syndrome
Mercy Health — Anderson Hospital is proud to support Kathleen Ferrara, RN, Family
Birthing Center in her efforts to change Ohio law for families and caregivers. This, in
her own words, is the story of her journey.
It’s more than just a little bit embarrassing to admit this, but before my daughter
Kathryn was born with Down syndrome (Ds) in 2009, what I knew about the disease
couldn’t fill a postcard. I was more than a little bit scared. I had a cesarean section;
when the time came for her to cry, there was silence. My fears were validated in the
reaction of the nurses present at her delivery. Instead of celebrating her birth, the OR
teams’ faces filled with shock, pity and even tears. This was supposed to be the
happiest day of my life but instead, people were apologizing to me for her birth.
Before Kathryn, I may have reacted the same way. They didn’t know — like I
didn’t — that this life would be the most amazing gift that I could have ever received.
Since that bittersweet day, I’ve talked to more than 250 families with children with Ds.
Most had similar or even sadder stories about their child’s diagnosis. So I made it a
priority to educate the delivery, NICU and maternity staff in area hospitals about their
unique role in how new parents experiences this confusing, yet celebratory time.
Recently, I spoke in Washington, D.C. at a national conference and taught a genetics
class at the University of Cincinnati about what it’s like to be a parent of a child with Ds.
I visited OB/GYNs, geneticists and perinatologists. I presented at Grand Rounds at
Cincinnati Children’s Hospital twice. I spoke at several regional perinatal nurse
managers meetings. The fact that I am both a parent and a nurse opened a lot of doors.
With this momentum, I wanted to do more. I wanted to ensure that all Ohio parents get
the information and support they need both before and after their baby is born. In
Kentucky, Massachusetts and Washington, D.C., laws require pregnancy caregivers to
give up-to-date, accurate and unbiased information on Ds and provide parents with the
names of local and national support groups. I was determined that Ohio would be next.
With the help of House Representative Peter Stautberg, I was invited to speak in
front of the Ohio House of Representatives and Senate. Both voted to pass the bill
and two weeks later, Governor Kasich signed House Bill 552, renamed the “pro
information law.” The bill went into effect March 20th, 2015 and will be enforced by
the Ohio Board of Health.
I’m grateful for all the wonderful support and encouragement that Mercy Health has
given me in improving the education parents receive about Down syndrome.
27
New birthing center
showcases teamwork
When Mercy Health — West Hospital opened in
November 2013 so did a new Family Birthing Center.
Thanks to the birthing center staffs at Mercy Health —
Anderson Hospital and Mercy Health — Fairfield Hospital,
the opening was a success. It took the dedication of the
entire region to orient and train the new employees and
to provide support when opening the new OB service
line. In a little over a year, Mercy Health — West Hospital
delivered 500 babies and we’re currently in the second
stage of applying for Baby Friendly hospital designation.
TeamStepps gives us
the tools to live our Promise
In 2014, the Cincinnati region implemented Promise and TeamStepps to make lives
better and to make healthcare easier. It started with training classes that focused on
ways we can deliver our Promise. The classes are very interactive with role play, class
participation and team building exercises.
One of the first techniques we adopted was Huddles. Huddles provide information
to the entire team to help us streamline care and have everyone working toward a
common purpose. Every team member is given information that is vital to the care
of patients in their department. Huddles are happening everywhere: nursing units,
dietary, therapy, respiratory and among leadership, just to name a few.
Suzanne Martin, a nurse manager, says that outcomes have been very positive.
“The Huddles have given staff a framework from which to work, making the plan for
that shift concise and clear. Everyone understands their role and the goal for their
shift. It brings the team together and gives them a voice.”
Huddles have improved care in the unit and in the hospital immensely. They help to
decrease length of stay, improve communication and keep the focus on the patient.
They’re now an extremely important part of the care that we deliver. We’re proud to
have made such a significant improvement.
29
Acting as one for heart health
To support our communities, each Mercy Health
hospital has a Wear Red committee that promotes the
American Heart Association and the Mercy Health
Heart Mini. In 2014, Mercy Health — Fairfield Hospital
expanded this goal to raise awareness about women
and heart disease through education and health
screenings at a health and wellness fair.
Community members and employees enjoyed massages, a Zumba demonstration
and a pharmacist who provided individual medication counseling. Speakers included
Manisha Patel, MD and Lynne Wagoner, MD followed by a patient panel that spoke
about their journey towards heart health. During the event, the Wear Red Committee
was also able to raise $5,000 to donate to the American Heart Association.
We thank all of our dedicated nurses and employees who support our mission, the
Mini Heart Marathon and the Wear Red Campaign. The whole thing was made possible
through the support of many nursing units, dietary and the HealthPlex.
Fairfield Hospital joins
select Magnet® community
If you haven’t yet heard, Mercy Health — Fairfield Hospital has achieved Magnet
recognition. This prestigious recognition is a reflection of our nursing professionalism,
teamwork and superiority in patient care.
Fairfield Hospital is the first Butler County hospital to achieve Magnet recognition and
the first adult hospital in Cincinnati to earn the recognition on its first attempt.
To achieve Magnet recognition, organizations must pass a rigorous and lengthy process
that includes on-site visits and demands widespread participation from leadership and
staff. Magnet evaluators look at the quality of nursing leadership, coordination and
collaboration across specialties and processes for measuring and improving quality of
care. These elements are essential to superior patient care and an accurate gauge of an
organization’s nursing excellence.
