The Ohio State University Medical Center Nursing Accomplishment Report
Nurses at The Ohio State University Medical Center are dedicated to health promotion, disease prevention and community — at the local and national levels. They are both devoted caregivers and leaders seeking to influence rapidly evolving national healthcare policies. Our nurses deliver compassionate care based on the best available evidence. They are supported by leaders who strive to create an environment that ensures nurses at all levels can actively develop, revise, implement, monitor and evaluate our standards of practice through shared governance.
World-Class Personalized Nursing Care at the OhiO State UniverSity Medical center Integrity Innovation Teamwork Leadership Excellence World-Class Personalized Nursing Care at the OhiO State UniverSity Medical center Nurses at The Ohio State University Medical Center are dedicated to health promotion, disease prevention and community -- at the local and national levels. They are both devoted caregivers and leaders seeking to influence rapidly evolving national healthcare policies. Our nurses deliver compassionate care based on the best available evidence. They are supported by leaders who strive to create an environment that ensures nurses at all levels can actively develop, revise, implement, monitor and evaluate our standards of practice through shared governance. Our nurses are positioned to provide world-class, personalized care to patients through: � Leadership that upholds our commitment to establish a culture that nurtures professional development through supportive relationships. � Integrity that demonstrates our commitment to provide compassionate care and recognize the worth and privacy of each individual. � Excellence that embodies our drive to perfect our competencies and enhance the quality, timeliness and cost-effectiveness of care at The Ohio State University Medical Center. � Innovation that drives the application of emerging best practices in health care to meet the unique needs of patients and families. � Teamwork that reflects our ideals of interdisciplinary collaboration with our patients and their families to promote optimal outcomes. Our efforts mirror the excellence set forth from Magnet� recognition -- nursing's highest honor. When you review the following stories of our staff, we hope they fill you with the same sense of pride and privilege we derive from working alongside them. The Ohio State University Medical Center Nurse Executive Council Mary G. Nash, PhD, RN, FAAN Chief Nurse Executive The Ohio State University Health System Table of Contents Transformational Leadership ........................................................................................... Pages 2-5 See how our nurses affect and shape their own role as leaders in our organization through continous learning. Structural Empowerment ................................................................................................. Pages 6-9 Learn about the shared governance practices guiding our future. Exemplary Professional Practice..................................................................................Pages 10-13 Review the ways our nurses demonstrate best practices in patient care. New Knowledge, Innovation and Improvements .................................................... Pages 14-17 Find out how our academic research mission keeps us at the forefront of care. Empirical Outcomes ...................................................................................................... Pages 18-23 See the measures that demonstrate how we improve people's lives through quality care. Awards and Honors and Points of Pride ...........................................................................Page 24 By the Numbers ...................................................................................................................Pages 25 At Ohio State, our focus on excellence is consistent with the Magnet� philosophy. This report highlights our nursing and patient care accomplishments as they relate to the Magnet� model. TM Transformational Leadership I Nursing Accomplishment Report 09 Transformational Leadership "We know that all of our nurses are leaders -- from bedside to boardroom," says Mary Nash, PhD, RN, chief nurse executive for The Ohio State University Health System. page 2 Transformational Leadership I Nursing Accomplishment Report 09 Transformational nursing leadership is not merely a series of skills or tasks. Rather, it is the ability to inspire nurses to expand their capacity and create the results they desire. The signs of transformational leadership are unmistakable -- it nurtures new and expansive patterns of thinking, sets collective aspirations free and establishes an environment where people continually learn together. Transformational Leadership in Action: The Nurse Manager Development Program When Lindsey Osting, BSN, RN, became a nurse manager, her responsibilities included areas such as finance and strategic communication in which she had little previous experience. When nursing satisfaction surveys indicated managers like Osting wanted a more formal on-boarding process, she worked with a committee of peers to develop a new