2017 Patient Care Services Annual Report

BAYHEALTH PATIENT CARE SERVICES 2017 ANNUAL REPORT

Nursing

excellence

BAYHEALTH.ORG

BAYHEALTH.ORG

A message from the Chief Nurse Executive (CNE) It is with great pride I present to you, Bayhealth’s 2017 Patient Care Services Annual Report. At Bayhealth, we have assembled a team of compassionate, empowered and skilled nurses, certified nursing assistants, pharmacists, and pharmacy technicians. Each of them is here because the health of our community matters. Knowing this makes me incredibly proud to have joined the team in 2017. In the short time I’ve been here, I’ve witnessed the drive our team has to improve the health of the Bayhealth community, and I look forward to playing my part.

Patient Care Services, and specifically nursing, has seen a number of changes in the past year. In 2017, nursing staff was introduced to a new shared governance structure and a new professional practice model, both of which empower staff to speak up and make a difference in patient care.

While changes were taking place within the department, a focus toward safety was made in an effort to make Bayhealth a high reliability organization (HRO). The background work on this project began in 2017 with an organization-wide rollout in 2018. Fitting in perfectly with HRO were safety huddles, which is a concept I brought with me to Bayhealth. Held each morning at all Bayhealth facilities, safety huddles allow team members to discuss issues, concerns, requests, resolutions, and my favorite part – great safety catches. Safety huddles have flourished across Bayhealth with team members from various departments participating, and I couldn’t be prouder of the improvements we’re making thanks to the team.

Still more work has been done, including the effort Patient Care Services has played in the planning of the Bayhealth Sussex Campus, which will open in early 2019. Along with these changes we have seen many successes, including bringing the DAISY Award back to Bayhealth, seeing nurses get published in national white papers, nurses attending and doing podium presentations at national conferences, and more.

These success stories and more are highlighted in this report.

Leadership is incredibly proud of the year Bayhealth has had, and we’re looking forward for what’s to come for the organization. Our work and patients mean everything to us, which is why we’ll continue in our drive to bring the nation’s best care to central and southern Delaware.

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

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Patient Care Services Annual Report 2017

TRANSFORMATIONAL LEADERSHIP

4-7

STRUCTURAL EMPOWERMENT

8-15

EXEMPLARY PROFESSIONAL PRACTICE

16-21 NEW KNOWLEDGE INNOVATIONS & IMPROVEMENTS

22-27

TRANSFORMATIONAL LEADERSHIP

Patient Care Services introduces new strategic plan The culmination of 2017 saw the completion of the Patient Care Services strategic plan for 2013-2017, and the welcoming of the 2018-2020 strategic plan. Tying in with Bayhealth’s own 2018-2020 plan, Patient Care Services is driven to bring the nation’s best healthcare to our communities here at home. It’s the team’s mission to strengthen the health of the community, one life at a time.

Patient Care Services goals fall into four categories: organizational excellence, culture, access & growth, and clinical integration. Achieving this mission starts with transformational leadership. At Bayhealth, staff in the Patient Care Services department is given ample opportunities to grow as leaders. Whether it’s through participation on a council, support with fellowships, tuition reimbursement, encouragement to join professional organizations, or opportunities to not only attend but present at national conferences, learning and growth opportunities are always available to team members.

Here at Bayhealth, team members have a voice, their opinions are valued and they’re part of the decision-making process.

“Patient Care Services is committed to cultivating a learning environment that ensures the ability of staff to deliver Bayhealth’s promise of bringing the nation’s best healthcare to our community. We hire only the best and continue to develop them with ongoing education, simulations, and support of advanced degrees and specialty certification,” says Senior Director for Women’s and Children’s Services Ronnie Kopec, RN, MS, NE-BC. “Leadership promotes research and encourages professional development by coaching and guiding staff, and leading by example. Our successes are evidenced by the many staff accepted as podium and poster presenters at national and international conferences, and proves our pledge to provide the safest and most up-to-date quality care to our patients.”

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Patient Care Services Annual Report 2017

• 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

• Increase percent of direct-care nurses with a bachelor of science in nursing or higher by one percent annually

CULTURE

• 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 expanding services to outpatient by 2020 • Implementing 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

Bayhealth.org/Nursing

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Promoting leaders from within Bayhealth Nurse Practitioner Paul Inge, MSN, FNP-C, has had quite the ride when it comes to his career at Bayhealth. Beginning as an orderly in the operating room in 1997, Inge has worked his way up to now being a nurse practitioner for Bayhealth Occupational Health.

Inge’s first job at Bayhealth was as an orderly, where he cleaned operating rooms after cases and assisted with positioning patients for surgery. He had wanted to see if he enjoyed the medical field before continuing his education.

Inge went on to nursing school. From there, he became a licensed practical nurse, then a med-surg registered nurse, and clinical coordinator. During this time, he achieved his bachelor’s degree in nursing and then his master’s in nursing in 2017. In the winter of 2017, he made the move from his med-surg unit to a nurse practitioner with Bayhealth Occupational Health.

While his commitment to help people has driven Inge in his career, he says Bayhealth helped him every step of the way in his education and in growing as a nurse. The tuition reimbursement program and scholarships helped pay for school.

