Download NURSING 2010 ANNUAL REPORT

S T. L O U I S C H I L D R E N ’ S H O S P I TA L
ANNUAL
REPORT
NURSING
2010
ABOUT US
2 x 2010 ANNUAL REPOR T
On the cover: Mary Beck, BSN, RN,
CPN, provides care for patients like
Conner Rhodes on the Hematology/
Oncology Unit.
ST. LOUIS CHILDREN’S HOSPITAL x3
Founded in 1879, St. Louis Children’s Hospital
(SLCH) is the oldest pediatric hospital west of the
Mississippi River and the seventh oldest in the
United States. The hospital has served patients from
all 50 states and nearly 60 countries.
SLCH has been recognized by Parents magazine as
one of the top five children’s hospitals in America.
The magazine names SLCH third in the nation in
orthopedics, third in neonatology, fourth in
pulmonary, fourth in emergency services and sixth
in cardiac surgery. The hospital also is on the
U.S.News & World Report Honor Roll of America’s
Best Children’s Hospitals.
SLCH was redesignated in 2010 as a Magnet®
hospital for nursing excellence by the American
Nurses Credentialing Center. To date, only about
two percent of the nation’s 5,000 hospitals have
achieved redesignation.
SLCH is the world leader in pediatric lung
transplantation, and has performed more than
300 lung and heart-lung transplant procedures.
One of the top transplant centers nationally, the
hospital has active programs in transplant for
heart, liver, kidney, lung and bone marrow.
250
Licensed Beds
3,044
Employees
1,082
Nurses
771
Physicians
184
Residents/Interns/Fellows
87
Advanced Practice Nurses
9.21
Nursing Average Years
of Service
9.3%
Nursing Turnover Rate
.9%
Nursing Vacancy Rate
1,187,391
9,105
Visits to StLouisChildrens.org
Visits to the Nursing Section
of StLouisChildrens.org
Contents
6
Transformational Leadership
2010 UTILIZATION
10
Structural Empowerment
15,615
Admissions
12
Exemplary Professional Practice
75,583
Patient Days
16
Process Improvement
18
New Knowledge
12,189
OR Cases
22
Building Systems of Safety
51,242
Emergency Visits
26
By the Numbers
215,392
Outpatient Visits
207
Average Daily Census
79
Transplants
274,792
Total Visits
4 x 2010 ANNUAL REPOR T
From Peggy
NURSING
EXCELLENCE
Shared Leadership redefines teamwork
I am pleased to present this 2010 annual
report for St. Louis Children’s Hospital
nursing and patient care services. I continue
to be amazed and proud of our team, who
take exemplary care of our patients and
families while providing an outstanding
learning environment for students and
medical trainees. The culture at St. Louis
Children’s Hospital is one that is admired
by everyone who enters our doors, and
each staff member contributes to that in
their interactions with patients, families and
each other. Despite many past
accomplishments, we continue to work to
improve the experience for our patients and
families, as well as the safety and
effectiveness of the care we provide.
The launch of our new Shared Leadership
model, with interdisciplinary councils for
Patient Safety, Clinical Practice,
Performance Improvement, Education and
Professional Standards, has been
particularly gratifying to watch. Front line
staff from all of our clinical departments
have come together in new ways to
discover the joys and opportunities created
by teamwork. In this report you will read
about some of their accomplishments in
this first year. Deeper understanding of
each other’s’ roles is leading to improved
communication and is helping us to
remove some of the barriers to creating a
Superior Patient Experience. New
guidelines for professional presence are
helping to create shared expectations for
our appearance, behavior and professional
relationships with patients and families.
While our professional, caring culture is
already strong, our staff have identified
some more specific standards for how we
“show up” in our roles at St. Louis
Children’s Hospital. This is an exciting
example of what can happen through
Shared Leadership. Front line staff are
determining the image they want to
present to our families and how they will
manage this with each other. Managers and
directors are supporting this conversation,
not leading it, and we will see how our
culture takes in these new ideas as the
discussion evolves. I am confident it will
ultimately make St. Louis Children’s
Hospital even more impressive!