The journey toward Magnet recognition for Fairfield Hospital was a journey that
spanned many years and was inspired and powered by the work of every team member.
For our nurses, it’s a well-deserved acknowledgement of the lives they save, the care
they provide, the anxiety they alleviate, the peace they instill and the comfort and
understanding they offer.
31
Fair opens the doors
to shared knowledge
The Mercy Health — Fairfield Hospital Diabetes and Wound Fair is an interactive,
hands-on, educational — and fun — experience for employees and our community. Our
nurses get to meet with diabetes and wound care representatives and gain knowledge
on the latest evidence-based practices, products and therapies. The community gets to
see that we’re committed to providing the very best care. Our continued low rate of
pressure ulcers and improved glycemic control shows that this education helps our
nurses take the best care of our patients.
The event helps our people share knowledge and come together as a team. A variety
of disciplines and departments are involved from across the care continuum: inpatient
and outpatient wound care, inpatient and outpatient diabetes education, pharmacy,
lab, dietary, home healthcare and multiple staff nurses.
This event has increased in size and participation every year. In 2015, the fair is
expanding with events at both Mercy Health — Fairfield Hospital and The Jewish
Hospital — Mercy Health.
32
Creating new options
for pregnant women
Until our prenatal clinics opened, options for
uninsured or under-insured pregnant women were
limited. We believe it fits our Mission to serve
this population with compassionate, quality care.
The Prenatal Clinics at Mercy Health — Fairfield,
Anderson and West Hospitals are a supportive,
concerned environment for that care. It’s where
our nurses are empowered to provide holistic care
to the most vulnerable of our patient population.
Our clinic nurses do an exceptional job of taking the time to learn various cultural
norms and incorporate them into the plan of care for each patient. Patients, in turn,
have confidence in their care. They trust that the nursing staff will always explain
treatment plans and answer questions in a way they understand. The clinic staff truly
cares about each and every patient and pregnancy.
Prenatal Clinic patients continue to have outcomes that are equal to patients being
cared for in private OB practices across the city. Fairfield Hospital averages 20
births per month from the clinic and has a very high rate of postpartum checkups.
West Hospital’s clinic, opened in January 2014, saw 100 new patients and performed
43 deliveries. Anderson Hospital cared for 176 prenatal women. Many of these
women return for subsequent pregnancies because of the wonderful care they
receive the first time.
33
Three education stories
In 2010, The Institute of Medicine (IOM) released a report called “The Future of Nursing:
Leading Change, Advancing Health.” The report found that quality nursing care isn’t just
about reducing mistakes; it’s also important to provide evidence-based nursing care.
The report also found that education in this area matters to quality — a lot. Studies have
shown that for every 10% increase in the proportion of BSN nurses, hospitals see a 4%
decrease in risk of death.1 Hospital staffs with more nurses with a Bachelor of Science
(BSN) or Master of Science in Nursing (MSN) have higher productivity and better patient
outcomes. 2 Because of this link, the report recommends that 80% of nurses should have
at least a BSN by 2020. To support this idea, the Tri-Council for Nursing* called for “all
registered nurses to advance their education in the interest of enhancing quality and
safety across healthcare settings.”
Mercy Health has adopted this consensus. Our goal is that by 2020, 80% of our nurses
will have at least a BSN. We honor and congratulate all of our nurses who have recently
obtained a higher nurses degree or are in school right now. To inspire you on your
journey towards higher education we selected stories from three nurses about how
education impacted their nursing career.
Stephanie Matusak, BSN, RN, CNOR
Mercy Health — Fairfield Hospital; Unit Based Educator CVOR;
Regional Shared Leadership Co-Chair
I’ve been a nurse at Mercy Health — Fairfield Hospital for over 35
years. As a diploma school graduate, it was always my intention
to further my education and achieve my BSN. However, life and
family presented challenges that took precedence over my own
educational endeavors. When we began our Magnet journey, our
CNO challenged each of us to take our education to the next
level. I realized that this was the perfect time for me to go back
to school. I had no excuses.
Returning to school at age 59 is somewhat intimidating. My typing and computer skills
were rather abysmal. Since the entire program was online, I not only struggled with
having the discipline to complete the work, but also with learning how to master the
computer. Each class was a challenge but brought with it great rewards. I can honestly
say that I learned something new with each class that I could apply to my current
professional practice.
Achieving my BSN really is the icing on the cake for my career. I now have the
credentials to go along with my many years of experience. I’m proof that age is not a
limiting factor. As nurses, we’re all life-long learners. Life is a journey and it’s never
too late to chart a new course!
34
Allison M. Schlinkert, MSN, RN
Mercy Health — Anderson Hospital; Clinical Education Specialist; Nursing Supervisor, A3
I started at Mercy Health — Anderson Hospital in 2012 and was
assigned the role of a Clinical Education Specialist for the cardiac
tower. I quickly realized that while I had served as the education
coordinator for a busy ambulatory surgical center, I knew very
little about educating 200+ cardiac nurses. I’ve always strived to
be excellent at whatever I’m doing and found graduate school
to be a great avenue to pursue excellence in my new role. With
encouragement from my boss, Kathi Edrington, I enrolled into
Walden University to obtain my Master of Science in Nursing with
a focus in Clinical Education. I graduated from the program in August 2014.
