news views Fall 2016
A Publication of the Department of Nursing and Patient Care Services University of Maryland Medical Center
Lisa Rowen’s Rounds:
The Power of One Voice The email from Arlene Davis, RN, BSN, OCN, was brief but unforgettable. Arlene, a nurse coordinator in the Stoler Pavilion, shared a poignant story about how our lack of wheelchairs at the main entrance negatively impacted a patient’s and family’s experience.
Lisa Rowen, DNSc, RN, CENP, FAAN Chief Nurse Executive University of Maryland Medical System Senior Vice President of Patient Care Services & Chief Nursing Officer University of Maryland Medical Center Associate Professor University of Maryland School of Nursing
Arlene wrote: “My patient, with increasing pain from bone metastases, was due for a bone scan. The patient arrived to the main entrance of the hospital at 10:10 AM for a 10:30 AM appointment in Nuclear Medicine. The patient’s family was told there were no wheelchairs available, and there were four patients already waiting for a wheelchair. We had no wheelchairs available in the Stoler Pavilion or Infusion Center. I told the family I would look for a chair. When I found a wheelchair and returned to the main entrance the patient had already attempted to walk to Nuclear Medicine because of her worry about being late to her appointment. I went to Nuclear Medicine with the chair, as I knew the patient was having increasing difficulty with weight-bearing due to hip and leg pain. The patient’s brother had actually carried her down the hall to Nuclear Medicine, because she was not able to tolerate walking.” I read the final sentence with tears in my eyes. This is not the kind of experience we want for any patient or family. In fact, it’s hard to even imagine this scenario but it was true. Arlene’s story was heartbreaking and put names and faces to our failure to provide something more than reasonable for our patient; a simple wheelchair. It was simply unacceptable. Arlene’s email was a powerful voice that asked for change and a call for action. And I’m happy to report that we have taken action and made change. A multidisciplinary team formed to address the first floor wheelchair challenge, led by Marianne RowanBraun, MSM, vice president for patient experience and
David Hunt, MSN, MBA, RN, vice president for patient access and emergency services. The team conducted an immediate assessment of the wheelchair situation and measured the number of available wheelchairs at any given time on the first floor. We learned we had only 27 available wheelchairs to accommodate patients at the Main, Gudelsky, and Trauma entrances. The goal was to make rapid change and a positive impact as quickly as possible. Instead of spending months collecting data on the exact number of wheelchairs we needed, we used our collective wisdom and agreed to increasing our first floor wheelchair fleet continued on page 6.
The Coordinated Care Center
at the University of Maryland Medical Center
Zina Kendell, BSN, MSA, LNHA, Program Manager, Transitional Care Coordination Program and Dale Rose, DHA, MS, RN, CENP, PCMH CCE, Director of Ambulatory Nursing
MISSION: To provide individualized intensive, comprehensive, coordinated ambulatory care for vulnerable (high-risk, rising-risk) patients; to facilitate their medical and social stabilization, and their ability to obtain ongoing care in standard primary care and subspecialty care medical homes.
To holistically address our patients’ needs to improve health and well-being through coordinated medical services, with emphasis on social determinants affecting health outcomes.
VISION:
Service Overview The Coordinated Care Center (C3) opened its doors on September 13, 2016. It is staffed with an expanded cohort of clinical support designed to provide diseasespecific primary and specialty care for patients until they are stable enough to be cared for in the traditional patient-centered primary or specialty care medical home. The medical home is a model for achieving primary care excellence so that care is received in the right place, at the right time, and in the manner that best suits a patient’s needs. Patients’ complex medical needs are met through high-quality primary care with access to more frequent and longer medical visits according continued on page 8.
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Fall 2016
In This Issue 1
Lisa Rowen’s Rounds
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Coordinated Care Center at UMMC
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Corporate Compliance
3
2016 Magnet® Conference – Empowering Nurses to Transform Health Care
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UMMC Respiratory Care Takes Top Honors at State Conference
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Achievements
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DAISY Award
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Spotlight on Pharmacy
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Staying Current with One’s Skills – How it Helped Save the Lives of Two Children
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Nursing Research Council is Now the Nursing Research and Evidence-Based Practice Council
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Certification Corner
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Journal Club
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Clinical Practice Update
Corporate Compliance Andrea Alvarez, Compliance Specialist – Education and Training Corporate Compliance and Business Ethics Group
In each issue, the Medical Center Compliance Program provides a short Frequently Asked Question (FAQ) for News & Views. We are looking for new ways to reach out to employees to raise awareness of compliance issues. Please let us know what you think, or suggest topics by emailing compliance@umm.edu or aalvarez1@umm.edu. Compliance FAQ Q: How is the HIPAA privacy and security rule enforced? A: “OCR (Office of Civil Rights) enforces the privacy and security rules in several ways: • By investigating complaints filed with it; • By conducting compliance reviews to determine if covered entities are in compliance; and, • By performing education and outreach to foster compliance with the rule’s requirements.
The OCR also works in conjunction with the Department of Justice (DOJ) to refer possible criminal violations of HIPAA.” (find more at www.hhs.gov/hipaa) Below are recent 2016 HIPAA settlements relevant to your work at UMMC. Advocate Health Care (Illinois) – HIPAA Advocate Health Care agreed to pay $5.55M to OCR to settle claims that it violated HIPAA. OCR launched an investigation in 2013 after Advocate submitted three different data breach reports. The breaches comprised continued on page 15.
Editor-in-Chief
Carolyn Guinn, MSN, RN Magnet Program Director Clinical Practice and Professional Development Managing Editor
Susan Santos Carey, MS Manager, Operations Clinical Practice and Professional Development Assistant Editor
Casey Embert, BA Project Specialist Clinical Practice and Professional Development Editorial Board
Lisa Rowen, DNSc, RN, CENP, FAAN Chief Nurse Executive University of Maryland Medical System Senior Vice President of Patient Care Services & Chief Nursing Officer University of Maryland Medical Center Associate Professor University of Maryland School of Nursing Greg Raymond, MS, MBA, RN Director, Nursing and Patient Care Services Clinical Practice and Professional Development, Neuroscience and Behavioral Health Suzanne Leiter Executive Assistant to the Senior Vice President of Patient Care Services and Chief Nursing Officer Chris Lindsley Director, Communication Services University of Maryland Medical System Anne Haddad Publications Editor University of Maryland Medical System
Find news&views online at http://umm.edu/professionals/nursing/newsletter and on the UMMC INSIDER at http://intra.umms.org/ummc/nursing/cppd/excellence/publications/news-and-views
NEWS & VIEWS is published quarterly by the Department of Nursing and Patient Care Services of the University of Maryland Medical Center. Scope of Publication The scope of NEWS & VIEWS is to provide clinical and
professional nursing and patient care services practice topics that focus on inpatient, procedural, and ambulatory areas. Submission Guidelines
Send completed articles via e-mail to scarey@umm.edu Please follow the guidelines provided below. 1. Font – Times New Roman – 12 pt. black only. 2. Length – Maximum three double spaced typed pages. 3. Include name, position title, credentials, and practice area for all writers and anyone named in the article. 4. Authors must proofread the article for spelling, grammar, and punctuation before submitting. 5. Provide photos and embedded images in separate .jpg files. 6. Submit trend data in graphic format with labeled axes. 7. References must be cited using APA format. 8. Editor will seek expert review of articles to verify and validate content. 9. Articles will be accepted based on appropriateness of content and availability of space in each issue. 10. Articles that do not meet the above guidelines will be returned to the author(s) for revision and resubmission.
