Oo3c 2013 kmh nursing annual report

2013 Nursing Annual Report Caring • Compassion • Quality

Table of Contents

2

4

8

The year 2013 was one of a kind for Kenmore Mercy, thanks to your input, interest, and dedication in expanding the hospital to better treat our patients.

Transformational Leadership

Structural Empowerment

Exemplary

Professional Practice

18

New Knowledge, Innovations, & Improvements

Empirical Outcomes

Editorial Staff Dawn M. Cwierley, AS, BS Cheryl W. Hayes, MS, ANP, NEA-BC Amanda Kramer, RN, BSN Heather Telford, RN, MS, CEN Laura Verbanic, PT, CPHQ Kathleen Vitthuhn, RN, MSN

2

Dear dedicated nursing associates,

Leadership Message

12

20

A Message From Our Leadership

James Millard, president and chief executive officer

With the building of our new south wing that now houses a state-of-theart Emergency Department on the first floor and a modernized Knee & Hip Center on the second floor, we have positioned ourselves for the changing needs of our growing community.

It was a pleasure to walk into planning meetings for each of these new units and to see our nursing staff working with our architects, construction teams, and executive leadership. Together, we created two amazing additions that truly define patientcentered care.

To help meet our continued surgical growth, plans were also initiated for the addition of two new operating rooms and the construction of a new Ambulatory Surgery Unit. With the involvement of our nursing team from the start, we expect these projects to be equally successful.

Kenmore Mercy Hospital is a better place for all those who work and seek care here because of each and every one of you. Keep up the good work!

Sincerely,

Jim

Phyllis Shaffer, RN, and Beth Woods, RN.

Dear friends and colleagues,

In 2013, Nursing’s impact on the delivery of patient care at Kenmore Mercy Hospital made a significant difference.

Cheryl W. Hayes, MS, ANP, NEA-BC, vice president of Patient Care Services

Nursing’s input was sought out for the planning of both the new Emergency Department and the new 2 South Orthopedic Unit, which opened in 2013. Nurses were included in work group sessions for design and layout of the new areas, as well as changes in process to ensure effective care, efficiencies, and staffing changes.

Data and studies were reviewed and discussed regarding best practices for patients, nursing and interdisciplinary team work flow. Equipment and furniture were selected and reviewed by our nurses, which ensured a safe and comfortable environment for the patients.

In the Operating Room and preoperative area, our nurses have been working on the new OR design, and improving processes. They have had a major input into their new documentation system.

The nurses at Kenmore Mercy Hospital are involved and leading the way at the hospital committee level, including the Patient Experience Committee, Shared Governance, Peer Review and Palliative Care Committee, to name a few.

In 2013, we had both an increase in the amount of nurses hired with their Bachelor of Science in Nursing and those who went back to school for their Bachelor’s degree. In addition, nursing certifications increased by 22 percent, indicating a desire for enhanced expertise in specific areas of nursing.

I am proud of our nursing team, from the novice to the experienced: nurses, nursing attendants, our leaders, advisors and educators. All have a very special role in planning and providing safe and compassionate care to all of our patients.

With sincere gratitude to the nursing staff,

Cheryl

Julie Wolcott, RN, Jessica Britton, RN, Rachael Kaplan, RN, and Tonya Heusinger, RN.

Nora Balon, RN, and Molly Sprada, RN.

3

Transformational Leadership Nurses Play Key Role in Opening of New Emergency Department The unveiling of Catholic Health’s newest Emergency Department in July 2013 marked a new era for Kenmore Mercy Hospital. “The opening of the new Emergency Department was a significant milestone in the 62-year history of the hospital,” said James Millard, hospital president and CEO. “After several years of planning and hard work, we were pleased and excited to deliver on our commitment to our patients and the community.”

Patient care was a top priority in creating the new unit, which is why the nursing staff played such a significant role in its physical design. This was evident by the location of several rooms. For instance, the SuperTrack area can be separated from the main Emergency Department and become negative pressure rooms during a heavy flu season. Another new feature was placing the charge nurse’s desk directly across from where ambulance crews enter, allowing for quick and efficient communication concerning patients.

The interdisciplinary team composed of Emergency Department nurses, physicians, leadership, Radiology, and Laboratory, is continuously working to improve patient flow, reduce wait times, and provide more efficient and effective emergency care services. Based on past experience, the nursing staff made suggestions about which food should be on hand for patients, supplies which should be at the bedside, and which medications would be needed in key areas.

Nursing staff was integral in the revamping of the electronic medical record locator screen, their key tool for patient flow and safety. This helped to create a more effective view of patient rooms. They also ensured that when patients moved to the postcare waiting area, they were still visible from the SuperTrack nursing station. This helped so patients did not feel left alone and increased patient safety, should their situation take an unexpected turn.

The new 24,000-square-foot unit is nearly twice as large as Kenmore Mercy’s original Emergency Department.

With 23 private patient treatment rooms, a SuperTrack area for minor medical emergencies, a dedicated decontamination room, and two resuscitation rooms, it is indeed state-of-art. In addition, onsite imaging equipment eliminates the need for patients to be moved for X-rays and CT scans.

Nearly 400 associates and dignitaries were on hand on July 25 when the Kenmore Mercy held its blessing and ribbon cutting to open the Emergency Department.

Heather Telford, RN, Amanda Kramer, RN, Rev. Msgr. Robert E. Zapfel, Raquel Martin, DO, Cynthia Zane, Walt Ludwig, Gary Constantino and Jim Millard cut the gold ribbon.

4

New Patient-Focused Knee & Hip Center, a Labor of Love for Nurses When Kenmore Mercy Hospital unveiled its brand new Knee & Hip Center in October 2013, it was more than a place for orthopedic patients to recover; it was a labor of love for the nursing staff that was part of its planning from the beginning.

According to Kathy Vitthuhn, RN, MSN, director of Patient Care Services, “Our 2 East nursing staff was integral in making this new unit come to be. They were involved in every aspect, including equipment and supplies needed, labor process changes, and even public relations.”

A key goal was to ensure both a patient-focused design and ease of care for those patients. The nursing staff was involved in everything from the room set up and traffic flow, to the types of supplies needed.

“As you walk through the unit, you will notice details like the use of a comfort chair to wheel patients to rehabilitation, the location of the conference room, how trapezes are set up, and so much more that our nursing team helped determine,” said Mary Hojnacki, RN, ONC, nurse manager over both the 2 East and 2 South patient care units.

