2018 Patient Care Services Annual Report

e c n e l l e c ex

NURSING

BAYHEALTH PATIENT CARE SERVICES 2018 ANNUAL REPORT

BAYHEALTH.ORG

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Patient Care Services Annual Report 2018

LEADERSHIP & PLANNING

4-7

TRANSFORMATIONAL LEADERSHIP

8-9

STRUCTURAL EMPOWERMENT

EXEMPLARY PROFESSIONAL PRACTICE

10-11

12-13 EMPIRICAL OUTCOMES

16-17

NEW KNOWLEDGE INNOVATIONS & INFORMATION

14-15

BAYHEALTH NEWS & RECOGNITIONS

18-23

LEADERSHIP & PLANNING

At Bayhealth, our model of care is person- and family-centered.

We embrace Planetree philosophies and believe in treating the whole patient – mind, body and spirit.

• Our core values are compassion, accountability, respect, integrity, and teamwork.

• Our goal is to achieve nursing excellence.

• Our goal is achieved through advocacy, empowerment and collaboration.

• Our work as nurses is grounded in research and evidence-based practice.

NURSING EXCELLENCE

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GRIT

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MIND IND D

ACCOUNTABILITY

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EMPOWERMENT EMPOWERMENT

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RIT S IR SP SPIR

COMPASSION

PATIENT PAT ATIENT EN NT & FAMILY FAM F M MILY Y CENTERED CEN N NTERED T D CARE CAR RE

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Patient Care Services Annual Report 2018

ASED PRACT ICE!

A Message from the Chief Nurse Executive (CNE) I am pleased to have the opportunity to highlight the wonderful work that we have accomplished over the course of 2018. This has been a busy year for Patient Care Services. From preparing for the opening of the Bayhealth Sussex Campus to committing to Bayhealth’s efforts to be a High Reliability Organization, our Patient Care Services team full of nurses, certified nursing assistants, pharmacists, and pharmacist technicians displayed their drive to not only bring the nation’s best healthcare here but to make Bayhealth the best place to work.

Becoming a High Reliability Organization (HRO) means we’re building a culture where we put safety for everyone who enters a Bayhealth facility – patients, visitors, volunteers, and staff – at the forefront of what we do. To achieve this, staff need to feel comfortable speaking up, and have they ever! Our team members are not only speaking up for safety, but making on average 100 great catches each month. By speaking up, we’ve been able to “stop the line” on safety concerns and make changes across the spectrum of care. Some of these changes include placing AED’s throughout the hospital in public areas, going live for a new emergency response for nonpatients, putting weight limit stickers on stretchers, and more. Each of these changes play a part in Bayhealth’s path to high reliability and make a world of difference to keeping everyone safe.

If making safety a priority wasn’t enough, our team was busy preparing to open the Bayhealth Sussex Campus, including working together to create new workflows for improved efficiency. This was a once-ina-lifetime experience for our nursing and pharmacy team members to be a part of creating a better way to provide healthcare in Sussex County for many years to come.

Pictured on the cover is Clinical Educator Brittany Oakey, who is the 2018 Nurse of the Year for Bayhealth Milford Memorial.

While these two major projects were ongoing, we saw a lot of successes throughout the year, including receiving the Planetree Silver Designation, being named a Leader in LGTBQ Healthcare Equality through the Healthcare Equality Index, and numerous other awards.

You’ll read about these awards, projects and more in this Nursing Annual Report. I hope you’ll be as amazed by the passion and dedication of our team as I am. Leadership is proud of the year Bayhealth and Patient Care Services has had, and we’re looking forward to what’s to come in 2019.

Brenda Blain, DNP, RN-BC, FACHE, NEA-BC Senior Vice President and Chief Nurse Executive

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Patient Care Services 2018-2020 Strategic Plan When 2018 began, Patient Care Services did so by welcoming the 2018-2020 strategic plan. Long before 2018 officially began, we were busy working through each of our strategic goals so progress was made on achieving them. Our mission is to strengthen the health of the community one life at a time, and each of these goals will aid us in living this mission. Our strategic goals correlate with Bayhealth’s strategic plan – organizational excellence, culture, access & growth, and clinical integration. Here are some of the ways we’re making progress on our strategic goals:

Progress Report ORGANIZATIONAL EXCELLENCE • Hired a readmissions nurse focused on reducing 30-day readmissions to meet or exceed annual organizational targets

• Continued preparations for the transition from Bayhealth Milford Memorial to Bayhealth Sussex Campus

• Achieved 100 percent staff HRO training

• Implemented a Post-Acute Care Program and developed a network of skilled nursing facilities system

• Worked on the Magnet document with a goal of applying for Magnet redesignation in 2019 • Planned NDNQI Town Halls for 2019 to continually assess and ensure Magnet peer group benchmarks are met or exceeded

CULTURE • Increased the percent of direct-care nurses with a bachelor of science in nursing or higher from 48 to 75 percent • Increased percent of direct-care nurses with national specialty certification from 47 to 53 percent • Formalized succession plans for clinical practical leaders to become clinical nurse specialists • Achieved Planetree Silver Designation

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ACCESS & GROWTH

Patient Care Services Annual Report 2018

• Hired a post-cate care manager to run the new Post-Acute Care Program • Added a Perinatal Testing Unit to Bayhealth Maternal Fetal Medicine office at Bayhealth Hospital, Kent Campus to serve higher-risk pregnant patients and their babies

