2016 Nursing Annual Report

The Advocate Nurse Empower. Serve. Thrive.

2016

Nursing Annual Report

The Advocate Nurse Brand Promise The Advocate Nurse

is skilled in the art of healing and serves as the face of patient care.

The Advocate Nurse brings years of research, education and experience to patients.

They are the center of clinical innovation and the heart and soul of Advocate Health Care.

The Advocate Nurse

is part of a diverse community of proud, dedicated individuals who

Empower. Serve. Thrive.

Table of Contents: Nursing by the Numbers 1

Transformational Leadership 2 Structural Empowerment 6

Exemplary Professional Practice 24

New Knowledge, Innovation and Improvements 32

Message from the Chief NursingNursing Executive by the Numbers Colleagues and Friends, I am extremely proud to present the outstanding accomplishments and personal achievements of our Advocate BroMenn Medical Center nursing team in this 2016 Nursing Annual Report.

This year we did an amazing job on our Magnet Journey, submitting our application in the spring and the final document to the Magnet appraisers in October. I want to recognize the nursing associates who practice in various roles throughout the medical center, for their tireless work in creating an environment of excellence and engagement, which breathed life into our Magnet document and made it a reality.

The process to achieve excellent outcomes is supported by our Nursing Professional Practice

About Advocate BroMenn Medical Center Advocate BroMenn Medical Center is a 221-bed, full-service, teaching hospital dedicated to serving our patients, their families, and our communities.

BroMenn Medical Center is designated as a Level II Trauma Center and a Level II Nursery; and is accredited as a primary stroke center, a chest pain center and a STEMI receiving center. The medical center is ISO 9001:2008 certified. Neonatology services were added in 2016.

2016 Awards • International Organization for Standardization (ISO) 9001-2008 certification

Model (PPM), “Quality Caring,” founded on building caring relationships, exemplary practice and a culture of safety. BroMenn Medical Center nurses, guided by our mission, values, and PPM, keep patients and families at the center of our practice. Our health care ministry is better because of you. The passion for what you do day in and day out is clear, and it is truly an honor to be part of this team.

As you read through this report, I hope you will be as impressed as I am by the accomplishments and the high level of quality demonstrated in practice by our nursing associates and interdisciplinary partners.

I am so grateful for remarkable associates, all who exemplify what truly exceptional organizations represent.

Laurie Round, MS, BSN, RN, NEA-BC Vice President Patient Care Services and Chief Nursing Executive

• American College of Cardiology Foundation’s NCDR ACTION Registry–GWTG Platinum Performance Achievement Award • American Heart Association Mission: Lifeline® Gold Receiving Quality Achievement Award for severe heart attack care • Center of Distinction Award & Center of Excellence Award for Wound Healing & Hyperbaric Medicine • Women’s Choice Award winner for Obstetrics, Patient Experience and Patient Safety

Nursing by the Numbers

• Chicago Tribune named Advocate Health Care as one of its Top Workplaces 2016

Total Number of Nurses Nurse Turnover Rate

8.89%

• DNV Healthcare recertification as a Primary Stroke Center

First Year RN Turnover Rate

16.6%

Nurse Vacancy Rate

5.13%

• American Heart Association/American Stroke Association’s Get With The Guidelines®-Stroke Gold Plus Quality Achievement Award with Target: Stroke Honor Roll

Nurse Tenure Average

• Target Stroke Elite recognition from the American Heart Association • Chest Pain Center with Percutaneous Coronary Intervention reaccreditation

New Nurse Hires in 2016

421

11.3 years 74

Percentage of BSN Prepared Nurses

69%

Percentage of MSN Prepared Nurses

9%

Percentage of Doctoral Prepared Nurses Percentage of Nurses with BSN or higher degrees

0.5% 74%

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Transformational Leadership

“I am proud to work at Advocate BroMenn Medical Center as a part of a collaborative team whose main goal is to always give outstanding patient and family centered care.”

– Stacy Barclay, BSN, RN Manager, Nursing Operations

Our Magnet Journey Advocate BroMenn Medical Center had an exciting 2016 in relationship to its Magnet Journey. While the writing teams continued to prepare required documentation, the Magnet application was submitted and accepted in March.

Document teams finished polishing the documents by mid-summer and a website was created with the assistance of Information Systems to display the final document. The electronic document was submitted to the Magnet Program Office and the Magnet appraisers on October 1st. Notification from the ANCC followed shortly stating the Organizational Overview documents were accepted and that the appraisers

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would take a couple of months to review the remaining documents. Anticipating a positive outcome and a site visit from the Magnet appraisers in early 2017, teams began making preparations. Like providing excellent care requires the collaboration of many people to be successful, the same applies to achieving Magnet designation.

The Advocate Nurse 2020 Our Vision To be a faith based system providing the safest environment and best health outcomes, while building lifelong relationships with those we serve.

Our Role The Advocate Nurse transforms care delivery throughout the patient and family journey, creating the safest environment and resulting in the best health outcomes.

Advocate Experience 1. Engage patients as active owners of their care 2. Minimize Care Variation 3. Eliminate Serious Harm 4. Education 2.0

AdvocateCare

Access & Affordability 1. Curb labor cost growth with improved quality: Workforce Optimization Transformational Leadership 2. Optimize care teams to improve quality, efficiency, and cost outcomes across care settings 3. Advance Practice Clinician (APC) Strategy

1.

2.

Optimize EMR Perfect Care Transitions throughout the continuum

Transformational Nursing Leadership 1.

2.

3.

4.

Development and implementation of the Advocate Nurse Strategy Strengthen succession planning and leadership development Build pipeline and competencies of future workforce that supports emerging care delivery models System Shared Governance restructure

The Nursing Strategic Plan was developed by the System Chief Nurse Executive and the Chief Nurse Executives of the sites to lead nursing to 2020.

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Transformational Leadership Advocate Health Care Professional Practice Model

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Nurses across Advocate BroMenn Medical Center continue to exemplify the caring behaviors and the essence of the professional practice model every day and in every encounter. The model has truly given a name and a depiction of the way that our nurses care for patients, for each other and for our organization. It is a daily reminder that the patients, their families, and our community should be at the center of all decisions.

Enculturation and adoption of the professional practice model took place throughout 2016. Nurses became comfortable talking about how their nursing practice, patient care, and collaborative partnerships connect to the model and how the practice model can help them to identify what is most important.

Goal-based Performance Evaluations Beginning in 2016, a new goal-based performance evaluation process was implemented. Nurses across the medical center shared common goals that would be reflected on performance evaluations. Having the same goals across all levels of nursing established key priorities and outcomes that required collaboration in order to be achieved.

The focus for 2016 goals included:

Target

Actual

Handwashing Compliance

90%

80%

Unassisted Falls

80%

90%

75th Percentile

75.3th Percentile

meets expectations

meets expectations

Inpatient HCAHPS

• Handwashing Compliance

Site Composite Goal

• Unassisted Falls

New Medication Education

90%

75%

• Patient Satisfaction

Pain Reassessment

90%

78%

• New Medication Education • Pain Reassessment • Site Composite Goal

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Nursing Associate Goal Plan for 2016

Transformational Leadership

Laura McCartney

Paula Wiesenhofer

Cindy Schaumburg

New Nursing Leaders • Laura McCartney, BSN, RN, CNOR, became the Manager of Cardiac Services (Cath Lab & Non-invasive Cardiology) in May. Laura received her BSN from Medical College of Virginia and is a Certified Nurse Operating Room. She has 24 years of experience in nursing. Her experience includes OR, PACU, (10 years of Cardiovascular surgery), 5 years of nursing management for GI, Rheumatology, Allergy, Diabetes Clinic, and Plastics. Her gifts include team building and process improvement.

• Paula Wiesenhofer, MSN, RN, became the 6 West Surgical Unit and Acute Rehabilitation Unit Manager in July. Paula has 21 years of nursing experience (14 years in the PACU, 2 in the OR, 3 in critical care, 1 in education as a Nurse Residency Program Coordinator). She received her BSN from Mennonite College of Nursing and her MSN in Nursing Systems Administration from Mennonite College of Nursing at Illinois State University. One of her gifts is her knowledge of surgical nursing.

• Cindy Schaumburg, MSN, RN, CPHQ, became the Quality/Regulatory Compliance Manager in October.

Cindy began her career at BroMenn Medical Center as a tech while she was attending nursing school and has been a nurse here for 37 years. She has served in multiple roles as a BroMenn nurse including as an RN in ICU, Same Day Surgery, Pre-Admission Testing, PACU, Case Management & Quality, a Clinical Educator, and as the Regulatory Coordinator before assuming her current role. She received her diploma in nursing from Mennonite Hospital School of Nursing, her BSN from Illinois Wesleyan, and her MSN from American Sentinel University. She is presently a Certified Professional in Healthcare Quality. One of Cindy’s gift is her organizational skills.

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Structural Empowerment

“I’m extremely proud to be a nurse at Advocate BroMenn Medical Center.