With 24 private rooms, a visitor’s lounge, and two centrally located nurses’ stations, this orthopedic wing, is one of a kind in many ways. Located adjacent to the physical therapy department, it offers a variety of conveniences.

The new unit also helps support the hospital’s high demand for orthopedic services in the region. In 2013, more than 920 total knee and hip replacements were completed at Kenmore Mercy, a 24 percent increase since the original Knee & Hip Center opened in 2004.

An official ribbon cutting was held on October 7, featuring a mix of staff, physicians, and executives. That was followed by open houses and orientation sessions to familiarize associates of various disciplines with the new unit.

The opening of the Knee & Hip Center in the new south wing was Kenmore Mercy’s most recent addition to Catholic Health’s growing Orthopedic Campus of Excellence.

Kenmore resident Rosemary Rivers, with Sydney Dirk, RN, was the unit’s first patient on October 14.

The 2 South nursing staff was integral in the development of the new unit.

Pictured here are Ann Skuse, RN, Sue Zeisz, RN, Kim Mis, a Trocaire student, Amber Siwy, RN, Danette Lee, unit clerk, and Teresa Viverette, NA.

5

Online Nursing Notes Provides Quick Access to News & Information Nursing Notes is the new intranet site specifically designed for the nursing staff at Kenmore Mercy Hospital. The site provides accessible communication, updates and education to our nurses. It supplements the Kenmore Kronicle, rounding and staff meetings to enhance communications of what is happening in Nursing.

The site was started in early November 2013 after Cheryl W. Hayes, MS, ANP, NEA-BC, vice president of Patient Care Services, met with the Shared Governance Council to discuss how nursing leaders could improve their communication to the nursing staff.

One of the ideas that surfaced, was an internet site that all nurses could access which would provide them with updates and information specific to their needs.

When it was determined that the website would be initiated, the Shared Governance Council chose the name “Nursing Notes.” Public Relations manager Dawn M. Cwierley and online services were instrumental in setting up this intranet site for nursing.

Jennifer Landroche, RN, reads a recent edition of Kenmore Mercy’s Nursing Notes.

Instructions on how to access the intranet site were distributed, including informational tents that were sent to the nursing units.

Nursing Notes includes Magnet updates, retirements, policy and procedure updates, Daisy Award information, the American Nurses Association Code of Ethics, general information about nursing, the Kenmore Mercy Hospital Nursing Annual Report, the Kenmore Kronicle and much more.

“We have had very positive feedback from the nurses who have visited this site,” added Hayes. “Staff especially liked the pictures of nurses.”

Nursing staff are welcome to contribute to the site by providing the information to the Patient Care Services office located in room 4005. Nursing leadership continues to work to improve this communication tool.

Nursing Notes can be found by accessing Internet Explorer at the bottom of the computer screen, then press “location,” then choose “Kenmore Mercy Hospital,” and finally, choose “Nursing.”

Sue Kirsh, RN, and Pat Vittuhn, RN.

6

Candice Garland, RN, and Holly Grimm, RN.

Nelya Patsukevych, RN, and Geraldine Janus, RN.

Disaster Drill Prepares Hospital for the Unexpected Since the September 11th attacks, hospitals across the nation have taken action to prepare for disasters through real-time emergency drills, like the two-hour exercise held at Kenmore Mercy Hospital in March 2013.

The simulation is designed to examine what would happen if there was an unexpected surge of victims transported to the hospital. According to Dan Schrantz, manager of Health, Safety, and Environment, “The hospital assesses its preparedness level all year long, including conducting drills twice a year.”

In fact, as part of our accreditation, the Joint Commission requires hospitals to conduct two annual preparedness drills. During the 2013 drill, the Kenmore Mercy incident command center was activated and more than 30 volunteers – from the Health Science Charter School in Buffalo, Community Emergency Response Team, and D’Youville College – acted as “victims” in the Emergency Room, and other areas of the hospital.

Since the Emergency Department staff run this type of drill every year, this one concentrated on the medical surgical units and the Intensive Care Unit’s ability to receive several patients at once. This would allow the Emergency Department to remain available to emergent patients.

Boston’s quick and appropriate response to the April 15 marathon bombing exemplifies the value of emergency preparedness.

“The bombings in Boston are proof that every department in a hospital needs to be prepared for anything,” said Heather Telford, RN, MS, CEN, director of nursing, critical care and emergency services.

In addition, she noted that one of the components of the hospital’s new Emergency Department us the ability to double up rooms to accommodate a rapid surge of patients and to segregate injuries quickly for rapid response during a mass casualty disaster.

Brenda Kramer, RN, and Donna Hall, PA, diagnose some “patients” during the disaster drill.

Sue McClure, RN, (far right) triages a group of “patients” in the Emergency Department.

7

Structural Empowerment KUDOS to Our Nursing Team During National Nurses’ Week in May, Kristen Parisi, RN, BSN, CCRN, Intensive Care Unit, was chosen as Nurse of Distinction. Kristen with Mary LaMartina, RN, BSN, CCRN, initiated the Healthy Work Environment in the ICU. Both had a significant role in the recent growth in the local American Association of Critical-Care Nurses.

Aaron Lange, RN, BSN, ONC, nurse team leader in orthopedic surgery, was chosen as Outstanding Staff Nurse. He has been instrumental in assuring the quality and efficiency in the orthopedic surgical area.

Parisi

Lange

Willet

Allyson Willet, NA, Intensive Care Unit, was chosen as Outstanding Nurse’s Assistant.

Catherine Mulawka, RN, MBA, stroke coordinator, received the John P. Davanzo Award for her efforts to enhance stroke services at Kenmore Mercy. As project advisor, she ensures that the hospital follows the Stroke Get With The Guidelines standards.

Mulawka

DiCarlo

Morello

Physicians chose Rob Morello, RN, from the Interventional Radiology Department, and Antonina DiCarlo, RN, a case manager in the Care Management Department, to receive the hospital’s Annual Medical Staff Associate of the Year Award for 2013.

Journal Club Started in Patient Care Services

Journal clubs in healthcare provide a venue to improve knowledge and discuss elements and design of research articles. The Patient Care Services department started a monthly journal club in September 2013.