“It would have been much harder to do this without Bayhealth’s support,” Inge said. “There were many exceptional nurses and people at Bayhealth that mentored me and helped me to be the kind of nurse that I am today.”

Supporting other opportunities Over the years, several nurse managers have benefited from this support through their participation in the American Organization of Nurse Executives Nurse Manager Fellowship. Bayhealth Cancer Institute Manager Stephanie McClellan, MSN, RN, CMSRN, completed the fellowship in 2017.

Starting early on in her fellowship, McClellan was already learning and growing as a leader. From seeing how healthcare facilities across the country were dealing with similar issues to finding areas of improvement as a leader, she absorbed everything she could. “Patients are sicker than they’ve ever been and this isn’t going to go away. It’s our job to become the best clinicians we can to provide the best care to the patients,” McClellan said. “The work we do really makes a difference and what I’m doing as a nurse manager helps the frontline staff become better caregivers.”

Her biggest takeaway from the experience was having a greater understanding and appreciation of nursing leadership.

“Hospitals across the nation are struggling with the same issues so it showed me we’re not in this alone. This makes finding the best and safest way to provide care even more important, especially when it comes to transitions of care. I’m amazed by what I learned from this fellowship and the ways other nurse managers are thinking outside of the box to get things done.”

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Patient Care Services Annual Report 2017

Leading in the community Some staff members lead both in their jobs and on their own time through their participation in professional organizations. In fact, several nurses even hold leadership positions with associations.

“I’m a member of several nursing organizations, and this is important to me because I have a passion for nursing. I feel fulfilled to work as a nurse and serve my community. These organizations offer an opportunity to give back to the community.”

— Teresita Raymundo, president Diamond State Chapter of American Association of Critical Care Nurses

“Healthcare is constantly changing so fast that we need to continuously find ways to strengthen our nurses. Being part of state and national professional organizations is one avenue that prepares us for the changes, and connects us with other nursing leaders.

I think the number of nurses involved in these organizations says a lot about our administration and their support for our professional development.”

“This organization helps improve my knowledge base for patient care. I’m part of a small chapter, but it helps us network with other nurses. Having so many Bayhealth nurses involved with and helping to start these organizations shows the nurses here understand the role these associations play in improving patient care.”

— Christina Olson, secretary Delaware Chapter of Academy of Med-Surg Nurses

“I like having the opportunity to network with other nurses and learn that we’re all dealing with the same problems. We’re able to talk about our concerns and bring back key information to share with other Bayhealth nurses. We also give back to the community, which is rewarding to be able to help people outside of Bayhealth.”

— Irene Roberts-Gulley, president Delaware Chapter of Academy of Med-Surg Nurses

— Susan Litchford, outgoing president Delaware Organization of Nurse Leaders

Along with nurses participating as leaders in professional nursing organizations, members of the Bayhealth Operating Room reestablished the local AORN chapter, Del-Mar Chapter 0802, in spring 2017. Association of PeriOperative Nurses (AORN) is committed to promoting excellence in perioperative nursing practice, advancing the profession and supporting the professional perioperative registered nurse. Having a local chapter helps nurses stay current with changes in the specialty as well as network with their peers at surgery centers and other hospitals. Through AORN, Bayhealth offers a Periop 101 RN fellowship for registered nurses who want to join the operating room.

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STRUCTURAL EMPOWERMENT

Frontline staff lead new shared governance structure For a large part of 2017, Patient Care Services – leadership and frontline staff – worked together to create a new Shared Governance Structure.

With a plan to go live in 2018, the group revised the structure in 2017 to elevate the decision-making ability of the council structure. The changes reflect the growth of Patient Care Services staff in their problem-solving and decision-making capacity, and empower them to be part of how the department moves forward.

The new council structure consists of principal councils and sub-councils, which feature frontline staff working alongside leadership. “Being a part of the restructuring of the Shared Governance and Magnet councils was a very eyeopening process for me. I had no idea all the different types of meeting structures that were out there and how our meetings followed suit. This change has brought an accountability with it in terms of increasing follow through with completing projects and tasks in a timely manner. I think it will stop us all from working on the same projects but in different directions. I’m really looking forward to the future of our councils.” – 2 West Clinical Coordinator Kelsey White, BSN, RN, CMSRN

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Patient Care Services Annual Report 2017

PERFORMANCE IMPROVEMENT

PROFESSIONAL DEVELOPMENT

EDUCATION

PHARMACY NURSING

SAFETY

COORDINATING COUNCIL APRN

PROFESSIONAL PRACTICE

LEADERSHIP

RESEARCH

INFORMATICS / TECHNOLOGY

NURSING OPEN FORUM

PCS

REWARD AND RECOGNITION

Here are the new councils and sub-councils: • Coordinating Council – Delegate, prioritize and direct work of the councils • Performance Improvement – Collect, analyze and disseminate data, and develop action plans to improve outcomes • Safety – Promote a culture of safety for patients and staff within the organization • Pharmacy Nursing – Evaluates processes that affect medication administration at Bayhealth • Leadership – Recommends the standardization of evidence-based operational, financial or human resource leadership practices for Patient Care Services • Nursing Open Forum – Forum to discuss solutions to evolve an environment that supports nursing excellence • Patient Care Services – Dissemination of the work of the councils

