the Nursing Annual Report
Transcription
the Nursing Annual Report
2014-2015 NURSING ANNUAL REPORT TABLE OF CONTENTS 01 Message from the Chief Nursing Officer 02 Nursing at Memorial Hermann Memorial City Medical Center 07 Transformational Leadership 08 Structural Empowerment 19 Exemplary Professional Practice 25 New Knowledge, Innovations and Improvements 31 Empirical Outcomes Message from the Chief Nursing Officer I always welcome the opportunity to feature and talk about our professional nurses here at Memorial Hermann Memorial City Medical Center. There is so much to be proud of at our hospital. The passion and compassion evident in the care our nurses deliver every day at Memorial Hermann Memorial City is truly amazing. Having earned designation as a Magnet® hospital in 2009, and in the process of undergoing redesignation in 2015, it is clear that our nurses have made the commitment to sustain the highest excellence in nursing practice. We consistently challenge ourselves to do more for our patients and more for our community. Our nurses are furthering their professional education, achieving new certifications and participating in Professional Nurse Development councils across the facility, all with the goal of serving our patients better while advancing their careers as registered nurses. Our nurses continue to have a voice in their professional practice. Their voices are heard through our unit-based councils and facility-wide shared governance councils. With their focused and enlightened perspective from the bedside, they frequently bring new ideas and improvements forward. Many of their ideas have been implemented hospital-wide. At Memorial Hermann Memorial City, our nurses’ hearts and hands often work outside the hospital walls as they take personal time to volunteer for the community. Our nurses partner with and mentor students pursuing a career in health care. They’re developing our future and shaping the healthcare workforce. Whether you’re an experienced nurse, a new graduate, a nursing student or an individual who is considering nursing as a potential career choice, I think you’ll be impressed by what it means to be a Memorial Hermann Memorial City nurse. As we are focused on creating our future in our efforts to improve and refine the clinical care and services we provide to every patient and family member, I invite you to learn more about our accomplishments highlighted in this report. We’re so very excited to share our clinical results, our accomplishments and our commitment to our profession with you. Please drop me a note to let me know what you think at [email protected]. Dan Kelly, M.B.A., B.S.N., RN Vice President, Chief Nursing Officer MEMORIAL HERMANN MEMORIAL CITY MEDICAL CENTER 1 “It was a nurse who held me, aided me, saved me, helped me, taught me, inspired me.” – Unknown 2 Nursing at Memorial Hermann Memorial City Medical Center The Nursing Mission: to advance the health of our community by partnering with patients, families and physicians to provide patient-centered, quality care, in a collaborative environment while promoting growth and operational excellence. The Nursing Vision: to promote trusting partnerships that deliver the best patient experience, through the selection, development, and retention of the highest performing nurses, while creating systems that achieve consistency and excellence in patient care. The Nursing Pledge: As a nurse at Memorial Hermann Memorial City Medical Center, I believe in making a positive difference for those I serve through compassionate, innovative, and evidence-based nursing care. Nursing Strategies • Provide highly reliable, customer-centered nursing care with a focus on service excellence, quality and safe clinical practice • Enhance the professional image of nursing • Partner with physicians to improve patient care outcomes • Drive high-quality outcomes by protecting, promoting, and optimizing the health and wellbeing of the patients we serve • Advance the professional growth of nurses to expand our service to the community • Optimize and demonstrate fiscal responsibility 3 Our Mission: to advance the health of our community by partnering with patients, families, and physicians to provide patient-centered, quality care, in a collaborative environment while promoting growth and operational excellence. The Nursing MVP (Mission, Vision and Pledge) As a professional nurse at Memorial Hermann Memorial City Medical Center My Nursing Pledge: As a nurse at Memorial Hermann Memorial City Medical Center I believe in making a positive difference for those I serve through compassionate, innovative, and evidenced-based nursing care. Pillar: Patients Pillar: People Pillar: Physicians Pillar: Quality & Safety Pillar: Growth Pillar: Operational Excellence Provide highly reliable, customercentered nursing care with a focus on service excellence, quality, and safe clinical practice. Enhance the professional image of nursing. Partner with physicians to improve patient care outcomes. Drive high quality outcomes by protecting, promoting, and optimizing the health and wellbeing of the patients we serve. Advance the professional growth of nurses to expand our services to the community. Optimize and demonstrate fiscal responsibility Nursing Goals: Nursing Goals: Create an environment that inspires professional development through internal and external educational opportunities. Increase employee retention through best practices in staffing. Nursing Goals: Enhance and utilize a culture that maximizes customer experience through hourly rounding, leadership rounding, bedside report and accountability. Reduce readmission through effective communication and education of patients and families from admission to discharge. Nursing Goals: Hire and retain a diverse, caring, compassionate, connected, and committed staff through shared governance. Improve interdisciplinary collaboration as the coordinator of the patient’s care. Advance health with a passion and inspiration for patient and family centered care. Nursing Goals: Achieve effective, high quality, nurse-physician communication. Promote a positive culture for nurse-physician relationships. Engage physicians in the implementation of evidence-based practice to ensure high quality patient outcomes. Utilize evidence based practice and research in all patient care areas. Eliminate serious safety events, falls with injury, and hospital acquired infections. Utilize data to drive process improvement. Memorial Hermann Memorial City nurses demonstrate excellence by emulating the core values of quality patient care, continuous improvement, partnerships, and professional development and growth. This allows them to elevate the professional image of nursing as reflected in increased accountability, leadership and fiscal responsibility. Since 2009, Memorial Hermann Memorial City has been designated by the ANCC’s Magnet Recognition Program®. Ultimately, Magnet designation is reflective of nursing care and quality and is considered the highest level of recognition the profession can receive. 