I found that my degree gave me confidence and the skillset to develop a new,
meaningful curriculum for staff nurses. My teaching style has become purposeful and
well thought out. I’m able to write for and provide continuing education hours for
almost all teaching at Mercy Health — Anderson Hospital.
I would highly encourage and support any fellow staff member to pursue a higher
degree if you feel like it would help you grow in your profession. Education is powerful.
It has the power to increase confidence and add value to your career.
Katherine J. Edrington, DNP, MBA, MSN-NEL, RN, CENP
Mercy Health — Anderson Hospital; VP Nursing and Site Administrator I chose to explore my Executive Leadership Doctorate of
Nursing Practice (ELDNP) because the knowledge and expertise
is relevant to both my work and my aspirations as a nursing
leader. Achieving this degree is my proudest accomplishment as
a nurse and is important to me personally. The knowledge and
experiences gained make earning my doctorate the most valuable
thing I’ve done as a leader. I was blessed to meet nurse executives
from the U.S. and abroad. The experiences shared among the
group are invaluable to my professional growth and expertise.
Taking extreme pride in my profession is important for those I serve as a leader, a
colleague and a friend. I believe this experience has made me a stronger leader, more
courageous and even more proud to be a nurse. I hope my efforts to further my
education have inspired, and will continue to inspire, others in this wonderful profession.
1 National Advisory Council on Nurse Education and Practice, 2010.
2 Aiken, Clarke, Cheung, Sloane, & Silber, 2003; Aiken, Clarke, Sloane, Lake, & Cheney, 2008; Curtin, 2003; Estabrooks,
Midodzi, Cummings, Ricker, & Giovannetti, 2005; Tourangeau et al., 2007.
* Comprised of ANA, American Organization of Nurse Executives (AONE), National League for Nursing (NLN) and
American Association of Colleges of Nursing (AACN)
35
Exemplary
professional practice
Exemplary professional practice is seen in the
amazing work done by Mercy Health nurses every day.
It’s in the expert patient care that they provide.
It’s in the collaboration they keep with every specialty
and department in every hospital. Most of all, it’s
in the outcomes that continue to improve.
Bringing patient
stays to a safer level
Research has shown that patients whose hospital
stay is too short tend to be re-admitted, while patients
whose stay is too long run the risk of more patient
harms. So The Jewish Hospital — Mercy Health nurses
led the way in making sure patients stay an appropriate
amount of time.
In February 2014, the hospital’s average length of stay (ALOS) was 1.08 days.
(The national ideal goal is 1.0 days.) This number helps management gauge care
delivery efficiency and quality. Decreasing ALOS — even by a little — takes a lot of
collaboration, a proactive look at the entire care process and active discharge
planning. A multidisciplinary team of direct care nurses, nurse management, social
workers, case managers and physicians huddled daily to streamline each patient’s
care. As of December 2014, our ALOS had fallen to 1.01.
38
Rehabilitation is a team effort
The Mercy Health Cardiac Rehabilitation Program
helps heart patients regain their highest level of physical,
psychological, social and vocational wellness.
At its core are medically-supervised exercise and
education from experienced staff. A team of
healthcare professionals from several areas work
together toward common health goals. Registered
nurses, exercise specialists, dietitians and other
specialists collaborate to design programs for
each patient. The individualized program may
include monitored exercise, weight control,
nutrition education, smoking cessation, stress
management, relaxation, psycho-social support
and more.
Each program is certified by the American
Association of Cardiovascular and Pulmonary
Rehabilitation — congratulations to The Jewish
Hospital — Mercy Health, which earned its
accreditation in 2014! This certification is unique
because a registered nurse with a background
in critical care supervises all sessions.
39
One of our own is a
Top 50 Cardiac Hospital
The Truven Health Top 50 Cardiovascular Recognition
singles out 50 top hospitals with superior cardiovascular
results. It’s an honor that Mercy Health — Anderson
Hospital has strived for since we added the Open Heart
Program in 2006. The evaluation looks at quality patient
outcomes, cost per case and how the team works
together to achieve these outcomes. Nursing has driven these initiatives along with our physicians and ancillary teams. CVOR, CVICU and Cardiac Cath Lab all played critical roles but every department
impacts the outcomes, perception and stewardship of our program. Our nurses have
worked hard to build this program, meet the needs of our community and develop
a presence in the cardiovascular healthcare arena. A prestigious recognition like this
instills trust and pride among the community, our physicians and employees in the
excellent care we provide.
40
Orthopaedic unit enjoys Joint
Commission Accreditation
The joint replacement program at Mercy Health —
Anderson Hospital uses an integrated team approach
to care for patients. Our patient-centered approach
leads to better outcomes, faster recovery and higher
patient satisfaction.
Recently, the program received Joint Commission Accreditation for Orthopaedics
Knees and Hips. Congratulations to Anderson Hospital for being recognized for your
exemplary work!
Collaboration happens on several fronts. Our dedicated joint replacement unit is located
near therapy services and patient education services. All eligible staff are certified in
orthopaedic care to provide consistent care. And we use multiple National Guideline
Clearinghouse practices for orthopaedic care, pain management and VTE prevention.
Meanwhile, patients and their families work with the care team in setting goals for
recovery, reviewing the care plan and tailoring it to meet the patient’s needs. This
creates patients and families who are better prepared and better educated patients
who enjoy better outcomes.