nurse manager orientation program incorporating mentorship, coaching, peer interaction and education offerings. "Nurse managers at Ohio State now have the opportunity to develop essential leadership skills and can take advantage of education programs supporting specific competencies including finance, quality and safety, ClairVia, research and evidence-based practice. Not only does this help new nurse managers get up to speed quickly; it also provides a tool for existing nurse managers to measure competency and progress," Osting says. "One of the most impressive elements is that nurses were key in developing the orientation standards," she adds. "This is another example of how, at Ohio State, nursing leadership does not rest merely with administrators and high-level managers." Photo at left, from left to right: Debra McCormick, RN, SNIV, CGRN, CNOR; Mary Kirkman BSN, RN; Sue Timmerman, RN, CDN; Nancy Wollam, RN, staff nurse IV; Florence Biliran, RN Photo at right: Lindsey Osting, BSN, RN page 3 Transformational Leadership I Nursing Accomplishment Report 09 Transformational Leadership The Clinical Ladder Program Supports Our Vision To extend leadership to the bedside, Ohio State also offers the Clinical Ladder program. "This is really one of the most vibrant and exciting programs at Ohio State," says Debra McCormick, RN, staff nurse IV. Clinical Ladder is a voluntary program in which nurses demonstrate expertise in the areas of clinical management, educational activities and research. The program enables nurses to advance their careers while maintaining a clinical focus on patient care at the bedside. McCormick has participated in Clinical Ladder and now sits on the committee that reviews applications to the program. "I learn so much when reading about the excellent work our nurses are doing at the bedside and am glad to work on a committee that encourages all nurses to reach for ever-higher levels of competency. With so many outstanding nurses at Ohio State, I am also excited that we have reworked the application process to encourage even more of us to climb the Clinical Ladder." Why We Remain a Workplace of Choice An important measure of transformational leadership is our ability to attract, select and retain exceptionally talented nurses to create a workplace of choice. Below are but a few of the many accomplishments that illustrate the standard of high performance for which Ohio State is known. � AONE Fellows -- The highly competitive American Organization of Nurse Executives Nurse Manager Fellowship is designed to help nurses develop and enhance leadership competencies. In recent years, seven Ohio State nurses have been accepted into this competitive program. � Professional Associations -- With membership and leadership in local, regional, state, national and international organizations, nurses at all levels are encouraged and given support to participate in professional nursing associations. � Nurse Professional Development -- Our nurses have the opportunity to participate in several professional development activities, including Nursing Grand Rounds and continuing education seminars. From July 2008 through June 2009, more than 8,200 nurses participated in Continuing Nursing Education programs at Ohio State. page 4 Transformational Leadership I Nursing Accomplishment Report 09 Focus on Excellence Service Excellence in Hourly Rounding and Discharge Phone Calls When nurses at Ohio State sought ways to improve patient care and the patient experience, they turned to empirical research. The result was a decision to focus on hourly rounding and discharge phone calls. Hourly Rounding for the 3 Ps 10 West Doan Hall � University Hospital "Everything we found pointed to patient rounding for the three Ps: Pain, Potty and Positioning," says Julie Marinelli, RN, CNP, nurse manager. "On our unit, nurses and patient care associates rotate to visit every patient each hour during the day to assess the patient's pain and take appropriate action, address bathroom needs and ensure the patient is properly and comfortable positioned," says Marinelli. The result is improved clinical outcomes for the patient, higher staff satisfaction and reduced risks and staff time answering call lights. Discharge Phone Calls Tower 10 � University Hospital East Patient feedback is crucial to improving the patient care experience. To proactively capture this feedback, charge nurses on Tower 10 make daily discharge phone calls to gauge patients' experiences and note opportunities for improvement. The result is a heightened awareness of patient feedback and lapses in care among the nursing staff. "Almost everything that we've done as a group (to improve the patient experience) has come from direct patient feedback," says Barry Frey, BSN, RN, nurse manager. Photo at right: Cheryl Reed, BSN, RN page 5 Structural Empowerment I Nursing Accomplishment Report 09 Structural Empowerment Empowered nurses are effective nurses. Of all the decision-makers in the hospital, bedside nurses are in closest proximity to the patient -- giving them the greatest power to interpret and act on subtle patient clues. Nurses are empowered when supported by policies, processes and structure that promote autonomous practice and independent