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Excellence EMPOWERED by pulling the pieces together N u r s i n g A nn u a l R e p o r t | 2 0 1 1 Magnet Model Dear Nursing Staff, Professional Practice Model Congratulations to Deaconess Nurses Transformational Leadership Leadership Chart for another year of progress toward national recognition for nursing excellence. This report will highlight another year of accomplishments by Deaconess nurse leaders at all levels that help position Deaconess Hospital and Health System for recognition as a leader in safe, compassionate, high-quality health care. Structural Empowerment These achievements are due to the leadership shown by many of you through the unit-based councils, the Nursing Shared Governance Councils, Healthy Work Environment teams, interdisciplinary teams (e.g., Stroke Team), core care teams and other nurse-led initiatives in which the difference nurses make results in great patient care. Because of these results, we also had a “perfect” accreditation HFAP survey, with no nursing deficiencies noted. Exemplary Professional Practice New Knowledge, Innovations & Improvements This is our fourth nursing annual report. It covers many Deaconess nursing contributions, including: • “hardwiring” efficient and effective use of EPIC • improving core measures and NDNQI nurse sensitive indicators • maintaining a strong position with skin care management, and • making important improvements in patient satisfaction across a number of nursing units. We achieved these goals while opening a new tower at Deaconess Gateway Hospital, expanding the Gateway ED, expanding the Deaconess Hospital ED and ORs, and remodeling the new unit 4800 ICU that’s scheduled to open in June of 2012. From Your Family To Ours The VHA RetuRN to Care Collaborative Teams that began work in 2010 continue to show their commitment to patient-centered care by enhancing our care delivery process for every patient as we meet their individual care needs during hospitalization. All medical surgical units and several ICUs across campuses have integrated this structure into their units. The remaining ICUs have incorporated many of the actions central to RetuRN to Care within their unit structures. In addition, the work of the Healthy Work Environment teams continues to help build highly effective teams across nursing units. 2 | Deaconess Health System The Emergency Department nurses at both campuses took a lead role in developing a standard of care for sexual assault patients, with a number of the nurses stepping forward to obtain their Sexual Assault Nurse Examiner certification in 2010. This year they have done significant work to ensure that we provide best practice in the care of these vulnerable patients—while expanding their expertise to also care for child victims. The new Professional Development Program for RNs rolled out at the end of 2010, and this year we’ve already recognized more than 13 nurses through this program. Other improvements to the program continue, and increased participation is evident. The SG Education Council continues to lead this initiative. Trauma Services had a very successful re-accreditation survey. The nursing leadership and staff who were involved were critical to such a strong survey, as were the other interdisciplinary team members who emphasized to the surveyors our team-based, high-quality, patient-centered care for trauma patients and their families. It will be apparent to all who read this report that Deaconess nurses are moving forward with an aggressive nursing-excellence agenda. I encourage you to read this report in detail. It will make you proud and even more determined to accomplish as much as possible in 2012 in the interest of extraordinary patient care. On behalf of Deaconess nurses, I would like to thank the Board of Directors and Linda White, President and CEO, for their ongoing support of nursing excellence and their continued loyalty and support of our pursuit of Magnet recognition. We will submit our documents by August 1, 2012. Let’s go for the gold and accomplish the goal of Magnet 2013. Sincerely, Cherona J. Hajewski, MSN, RN, NEA, BC Vice President and Chief Nursing Officer, Deaconess Hospital EXEMPLARY PROFESSIONAL PRACTICE ............................................................. 36 NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTS ................................... 42 FROM YOUR FAMILY TO OURS ................................................................................45 Deaconess Health System pulling the pieces together Licensed beds at Deaconess Gateway Hospital (excluding ancillary areas) Licensed beds at Deaconess Cross Pointe Deaconess Hospital Campus Surgery Cases Gateway Campus Surgery Cases From Your Family To Ours 323 158 60 4,180 3,842 Licensed beds at Deaconess Hospital (301 acute-care beds) Transformational Leadership STRUCTURAL EMPOWERMENT ................................................................................10 Leadership Chart LEADERSHIP ChART ..................................................................................................... 8 Structural Empowerment Transformational Leadership ....................................................................... 6 Exemplary Professional Practice PROFESSIONAL PRACTICE MODEL ......................................................................... 5 New Knowledge, Innovations & Improvements MAGNET MODEL ............................................................................................................ 4 Professional Practice Model Magnet Model Table of Contents 2011 Nursing Annual Report | 3 Magnet Model The Magnet Model Professional Practice Model ES IN NURSING & HEAL U S S TH AL I CA B O RE GL Structural Transformational Leadership Empowerment Transformational Leadership Empirical Outcomes Exemplary Professional Practice Leadership Chart New Knowlege, Innovations & Improvements Structural Empowerment Exemplary Professional Practice The Magnet Model consists of five components, including the sources of evidence from each component. They include: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations & Improvements. New Knowledge, Innovations & Improvements Transformational Leadership: Focuses on leadership within the organization and their actions to influence change, values, behaviors, vision and beliefs. To achieve this goal, leaders must be strong communicators and good listeners while supporting future practices. Structural Empowerment: The involvement of nurses at every level making the best decisions with the most optimal outcome—from the bedside to the CNO. Nurses are valued at Deaconess, and we recognize them for their achievements both within the system and community-wide. From Your Family To Ours Exemplary Professional Practice: The essence of Magnet nurses and a Magnet organization! The goal of this component is to guide practice by using a strong model that focuses on collaboration, communication, nursing practice and professional development to provide the highest quality care to patients. 4 | Deaconess Health System Another key point to this component is a strong shared governance, which is vital to the success of the organization. With the integration of the Professional Practice Model of Nursing along with the Professional Development Program, the leaders of today are making way for the leaders of the future. New Knowledge, Innovations and Improvements: Evidence-based practice provides our patients with the safest and best practices while generating new knowledge. To be successful, Deaconess must continually build on the current knowledge base by using existing evidence while applying new evidence to achieve optimal outcomes. Empirical Outcomes: From excellent nursing care at the bedside, and by having proper structures in place, we continue to see growth and improvement in patient satisfaction and outcomes. LPN PCA Tech CA Physician Case Manager Quality Analyst Social Worker Chaplain Admin Interdisciplinary Team: EN T PATIENT E M UA TE IM Interdisciplinary Care Plan Coordination Integrate & Coordinate Interdisciplinary Activities Manage Length of Stay and Utilization PL Outcome: Evidence-Based Practice Care Resulting in Best Outcomes. DEACONESS FIRST Fantastic People Increasing quality Resulting in growth Superior service CNO/Leadership Professional Development Accountability Community Service Nursing Shared Governance/Unit Based Council EBP / Research Shared Decision Making Autonomy Best Patient Outcomes Code of Ethics RN Retention Innovation Patient Satisfaction T Vision/Values Deaconess Nursing Professional Practice Model aligns with the Magnet Model. Our model is patient-focused, evidence-based and utilizes the expertise of the interdisciplinary team; all are components of professional practice. It also demonstrates the support the organization gives us to achieve excellence in nursing. Our Professional Practice Model (PPM) • Integration of a patient-focused care delivery system delineates nurses’ authority and accountability for clinical decision-making and outcomes. • Demonstrates a collegial and collaborative relationship between nursing and the interdisciplinary team. • Reflects the Nursing Process and the Nurse Practice Act, which is foundational to clinical decision-making. • Displays the infrastructure of support provided by organizational and nursing leadership. • Reflects the professional values that Deaconess nurses hold regarding their practice: evidence-based patient care, working relationships, work environment, professional development, and recognition of the contributions they provide at the bedside. • Demonstrates the embracement and application of the Code of Ethics for Nurses as nursing practice and interdisciplinary care is enveloped in a caring and healing environment. 2011 Nursing Annual Report | 5 Magnet Model Leadership Chart Pharmacy PT, OT, ST Resp. Therapy Dietician Lab/Rad Structural Empowerment RN Exemplary Professional Practice Evid enc e-B a New Knowledge, Innovations & Improvements DIAGNOSE P ASSE SS Inte rdi sci pl m Tea tice rac dP se LAN y ar in Care Delivery From Your Family To Ours Patient Need ealing Environment nd H ga rin Ca PATIENT-FOCUSED CARE DELIVERY AL EV ng and Healing Env iron Cari me nt ealing Enviro and H nme g n i r nt Ca Transformational Leadership Professional Practice Model Professional Practice Model PROFESSIONAL PRACTICE MODEL OF NURSING Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Structural Empowerment Exemplary Professional Practice New Knowledge, Innovations & Improvements From Your Family To Ours Transformational Leadership Focuses on leaders within the organization and their actions to influence change, values, behaviors, vision and beliefs. To achieve this goal, leaders must be strong communicators and good listeners while supporting future practices. 6 | Deaconess Health System • Reimbursement for nursing degrees exceeded $196,000 during 2011. Continuing Education Opportunities for Deaconess Nurses Deaconess provided continuing nursing education, with 74 activities, classes and seminars offered throughout 2011. • Deaconess nurses earned up to 372.2 contact hours. • 2,097 attendees took advantage of the programs that were offered at Deaconess last year. • 1,378 of these were nurses from Deaconess and the Tri-State area. Deaconess Nurses in Professional Organizations As of September 25, 2011, according to the professional development survey, there were 270 nurses who hold membership in a professional organization. Deaconess is proud to have several nurses holding offices in local chapters of professional nursing organizations. Deaconess Leadership Training from Novice to Expert Deaconess nurses are supported every day in the growth and development of professional nursing at all levels. Many nurses, from staff nurses to nursing leaders, attend leadership training with Deaconess’ support, including: • VHA Nursing Leadership Institute and IHA Management Institute Leadership training • Southwest IONE Annual Leadership Conference • Strategic Planning Day • Lean Six Sigma Training • Deaconess Leadership Annual Conference Certified Nurses at Deaconess Magnet Model From Your Family To Ours According to the Professional Development Survey taken by nurses in fall 2011, 349 nurses currently hold specialty certifications in the health system. Many more are actively pursuing certifications. This number has continued to grow throughout the years thanks to the encouragement and assistance provided by Deaconess. Professional Practice Model According to our current nursing professional development survey, BSN-prepared nurses have increased to 437, and MSN-prepared nurses to 54 and 1 DNP. There are 167 nurses pursuing BSN degrees and 98 pursuing MSN degrees. Seventy-five percent of our leadership team has a BSN or higher, with the other 25% to complete their BSN or higher in 2012. Transformational Leadership • In 2011 Deaconess paid more than $41,000 for first-time voluntary nursing certifications. Leadership Chart Deaconess Nurses Achieving Advanced Degrees We are proud of our Deaconess nurses and all their levels of education and achievement! Deaconess nurses continue to seek out opportunities to further their education and advance their degrees. Structural Empowerment eaconess recognizes the important relationship between education and improved patient outcomes. The organization supports nurses’ pursuit of continuing education through seminars, advanced degrees, classes, certifications and professional organizations. Exemplary Professional