health
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hope
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2013 NURSING ANNUAL REPORT
healing
2 | N U R S I N G A N N UA L REP O R T
Compiled by Jacqulyn Robison, BSN, RN, GRN Contact Jacqulyn Robison, BSN, RN, GRN P 308.630.1450 E Jacqulyn.Robison@rwmc.net 4021 Avenue B Scottsbluff, NE 69361 rwhs.org
Contents
REG I O N A L W E S T H E A LT H S ER V I C E S
Message From The CEO.............................................................................4 Message From The CNO............................................................................6 Shared Governance/Magnet Update........................................................8 Snapshots From 2013 Breakfast With Shirley.........................................9 2013 Nurses Day Award Winners...........................................................10 RN Magnet Awards.................................................................................. 11 2013 Star Awards Presented to Nurses................................................ 13 2013 Patient Safety Annual Report....................................................... 15 Behavioral Health Unit.............................................................................17 Acute Rehabilitation Unit........................................................................ 18 Medical Surgical Services....................................................................... 19 Birth and Infant Care Center and Pediatrics...........................................21 Wound Clinic, Float Pool, House Supervisors, Restorative Care, and Dialysis ............................................................... 23 Endoscopy Unit.........................................................................................24 Perioperative Services ............................................................................25 Outpatient Surgery (OPS)........................................................................ 26 Perianesthesia Care (PACU) ....................................................................27 Operating Room (OR) .............................................................................. 29 Scottsbluff Surgery Center (SBSC) .........................................................31 Critical Care and Emergency....................................................................32 Air Link Transfer Center........................................................................... 35 Home Care............................................................................................... 36 Imaging Services......................................................................................37 Cath Lab.................................................................................................. 38 Cardiac And Pulmonary Rehabilitation................................................... 39 Case Management.................................................................................. 40 Community Health....................................................................................42 Pharmacy Medication Reconciliation Nurses ....................................... 44 Quality Resource..................................................................................... 45 Risk Management ................................................................................. 46 Trauma Services.......................................................................................47 Wound Care/Ostomy Report ................................................................. 48 Shared Governance Report.................................................................... 50 Certified Nurses....................................................................................... 54
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4 | N U R S I N G A N N UA L REP O R T
MESSAGE FROM THE CEO Todd Sorensen, MD, MS
President and CEO | Regional West Health Services
To my patient care colleagues: The health care system in the United States continues its rapid transformation, though to what exactly is not yet clear. We know the focus must change towards a much more patient-centered system in which the patient’s needs are considered above other considerations.
our last serious safety event at
The Institute for Healthcare
Our efforts at Regional West
Improvement has defined a
over the past several years have
all are making in this important
“Triple Aim” initiative to serve
been quite consistent with the
as a beacon for improvement
Triple Aim, and we must remain
efforts. The Triple Aim is:
true to these objectives in order
Population Health Management
to prosper in the future. Our
(PHM) is the second of the Triple
focus on patient safety is the
Aim goals. This goal, as its title
most important element of this
suggests, is directed at finding
goal—we must never passively
and carrying out activities
accept that patients might
that will result in an overall
be harmed as a result of an
improvement in the health of the
encounter with our system. We
population. This is more difficult
have made progress on our goal
for hospital systems to address,
of reaching a Serious Safety
because the goal of most health
Event Rate of zero by the end of
systems is to increase activity
2014, having gone 113 days since
while the goal of PHM is to
• Improving the patient experience of care, including safety, quality, and satisfaction; • Improving the health of populations; and • Reducing the per capita cost of health care.
the time this is being written, but constant attention to patient safety is required for us to achieve the ultimate safety goal: that patients are never harmed in our institution. I am very appreciative of the efforts you initiative, and know that you will not relax your focus on safety.
REG I O N A L W E S T H E A LT H S ER V I C E S
improve the population’s health
And of course we are all aware
same remarkable inventiveness
and thus decrease the need for
of the need to reduce cost as we
with respect to the present
hospital and other services.
are developing all these other
challenges we in health care
capabilities. This represents
face. And I am equally confident
perhaps the biggest challenge
that we have the best team we
we face, that is, building new
could have to help us move
capability in the face of falling
forward.
We are working hard with eight other systems around the state as members of the Regional Provider Network (RPN) to find ways to acquire the capabilities to do PHM. These requirements include such things as data and information systems, case management protocols, and clinical pathways, all of which represent substantial challenges
volumes and payments for what we do. This is a challenge being faced by virtually every system in the country, so there are lots of really smart people working on it, but never the less it remains a major challenge.
for systems our size to do
As always in times of rapid
alone. We are excited about
change, the future is at once
the possibilities represented by
frightening and enticing. Given
RPN, both because it will enable
the opportunity and sufficient
these capabilities and because
reason, American initiative has
doing good PHM will prove to
proven time and again to have
be tremendously valuable to the
remarkable ability to invent
people of the region.
new ways of doing things. I am confident that we will find the
Thanks for all you do! Todd
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6 | N U R S I N G A N N UA L REP O R T
MESSAGE FROM THE CNO Shirley Knodel, RN, MS Chief Nursing Officer | Vice President Patient Care
OUR MISSION
We have an active Board Quality
Regional West Health Services seeks to serve all the people of
Committee, which contains
its communities as a steward of their health and health care.
community members who serve on our board of directors. They
OUR VISION
Our vision is that patients, physicians, and staff are valued and are the receivers and givers of health care that is safe, efficient, and of the highest quality both now and in the ever-changing future.
participate in a review of our quality reports every month and ask questions as well as make suggestions. Through education, collaboration, and transparency, we are driving more focus on
VALUE STATEMENT
We ask-always-What is in the best interest of the patient?
best practice clinical guidelines,
While we have been taught as
In 2013, we focused heavily on
procedures, ongoing education,
health care workers that first we
safety training for all staff and
and accountability. In 2012 we
are to do no harm, our mission
providers, making safety a core
also added nursing peer review
goes beyond that. It takes us
value and developing safety
as a process that has matured
from malfeasance, meaning
coaches on each unit for each
through 2013. It has been an
to do no harm, to beneficence,
shift. We have become more
excellent learning tool to drive
meaning a commitment to
proficient at analysis of near
best practice and improve
promoting the client’s well
misses, incident reports, and
quality.
being. To do that we have to
serious safety events. We have
live our value statement, “We
gained proficiency in apparent
ask-always–What is in the best
cause analysis, root cause
interest of the patient?”
analysis, and common cause
How are we doing this? By shining an intense focus on safety, quality, and the patient experience carried out in an efficient manner.
analysis. Our serious safety event has shown a downward trend since 2010 when we began our journey to make safety a core value but we are not accepting that. Our goal is to reach zero events.
clear consistent policy and
The core quality measures are showing improvement in all categories. The quality dashboard at the time of this writing shows 39 of 47 measures with a percent positive to be above 90 percent. Twenty of those measures also saw an increase in the percent positive from 2012 to 2013, with many
REG I O N A L W E S T H E A LT H S ER V I C E S
of them achieving 100 percent
transparency will need vigilance
the decision in 2013 to pursue
positive.
to continue improvement. Our
Pathway to Excellence.
We have focused on improving the patient experience as well.
goal is to be at or above the 90th percentile rank for patient
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We were rewarded for our
satisfaction overall.
hard work in 2013 by being
inpatient satisfaction metric at
Our Shared Governance
Commission as well as The
or above 90 as the percentile
Committees and Unit Practice
American College of Surgeons
rank in comparison to other
Councils have accomplished
reaccrediting us in our Level
hospitals in our database. Our
much in 2013. Shared
II trauma designation. These
latest month’s inpatient scores
Governance has restructured to
recognitions are proof of the
show that we have six metrics
roll quality and safety together,
hard work and dedication of staff
at or above the percentile
added a Nurse Finance Council,
and providers working together
rank of 90. They are courtesy
and a Night Shift Council. The
to provide outstanding care
and respect of nurses, clear
Nurse Finance Council has
to our patients. Our ongoing
communication by nurses,
been focusing on cutting costs
accreditations in CAMTS for
communication of possible side
through efficiency by creatively
Air Link, Cancer Service’s
effects of medications, quality
looking at processes that can
outstanding achievement
of food service, explanations
be streamlined and eliminating
award from the American
of new medicines, and talking
waste. The Night Shift Council
College of Surgeons for the
to patients about help after
is working on issues that
fourth time in a row, CARF
discharge.
are unique to that shift. It is
accreditation for Acute Rehab
important to engage night shift
Unit, and the Bariatric Center
staff to bring consistency and
of Excellence designation all are
reduce variation in order to
additional examples of providing
improve patient care. Employee
outstanding care and putting the
engagement is essential to
best interests of the patient first.
A year ago we had only one
We are imbedding the use of AIDET, rounding with a purpose, hand off communication, collaboration across care teams, and transparency with patient satisfaction results. Staying steady with our course of education, collaboration, and
success in improving the patient experience. The Shared Governance Council, along with nursing leadership, made
reaccredited by The Joint
8 | N U R S I N G A N N UA L REP O R T
SHARED GOVERNANCE/ MAGNET UPDATE Jacqulyn Robison, BSN, RN, GRN
Survey Preparedness and Magnet Coordinator
A
pril 2014 marked the
them. I was privileged to serve
all driven and motivated. The
beginning of my Magnet
with many nurses who worked
bitter truth is that patient
Coordinator position at
diligently on this new process.
satisfaction scores are a part of
Regional West Medical Center. Up
As I get to know the culture here
our daily trend and sometimes
until this time, Jordan Colwell
at Regional West, my goal is to
we get overwhelmed by hearing
did a wonderful job at facilitating
get to know each nursing staff
this statement day after day.
the different Shared
Pathways is meant to keep the
Governance meetings and
nursing structure energized,
pursuing Magnet status.
excited, and equipped to be
He also did extensive
ready and work those long 12
research on transitioning
hour days, even when there
from the pursuit of Magnet
seems to be no end in sight.
Accreditation to Pathways
My goal is to help everyone get
to Excellence—both
the recognition they deserve as
of which are obtained
well as help everyone learn how
through the ANCC. Jordan
to shift in this world of ever
has transitioned into a
evolving health care.
new role with Regional
Here’s to a new path in which
West Health Services and I would like to applaud him for
member personally and see what
all the hard work he has done
they hope to achieve in their
here at Regional West as Magnet
professional career. Pathways
Coordinator.
institutes 12 steps to help gain
My background originates from the Omaha community where I worked for 13 years at a
accreditation. With everyone’s help, I believe this endorsement is very attainable.
hospital that was in the process
Regional West has some truly
of working on their Pathways
talented leaders, Shared
to Excellence Certification for
Governance Council members,
the last year of my tenure with
and bedside nurses who are
we will all be traveling together. Here’s to helping each other stay focused along the way. Finally, here’s to making our efforts as a team so that none of us are left behind on this Pathways journey. Respectfully, Jackie
REG I O N A L W E S T H E A LT H S ER V I C E S
SNAPSHOTS FROM 2013 BREAKFAST WITH SHIRLEY Shirley Knodel, RN, MS
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10 | N U R S I N G A N N UA L REP O R T
2013 NURSES DAY AWARD WINNERS Friend of Nursing Award
Outstanding LPN
Peg McFarland | Perioperative Technology and Support Coordinator
Sonya Gilliand, LPN | Perioperative Department
“
Peg McFarland is a deserving nomination for the Friend of Nursing
“
One of Sonya’s great qualities is her attention to safety as a core value.
Sonya has always provided
Award. Peg is the Office/Tech
care according to Regional
Support Coordinator in the
West Medical Center’s
Operating Room. Peg deserves
elements for safety behavior.
this award because she does
Sonya models the behavior
so much behind the scenes
patient first every time, working together, and
work that she never gets recognized for. Peg not only
improving every day. The patient is the most
does scheduling for the OR, posts patient charges,
important whenever Sonya dons her blue scrubs.
makes numerous reports for various people, keeps
She is attentive to the special needs of the patient
track of all the employee’s time cards, but she also
that occur in the Operating Room and strives for the
has been given the huge task of helping our HSM
best outcomes with all patients.”
upgrade. HSM is the system that is used in OR for charting and charges.”
REG I O N A L W E S T H E A LT H S ER V I C E S
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RN MAGNET AWARDS Empirical Outcomes
Transformational Leadership
Ruth McGee, BSN, RN | 3rd Floor
Lori Reifschneider, RNC-AWHC | Nurse Manager, Regional West Physicians Clinic
“
Ruth encourages her
fulfill them no matter what
“
they are. Involves doctors,
helping several of us during
nurses, aides, and other
tragic personal occurrences.
departments necessary to
She was understanding in
fulfill the needs of the patient.”
providing time away from our
patients by being a good listener, is observant of
possible needs, and strives to
Lori is very compassionate and supportive of her nursing staff. She has
been right there beside us,
jobs and then when we returned, she provided staffing support that allowed us to get back into our
Exemplary Professional Practice Chris Micheels, RN | Perioperative Department
“
Some of the descriptive qualities of her character include: good-natured,
prudent, good judgment, talented teacher and mentor, gentle, patience, compassionate, a wealth of knowledge, valuable resource and just plain brilliant!”
working roles. But more important, she also gave us wonderful emotional support and encouragement, above and beyond anything required by her position. Lori truly cares for each of her staff.”