decision-making. By soliciting input and ideas to identify and resolve operational and quality issues from nursing staff at all levels, Ohio State cultivates collaboration and the free exchange of ideas. With nursing represented across the leadership spectrum, nurses are empowered to achieve the highest degree of clinical excellence and professional fulfillment. page 6 Structural Empowerment I Nursing Accomplishment Report 09 Structural Empowerment in Action: Shared Governance Ohio State has operated in a shared governance model at each of its five hospitals since the 1990s, based on the belief that decisions made closest to point-of-care delivery result in positive patient, staff and system outcomes. In 2009, nurse and Health System leaders agreed that more could be accomplished if the model could be bridged system-wide. To establish operational systems and processes that support efficient, effective and safe nursing practices, Ohio State leveraged the talents of Lisa Murray-Johnson, PhD, clinical program manager in the Department of Nursing and Patient Education at OSUMC and adjunct assistant professor in Ohio State's College of Nursing. Murray-Johnson was committed to a shared governance model that was bottom up, not top down. "We interviewed more than 150 staff nurses to find out what they thought a shared governance model at Ohio State should look like," she says. The data revealed that nurses are empowered when they have control and accountability over their practice, have opportunities to collaborate with other healthcare professionals and can extend their influence into administrative areas previously controlled only by managers. Nurses then were invited to apply to become part of the Shared Governance Design Team that would define the structure and details needed to implement a new system-wide shared governance model. Working from the focus-group data, best-practice research and feedback from their units, this team designed a model built on two pillars: unit councils and central councils. Unit Councils -- As much as possible, unit nurses make decisions that affect their individual nursing unit or area. Formed at the discretion of the unit staff, each unit council makes practice and policy recommendations and examine such subjects as unit cleanliness, change of shift handoffs, patient satisfaction and quality/performance improvement. Central Councils -- Issues and decisions that have impact across more than one unit or affect other departments and professional disciplines are taken to one of the central councils, most of which are led by staff nurse chairs. Current central councils include Clinical Practice Council, Magnet Council, Professional Development Council, Quality Council and Research Council. The new Health System shared governance structure is similar to that of Ohio State's Comprehensive Cancer Center -- Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. Established in 2004, The OSUCCC-James Cancer Hospital and Solove Research Institute shared governance model combines unit councils with central councils including the Clinical Practice Council, Management Council, Magnet Council, Mid-Level Provider Council, Professional Development Council, Quality Council and Research Council. Anne Fletcher, BSN, RNC, is one of the Shared Governance Design Team members. "Many organizations talk about shared governance, but in reality they implement strategies developed in the boardroom and handed down to the bedside," she says. "It is so exciting that Ohio State is relying on staff nurses as a guiding force to develop a comprehensive shared governance model that gives nurses a voice in the future of health care." Photo at left: Members of Ohio State's Health System Shared Governance Research Council page 7 Structural Empowerment I Nursing Accomplishment Report 09 Structural Empowerment Nurses Give Voice to Change through Education and Community Service Structural empowerment gives nurses a voice throughout Ohio State, supports a productive, engaged workforce and leads to staff satisfaction, patient satisfaction and improved patient outcomes. � Nursing Grand Rounds -- Professional Nursing Grand Rounds provide a continuing educational forum to educate nurses about professional practice issues. With the topics selected by staff nurses from the Nursing Education Council, nurses are empowered to achieve the highest professional nursing practice standards. According to Imelda Teng, BSN, RN, "Nursing Grand Rounds are a wonderful educational opportunity for our nursing staff." � Operation Feed -- This year, in conjunction with Nurses Week, Ohio State's nurses supported Operation Feed by collecting boxes of food and cash donations. The Mid-Ohio Foodbank sponsors Operation Feed and helps collect non-perishable food for distribution to 228 food pantries and soup kitchens that provide meals for children, senior citizens and families throughout Central Ohio. Nurses Lead the Way at OSU Harding Hospital At OSU Harding Hospital, nurses are using their practical knowledge of what works for patient care and hospital operations to make the experience better for patients, families and staff. Janet Schaffer, BSN, RN, is part of the Shared Governance Design Team at OSU Harding Hospital. "I