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2011 Nursing Annual Report INTEGRIS Baptist Medical Center www.integrisOK.com 2011 Nursing Annual Report INTEGRIS Baptist Medical Center 1 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 2 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 3 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 4 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 5 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 6 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. 7 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 9 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. 10 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 11 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 12 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