• Research – Insures the conduction, and internal and external dissemination of primary nursing research • Professional Practice – Recommends standardization of evidence-based nursing practice across Bayhealth where care is delivered • Reward and Recognition – Assess, plan, implement, and evaluate reward and recognition programs within Patient Care Services • IT – Assess and evaluate the use of data and technology within Patient Care Services • APRN – Evolve the role of the APRN at Bayhealth with a focus on top of license evidence-based practice • Education – Assists Education department in the assessment of staff educational needs and patient education • Professional Development – Focuses on the development of a future-ready workforce within Patient Care Services

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Nurses as teachers Nurses at Bayhealth teach in a variety of ways. Some work in Education where they’re provided the opportunity to not only teach patients how to better care for themselves via community programs, but also on a staff level by working every day to teach nurses the constant changes in healthcare. Preceptors are placed on each unit to help onboard new staff. Some nurses also work as preceptors for nursing students who come in to Bayhealth for rotations. Then there are clinical nurse specialists who not only mentor novice nurses, but take a lead role along with clinical coordinators in teaching fellowships. Along with educating staff, leadership also supports staff member participation in external education programs.

DEVELOPING SKILLS OF STAFF Bayhealth team members are provided several opportunities for growth. Current fellowships are Periop 101 for Operating Room nurses, Med-Surg, Critical Care, Emergency and Trauma Services, Women’s and Children’s Services, and Inpatient Rehab. There’s also a Research Fellowship, a RN First Assistant program, and a surgical technologist program available. Moreover, Bayhealth is driven to grow by adding additional fellowships.

The Inpatient Rehab was new in 2016 and a Women’s and Children’s Services Fellowship started in 2017.

Clinical Coordinator Brittany Oakey, RN, said the rehab fellowship is helping the nurses become better caregivers.

“This allows them to see the big picture of the care they’re providing,” Oakey said. “Through this education, I think they’re becoming more comfortable with the patients.”

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Patient Care Services Annual Report 2017

Clinical coordinators and clinical nurse specialists play a pivotal role in developing and leading the fellowships.

“Bayhealth is giving nurses an opportunity to build their skills, critical thinking, and most importantly, confidence,” said Critical Care Coordinator Holly Dapias, RN, BSN, CCRN. “You’re going to develop relationships with people all over the hospital and both campuses.

You’re going to have the opportunity to do the things that make you nervous without feeling unsafe or embarrassed.

In the end, you’re going to be more confident and competent providing care to your patients.”

Sometimes the educational experiences are outside of fellowships and trainings. In the summer of 2017, Bayhealth participated in a mass-casaulty drill

in conjunction with the Dover Air Force Base and other organizations. The drill was a simulation of several plane crashes to give each Emergency and Trauma Center an opportunity to practice treating a large number of patients.

Later on in the year, two large-scale simulations involving Bayhealth’s Emergency and Trauma Centers, Women’s and Children’s Services, Anesthesiology, Information Technology, Public Safety, Clinical Engineering, Diagnostic Imaging, Obstetrics, Neonatalogy, the Blood Bank, and Pediatric hospitalists took place. While simulations are common within fellowships, the larger scale program provided education to multiple groups and allowed an opportunity to practice caring for multiple patients with multiple specialties.

“Through learning opportunities such as this, we become better prepared to care for our patients in similar real-life circumstances. I look forward to future simulations, where we test the hospital systems to ensure our patients receive exceptional care every time,” said Special Care Nursery and Pediatric Clinical Nurse Specialist Sarah Knavel, MSN, APRN, PCNS-BC.

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Giving back to the community Teaching extends beyond the walls of Bayhealth; it flows to the community in the form of events and fundraisers. Bayhealth as a whole, including Patient Care Services, has built strong community partnerships with a goal of improving patient outcomes and advancing the health of patients in the Bayhealth community. Nursing, Education and Pharmacy staff take a collaborative approach when it comes to giving back to the community. Staff members educate the community through flu clinics, Diabetes Clinics, STEPS Clinics, clinical breast exams, and fundraisers such as the Southern Delaware Heart Walk and the Lewes Polar Bear Plunge benefitting Delaware Special Olympics.

Senior Director of Pharmacy Alex Zarow, RPh, MS, MBA, has participated in the Lewes Polar Bear Plunge for several years. This year Alex’s Snow Cubs, featuring several Pharmacy team members, raised more than $3,200 through the event. “I honestly find the event to be more rewarding each year I participate,” Zarow said. “It provides me the opportunity to support a wonderful cause for the Delaware Special Olympics. Taking a dip into the Atlantic Ocean is a small sacrifice for all the monies we raise to support our athletes.”

Project SEARCH Another way Bayhealth gives back has been by hosting Project SEARCH. Project SEARCH is a high school transition program designed for students seeking to learn independent living skills as well as transferrable, marketable job skills.

In addition to classroom instruction, students rotate through three 10-week internships with various departments – including Nursing, Education and Pharmacy – during the academic year.