Guidelines were put into place to share research in the areas of nursing practice, performance management and leadership. Articles are offered to the Nursing Leadership team to read and consider two weeks prior to the established meeting.

Each member of the team chooses and leads the discussion of the research article on a rotational schedule. The team leader has the freedom to use the material anyway they choose to promote interactive dialogue. The journal club is open to anyone interested in research and evidenced based practices at Kenmore Mercy Hospital.

Research presented and discussed in 2013 included: What You Accept is What You Teach

by Michael H. Cohen

5 Generations in the Nursing Workforce: Implications for Nursing Professional Development

by Julie A. Bell DNP, RN-BC, CPN Staying Cool under Fire: How well do you Communicate?

by Maureen Habel, RN, MA

8

Niagara University BSN Program Helping To Build Future Leaders Kenmore Mercy Hospital continues to work with Niagara University to build its future leaders through the “RN to BSN” degree program for registered nurses who want to advance their careers.

Currently, six nurses are in the Niagara University cohort to graduate in May 2014. This includes Amy Baker, RN, Johanna Boyd, RN, Christine Clark, RN, Nicole Faulkner, RN, Kathleen Walsh, RN, and Michelle Yeates, RN. Five additional “RN to BSN” students were selected in 2013 after a rigorous application process. These nurses will begin their classes in 2014. Congratulations to Jessica Ambramski, RN, Kristine Dix, RN, Holly Grimm, RN, Elizabeth Kaminski, RN, and Mary Jane Lodico, RN.

The cohort with Niagara University includes paid tuition and the needed materials to accomplish their degree.

Thank you to all of our nurses who are working to obtain their Bachelor of Science and Master’s degrees in Nursing. Their work demonstrates commitment and advancement in nursing.

Delegation of Staff Nurses Helps Promote Committee Day A “committee” is defined as a body of persons delegated to consider, investigate, take action on, or report on some matter.

There were many well-defined committees that met regularly at Kenmore Mercy Hospital on various dates and times during the month and most met for one hour.

Input from the staff was important to all of these committees, however they could not always be freed up to attend these meetings. Our patients come first, so the committees were not as well attended as they could have been.

To solve this problem, a monthly Committee Day was started. Any committee that needed nursing input was combined into an all-day meeting with a standard schedule of meetings for the day. Each nursing unit selected a staff nurse to attend the entire day, along with their manager.

By scheduling nurses to attend all-day, they could focus on the various committees, offer input and recommendations, report back to their peers, follow-up with issues and bring back information from the staff at the next monthly meeting.

By changing the way the meetings were scheduled, it allowed for consistent staff nurse attendance at meetings and for managers to be more available on their units the rest of the month. This change has improved communication to all levels of staff.

Kenmore Mercy’s committees include important subjects like pain management, patient experience, core measures, medication safety, fall prevention, patient safety, Joint Commission, shared governance, and Magnet.

9

Nursing Staff Committed to Our Community Kenmore Mercy’s nursing staff truly live Catholic Health’s Mission and Values each and every day as they “provide the healing love of Jesus,” through their patient care. They also participate in a number of Mission Integration activities, including the hospital’s annual Thanksgiving food basket collection.

Each year, associates and staff gather to bless and distribute Thanksgiving food baskets that were prepared to help needy families throughout the local community. In 2013, baskets were prepared for more than 60 families, including some who work at Kenmore Mercy Hospital.

“With the downturn in the economy, many families in Western New York struggle to be able to celebrate during the holiday season. Now, more than ever, there is a need in our community,” said 2 South and 2 East nurse manager Mary Hojnacki, RN, ONC, a member of the Mission Integration Committee.

“Thankfully, through the combined efforts of our hospital staff, we are able to share the true spirit of giving with those who need it most,” she added.

Sarah Smith, RN, and Amanda Morgan, RN, from 2W, help prepare a basket for a local family.

Various hospital departments donate all the trimmings and carefully put together the individual baskets. This includes a complete Thanksgiving meal including turkey, stuffing, sweet potatoes and corn to cranberry sauce and pumpkin pies - to be distributed by local parishes.

BeadforLife Donation Helps Impoverished Ugandan Women

Kenmore Mercy Hospital’s Nursing leadership supported the BeadforLife organization by purchasing more than $500 worth of jewelry.

BeadforLife is a nonprofit organization that provides impoverished Ugandan women an opportunity to sell their beads, enabling them to move out of extreme poverty. Their motto is “eradicating poverty one bead at a time.”

The beaded jewelry is made out of rolled recycled paper and made into necklaces, earrings and bracelets. The BeadforLife organization then sells the beads worldwide. The women receive payment for the beads, and use this money to feed and clothe their families, build homes, and schools.

The BeadforLife organization describes these Ugandan woman beaders as resilient, hard working and resourceful.

Everyone who received the beads has enjoyed their colorfulness and comfort, while supporting a worthy cause.

10

Teddy Bear & Doll Clinic Inspires Children During Kenmore Mercy’s open house on July 31, the hospital showed off its new Emergency Department to neighbors in the Ken-Ton area. The community was invited to meet members of the hospital’s emergency care team and tour the new facility before it opened to the public.

In addition, children were welcome to bring along a favorite doll or stuffed animal for an “ER checkup” during a Teddy Bear & Doll Clinic at the event.

Nurses and children worked side by side to give these play friends a diligent exam and provide medical tests. While it was a day of fun, the hospital also hopes that the exercise helped children understand and cope with their own illnesses.

Cheryl Robinson, RN, has her hands full with several stuffed “friends” who were brought in for their checkup.

“Exposing children to nursing staff, medical equipment, and the Emergency Department environment before they become sick or injured makes an actual visit less scary,” said Amanda Kramer, RN, BSN, nurse manager, Emergency Department.

Shared Governance: Empowering Nurses To Make A Difference The Shared Governance model at Kenmore Mercy Hospital is an organizational structure in which clinical nurses have a voice in determining nursing practice, standards and quality of care.

This innovative concept gives staff nurses control over their practice and can extend their influence into administrative areas previously controlled only by managers. Noted as a key strategy to improve patient safety and increase associate and patient satisfaction, the model provides structure and context for direct patient care.

The structure allows nurses to use their expertise and knowledge to guide their actions and shows their commitment to their own practice and to the mission of the hospital.

