Augusta Health Nursing Division – Annual Report 2012

Augusta Health 78 Medical Center Drive Fishersville, VA 22939 Phone (540) 332-4000 Staunton Phone (540) 932-4000 Waynesboro Toll Free 1-800-932-0262 www.augustahealth.com

A Message from our VICE PRESIDENT OF OPERATIONS 2012 has been a year of accomplishments for Augusta Nursing. We have continued to “hardwire” our commitment to a shared governance structure, believing that nurses are part of the decision making process and equally involved in the education opportunities these decisions bring. The Division of Nursing has also continued to strive toward higher education, whether through encouraging staff to continue their formal education, pursue a certification in their specialty area or through the offering of more “on the spot” in-services to help in their daily practice. On our journey forward, our focus continues to be on professional growth and teamwork. Together we really can achieve anything!

— LISA CLINE, MSN, MBA, RN

A Message from our VICE PRESIDENT/CHIEF NURSING OFFICER When looking at nursing here at Augusta Health, it is clear we have a strong foundation of commitment to high quality patient care. Nursing leadership is also very committed to developing the optimal practice environment for our patients and our staff. In 2013, we will continue our journey to Magnet, but more so, to total nursing excellence. A re-focus on “Back to Basics” will support our mission at the bedside. Streamlining processes such as documentation will allow the nursing staff to be with the patients more during any particular shift. It is going to be an exciting and challenging year for all of us.

— BOB MCWHIRT, DNP, RN, NE-BC, ACNS-BC

© 2013. Augusta Health Nursing Division 2012 Annual Report compiled by Patra H. Reed MSN, RN, CNML, Magnet Program Director.

Photos courtesy of ryanmoserphotography.com, Woods Pierce, and Augusta Health staff.

Augusta Health

AT-A-GLANCE

REGISTERED NURSES (RNS)

531 PERCENTAGES OF NURSES WHO HAVE A BSN OR MSN

38% PERCENTAGE OF DIRECT CARE NURSES WHO HAVE EARNED SPECIALTY CERTIFICATIONS

21% OTHER EMPLOYEES

1620 AMG PHYSICIANS

59 LICENSED BEDS

255 TOTAL ADMISSIONS

11,176 TOTAL ED VISITS

56,530 + Recipient of HealthGrades Distinguished Hospital Award for Clinical Excellence™ (2005-2007, 2009-2011)

ADMISSIONS FROM THE ED

13%

+ Recipient of HealthGrades Patient Safety Excellence Award™ (2010-11)

TOTAL BIRTHS

1,157

+ Named a 100 Top Hospitals® by Thomson Reuters, also one of twelve of the Top 100 hospitals to receive the Everest Award.

TOTAL SURGERIES

17,155

+ Joint Commission, Primary Stroke Center Certification + Accredited Chest Pain Center as designated by the Society of Cardiovascular Patient Care

TOTAL CARDIAC CATHETERIZATIONS

749

+ Full Cancer Accreditation from the American College of Surgeons Commission + First hospital in the region to receive full accreditation from the National Accreditation Program for Breast Centers (NAPBC).

TOTAL OUTPATIENT VISITS

584,516

+ Home Health Care Provider of HomeCare Elite™

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Nursing at Augusta Health

Caring for our community with compassion, skill and knowledge.

VISION To ensure a legacy by advancing the art and science of nursing through evidence-based practice and collaborative care.

PHILOSOPHY Nursing at Augusta Health is fluid, dynamic and able to accept the changes the future of healthcare may bring. Nursing is charged with responsibility and challenge; responsibility to grow, to become skilled at our profession, and the challenge to do so with grace, poise and professionalism. Nursing at Augusta Health stems from our Nursing Professional Practice Model built from the foundation of Patient Centered Care and

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the nursing components of compassion, teamwork, knowledge, and excellence. The incorporation of cultural and ethnic diversity along the illness-wellness continuum while providing competent evidence-based care is the very core and essence of nursing at Augusta Health. Patients exist as individuals, families, groups and communities. Each person is unique and possesses inherent dignity, worth and

rights. Throughout the life span, people have potential for growth and development.

Nursing supports the relationship between our patients and their environment and strives to optimize care to ensure our patients proceed to their next level in the best possible physical, emotional and spiritual condition. It is our duty and our privilege at Augusta Health to provide safe passage.

