Download 2011 Nursing Annual Report INTEGRIS Baptist

2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
www.integrisOK.com
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
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2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Transformational Leadership
Many of you have heard me say that becoming and maintaining Magnet
designation is more than “a certificate that we display on the wall.” It is the
culture that you design and create that allows professional nurses to practice
in a manner that demonstrates their expert knowledge, evidence-based
practice and pride in their ability to provide safe and compassionate care to
their patients. Throughout our journey, we have paused to ask the question,
“Do we want to be a Magnet facility?” It is a choice.
The answer continues to be an overwhelming “yes,” communicated by our
nursing staff and leadership team. This designation reflects our vision for
the professional practice of nursing at INTEGRIS Baptist Medical Center.
Nursing is a career that is flexible and dynamic. As nurses we demonstrate
a willingness to continue our growth as a profession and to strive to achieve
the best practices with best clinical outcomes for our patients. This requires
ongoing and advanced education.
Today, it is very common to see nurses practicing at the bedside with a
master’s degree. We are even seeing an increase in the number achieving
a doctorate degree in nursing practice. We foresee a bachelor’s degree
eventually being the baseline for entry into our professional practice.
Our focus this year has been to formalize the “unit-based councils” to have
a reporting relationship not only to individual units but to the Council of
Nursing Excellence. We wanted to create a forum that enhances bi-directional
flow of communication and staff engagement in achieving our nursing and
organizational goals. We recognized that in order to affect the outcomes – it
was critical to engage our staff in the development of nursing goals and
defining the process improvements required to achieve the expectations.
In addition, nursing leadership uses the Council of Nursing Excellence as
a formal forum to bring forward strategy and advocacy issues. The council
can then help to identify process improvements/solutions to address quality,
evidence-based practice opportunities, technology gaps, and patient safety
and satisfaction improvements needed. This council has been very effective
and helpful in assisting nursing leadership with practice issues, and
methods to enhance collaboration and communication.
This year our focus has been on creating a stronger Culture of Safety
environment, as defined by you! Not only are we concerned about patient
safety, we have been focused on staff safety, also. For example, we conducted
a drill for all shifts that helped us plan for an “armed intruder/shooter.”
While this was a real wakeup call for many of us, we are seeing evidence
across the nation that prompts us to be more vigilant and prepared. Feedback
from throughout the organization has been very positive and appreciative
about proactively addressing these concerns.
This year we are in the process of developing a focused methodology
for tracking exemplary outcomes to identify if there is a correlation
with staffing effectiveness. The findings will be shared throughout the
organization, including our board of directors. In addition, we are in the
process of implementing an electronic scheduling system that will allow the
organization to improve forecasting abilities and match needs with available
staffing resources.
In closing, I wish to express my sincere thanks and gratitude to the entire
nursing staff and leadership team. Your continued commitment to clinical,
service and operational excellence is very much appreciated. I feel blessed
every day to be able to lead such a dedicated and professional team of
nurses. I hope you will take a moment to read this second annual report and
reflect on the many accomplishments of nursing. In our effort to be more
transparent, we have highlighted our current performance as well as areas of
focus for the future.
Thank you again for everything you do to provide exceptional patient care.
Please know how very proud I am of you and this wonderful organization.
Best Wishes,
Joni Tiller, RN, B.S.N., M.A.
CNO and Vice President, Patient Care Services
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Joni Tiller
RN, M.A., B.S.N.
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Transformational Leadership
Nursing Strategic Goal FY11 Highlights
Clinical Excellence/ Service Excellence
Culture of Safety
Transformational Leadership, Structural Empowerment, Exemplary Professional Practice
Every department will develop unit based peer review councils that report to the Council of Nursing Excellence.
by Design
Professional Collaboration
New Knowledge, Innovation and Improvements
Every department and all of nursing services will develop professional collaboration with medical staff to
enhance patient quality outcomes through standardized practice and utilization of protocols.