12 | N U R S I N G A N N UA L REP O R T New Knowledge, Innovations, and Improvement Mary Lockwood, RN | Perioperative Department
“
Mary Lockwood should receive the RN Magnet Award. Mary is an RN in
Structural Empowerment Lenna Booth, BSN, RN | Interventional Radiology
“
I feel Lenna is very deserving of this award for many reasons. First of all,
as a senior staff member in a
the Operating Room who is also
very small department, a lot of
the supervisor of the
the decision making on a day to
preoperative assistants in the
day basis falls to her, as well as
instrument room. Since taking
the delegation of the paperwork
on this difficult role, Mary has
and work load. She spends many hours during their
had to learn about the OR instrumentation, as well as
quiet times working on reviewing and updating the
proper cleaning and sterilization. Mary is in charge of
policies and procedures that govern that department.”
making sure that all instruments and trays used in the surgery cases are properly decontaminated, washed, and then sterilized based on not only the AORN standards (operating room standards), but Joint Commission standards and AAMI standards (Association for the Advancement of Medical Instruments).”
Outstanding Preceptor of Nursing Students Travis Hargreaves, BSN, RN, CCRN | CICU/PICU
“
I would like to recommend Travis for the Preceptor award nomination.
Travis is an excellent example of how a preceptor should guide his nursing students.”
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2013 STAR AWARDS PRESENTED TO NURSES Lenna Booth, BSN, RN | Interventional Radiology
I
f you are looking for an excellent and compassionate nurse,
Lenna can be the role model, according to her patients that
Lauretta Lopez, RN | Preadmit Testing
C
ongratulations to Lauretta for being awarded STAR of the
Year for 2013.
she has taken care of.
To truly understand why
“During a recent stay at
Laurie) is deserving of the
Lauretta (also known as
Regional West, I received a stress test in the
STAR of the Year award for 2013, one must read the
Respiratory Therapy Department. My nurse, Lenna
letter that was written to our CNO here at Regional
Booth, was absolutely wonderful. She went into
West. This will paint the picture of how Laurie is
great detail to explain the procedure. She then
another excellent role model in nursing for her
explained the possible uncomfortable side effects.
compassion, awareness, and courage.
Unfortunately, some do happen. But Lenna was so precious and compassionate. She held my hand and through my IV she reversed the meds and took the pain away. I can’t say enough about her wonderful
“Dear Ms. Shirley Knodel, RN, I am writing to commend Laurie Lopez, RN for the highly professional and courageous actions she took to try
care for me. She is truly a Shooting Star.”
and save the life of a cardiac arrest patient while
“Lenna gave me quality understanding and amazing
2013, my wife and I were on vacation and staying at
patience all through the heart testing. Always caring,
a resort in Puerto Vallarta. At around noon we sat
her touch and sweet smile that shone from her heart
near the main pool area and soon thereafter began a
to mine. Bless you Lenna for your outstanding care
conversation with two men who were sitting next to
for me.”
us. Without warning, one of the men slumped down
“Lenna has also taken the time with patients undergoing radiology procedures who have claustrophobia or anxiety. These types of tests can be scary and nerve-racking. She took the time to listen to a patient who was severely distressed and put that patient at ease while showing patience and compassion. Thank Lenna for being a role model. You have earned your STAR award with grace.”
vacationing in Puerto Vallarta. On Friday, May 3,
in his chair and his eyes rolled backward. Being an EMT, I immediately began an examination of him (patient), opened an airway and found he was not breathing and there was no heartbeat present. The man’s partner told me the patient had double bypass heart surgery in 2010, was a diabetic, and he had taken his medication earlier that day. We cleared the chairs away, and laid down some towels on the ground in preparation for beginning CPR. I was joined by Jose, who is the resort’s activities director, and he helped me bring the patient
14 | N U R S I N G A N N UA L REP O R T
to the ground. Jose did two
to us and we placed that on
an unfortunate outcome and it
rescue breaths and we again
the patient. Ten minutes later
is just not always possible to put
checked for vital signs and
the ambulance crew arrived.
it out of your mind and return
found none. We then began
The defibrillator model they
to vacation mode. I want to
performing CPR. We were
had is one we used over 10
commend RN Lopez for joining
immediately thereafter joined
years ago. They shocked the
us in performing CPR, which
by Laurie Lopez, who identified
patient a couple of times with
was exhausting given the length
herself as a nurse. RN Lopez
negative results. The medic crew
of time involved, coupled with
also did an examination of the
struggled with establishing
the heat and humidity that
patient and she then joined us in
an IV and administering the
existed. Her professional, take
performing CPR. She and I took
medications. You could see
charge manner was reassuring
turns doing compressions while
the frustration in the facial
to all that we had a highly
Jose continued to give mouth to
expressions of the doctor and
skilled and experienced nurse
mouth resuscitation.
she directed RN Lopez to
on-scene and that the patient
assist with the administration
was going to receive the very
of medications, which she
best in what we could do to
performed without delay and
save his life. Please extend
in a highly skilled manner.
to RN Lopez my most sincere
The patient was strapped to a
thanks and appreciation for all
backboard and then carried
that she did that day. She was
to an elevator where we stood
courageous.�
Lopez had the highest level of medical training present and she took charge of the situation. I was very impressed with her oversight of the situation and the professional manner by which she gave us direction and carried out patient care. After approximately 40 minutes of performing CPR, a doctor arrived on scene. Apparently, the hotels contract with a local doctor to respond when a guest becomes ill. The doctor did not have any equipment with her. She helped maintain the patient’s airway while we continued to perform CPR. Another guest at the hotel brought her portable oxygen machine and a nasal cannula
him up for the elevator ride to the upper parking area where the ambulance was located, all the while still performing compressions and ventilating
Thank you again, Laurie, for your excellent nursing skills. You have modeled the wonderful skills as a nurse that we know
with a bag-valve mask.
all of our staff carries as well.
We later learned that the patient
Regional West.
did not survive the cardiac arrest. I returned to the pool area and met with RN Lopez and we gave each other a supportive hug. As often as we respond to these kinds of medical emergencies, there is always a tug at your heart when there is
We appreciate you here at
REG I O N A L W E S T H E A LT H S ER V I C E S
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2013 PATIENT SAFETY ANNUAL REPORT Susan Backer, MSN, APRN-CNS, ACNS-BC
Clinical Nurse Specialist/Patient Safety Officer
2
013 marks four years since
Pelster, Environmental
Individual Failure Modes by
the start of our patient
Services, help lead this
category.
safety initiative. We ended
program.
the year with a Serious Safety Event Rate (SSER) of 0.55, which is just over a 77 percent reduction in serious safety events since we started this journey in 2009. Our
• Safety Behavior Training
• 2013 year end Common Cause Analysis data:
New Hire Orientation. We have
Compliance 23.1%
goal for 2013 was 0.25. It was
Critical Thinking
23.1%
disappointing not to reach that
Attention to Detail
12.5%
goal and serves as a reminder to maintain diligence in using the
continues on the first day of
Knowledge and Skill 11.3%
a dedicated team of people who deliver this information. Trainers are as follows: • Sean McCracken— Cardiopulmonary
Process 9.4%
• Sylvia Dolberg—Assistant
help decrease error and therefore,
Communications 7.5%
Director, Imaging Services
decrease harm to patients.
Culture/Mission
2013 highlights
Non-Intuitive
safety behavior tools that will
• Safety coaches completed
6.3%
Outpatient Surgery (OPS)
Environment 1.9%
a successful year. These
Planning and
dedicated front line workers
Coordination 1.9%
continue to work with their
Policy and
managers and directors to build and reinforce accountability of the safety behavior tools; coach and
Procedure 1.9% Resource Allocation
0.6%
Work Stress
0.6%
cross monitor co-workers; and
Culture remains high at 84.3
provide support and education
percent in the System Failure
to staff.
Modes by category. Critical
Dylan Cardiff, Safety Coordinator, and Christa
• Karna Kleager—Manager,
Thinking and Compliance, at 30.8 percent and 23.7 percent respectively, are the top two
and Post Anesthesia Care Unit (PACU) • Dylan Cardiff—Safety Coordinator • Linda Fowler—Clinical Coordinator, ICU/PCU • Michelle Powell—Staff RN, Outpatient Surgery • Lenna Booth—Staff RN, Interventional Radiology • Leader Safety Behavior Training is provided quarterly for new leaders. It is also open to current leaders as
[continued to page 16]
16 | N U R S I N G A N N UA L REP O R T [continued from page 14] a refresher and to anyone
• Enhance the practice of
Survey to AHRQ (Agency for
who wants to further develop
nursing and promote nursing
Healthcare Research and Quality)
their leadership skills. Julie
as a profession
Hospital Survey on Patient Safety
Schaff, Education Department Director, coordinates this training. • Nursing Peer Review Committee (NPRC) started in June 2013. This committee was developed by the Shared Governance Quality and Safety Council. The purpose of the NPRC is to ensure quality performance of direct nursing care at Regional West Medical Center by assessing the performance of nursing practice and utilizing the results of such assessments to improve care. Committee goals are to • Improve the quality of care provided by individual nurses • Monitor nurses’ practice performance • Identify opportunities for performance improvement • Identify system process issues • Monitor significant trends by analyzing aggregate data • Ensure that the process for peer review is clearly defined, fair, defensible, timely, and useful
The committee is made up of direct care RNs from the core nursing units. Members are: • Toni Straub—ICU/PCU • Ginny Blackburn— Perioperative Services • Jennifer Hooton—Acute Rehab Unit • Danielle Dorshorst—Perinatal Unit • Lisa Descharme—Ortho/ Neuro Unit (2E) • Rachel Hutchinson—Adult Post Surgical Unit (2W) • Susan DeBlieck—Medical/ Oncology Unit (3E) • Lorrie Joplin—Emergency Department • Kelly Fiesterman—Medical/ Oncology Unit (left mid-year for a different position) • Will Branham—Emergency Department (left organization)
Culture. The Pascal survey was last administered in December 2011 through VHA Mountain States. Since this chapter has since dissolved we investigated other survey options. We decided on the AHRQ Hospital Survey on Patient Safety Culture and feel that it best reflects the work we are doing in the Safety Culture Initiative. The survey closed in early January 2014 and data is currently being analyzed. Everyone is working hard to keep safety at the forefront. That’s not easy to do in this ever changing and uncertain health care climate. We know one thing is certain—keeping our patients safe must be a Core Value. Patient safety affects all other aspects that are important in health care, such as finances, quality, and satisfaction. If we can’t keep our patients safe, nothing else really matters.
It is a joy to work with this engaged and dedicated group of
“We are what we repeatedly do.
front line nursing staff.
Excellence, therefore, is not an act
We ended the year with a hospital survey on Patient Safety Culture. We changed survey tools this year from Pascal Metrics Culture
but a habit.” —Aristotle
BEHAVIORAL HEALTH UNIT
REG I O N A L W E S T H E A LT H S ER V I C E S
| 17
Mary Armstrong, RN
Director, Behavioral Health Unit
“
Acceptance of the
who have the passion to work
All staff completed the Hendrich
unacceptable is the
with these complex patients and
II falls education in August 2013
greatest source of grace
who understand the mind body
and we are optimistic that we
in this world.”
connection in overall health and
will continue to meet or exceed
well-being.
our target of five falls per 1,000
—Eckhart Tolle
When I read this quote, I can’t help but think that nurses who work in the behavioral health field must be gifted with an inordinate amount of grace. Working with mentally ill patients day in and day out takes a special kind of person. Psychiatric nurses “go where angels fear to tread,” caring for patients who are deeply depressed, floridly psychotic, or addicted to substances is very challenging in and of itself. However, the true strength of the
The Behavioral Health Unit faced many challenges during 2013.
Patient satisfaction continues to
Largely due to better outpatient
be area of primary focus. In 2013,
management and more effective
staff received training in AIDET
psychotropic medications, we saw
as a primary communication tool
a 15 percent decline in inpatient
for all interactions with patients,
census. Along with shrinking
families, and other customers.
revenue sources and ever growing
Throughout the year we honed
requirements from regulating
our communication skills and we
agencies, it has been an ongoing
hope to see steady improvement in
challenge to balance need with
our patient satisfaction scores as
available resources.
a result.
In spite of the challenges we had
2014 will once again be a year
many things to celebrate!
of transitions as we adjust to
psychiatric nurse is acceptance
We made it through three surveys
of the unacceptable. Being
in 2013; Joint Commission, CMS,
able to sit with a patient who is
and Region I without any major
experiencing intense emotional
deficiencies.
pain, to listen and truly hear what they are saying and to accept their level of despair without false encouragement requires a keen awareness of your own attitudes and feelings. We are fortunate to have nurses on the Behavioral Health Unit
patient days.
With safety always at the forefront, we finished 2013 with no serious safety events on the unit. We are very proud to say that the overall patient fall rate decreased significantly from 16 unassisted falls in 2012 to just two in 2013.
downsizing the unit from 18 to 12 beds and reducing staff by a total of six positions. Forging ahead in the uncertain health care world will require grace and a fair share of tenacity but we are up for the challenge.
18 | N U R S I N G A N N UA L REP O R T
ACUTE REHABILITATION UNIT
A
Tami Bokelman, MSW
Pam Cover, RN, CRRN
Program Director
Nurse Manager
lthough the Acute Rehab
and praise given to staff who
medication administration once
Unit (ARU) did not see
are praised by patients during
they have been discharged. The
growth in our 2013
rounding.
hope is to improve patient safety,
average daily census, we had many positive things happening on the unit throughout the year. When looking at our patient population, we grew in the area of patient referrals, and the number
Part of the Performance Improvement activity on ARU includes the scoring of the Functional Independence Measurement (FIM) of each
see a decrease in re-admission rates, and increase patient satisfaction rates in the area of explanations regarding new medications.
patient. The FIM instrument is a
During the year, the ARU Patient
seven level scale that measures a
Advisory Council was active and
patient’s level of independence. In
supportive in many ways on the
2013, we were able to purchase
unit, in the hospital, and in the
an On-Demand web-cast
community. They sent letters
subscription that provides easy
to the hospital administration
access for nursing and therapy
speaking to issues of accessibility
to provide continuous training
for parking and restrooms.
average.
for FIM scoring. This is very
Changes were made within the
important education, as this
hospital to address these issues.