Practice D New Knowledge, Innovations & Improvements Professional Development Highlights for 2011 2011 Nursing Annual Report | 7 Cheron Magnet Model MSN, RN Patient C Vice Pres Kathy Clodfelter MSN, RN, CHS, NE-BC Critical Care & Trauma Services Director, Magnet Program Director BSN, RN, MBA, NE-BC Patient Care Services Director (DGH) Darla Bush April Winkleman Michelle Decorrevant RN Cardiovascular ICU Manager (DH) RN Medical Surgical ICU Manager (DGH) Erin Smith Belle McCool Christa Wolf Structural Empowerment BSN, RN Adult Mental Health Unit Manager (DH) DNP, RN, NE-BC Peds Trauma, Trauma & Cardiovascular Surgical ICUs Manager (DH) BSN, RN, CNRN Neuro ICU & Neuro Science Manager (Gateway) Kristi Spencer Lanney Avis Debra Wilson BSN, RN Child/Adolescent Services Manager (Cross Pointe) BSN, MS, RN, NE-BC, CCRN Neuro Medical Surgical ICU & Neuro Care Center Manager (DH) MSN, RN, OCN Surgery Oncology Manager (DGH) Amanda Elikofer Sara Holzmeyer Transformational Leadership Jill Buttry MSN, RN Deaconess Cross Pointe Psych Mental Health Administrator Leadership Chart Professional Practice Model Cheryl Reitman RN Adult Services Manager (Cross Pointe) Exemplary Professional Practice BSN, RN Trauma Program Manager (DH) BSN, RN, CMSRN Orthopedics Manager (DGH) New Knowledge, Innovations & Improvements Karen Fox Staci Chambers BSN, RN, CCRN Cath Lab, CVSS & Non-Invasive Cardiology Manager (DH) BSN, RN, CMSRN General Medical Telemetry Manager (DGH) ADONs Paula Yarbrough From Your Family To Ours BSN, RN, CPN, NE-BC Pediatrics and PICU Manager (DGH) Call Center Nurses ADONs Radiology Nurses 8 | Deaconess Health System Chancellor Center na Hajewski MSN, RN-BC, NE-BC, CNRN Employee Education & Health Science Library Manager Lynn Lingafelter RN, BHS, MBA Emergency & Surgical Services Director Sara Goedde Ellen Wathen Marlene Waller BSN, RN Cardiovascular Care Center Manager (DH) PhD, RN Magnet Recognition Program, EBP & Nursing Research Program Coord. RN, CEN Emergency Services Manager (DH and DGH) Patty Laird Lois Welden Libby Ketchem MSN, RN, OCN, NE-BC Surgical Medical Care Center & Lift Team Manager (DH) MSN, RN Advanced Practice Nursing, Primary Stroke Center Coord., Lead CNS MS, RN, NE-BC Wound Care Center, PACU, SDCC & Pretesting Manager (DH and DGH) Erin Fuhrer Sally Finley MSN, RN, ONC, NE-BC Ortho Medical Care Center Manager (DH) RN Case Management Services Manager Laticia Gunderson Sonja Frisby Leigh Ann Gamble MSN, RN, NE-BC Home Care, Hospice & HME Manager Angela Stroud Vicki Jasper RN, CMSRN OP Chemo, Oncology/ Pulmonary & General Med-Surg Manager (DH) RN, CHPN Home Services Clinical Manager Diana McDaniel MSN, RN, CASC Pain Management Manager (DGH and West-Side Clinic) New Knowledge, Innovations & Improvements BSN, RN, NE-BC Dialysis & Cardiac Renal Care Center Manager (DH) RN, BSN, CNOR Surgery Deparmtnet Manager (DH and DGH) Transformational Leadership Linda Cason Leadership Chart MSN, RN, NE-BC Med-Surg & Specialty Services Director Structural Empowerment Kay Vaught Exemplary Professional Practice Care Services sident, CNO Professional Practice Model Magnet Model N, NEA-BC Jennifer Kirby From Your Family To Ours RN, CMSRN IV Therapy, WOCNs and Resource Team Manager (DH) 2011 Nursing Annual Report | 9 Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Structural Empowerment Exemplary Professional Practice New Knowledge, Innovations & Improvements Structural Empowerment From Your Family To Ours Structural empowerment means the involvement of nurses at every level, making the best decisions with the most optimal outcome—from the bedside to the CNO. Nurses are valued at Deaconess, and we recognize them for their achievements, both within the system and community-wide. 10 | Deaconess Health System Claire Bennett, BSN, RN Gateway Surgery Oncology Staff Nurse, Magnet Specialist Sara Holzmeyer, BSN, RN, CMSRN Manager of Gateway Ortho Jill Buttry, MSN, RN, CNS Critical Care and Trauma Director, Magnet Director Genny Kamer, BSN, RN, CCRN CVSICU Staff Nurse, Magnet Specialist Karen Fox, BSN, RN, CCRN Manager of CVSS/Cath Lab Andrea Klotz, BSN, RN Med/Surg 5200 Staff Nurse, Education/PDP Council Chair for 2012 Melody Littrell Education Specialist, Writing Team Marian Schneider, RN CVSICU Staff Nurse, Image of Nursing Council Chair for 2012 Michelle Stoll, MSN, RN Clinical Educator at Gateway Ellen Wathen, PhD, RN-BC EE&D, Magnet Document Writer • Honoring the Past; Creating the Future • Baltimore, Maryland — October 2011 • There are currently 393 international Magnet facilities across the globe • There are currently 12 facilities in Indiana, with the first one designated in 2003. • This is just the tip of the iceberg of what is available at a Magnet conference. Shared governance chairs, liaisons, leadership and staff nurses brought home many ideas, so find them and ask questions! Feedback “After returning from the Magnet conference, I realized that this journey is one that uses all our strengths as an organization collectively to meet the challenge of staying on the path that’s going in the right direction.” Michelle Stoll, MSN, RN— Clinical Educator at Deaconess Gateway “I learned we are well on our way to achieving Magnet. We need to recognize each other and the great things we do every day!” Claire Bennett, BSN, RN— Surgery Oncology Gateway “Improving work environments and decreasing patient load by one patient decreases mortality rates. Decreasing the patient load in an unhealthy work environment shows no change in mortality rates.” Sara Holzmeyer, BSN, RN, CMSRN— Manager, DGH Ortho “I really took away the big picture that nursing isn’t just my perception of my patients on my unit. The profession and passion that drives it is so much bigger than that. Every day there are so many nurses just like my Deaconess colleagues and myself who are doing our best to care for others and improve the way we do so to better serve everyone.” Andrea Klotz, BSN, RN—Med/Surg 5200 After hearing a session on resiliency training for stress reduction, I saw that educational intervention increased patient satisfaction and teamwork, resulting in a huge impact on their organization and promoting excellence in care, leadership, integrity, respect, collegiality and a healthy work environment. Marian Schneider, RN, CVSICU 2011 Nursing Annual Report | 11 New Knowledge, Innovations & Improvements • Nurses traveled from as far as the Netherlands, China, Finland and New Zealand, with Australia being the farthest away! Exemplary Professional Practice Structural Empowerment • More than 7,500 national and international nurses in attendance • Attended sessions on Falls, HAPU, Restraint and Sitter Usage, Care Delivery Models (such as Jean Watson’s Theory of Caring), Healthy Work Environment and documentation writing/submission workshops. Magnet Model Leadership Chart Highlights From Your Family To Ours Cherona Hajewski, MSN, RN, NEA-BC Chief Nursing Officer Betty Nelson, BSN, RN, BC Heart Hospital Staff Nurse, Quality and Safety Council Chair for 2012 Professional Practice Model Attendees Transformational Leadership Magnet Conference | 2012 Magnet Model The Journey from Novice to Expert Professional Practice Model W Transformational Leadership e are excited to join with these nurses as we pave the way for them from Novice to Expert. Katie Burnett in Human Resources has done an excellent job assisting our managers in finding new graduates to add to our excellent nursing staff. These nurses will begin their journey as new nurses in our organization. Leadership Chart Structural Empowerment University of Southern Indiana Vincennes University • • • • • • • • • • IVY Tech Community College • • • • • • • Exemplary Professional Practice • • • • • • • • • • • New Knowledge, Innovations & Improvements • • • • • • • Lindsey Adcock, BSN—DGH Neuro ICU Lindsey Cobb, BSN—DGH Neuro ICU Theresa Adler Richardson, BSN—Surgery Ashley Aufman, BSN—DGH Pediatrics Erica Berning, BSN—DGH Neuroscience Abby Buck, BSN—DGH Ortho Samantha Chambers, BSN—DH Trauma/ CVSICU/Peds Trauma Melinda Clark, BSN—Wound Care Clinic Chantal Dash, BSN—DH Emergency Michelle Ferguson, BSN—DGH Ortho Kristin Fischer, BSN—Resource Team Ashly Guth, BSN—DGH Surgery Oncology Alysha Hall, BSN—DH CRCC Laura Hall, BSN—DH SMCC Jessica Harper, BSN—The Heart Hospital Amber Lang, BSN—DGH Surgery Oncology Avery Lebowitz, BSN—DH Trauma/CVSICU/ Peds Trauma JaeWon Lee, BSN—DH CVCC Katie Lindsey, BSN—DH Emergency Elizabeth Kramer, BSN—DH SMCC Stuart Love, BSN—The Heart Hospital Samantha White, BSN—DH OPCC Lissa Wilkey, BSN— DH OPCC Amanda Wilson, BSN—DH SMCC Courtney Woods, BSN—DGH Ortho Allison Vick, BSN—DGH Surgery Oncology Brandy Waninger, BSN— DGH General Med/Tele Dawn Rogers, BSN—DH Trauma/ CVSICU/Peds Trauma Lauren Meneghetti, BSN—DGH Surgery Oncology Kayle Neurenburn, BSN—DH NCC Andrea Schnur BSN—DH CVCC Brett Schipley, BSN—DH CVICU Peter Sieg, BSN—DH CVCC Katelyn Russell, BSN—DGH MSICU Shawna Haywood, BSN—DH OPCC University Of Evansville From Your Family To Ours • Ashtin Collins, BSN—DH/DGH Surgery • Courtney Dauby, BSN—DH Trauma/ CVSICU/Peds Trauma • Jordan Dawson, BSN—DH NMSICU • Brianne Denning, BSN—DH CVCC • Ann Dodge, BSN—DGH Neuroscience • Olivia Edens, BSN—DGH Ortho • Amanda Malone, BSN—DH NMSICU • Morgan Roos, BSN—DH CRCC • Bryanne Hartman, ASN—DGH Emergency • Casey Dittmer, ASN— DGH General Med/Tele • Nicole Fischer, ASN—DGH MSICU • Heather Keller, ASN—DH CRCC • Anna Villian, ASN—DH OMCC • Elizabeth Walker, ASN—DH NCC • Jamie Long, ASN—DGH General Med/Tele • Amber Becker, ASN—DH OMCC • Donna Datkamp, ASN—DH Med/Surg 5200 • Crystal Smith, ASN—DH OMCC • Amber Townsend, ASN—DH Med/Surg 5200 • Jodi Sullenger, ASN—DH SMCC • Tiffany Summers, ASN— DGH General Med/Tele • April Schaefer, ASN—DH CVCC • Jamie Webb, ASN— DGH General Med/Tele • Jessica McCord, ASN—DH CVCC • Mindy Lutz, ASN—DH OPCC • Ellen Kramer, ASN— DGH General Med/Tele • Krista Hollingsworth, ASN—DGH Ortho • Terra Delano, ASN—DH OMCC Henderson Community College • Sarah Brown, ASN—DH NMSICU • Paige Perry, ASN—DH SMCC Wabash Valley Community College • • • • • Kathryn Adams, ASN—DH CRCC Dennis (Chad) Griffin, ASN—DH CVICU Stacey Rafferty, ASN—The Heart Hospital Taelor Johnson, ASN—DH OMCC Kathryn Adams, ASN—DH CRCC Hope College • Janette Zandstra, BSN—DH Trauma/ CVSICU/Peds Trauma IECC • Jessica Clodfelter, ASN—DH OPCC Frontier Community College • Lori Esmon, ASN—DH Med/Surg 5200 University of Indiana • Maegan Reeves, BSN—DGH MSICU Maryville University • Amanda Schmeltz, BSN—DH Trauma/ CVSICU/Peds Trauma Murray State University • Brittany Clemmons, BSN— DGH General Med/Tele 12 | Deaconess Health System • Katherine Faver—USI • Jennifer Schwartz —USI Adjunct Faculty Deaconess nurses have the honor to participate as adjunct faculty at many of our Tri-State nursing programs to provide expert education to our many upcoming bright stars of nursing. Magnet Model Exemplary Professional Practice University of Southern Indiana • Cherona Hajewski, MSN, RN, NEA-BC • Edith Hoehn, BSN, RN, CVRN • Diana Everley, BSN, RN-BC, CNRN • Linda Ogle, BSN, RN, CCRN • Debra Norman, RN, BS, MHA • Tonya Krieg, BSN, RN, OCN, CMSRN • Erin Georges, BSN, RN, CCRN • Paula West, MSN, RN, CNS • Teresa Price, BSN, RN, CNRN New Knowledge, Innovations & Improvements IVY Tech Community College • Cynthia Hodge, MSN, RN, OCN • Leslie Kirkwood, MSN, RN, CCRN Henderson Community College • Jill Rector, RN • Janet Ziegler BSN, RN, CMSRN From Your Family To Ours University of Evansville • Linda Cason, MSN, RN-BC, NE-BC, CNRN • Ellen Wathen, PhD, RN-BC • Jean Hunt, MSN, CVRN, RN-BC • Jane Rauscher, MSN, RN, CPNP • Denise McDowell, MSN, RN, CPNP • Joan Fedor-Bassemier, MSN, RN • Cynthia Schaefer, MSN, RN • Jerrilee Lamar, PhD, RN, CNE • Diana McDaniel, MSN, RN Professional Practice Model • Sarah McQuay—IVY Tech Transformational Leadership • Cassie Eckerle—USI Leadership Chart Deaconess Hospital would like to congratulate the winners of the Nursing Scholarship Awards. Each scholarship is valued at $7,000. These scholarships go to local nursing students throughout the Tri-State. If the nursing student accepts the scholarship, he or she commits to working two years at Deaconess as a nurse after graduation. Structural Empowerment Scholarship Winners for May 2011 2011 Nursing Annual Report | 13 Magnet Model Professional Practice Model Community Service Programs & Contributions O ur community says thank you to Deaconess nurses for all the community programs you have participated in. Transformational Leadership • Deaconess Day of Caring at Eastland Mall • National Night Out • Multiple stroke screenings throughout the community • EVSC blood pressure screenings • Day of Dance • Doctor’s Day • Allure: An Evening for Women Leadership Chart • Memorial Baptist Church health fair • Employer health fairs at Toyota, Mead Johnson and Vectren • Buehler’s/IGA blood glucose screenings • Race for the Cure • Frog Follies • Vanderburgh County 4-H Fair • West Side Nut Club Fall Festival • Go Red for Women’s Health at several community events • Community 1st Health Fair Structural Empowerment Deaconess nurses logged more than 150 volunteer hours for Deaconess Community Advocate Nurses (CAN). The Resource Center with Becca Scott created many new opportunities last year for Deaconess nurses at any level to participate in. Exemplary Professional Practice New Knowledge, Innovations & Improvements From Your Family To Ours 14 | Deaconess Health System 100% 80% Attendance 40% Pass R ate 20% 0% 2010 Magnet Model Professional Practice Model Structural Empowerment 60% 2011 Year Critical Care