At Kenmore Mercy, the Patient Care Services’ Shared Governance Committee meets monthly and has representatives from each patient care area who act as communication liaisons to their unit based councils.

Each Unit Based Council meets monthly regarding their departmental initiatives and practice issues. Nurse managers are not voting members by design, but may act as facilitators and advisors when needed.

The Shared Governance model implemented at Kenmore Mercy provides a vital communication tool for nursing as well as the interdisciplinary team involved in patient care. By empowering direct care nurses, the entire continuum of care is directed at the patient’s experience.

Melissa Caldwell, RN, Connie Skulski, RN, Jessica Yormak, RN, Jessica Klug, RN, and Melissa Wright, RN, are some of the members who represent their peers on Shared Governance.

11

Exemplary Professional Practice Changing of the Guard: The Art of Bedside Handoff Bedside Handoff was initiated at Kenmore Mercy in September 2013.

Although verbal handoff was already a practice on many nursing units, there was still opportunity to improve communication between nurses.

Bedside Handoff is a best practice to ensure patient safety and quality across the healthcare industry. According to the Joint Commission’s National Patient Safety Goals, Bedside Handoff promotes patient safety and allows an opportunity for patients to correct misconceptions.

Bedside Handoff occurs at the beginning of a shift. When a transfer of care occurs, this protocol ensures that the patient’s needs and plan of care are followed through by the nurse assuming the care.

Benefits of Bedside Handoff include: increased patient involvement and understanding of their care; decreased patient anxiety at change of shift; increased accountability; teamwork and relationships among nurses; and decreased potential for errors. It also allows the oncoming nurse an opportunity to visualize the patient and ask questions.

Mary Whelan, RN, and Mary Jane Lodico, RN, talk with a patient during shift change.

This has proven to be a positive change for the nurses, as well as for the patients who are able to better express their expectations. This practice drives accountability and open communication. Patients have made many positive comments about this form of handoff.

Nurses Contribute to Endoscopy Unit’s Efficiency The Kenmore Mercy Hospital endoscopy preceptors were busy in 2013, as the demand for endoscopy procedures increased.

The Buffalo Medical Group and the Delaware Surgical Group increased their volume due to the highly productive staff nurses in the Endoscopy Department.

An increase of more than 1,000 procedures in 2013 can be credited to the efficiency of the nursing staff. The nurses created a patient flow system, which resulted in quicker and safer room turn over (patient out to patient in).

This efficiency gained the hospital a positive reputation in the physician community, leading to increased block time for procedures.

Mary O’Connor, RN, and Nancy Nikisher, RN.

With the help of preceptors Lucille Quinlin, RN, MSN, Mary O’Connor, RN, BSN, Nancy Nikisher, RN, Marie Sullivan, RN, and Judy Lalime, RN, this transitional period was smooth and orientation was completed in a timely fashion.

The endoscopy departments throughout Catholic Health standardized policies and the documentation record in 2013 in preparation for the implementation of the electronic medical record. Thanks to the endoscopy nurses’ input, the department has also implemented PICIS, which is the same system used in the Operating Room, Ambulatory Surgery Unit, Pre-Admission Testing and Post-Anesthesia Care Unit.

12

Comfort Rounds Help Boost HCAHPS Scores for Surgical Patients In response to low Hospital Consumer Assessment of Healthcare Providers and Systems and National Research Corporation Picker scores from surgical patients, Kenmore Mercy’s Pain Committee initiated the concept of comfort rounds in mid-2012.

The interdisciplinary team is comprised of the unit’s charge nurse, as well as representatives from the Pharmacy and Spiritual Care departments who address postoperative pain management. A few months later the program was expanded to all the medical units.

The primary purpose of the team is early identification of pain management problems. They round on surgical patients postoperative day one and medical patients within 24 hours of admission.

Patients are asked if they feel their pain is being managed. If the response is “no,” the team explores the reason and then takes action to resolve it. The intervention can be as simple as the patient being reminded to ask for pain medication as soon as the pain begins to increase. It may also mean having the nurse request an evaluation by a pain management specialist. In either case, the result is prompt and effective pain management.

The team also inquires about the use of opioids preoperatively. This may indicate a need for a higher dosing of pain medication in patients who need opioids prior to admission or a lower dose of pain medication in the opioid naive patient.

Pain medication can be less effective if not used properly, therefore patient education is very important. The team will encourage patients to request pain medication before their pain becomes severe. Some patients avoid using pain medications because of the side effects, which is also something that the team educates patients about.

Patients may express non-medical concerns and that is where Spiritual Care can offer very special and unique assistance. There are frequent concerns over the length of their recovery time and how that will affect family dynamics. In many cases, having a compassionate listener is all that is necessary. However, sometimes additional resources can be suggested by Spiritual Care.

While the team is unable to round on every patient, more patients are voicing positive responses to formal and informal surveys concerning pain management.

In addition, staff reports feeling better able to care for the whole person and not just the medical problem. The team approach also lends itself to improved communication between patients, families and medical professionals.

Jaimie Rogemoser, Pharmacy intern, Brian Wetzel, clinical pharmacist, Louann Stephans, RN, and Rev. Nancy Faery, chaplain, round on a patient.

13

2013 Certifications Certified Emergency Nurse (CEN) Diane Taylor, RN Heather Telford, RN

Board Certified Nurse Practitioners (CNP) Mary Dowd, NP Rita Colicchia, NP Elizabeth Grundtisch, NP Esther Sprehe, NP Andrea Schmitt, NP Sister Mary Walter, NP

Certification in Cardiac Medicine (CMC) Sandra Conti, RN

Certified Gastroenterology Nurse (CGRN) Heidi Frushone, RN Janet Gonzalez, RN Jane Weidner, RN

Certification for Nurse Managers and Leaders (CNML) Veronica Valazza, RN

Certified Nurse Operating Room (CNOR) Linda Butski, RN Sharon Greathouse, RN Rachel Nowak, RN

Certified Post Anesthesia Nurse (CPAN) Scott Berube, RN Pam Farrell, RN Sue Hartel, RN Rene Marriott, RN

Certification in Wound Ostomy Nursing (CWON) Sue Wren, RN

Critical Care Registered Nurse (cont.)