“To do what nobody else will do, a way that nobody else can do, in spite of all we go through, is to be a Nurse.”

— Rawsi Williams, RN

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“We are what we repeatedly do. Excellence, therefore, is not an act but a habit.”

—Aristotle

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Development of Our Professional Practice Model:

AUGUSTA HEALTH NURSING PROFESSIONAL PRACTICE MODEL

PATIENT CENTERED CARE As a collaborative effort, the Professional Practice Council, the Magnet Champions, and the Management Council created a model to illustrate Augusta Health nursing’s Professional Practice Model. The model represents the Augusta Health star, incorporating the nursing components, the organizational pillars, and key components necessary to sustain nursing excellence-all centered on the patient/family. The roll-out of this model was initiated in June 2012 and will continue through 2013.

In Patient Centered Care the needs of the patient and family are the priority. The focus is not simply on the disease or condition but rather on the physiological, spiritual, and emotional needs combined. This type of focus works to empower the patient to be involved in his or her own care and decision making process.

INNER CIRCLE = Patient and Family OUTER CIRCLE= Nursing Components STAR POINTS= Hospital Pillars Representing Organizational Values GRAY FABRIC= Components Sustaining Nursing Excellence

At Augusta Health our nursing practice is patient-centered, focusing on the individual needs of the patient and family. It makes the patient and their loved ones an important part of the health care team while empowering them to be involved in all aspects of their care. Compassionate and caring relationships allow us the foundation to assure excellence in outcomes.

Teamwork contributes to the high level of clinical knowledge and expertise we provide in the overall care of the patient.

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Shared Governance Shared Governance is an innovative nurse centered organizational framework which provides nurses with professional autonomy and shared decision making capabilities. It is based on the principles of partnership, equity, accountability, and ownership at the point of service. In a time of much change in our healthcare environment, it is imperative that as nurses, we take the lead in decision making at the point of service. The best decisions are made at the point of care — providing evidence based, costeffective care, while evaluating the services provided.

Shared Governance creates an atmosphere in which all members of the healthcare team have a voice in decision making, encouraging diverse and creative input while optimizing patient care. Professional nurses accept accountability for individualized nursing care based on quality outcomes. Nursing practice also includes professional self development, as well as the ethical and legal responsibilities involved in patient care. Benefits of a Shared Governance model are apparent to the nurse, the patient, and the organization. These include:

n n n n n

Autonomy in clinical decision making Participation in leadership decision making Adequate staffing Increased RN satisfaction Enhanced RN-MD collaboration

n n n n n n n n

Decreased LOS Increased patient satisfaction Decreased unexpected events and complications Reduced patient complaints Reduced RN turnover and vacancy rate Competitive economic advantage Marketing advantage Higher quality of nursing care

While every Shared Governance model looks slightly different, Augusta Health’s model consists of councils at both the hospital and the unit level. Members represent all areas of nursing and are accountable for decisions that fall within the context of the council.

Councils consist of 12-16 voting members. Our “star” model consists of 5 hospital councils: Professional Practice, Education, Quality/Performance Improvement, Research, and Management. All councils report through the Coordinating Council.

On the periphery of the main star are the “shooting stars” which represent the unit level councils, task forces, and peer review (coming soon).

Magnet Champions: Pictured L to R front row Yvonne Eisenberg Michele Davis Tammy Patterson Amy Hougan back row Mim Wenger Patra Reed Kira Griffin Suzanna Hicks Hostetter Diane DeCourcy

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Caring is the essence of nursing.

—Jean Watson

Council Highlights from 2012 PROFESSIONAL PRACTICE COUNCIL

EDUCATION COUNCIL

n n n

n n

n n n n

Revision of the Nursing Assessment Policy Computerization of Nursing Care Plans Development of the Professional Practice Model Revision of the Visitor Policy, development of brochure Process revision for High Alert Medications Guidelines for Staff Floating Change in Dyshagia Screening Tool

QUALITY/PERFORMANCE IMPROVEMENT COUNCIL n n n n

Organization-Wide Implementation of Workplace Violence Policy Support Partner Initiative implementation Infectious Disease data tracking and education Safe Patient Handling Project initiation

n n n

Wound Photography Implementation of Thomson Reuters Patient Instructions 1st Annual Nursing Symposium…”Nurses Driving Quality in Healthcare Reform” Assisted with redesign of the Preceptor Class Began work on “Charge Nurse University”