In 2017, Project SEARCH received the Employment Outcomes Award at the 11th Annual Project SEARCH Conference. The award recognized the program for attaining employment outcomes of 80 percent.

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Patient Care Services Annual Report 2017

Pharmacy awards Each year, Pharmacy staff are honored for their work throughout the year with the PACE (Pharmacists Achieving Clinical Excellence) and DEPTH (Dedicated Excellence of Pharmacy Technicians in Healthcare) awards. Each winner is awarded for going above and beyond in their daily duties.

ERIKA RUST, PHARMD, BCPS Bayhealth Hospital, Kent Campus PACE Award

PHARMACY RESIDENCY The Pharmacy offers a postgraduate one-year residency program based on the ASHP Residency Learning System. Core rotations are offered in ambulatory care, oncology, cardiology, infectious disease, critical care, and more. During the program, the resident is required to complete a variety of activities including presenting accredited literature, conducting a Medication Use Evaluation, completing a research project, and providing clinical instruction to pharmacy students.

The residency program graduated three post-graduate year one (PGY1) students from the program, and was matched with three more PGY1 fellows for the current year.

JETTA SARGENT, CPHT Bayhealth Hospital, Kent Campus DEPTH Award

EMMANUEL ASARE, PHARMD Bayhealth Milford Memorial PACE Award

CHARLES ROGERS, CPHT Bayhealth Milford Memorial DEPTH Award Bayhealth.org/Nursing

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Honored for going above and beyond: Nurses of the year

Kent Campus Nurse of the Year Glenda Delacruz

Each year, Bayhealth honors nurses who demonstrate the organization’s core values of compassion, accountability, respect, integrity, and teamwork. The 2017 Nurses of the Year were 1A Night Shift Clinical Coordinator Glenda Delacruz, BSN, RN, CMSRN, and ICU Night Shift Clinical Coordinator Twinez Thompson, BSN, RN, as the Nurses of the Year for the Kent Campus and Milford Memorial.

Their fellow departmental winners were:

2017 Bayhealth Hospital, Kent Campus winners • Med-Surg – Glenda Delacruz • Critical Care – Denise Jones • Advanced practice – Theresa Latorre-Tegtmeier • Nurse educator – Carrie Holmes • New registered nurse graduate – Jennifer Mast Milford Memorial Nurse of the Year Twinez Thompson

• Nightingale nurse leadership – Jayvie Bueno

2017 Bayhealth Milford Memorial winners • Med-Surg – Kimberly Megonigal • Critical Care – Twinez Thompson • New registered nurse graduate – Heather Kreider • Nightingale nurse leadership – Renee Griffith

Bayhealth nurses were also honored with other organization-wide honors:

Milford Memorial Educator of the Year Patricia Deer

• Bayhealth Milford Memorial Educator of the Year – Bariatric Program Coordinator Patricia Deer, BSN, RN, CNOR, CBN The honors even extended beyond Bayhealth walls: • Then Bayhealth Wound Care Center Clinical Coordinator Julie Willey, RN, was recognized nationwide

by Healogics, Inc. with the esteemed Mary Cook Nurse of the Year Award.

Healogics, Inc. Mary Cook Nurse of the Year Julie Willey 14

Patient Care Services Annual Report 2017

Bringing DAISY back to Bayhealth Bayhealth relaunched the DAISY Award in 2017. Formed in 2000 by the family of J. Patrick Barnes, the honor recognizes the “unsung heroes” of the nursing profession. “I continue to be impressed by the drive, compassion and skill of nurses throughout the Bayhealth system,” said Andrea Holecek, EdD, MSN, MBA, RN, NE-BC, FACHE. “We are thrilled to not only have reintroduced the program, but to have had the response we did allowing us the opportunity to reward outstanding nurse role models in a special way.”

HERE ARE BAYHEALTH’S 2017 DAISY AWARD WINNERS: July – Lauren Rainey, MSN, RN, CEN, CPEN Bayhealth’s first DAISY Award winner recipient was Lauren Rainey, who was nominated after helping a family in a domestic abuse situation find safe shelter. “Lauren has such a big heart and it was admirable of her to not discharge the family until she knew they had a safe haven,” her nominator wrote.

August – Olivia Washinski, BSN, RN, CBIS Olivia Washinski was nominated by her Bayhealth Neurosurgery coworker Rahmia Woodson after assisting with a patient who was registering for an appointment. “Due to Olivia’s fast thinking, amazing nursing skills, and extremely caring heart, she was able to help the patient and she has fully recovered,” Woodson wrote in the nomination.

September – Debbie Bowden, RN, CCRN Thirty-one year veteran Debbie Bowden was nominated by Day Surgery coworker Kathy Steindl for her work with a patient. “She was present for him and encouraged him to keep fighting. She never let him give up, even after two more surgeries and more antibiotics,” Steindl said.

October – Laura Jermyn, BSN, RN, CMSRN Med-Surge Nurse Laura Jermyn was nominated for the award by the wife of a patient at Bayhealth Milford Memorial. “Hospitals are scary even when you know the environment, but having a nurse that you can trust with your most precious family is priceless,” the nominator wrote.