4 Our Vision: to promote trusting partnerships that deliver the best patient experience through the selection, development, and retention of the highest-performing nurses, while creating systems that achieve consistency and excellence in patient care. Promote academic partnerships and improved talent acquisition processes. Pursue new patient populations through the creation and expansion of services. Dan Kelly Vice President and Chief Nursing Officer Nursing Goals: Optimize supply costs and improve resource utilization to ensure the right supplies and equipment are available for the right patient at the right time. Standardize care and improve efficiency in patient flow using current technology. Organizations that obtain the designation must consistently outperform national benchmarks regarding nursing and patient satisfaction scores and nursing-sensitive indicators including Catheter-Associated Urinary Tract Infection (CAUTI), Hospital-Acquired Pressure Ulcers Stage II (HAPU Stage II and Above), Central Line-Associated Bloodstream Infections (CLABSI) and Patient Falls. Research supports that Magnet facilities foster an environment conducive to achieving improved patient safety outcomes. MEMORIAL HERMANN MEMORIAL CITY MEDICAL CENTER NURSING ORGANIZATIONAL CHART Paul O’Sullivan, CEO Dan Kelly, Vice President, CNO Office of Designations Magnet & Baldrige Coach Mary Poe Sr. Admin. Director, Women’s & Children’s Karen Childs Mary Poe Sr. Admin. Director, Critical Care Patricia Howell Sr. Admin. Director, Med/Surg Maryellen McGlothlin Sr. Admin. Director, Nursing Services Vacant Sr. Admin. Director, Emergency Services Adult Harold Engle Director, MFM/OB Special Care, OBED L&D Lynneece Rooney Director, MICU/SICU Margie Witt Director, 6M/7M Mila Goldstein OAs Patricia Howell Manager, ED Melanie Aluotto Director, Dialysis Margie Witt Manager, 6M Olu Funke Float Pool Harold Engle Emergency Services Pediatric ED Manager, MICU Dora Barrows Manager, 7M Vacant Director, CRM Shayla Preston Manager, CDU Chauntelle Long Manager, SICU Prince Balason Director, 5E/7E Barbara Thomas Director, Volunteer Services Bailey Curtis Director, Neurosciences Angela Dever Manager, 5E Purisma “Dolly” Vingco Manager, Chaplaincy Services Rick Chandler Manager, IMCU Pamela Mare Manager, 7E Elizabeth Bench Project Manager, Magnet Nadia Saiphoo Manager, Neuro ICU Jason Hayes Director, 6E Maria Jardiolin Educators Maryellen McGlothlin Manager, Labor & Delivery Jennifer Johnson Manager, Family Life Center Robin Gray Manager, NICU, Pediatrics Kevin Hart Updated 5/21 /2015 Using components of the Magnet Model (on right), our nursing leaders and clinical nurses transform practice through empowerment of our staff and use of our shared governance model to evaluate and implement evidence-based interventions. These innovations raise the bar on quality for nurses at the bedside, creating an exemplary practice environment for generating new knowledge and improvements. As a result, excellence in patient outcomes is achieved and supported by empirical findings. Program Specialist, Emergency Management Mike Barron Manager, 6E Jenneta Manning MAGNET MODEL s in Nursing & Healt hC Issue l a are b o l G Structural Empowerment Transformational Leadership Empirical Outcomes Exemplary Professional Practice New Knowledge, Innovations, & Improvements 5 Senior Nurse Leaders at Memorial Hermann Memorial City Dan Kelly, M.B.A., B.S.N., RN Vice President and Chief Nursing Officer Harold Engle, M.B.A., B.S.N., RN, CCRN-K Senior Administrative Director, Emergency Services Karen Childs, M.S.N., B.S.N., RN-OB Senior Administrative Director, Women’s & Children’s Mary Poe, M.S.N., B.S.N., RNC Office of Designation, Magnet & Baldridge Maryellen McGlothlin, B.S.N., RN, NE-BC Senior Administrative Director, Medical/Surgical Services Patti Howell, M.B.A., B.S.N., RN, CCRN-K Senior Administrative Director, Critical Care Transformational Leadership In 2014, Memorial Hermann Memorial City nurses were empowered to advocate for both fiscal and technology resources. The process involves nurse leaders rounding with direct care nurses monthly and asking each of them, “Do you have the basic tools and equipment to do your job?” This had an enormous impact in improving the clinical nursing environment across the Memorial Hermann Memorial City campus. Nursing leaders at all levels of a Magnet-recognized organization must demonstrate advocacy and support on behalf of staff and patients to transform values, beliefs and behaviors. The CNO must be strategically positioned within the organization to effectively influence other executive stakeholders, including the board of directors/trustees. Nursing’s mission, vision, values and strategic plan must align with the organization’s priorities to improve performance, wherever nursing is practiced. Mechanisms must be implemented for evidence-based practice to evolve and for innovation to flourish. As a result, nurses throughout the organization should perceive their voices are heard, their input is valued, and their practice is supported. – A New Model for ANCC’s Magnet Recognition Program, 2014 As an example, Administrative Director of Medical Surgical Services Maryellen McGlothlin, B.S.N., RN, rounded on several medical surgical units. On one of these units, McGlothlin met with a direct care nurse who requested a microwave, a refrigerator, and a workstation on wheels (WOW). This request was documented using the Spotlight Report. Requests from medical surgical nurses on the 7 East/Cardiology unit Stoplight Report included an additional BP machine, two microwave ovens, a refrigerator, lockers, backboards, thermometers and bedside commodes. Stoplight Report The Stoplight Report is a tool used to document the direct care nurses’ needs for fiscal and technology resources. This helps to transform the clinical work environment in practical ways, which is in line with the Memorial Hermann Memorial City Nursing Strategic Plan that directly impacts quality, safety, patients, operational excellence, people, physicians and growth. The Stoplight Report is reviewed each month with the direct care nurses. As a result of this collaboration, all of the nurse requests were granted. Additional WOWs were also purchased so that direct care nurses could continue to improve on developing personal and professional technology skills and continue to provide best nursing practices. 