CLINICAL INTEGRATION • Implemented a Palliative Care Program at Bayhealth Milford Memorial in January 2018 • Developed plans to expand services to outpatient in 2020 • Implemented a transition to practice program for registered nurses new to Bayhealth

Our Goals • Increase overall patient satisfaction to meet or exceed annual organizational targets

ORGANIZATIONAL EXCELLENCE

• Increase emergency department overall satisfaction to meet or exceed annual organizational targets • Reduce hospital-acquired infections to meet or exceed annual organizational targets • Reduce 30-day readmissions to meet or exceed annual organizational targets • Actively participate in and support the process to become a High Reliability Organization by assuring 100 percent of staff attend HRO training by July 2018 and implementing the safety toolkit by July 2018 • Apply for Magnet redesignation in 2019 • Continually assess unit-level nursing quality indicator data to ensure that Magnet peer group benchmarks are met or exceeded

CULTURE

• Increase percent of direct-care nurses with a bachelor of science in nursing or higher by one percent annually • Increase percent of direct-care nurses with national specialty certification by one percent annually • Increase retention of direct-care nurses by two percent over the 2017 baseline by December 2018 • Assure registered nurses satisfaction meets or exceeds Magnet peer group benchmarks • Formalize succession planning programs for nursing leadership roles, including clinical nurse specialists, nurse managers and nurse directors • Support Planetree initiatives that promote patient and family centeredness

ACCESS & GROWTH

• Transition Bayhealth Milford Memorial to the new Bayhealth Sussex Campus, with the patient move coming in February 2019 • Address care transitions across the continuum of care, including implementing quality improvement ratings for post-acute facilities by fall 2018, and developing and hiring for the role of a post-acute manager by spring 2018 • Apply new strategies to address maternal health including formulating a peri-natal testing and obstetrical emergency services plan at Bayhealth Hospital, Kent Campus by January 2019, and implementing an OB hospitalist program at Bayhealth Hospital, Kent Campus in 2019

CLINICAL INTEGRATION

• Implement a Palliative Care program at Bayhealth Milford Memorial by January 2018 and expand services to outpatient by 2020 • Implement transition to practice programs for registered nurses new to Bayhealth and apply for program certification (PTAP) by 2019 • Standardize operational and clinical nursing practices to promote efficiency and support a high reliability culture by completing a gap analysis for Bayhealth Sussex Campus by January 2018, building actions plans and completing applicable workflows by September 2018

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TRANSFORMATIONAL LEADERSHIP

New Faces in the Crowd The Patient Care Services team welcomed three new leaders in 2018 – Director of Education Angel Dewey, MSN, RN, APRN, ACNS-BC, CCRN, CNRN; Senior Director of Patient Care Services at Kent Campus, Sharon Urban, MSN, RN, NE-BC, RN-BC, CNML; and Senior Director of Emergency and Trauma Services Gust Bages, RN, BSN, MHA.

ANGEL DEWEY – EDUCATION Dewey made the transition to Education director in January 2018 after spending 22 years in critical care nursing, including time spent as a clinical educator and clinical nurse specialist. By the end of the year, Dewey helped her department bring in a fresh approach to staff education. These changes included CPR challenges, fire training simulations and a nursing residency program. A two-day course was offered for Advanced Cardiovascular Life Support as an alternative to the online module. Annual mandatory education evolved to including gaming and other interactive modules. Educators began using reallife examples to show how mistakes happen and how to avoid them in the future. “We want to make sure all the education we provide is meaningful,” Dewey said. “When we moved to HealthStream a few years ago, it was a big leap for us. Now we’re ready for a new leap, one that will include hybrid education so we can continue to educate our staff members in the most effective ways possible.”

SHARON URBAN – PATIENT CARE SERVICES When Urban joined the team in April 2018, she brought with her 20 years of experience in the nursing field, ranging from a staff nurse to staff development and education specialist, and nurse manager. Since joining Bayhealth, she’s been busy restructuring the role of clinical nurse specialists and creating succession plans for clinical practice leaders along with expanding the Bayhealth Palliative Care Program and decreasing 30day readmissions. “Sometimes making the toughest decision can impact thousands of people in a positive way, and I like being in a position where I can make that sort of difference,” Urban said.

GUST BAGES – EMERGENCY AND TRAUMA SERVICES Bages began his time with Bayhealth in mid-December, and brought with him a wealth of experience as a director of Emergency Services. He was the director of Emergency, Trauma Center and Observation Services at Abington Jefferson Health in New Jersey for three years. Prior to that, Bages held increasingly responsible positions at Our Lady of Lourdes Medical Center, spending seven years as their director of Emergency Services. With Bayhealth, Bages is responsible for emergency and trauma services at Bayhealth Kent and Sussex Campuses, as well as the Emergency Center in Smyrna.

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Patient Care Services Annual Report 2018

Transforming Care with Safety Huddles By the time 2018 began, Bayhealth’s safety huddles were in full swing. Brought to Bayhealth by Chief Nurse Executive Brenda Blain, DNP, RN, FACHE, NE-BC, safety huddles work in tandem with Bayhealth’s efforts to be a High Reliability Organization. Safety huddles are an opportunity to improve overall communication surrounding safety initiatives within the organization as well as a chance to share lessons learned and great catches as precursors to potential safety events. Safety huddles are held at both Bayhealth Hospital, Kent Campus and Bayhealth Hospital, Sussex Campus. Similar meetings are held with outpatient services and physician practices as well.