BroMenn really makes everyone feel like they are family. I love my work family and the care that is delivered to all is tremendous. I truly feel blessed to be a part of the Advocate family.”

– Mike Becker, RN

Nursing Practice Council and Unit Shared Governance The Nursing Practice Council (NPC) at Advocate BroMenn Medical Center has accountability for establishing and maintaining the standards of nursing practice. Nurses come together to share best practices and to problem-solve the challenges that come with working in a complex health care environment.

Council participants include clinical nurses who chair their Unit Shared Governance Councils, nurse educators, and nurse leaders from across the organization.

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Shared Governance

Some of the 2016 Highlights from NPC Included: • Discussion and activity planning for the Professional Practice Model.

• 2016 Nurses Week planning, including poster development highlighting each unit’s Shared

Governance projects.

• Addition of a nursing intervention related to EEGs added to the EMR to address the safety concern

of delayed reading of EEGs when ordered during a hospitalization.

• Revision of the Guiding Principles of Nursing to incorporate the Quality Caring Model.

• Reviewing, editing, and retiring applicable nursing forms.

• Monthly review of quality data with recommendations to improve quality scores.

• Presentation from NPC member, Jennifer Perry, on the research study completed by Center for

Wound Healing regarding lidocaine/EMLA for wound debridement.

• Input into the Hand Hygiene “Secret Shopper” process.

• Discussion of new medication education and pain reassessment audit method with Quality Care

Coordinators.

• Feedback/recommendations on the Advanced Directive process.

• Insulin dose timing and coordination of dietary tray delivery process change.

• Sedation Scale assessment discussion with Clinical Informatics to determine the best location

for the assessment.

• Discussion with Pharmacy regarding possible solutions to increasing pneumonia vaccine

administration compliance.

• Sponsored the Mitten, Hat & Scarf tree with donations going to those in need in the community.

• Provided cookies and hot chocolate to patient care providers at Christmas time as a part of

peer reward and recognition.

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Structural Empowerment Shared Governance 2016 Highlights Patient Care Improvements

• ICU and CVCU established the Standard of Care (SOC) guidelines for the application, maintenance, and discontinuation of BiPAP. Some components in this evidence-based standard of care included: oral care, maintaining skin integrity, and increasing communication between RNs and respiratory therapists. A specialized Mepilex was purchased for the use with BiPAP masks. This SOC will be finalized in 2017.

• The Mother Baby Unit (MBU) prepared for the introduction of neonatology services. Education for nursery associates and respiratory therapists was completed regarding new equipment, methods of oxygen delivery, and respiratory support. New order sets and assessment tools were built.

• Mother Baby Unit hardwired evidence-based practices of delayed and immersion bathing for newborns.

The team noted positive feedback from families, better thermoregulation, and improved breastfeeding initiation rates.

• Outpatient Infusion collaborated with the heart failure nurse and with cardiologists/nurse practitioners to establish a protocol for heart failure patients in the outpatient setting and reduce hospital readmissions.

• The Cath Lab team completed a gap assessment against evidence-based practice literature on Surgical Site Infection prevention strategies. Several practice measures were identified to ensure procedure sterility and improve procedure outcomes. Training in those measures and implementation of procedures began and SSI rate will be measured in 2017 to monitor the results of the practice change.

• Sepsis education continued in the Emergency Department including updated evidence for IV fluid administration. The attendance of the Clinical Nurse Specialist and the Clinical Coordinator during Sepsis Codes has enhanced coordination of care and improved IV fluid documentation.

• The Medical Oncology Specialty Unit collaborated with the physicians of the Hospitalist Program on the development of a new Alcohol Withdrawal Protocol.

Patient Safety

• MBU implemented a patient safety contract, specific to OB, addressing falls prevention and infant safe sleep. This contract has been adopted by several other Advocate hospitals.

• Mental Health Unit (MHU) Shared Governance continued to monitor, hardwire, and address needed changes to its fall preventions measures implemented in 2015. The MHU has experienced a decrease in patient falls, as tracked by the falls committee and measured by KRAs. • The Emergency Department Shared Governance looked at opportunities to improve the process of monitoring patients at risk for self-harm or harm to others. They decided to eliminate the use of Public Safety Officers and use Nursing Technicians (NT) in that role instead. All associates underwent specialized training to learn tools to better manage patients who were exhibiting aggressive behavior. NTs now provide direct observation of patients, utilize their skills to evaluate patients for escalating behavior and collaborate with the patient’s RN to assess/reassess the patient’s risk level. Restraint utilization will be measured to evaluate the benefit of this practice change.

• Emergency Department Shared Governance completed the ENA Workplace Violence Emergency Department Assessment Tool which revealed a perception that the workplace was not a safe place to practice. Survey results were presented to the BroMenn Medical Center Workplace Violence Committee, who recommended securement of the ED doors with the ability to lock down the department. Multiple badge readers, a video intercom, and an ambulance door key pad were installed. A post-implementation assessment tool revealed an increase in nursing’s perception of safety for themselves and their patients.

• The Perioperative Safety Committee made up of HRU Safety coaches determined handoff communication to be one of the highest risk areas for a safety event to occur due to multiple handoffs between areas.

Following a nurse’s perception survey and audits to determine the use of an existing SBAR Handoff tool, the decision was made to re-educate, reset expectations and monitor utilization compliance.

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Structural Empowerment

Pain Control

• 6 West Surgical completed a literature review on scheduled pain medication versus PRN medication for orthopedic patients. The project will continue in 2017 with an ultimate goal of proactively managing pain in this patient population.

Patient Satisfaction

• The Same Day Services Advocate Experience Committee identified an opportunity to care for families and patients as they wait for surgery. The committee partnered with Volunteer Services to provide a Comfort Care Hostess to round on patients’ families for two hours a day during peak surgical volume. A job description and training manual were developed. The implementation went smoothly and currently all five shifts are covered with trained hostesses.

• Staff from the PACU completed an evidence-based literature review regarding visitation of family members or legal guardians for pediatric patients in PACU. A policy for PACU visitation was developed and implemented. Data collection will begin in January 2017 by calculating a FLACC score on pediatric patients at pre-determined intervals.

Documentation Improvement

• Acute Rehab changed the documentation for required FIM scores by adding check boxes that nurses can use to provide supporting documentation for their score. As a result, charting compliance improved to 100%. The change also improved FIM scoring accuracy and decreased nursing documentation time.

• Acute Rehab combined their I&O and rounding logs to decrease paper checklist documentation and decrease nursing and nurse tech workload.

• The PCU Shared Governance Team chose to re-evaluate the neuro assessment documentation after a review of the literature revealed there was an improvement opportunity. A new assessment is expected to be implemented in early 2017.

• The Progressive Care Unit (PCU) developed a ventriculostomy checklist. This will ensure safety elements of the ventriculostomy set-up and orders are reviewed during shift change for this high risk/low volume patient population.

Process Improvement

• To ensure that the CHF standard of care is implemented for each patient (including patients with a history of CHF), to reduce readmissions, and to set an example for patients, performance improvement efforts in Critical Care focused on consistent daily standing weights for this population.

• Associate suggestions regarding improvement of first case on time starts were prioritized by the PeriAnesthesia Leadership Shared Governance group and an improvement plan was developed. Continued attention to first case on time percentages and daily follow up is planned for 2017.

Patient Education

• Critical Care created education for patients and families regarding rules and expectations while in the ICU and Mental Health Unit Settings. The education is expected to be available in early 2017.

• To improve KRA goals for first dose medication education documentation, MHU Shared Governance members developed a psychiatric medication education tool/poster. Due to a variety of side effects that any given medication may have, the most common side effects of the medications were narrowed to just a few, so medication teaching would be consistent among nurses. Dr. Dhorajia, psychiatrist, and Steve Pinneke, director of pharmacy, were also asked to collaborate on this project. The effectiveness of the teaching tool/poster will be monitored through first dose medication education data collected for KRAs, as well as through Press Ganey Survey questions regarding patient medication teaching. The posters will be displayed in patient common areas, including both lounges, classroom, and hallway and a smaller version will be available for nurses to use during medication administration.

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Structural Empowerment Academic Partnerships Wendy Woith named Advocate BroMenn Medical Center’s Endowed Professor Wendy Woith, PhD, RN, FAAN, officially assumed the Endowed Professor role in May 2016. The professorship is focused on excellence in nursing, research, and EBP (evidence-based practice). Wendy mentors nurses in the development and execution of research and evidence-based practice projects.

She co-chairs the Nursing Research Council with Trayce Bartley, MSN, RN, Director of Perioperative Services. Wendy also serves on the Advocate Health Care Research Council and actively participates on the annual Nursing Research Symposium planning committee.

Developing Future Nurses and Peers As clinical nurses continue to grow professionally and assume leadership and advanced practice roles, succession planning is important to ensure ongoing excellent patient care at BroMenn Medical Center. To prepare future generations of nurses and nurse leaders at the medical center, it is imperative to develop students from local nursing schools and attract them to the culture of excellence at BroMenn Medical Center so they will remain in central Illinois for their career. To accomplish this, a multi-pronged approach is used, including the establishment of collaborative relationships with local colleges and universities, the provision of excellent on-site clinical experiences, use of a summer internship program, and the offering of nursing student informational sessions.