7 Structural Empowerment The second of the five Magnet model components, Structural Empowerment, is integral to ensuring that nurses have the tools they need to be the central part of the patient care decisionmaking process. The ANCC describes Structural Empowerment as follows: Solid structures and processes developed by influential leadership provide an innovative environment where strong professional practice flourishes and where the mission, vision, and values come to life to achieve the outcomes believed to be important for the organization. Further strengthening practice are the strong relationships and partnerships developed among all types of community organizations to improve patient outcomes and the health of the communities they serve. This is accomplished through the organization’s strategic plan, structure, systems, policies and programs. Staff needs to be developed, directed and empowered to find the best way to accomplish the organizational goals and achieve desired outcomes. This may be accomplished through a variety of structures and programs; as one size does not fit all. – A New Model for ANCC’s Magnet Recognition Program, 2014 9 STRUCT U R AL EM POW E R M E NT Memorial Hermann Memorial City Medical Center Shared Governance Councils Structure Professional Nursing Development Council Nursing Research and EvidenceBased Practice Council Nursing Leadership Council Nurse Staffing Effectiveness Council Unit-Based Councils Magnet Champs Nursing Quality Council Professional Nursing Practice Council Revised 4/16/2015 Nursing Shared Governance Council Our Shared Governance councils, which are nurse-driven, support and demonstrate structural empowerment. Each council has a chair and a co-chair who are appointed or elected by the council members, who are bedside care nurses. Each council is guided by a specific mission and accountabilities, as described in the Memorial Hermann Memorial City nursing bylaws, which allows them to focus on different aspects related to improving nurse practices. 12 10 • Professional Development Council Mission: • Define educational needs, structures, and processes as they pertain to building a culture of nursing excellence that attracts and retains quality nurses, and develops rewards and recognition. • Collaborate with Human Resources to determine the structures and processes to recruit and retain quality nurses. • Develop in partnership with clinical nurse educators to provide unit-based education and incentives related to new knowledge and nurse recruitment, retention, reward and recognition. • Develop and guide formal and informal reward and recognition of nurses. • Participate in planning the annual Nurses Week, Certified Nurses Day™, and other nurse-related celebrations. • Promote nurses’ individual accountability and team ownership of retaining best nurses.. STRUCTUR AL EM POW ERM ENT • Professional Practice Council Mission: • Support and implement the standards of the nursing practice. • Define the roles and responsibilities of patient care support staff. • Evaluate and implement evidence-based practices. • Incorporate nursing research findings into clinical practice as appropriate. • Participate in the improvement of patient care and safety. • Participate in the improvement of employee safety and address multidisciplinary issues that impact patient care areas. • Participate in the review and recommendation of products and equipment brought into the patient care areas. • Review and approve applications and make recommendations for clinical ladder advancement. • Nursing Quality Council Mission: • Define structures and implement nursing quality improvement programs. • Collaborate in nursing continuing education and patient education programs. • Support evidence-based clinical practice, nursing outcomes, and empirical outcomes. • Integrate nursing performance improvement programs with the hospital quality improvement system (Six Sigma). • Evaluate the effectiveness of the quality improvement programs and make recommendations to appropriate departments, committees, and organizations. • Assess and reassess both patient education and nursing continuing education as it relates to quality of care. • Promote, facilitate, and evaluate the use of evidence-based nursing practices on unit. • Research and Evidence-Based Practice Mission: Research and Evidence-Based Practice (EBP) are essential to providing excellent nursing care. Nurses define problems and use a process where they improve their knowledge and skills to affect positive clinical changes and outcomes. A Research and EBP culture requires a structured collaborative approach from nurses at all levels, as well as an interdisciplinary problem-solving approach. Use of Research and EBP in nursing is essential to patient-centered care and safety, efficiency, timeliness, equity and excellence. • Nurse Staffing Council Mission: • Positively impact and address staffing-related issues that affect the safety and quality of patient care and nurse practices. • Return the control of nursing practice back to those having direct patient care, and return autonomy to the workplace. • Review risk indicator for nursing dynamics (e.g., staffing grids, actual staffing data, recruitment and retention). • Determine how correlation data (e.g., fall data) applies to patient care and ascertains if there is a correlation or not. • Review staffing policies and accept input from all areas of the hospital to ensure the needs of our patients are being met. • Provide direct care nurse input and recommendations to the Nurse Staffing Plan to ensure that we comply with the Texas Nursing Safe Staffing Law (Senate Bill 476). • Review skill mix and nurse characteristics with staff to ensure that quality care is available on all shifts and units. 11 STRUCT U R AL EM POW E R M E NT DAISY Award DAISY is an acronym for Disease Attacking the Immune System. The DAISY Foundation was formed in November 1999, by the family of J. Patrick Barnes, to honor the exceptional nurses who cared for J. Patrick until his death at age 33 from complications of idiopathic thrombocytopenic purpura. The DAISY Award recognizes one nurse each month for going above and beyond to deliver exceptional patient care. The Memorial Hermann Memorial City DAISY Program recognizes extraordinary nurses who have been nominated for their compassion and clinical skills provided to patients and families. 