Stephen Griggs, RN Jason Kiska, RN Mary LaMartina, RN Lori Ann Meder, RN Tom Nader, RN Kristen Parisi, RN Maria Richardson, RN Bridget Walborn, RN

Interventional Radiology Nurse Certification Deborah Arnet, RN Kathleen Daley, RN Christine McGee, RN Robert Morello

Med-Surg Certification (CMSRN) Johanna Boyd, RN Nancy Chojecki, RN Brenda Cramer, RN Annette Gillies, RN Michelle Harris, RN Carole Woomer, RN

Nurse Executive, Advanced-Board Certified (NEA-BC) Cheryl W. Hayes, MS, ANP, NEA-BC, RN

Orthopedic Nursing Certification (ONC)

Delretta Billips, RN Alan Chittley, RN Christine Clark, RN Nicole Faulkner, RN Mary Hojnacki, RN Pamela Koetzle, RN Betty LoFaso, RN Deborah Micholas, RN Susan Wasielewski, RN Monica Wideman, RN Suzanne Zeisz, RN

Critical Care Registered Nurse (CCRN) Jessica Bohlman, RN Melissa Borgese, RN Sandra Conti, RN Jasmin Girard, RN

14

This list includes certifications completed prior to December 31, 2013.

Nursing Peer Review Continues to Evolve Nursing peer review at Kenmore Mercy Hospital is defined as the evaluation of the professional performance of nursing practice to identify opportunities to improve patient care and the delivery of safe care.

Nursing peer review is growing and evolving. The established Peer Review Committee involves the direct nursing staff members from all areas of the hospital, including Medical-Surgical, Telemetry, Perioperative, Emergency Department, Intensive Care Unit, Gastrointestinal Unit and the Medical Rehabilitation Unit.

A nursing leader liaison facilitates the Peer Review Committee as needed.

The group meets monthly to identify and discuss areas that may include nursing practices, nursing processes, reviewing data and reviewing of policies and procedures. Examples of what the Peer Review Committee has worked on include secondary intravenous infusions and medication reconciliation between different departments and disciplines. Recommendations are made, then provided to nursing leadership, peers, physicians or other members of the interdisciplinary team.

In addition to the Peer Review Committee, nursing peer input tools were implemented in the ICU and in nursing leadership. This peer review process facilitates positive nursing practice and growth for all who participate. The nurse peer reviewer completes the peer input tool on another nurse, providing participants with valuable input, demonstrating mutual regard, trust and active engagement between fellow nurses.

Nurses also continue to be active in the interviewing process of new nurses to the unit. This has been very helpful to the nursing staff and the hiring manager.

The manager receives direct input from the nursing staff by engaging them and empowering the nurses to assist with the interview process and decision making to select a new registered nurse or graduate nurse who they consider a good fit for their particular unit.

2013 Peer Review Committee Members

Deborah Micholas, RN, and Piper Antonuccio, RN.

Piper Antonuccio, RN - Nursing Leadership Liaison Jeff Beach, RN- 3 East Johanna Boyd, RN - Float Elizabeth Cali, RN - ED Sue Conover, RN - 3 West Christine Cramer RN - ICU Joyce Douglas, RN - 3 East Mary Ann Franklin, RN - OR Linda Gromada, RN - OR Krista Lang, RN - MRU Sarah Lichtenberger, RN - 3W Irene McNeill, RN - ICU Deb Micholas, RN - 2E/2S Carolyn Sweeny, RN - Float, Perioperative & GI Jessica Yormick, RN - MRU

15

Patient Experience Initiatives Excel in 2013 At Kenmore Mercy Hospital, patient satisfaction is our top priority. The hospital promotes healing and wellness by offering unsurpassed clinical quality and compassionate care for the whole person. In 2013, the hospital implemented a number of unique services and initiatives to ensure each patient’s stay was as comfortable and convenient as possible.

Front Line Staff Involvement Front line nurses have been active participants in the hospital’s Patient Experience Committee, providing ideas on how to make improvements and giving realistic feedback on implementation strategies.

Pain Management & Comfort Rounds Nursing, in conjunction with Pharmacy and Spiritual Care, has taken an active role in the comfort rounds, assuring that patients are receiving the best pain management possible. A pain management brochure was also created to distribute to patients.

Patient Call Backs With post-discharge follow up calls made by registered nurses, the aim is to effectively decrease the hospital’s readmission rate. This post-discharge follow-up phone call allows the patient’s actions, questions, and misunderstandings, including discrepancies in the discharge plan, to be identified and addressed. It also allows for the opportunity to discuss any concerns from caregivers or family members.

Picture Perfect Rooms A partnership between Environmental Services and Nursing led to the Picture Perfect program through which individuals in these departments are ensuring that all patient rooms are set up in a standard look and meet specific cleaning protocols. A detailed quality checklist was developed with the input of associates from the Nursing and Environmental Services departments.

Rounding With a Purpose Patient rounding was revitalized with input from nursing associates. Registered nurses are paired with nursing attendants to round on patients in two hour increments and ask patients about personal needs, positioning and pain. Charge nurses and nurse managers also round on patients to see how their hospital stay has been and to complete service recovery when needed.

Quiet at Night Quiet champions were assigned on each patient care unit to help recognize causes of noise that may be disrupting patients. New quiet signage was created and posted on all units. The “Restful Night Menu” was officially rolled out, which offers patients a selection of items to help them rest. Also, “Quiet Time” now starts at 8 p.m., during which staff dim lights throughout the hospital, which creates a look of quietness. An overhead announcement is also made to let visitors know that “Quiet Time” has started and they should prepare to leave the hospital before 8:30 p.m. In addition, it is requested that everyone keep their voices down.

16

Linda Anthon, RN, rounds on Robert Brandon, a patient on 2 West.

Michelle Gialella, NA, and Kelly Wagner, RN, display some examples of our “Restful Night Menu” options.

Palliative Objectives Better Serve Patients One of the objectives of palliative care is to intervene early during a patient’s hospitalization in order to concurrently treat their medical condition and to help manage symptoms.

As a nurse, it is important to recognize the possibility that more appropriate, less invasive treatment may be needed. Kenmore Mercy Hospital’s multidisciplinary Palliative Care Committee has successfully initiated a Palliative Care Program which addresses patients’ care during and after hospitalization.

Kenmore Mercy’s Palliative Care Committee includes individuals from various disciplines, including Lisa Smith, RN, Annette Gillies, RN, Cheryl Tumia, RN, James Fitzpatrick, MD, John Ingraham, RN, Rev. Nancy Faery, Deborah Micholas, RN, and Rev. Steve Luchies.