Operational Excellence
Professional Development
Structural Empowerment
Formal Education
National Certification
Professional Organization Involvement
Nursing Executive Masters
By July 2011
Minimum of one
Leadership
Clinical Directors
Team Managers
Bachelors
By July 2012
Organizational goal> 50%
B.S.N.; clinical director
By July 2012
to set unit goal
Direct Care Staff
Organizational goal> 50% Organizational goal>
26% of eligible staff;
B.S.N.; clinical director
clinical director to set
to set unit goal
unit goal
Minimum of one
Minimum of one
Encourage participation
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Successful EMR Go Live
Transformational Leadership; New Knowledge, Innovation and
Improvements
Staffing Effectiveness
Transformational Leadership; Exemplary Professional Practice;
New Knowledge, Innovation and Improvements
As evidenced by review and analysis of the relationship between
staffing and clinical quality outcomes.
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Structural Empowerment
Putting the Pieces Together The six workgroups
Nursing is by nature a collaborative profession centered around quality patient care.
We must work together to ensure the health and safety of our patients and the success
our organization. With this in mind, the Council of Nursing Excellence was eager to become
more intertwined in the model of collaboration. After much research and deliberation, the
council adapted to a more dynamic model.
HCAHPS1
Discharge
RN
of
Communication Medication
Communication
HCAHPS
2
•Pain Management
ss
•Environmental Cleanline
•Responsiveness of Staff
•Quietness of Environment
The nurses modified the meeting layout to promote group discussion. The new structure
consists of round tables instead of the traditional “U” shape set-up to facilitate
communication and collaboration. They chose to continue with standing agenda items
including CNO remarks and pertinent organizational strategies and updates during
the morning hours. The afternoon is now dedicated to active involvement in workplace
initiatives.
The large group separates into six smaller workgroups focused on facilitating activities
to improve patient care. Each workgroup is chaired by a council member with a nursing
leadership representative serving as a mentor. All workgroup members actively participate
in the development and implementation of initiatives and monitor their outcomes. The new
structure allows nurses and other disciplines who are not members of the council to be ad
hoc members based on project involvement. The workgroups are fluid and adjusted based on
patient and hospital
needs. The workgroup
arrangement has
changed once since
the April restructure.
Workgroup Initiatives
Council of Nursing
Excellence
Work Life Balance
•Recruitment and Retention
•Professional development
•National Certification
•Workplace Hostility
•Workplace Safety
• Education Support
Throughput – Shadowing other units during
orientation and exploring reasons for divert
HCAHPS 2 – Pain management:
Helping patients set realistic comfort goals
Nurse Sensitive Indicators – Pressure
ulcer prevention
WorkLife Balance/ Safety – Professionalism in nursing
Rotating Topics – Policy and procedure
communication and implementation in
patient care areas
1.4%
3.6%
45.7%
49.3%
ED
ICU
Outpatie Thr
oughpu
Departm nt
t
ents
Physicia
Partners n
hip
Procedu
Areas ral
Floors
Magnet
Policy and
Grievances
Procedure Rotating
Topics
HCAHPS 1 – Incorporating medication side
effects into patient education
Nationally Certified RNs
Direct Care RN
Education Level
Medication ion
Reconciliat
Associates
Bachelors
Masters
Diploma
Nationally certified
eligible RNs comprise 35 percent
of direct care staff. 81 percent of
leadership RNs are
nationally certified.
Leadership RN
Education Level
Quality of Life
Palliative Care
45.7%
5.7%
Nurse Sensitive Indicators
•Hospital Acquired Conditions
•Staffing Effectiveness
•Pressure Ulcers
•NDNQ
•CLABS
•Sepsis •Falls •VAP
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48.6%
Associates
Bachelors
Masters
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Structural Empowerment
From Checklists to Critical Thinking
INTEGRIS Health provides a formal nurse residency program for all new graduates who have
less than six months of nursing experience. The program is designed to assist new nurses in
their transition from advanced beginner to a competent level of nursing practice.
A soft topic such as delegation, prioritization, stress relief and documentation is provided
in addition to a clinically based topic. The clinical topics utilize a patient simulator
that breathes, talks, has vital signs, responds to medications, and projects appropriate
hemodynamics onto a monitor that reflects the clinical situation and interventions that have
occurred. The clinical scenarios are generally high risk and problem prone.