BroMenn Medical Center is fortunate to have academic partnerships with three schools of nursing in Bloomington/Normal, Illinois, including Mennonite College of Nursing (MCN) at Illinois State University, Illinois Wesleyan University, and Heartland Community College. Relationships with these academic institutions are maintained in a number of ways and led by CNE Laurie Round.

Traditional on-site clinical experiences for nursing students are augmented by various experiences offered for students to learn about and observe the work of nurses throughout the organization. These opportunities introduce students to a range of career opportunities, both clinical and non-clinical, that are available at the medical center.

BroMenn Medical Center also offers a paid summer internship program for qualified candidates who have completed their junior year of nursing education.

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Each intern is paired with a clinical nurse coach who supports their growth in gaining critical thinking skills and navigating the complex care of patients in their area of interest. The feedback from interns has been extremely positive. Many of the interns continue employment within nursing at BroMenn Medical Center during their last academic year, further increasing their potential for employment as clinical nurses at BroMenn Medical Center upon graduation.

Additionally, BroMenn Medical Center hosts a variety of informational sessions for nursing students to find out more about nursing at the medical center, to learn about interviewing skills, and to give them an opportunity to ask questions. Clinical nurses at BroMenn Medical Center who completed their nursing education at one of the local universities or colleges participate in these sessions to give their perspective, tour students in areas of interest, and build relationships, both as alumni and as future colleagues.

Succession planning must include positive, collaborative experiences for nursing students at every opportunity, whether it be well-rounded clinical rotations, internships, or informational sessions.

As the nursing workforce ages, new graduate nurses become the medical center’s future nursing workforce pipeline.

Number of undergraduate nursing students in 2016: Spring 2016

373

Summer 2016

28

Fall 2016

283

Total 684

Structural Empowerment 2016 Summer Interns

Front row left to right: Sheron Howard, Elizabeth Barclay, Darci Jones Hoepner, Kaitlyn Hjerpe Back row, left to right: Haley Dzierzynski, Caitlin Hallatt, Hannah Wolles, Morgan Love

Professional Development BroMenn Medical Center offers nurses the opportunity to develop professionally. Nurses can receive financial support through the Advocate Health Care Education Assistance Program when seeking nursing degrees and specialty nursing certifications. Flexible work schedule options support scheduling needs when taking classes. In addition to the system resources, BroMenn Medical Center has a professional development plan that identifies key organizational learning priority areas for the year and offers financial support for nurses to attend conferences/continuing education that help achieve these priorities. In 2016, 70 nurses took advantage of this professional growth opportunity. Advocate Charitable Foundation funds covered the $22,541 in expenses for these education experiences.

LEARN The Advocate Nursing Strategic Plan was developed in 2014 by Susan Campbell, DNP, RN, NE-BC, Advocate Health Care’s (AHC) Senior Vice President and Chief Nursing Officer and the hospital Chief Nursing Executives (CNEs) with a vision of defining and developing The Advocate Nurse. Susan’s goal was for each nurse to be provided with a strong educational foundation to deliver the same outstanding level of care to each and every patient touched within the

Magnet Conference Oct 2016 Had a great time while it lasted!

The Magnet conference was cut short due to a hurricane. The trip home made for some great bonding and memory making.

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Structural Empowerment LEARN continued

organization. The plan laid out the strategies to be reached by 2020 to meet the demands of the changing healthcare environment.

The first initiative of the strategic plan was a redesign of nursing orientation both for new graduate nurses, as well as experienced nurses. The goals of the redesign were: • To improve the orientation process • To increase new hire and coach satisfaction with

the orientation process • To improve the retention of new hires

A system-wide team was tasked with analyzing the current format and developing a new, innovative program.

The newly developed orientation process model is called LEARN (Launching Excellence in Associates and RNs). LEARN consists of a four-day immersive orientation program. Each day of the four day program is based on simulations, hands-on skills stations, and small group debriefing sessions.

Competency of the new RN is assessed daily as he/she progresses through the stations. After demonstrating initial competency at the completion of LEARN, the new RN begins unit-based orientation with their assigned Coach which is tailored to meet the needs of the new nurse.

The program was implemented at BroMenn Medical Center on January 4, 2016.

“The essence of teaching is to make learning contagious, to have one idea spark another.”

– Marva Collins New Graduate Nurse Residency In 2016 the New Graduate Nurse Residency program transitioned from a site-based program to a systemwide standardized residency program.

Twelve new nurse residents “graduated” from BroMenn Medical Center’s site-based program in November 2016. The site program met monthly for one year. The emphasis of this program was developing critical thinking skills, sharpening clinical practice, and promoting professional development. It also allowed a safe place to voice concerns and fears in a supportive environment and to celebrate “wins” both personal and professional, with friends and peers.

In September of 2016, BroMenn/Eureka initiated the first cohort of the system-wide program. This program fosters a positive experience for all newly licensed nurses as they transition into practice and is required for all eligible new graduate nurses.

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Based on the Vizient/AACN™ model, Advocate’s New Graduate Nurse Residency Program is one year in duration, with monthly seminar meetings. This program does not take the place of hospital or unit orientation, but instead focuses on leadership, quality outcomes and the professional role of the nurse.

The seminar meetings incorporate blended learning/ teaching strategies that include didactic, hands-on content, case studies, simulation, and facilitated discussion. In the new program the focus shifted away from clinical skills, but the environment of sharing, support and camaraderie still exists.

BroMenn Medical Center’s first group consists of 22 new graduate RNs. The group is currently working on evidence-based projects which will be presented in August, 2017.

Structural Empowerment Clinical Ladder Success through Excellence in Practice (STEPS)

Katie Brown NCIII, Meredith Diaz NCIII, Rachel Keighin NCIII, Ashley Painter NCIII, Sarah Smithson NCIII

In 2016, the STEPs program was Advocate’s professional advancement program for full and part-time registered nurses who provide direct patient care. The program recognized nurses who exemplify professional practice and clinical skill in their areas of expertise. In 2016, five deserving nurses from BroMenn Medical Center were promoted to Nurse Clinician III (NCIII) status within the STEPs program. Promotion to NCIII required completion of an application, peer reviews, completion of 15 contact hours of continuing education, a written case study and presentation of the study to the Clinical Career Advancement Board. Congratulations to these deserving nurses who were promoted in 2016: • Katie Brown, MBU • Meredith Diaz, PCU • Rachel Keighin, MBU • Ashley Paynter, 6 West • Sarah Smithson, PCU

Professional Certified Registered Nurses Advocate Health Care and Advocate BroMenn Medical Center support continuous professional development including the attainment of professional nursing certification in one’s area of specialty. Certification signifies the licensed professional has mastered a body of knowledge and acquired skills to meet certain predetermined standards specified by that profession for specialty practice. In 2016, BroMenn Medical Center added three new nursing certifications to our list: Certified Breastfeeding Counselor (CBC), Certified Heart Failure Nurse (CHFN), and Certified Medical Surgical Registered Nurse (CMSRN).

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Structural Empowerment Nurses with Magnet-Recognized Certifications ACM (Accredited Case Manager) • • • • • • • • • •

Brandie Anderton, Care Management Tena Bliss, Care Management Lisa Crane, Care Management Nichele Gavin, Care Management Susan Henkel, Care Management Jenny Messier, Magnet Jeff Smith, Care Management Cindy VanDusen, Care Management Laura Wiley, Care Management Shelly Zobrist, Care Management

ACNS-BC (Adult Clinical Nurse Specialist) •

Victoria Steinkoenig, Clinical Education

CAPA (Certified Ambulatory Perianesthesia Nurse) •

Corinn Desmond, Same Day Surgery

CCNS (Critical Care Clinical Nurse Specialist) •

Donna Schweitzer, Clinical Education

CBC (Certified Breastfeeding Counselor) • • • •

Teresa Boyle, Mother Baby Unit, new 2016 Ann Groonwald, Mother Baby Unit, new 2016 Sara Mounce, Mother Baby Unit, new 2016 Keli Sidebottom, Mother Baby Unit, new 2016

CCNS (Critical Care Clinical Nurse Specialist) •

Donna Schweitzer, Clinical Education

• • • •

• • • • •

•

• •

• • • • • •

CCRN – Pediatrics (Critical Care Registered Nurse) •

Michael Mandrell, Emergency Dept

• • •

• •

•

•

• • • •

Peggy Jacobs, Mother Baby Unit

CNOR (Certified Nurse Operating Room) • • • • • • •

•

Penny Boser, Emergency Dept Kathy Brown, Nursing Office Leslie Carter, Emergency Dept Mike Kelly, Emergency Dept Michael Mandrell, Emergency Dept

Angie Harrison, 6 West Surgical, new 2016 Angela Turner, Med/Surg, new 2016 Jen Wellwood, 6 West Surgical, new 2016