In a year when the Institute of Medicine
and Robert Wood Johnson Foundation
published a report on The Future of Nursing
calling for us to achieve 80 percent
baccalaureate preparation for nurses by
2020, it was gratifying to see that further
formal education and specialty certification
continue to be strong values in our
organization. We now have 65 percent of
our staff nurses BSN-prepared, with many
more in school working toward either a
BSN or a graduate degree. In addition, we
have 34 percent of our total nursing
population certified in a specialty area, up
from 24 percent last year. We also trained
10 additional Evidence-Based Practice
(EBP) Scholars, so that we now have at
least one on every patient care unit. Several
of these scholars have gone on to develop
research studies out of their EBP projects,
where a gap in the science of nursing
practice was identified. All of this assures
that our patients receive care from nurses
who are knowledgeable, well-educated and
specialized in pediatric care.
It was another busy, exhilarating year with
many accomplishments. It is a pleasure to
serve as a leader for staff who strive to be
their best for every patient, every family,
every day!
Peggy Gordin, MS, RN, NEA-BC, FAAN
Vice President, Patient Care Services
ST. LOUIS CHILDREN’S HOSPITAL x5
2010 Nursing Awards
St. Louis Children’s Hospital presents the Nancy A. Ross, RN, Nursing Awards each year. The awards are based on professional
standards of nursing exemplified by the Magnet® designation, a national award for nursing excellence:
Rookie of the Year
Yvonne Castaneda, RN, Cardiac ICU
Excellence in
Family-Centered Care
Castaneda continually goes above and
beyond with the patients and families
that she serves. She is loved by families
for her honest, caring and compassionate
nursing care. She keeps families involved
and informed.
Kim Sauder, BSN, RN, CPN,
8 West General Medicine
Excellence in
Nursing Leadership
Excellence in
Professional Nursing
Amanda Mattler, RN, CPN,
Dialysis/Infusion/Pheresis Unit
Mary Mintun, MSN, RN, Cardiac ICU
A staunch supporter of family-centered
rounds, Sauder serves on a task force that
is evaluating the rounds process to ensure
it meets the needs of patients and families,
as well as the educational needs of
residents.
Mattler, the unit’s assistant nurse manager,
was nominated by her entire team. She
was praised for her ability to deal with
challenging transitions in a positive way.
Mintun, a charge nurse, has been
instrumental in the planning,
development and initiation of the
Shared Leadership Council to improve
patient care and provide a superior
patient experience.
Excellence in Mentoring
Partner in Caring
Ann Donze, MSN, RN, NNP,
Newborn ICU
Matthew Sinople, PCA, Cardiac ICU
Donze was nominated for her ongoing
mentorship and commitment to the
Evidence-Based Practice (EBP) scholar
students at SLCH. She was cited for her
knowledge of the EBP process and ability
to translate it to the practicing nurse at
the bedside.
Community Service
Diane DuBois, MSN, MPH, RN, RN-BC,
Answer Line
Through several volunteer activities, DuBois
supports the mission of improving the
health of the people and communities the
hospital serves. For example, each week
she volunteers as an educator for grades
kindergarten through eight at the Litzinger
Road Ecology Center.
Nurses say Sinople is kind and responsive
to the needs of the families and staff of the
Cardiac ICU, and often knows what is
needed for the patient.
Excellence in
Nursing Research
Barbara Gavillet, RN, RN-NIC,
Newborn ICU
Gavillet promotes excellence in nursing
research at SLCH by being an EvidenceBased Practice (EBP) scholar and engaging
in efforts to fight bloodstream infections.
TRANSFORMATIONAL
LEADERSHIP
6 x 2010 ANNUAL REPOR T
Nursing leadership identifies and communicates the
mission, vision and values within the organization
and asks for the involvement of nursing to achieve
goals.
ST. LOUIS CHILDREN’S HOSPITAL x7
Amy McAlister, BSN, RN, CPN, CNN, shares her nursing experiences as a Dialysis Center nurse with Sue Harper, M+ (ASLP), medical
technologist, Clinical Laboratories, as part of the Shadowing Program initiated by the hospital’s Shared Leadership Education Council.
Shared Leadership
contributes to the
Superior Patient
Experience
What is Shared Leadership?
Shared leadership is both a philosophy
and a structure. The philosophy behind
shared leadership is front-line staff are
empowered to take the lead in making the
decisions that affect patient care and parent
and employee satisfaction. Front-line staff
lead the councils that make the decisions
while leadership mentors and supports the
implementation of those decisions.
Amy McAlister, BSN, RN, CPN, CNN,
and her patient Shanna Basile.
Patient Safety Council
Development of the Good Catch
Program and the role of the Safety
Coach were key accomplishments
achieved by the Patient Safety Council.