Our program’s goals and metrics cascade down to every staff member. We review
progress monthly at the Orthopaedic Service Line Committee and report results
bi-annually to our Quality and Patient Safety Council. Day-to-day improvement work
is carried out at the unit level as well as through the hospital’s Safety Across the
System Committee that meets every other week. Continuous Small Tests of Change
and incorporation of these changes into the process are the backbone of our
constant and sustained improvement.
The program has seen significant improvement in many measures, including:
•
Rate of patients who are discharged home
•
Ambulation distance of hip and knee replacement patients
•
Attendance at pre-op education classes
•
Rate of falls and falls with harm
41
Certification reinforces
skills and knowledge
Certification offers several rewards to nurses: personal growth, recognition, autonomy,
empowerment, career advancement, more marketability, higher self-esteem, more
collaboration, financial reimbursement and more confidence in dealing with and
diagnosing patients. And that’s not all. The National Credentialing Research Coalition
says that certified nurses have higher patient satisfaction ratings, more effective
communication skills, fewer disciplinary events and higher job satisfaction. Plus,
supervisors score certified nurses higher in teaching, collaboration and planning.
Mercy Health congratulates all of our certified nurses for validating their mastery
of skills, knowledge and abilities through certification or recertification.
In 2014, nurses at three Mercy Health hospitals (Anderson, Fairfield and The Jewish
Hospital) earned certification together through specific review courses.
Medical-Surgical Nursing Certification Review Course (AMSN)
Congratulations to:
Erika Andres
Deborah Bastin
Gina Biller
Emily Bohne
Rita Cassidy
Nathanael Chaney
Kendra Chesnut
Lauren Gettelfinger
Heather Gill
Lora Graham
Patricia Haggard
Kristin Hedrick
Kelly Johnson
Suzanne Martin
Krista Meyer
Kristen McSorley
Patricia Miles
Elizabeth Murph
Amanda Riggan
Terri Rohdenburg
Emily Shroyer
Marjorie Stayton
Emily Sullivan
Lacey Summerly
Marquisse Watson
Rehabilitation Registered Nurse Certification (CRRN)
Congratulations to:
Kathy Calihan
Denise Evers
Jan Gordon
Sharon Neanover
UJ No
Devona Pater
Sally Purdy
Teresa Raleigh
Frieda Rowell
Kim Solmos
Dwayne Taylor
Bone Marrow Transplant Certification Review Course (BMT)
Congratulations to:
Brittney Browne
Liz Burke
Tiffany Holt
Leslie Hillner
Nancy Murrin
Orthopedic Nurses Certification (ONC)
Congratulations to:
Andrea Anno
Melody Bourbeau
42
Kristin Bridewell
Maureen Burns
Julie Engelkamp
Karly McMains
Molly Montgomery
Sharon Moore
Tiffany Scherzinger
Ashley Wright
Getting on the same
page with patients
Mercy Health — Clermont Hospital had a goal: improve the patient experience
by improving discharge instructions. We felt this would increase patient education,
decrease the readmission rate and ultimately increase patient satisfaction.
At discharge, it’s important for nurses to provide enough information about the
patient’s illness and medications. With the right instructions, patients can better care
for themselves once they leave and continue on a healthy road.
We introduced a discharge checklist that listed instructions and medications.
The nurse and patient review this list together to ensure that all necessary items are
covered and understood. Along the way, the nurse asks review questions like:
•
hat new medications will you go home on? What are they for?
W
What are the side effects?
•
What symptoms should you watch for after leaving? When should you call the doctor?
•
When is your follow-up appointment?
•
Any difficulty getting to appointments or affording medications?
•
Any special equipment needed to go home?
Discussing these topics is one more opportunity for the patient to understand
what they need to do and ask any questions that they might have. After implementing
this checklist on all inpatient units, we’ve seen a great improvement in our
discharge experience.
MERCY HEALTH — CLERMONT HOSPITAL DISCHARGE INSTRUCTIONS
100
85
80
All Press Ganey
Database Mean
60
40
20
N
O
ct
.2
0
14
ov
.2
0
D
14
ec
.2
0
14
14
0
14
.2
0
Se
pt
.2
ug
A
ly
20
14
14
20
Ju
Ju
ne
20
14
14
ay
M
A
pr
il
20
14

14
20
20
ch
M
ar
b.
Fe
Ja
n.
20
14
0
43
Improving the patient
experience by transforming
the culture
In November 2013, Mercy Health — West Hospital opened to serve the needs of a
community with two closing hospitals, Mt. Airy and Western Hills. These hospitals had
experienced declining volumes, patient scores and reputations. A new patient
experience was needed.
To provide this new experience, West Hospital started by opening an interventional
cardiac program and a maternity program. We also launched a strategic initiative
aimed at creating a cultural transformation. An interdisciplinary team developed a
comprehensive plan of behavior guidelines and care standards that all employees were
committed to practicing. This guide was also used during the hiring and interviewing
process, hospital orientation and observational rounding.
A leadership rounding program was also started for all inpatients. With this online tool,
leaders can document patient feedback at the point of service and mangers can review
it daily with their staff. Feedback covered patient observations, bedside shift report,
explanation of medicines, response to call light and general satisfaction with care.
This program allows us to remove communication barriers, analyze patient feedback in
real-time and create solutions to transform our culture. All while recognizing our direct
care staff for providing excellent care.
As a result of this culture-changing effort, the hospital’s overall rating improved from
66.7% to 75% and all other HCAHPS (Hospital Consumer Assessment of Healthcare
Providers and Systems) metrics also improved.