For a nurse resident to be successful, it requires a strong supportive preceptor who not only
precepts during the months of orientation, but also provides the ongoing mentorship. It also
requires the support of the clinical director, team manager, clinical educator and all of the
staff both nursing and non-nursing with whom the nurse resident interacts.
The simulation provides a safe environment so when nurses have the same experiences with
their patient they know how to respond. In addition, the nurse resident calls a physician actor
to provide updates or request orders. This is not always a positive experience, but it provides
an opportunity for the nurse resident to practice having difficult conversations.
The nurse residency program is designed to augment these various avenues of support and is
divided into stages. Stage one is the period of true orientation. Nurse residents attend many
orientation classes. During this time they experience a steep learning curve by learning the
work flow of the department, learning the beginning phases of critical thinking, and learning
how to prioritize, delegate and manage their time more effectively.
The nurse resident also works with patient family actors explaining procedures, outcomes and
care they are providing. In some scenarios, an additional patient actor is added to the mix
so the residents have to prioritize the care they provide to both the simulator and the patient
actor.
During stage two, nurse residents begin advancing to the level of competence necessary to
function independently. They have the support of monthly nurse residency seminars, where
they spend four hours with their peers continuing to learn and grow. During the residency
seminars, time is allotted for nurse residents to share experiences that have happened during
the month. This time allows the resident to realize they are not alone in their feelings.
After completion of the six month nurse residency program, the resident graduates. It is
inspiring to see how thought processes evolve from checklists to critically thinking. More than
650 nurses have participated in the Nurse Residency program. Many nurses feel the program
is very beneficial in solidifying their foundation as a new nurse.
Education
courses and modules
had 3,883 participants
totaling 1,885,197
education hours.
Nurse Residents Summer 2011
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2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Exemplary Professional Practice
Awards
March of Dimes Nurse of the Year award recognizes and celebrates outstanding nurses across Oklahoma. The awards gala is a
statewide event supporting the March of Dimes mission while recognizing exceptional nurses, creating awareness and promoting
the future of the profession. Debbie Baade, RN, was named Perioperative Nurse of the Year for 2010.
Connie Somers-Wilder Memorial Scholarship award distinguishes nurses who have demonstrated outstanding care and education
in diabetes through dedication and innovation in the daily practice of patient care. Recipients of the 2010 award are Robert
Douglas, RN, and Darsi Landsberger, RN.
Debbie Baade, RN
Virginia Staples award acknowledges a nurse for outstanding contributions to the Council of Nursing Excellence. The receiver
displays teamwork, supports peers and serves as a positive professional role model. The 2010 recipient is Traci Stites, RN.
Tommy Lewis Memorial Scholarship award honors a nurse for excellence and leadership in fall prevention. Wayland Smith, RN,
received the award for 2010.
Larry Pennington award recognizes a staff member for the care and compassion provided to heart cath lab patients. Barbara
Hooks, RN, was the recipient for 2010.
Robert Douglas, RN
Darsi Landsberger, RN
Traci Stites, RN
Wayland Smith, RN
Barbara Hooks, RN
Susie Jones, APRN-CNS, RN
The American College of Critical Care Medicine fosters the highest goals of multiprofessional critical care medicine, honoring
individuals whose achievements and contributions demonstrate personal commitment to the goals. The prestigious designation
of fellow of the American College of Critical Care Medicine honors practitioners who have made outstanding contributions to
the collaborative field of critical care. Susie Jones, APRN-CNS, was accepted into the FCCM June 2011. She is the only nurse from
Oklahoma to receive this honor.
Preceptor of the Year is awarded to a registered nurse who
embodies the values of Love, Learn and Lead, and provides and teaches
patient care in accordance with established nursing practice standards.
The preceptor demonstrates safe, accurate skills utilizing resources
effectively and appropriately, and has excellent leadership and critical
thinking skills. Tammy Kostelecky, RN, is the November 2010 award
recipient and Allison Henrich, RN, is the June 2011 award recipient.