The Good Catch Program rewards and
recognizes staff who identified unsafe
practices, thus preventing an error from
reaching the patient. The Safety Coach
is a staff member on each unit who
champions safe practice initiatives and
serves as a safety resource for staff.
Professional Standards
Council
In an effort to promote discussion
among Patient Care Services units and
departments, the Professional Standards
Council developed discussion toolkits
for their representatives with the goal
to engage staff in conversations around
how professional presence affects safe
care, effective care and exceptional
service. The toolkit includes parent
videos, survey results, staff pictures
demonstrating dos and don’ts,
commitment cards and tips on crucial
conversations.
Education Council
A subcommittee of front-line staff from
the Education Council has implemented
an inter-professional Shadowing
Program designed to gain knowledge
and perspective of clinical processes
throughout the hospital that contribute
to the Superior Patient Experience.
The program allows staff from many
areas of the hospital the opportunity
to shadow another department. They
then bring their experiences back to
their home department with the intent
to strengthen relationships between
disciplines/departments, and ultimately
improve the inner-workings of St. Louis
Children’s Hospital.
8 x 2010 ANNUAL REPOR T
What SLCH nurses say
about Shared Leadership
St. Louis Children’s Hospital
nursing staff participated in
a survey this past year about
Shared Leadership. Key results
included:
Becky Finke, BSN, RN, CPN, assists
Claudia Claudio, RRT, with a BiPAP
treatment. New respiratory care
guidelines have been implemented
through the Shared Leadership Clinical
Practice Council.
hospital and a customized unit-specific
handout to communicate the most
important information parents should
know about the unit where their child
is admitted. This guide eliminated the
need to provide multiple single sources
of information.
Brandy Benetin, BSN, RN, shares helpful
patient information about the 12th floor
from the new Orientation Guide with
Andrea Postawko, whose daughter was
admitted to the Neurosciences unit.
Performance Improvement
Council
The Performance Improvement Council
identified an opportunity to standardize
the educational content provided to
parents on admission. A subgroup of
this council created an Orientation
Guide, which includes a Family and
Patient Guide to Services, a Guest
Information brochure with a map of the
Clinical Practice Council
Due to the vast amount of information
and requests for practice changes that
are presented to the Clinical Practice
Council, a need was identified for a
process to categorize clinical issues that
would have the greatest impact on the
patient experience. Staff members from
the council prioritized these clinical
issues and developed several task
forces based upon the most pertinent
clinical needs. As a result, several
multidisciplinary respiratory care and
vascular access guidelines have been
approved and implemented.
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believe Shared Leadership
is important to patients
and families
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believe Shared Leadership
is important for the
hospital.
The survey also provided an
opportunity for comments.
Here’s what a few nurses wrote:
“I think Shared Leadership
has resulted in a more open
environment and also has
shifted responsibility to
front-line staff. Keep up
the process.”
“It seems to be a very
important way to improve
the processes within the
hospital by using the input
and involvement of the
employees.”
“I am a rep, and I really enjoy
meeting staff from different
departments and learning
about different perspectives.”
ST. LOUIS CHILDREN’S HOSPITAL x9
The Shared Leadership Coordinating
Council provides oversight for the
coordination and integration of all
councils. Members include:
1st row (top) from left:
Amy Westfall, OTD, OTR/L
Michelle Nadler, MSN, RN, CPNP-PC
Anna Welbelhuth, PharmD
2nd row:
Mara Bollini, MHA, BSN, RN
Jill Malen
Catherine Meyers
Mary Mintum, MSN, RN
Heidi Fields, MSN, RN, CPNP-PC
3rd row:
Teresa Amrhein, BSN, RN, CPN
Steffanie Rauscher, MHA, RN, CSSBB
Peggy Conroy, BSN, RN
{̅ ÀœÜ\
Cindy Vishy, MSN, RN-BC
Peggy Gordin, MSN, RN, NEA-BC, FAAN
Sue Griffard, BSN, RN, RNC
5th row (bottom):
Jim Burns, MT (ASCP), BS
Barb Gavillet, RN, RNC-NIC
Michelle LaGrone, MDiv
Lisa Steurer, MSN, RN, CPNP-PC, CPN
STRUCTURAL
EMPOWERMENT
10 x 2010 ANNUAL REPOR T
Nurses throughout the organization are involved in
governance and decision-making structures
and processes.
