Nursing Annual Report 2014
Transcription
Nursing Annual Report 2014
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 N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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 N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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 Shared Leadership Co-Chairs N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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 N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 Vice President, Chief Nursing Officer Mercy Health — West Hospital 12 M E R C Y H E A LT H 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 N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 Vice President, Chief Nursing Officer Mercy Health — Clermont Hospital 14 M E R C Y H E A LT H 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 Shared Leadership Co-Chairs N U R S I N G A N N UA L R E P O R T 2 0 1 4 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. N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 0 ov 13 .2 0 D e c 13 .2 J a 01 n. 3 2 Fe 0 1 b. 4 M 2 a r 01 ch 4 A 20 14 pr il 20 M ay 14 J u 20 n e 14 2 J u 01 ly 4 A 2 01 ug 4 .2 0 14 13 0 N O ct .2 pt .2 13 13 0 .2 Se A ug 20 13 Ju ly 20 13 Ju ne 20 13 M il pr A ar M ay 20 13 13 ch 20 20 b. Fe Ja n. 20 13 1.0 HOSPITAL RATING BY DISCHARGE MONTH 100 0 Rating 1 Rating Top Box Percentage 80 2 Rating 3 Rating 60 4 Rating 5 Rating 40 6 Rating 20 7 Rating: 4.7% 2014 YTD 8 Rating: 13.6% 2014 YTD 20 M E R C Y H E A LT H ov 13 .2 0 ov 13 .2 0 D e c 13 .2 J a 01 n. 3 2 Fe 0 1 b. 4 M 2 a r 01 ch 4 A 20 pr 14 il 20 M ay 14 J u 20 n e 14 2 J u 01 ly 4 A 20 ug 14 . S e 20 pt 1 4 .2 0 14 0 13 N N .2 O ct . – Se pt 20 ne Ju ly – J u il – pr A Ja n. – M ar ch 20 13 0 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 76.1 0 0 13 20 3Q 20 2Q 14 1Q 20 13 20 20 4Q 20 3Q 2Q 14 20 1Q 20 13 4Q 20 20 3Q 2Q 14 0 20 20 1Q 20 20 20 4Q 40 13 40 13 40 13 60 13 60 13 60 13 75.1 All Press Ganey Database Mean N U R S I N G A N N UA L R E P O R T 2 0 1 4 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. N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H N O ct .2 0 14 ov .2 0 D 14 ec .2 0 14 Ja n. 20 15 0 14 14 .2 0 Se pt .2 ug A Ju ly 20 14 14 14 20 ne Ju M ay 20 20 il pr A M ar ch 2 0 14 14 0 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. N U R S I N G A N N UA L R E P O R T 2 0 1 4 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. N U R S I N G A N N UA L R E P O R T 2 0 1 4 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. N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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. N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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) N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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. N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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 N U R S I N G A N N UA L R E P O R T 2 0 1 4 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. MERCY HEALTH — FAIRFIELD HOSPITAL 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 THE JEWISH HOSPITAL — MERCY HEALTH Bone Marrow Transplant Certification Review Course (BMT) Congratulations to: Brittney Browne Liz Burke Tiffany Holt Leslie Hillner Nancy Murrin MERCY HEALTH — ANDERSON HOSPITAL Orthopedic Nurses Certification (ONC) Congratulations to: Andrea Anno Melody Bourbeau 42 M E R C Y H E A LT H 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 N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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. MERCY HEALTH — WEST HOSPITAL 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 MERCY HEALTH — WEST HOSPITAL 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 N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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 CVU MERCY HEALTH — 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 CVU MERCY HEALTH — 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 M E R C Y H E A LT H 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) N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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 N U R S I N G A N N UA L R E P O R T 2 0 1 4 51 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 M E R C Y H E A LT H DAISY Award Winners Mercy Health congratulates all of our team members who demonstrate exemplary professional experience and live our Mission, Values and Promise. MERCY HEALTH — FAIRFIELD HOSPITAL 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 MERCY HEALTH — ANDERSON HOSPITAL 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 MERCY HEALTH — WEST HOSPITAL 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 THE JEWISH HOSPITAL — MERCY HEALTH 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 N U R S I N G A N N UA L R E P O R T 2 0 1 4 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. N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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 M E R C Y H E A LT H 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 M E R C Y H E A LT H 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! N U R S I N G A N N UA L R E P O R T 2 0 1 4 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. N U R S I N G A N N UA L R E P O R T 2 0 1 4 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 M E R C Y H E A LT H 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 771CINBRO (3/15)