November – Kasey Murphy, BSN Mother Baby Nurse Kasey Murphy was nominated after her attention to detail led to an apnea diagnosis in a newborn. “Our family can’t thank Kasey enough. Her astute analysis, passion for her work, attentiveness, and thoughtfulness for her patient’s health can never be repaid. Those who are fortunate enough to end up in her care are undoubtedly in the best of hands,” the nominator wrote.

December – Krystal Messick, RN Med-Surg Nurse Krystal Messick was nominated by a fellow Bayhealth nurse for the care provided to the woman’s mother during a hospital stay. “Messick’s acts of kindness were above and beyond what we expected and meant a great deal to us, especially considering that mom wasn’t Krystal’s patient, but she saw the need to help her coworker and a patient,” the nominator wrote.

EXEMPLARY PROFESSIONAL PRACTICE

Nursing leadership supports the desire of team members to continue their education. Nursing leadership is proud to report the following 2017 nursing clinical nurse statistics.

799.9

12%

47%

3%

FULL-TIME NURSES

CERTIFIED

44%

ASSOCIATES DEGREE IN NURSING

RN TURNOVER RATE

NURSES

NURSING DIPLOMAS

48%

6%

BACHELOR’S DEGREE IN NURSING

10%

RN VACANCY RATE

MASTERS DEGREE IN NURSING

Leaders in nursing also continue to further their education in an effort to improve patient care. The following are education statistics pertaining to nursing leadership:

90% 34% 66% CERTIFIED

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BACHELOR’S DEGREE

Patient Care Services Annual Report 2017

MSN OR ABOVE

New Professional Practice Model unveiled After two years of updating Bayhealth’s professional practice model to better align with nursing values at Bayhealth, the new model was unveiled in late 2017. “This is a physical representation of who we are as a nursing service and what we believe is important for patient care,” said Holecek. “Who we are as a department has evolved over time, so it was important for us to reevaluate, reassess and redesign our model to signify who we are today.”

NURSING EXCELLENCE

AM Y

MIND IND D

ACCOUNTABILITY

ATTIIO ON N ORRA ABBO OLLLLA CO C

EMPOWERMENT EMPOWERMENT

AD A DVVO OC CA CYY AC

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

RIT RIT S IR SP SPI

COMPASSION

TE

GRIT

WO R

T

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R E S P EC

INTE

ursing is Gro Bayhealth N NCE-B unded in

RCH & EVIDE RESEA

ASED PRACT ICE! Bayhealth.org/Nursing

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Putting safety into focus When Bayhealth welcomed Brenda Blain as the new chief nurse executive, she brought with her ideas for how to improve the continuum of care at Bayhealth.

One such idea is the concept of safety huddles, which are held during the week at all Bayhealth facilities and provide team members across the spectrum of care an opportunity to know the pulse of the organization.

Huddles at all the Bayhealth facilities feature faces from across the organization from physicians to nurses and pharmacists to clinical engineers. “We look at concerns, requests, track and resolve issues, and my favorite part – celebrate great safety catches by our staff and providers,” Blain said.

ICU Clinical Coordinator Genna Helfrich, BSN, RN, believes the safety huddles are a good way to collaborate with an interdisciplinary team and also gives her a global sense of what’s going on in the organization. “It’s nice to see physicians there and to hear about other issues going on in other units. It shows issues aren’t isolated to one floor. A lot of information is also disseminated.”

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Patient Care Services Annual Report 2017

“The safety huddles are an excellent vehicle for communication. We get team members for multiple departments together in one room to address concerns,” said Magnet Program Director and Patient Care Services Director at Milford Andrea Holecek, EdD, MSN, MBA, RN, NE-BC, FACHE. “The huddles are more than just a discussion; we’re able to talk to the right people about issues and problems. Then they hold each other accountable to fix the concerns. While safety huddles began in the later half of 2017, I’m really excited to see how this transforms patient care for Bayhealth.”

Palliative Care – helping patients reach goals Living with a debilitating disease or illness can be stressful. A new Palliative Care Program launched at Bayhealth Hospital, Kent Campus in 2016, and was so successful the service expanded to Bayhealth Milford Memorial. Palliative care improves the quality of life for patients and their families when facing a serious illness. The program aids patients during all stages of a serious illness, but is best introduced early on in the treatment process.

The team works with patients suffering from a number of illnesses, including cancer, cardiac disease and lung disease, such as chronic obstructive pulmonary disease (COPD). “The biggest misconception about palliative care is that it’s only about comforting the patient at his or her end of life. Palliative care is about goal setting and discovering what’s important to the patient. We need to make sure that our medical plans are based on the goals of the patient,” said Palliative Care Nurse Practitioner Theresa Latorre-Tegtmeier, MSN, APRN, FNP-C. “Our leadership saw a gap in care for patients in central and southern Delaware, and decided to address it. This really is the best thing for the patients.”

Safe patient handling project complete Bayhealth completed its five-year safe patient handling equipment project in the spring of 2017. With ceiling lifts available in nearly every room a patient lift or transfer may occur, both Bayhealth hospitals are now minimal lift facilities. The goal of the project was to develop a culture where peers hold each other accountable for safe practices.