One of the biggest improvements as a direct result of safety huddles is communication across all levels.

This communication helped reduce central line days across the organization. Through the safety huddle, a discussion of each central line was held, the purpose of the line and alternative solutions to patient care that lead to the removal of the central line occurred. Prior to these discussions, patients would have central lines longer than a course of treatment. These discussions keep central lines at the forefront, lowering the total number of CVCs each month. Bayhealth is seeing similar trends of reducing hospital acquired pressure ulcers/injuries and CAUTI have also surfaced since implementation of safety huddles.

campus,” said Perioperative Services Interim Director Carol B. Leon, MSN, RN, CNOR, NEA-BC. To improve communication between shifts, team members at Bayhealth Emergency and Trauma Center, Milford Memorial, began doing twice-a-day Daily Huddles. Led by the nurse manager, clinical coordinators and charge nurses, the team meets during shift change to address issues and answer questions in real time. The huddles helped the team implement a new bedside triage system, where patients are taken directly to an available bed instead of spending time in the waiting room. They’ve also seen success with reducing medication errors; at one point in the fall of 2018, the staff went 708 days without a medication error.

“It’s amazing to see our work come to life and to see people want to come to work. I’m proud of our efforts to make this change,” said Clinical Coordinator Caricia Rickards, BSN, BN, CEN. Rickards is pictured below with fellow Clinical Coordinator Kate Santry, BSN, RN, CEN.

SUCCESS IN DEPARTMENT HUDDLES Both Perioperative Services and the Bayhealth Emergency and Trauma Center, Milford Memorial have seen much success with unit-based daily huddles. While both sets of huddles began before Bayhealth’s path to high reliability started, they’re excellent examples of how Patient Care Services is contributing to these efforts.

Perioperative Services leaders hold daily morning huddles, where team members from the Operating Room, Day Surgery, Endoscopy, Anesthesia, and Post-Anesthesia Care talk about how the successes and opportunities experienced during morning surgeries. In the two years since these leader huddles began, Perioperative Services increased first-case starts times and decreased turnover times. “These huddles help us with our efficiency, give us a chance to address concerns, improve camaraderie between departments, and is an opportunity to talk to team members from the other Bayhealth.org/Nurses

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STRUCTURAL EMPOWERMENT

Making Changes through Shared Governance Patient Care Services launched a new Shared Governance structure in January 2018. The goal of restructuring Shared Governance at Bayhealth was to elevate the decision-making abilities and problem-solving skills of staff. “Our staff on the units see firsthand what our staff and patients need to live better and healthier lives. This is why it’s so important they be empowered to make decisions and changes that impact the work environment and patient care,” said Chief Nurse Executive Brenda Blain, DNP, RN, FACHE, NE-BC. “This Shared Governance structure gives our staff opportunities to be leaders in change and moving our department forward in patient care,” Blain said.

Here are a few examples of changes made this year through shared governance: • Performance Improvement Council – Led the development of changes to the restraint policy and documentation. They also redesigned and improved the PI reporting tools for pain, restraints, and blood.

• Professional Practice Council – Improved communication with Materials Management, which enhanced relationships for materials substitutions.

• Clinical Safety Council – Identified the need for education regarding use of bed alarms and worked with Clinical Engineering to provide adequate signage on beds.

• Education – Completed the educational needs survey, developed training for council officers and distributed hospital-wide shared governance education. Initiated planning for 2018 Education Week, including the Education Conference and Educator of the Year Awards.

• Professional Development Sub-Council – Created the Mentor Program.

• Reward and Recognition Sub-Council – Celebrated staff through the Doctor’s Day Award, Nursing Recognition Dinner, Nurses Week celebrations, and assistive staff recognition.

Evolving Roles and Succession Planning Clinical nurse specialists saw their role change significantly in 2018, when they went from being unit based to a population health model.

Following a unit-specific role, there were often duplications in work, which created variable practices across the organization. Now clinical nurse specialists (CNS) are assigned to specific

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populations of patients, such as behavioral health, palliative care, acute, and cardiac care. The goal of the CNS restructure is to increase the use of evidence-based practice within the organization; provide clear, standardized practices for staff; and, ultimately, improve patient outcomes.

Continued on page 11

Continued from page 10 “This gives us an opportunity to be a liaison between the different inpatient and outpatient departments.

We’re no longer siloed to a particular unit,” said Cardiac Clinical Nurse Specialist Ludy Santiago-Rotchford, MSN, APRN, ACNS-BC, PCCN.

Along with the restructured role of CNSs, succession planning was put in place for clinical practice leaders (CPL). The planning set up CPLs to transition to the role of clinical nurse specialists once they’ve completed the education and certification requirements. Thus far, all clinical practice leaders have been successfully promoted to clinical nurse specialists.