ISSUE Winter 2017 Spring 2017 Summer 2017 Fall 2017
DUE DATE January 2, 2017 May 1, 2017 July 10, 2017 October 2, 2017
Displaying Credentials
The UMMC standard for displaying of credentials is based on the ANCC Guidelines. The preferred order is: • highest earned degree (can list more than one if in different fields) • licensure • state designations or requirements • national certifications and honors • other recognitions Nurses with two or more nursing degrees (MSN, BSN) should only list their highest nursing degree, along with other degrees obtained. Example: Betty Smith, MSN, MBA, RN. Why this order: The education degree comes first because it is a “permanent” credential, meaning it cannot be taken away except under extreme circumstances. The next two credentials (licensure and state designations/requirements) are required for you to practice. National certification is sometimes voluntary. Awards, honors, and other recognitions are always voluntary. If you would like additional information, please visit http://www.nursecredentialing.com and search using the word “credentials.”
news &views 2016 Magnet® Conference – Empowering Nurses to Transform Health Care Carolyn Guinn, MSN, RN, Magnet Program Director
The American Nurses Credentialing Center (ANCC) national Magnet® conference is always a memorable event that brings nurses together from all over the world to share best practices and celebrate nursing. Attendance reached a record high of nearly 10,000 at this year’s conference in Orlando, FL, of which 2,200 were from countries outside of the U.S. Even though hurricane Matthew shortened the conference, those in attendance from the University of Maryland Medical Center (UMMC) were able to experience why so many organizations are striving to achieve/ maintain Magnet® designation and learn how this is accomplished. The theme of this year’s conference, “Empowering Nurses to Transform Health Care,” was fitting for the current health care environment. Presentations were focused on providing highquality, cost-effective care to patients and ensuring the personal health and well-being of the nurse. Being chosen to present at the conference is very competitive and only Magnet® organizations are allowed to submit abstracts. We are proud to share that UMMC had four abstracts accepted for presentation this year – three podium and one poster. Two UMMC nurse leaders were also part of collaborative podium presentations with colleagues from outside of the organization. Congratulations to all the presenters and to those that submitted abstracts. Unfortunately, the three UMMC podium presentations were cancelled due to the conference closing early; however, the poster presentation and one of the collaborative presentations occurred. The ANCC will be making a decision in the near future to determine how the cancelled presentations may be made available to the attendees. We look forward to supporting our presenters in sharing the dissemination of this great work. The next conference will be held October 11-13, 2017 in Houston, Texas. Call for abstracts will occur December 2016 – January 2017. If you are thinking about submitting an abstract, now is the time to start crafting your submission. Abstract guidelines will be shared as soon as they are available. If you have any questions about the conference or abstract submission, please contact Carolyn Guinn, MSN, RN, Magnet program director, at cguinn@umm.edu or x8-4962. Priya Nair, MS, RN, Nurse Manager, Ambulatory Services
Left to right: Greg Raymond, MS, MBA, RN, Director, Nursing and Patient Care Services, Clinical Practice and Professional Development, Neuroscience, and Behavioral Health; Michele Zimmer, MS, RN, CCRN-CMC, SCN II, Cardiac Progressive Care; and Patricia Woltz, PhD, RN
UMMC Podium Presentations Do No Harm: Making the Case for a Nurse-Led Sustainability Program. Justin Graves, RN, author/presenter and Denise Choiniere, MS, RN, author Discovering How New Nurses Learn to Respond to Alarms Using Simulation. Jamie Tumulty, RN, CPNP-AC; Patricia Woltz, PhD, RN; Lisa Rowen, DNSc, RN, CENP, FAAN Transitional Surgery Center: An Innovative Interdisciplinary Approach in Reducing Thirty-Day Hospital Readmissions. Priya Nair, MS, RN; Jennifer Zeller, MS, CRNP; Carmel McComiskey, DNP, PPCNP-BC, CPNP-AC, FAANP, FAAN
UMMC Poster Presentation Professional Advancement Model. Michele Zimmer, MS, RN; Patricia Woltz, PhD, RN; Erin Barnaba, MS, RN; Greg Raymond, MS, MBA, RN
Collaborative Podium Presentations Facilitating Effective Transitions of New Graduate Nurses: Magnet® Organizations’ Response to SE7a. Sheryl Cosme, DNP, RN-BC (ANCC); Priya Nair, MS, RN (UMMC); Carey Yarbrough, MSN, RN (ANCC) Advanced Practice Registered Nurses’ Perceptions of Patient Workload: Results of a Multi-Institutional Survey. April N. Kapu, DNP, BS, APRN, ACNP-BC (Vanderbilt University Medical Center); Carmel McComiskey, DNP, PPCNP-BC, CPNP-AC, FAANP, FAAN (UMMC); Patricia Selig, PhD, FNP-BC (Virginia Commonwealth University Medical Center); Julie Raaum, DNPc, MSN, FNP-BC (Medical College of Wisconsin) u
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PATIENT CARE SERVICES | RESPIRATORY
UMMC Respiratory Care Takes Top Honors at State Conference Christopher Kircher, MS, RRT-ACCS; Maria Madden, BS, RRT-ACCS; and Jennifer McGrain, MS, RRT
Now in its 36th year, the Conference by the Sea brings respiratory therapists from Maryland and neighboring states to Ocean City, Maryland, for three days of lectures, vendor displays, hands-on workshops, and many enjoyable educational events. Hosted by the Maryland/DC Society for Respiratory Care, this state conference is a great way for over 500 respiratory care professionals and other industry personnel to meet, learn together, and recharge one’s professional pride.