Challenge A few of the nurses from the 2010 CCRN drive participated in the AACN Critical Care Challenge with Tri-State schools of nursing and hospitals and won the trophy for 2011. • Jason May, BSN, RN, CCRN— DH Trauma ICU • Josh Johnson, BSN, RN, CCRN— DGH Neuro ICU • Linda Ogle, BSN, RN, CCRN— DH Cardiovascular Surgical ICU • Travis Wilcox, RN, CCRN— DH Cardiovascular ICU • Craig Mims, RN, CCRN— The Heart Hospital • Christin Wallace, BSN, RN, CCRN— DH Neuro/MedSurg ICU • Tami Weisshaupt, RN, CCRN (Alternate)—The Heart Hospital “I was proud to represent Deaconess. The team members were only a sample of what the ICUs at Deaconess Hospital and Deaconess Gateway Hospital have to offer! Bringing home the trophy this year brought a sense of pride and respect across all the critical care areas. Being a critical care nurse is a humbling experience, knowing that many decisions you make can greatly affect a patient.” — Josh Johnson, BSN, RN, CCRN 2011 Nursing Annual Report | 15 Exemplary Professional Practice Percentage CCRN Drive Results Transformational Leadership The second group had an 89% pass rate, and the evaluations regarding the changes were all positive. We are awaiting approval for our 2012 proposal for a repeat “Exam Cram” review course with Deborah Tuggle and two additional review sessions in which applicants practice test questions as a group. New Knowledge, Innovations & Improvements The evaluations were reviewed by CCRN drive committee members, who decided that we should change our strategy based on feedback from the nurses. The second group started their session in February 2011 and had 23 RNs who participated. We offered 16 hours of review sessions that were taught by CCRN- or MSN-prepared instructors who hosted a two-day “Exam Cram” by national speaker Deborah Tuggle, MSN, RN, CCNS, an instructor from Louisville, Kentucky. From Your Family To Ours In May 2010 we started our first CCRN drive for critical care. There were 19 RNs who participated. Each participant attended four eight-hour review sessions for a total of 32 hours of review time. The review sessions were taught by Deaconess educators and staff members. The CCRN pass rate for that group was 50%. Leadership Chart Critical Care Certification Drive Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Image of Nursing Council Structural Empowerment Cherona Hajewski, MSN, RN, NEA-BC Chief Nursing Officer Exemplary Professional Practice Kathy Clodfelter, BSN, RN, NE-BC, MBA Director of Patient Care Services—DGH Jill Buttry, MSN, RN, CNS Magnet, Critical Care, Trauma Director Diane Wallace, RN SDSS/PAT—DH Vicki Martin Berntson, BSN, RN, CMSRN SMCC—DH Margaret Anderson, RN Med/Surg Neur ICU—DH Kim Mastison, RN, CMSRN Neuro—DGH Melinda Byers, RN CRCC—DH Jackie Spears, RN SDSS/PAT/PACU—DGH Sarah Joyce, BSN, RN OMCC—DH Jamie Browning, RN Ortho—DGH Leah Bucherl, RN CVSS—DH Valerie Wills, BSN, RN Pediatrics and PICU—DGH Cindi Lemen, RN, CCM Case Management Brian Miller, RN Cath Lab—DH Edna Fletcher, RN, RN-BC Cross Pointe Adult Teresa Whitledge, RN, CNOR Surgery Department— DGH/DH Rachel Wire, RN Emergency Department New Knowledge, Innovations & Improvements Melissa Jassim, BSN, RN CVCC—DH Russell Kirby, RN, CEN Emergency Department—DH Rachel Roy, BSN, RN CVICU—DH Jean Hunt, MSN, CVRN, RN-BC Employee Education & Development Charla Buttram, RN IV Therapy—DH Ashley Robb, RN Neuro Care Center—DH Carolyn Putnam, RN, CMSRN SMCC—DH Peggy Huey, RN Adult Mental Health Unit—DH From Your Family To Ours 16 | Deaconess Health System Lisa Williams, RN Procedure Center April McBride, RN Home Care/Hospice Katie Burnett Human Resources Nurse Recruiter Michelle Almon, BSN, RN Endoscopy—DH/DGH Ellen Wathen, PhD, RN-BC Nursing Excellence Nancy Aud, RN, CMSRN General Med-Tele—DH Renee Bower, RN Med/Surg 5200—DH Claire Bennett, BSN, RN Magnet Specialist/Surgery Oncology Kara Donnetta, RN Endoscopy—DH/DGH Promote the professional image and practice of nursing at Deaconess Health System • Promoted certifications • Deaconess Health System offered to pay for all initial certification exam fees prior to exam • Presented AIDET communication information, which has been implemented across Deaconess Health System nursing units • Supported “Zero Tolerance” policy, protecting employees from abusive work-related behaviors • Council chair participated on the physician loyalty team to help improve communication with medical staff National Nurses’ Day 2011 Image of Nursing Council members participated on the Nurses’ Day/Nurse of the Year subcommittee and helped plan Nurses’ Day and the Nurse of Year Ceremony for 2011. These were two very successful events this year. • The lobbies of both Deaconess Hospital and Deaconess Gateway Hospital were decorated with unit posters displaying RN pictures and artwork created by hospital employees’ children. • For National Nurse’s Day, Deaconess Foundation funded the nationally renowned speaker Liz Jazweic, RN, for two inspirational presentations that were “live-fed” to the Gateway campus concurrently. • WIKY radio station interviewed Cherona Hajewski, MSN, RN, NEA-BC, VP Patient Care Services and CNO, regarding efforts at Deaconess to convey their appreciation of excellent care given by each Deaconess nurse. • Johnson Hall became an elegant destination for nurses to mingle with colleagues. The wonderful food and decorations planned by the subcommittee and Deaconess Catering Services impressed everyone in attendance. Music added ambience, and the continuous slide show of Deaconess nurses captivated the audience. All Deaconess nurses had their names placed in a drawing for chances to win prizes, and each Deaconess nurse received a complimentary cup inscribed: “Excellent Care, Excellent Nurses. Thank you for being a DH nurse.” This was an inaugural event, and word quickly spread that this was the event to attend. 2011 Nursing Annual Report | 17 Magnet Model Professional Practice Model Transformational Leadership Medical information was well received, and nurses who participated gained personal satisfaction at this much-needed community event. Improve nurse-to-physician communication and collegiality • Provided communication exercises for council members Leadership Chart • Distributed disease-specific pamphlets according to test results Structural Empowerment • Provided resources for follow-up • Promoted advancement of formal education beyond the diploma/associate degree nurse (ADN) level by encouraging tuition reimbursement programs and the privilege to self-schedule work hours, enabling nurses to return to the classroom Exemplary Professional Practice Participate in the Community First Day at C.K. Newsome Center • Counseled 125 participants about their abnormal test results New Knowledge, Innovations & Improvements The Image Council worked with Deaconess Resource Center to promote the positive perception of nursing throughout the Tri-State by establishing a Deaconess Day of Caring in April 2011. Many nurses provided stroke education, nutrition and exercise information, and alcohol and depression screenings. From Your Family To Ours Promoting Nursing Magnet Model 2011 Nurses of the Year Professional Practice Model Advancement of the Profession Award Betty Nelson, BSN, BC-RN — The Heart Hospital Transformational Leadership Betty encourages, motivates and inspires co-workers, assisting in their professional development. She is instrumental in encouraging active participation from co-workers in the improvement of quality on her unit enlisting co-workers to engage in making needed change. Her attitude is contagiously positive, and her compassion is sincere. Community Service Award Cathy Wagner, BSN, RN — Deaconess Home Health Leadership Chart Cathy is a liaison for referrals and marketing in the region, an online USI instructor in tele-health monitoring, a community CPR instructor, and a volunteer at local health fairs and blood pressure clinics at assisted-living facilities. Excellence in Clinical Practice Award Kim Brace, RN, CMSRN — Surgical Medical Care Center Structural Empowerment Kim is an expert nurse in the care of surgical and trauma patients. She has excellent critical thinking skills and is able to see the whole patient from vital signs, lab results and her head-to-toe assessments. She is thorough and efficient in her care but also demonstrates compassion toward her patients and their families. Leadership Award Exemplary Professional Practice Michael Aders, RN — CVSICU Michael encourages staff to participate, updates us on plans, asks for feedback, relays information to the team, and explains rationale for decisions. As two units merge and learn new skill sets, surroundings and co-workers, Michael is paving the way for positive change. He is a beacon of professionalism, courtesy and respect. Mentorship Award Jennifer Ramsey, BSN, RN, CCRN — CVSICU New Knowledge, Innovations & Improvements Jennifer is an amazing source of knowledge and skill in the field of critical care. She is tireless in her efforts to drive for clinical excellence. She can always be counted on to teach others the proper methods of patient care. Florence Nightingale InPatient Award Tonya Kreig, BSN, RN, OCN — Surgical Oncology Gateway Tonya exemplifies the Deaconess credo by volunteering her time promoting cancer awareness and education. She consistently encourages and inspires those around her. She is very caring, compassionate and sympathetic, taking the best possible care of her patients and their families. From Your Family To Ours Florence Nightingale OutPatient Award Laura Benkert, BSN, RN — Procedure Center Deaconess Clinic Laura is a bright example of the type of nurse and individual we all hope to work with and to have care for our loved ones during difficult times, which can occur while receiving health care. When Laura finishes with a patient, they know that a nurse who truly loves her job cared for them. 18 | Deaconess Health System Anne Ainsworth Joseph Fields Noni Roberts C. Danielle Alderson Shirley Gubler Dawn Rowley Janie Arington Tammy Hildebrandt Kirby Russell Nancy Ash Elizabeth Ivy Mary Beth Schitter Graceanna Austin Sarah Joyce Michelle Sharp Teri Bassett Denise Kohut Kymber Baumholzer Gigi Kozinski Heather Stonecipher-Short Patricia Bender Tonya Krieg Laura Benkert Melanie Mahone Kathy Beyer Ashley Mellott Jill Boles Tara M. Moore Kim Brace Sallie Moseley Kristina Brown Sara Mossberger Shawn Brown Betty Nelson Kathy Clevidence Vena Owen Angie Cox Kari Pawlak Rebecca Deig Whitney Porter Jill DeShields Carolyn Putnam Shauna Dilger Jennifer R. Ramsey Amber Dillon Jill Rector Michael Clint Sheffer Mindy Shoulders Libby Sisk Chris Smith Sarah E. Smith Amy Stott Kelsie Tarter Cindy Ulrich Cathy Wagner Christin Wallace Rachael Waninger April Winkleman Magnet Model From Your Family To Ours New Knowledge, Innovations & Improvements Janet Ziegler Professional Practice Model Gail Riedford Transformational Leadership Briana Elpers Leadership Chart Michael Aders Structural Empowerment Sixty nominations were received for Nurse of the Year awards. We would like to congratulate and say thank you to the following nurses for all their hard work and dedication to Deaconess, our patients and their fellow staff. Exemplary Professional Practice Nurse of the Year Nominees 2011 Nursing Annual Report | 19 Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Nursing Practice Council Structural Empowerment Cherona Hajewski, MSN, RN, NEA-BC Chief Nursing Officer Exemplary Professional Practice Jill Buttry, MSN, RN, CNS Magnet Program, Critical Care, and Trauma Program Director Karen Jochim, RN, CCRN CVSICU/Trauma/Peds Trauma Rachel Roy, BSN, RN, CCRN CVICU (2900) Jennifer Palmer, BSN, RN, CMSRN EE &D Nancy Lutz, RN, SMCC—DH Kim Mastison, RN, Ortho—DH New Knowledge, Innovations & Improvements Melissa Dotson, BSN, RN Neuro/MSICU (3900) Jan Woehler, RN—CRCC Outgoing Meghan Smith, RN—CRCC New Rep Peggy Huey, RN—Adult Mental Health Carol Scarafia, RN, CMSRN—OMCC Barbara Wade, RN, OCN, CHPN OPCC (5100)—DH Camella Mack, RN Med/Surg (5200) Outgoing—DH Heather Powell, RN, CMSRN Med/Surg (5200) Outgoing—DH From Your Family To Ours Renee Bowyer, RN—Med/Surg (5200)—DH Peggy Hutchinson, RN—ADON—DH Leah Cox, RN—Case Management Lois Weldon, MSN, RN, CNS Clinical Nurse Specialist Teresa Whitledge, RN, CNOR Surgery Department—DH/DGH Edna Fletcher, RN—Cross Pointe 20 | Deaconess Health System Nikki Nixon, RN—CVCC—DH Jennifer Reeves, RN CVCC—DH Linda Broerman, MSN, RN Pain Management Brenda Jost, RN—Procedure Center Haley Lemkuhler, RN CVCC Outgoing—DH Tonya Vaupel, MSN, RN Quality Innovation and Improvement Amy Brown, RN, RCIS, Cath Lab—DH Reagan Robbins, RN Radiology—DH/DGH Janet Thompson, RN—CVSS—DH Karen Fleck, RN, CDE Diabetes Educator Dande Osborne, BSN, RN, CEN Emergency Department Debbie Austill, BSN, RN Endoscopy—DH/DGH Brittany Clemons, BSN, RN General Med/Tele—DGH Kelly Memmer, RN—MSICU—DGH Josh Johnson, BSN, RN, CCRN Neuro ICU—DGH Jacqueline Spears, MSN, RN PACU—DGH Emily Low, RN, CPN Pediatrics and PICU—DGH Aaron Stoll, BSN, RN, CHPN Surgery Oncology—DGH Beverly Johnson, RN Home Care Services Paula Payne, BSN, RN—IV Therapy—DH Genevieve Kamer, BSN, RN, CCRN Magnet Specialist Claire Bennett, BSN, RN Magnet Specialist Tara Moore, BSN, RN, CPAN PACU—DH Linsdey Morris, RN, CLN, CPHRM Safety and Risk Management Patty Leggett, BSN, RN, CMSRN, CCRN SSDS/Pre-Testing—DH Paula Snodgrass, RN, CWOCN, CMSRN Wound Care Services Amanda Elikofer, BSN, RN Manager Trauma Services Candice Alderson, RN DGH Surgery Oncology Michelle Stoll, MSN, RN DGH Clinical Educator Vicki