Tammy Kostelecky, RN, ED
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Allison Henrich, RN
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Exemplary Professional Practice
Weight Loss Program Accreditation
Hat’s Off and
WOW Awards
The INTEGRIS Weight Loss Center at Baptist Medical Center
has been accredited as a Level 1a facility by the Bariatric
Surgery Center Network accreditation program of the
American College of Surgeons. Established by the American
College of Surgeons in 2005 in an effort to extend quality
improvement practices to all disciplines of surgical care, the ACS BSCN accreditation
program provides confirmation that a bariatric surgery center has demonstrated its
commitment to providing the highest quality care for its bariatric surgery patients.
The HEART committee recognizes and rewards employees and volunteers for their
exceptional dedication to patients and their families, and coworkers. The Hat’s Off and
Wonderful Outstanding Worker award is given to an employee who goes above and beyond
their normal work performance, exemplifying our values of Love, Learn and Lead.
WOWs are those individuals who are doing their job, plus something extra. They are the
employees everyone loves to work with, the person you can count on and who knows how
everything works and is always willing to share knowledge. The purpose of the Hat’s Off
award is to promote, encourage and recognize extraordinary behavior that surpasses job
expectations and enhances customer relations and patient and family satisfaction.
Accredited bariatric surgery centers provide not only the hospital resources necessary
for optimal care of morbidly obese patients, but also the support and resources that are
necessary to address the entire spectrum of care and needs of bariatric patients, from
the pre-hospital phase through the postoperative care and treatment process.
The designation signifies the INTEGRIS Weight Loss Center has met essential criteria to
ensure it is fully capable of supporting a bariatric surgery program and its institutional
performance meets the requirements outlined by the ACS BSCN accreditation program.
Beth Condley
Karen Perry
Donna Potter
Regina Pittman
Angela Bray
Kristin Mueggenborg
Paula Sharry
Nancy Sigl
Sharon Wilson
Amy McCracken
Janice Nolen
Nursing requirements for annual bariatric education include the following.
•Sensitivity training: available as an LMS module for all hospital staff
•Signs and symptoms of common bariatric surgery postoperative complications such
as pulmonary embolus, anastomotic leak, infection and bowel obstruction
•Patient transfers and mobilization
INTEGRIS Baptist Medical Center also boasts two nationally certified bariatric nurses:
Sarah Kitchen, RN, CBN, bariatric program coordinator, and Andrea Stevens, RN, CBN,
6 East direct care nurse.
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Cristy Warfield
Debbie Fussell
Tammy Stanford
Cindy Blalock
Christy Cate
Jeanna Golden
Mary Jung
Debbie McCann
Melinda Miller
Cindy Shelley
Vicki Smith
Kathy Stallcup
Lacey Thompson
Charita Williams
Jana Williams
Kristi Little
Brett Newman
Michelle Knight
Anita Bell
Heather Gilbert
Janis Heer
Latricia Major
Justin Simon
Mendy Stoeser
Joan Barker
Melissa Meloche
Holly Wright
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Exemplary Professional Practice
On the Road to a Safe Environment
Emergency Department
Cost Incurred Injury Claims
The Road Map program helps employees focus on the benefits of proactively changing
behaviors that put them at risk for serious accidents. The program goals include decreasing employee lost work time and employee injuries, including injuries that cause life
changing events.
$14,000
6
Injuries
$13,103
Cost
5
$12,000
$10,000
Number of Injuries
The emergency department has a higher number of nurse injuries making it a perfect
place to pilot the program. A unit based safety committee was developed and its leadership selected. Monthly committee meetings consist of analysis of incident reports, staff
education and development of unit specific safety objectives defined by direct care staff
and managers.
$8,000
3
$6,000
2
$4,000
Outcomes include: 1) reduction in injury severity and decreased lost work time as
evidenced by the decrease in department disability costs, and 2) department incidents
maintained or reduced from the previous fiscal year.
1
$859
$2,000
$15
0
$0
FY09
FY10
FY11
Fiscal Year
Success of the Road Map program resulted in empowered emergency staffs who are
wproactively improving their work environment.