MERCY HEALTH — WEST HOSPITAL PATIENT EXPERIENCE SCORES
4%
100
2013 HCAHPS
top box scores
80
2014 HCAHPS
top box scores
60
% improvement
40
13%
2%
5%
10%
5%
Hospital
environment
Pain
control
20
0
44
Overall rating Communication
of the hospital
with nurses
Help from
hospital staff
Discharge
instructions
A better model
for quicker care
At Mercy Health — West Hospital, we realized that our emergency department’s (ED)
patient flow process wasn’t working as well as it should. So in 2014, we started a project
to improve door-to-bed and door-to-provider times and reduce the discharged length
of stay (DLOS). Through a literature review of evidence-based practices, the ED team
found that a Provider in Triage (PIT) model of care would help staff and providers
evaluate patients in a quick, efficient way. To implement the PIT model, we educated
providers and nurses on the new model, analyzed the data daily, added nursing shift
supervisor positions and redesigned nursing assignments. Door-to-bed time and
DLOS have both decreased since we started the PIT model.
ED DOOR TO BED
Average minutes
12
10
8
6
4
2
N
O
ct
.2
0
14
ov
.2
0
14
D
ec
.2
0
14
14
0
14
.2
0
pt
Se
A
ug
.2
20
ly
Ju
Ju
ne
20
14
14
14
20
ay
M
A
pr
il
20
14
0
DISCHARGE LOS
150
125
N
O
ct
.2
.2
0
14
ov
.2
0
14
D
ec
.2
0
14
0
14
14
0
Se
pt
.2
ug
A
Ju
ly
20
14
14
14
Ju
ne
20
20
ay
M
pr
il
20
14
100
A
Average minutes
175
45
Community served
by complete collection
of heart services
When opening Mercy Health — West Hospital, we quickly
saw that comprehensive cardiology was needed to serve
the west side of Cincinnati. Nurses from Mercy Health —
Fairfield Hospital, Mercy Health — Anderson Hospital and
The Jewish Hospital — Mercy Health went above and
beyond to train for the new cardiology service line.
Today, our services are complete with two cardiac catheterization laboratories, an
electrophysiology lab, a hybrid operating room, two cardiovascular operating rooms
and a 12-bed cardiovascular Intensive Care Unit. Our catheterization lab is the only
Mercy Health facility performing Ocelot ultrasound guided atherectomies and radial
interventions with same-day discharge.
The results are a picture of efficiency and effectiveness. Our door-to-balloon response
time (as fast as 22 minutes) far exceeds the national standard of 90 minutes. In the last
year, our cardiovascular operating rooms have performed 94 open heart surgeries and
52 thoracic cases, rates which are 52% above projected volumes. This team has over
70 years of combined open heart surgery experience and includes experienced open
heart nurses, surgical assistants, surgical technicians and a dedicated cardiac
anesthesiologist and perfusion team.
Thanks to these services, patients who once had to travel across town now have access
at their doorstep. This convenience and the cooperation of the entire cardiovascular
team have helped improve the care of an entire community. The cardiac team has
been part of community outreach efforts like the Go Red Campaign (female heart
disease awareness) and Healthy Happy Hours (quarterly health education events).
Meanwhile, resources such as the Heart Failure hotline provide advice and build trust
with our residents.
As our community evolves, what healthcare success means is always changing.
Staying the same is not an option. West Hospital remains a vision of growth.
46
Patient safety on the mend
In 2013 the cardiovascular unit at Mercy Health — Fairfield Hospital had 12 falls, one
with serious harm. In response, our Clinical Council set a goal to decrease our falls by
50% in 2014. We developed a quality and safety committee that focused on all patient
harms, with three task forces to focus on three different areas: falls, hospital acquired
infections and pressure ulcers. After carrying out the task forces’ action plans, the unit
had zero falls with injury, fewer hospital acquired infections and zero pressure ulcers.
Below are more detailed results:
CVU TOTAL FALLS WITH INJURY
1.5
Total falls with injury
MHF CVU mean
Mean
1.2
Total falls with injury
NDNQI database mean
0.9
0.6
Total CAUTI in CVU:
4
0.3
0.0
1
14
4Q
Total HAPU
MHF CVU mean
8
Total HAPU NDNQI
database mean
6
2014
20
14
14
20
3Q
20
14
2Q
20
13
1Q
4Q
20
20
13
13
3Q
20
13
20
2Q
1Q
4Q
20
12
2013
CVU PRESSURE ULCERS
CVU MERCY HEALTH —
FAIRFIELD HOSPITAL
HAI: CLABSI
Total CLABSI in CVU:
1
2013
0
2014
4
FAIRFIELD HOSPITAL
HAI: VAP
2
14
20
14
4Q
3Q
20
14
2Q
20
14
1Q
20
13
4Q
20
13
20
3Q
20
2Q
20
13
13
0
1Q
Mean
FAIRFIELD HOSPITAL
HAI: CAUTI
Total VAP in CVU:
2
2013
0
2014
Collaboration makes for
more efficient surgery time
To increase efficiency in 2014, our surgery department
looked to increase its operating room (OR) Prime Time
Utilization rate from 63% to 80% (recommended by
regional Clinical Utilization Efficiencies).