Left to right: UMMC respiratory therapists Elshadie Ramdat, MS, RRT-NPS; Deborah Linehan, BS, RRT-ACCS; Kendall Williams, RRT; Maria Madden, BS, RRT-ACCS; and former UMMC respiratory therapist, Geof Lear, RRT
Over the past several years, University of Maryland, Baltimore respiratory therapist and clinical research manager Jennifer McGrain, MS, RRT, has hosted an open forum for abstract poster presentations. McGrain comments that “It was my vision to have a place where those new to research and public presentation could share their original work and receive feedback from fellow respiratory therapists, leaders, and educators. The open forum presentations at the state level will provide those with aspirations of presenting nationally a more relaxed place to start.” Held on the second day of the conference, participants have the opportunity to answer questions from clinicians stopping by to view their posters. This often helps to prepare for questions that may be asked of them during the open forum, where each presenter stands at a podium before an audience of typically 50–60 of their peers. The 2016 event was moderated by McGrain and judged by the clinical director from the Community College of Baltimore County’s respiratory care program, Virginia Forster, MS, RRT and
Lisa Joyner, MEd, RRT, RRT-NPS, director of clinical education for the Salisbury University respiratory care program. This year, the UMMC team proudly prepared four poster presentations highlighting several very interesting topics. A few individuals from UMMC were experiencing the open-forum event for the first time. All were well prepared and did a great job of explaining their posters and fielding questions from the audience. From those in attendance, it was clear that there were several that really stood out for the content and delivery. The respiratory therapists and their co-author peers should be very proud as UMMC took the three top awards in a ceremony that took place later that day. In first place, Elshadie Ramdat, MS, RRT-NPS and Deborah Linehan, BS, RRT-ACCS, presented “Intrapulmonary Percussive Ventilation Assist in Weaning Pediatric Patients from Extracorporeal Membrane Oxygenation.” Co-authored by Paul Johnson, RRT; Maria Madden, BS, RRT-ACCS; and Jason Custer, MD; this abstract has also been published in Respiratory Care and will be presented at the 2016 American Association for Respiratory Care’s National Congress. In second place, Kendal Williams, RRT, presented a topic that was co-authored by Madden, Angela Toney, RRT; Tera Martin, RRT; Sabrina Cho, RRT; Kara Vogt, RRT; McGrain; and Deborah Stein, MD. The poster entitled “An RT-Driven Protocol Increased Mechanical Ventilation Liberation in Cervical Spine Injury Patients,” highlighted the aggressive secretion clearance activities which have supported some of our most difficult-to-wean patients. This abstract will be published in Critical Care Medicine and then presented at the 2017 Society for Critical Care Medicine (SCCM) conference. In third place, but by no means any less impressive than the first two, Madden presented “P-Low of 0 CMH2O Maximizes Peak Expiratory Flow Rate While Optimizing Carbon Dioxide Removal in Airway Pressure Release Ventilation.” Co-authored by Penny Andrews, RN, BSN; Melissa Thurber, BS, RRT; Ben Mellies, RRT; Williams; Josh Satalin, BA; Louis Gatto, PhD; Gary Nieman, BA; and Nader Habashi, MD; this abstract described the very unique ventilation strategy that the UMMC critical care program has come to be known for on the national and international stage. This abstract poster has been published in Respiratory Care and will also be presented at the 2016 AARC National Congress. Though a fourth poster did not place, Madden co-authored the abstract “The Endotracheal L Tube Using Optimal Clamping Technique Prior to Disconnection Maintains Airway Pressure Reducing Risk of Derecruitment.” Presented by former UMMC respiratory therapist Geof Lear, RRT, this abstract represented a great collaboration between our nursing and physician peers, with co-authors Andrews and Habashi. Further highlighting interdisciplinary research is an abstract that was not presented at the Conference by the Sea, but will be published in Critical Care Medicine and shared at the 2017 SCCM conference. “To Prone or Not to Prone The Adult V/V ECMO Patient,” is authored by Kate Dolly, RRT; Maria Madden, BS, RRT-ACCS; Raymond Rector, CCP LP; Tina Wright, RRT; Amber Pyzik, RN; Ali Tabatabai, MD; Daniel Herr, MD; and continued on page 7.
news &views Achievements
Circle of Excellence Awards topics, including continued staff training on continuous renal replacement therapy The American Association of Critical Care Nurses (AACN) awards twenty-five Circle and the molecular adsorbent recycling of Excellence Awards each year to nurses recognized by their peers for exemplifying system (MARS). He played a key role in excellence in the care of acutely and critically ill patients and their families. establishing the MARS program at the Shock Trauma Center, which has enabled He spearheaded efforts to reduce This year we are pleased to announce that survival of critically ill patients that in catheter-associated urinary tract infections the past would have likely succumbed Paul Thurman, MS, ACNPC, CCNS, CCRN, (CAUTI), in large part by developing and a clinical nurse specialist at the R Adams to their severe liver injury. Knowledge he implementing a nurse-driven catheterCowley Shock Trauma Center at the has imparted to others has undoubtedly University of Maryland Medical Center, has removal protocol and bladder scan fostered improved care and outcomes algorithm now used throughout the been selected to receive this prestigious for critically ill trauma patients and their Medical Center. Paul has used his strong award. Paul’s quest to ensure excellent families. knowledge base to educate and mentor care to acute and critically ill patients and Congratulations to Paul on a numerous nurses, physicians and others families has accomplished a number of well-deserved honor! on a variety of trauma and critical care outstanding outcomes. Karen A. McQuillan, MS, RN, CNS-BC, CCRN, CNRN, FAAN, Lead Clinical Nurse Specialist
Congratulations to the following UMMC nurses promoted in the October 2016 cycle
Sarah B. Kosmer, MS, RN, CNL, CPN Pediatric Progressive Care Unit
Rachel E. Sybor, MS, RN, CPN, CNL Pediatric Progressive Care Unit
Kristina S. Lerman, BSN, RN, CCRN Neuro Care ICU
Lauren M. Westbrook, BSN, RN, CCRN, TCRN Trauma Resuscitation Unit
Senior Clinical Nurse I
Sorah Levy, BSN, RN Surgical/Thoracic IMC
Allison R. Baden, BSN, RN, CCRN Medical ICU
Jessica Masters, BSN, RN, CCRN Pediatric ICU
Barbara Bosah, BSN, RN, PCCN Surgical/Thoracic IMC
Michelle L. Bardakh, BSN, RN Multi Trauma Intermediate Care Unit 5
Elizabeth A. Miller, BSN, RN, TCRN Trauma Resuscitation Unit
Nimeet Kapoor, BSN, RN, CCRN, FCCS Medical ICU
Amanda N. Borradaile, BSN, RN Main Operating Room
Kerstin E. Moran, BSN, RN, CMSRN Surgical Acute Care
Lisa Petty, BSN, RN, CCRN, HNB-BC Mobile Practitioner/Rapid Response Team