New outcome components as of July 2011
• Increase in emergency department total participation
• Increase in preventable hazards identified by staff
INTEGRIS Baptist Facts
Total admissions (excluding newborns) 22,253
Total births (including NICU) 2,252
Emergency department visits 57,360
Surgical procedures 17,411
Cath lab procedures22,342
Interventional radiology procedures
10,064
Transplants 179
Safety Committee
8
Total Incurred Cost
4
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Exemplary Professional Practice
Advanced Practice Nurses
Improving Outcomes and Changing Lives
Vicki Oliver, APRN-CNS, is the first advanced practice nurse in
the perioperative area. Oliver has been with INTEGRIS Baptist
for 18 years and in her current role as the perioperative clinical
nurse specialist since 2010. She assists with complex patients
preoperatively and postoperatively. Oliver serves as a resource for
surgical personnel, educates and incorporates evidence based
practice, and precepts graduate students. She also facilitates
quality improvement initiatives for the surgical patient core
measures as the chair of the Surgical Care Improvement project
interdisciplinary committee.
INTEGRIS Baptist employs several advanced practice nurses in many different specialties.
APRNs are licensed individual practitioners who practice independently yet collaboratively
with physicians, nurses and other members of the health care team.
APRNs medically manage and treat specific patient populations; they diagnose, order tests,
perform procedures and write prescriptions. Several APRNs work to employ research and
evidence based practice into daily care. Most importantly, they serve as an expert resource
for physicians and nursing staff. APRNs impact the lives of patients in pediatrics, transplant,
neonatal care, diabetes, cardiovascular services, palliative care,
oncology, surgical services and nursing quality.
There are several new additions to the APRN team. Tamara Meier,
APRN-CNS, is the diabetes nurse specialist for Glucose Management
Services. Meier is an advanced practice nurse with prescriptive
authority certified in acute and critical care. She comes to us from
Evident Health Services where she worked extensively with patients
in hyperglycemia and diabetes management. Meier leads the
hyperglycemia care team and inpatient hyperglycemia and diabetes
initiatives, including Joint Commission certifications.
Vicki Oliver, APRN-CNS
Beth Condley, APRN-CNP, is a pediatric nurse practitioner certified
in acute care. Condley came to INTEGRIS in May 2010 from the
Tulsa area and primarily works on the pediatric floor. She is
responsible for day to day medical care and works collaboratively
with the pediatric residents and intensivists. Condley assists with
admissions, discharges and procedures.
Tamara Meier, APRNCNS
Chuck Cornwell, APRN-CNS, has been with INTEGRIS Baptist
since 1994, where he began his career as a nursing assistant
and progressed to APRN in 2007. Cornwell is a clinical nurse
specialist certified in acute and critical care, and began as the
transplant CNS in 2010. He assists the transplant intensivists
with assessments, consults, progress notes and procedures.
Cornwell independently places arterial lines, PICC lines, central
venous catheters, intubates and assists with more complex
procedures. He developed an educational packet with expectations
and requirements for medical residents who rotate through the
transplant ICU.
Debbi McCullock, APRN-CNP, guides the palliative care team initiatives. McCullock started
her nursing career at INTEGRIS Baptist more than 15 years ago. She
is recognized by the Oklahoma Board of Nursing as an advanced
practice nurse – family nurse practitioner – and is a faith minister
within her denomination. These two passions led her to spend
the majority of the five years she has been away from INTEGRIS
providing care to the most underserved populations within our
community. McCullock was a nurse practitioner for the primary
care clinic of the City Rescue Mission and was subsequently in
collaborative practice with family medicine physicians responsible
for providing care to students at a local university.
Debbi McCullock, APRN-
Beth Condley, APRNCNP
Chuck Cornwell, APRNCNS
CNP
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2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Exemplary Professional Practice
New and Improved Care:
It’s Not the Way We’ve Always Done It
The concept of mother-baby care was implemented in the Women’s Center to provide the
best foundation for maternal/ infant bonding and optimal opportunity for breastfeeding.
The physical renovation and process change became reality in June 2011. 4 West became
a 15 bed labor, delivery and recovery unit. Patients labor, deliver and recover in the same
room, then move to 4 East. Should a patient desire to stay in the same room from admit
to discharge, the request can be accommodated since all 37 rooms on the fourth floor are
LDRP capable.
4 East is typically quiet and peaceful while 4 West is often busy and bright with the 24
hour activity of laboring and delivering, thereby making 4 East the ideal location for a
mom and baby recovering and bonding. A three bed triage/ non-stress test area was also
created. The triage/NST room has an RN assigned daily from 8 to 5 to provide continuity
and education for high-risk OB patients.