Collecting data affecting our block policy was the place to start. We gathered block
utilization data and reported it monthly to the department of surgery. We changed our
metrics to capture room time instead of procedure time, which gives a more accurate
picture of the time a case takes. We tracked reasons for delays and reported these
findings to the OR Governance Council, while the Chief of Surgery followed up with
physicians personally.
Along the way, we evaluated and changed many processes. Long cases were
scheduled to start earlier in the day. During Crystal Ball Huddles, we evaluated
patients the day before surgery to avoid potential delays the next day. As a result,
by the end of 2014, our prime time utilization was greater than 80%.
The collaboration between direct care nurses, leadership and physicians has been
crucial to help drive this change.
MERCY HEALTH — WEST HOSPITAL OR PRIME TIME OPTIMIZATION
100
80
80 All Press Ganey
Database Mean
60
40
20
48
N
O
ct
.2
0
14
ov
.2
0
D
14
ec
.2
0
14
0
14
14
.2
0
Se
pt
.2
ug
A
Ju
ly
20
14
14
14
20
20
ne
Ju
ay
M
A
pr
il
20
14
0
With a focus on patients,
nurses play crucial role
With the opening of the new Mercy Health — West
Hospital came an emphasis on reducing patient harms by
creating a patient-centered environment. Our nurses took
the lead to advocate for patient resources, start safety
initiatives such as a fall prevention program and commit
to a culture where the patient is first.
The strategy was threefold. First, new equipment was purchased to help prevent falls,
decrease central line infections and decrease pressure ulcers. Second, our nurses led
the education of this new equipment. Third, our nurses held each other accountable to
use the most current evidence-based practices when caring for patients.
The results were dramatic. In 2014, the rate of patient harms dropped by 67% from the
previous year.
MERCY HEALTH — WEST HOSPITAL PATIENT HARMS
0.8
Per 1,000 patient days
0.7
67% decrease
0.6
in patient harms
from 2013 to 2014
0.5
0.4
0.3
0.2
0.1
0
2013 (prior to Mercy
West opening)
2014 (post Mercy
West opening)
49
Cross training: a win for the
staff. A win for our patients.
“You never truly understand someone until you’ve
walked a mile in their shoes.” It’s a very fitting adage
at Mercy Health — Fairfield Hospital.
Sharing staff and resources to care for surgical patients made sense to our SDS and
PACU staff. So to increase team efficiency, productivity and understanding, we created
a cross training program. Cross training gives our nursing staff the knowledge and
skills to care for patients throughout the surgical experience.
With this training, nurses can provide more comprehensive care. They can also
understand why it’s important to ask certain questions to avoid problems that could
compromise recovery or home care. Our patients have seen better teamwork and
continuity in their care as our integrated team works to give them the best possible
patient-centered care.
This shared model has given us more flexibility in staffing, promoted teamwork and
enhanced the skillset of the entire staff in these departments. Each team member has
greater awareness of the next phase of care. To keep the momentum and comradery
strong, the clinical coordinators have recommended that all new hires be cross
trained as well.
50
Taking a proactive approach
to reduce infections
In an effort to reduce patient harm, Mercy Health — Clermont Hospital’s Intensive Care
Unit wanted to decrease unnecessary use of urinary catheters and the frequency of
CAUTI. A nurse-driven Foley protocol was developed by Nursing Quality and approved
by the Nurse Safety Council, site CNOs and the Medical Executive Committee. Use of
the protocol reduces risk of catheter-associated urinary tract infections (CAUTI)
because it serves as a clear guideline for catheter removal. We display our harm metric
data every day for the staff and patients to see. We also developed a monitoring tool
that the staff uses during a daily safety call with the manager.
This program is successful because our nurses, leadership, quality and infection
prevention are committed to being proactive in the safety and quality of care
we provide.
MERCY HEALTH — CLERMONT HOSPITAL ICU INCIDENCE OF CAUTI
14
12
84.6% decrease
10
in incidences of CAUTI
from 2013 to 2014
8
6
4
2
0
2013
2014
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Putting our best foot forward
for new employees
New employee orientation was an important initiative in
2014. Mercy Health regionalized new employee orientation,
which meant that the best professional practices were
standardized across each region. Each of the five acute
care sites collaborated to design, develop and implement
an orientation that worked for that region. System-wide
orientation content experts communicate every two
weeks to make sure that a standard approach is given
to all new employees.
52
DAISY Award Winners
Mercy Health congratulates all of our
team members who demonstrate
exemplary professional experience and
live our Mission, Values and Promise.