RESEARCH COUNCIL n n n n n

CINAHL (online search engine for nurses) Partnership with JMU Education to staff on Research Awareness Isolation Trash policy revisions Nursing Library (to open in 1st QTR 2013)

MANAGEMENT COUNCIL n n n n

Clinical Ladder revisions Policy Review Bedside Reporting implementation and review Review of new electronic scheduling tool (Ultipro) NURSING DIVISION ANNUAL REPORT

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Patient Satisfaction.

“They may forget your name, but they will never forget how you made them feel.”

—Maya Angelou

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service quality people ďŹ nancial growth community

Augusta Health will become the healthcare system of choice for the community.

Implementation of a Patient Centered Services Liaison Our liaison coaches each individual staff within the organization on an individual basis on AIDET (Acknowledge, Introduce, Duration, Explanation, Thank You) and the importance of the quality of patient satisfaction, leading staff in the hardwiring of hourly patient rounding. This role assists in coaching and mentoring of staff to help them achieve individual and organizational expectations. The liaison also works with Directors and staff, educating and communicating on patient satisfaction results.

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Unless we are making progress in our nursing every year, every month, every week, take my word for it we are going back. 窶認lorence Nightingale

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service quality people financial growth community

Achieving top quality outcomes for our patients is an expectation for nursing at Augusta Health. In addition to patient satisfaction, we also monitor our quality based on national benchmarks in areas of nursing sensitive indicators such as falls, falls with injury, ventilator associated pneumonia, and bloodstream infections.

Fall Prevention FALLS PER 1000 PATIENT DAYS The Agency for Healthcare Research and Quality (AHRQ) implemented a team to develop a toolkit focusing on overcoming the challenges associated with developing, implementing, and sustaining a fall prevention program. The toolkit was developed under a contract with the Agency for Healthcare Research and Quality through the ACTION II program (Accelerating Change and Transformation in Organizations and Networks).

Purpose: Improve Fall Rate Hospital Wide This will be accomplished by analyzing gaps in current fall prevention protocols as compared to recommendations found in literature review and ECRI Toolkit of Best Practices. The study began with a survey of Fall Prevention Knowledge of staff on unit to obtain baseline of knowledge related to Fall Prevention.

The unit would serve as a representative to trial various methods suggested by ECRI and Fall Team to lower fall rate.

The Agency for Healthcare Research and Quality's (AHRQ) mission is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. As 1 of 12 agencies within the Department of Health and Human Services, AHRQ supports research that helps people make more informed decisions and improves the quality of health care services.

Goals of Project: n n

The Fall Prevention Toolkit was created by a core team with expertise in fall prevention and organizational change. The team lead by AHRQ included staff from the RAND Corporation, ECRI Institute, and Boston University.

n n

ECRI visited Augusta Health in 2011 to assess our Fall Prevention Program and identify areas to decrease patient falls. After the consultative visit, ECRI requested that Augusta Health provide a quality improvement team to participate with five other medical centers across the nation for a one year project in developing the toolkit.

n n

n

The purpose, goals, and accomplishments of the interdisciplinary Fall Prevention Team at Augusta Health while working with ECRI were the first steps in decreasing patient falls and sustaining a Fall Prevention Program.

n

Augusta Health fall rate will decrease by a measurable percentage Augusta Health staff will become aware that Fall Prevention is an important intervention and that all staff must work together to prevent falls Augusta Health staff will utilize all tools provided by the Fall Team to prevent patient falls and injuries RNs will follow new policy on Assessment after falls and be able to identify neurological injuries due to implementation of new policy Develop new Plan of Care that RNs can utilize to prevent falls Implementation of Root-cause analysis after each fall will help to identify gaps in current protocols that can then be brought back to Directors and utilized to educate staff on areas of weakness in current practice Inpatient RNs, LPNs, and PCTs will work together utilizing new strategies and interventions to prevent falls in the various patients served by Augusta Health All staff will start to be accountable for preventing falls

TIMELINE — JANUARY 2012: ECRI STUDY BEGINS 1ST QTR 2012

2ND QTR 2012

3RD QTR 2012

4TH QTR 2012

n

n n

n

n

n n n n

Literature review associated with toolkit provided by ECRI Monthly meeting via telephone conference Attend ECRI meeting in Maryland Select tools and start trial on 3E Start trial of new tools on 3 East

n n n n

3 weeks and no falls!