Patient satisfaction continued to
scoring is part of what drives
They have also sent letters to the
be a focus area for ARU during
quality/reimbursement on ARU.
City of Scottsbluff with similar
2013. In order to help with
The staff received continuing
requests and those efforts are
employee engagement, we had
education credit upon completion
ongoing. We are proud of them for
the ARU staff actually take the
of these modules.
making a difference!
that came from an external facility grew by 5.5 percent. We were able to return 76 percent of our patients to their home setting, and only eight percent of our patients returned to an acute care setting. That is almost three percent lower than the national
survey as if they were a patient on the unit, and then took a look at how we would score ourselves. From there we decided what areas we would like to focus on. We maintain a consistent practice of leadership rounding on patients, and provide timely follow-up with staff on any concerns/issues, as well as timely recognition
Also in the area of Performance Improvement on ARU, Unit Manager Pam Cover worked on education for discharge medications as a quality indicator. She has put an assessment into place to determine which patients may be at high risk for re-admission secondary to
REG I O N A L W E S T H E A LT H S ER V I C E S
| 19
MEDICAL SURGICAL SERVICES Diana-Jean Baratta, MSN, MA, RN Director, Medical Surgical Services
T
  he Medical Surgical Services
organization helping cancer
Lisa Fabricius (MedSurg), Tara
Department includes the
patients who live in western
Shallenberger (MedSurg), Christy
Orthopaedic/Neurologic
Nebraska and eastern Wyoming.
Walters (MedSurg), and Mona
Surgical Unit, the Adult Post-
The Ortho/Neuro Council
Urwin (Bariatric).
Surgical Unit (including care of
addressed the process of dismissal
the bariatric surgery patients),
education and has initiated a
the Medical/Oncology Unit, and
project to help nursing save steps
Vascular Access Team. Staffed
and allow entering the room with
with teams of licensed, professional
hands free to enhance good hand
nurses and nursing support
hygiene. The Adult Post-Surgical
personnel, we strive to provide
Council initiated a project to
high quality, safe, compassionate
answer call lights more quickly.
May 2013.
Also involved in Nursing Shared
We would like to recognize Joyce
nursing in collaboration with other disciplines. Our department strives to keep the patient at the center of
Governance from our department
all of our considerations.
during 2013 were Paul Adams
The front line nursing staff are
Baratta (Administrative Advisor,
the true experts at patient care.
Prof Practice), Mary Barraza (Co-
Therefore, dynamic Unit Practice
chair, Nurse/Pharmacy), Mike
Councils (UPC) are an essential
Bokelman (Nurse Finance), Lena
part of unit improvement and
Miramontes (Professional Practice),
performance. The UPC chairs were
Rebecca Montanez (Care and
Kara Plett (Medical/Oncology), Shy
Practice), Amanda Norman (Care
Engel (Ortho/Neuro), and Sam
and Practice), Liz Ossian (Quality
Kizzire (Adult Post-Surgical). This
and Safety), Nicki Rotert (Night
year, each Unit Practice Council
Shift Council), Tara Shallenberger
created charters to better realize
(Secretary, Professional Practice),
their mission and purpose within
and Vianey Zitterkopf (Professional
the nursing governance system.
Practice).
The Unit Practice Councils meet monthly. Through their council, Medical/Oncology participated in the Festival of Hope, a nonprofit
(Chair, Nurse Finance), Diana
RNs who have maintained their specialty certifications include: Megan Anderson (Oncology),
It is always great to have someone join our team in a nursing support role, then advance to RN. We congratulate Amanda Norman, formerly CNA on Ortho/Neuro, who achieved her RN degree in
Sinner, LPN, who achieved the President’s Award for contributing over 1,000 hours as a community volunteer. Leading the teams of our three nursing care units are the Clinical Resource Nurses (CRN), experienced nurses who offer support to the nursing staff, coordinate nursing care, and are instrumental in communications both on and off the units. Our Clinical Resource Nurses during 2013 were Andrea Arellano, Shelley Dupuy, Shereen English, Lisa Fabricius, Rachel Hutchinson, Nikki Rotert, Melanie Schanaman, Jennifer Schmer, Tammie Setter, Tara Shallenberger,
[continued to page 20]
20 | N U R S I N G A N N UA L REP O R T [continued from page 19] Tammie Setter, Lenae Snyder,
Diana-Jean Baratta, Director;
about patients other than their
Crystal Sterkel, Ruth Vasquez,
Chris Buhr, Manager Medical/
own assignment. Since we want
Sheree Verbeck, and Christy
Oncology; Rebecca Montanez,
the staff to be responsive to call
Walters. The three nursing units
Manager Ortho/Neuro and
lights with anyone available
are seen as sister units, with the
Adult Post-Surgical have made
expected to answer any light, and
CRNs collaborating across units for
efforts to round regularly on the
all responsible for patient safety,
staffing and other patient needs.
units, visiting with both patients
certain critical information needed
This collaboration has noticeably
and unit employees, which is
to be disseminated to the entire
increased over the last year as the
important in developing sensitivity
team. Therefore, a before shift
CRNs engaged in two Leadership/
to operations. Staff members have
team huddle was established, the
Teambuilding retreats including
commented that they enjoy having
off-going charge reporting to the
teambuilding exercises, a fun yet
leadership present.
entire on-coming team about fall
meaningful game facilitated by Randy Meininger, and the YMCA facilitated ropes course. Activities
Mandatory staff meetings were established to ensure all nursing
risk, code status, and other crucial organizational information.
staff receive the information
Concerned about patient
and education necessary for
satisfaction, infection prevention,
daily operations.
their role. We are grateful to
and privacy, the department
the many people who took time
piloted a private room project.
Two new Clinical Coordinators,
to speak to the groups during
There are seven very small double
Melissa Snyder and Stacey
2013. These included Austin
rooms on Medical/Oncology and
Powell, were hired to help with
Engel (charting from a risk
nine additional double rooms on
the continuous educational
management perspective); Shirley
the Post-Surgical Unit. Ortho/
needs of the department nursing
Knodel, Sarah Shannon, and
Neuro has all private rooms and
staff. Simulation as a learning
Connie Rupp (uniform research
only fills up about half the time.
methodology was introduced.
project); members of the Quality
Working together, we try to avoid
Melissa and Stacey used
Department (documentation
rooming two patients together
simulation training to teach
to meet CORE measures); Paul
until we cannot. The project has
recognition of the signs and
Hofmeister and Kathy Gibbons
been mostly successful, with
symptoms of sepsis, when to call
(HIPPA compliance); Susan Backer,
patients sharing a room only at
the Rapid Response Team, and
Michelle Powel, and Liz Ossian
times of very high census or when
how to conduct a Code Blue.
(nursing peer review); and Dylan
their diagnosis makes it more
Both clinical coordinators were
Cardiff (fire extinguisher training).
appropriate to keep them within
required cooperation and critical thinking resulting in carry-over to
instrumental in conducting the department’s Education Days to ensure competency. In addition, they have been very involved in the residency program for new graduates and in working with the Education Department to define unit competency expectations.
Nursing hand-off shift-to-shift occurs at the bedside and was introduced in 2012. We realized that, while bedside report improves safe patient handover, the team had become more fragmented, knowing nothing
the specialty area. Both patients and nurses have expressed their appreciation of our efforts.
REG I O N A L W E S T H E A LT H S ER V I C E S
BIRTH AND INFANT CARE CENTER AND PEDIATRICS Connie Rupp, BSN, RN
Director, Birth and Infant Care Center and Pediatrics
T
he delivery of high quality,
• Safe Sleep education
percent. Here at Regional West,
safe, and efficient care
• ER11 training
we are happy to report that our
that keeps the patient at
the center of our concerns will continue to be our focus as we move forward in 2014. Birth and Infant Care Center Staff • We welcomed some new faces in 2013; Vanessa Rhembrandt, RN, and Jessica Kortmeyer, RN. Awards • In 2013 there were two nominees for the 2013 Regional West Medical Center’s Precepting Nurse’s Award; Michelle Dillon and Jessica Brumbaugh. • Connie Rupp was nominated for
• NORS education • “How To’s and What If’s of Breastfeeding” • CCHD screenings program • AIDET training and documentation Equipment/Supplies • New Hospira Smart A+ IV Pumps • New sleep sacks for babies • Electronic hands-free hand sanitizer dispensers Breastfeeding We have continued to implement Skin to Skin after birth. As
breastfeeding initiation rate average is 85 percent. Neonatal Intensive Care Unit (NICU) Staff • We welcomed a new face in 2013; Carly Temple, RN. Education • Hospira Smart A+ IV Pump education • Safe Sleep education • ER11 training • NORS education • How To’s and What If’s of Breastfeeding”
research proves, our breastfeeding
• CCHD screenings program
Outstanding 2013 RN Magnet
latch scores have improved as
Award, Transformational
well as our breastfeeding duration
• AIDET training and
Leader.
because of this practice change.
• Sara Kraft-Leavitt won the award for the “Best Nurse” in the Star Herald Newspaper. Education • Postpartum hemorrhage • Hospira Smart A+ IV Pump education
documentation
This also has been a patient
Equipment
satisfier. Our mothers report
• New sleep sacks for babies
this has been such a wonderful
• Hospira Smart A+ IV Pump
experience they wish they could have done this with their other
education
babies. Breastfeeding is on the rise because of the known benefits and health care reform. Nationwide the breastfeeding rate is 77
[continued to page 22]
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22 | N U R S I N G A N N UA L REP O R T
[continued from page 21] Pediatrics
Awards
Safety Improvements
Staff
In 2013 there were four nominees
• Use of Smart IV pumps
• We welcomed a new face in 2013;
for the 2013 Regional West Medical
Kristin Mitzel, RN. Equipment/Monitoring • A new NaviCare Nurse-Call System was installed on the Pediatric floor. • New Hospira Smart A+ IV Pumps were installed. Education • Pediatric Case Review-Meningitis • New Smart A+ IV Pumps • ER11 training • NORS education
Center’s Precepting Nurse’s Award; Nina Grubbs, Catharine Houstoun, Jennifer Komarek, and Julie Meier. All Areas Patient Satisfaction • We are continuing to work on improving patient satisfaction. In 2013, each staff member wrote an example of how they were able to improve patient satisfaction
• Implementation of breast milk double check by two people • Continuous education and reinforcement of the use of Safety Tools. Use of Safety Story at every meeting. Encouragement of reporting good catches. Joint Commission Survey • Successful 2013 survey! • Performance Improvement white boards
or make a difference for a patient. This was our way of
• Implemented magnetic white
proving competence of the
boards in BICC and Peds to
understanding of what patient
display monthly and quarterly
• Pediatric case review-Sepsis
satisfaction means. These were
progress in Performance Improvement.
• AIDET training and
used weekly in our Friday Updates for staff to read. We
• Pediatric case review-Pertussis
documentation • ER12 training • UPRIGHT fall prevention education
also worked on AIDET and have been monitoring for usage and success.
REG I O N A L W E S T H E A LT H S ER V I C E S
| 23
WOUND CLINIC, FLOAT POOL, HOUSE SUPERVISORS, RESTORATIVE CARE, AND DIALYSIS Sarah Shannon, BSN, RN | Director, Wound Clinic, Float Pool, House Supervisors, Restorative Care, and Dialysis
Wound Clinic
Surgery, Interventional Radiology,
DaVita started providing
A Wound Symposium was held
Cardiac Rehab, Scottsbluff
Peritoneal Dialysis Services at
in October 2013. Thank you
Surgery Center, and the
Regional West Medical Center.
to Dr. Walsh, the Education
Emergency Department.
Department, and the Wound
Language Access
Dialysis
The Language Access Coordinator
Monthly Quality Assurance and
position was approved and has
success.
Facility Management meetings
since been filled. More to come on
have been established between
this.
Float Pool
DaVita and Regional West
The Clinical Rescue Team staff
Medical Center. A new process for
floated to the following areas in
sending water culture reports to
2013: 2E, 2W, 3rd, 4th, ICU/PCU,
the Infection Control Committee
Postpartum, Peds, Outpatient
has been established.
Clinic staff for your involvement in making the symposium a great
24 | N U R S I N G A N N UA L REP O R T
ENDOSCOPY UNIT Lucrecia Spady, MSN, RN, CGRN Unit Manager, Endoscopy
T
  he Endoscopy nurses
The nursing staff helped to
with an emphasis on nursing
provide the majority of their
promote the health of the
management.
nursing care to patients at
community for colon cancer
the Scottsbluff Surgery Center-
awareness by setting up the 1st
Endoscopy Unit. However they
Annual Boxer Rebellion which was
also provide support to Regional
a 5K Fun Run/Walk that raised
West Medical Center inpatients
awareness for colon cancer month.
who need an Endoscopic
They raised over $1,000 that they
procedure. Thus, they also
donated to Festival of Hope.
strive to be knowledgeable of the hospital nursing protocols by being involved with PCS’s nursing activities such as their PI intervention, which was to check if pain was assessed appropriately. A major project this year for the Endoscopy Department was the transition from paper charting to computerized documentation. We went live in July.
Promoting continuing education is an ongoing goal of the nurses which was evident by: Lucrecia Spady, Pam Engelhaupt, Amber Gomez, and Rebecca Robles represent Endoscopy on the Shared Governance Councils. Lucrecia Spady, Unit Manager, graduated October 25 with her Master of Nursing degree
Joni Bruce is our new safety coach and will help us stay educated on our safety culture initiatives. Pam Engelhaupt, RN is working on her Bachelor of Nursing degree and will graduate in December 2015. Lucrecia Spady, Unit Manager, became the Management Advisor for the Quality and Safety Council.