Rausch, BSN, RN CMSRN Team Leader, Neuroscience Unit—DGH Cathy Basham, RN Neuroscience Unit—DGH Valerie Wills, BSN, RN—Pediatrics & PICU—DGH Ellen Wathen, RN-BC, PhD. EE& D, Nursing Excellence, Document Writer Mellodee Montgomery, MT, MA, RN, CIC Infection Control Aprile Sandefur, RN—Infection Control Packy Fairless, RN, MSN— Internal Audit Michelle Schymik, PharmD—Pharmacy Outcome goals are to reduce complications with both peripheral and central line access through monitoring and performance standards. The achievements of this group include global education, improvement in communication across campuses, improvement In August 2011 the Heart/Gateway IV Therapy Team was formed to support the need for additional IV services at the Gateway campus. A preliminary pilot study on phlebitis was completed at the Gateway campus to measure IV therapy performance and has provided baseline data for a future project to evaluate the primary causes of phlebitis defined in our care practices. This information will provide a framework to improve IV practices globally. Deaconess Gateway Hospital Phlebitis Study Initial 60% 40% September 20% November October Oncology Departments Med Tele Ortho Neuro Neuro ICU Med ICU 0.00 Reforming of Standards of Documentation Team • Their focus: Top five EPIC flowsheets that are most commonly used. • A laminated, color-coded tool was developed. • These were reviewed and standards developed by staff nurses, management and education department nurses. • Posters of Standards of Documentation at Skills Day for all RNs and PCAs. 2011 Nursing Annual Report | 21 Magnet Model New Knowledge, Innovations & Improvements August From Your Family To Ours Percentage 80% Professional Practice Model in care and maintenance of central lines, and improvement of IV standards for documentation in EPIC. A monthly review and update of policies were implemented November 2011 to sustain quality and to align with the current standards. The future educational goal is a standardized process to disseminate those updates and standards into the culture of caring at Deaconess Hospital through the Shared Governance of Nursing Practice Council. Transformational Leadership The Intravenous Quality Collaborative (IVQC) is an interdisciplinary team with a mission to improve the quality of intravenous (IV) therapy via assessment of educational needs, collaboration across campuses and disciplines, provision of adequate IV therapy resources, and coordination of IV therapy services. The purpose of the IVQC is to improve patient outcomes by decreasing complications through early vascular access assessment, appropriate IV device placement, vein preservation and staff nurse education. The Centers for Disease Control and Infusion Nurse Standards of Practice guide Deaconess IV practices and the role of the IVQC team. Leadership Chart IV Quality Collaborative Team Development Structural Empowerment The Practice Council promotes continuous improvement in the quality and delivery of patient care through supported evidence-based practice by actively identifying and incorporating evidence-based research into all nursing polices. Exemplary Professional Practice Promoting Quality Professional Practice Model • Policies now reviewed for changes in practice by groups at the direct care level: Pediatrics Core Team, ICU Core Team, Oncology, IV Collaboration Team and delegated to members of Practice. Transformational Leadership • Any changes to practice reflected in new skills or updated skills from Mosby’s are reviewed and discussed. • Some policies are not accepted into practice because our Deaconess practice is more stringent or specific than the practice that is described in Mosby’s—upholding our Deaconess standards. Leadership Chart mOSBY’S uSAGE rEPORT Structural Empowerment # of Generic Logins Magnet Model Mosby’s Review of Nursing Skills Defined 1600 1400 1200 1000 800 600 400 200 0 1/11 2/11 3/11 4/11 5/11 6/11 7/11 8/11 9/11 10/11 Exemplary Professional Practice Top Five mOSBY’S Skills Visited (January–December 2011) New Knowledge, Innovations & Improvements 591 639 Medication administration of ivp and iv drips at Deaconess Dyspnea: Positioning the patient (pediatric) 234 From Your Family To Ours Blood products: administering 201 950 Ring removal Postmortem care 22 | Deaconess Health System Clamping of Foley after 1000cc output evidencebased? Carol Scarafia, RN, CMSRN, and Patsy Fraisier, RN, OCN, CHPN, CMSRN–OMCC No evidence to support this practice after collaboration with physicians and literature review. Updated in Mosby’s, and Practice Change Flyers sent out to units. Life Vest (Wearable Cardioverter Defibrillator) Lynn Schnautz, MSN, RN,CCRN,CCNS,NP-C – The Heart Hospital Presentation of information to ask that guidelines for usage be inserted into Mosby’s. Motion accepted to accept to add into Mosby’s skills; Practice Change Flyer sent to all units. Patient Safety: IV fluids are to be on pump for pre-procedure Rachel Greene, MSN, RN OR presentation regarding Holding Area with IVs infusing only by IV pump. Motion made and accepted to add into Mosby skills; Practice Change Flyer sent to all units. No current P&P for extravasation other than chemo or vasopressors. Lana Roth, RN–IV Therapy Researched and presented additions to the extravasation skill in Mosby’s. Motion made and accepted to add Mosby skill, information to UBC, and Web inservice to educate staff. Procedure for replacement or reinsertion of catheter with patients with healed suprapubic catheter. Patsy Frasier, RN, OCN, CMSRN–OMCC Problem researched and brought by OMCC to Practice Council for insertion into Mosby’s. Motion made and accepted to add into Mosby’s skills. Information sent to UBC, and Practice Council Flyers sent to all units. IV access guidelines for chronic renal patient with fistulas. In collaboration with nephrologists: New guidelines for preservation of patient veins that are at risk for hemodialysis. Motion made and accepted to add into Mosby’s skills; Practice Council Flyer sent to all nurse managers. New pain pumps to be used for joint replacement, general surgery, bariatric surgery or rib fractures. Amanda Eilkofer, BSN, RN– Manager, Trauma Services Presentation of information regarding pain pumps On-Q Bloc with SelectA-Flow and On-Q pain buster. Motion made and accepted to add into Mosby’s skills; Information to UBC and Practice Council Flyer sent to all managers. What is evidence-based practice for how blood cultures should be collected? Venipuncture is recommended method for obtaining blood cultures. Reviewed Mosby’s and lab protocol, blood cultures from central lines to be paired with venous sample. Arterial lines are not recommended. Motion made and accepted to add into Mosby’s, Information to taken to UBC, and Practice Change Flyers sent to all managers. Practice in current policy different than what is recommended in Micromedex around IV use of Versed. Josh Johnson, BSN, RN, CCRN–Neuro ICU DGH Presentation of researched problem and brought the issue of IV Versed usage and recommendations to be made. Discussed and accepted to change Versed from IVP to IM only on patients in medical surgical units. 2011 Nursing Annual Report | 23 Transformational Leadership Skill updated in Mosby’s and website linked regarding Heimlich valves. Leadership Chart Presentation of Heimlich valves: No information currently in Mosby’s. Structural Empowerment Heimlich Valves Sallie Mosely, BSN, RN The Heart Hospital Exemplary Professional Practice OUTCOME New Knowledge, Innovations & Improvements PROCESS From Your Family To Ours STRUCTURE Professional Practice Model Magnet Model Examples of nurses owning their practice Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Quality and Safety Council Chair: Chair Elect: Liaison: Structural Empowerment Clerical Support: Jill Buttry, MSN, RN, CNS Director for CC, Trauma, Magnet Program Exemplary Professional Practice Cherona Hajewski, MSN, RN, CNAA, NEA-BC Chief Nursing Officer Claire Bennett, BSN, RN Magnet Specialist/ Surgery Oncology—DGH April Watters, RN Radiology Sonja Marx, BSN, RN Endoscopy—DH/DGH New Knowledge, Innovations & Improvements Kelly Stead, RN Surgery Outgoing—DH/DGH Misty Adye, RN Surgery Outgoing—DH/DGH Teresa Whitledge, RN, CNOR Surgery Incoming—DH/DGH Jackie Badar, RN Cath Lab—DH Svetlana Squier, BSN, RN CVSICU/Trauma/Peds Trauma—DH Julia Ellington, RN, CMSRN PAT/SDCC—DGH Jackie Spears, RN PACU—DGH Lisa Rickey, BSN, RN CVCC—DH Lucinda Mathew, RN, CCRN CVICU—DH Nancy Robinson, RN IV Therapy—DH Nancy Ash, BSN, RN, CMSRN SMCC—DH Rachel Finch, RN General Med/Tele—DGH Aaron Stoll, BSN, RN, CHPN Surgery Oncology—DGH Sheila Ferrell, RN MSICU—DGH Cathy Merrick, RN-BC, CCRN Neuro/MSICU—DH April Donaldson, RN CRCC—DH Kim Liberman, RN, OCN, CHPN OPCC—DH Andrea Klotz, RN Med/Surg (5200)—DH Mary Ann Niemeier, RN, CM Home Services/Hospice Libby Payne, MSN, RN Employee Education Mellodee Montgomery, MT, RN, MA, CIC Infection Control Lindsey Morris, RN, CLN, CPHRM Risk Management Erin Fuhrer, BSN, RN, OCN, NE-BC Fall Team Member Jenny Cissell, BS, RN, CDE Diabetes Educator Lisa Hirsch, BSN, RN Procedure Center/Endoscopy From Your Family To Ours Peggy Huey, RN Adult Mental Health Unit—DH Amanda Blanton, BSN, RN, WOCN, CFCN Wound Care/Skin Team Edna Fletcher, RN-BC Cross Point Adult Incoming Ellen Wathen, PhD, RN-BC Nursing Excellence/EE&D Crystal Sensmeier, BSN, RN PACU—DH Randi Sylvester, ADN, RN Cross Point CHAD Lois Welden, MSN, RN Clinical Nurse Specialist Linda Neville, ADN, RN PAT/SDCC—DH Patsy Frasier, RN, ONC, CMSRN OMCC—DH Kim Burk, RN Restraint Team/Neuro ICU—DGH Juanita Little, ADN, RN Cardiovascular Short Stay—DH 24 | Deaconess Health System • Display made for the Patient Safety Fair in fall 2011. Better • Some units used Safety Huddle to address SCIP measures, especially Foley Days scip all-or-none bundle DH and DGH Magnet Model Professional Practice Model Education and understanding of SCIP measures • Reviewed SCIP measures monthly and • Educated staff members on SCIP discussed barriers/improvements. measures through PowerPoint and games for retention of knowledge. • Information shared across units regarding checklists to use by the • Invited quality improvement owner nurses for improving treatment and Lori Mercer to educate and identify documentation standards. problem areas. Transformational Leadership Promoting Safety Leadership Chart 100% 90% 80% 70% 60% 7/09 10/09 1/10 Goal 4/10 7/10 10/10 Mean 1/11 4/11 7/11 UCL LCL scip all-or-none bundle Better Exemplary Professional Practice Actual 4/09 The Heart Hospital 120% 100% 80% 60% 40% 20% 0% 10/08 1/09 Actual 4/09 7/09 10/09 1/10 Goal 4/10 7/10 10/10 Mean 1/11 UCL 4/11 7/11 LCL Improving skin assessment and documentation • What wounds need WOCN consults? • Identify who is at highest risk for skin breakdown. • What is a proper turn? 40 degrees is • Detailed education on documentation of skin on admission to hospital and after transfer to unit. • Require documentation on LDAs: size, blanchable vs nonblanchable, description of wound. evidence-based. • Report of skin breakdown from prevalence and incidence days along with MRN #’s for staff to take back to the unit to determine causes and breakdown in communication. 2011 Nursing Annual Report | 25 New Knowledge, Innovations & Improvements 10/08 1/09 From Your Family To Ours 40% Structural Empowerment 50% • Removal of old mattresses • Mepilex dressing implementation across all campuses • Skin Team members have developed many informational binders and posters to improve skin care education based on clinical area Exemplary Professional Practice Includes 2000, 2100, 2900, 3900 • They plan to continue to research further skin improvements and evaluate usage of current products Deaconess Gateway Hospital % of Surveyed Patients with Hospital-Acquired Pressure Ulcers All Adult Critical-Care Units 8.00 Percentage Structural Empowerment Deaconess Hospital % of Surveyed Patients with Hospital-Acquired Pressure Ulcers All Adult Critical-Care Units 10.00 • Monthly skin prevalence and incidence to screen every patient 6.00 4.00 2.00 0.00 Includes MSICU, Neuro ICU 14.00 12.00 10.00 8.00 6.00 4.00 2.00 0.00 3Q11 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 Hospital Adult Critical Care Median 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 Hospital Adult Critical Care Median 0.00 0.00 12.50 0.00 0.00 7.14 5.00 4.17 Mean 9.25 7.66 7.71 7.26 7.55 7.16 6.39 6.67 Mean 9.25 7.66 7.71 7.26 7.55 7.16 6.39 6.67 Deaconess Hospital % of Surveyed Patients with Hospital-Acquired Pressure Ulcers All Adult Med-Surg Units 3.50 New Knowledge, Innovations & Improvements Includes OMCC, SMCC, OPCC, NCCU, 5200 Deaconess Gateway Hospital % of Surveyed Patients with Hospital-Acquired Pressure Ulcers All Adult Med-Surg Units 3.00 2.50 Percentage Leadership Chart • Skin Team education of specific skin issues, including tears, yeast, pressure ulcers, fungating tumors, etc., along with treatment guidelines Percentage Transformational Leadership This year has been a year of growth in many ways for the Skin Care Team. They have not only seen growth in the team itself, but they have also been involved in major changes regarding skin/wound care at Deaconess. Percentage Professional Practice Model Team Leads: Paula Snodgrass, BSN, RN, WOCN; and Amanda Blanton, BSN, RN, WOCN, CFCN Liaison: Jennifer Kirby, RN—Manager, Resource Team, IV Therapy, Wound Care 2.00 1.50 1.00 0.50 0.00 Includes MCRU, Ortho, Neuro, SurgOnc 12.00 10.00 8.00 6.00 4.00 2.00 0.00 3Q11 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 Hospital Adult