Continuous rooming in with moms and babies is encouraged based on evidence that
indicates newborns should be with mom for 23 out of 24 hours for the first few weeks of
life. Historically, newborn care was performed in the nursery only; infants were brought to
the nursery early in the morning and for the pediatricians to examine when they arrived.
The pediatricians made notes on the chart and left, rarely going to the mom’s room to
discuss the newborn.
The process changes address previous areas of patient dissatisfaction by allowing the
newborns to receive a majority of their care in the patient room without being moved to
the nursery. Rooming in encourages breastfeeding on demand based on the developing
schedule of the mother/baby couplet. Evidence indicates patients enjoy having the same
nurse who is able to teach them about caring for themselves and their newborn.
Women’s Center Staff
Multiple training hours were provided for the Women’s Center staff members who were
learning new skills and delivery of care processes. Newborn nursery staff and gynecology/
medical surgical staff were both trained in mother-baby care. Labor and delivery staff
attended training in newborn care to provide couplet care during the recovery phase
including breastfeeding, newborn assessment and interventions.
Another area of focus was the discharge process. The unit based council worked with LEAN
principles to improve the discharge process for moms and babies. The discharge process
begins upon admission and continues throughout the patient stay to avoid congestion on
the day of discharge. The process was designed to provide a consistent flow of information
between staff, patient and family. The Women’s Center now has a bright and beautiful
physical appearance that matches the talent and commitment of its amazing staff!
INTEGRIS Baptist
employs approximately
922 nurses.
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2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Exemplary Professional Practice
Practice Changes Big and Small
Family Council Partnership
Nursing staff from the burn unit identified the need for a
standardized protocol to treat patients with alcohol withdrawal.
Burn patients often suffer during their hospitalization from
problems associated with this diagnosis. Recognizing that an
alcohol withdrawal protocol could benefit patients who suffer
from this syndrome throughout the facility, Shanelle StensaasArcher, RN, worked with one of our INTEGRIS physicians and her
colleagues to develop an evidence based treatment plan.
The Family Council of INTEGRIS Baptist was chartered in the summer of 2006 as a
specific initiative of the organizational strategy to “Provide quality of care and service that
exceeds our patients’ expectations.” After purposefully selecting members with an array of
experiences, the inaugural meeting was held on Nov. 28, 2006.
The alcohol
withdrawal protocol
includes a research
driven withdrawal
assessment tool
used to evaluate
symptoms and
guide treatment.
The protocol
encompasses
Shanelle Stensaas-Archer, RN
both nursing and
pharmacological measures including monitoring, medications,
vitamins and fluids. Once approved, the order set will be
available for use hospital wide; it is currently receiving approval
through the appropriate medical committees.
Nurses are encouraged to identify any patient care concerns
or obstacles they face so potential changes in practice can be
researched. No matter how simple or complex, a change in the
way we provide care could potentially be the difference in patient
outcomes.
What initially was planned as a quarterly meeting quickly turned into a monthly meeting
at the recommendation of the council, based on their desire to partner with us to improve
experiences and outcomes for all patients and families. The American Hospital Association’s
Institute for Family Centered Care serves as a guidepost, with both their hospital selfassessment tool and expertise in developing supportive cultures.
As the group has matured, the significance of its collective influence has grown. Family
Council contributions may be found in these initiatives.
• hand hygiene campaign
• condition H response process
• fall prevention program
• palliative care service
• patient room design
• HCAHPS and patient satisfaction surveying
• emergency department practices, and
• improved patient and
family communication
The Family Council
initiatives, identified as best
practices, are being shared
throughout INTEGRIS Health.
Family Council: Judy Walling, Kim Spady, Jimmie Sperling, Norman Blacklee,
Karrie Oertli, Julie Krywicki, Donna Sperling, Carole Blacklee, Hilda Lewis
Not pictured: Leva Swim, Joni Bruce, Daisy McNeil, Grant and Vanessa
Morgan, Lillian Perryman and Kim Frank
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2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Exemplary Professional Practice
Super Heroes of EMR Implementation
As part of INTEGRIS Health’s HealthCare CONNECT initiative, INTEGRIS
Baptist was forecast to go live with a new electronic medical record
on May 3, 2011. As we considered impact on staff along with gravity
of associated workflow changes, it was determined that investigation
of Super User methodology to support end users before, during and
immediately post conversion was warranted.