REG I O N A L W E S T H E A LT H S ER V I C E S
PERIOPERATIVE SERVICES Judy Bowlin, BSN, RN
Janet Lewis, MA, BSN, RN, CNOR
Pre-Admit Testing
Director, Perioperative Services
P
| 25
re-Admit Testing staff saw
results available to us in advance
Pre-Admit Testing staff then do
over 6,300 patients in
of the patient’s Pre-Admit visit
a follow-up with patients to see if
2013. This number includes
but the questionnaire contains
they watched EMMI and if they
those we saw in advance of the
Protected Health Information (PHI)
have any questions that EMMI did
day of surgery and those whose
and at this point in time we don’t
not answer. We are finding that
preliminary visit had been via
have a secure way for the patient
the patients who watch EMMI
telephone with the completion of
to return the information to us.
really like the program and most
the visit on the day they came in for their procedure.
August brought us Expectation
In February we implemented the
Information, or EMMI for short.
use of a pre-surgical questionnaire
EMMI is an online education tool
in an effort to streamline the
that is assigned by the surgeon’s
information we collect as well as
office staff. Patients can access
save time for patients and staff.
educational material concerning
We had hoped we could put this
their operative procedure and ask
questionnaire online and have the
questions about their procedure.
Management of Medical
feel that EMMI answered any questions they had.
26 | N U R S I N G A N N UA L REP O R T
OUTPATIENT SURGERY (OPS) Karna Kleager, BS, RN
Unit Manager, Outpatient Surgery
T
  he title Outpatient Surgery
infections, (such as MRSA) range
team are Mary Duncan and Alicia
(OPS) is a little misleading for
from monthly to as frequently as
Snelling. Both are experienced
our particular unit. We do
three times a day. Those patients
nurses who are great additions to
not actually perform the surgical
requiring 24/7 antibiotic therapy
the unit.
procedures in the unit but in the
usually are treated for a minimum
past year the OPS staff admitted
of six weeks. We strive to provide
3,791 patients for surgery, of which
consistent and high quality care to
1,540 remained in the hospital after
these patients and their families.
Staffing committee: Jennifer Meyer
2013 Highlights
Michelle Powell and Kendra Vera
Obtaining certification in the
Concurrent chart review: Michelle
the same day.
national organization, American
Keener and Bobbi Decker Patient
Society of PeriAnesthesia Nurses
follow-up calls: Kelsey Judy
In addition, the OPS Unit
(ASPAN), is a goal for OPS staff.
continues to provide the pre- and
Membership to this organization
post-procedural care of patients
provides resources for certified
undergoing outpatient cardiac
new nurse orientation programs
catheterization, pacemaker
and up to date evidence-based
placements, and pacemaker
practice recommendations. Certified
generator changes. As Dr. Sorensen
PeriAnesthesia Ambulatory Nurses
explained, we are seeing a decrease
(CAPA) in OPS are Roxie Shaul and
in in-patient volumes and we are
Michelle Keener.
surgery for recovery while 2,251 patients returned to OPS after their surgery and were discharged home
experiencing some of the same with
Individual employee participation includes: and Kris Ferguson Safety coaches:
OPS UPC: Kendra Vera, Bobbi Decker, Mary Duncan, Kris Ferguson, Linda Doughty, and Aggie Collopy Nurse/Pharmacy Committee: Marlyce Burkey Shared Governance Councils: Michelle Powell, Kelsey Judy, and Mary Duncan Informatics/ER 12/MU: Michelle Keener Nursing
outpatient surgical volumes.
Michelle Powell maintains a Medical
The biggest challenges though
also remains to be one of the original
this past year are the significant
Safety Behavior trainers, presenting
increase in the outpatient infusion
Safety Behavior training to new hires
therapy services provided in OPS.
on a monthly basis during employee
In 2012, 957 patients received
orientation.
the correct time, DVT prophylaxis,
Michelle Keener represented OPS
first cases of the day, and patient
in the efforts to complete the ER
satisfaction are the focus of OPS
12 upgrade, dedicating time to
Process Improvement.
blood transfusions or medication infusions in the OPS Unit. In 2013 that number increased to 1,323. Patients’ needs for the treatment of MS, immune deficiency disorders, migraines, chronic medical conditions, or acute and persistent
Surgical Nursing Certification. She
screening review, testing upgrades, and mentoring staff during go-live. The newest members of the OPS
Finance: Roxie Shaul Service Excellence: Shon Peterson and Alicia Snelling. Hand hygiene monitoring, correct antibiotic selection being administered at attention to on-time start for the
REG I O N A L W E S T H E A LT H S ER V I C E S
| 27
PERIANESTHESIA CARE (PACU) Karna Kleager, BS, RN
Unit Manager, Perianesthesia Care Unit
P
roviding care to patients
completion of their degrees,
Staff members continue to
within the perianesthesia
transitioning from student
work on completing the ASPAN
setting is demanding in
to graduate, and summer
Competency Based Orientation
nature. The nurses need to be
internships are provided with
Program. The program is designed
well-equipped with the skills
challenging situations with one-
for orientation of new staff, but
in assessment, planning, and
on-one mentoring. Staff mentors
long standing staff felt a need to
critical thinking required for
completed the Core Curriculum
also complete the program growth
this fast paced environment as
for Clinical Coaches-Preceptor
and development.
well develop other competencies.
Development program. Chris
These competencies include skills
Micheels and Tracy Payne serve
in mentorship, communication,
as CSIs for the University of
management of crisis situations,
Nebraska Medical Center student
and being the champions for
nurses.
August 2013. Julianne transferred
Obtaining certification in the
upon her experience to provide
national organization, American
guidance on central line dressing
Society of PeriAnesthesia
changes.
patient safety. Regional West’s PACU nurses work to maintain high quality in these areas by developing skills to deal with high patient acuity, fast patient turnover, and communication challenges between units and collaboration with surgeons, anesthesia providers, and the
Nurses (ASPAN), remains a high priority in PACU. Membership to this organization provides resources for certified new nurse orientation programs and up-
entire perioperative team.
to-date evidence-based practice
2013 Highlights
of the benefits. Currently our
Chris Micheels was the recipient
Certified PeriAnesthesia Nurses
of the Exemplary Professional
(CPAN) are: Sandy Hebbert,
Practice award for Nurses Day
Chris Micheels, Tracy Payne,
2013.
Kay Lemons, and Andrea Ray.
PACU continues to be highly recognized for its learning opportunities. Students
recommendations, to name a few
Katherine Tuttle is scheduled for the certification examination in
The newest members to the unit, Julianne Meisenburger and Regina Rutter, both started in from 2W and we immediately drew
Laura Wright, Simulation Coordinator, will be working with PACU and OPS on patient education dealing with low volume/high risk situations, such as Malignant Hyperthermia. Katherine Tuttle and Nancy Ross were instrumental in the ER 12 upgrades, spending hours reviewing the screen content, testing the changes, and mentoring staff during the go-live.
2014.
completing rotations for
[continued to page 28]
28 | N U R S I N G A N N UA L REP O R T [continued from page 27] PACU staff involvement in Regional West activities Staffing committee: Laura Wright and Andrea Ray Safety Coach: Chris Micheels Service Excellence: Tracy Payne and Kellie Witcofski Informatics, ER 12 and MU: Nancy Ross and Katherine Tuttle UPC: Katherine Tuttle, Sandy Hebbert, Kay Lemons, Ginny Blackburn, and Andrea Ray Shared Governance Councils: Sandy Hebbert, Katherine Tuttle, and Kellie Witcofski Nursing Peer Review: Ginny Blackburn Nurse/Pharmacy Committee: Kay Lemons Process Improvement activities such as hand hygiene monitoring, correct antibiotic selection being administered at the correct time, DVT prophylaxis, and attention to on-time start for the first cases of the day remain of utmost importance to the PACU.
REG I O N A L W E S T H E A LT H S ER V I C E S
OPERATING ROOM (OR) Kim Brown, BSN, RN, CNOR
Unit Manager, Operating Room
O
perating Room personnel
Daily Huddles are held at 6:30
Documentation-MSM, sternal
provide surgical care
a.m. before cases begin so any
saw, rib and facial plating system,
for members of our
safety issues can be discussed.
laser safety, AIDET, wound
community as well as regions surrounding Scottsbluff. Procedures performed can be simple or extremely complex with newer, bigger, and better technology. Approximately 5,151 cases were performed in 2013. November and December kept staff very busy with 426 and 500 cases done concurrently. 2013 Highlights Patient safety is at the forefront of our daily activities. The surgical safety checklist has been implemented as a planning tool for staff, surgeons, and anesthesia. This checklist is comparable to a pilot’s checklist. Surgical checklist posters are posted in each operating room as a visual job aide. Circulating nurses are verifying needs with the surgeon before the patient is taken to the operating room to ensure all equipment is available. Safety coaches Nate Walker and Kim Mann provided updates to enhance our awareness of safety behaviors needed to provide a safe environment for our patients.
As surgical procedures and technology become more complex, our need for education expands. Rhonda Groshans, Clinical Educator, continues to provide
classification, CLABSI, Malignant Hyperthermia, Bupivacaine Liposomal, liposuction machine, I-Stat, and the use of emergency manuals.
vital education and competency
Highlighting the year for
testing for staff.
education was our first simulation
Competency testing round robin involved the use of specialty tables, the set-up of suction dilatation and curettage machine, laser safety, and sterilization. Set-up of the pediatric bronchoscope was required by all staff as this is a high risk, low volume procedure. Emergency craniotomy procedure set-up was performed by all staff as well, due to the number of cases performed as a result of traumatic injuries. Annual education provided for the year included a program on concussion, Stryker equipment, Atrium chest collection system, Neptune suction, TURP Bipolar, wound vacs, Code Silver,
demonstrating Malignant Hyperthermia. A simulation brief was presented incorporating safety behaviors for the actual simulation. Staff was divided into groups and simulations were held and recorded. All staff then reviewed the videos, critiqued, and debriefed. Staff embraced the simulation and voiced the need for further experience with simulations related to Operating Room scenarios. Education Stephanie Poole and Angie Kelley completed the PeriOp 101 program designed to educate nurses new to the perioperative environment. Dayna Dondelinger and Kim Mann have both been accepted
[continued to page 30]
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30 | N U R S I N G A N N UA L REP O R T
[continued from page 29]
into the UNMC LEAD (Nurse Leader/Executive Advanced Development) Master in Nursing program.
• Dayna Dondelinger, BSN, RN, CNOR • Rhonda Groshans, RN, CNOR • Darcy Haslam, BSN, RN, CNOR
Nurses (AORN) Congress in San Diego, Calif. Joy Stuckert and Pam Adams attended the national Association of Surgical Technologists (AST) meeting
Colleen Kelly passed the
• Colleen Kelly, BSN, RN, CNOR
certification exam for Operating
• Janet Lewis MA, BSN, RN, CNOR
conferences provide staff with
• Mary Lockwood, RN, CNOR
education related to safe care
Room nursing. Regional West Medical Center was
• Kim Mann, BSN, RN, CNOR
the first hospital in Nebraska to
McKesson Surgical Manager
be awarded the CNOR STRONG status from the Competency and Credentialing Institute (CCI). To qualify, the institution must have 50 percent of their eligible Operating Room nursing staff CNOR certified. Because of the high percentage of certified nurses, “The facility advances a culture of patient safety.” Our certified nurses are: • Kim Brown, BSN, RN, CNOR • Christy Jay, BSN, RN, CNOR
in New Orleans, La. Both
of the perioperative patient, advances in surgical techniques, and new technology.
(MSM) was successfully updated to version 16. Dayna
Process Improvement activities
Dondelinger and Peg McFarland
continue to be a priority for staff,
were instrumental in the build,
which includes monitoring of
implementation, and education of
hand hygiene, use of immediate
staff. Randy Levendofsky, Bobbi
sterilization, and on time 7 a.m.
Armstrong, Cheryl Kostman, and
starts. The Operating Room staff
Project Manager Doug Rupp were
is also responsible for assuring
the IT members involved in the
compliance with the SCIP core
support for the implementation.
quality measures. Fifty chart audits are performed monthly and
Darcy Haslam, Rhonda
feedback is given to staff to ensure
Groshans, and Janet Lewis
compliance with documentation.
attended the national Association of Perioperative Registered
REG I O N A L W E S T H E A LT H S ER V I C E S
| 31
SCOTTSBLUFF SURGERY CENTER (SBSC) Crystal Kildow, BSN, RN
I
Clinical Coordinator, Scottsbluff Surgery Center
n 2013, the Scottsbluff Surgery
Medication Reconciliation was always
Center (SBSC) provided care
a process that was completed at the
and Spring Sherrell serve on our
for over 1,700 patients. Our
SBSC, however not in the Horizon
Staff Scheduling Committee.
specialty list includes Orthopaedics;
Health System (HHS). Therefore,
Ear Nose and Throat; Plastic
we implemented use of HHS for
and Reconstructive Surgery;
Medication Reconciliation for every
Pain Management; Dental; and
patient, every time.
Gynecology.