CNM (Certified Nurse Midwife)

Linda Avery, Diabetes Services

•

Pam Bierbaum, Quality Laurel Mode, Quality, new 2016

CMSRN (Certified Medical Surgical Registered Nurse)

•

CEN (Certified Emergency Nurse)

Melanie Evelsizer, Center for Wound Healing Jennifer Perry, Center for Wound Healing Missy Smith, Center for Wound Healing

CIC (Certified in Infection Control)

CDE (Certified Diabetes Educator) •

Janette Chambliss, Palliative Care, new 2016 Gay Shoot, Palliative Care

CHRN (Certified Hyperbaric Registered Nurse)

•

•

Rebekah Lavicka, Heart Failure, new 2016

CHPN (Certified Hospice & Palliative Nurse)

Michael Mandrell, Emergency Dept Bridget McClusky, Intensive Care Michael Mueller, Cardiopulmonary Service Marilyn Nelson, Emergency Dept Emyli Quain, Cardiovascular Care Unit Kody Schisler, Intensive Care – new 2016 Donna Schweitzer, Clinical Education Marissa Smith, Intensive Care Megan Threm, Cardiovascular Care Unit Suzanne Wilcox, Clinical Resource Unit

•

Cheryl Hart, Same Day Services Kevin Irwin, Same Day Services, new 2016 Betty Kaupp, Post Anesthesia Care Unit Yvonne Rees, Same Day Services Sonia Vercler, Perioperative Services

CHFN (Certified Heart Failure Nurse)

•

•

Marilyn Nelson, Emergency Dept Amber Painter, Emergency Dept Lori Ritter, Emergency Dept Emily Ruedi, Emergency Dept Jennifer Toohill, Emergency Dept

CGRN (Certified Gastrointestinal RN)

CCRN – Adult (Critical Care Registered Nurse) •

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•

Crystal Bricker, Operating Room Barbara Hancock, Operating Room Cindy Hauk, Materials Management Michael Hoeft, Operating Room Laura McCartney, Cardiac Services Todd McCartney, Operating Room Meg Noreiko, Operating Room Rayford Rattley, Operating Room Niki Tracy, Operating Room

CPAN (Certified Post Anesthesia Nurse) •

Betty Kaupp, Post Anesthesia Care Unit

CPEN (Certified Pediatric Emergency Nurse) •

Michael Mandrell, Emergency Dept

Structural Empowerment CPHQ (Certified Professional in Healthcare Quality

RN-BC- Medical/Surgical Registered Nurse

Ann Frederick, Quality Tami Olson, Quality Cindy Schaumburg, Quality

•

CPN (Certified Pediatric Nurse)

•

• • •

•

Michael Mandrell, Emergency Dept

CPPS (Certified Professional in Patient Safety) •

Kristie Wolfe, Patient Safety

CRN (Certified Radiology Nurse) •

Janet Sutter, Radiology

CRRN (Certified Rehabilitation RN) • •

Dayna Krowlek, Acute Rehab Amanda Parrish, Acute Rehab

CWCN (Certified Wound Care Nurse) •

Linda Bergren, Wound/Ostomy

CWOCN (Certified Wound, Ostomy, Continence Nurse •

Becky Hatfield, Wound/Ostomy

CWON (Certified Wound Ostomy Nurse) • •

Linda Bergren, Wound/Ostomy Teresa Novy, Wound/Ostomy, new 2016

FNP-BC (Family Nurse Practitioner) •

Miranda Gonzalez, Mother Baby Unit

IBCLC (International Board Certified Lactation Consultant) •

Lucinda Edgren-Gebhardt, Mother Baby Unit

NEA-BC (Nurse Executive Advanced) •

Laurie Round, Administration

NE-BC (Nurse Executive) • •

Lori Harper, Nursing Practice and Obstetrics Stephanie Moore, Critical Care/Emergency Svcs

NP-C (Family Nurse Practitioner) •

Miranda Gonzalez, Mother Baby Unit

OCN (Oncology Certified Nurse) • •

Jeanne Aden, Medical Oncology Specialty Unit Patty Omahana, Cardiovascular Care Unit

ONC (Orthopedic Nurse Certified) • •

Angie Le, 6W Surgical Cindy Wells, Progressive Care Unit

PCCN (Progressive Care Certified Nurse) •

• •

•

Jennifer Abraham, Medical Oncology Specialty Unit Donna Anderson, Medical Oncology Specialty Unit Gayle Guffey, Quality Kristin Remmers, Medical Oncology Specialty Unit Angie Schoon, Cath Lab

RN-BC – Nursing Professional Development • •

Alicia Allen, Medical/Surgical Dana Robbins, Clinical Education

RN-BC – Psychiatric & Mental Health Nurse • • • •

Patricia Kruse, Mental Health Sara Purfield, Mental Health Peggy Vanhorn, Mental Health Toni Winks, Mental Health

RNC-LRN (Low Risk Neonatal Nursing) • • • • •

Linda Baer, Mother Baby Unit Michelle Braun, Mother Baby Unit Lisa Gilmore-Riess, Mother Baby Unit Angela Philpott, Mother Baby Unit Lori Troyer, Mother Baby Unit

RNC-MNN (Maternal Newborn Nursing) • • • •

Brenda Drury, Mother Baby Unit Susan Kaufman, Mother Baby Unit Kathy Macy, Mother Baby Unit Joan Yoder, Mother Baby Unit

RNC-NIC (Neonatal Intensive Care Nursing) •

Denise Hammer, Mother Baby Unit

RNC-OB (Inpatient Obstetric Nursing) • • • • • • • • • •

Jessica Baker, Mother Baby Unit Lucinda Edgren-Gebhardt, Mother Baby Unit Melissa Eskridge, Mother Baby Unit Mary Finley, Mother Baby Unit Ann Groonwald, Mother Baby Unit Peggy Jacobs, Mother Baby Unit Lori Pearson, Mother Baby Unit Keli Sidebottom, Mother Baby Unit Susan Wilkins, Mother Baby Unit Stephanie Wollenberg, Mother Baby Unit

SANE-A (Sexual Assault Nurse Examiner-Adult) •

Tammy Vandegraft, Emergency Dept

SCRN (Certified Stroke Registered Nurse) •

Victoria Steinkoenig, Clinical Education

Bet Atkins, Clincal Resource Unit

RN-BC – Gerontological Nurse •

Teresa Novy, Wound/Ostomy

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Structural Empowerment New Nursing Degrees Received in 2016 • Gayle Guffey, Quality Resource Management

Master’s degree in Nursing Systems Administration from Mennonite College of Nursing at Illinois State University • Denise Hammer, Mother Baby Unit

DNP from Mennonite College of Nursing at Illinois State University • Missy Hardesty, Intensive Care Unit

BSN from Mennonite College of Nursing at Illinois State University • Michael Mandrell, Emergency Services

MSN in Adult-Gerontology Acute Care Nurse Practitioner with Emergency Nurse Practitioner Subspecialty from Loyola University Chicago • Dusti Manning, Radiology

BSN from Mennonite College of Nursing at Illinois State University • Patty Omahana, Cardiovascular Care Unit

MSN in Nursing Education from American Sentinel University • Candace Ramirez, Clinical Resource Unit

BSN from Northern Illinois University

• Amy Short, Nursing Operations

BSN from Chamberlain College of Nursing • Audrey Sokol, Clinical Resource Unit

BSN from Bradley University • Loretta Tay, Mother Baby Unit

BSN from Methodist • Megan Threm, Cardiovascular Care Unit

MSN (FNP) from Olivet Nazarene University • Kacie Zielsdorf, Mental Health Unit

BSN from Western Governors University

• Ashton Saindon, 6 West Surgical Nursing

BSN from Chamberlain College of Nursing

Nurses Becoming Better Teachers The 2015 Learning Needs Assessment conducted at BroMenn Medical Center identified diabetes as one of the most requested education topics by nurses. Nurses verbalized, and patient satisfaction data revealed, that nurses were not comfortable with teaching patients the “survival skills” that were needed for discharge. Linda Avery, MS, RN, CDE, Diabetes Educator, developed a lecture and hands-on education session to improve the nurses’ expertise in teaching a diabetic patient.

In March and April of 2016, nine Nurse Quarterly sessions, focused solely on Diabetes Education, each two hours in length, were conducted. Two contact hours were awarded for attendance at the sessions through the Ohio Nurses Association. Nurses from across the hospital participated in the education.

Linda developed the curriculum of the class to include a lecture component, giving the nursing

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associates evidence-based information on the latest recommendations for diabetes care of the hospitalized patient from the American Diabetes Association, and a review of the teaching techniques for transitioning a patient from hospital to home.

During the second half of the session, attendees were divided into small groups and given a “kit” containing an insulin pen, a home glucose monitor, an insulin syringe, a vial of normal saline, patient education, the hypoglycemia treatment protocol, glucose tablets, the teaching outline and a skin/ subcutaneous pad. Each attendee was tasked with reviewing the materials in the kit. Using the provided scenario, each nurse utilized role play to teach the other members of their small group, practicing their patient education techniques.