Step-Down Median 0.00 2.44 2.44 0.00 0.00 2.44 0.00 0.00 Hospital Adult Med-Surg Median 0.00 0.00 12.50 1.61 0.00 7.14 5.00 4.17 Mean 3.06 2.78 2.54 2.43 2.64 2.63 2.25 2.20 Mean 3.06 2.78 2.54 2.43 2.64 2.63 2.25 2.20 Deaconess Hospital % of Surveyed Patients with Hospital-Acquired Pressure Ulcers All Step-Down Units 5.00 Percentage Magnet Model Skin Team Subcommittee Includes CVCC, NTCA, CRCC 4.00 3.00 2.00 1.00 From Your Family To Ours 0.00 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 Hospital Adult Step-Down Median 0.00 0.00 2.86 0.00 0.00 0.00 0.00 0.00 Mean 4.59 4.38 3.77 3.99 4.06 3.83 3.39 3.29 26 | Deaconess Health System Fall Team is now an interdisciplinary team with members from direct care nurses, managers, laboratory staff, pharmacy staff, physical medicine staff, employee education department, with consultation of University of Evansville nursing faculty to ensure all areas of the hospital identify falls as a priority. The Fall Team has been working very hard this year to improve patient safety regarding falls. The team identifies monthly unit fall rates and discusses where problem areas are as well as who is doing well. The Fall Team encourages unit-based participation and the use of evidence-based interventions to keep our patients safe. • Implementation of Fall Trophy to highlight those making strides to improve fall rates • Evaluation of hourly rounding and effectiveness • Implementation of management hourly rounding with staff, patients and family • Evaluation of current fall prevention strategies • Discovery of new interventions that are evidence-based practice • Many new practice changes to come in 2012, with inclusion of all Deaconess employees utilizing an interdisciplinary approach to preventing falls Includes 2000, 2100, 2900, 3900 Deaconess Gateway Hospital Total Falls per 1,000 Patient Days All Adult Critical Care Units 2.50 Total Falls per Patient Day Falls per 1,000 Patient Days Deaconess Hospital Total Falls per 1,000 Patient Days All Adult Critical Care Units 2.00 1.50 1.00 0.50 0.00 Includes MSICU, Neuro ICU 3.00 2.50 2.00 1.50 1.00 0.50 0.00 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 4Q09 1Q10 3Q10 4Q10 1Q11 2Q11 3Q11 Hospital Adult Critical Care Median 0.83 0.96 0.00 0.00 0.43 1.91 1.94 0.47 Hospital Adult Critical Care Median 2.41 1.09 1.15 1.21 1.39 1.26 1.17 1.46 Mean 1.33 1.36 1.28 1.28 1.19 1.19 1.21 1.19 Mean 1.33 1.36 1.28 1.28 1.19 1.19 1.21 1.19 Deaconess Gateway Hospital Total Falls per 1,000 Patient Days All Adult Med-Surg Units Includes OMCC, SMCC, OPCC, NCCU, 5200 Total Falls per Patient Day Total Falls per Patient Day Deaconess Hospital Total Falls per 1,000 Patient Days All Adult Med-Surg Units 7.00 6.00 5.00 4.00 3.00 2.00 1.00 0.00 2Q10 Includes MCRU, Ortho, Neuro, SurgOnc 8.00 7.00 6.00 5.00 4.00 3.00 2.00 1.00 0.00 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 4Q09 1Q10 2Q10 3Q10 4Q10 2Q11 3Q11 Hospital Adult Med-Surg Median 5.66 4.66 3.45 4.43 5.60 5.05 3.86 6.31 Hospital Adult Med-Surg Median 1.76 4.77 4.42 4.24 3.79 3.76 3.35 5.66 Mean 3.88 3.78 3.78 3.71 3.76 3.57 3.59 3.55 Mean 3.88 3.78 3.78 3.71 3.76 3.57 3.59 3.55 3Q11 1Q11 Includes CVCC, NTCA, CRCC 6.00 5.00 4.00 3.00 2.00 1.00 0.00 4Q09 1Q10 3Q10 4Q10 1Q11 2Q11 3Q11 Hospital Adult Step-Down Median 3.73 2.92 5.32 2.92 5.02 3.08 2.91 3.73 Mean 3.39 3.27 3.29 3.38 3.31 3.29 3.20 3.16 2Q10 Professional Practice Model From Your Family To Ours Total Falls per Patient Day Deaconess Hospital Total Falls per 1,000 Patient Days All Step-Down Units Transformational Leadership DH Staff Lead: Jennifer Palmer, BSN, RN, CMSRN—EE&D Gateway Staff Lead: Amber Schenck, BSN, RN, CMSRN—DGH General Medical Telemetry Liaisons: Erin Fuhrer, BSN, RN, ONC—Manager, OMCC; and Theresa Price, BSN, RN, CNRN—Resource Team Leadership Chart Fall Team Subcommittee Structural Empowerment • Assisting in hardwiring effective hourly rounding with the Six P’s across all units. Exemplary Professional Practice • Maintaining line of sight with patients during bathroom assistance. New Knowledge, Innovations & Improvements • Fall boards with safety huddles as the focus being implemented across campuses. Magnet Model Fall Prevention Initiatives 2011 Nursing Annual Report | 27 Transformational Leadership Restraint Team Gateway Staff Lead: Kim Burk, BSN, RN—Gateway Neuro ICU Liaisons: Christa Wolf, BSN, RN, CNRN—Manager, Gateway Neuro and Neuro ICU; and Belle McCool, DNP, RN, NE-BC—Manager, Trauma, CVSICU and Peds Trauma Clerical Support: Dawn Wall—Medical Executive Secretary Leadership Chart • Policy revisions to meet regulatory guidelines The Restraint Team monitors and implements changes regarding restraint usage, documentation and policies to meet HFAP and CMS regulatory standards. Structural Empowerment • Best practice link to add care plan every time RN documents in med/surg restraint flowsheet • Evaluation of restraint documentation to meet regulatory guidelines • Updated restraint audits to ensure practices being followed correctly • Changes made to documentation flowsheets to ensure best practice followed • Restraint audits are done by management or designated person to ensure accuracy and follow-up Exemplary Professional Practice Deaconess Hospital Percent of Patients with Physical Restraints (Limb and Vest) All Adult Critical-Care Units New Knowledge, Innovations & Improvements Includes 2000, 2100, 2900, 3900 25.00 20.00 15.00 10.00 5.00 0.00 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 Hospital Adult Critical Care Median 21.59 5.00 17.14 7.14 21.59 0.00 11.54 17.14 Mean 19.62 18.58 18.27 18.77 17.22 18.23 17.71 17.00 3Q11 Deaconess Gateway Hospital Percent of Patients with Physical Restraints (Limb and Vest) All Adult Critical-Care Units From Your Family To Ours Percentage Professional Practice Model November: Neuroscience and Neuro ICU from Gateway have been working diligently to decrease falls and improve safety awareness through education of staff, families and patients, along with implementation of new products to decrease falls. Percentage Magnet Model Fall Trophy Winners for 2011 October: Cardiovascular Renal Care Center attributes improved fall numbers to management’s rounding with RNs and PCAs to ensure proper hourly rounding. PCAs also educated on not leaving patients unattended in the restroom, since this is the most common place for falls to occur. Includes MSICU, Neuro ICU 28 | Deaconess Health System 25.00 20.00 15.00 10.00 5.00 0.00 4Q09 1Q10 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 Hospital Adult Critical Care Median 14.29 14.29 12.50 0.00 18.18 12.70 5.00 0.00 Mean 19.62 18.58 18.27 18.77 17.22 18.23 17.71 17.00 • Evaluation of pilot program initiated on CVCC with education done throughout the organization. • Plan for 2012 is to transition hall pass to EPIC for printing so that information is pulled directly from the medical record. Unit-based Quality Improvement Projects Presented at Quality Council April Waters, RN— Radiology Department (DH/DGH) Rounding program for Radiology placed nephrostomy tubes, abcess drains, kyphoplasty’s, patient teaching port-a-caths. Nancy Robinson, RN—IV Therapy (DH) IV team now rounding on all PICCs daily to decrease # of occlusions and decrease usage of Activase. New hubs with clear casings to ensure proper flushing of ports. Improving insertion at bedside with ultrasound guidance and over-the-wire exchange procedure. Sonja Marx, BSN, RN—Endoscopy (DH/DGH) Time-out audits with site verifications. Changed cleaning product to increase turnaround time. Improved medication scanning from 25–50% to 100%. All RNs to have PALS training. Lucinda Mathew, RN, CCRN—CVICU (DH) After education and posting of checklist: Staff are now doing bedside safety checks at change of shift to include turning, skin/dressing check, restraint/fall risk, lines/drips/LDAs, MAR review, order review, room cleanliness. Kim Liberman, RN, OCN, CHPN—OPCC (DH) Created communication tree to improve communication scores through direct communication. Implemented Lunch Buddies to improve lunch free of patients from 12%. Implemented patient satisfaction team. Unit-based Race for the Cure and monthly OPCC “Team Nights” Aaron Stoll, BSN, RN, CHPN—Surgery Oncology (DGH) Four Eyes in Four Hours initiated in June 2011. Two nurses visualize and document patient’s skin assessment within four hours of admission. Kim Burk, RN— Neuro ICU (DGH) Created education pamphlets for bedside procedures and involving patient/ families with care conferences starting with subarachnoid patients. April Donaldson, RN—CRCC (DH) CRCC developed Renal Skills Day for nursing staff to improve patient satisfaction, quality measures and renal competencies. Rachel Finch, RN— General Med/Tele (DGH) Staff developed simple handouts to assist with nurse/patient education. Staff also developed a comfort box that has several different items such as contact lens cases, crossword puzzles, etc. Jackie Badar, RN— Cath Lab (DH) Cath lab is measuring Response to patient arrival. Cath lab staff educating on arrival time of staff and how it affects the Cath lab turn around. Educated on Radial access and TR bands. Lisa Rickey, BSN, RN—CVCC (DH) Staff implemented bedside care conferences with social work, case management, charge RN, RN, manager, patient and family. Also presented on interventions put in place for fall prevention. Lisa Hirsch, BSN, RN—Deaconess Procedure Center (DH) The Procedure Center has been 100% compliant with hospital outpatient procedure (HOP) quality measures for the last 12 months. They also perform audits on 10% of their moderate sedation and handoff. They also provide patient call-backs on 100% of their patients. 2011 Nursing Annual Report | 29 Magnet Model Professional Practice Model Transformational Leadership • Revisions to DHS handoff in EPIC to ensure patient care is streamlined for effective handoff communication. Leadership Chart • Involvement of families in bedside report when able to ensure continuity of care. Structural Empowerment • Team revised hospital P&P 40-74 Handoff Communication Tools “SBAR and Hall Pass” after evaluation of tools and changes made to increase patient safety. Exemplary Professional Practice Handoff Communication Team ensures a safe and effective handoff of clinical information across the health system. • Development and implementation of bedside shift reporting in all inpatient nonpsychiatric units. New Knowledge, Innovations & Improvements Team Lead: Lisa Hensley, MSN, RN—DH CVCC Team Lead Elect: Genevieve Kamer, RN, BSN, CCRN CVSICU/Trauma/Peds Trauma Liaisons: Paula Yarbrough, BSN, RN, NE-BC, CPN—Manager, DGH Pediatrics; and Patty Laird, MSN, RN, OCN—Manager, SMCC Clerical Support: Lavonna Armstrong—Executive Secretary Surgical Services From Your Family To Ours Handoff Communication Team Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Education & Professional Development Council Chair: Structural Empowerment Exemplary Professional Practice Jill Buttry, MSN, RN, CNS Magnet,Trauma & Critical Care Director Cherona Hajewski, MSN, RN, NEA-BC Chief Nursing Officer Teresa Whitledge, RN, CNOR Surgery Department— DH/DGH Emily Dawson, RN Endoscopy—DH/DGH New Knowledge, Innovations & Improvements Lynne Belcher, RN Cath Lab—DH From Your Family To Ours Svetlana Squier, BSN, RN CVSICU—DH Alice Haire, RN Radiology Mary Dawn Weaver, RN, CLNC CVSS New Rep—DH Donna Cobb, MSN, RN, CCRN, CNRN Trauma/Peds Trauma Angelea McEllhiney, RN, CPN Pediatrics and PICU—DGH Kimberly Pixley, RN Pediatrics and PICU—DGH Amy Pierce, RN PACU—DH 30 | Deaconess Health System Darlene Wolf, RN, CMSRN Same Day Surgery—DH Hannah Ison, MSN, RN, CMSRN OMCC—DH Myra Taber, BSN, RN Same Day Surgery—DGH Jill Graul, RN Case Management Kirby Dewig, RN CVCC New Rep—DH Sharon Dunville, MSN, RN, OCN, CMSRN OPCC—DH Lisa Relleke, RN, CMSRN IV Therapy—DH Craig Meyer, BSN, RN SMCC—DH Vicke Rauch, RN Neuroscience—DGH Angie Cox, MSN, RN, CCRN, CNRN Neuro/MSICU (3900)—DGH Patricia Bender, BSN, RN, CMSRN Emergency Department—DH Aaron Stoll, BSN, RN, CHPN Surgery Oncology—DGH Jill Rector, RN CRCC—DH Peggy Huey, RN Adult Mental Health Unit—DH Edna Fletcher, RN-BC Cross Pointe Adult Teri Bassett, BSN, RN Home Care/Hospice Amy Stott, RN Deaconess OP Procedure Center/Endoscopy Mary Ann Allen, BSN, RN EE&D Brielle McKinney, BSN, RN,CMSRN Diabetes Center Rachel Greene, MSN, RN, CAPA PACU, SDCC, Pre-testing, GI, Pain Genevieve Kamer, BSN, RN, CCRN Magnet Specialist Claire Bennett, BSN, RN Magnet Specialist Ellen Wathen, PhD, RN-BC EE&D, Document Writer The hard work of the PDP committee has paid off; as of December 2011, 13 RNs have achieved PDP recognition. All three levels were represented, and a pinning ceremony in December recognized 12 of those 13 participants, with the last participant recognized a week later. PDP has become a major topic across nursing. According to a fall 2012 nursing survey, there are as many as 200 nurses interested in participating in the PDP. The PDP committee has taken several comments regarding the PDP and will update the PDP program to include this feedback. Magnet Model Professional Practice Model From Your Family To Ours Increase Nursing Specialty Certifications by promoting certifications throughout the year as one of six cores of the Professional Development Program. • Information was provided from EE&D, Human Resources and the Deaconess P&P regarding the process for taking a certification and the payment. • Promoted the annual recognition luncheon for all nurses who received a certification or higher degree. • A nurse with three specialty certifications presented