ST. LOUIS CHILDREN’S HOSPITAL x11
S
Simulation Center provides
training ground for new
transport nursing model
The Transport Team at St. Louis Children’s
Hospital dedicated the past two years in
transitioning to a nurse-nurse-paramedic
model for staffing on most trips. The move
was made due to scheduling challenges
with resident physicians as well as
benchmarking data from other pediatric
transport teams. A comprehensive
education plan to train nurses on the
increased responsibilities included
monthly blocks of time in the hospital’s
Saigh Pediatric Simulation Center.
Nurses wrote scenarios based on real trip
situations and used the center for skillbuilding labs to practice such skills as
intubation and placing lines. Sessions also
were held to train physicians from each
unit of the hospital to serve the role of
medical control to respond to incoming
patients and support the nurses over the
phone during a transport.
The new nursing model has given nurses
increased pride in their team. “Transport
Team nurses are highly trained and
possess advanced skills,” says Kathy
Donovan, BSN, RN, C-NPT, Transport
Team manager. “The team is regarded
as one place nurses can really use their
skills and critical-thinking ability.”
Nurses serve as single
point of contact at new
transfer center
Pediatric nurses that staff Children’s
Direct took on a critical role this
past year as the centralized point of
contact for patient transfers from
other hospitals, direct admissions and
dispatching the St. Louis Children’s
Hospital’s Transport Team. Children’s
Direct expanded to a full-service
transfer center, and today these
nurses continue to provide a seamless
referral process for outlying hospitals,
physicians and their patients.
“Our experienced pediatric nurses at
Children’s Direct—all with either critical
care or emergency unit experience—
are the clinical equivalent to air
traffic controllers, with their quick
coordination of complex steps to get a
patient here safely,” says Doug Carlson,
MD, Children’s Direct medical director.
“Our first year has taught us a great
deal about how we can continue to
streamline the process. We actively seek
input from our referring physicians so
Jayson “Happy” Garcia enjoys a
beautiful day on the hospital’s rooftop
garden.
we can make transferring patients to us
even easier.”
The Transfer Center is now available
24 hours a day, seven days a week.
Customers are regularly surveyed
regarding the nurse’s ability to quickly
connect the referring and accepting
physicians as well as their ability
to provide pre-admission clinical
information to physicians and nurses on
accepting units.
In 2010, Children’s Direct nurses managed 12,806 calls including:
Transport Team nurses Michelle Sarli,
BSN, RN, RNC, Angela Tumminia,
BSN, RN, and Stefanie Senn, BSN,
RN, participate in the treatment of an
accident victim in the hospital’s Saigh
Pediatric Simulation Center.
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EXEMPLARY
PROFESSIONAL PRACTICE
12 x 2010 ANNUAL REPOR T
Nursing practice illustrates the mission, vision
and values of the organization. Patient care is
family-centered and nurses are accountable for
clinical decision making and outcomes.
Interdisciplinary collaboration is evident, as the
nurse practices within a culture of safety in an
environment that supports quality monitoring
and improvement to achieve optimal patient
outcomes.
ST. LOUIS CHILDREN’S HOSPITAL x13
S
New role for nurse
practitioners
Although the number of consecutive
hours a resident can work dramatically
decreased beginning July 2011,
St. Louis Children’s Hospital will be
prepared for these sweeping changes
with a pilot program that incorporated
nurse practitioners into the model of
care on inpatients units. The trial care
model replaced an intern with a rotating
nurse practitioner.
“This model supplements the new
work-hour restrictions of interns and
residents. It also adds someone to the
care team who has managed the care of
this patient population for a consistent
period of time, which is often essential
to the patients and families who come
to us routinely for hospitalization,”
says Susan Hibbits, MBA, OTR/L,
FACHE, director, Neuroscience
and General Medicine.
“This new model of care will be a great
blend, combining the educational
focus of residents with the patient care
expertise of nurse practitioners on
8 East,” says Cheryl Grave, MSN, RN,
CPNP-PC. “As nurse practitioners, we
have the opportunity to look at the big
picture, not just a patient’s diagnosis.
Because we treat complex patients, this
is a challenging position, and I was
thrilled to participate on the ground
floor of this program.”
Cheryl Grave, MSN, RN, CPNP-PC,
checks in on her patient Zachary
McClelland on 8 East.
Mandt training helps staff
face challenging situations
More than 100 hospital employees,
including nurses, PCT’s, Public Safety
officers and child life specialists, have
participated in Mandt basic training
to increase workplace safety through
positive behavior and the development
of healthy relationships. The philosophy
of the Mandt System® “Putting People
First” curriculum is based on the
principle that all people have the right
to be treated with dignity and respect.