12 2014/2015 DAISY Winners • Anton DeGuzman, A.D.N., RN, 7M • Ian Binns, B.S.N., RN, 7M • Tiffany Hatch, B.S.N., RN, CDU • Sophie Harris, B.S.N., RN, NICU • Nhu Do, B.S.N., RN, 7E • Alberto Galvan, B.S.N., RN, MICU • Ihechi Nwachokwu, B.S.N., RN, 7M • Roselyn Flauta, B.S.N., RN, SICU • Trinh Linh, B.S.N., RN, 7M • Laura Wueste, A.P.R.N., RN • Marisa Ehrich, RN, FLC STRUCTUR AL EMPOW ERM ENT COMMITMENT TO PROFESSIONAL DEVELOPMENT CURRENT CERTIFICATIONS FOR NURSING BY SPECIALITY Certified Case Manager Jennifer Johnson, CCM Kathleen Nipper Johnson, CCM American Case Management Certification Stephanie Campbell, ACMA Karen Charba, ACMA Sharon Humphreys, ACMA Deborah Tarner, ACMA Fellow American Academy of Case Management Certification Elaine Cavenall, FAACM Rossanny Cerino, FAACM Joanna Davidson, FAACM Marietta Guinhin, FAACM Sharon Humphreys, FAACM Abeni Jones, FAACM Leilani McCarthy, FAACM Gail McNeal, FAACM Judy Roberson, FAACM Shelia Rougeaux, FAACM Certified Diabetes Educator Nadia Saiphoo, CDE Gail Llewellyn, CDE Certified Nurse Midwife Lynneece Rooney, CNM Certified Emergency Nurse Melanie Aluotto, CEN Kara Edwards, CEN Lauren Ivanhoe, CEN Steven Talbot, CEN Marcie Woodard, CEN Certified in Infection Control Certified Nurse Manager Leader Helen Nielsen, CNML Margie Witt, CNML Certified Low Risk Newborn Jocelyn Guzman, RNC-LRN Certified Neonatal ICU Nurse Roxanne Cabori, RNC-NIC Sophie Harris, RNC-NIC Kevin Hart, RNC-NIC Karen Parthum, RNC-NIC Cathy Singer, RNC-NIC Amy Theall, RNC-NIC Certified Nurse Executive Annette Conley, NE-BC Louise Hernandez, NE-BC Daphney Jacques, NE-BC Maryellen McGlothlin, NE-BC Certified Advanced Nurse Executive Bernadette Pollard, NEA-BC Certified Nurse Operating Room Jennifer Amedio, CNOR Anjanette Bryant, CNOR Rebecca Burt, CNOR William Coakley, CNOR Denise Collins, CNOR Constance Curtis, CNOR Nathalie Desinor, CNOR Ann From, CNOR Deborah Lucas, CNOR Dina Roane, CNOR Bernita Russo, CNOR Barbara Sparks, CNOR Adoracion Tangalin, CNOR Certified Orthopedic Nurse Maria-Belen Jardiolin, ONC Joseph Galvan, ONC Jenneta Manning, ONC Thelma Redondiez, ONC Certified Wound, Ostomy and Continence Nurse Barbara Kebodeaux, CWON Nnenna Nelson, CWON Larry Ong, WCC Critical Care Registered Nurse Clinton Alsup, CCRN Jennifer Amedio CCRN Tammera Averette, CCRN Brenda Borhary, CCRN Laurie Brumley, CCRN Marian Buado, CCRN Jeanne Caneda, CCRN Nelia Collado, CCRN Margaret Conner, CCRN Irene DeLeon, CCRN Nida Dumantay, CCRN Soyna Gaines CCRN Michael Garcia, CCRN Hilaria Gascon, CCRN Katharine Hicks CCRN Linda Holifield, CCRN Andronico Inocenio, CCRN Daphney Jacques, CCRN Trudy La, CCRN Maria Luz, CCRN Robert Malinsky, CCRN Jacquelyn Marchman, CCRN Irene Martin, CCRN Mariam Namakar, CCRN Ibrahim Noubani, CCRN Barbara Paredes, CCRN Paige Percoski, CCRN Suzy Robinson, CCRN Diane Stephenson, CCRN Jean Talosi, CCRN Joseliza Tan, CCRN Rubylyn Toquero, CCRN Vicki Trask, CCRN Lisa Verbeke, CCRN Yu Wang, CCRN Felisa Wong, CCRN Amy Wriht, CCRN Critical Care Registered Nurse-Knowledge Harold Engle, CCRN-K Patty Howell, CCRN-K Cardio-Vascular Certified Nursing Maria Meneses, CVCRN Certified Bariatric Nurse Debbie Cook, CBN Suzanne Hovis, CBN Trudy Ivins, CBN Laura Moreno, CBN Caroline Wesgona, CBN Certified Gastroenterology Nurse Josefina Bernstein, CGN Staci Norman, CGN Vicki Norman, CGN Cary Yeary, CGN Certified Medical Surgical Registered Nurse Ida Aristizabel, CMSRN Martha Awotwe, CMSRN Liz Bench, CMSRN Monica Climaco, CMSRN Charlotte Elizondo, CMSRN Mureal Escano, CMSRN Staci Forcade, CMSRN Maria Hurtado, CMSRN Maria Lapat, CMSRN Maudheler Lewis, CMSRN Carla Mondelli, CMSRN Isioma Okoye, CMSRN Alana Pollard, CMSRN Jenn Rivas, CMSRN Olofunke Taiwo, CMSRN Barbara Thomas, CMSRN Purisima Vingco, CMSRN Maria Wilson, CMSRN 13 STRUCT U R AL EM POW E R M E NT COMMITMENT TO PROFESSIONAL DEVELOPMENT CURRENT CERTIFICATIONS FOR NURSING BY SPECIALITY Healthcare Quality Debbie Garbade, CPHQ Certified Patient Safety Officer Debbie Garbade, CPSO Certified Healthcare Risk Management Ellen Davis, CPHRM Debbie Garbade, CPHRM Certified Neuroscience Registered Nurse Nelia Collado, CNRN Guoqing Fan, CNRN Amy Lewis, CNRN Maryann Mendoza, CNRN Paige Percoski, CNRN Perianesthesia Certified Registered Nurse Vivien Swaren, CPAN Stroke Certified Registered Nurse Angela Dever, SCRN Paige Percoski, SCRN Electronic Fetal Monitoring Leah Burnitt, EFM Angela Fraizer, EFM Jennifer Johnson, EFM Kystal Wilkins, EFM Barbara Wilson, EFM 14 Certified Obstetric Registered Nurse Kathy Armitage, RNC-OB Leah Burnitt, RNC-OB Lucia Champange, RNC-OB Karen Childs, RNC-OB Brandy Duffy, RNC-OB Angela Frazier, RNC-OB Veronica Gaston, RNC-OB Robin Gray, RNC-OB Bridget Ikejimba, RNC-OB Jennifer Johnson, RNC-OB Margo Makowski, RNC-OB Jennifer Maiorana, RNC-OB Shean Manickchan, RNC-OB Gail Matejka, RNC-OB Teena Middleton, RNC-OB Jennifer Rocha, RNC-OB Lynneece Rooney, RNC-OB Barbara Wilson, RNC-OB Certified Hospice and Palliative Care Corrine Ferchak, CHPN Tracie Meeks, CHPN Certified Breastfeeding Counselor Lucia Champange, CBC International Board Certified Lactation Consultant Aida Alinsub IBCLC Susan Boehning IBCLC Rebecca Ovbiaele IBCLC Heather Sanderson IBCLC Leslie Trevino IBCLC Evelyne Volny IBCLC Certified Lactation Counselor Foluke Akinola, CLC Maternal Newborn Nursing Amor Ballestero, RNC-MNN Mimoza Duraj, RNC-MNN Irma Garza, RNC-MNN Erica Huckaby, RNC-MNN Lucy Langley, RNC-MNN Rebecca Ovbiaele, RNC-MNN Memusa Paez-Cabangon, RNC-MNN Mary Poe, RNC-MNN Oncology Certified Nurse Arrian Amini, OCN Jessica Burgess, OCN Maritess Castilan, OCN Constance Curtis, ONC Karen Davin, OCN Nancy Evans, OCN Anton De Guzman, OCN Mila Goldstein, OCN Certified Cardiac Rehabilitation Professional Donna McFadyen-Taylor, CCRP Certified Pediatric Nurse Holly Beck, CPN Jan Davis, CPN Jody Duncan, CPN Penny Kakoolaki, CPN Lisamma Kurian, CPN Josephine Larbi, CPN Jessica Oliveira, CPN Cecilia Pangandoyon, CPN Aimee Strech, CPN Association of Pediatric Hematology/ Oncology Nurses Ashlyn Ward, APHON Certified Pediatric Hematology/ Oncology Nurse Mary Higan, CPHON Trauma Nurse Certification Claire Lasiewski, TNCC STRUCTUR AL EM POW ERM ENT Certified Nurses Day TM Celebration Charge Nurse Academy Memorial Hermann Memorial City promotes leadership at the point of care and enhances competencies at all levels. Memorial Hermann Memorial City knows that charge nurses play a pivotal role in providing leadership, and are vital to the overall improvement of patient outcomes and effective management of the nursing unit. The Charge Nurse Academy curriculum includes healthcare economics/finance, effective communication, conflict management, resource management and self-development. 