on what encouraged her to obtain certifications and the value in being certified. Transformational Leadership Implement a Professional Development Program (PDP) to replace our past career ladder. This has given nurses the opportunity to grow as professionals and be well-developed within the many areas of nursing. The PDP committee educated staff in late 2010 and the beginning of 2011 on a variety of topics that directly relate to PDP cores and electives. After education was complete, implementation and publicity around PDP was started. • For two months, weekly information tables in high-traffic areas of the hospitals provided information to nurses. • Nursing Excellence and Deaconess.com websites were updated to include ambassadors’ contact information and the PDP program so nurses can access the program from work or at home. Leadership Chart Increase nurse knowledge to help nurses pursue advanced nursing degrees through an education fair to provide information for nurses who want to go back to school. • In April 2011, a half-day education fair was offered at both Deaconess Hospital and Deaconess Gateway for nurses only. • Information and representatives were available for a variety of programs (Associates, BSN, BS, MSN, DNP, etc.) • Eight different programs were represented, as well as Deaconess Human Resources, to discuss tuition reimbursement. • Sixty-two evaluations were received, which showed that RNs had an increase in knowledge about obtaining an advanced nursing degree and available resources. Structural Empowerment • Certification questions, barriers and benefits were discussed as a council. • Educated members about upcoming opportunities for review courses and materials. Exemplary Professional Practice The Education and Professional Development Council monitors and evaluates the educational needs of nursing staff and helps plan, implement and evaluate educational programs as needed by direct-care nurses. New Knowledge, Innovations & Improvements Promoting Development 2011 Nursing Annual Report | 31 Magnet Model Professional Practice Model Professional Development Participants for 2012 T he following participants went above and beyond to achieve their professional development recognition. Each participant must participate in at least four of the six cores to participate and also provide evidence of at least 40 electives. The Core Areas are: Transformational Leadership • Quality Data Collection: Applicant actively participates in quality data collection at the unit or hospital level. • Example of Excellence: Applicant serves as a role model who demonstrates and exhibits service excellence behaviors to impact patient satisfaction. • Continuing Education: Applicant must complete twenty continuing education hours from an accredited nursing-related program or source. Leadership Chart • Certifications: Applicant holds a specialty certification by a national professional nursing organization in which credentials are obtained. • BSN or BS with major in nursing • Membership in professional nursing organization The Electives include: The opportunity to obtain more than 280 different points in electives, with areas ranging from publications, mentorship, advanced educational levels, community service, writing or updating policies and procedures, advanced certifications, presentations on evidencebased practices, Journal Clubs, committees, providing inservices for staff, and more. Please congratulate these nurses for taking a leap into the frontier of PDP and achieving this accomplishment. Structural Empowerment Bronze Level (4 Cores and 40 Electives) Afsaneh Hahn, BSN, RN Exemplary Professional Practice • • • • RN at Deaconess for 12 years Works in surgery Earned her BSN from USI Involved in her unit quality data project involving the Hemocue/Istat • Led a journal club for her unit • Reviewed and revised several policies • Member of the Medical Surgical-Neurological Conference planning committee Meros-Ann Fortney, BSN, RN, CNOR New Knowledge, Innovations & Improvements • Works in surgery • Obtained her BSN in the Philippines and started working for Deaconess in 2006. • Certified Operating Room Nurse (CNOR) • Member of the Philippines Nursing Association of Indiana • Pursuing her MSN at USI in the Nursing Education Program • Volunteered her time to work at health fairs and participated in screenings at local schools. Dawn Rowley, RN, CCRN From Your Family To Ours • Deaconess nurse for nine years • Member of the American Association of Critical Care Nurses • Participated in quality data collection and contributed to educating other RNs, both on her unit and throughout critical care • Course instructor for ICU competencies, participates in ICU Competency day and planning the “CCRN Exam Cram” • Presented at Patient Care Circle • Nominated by her peers for Nurse of the Year 32 | Deaconess Health System Angela Sawyer, BSN, RN, CCRN • With Deaconess for 11 years • Works in Critical Care • Member of the American Association of Critical Care Nurses • Helps with the IOPA Regional Collaborative • Member of Sigma Theta Tau International Honor Society of Nursing • Tracked data to improve quality of care for trauma patients through using audits to identify risks of DVT and C-Spines clearance • Developed a research project on Mepilex dressing • Presented at Patient Care Circle Pamela Leatherland, BSN, RN, CMSRN • Works on Surgical Medical Care Center (SMCC) • Member of the Academy of Medical Surgical Nurses and serves as the co-chair of recruitment and membership for the local chapter. • Part of the research project on SMCC unit, which involved the use of chewing gum in surgery patients. • Member of Research Council and her Unit-Based Council • Volunteered as a nurse at the Southern Indiana Classic Marathon Valerie Wills, BSN, RN • Graduated from USI with her BSN in 2009. • Enrolled in the master’s program at Frontier School of Midwifery • Works on the Gateway pediatric unit • Preceptor • Member of the Nursing Shared Governance Image council • Member of Sigma Theta Ta Honor Society of Nursing • Reviewed and revised a policy • Volunteered in the community • Began her career with Deaconess in 1973 • Currently works in Same Day Surgery at Deaconess Hospital • Longstanding history of being involved and making a difference at Deaconess Gold Level (6 Cores and 65 Electives) Donna Cobb, MSN, RN, CCRN, Peds CCRN, CNRN • First Deaconess RN to be recognized in Deaconess Professional Development Program. • Works in Pediatric Trauma • Received her BSN and MSN from the University of Evansville • Holds certifications in both Critical Care Registered Nurse and Certified Neuroscience Registered Nurse • Member of the American Association of Critical-Care Nurses • Taught numerous classes for nurses, participated in unit level journal club, and has written articles for the nursing newsletter. • Researched and developed a new policy about caring for patients in a barbiturate coma. • Significant part of the PDP committee and assisted in developing and encouraging other RNs with this program. Janie Arington, MSN, RN Linda Martin, BSN, RN, CMSRN • Has been with Deaconess for 11 years • Works on the Surgical Medical Care Center (SMCC) • Very involved on her unit and throughout Deaconess • Maintained her CMSRN (Certified Medical Surgical RN) • Member of the Academy of Medical Surgical Nurses and involved as a part of the Education Committee of the local chapter • Has demonstrated leadership by being a super trainer on various processes, equipment, quality improvement projects and inservices. • Conducted journal clubs • Preceptor for new nurses • Assists with SNIP class; presented at the CMSRN review course and presented once at Patient Care Circle • Reviewed nine hospital policies • Participated in nursing community service Magnet Model From Your Family To Ours • Obtained her MSN and changed roles from a cardiac staff RN to working a split between administration and urology as a Certified Clinical Nurse Specialist • Obtained her MSN from Liberty University, where she completed the Adult Care Critical RN track. • Submitted an article for publication • Active in many groups, including the CAUTI Research Committee, Education Council and the PDP Committee, and she was a champion for the CVSS’s Unit-Based Council. • Gave a presentation to the Research Council on physician-assisted suicide. • Member of American Association of Critical Care Nurses • Nominated for Nurse of the Year this year Professional Practice Model • Graduate of the Deaconess School of Nursing • Has worked at Deaconess for more than 35 years, since 1973 • Works in surgery • Super trainer for flash sterilization • Reviewed several policies and revised a total of three in this past year • Involved in the Tri-State’s chapter of the Association of Perioperative Registered Nurses. Teresa served as the president from 2009 to 2010. • Chairperson of several committees Transformational Leadership Teresa Whitledge, RN, CNOR Leadership Chart Darlene Wolf, RN, CMSRN • Member of the Academy of Medical Surgical Nurses (AMSN) • Involved in starting our local AMSN chapter in Evansville last year and is serving as president • Member and ambassador for the Professional Development Program Structural Empowerment • First Deaconess RN to submit a Professional Development Portfolio. • Started at Deaconess Hospital Emergency Department in 2005 • Member of the Emergency Nurses Association. • Attended the 2010 ANCC National Magnet Conference • 2011 Research Council chair • Chair of the Emergency Department’s Unit-Based Council • Completed extensive research on early detection of sepsis and treatment guidelines resulting in articles, inservices and presenting at the Clarian Health Nursing Research Conference Exemplary Professional Practice Kristina Brown, BSN, RN New Knowledge, Innovations & Improvements Silver Level (5 Cores and 55 Electives) 2011 Nursing Annual Report | 33 Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Research and EvidenceBased Practice Council Structural Empowerment Exemplary Professional Practice New Knowledge, Innovations & Improvements Teresa Whitledge, RN, CNOR Surgery—DH/DGH Krista Price, RN OMCC—DH Susan Alka, RN, CCRN PACU—DH Lori McDonald, RN OPCC—DH Japhia Leach, RN CVCC—DH Rachel Greene MSN, RN, CAPA PACU, SDCC, Pre-testing, GI, Pain Matt Gibson, RN, CRNI IV Therapy—THH Maria Alsop, RN Med/Surg 5200—DH Pam Leatherland, BSN, RN, CMSRN SMCC—DH Heather White, BSN, RN Home Care Services Amanda Sollman, BSN, RN General Med/Tele—DGH Amy Stott, RN Deaconess OP Procedure Center/Endoscopy Heather Weir, RN Ortho—DGH Lydia Rutherford, RN Wound Services Chasity Archer, RN Neuro MSICU—DH Cindy Head, RD, CDE Diabetes Center Danette Culver, BSN, RN NICU— DGH Chris Politano, OT Physical Medicine Janet Ziegler, BSN, RN CRCC—DH Monica Corcoran, MLIS Health Science Library From Your Family To Ours 34 | Deaconess Health System 212th Degree: Our Healthy Work Environment Initiative Poster Presentation at Clarian Nursing Research Conference Indianapolis, IN Kristina Brown, BSN, RN; Dande Osborne BSN, RN— Emergency Department; and Libby Payne, MSN, RN—EE&D Stopping Sepsis in Its tracks Poster Presentation USI Nursing Research Conference and Clarian Nursing Research Conference Indianapolis, IN Kristina Brown, BSN, RN Emergency Department Court Is in Session Poster Presentation at USI Nursing Research Conference Lois Welden, MSN, RN— Nursing Services Blood Conservation: Reduction of lab draws and transfusion guidelines Poster presentation at Clarian Nursing Research Conference as well as published in Nursing Leadership Matt Gibson, BSN, RN— IV Therapy—THH Nursing Clinical Series Dane Strongvein to provide education on IV therapy Deaconess Nursing Newsletters and two online publications for IV therapy Ellen Wathen, PhD, RN-BC—EE&D Professional Development Template: A Tool for New-Nurse Orientation/ Fellowship Program USI Nursing Research Conference Angela Cox, MSN, RN, CNRN, CCRN; and Noni Roberts, RN, CCRN Multidisciplinary Rounding: Don’t Be a Missing Piece of the Puzzle USI Nursing Research Conference Dr. Belle McCool, DNP, MSN, RN—Manager, CVSICU/ Trauma/Peds Trauma DNP Capstone Project: Transforming Nurse Manager Skills to Create and Sustain Healthy Work Environments USI Nursing Research Conference Edith Hoehn, BSN, RN; Jennifer Palmer, BSN, RN, CMSRN; and Carol Scarfia, RN, CMSRN Evidence-Based Policy and Procedures: Making Online System Your Own Clarian Nursing Research Conference Indianapolis, IN How many evidence-based practice opportunities were available last year? • EBP Basic Course was offered six times. • EBP Intermediate Course was offered four times. • Court Is In Session was offered once at Gateway. It was duplicated in fall 2010 and is planned to be presented at Medical Surgical Neurological Conference in 2012. • Council members encouraged and given opportunities to attend research conferences and events. What do we see in the future for nursing research at Deaconess? Magnet Model From Your Family To Ours Ellen Wathen is our charter member of the Improvement Science Research Network. It facilitates research projects in multiple hospitals to move research findings into practice sooner. Members from all over the U.S. have the opportunity to collaborate on research and share information on studies they are participating in. Professional Practice Model Janet Zigler, BSN, RN, CMSRN; Kaye Cates, BSN, RN, CMSRN; Jill Rector, RN; Roxie Sullivan, RN, CMSRN; and Jeanette Woehler, RN, CMSRN, CRCC Transformational Leadership Poster Presentation at USI Nursing Research Conference Leadership Chart Wound Care Planning Guide Structural Empowerment Heather White, BSN, RN Home Care Services Exemplary Professional Practice Nursing Research and Evidence-Based presenters for 2011 New Knowledge, Innovations & Improvements Promoting Research Deaconess Hospital was chosen last fall as one of five hospitals in the U.S. to participate in a study. Ellen will continue to apply for additional studies as they are presented. 