Emily J. Brown-Umosella, BSN, RN, CCRN Cardiac Surgery ICU
DoRhonja J. Nichols, BSN, RN Multi Trauma Critical Care Unit
Sarah Watts, BSN, RN, CPEN Pediatric Emergency Department
Jacqueline R. Christian, MSN, RN 10 East Medical Telemetry Unit
Irene S. Soybelman, MS, RN, CNL, CYT GCC Stoler Clinic
Julieann Griffith, MSN, RN, CCRN Medical ICU
Jennifer M. Spelta, BSN, RN, PCCN, CCRN Surgical ICU
Jennifer A. Klimczak, BSN, RN, OCN GCC Medical Oncology
Nicole R. Swope, BSN, RN, CPN Pediatric Progressive Care Unit
Senior Clinical Nurse II
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Rounding Report, continued from page 1. to 100: 70 distributed to six strategic parking stations and 30 maintained in Facilities as backup. Our First Floor Patient Flow Wheelchair Plan rolled out on October 17th when 70 new, self-propelled wheelchairs, marked with an attached label, were distributed to the following wheelchair parking stations: ◗◗ Stoler Pavilion, two locations; ◗◗ Main Entrance information desk; ◗◗ Registration waiting area; ◗◗ Gudelsky Entrance information desk; ◗◗ Radiation Oncology, behind the front desk; and, ◗◗ Shock Trauma Critical Care Tower Entrance: (corner of Lombard and Penn), behind the security desk. Each parking station is responsible for maintaining a surplus of chairs for use on the first floor and a mechanism for replenishing the parking stations has been established. The 70 chairs will be supported by an additional surplus of identical chairs that will be kept with the Facilities team. All other wheelchairs in our current inventory, including all Stryker wheelchairs, will be moved to the patient care units, the Emergency Department, and the Shock Trauma Outpatient Pavilion. It is important that we all keep an eye on wheelchairs and their appropriate location. If you find a First Floor Wheelchair on another level, please return it to any parking station on the first floor. With the surplus of chairs added to our operation there is no need for staff to retain wheelchairs in their areas just to make sure one will be available when they need it. A wheelchair should always be available for your use and always available for patients and families when they arrive for care. Upon arrival, patients and families will be told they can use the wheelchair for the duration of their visit (wherever they travel in the Medical Center) and asked to please return the wheelchair to the First Floor when departing. Education will be ongoing as we continue to monitor and evaluate this first phase of remedy. I would like to recognize Arlene Davis for getting the ball rolling and turning awareness into action. Arlene saw and voiced an important issue and did it in a compelling, heartfelt way. Arlene’s message resonated with all of us, and a concerned group,
which included Arlene, mobilized to action, which led to the desired outcome within two months. Thanks for being a mover and shaker, Arlene! See page 7 to read the First Floor Patient Flow Wheelchair Process. What a necessary improvement inspired by a powerful voice. The First Floor Patient Flow Wheelchair Team Arlene Davis, RN, BSN, OCN Senior Clinical Nurse I Stoler Pavilion Cassie O’Malley, MS, RN, OCN Nurse Manager Stoler Pavilion Denise Choiniere, MS, RN Acting Director of Nursing Greenebaum Comprehensive Cancer Center
Robin Hines Manager 1-Call Communications Center Operations Support Services Jessica Brittner Manager Patient Financial Services
Shannon O’Brien, RN Nurse Manager Radiation Oncology
Sean Monroe Senior Business Support Manager Patient Financial Services
Gisele Stevenson, MS, RN Manager Patient Placement Center
Marvena Cole Manager Volunteer Services
Kerry Sobol, MBA, RN Director Patient Advocacy and Commitment to Excellence
Joann Couser Administrative Sergeant Security
Candace Holcombe-Volke Project Manager Patient Experience Sean Barrett Manager Patient Transportation Services Paul Edwards Team Lead Patient Transportation Carson Cain Manager Clinical Engineering Antonio Covington Clinical Engineering Dali Alapati Clinical Engineering
Our new First Floor Wheelchairs
Norma Thomas Clinical Engineering
Maurice Davis Director Security Curtis Wright Director Environmental Services Philips Khuu Admitting Specialist Patient Administrative Services
David Hunt, MSN, MBA, RN Vice President Patient Access and Emergency Services Marianne Rowan-Braun, MSM Vice President Patient Experience continued on page 7.
news &views Rounding Report, continued from page 6.
First Floor Patient Flow Wheelchair Process Representatives from each wheelchair station must check par level at 6:00 AM, 10:00 AM, 2:00 PM, and 6:00 PM. Call 1-Call (8-5174) if below 50% par for your area and request additional wheelchairs, or to report a surplus.
Offer a wheelchair to any patient or visitor who needs one. NEVER tell someone we cannot provide a wheelchair or help escorting. If you have a wheelchair, but the person needs someone to escort them: 1. Take the person where they need to go. 2. If not able to leave your post, call the UMMCareCenter @ 8-7219, the Care Porters @ 7-0812, or 7-0813, OR call the main desk @ 8-5473 and ask for assistance. 3. If you feel you are in “crisis” mode, meaning there is no support of volunteers or Guest Services staff and you are unable to escort the patient yourself, call 1-Call (8-5174) and have the Patient Transport Team Lead paged to help pick up the patient.
If you do not have a wheelchair, call 1-Call (8-5174) immediately to have a chair brought for the patient/visitor AND to replenish your par level. This should not happen if the process noted above is followed. There are par levels established in these wheelchair parking locations: Stoler Pavilion, Main Lobby, Registration Lobby, Gudelsky Lobby, STC ground floor Lobby, and Radiation Oncology.
Respiratory Care Takes Top Honors, continued from page 4. Jay Menaker, MD. This is an important and continued collaboration between respiratory therapists and the ECMO team. The efforts described above represent a growing interest in research by a group of respiratory therapists who have come together to form the respiratory care scholarly works committee. Madden says, “Learning how to prepare a topic for presentation has included research training, abstract construction, and an ability to practice with peers. Breaking down the mystery behind the process has opened up a new level of interest in research and has provided an exciting connection for staff and their profession. This committee already has its sights set on several other topics, including one that will highlight the department’s efforts to orient new employees in a more structured and consistent manner.” Being viewed as a great step forward, this approach to precepting grew out of a staff-led desire to better embrace our newest therapists. The staff wasted no time in putting this heart-felt need into action. This committee of individuals represents just one of several groups that are forming a dedicated connection to the
Preceptors and newly hired respiratory therapists work together in the Trauma Simulation Lab for two days of competencies and simulations.