900 800 500 700 400 600 500 300 400 200 300 200 100 0 BSN MSN Total RN Count Total RN Count Staff Count BSN/MSN Certified Nurses Day is a national day to honor and recognize the important achievement of nursing specialty and subspecialty certification. Certification is a milestone of personal excellence along the professional journey. Memorial City Nursing Education Trend 600 100 FY2013 Q1 FY2013 Q2 FY2013 Q3 FY2014 Q1 FY2014 Q3 FY2014 Q4 FY2015 Q1 363 372 358 324 393 430 502 19 20 14 9 17 32 25 599 613 605 516 667 752 781 0 *No data for FY13 Q4 or FY14 Q2 15 STRUCT U R AL EM POW E R M E NT Nurse Practitioners Insertion of PICC Lines and Dressing Changes Memorial Hermann Memorial City has employed advanced practice registered nurses (APRNs) since 2011. Their hard work, attention to detail, and patientcentered care has resulted in the cardiovascular program receiving a three-star rating from the Society of Thoracic Surgery. This award has elevated the Memorial Hermann Heart & Vascular Institute-Memorial City cardiovascular program to the top 8% of cardiovascular surgery programs in the United States. The APRNs had a direct impact on achieving this award based on meeting 100% compliance with the required medications at discharge, a decrease in the length of stay by two full days, a decrease in readmission rates, and an overall increase in patient satisfaction and consulting physician satisfaction with the cardiovascular surgery service at the Institute. Memorial Hermann Memorial City leadership promotes, encourages, and supports the active participation of all nursing staff in professional nursing organizations. The Memorial Hermann Memorial City Peripherally Inserted Central Catheter (PICC) team nurses attend the Infusion Nurse Society (INS) and Association for Vascular Access (AVA) chapter meetings. Through participation in these professional nursing organizations, the importance of avoiding hospital-acquired conditions, particularly CLABSIs, is emphasized. Dora Li, M.S.N., RN, CRNI VA-BC, attended the Association for Vascular Access Annual Scientific Meeting and returned to the organization with a plan to provide more intensive education for direct care nurses in dealing with access, maintenance, and care of central lines. In February 2014, the PICC team collaborated with critical care educators to develop an educational program for the Intensive Care Unit (ICU) nursing staff that defined the interventions required for the proper use, maintenance and care of central lines in order to decrease the risk of CLABSIs. Best practice guidelines from the American Association of Critical-Care Nurses (AACN), the INS and AVA were used to develop the educational program. The education included instruction on maintenance of central lines, causes of occlusions, dressing change techniques, directions regarding medications and adverse reactions. The educational offering was held during the ICU annual competencies in March 2014, and included various teaching methodologies: explanation, discussion, handouts, questions and answers, and return demonstration. All nurses employed by SICU, MICU, IMCU and Neuro ICU received this education. 16 STRUCTUR AL EM POW ERM ENT In the fourth quarter of 2013, the CLABSI rate in all ICUs (SICU, MICU, IMCU, Neuro ICU) was 3.28. After implementation of these interventions, in the second and third quarter of 2014, the CLABSI rate in all ICUs decreased to 2.5. instructor contacts Maryellen McGlothlin, B.S.N., RN, the administrative director of Med/Surg at Memorial Hermann Memorial City, several months prior to the start of the upcoming semester and identifies the number of preceptors needed. At the same time the school will submit a clinical placement request form. McGlothlin sends an email to all nursing managers and directors to ask if there is willingness to precept a HBU management student. The resources allocated by Memorial Hermann Memorial City include approximately 120 hours of nursing leadership time for precepting an RN management clinical practicum. Additional resources allocated include the use of a conference room for the student’s weekly pre- and post-conference with the nursing instructor. Affiliations with Schools of Nursing Memorial Hermann Memorial City is committed to the health of the community and participating in and supporting nursing’s involvement in education and community projects. The nursing strategic plan promotes growth through academic partnerships and improved talent acquisitions. One objective within the strategic plan is to support growth and nursing leadership while advancing the professional growth of nurses to expand our services to the community. To support this nursing goal, resources are allocated for affiliations with schools of nursing during the budgeting process. Key initiatives are discussed with nursing leaders to determine what resources, human and financial, are needed. Each school of nursing affiliation starts with a student affiliation agreement between Memorial Hermann Memorial City and the school entity. Clinical and leadership preceptors are needed for nursing students from many nursing schools. Houston Baptist University (HBU) partners with Memorial Hermann Memorial City for their senior management student clinical rotations. The HBU lead nursing Nursing students are assigned to specific nursing leadership who volunteer their time to teach and mentor. Nursing leaders participate in each student’s review and reinforce skills that support current nursing strategic initiatives. One of the initiatives is customer service: enhancing and utilizing a culture that maximizes customer experience as it relates to effective communication and education. 17 “Quality is never an accident. It is always the result of deliberate intent guided by sincere effort, intelligent direction and skillful execution. It represents the wisest choice among many alternatives.” 12 Exemplary Professional Practice The professional nursing team at Memorial Hermann Memorial City is committed to providing the safest quality care for our patients and families, and that means taking advantage of every possible opportunity to learn and share best practices with their colleagues. This commitment to both the art and science of nursing is what transforms someone with a gift of caring for others into a nurse of Exemplary Professional Practice. As the third of five Magnet model components for nursing, Exemplary Professional Practice is defined as follows: The true essence of a Magnet organization stems from exemplary professional practice within nursing. This entails a comprehensive understanding of the role of nursing; the application of that role with patients, families, communities, and the interdisciplinary team; and the application of new knowledge and evidence. The goal of this Component is more than the establishment of strong professional practice; it is what that professional practice can achieve. –A New Model for ANCC’s Magnet Recognition Program, 2014 19 EXEMPL ARY PROFES SI O NA L P R ACTI CE Fall Project One of Memorial Hermann Memorial City’s safety initiatives is to prevent patient falls. A hospital fall team was created