find it very exciting what we're doing, because instead of just ideas and policy and rules coming down, we get to say, `What's best for our patients? What do they need? What do they like? What makes them happy?'" Shaffer says. "Shared governance really comes from the bedside up because we DO know the patients, we ARE the frontlines, we KNOW what works." Photo at right: Janet Schaffer, BSN, RN; Ginger Supplee, BSN, RN page 8 Structural Empowerment I Nursing Accomplishment Report 09 Focus on Excellence Commitment to the Community Ohio State nurses are members of many community organizations and volunteer in a vast number of areas reflecting personal and professional commitments. Almost 250 nurses reported volunteer and community efforts with more than 400 entries in a Community Involvement report for the last few years. Specific contributions include University Hospital East Community Day, March of Dimes, American Red Cross, the SOAR Program and Operation Buckeye. Nurse residents participate in Operation Buckeye by collecting supplies for U.S. troops. Pelotonia Riders Raise $4.5 million for Cancer Research at Ohio State Chris Krall BSN, RN, OCN, is a nurse at The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute. During Pelotonia's inaugural tour, Krall biked 100 miles. "Participating was a no brainer. I have been a nurse at The James since 1996 and have witnessed many incredible people fight cancer. It was the least I could do to honor and remember them," says Krall. Before riding in Pelotonia, Krall didn't even own a bike. "The expenses, those shoes, colleagues seeing me in bike shorts, the falls, the hills and the tears, these are nothing compared to chemo." Krall was one of hundreds of healthcare professionals who contributed to the success of the inaugural Pelotonia tour, whether it was by passing out survivor gifts, staffing information booths or riding. Together with friends, family, neighbors and colleagues, 2,265 riders raised $4,511,868.42 that will go directly to life-saving research. Krall and other Pelotonia riders from 31 states and Canada � including Lance Armstrong � drew cheers, handmade signs and an outpouring of support along the route and throughout the entire weekend. The second annual Pelotonia will be held August 20 to 22, 2010. page 9 Exemplary Professional Practice I Nursing Accomplishment Report 09 Exemplary Professional Practice At Ohio State, personalized nursing care means providing the right care for the right person at the right time. It is care that is deeply compassionate and informed by evidence-based nursing and scholarship in nursing practice -- every patient, every time, every touch. Defining and embracing exemplary professional practice values and performance expectations makes meeting these high standards possible. Ohio State has created a culture in which all nurses are expected to integrate individual clinical expertise with the best available clinical evidence. From research to staffing support tools to formal mentoring, Ohio State ensures that nurses have the resources to make conscientious use of evidence-based practice. page 10 Exemplary Professional Practice I Nursing Accomplishment Report 09 Exemplary Professional Practice in Action: Staffing With ClairVia "Having enough staff members available to meet patients' personalized healthcare needs is key to both patient safety and satisfaction," explains Traci Mignery, RN, nurse manager, 4 Ross. "In the past, nurses submitted their scheduling preferences on paper, and then nurse managers entered all of the data into the computer to generate a final schedule. Needless to say, this was very time-consuming and not always responsive to patient and staff needs." Mignery was encouraged when nursing leadership at Ohio State made a commitment to finding a scheduling solution that was efficient, organized and responsive. Leadership formed a multidisciplinary team -- including many staff nurses -- to research, review and select a workforce performance management tool. The final choice of the team was the ClairVia Workload Management System. It is designed to: � Promote more efficient resource allocation � Improve performance measurement and outcome tracking � Eliminate manual data gathering and reporting � Provide tools to improve leadership's ability to make operational decisions � Offer real-time decision support for precise deployment of staff � Provide simpler, more accurate cost, productivity and overall performance reporting � Enable unit-to-unit and facility-to-facility benchmarking "It is one thing to say that nurses are important, but to follow that with action by allowing nurses to make important capital decisions about a system-wide change -- that really shows nurses matter," says Mignery. Mignery has been just as impressed as the ClairVia system has gone live. "This workload management system not only improves positive patient outcomes by allowing us to measure and predict each patient's nursing needs," she says. "It also gives nurses more control over individual shift scheduling. I can access and manage my schedule from home, which makes me more effective in both my professional and personal life." page 11 Exemplary Professional Practice I Nursing Accomplishment Report 09 Exemplary