Meet with ECRI representative to discuss tools already being trialed Start trial of Fall Care Plan Start weekly brainstorming meetings weekly Start trial of Morse and Stratify Fall Assessment Completed first rounding safety audit of unit

n n

Met with sub-committee to discuss what interventions to date had been most effective in fall prevention Complete electronic education for all staff Presented findings to Quality and Safety Board members

Fall Awareness Education (including the Room of Horrors-room with multiple things that could possibly lead to a patient fall)

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2012 Nursing Sensitive Indicators BENCHMARK: National Database for Nursing Quality Educators.

NDNQI is a national nursing measurement program which provides hospitals with organization and with level performance comparison data to state, national, and regional compare groups. This data assists in patient safety and quality improvement efforts.

TOTAL ASSAULT RATES

NHPP (NURSING HOURS PER PATIENT DAY)

INJURY ASSAULT RATES

CENTRAL LINE ASSOCIATED BLOODSTREAM INFECTION PER 1000 CENTRAL LINE DAYS PERCENT OF PATIENTS WITH PRESSURE ULCERS

PERCENT OF PATIENTS WITH HOSPITAL ACQUIRED PRESSURE ULCERS

CATHETER ASSOCIATED URINARY TRACT INFECTIONS PER 1000 CATHETER DAYS

VAP/1000 Ventilator Day

VENTILATOR ASSOCIATED PNEUMONIAS PER 1000 VENTILATOR DAYS PERCENT OF PATIENTS WITH RESTRAINTS

Pediatric Intravenous Sites with Infiltrations 12

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2012 = 0

Support Partner Policy Roll-Out Augusta Health recognizes that by working together with all patients and their families, we will be able to achieve our common goals-a health system that provides a rich and rewarding work environment and a safe, high-quality experience for patients and their families.

A support partner is someone of the patient’s choosing who serves as the patient’s advocate. The support partner should be willing to learn how to help their family member or friend during their hospitalization and upon discharge.

The Quality and Performance Improvement Council designed a comprehensive education program for all staff to include: n n n n n n n

Health Stream module Roving in-services Flyers Pamphlets Poster Skills day Developed a “frequently asked question” sheet for distribution to staff

This program is thought to be a win-win situation for the patient and their support partners. The patient and partners are made to feel like part of the healthcare team. The studies/articles reviewed by the QPI council revealed that the nursing staff actually gained time back in their day because he/she was not communicating the same information to a large number of family members and friends regarding the patient’s condition. WIN-WIN for patients, family and staff!

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“Our job as nurses is to cushion the sorrow and celebrate the joy, everyday, while we are ‘just doing our jobs’.”

—Christine Belle

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Position Augusta Health to be the healthcare employer of choice in the region.

NDNQI, National Database for Nursing Quality Indicators includes a survey of RN Satisfaction administered on an annual basis.

In 2012, we began the role of the RN Satisfaction Survey Champions. The main role of the Champion is to educate all RNs on the purpose and importance of survey and to encourage participation during the survey dates. They focus on the importance of this survey for nursing, how it is different from the employee survey, reinforce the anonymity of the survey, and to share the timeline for action planning post survey. Through this communication staff have a sense of how the information will be utilized in a timely manner, and can share ideas of how to encourage staff participation for improvement.

Response Rates were communicated on a regular basis. Results—Increased Participation!

As soon as the scores were available, the managers and unit council leadership reviewed the results and together the unit councils and RNs designed action plans for their areas based on the results. These plans are driven by the RNs on the unit.

NUMBER OF RESPONSES

EXAMPLE: RN SATISFACTION SURVEY 2012 ACTION PLAN UNIT: EMERGENCY DEPT ISSUE/AREA TO ADDRESS: Nurse Participation in Hospital Affairs FOCUS AREA: Nursing Participation GOAL Provide a monthly newsletter 100% of the year to increase staff awareness.