Information was obtained from Cerner and other hospitals that had used
the Super User concept for successful implementation to assist us in
determining our strategy. In March 2011, the executive management
team approved the Super User program for INTEGRIS Baptist.
The Super Users were provided additional intense training and
removed from direct care during the post go live transition period
to support the front line staff. Super User responsibilities included the
following.
• Positively support HealthCare CONNECT and encourage staff
• Participate in pre-go live activities such as refresher classes
• Know SOPs (standard operating procedure) and stress consistency
with staff
• Log issues with the help line
• Attend future Super User updates
for collaboration and communication
• Communicate changes to staff
The cost and support was a significant
commitment by the executive team
and demonstrates their dedication to
the project as well as to the
clinicians affected by this initiative.
Immediately after the May go live of this tremendous initiative, it
was apparent the conversion went more smoothly than other previous
conversions. The success is credited to hard work and continual effort
of our 241 Super Users.
Super User updates are held regularly where staff are shown new
improvements or additions and have the opportunity to share thoughts
and ideas, and receive feedback with challenges they have encountered.
As processes evolve with the new EMR, continuation of the Super User
program is imperative to our future success!
Super User training,
conversion and post go live support totaled
10,384 unbudgeted hours or 5 FTEs costing
more than $300,000.
Guardian Angel
Nursing Honorees
Jennifer Anderson
Joseph Beeton
Larry Bickerstaff
Blake Chelf
Sharla Grounds
Brandon Hatton
Kaylyn Heidebrecht
Janet Hess
Kim Higdon
Laura Holley
Misty Jernigan
Carolyn Linson
Robin Maciag
Melanie Ransom
Dana Selby
Amy Smith
Lisa Thayer
Emily Weathers
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Advancing through
Clinical Excellence
(clinical ladder)
ACE Award
Recipients
Level 1
Debbie Baade
Victoria Bednarz
Jamie Blaylock
Keri Boubam
Brandi Buck
Martha Camp
Ashley Campbell
Megan Cash
Blake Chelf
Barbara Coleman
Chelsei Cosgrove
Victoria Crittenden
Jennifer Downing
Jacqueline Gilmore
Allison Henrichs
Misty Jernigan
Carolyn Linson
Kristie Little
Susan Lyons
Latricia Major
Beth McDonald
Tammy
Mehdizadeh
LaRhonda
Richardson
Terri Robinson
Leida Schimmer
Kathy Scott
Ashley Speicher
Shanelle Stensaas
Mendy Stoeser
Ancy Varughese
Jennifer Waldron
Shawna Young
Level 2
Barbara Downs
Lynne Lusk
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
New Knowledge, Innovations and Improvements
All Cause Mortality for Patients with a Positive Severe Sepsis or
Septic Shock Screening
What a Difference a Year Makes
45%
Sepsis is a medical emergency similar to a heart attack or a stroke due to the interruption of
oxygen and nutrients to the tissues. It is estimated more than 750,000 people develop severe
sepsis in the United States each year. Mortality rates for severe sepsis and septic shock range
from 30-60 percent.
40%
35%
Percent Mortality
30%
In September 2010, INTEGRIS Baptist initiated an intense focus on sepsis screening and
treatment beginning with the hiring of a dedicated sepsis coordinator. The sepsis coordinator,
Belinda Lechtenberg, RN, worked to improve the process for early identification and treatment,
which ultimately decreases mortality.
25%
20%
15%
10%
5%
Since most hospital admissions originate from the emergency department, the sepsis screening
process started with all adult ED patients. The screening process was then introduced in the
intensive care units. ICU screens occur daily, on admission and with a condition change.
Additional goals are being established relative to meeting resuscitation targets within six hours
of recognition. Patient mortality (all cause) has decreased by 17 percent for patients identified
with severe sepsis or septic shock.