A surgical safety checklist was
Our unit continues to explore
implemented successfully in the
new technology and advance with
Operating Room with the help of
current and new recommendations
Dr. Jonathan Morgan, Chief Medical
for providing patient care. We
Officer. This helps ensure that
strive to maintain efficiencies not
patients being prepped for their
only for the patient but also the
surgical procedure have a checklist
physicians with the ever-growing
of certain tasks performed before
change in medicine. It is of utmost
transport to the operating room,
importance that we have positive
before induction of anesthesia, before
patient experiences when entering
skin incision, and before the patient
our facility, throughout their stay,
leaves the operating room.
as well as return visits to our organization. 2014 will highlight many opportunities for improvement and we are ready for the challenge to
Hard work and diligence was poured into the process of converting from paper to electronic patient
• Carmen Benavides, Peg Jackson,
• Danielle Brown is safety coach for the Surgery Center. • UPC Committee consists of Danielle Brown, Spring Sherrell, Carmen Benavides, and Peg Jackson. • Falls Committee is represented by SBSC employee Leslie Ilg. • Perioperative and Women’s Value Analysis consists of members Carmen Benavides and Crystal Kildow. • Kelsey Winger serves on the Evidence-Based Practice Council. • Tara Harpold serves as a CSI through the UNMC precepting program for nursing students. • Amy Henke and many volunteer staff members for chart reviews.
provide even better patient care.
documentation. We were very
2013 Highlights
in the McKesson Surgical Manager
Participation in a Lean Six Sigma
upgrade. This is still an ongoing
project identified the need to adopt
process as we have had to convert
the Pathways Healthcare Scheduling
all of our physician preferences,
(PHS) system. This change saved
supplies, unit specifications, level
our organization money not only for
charges, and many more items into
We look forward to a prosperous
the software, maintenance, manual
this new system.
2014 and hope that we can
billing, and coding processes, but also helped aid in the continuum of care for the patient.
involved with many departments
Individual employee participation includes:
• Cheryl Darst serves on the Unit Secretaries Committee. • Carisa Crawford demonstrated diligence in her learning skills by cross training for dental procedures.
continue to provide this community with wonderful surgical experiences.
32 | N U R S I N G A N N UA L REP O R T
CRITICAL CARE AND EMERGENCY Nancy Hicks-Arsenault, MBA, BSN, RN
Director, Critical Care and Emergency Services
C
ritical Care and
and in leadership to all on the
Specialty certification is one
Progressive Care staff is
unit. The collegial relationship
way competency is recognized
unique in their desire and
with all disciplines has grown
for nurses. The CICU/PCU has
love for controlled chaos and the
and continues to foster excellent
nine nurses who have achieved
utilization of crisis management
patient outcomes. Stephen sets the
the CCRN certification. This
skills during every shift. Regional
example for continuing to expand
achievement is recognized as the
West Medical Center is blessed
his knowledge through pursuing
“Gold Standard” of excellence
to have this talent. These nurses
a master’s degree in nursing
in critical care nursing.
promote and help patients achieve
leadership.
Congratulations to Stephen
the highest healthy outcomes possible while being efficient and adaptable to optimize individualized care. Leadership continues to promote advancing knowledge and skill through
Linda Fowler, BSN, RN, continues in her role as clinical coordinator for Critical Care Services, coordinating advanced education and mentoring. Linda has been
Matthews, Linda Fowler, Leigh Miller, Cheryl Patrick, Cheryl Hoxworth, Teal Smith, Jackie Delatour, Marilyn Stoddard, and Travis Hargreaves.
instrumental in the success of
Our staff includes 34 registered
so many new graduates and
nurses with bachelor degrees,
seasoned nurses. Education based
three with diplomas, and eight
professionals.
on simulation was implemented
with associate degrees. We also
successfully. The sepsis treatment
have five health unit coordinators
Stephen Matthews, BSN, RN, has
bundle was the first of many
and 15 telemetry technicians.
been with our organization since
simulation trainings. This
We have a medical director and
January 2012. Stephen brings
multidisciplinary approach has
pulmonologist who have been
leadership and consistency to
fostered communication and our
instrumental in helping our team
the unit. He has successfully
culture of safety. Linda has been
improve patient outcomes with
decreased the number of
instrumental in encouraging staff
new protocols and education
travelers to one, and is looking
to return to school and/or become
continuously. We have a dedicated
forward to being fully staffed
certified in their specialty. Linda
social worker to ICU and PCU,
with Regional West employees in
is also pursuing a Clinical Nurse
case management, pharmacist,
early 2014. Stephen continues
Specialist degree.
medication reconciliation nurses,
continued education, review of current knowledge, and passing knowledge to new students and
to provide expertise clinically
dietician, therapy staff, and
REG I O N A L W E S T H E A LT H S ER V I C E S
many more to make the team
selecting professionals to attend
days and times working closely
complete. This team cared for
conferences. The council has
with our radiology partners.
1,109 patients and families in
been very active in on-boarding
the Progressive Care Unit (PCU)
our new staff and creating an
and 922 patients and families in
environment of support and
the ICU.
growth.
nurse manager in November.
Staff members in school
The Scheduling Committee
Education Department with
pursuing higher degrees include
has been active in balancing
high recommendations and
Nancy Hicks-Arsenault, Stephen
schedules and advising
great experience. Alicia is
Matthews, Linda Fowler,
management leaders as we
an excellent communicator
Kristen Ferguson, Meghan
build in the flexibility of flexing
and brings leadership and
Blaylock, Teal Smith, Matthew
staffing needs to match census
consistency to the unit. She
Schneider, Kristene Perrin, and
that may vary greatly in 12
has successfully decreased
Travis Hargreaves. Telemetry
hours. They are very much
the number of travelers to one,
technicians in school pursing
appreciated!
and is looking forward to being
higher degrees include Emily Aragon and Mary Acosta. Congratulations to all who balance work, school, and home life!
Emergency Services The Emergency Department had a record year in the number of patient visits, with more than 17,000. With increased
| 33
Alicia Kunz, MSN, RN, joined the Emergency Department as Alicia came to us from the
fully staffed with Regional West Medical Center employees in early 2014. Alicia has collegial relationships with all disciplines and fosters excellent patient outcomes.
The CICU/PCU has an active
volume came the need to utilize
Unit Practice Council. They
hallway beds more than ever.
Alice Fillingham, BSN, RN, is
are currently working on a
This problem was mitigated in
our clinical coordinator and
sedation vacation protocol,
October when five additional
has been amazing. She works
sepsis order sets, and managing
Emergency Department rooms
very hard to bring quality
delirium in the ICU patient.
were opened. The new area also
education programs to the unit
The council also sets guidelines
gives expansion capacity of
and hospital-wide audiences.
to assist management in
seven more beds in high census
This year she brought more
[continued to page 34]
34 | N U R S I N G A N N UA L REP O R T [continued from page 33] simulation learning opportunities
physician clinic staffs and has
Our documentation analyst, Kathy
to our staff. These opportunities
helped many patients.
Jacobsen, BSN, RN, continues to
have included quarterly education tied to our staff meetings, pediatric case reviews with CEUs and CMEs, and a transition to critical care class for our new staff. Alice has a contagious smile and positive attitude. ‘Thank you’ seems so small for all the work Alice has done. We have nine nurses who have obtained specialty certification. Congratulations to Alice Fillingham, Linda Fowler, Lorrie Joplin, Sheri McDonald, Sarah Paetow, Laura Wolfe, Erin Hill, and Linda Borelli. This makes 38 percent percent of our RNs who are
The council worked hard to ensure a week full of celebration during Nurses’ Week and coordinated many activities. The celebration also included an EMS week celebration with a cook out! Dr. David Cornutt assumed medical director duties in January. He worked hard to help manage the hallway overflow patient concerns. He was also instrumental in finding additional physician staff to fill our needs until we hire permanent staff. Dr. Cornutt also was very helpful in opening our five new exam rooms and the flow changes
certified!
accompanying that opening.
The Unit Practice Council has
The Emergency Department
worked diligently on improving our emergency care and improving our patient outcomes and core measure scores. The council worked hard on implementing a subcutaneous rehydration protocol in appropriate cases. Education included the
continues to have better than national averages for door to triage to exam room discharge decision to out for discharged patients. Much work is being done to improve our decision to admit to out the door.
do a fabulous job giving feedback to staff appropriately after 100 percent chart review. Our documentation reviews demonstrate an improvement year after year. We have successfully optimized billing by $53,000 a month with feedback to RN staff in real time relating the documentation to care provided. The emergency team continues to amaze me with their focus on improving our quality and safety care initiatives.
REG I O N A L W E S T H E A LT H S ER V I C E S
| 35
AIR LINK TRANSFER CENTER Doug Carrell
Director, Air Link and Transfer Center
A
ir Link continues to provide service in partnership with Med-Trans Corporation.
Air Link welcomed a new pilot, Nash Saunders, and a mechanic, Chris Farrier, to our team. We are also proud to announce two new team members. Amanda Lashley was hired as a full time flight nurse and Anthony (TJ) Krajewski II was hired as a full time flight paramedic. Both are currently working on their advanced
• Wade Wells compiles quality improvement data. • Natalie Arnold coordinated public relations events and the Air Link Mentoring Program (which include over 80 hospital and EMS agencies). • Jason Rairigh and Howard McCormick continue to coordinate the equipment and inventory needs of the program. • Dee Vogel assists with
certifications.
policy review and time and
The Air Link management team
representative for the Nebraska
consists of Doug Carrell, Director;
Association of Air Medical
Tracy Meyer, Chief Flight Nurse;
Services (NEAAMS).
and Dr. Peter Meyer, Medical Director. Dr. Meyer continues to fly as an active crewmember of the flight team. The Air Link Team • Sean Shirley is Air Link’s Safety Officer and Safety Coach. Sean has been deployed to Germany to serve for the military until mid June 2014. • Trish Garner is very active as the Clinical Educator of the flight team, and has been instrumental in coordinating on going educational events.
attendance. Dee is Air Link’s
• Dan Hughes is responsible for collecting quality improvement data as well as completing the action reports for the PAIPs (Post Accident Incident Plan). • Kyla Ansley has taken over
In May 2013, Air Link was surveyed by the Commission on Accreditation of Medical Transport Systems (CAMTS) for the purpose of reaccreditation. Air Link was awarded full accreditation. The Air Medical Transport Conference (AMTC) was held in October 2013 in Virginia Beach, Va. Air Link hosted TNATC (Transport Nurses Advanced Trauma Course). Flight team members from many different flight programs attend the certification course. Air Link places an emphasis on quality patient care, continued learning, and mandatory advanced certifications. One hundred percent of the Air Link flight team is CFRN (Certified Flight Registered Nurse) or FP-C (Flight Paramedic Certified) certified, with
assisting the flight team with
the exception of Amanda Lashley
Marketing and Public Relations.
and TJ Krajewski II (new hires).
She has been a great addition
Both will be taking their respective
to our team.
certification exams in 2014.
Every member of the Air Link flight
Air Link had a very busy year, and
team has additional responsibilities
looks forward to having another
that directly relate to the quality of
successful and SAFE 2014.
the service we provide.
36 | N U R S I N G A N N UA L REP O R T
HOME CARE Diana Rohrick, RN
Director, Home Care, Palliative Care, and Prairie Haven Hospice
2
013 was a year of positive
From the retreats and the joint
consistency and growth for both of
forward motion for Regional
efforts at partnering in care, came
these professionals.
West Home Care as it began
the incept of the Partnership
the long awaited process of joining
Unit Practice Council (UPC). This
forces, literally and figuratively,
group, with representatives from
with Prairie Haven Hospice and the
Home Care (HC) and PHH has met
newly implemented Palliative Care
monthly working on format and
program at Regional West Medical
structure as well as issues involving
Center.
all three entities. The chairperson
Beginning the first of the year Linda Rock, Lisa Rien (Finance) and Diana Rohrick began to discuss and prepare for a merging of the two existing entities along with the birth of the new Palliative Care program. The first retreat for all participants came about in March 2013. The second retreat was in April. Linda Rock announced her plans to retire in July 2013. Orientation began in January for Diana Rohrick to become Director of not only Home Care, but Prairie Haven Hospice (PHH) and Palliative Care as well. Linda agreed to stay on as a consultant, assisting with orientation for Diana as well as involvement in the creation and implementation of the Palliative Care program.
for this group is Diann Lauder with Kathy McLellan as co-chair. The Levels of Authority and Concensus Scale were introduced, accepted, and utilized at all meetings. Shirley Knodel, CNO, has been instrumental in lending her support to the whole partnership movement and has attended Partnership UPC meetings and retreats to offer encouragement as well. Due to the restructuring of leadership with this new group, it was determined that Diana would need Clinical Team Leaders to assist in the day to day running of each agency. These positions were filled by Chris Centgraf, RN, for Home Care and by Suzy Solano, previous Spiritual Care Coordinator for Hospice, in the new CTL role for that department. Being new to leadership roles has meant significant orientation and ongoing mentoring but has resulted in
Throughout all of this important work, both agencies have continued to provide exceptional care, deal with new regulatory changes, and even manage a move for PHH from Medical Plaza North to an adjoining space on the second floor of St. Mary Plaza with the current Home Care office. Palliative Care has seen the hiring of our physician, Dr. Connie Beehler and an APRN, Deb Moore. Despite the many hurdles that arise when beginning a new program, it is now providing much needed care to Regional West Medical Center patients on a consulting basis, and working with Prairie Haven Hospice as well. A steering committee was established and has been meeting to work through issues and gain support of leadership and staff in this vital program. All in all it has been a busy but productive year for Home Care, Palliative Care, and Prairie Haven Hospice and 2014 will continue to show changes in the evolution of these programs.