Structural Empowerment 2016 Nurses Week Highlights Nurses Week (May 6-12) is a time to acknowledge and recognize our nurses for the work that they do for patients, families and the community. Highlights of the week included: • A presentation by Faith Roberts entitled “From

Wedding Rings to Nose Rings – Generational Differences • A pancake breakfast prepared and served by

nurse leaders • A poster session highlighting Shared

Governance and nursing practice was sponsored by the Research Council and displayed publicly for associates and the community

• Blessing of the Hands by our chaplains and

chaplain residents • Presentation of Nursing Excellence Awards

Reward & Recognition Nursing Excellence Awards Nursing Excellence Awards were presented to four very deserving nurses.

Patient Advocacy Kevin Irwin, RN, CGRN, Same Day Surgery

Clinical Care Lindsey ZumMallen, BSN, RN, Progressive Care Unit

Leadership Jenny Messier, BSN, RN, ACM, Magnet

Mentoring Linda Vierhout, RN, Eureka Inpatient Unit

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Structural Empowerment Nursing Story Awards The theme for the 2016 Story Contest was focused on the 8 Caring Factors as identified in the Quality Caring Model, the nursing theory which the Nursing Professional Practice Model is built upon. Nursing Story Awards were presented to: First Place: Brittney DeCroix, BSN, RN, Mental Health – “Becoming a Mental Health Nurse: My Path to Self Discovery” Second Place: Denise Hammer, MSN, RNC-NIC, Mother Baby Unit – “Weekend A” Third Place: Susan Zobrist, BSN, RN, Nursing Operations – “Champion the Value of People” Honorable Mention: • Bet Atkins, BSN, RN, PCCN, Clinical Resource Unit – “A Matter of Perspective” • Amanda Rios, BSN, RN, Medical Oncology Specialty Unit – “Mrs. Finck Loves Smiling Faces” • Missy Smith, RN, CHRN, Center Wound Healing – “Learning to Dance in the Rain” • Beka Lavicka, BSN, RN, CHFN, Cardiopulmonary Services – “Hoofbeats”

2016 Certified Nurses Day

March 19th is Certified Nurses Day. Certified Nurses Day honors nurses worldwide who contribute to better patient outcomes through national board certification in their specialty. Board certification is an important way to distinguish nurses who demonstrate an exceptional level of competency, skill, and knowledge in their field.

Certified Nurses’ Day was celebrated at BroMenn with a breakfast to honor our certified nurses.

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Structural Empowerment Nursing’s Value Leaders Four nurses were honored in 2016 as Quarterly Value Leaders because of their display of one or more of our five core values: Compassion, Equality, Excellence, Partnership and Stewardship.

Excellence Sara Mounce, Mother Baby Unit

Partnership Jason Pate, Intensive Care Unit

Partnership Laura Deisher, Cardiovascular Care Unit

Stewardship Ra’Net Bye, Same Day Services

Patient Safety Award Each year Advocate Health Care recognizes Patient Safety Awards Winners from each site. In early 2016, Patient Safety Award Winners Kelsey Anderson and Angie Harrison were honored.

Kelsey, the patient’s primary nurse, received an order to place a new drug patch on a patient. The dose was ordered from the patient’s home medication list. Prior to applying the new patch, Kelsey noted the old patch she was removing did not match the newly ordered higher dose. Kelsey brought this to Angie’s attention and together they validated the medication reconciliation list matched the medication list from the nursing home.

Still concerned, Angie called the nursing home to confirm the patch dosage and was informed there was an error on the list they sent. The physician was notified, and the correct dose was ordered and administered.

Their attention to detail, questioning attitude using QVV and stop the line, and communicating clearly using clarifying questions prevented this patient from receiving six times the intended dose of a strong narcotic pain medication.

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Structural Empowerment Community Partnership Mental Health First Aide Mental Health First Aid is the initial help offered to a person developing a mental health or substance use problem, or experiencing a mental health crisis. The first aid is given until appropriate treatment and support are received or until the crisis resolves. Advocate BroMenn Medical Center has the unique opportunity to offer a Mental Health First Aid course to our nurses throughout the year for continuing education hours. The course provides an overview of many mental health diagnoses, along with resources to provide to patient and community members to assist with early diagnosis and recovery.

Mental Health disorders often co-exist with a medical condition. Participants in the course learn risk factors and warning signs of mental health and substance use problems, information on depression, anxiety, trauma, psychosis, and substance use, along with a 5-step action plan to help someone who is developing a mental health problem or in crisis. The education is also used to decrease the stigma surrounding mental illness.

This evidenced-based program has been brought to us through collaboration and grants from BroMenn Medical Center’s Community Wellness department and the McLean County Health Department. The class is offered collaboratively with trainers from Advocate Eureka Hospital, the Center for Human Services, Emergency Medical Systems, and BroMenn Medical Center.

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Structural Empowerment Young Hearts for Life Cardiovascular disease is the leading cause of death in the United States and in Illinois. The Young Hearts for Life (YH4L) Cardiac Screening Program identifies high school students at risk for sudden cardiac death. YH4L seeks to detect young adults at risk for sudden cardiac death. YH4L does this by providing FREE EKGs that can identify those heart conditions that can cause sudden death. YH4L uses trained volunteers to staff these events. In 2016, approximately 200 volunteers came together for six screening events at area high schools. Among the volunteers were several BroMenn Medical Center nurses including, Emyli Quain, Sherry Bailey, Molly Emery, Justyna Koscielniak, Mary Tedford, Laurie Gabaldo, Sherri Pearson, Teresa Bailey, Jennifer Perry, Victoria Perry, Megan Threm, and Allie Wholf.

BroMenn Medical Center screened 1,239 students in 2016. Of those, 12 students were recommended for further evaluation.

YH4L in our community has not only effectively identified students with potential life threatening conditions, but has served to increase awareness of the risks of sudden cardiac death in young people.

Chase for Champions On April 16, 2016, the Chase for Champions event honored local first responders, while raising money for the Advocate BroMenn Medical Center Stroke Program. There were over 600 attendees and $85,000 in proceeds were directed to the stroke services at the medical center. The funds helped purchase specialized therapy equipment to augment the recovery and enhance the independence level of stroke survivors.

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Structural Empowerment Stroke Education for the Community In 2016, members of the Advocate BroMenn Medical Center Stroke Team continued to educate Bloomington/ Normal and surrounding area community members in an effort to improve early recognition and treatment timing of stroke. Below are the events that team members participated in: • Concerns of the Heart community education event • Women’s Health Night at Illinois State University • “Your Brain Your Future” presentation at Eureka

College in Eureka, Illinois and at Seniors for Healthy Living • Article titled “For women: 4 must know facts about

stroke” published in Healthy Outlook

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• Stroke education to Eureka Middle School children,

faculty, and staff • Stroke Education at State Farm and Country

Companies • “Brain Health” presentation at the Senior Expo

Dessert with the Doctor: “Oh…It’s Just a Migraine”

Structural Empowerment Springfield Nurse Advocacy Day Nurses from BroMenn Medical Center and Eureka Hospital joined other Advocate nurses for Nurse Advocacy Day on May 11, 2016. Nurses traveled to Springfield for a day of education and had the opportunity to meet with their local legislators and Governor Bruce Rauner. Topics discussed included support of the nursing licensure compact, need for a state budget, and the opioid epidemic. It was an empowering day where the Advocate nurses made their voices heard.

Legislative Forum The Nurse Advocacy Council sponsored BroMenn Medical Center’s annual legislative forum. Nurses Crystal Bricker (BroMenn) and Jennifer Steinhausen (Eureka), members of the Advocate Nurse Advocacy Council moderated the event. Four legislators attended the event and answered questions. BroMenn Medical Center and Eureka Hospital nurses and associates attended, as well as nursing students from Illinois State University and political science students from Illinois Wesleyan University.

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Exemplary Professional Practice

“I am proud to be a part of an organization that makes patient safety a top priority. As a Safety Coach, I am proud to lead others in using our BE SAFE Tools to provide safe care…always. I love the enthusiasm and dedication of every associate, physician and resident to help reach that goal together.”

– Katie Brown, BSN, RN Nursing Satisfaction

High Reliability Journey

Each year bedside nurses are asked additional questions through the Associate Satisfaction Survey to elicit their satisfaction and engagement in the key areas of leadership access and responsiveness, professional development, interprofessional relationships, RN-to-RN teamwork and collaboration, autonomy, and adequacy of resources and staffing.

The graph below demonstrates that BroMenn Medical Center nurses rated their satisfaction higher than the national benchmark in all six areas.

There is nothing more important than the safety and quality of patient care we deliver. An estimated 210,000 to 440,000 people on an annual basis die as result of preventable medical error. In 2016, Advocate BroMenn Medical Center continued moving forward in the system journey to become a High Reliability Organization (HRO) and eliminate all serious patient harm by the year 2020. HROs operate under difficult conditions all the time, yet manage to have fewer than their fair share of errors. They decrease the chance of making an error by striving to make their systems ultra-safe. High Reliability Units (HRU) focus on eliminating serious preventable harm through an enhanced culture of safety at the unit level. High Reliability is achieved in collaboration with front line associates (Safety Coaches) through culture change, coaching, problem-solving, and process redesign.