Preventing Illness with Annual Wellness Visits Bayhealth is part of the statewide eBrightHealth Network Accountable Care Organization (ACO) that brings together more than 1,200 primary and specialty care clinicians from four regional health systems, two federally qualified health centers, and nine private primary practices. The ACO’s statewide collaboration helps clinicians address clinical, behavioral, social, and other needs of Medicare beneficiaries to improve their access to care, prevent unnecessary emergency department visits and decrease the amount of time spent in the hospital. Several programs support the work of the ACO, including annual wellness visits. The visits help patients get the preventive and wellness services they need to remain healthy. “These wellness visits help keep patients on track with annual tests like mammograms and vaccines. It could mean preventing an illness or catching a disease like cancer in its early stages,” said Bayhealth Medical Group Licensed Practical Nurse Susan Larimore.

Choosing Wisely with Antibiotic Stewardship Initiative Throughout 2018, Bayhealth participated in eBrightHealth ACO’s Choose Wisely® Antibiotic Stewardship Initiative. This program worked to decrease antibiotic use in both inpatient and outpatient settings. Bayhealth pharmacists were recognized in late 2018 for their work on the project. “The number of antibiotics in the pipeline for development face an increased chance of resistance because of the use of antibiotics today,” said Clinical Pharmacist Janelle Caruano. “We need to determine if a patient really needs an antibiotic in a judicial manner because every time they’re used inappropriately, they can potentially do more harm than good.”

Bayhealth Nurse Named to State Board Bayhealth Forensic Nurse Clinical Coordinator Dawn Culp, MSN, RN, SANE-A, SANE-P, FNE, was appointed in 2018 to the Delaware Victim’s Compensation Assistance Program Appeals Board. Culp was nominated for the seat by Gov. John Carney and confirmed by the Delaware State Senate. She is serving on the appeals board for a three-year term. The Victims’ Compensation Assistance Program aids victims of violent crimes. “I’ve always been an advocate for victims, and this is just another way I can continue to do that work for the people of Delaware. I’m so thankful for this opportunity, and I look forward to serving on this board and being out in the community as an extension of Bayhealth,” Culp said.

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EXEMPLARY PROFESSIONAL PRACTICE

Exemplary Professional Practice Nursing leadership at Bayhealth is driven to support the growth of our nurses. From encouraging team members to continue their education to helping them with certifications and providing professional development, we believe in cultivating the talent of our nurses and helping them grow to become nurse leaders in their own right. Doing so has brought much success to the nursing staff at Bayhealth, as shown through the below clinical nurse statistics.

715 143 858 18.9% 6.6% FULL-TIME NURSES

34%

PART-TIME, RELIEF, OR PER DIEM NURSES

ASSOCIATES DEGREE IN NURSING

TOTAL NURSES

53% CERTIFIED NURSES

RN TURNOVER RATE

75%

BACHELOR’S DEGREE IN NURSING

RN VACANCY RATE

9.6%

MASTERS DEGREE IN NURSING

To celebrate nurses who are certified, Bayhealth holds an annual certification dinner. The first year of the annual certification dinner, less than 100 nurses were certified. In the eleventh year of the dinner, there were more than 400 nurses certified. “It’s great to see how we have grown the numbers of certified nurses in the last decade and it’s nice to celebrate this achievement for our nurses. We believe it’s important to help our nurses progress in their careers,” said Bayhealth Cancer Institute Manager Stephanie McClellan, MSN, RN, CMSRN, NE-BC.

Supporting Practice Transition To help nurses with less than 12 months of acute care experience, Bayhealth created a Nurse Residency Program in 2018. Based on guidelines established by the American Nurse Credentialing Center (ANCC) Practice Transition Accreditation Program (PTAP), the program was created at Bayhealth to facilitate a successful transition for nurses to independent practice.

The program takes a multidisciplinary approach, and is led by med-surg and critical care coordinators.

“We love our new nurses,” said Medical Surgical Coordinator Amy Cunningham, MSN, RN-BC. “We love to see their excitement and enthusiasm. However, we also know being a nurse in the acute care setting is much different than being in an academic setting. We want to have all the tools in place to ensure our new nurses get the education and support they need to succeed.” The current goal is to apply for PTAP accreditation through ANCC by January 2020.

“The new residency program is a group effort among many disciplines at Bayhealth,” said Critical Care Coordinator Michelle Thompson, MSN, RN, PCCN. “It’s exciting to see everyone working together to help our nurses succeed. Our goal is to make sure our new nurses feel supported.”

During the residency, each cohort meets once a month for six months to learn about various nursing principles, such as patient safety and satisfaction, resiliency, time management, critical thinking, prioritization, and ethics. New nurses are paired with a mentor, who they team up with following completion of orientation. The program also includes meetings every one to two weeks throughout orientation with one of the two coordinators. These meetings help ensure established objectives and measurable outcomes are being met while also establishing strategies and goals for the coming weeks.

Preparing Nursing Students In April 2018, Bayhealth created a new role – collegiate nursing care technician (CCT) – for nursing students to gain exposure and experience in an acute care setting in preparation for a career as a professional nurse.

“Students benefit from the mentoring of expert nurses, become enculturated in professional practice standards and demonstrate an understanding surrounding our

Planetree philosophy, which puts our patients and families at the center of all we do,” said Director of Professional Recruitment, Patient Advocacy and Service Excellence Marianne Foard, MS, RN, NE-BC, PRC. Ten of the 14 CCTs were hired for registered nursing roles.

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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTS

Preparing for the Opening of the Bayhealth Sussex Campus From the moment Bayhealth announced the Bayhealth Sussex Campus project, nurses were heavily involved—especially with patient rooms.