Each RN will fill out a satisfaction survey at each quarterly meeting regarding the new process on conveying information.

TIMELINE Monthly newsletter will begin January 1st 2013, and be dispensed monthly for 1 calendar year. The monthly newsletter will be the responsibility of the ED Unit Council Chair, who will collaborate with each task force chair, and ED Management.

DESCRIBE PLAN Member of ED Unit Council will speak at each quarterly meeting, and staff will have opportunity to fill out satisfaction survey with new process. Action plan will be reviewed prior to the next Unit Council meeting, and addendums will be made as necessary.

WHO WAS INVOLVED IN FORMULATING THE PLAN Denise Paserba RN, Donna Fenske RN, Donna Hurst, RN, Jeri Pugh RN, Laura Dunning RN, and Todd Dickerson RN HOW INFORMATION IS COMMUNICATED TO ALL RNS Information will be conveyed through monthly newsletter, and be reviewed at each quarterly meeting.

NATIONAL 50TH PERCENTILE

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Nursing Participation in Hospital Affairs

2.90

2.77

Nursing Foundations For Quality of Care

3.11

3.03

Nurse Manager, Ability, Leadership, and Support of Nurses

3.03

2.98

Staffing and Resource Adequacy

2.80

2.48

Collegial Nurse-Physician Relations

3.10

3.10

Mean Practice Environment Scale

2.98

2.87

DATA COLLECTION AND FINDINGS Data will be collected by RN Survey Champions, and reviewed after each survey. The data will be reviewed by ED Unit Council Chair, and presented to Council following quarterly meetings.

PRIMARY CONTACT: Laura Dunning RN, ED Unit Council Chair NURSING DIVISION ANNUAL REPORT

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HIGHLIGHTS OF

A C T I V I T I E S

NURSES WEEK: M AY 7 - 1 2

• • • • • • • • •

“I just wanted to send you a memo to let you know how nice Nurse’s week was for us. I could tell a lot of thought went into the week. Thank you for making it a great time for the Nurse’s as well as support staff!”

“Nurses week was great!! I especially enjoyed the Relaxation Day on Thursday, I didn’t want to leave! I know a lot of time and energy went into the planning and delivery of it. It would be wonderful if we could offer something like that periodically, maybe a mini relaxation day quarterly. Thanks to all who helped with making the week a big success.”

“I just wanted to say how much I truly enjoyed the wonderful relaxation room that was created for us to enjoy. It was fabulous and absolutely the perfect way to help celebrate nurses week.

I could feel the stress leaving when I walked into the room. I would love to see a simpilier version placed somewhere in the hospital so that we could experience that wonderful feeling whenever we needed it. Thanks again to all who helped make it possible.”

• • • •

15 Minute Chair Massages Pancake Breakfast Ice Cream Social Night Shift Ice Cream Delivery Raffle Drawings Learn to Share Your Story My “WOW Moment” Come One, Come All… It’s a “Poppin’ Good Time for ALL Clinicians!

Recognition time for all nurses on our Clinical Ladder Mindfulness and General Stress Management Sessions Relaxation and Meditation Room Chance Auction Lunch and Learn—Back to School to Get Your BSN or MSN? Nurses Ball for ALL

“The relaxation day today (Thurs) was wonderful !!! I didn’t want to leave but had to go back to work. I know there was a lot of preparation and THANK YOU to those responsible. Again, thank you.”

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About The DAISY Foundation The DAISY Foundation was established in 1999 by the family of J. Patrick Barnes who died of complications of the auto-immune disease Idiopathic Thrombocytopenia Purpura (ITP) at the age of 33. (DAISY is an acronym for Diseases Attacking the Auto-Immune System.) During Pat’s 8 week hospitalization, his family was awestruck by the care and compassion his nurses provided not only to Pat but to everyone in his family. So one of the goals they set in creating a Foundation in Pat’s memory was to recognize extraordinary registered nurses everywhere who make an enormous difference in the lives of so many people by the superhuman work they do everyday. above: John Arneson and Carolyn McCartney