REG I O N A L W E S T H E A LT H S ER V I C E S
| 37
IMAGING SERVICES Kari Flom, RN
Radiology Supervisor, Imaging Services
I
n 2013, Imaging Services has
In CT, there were 150 sedated
We recently implemented a new
expanded to include a Prep and
biopsies, 115 drains, and 162
hemodynamic monitoring system
Recovery Area. This area is
hydrations for a total of 431. In
that has the capability to better
utilized, not only for prepping and
our main department, there were
monitor a patient’s respiratory
recovering our patients, but also as
653 pain management cases,
function during procedures. It is
a hospital-based clinic for Radiology
186 myelograms and LPs (the
versatile enough to be used with all
Imaging of Nebraska, fully staffed
myelograms were also imaged in
our patients, not just those in the
by Imaging Services staff. We have
CT), and 96 miscellaneous for a
Interventional Suite, making our
also changed our process to include
total of 710. MRI saw 178 patients
practice more consistent and safer.
a “Pre-procedure Assessment�
and NM had 49. US were 122
It also has the capability to generate
visit (similar to PAT) for all of our
biopsies and 126 centesis for a total
letters for the ordering physician,
procedures requiring sedation. This
of 248. There were also 279 patients
the patient, our clinic for follow-up
has greatly reduced the number
seen only in our clinic and prep
needs, and our nursing staff for
of cases requiring cancellation
and recovery areas.
follow-up phone calls. The system
on the day of the procedure, and better equips us to give the safest possible care with the best possible outcomes. It has also decreased patient anxiety by educating in advance, thereby increasing our patient satisfaction. Nurses saw a total of 2,519 patients this past year. In the Angio Suite, there were 98 angio/venograms, eight arterial declots, 83 central lines, 84 dialysis grafts, eight tumor embolization/ablations, 11 endografts, 29 IVC filters, and 75 kyphoplastys for a total of 416.
Of these patients, 508 were added on, 311 were inpatients, 50 received stents, and 39 were with anesthesia. Imaging Services nurses continue to be involved in our IR Council as well as chairing the Shared Governance Committees. We are active in our professional organizations, and together strive to be strong patient advocates, providing the safest care possible.
keeps a comprehensive list of all procedures done for each patient, helping us be better prepared for each new procedure.
38 | N U R S I N G A N N UA L REP O R T
CATH LAB
Brooke Borgman, BS, BSN, RN Cardiac Cath Lab
2
PICTURED L TO R: Brooke Borgman, Michelle Rairigh, Lenna Booth.
013 was again a time
procedures performed in the
of transition for the
Cath Lab.
Cardiac Cath Lab staff.
In February, Colorado Health Medical Group (CHMG) returned to Regional West Medical Center to provide cardiology coverage for both inpatients and outpatients. In August, we welcomed Mandi Barry, BSN, RN, to the Cath Lab staff. In September, Dr. Chris Lambert joined the CHMG team as a full-time
New treadmill equipment was successfully installed. Cath Lab staff underwent certification in the insertion and management of the intra-aortic balloon pump. Other • All staff maintain ACLS certification. • Brooke Borgman teaches
cardiologist based in Scottsbluff.
classes for the New Grad
Cindy McCumbers, APRN-
Nurse Residency program:
NP, transitioned back to the
Cardiac Assessment, Cardiac
CHMG team from the hospitalist
Simulation, and Basic EKG.
program.
Brooke also is a member of the Care and Practice
Policy changes were made implementing the transradial approach for heart catheterizations performed by several of the CHMG cardiologists. Chart audits were implemented. Education was completed for the staff that would be seeing the trans-radial approach patients. Educational posters were made for the
Committee. • Mandi Barry serves on the Quality and Safety Committee and the Meaningful Use Committee. • John Vidlak has undergone education on the Zoll Life Vests, Medtronic Pacemaker interrogations.
• Brooke Borgman is currently working on her master’s degree in Adult Acute Care Nurse Practitioner with plans for a May 2015 graduation.
REG I O N A L W E S T H E A LT H S ER V I C E S
CARDIAC AND PULMONARY REHABILITATION Nancy Leisy, RN, MSHS, CHES
Cardiac and Pulmonary Rehabilitation Manager
N
ew faces that began their
patients and meeting the required
employment in Cardiac
core components of cardiac
Rehab this year:
rehab; as well as addressing the
• Nancy Leisy, RN, MSHS, CHESCardiac Rehab Manager • Kara Lemoine, RN, BSNEducation Coordinator/Care Coordinator 2013 was our preparatory year for national recertification of the Cardiac Rehab Program. With this came some changes in the way we complete and track staff competencies as well as learning and implementing new regulations and certification requirements related to our daily practice. Staff worked diligently to incorporate the Nursing Care Coordinator model in their care of patients this year. By moving to this type of coordinated care, patients are followed by the same staff person through their entire rehab program. This type of coordination of care allows staff as well as patients to get to know each other better, and creates more continuity of care as well as ownership in progressing
exercise, nutrition, education, and psychosocial needs of the patient. Through our safety meetings and staff observation, the cardiac rehab treatment area was rearranged this year to facilitate a safer path for patients to find their way and maneuver within the department. The cardiac rehab team continues to strive toward the best care possible by showing their commitment to education as Pam Zitterkopf, RN, BSN is working on her master’s degree in nursing and will graduate in May 2015. We are looking forward to 2014 as we submit all of our supporting documentation for national re-certification of our Cardiac Program.
| 39
40 | N U R S I N G A N N UA L REP O R T
CASE MANAGEMENT Karen Houk
Case Manager
2
013 was a year of great
patient through the continuum
advisors provide support and
change for the Case
of care. This includes daily
will advise on cases that are not
Management team with
review of clinical criteria for
otherwise supported by Executive
the release of new rules and
continued hospital stays and
Health Resources (EHR). EHR
regulations by the Centers
communicating with the
is Regional West’s contracted
for Medicare and Medicaid
patient as necessary regarding
physician advisor group which
Services. These regulations set
insurance certification for
gives direction and support
forth specific requirements for
their hospital stay. As strong
on Medicare and Medicare
physician certification related to
patient advocates, they deliver
Replacement plan claims that
level of care status and medical
written information and provide
do not meet criteria for medical
necessity for hospitalized
a full explanation to patients
necessity on admission or
patients. The RN Case
regarding observation status
continued stay.
Management staff work diligently
and Medicare rights so patients
to remain current on these
can be fully educated on their
rapidly changing regulations so
rights/responsibilities in these
they can provide support and
areas. These are just a few of the
education to our medical staff in
multifaceted responsibilities of
order to maximize compliance.
the RN case manager.
This includes daily review of patient medical records and consistent communication with providers to ensure all required elements for physician
The Case Management Team includes Julie Kautz, RN; Irma Walter, RN; Jessica Brumbaugh, RN; Nichole Hoesing, RN; Vicki
certification are met.
McLamb, RN; Lois Cannell,
In addition, the RN case
Supervisor; Jodi Willats, MSW,
managers also provide clinical
and Stephanie Hawley, RN,
review to insurance companies
Interim Co-Directors. Case
and communicate with providers,
management physician advisors
nursing staff, patients, and
are Dr. Lisa Scheppers and Dr.
ancillary services to move the
Erica Gelgand. The physician
RN; Karen Houk, RN, CM
During the past year Lois Cannell, RN, and Karen Houk, RN, obtained their ACM Certification through the National Board for Case Management. 2013 was a promising year for the Clinical Documentation Improvement (CDI) nurses. While they continued to review charts daily for documentation improvement opportunities, they also began to quickly gear up for the upcoming implementation of ICD-10. Recently, the implementation of ICD-10 was delayed by the Centers for
REG I O N A L W E S T H E A LT H S ER V I C E S
Medicare and Medicaid Services
to attend the 2013 Sixth
(CMS) which will allow the CDI
Annual ACDIS Conference
nurses to better prepare the
in Nashville, Tenn. The CDI
providers in their service lines
RN case managers continue
for the now 2015 implementation
to meet with medical staff
date.
routinely to distribute tidbits
The changes in ICD-10 will impact our ability to capture the acuity of our patients and the hard work
| 41
PICTURED L TO R: Alane Britt, Julie Kautz, Lois Cannell, Karen Houk, Shannon Brown, Nichole Hoesing, Irma Walter. Not pictured: Shelly Thomas
of information throughout the year so that when the implementation does finally occur it will not appear to be such a
Thompson, RN, who covers the hospitalist service line. Stephanie Hawley, RN, ACM, directly oversees the CDI program and
drastic change in their practice.
coordinates the medical necessity
information will be changing and
With the assistance of multiple
RN case managers continue
while it may all mean the same
entities throughout the facility,
to prepare for obtaining their
thing in the medical world, it does
the CDI team was able to surpass
professional certification (CCDS,
not translate that easily into the
their goal of a Case Mix Index
Certified Clinical Documentation
coding and billing world where our
of 1.4514. We actually ended the
Specialist) during their down time.
facility and physicians are being
year at 1.4854 (up from 2012
graded. This specific verbiage is
at 1.3823) which equates to a
also required to be in the medical
financial impact of about $3.8
record in order for Regional West
million for the facility and more
Medical Center to be reimbursed
accurate profiles for the providers
appropriately.
and facility being reported out to
of our providers. Some of the verbiage required to relay this
Some of the ICD-10 preparation
consumers.
activities have included intensive
The current CDI RN case
on-line training courses (totaling
managers are Andrea Arellano,
over 100 hours) as well as
RN, who covers the general
attending multiple in-house ICD-
medical service lines; Jackie
10 modules. The CDI RN case
Carter, RN, who covers the
managers were fortunate enough
surgical service lines; and Mollie
appeals for the facility. The CDI
42 | N U R S I N G A N N UA L REP O R T
COMMUNITY HEALTH Paulette Schnell, RN Nurse Manager
The Community Health
provide immunizations for both the
meetings and assisting with the
Department at Regional West
Vaccine For Children’s Program
coordination of both the county
Medical Center is unique in that
and for privately insured clients
and hospital’s bio-terrorism and
the staff provides services to both
of all ages. We have expanded our
all-emergency preparedness plans.
the hospital and to the Scotts Bluff
immunization services to cover
County Health Department. This
all travel vaccines as well. Nurses
creative contract arrangement
hold routine immunization clinics
allows both entities to be active in
on Tuesdays with both daytime
the public health of Scotts Bluff
and evening clinics available.
County.
Approximately 3,300 vaccines are
This past year, multiple programs were coordinated for the community and hospital. In 2013 Community Health saw a change in management. Martha Stricker, RN, BSN, transferred to Regional West Physicians Clinics. Paulette Schnell, RN, who has worked as a Community Health Nurse for many years, became the new manager. Through this process, two new employees became a part of the staff. Hannah Weisgerber, RN, BSN, and Terri Allen joined us late in 2013. Both Hannah Weisgerber and Paulette Schnell are in the graduate nursing program at UNMC. The Community Health Immunization Clinic continues to
delivered to children from birth through age 19 annually. Sandy Preston, RN, BSN, Immunization Coordinator, attended the Nebraska Immunization Conference in Omaha for continuing education in the area of vaccine preventable disease. Colon cancer awareness and a screening kit distribution campaign took place with information being shared on risk factors. Deb Keener, RN, is the project coordinator. There were 258 fecal occult blood test (FOBT) kits distributed throughout the community. Community Health is an active partner in the Panhandle Regional Medical Response System (PRMRS), attending monthly
Throughout the year, Community Health also coordinated quarterly genetics clinics with MunroeMeyer Institute, a part of the University of Nebraska at Omaha. Seventy-six clients and their families were served in 2013. The department also coordinated several health screenings at area businesses through its involvement with the Panhandle Worksite Wellness Council. In 2013, people received a variety of preventative screenings including lab work, bone density screening, glaucoma checks, and blood pressure checks. Community Health partnered with Regional West Physicians Clinics to provide another annual drivethru influenza clinic. This event allowed over 500 residents to receive an immunization against flu without ever having to leave their car. A walk-in flu clinic at St. Mary’s Plaza provided an
REG I O N A L W E S T H E A LT H S ER V I C E S
additional 300 more residents this protection. One area on which Community Health focuses is providing flu shots at the worksite. In 2013, 56 businesses held onsite flu clinics for their employees. This resulted in over 1,400 more immunizations against influenza being delivered to residents of Scotts Bluff County. The injury prevention coordinator continues to function in partnership with Trauma Services. Holly Johnston, RN, BSN, reaches out to the community with information on the top 10 traumas in the region as well as educating on current hot topics such as concussion legislation and distracted driving. Regional West Medical Center is one of 100 hospitals across the nation that is contracted with the Consumer Product Safety Commission (CPSC) to review Emergency Department visits for accidents and trauma related to commercial products. This data is supplied to the CPSC and utilized to develop safety recalls for consumers.
| 43
44 | N U R S I N G A N N UA L REP O R T
PHARMACY MEDICATION RECONCILIATION NURSES Kelsey Kriewald, Pharm D, RPH
Clinical Coordinator, Pharmacy Department Activities for 2013-2014
nurses intervene when
• Pharmacy has six RNs who
needed by making calls to
work from the Pharmacy
the physician to clarify any
Department to obtain the
medication discrepancies.
patients’ home medication list at admission. • There is one nurse in the
• The pharmacy medication reconciliation nurses also complete initial screening for
Emergency Department daily
influenza and pneumococcal
and two nurses up on the
vaccines and forward
floors from the hours of
information obtained from
8 a.m. to 6:30 p.m. daily.
the patient and from NESIIS
• The nurses obtain a complete
to the pharmacists for review
L to r: Tammy Cox, Ron Ward, Marilee
and follow-up to order needed
Monohon, Yolanda Gonzales, and Consuelo
vaccinations.