Along with preventing employee injuries, the use of ceiling mounted lifts helps to ensure patient comfort, dignity and safety during the transfer process.

“Through this project, we’re preventing what could be careerending injuries to staff.”

— ANDREA HOLECEK, EdD, MSN, MBA, RN, NE-BC, FACHE

“We were thrilled to complete this project because it makes everyone involved safer,” said Magnet Program Director and Director of Patient Care Services at Milford Andrea Holecek, EdD, MSN, MBA, RN, NE-BC, FACHE. “A patient handling injury isn’t usually the result of a one-time wrong twist or turn when lifting a patient. Rather handling injuries occur when healthcare workers repeatedly lift patients over the course of their career. Through this project, we’re preventing what could be career-ending injuries to staff.”

This project was made possible thanks to the collaboration among Nursing, Clinical Engineering, Plant Operations, Education, Materials Management, and Human Resources. And even though all of the lifts were installed in 2017, it doesn’t mean the work ends there. “This is a cultural change, and we have to continue to push forward and empower our peers to use all equipment available. We have to keep doing better and better to make safe patient handling part of how we give care,” Holecek said.

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Building a culture of safety and quality For Magnet® Redesignation, we must provide nurse-sensitive indicator data, always looking back at the most recent 8 quarters, and demonstrate outperformace of NDNQI benchmarks. With data through 1st Quarter 2018, we are meeting (and exceeding) these expectations.

Magnet hospital benchmarch Average of Bayhealth units

CAUTI BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK 3.0 2.7

• 16 out of 19 units have met or exceeded 5 out of 8 quarters

2.4

• 5/19 units have 0 incidents Peds, 3N, 3W, 3E-KGH, 3S-MMH

2.1 1.8 1.5 1.2 0.9 0.6 0.3 0.0

2017 Qtr 1

2017 Qtr 2

2017 Qtr 3

2017 Qtr 4

CLABSI BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK 1.0

• 19 of 19 units have met or exceeded 5 out of 8 quarters

0.9

• 18/19 units have 0 incidents

0.8 0.7 0.6 0.5 0.3 0.2 0.1 0.0 0.0

20

2017 Qtr 1

2017 Qtr 2

2017 Qtr 3

Patient Care Services Annual Report 2017

2017 Qtr 4

FALLS WITH INJURY BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK 1.0

• 11 of 19 units have met or exceeded 5 out of 8 quarters

0.9 0.8

• 7/19 units have 0 incidents

0.7

NICU,CVSICU, NEURO ICU,ICU-KGH, 2B, 3S-MMH, WMS-MMH

0.6 0.5 0.3 0.2 0.1 0.0 0.0

2017 Qtr 1

2017 Qtr 2

2017 Qtr 3

2017 Qtr 4

HAPU STAGE 2 AND ABOVE BAYHEALTH PERFORMANCE AGAINST MAGNET HOSPITAL BENCHMARK 4.7

• 11 of 19 units have met or exceeded 5 out of 8 quarters

4.2 3.8

• 9/19 units have 0 incidents

3.3

2N-IMC, 4A,3N,1A,2B, 3W, ICU-MMH,2W-MMH, 3S-MMH

2.8 2.3 1.9 1.4 0.9 0.4 0.0

2017 Qtr 1

2017 Qtr 2

2017 Qtr 3

2017 Qtr 4

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NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTS

New knowledge, innovations and improvements Along with having strong leadership, empowered professionals and exemplary practice, Bayhealth nurses contribute to patient care through innovative changes in the healthcare environment. Through planning for future healthcare facilities to making small changes on units, the staff at Bayhealth is searching for ways to improve their knowledge and care.

Bayhealth is in the midst of building for the next 100 years with the Bayhealth Sussex Campus project. Numerous nursing staff are a part of the project, including Bayhealth Milford Memorial nurse Morgan McKenzie, BSN, RN. McKenzie is part of several committees who are ushering in the new era of healthcare. McKenzie and other Bayhealth team members helped the design teams to conceptualize patient rooms in the new hospital and outpatient center. “It’s an honor that Bayhealth administration allowed us to be part of these conversations,” said McKenzie. “This is such an exciting project, and it means that much more that we were afforded the opportunity to collaborate as a team in order to provide our patients with the best care possible.”

Transforming care with acuity-adaptable units Nursing units at both Bayhealth Milford Memorial and Bayhealth Hospital, Kent Campus are in the process of transforming to become acuity-adaptable in an effort to better care for patients. This means whether a patient requires med-surg or intermediate (IMC) levels of care, they will receive it on an acuity-adaptable unit.

Research shows acuity-adaptable units will cut down on patient transfers, increase collaboration with unit staff and families, decrease the risk of patient falls, reduce infection rates, enhance continuity of care, improve communication with hand-off reports, and increase productivity.

The Bayhealth Hospital, Sussex Campus will have three 24-bed Acute Care Units. Nursing units at Bayhealth Milford Memorial have been training for the past year to prepare for working in such a unit.