The Palliative Care Committee began in August 2013 and has set up educational opportunities to learn more about palliative care through webinars and classroom discussion. Palliative care nurse champions have volunteered to coach others in identifying patients that may be candidates for the program.

Physician champions have provided education at all levels of the team. A physician was appointed to provide palliative care consults. Care begins in the hospital and continues through our Palliative Home Care Program.

The two quality indicators that have been monitored since August 2013 include: 1) reduction in time to a palliative care consult and 2) completion of patients’ MOLST forms upon discharge. Targets were met for the MOLST form completion and time to consult is showing a downward trend.

Our Palliative Care Program has allowed for an alternative to care that has shown positive results for the patients and their families.

A special thank you to our palliative care nurse champions: Jessica Bohlman, RN – ICU Johanna Boyd, RN – Float Nicole Faulkner, RN – 2E/2S Annette Gillies, RN – 2W

John Ingraham, RN – 2W Louann Stephans, RN – 2W Lori Ann Meder, RN – ICU Cheryl Tumia, RN – 3E Deborah Micholas, RN – 2E/2S Jean Wood, RN – ED Janice Ruffino, RN – 3E

Foundation Funding Provides Education to Nursing Staff

A special thank you to the Kenmore Mercy Foundation who raises funds to provide key financial support for staff education like those courses listed below.

AACN National Teaching Institute & Critical Care Exposition (3) ANCC National Magnet Conference Catholic Health Cardiovascular Symposium (4) Critical Care Nursing Conference Education Orthopedic Conference Heart Failure Conference ICU Conference (3) Improving Wound Care (5) Innovations in Total Hip Arthroplasty Webinar (12) NAON Poster Presentation

North American Spine Society 28th Annual Meeting (2) Orthopedic Technology Conference Palliative Care Seminar (2) Pathway to Excellence Conference Primary Care & Pharmacology Update Conference Recertification-Radiology Nurse Education Seminar Skin Care and Wound Management Conference Understanding Dementia Seminar (2) Whole Person Care: Restoring the Heart and Humanity in Healthcare (2)

17

New Knowledge, Innovations & Improvements Nurses Present at International Stroke Conference Associates from Kenmore Mercy Hospital’s Nursing and Pharmacy departments had the privilege of presenting at the 2013 International Stroke Conference in Honolulu, Hawaii. A poster presentation by Amanda Kramer, RN, BSN, nurse manager, Emergency Department, Catherine Mulawka, RN, MBA, project advisor, and Kevin Brandon, RPh, clinical pharmacist, was published outlining how Nursing and Pharmacy work together to decrease decision to needle times for tPa. Through clinical observation, it revealed inconsistent Emergency Department decision-to-needle tPa times due to differing processes, including pharmacists mixing in the central pharmacy, Emergency Department nurses mixing at the bedside, and holding the tPa vial for stroke neurologist to mix upon arrival at the bedside.

By implementing bedside conference between the clinical pharmacist and Emergency Department nurse to identify eligible candidates, it allowed the clinical pharmacist to prepare tPa in preparation of anticipated administration which led to a decrease in the decision to needle time and overall door to needle times for tPa in stroke patients.

Role of the Clinical Pharmacist in Reducing Decision-to-Needle tPa Times During Code Stroke in the Emergency Department Kevin Brandon, RPh Clinical Pharmacist, Amanda Kramer, RN BSN Senior Clinical Advisor, Catherine Mulawka, RN MBA Stroke Coordinator & Clinical Project Advisor

BACKGROUND BACKGROUND

RESULTS RESULTS

Clinical observation revealed inconsistent Emergency Department decision-to-needle tPA times due to differing processes including: pharmacist mixing in the central pharmacy, Emergency Department RN mixing at bedside and holding the tPA vial for stroke neurologist to mix upon arrival at the bedside.

•Utilization of Clinical Pharmacist during Code Stroke to calculate and mix tPa reduces decision-to-needle time

•2011: zero minute decision-to-needle achieved in 60% of administrations

FINANCIAL DISCLOSURE: No relevant financial relationship exists

Decision to Needle Trend

tPA TAT 2011 & 2012

METHOD METHOD

50 180 160

40

140 120

80 60

•Clinical Pharmacist added to Code Stroke pager team in May 2010

20

•Implemented process of bedside conference between Clinical Pharmacist and ED RN to identify eligible candidates, allowing the Clinical Pharmacist to prepare tPa in preparation of anticipated administration •Progressed Clinical Pharmacist’s role to include immediate bedside medication education to patient and/or family, including verbal and written education materials

18

20

40

10

0 2/10/11

•Expanded Clinical Pharmacist role to include mixing tPa at beside in conjunction with nurse, while maintaining compliance with USP 797 Guidelines*

30

100

•Established goal of zero minute decision-to-needle time

•Initial Clinical Pharmacist role consisted of dose calculation and verification with ED nurse at bedside

AUTHOR AUTHOR DISCLOSURE DISCLOSURE INFORMATION INFORMATION

•2012: (through July): zero minute decision-to-needle achieved in 78% of administrations

•Reduce decision-to-needle times, increasing the opportunity for successful patient outcomes

•Identified areas for process streamlining and reducing potential for error by calculating and mixing tPa at the bedside

IMPLICATIONS IMPLICATIONS FOR FOR PRACTICE PRACTICE

•2010: zero minute decision-to-needle time not achieved

•Implement a consistent process for tPa calculation and mixing

•Reviewed existing process of calculating, mixing, and administering tPa

•Addition of a Clinical Pharmacist to the Code Stroke team resulted in a reduction of decision-to-needle tPa times in the Emergency Department

•Addition of Clinical Pharmacist to Code Stroke team, with responsibility of calculating and mixing tPa at the bedside, has resulted in improved zero minute decision-to-needle times.

PURPOSE PURPOSE

•Conducted retrospective chart review to establish baseline tPa decision-to-needle times in the ED

CONCLUSION CONCLUSION

7/11/11

7/24/11

8/12/11 10/25/11 2/16/12 Door to Decision

2/23/12

Decision to Needle

4/20/12

5/20/12

7/26/12

0

A Year of Accomplishments Puts Kenmore Mercy on Top The year 2013 was full of amazing accomplishments at Kenmore Mercy Hospital. Nursing, take pride in all the things you helped to make happen!