Professional Practice Often, the Emergency Department represents the first line of defense for sick or injured patients. Short wait times and a positive experience are important drivers of both patient satisfaction and a favorable community image. Conversely, inefficient processes that cannot handle peak demand place patients at risk and create a stressful working environment. In the summer of 2008, The Ohio State University Health System was performing below national benchmark standards for key performance metrics. It was taking too long to see patients, too many patients were leaving before they were even seen and there were too many hours of diversion. "The only way to improve processes is to take an accurate measurement of current practice and set higher expectations," says Tammy Moore, director of Emergency Services. "Working from the empirical data, nurses, physicians and our other healthcare professionals developed a number of tools to drive reduction in door-to-physician, door-to-discharge and door-to-inpatient cycle times, while simultaneously improving patient and staff satisfaction." To the credit of our healthcare providers, there has been a marked improvement in the patient experience. Our national benchmark length of stay for patients prior to being seen decreased by 20 percent between July 2008 and October 2009, with the number of patients leaving the ED without being seen at all reduced to less than two percent. These improvements are reflected in the overall patient satisfaction scores for the period. * National benchmark 1.2 percent, ** National benchmark 5.1 hours, *** National benchmark 78.5 page 12 Exemplary Professional Practice I Nursing Accomplishment Report 09 Focus on Excellence Jill Rasey, MSN, RN, CNP; Meleana Burt, CNP Clinical Practice Alert Sometimes an event prompts an immediate need for a nursing practice review. With Ohio State's technology infrastructure, the new Clinical Practice Alert feature enables nurses to be notified immediately when such an event occurs. For example, last year a nursing director discovered the need for communication and clarification of a practice change in verifying nasogastric tube placement in agitated or confused patients. The case was reviewed, a root cause analysis conducted and recommendations received. An immediate literature review commenced, and the standard of care was updated. Using the Clinical Practice Alert, a high-priority e-mail was sent promptly to all nurse managers and directors. In addition, the alert was hand-carried throughout the system and presented to the charge nurse and nurse manager for immediate distribution. Photo at left: Vanessa Withers, RN; Philip Holt, BSN, RN, CEN; Deb Macioci, RN; Cheryl Levering, RN, CEN; Justin Crockett, EMT-P; Margaret HickleGrimm, RN, BSSW; Stacey Boyer, PCA page 13 New Knowledge, Innovation and Improvements I Nursing Accomplishment Report 09 New Knowledge, Innovation and Improvements The Ohio State University Medical Center saves lives and improves the quality of life by rapidly translating the latest discoveries from the research lab to the bedside. As the primary bedside care providers, nurses must make sound interpretations of new knowledge, clearly articulate their understanding and make rapid judgments -- all while maintaining the empathy to offer a hug, a touch of the hand or the gift of listening to a patient. With Ohio State's passion for new knowledge, innovations and improvements, nurses continuously refine their professional values, competencies, knowledge and skills. page 14 New Knowledge, Innovation and Improvements I Nursing Accomplishment Report 09 Integrated Health Information System (IHIS) In August 2009, The Ohio State University Medical Center kicked off the largest IT project in its history � an Integrated Healthcare Information System (IHIS). When completed, IHIS will replace all major patient-care systems with an integrated and patient-centric electronic medical record (EMR) system to support patient care, research and education throughout OSUMC. IHIS is an addition to the current Epic platform that houses Ohio State's Outpatient EMR, the Operating Room (OR) system at the Outpatient Surgery Center and the new pharmacy system. Employee feedback is essential to the development of a well-designed IHIS that helps achieve the research, education and patient care goals of our organization. More than 250 nurses attended IHIS validation sessions to get an overview of the new applications and offer development insight. Exemplary Professional Practice in Action: Oral Care Research Project "Traditionally, oral care is generally considered a comfort factor for patients and is left to the discretion of the individual bedside nurse," explains Cindy Gatens, MS, RN, clinical nurse specialist at Dodd. "However, when reviewing research literature with our speech therapists and the department of Nursing Quality and Translational Research, we discovered there may be a link between oral care and aspiration pneumonia in stroke patients." With support from Esther Chipps, PhD, RN, Ohio State's clinical nurse scientist, Gatens and a team of interdisciplinary health professionals launched a research project to test the application of a systemic oral care