Approximately half of these staff
members have completed advanced
classes.
Sara Weyhrich, MSN, RN, CPN, unitbased clinical educator, used her Mandt
skills when faced with a 16-year-old
patient with autism who often is a
challenge for the 12th floor nurses.
The patient became agitated and
began banging his head with his hand,
which caused a nosebleed. Sara used
distraction, one of the techniques taught
in class, to help the patient regain
control of his behavior.
Cindy Atkinson, RN, and Ken Robinson,
Public Safety officer, collaborated on
Mandt training strategies on 7 West.
“Mandt training reinforces staff to
stay calm, talk through situations and
communicate. Sometimes it demands
flexibility and open mindedness about
a patient’s needs,” Weyhrich says. “A
PCT on our floor used the training on
another unit when a patient repeatedly
requested a shower, although a shower
wasn’t needed. The PCT granted the
patient’s request and after a lengthy
shower, the patient went directly to
sleep. It was later discovered that
a long, hot shower was part of this
patient’s daily bedtime routine at home.
14 x 2010 ANNUAL REPOR T
Healthy Kids Express
celebrates 10 years,
100,000 Patients
It’s been 10 years since the first
Healthy Kids Express hit the road.
Mobile unit staff have seen more than
100,000 children and performed over
200,000 screenings including hearing
and vision, anemia, lead, dental,
asthma and scoliosis. Services also
include height/weight measurements
and immunizations.
The service does not stop with
screenings. Social workers and nurses
follow up with families to resolve issues
or potential problems identified by the
exams. Healthy Kids Express provides
services to 20,000 children per year,
which is made possible through the
generosity of donors to the St. Louis
Children’s Hospital Foundation.
This past year, the Healthy Kids Express
dental program expanded its service.
The van visits different sites four days
per week to perform screening and
cleaning, as well as restorative work
including fillings, extractions, stainless
steel crowns and root canals. For
many of these children it is their first
experience with dental care.
Healthy Kids Express dental staff
LaToya Wilson, DDS, right, and
Jamelle Rucker, dental assistant, travel
throughout the St. Louis area to
provide dental care to children like
Lauren Patrick.
Because tooth decay is one of the
most common childhood diseases in
the United States, the Healthy Kids
Express dental program visits schools
and organizations to educate children,
provide teeth cleaning and fluoride
treatments as well as exams and
restorative care. On average, a child
seen on the van has six or more cavities
or dental problems.
ST. LOUIS CHILDREN’S HOSPITAL x15
S
Healthy Kids Express Milestones
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Jamelle Rucker, dental assistant,
provides an X-ray for Brad Patrick
in order to give Dr. Wilson all the
information needed for proper
diagnosis.
PROCESS IMPROVEMENT
16 x 2010 ANNUAL REPOR T
St. Louis Children’s Hospital receives more than
50,000 visits each year to its Emergency Unit.
In order to continue to provide a superior patient
experience, several process improvement efforts
have focused on the continuum of emergency care
to enhance comprehensive service to patients
and families.
ST. LOUIS CHILDREN’S HOSPITAL x17
S
Resource nurse
Patients and families that come to the
Emergency Unit (EU) for urgent care
now have access to a Resource Nurse, a
nurse completely dedicated to providing
a seamless transition to inpatient
care. Initially trialed on the hospital’s
inpatient units, today this role is based
out of the EU to help with admissions
and fluctuations in census. Float pool
nurses staff the position because of
their unique skill set and experience
of working on all inpatient units, ICUs
and the EU, and with the inpatient
documentation systems.
The Resource Nurse starts the
admission process by reviewing medical
information and meeting the patient
and family immediately after arrival.
Additional information is gathered
while initiating the admission history
profile, which often can be completed
before the patient even leaves the EU.
As time permits, the Resource Nurse
will transport patients from the EU to
inpatient units, orient them to their
room and settle them in for their stay.
The scope of the role continues to
develop with ongoing feedback from all
staff involved. Resource nurses report
that it’s rewarding to help staff and
advance care while spending more
time with patients and families.
Resource Nurses like Megan Thomas,
BSN, RN, have given patients and
families a better admission process and
provided much-needed assistance
with EU workflow.
EU throughput improves
patient experience
Two years ago, opportunities were
identified to improve the patient
experience in the EU, a critical access
point to St. Louis Children’s Hospital.