respiratory care profession, and are showing true pride in being UMMC employees. In settings such as the Conference by the Sea and the much larger National American Association for Respiratory Care Congress, the UMMC Respiratory Care Department is working diligently to have regular representation. u
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Coordinated Care Center, continued from page 1. to individual needs. Intravenous hydration and antibiotics are among the treatments available, with other infusion services in development. The integrated Transitional Care Coordination (TCC) management program provides the care coordination and support for patients with chronic conditions and psycho-social challenges that create a high risk of hospital admissions or emergency room visits. Offering a patient-centered, evidence-based, multidisciplinary approach, a team from C3 consisting of a nurse care coordinator, social worker, pharmacist, and community health worker provides care coordination to post-hospital discharges for as long as needed. Patients are connected, as needed, to primary care providers or
Patient lobby at the Coordinated Care Center in the Harbor Loft Building
comprehensive specialty care clinics for continued management of their conditions. The program team provides resources and education that guide patients toward self-management of their chronic conditions. The TCC program partners with the patient in their community and their providers, internal and external to UMMC, to assure patients are connected to the appropriate care and supportive community services. The primary strategy of the C3 is to provide patient-centered care coordination that identifies and reduces barriers to the restoration of health and well-being. Patient-centered focus means that the program assists the patient in collaboration with the care team in developing realistic and achievable goals that lessen the need for hospital admission or use of emergency medical services in the acute care facility. Behavioral counseling is also an integral part of the clinical program. Types and Ages of Patients Served The Coordinated Care Center program provides care to patients age 18 years and older who have been referred by the TCC postinpatient hospitalization, the Emergency Department, the Urgent Care Center, the community, or campus providers. The patients are screened to determine whether they require the timely access, complex clinical interventions, and/or care coordination not
otherwise readily available in a traditional primary or specialty practice. Safe avoidance of utilization of a higher level of care, as well as comprehensive assessments of individualized social determinants of health, are two key mission imperatives. Patients are served at all levels of income. Scope and Complexity of Patient Care Needs There is a wide scope and complexity of needs among patients supported in the C3 setting. These patients need comprehensive primary and specialty care follow-up due to a new diagnosis, recurrent unaddressed symptoms, or multiple chronic conditions, including those with a secondary behavioral health diagnosis. The social determinants that affect health and well-being will also be addressed. Many of these patients have no primary care provider, have not bonded with their provider, or have conditions that require more intensive management than usually provided in a primary care practice. Efforts are directed at disease stabilization through more frequent, extended visits than would be anticipated in a traditional ambulatory setting and through embedded selfmanagement facilitation. Patients receive ongoing medication management, disease education, coordination of care-related services, advanced care planning, social services, and mental health care coordination. Strategies to Meet Patient Care Needs This Center provides immediate access and expedited appointments to specialists, with a focus on a multiplicity of chronic conditions and behavioral health services, to meet the needs of this high-risk/high-utilizer patient population. In addition, there will be expanded capabilities including oxygen, nebulizer machines, intravenous infusion capability for fluids and antibiotics, wound care, diagnostic laboratory evaluation, and disbursement of medications. These services will allow the clinic to provide a higher level of care than is typically available in the ambulatory practice. The Coordinated Care Center is well-positioned to provide our patients an enhanced clinical option toward health stabilization and improved self-management. This clinic is hybrid in nature. It presents an alternative for patients who habitually visit the emergency department and would benefit from complex care coordination support. The relationship with a traditional clinic will be either re-established or established once the goals of the Coordinated Care Center have been achieved. All efforts are aimed toward a reduction in unnecessary admissions or readmission. The University of Maryland Medical Center has played a tremendous role through the decades in improving population health. The Coordinated Care Center is yet another exciting landmark in our journey toward improving quality, safety, and the patient experience. u The C3 is located in the Harbor Loft Building at 36 W. Paca Street. Hours of operation are Monday-Friday, 8:00 AM to 5:00 PM, with expanded hours anticipated due to projected volume growth and program needs.
news &views DAISY AWARD The DAISY Award for Extraordinary Nurses is a national recognition program to honor exemplary nurses. Patients, their families, and UMMC staff submit nominations, and the UMMC DAISY Committee chooses one nurse each month to receive the DAISY Award. AUGUST Dennis Vidal, BSN, RN Neuro Intensive Care Unit Dennis Vidal was nominated by one of his patients, who thanked him for the exceptional and loving care he provided. The patient wrote in an email: “I don’t know how much you remember me while I was under your care at the University of Maryland Hospital, but I do remember how much you cared about my comfort and safety. The night you had me under your loving care was my worst night in the many that I had spent in the hospital over the many years. My history has been a previous back surgery, bypass surgery and an aortic valve replacement, all at University of Maryland Hospital. Of all the previous wonderful nurses, aides and other attendants of my care, you are the one that stands out as the most caring individual and I wanted to especially thank you for your wonderful service. I don’t know how I would have made it through the night without your vigilance and caring attitude. As an EMT, I have seen medical personnel from average to exceptional and I feel that you fall into the category of exceptional. Thank you, Dennis, for all you did for me, even though our night was short.” SEPTEMBER Peggy Torr, BSN, RN, OCN University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center A former patient recognized Peggy Torr’s ability to make each patient feel special, safe and secure. The patient wrote: “As I was leaving the University of Maryland Medical Center recently, I heard a very happy voice encouraging a patient into a van with such compassion that I moved closer to hear the conversation. When I did, I realized that it was my former nurse, Peggy. I was delighted to hear her call out my name, as she was an amazing health care provider when I needed guidance, reassurance, and humor as a prescription to move forward with my cancer treatment. One could say that Peggy is an outstanding bedside nurse, but we might want to whisper that, as we know that all outstanding bedside nurses
Nomination forms are available in all nursing units and on the UMMC Insider and website – umm.edu/DAISY.
who are current with the latest research and who have fortitude to deliver information in an honest and caring manner are offered endless opportunities to climb the professional ladder of nursing roles – so that they are no longer at the bedside. Then there is Peggy, who has devoted her career to bedside nursing because she loves what she does and she makes every patient feel like they are the only patient she has. While I was a patient, [one time] I noticed that my chemo bag was fuller than usual, which caused me some great anxiety. When I rang for the nurse, Peggy came to my bedside and I heard her figuring out loud the formula for the chemo bag. Of course, she could have used the machine, but her incredible skills to problem-solve not only brought a mathematical conclusion, but also involved the pharmacist in our meeting, who reassured me that everything was okay. Peggy is a DAISY Nurse because of all she does to make a patient feel safe and secure with her loving kindness and her incredible knowledge of cancer treatment, as well as her ability to add her humor to make you smile.” OCTOBER Jenna Carl, BSN, RN Medical Intermediate Care Unit Below is an excerpt from the nomination letter by Jenna’s nurse manager, Ruth Borkoski, BSN, RN: “I need to take this opportunity to recognize a nursing hero. This morning as Jenna was coming to work, she stopped in at Au Bon Pain for breakfast. She saw a lady who was clearly in distress and went directly to her. Although there were some people around, there was no one with a medical background in attendance. Jenna recognized that her symptoms were indicative of a diabetic emergency and used her nursing background to treat it. The lady was not responsive at first, but after Jenna’s interventions, she became a little more interactive. Jenna had Security retrieve a wheelchair and took the patient to the Emergency Department. All this BEFORE her shift began!” “I am always proud of the staff with whom I work, but occasionally the pride is overwhelming,” Ruth continued. “We are a society in which people rush here and there and don’t always respond to situations around us. I am so lucky to work with people who really care about others. I would like to nominate Jenna for a DAISY Award. The care she provides every day, as part of her job and also as part of her community, is exceptional.”
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Spotlight on Pharmacy
A New Medication Dispensing System is Coming to UMMC Joseph J. DiCubellis, RPh., MPH, Senior Director of Pharmacy, UMMC, and Timothy Wu, PharmD, Health System Pharmacy Administration Resident
The Pyxis Enterprise Solution (ES) system is an automated medication dispensing system marketed by Becton, Dickinson and Company (BD) which supports the decentralized medication management model our Medical System is moving towards.