January • Ranked among the top five percent of hospitals in the nation for joint replacement services in 2013 by Healthgrades • Received the Healthgrades Joint Replacement Excellence Award and was a five-star recipient for joint replacement, total knee replacement, and total hip replacement for the seventh year in a row (2007-2013)

February • Accepted the Kenmore-Tonawanda Chamber of Commerce’s 2012 Green Globe Award • Designated as a Blue Distinction Center + hospital for “Total Value” in both knee and hip replacement and spine surgery by BlueCross BlueShield of Western New York

Sharon Greathouse, RN, Aaron Lange, RN, Jim MIllard, Marcus Romanowski, MD, Mary Hojnacki, RN, and Betty LoFaso, accept our 2013 orthopedic awards.

March • Named a finalist in the 2013 “Best Places to Work” in Western New York awards according to Buffalo’s Business First newspaper April • Named among the top five percent of hospitals in the country for patient safety as a recipient of Healthgrades Patient Safety Excellence Award™

May • Awarded the 2013 Get With The Guidelines®–Stroke Gold Quality Achievement Award from the American Heart Association / American Stroke Association • Received the Partner Recognition Award from Practice Greenhealth, recognizing the hospital for its commitment to environmental practices and sustainability

Linda Butski, RN, and Kathy McAlpine accept the KenmoreTonawanda Chamber of Commerce Green Globe Award.

July • Opened a brand new, state-of-art Emergency Department • Obtained Disease-Specific Care Certification for Total Knee, Total Hip Replacement, and Stroke Services by the Joint Commission • Received the 2013 Get With The Guidelines®-Heart Failure Silver Plus Performance Achievement Award by the American Heart Association/American Stroke Association • Recognized as the only hospital in New York State to make the American Heart Association’s Target: Heart Failure Honor Roll for improving patient care and reducing hospital readmissions August • Ranked among the top ten hospitals across the United States with the highest quality yet lowest charges for knee & hip procedures by NerdWallet Health, a consumer advocacy website October • Opened a brand new Knee & Hip Center and remodeled the Rehabilitation Gym

Rosanne Hemmitt from the American Stroke Association with Jim Millard, Janet Kay, RN, Edward Stehlik, MD, and Jason Jankowiak.

19

Empirical Outcomes Clinical Orthopedic Advisor Presents at NAON Congress Betty LoFaso, RN, BSN, MSEd, ONC, clinical orthopedic advisor for the Knee & Hip Center, was chosen to present a poster at the National Association of Orthopedic Nurses Congress (NAON) in San Antonio in May.

She presented on the successful implementation of a interdisciplinary evidence-based practice for elective total knee replacements resulting in Joint Commission Disease Specific Certification and Healthgrades five-star recognition. Betty was also one of two NAON scholarship recipients.

LoFaso

Successful Implementation of a Multidisciplinary Evidence Based Practice for Elective TKR Resulting in JC Disease Specific Certification & Healthgrades Five-Star Recognition History

Preparation for Certification

2003 • • • • • • •

Small group of surgeons developed standardized post-op order sets Offered pre-op total knee classes Hired a clinical orthopedic advisor Developed clinical pathway for total knee patients Dr. Repicci recognized for Unicondylar Knee Replacements Increased total knee volume Expanded existing Knee & Hip Committee to include multidisciplinary group

2007 - 2008 • • • • •

Purchase of MAKO robot for the orthopedic robotic surgery program Implemented orthopedic bundles Achieved five-star rating from Healthgrades for total knee replacement Implemented electronic medical record for nursing Added orthopedic PAs in patient care

2010

Medical and administrative team gather for the ribbon cutting of the Knee & Hip Center.

2009 • • • • • •

2010

• Achieved five-star rating from Healthgrades for total knee replacement • Multidisciplinary team established to address pain management

2004

Onsite pre-op total knee classes offered Began patient satisfaction surveys Provided individual post-op education Knee & Hip Center opens Specific room designated for total knee patients Patients provided with physical therapy twice a day

2005 - 2006

September • Developed committee for Joint Commission’s Disease Certification (monthly meetings) - Created Joint Commission resource binder - Researched evidence based practice - Developed clinical practice guidelines - Compiled existing data for evaluation - Reviewed Joint Commission standards - Identified data indicators - Provided hospital-wide nurse education for care of post-op total knee patients • Recognized need for aggressive pain management for patients with chronic pain • University at Buffalo School of Nursing Dedicated Education Unit program piloted on the surgical unit • Designated by Blue Cross and Blue Shield of Western New York as a Blue Distinction Center for Knee and Hip Replacement • October • Achieved five-star rating from Healthgrades for total knee replacement • December - Started initial update of policies - Revised orthopedic order sets to reflect evidence based practice - Adjusted antibiotic dosing - Increased patient participation in pre-op education classes

• Standardized order sets for all orthopedic surgeons • Designated a patient advocate position • Required training of all newly hired orthopedic nurses in care of post-op total knee patients

2011 •

•

•

•

•

January - Submitted first part one of JC certification application - Onsite visit by CSR consultant conducted - Instituted multidisciplinary post-op pain rounds - Developed disease specific goals for total knee patients - Multidisciplinary team initiated discussions regarding development of pain management brochure - Prepared clinical practice guidelines March - Educated nurses on clinical practice guidelines - Knee & Hip Center nurses submitted application for orthopedic certification exam April - Developed specific traffic patterns in surgery - Initiated use of pre-op chlorehexidine wipes - Began distribution of pain management brochure to all surgical and medical patients - Initiated end tidal CO2 monitoring in at risk post-op total knee patients May - Fully implemented clinical practice guidelines - Began weekly hospital-wide mock surveys - Identified area in need of improvements as a result of mock surveys July - Implemented use of IV COX-1 inhibitor for initial post-op pain management - Completed JC certification survey - Submitted JC certification data post survey

Awarded Joint Commission Disease Specific Certification for Total Knee Replacement

2011 •

•

•

• •

• •

The Future

August - Implemented opioid analgelic quick reference sheet for nurses - Conducted McCaffrey’s knowledge and attitude survey on pain management October - Achieved five-star rating from Healthgrades for total knee replacement November - First group of Knee & Hip Center nurses received orthopedic certification - Invited pain management specialist from Roswell Park Cancer Institute to speak to multidisciplinary team Pharmacy and Spiritual Care added to pain rounding team Identified need for additional orthopedic equipment which was purchased with funding from Kenmore Mercy Foundation Developed strategies to increase percentage of on time surgery starts Continued initiatives to decrease infection rates A rendering of a patient room on the new orthopedic floor scheduled to open in summer 2013.