Two units – IMC and 3 East – are already running as acute care units. Clinical Coordinators Megan Lawless, BSN, RN, PCCN, and Pamela James, MSN, RN-BC, are already seeing the benefits of the new system on IMC and 3 East. “By not moving patients to a different unit, we’re getting to know them better since they’re on the unit longer,” Lawless said. “Plus this allows patients to rest, relax and get better without the stress of moving units.”

Two units at Bayhealth Hospital, Kent Campus are transitioning from Med-Surg to acuity-adaptable. Team members on 3 West and 4A began training in 2017 with a goal of changing to the new system in February 2018.

“This is a different approach to care. 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,” said 3 West Nurse Manager Kathy Boyer, MSN, RN, CMSRN, CNML.

Developing professionally through conferences Going to healthcare conferences allows team members to share what they’re doing with colleagues across the nation, and bring back what they learned from the conference in an effort to improve patient care.

Several nurses attended conferences in 2017, including Women’s and Children’s Services Clinical Coordinator Laura Mills, MSN, RNC-OB, CPN, CNL; Kristen Short, BSN, RN; and NICU Night Shift Clinical Coordinator Tenaya Strong, BSN, RNC-NIC, who presented posters at the National Mother Baby Nurses Conference.

Mills and Short, along with Lactation Services Program Coordinator Gail Smith, RN, IBCLC, presented a poster on the role of peer counselors with exclusive breastfeeding in a rural hospital. Strong, with Anne Sanders, BSN, RNC-NIC, presented a poster on how code carts have evolved over the last decade. Each poster was a culmination of a research project and ultimately presented an opportunity for growth in patient care. “I

always enjoy going to a conference because we get to learn the newest innovations in our practice,” Strong said. “I believe in embracing change rather than remaining stagnant when it comes to patient care.”

Like Strong, Mills and Short appreciate meeting peers from across the country. Specifically, they like viewing other poster presentations and attending breakaway sessions.

Not only are they able to bring back new information, but it gives them ideas for future research projects, Short said.

“A lot of what we see at the conference are things we’re already doing so we’re able to make suggestions on what other hospitals should do,” Short said.

“We receive a lot of support from our leaders to attend these conferences. I think more people would go if they knew Bayhealth would support it,” Mills said.

“These conferences allow for continued professional development and improve patient care.”

“I believe in embracing change rather than remaining stagnant when it comes to patient care.”

-TENAYA STRONG, BSN, RNC-NIC

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Using research to improve patient care Members of the Research Council span across Patient Care Services, all with a variety of focuses. Research plays a vital role in the work of Bayhealth team members as they not only want to find ways to improve care, but want to know why we do things the way we do. Sometimes this research extends beyond the walls of Bayhealth. Such was the case with Clinical Nurse Specialist Ludy Santiago-Rotchford, MSN, APRN, ANCS-BC, PCCN; she was part of a National Association of Clinical Nurse Specialist (NACNS) task force on chronic conditions and was recently published in a white paper.

Titled, “Addressing the Needs of Patients with Chronic Conditions. The Role of the Clinical Nurse Specialist,” the paper concludes that the role of the CNS helps manage patients with chronic conditions, can lead to collaboration across the healthcare setting and serve as a bridge between disciplines. “We have an outstanding group of CNSs, but it’s still important to remind everyone that we’re not only here to help with patient care, and to improve nursing practice and systems, but we’re here to also manage chronic conditions.

Due to healthcare reforms, there are new opportunities for CNSs to provide reimbursable services as consultants. There are CNSs who are leading transitional care programs based on the University of Penn model that has proven success on reducing 30-day readmissions,” she said.

BAYHEALTH NAMED TOP PERFORMER BY HEALTHCARE EQUALITY INDEX (HEI) Bayhealth continues to make progress in providing patientand family-centered care. In 2017, Bayhealth was named a “Top Performer” for the Healthcare Equality Index. HEI is the national LGBTQ benchmarking tool that evaluates healthcare facilities’ policies and practices related to the equity and inclusion of their LGBTQ patients, visitors and employees.

A task force featuring clinical and non-clinical staff work together all year to improve services and programs for the LGBTQ community. “The things we are currently doing really benefit our community and our staff,” said Director Patient Advocacy, Service Excellence and Professional Recruitment Marianne Foard MS, RN, NE-BC, PRC. “We are taking a global approach to promoting LGBTQ at our facilities. We are continuing to make great strides in these efforts.”

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Patient Care Services Annual Report 2017

Riva the Robot: valuable member of the Bayhealth Pharmacy team Riva the Robot is a robotic intravenous automation system used to prepare prescription medication for hospitalized patients, and assists the Inpatient Pharmacy professionals at Bayhealth Hospital, Kent Campus. Pharmacy Operations Manager Rita Montone, RPh, MBA, and Pharmacy Technician Supervisor Paul Davis, CPhT, and their staff depend on Riva to ensure that every IV, bottle, and syringe are properly mixed, weighed and labeled for accuracy.

“Riva has helped us improve the accuracy of our dosages, reduce cross-contamination, and dramatically lower our margin of error as we fill prescriptions,” Montone said. Moreover, Riva is a valuable ally in Bayhealth’s fight to prevent infection. After Pharmacy staff loads Riva’s cassettes with concentrated vials, syringes, bags, and medication, it’s up to her to mix and measure the prescriptions.