The new Pyxis MedStation ES features many familiar core Pyxis MedStation functions. However, the strength behind the new Pyxis ES platform lies in its ability to provide capabilities that can be leveraged in unprecedented ways across the health care system. Integration between Pyxis MedStation ES system and health care information technology provides the data staff need to support real-time decision-making and reporting, as well as providing hospital and system leadership information to support longterm growth strategies. In providing a platform to manage hospital networks, Pyxis ES allows health care systems to properly tackle situations that arise at a system level. As the University of Maryland Medical System (UMMS) grows, the number of patients that we care for has also increased. In order to provide optimal and efficient patient-centered care, leadership has looked into new technologies to further strengthen health care operations at a system level. As many of the hospitals within UMMS move towards a cartless medication supply model, a solution needed to be identified that was both feasible and scalable. After extensive research and review, UMMS decided that the Pyxis ES system would provide the technological solution which would allow us to better care for our patients. Currently, Pyxis ES is already
The new Pyxis MedStation ES
implemented at our system hospitals at UM Baltimore Washington Medical Center, UM Shore Regional Health, and UM Charles Regional Medical Center. Other hospitals planning to roll out Pyxis ES in early 2017 are UMMC, UMMC Midtown Campus, and UM Rehabilitation and Orthopaedic Institute, with the remaining system hospitals to follow. By providing custom-built medication drawers with multiple storage options, Pyxis ES provides users with the ability to customize based on the needs of each unit within a hospital. With Pyxis ES, there is much flexibility with storage space options to ensure that most medications needed on the floor are there for the staff. This customization allows collaboration between nursing
and pharmacy staff to build each automated dispensing cabinet to suit the specific needs of each hospital unit. By customizing each automated dispensing cabinet, inpatient pharmacy services are able to ensure more than 90% of all medications used are available on the unit to improve medication delivery times, as well as prevent most medication delays. By moving to Pyxis ES, workflow for both pharmacy and nursing services should become more efficient, allowing our health care providers to focus more on the patient and less on technical tasks. As we move towards a population health model of payment, formulary management and standardization of practice becomes more important for cost savings, medication safety, and providing outcome-based results. Pyxis ES is able to provide a unified platform for pharmacy, nursing, and information technology to fulfill these needs of our health care system. Pyxis ES does this by providing a platform that could be used system-wide to ensure standardization. From an IT and pharmacy standpoint, it allows unification throughout the system, which strengthens drug purchasing power, enables cost savings, captures additional charges, improves medication safety, and assists with the complications of managing the formulary from a system level (Work, 2010). For other health care systems which have already adopted Pyxis ES, such as Ochsner Health System in Louisiana, Warren (2014) states they have shown that Ochsner has become more efficient in the operations of continued on page 11.
news &views New Medication Dispensing System, continued from page 10. medication procurement and dispensing while obtaining the many benefits as previously described above. By increasing the amount of automation in the distribution system, Pyxis ES enables pharmacists to focus on more clinical aspects of patient care. Through automation and the proper implementation of new technologies such as Pyxis ES, UMMS will move
forward as a health care system in providing optimal outcome-based care for our patients. u References Pyxis MedStation™ ES System.(2016) Retrieved from http://www.carefusion.com/our-products/ medication-and-supply-management/medicationand-supply-management-technologies/ pyxis-medication-technologies/pyxis-medstationes-system
Warren, S. (2014). Standardizing processes across the health system enables pharmacists to expand their role in clinical care. Retrieved from http:// www.carefusion.com/documents/case-studies/ medication-supply-management/DI_OchsnerHealth-System_CS_EN.pdf Work, M. (2010). Automating the OR supply chain at Memorial Hermann Healthcare System: Implementing point-of-use automation for the operating room. Retrieved from http://www. carefusion.com/Documents/case-studies/ medication-supply-management/DI_MemorialHermann-HFM_CS_EN.pdf
Staying Current with One’s Skills – How it Helped Save the Lives of Two Children Casey Embert, BA, Project Specialist, Clinical Practice and Professional Development
Health care workers often perform heroic acts with no recognition or fanfare. Sometimes they reduce their selfless acts as simply doing the right thing at the right time. But it is clear that the benefits of staying up-to-date on essential skills like basic life support (BLS) extends far beyond complying with hospital regulations. One can never predict when an emergency situation will require quick action to save a life. On July 30, 2016, while on summer vacation in Omaha, Nebraska, to visit her daughter, Patti Jones, MS, ACNP-BC, CCRN (nurse practitioner in Interventional Radiology at UMMC), was put to the test during an afternoon with her grandchildren at Papio Bay Aquatic Center. “I noticed a small child floating face down and lifeless,” Jones recalls. “I picked her up, turned her over, and noticed that she was blue and unresponsive with no heart rate or respirations.” Jones noticed another small child floating nearby, also face down and lifeless. She signaled a lifeguard, who immediately pulled the other victim out of the pool. Both Jones and the lifeguard simultaneously began performing CPR on the two children. A day at the pool quickly turned into a parent’s worst nightmare. Neither parent was aware that their daughters, ages three and four, had wandered off into the pool and were distraught at the scene. Jones comforted the parents so that she and the lifeguards could continue their lifesaving efforts for the children.
“The lifeguards were young and inexperienced, so my effort was mostly concentrated on making sure things were being done in the right way,” Jones says. “Thankfully we were able to resuscitate them before the EMTs arrived.” Jones learned two valuable lessons about situational awareness on that day. “[First], small kids are quick to wander off and have no fear of the water, so caretakers should be evervigilant of them,” Jones says. “[Second], the children had obviously been floating in the water for a period of time but the lifeguards and people in the pool didn’t really notice until I called for help,” Jones explains. “I think it’s human nature to respond to calls for help and sometimes miss what’s right in front of you.” Because of Jones’ swift response and clinical training, both girls were transported in stable condition to the Children’s Hospital & Medical Center in Omaha. “I don’t consider what I did heroic because I would like to think anyone would have done the same thing in this situation,” Jones admits. “But, I do consider it a great honor to have been in the right place at the right time to save the little girls.” u
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The Nursing Research Council is now the Nursing Research and Evidence-Based Practice Council Lisa Petty, BSN, RN, CCRN,SCN I, Co-Chair, NREBPC; Danielle Evans, BA, BSN, RN, CCRN, SCN II, Co-Chair, NREBPC; Kimmith Jones, DNP, RN, RN-BC, Director of Translation to Nursing Practice; and Casey Embert, BA, Project Specialist
During this past year, the name of the Nursing Research Council was changed to the Nursing Research and EvidenceBased Practice Council (NREBPC). This was an important part of our broader strategic initiative to emphasize our commitment to innovation, educational excellence, and achievement. The Council also wanted to reflect the ongoing work of research and evidence-based practice (EBP), along with all of the projects taking place at the University of Maryland Medical Center (UMMC). The leadership of the Council consists of two co-chairs and the director of translation to nursing practice. Nurses from across the Medical Center and from a variety of departments form the Council membership. The NREBPC meets the first Thursday of every month from 12:00 PM to 1:30 PM in the Lipitz board room. Events are held regularly throughout the year in an effort to promote a spirit of inquiry, to educate, and to share information about research and EBP. Establishing a spirit of inquiry within the Medical Center has the potential to improve patient outcomes and satisfaction, both important in today’s health care environment (Melnyk, et al. 2014). The events that the NREBPC sponsors include Journal Club, We Discover, and Nursing Grand Rounds. The Journal Club, held quarterly, discusses research or EBP findings and compares them to practice at UMMC. When appropriate, the outcome of a journal club may revise practice standards to ensure that our practice is evidence based. We Discover is a series of presentations and workshops designed for clinical nurses involving process improvement, EBP, research, and evidence translation. We are currently looking to a possible change in meeting times to accommodate night shift and provide “drop-in” sessions to assist staff in developing their projects or answer questions about a current project. Nursing Grand Rounds recognize staff who demonstrate expertise in patient management, presents studies that identify a “take-away” message, and builds collaboration and respect through cross-unit and division involvement. Details and calendar dates are listed on the following link: http://intra.umms. org/ummc/nursing/cppd/research/events. These events culminate with the annual Clinical Practice Summit (CPS), which serves as a venue for nurses and members of other disciplines throughout UMMC to display the extraordinary work that is being accomplished through poster presentations. These presentations include educational and professional development initiatives, and process improvement and evidencebased projects occurring in various units and areas of the Medical Center. The Summit is held each year during Nurses Week, and posters are displayed in the Weinberg Atrium. The last CPS held in May of this year, was the first time the NREBPC included four awards: Best EBP Poster, Best Research Poster, Best Performance Improvement Poster, and The People’s Choice Award. Summit attendees voted to select the winners who were highlighted in the summer issue of News & Views.