intervention in stroke patients. The American Association of Rehabilitation Nurses and Sigma Theta Tau funded the proposal. Patient volunteers were divided into a control group and an intervention group. Nurses will provide the intervention patients with a vigorous oral care program including selected oral hygiene products and a battery operated toothbrush. The health of the patient's oral cavity, oral intake, caloric intake, severity of dysphagia, incidence of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus (MRSA) and the patient's perceived quality of life will be measured. The next step will be to determine if decreased oral pathogens reduce the incidence of aspiration pneumonia in stroke patients. "It is the job of advanced practice nurses to find answers to new questions," says Gatens. "With the resources provided to nurses at Ohio State -- from having time to conduct research and support from the Department of Nursing Quality and Translational Research -- we can make a difference for our own patients and throughout the Health System." Photo at left, from left to right: Rozena Davis, BSN, RN, Cindy Gatens, MS, RN, CRRN , Rosemary Coriell, BSN, RN. page 15 New Knowledge, Innovation and Improvements I Nursing Accomplishment Report 09 New Knowledge, Innovation and Improvements Measuring Safety Behaviors in Nurses: Developing a New Instrument Reading three Institute of Medicine's reports, To Err is Human: Building a Safer Health System, Crossing the Quality Chasm: A New Health System for the 21st Century and Keeping Patients Safe: Transforming the Work Environment of Nurses, resulted in a shift in research interests for Ohio State's Esther Chipps, PhD, RN, clinical nurse scientist. "While patient safety has been a focus of health care for some time, these reports and others make it clear that there is a substantial gap between stated patient safety goals and actual results," explains Chipps. "Furthermore, the majority of studies about patient safety simply address issues of organizational culture and staff attitudes about patient safety. I want information about what really happens at the bedside. I want to know how nurses respond when they have 18 tasks, five patients and constant interruptions so we can develop safety initiatives that address real-life nursing practice." The project is called "Measuring Safety Behaviors in Nurses: Development of a New Instrument" and is led by Chipps. After conducting an extensive literature review, the research team interviewed 14 nurses about everyday challenges in delivering safe care. Based on the general themes that emerged, the team created a series of representational case studies that they then reviewed with focus groups of experienced nurses. Following input from the expert nurse clinicians, the case studies will be refined and pilot tested on 15 volunteer staff nurses who work in the acute care setting. The nurses will be asked to clarify the severity of the error within the case studies and select from a list of 20 factors that could have contributed to the error, such as a lack of experience, misuse of equipment or an unexpected change in workload. They will also be asked about their own performance, using a response scale that includes levels such as, "I have never done this before," and, "I have done this only once." Once the pilot testing is complete and the response instrument finalized, the research team will work with the Ohio Nurses Association (ONA) to contact at least 800 Registered Nurses through e-mail to recruit enough participants for meaningful data analysis. "In order to design teaching programs and hospital policies that support patient safety, we simply must find the commonality in the challenges nurses face in delivering safe care," says Chipps. "To our knowledge, this project represents the first instrument that describes the safety behaviors of nurses and will give us the information needed to advance the safety of the patient." page 16 New Knowledge, Innovation and Improvements I Nursing Accomplishment Report 09 Focus on Excellence Current research initiatives supported by the 2009-2010 Nursing Research Council include: � Impact of System-centered Factors, and Processes of Nursing Care on Fall Prevalence and Injuries from Falls � Measuring Changes in Nurses' Burn Prevention Knowledge � Post Baccalaureate Graduate Nurse Residency Program Demonstration Project Evaluation and Study � The Impact of an Education Program on the Reduction of Bullying in Inpatient Nursing Units � Impact of an Oral Care Protocol on Post Stroke Survivors � THROAT Assessment: An Inter-rater Reliability Study The Research Team � Esther Chipps, PhD, RN, clinical nurse scientist � Nancy Ryan-Wenger, PhD, RN, CPNP, FAAN, director of Nursing Research at the Nationwide Children's Hospital � Sharon Schweikhart, PhD, associate professor, director of the Master of Health Administration Program at The Ohio State University College of Public Health � Victoria Elfrink, PhD, RN, clinical assistant professor at The Ohio State University College of Nursing � Celia Wills, PhD, RN, associate professor at The Ohio State University College of Nursing � Emily Patterson, PhD, research scientist at The Ohio State University College of Engineering � Recognition and Treatment of Alcohol Withdrawal Syndrome in Burn Patients: Impact on Nursing Care and Patient Outcomes Using a New Clinical Guideline � Neonatal Abstinence Syndrome: Outcomes for Infants � Nursing Handoff: An Exploration of the Process � Workplace Bullying and Emotional Exhaustion � Using Computer-Based Learning as a Method of Establishing Competency in High Risk, Low Volume Nursing Care � Measuring Safety Behaviors in Nurses: Development of a New Instrument � Early Assessment and Planning for Vascular Access Device: Impact of Length of Stay page 17 Empirical Outcomes I Nursing Accomplishment Report 09 Empirical Outcomes The vital role of nursing at Ohio State is not only illuminated in the many inspiring stories of care shared by grateful patients and families; it also is captured in carefully measured and evaluated empirical outcomes. Our nursing quality directly affects patient outcomes and is reflected in system-wide measures of productivity, efficiency and financial health. Evaluating standards of practice allows our nurses at all levels to access, evaluate and integrate empirical data to improve practice and patient outcomes. By continually reviewing our nursing practice, Ohio State is positioned to provide world-class, personalized care. page 18 Empirical Outcomes I Nursing Accomplishment Report 09 Empirical Outcomes in Action: Ergonomics "Safely moving patients is just the right thing to do -- both for patients and nurses," says Jason Gilbert, RN, nurse manager, 7 Ross. "That's why it's important to use empirical outcomes to ensure that process or equipment changes improve patient and staff outcomes." Gilbert is a member of the multidisciplinary Ergonomics Committee, which focuses on safely moving patients and includes representatives from administration, nursing, physical therapy, finance, rehabilitation, employee health and safety. The group evaluated Ohio State's employee injury and patient safety data to determine the impact of ergonomics. "We found traditional patient handling techniques, such as individual or team lifting, have an enormous cost to staff safety as well as patient outcomes and satisfaction," explains Gilbert. "As obesity trends continue to rise, our nurses are at substantial risk for back injury when moving patients. Resulting injuries lead to expensive rehabilitation for the injured nurse and increased overtime cost to cover his or her job." He adds that patients feel uncomfortable emotionally when an entire team of nurses gathers to move them, which subtly affects patient satisfaction. Using the data collected, committee members evaluated ergonomic patient slings from several different vendors and visited a Cincinnati-area hospital with similar equipment. The committee then conducted an assessment of every patient care unit at Ohio State and made recommendations for equipment needs. The Board approved $150,000 to purchase the new sling-type equipment, which recently arrived. Nurses have completed in-service education on the proper use of the equipment. "Our nurses are extremely gratified not only to have an improved care delivery model, but also to feel part of an important decision-making process. With the opportunity for nurses to participate in empirical-outcomedriven care decisions, we can see how our work can have significant impact across the entire Ohio State University Health System," Gilbert concludes. page 19 Empirical Outcomes I Nursing Accomplishment Report 09 Empirical Outcomes Changing the Numbers: Hospital-acquired Pressure Ulcers Despite technological and preventive advances in recent years, the incidence of hospital-acquired pressure ulcers remains distressingly high across the nation. Reducing the incidence of hospital-acquired ulcers became one of four main areas of focus at Ohio State in 2009. Under the leadership of the department of Nursing Quality and Translational Research, a multidisciplinary quality-improvement team compiled research and created a new protocol. The rate of hospital-acquired pressure ulcers at Ohio State is now well below the national benchmark. Thirty-two percent of nursing units met the National Database of Nursing Quality Indicators top quartile for hospital-acquired pressure ulcers per 1,000 patient days. In addition, 47 percent of units had a decrease in unit-acquired pressure ulcers between 2008 and 2009. The Blood and Marrow Transplant (BMT) unit in Ohio State's Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute has been without a hospital-acquired ulcer for over three years. In the most recent quarter, University Hospital East had only one case in all of its medical-surgical units. To further improve outcomes, Ohio State participated in an additional review sponsored by the University Health Systems Consortium (UHSC), an alliance of 103 academic medical centers working together to accelerate clinical and operational excellence. Ohio State was one of only two hospitals named as a "Best Performer" in the study and was subsequently invited to share the story of our success at the annual University Health System Consortium Knowledge Transfer Meeting. page 20 Empirical Outcomes I Nursing Accomplishment Report 09 Focus on Excellence Reducing Patient Falls Reducing the number of falls