Riva is able to accurately measure a dosage the same way every time. Although many medical staff can correctly estimate 20 milliliters in a syringe, Riva doesn’t estimate.

“Riva fills bags and syringes by volume, and then validates it each by weight,” said Davis.

After Riva prepares the mixtures according to the prescription, she labels each IV bag or syringe with the name of the medication, its dosage, shelf-life, and bar codes. Pharmacists check each medication to ensure that the measurements and mixtures are accurate.

“Using Riva ensures better medication safety and greater efficiency,” said Montone. “We’re happy to have her.”

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Ambulatory Pharmacy receives two new accreditations

DIABETES EDUCATION TRANSITIONS TO PHARMACY

The Bayhealth Ambulatory Pharmacy at Bayhealth Hospital, Kent Campus recently received accreditations through the Accreditation Commission for Health Care (ACHC) in Specialty Pharmacy and Durable Medical Equipment. These accreditations allow Ambulatory Pharmacy staff to process most specialty medication prescriptions and bill insurance for durable medical equipment. “Receiving these accreditations will play an important part in patient satisfaction because they will allow us to better serve our patients,” said Pharmacy Director Alex Zarow, RPh, MS, MBA.

To improve the care provided to diabetic patients, the diabetes education team is now in the Pharmacy department. Over the last several years, the diabetes educators have worked closely with Pharmacy staff in terms of caring for patients who are diabetic. Because of this, it was decided that the educators would transition from the Education department to Pharmacy.

The durable medical equipment accreditation deals specifically with providing equipment such as crutches, splints and boots to patients who need them, particularly after a visit to Emergency and Trauma Services. Specialty pharmacy services assist with medication-specific monitoring, meaning our pharmacists specialize in recommending dose adjustments, researching drug interactions and providing counseling about the unique side effects of medications used in certain disease states. Bayhealth’s Specialty Pharmacy accreditation will predominately benefit oncology patients.

“This will allow us to take a unified approach to patient care,” says Pharmacy Director Alex Zarow, RPH, MS, MBA. “Diabetes is highly prevalent in our community and we see a number of these patients readmitted. We’re now taking a collaborative approach to better serve our patients. In the coming months, we expect to see some process changes that will evolve the care we provide.”

Clinical Manager and Oncology Pharmacist Carl Popelas, PharmD, BCOP, says the new Specialty Pharmacy accreditation will bring another layer of convenience to oncology patients. “This sets a standard for the care we provide to the community and is very important as a whole when it comes to patient safety and quality care,” Popelas said.

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Patient Care Services Annual Report 2017

Bayhealth hospitals designated Primary Stroke Centers Bayhealth Milford Memorial earned The Joint Commission’s Gold Seal of Approval® and the American Heart Association/American Stroke Association’s HeartCheck mark for Advanced Certification for Primary Stroke Centers in 2017. Bayhealth Hospital, Kent Campus was also re-designated as a Primary Stroke Center.

The Gold Seal of Approval and the Heart-Check mark represent symbols of quality from their respective organizations. The designation of Primary Stroke Center means both Bayhealth hospitals have met and seek to maintain The Joint Commission’s high standards in providing stroke care and are now certified for delivering the next generation of care to stroke patients.

“If someone in our community has stroke symptoms,

they deserve care quickly. With these certifications, we can assure Kent and Sussex County residents that they’ll receive excellent timely care when needed,” said Senior Vice President and Chief Nurse Executive Brenda Blain, DNP, RN-BC, FACHE, NEA-BC. This is the first time Milford Memorial received the designation. “The healthcare team at Milford is extraordinary,” said Milford’s Senior Director of Patient Care Services Andrea Holecek, EdD, MSN, MBA, RN, NE-BC, FACHE. “They’re highly qualified individuals who’ve had extensive training in the care of stroke patients. I’ve seen true collaboration as they continually focus on meeting and exceeding national standards.”

Bayhealth receives resuscitation award Bayhealth Hospital, Kent Campus has been awarded the Get With the Guidelines®-Resuscitation Silver Award for implementing specific quality improvement measures outlined by the American Heart Association® (AHA) for the treatment of patients who suffer cardiac arrests at the hospital.

The AHA’s Get With The Guidelines®-Resuscitation program is one set of guidelines Bayhealth uses to develop and implement protocols for reducing disability and death from cardiac and respiratory emergencies. This evidencebased quality improvement program can result in better patient outcomes, with more patients surviving cardiac arrest and eventually being discharged from the hospital.

Education Director Angeline Dewey, MSN, RN, APN, ACNS-BC, CCRN, CNRN, was a pivotal leader of the critical care team prior to her promotion from clinical nurse specialist to Education director. “This honor really speaks to the collaboration among critical care staff – nursing, respiratory therapy, anesthesia, and emergency medicine,” Dewey said. “We’ve been able to achieve and sustain nationally accepted standards for cardiac resuscitation. This exemplifies the excellent care provided to our patients during a time when their lives are at stake.”

Bayhealth.org/Nursing

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