Beth Brown — Infusion
Lindsey Donges — 3A
Jennifer Hughes — 3T
Machelle Kibby — ICU
Jamie McCord — 5T
Heidi Moser — OR
Anne Noe — 4T
UJ Noe — Rehab
Lora Sams — 3A
MaryJo Schappacher — PACU
Marcie Turner — CVU
Dorionne Whitaker — ICU
Kristin Fletcher — A1
Jackie Jenkins — ICU
Pam Mathieu — MAASC
Katie McClure — PACU
Chris McPhillips — ICU
Rachel Memory — FBC
Tasha Morlatt — ICU
Ion Patterson — FBC
Matt Schaefer — Cath
Adam Thompson — A1
Debby Truster — FBC
Ericka Brown — 4 West Med Surg
Robin Coyne — Radiology
Erika Dodson — Family Birthing Center
Valerie Fagaly — Progressive Care Unit (PCU)
Marilyn Farrow — Harrison Medical Center
Catherine Frank — Emergency Department
West Hospital
Ron Gray — Cath Lab West Hospital
Megan Grieshop — 3 West Ortho
Nova Hurt — 3 West Ortho
Luke Landry — 3 West Ortho
Dixie Lay — 4 West Med Surg
Diane Luebbe — Emergency Department
Western Hills
Abby Steinacker — 4 West Med Surg
MERCY HEALTH — CLERMONT HOSPITAL
Kim Arnett — 2 West Med Surg
Laura Bange — Palliative Care
Sue Chaffin — PACU
Clint Fox — OR
Lisa House — Case Management/Quality
Sue Sattler — Same Day Surgery
Hiskias Tekeste — BMTU
Rosemary Varvel — BMTU
53
New knowledge,
innovation and
improvement
Transformational leadership, structural empowerment
and exemplary professional practice create a culture of
possibility. Our nurses excel in that culture to drive new
knowledge, innovation and improvements. Then they put
it all to practical use. This is how our nurses develop new
ways to serve. This is how we change healthcare.
Nurse gives back
to help hundreds learn
Every year, a group of nurses from The Jewish Hospital —
Mercy Health develops a nursing conference thanks
to the generosity of Barbara Wells Marshall, one of our
nursing grads.
After finishing school, she moved to Los Angeles to create the first intensive care unit
at Cedars of Lebanon Hospital. Later, she turned her skills into volunteerism in a variety
of settings. She and her husband created the Barbara and Garry Marshall Family
Foundation, dedicated to ongoing support of health, education and culture.
The Jewish Hospital continues to benefit from her generosity and funds for continued
nursing education. About 150 nurses attend the conference each year, which offers
evidence-based education on how nursing care affects outcomes, patient experience
and research.
Teaming up to offer
a new surgery option
Patients now have a minimally-invasive surgical choice at
Mercy Health — West Hospital, The Jewish Hospital —
Mercy Health and Mercy Health — Anderson Hospital.
These hospitals added a Robotic Surgery Program in
2014. With this procedure option, patients lose less
blood, spend fewer days in the hospital and have faster
recovery times. The equipment has been especially
popular in gynecology, gynecology-oncology, urology
and orthopaedics. The Robotic Surgery Steering
Committee of Nurses, Surgeons and Surgical Assistants
collaborated to establish and grow our new program.
Congratulations to our operating room nurses for leading
this best practice.
57
Real-time information sharing
brings caregivers together
Awarix came to The Jewish Hospital — Mercy Health
in July of 2014. This workflow system has helped us
standardize our process throughout the Cincinnati market.
Awarix lets all caregivers and ancillary departments
see and share information easily, which has improved
communication, accountability and patient flow.
Nurses appreciate the real-time workflow alerts and the amount of information that
pulls from CarePATH into Awarix — no need to double document! Every inpatient
nursing unit and ancillary department was involved in the Awarix launch. With trainthe-trainer sessions, education sharing, field trips to see the program in action and
significant support from the region, the addition of Awarix has been a huge success.
58
Published study focuses
on neonatal withdrawal
A study by a group of medical staff from Mercy Health — Anderson Hospital was
recently published in the Journal of Pediatrics. “Universal Maternal Drug Testing in a
High-Prevalence Region of Prescription Opiate Abuse” is authored by Scott Wexelblatt,
Laura Ward, Kim Torok, Betty Tisdale and Jim Grenberg. They wanted to evaluate the
effectiveness of a maternal drug testing protocol as it relates to neonatal abstinence
syndrome (NAS).
Results showed that traditional screening methods underestimate in utero opioid
exposure. Of 2,956 cases, 159 (5.4%) positive results were recorded. Of these, 96
were positive for opioids. Of these, 19 (20%) opioid-positive urine tests were recorded
in mothers without risk factors. Of these, seven (37%) required admission to the
special care nursery for worsening signs of NAS. Of these, one required
pharmacologic treatment.
Preparing to lead
in nursing research
Nursing is healthcare’s largest discipline. With so much
presence, nursing scholarship needs to drive healthcare
policy and change and advance health. It’s important to
build strong nursing science, practice and policy through
nursing research.
Tracey Vitori, Nurse Practitioner for Cardiothoracic Surgery at Mercy Health —
Anderson Hospital, has specifically looked at delirium, anxiety, depression and hostility
on recurrence of acute myocardial infarctions and all-cause mortality and psychometric
properties of the brief symptom inventory in a prison population with cardiac disease.
Based on her research, Tracey presented best practices at the national level to the
Southern Nursing Research Society and Preventive Cardiovascular Nurses Association.
She was also selected by the University of Kentucky and the AACN to represent
nursing during their Annual Policy Summit in Washington, D.C.
Work like this directly impacts clinical care and fosters an incredible foundation for
excellence. Scientific inquiry protects our patients and their health. Research programs
that define and stratify risk will help providers make better decisions and manage
targeted populations, providing better care for patients. Nursing is the national voice
for needed policy changes that can improve health and healthcare.
60
Coordinated CHF program
decreases readmissions
The Congestive Heart Failure (CHF) program at Mercy Health — Fairfield Hospital
creates a collaborative network of inpatient and outpatient care to reduce
readmissions and improve quality.
Our nursing team’s coordination of care starts with inpatient education. This includes
individual education at the patient’s bedside and group education for patients and
their providers. To support outpatients, we provide telephone follow-up, support and
group visits in the CHF clinic. These visits provide a community for patients, with more
education, medication assessment and emotional support.