Hernandez. Not pictured: Karen Perkins.
list of the patient’s home medications and allergies and update the electronic medical record for all inpatients. • The nurses make calls to outpatient pharmacies for information regarding medications and dosages. • They also search multiple electronic medical record databases to determine the medications the patient took at home (NextGen, NeHII, NRX-QS1, Home Health, Hospice, Palliative Care, and HPF). • After comparing the patient’s home medications with the medications ordered in the hospital, the pharmacy medication reconciliation
• Historically, the pharmacy medication reconciliation nurses screen more than 7,600 patients annually. They are here every day, including holidays! Our pharmacy medication reconciliation nurses include: • Tammy Cox, RN • Yolanda Gonzales, RN • Consuelo Hernandez, RN • Marilee Monohon, RN • Karen Perkins, RN • Ron Ward, RN
REG I O N A L W E S T H E A LT H S ER V I C E S
| 45
QUALITY RESOURCE Margo Ferguson, MT (ASCP) Director, Quality Resource
T
he Quality Resource
The nurses have responsibility for
Department consists of 11
aspects of Centers for Medicaid
employees who support
and Medicare (CMS) and Joint
performance improvement,
Commission (JC) quality reporting
infection prevention, and related
requirements including Core
quality and safety activities
Measure chart abstraction,
throughout Regional West Medical
provider and staff education, and
Center. Seven of the 11 employees
Opportunity for Improvement
are RNs with distinct areas of
(OFI) reporting. Nurses prepare
focus within continuous quality
documents and/or reports for
improvement initiatives and
review at a variety of committee
regulations. Department staff RNs
meetings, including Medical,
are:
Surgical and Perinatal/Peds,
• Janelle Schroeder, MSN, RN— Clinical Quality Improvement (CQI) Nurse Coordinator • Linda Armstrong, BSN, RN— Clinical Data Quality Analyst • Vicky Stoll, RN—Clinical Data Quality Analyst • Kris Henkel, RN—Clinical Data Quality Analyst • Janice Casey, RN—Clinical Data Quality Analyst • Jeanie Miller, RN, BC— Clinical Data Quality Analyst • Amanda Sabo, BSN, RN— Infection Prevention and Epidemiology Nurse
M&M, and committee meetings. Additionally, nurses participate in the Root Cause Analysis Team. Each nurse in the department serves as a content expert, resource, and support to other departments.
• Concurrent infection prevention • Infection prevention policy revisions • Implementation of Infection Control Committee • Implementation of Central Line Insertion Practice (CLIP) checklist • CLABSI education for staff with a target goal of ZERO • Annual infection prevention risk assessment • Ongoing implementation of the Midas DataVision and Stat It modules • Development of the Procedural Sedation documentation improvement audit
Work highlights of 2012 for the Quality Resource Department • Data collection began on new Core Measures: stroke, VTE, and inpatient-based psychiatric measures • Ongoing education and training for new Core Measures • Meaningful Use collaboration
• Fall prevention program support and collaboration
46 | N U R S I N G A N N UA L REP O R T
RISK MANAGEMENT Austin Engel, BSN, RN
Director, Risk Managementt
T
he 2013 risk assessment
Timely and thorough responses
If you have any other questions
was conducted in March. I
to concerns are very important to
or concerns regarding Risk
want to thank the units that
our patients and their families.
Management or want to report any
participated in the assessment. Our next scheduled risk assessment is planned for the first
In 2012, a defensive documentation was presented to
quarter of 2015.
the Med/Surg areas. Throughout
In the second quarter of 2013,
to most of the nursing units.
the Risk Management and Guest
There were great questions and
Relations Departments worked
dialog during these sessions. If
closely together to standardize the
you would like this presentation
patient grievance process. Risk
presented to your department
Management, Guest Relations,
please do not hesitate to contact
and members of the Regional West
the Risk Management Department
Physicians Clinic are now working
at 308.630.2895.
to implement a similar process in the Physician’s Clinic as well.
2013 this education was provided
concerns please feel free to call Austin Engel at 308.630.2895. If you have any Guest Relations concerns please call Connie Ruff at 308.641.7556.
REG I O N A L W E S T H E A LT H S ER V I C E S
TRAUMA SERVICES Shermaine Sterkel, BSN, RN, CCRN Trauma Nurse Coordinator
R
egional West Medical
3. Livestock related
September 2013 and March 2014
Center is a Level II
4. Motorcycle Crash (MCC)
at Regional West Medical Center.
5. All-Terrain Vehicles (ATV)
Holly Johnston, injury prevention
College of Surgeons since 1996.
6. Assault
coordinator, made presentations
Regional West is the lead Level II
7. Motor pedestrian
to students at Scottsbluff High
Trauma Center in Region 4 of the
8. Sports related
Trauma Center, and has
been verified by the American
State of Nebraska. The Trauma Services
9. Farm/heavy equipment incident
Department includes Rommie
10. Bicycle crash
Hughes, MD, Trauma Medical
Deana enters all of the trauma
Director; Shermaine Sterkel, RN, Trauma Program Manager; Deana Spreier, Trauma Registrar and Performance Improvement (PI) Coordinator; and Holly Johnston, RN, Injury Prevention Coordinator. In 2013, Regional West Medical Center treated 538 trauma patients. Of those patients, 207 were trauma team activations with 55 full trauma team activations and 158 partial trauma team activations. In 2013, the top 10 causes of injury from most to least were: 1. Falls 2. Motor Vehicle Crashes (MVC)
patients into the trauma registry and performs 100 percent review of the cases for performance improvement opportunities. This information determines the trauma cases that go to review at Trauma PI and Patient Safety (TPIPS) as well as to Trauma Peer Review (TPR). Deana also has responsibility and oversight of approximate 275 trauma
School about “Teens in the Driver Seat.” Trauma Services had our reverification visit by the American College of Surgeons as a Level II Trauma Center in November 2013. Trauma Services is implementing a new trauma registry software “Image Trends.” We are also implementing a new Trauma Quality Improvement Program called (TQIP). We anticipate these new programs to better support our PI and patient outcomes.
patients and their data that is
Trauma Services is also working
entered into the trauma registry
with our Marketing Department
of our 10 Region 4 hospitals.
on a formal Marketing plan.
The Trauma Service at Regional
This will be to facilitate outreach
West Medical Center has been
of our Level II Trauma Center
busy educating and training
and our compliment of surgical
our region’s new trauma nurse
services to take care of our
coordinators/registrars. We
trauma population.
held our Region 4 PI meeting in
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48 | N U R S I N G A N N UA L REP O R T
WOUND CARE/OSTOMY REPORT Jeanette McFeely, RN, BSN, CWOCN Skin Integrity Team Committee
T
he Skin Integrity Team meets
participants helping with the
to discuss and educate staff
quarterly pressure ulcer prevalence
concerning factors that
studies is 10.
compromise skin integrity, whether that is due to a pressure ulcer, disease process, skin tears, etc. They discuss education, charting screens, reporting, bed surfaces, products (new, house-wide, and/ or samples), data collection, PI projects, pilot projects. Members assist with the Quarterly Magnet Prevalence Pressure Ulcer Studies, keep their units informed of education opportunities offered for wound and ostomy care, and update their units on new skin care and pressure ulcer prevention strategies. There is representation from the following units: PCU, ICU, 2W, 2E, 3rd, 4th, Dietary, Education, Interventional Radiology, and Purchasing. Goals of the Skin
Education opportunities coordinated and presented for employees included: • “Wound Care 2013.” This free presentation was open to area nursing homes and care facilities, sponsored by KCI. • New SWANK pressure ulcer prevention competency PowerPoint with quiz. • Revised “Pressure Ulcer Facts” sheet that is in the admission packets. • Writing “Skin Care Notes” articles for each Magnetic Times publication. • Coordinated, presented, and
Integrity Team are to educate staff
participated in the Wyo-Braska
to focus on skin issues, not only
Wound Care Conference. This
the issues that are present, but
conference is open to the
interventions needed to prevent
region.
skin breakdown.
• Sage representative here to
Attendance: The average number of
demonstrate chair slider and
members at each monthly meeting
Prevalon heel off-loading boot.
is seven, which is 50 percent of the active members. The average
• Calmoseptine and Silvasorb gel now in medical pyxis. • SWANK courses for Excel Care bed and bariatric bed. • Looked into getting wound numbers on SBAR. • Revised and distributed laminated decision tree for heel pressure relief. • Information shared about free CEUs on ostomy care through Hollister.com. • Viewed “Targeting Zero Made Easy! Your Path to Prevention.” • Bi-monthly presentation to newly-hired nursing staff, “Pressure ulcer staging, how to make referral, pressure redistribution devices, Braden Scale.” • Bi-yearly presentation to nursing residency program on ostomy care, wound care, and pressure ulcer staging. • Reporting topics to care and practice.
REG I O N A L W E S T H E A LT H S ER V I C E S
| 49
Number of patient appointments a year Year
2009
2010
2011
2012
2013
Consults (Initial appt)
165 (16%)*
151 (8%)*
209 (11%)
255 (12%)
260 (12%)
F/U with physician
118 (12%)
348 (20%)
376 (19%)
369 (17%)
499 (23%)
Wound/Ostomy F/U
726 (72%)
1,254 (72%) 1,374 (70%) 1,522 (71%)
1,425 (65%)
TOTAL
1,009
1,753
2,184
1,959
2,146
Magnet quarterly prevalence
• 0 patients with Pus
Regional West Physicians Clinic-
pressure ulcer studies
• 0 HA
Surgery, Vascular Diagnostics;
At each quarterly study, the
• 0 POA
auditing nurses review pressure
July 23
ulcer staging along with the
• 10 skin team members
importance of providing an accurate study and doing a thorough assessment on all
participated • Assessed 43 out of 48 patients
and Dr. Mark Willats with Western Plains Foot Center. Dr. Walsh remains the medical director and is certified as a wound specialist. The nursing staff include: Rachelle Noe, RN, BSN, CWOCN; Amy Mosteller, NA-C; Sheila Kihlthau,
patients. Prevention interventions
• 6 patients with 9 PUs
are recommended to staff
• 3 HA
nurses along with stressing the
BSN, CWOCN. PRN staff include:
• 6 POA
Pat Takuski, RN, BSN; and Carrie
importance of charting ulcers present on admission (POA). Below are the statistics of this year results: February 26 Hill-Rom National Study • 10 skin team members participated • Assessed 56 out of 69 patients • 6 patients (patients) with 13 pressure ulcers (PUs) • 7 Present on Admission (POA) pressure ulcers in hospital • 6 Hospital Acquired (HA) April 23 • 10 skin team members participated • Assessed 58 out of 70 patients
October 22, 2013 • 11 skin team members participated • Assessed 62 out of 71 patients • 6 patients with 6 PU • 5 HA • 1 POA
RN; and Jeanette McFeely, RN,
Snygg, RN, BSN. The Wound/Ostomy clinic has increased the number of new patients seen each year, as demonstrated in the table above. We use advanced dressings and skin substitutes to facilitate closure in difficult non-healing wounds. We see ostomy patients who have skin breakdown or pouching issues, and
Outpatient Wound/Ostomy Clinic
counsel patients with incontinence
The Outpatient Wound/Ostomy
issues.
Clinic is located at Regional West Medical Plaza North, Suite #1400. The clinic is held on Monday, Wednesday, and Friday of each week. New patients are seen by the rotating medical staff and follow-up visits are scheduled as needed. The medical staff include: Dr. Melissa Stade and Dr. Jason Walsh with
50 | N U R S I N G A N N UA L REP O R T
SHARED GOVERNANCE Coordinating Council &
Vision statement
Care and Practice Council
The council is actively seen
Elizabeth Ossian, BSN, RN Chair Coordinating Council Mission The Shared Governance Coordinating Council will collaborate to lead, coordinate, and communicate the activities of nursing Shared Governance Councils to keep patient care the central focus of all we do. Vision Statement We are the voice of nursing staff by facilitating communication, collaboration, support, delegation, leadership, and education through Shared Governance. Values Empowerment | Responsibility Accountability | Shared Decision-making
Care and Practice Council Mission Promote, facilitate, and coordinate patient care
and utilized as a resource for patient care issues to ensure superior clinical performance resulting in outcomes that outperform benchmark data.
Additionally, Quality and Safety
2013 was a year full of
Hand Hygiene project using the
accomplishments for the Nursing
Targeted Solution Tool from the
Shared Governance Councils.