to develop best practices for fall prevention. The best practices include: the use of the Post Fall Investigation Tool, patients wearing yellow arm bands and yellow socks to alert staff and family members, along with the use of a fall sign on patient room doors. In addition, all patient rooms display a “Please Call Stop a Fall” sign. The Cardiology unit (7E) was chosen to be the pilot. The goal was to decrease patient falls on the unit by 50 percent. The falls team used Define, Measure, Analyze, Improve and Control (DMAIC) methodology to identify critical factors leading to injurious falls, and implemented targeted solutions to address the critical factors. Periodic meetings of the fall team were held and team members reported the following: Define: Identified process issues of variation in assessing presence of secondary diagnosis and history of falls, patients unaware of falls risk levels, subjectivity resulting in variation of interventions selected, confusion on definitions of some interventions (assistive devices, hip protectors, non-slip floor mats), 20 interventions selected on variance report either not in use or not applicable, variations in reports. Measure: Streamlined data collection process, implemented new post-fall huddle tool, identified 28 contributing factors. High priority factors: nurses not having completed priorities, not rounding with purpose, staff not recognizing patients in or out of the room, desensitization from treating all patients at risk for fall. Completing high priority factors resulted in a more accurate assessment and education of fall risk. Memorial Hermann Memorial City also identified patient education needs through interviewing patients and their nurses. Analyze: Implementation of robust data collection: medication, call light response time, call light behaviors, and change in condition. Through this analysis, Memorial Hermann Memorial City found the following root causes of falls on the Cardiology unit: • Gender – males are injured more often than females (66%) • Lack of assistance – most falls with injury are unassisted (93%) • Bathroom-related activity prior to fall – injuries related to the bathroom (54%) EXEMP L ARY P RO FES S IO NA L PR ACTICE • Inconsistent patient education about bed alarms – patients interviewed said they were not educated on falls (64%) • Bed alarm not on – patients injured did not have bed alarm on (54%) • Not calling for help – patients with injuries had called for help (0%) • Staffing – fall injury rate correlates with vacancy rate; the higher the vacancy rate, the higher the fall rate and Safety Metrics indicate that the most consistent injuries to RN staff over the past two years have been trips, falls, and injuries related to patient handling and needle sticks. As part of our process, these injuries are tracked in our SafetyNet reporting system, which enables the employee’s supervisor to complete an injury investigation. The intent and focus of the Workplace Safety Initiative at Memorial Hermann Memorial City has been to develop a culture where direct care staff is mindful of their actions at all times and they are empowered to speak up about safety concerns. The percent of RN injury related to needle sticks in April – June 2013 was 27.27%. Memorial Hermann Memorial City’s goal was to increase workplace safety for nurses by reducing the percentage of RN injuries related to needle sticks. Improve: Fall team met and identified 22 targeted solutions to address 16 root causes. A robust improvement plan was developed and implemented. Control: Continued safety audits are performed to ensure appropriate interventions are in place (bed/chair alarms on, arm bands, white board communication, door tags). Monthly monitoring of Fall with Injury Rate and Total Falls Rate is communicated in a timely manner. Full support and buy-in has been obtained with all stakeholders. Through the utilization of the Professional Practice Council, the Leadership Council, Education Resource Specialists and direct care nursing, Memorial Hermann Memorial City took the following steps to ensure direct care nurse safety to prevent needle sticks. The suggestion was to increase the use of Vacutainer® access devices throughout the hospital. This new practice was taken to the hospital Professional Practice Council. The Council found that the Vacutainers® were not stocked on all the Workplace Safety for Nursing In July 2014, Memorial Hermann Health System announced a renewed focus and prioritizing of employee safety. Memorial Hermann Memorial City Occupational Health RN Needle Stick Injuries 30.00% I n t e r v e n t i o n Percent 25.00% 20.00% 15.00% 10.00% 5.00% 0.00% % RN Injury related to needle sticks April - June 2013 (Q4 FY 2013) 27.27% August 2013 Feb. 2014 April - June 2014 (Q4 FY 2014) July - Dec. 2014 (Q1 & Q2 FY 2015) 14.28% 8.75% 21 EXEMPL ARY PROFES SI O NA L P R ACTI CE The intervention was effective and the percent of RN injuries related to needle sticks was decreased from 27.27% to 8.75% by the fourth quarter of 2014. Rapid Response Team units and that the staff was not consistently trained to use them. The Council agreed these items and education needed to be available to all direct care staff. The Professional Practice Council decided to take the recommendation to the Leadership Council to add to the unit’s PLR and determine education needs of staff. The Rapid Response Team (RRT) was activated during the second quarter of 2013. The dedicated RRT has decreased the number of codes called and the number of times physicians and nurses were pulled from their unit to address codes. The goal was to increase the number of RRT calls and reduce the number of codes called. In February 2014, the RRT department was 75% staffed and their duties included reviewing the code blue responses, and assisting with patient assessments and emergency interventions. In March 2014, the RRT nurses began attending staff meetings to introduce themselves and explain how they could partner with direct care nurses: educating, starting IVs, assessing septic patients, and designing and conducting mock codes. By the fourth quarter of 2014, the number of RRT calls had increased to 202 and the number of codes had decreased to 7. Rapid Response Team Activations and Number of Codes Number of Activations/Codes 250 150 100 50 0 Codes RRTs 22 Intervention 200 Q1-2013 6 80 Q2-2013 23 76 Q3-2013 20 113 Q4-2013 20 100 Q1-2014 13 111 Q2-2014 14 106 Q3-2014 13 171 Q4-2014 7 202 27 New Knowledge, Innovations and Improvements Magnet-recognized organizations integrate evidence-based practice and research into clinical and operational processes. Nurses are educated about evidence-based practice and research, enabling them to appropriately explore the