It requires a shared commitment to fundamentally change the way leaders, physicians, and associates think, communicate, and act. Key achievements for 2016 include: • the addition of 14 new HRUs and 48 new Safety

Coaches bringing our total to 17 HRUs and 71 Safety Coaches 24

High Reliability Journey continued • a 55% reduction in our Serious Safety Event Rate

from the baseline established in January 2014 • leading the system in Patient Safety Event

reporting, ending the year at a rate of 12.0 with a goal of ≥4.0 • an 86% increase in the number of safety events

reported in 2016 compared to 2015 • an AHRQ Culture of Safety percentile rank of 82

with a goal of ≥75th percentile • over 20 nominations for the Annual Patient

Safety Award Some examples of unit-based HRU projects from 2016 to address safety concerns include: • Safe Sleep: ‘All Hands on Deck’ philosophy and

education (Mother Baby Unit) • Development of a Ventriculostomy Checklist for

use at handover (Progressive Care Unit) • Measures to reduce potential for pressure

ulcer development during long imaging exams (Radiology) • New patient education developed for patients

discharged on Lovenox (6 West Surgical) • Development of an SBAR Handover

Communication tool (Perioperative Services)

Quality Management Program Advocate BroMenn Medical Center’s Quality Management focus areas and achievements for 2016 include: Ongoing Maturation of the Quality Management System (QMS) • Implemented a new management review and

process owner reporting process • Developed processes to support risk-based

thinking and change management

• Completed 53 audits and implemented 34

process improvements • Hosted DNV for site visit for Managing Infection

Risk Certification (results to be announced in 2017) Significant Outcomes Included: • Unassisted falls rate at the 90th percentile • National Surgical Quality Improvement (NSQIP)

metrics met or exceeded all performance targets • Elective delivery rate at 0.9% (target < 3%) • Setting best practice blood utilization

performance nationally with a 44% decline in RBC utilization • Sedation documentation metrics for bedside

procedures at 98%, exceeded the performance target of 90% • Restraint documentation metrics, both for violent

(92%) and non-violent restraints (95%), exceeded the performance target of 90% • STEMI door to balloon time is now consistently

beneath 90 minutes • Stroke door to TPA needle time averaged 62

minutes • HCAHPS satisfaction with pain management was

at the 73rd percentile nationally; satisfaction with discharge planning was at the 83rd percentile • Behavioral Health patient satisfaction remains

high at the 89th percentile nationally • Length of stay was managed efficiently and was

12% less than expected • Emergency Department left without being seen

rate was 1.9%, meeting the target of < 2% • Readmissions within 30 days were as expected,

readmissions from the Skilled Care PAN were 21% lower than expected

• Completed an inventory, and improved control of

non-policy/procedure documents • Established a site Policy/Procedure Committee

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Exemplary Professional Practice Infection Prevention 2016 Annual Summary

• Clean storage for dialysis machines • Cleaning responsibility designation in MBU LDRP

and OR Suites

In addition to prompt responses to public health concerns such as Mumps, Zika, and Influenza, and ongoing surveillance of healthcare acquired infections and drug resistant organisms, BroMenn Medical Center’s efforts for 2016 centered on reducing infection risk through a number of activities.

Improving compliance with hand hygiene was a year long initiative. Enhanced monitoring of infection related patient safety event reporting enabled the medical center to strengthen processes for reducing infection risks through internal consultation and risk assessment.

The strength of the Infection Prevention Program lies in the integrated approach that includes interprofessional and multi-departmental collaboration, while utilizing risk reduction strategies.

During 2016, risk assessments were completed on: • Re-isolation of patients colonized with ESBL and

CRE infections

• Glove use by Support Services when

transporting contaminated waste • Nurse Call Assist Devices • Shingles and isolation usage • Movement and transport of patients, potentially

contaminated items and clean supplies • Safe use of tube system • Green tape to mark clean items

In 2017, key areas of focus will be on improving overall compliance with hand hygiene, ongoing assessment of several newer infection risk reductions strategies and continued use of risk assessments for both current and new processes that impact patient and associate safety.

Nurse Experts Sharing Their Expertise

Becky Hatfield, Linda Bergen, Teresa Novy and Jennifer Ringsby.

At Advocate BroMenn Medical Center the Wound Ostomy nurses play a unique role in the care of the patient needing wound and/or ostomy care. As the experts, the Wound Ostomy nurses collaborate with almost every area of the hospital to help treat patients and families, provide individualized wound care options and provide nursing education. The Wound Ostomy nurses work closely with the bedside nurses and physicians, recommending the best evidence-based treatments. Each Wound Ostomy nurse is passionate about staying on the cutting edge of best practice.

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Exemplary Professional Practice Nurse Experts continued

The Wound Ostomy nurses work daily with each new ostomate to provide needed education to the patient and the family. The time spent with patients and their significant others provides a basis for the relationships built with each person. The relationships with each ostomate varies and can be full of concerns, tears and eventually acceptance. The goal is for the ostomy patients and families to leave the medical center with a basic understanding of their surgery and the ability to care for themselves.

The Wound Ostomy department collects data to measure Hospital Acquired Pressure Injury (HAPI) outcomes. Recent terminology changes by the National Pressure Ulcer Advisory Panel (NPUAP) have led to the words “pressure ulcer” being switched to “pressure injury”.

The goal of the Wound Ostomy Department is to provide wholistic, comprehensive and compassionate care to the population of wound and ostomy patients at BroMenn Medical Center, in an effort to improve patient outcomes.

It’s a beautiful thing when

a career and a passion come together.

Comprehensive Care Program Throughout 2015 the inpatient palliative care team partnered with medical center leaders from several different disciplines and created the “Comprehensive Care Program”, a pilot program designed to support patients after discharge who have multiple chronic illnesses and are at a high risk for readmission. The pilot program was implemented in April of 2016 and included 31 patients.

The Comprehensive Care Program is a 30-day post discharge program aimed at supporting and navigating patients through transitions of care by: • Facilitating self-identified personal goals around

symptom and disease management • Supporting functional recovery

develop a plan of care with individualized patient centered goals. The PCN provides ongoing support throughout the term of the program by coordinating the plan of care and providing motivational coaching and structured patient education to help the patient achieve their goals. The program ends once the following outcomes are demonstrated: • Patient is knowledgeable about medications and

has a solid administration process • Patient maintains a record keeping system that

ensures continuity of care across providers and settings • Patient is aware of and utilizing appropriate

community and healthcare resources

• Teaching self-management skills

• Patient has established an Advanced Plan of Care

• Removing barriers

• Patient has made life style changes to achieve

• Integrating community and health resources

The program is facilitated by a Patient Care Navigator (PCN), a nurse with specialized clinical training and Palliative Care certification. The PCN partners with patients and providers to navigate the patient through complex issues and barriers.

Upon discharge and within 48 hours, a wholistic and comprehensive evaluation is conducted in the patient’s home by the PCN. The PCN works with the patient, family and provider, as well as a multidisciplinary care team from the hospital to

optimum state of health • Patient is knowledgeable about indications that

their condition is worsening and how to respond.

The data collected revealed successful results.

Among the most impressive was the decline in readmissions. The readmission rate for the 31 patients prior to the program was 28% and following implementation decreased to 8%. Helping patients to manage their chronic illnesses and addressing barriers to care, patients are able to overcome the multitude of challenges they face after discharge.

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Exemplary Professional Practice Interdisciplinary Partnership Neurosciences Adds a New Service Neuroendovascular services is a subspecialty within the realm of interventional radiology that treats complex conditions such as strokes, aneurysms, arterial stenosis, tumor embolization, and arteriovenous malformations. Prior to 2016, Advocate BroMenn Medical Center’s neuroendovascular services were limited to treating acute ischemic stroke. With the increased engagement of Dr. Ajeet Gordhan, a neurointerventional radiologist, BroMenn Medical Center will be able to offer the community a broader scope of services in treating complex brain and vascular disease.

Cardiac Collaborative

Poster presentations demonstrating the quality improvements on reduction of acute kidney injury will be displayed at the American College of Cardiology National Cardiovascular Data Registry conference in Washington D. C., presented by Bev Glendon, BSN, RN, in March, 2017 and another at the 5th Annual Advocate Health Care Research Symposium in April, 2017. Kevin Kennel, BSN, RN, and Angie Schoon, MSN, RN-BC, MSN, Cardiac Cath Lab nurses will present the poster at the Advocate Research Symposium.