Joint Commission. Originally
The Coordinating Council is
piloted on the Med/Surg floors,
a group made up of chairs
this is now being utilized
and chairs-elect of each of the
house-wide to identify the right
councils, with Shirley Knodel
interventions for each unit to
as our management advisor
improve hand hygiene. Hand
and Jacqulyn Robison, the new
hygiene compliance is improving
Survey Preparedness/Magnet
and we will continue to monitor
Coordinator. (Jordan Colwell
this as we move forward.
held this position previously.)
continued working on the
Care and Practice launched the
The Quality and Safety Council
new fall prevention program
was instrumental in launching
based on the Hindrich 2 model
Nursing Peer Review last year.
for assessing risk of falls. This is
The Nursing Peer Review
a great example of an evidence-
Committee (NPRC) is made up
based nursing practice change.
of bedside nurses and meets
In the computer charting, there
monthly to review select cases to
is now a different fall assessment
determine where we can improve
and suggested interventions to
our care. This is a confidential
improve our ability to predict a
process which includes
patient’s propensity for falling.
reviewing the medical record and
This also better reflects our
interviewing nurses involved to
actual interventions being
determine if we need to change
performed. In addition to the
any part of our processes.
newer fall assessment tool, the Falls Committee has been
REG I O N A L W E S T H E A LT H S ER V I C E S
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reorganized to examine post-fall
scrubs would help patients more
between Nursing, the Finance
huddles and what improvements
easily identify their RNs, hopefully
Department, and Purchasing
we can make to our current
in an effort to improve patient
to improve how we utilize our
practice following a fall.
satisfaction scores. All nurses,
resources. This council created a
regardless of home unit, had the
link on the Regional West Intranet
opportunity to vote for one of four
for anyone to suggest ways to use
possible colors, with pewter being
our dollars more wisely. Currently,
the final selection. Questions were
the ED is piloting a plan to return
inserted into the Healthstream
to the re-usable blood pressure
questionnaire for measuring data
cuffs and pulse-ox sensors. There
at baseline, then again following
have been many good suggestions
the uniform change. So far there
through the Intranet link and the
has been positive response from
committee is now working on a
both staff and patients!
way to communicate the progress
Evidence-Based Practice researched nursing fatigue and the importance of meal breaks. This group compiled a recommendation that was presented to Nursing Leadership. The nursing fatigue project has now been handed over to the Quality and Safety Committee. Last fall, the Coordinating Council
of those ideas as well as the total
decided to combine EvidenceBased Practice with Care and Practice. The new combined committee kept the name Care and Practice.
dollar amount saved. Night Shift Council The relatively new Night Shift Council worked on improving the night food cart rotation and selection, ensuring lunch breaks,
Professional Practice Professional Practice has their hands full each year with keeping the clinical ladder up-to-date and relevant. They also plan the Nurses’ Week activities and
improving transfer times, and so on. This is a particularly special committee because it specifically addresses concerns for the night shift that previously had no good way to be addressed.
you may have seen the nurses from 2nd and 3rd floors wearing. This is part of a research project for UNMC MSN students to determine if single-color matching
are focusing on two major goals in accordance with the goals presented by Dr. Sorensen last fall: “How can we reduce Serious Safety Events (SSE) to zero?” and “How can we achieve 90th percentile patient satisfaction rating?” I would like to take this opportunity to encourage all
Nursing Awards. Another visible project is the single-color uniforms
Going forward into 2014, we
nurses to join one of the Shared Nurse Finance Council Another exciting new committee is the Nurse Finance Council. This brand new committee creates a closer working relationship
Governance Councils. This is the best opportunity to have a positive influence on nursing practice at our hospital and we can best do that if all areas of the hospital are represented. If you have any
52 | N U R S I N G A N N UA L REP O R T questions you can email me
Future Projects
dress code and social media.
at elizabeth.ossian@rwmc.net.
Our next project was and
We have emphasized to staff
Thank you, and here’s to
is Nursing Fatigue meal/
members and the leadership
a successful 2014!
breaks project. A survey was
on this council to remember
developed in Survey Monkey.
HIPAA laws and respect
We had meetings with nursing
when using the Internet
leadership and nursing
and social media sites like
directors to address questions
Facebook. Confidentiality is
and get feedback. After that
very important and we must
meeting it was decided to
remember to be professional
include all departments in
at work and when at home.
the hospital that had 24/7
Not posting pictures of the
coverage like lab, radiology,
hospital with patients is a very
etc. A purpose statement was
crucial part of maintaining
developed, as well as a letter
confidentiality. The council
written to managers and staff
addressed this as social media
explaining about the survey. A
is a part of everyday life and we
benchmark data.
timeline for the project was also
must emphasize this.
Projects
have been made to alert staff of
Quality and Safety finished
the survey. The survey will run
our part of the hand-washing
from June 8-30. We hope to
project last September. We then
start analyzing data in July.
Quality and Safety Council Christy Jay, BSN, RN, Chair Mission To promote and maintain best practices for patient safety and quality care. Vision Outcomes measures consistently outperform
written and revised. Posters
started Nursing Peer Review.
and the criteria for how to choose members. We then had meetings with Leadership and talked to all the nurses at their floor’s staff meetings to let everyone know what NPRC was. The committee was formed on recommendations from directors and has been going well. The committee celebrated NPRC’s progress and success during our October meeting.
tubing was approached. After investigating the practice of when to change new IV tubing, it was discovered that all IV tubing throughout the hospital
We developed the reasons why the committee was needed,
The education on use for IV
Professional Practice Council Lenna Booth, BSN, RN, Chair Mission The Professional Practice Council’s mission is to promote and support the professional nurse through a positive work environment and staff development activities. Projects The Professional Practice Council looked at issues like
(unless it is blood tubing) is good for 72 hours, including IV antibiotic tubing. This should be kept sterile with capping of the tubing when not in use and should also be labeled to show its date and time to follow the 72-hour rule. This is something that continues to take education, practice, and accountability from the staff members throughout the hospital.
REG I O N A L W E S T H E A LT H S ER V I C E S
Other subjects discussed
will also help staff members,
scores as a result of change,
throughout the year by the
physicians, and midlevel
researched and initiated by Night
PPC included
providers distinguish the
Shift Council.
• Emergent/trauma call response time • Safety stories shared at the meetings • Medications should not be given through the blood tubing during blood transfusions • Education on chest tube drain systems • Initiating mentor programs such as a nurse residency program that was shared by Alicia Kuntz, RN, who was with the Education Department at the time
difference between a licensed provider and a non-licensed provider.
Council worked on helping
Revisiting the dress code policy
breaks and ways to include the
will also help in promoting a
night shift on food options. Out
professional environment that
of this, the staff encouraged their
is also ensuring a safe practice
co-workers to take breaks and
facility when patients choose
also placed more clocks around
Regional West Medical Center for
units to remind staff to utilize
their primary health care facility.
this time to recharge so they can
Nurse Retention This is something that Lucrecia
something that will be looked at. The proposed project will be to institute color-coded scrubs for the different departments. The hope is to promote patient safety. This will happen because patients, their family members, and visitors will know who to contact for information and questions while eliminating confusion and time spent
ensure that staff takes its meal
be ready to provide safe patient care.
Spady studied for her master’s
Another big topic that this
degree. It is always a changing
council discussed was related
practice as society changes,
to changing the medication
however, and this council is open
pass times. Collaborating with
to any suggestions or research in
the Pharmacy Department, the
how to keep nurses on staff.
Night Shift Council was able to see positive results in the time change for medication cart
Future Projects The colored scrubs research is
This past year the Night Shift
Night Shift Council Matt Blaylock, BSN, RN, Chair Mission The Shared Governance Night Council will focus on evidencebased behavior, environment, and practice changes to influence patient satisfaction scores, consistently achieving top-box score in all areas.
searching for the proper person
Vision
in their loved one’s care. This
Excellent patient satisfaction
exchanges. This time was shifted from the time frame of 10-11 p.m. to 11:01 p.m., which created effective workflow for both departments. Facilitating discharges was the last topic that the Night Shift Council has been involved with, to better serve patients and getting them discharged to home. At night, the staff does not see as much of the process for discharges and have worked
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54 | N U R S I N G A N N UA L REP O R T
with educational opportunities
Vision
An Intranet link was also
in seeing this process through.
Cost effective management
created for employees to submit
They have also gained team
of labor and supply resource
their input to the council for
member support with the
utilization.
cost-cutting ideas to save waste
hospital’s social workers to help increase the momentum
The Nurse-Finance Council
and money. These submissions have been automatically going
of this process.
was created in 2013. The
Future of Night Shift
Department and Finance
The night shift team members
Department is to collaborate
here at Regional West are
on ideas that would create a
an important part of the
cost-effective environment here
Future Projects
puzzle that serves our patient
at Regional West. This would
Trash bins for waste: Linda
population. The atmosphere
include ways to become more
reports that they have bins
of working night shift is such
efficient in labor costs and with
that they can use and place on
a blessing to our community.
use of medical supplies.
the units for a pilot project for
It would be great to see more involvement of the different night shift members as we remember their part in what they do in serving this hospital system and community. Thank you for all that your team does, night shift.
common goal from the Nursing
Projects The council came up with some great avenues for cost-effective ideas during their first year. Non-usable blood pressure cuffs and pulse oximeters for patients in non-isolation rooms were instituted that with proper disinfectant education
Nurse-Finance Council Paul Adams, BSN, RN, Chair Mission The Nurse-Finance Council will serve as a collaboration to optimize fiscal responsibility across all areas of nursing while maintaining the delivery of safe, quality, and efficient patient care.
amongst staff members could
to the council and are able to be presented to the council for discussion.
clean waste, so employees can see what/how much we waste as far as supplies. Paul asks how education will take place on units when bins are placed. Linda states they will educate at the time they are placing the bins. This may generate ideas from staff on cost-savings ideas.
be re-used for patient care.
Scott Wentz from Finance
Another innovative idea was
was able to share areas of
the standardization of IV
cost that were calculated
trays. These trays were built
with the different avenues
to suit the needs for nurses in
of lunch breaks, overtimes,
initiated IV access. The staff
meetings, and education. Out
created one universal IV tray
of this it was determined that
kit for the nursing units that
different units could watch for
would hold the supplies and
clocking in and out. Making
cut down in waste of products.
sure to not clock in more than
REG I O N A L W E S T H E A LT H S ER V I C E S
seven minutes early from the assigned shift can help with over shifts. Directors of the different departments have been educating their staff on this and holding them accountable. An automatic deduction for a 30 minute lunch break was also brought into the discussion at one time that could be a potential avenue as well. Value-based purchasing is another important aspect of health care in the future. As time goes on, this council will be able to come up with important ideas and ways to promote money saving channels that also institute the growth of patient satisfaction.
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56 | N U R S I N G A N N UA L REP O R T
2013 REGIONAL WEST MEDICAL CENTER CERTIFIED NURSES Accredited Case Manager (ACM) Lois Cannell Stephanie Hawley Karen Houk Antigua and Barbuda Midwifery Association Claudia Mack-Simon Certified Ambulatory Perianesthesia Nurse (CAPA)
Teal Smith Shermaine Sterkel Marilyn Stoddard Certified in Electronic Fetal Monitoring (C-EFM) Vivianna Palomo (dual certifications) Shari Rogers Certified Emergency Nurse (CEN) Melissa Amateis Linda Borelli Alice Fillingham Linda Fowler (dual certifications) Trisha Garner (dual certifications)
Michelle Keener
Erin Hill
Roxie Shaul
Kathy Jacobson
Certified Bariatric Nurse (CBN) Ramona (Mona) Urwin Certified Case Manager (CCM) Jackie Carter Certified Clinical Health Coach (CCHC) Pamela (Pam) Zitterkopf Certified Critical Care RN (CCRN) Joshua Beals Jessica Conn Jacqueline (Jackie) Delatour
Lori Joplin Jessica Slaght-Langworth (triple certifications) Amanda Lashley Sherry McDonald Thomas (Tom) Moore Laura Wolfe Sarah Paetow Certification in Field Epidemiology Paulette Schnell Certified Flight Registered Nurse (CFRN)
Linda Fowler (dual certifications)
Trisha Garner (dual certifications)
Travis Hargreaves
Tracy Meyer
Cheryl Hoxworth
Jason Rairigh
Jessica Slaght-Langworth (triple certifications)
Sean Shirley
Stephen Matthews
Dee Vogel
Leigh Miller Cheryl Patrick
REG I O N A L W E S T H E A LT H S ER V I C E S
Certified Gastroenterology Registered Nurse
Sandy Hebbert
(CGRN)
Peg Jackson
Lucrecia Spady Certified High Risk Neonatal Nursing Stacy Ingersoll (dual certifications) Certified Inpatient Obstetrics Nurse (RNC-OB) Mary Coon
Billie Kniss Katharina Lemons Tracy Payne Chris Micheels Andrea Ray
Ramona Giles
Certified Professional Utilization Reviewer
Robin Cushing
(CPUR)
Krissa Randall Certified Lactation Counselor (CLC) Keara Brunner
Julie Kautz Kristi Henkel Certified Rehab Registered Nurse (CRRN)
Stacy Ingersoll (dual certifications)
Darlene Cooper
Cynthia Francisco (dual certifications)
Pam Cover
Vivianna Palomo (dual certifications)
Cindy McGaughy
Certified Medical Interpreter (CMI-Spanish) Sarah Shannon Certified Nurse Operating Room (CNOR) Dayna Dondelinger Rhonda Goshens Darcy Haslam Christy Jay Colleen Kelly Mary Lockwood Kim Mann Janet Lewis Kim Brown Leslie Ilg Joann Walter (new) Certified Pediatric Emergency Nurse (CPEN) Jessica Slaght-Langworth (triple certifications) Certified Perianesthesia Nurse (CPAN)
Certified Wound Ostomy Continence Nurse (CWOCN) Jeanette McFeely Rachelle Noe Clinical Nurse Specialist Adult Health and Illness (ACNS-BC) Susan Backer Emergency Medical Tech-Basic (EMT-B) Vanessa Rhembrandt Gerontology Nurse Certified (BC) Irma Walter Kathi Yost GI Technical Specialist Certificate from Society for Gastroenterology, Nurses, and Associates (SGNA) Donna Klein, LPN Kathy Mackrill, LPN
| 57
58 | N U R S I N G A N N UA L REP O R T International Board Certified Lactation Consultants (IBCLC) Cynthia Francisco (dual certifications) Medical-Surgical Board Certified Nurse (CMSRN) Delfina (Tina) Delgado Lisa Fabricius Michelle Powell Tara Shallenberger Christina Walters Oncology Certified Nurse (OCN) Megan Anderson Ione Beavers Leslie Biggs Susan Schoeneman Orthopedic Nurse Certified (ONC) Christine (Chris) Buhr Kimberly (Kim) Meininger Marilyn Noel Outcome Assessment Information Set Certified Nurse (OASIS) Michelle (Shelly) Meisner Peripherally Inserted Central Catheter (PICC) Insertion Certification John Beard Michael (Mike) Bokelman Psychiatric and Mental Health Certified Sheli Goodwin Tamara (Tami) Lewis Resident Assessment
Coordinator – Certified (RAC-CT) Sheila Kihlthau Sharon Marlow Sexual Assault Nurse Examiner/Sexual Assault Forensic Examiner (SANE/SAFE) Mandy Shaul-Bolek
REG I O N A L W E S T H E A LT H S ER V I C E S
4021 Avenue B | Scottsbluff, NE 69361
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