2012 The Daisy Award for Extrordinary Nurses FEBRUARY Brittany Lovell, ED Nominee: Molly Hileman, ICU Nominee: Catherine Deane, ICU MARCH Pamela Mathews, Hospice APRIL Emily Clements, Surgical MAY Nominee: Emily Clements, Surgical JUNE Sabine Dukes, PCU JULY Amy Meyerhoeffer, PCU Nominee: Ashley Holsinger, ICU AUGUST Sarah Parker, PCU Nominee: Meg Shrader, Oncology SEPTEMBER Vickie Hottel, OB OCTOBER Carolyn McCartney, PCU NOVEMBER Nominee: Mariya Akopov, PCU DECEMBER Diane DeCourcy, Infusion Center

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WHAT IS THE DAISY AWARD? The DAISY Award is an international program that rewards and celebrates the extraordinary clinical skill and compassionate care given by registered nurses everyday. Augusta Health is proud to be a DAISY Award Partner, recognizing one of our registered nurses with this special honor each month. Each month, the Daisy Council reviews all forms submitted by patients, families and peers. A winner is selected for recognition. A “nominee” may also be named if more than one meets the criteria.

In November we shared our Daisy recognition at the Nursing Excellence Summit. Jon Arneson was present as we read his nomination form.

As a registered nurse employed by Augusta Health in Fishersville, Virginia, Carolyn McCartney demonstrates and fulfills everything I feel would qualify her for the Daisy Award.

Beginning September 18th of this year, I spent six days in the area of her care at Augusta Health.

During my stay Carolyn was, quite regularly, the nurse on duty.

Though I will say all the nurses caring for me did excellent work, Carolyn stands out as the one whom I would be honored to nominate for the Daisy award for the following reasons: she was constantly pleasant, responsive and attentive to my needs, while, at the same time, demonstrating a high degree of competency and efficiency in her nursing skills. Carolyn is genuine in her nature, strongly compassionate and possesses the outstanding ability to make one feel as much like a person as a patient, readily and naturally retaining and sharing details about things that are meaningful to her patients. Her warm and personable demeanor and at the same time high degree of medical professionalism with her patients, their visiting family and friends and her coworkers, make her the perfect candidate for the Daisy Award. I am most grateful for Carolyn’s exemplary care during my five days of hospitalization at Augusta Health and hereby nominate her for this award. Should Carolyn receive the Daisy Award and should an official ceremony be held, my wife and I would be most grateful to be invited, in order that we may congratulate and thank Carolyn personally.

You Make the Difference

2012 WINNERS 3East OB/Peds PCU ICU CPD Endo SNF Rehab OR Hospice Home Health OPS/PACU

Carolyn Winston Amanda Hashagen, RN Brenda Bennett, LPN Kasey Hoard, RN Jared Murphy Tina Bartley, RN Jinky Knox, LPN Angie Cave, CNA Mary Roudabush, RN Bobbi Coeyman Marcia Helmick Sue Jones, RN

You Make the Difference “You Make the Difference” winners personify Augusta Health’s remarkable patient experience by going above and beyond for patients & families they care for each day. The winning staff member can be: ANY member of the patient care nursing division staff and should: n Demonstrate awareness that “little things” make big difference. n Make a connection by taking “extra” time with patient and/or family. n Pay close attention to emotional & physiological needs of patient and/or family. n Be recognized as a role model for other staff.

A winner is chosen by the unit/department each month. At the end of the year the unit/department votes on their winner of the year from their monthly award recipients. These individuals attend a luncheon in their honor.

“It is not how much you do but how much love you put in the doing.”

—Mother Theresa

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In order to provide the best care to patients, nurses must have the appropriate supplies and equipment. In this time of healthcare reform, it is also imperative that nurses act as good stewards of resources.

OR Custom Procedure Trays The OR conducted a review of their custom procedure trays to: n remove items that were frequently discarded from the opened pack thus reducing waste streamline handling and reducing cost n replace items with lower cost generic alternatives when clinically indicated n remove convenience packaging where indicated n discontinue the use of a custom tray if a standard pack was available from the manufacturer n met with vendor’s clinical support team to assure that changes would be consistent with best practice recommendations. n consulted with surgeons to approve changes that may impact surgical case presentation or progression This review encompassed many surgical specialties and reduced overall annual OR supply expense by $100,026.