Project teams led a comprehensive
effort that resulted in a decrease in the
number of patients that leave without
being seen (LWBS) to less than
3 percent and a decrease in a patient’s
average length of stay (ALOS) for
discharge to home patients to less than
165 minutes. The project continued
into 2010 to find new ways to improve
care while sustaining the improvements
made in 2009.
Team members continued to
improve throughput by piloting and
implementing enhanced workflow
methods and adjustments to surge plans
The EU Throughput project team added
a hospitality approach when patients
must wait. Staff like Dan Bruns, BSN,
RN, received appropriate scripting for
patients and their families.
by analyzing EU data for additional
triggers. Projects were added, including
piloting a pediatric nurse practitioner
at triage and development of training
tools, such as a hospitality approach
involving scripting for waiting patients
and creation of an EU decisionmaking game. Similar to Monopoly,
the game was based on triggers to test
the department’s surge plan and its
effectiveness in patient throughput.
Patient experience scores remained
above target throughout the year.
NEW KNOWLEDGE
18 x 2010 ANNUAL REPOR T
Innovations and improvements, evidence-based
practices and research are integrated into clinical and
operational processes. Innovation is encouraged to
discover new ways to achieve high quality and
effective and efficient care.
ST. LOUIS CHILDREN’S HOSPITAL x19
S
Evidence-Based Practice
Evidence-Based Practice (EBP) is a
problem-solving approach to clinical
practice that integrates the use of best
evidence in combination with a clinician’s
expertise and patient preferences to
make decisions about the care provided.
Since 2007, St. Louis Children’s Hospital
has offered an annual EBP Scholar’s
Program that instructs the bedside nurse
in this process. Several projects have been
developed since the program’s inception to
improve patient outcomes. In some cases,
enough evidence is found to change practice
immediately. In other cases, more research
is needed before a practice change can
be implemented.
Sabbatical changes practice,
decreases BSI
Like so many nurses, Barb Gavillet,
RN, RNC-NIC, is passionate about the
babies she cares for in the Newborn
ICU. When she joined the hospital’s
Evidence-Based Scholars Program, she
already had a question in mind: What
is the best practice for changing IV lines
in the Newborn ICU? Gavillet found
little information during a literature
search and a benchmark study with half
a dozen hospitals. Unable to locate a
standard practice, Gavillet’s mission to
improve the health of her patients led
the Newborn ICU nurse to launch
a sabbatical.
“When I was approached about the
sabbatical, I wasn’t sure where to begin,
but I received so much support from
everyone,” she says. “It was something
that I really believed in. I thought
changing our IV lines every 24 hours
would reduce our bloodstream
infections (BSI) in the Newborn ICU.
Every time a line is opened, the risk of
infection increases.”
A few months following this practice
change, the Newborn ICU experienced
a drop in BSIs and went 80 days
without an infection. And, Gavillet’s
work continues. Plans call for trials
of a new Broviac dressing and a
chlorhexidine impregnated, timereleased foam patch to further
decrease BSIs.
BSI Sabbatical Steps
Barb Gavillet, RN, RNC-NIC, and
patient Ian O’Connor. Her efforts have
contributed to decreases in Newborn
ICU bloodstream infections.
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learn about new practices using
chlorhexidine and biopatches.
Patient education tools are critical
teaching resources for Tina LaPlant,
RN, assistant nurse manager, Same-day
Surgery, with patient Johnny Reynolds.
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comprised of front-line nurses.
UÊ ˜Ã̈ÌÕÌi`ÊVi˜ÌÀ>Êˆ˜iʘÕÀÃiÊ̜Ê
manage lines and dressings.
UÊ iÛiœ«i`Ê}ÀœÕ«ÊœvÊvÀœ˜Ì‡ˆ˜iÊ
nurses as Broviac super users,
specially trained on application
of dressings.
UÊ ÃÌ>LˆÃ…i`Ê>V̈œ˜Ê«>˜Ê܈̅Ê
Pharmacy to reconstruct their
work load and flow to
accommodate change.
UÊ *ÀiÃi˜Ìi`Ê«À>V̈ViÊV…>˜}iÊ
recommendation to Unit-Based
Joint Practice Team and received
full physician approval.