2011 Nursing Annual Report | 35 Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Structural Empowerment Exemplary Professional Practice New Knowledge, Innovations & Improvements Exemplary Professional Practice From Your Family To Ours The goal of this component is to guide practice by using a strong model that focuses on collaboration, communication, nursing practice and professional development to provide the highest quality of care to patients. Another key point to this component is a strong shared governance, which is vital to the success of the organization. 36 | Deaconess Health System Healthy Work Environment Conference Deaconess held an eight-hour workshop, Healthy Work Environment: Helping You Help Your Unit. The workshop was developed to help Deaconess nurses understand what Healthy Work Environment can do for them and their units, and it offered tools for implementation. The workshop was attended by more than 75 nurses from Deaconess Hospital, Deaconess Gateway Hospital and Deaconess Cross Pointe. VHA RetuRN to Care SMCC used the RetuRN to care model, which is composed of three crucial relationships: the relationship with the patient and family; the relationship with self; and the relationship with co-workers. The model is surrounded by a framework of leadership, teamwork, professional practice, patient care delivery, resourcedriven practice, and outcomes. SMCC began this process in April 2008. They attended three face-to-face meetings conducted by VHA over the course of the first year. These meetings included presentations from other facilities and reviews of best practices. The team conducted weekly meetings and developed an action plan. This process has helped in the implementation of hourly rounding and preventive measures such as turning patients and offering to take patients to the bathroom to prevent falls. SMCC’s patient satisfaction and HCAHPS scores have steadily had an upward trend. They currently meet about every other week to continue their RetuRN to care initiative. 2011 Nursing Annual Report | 37 Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Structural Empowerment • Currently, more than 70% of the inpatient nursing units at Deaconess Hospital have implemented HWE elements, and more than 50% of those have initiated full HWE programs that include a staff contract. Good-to-Great Grants There were several Good-to-Great Grants awarded by the Foundation to nursing units and ancillary departments to improve patient and staff satisfaction. Keep coming up with great ideas and moving forward on innovations to improve our work environment no matter where we work. Staff who are motivated and excited about coming to work are more satisfied, which can lead to improved patient satisfaction. Exemplary Professional Practice Many HWE champions worked hard last year to share HWE standards across the units at Deaconess Hospital and Deaconess Gateway Hospital. Improving the work environment has helped improve RN satisfaction scores overall. There have been significant improvements in several units that have implemented these standards. Many of these units had RN satisfaction above the mean in various different areas: RN-RN, RN-MD, professional status, decision making and autonomy, to name a few. 10 Tips of Skilled Communication The committee developed a 10 Tips of Skilled Communication poster that will be posted throughout both campuses soon. The Ten Tips were created by the HWE steering committee as they read and discussed the book Crucial Conversations along with many other great resources on good communication. The journal club discussion was held at the meetings to discuss Crucial Conversations to better help the committee understand communication techniques to bring to the nursing units. New Knowledge, Innovations & Improvements Healthy Work Environment Steering Team Chair: Kathy Bell, BSN, RN—Neuro MSICU until April 2011 Chair-Elect: Melissa Jassim, BSN, RN— CVCC, assumed chair position April 2011 Liaison: Cherona Hajewski From Your Family To Ours Improving Decisions and Outcomes Magnet Model Professional Practice Model Transformational Leadership Value-Based Purchasing The value-based purchasing (VBP) program was implemented by the Centers for Medicare and Medicaid Services to promote higher quality care. The program is built on inpatient quality reporting measures, including 12 clinical measures (heart attack, pneumonia, heart failure and SCIP core measures) and eight patient experience measures (HCAHPS survey). The goal is to move from a “pay for service” model to a “pay for performance” model and reward better value, patient outcomes and innovation. Leadership Chart All-or-None Bundle scores show the percent of patients who receive all indicated care as established by core measures. For example, the heart failure All-or-None Bundle score shows the percent of patients hospitalized with a heart failure diagnosis who have the following completed and documented: Better If any of these items are indicated but not completed and documented, the patient doesn’t meet the heart failure All-or-None Bundle. This means staff nurses must follow documentation guidelines and practices to ensure core measures are met, engage with families to provide an excellent patient experience, and use our metrics to allow us to improve daily care. HCAHPS Overall Rating—%9’s and 10’s DH and DGH Structural Empowerment 90% 85% 80% 75% 70% 65% 60% 55% 50% •Discharge instructions (including activity, diet, follow-up, medications, symptom worsening and weight monitoring) provided to patient • Ejection fraction documented • ACEI or ARB prescribed for LVEF dysfunction or contraindication documented by provider • Cessation counseling completed for patients who are smokers Better 95% 90% 85% 80% 75% 70% 65% 60% 10/08 1/09 4/09 7/09 10/09 1/10 Actual Exemplary Professional Practice Better 4/10 7/10 10/10 Mean 1/11 4/11 UCL 7/11 55% 100% 100% 90% 90% 80% 80% 70% 70% 60% 60% 4/09 New Knowledge, Innovations & Improvements Better 7/09 10/09 1/10 Goal 4/10 7/10 10/10 Mean 1/11 4/11 7/11 UCL 120% 100% 80% 80% 60% 60% 40% 40% 20% 20% 4/10 7/10 10/10 1/11 Mean UCL From Your Family To Ours Better 4/11 0% 7/11 LCL 4/09 7/09 10/09 1/10 Goal 10/08 1/09 4/09 Actual 7/09 10/09 1/10 Goal Pneumonia All-or-None Bundle DH and DGH 110% 100% 90% 80% 70% 60% 10/08 1/09 Actual 38 | Deaconess Health System 4/09 7/09 10/09 1/10 Goal 4/10 Mean 5/10 8/10 11/10 2/11 5/11 UCL 8/11 LCL 4/10 Mean 7/10 10/10 1/11 4/11 7/11 UCL LCL Heart Failure All-or-None Bundle THH Better 120% 2/10 Mean Actual 100% 7/09 10/09 1/10 Goal 10/08 1/09 LCL Heart Failure All-or-None Bundle DH and DGH 10/08 1/09 4/09 Actual 8/09 11/09 Heart Attack All-or-None Bundle THH Better 110% Actual 5/09 Actual Heart Attack All-or-None Bundle DH and DGH 10/08 1/09 11/08 2/09 LCL 110% 0% HCAHPS Overall Rating—%9’s and 10’s THH 7/10 10/10 1/11 UCL 4/11 7/11 LCL 4/10 7/10 10/10 1/11 Mean UCL 4/11 7/11 LCL Hypoglycemic Response The diabetes clinicians at Deaconess Hospital have taken the initiative to improve our treatment for hypoglycemic episodes. Over the last year, they have changed the hypoglycemia policy/ protocol and education. This included treatment options, identification of response time, documentation, and timely relay of information to RNs to treat effectively. The diabetes clinicians utilized pocket cards that many units have attached to computers on the units and/or posted in pantries. This was developed to help staff identify signs and symptoms; treat, observe, re-treat if necessary; and become familiar with guidelines regarding hypoglycemia. The goal for treatment is less than 20 minutes. This includes identification of hypoglycemia (blood glucose less than 70mg/dl), completed treatments, and re-checks of bedside blood glucose (BBG). The clinicians educated on appropriate treatment and monitoring of blood sugars after a hypoglycemic episode. Blood sugars tend to drop after a period of time, post-treatment. The pocket cards describe how often blood sugars must be monitored after an initial hypoglycemic episode. Managers now get reports on time-to-treatment, blood sugar re-checks and the percentage of staff using the hypoglycemia protocol correctly. Hypoglycemic Response Time Initial BBG, Treatment-to-Recheck BBG 120 Magnet Model Professional Practice Model Transformational Leadership Leadership Chart 80 60 January 2011 November 2011 40 20 M C IC U IC NM C CV U NC C CR CC O PC 52 C 00 M S CV CC SM CC M O ed M CC /T Su ele rg D /O GH nc Ne DG ur o H IC U Ne DG ur H o O DG rt ho H DG M H SI CU He D ar t H GH os pi ta l Goal for treatment: 20 minutes M U IC SI a CV Tr a um CU 0 2011 Nursing Annual Report | 39 From Your Family To Ours Response Time (min) 100 Structural Empowerment One of Behavioral Service’s Deaconess Hospital goals is to continue to improve RN satisfaction rates by providing more education, promoting autonomy and strengthening communication between all disciplines of the health system. As we approach the upcoming year, we’ll continue to work as an integrated team to improve patient outcomes and staff satisfaction. Exemplary Professional Practice Services They continue to make patient and staff safety a priority and have recently received approval for additional security cameras. Other upcoming improvements include additional security staff to Cross Pointe throughout the night-time hours and the recent implementation of the badge scanning system. They are excited about these improvements, as safety is essential in providing a therapeutic environment for those they serve. New Knowledge, Innovations & Improvements Deaconess Cross Pointe Behavioral The behavioral health units are proud of the accomplishments of 2011 and are looking forward to 2012. They continue to strive to lower their number of restraints and increase the education of staff. The staff of Deaconess Cross Pointe’s Adult Unit, Child and Adolescent Unit and 4200 Unit float within the three behavioral health departments. Each unit works very well together to meet patients’ needs and aid in their successful recovery. Leadership Chart Structural Empowerment One strategy in initiating the CAUTI prevention project was to embed the CAUTI evidence-based care practices within the electronic health record (EHR) to assist in driving evidence-based care practices. By using clinical decision support features of the EHR, it would assist in driving and sustaining evidencebased care delivery and documentation. We are seeing positive results in performance and surveillance outcomes. • Significant improvement shown in documentation practice for both ICU and non-ICU units. • Non-ICU units demonstrated the greatest improvement by the third quarter of the study. • Significant improvement shown in census with catheters and criteria on non-ICU units versus ICU units. • Both ICU and non-ICU demonstrated significant improvement in care practices and documentation. Each unit has taken ownership and performs monthly prevalence studies. Prevalent outcomes showed that: Exemplary Professional Practice A major emphasis of the CAUTI Preventive Bundle is to limit the duration of an indwelling catheter. Currently, the incidence of CAUTI show a constant downward trend. Obviously, staff are making a conscious effort to help keep our patients safe from a CAUTI by adhering to catheter care practices. A big thank you to all staff who are making a difference in this area! • Within the first six months, care practices increased from 56% to 93%. • The number of catheter insertions showed a downward trend from 29% of census at baseline to 25% six months post-implementation. Furthermore, sustained decrease in overall catheter insertions continued a year later to 20%. New Knowledge, Innovations & Improvements Deaconess Hospital Catheter-Associated Urinary Tract Infections per 1,000 Catheter Days All Adult Critical-Care Units Deaconess Gateway Hospital Catheter-Associated Urinary Tract Infections per 1,000 Catheter Days All Adult Critical-Care Units 2.50 Includes 2000, 2100, 2900, 3900 2.50 2.00 1.50 1.00 0.50 0.00 Includes MSICU, Neuro MISICU 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 Percentage Transformational Leadership Using the Electronic Health Record to Drive Evidence-Based CAUTI Care Practices 2.00 1.50 1.00 0.50 0.00 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 Hospital Adult Critical Care Median 0.44 0.51 1.21 0.00 0.51 0.00 Hospital Adult Critical Care Median 1.24 0.00 0.00 0.00 0.00 0.00 Mean 2.17 2.29 2.03 2.08 2.05 1.95 Mean 2.17 2.29 2.03 2.08 2.05 1.95 From Your Family To Ours Deaconess Hospital Catheter-Associated Urinary Tract Infections per 1,000 Catheter Days All Adult Step-Down Units 3.00 Includes NTCA Percentage Professional Practice Model CAUTI Project Update Percentage Magnet Model ANCC Accredited Nursing Skills Competency Program A new American Nurses Credentialing Congratulations to those who participated in Deaconess’ first ANCC-accredited Center (ANCC) Accredited Nursing Skills competency program was brought Nursing Skills Competency Program. to Deaconess so that nursing staff at Jessica Barnes, RN Myra Taber, RN Deaconess Hospital and Deaconess Mary Beth Schitter, RN Mary Correll, RN Gateway Hospital medical surgical floors Jacquelyn Dixon, RN Carmella Mach, RN were more comfortable and competent in Jennifer Wright, RN Megan Jahn, BSN, RN, CMSRN the application and care of Wound V.A.C Nancy Ash, RN Linda Martin, RN therapy. Nurses are able to transition Tracie Johnson, RN Amanda Nosko, RN Destiny Smith, RN patients from the hospital Wound V.A.C Amber Schenk, BSN, Bill Chapman, RN system to the home care Wound V.A.C RN, CMSRN system. 