Critical Care Collaborative Critical Care Collaborative 2016 Accomplishments • Standard orders for telemetry for non-ICU

patients • CMAC video intubation approval • Emergency Department Sepsis Orders and

Sepsis Protocols • Emergency Department and Hospitalist handoff

to eICU procedure

Surgical Collaborative Heart Failure Patients – Improved Referrals & Decreased Readmissions. Beka Lavicka BSN, RN, CHFN, Heart Failure Nurse, serves an important role in ensuring that patients receive the care they need following discharge from the hospital. She guides Advocate Heart Institute patients to the outpatient Heart Failure Clinic, and makes referrals to Cardiac Rehabilitation. With thorough medication reconciliation being completed by the HF clinic and the referrals to Cardiac Rehab increasing, the HF risk adjusted readmission rate in the last half of 2016 was reduced to 14.7%, down from 18% in 2015.

Reduction in Acute Kidney Injury Post Percutaneous Coronary Intervention (stenting): Efforts continued in 2016 to sustain the gains made with this initiative.

BroMenn Medical Center maintained a Risk Adjusted Acute Kidney Injury Rate in the 75th-90th percentile of the American College of Cardiology National Cardiac Data Registries Cath PCI Outcomes Report in 2016.

Key interventions included: • Working collaboratively with care providers at

different patient care contact points to identify problems and solutions • Preventing AKI with hydration as a first line

intervention • Using a Contrast Induced Nephropathy risk

assessment tool to manage care 28

The Surgical Collaborative is a multidisciplinary group that meets monthly and is charged with improving patient outcomes and removing barriers to efficient and effective practice, while ensuring a sustainable practice model is maintained. In July 2016, an opportunity to develop strategies for reducing the risk of surgical site infections (SSI) among high body mass index (BMI) patients was identified.

The Surgical Site Infection Round Table Committee was formed in August 2016. The multidisciplinary workgroup performed literature reviews, benchmarked with other hospitals, and consulted with surgeons, mid-level providers, and front line nurses of leading bariatric programs to identify best practices and risk reduction strategies for the high BMI population.

Multiple new strategies and best practices were identified to help reduce the SSI rate for the targeted population. Notable strategies implemented included: revised methods and standardization for prepping and cleaning the surgical site prior to surgery; nurse training on dressing change procedures, along with the use of single use equipment; and finally, the use of a moisture-wicking fabric with antimicrobial silver that effectively manages complications associated with skin folds.

Exemplary Professional Practice The implemented strategies provided a significant reduction in SSI infections within the identified population. The success the workgroup achieved was attributed to the willingness of the multidisciplinary members to meet regularly and search for strategies and best practices that would achieve the goals and through the partnership with front-line nurses and caregivers, who implemented the new practices.

Obstetrics/Nursery Collaborative OB/Nursery Collaborative 2016 Accomplishments • Emergency labor to C-Section drills added to the

annual competencies • Streamlined the process of pediatrician rounding

by providing them with a rounding sheet that automatically pulls documentation from the EMR • Neonatology joined the OB/Nursery

Collaborative team • Developed an OB Alert in collaborative with the

Emergency Department with implementation planned for March 2017 • Tdap vaccination continues to be available in

the Atrium Pharmacy for patients and family convenience

Sepsis Program Sepsis affects over 750,000 patients annually and is one of the leading causes of death in the United States. While Advocate BroMenn Medical Center and Advocate Eureka Hospital have had a screening protocol for sepsis in place for the last decade, we recognized there were further opportunities surrounding sepsis recognition and screening. In 2016, we partnered with an outside vendor to provide automatic real-time scanning for sepsis through the Sepsis Visual Smartboard. The Sepsis Visual Smartboard utilizes an algorithm written from current evidence-based guidelines and scans the Meditech EMR for qualifying data. Every 3 minutes the algorithm scans every patient chart in the Emergency Department and most inpatient units looking for criteria such as abnormal vital signs, infection criteria, and abnormal lab results. If the algorithm picks up qualifying criteria, it automatically results the screening to the Sepsis Visual Smartboard and the patients EMR. The Sepsis Visual Smartboard was activated at BroMenn Medical Center and Eureka Hospital in August of 2016. BroMenn Medical Center is currently partnering with the Advocate Children’s Hospitals to write a pediatric sepsis screening protocol to be

utilized at all sites. This pediatric screening protocol will also be incorporated into the Sepsis Visual Smartboard to screen for qualifying sepsis criteria for our youngest and most vulnerable populations.

Emergency Department Pharmacist At Patient Safety Committee meetings in 2015, inadequate medication reconciliation for patients admitted through the Emergency Department (ED) was identified as a concern. With 50.7% of patients admitted to the medical center through the ED, this provided a significant organization-wide opportunity to improve the process of reconciling medications as a foundational element for treating patients in the inpatient setting and enhancing patient safety and quality of care.

Several steps were taken throughout the second half of 2015, to add pharmacists to the ED. These included adding additional pharmacy FTEs, evaluating and implementing a practice model for the ED pharmacists, and developing a process and procedures. The ED Pharmacist coverage in the ED was implemented at the end of 2015. During medication reconciliation for patients admitted through the ED, pharmacists review patient charts and medical histories, interview patients and family members, and consult with the patients’ physicians in order to obtain accurate medication histories.

The pharmacists update patients’ electronic medical records noting any changes in the medications listed.

In addition, the pharmacists make recommendations for current therapy and serve as a resource to associates and physicians. Patients admitted through the ED during hours not covered by an ED pharmacist have their medication histories reviewed and reconciled the next morning by the ED pharmacist.

Prior to the implementation of pharmacists in the ED, the percentage of medication errors within the medical center that reached the patients was 38%.

Pharmacy leading the medication reconciliation process upon admission has improved patient information for treatment and has positively impacted the transitions of care by providing a more accurate home medication list from which to reconcile medications at the time of discharge.

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Exemplary Professional Practice Emergency Department Pharmacist continued

Since ED pharmacist implementation, the percentage of medical center medication errors reaching patients has decreased. This initiative was championed by Laurie Round, MS, BSN, RN, NEA-BC, Vice President Patient Services and CNE.

The clinical practice change promoted patient and family centered care. The purpose of the change was to increase exclusive breastfeeding, reduce the number of at-risk breastfed newborns who receive formula supplementation and decrease admissions to the SCN. Pre-implementation data revealed that 61.67% of at risk newborns were exclusively breastfed.

The goal of the management of newborns at risk for hypoglycemia project was to increase exclusive breast feeding/human milk consumption for at risk newborns during the first two days of life or for the length of the hospital stay if less than two days.

Newborn Hypoglycemia In 2015, the Nursery Focus Shared Governance Group at BroMenn Medical Center implemented an evidence-based practice change utilizing 40% glucose gel for newborns at risk for hypoglycemia.

Previously the screening and management of at-risk newborns with low blood glucose concentrations involved the use of formula, which can reduce breastfeeding rates, and/or increase admission to the Intermediate Care Nursery for intravenous dextrose infusion.

The nurses recognized that their professional relationships and collaboration with their interprofessional partners were key to the successful implementation of this practice change.

The collaboration for the evidence-based change that occurred between the Nursery Focus Shared Governance Group Implementation Team, Adam Ebreo, MD, pediatrician; William Cummings, PharmD, pharmacy analyst, Valerie Dotson, MT(ASCP), lead laboratory assistant and point of care coordinator, laboratory; Diane Anderson, RN, MBU clinical informatics system coordinator and Mark Ficek, BA, senior field analyst, Information Systems, was instrumental to complete the evidence-based practice change. In alignment with the PPM, the clinical nurses pursued clinical excellence for their patients through the Shared Governance structure. The nurses on the Nursery Focus Shared Governance Group demonstrated leadership as they influenced and encouraged their peers during the implementation phase.

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The practice change was based on the AAP (2011) guidelines with inclusion of the use of 40% glucose gel (Adamkin, 2011). On December 5, 2015 the management of newborns at risk for hypoglycemia evidence-based practice change was initiated for all newborns.

Through the implementation of this evidence-based clinical practice change utilizing 40% glucose gel for at risk newborns, MBU increased the percentage of exclusively breastfed at risk newborns from 61.67% to 68.9%. Through the involvement of the clinical nurses in the implementation of the PPM, they displayed increased awareness of the structures and processes that support success when implementing organizational practice changes.

Exemplary Professional Practice Workplace Safety Throughout 2016, multiple initiatives were undertaken to address potential and realized threats to the safety of associates including: • New lights installed along Apple Street between

the medical center and the Main Street parking lots • New Workplace Violence reporting tool

implemented August 15, 2016 • Badge access implementation for the Emergency

Department doors, restricting access.

• Coating Intensive Care Unit glass in several

rooms and at the nurses station to prevent the glass from shattering if hit with an object

• All ICU and ED staff receiving refresher

Managing the Aggressive Person training.

• Mental Health First Aid being offered to nursing

associates for CEs, with plans to continue providing the training in 2017 • Panic alarm installation in the ICU and ED • Active shooter education for all associates • Ongoing leadership dialogue with local

police chiefs, discussing ongoing trends and opportunities.

• ED techs trained to provide patient watches in the

ED, allowing Public Safety to be free to perform more proactive rounds throughout hospital and areas surrounding the hospital campus

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New Knowledge, Innovation and Improvements

“I am proud to be part of the Nursing Resource Pool (Clinical Resource Unit) at Advocate BroMenn Medical Center because it allows a nurse to grow and gain knowledge in a variety of different nursing areas.”