Patient rooms at the Bayhealth Sussex Campus were designed not only with the patient in mind, but staff as well. The new hospital features same-sided rooms, meaning each patient room looks exactly the same.

The design was conceived thanks in part to a lot of research and user groups doing workflow mock ups.

Registered Nurse Morgan McKenzie said they went step-by-step to see what changes could be made to improve workflows. The end results are changes that may seem minor but overall make team members more efficient. “Through doing this, we’ve found ways to cut back on time. We’re making changes that will stop us from wasting time walking up and down the unit, which means we have more time with the patients,” McKenzie said.

These changes included having computers, sinks and nurse servers in every patient room; using a “unit of one” approach where medications and equipment are strategically placed; putting sharps containers in convenient locations, and more.

Along with designing the patient rooms, nurses were also involved in creating a new supply distribution system. Instead of scanning supplies, the new hospital uses a two-bin system. With this change, supplies will be placed in two bins that are placed front to back on a shelf, supplies are picked

from the first bin, and when it’s empty, it’s placed on the top shelf to be refilled by warehouse staff.

The second bin is then pulled forward to be used.

With this new inventory system, the bins are rotated in a way so staff never run out of supplies and are easily alerted when a refill is necessary. It also means spending less time with supplies and more time at the bedside supporting patients.

2 North Nurse Laura Payton, RN, BSN, worked with Materials Management leadership on the project.

After coming up with a design, they built a mock room in 2018 at Bayhealth Milford Memorial to better understand the workflow. “This was a great opportunity because every clean supply room looks the same, and we save so much time from not having to find and then scan supplies. This streamlines our work by having supplies in the same place in each room,” Payton said.

Improving Efficiency of Supply Management Previously whenever a team member at Bayhealth Milford Memorial needed isolation precaution supplies (formerly stored on prepared isolation carts), they had to leave the unit to get a large spaceconsuming metal cart from Central Supply. To cut down on the time it took to receive isolation materials and reduce physical obstacles in the hallway, nursing units switched from the remotely stored carts to an over-the-door hanger storage system. This system enables needed supplies, such as gowns, gloves, eye shields, and more to be stored on the unit at all times

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Patient Care Services Annual Report 2018

and consumes far less space. The new system was planned for use with the Bayhealth Sussex Campus opening. “Our leadership encourages us to find ways to improve workflows and efficiency,” said Nurse Manager Renee Griffith, MSN, RN, PCCN, CNML. “This was an idea that was discussed in a meeting and our CNE encouraged us to find a solution. We trialed the new system at Milford Memorial with great success and instituted it at the Kent Campus. The new hospital has the nurse servers with all the isolation needs ready to go.”

Taking Acuity Adaptable Care to Kent As the rest of the nursing units at Bayhealth Milford Memorial trained to become acuity adaptable units at Bayhealth Sussex Campus, two nursing units at Bayhealth Hospital, Kent Campus also made the transition. The Kent units that transitioned were 3 West and 4A; these units specialize in surgical and oncology patients. “This is a different approach to care,” said 3 West Nurse Manager Kathy Boyer, MSN, RN, CMSRN, CNML. “We believe that keeping patients in the same unit during their stay will lead to better outcomes, and improved patient management, patient satisfaction, and nurse satisfaction.”

Perinatal Testing Unit Opens To better serve Bayhealth’s higher-risk pregnant patients and their babies, a Perinatal Testing Unit (PTU) was added to the Maternal Fetal Medicine office at Bayhealth Hospital, Kent Campus. The PTU is equipped to provide biophysical profiles and non-stress tests to women from 28 weeks gestation to delivery, which assesses the health of the baby with a goal of preventing stillbirth. Patient benefits of the PTU include a more organized and predictable perinatal testing schedule, quicker access to specialists, overall convenience, and a patient education component where the PTU nurses partner with the patient to help them better care for themselves.

Preventing Patient Falls with EarlySense Bayhealth piloted a contact-free patient monitoring system called EarlySense on the 1A Med-Surg Unit in 2018. EarlySense is a system where the monitor is placed under the patient’s mattress that provides continuous measurements, and reports of patient heart and respiratory rates. It also provides bed-exit sensitivity to assist with turn/repositioning timing needs and acts as an alarm for fall-risk patients. Clinical Informatics Nurse Will

Harvey, MSN, RN, CEN, CPEN, CPHIMS, and Clinical Nurse Specialist Robin Maracle, MSN, RN, AGCNS-BC, CMSRN, were instrumental in bringing EarlySense to Bayhealth. Along with making patients more comfortable, they’re hoping the system will help decrease patient falls, Code Blue calls, hospital acquired pressure ulcers, and hospital acquired infections.

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EMPIRICAL OUTCOMES

Maintaining a Culture of Safety and Quality For Magnet® Redesignation, Bayhealth must provide nurse-sensitive quality indicator data, always looking back at the most recent eight quarters, demonstrating performance that meets or exceeds NDNQI (National Database of Nursing Quality Indicators) benchmarks on the majority of our units for a majority of the time. Throughout 2018, Bayhealth successfully met or exceeded these expectations. The data is accumulative, but broken down by quarter.