SCD Pumps The inpatient nursing units experience gaps in order fulfillment for DVT prevention therapy through SCD sleeve use due to limited pump availability and patient noncompliance due to discomfort with the sleeve. A multidisciplinary team led by the Patient Care Value Analysis Team (VAT) team in collaboration with the OR and Clinical Engineering Directors reviewed options to correct this deficiency.

This review included: n Contract terms and GPO landscape n Device compatibility with existing inventory n Training needs of the staff n Therapy effectiveness and patient comfort n Cost neutrality A lease agreement was awarded to the incumbent vendor resulting in: n Upgrading the existing pumps and adding to the overall number of pumps available. n Increased patient compliance with sleeve use due to more comfortable material in the sleeve construct. n Sleeve/tubing interchangeability between pump models (on-hand inventory of sleeves were compatible with the new pumps). n Phased implementation of the device and sleeve. The pumps were delivered on demand due to the urgent need for additional pumps. Sleeve upgrade will occur when adequate inventory planning is complete. Phase 2 sleeve implementation will include additional training and retraining for the new pumps to evaluate effectiveness of the upgrade. n Decrease in sleeve expense of no less than $10,300 per year. It is presumed that actual savings will be higher as the ability to meet demand will increase sleeve use, thus improving patient outcomes.

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“If you want others to be happy, practice compassion.

If you want to be happy, practice compassion.”

— Dalai Lama

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Our nurses continue to grow professionally through continuing education, specialty certifications, clinical ladder, and the use of evidence based practice and nursing research.

Augusta Health celebrates Certified Nurses Day by honoring their Board Certified Nurses Augusta Health celebrated Certified Nurses Day by honoring its’ board certified nurses at a reception on the café patio on Monday, March 19, 2012. Board Certification of nurses plays an increasingly important role in the assurance of high standards of care for patients and their loved ones. Nursing, like health care in general has become increasingly complex. While a registered nurse (RN) license provides entry to general nursing practice, the knowledgeintensive requirements of modern nursing require extensive education, as well as a strong personal commitment to excellence by the nurse.

The following nurses were recognized for their professionalism, leadership, and commitment to excellence in patient care: Joe Ann Day Sherri Harris Patricia Claffey Amy Hougan Michelle Clark Beatrice Benson Martia Hevener Connie Wimer Sabine Dukes Tueme Balksmith

RN, CNOR RN, CPAN RN, CAPA RN-BC RN, CVN-BC RN, CCDS RN, CFN RN, CFN RN, PCCN RN, PCCN

Brandy Hoell Julie Dickerson Rae Cook Dylan Fix Michelle Sprouse Diane Hall Stephanie Brooks Kiley Bailey Theresa Rase

RN, CCM RN, CCM RN, CCM RNC-OB RNC-OB RNC-OB RNC-OB RNC-OB RNC-OB

Congratulations to our Augusta Health team members who received an advanced degree during 2012: BACHELORS OF SCIENCE IN NURSING Jenny Talley, Eastern Mennonite University Ashley Holsinger, Eastern Mennonite University Tara Crawford, Chamberlain University Paige Hensley, Eastern Mennonite University Gena Johnson, Eastern Mennonite University Amanda Traynham, University of Virginia Angie Shull, Western Governors University Faith Huff, James Madison University Musangilayi Diyoka, James Madison University

MASTER OF SCIENCE IN NURSING Allison Chupp, James Madison University Aimee Karnes, American Sentinel Tracy Sansossio, American Sentinel Linda Freed. Liberty University Roxanne Harris, Eastern Mennonite University Kristin Hanger, James Madison University

MASTERS IN BUSINESS ADMINISTRATION Tammy Irby, Averett University

LPN TO RN Megan Dull, Blue Ridge Community College Holly Stansberry, Eastern Mennonite University Megan Clayton, Liberty University

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above, l to r: Stephanie Belt, Yvonne Eisenberg, and Roxanne Harris

Clinical Ladder The Registered Nurse Clinical Ladder is a career pathway advancement program designed to recognize registered nurses for their contributions to quality patient care as well as their continuously expanding clinical knowledge and professional advancements. The Clinical Ladder provides advancement opportunities for professional registered nurses choosing to focus their careers on clinical practice. Augusta Health recognizes that the work environment is important and it promotes a climate for practice in which nurses focus on the delivery of quality individualized care, an attitude of life long learning and a respect and value of one another.