– Justin Eighner, BSN, RN Nursing Research Council BroMenn Medical Center’s Nursing Research Council members spent 2015 developing a process that would guide nursing associates in designing and implementing an evidence-based practice or research project. They worked closely with Information Systems on a web portal so that access to all necessary tools and resources was available online. In 2016, Council members mentored shared governance groups, helping them build understanding of evidence-based practice and research as project ideas arose. Four research projects were either completed or underway in 2016, and several units conducted evidence-based practice projects. Every nursing unit has identified at least one project they plan to implement in the coming year.

Advocate BroMenn Nursing Research The following studies were in progress or completed in 2016: • Comparison of Two Topical Anesthetics for

Sharp Wound Debridement, Jennifer Perry BSN, RN, CHRN, Primary Investigator. Study was completed March 7, 2016. Findings demonstrated

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no significant difference between the topical anesthetics investigated; however, patients preferred 4% Liposomal Lidocaine.

• Does manager rounding influence increased

adherence to bundled fall risk reduction strategies and nurse work engagement,

Toni Winks, BSN, RN-BC, Primary Investigator.

Study was completed August 3, 2016. Data currently being analyzed.

• Management of newborns at risk of

hypoglycemia, Denise Hammer, DNP, RNC-NIC, Primary Investigator. Study completed and demonstrated a decreased need to transfer

newborns to a higher level of care when glucose gel was utilized.

• Breastfeeding Support Group, Peggy Jacobs,

DNP, RNC-OB, CNM, APN, Primary Investigator.

Initiated January 19, 2016. Continue to enroll participants in the study.

Advocate Research Symposium Eight nurses from Advocate BroMenn Medical Center attended the 4th Annual Advocate Health Care Nursing Research Symposium, Building the Future of Nursing Science, at Drury Lane Theatre & Conference Center on April 6, 2016. Sixty abstracts were submitted for podium and poster presentations; 52 were accepted. Two of the abstracts accepted for poster presentations and one abstract for podium presentation were from BroMenn Medical Center.

These presentations included: • Ellen McComb and Cora Bennett– Podium

presentation on the Reduction of Upper Extremity DVT with PICC catheter using ZIM • Susan Kaufman – Poster presentation on Delayed

Bathing of Newborns • Kristin Peterson and Tori Steinkoenig – Poster

presentation on Stroke Community Education: Know Your Sign

Cora Bennett, Same Day Services

Evidence-based Practice Improving the perioperative experience for the patient who is tolerant to opioids with EBP In the spring of 2013, a Post Anesthesia Care Unit (PACU) nurse at Advocate BroMenn Medical Center identified that patients who were regularly taking prescribed opioids prior to surgery had very difficult pain control during their PACU stay. She brought this problem forward at a PeriAnesthesia Shared Governance committee meeting. It was identified that the hospital had no formal way to screen patients at risk for opioid tolerance and there was no specific plan to manage the patients prior to, during, and after surgery. A multidisciplinary subgroup of the PeriAnesthesia Shared Governance committee was formed to develop a mechanism for screening patients for opioid tolerance and to develop an evidence based plan of care.

Although all patients with opioid tolerance may have difficulty with acute pain control, initially the

subgroup decided to focus on spine surgery patients.

The interdisciplinary shared governance workgroup developed an evidence-based plan of care for patients at risk for opioid tolerance undergoing spine surgery. The plan of care consisted of evidencebased interventions for the nurses and anesthesia providers during each peri-operative phase and was implemented in May of 2015.

Post implementation data analysis showed that an evidence-based pain management plan of care for patients at risk for opioid tolerance undergoing spine surgery positively influenced their perioperative experience as compared to prior practices. The data was shared with anesthesiologists and they expressed a desire to expand PORA screening and plan of care to all non-emergent surgical patients.

This was accomplished as of April 18, 2016.

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New Knowledge, Innovation and Improvements Perioperative Experience continued

Expanding PORA to all patient types has resulted in similar outcomes as for neurosurgery patients. The care plan if applied as suggested shortens the length of stay in PACU and lowers pain scores resulting in a better experience for the patient who is tolerant to opioids.

Contrast Induced Nephropathy The Invasive Cardiology Department performs 225 percutaneous coronary interventions (PCIs) per year.

A known potential complication is acute kidney injury (AKI), most commonly caused by contrast induced nephropathy (CIN). AKI has been demonstrated to increase morbidity and mortality in this group of patients. It was noted by the shared governance council that the 2013 rate of CIN was 7.78%, higher than the 50th percentile benchmark of 6.12% reported in the American College of Cardiology’s Cath/PCI registry. The shared governance council undertook a project to conduct a literature review for best practice and to develop evidence-based protocols to reduce CIN-related AKI for this patient population.

Following implementation of the protocol there was significant improvement in risk-adjusted AKI rate.

ABMC showed a decrease in risk-adjusted AKI from 7.78% to 2.28%, outperforming not only the 50th percentile registry benchmark, but also the 75th and 90th percentile performance for risk-adjusted AKI.

Quality Improvement Stress Test Timing One of the recommended metrics from the Society of Cardiovascular Patient Care (SCPC) is chest pain patient observation length of stay (LOS).

Observation length of stay (LOS) is measured from the time of the physician order for observation status to the time of discharge. The advantages of a shorter observation LOS are improvement in patient satisfaction, reduction of costs, and improvement in patient throughput, ensuring medical center beds are available when needed.

The interprofessional Chest Pain/Cardiac Collaborative Committee identified that the mean observation LOS presented an opportunity for improvement. In September 2015, the mean observation LOS for chest pain patients was 23.8 hours. An interprofessional workgroup was established with members from the Chest Pain/ Cardiac Collaborative Committee to look at the organizational processes surrounding the length of stay.

The goal was to reduce the mean length of stay for observation chest pain patients, measured in hours and monitored monthly.

The workgroup identified that historically the first cardiac stress test slots available in the morning were designated for outpatients. This led to hospitalized observation patients waiting until later in the day for their testing, delaying discharge, and keeping medical center beds occupied, thus reducing throughput.

Changes were made in the scheduling program to block morning tests for hospitalized patients.

The following additional changes were made: • Cardiology contacts the critical care charge

nurse each morning to prioritize patients to be scheduled for stress testing.

• Nuclear Medicine collaborates with Cardiology

to ensure the isotope will be available at the appropriate time.

These results led to the adoption of ABMC’s protocols for the risk stratification tool and the renal protection/ hydration protocol across the Advocate Health Care system.

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• Advocate Heart Institute scheduling ensures

cardiologists are available to oversee the patient procedures.

The above changes were implemented February 1, 2016.

New Knowledge, Innovation and Improvements Stress Test Timing continued

Poster Presentations

With the process changes, the mean observation LOS for chest pain patients was reduced from the baseline of 23.8 hours in September 2015 to 20.1 hours in May 2016. The team continues to monitor progress.

Podium Presentations Advocate BroMenn nurses had the opportunity to share their expertise and provide education during 2016. A few examples include: • Jennifer Perry, Wound Healing, and Wendy

Woith, Endowed Professor, presented the Wound Healing Clinic’s research finding to Nurse Practice Committee members on May 4, 2016 • Beka Lavicka, Heart Failure Nurse, provided a

Heart Failure presentation to the hospitality staff in March of 2016.

Poster Presentations provided by nurses during 2016 included: • Brenda Drury & Kathy Macy, MBU, presented

their Newborn Bathing poster at the National Mother Baby Nurses Conference in Nashville, Tennessee in September 2016. The conference was organized by the Academy of Neonatal Nurses.

• Kelsey Anderson, ED, (& classmate) presented

a poster entitled “Characteristics of Heart Failure Patients Followed in an Outpatient Disease Management Program” at the American Association of Heart Failure Nurses conference in Arizona in June 2016. The poster was developed as part of their Masters in nursing program.

• Denise Hammer, MBU, presented a

poster entitled “Management of Neonatal Hypoglycemia” at the ISU DNP Intensive Days • Kristin Peterson, PCU, and Victoria Steinkoenig,

Clinical Education, presented a poster at International Stroke Conference 2016 held in Los Angeles, California in February. The poster was titled ‘Community Education-Impact of Knowing Your Sign, on an evaluation of community stroke education’.

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Coming in 2017 New Advocate Integrated Nursing Professional Practice and Care Delivery Model In 2017, nurses across the Advocate Health Care system will be rolling out a new integrated Nursing Professional Practice and Care Delivery Model. The new model includes the familiar components of the current practice model but adds to it the traits of the Care Delivery Model that were identified by nurses across the Advocate system at the 2015 Advocate Nursing Summit. The new integrated model incorporates what has traditionally been two graphics into one.

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The Advocate Nurse Empower. Serve. Thrive.

“Everyone in healthcare really has two jobs when they come to work every day: “to do their work and to improve it.”

— Author Unknown

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