UÊ ˜ÌÀœ`ÕVi`ÊÓ{‡…œÕÀÊ6ʏˆ˜iÊV…>˜}ið
20 x 2010 ANNUAL REPOR T
ST. LOUIS CHILDREN’S HOSPITAL x21
S
Evidence-based practice
project focuses on exercise
“The EBP program gets your feet wet
and then once you get a project rolling,
it opens up a whole new world to
you,” says Jeff Filipiak, BSN, RN, CPN,
assistant nurse manager, 7 East. He has
devoted this past year to preparing for
what could result in a new approach
to inpatient exercise for children with
cystic fibrosis (CF). Filipiak’s EBP
project will test the concept of exercise
using video gaming on patients with CF.
Traditionally on isolation, these
patients receive daily physical therapy
by using either a treadmill or lower
body ergometer once a day in their
rooms. Filipiak and his EBP research
team hope that study participants find
enjoyment using Wii gaming equipment
that is both purposeful and visually
stimulating.
“Ultimately, exercise is a big part of
staying healthy for a patient with CF,
and we are optimistic that the Wii may
change their exercise habit,” Filipiak
says. “Parents of children with CF are
always looking for ways to engage their
child in activity, and exercising on the
Wii while in the hospital can provide
for a new and fun way to get that
much-needed exercise.”
Brandi Richard, BSN, RN, and Emily Vannoy, BSN, RN, are among the staff on the
10th floor nursing unit that dedicated their efforts to bringing nursing quality metrics
above 90 percent compliance. Bulletin boards located on the inpatient surgical floor
display each of the unit’s quality measures and progression toward success.
10th Floor achieves
quality goals
In an effort to improve the quality
of nursing care on their unit, the
10th floor inpatient surgical unit
devised strategies to achieve a
90 percent or higher compliance rate
on 15 different nursing quality metrics.
With support from their Unit-Based
Joint Practice Team, nurses identified
the following quality metrics as
priorities:
UÊ hand hygiene
Using the Wii, Landon Fryepoore
tries running in place in his room with
Clayton Copley, LPTA, and Nikki Danis,
BSN, RN.
UÊ fall risk
UÊ admission height and weight
UÊ admission pain score.
Improvement strategies included
staff meeting discussions and badge
reminder cards on compliance issues.
Nurses went a step further to request
detailed audits—in instances such
as when they failed to document
following a pain reassessment—so they
could understand where to focus their
personal opportunities
for improvement.
BUILDING SYSTEMS
OF SAFETY
22 x 2010 ANNUAL REPOR T
St. Louis Children’s Hospital is creating structures
and approaches to continually improve patient
safety. From pursuing technologically advanced
teaching methodologies to creating a culture where
front-line nursing staff can become leaders focused
on patient safety initiatives, nurses strive to
achieve optimal patient outcomes.
ST. LOUIS CHILDREN’S HOSPITAL x23
S
Nurses change heparin
practices in Cardiac
Catheterization Lab
Several nurses who participated in a
performance improvement training class
used their new skills to study recent
medication errors involving the use
of the “high alert” drug heparin in the
Cardiac Catheterization Lab (CCL).
Nurses shadowed CCL staff to
observe current procedures and
prepared a process flow chart, which
indicated gaps and inconsistencies
during medication preparation. Their
evaluation found that two syringes
were on the sterile field — heparin,
administered for de-coagulation, and
lidocaine, used to numb the skin.
“By understanding the process, we
were able to standardize it, develop
comprehensive guidelines as well as
implement the preparation of only one
form of heparin for the sole purpose of
de-coagulation of patients. This syringe
is not put on the sterile field, but is
now drawn up and administered at the
point in which it is needed,” says Mary
Hoffner, MBA, BSN, RN, CPN, patient
safety specialist. “Now just one syringe
is placed on the sterile field at any time,
which eliminates the possibility of
someone picking up the wrong syringe.”
Now in the control phase of the project,
Lori Balzer, BSN, RN, charge nurse,
Cardiac Catheterization Lab, Mary
Hoffner, MBA, BSN, RN, CPN, patient
safety specialist and Mary Mintun,
MSN, RN, charge nurse, Cardiac ICU,
seek additional project outcomes in the
coming months.
Good Catch program
promotes patient safety
As part of Shared Leadership and the
Patient Safety Council, the Good Catch
program was introduced to recognize
and reward staff members who identify
a risky situation and intervene in order
to lessen or prevent harm to patients,
families and staff. The overall intention
of the Good Catch program is to
promote safe and effective care.
Award example: A medication had
been ordered and reached the unit for
one of Jennifer Jacobi’s patients. She
noted that the medicine was different
from the one infusing and alerted
the physician before giving the new
medication to the patient.