Patients who screen positive for severe sepsis/ septic shock can be placed on the sepsis
protocol. The protocol includes time sensitive treatment goals essential to successful patient
outcomes. The initial treatment goals include completion of the following within four hours of
recognition.
• Serum lactate
• Blood cultures times two
• Administration of 20 mL/kg
fluid bolus
0%
Successful outcomes in the emergency department and ICUs led to a second sepsis coordinator, Ancy Varughese, RN. Varughese’s position was created to implement sepsis screening in
non-ICU areas, which has already started on 10 East and 5 East.
• First dose of antibiotics
Severe Sepsis or Septic Shock Initial Treatment Goals
% of patients with 4/4 goals met
Total number of patients screened
>44,000 75 patients/ month screen positive for severe sepsis/ septic shock
% of patients with 4/4 goals not met
90%
80%
70%
Emergency Department
3,700 patients/ month screened
95 percent screening compliance rate
60%
50%
40%
Intensive Care Units
1,200 patients/ month screened
90 percent screening compliance rate
30%
20%
10%
60
0%
50
40
13
Ancy Varughese, RN and
Belinda Lechtenberg, RN
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
New Knowledge, Innovations and Improvements
Helping Hands
Patient Advocacy Made Easy:
Another INTEGRIS Baptist First
Many think of the Oklahoma Board of Nursing as a disciplinary body; however, their purpose is
to ensure the residents of Oklahoma receive safe nursing care.
A question was posed to the board: “Is it within the scope of practice for a registered nurse to
place a nasogastric tube in a patient who has undergone anatomy-altering surgery of the upper
gastrointestinal tract or stomach?” Research revealed there was no position statement or
guidelines available from any professional nursing organization.
Sarah Kitchen, RN, led the way as a content expert on a board task force designed to review
the practice issue and make recommendations. Guidelines were developed allowing registered
nurses to place NG tubes with the assistance of guided imagery in this population after the
nurses have had additional education and training.
Oklahoma has become the first state to have guidelines on this practice issue. Moving forward,
INTEGRIS Baptist will work with other health care organizations to increase awareness for
asking the right patient history question and the need for a competency program. Several 6 East
nurses are being trained for the procedure.
The throughput nurse concept was created several years ago to safely and efficiently
transfer and relocate our patients throughout the hospital. The initiative first began with
patients in the admitting and emergency departments.
Throughput nurses initiate the admission process for patients waiting for an inpatient
bed. Patients are relocated to designated throughput rooms where they are safely placed
in a bed to begin treatment. The rooms have been established among various units with
9 East being the most recent location.
The throughput nurses assist with the following.
• Completion of initial patient history and patient and family education
• Timely initiation of lab tests, IVs and other procedures
• Communication with physicians on initial assessment findings, lab results, need for
additional orders, etc.
• Transporting patients between units when needed
• Recovering interventional radiology patients prior to their discharge
We would like to extend a special thank you to the throughput nurses for assisting
throughout the facility as we continue to strive for prompt, appropriate and safe
placement of our patients.
Through our Health Careers program, we placed 47 new RNs.
Sarah Kitchen, RN
We provided clinical rotation sites for 115 clinical groups
with 1,618 nursing students from 18 nursing schools.
There were 46 nurse externs and 65 nurse residents.
14
Michelle Vanderburg, RN,
throughput nurse
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
Empirical Outcomes
INTEGRIS Baptist Nurse Satisfaction Survey
National Database for Nursing Quality Indicators
80
2009
Central Line Associated Blood Stream Infections
National Healthcare Safety Network
NHSN mean
2010
Adult ICU
2.50
60
Rate per 1,000 Central Line Days
2.00
50
40
30
20
1.50
1.00
0.50
10
0.00
0
Job Enjoyment
Autonomy
Nursing
Administration
Nursing
Management
RN-MD
Interactions
RN-RN Interaction Professional Status
Ventilator Associated Pneumonia
National Healthcare Safety Network
NHSN Mean
2.5
2
Rate per 1,000 Ventilator Days
Adapted Index T-Scores
<40= Low Satisfaction
>60= High Satisfaction
70
1.5
1
0.5
0
15
Adult ICU
2011 Nursing Annual Report
INTEGRIS Baptist Medical Center
16