CAUTI BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK 1.2

• 17 out of 17 units have met or exceeded benchmarks during 5 out of 8 quarters

1.1 1.0 0.8

• 8 of 17 units have 0 incidents – 2B, 4A, 3N, 3A, IMC, 3E-MMH, and 3S-MMH

0.7 0.6 0.5 0.3 0.2 0.1 0.0

2018 Qtr 1

2018 Qtr 2

2018 Qtr 3

2018 Qtr 4

CLABSI BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK

0.6

• 17 of 17 units have met or exceeded benchmarks during 5 out of 8 quarters

0.5 0.4 0.4

• 14 of 17 units have 0 incidents – Neuro ICU, PCU, 2B, 3W, 1A, 3E-KENT, 3N, 3A, CVSICU, IMCMMH, 2W-MMH, 3E-MMH, 3S-MMH, and Rehab

0.3 0.3 0.2 0.1 0.1 0.0 0.0

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2018 Qtr 1

2018 Qtr 2

Patient Care Services Annual Report 2018

2018 Qtr 3

2018 Qtr 4

• The “0” in quarters 1, 2 and 3 represent 0 CLABSI for the 17 submitting units

FALLS WITH INJURY BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK 0.3

• 16 of 20 units have met or exceeded benchmarks during 5 out of 8 quarters

0.3 0.3

• 5 of 20 units have 0 incidents – Neuro ICU, SCN, CVISCU, 3S-MMH, and WMS-MMH

0.2 0.2 0.1 0.1 0.1 0.0 0.0 0.0

2018 Qtr 1

2018 Qtr 2

2018 Qtr 3

2018 Qtr 4

HAPU STAGE 2 AND ABOVE BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK 3.2

• 11 of 16 units have met or exceeded benchmarks during 5 out of 8 quarters

2.8 2.5

• 6 of 16 units have 0 incidents – 1A, 2B, 3W, 4A, 2W-MMH, and 3S-MMH

2.2 1.9 1.6 1.2 0.9 0.6 0.3 0.0

2018 Qtr 1

2018 Qtr 2

2018 Qtr 3

2018 Qtr 4

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BAYHEALTH NEWS & RECOGNITIONS

Outpatient Surgery Center Added to Kent Campus Bayhealth acquired the Dover Surgicenter in 2018, which added an outpatient surgery center to the Bayhealth Kent Campus. Orthopaedic surgery, podiatry, general surgery, otolaryngology, gastroenterology, pain management, plastic surgery, and oral surgery are currently offered at the new Bayhealth Surgery Center, Kent Campus. As procedures are added, the acquisition will further enhance access to care to our community here at home in a safe, high-quality environment. Bayhealth Senior Vice President and Chief Nurse Executive Brenda Blain, DNP, RN-BC, FACHE, NEA-BC, oversees operations at the new Bayhealth Surgery Center, Kent Campus.

Expanding Palliative Care to Milford Two years after launching a Palliative Care Program at Bayhealth Hospital, Kent Campus, the program expanded to Bayhealth Milford Memorial in 2018. Palliative Care improves the lives of their patients and their families when facing a serious illness. Offering Palliative Care in Milford allows Bayhealth to fill a gap in care. To help with the expansion, Bayhealth brought on Palliative Care Nurse Practitioner Suzette Flores, DNP, MSN, BSN,

BSW. “I love being there for patients and families, to provide education and options. I want to help them with their quality of life and symptom management,” Flores said. “What I find is patients really appreciate the time we take to talk to them about their wants and needs.”

Pediatric Unit Finds a New Home The 2017-2018 flu season was a difficult one for Delaware, and Bayhealth was subsequently inundated with sick patients. Of the total 7,433 confirmed flu cases statewide, 2,316 of them were confirmed at Bayhealth. This meant Bayhealth Emergency and Trauma Center, Kent Campus was busier than normal. One particular day, it was announced in Bayhealth’s safety huddle that there were 26 patients being held in the 44-bed ED because inpatient units were filled to capacity.

The only available beds that day happened to be on the Pediatric Unit (2E). In an effort to decrease congestion in the ED and provide the best care possible to our patients here at home, Women’s & Children’s Services leadership decided that the pediatric treatment area could temporarily 18

Patient Care Services Annual Report 2018

move into the Women’s & Children’s available beds so that the beds on unit 2E could be used to help admitted inpatients still in the ED. The move, which eventually became permanent, brought the pediatric patient population to the Mother/Baby wing of the hospital. “This was a great collaboration between the different departments to not only move our patients safely, but to find a solution to a problem,” said Senior Nurse Manager Karen Kelly, MSN, RNC-OB. Now the old Pediatric Unit 2E can be used for other needs while the pediatric population can be cared for in closer proximity to the rest of Women’s & Children’s Services.

Nurse Leaders Publish Book on Best Practices in Ethical Decisions Senior Director of Patient Care Services Andrea Holecek, EdD, MSN, MBA, RN, NE-BC, FACHE, and Director of Education Angel Dewey, MSN, RN, APRN, ACNS-BC, CCRN, CNRN, celebrated the release of their book, “The Nurse’s Healthcare Ethics Committee Handbook.” The book came about after the duo presented at a national nursing conference in 2016, where they were approached by an acquiring editor from international honor society of nursing, Sigma Theta Tau, about writing the book.

The book was released in August 2018.