safest and best practices for their patients and practice environment while gaining new knowledge. As the fourth of a five-component Magnet model, New Knowledge, Innovation and Improvements is defined as below: Innovations in patient care, nursing, and the practice environment are the hallmark of organizations receiving Magnet recognition. Establishing new ways of achieving high-quality, effective, and efficient care is the outcome of transformational leadership, empowering structures and processes, and exemplary professional practice in nursing. –A New Model for ANCC’s Magnet Recognition Program, 2014 25 N EW KN OW L EDG E, I NNOVATI O NS A ND I M P ROV E MENTS Journal Clubs Memorial Hermann Memorial City’s nurse-driven effort to integrate best practices into the clinical environment involved evaluating existing nursing practices through Journal Clubs. Journal Clubs encourage nurses to review evidence-based literature that may have an impact on existing clinical practices. A hospital-wide Journal Club was created by Pediatric Nurse Educator Jessica Oliviera, B.S.N., RN, CPN, to foster an evidence-based learning environment for Memorial Hermann Memorial City nurses. A hospital-wide presentation was given on the importance and benefits of Journal Clubs. This served to support and encourage the direct care nurses that attended to start individual unit-based Journal Clubs. After attending the Journal Club presentation, Amor Ballestro, B.S.N., RNC-LRN, charge nurse in the Family Life Center, used the Journal Club’s new knowledge as a platform for evaluating kangaroo care at birth for full-term infants in the newborn nursery. Kangaroo care is skin-to-skin contact with mother and baby immediately after birth. The Journal Club provided the necessary structure that enabled the nursery nurses to evaluate the validity of kangaroo care for full-term infants. This helped them to develop new knowledge and skills, as they were already familiar with the importance and necessity of providing kangaroo care in preterm infants, but were not sure of its benefits or a needed practice in full-term infants. The process that Ballestro conducted included a literature search that provided an article for the nursery nurses to review via the Nursery Journal Club: Walters, M., Boggs, K., Ludington-Hoe, S., Price, K., & Morrison, B. (2007). Kangaroo Care at Birth for Full Term Infants – A Pilot Study. MCN American Journal Maternal Child Nursing. 2007 Nov-Dec; 32(6): 375-381. 26 The Nursery Journal Club met and reviewed the article, and discussed their current practice compared to the best practice identified in the article’s use of kangaroo care for full-term babies. In addition, Ballestro provided an article for the nursery nurses to review: Cong, X., Ludington-Hoe, S., Vazquez, V., Zhang, D., & Zaffetti, S. (2013). Ergonomic Procedure for Heel Sticks in Kangaroo Care (Skin-to-Skin) Position. Neonatal Network, 2013; 32(5):353-357. After a review of the evidence, the recommendation was made to incorporate kangaroo care into newborn nursery practice. Surgical Attire Policy and Procedure Many of the nursing policies and procedures that guide nursing practice at Memorial Hermann Memorial City originate at a Memorial Hermann system level to ensure consistency in nursing practice across the system. The System and Entity Policy, Procedure and Guideline (PP&G) process is set up to enable all staff to have access to approved PP&Gs and to facilitate consistency in the development and management of PP&Gs. When a question, concern, or issue arises with an existing nursing practice, and there is a PP&G involved, the item is brought to the attention of the document owner who is the Chief or Director responsible for owning a particular policy, procedure, or clinical guideline, and for its periodic review or update. The document owner assigns content experts to review the issues and revise or write the policy or procedure. Throughout the review process, the policy is sent and reviewed by the PP&G committee as well as stakeholders, which are interdisciplinary healthcare providers (i.e., Critical Care Council, Med-Surg Council, Physician Committees, Pharmacy), to ensure the written information reflects their input and is accurate and evidence- based. For example, a Surgical Site Infection (SSI) task force was created with the intention of eliminating SSIs at Memorial Hermann Memorial City. The task force consisted of a hospital-wide multidisciplinary team that In June of 2013, a hospitalwide Journal Club was created by Pediatric Nurse Educator Jessica Oliviera, B.S.N., RN, CPN, to foster an evidencebased learning environment for Memorial Hermann Memorial City nurses. N EW KN OW L EDG E, I NNOVATI O NS A ND I M P ROV E MENTS was championed by our former Chief Operating Officer, Jim Witt, M.B.A., B.S.N., RN. The task force adopted the Pathway to Zero Surgical Site Infections created by Dr. Waleed at Kaiser Sunnyside Medical Center in Clackamas, Oregon. The first item in this pathway is Operating Room (OR) attire. The task force assigned Annette Conley, M.H.A., B.S.N., RN, director of Inpatient Perioperative Services; Shanna Harris, M.H.A., MT (ASCP), Six Sigma Master Black Belt; and Karen DeKay, manager of Infection Prevention, to lead the work on developing a surgical attire policy and procedure. Annette Conley was assigned to be the document owner. The team performed a literature review and decided to use the Association of Perioperative Registered Nurses (AORN) guidelines in developing their policy and procedure. The team, led by Conley, worked on the policy and procedure, asking for input from all affected areas. They presented the Development Plan and Education and Communication Plan to the Memorial Hermann Memorial City PP&G committee and, with the approval of the committee, proceeded in finishing the policy and procedure. The policy and procedure was completed and published. 