2.50 2.00 1.50 1.00 0.50 0.00 40 | Deaconess Health System 2Q11 3Q11 Hospital Adult Step-Down Median 0.00 0.00 Mean 2.50 1.97 2.50 4Q10 1Q11 2Q11 3Q11 Hospital Adult Critical Care Median 0.00 1.05 1.65 0.00 0.51 0.00 Mean 1.08 1.30 1.13 1.18 .098 1.31 Deaconess Gateway Hospital Central Line Associated Blood Stream Infections per 1,000 Central Line Days All Adult Critical-Care Units 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 Hospital Adult Critical Care Median 0.00 0.00 0.00 0.00 0.00 0.00 Mean 1.66 1.97 1.64 1.63 1.56 1.93 Deaconess Hospital Ventilator-Associated Pneumonias per 1,000 Ventilator Days All Adult Critical-Care Units 2.50 2.50 2.00 1.50 1.00 Includes 2000, 2100, 2900, 3900 0.50 0.00 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 Hospital Adult Critical Care Median 2.75 0.00 0.00 0.00 0.00 0.00 Mean 1.08 1.30 1.13 1.18 0.98 1.31 Percentage Percentage 3.00 Includes MSICU, Neuro ICU 0.50 0.00 2.00 1.50 1.00 0.50 0.00 2Q10 3Q10 4Q10 1Q11 2Q11 3Q11 Hospital Adult Critical Care Median 1.34 0.00 0.00 0.00 0.00 0.00 Mean 1.66 1.97 1.64 1.63 1.56 1.93 2Q10 3Q11 Hospital Adult Step-Down Median 0.00 0.00 Mean 0.00 0.00 Exemplary Professional Practice Includes NTCA Percentage Deaconess Hospital Central Line Associated Blood Stream Infection per 1,000 Central Line Days All Step-Down Units 1.00 0.90 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Emergency Department Sexual Assault Nurse Examiner (SANE) Program Several of our Emergency Department nurses were able to attend advanced education in the forensic examination and care of sexual assault victims. • The basis of our SANE program is the belief that sexual assault victims have the right to immediate, compassionate and comprehensive medical/legal evaluation and treatment by a specially trained professional. • The services of trained, experienced SANE practitioners help preserve the victim’s dignity, enhance forensic medical evidence collection and increase the prosecution of sex offenders. Magnet Model Leadership Chart 3Q10 1.50 1.00 Structural Empowerment Includes MSICU, Neuro ICU 2Q10 2.00 • Since the development of the Deaconess Health System SANE program, staff members have treated more than 150 victims of sexual assault. Adult/Adolescent SANE Barbara Dewitt, RN—DH Vicki Wright, RN—DH Shawn Brown, RN, TNS—DH Jessica Hahn, BSN, RN—DH Monica Larue, RN, CMSRN—DH Tamara Conrey, RN—DGH Amy Dodson, RN—DGH Rachel Wire, RN—DH Amanda Payne, RN—DGH Patty Bender, RN, CMSRN—DH Pediatric and Adult/Adolescent SANE Kathalene Keller, BSN, RN, CEN 2011 Nursing Annual Report | 41 New Knowledge, Innovations & Improvements 1.80 1.60 1.40 1.20 1.00 0.80 0.60 0.40 0.20 0.00 Deaconess Gateway Hospital Ventilator-Associated Pneumonias per 1,000 Ventilator Days All Adult Critical-Care Units Percentage Includes 2000, 2100, 2900, 3900 Percentage Deaconess Hospital Central Line Associated Blood Stream Infection per 1,000 Central Line Days All Adult Critical-Care Units Professional Practice Model The Ventilator Associated Pneumonia Bundle is now in EPIC. Review of literature and evidence-based practice has helped ensure patients receive the best care possible while in the ICU. The CCC Team will continue to keep these issues on our radar to keep us striving for excellence. From Your Family To Ours The original Central Line Prevention Bundle was developed through the Critical Care Core (CCC) Team. This project is now being managed by the IV Quality Collaborative Team, and staff from both departments continue to do amazing work regarding prevention of blood stream infection rates. Transformational Leadership Critical Care Core Team Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Structural Empowerment Exemplary Professional Practice New Knowledge, Innovations & Improvements New Knowledge and Innovation From Your Family To Ours Evidence-based practice provides our patients with the safest and best practices while generating new knowledge. To be successful, Deaconess must continually build on its knowledge base by using existing evidence while applying new evidence to achieve optimal outcomes. 42 | Deaconess Health System Expanded Emergency Department While the kick-off for this project involved working a Saturday, it was an opportunity to celebrate the history and closeness of the department. Music played the entire day; the more experienced staff members shared pieces of “preserved history” such as handwritten preferences cards. When lunch time rolled around, everyone stopped working and ate barbeque together. The team turned a day that could have been drudgery into a celebration. Expanded Surgery Suites New Unit 4800 Under Construction Magnet Model Professional Practice Model From Your Family To Ours OR Expansion Build Out In April 2011, DH Surgery completed phase I of a four-phase building project. Phase I involved removal of one existing OR suite to allow for expansion of the center core and three new OR suites. This project coincided with go-live of the new electronic health record for OR. To ensure each of these projects started smoothly, each member of the surgery team pulled together. Team leaders, center core staff and staff volunteers cleaned shelving, reorganized stock and revamped the department. Transformational Leadership 4800 Addition: Cardiovascular Surgical ICU and Trauma Merge has presented a challenge to everyone. In fall 2010, following the strategic A unified 4800 Unit-Based Council building and remodeling plan for was formed to represent everyone’s Deaconess Hospital, the decision was interests. An education plan for all staff made to combine Trauma Intensive was developed to promote advanced Care, Cardiovascular Thoracic Surgical learning, competencies and proficiency. Intensive Care and Pediatric Trauma into A Healthy Work Environment committee one unit on the fourth floor. The new was implemented to continue good Unit 4800 will include a 22-bed intensive collaboration, communication and team care and step-down area. The projected building. It’s the goal of the 4800 staff to opening for the unit is May 2012. provide compassionate, quality care to Nurses from all three areas were actively all patients, matching the expertise of the involved in the design and development staff to the needs of patients. of the unit. Merging three different staffs Leadership Chart Over the last year, staff rose to the challenge of working in and around the construction site with no disruption of service to patients and visitors. The investment in the Emergency Department shows the value and commitment Deaconess Health System places on emergency services. Structural Empowerment pleasing for patients, visitors and staff. Exemplary Professional Practice Emergency Department Expansion 2011 was an exciting year for the Emergency Department at Deaconess Hospital, with the addition of 5000 square feet of space. Staff were closely involved in design and workflow change, including relocation of security, triage, visitor lounge, patient registration/ financial counseling and the six-room treatment area and waiting area. The ED is now full of light, open and aesthetically New Knowledge, Innovations & Improvements Promoting the Future 2011 Nursing Annual Report | 43 Magnet Model Professional Practice Model OpTime Since 2008, Deaconess’ goal to increase continuity of care across the health system has been met through spreading EPIC across all departments. O.R., EPIC, I.S., Risk Management, Quality Improvement, physicians and representatives from all nursing teams were involved in the process. All nursing departments across the health system are now charting in EPIC so that all patient information is available to all health care providers within the health system. OR staff attended classes earlier this year for EPIC documentation education, implementation and evaluation. The real-time documentation of the surgery record has not changed but is now available to all caregivers at the time of procedure. Transformational Leadership Leadership Chart Deaconess is the first hospital in Indiana to reach HIMSS Stage 7 This ultimately improves performance, A health care organization’s goal with patient safety and patient care quality. its EHR is to reach HIMSS Stage 7, the Stage 7 hospitals are truly paperless. highest stage of an environment in which paper charts are no longer used in delivDeaconess was awarded Stage 7 status ering patient care. According to HIMSS, November 10, 2011. Deaconess was the stage 7 health care organizations support first health care organization in Indiana to the true sharing and use of patient data. earn this award! Structural Empowerment Palliative Care Consult Team Palliative care focuses on providing specialized medical care to help relieve patients’ pain and stress during a serious illness, regardless of the diagnosis. The goal is to improve quality of life for both the patient and the family at any age and at any stage in a serious illness and to reduce readmissions and ICU stays. Services can be provided together with curative treatment. Exemplary Professional Practice New Knowledge, Innovations & Improvements After years of research into palliative care and its impact on our health care system, Deaconess approved the palliative care service line in November 2010. In August 2011, Deaconess Palliative Care Services started with the inpatient consult team, which consists of physicians, nurses, social workers, pharmacists, chaplains and therapists. The team meets daily and From Your Family To Ours 44 | Deaconess Health System rounds on palliative care patients in the hospital. In the four months since palliative care has started, they have been consulted on 180 patients. Of those 180 patients, they have collaborated with other disciplines to provide 55 hospice referrals, 54 different consulting physicians, and 98 ICU days saved. The Palliative Care Service Team will present a day of education to nursing staff across both Deaconess campuses. Palliative and End-of-Life Nursing Care: Connecting the Pieces will provide Deaconess nursing staff the education and tools to care for chronically ill patients and their families throughout their disease process. Magnet Model Thank You Deaconess would like to say thank you for all the wonderful things that nursing services and ancillary staff accomplished last year. Here are just a few of your major accomplishments in 2011. Congratulations! •HFAP Survey with Accreditation—May 2011 Leadership Chart From Your Family To Ours •American College of Surgeons Level II Trauma Reverification—Fall 2011 Transformational Leadership Professional Practice Model Units throughout the organization do things that go above and beyond the call of duty on a daily basis. Deaconess has some of the most amazing, caring, compassionate and considerate employees in the Tri-State. Thanks to everyone for the things you do each time you walk through the doors! Structural Empowerment The unit has had some of its own struggles and growing pains during the year. Opening at the end of 2010 with 12 beds, census quickly increased. The unit pulled together as a team during this time. Many staff members worked extra hours to help their co-workers during their time of need. Many patients and families have been through the sixth floor of Gateway over the past year. They have touched the lives of the staff in ways some never imagined. Exemplary Professional Practice Throughout the past year, many units at Deaconess have gone above and beyond to provide the best care to their patients and families. Many new units have opened, and many are in the process of remodeling and expanding. The Surgery Oncology unit at Gateway recently celebrated its first birthday! New Knowledge, Innovations & Improvements Surgery Oncology Gateway •Primary Stroke Center Survey and Designation—March 2011 •Top 100 Places to Work 2011 Nursing Annual Report | 45 Magnet Model Professional Practice Model Transformational Leadership Leadership Chart Structural Empowerment Exemplary Professional Practice New Knowledge, Innovations & Improvements From Your Family To Ours 46 | Deaconess Health System Front Cover Design The design on the front cover is our new Magnet motto for 2012. All units were invited to submit ideas for the motto. Once ideas were submitted, a complete list of ideas was sent out to each unit manager to post on the unit. Feedback was welcomed, and each unit was encouraged to submit their top vote for the Magnet Motto. At the end of the competition there was a three-way tie. The Magnet Writing Team looked at each motto and decided they liked the way two of them sounded together. Thus our Magnet Motto was born! Thanks to all units that participated, and congratulations to Deaconess Hospital Emergency Department and Michael Hart in Public Relations for helping pull together a great motto for our Magnet journey! Deaconess Hospital 600 Mary Street • Evansville, IN 812-450-5000 Deaconess Gateway Hospital 4011 Gateway Boulevard • Newburgh, IN 812-842-2000 Deaconess Cross PointE 7200 E. Indiana Street • Evansville, IN 812-476-7200 800-947-6789