Honor Walks – Paying Tribute to Organ Donors Bayhealth began conducting honor walks in 2018 as an opportunity for team members to line the walls as organ donors and their loved ones make the trip from the Critical Care Unit to the Operating Room (OR). Critical Care staff suggested the honor walks after seeing other hospitals do walks of respect for organ donors. Announced hospitalwide via employee emails, hundreds of team members from the spectrum of care attend the honor walks.

New AEDs Throughout Kent New life-saving equipment was distributed through Bayhealth Hospital, Kent Campus in 2018. Automated External Defibrillators, or AEDs, are located in eight locations where crash carts, or AEDs, were previously not readily available. Thanks to the new AEDs, life-saving treatment can be administered immediately in non-patient care areas, such as the cafeteria, lobby and gift shop.

Facebook Workplace Launches Workplace by Facebook launched at Bayhealth in spring 2018. Used by companies across the country, Workplace is an engagement tool that allows teams to seamlessly collaborate and communicate on a secure network in a format similar to other social media formats. Nursing was looking for a way to engage all nursing staff across Bayhealth. Team members can post announcements, communicate about meetings and even livestream Shared Governance meetings via Workplace. Nearly, 1,500 team members – 800 or more of which are nurses – have created accounts in Bayhealth Workplace.

Clinical Informatics Nurse William Harvey, MSN, RN, CEN, CPEN, CPHIMS, was instrumental in bringing Workplace to Bayhealth. “We’ve leveraged Workplace for a lot, including spreading the word about our holiday food drive and promoting our Nursing 5K that raises money for professional development. We use Workplace for staff feedback and even as a communication tool when we have ED staff working at the Firefly Music Festival,” Harvey said.

Workplace Violence Program Launches Bayhealth’s Workplace Violence Program launched in 2018 with a goal of teaching team members, including nurses, how to deescalate situations before patients become violent. Through the program, staff does the NAPPI (Non-Abusive Psychological and Physical Intervention) training, which is designed to be nonabusive and effective for protection of self and others.

Using the NAPPI de-escalation techniques reduce the

need for physical and more aggressive intervention.

Along with the NAPPI training, a violence indicator flag went live in Bayhealth’s Epic electronic health record in 2018 so Emergency and Trauma staff can clearly indicate up-front precautions of possible combative interaction with the patient, without even having to comb through the chart.

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Excellence Honored Throughout the year, team members are honored for demonstrating Bayhealth’s core values of compassion, accountability, respect, integrity, and teamwork. Patient Care Services team members have been honored in the Nurses of the Year Awards, Pharmacy Awards and Patient Safety Awards.

OVERALL NURSES OF THE YEAR 4A Nurse Susanna Beabout, BSN, RN, CMSRN, and Clinical Educator Brittany Oakey, BSN, RN, CRRN, (pictured on the cover) are the 2018 Nurses of the Year for Bayhealth Hospital, Kent Campus and Bayhealth Milford Memorial.

The following are the winners for their respective nursing specialties: Bayhealth Hospital, Kent Campus nominees and winners • Med-Surg – Mary Lou Hawkins • Critical care – Kimberly Wilt • Advanced practice – Jessica Taylor • Nurse educator – Cynthia Mather • New registered nurse graduate – Natalie Shane • Nightingale nurse leader – Sue Beabout Bayhealth Milford Memorial nominees and winners • Med-Surg – Karen Mika • Critical care – Lisa Morrissey • Nurse educator – Brittany Oakey • New registered nurse graduate – Ashton Tomlinson • Nightingale Nurse Leader – Jennifer Fields 20

Patient Care Services Annual Report 2018

PHARMACY AWARDS The PACE (Pharmacists Achieving Clinical Excellence) Award for pharmacists and DEPTH (Dedicated Excellence of Pharmacy Technicians) Award for pharmacy technicians are awarded to the pharmacist or technician whose clinical skill and compassionate care exemplify the kind of pharmacist/technician Bayhealth patients, their families and staff recognize as an outstanding role model. This year’s award winners are as follows: • Janet Binder Bayhealth Hospital, Kent Campus PACE Award • Chalitnee (Bow) Lamlert Bayhealth Hospital, Kent Campus DEPTH Award • Tamanna Patel Bayhealth Milford Memorial PACE Award • Melissa Droddy Bayhealth Milford Memorial DEPTH Award

SAFETY EXCELLENCE AWARDS The Annual Safety Excellence Awards recognizes team members that make safety of patients a priority. Regina Coverdale, BSN, RN, was the 2018 Bayhealth Milford Memorial winner. After completing her HRO training, Coverdale constructed a reference sheet containing elements covered in the training, and these sheets are posted at desktops in the Total Joint Center. Coverdale was nominated by a coworker, who highlighted these efforts in the nomination.