Jennifer Jacobi, RN, prevented an
incorrect medication from being
administered to her patient on the
12th floor. She received a Best Catch
award for her efforts.
Award example: Pediatric ICU
nurse Jessica Peters, RN, prevented
an incorrect medication from being
administered to her patient. The
medication was inadvertently ordered
for her patient, but Jessica recognized
that the indications for that medication
did not fit the patient’s diagnosis or
post-operative care plan. She further
inquired with the parents whether their
child was prescribed that medication at
home, and they said it was not.
Jessica Peters, RN, was recognized
with a Good Catch award because
she prevented an incorrect medicine
from being given to her patient in the
Pediatric ICU.
24 x 2010 ANNUAL REPOR T
Carol Strobl, RN, and Dr. Lisa Madden
can now review a patient’s treatment
roadmap online, thanks to the
introduction of computerized provider
order entry on 9 West.
Computerized provider
order entry offers safer
chemotherapy practices
Days before chemotherapy is prepared
for a child, dozens of staff are involved
and many checks and balances have
to be completed. When chemotherapy
protocols were planned to become
part of KiDDOS (Komputerized
Inter-Disciplinary Documentation
and Ordering for Safety), a yearlong collaborative planning process
was initiated. Input from oncology
physicians, nurses and pharmacists
was crucial to build the safest
system possible for administering
chemotherapy to children with cancer.
Since the process involved in ordering
chemotherapy is unique, the task force
overcame many challenges. The new
system now provides an electronic
dosage calculation that reduces or
eliminates human error, as well as
any confusion caused by unclear
handwriting. In addition to the actual
chemotherapy agents, the KiDDOS
orders contain all of the monitoring
parameters necessary with the agents to
add another layer of safety.
“The order sets standardize the way
chemotherapy is written so there is
consistency in prescribing practices
by the providers, which improves the
process for each step down the line,
including dispensing and administration
of the agents,” says Deborah Robinson,
MSNR, RN, APRN, BC, PNP, CPON. “In
addition, standardized order sets for the
most common diseases are built into the
KiDDOS system, providing additional
safety in the process and increasing the
time providers can spend with patients.”
Aaron Hines, BSN, RN, with 7 West
patient Brooklynn Shipp as she prepares
to go home to Springfield, Mo.
ST. LOUIS CHILDREN’S HOSPITAL x25
S
26 x 2010 ANNUAL REPOR T
2010 by the numbers
Education
Simulation
26%
Associate’s degree or diploma
59%
Bachelor’s degree
16%
Master’s degree
2,190
6
1%
Doctorate
178
Nurses currently in school
74
450
89
Pursuing master’s degree
13
Pursuing doctorate
20
Nursing school affiliations
71
Oral presentations
Participants
37
Poster presentations
Research projects
15
Publications
16
Current research projects
Professional Development
322
88
Nursing Grand Rounds presented
336
Nursing Grand Rounds participants
104
Continuing education programs
4,674
Training events
Pursuing bachelor’s degree
365
8
Advancing Nursing Practice
36
Nurses who are certified within a
specialty
Nurses who worked in summer
camps for children with special
needs or chronic illnesses
810
Community education events
Professional Nurse Development
Program participants
24,706
Total current evidence-based
practice scholars
Served by the Family Resource
Center health information library
72,736
After Hours calls
28,091
Answer Line calls
32,950
Screened by Healthy Kids Express
Screened on
Healthy Kids Express
Mobile Health Vans
Oral and Poster
Presentations
400
152
Nurses who are members of
professional organizations
Continuing education program
participants
Certification
Community Outreach
200
35,000
32,950
365
166
320
163
160
29,000
264
121
240
120
224
108
105
206
23,000
180
17,746
160
80
17,000
118
13,433
80
0
40
2005
2006
2007
2008
2009
2010
0
41
2005
11,000 9,433
9,134
2006
2007
2008
2009
2010
5,000
2005
2006
10,789
2007
2008
2009
2010
More than 15,000 patients were
admitted to St. Louis Children’s
Hospital in 2010. Ashanti McDalton
was a patient on the hospital’s
7th floor.
ST. LOUIS CHILDREN’S HOSPITAL x27
S
ONE CHILDREN’S PLACE | ST. LOUIS, MISSOURI | 63110 | 314.454.6000 | STLOUISCHILDRENS.ORG
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