The program encourages interdisciplinary work between primary care physicians and
cardiologists, as well as pharmacy, physical therapy, dietary, spiritual care and cardiac
rehabilitation. Hospital and community resources like home healthcare, extended care
facilities, a hospital based infusion center and support groups also create easier access
to CHF healthcare.
Our CHF program has increased the quality of care. In 2014, of 70 patients in the
program, three had a 30-day readmission — only one related to CHF. In the future,
we hope to replicate this model at all five Mercy Health acute care sites.
Direct care nurses complete
six patient care studies
Merging a nursing research program into the culture of a
suburban community hospital was vital to Mercy Health —
Fairfield Hospital’s Magnet journey. This is often a
challenge for organizations not affiliated with academic
health centers. Through shared governance, our direct
care nurses were empowered through workshops,
grand rounds, access to research advisors and webinars.
The result: an annual average of six complete IRBapproved studies from direct care nurses. In the end,
patient care at Fairfield Hospital was ultimately improved
from new knowledge generated by nurses.
CONGRATULATIONS TO OUR FAIRFIELD HOSPITAL NURSES
Exploring the Effects of Implementing
“The Guideline for the Second Stage
of Labor Management” on Maternal
and Infant Birth Outcomes
Debora Graham
Marie Leist-Smith & Donna Green
CAUTI — Improving Patient Outcomes
and Nursing practices
Nursing Practices to Monitor Glucose
Control in Medical/Surgical Patients:
A Retrospective Chart Review
Michelle Haas
Laura Brausch
Exploring Nursing Knowledge Related
to Hypoglycemia in Medical/Surgical
Patients: A Staff Survey
Laura Brausch
62
One Million Global Catheters,
PIV World Prevalence Study
Exploring the Incidence of Hypoglycemia
Following Treatment for Hyperkalemia
Cathy Collins
Mercy Health nurses invited
to national presentation
Congratulations to the Family Birth Center nurses
at Mercy Health — Fairfield Hospital and Mercy Health —
West Hospital for presenting at the AWHONN
National Conference.
They were selected from hundreds of best practices to present at the national
conference. Their presentations:
•
Neonatal Abstinence Syndrome: Non-Discriminatory, Multidisciplinary Care
•
Community Perinatal Outreach Programs for Improving Prenatal Education
•
Surprise! Breastfeeding Happens Outside The OB Unit!
63
Wound care and cath lab
nurses save limbs
Patients can often visit a Wound Care Center with a lower extremity wound but not
know the cause. Because wounds often develop due to poor circulation, checking for
Peripheral Vascular Disease (PVD)/Peripheral Artery Disease (PAD) is essential.
Once a patient has been diagnosed with PVD/PAD, our Wound Care Center nurses and
catheterization laboratory nurses come together to form a single team. The cath lab
uses peripheral angiogram, balloons, stents, atherectomies and thrombolytics to try to
re-establish circulation. Once this happens, the Wound Care Center uses Hyperbaric
Oxygen Therapy, skin grafts, debridements and supportive wound care.
By resolving the underlying cause, the wound has a much better chance of healing — in many cases, saving patients’ limbs from amputation.
The relationship between these two nursing teams is highly collaborative. By using
their respective skills and expertise, the nurses have developed a close professional
relationship and an unsurpassed level of care. The patients’ path toward healing is
cohesive, seamless and of the highest quality. The Wound Care Center has one of the
highest healing rates in the nation, due in large part to this relationship with the cath lab.
Faster communication
improves response time
The Central Monitoring Unit (CMU) at Mercy Health —
West Hospital has improved response time to emergency
situations and the safety for our patients. The unit is
staffed 24/7 by two monitor techs chosen for their
years of experience and expertise in reading cardiac
monitors. With this equipment, they’re able to monitor
patients throughout the hospital on five different
floors. Nurses can call the CMU directly from the patient’s
room. And with Intellispace technology, the CMU can
send an image of the patient’s EKG rhythm directly to a
nurse’s phone. The program also sends regular reminders
to the staff when leads remain off or when the tele-pack
batteries need replacing. In emergencies, the staff can
call a code for a lethal rhythm if they can’t get in touch
with the nurse.
65
Adding a valuable
patient safety tool
High fall risk patients are generally placed in rooms close
to the nursing station. There’s more activity there and
patients who fall are more likely to be seen. Patient sitters
are often used for patients that are at the highest risk.
At four Mercy Health hospitals, the AvaSys Camera
system is used to supplement this need for patient sitters.
At Mercy Health — West Hospital, Mercy Health — Fairfield Hospital, Mercy Health —
Anderson Hospital and The Jewish Hospital — Mercy Health, the system is a welcome
addition. A small camera is placed into rooms for patients who are considered
moderate to high fall risks. They can then be monitored from the nursing station.
This allows monitor watchers to talk directly to the patient about not getting out
of bed until someone can get to the room.
66
OUR MISSION
We extend the healing ministry of Jesus by improving the health
of our communities with emphasis on people who are poor
and under-served.
OUR VALUES
Compassion, Excellence, Human Dignity, Justice, Sacredness
of Life and Service.
OUR PROMISE
To make lives better — mind, body and spirit.
To genuinely enjoy being of service.
To make healthcare easier.
mercy.com
A Catholic healthcare ministry serving Ohio and Kentucky
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