DAISY Award Honorees Bayhealth is a partner of the DAISY Foundation. Formed in 2000 by the family of J. Patrick Barnes, the DAISY Foundation and Award recognizes the “unsung heroes” of the nursing profession. Here are Bayhealth’s 2018 DAISY Award winners: January

May

September

ERIC LEHR Bayhealth Emergency and Trauma Services, Milford Memorial

EMMA COLEMAN Cardiovascular Surgical Intensive Care Unit, Kent Campus

MELISSA YORK Progressive Care Unit, Kent Campus

February

June

ASHLEY ESCABI 4A, Kent Campus

SHERI CARROW Bayhealth Emergency Center, Smyrna

March RICHARD RICKS (pictured below) Bayhealth Emergency and Trauma Services, Kent Campus

April TANYA KARAMAN Women’s & Children’s Services, Milford Memorial

July MICHELLE MAXTON Post-Anesthesia Care Unit, Kent Campus

October and November MELISSA BROZEFSKY AND KRISTINA SEMONICK Intensive Care Unit, Kent Campus

December CHRISTY BREEDING (pictured below) 3 East, Milford Memorial

August TRISHA BENTLEY Bayhealth Women’s Center, Kent Campus

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Bayhealth Earns Planetree Silver Certification

Bayhealth Hospital, Kent Campus and Bayhealth Milford Memorial were awarded Silver Certification for Excellence in Person-Centered Care by Planetree International in 2018. Bayhealth is one of only seven healthcare organizations internationally with the Silver-level certification since Planetree first introduced the recognition level in 2012. Bayhealth is one of only three healthcare organizations in the U.S. designated Silver Certification.

“This achievement demonstrates our commitment to our patients, their families and the communities we serve,” said Senior Vice President and Chief Nurse Executive Brenda Blain, DNP, RN-BC, FACHE, NE-BC.

“Achieving Silver Certification for Excellence in PersonCentered Care demonstrates the compassionate, highquality service provided by everyone at Bayhealth.”

Bayhealth achieved this recognition after submitting a comprehensive document that captures more than 25 specific criteria, which was followed by a three-day site visit conducted by Planetree. There were several areas where Bayhealth excelled, including patientdirected visitation, opportunities for patient and family input through patient partners, community access to health and wellness programs, family involvement in care through the Care Partner Program, and sensitivity around the cultural norms and preferences of patients.

Bayhealth named leader in LGTBQ Healthcare Equality Bayhealth is proud to have announced its inclusion in the Human Rights Campaign (HRC) Foundation’s Healthcare Equality Index (HEI) as a Leader in LGBTQ Healthcare Equality. Bayhealth Hospital, Kent Campus and Bayhealth Milford Memorial are two of the 418 facilities to receive the honor after earning a top score of 100. The HRC is the educational arm of America’s largest civil rights organization working toward achieving equality for lesbian, gay, bisexual, transgender, and questioning people.

The findings were part of the unique 2018 HEI survey that encourages equal care for LGBTQ Americans by evaluating inclusive policies and practices related to LGTBQ patients, visitors and employees. Bayhealth earned top marks in patient-centered care, patient services and support, employee benefits and policies, and patient and community engagement.

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Patient Care Services Annual Report 2018

Bayhealth was named a HEI leader in 2016 and then a top performer in 2017. Those involved are proud of the work done this past year to achieve the leader designation again. “Over the past two years, we’ve become increasingly aware of the LGTBQ patients in the Bayhealth community. We’re driven now more than ever to make sure these patients, families, visitors, and team members are treated with the kindness, dignity and respect they deserve,” said Director of Patient Advocacy, Services Excellence and Professional Recruitment Marianne Foard, MS, RN, NE-BC. “Our work is also making Bayhealth a more inclusive organization to work for.”

1A: Two-Time PRISM Award Winners For the second time, Bayhealth Hospital, Kent Campus Med-Surg Unit 1A has received the prestigious Academy of Medical-Surgical Nurses (AMSN) PRISM Award®, which is a national recognition of the exemplary practice of med-surg units. 1A previously received the honor in 2014, and is the only med-surg unit in the state to receive the honor.

The PRISM Award is a three-year recognition where medsurg units submit an application and are graded based on their ability to meet set criteria related to effective leadership, recruitment and retention of staff, evidence-

based practice, positive patient outcomes, healthy practice environments, and lifelong learning of staff members.

1A Nurse Manager Dianne Halpern, MSN, CNML, RN, supports high reliability by empowering her staff to have a questioning attitude and find ways to make patient care even better, and to hold each other accountable to do the right thing for patients and each other. “I’m very grateful to have the staff that I have. It’s because of them and what they do every day that makes 1A, 1A,” Halpern said. “We have a great team, and I know that’s why we got this a second time.”

Worth Noting Along with recognitions from Planetree, Healthcare Equality Index and the PRISM Award®, there were several other awards Bayhealth received throughout 2018 that nursing was heavily involved with. These awards include the following: •

Get with the Guidelines®–Resuscitation Gold Plus Award, which was given to Bayhealth Hospital, Kent Campus for implementing quality improvement measures for the treatment of patients who suffer cardiac arrests at the hospital.

•

Mission: Lifeline Silver Receiving Quality Achievement Award, given by the American Heart Association to Bayhealth Hospital, Kent Campus for quality heart attack care.

•

Get with the Guidelines® Stroke Silver Plus Quality Achievement Award, which was given to Bayhealth Hospital, Kent Campus and Bayhealth Milford Memorial for meeting measures for the diagnosis and treatment of stroke patients.

•

Target: Stroke Honor Roll, which was given to Bayhealth Hospital, Kent Campus for reducing the time between a stroke patient’s arrival to the hospital and treatment with tPA.

•

Robert A. Warriner III, MD, Center of Excellence Award for 2017 by Healogics, given to the Wound Care Center at Bayhealth Hospital, Kent Campus for excellence in advanced wound care services.

•

Commission on Accreditation of Rehabilitation Facilities (CARF) Reaccreditation for the Inpatient Rehabilitation at Bayhealth Milford Memorial.

®

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