2013

Dr. Marcus Romanowski, Chief of Orthopedic Surgery, and Jim Millard, President & CEO, accept the 2012 Healthgrades Award.

2012

•

• • • •

•

Continue to improve existing outcome by: - Revising antibiotic selection and dosing - Increasing number of certified orthopedic nurses - Developing standardized pre-op order sets - Implementing out of bed, day of surgery for select total knee patients - Continuing multidisciplinary pain rounds - Implementing services of pain management specialist - Developing orientation program for current and future orthopedic surgeons Dietary initiates early order to accommodate physical therapy schedule Identify need for local NAON chapter Continue to prepare for Joint Commission recertification Prepare for orthopedic growth with two additional surgical suites, new surgeons, and construction of a new patient unit Work toward meeting need for multimedia pre-op education

• Started construction of a brand new orthopedic patient care unit and Emergency Department • Initiated daily surgical pain rounds

Awarded in July 2011

Awards & Recognitions Joint Commission - Total Knee & Total Hip Replacement Certification (2011) Expert reviewers looked for compliance with more than 40 standards of care specific to the needs of patients and families, including infection prevention and control, process improvement, leadership and medication management. Kenmore Mercy is the first hospital in the Buffalo area to receive this award and one of only five hospitals in New York State.

Healthgrades - Joint Replacement Excellence Award (2011 - 2013), five-star recipient for joint replacement, total knee replacement, and total hip

Blue Distinction - “Center Plus” Designation for “total value” in knee & hip replacement (2013)

The report, American Hospital Quality Outcomes 2013: Healthgrades Report to the Nation, evaluates how approximately 4,500 hospitals nationwide performed on risk-adjusted mortality and complication rates for nearly 30 of the most common conditions and procedures from 2009-2011.

The Blue Distinction Centers for Specialty Care® program recognizes hospitals across the country that have a proven track record for delivering better results – including fewer complications and readmissions – than hospitals without these recognitions. Catholic Health hospitals are the only Buffalo area hospitals to receive this award.

Acute Falls The 2013 fall rate target was met with the year closing out at 2.51 with a target of 2.94. The Kenmore Mercy Hospital Fall Prevention team remained active with participation from front line nurses who helped identify patients at high risk and using preventative fall measures. Falls per time of day per unit were reviewed for opportunities for improvement. After an extensive literature search, Kenmore Mercy Hospital removed vest restraints from the facility. There was no increase in falls since the removal of the vest restraints.

20

Central Line-Associated Bloodstream Infection (CLABSI) Central line-associated bloodstream infections for 2013 were at .51, slightly above the target of .50. Education was provided to the staff regarding avoiding femoral lines. Other initiatives to reduce CLABSI included: reduced use of anticubital area for intervenous placements; continual assessment of the need for central lines; and direct observation of central line dressings and biopatch placement.

Catheter-Associated Urinary Tract Infection (CAUTI) Catheter-associated urinary tract infections were 1.57 in 2013 verses our target of 1.10. The Institute for Healthcare Improvement team was working on CAUTIs all year. Nursing has been prompting providers to discontinue unnecessary use of foley catheters to reduce foley days and decrease the risk of infection. Education on the prevention of CAUTI is provided to new nurse hires and continue education to nurses assessment of the need for foley catheters is reviewed daily by the nurses and interdisciplinary team.

21

Ventilator Associated Events Kenmore Mercy Hospital had an outstanding year with no ventilator associated events. The ventilator associates events bundle was revitalized with the definition change in January 2013. Infection Control and Quality & Patient Services have been rounding to remind associates of the bundles.

Ongoing Sepsis Journey at Kenmore Mercy Hospital In 2013, Kenmore Mercy Hospital continued to achieve improved outcomes for septic patients due to our aggressive sepsis protocol which was implemented as a collaborative effort in the Emergency Department and Intensive Care Unit in January 2012. A shorter length of stay for our patients usually means better outcomes.

For our septic patients at Kenmore Mercy, the average length of stay and overall cost per sepsis case trended downward during the year. Our endeavor and success were noticed and eventually adopted by Catholic Health in September when the New York State Department of Health mandated a proactive approach for all hospitals in New York State.

22

Readmission Rates Steadily Declining The readmission rate has been steadily declining throughout 2013. Registered nurses provide detailed discharge instructions to patients. These thorough instructions allow for the patient and family to ask questions and have a good understanding of how to stay healthy upon discharge. Registered nurses who work in the Care Management Department have also assisted by collaborating with the Emergency Department providers to place patients in the appropriate level of care. If the patient is not ready to return home, but does not meet criteria for a hospital admission, providers have had positive results in diverting them to the Medical Rehabilitation Unit, subacute and observation status.

Pressure Ulcers In 2013, we had a pressure ulcers’ rate of 1.44 verses a target of 1.71. The nursing staff worked diligently with purposeful rounding to turn and reposition patients. They also inquired about personal needs to keep patients’ skin dry. Skin champions were assigned to every unit as a skin resource. They also completed the monthly prevalence study. Nursing measures to assess the skin from head to toe upon admission facilitated the identification pressure ulcers and areas of potential breakdown facilitated the reduction in the rate of hospital acquired pressure ulcers.

23

OUR MISSION We are called to reveal the healing love of Jesus to those in need.

OUR VISION Inspired by faith and committed to excellence, we will lead the transformation of health care in our communities.

OUR VALUES Reverence Nursing reflects our values and mission by the acknowledgement of the sacredness of human life and the individuality of their needs and goals.

Compassion Nursing provides compassionate care by identifying the connectiveness of each person through the relationship with each other and their environment.

Justice Nursing advocates for our patients to achieve their personal goals, respecting and recognizing the differences in each individual.

Excellence Nursing continually strives for quality and excellence through the care we deliver through communication to our patients, families and the interdisciplinary team.

Nursing strives to interact with our patients to achieve their goals, promote, maintain and sustain health and to ensure satisfaction of the care the patient receives.