is a priority for all units, and 8 Rhodes PCU completed a full review of all falls over a 13-month period. The result was creation of a unit-specific, computer-based learning module incorporating evidence-based recommendations that are reinforced through Nursing's Falls Prevention policy. In addition, education on bed alarms was reinforced during mandatory restraint education. To facilitate timely use by nursing staff, all bed alarms and associated supplies are now in one location. Patients and families also receive a welcome packet containing falls prevention information on admission to the unit. As a result, 21 percent of nursing units meet or exceed the National Database of Nursing Quality Indicators top quartile for patient falls per 1,000 patients. Between 2008 and 2009, 59 percent of units achieved a decrease in patient falls. Photo below, names left to right: Chris Rizzo, BSN, RN, Christina Karapelou, BSN, RN, Patient: Ruth Cantwell page 21 Empirical Outcomes I Nursing Accomplishment Report 09 Empirical Outcomes Caring for Our Diverse Community Columbus is the second-largest city for refugee resettlement in the U.S., after New York City. Although many patients speak English at work and in their daily lives, they often revert back to their primary language while sick or in pain. The use of interpreters and translated materials for patient education has become essential for patients' safety and positive outcomes. Last year alone, nearly 150 languages were requested through OSUMC's Interpretation Services. As a result, OSUMC has worked with other health systems in central Ohio to develop healthinfotranslations.org. This Web site contains nearly 3,000 informational materials on more than 250 health education topics, each translated into up to 18 languages. The site has been used by thousands of people across the U.S. and in at least 100 foreign countries. Family-Centered Maternity Care Empowers Patients and Families A care initiative practiced by the OSUMC Maternity Center, Family-Centered Maternity Care (FCMC) redefines the relationships between and among the childbearing woman, her family and healthcare providers. By practicing sensitivity and responsiveness to the family's beliefs, values and customs, staff members reinforce the physical and psychosocial needs of the mother, baby and family. FCMC has been found to increase staff and patient satisfaction, empower mothers and families, and follow evidencebased practice. As a result of these efforts, patient satisfaction has increased by more than 35 percentile points in national comparisons. Photo at right, names left to right: Candy Engel, RN; Ruth Labardee, MSN, RNC, CNL; Sheela Palma, BSN, RN page 22 Empirical Outcomes I Nursing Accomplishment Report 09 page 23 Recognition and Points of Pride I Nursing Accomplishment Report 09 Excellent Nurses Lead to National Recognition The Ohio State University Medical Center Points of Pride U.S.News & World Report's Honor Roll � 4,861 hospitals considered. � 21 hospitals in the country named to the prestigious Honor Roll. � Based on quality, outcomes and reputation. � 17th consecutive year the magazine has named OSUMC as one of "America's Best Hospitals." ANCC Magnet � Recognition � University Hospital and Ross Heart Hospital have again been awarded Magnet status by the American Nurses Credentialing Center (ANCC). It is the highest award a hospital can receive for outstanding achievement in nursing services, held by only 5 percent of hospitals nationwide. Beacon Award � The Ross Heart Hospital received the Beacon Award for Critical-Care Excellence, recognizing it as one of the best critical-care units in the nation. This honor, sponsored by the American Association of Critical-Care Nurses, is awarded to units that achieve the highest quality outcomes and provide exceptional care to patients and their families. Leapfrog � The Ohio State University Hospital and The Ohio State University Comprehensive Cancer Center - Arthur G. James Cancer Hospital and Richard J. Solove Research Institute were named to the Leapfrog Group's 2009 list of the 45 U.S. hospitals that deliver the best quality care while attaining the highest levels of efficiency. The Leapfrog Group is a national organization created by some of the nation's largest employers to improve health care quality. page 24 Recognition and Points of Pride I Nursing Accomplishment Report 09 By the Numbers Total Number of RN FTEs .......................................................2163 Total Number of Advanced Practice Nurses ........................ 297 Total Number of Support Staff (PCAs, etc) .........................698 Skill mix percentage of RNs .............................................75.60% Percent of RNs Certified ....................................................19.79% Percentage of RNs with Diploma .......................................9.75% Percentage of RNs with Associate ..................................35.46% Percentage of RNs with Baccalaureate .......................... 53.77% Percentage of RNs with Masters.......................................2.40% RN Turnover rate for FY 2009 ........................................... 7.20% RN Vacancy Rate for FY 2009 ..........................................8.90% page 25