The Council plans to make a few changes in 2017 to the CPS to allow for electronic submission of posters and abstracts and to expand the voting to further engage staff and raise awareness of the innovative work occurring at the Medical Center. The link for the poster templates is http://intra.umms.org/ummc/nursing/ cppd/research/presentations-and-publications. Next spring, the Summit will be held May 9th and 10th. In the coming months, please look for deadline dates to be announced for abstracts and poster submissions. Poster presenters chosen for presentation rounds will be required to make a commitment to being present during the rounds to answer questions and speak to their project. If there is more than one author, a team approach may help to cover the poster during rounds. An individual must complete the review of all posters before they can place their vote(s) for awards. When voting on posters, comments are encouraged. Award categories in 2017 will include categories from last year – including Best Research Poster, Best EBP Poster, and Best PI Poster – but will expand to include a miscellaneous category, which was designed to encourage participation from all areas in the hospital, and not just nursing. This category will include evaluation studies, baseline data for process improvement projects, and case studies. The People’s Choice Award will expand to include the three best poster projects. The NREBPC is looking forward to reading about the fantastic work you are doing through your posters. Remember to reach out if you have any questions. We are here to assist. The following link has contacts for EBP information: http://intra.umms. org/ummc/nursing/cppd/research/nursing-ebp/ebp-contactinformation. u References Melnyk, B. M., Gallagher-Ford, L., Long. L. E., Fineout-Overholt, E. (2014). The Establishment of Evidence-Based Practice Competencies for Practicing Registered Nurses and Advanced Practice Nurses in Real-World Clinical Settings: Proficiencies to Improve Healthcare Quality, Reliability, Patient Outcomes, and Costs. Worldviews on Evidence-Based Nursing. 11: 1. p. 5–15. DOI: 10.1111/wvn.12021
news &views Certification Corner
UMMC’s Drive to Get Certified Brian Le, MS, RN, CCRN, SCN I, Medical Intensive Care Unit
An important component of being designated a Magnet® organization includes a commitment to the professional development of nurses. This includes providing the support and resources to achieve national certification. Setting annual goals for nursing at the organization and unit level are part of the Magnet® expectations. Achieving a higher level of certified nurses has been identified as one of the top priorities for the University of Maryland Medical Center’s (UMMC) upcoming Magnet® re-designation in 2018.
With that in mind, the nursing Certification Committee, with the support of the Professional Advancement Council, is conducting a multifaceted approach to addressing the needs of our clinical nurses and empowering them to take their practice to the next level. To achieve this goal, the Committee recognizes that the following needs to occur: ◗◗ Identification of NEEDS; ◗◗ Access to RESOURCES; ◗◗ Providing GUIDANCE and SUPPORT; and ◗◗ Increased RECOGNITION. In order to address these items, a survey will be conducted to identify barriers to achieving certification and what incentivizes nurses in our organization to obtain certification. Based on this feedback, the Certification Toolbox located on the UMMC Insider will be updated to include additional resources to assist those seeking certification. This will include information about the availability of local/regional review courses and study groups for specific certifications, in addition to the names/ contact information of UMMC nurses that are willing to assist those needing more guidance in regards to a specific certification. Currently, resources are being added to the Certification Toolbox to include instructions on obtaining test prepayment from the unit’s education budget, certification study guides, and general test-taking strategies.
UMMC values national Brian Le, MS, RN, CCRN, Senior Clinical Nurse I, MICU and certification and recognizes Natalie Mollish, BS, BSN, RN, CCRN, Clinical Nurse II, MICU this achievement by doubling a certified nurse’s continuing for certification regardless of unit size or education budget from $500 to specialty. Every unit has an equal chance $1,000 annually. The nurse is allowed to win these awards and recognitions to use these funds in any manner they at the annual certification breakfast. choose, including national membership The Committee hopes that this friendly dues or conference/workshop fees. In competition will encourage teamwork the coming months, increased visibility on the units to support each other in of how the organization values becoming certified. certification will occur. This will include The Certification Committee meets the updating of unit plaques to recognize bi-monthly on the first Thursday of the certified nurses who have achieved the month from 8:00 AM to 9:00 AM this milestone in their professional in room J36 on the 6th floor of the journeys, along with some additions to Gudelsky Building. Units are encouraged the annual certification breakfast. to send a representative to collaborate Every year, UMMC takes a brief on certification efforts and to share moment to celebrate those nurses resources. For more information, please who explore the outer reaches of their contact Brian Le, committee chair, at specialties and prove themselves as ble@umm.edu or go to the certification experts by achieving national certification. support web page on the Insider at The Certification Committee is pleased http://intra.umms.org/ummc/nursing/cppd/ to announce that a new tradition will excellence/nursing-and-pcs-governancetake place at the March 2017 breakfast. UMMC leadership, with assistance from councils/professional-advancement-council/ certification-support. u the Committee, will recognize the units which hold certification as one of their proudest accomplishments. There will be awards and prizes given to participating units supporting eligible nurses to achieve higher levels of specialty certification. Some of the award categories include “Most Certified Nurses in Specialty,” “Most New Certified Nurses,” and “Most Certified Nurses Overall.” Categories will reflect growth and efforts
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Journal Club Chinwe Anadu, MS, BSN, RN, CCRN, Clinical Nurse II, Surgical Intensive Care Unit, facilitated the October Journal Club for the article “Prophylactic Sacral Dressing for Pressure Ulcer Prevention in High-Risk Patients” (Bryne et al, 2016). The purpose of this study was to determine the effectiveness of using silicone-based dressings preemptively as a means to reduce and prevent pressure ulcers in patients at high risk for pressure ulcers.