28 Catheter-Associated Urinary Tract Infections (CAUTIs) The Memorial Hermann Memorial City nurse-led CAUTI champion team implemented new knowledge collected from evidence-based best practice and national guidelines to reduce CAUTIs within our facility. CAUTI numbers were collected, with data tracked for decreasing the incidence of CAUTIs without successful improvement, despite being below the national data average. In November 2013, the pre-data showed that an average of 3.5 CAUTIs occurred per month. The nurses saw this as an opportunity to improve on the quality of patient care and improved health outcomes with the new knowledge by introducing new insertion techniques and reconsidering whether patients truly required urinary catheters. Their goal was to reduce the incidence of CAUTIs as measured by the average number of CAUTIs/month. Memorial Hermann Memorial City developed a task force of point-of-care CAUTI champs supported by project leader Maryellen McGlothlin. She was appointed to this position based on her extensive nursing experience in the acute care environment, and direct responsibility for five NEW K NOWLEDG E, INNOVATIO NS AND IM PROVEM ENTS medical surgical units at the hospital. The CAUTI champs were selected based on a volunteer basis. In January 2014, the CAUTI champs held their first meeting in which they reviewed current national legislation, financial impact and adverse patient outcomes data. Group discussion resulted in recommendations to reduce CAUTIs at Memorial Hermann Memorial City. In March 2014, the infection prevention specialists (Shaunte Walton, M.S., MB (ASCP), CIC; and Julia Thomas, MAOM, MT (ASCP)) presented data to the CAUTI champs that showed current national CAUTI data and highlighted the fact that Memorial Hermann Memorial City was below the national average. Recommendations were made to collaborate with C.R. Bard, Inc., a company that manufactures medical devices. In April 2014, the Bard representatives performed an insertion gap analysis in the Main Operating Room (MOR), Emergency Department (ED), Labor and Delivery (L&D), and the Medical Intensive Care Unit (MICU) that showed significant improvement was needed with insertion techniques. This new knowledge led to a facility-wide awareness and improvement in nursing practice with each Foley catheter insertion. The CAUTI champs created a universal poster that was used in each unit to present the new urinary catheter insertion guidelines focusing on new knowledge. This new knowledge included using a two-person/nurse insertion team, having a valid reason for a urinary catheter insertion, committed use of the catheter stat lock and securement device, using best practices with catheter and peri-care, and proper drainage bag placement. This project continued through May 2014 when the CAUTI team reviewed evidence-based literature and focused on the following article: Parry, M. F., Grant, B., & Sestovic, M. (2013). Major article: Successful reduction in catheter-associated urinary tract infections: Focus on nurse-directed catheter removal. AJIC: American Journal of Infection Control, 411178-1181. doi:10.1016/j.ajic.2013.03.296. This was used as a source of best practices that integrated new knowledge with improving clinical practices. In June 2014, this new insertion technique knowledge was incorporated by the nurses and implemented facility-wide as a best-practice change for insertion. This also fulfilled a key focus of the 2014 National Patient Safety Goal - NPSG.07.06.01: to use proven guidelines to prevent infections of the urinary tract that are caused by catheters. The clinical nurse practice changes that were implemented included: • using best practices to ensure that there is a need and indication for a urinary catheter • using stat lock and green safety clip on catheter • adhering to safe urinary catheter care and peri-care • obtaining urine samples using the needleless sampling port • ensuring proper catheter bag placement • providing patient and family education To scrutinize the necessity of inserting a urinary cathether, nurses employed the HOUDINI acronym: Hematuria, Obstruction, Urological surgery, Decubitus ulcer(s), Immobile, No Code, and Input and Output (I&O). This led to a significant decrease in CAUTIs as well as decreased the use of urinary catheters at Memorial Hermann Memorial City. By the end of June 2014, all nursing practice changes were effectively in place. 29 Empirical Outcomes Today’s Magnet recognition process primarily focuses on structure and processes, with an assumption that good outcomes will follow. Currently, outcomes are not specified, and are minimally weighted. There are no quantitative outcome requirements for ANCC Magnet Recognition. Recently lacking were benchmark data that would allow comparisons with best practices. This area is where the greatest changes need to occur. Data of this caliber will spur needed changes. In the future, having a strong structure and processes are the first steps. In other words, the question for the future is not “What do you do?” or “How do you do it?” but rather, “What difference have you made?” Magnet-recognized organizations are in a unique position to become pioneers of the future and to demonstrate solutions to numerous problems inherent in our healthcare systems today. They may do this in a variety of ways through innovative structure and various processes, and they ought to be recognized, not penalized, for their inventiveness. Outcomes need to be categorized in terms of clinical outcomes related to nursing, workforce outcomes, patient and consumer outcomes, and organizational outcomes. When possible, outcomes data that the organization already collects should be utilized. Quantitative benchmarks should be established. These outcomes will represent the “report card” of a Magnet-recognized organization, and a simple way of demonstrating excellence. –A New Model for ANCC’s Magnet Recognition Program, 2014 31 EMP IRI C AL OU TC OM E S Nursing-Sensitive Clinical Indicators We benchmark our performance against the American Nurses Association (ANA) National Database of Nursing Quality Indicators (NDNQI). Injury Falls Per 1,000 Patient Days 0.60 0.40 0.20 0.03 0.00 -0.20 -0.09 -0.11 -0.11 -0.40 -0.31 -0.28 -0.80 -0.28 -0.34 -0.43 -0.50 -0.60 2013 Q2 Hospital 2013 Q3 Mean 2013 Q4 10th Pctl -0.09 2014 Q1 25th Pctl 2014 Q2 2014 Q3 50th Pctl 2014 Q4 2015 Q1 75th Pctl 90th Pctl Central Line Associated Blood Stream Infections per 1000 Central Line Days 0.60 0.40 0.20 -0.20 0.06 0.05 0.00 0.00 -0.11 -0.14 -0.40 -0.60 Hospital 32 -0.34 -0.37 2013 Q2 2013 Q3 Mean 2013 Q4 10th Pctl -0.19 2014 Q1 25th Pctl 2014 Q2 2014 Q3 50th Pctl 2014 Q4 75th Pctl 2015 Q1 90th Pctl EMP IRICA L OU TCOM ES Nursing-Sensitive Clinical Indicators We benchmark our performance against the American Nurses Association (ANA) National Database of Nursing Quality Indicators (NDNQI). Percent of Surveyed Patients with Hospital-Acquired Pressure Ulcers Stage II and Above 1.00 0.80 0.84 0.60 0.40 0.20 0.09 0.00 -0.07 -0.20 -0.28 -0.31 2013 Q3 2013 Q4 -0.40 -0.60 2013 Q2 Hospital Mean 10th Pctl -0.10 -0.18 -0.33 2014 Q1 2014 Q2 25th Pctl 2014 Q3 50th Pctl 2014 Q4 75th Pctl 2015 Q1 90th Pctl Catheter-Associated Urinary Tract Infections per 1000 Catheter Days <=2014 0.80 0.60 0.40 0.20 0.00 -0.20 -0.40 -0.31 -0.15 -0.24 -0.20 2013 Q3 2013 Q4 -0.04 -0.03 2014 Q3 2014 Q4 -0.24 -0.60 -0.80 2013 Q2 Hospital Mean 10th Pctl 2014 Q1 25th Pctl 2014 Q2 50th Pctl 75th Pctl 90th Pctl 33 921 Gessner Houston, TX 77024 memorialhermann.org 713.222.CARE (2273) 4408157