In spite of our best efforts and use of pressure ulcer prevention protocols, data shows that patients still develop pressure ulcers during their hospital stay. Hospital-acquired pressure ulcers (HAPU) not only affect reimbursement, but they also have financial implications for the hospital due to additional treatment and increased length of stay. Pressure ulcers are considered quality care indicators. The Agency for Healthcare Research and Quality (AHRQ) estimates annual costs for pressure ulcer treatment at $9.1– $11.6 billion and individual patient costs at about $20,900 – $151,700 per HAPU (U.S Department of Health and Human Services). HAPU claims are the second most common settled claim after wrongful death (U.S. Department of Health and Human Services). Needless to say, it is in the best interest of hospitals to continue to work to figure out ways to decrease pressure ulcer incidence in patients during their hospital stay. This study was designed and conducted as a quasi-experimental, nonrandomized, observational study. There was no conceptual model or nursing framework disclosed or referred to as a guideline for this study. The study was conducted at a tertiary care academic medical center and Level 1 trauma center with 951 acute beds. Three intensive care units (ICUs) participated in the study – surgical coronary care unit (SCCU), medical coronary care unit (MCCU), and medical intensive care unit (MICU) – which were comprised of coronary care/cardiac surgery patients and medical ICU patients. It involved
an initial sample size of 584 patients; however, based on specific inclusion and exclusion criteria, the final sample size was pared down to 243 patients, out of which only 200 had complete data that could be utilized for analysis of results and conclusions. The period of study was May through November of 2012. During the initial seven months, baseline data was collected on patients in all three ICUs within the hospital. The next phase of the study (duration of seven months) was the implementation of siliconebased dressings on the sacrum of patients included. Methods utilized included the use of explicit inclusion and exclusion criteria to screen patients. Patients with any one of the following were included: surgery >4 hours; cumulative surgeries >6 hours; cardiac arrest this admission; vasopressor >48 hours; shock; sepsis or multiple organ dysfunction syndrome (MODS); or patients positive for five or more conditions out of 20 additional criteria listed. Once patients were admitted to the unit, the nurses assessed them using the criteria listed above. Those included in the study had ALLEVYN gentle border sacral dressing applied to their sacrum. Once during each shift, dressings were peeled back and a thorough skin assessment was performed on these patients by the nurse. The sacral dressing was changed every three days for patients participating in the study and all skin assessments were completed per hospital protocol and set guidelines. All assessments were documented in a data collection tool and the completed data collection tools were collated weekly
by unit education specialists. After seven months, results obtained in the ICUs showed a decrease in pressure ulcer incidence rates of anywhere from 3.4 to 7.6 per 1,000 patient days. Additionally, results obtained on the surgical coronary care unit were somewhat significant with P = 0.08, thus leading the authors to conclude that use of these dressings as a prophylaxis may be significant in reducing and preventing pressure ulcers in high-risk patients. The P value is a number between 0 and 1 obtained from a chi square test, if P ≤ 0.05 the results are considered significant and is strong evidence to accept the alternative hypothesis (Ha). The alternative hypothesis in this study is that the use of silicone-based dressings will reduce pressure ulcer incidences and rates in high-risk patients versus the null hypothesis (Ho), which is that use of silicone based dressings will not change the incidences and rates of pressure ulcers in these patients. However, the study has some limitations and weaknesses. Before and during the study, demographic data was not collected on any study patients. This lack of demographic data means that it is undetermined if there are other factors in play that may have biased the results obtained. Furthermore, the study was quasi-experimental, non-randomized, and observational. In clinical research, an experimental, randomized control trial still remains the gold standard for producing results with high validity and reliability. The quasi-experimental nature of the study and the sample population selection methods are indications of the presence of threats to external and internal validity of results, thus a low confidence in results was produced. Also, as stated previously, the P values obtained for hypothesis testing using the chi-square test range from 0.08 to 0.27. These values are not strong enough to continued on page 15.
news &views Journal Club, continued from page 14. validate the Ha and completely reject the Ho. Additionally, inter-rater reliability was not assessed since the repositioning of patients was not monitored during the study. With such high P values and questionable validity and reliability it would be necessary to repeat the study, perhaps over a longer period of time, to determine if similar results can be
rates. These initiatives included a multidisciplinary hospital pressure ulcer committee, use of dermal defense champions, and increased education and awareness on the units to prevent pressure ulcers. Nevertheless, in spite of the aforementioned limitations, the results indicate a reduction in pressure ulcers
Incidence and Rates of Pressure Ulcers in All UMMC ICUs Apr/Jun 2014 to Jan/Mar 2016
CSICU
MICU
SICU
Avoidable Pressure Ulcers
16
7
13
Unavoidable Pressure Ulcers
24
32
20
Total
40
39
33
Table 1
reproduced to validate the results and conclusions reported by this study. Other factors to be taken into consideration, as reported by the authors of this article, include the fact that this study was conducted at the same time as new initiatives were taking place within the hospital to decrease pressure ulcer
pressure ulcers. This study can be beneficial as a reference and/or resource for nurses to conduct studies and process improvement projects that will contribute to our body of knowledge and lead to modifications that improve our current practices. In addition, the results will help formulate new guidelines and implement education for pressure ulcer prevention and reduction. This may be a novel tool to further explore and develop in the fight to improve patient satisfaction and prevent ulcers in highrisk patients. u References Bryne et al. (2016). Prophylactic Sacral Dressing for Pressure Ulcer Prevention in High-Risk Patients. American Journal of Critical Care, 228-234. US Deparment of Health and Human Services. (n.d.). Are we ready for this? Retrieved from Agency for Healthcare Research & Quality: http://www.ahrq.gov/
in the patients involved in the study. Therefore, this study can be utilized as a reference for future research and in designing future studies. At UMMC, available data supports higher incidences and rates of pressure ulcers in all ICUs (see Table 1). Patients in our ICUs are significantly at higher risk for developing
Corporate Compliance, continued from page 2. the ePHI of four million individuals and included names, credit card numbers, and dates of birth. One laptop was stolen during a burglary of an Advocate office. An outside party then accessed an Advocate BA’s network, compromising 2,000 patients. Finally, 2,000 more patients were breached when an employee’s unencrypted laptop was stolen from their car. Advocate has since enhanced their data encryption measures. No indication that any of the ePHI has been misused. Catholic Health Care Services (Philadelphia) – HIPAA Business Associate The OCR reached its first settlement with a business associate resulting in a $650,000 fine and a two-year corrective action plan. Catholic Health Care Services of the Archdiocese of
Philadelphia provided management and information technology services as a business associate to six skilled nursing facilities. The OCR received notification in April 2014 that a CHCS-issued, unencrypted cell phone that was not password protected was stolen from an employee. Upon investigation, it was found that 412 individuals were affected by the breach. u
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Clinical Practice Update