The Clinical Ladder places primary emphasis on the four designated nursing components at Augusta Health, compassion, knowledge, teamwork, and excellence in the provision of patient care. Augusta Health’s Clinical

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Ladder is a five level system that places nurses’ clinical practice and skill at the core of their professional development and recognition.

Within the 5 levels, there are also 5 distinctions based on Benner’s Model of Novice to Expert (2001) describing five stages of nurse development. In order to advance to the next level, an Expert level of practice must be reached (exception Clinician I).

CLINICIAN III 92 CLINICIAN IV 5 Roxanne Harris (OB) Michelle Sprouse (OB) Martha Kennedy (OR) Yvonne Eisenburg (OR) Stephanie Bolt (OPS)

Nursing Research Accountablility for taking care of patients at the bedside can be shown when they imply evidence based practice and nursing research. In an ever changing healthcare environment, nursing research is becoming essential to provide the optimal care to all patients. Research acts to improve care, reduce cost, and impact efficiencies.

HEMOLYSIS STUDY One example of current nursing research focuses on the reduction of hemolysis obtained in specimens acquired in the Emergency Department by employing the BD Nexiva™ Closed IV Catheter System in conjunction with the BD Vacutainer® Luer-Lok Access Device® blood sampling system.

Augusta Health will use a sampling size of 1500 successful blood sample collections obtained from IV catheters to compare the BD Nexiva™ Closed IV Catheter System in conjunction with the BD Vacutainer® LuerLok Access Device® blood sampling system vs. the BD Insyte™ Autoguard™ IV Catheter using the BD Vacutainer® Luer Slip blood sampling system. This study will be carried out in three distinct phases: A Study Pilot with 750 catheters, Phase 1 with blood samples collected from the BD Insyte™ Autoguard™ IV Catheter, Phase 2 with 500 blood samples collected from the BD Nexiva™ Closed IV Catheter, and Phase 3 will consist of 250 BD Nexiva™ Closed IV Catheter System in conjunction with the BD Vacutainer® Luer-Lok Access Device® blood sampling system and another 250 BD Insyte™ Autoguard™ IV Catheter using the BD Vacutainer® Luer Slip blood sampling system. We will start Phase 3 in January 2013.

Timeline of BD Study: Arrival to Augusta Health ED May 2011-May 2013 If the study indicates that there is a reduction in hemolysis; there will be a significant positive impact to patient satisfaction. Lower hemolysis translates to lower instances of performing a second phlebotomy procedure; less patient discomfort and less wait time for testing turn around time. There is also an effect on ED throughput time as staff would not have to repeat the test, thus taking time and effort away from other needed care and tasks. There is a positive financial impact as less labor and equipment is needed to run repeated tests. This is a perfect demonstration on how innovation from staff involved in the patient’s care can impact Augusta Health on many different levels.

First Annual Education Symposium The Education Council planned a day filled with an opportunity to learn about healthcare reform from experts in the field, share in nursing excellence in our poster presentation room, and have time to network with peers.

Approximately 90 nurses participated in this 1st Annual Event featuring Augusta Health's own CEO, Mary Mannix, CNO, Bob McWhirt, and VP of Operations, Lisa Cline. Six concurrent sessions rounded out the days including experts from our own nursing and medical staff as well as Wes Russell, Jr, Deputy Attorney General with the Civil Litigation Division and Michael Longacre, Senior Level Reimbursement and Managed Care Representative.

Participants were also treated to a light breakfast, catered lunch, free tickets to a chance auction with over 20 exciting items, and 8 hours of PAID education time. The poster presentation room featured 25 posters from staff showcasing nursing research, evidence based practice and quality improvement initiatives from their own units/departments. Feedback was extremely positive and planning for the 2nd Annual event began immediately!

Home Health and Hospice Computer Conversion In order to complete the organizational goal to have access to a complete electronic medical record care across the continuum of care, our Meditech Home Health and Hospice system needed to be upgraded to the Maestro Software. The new software is one data platform, task oriented (like PCS), provides medication information across the continuum of care, integrates with our telehealth system, provides access to scheduling in the field, records can be scanned into the system, thus making a complete electronic record. n Complete electronic medical record. Access and ease of flow across the continuum of care for all healthcare providers n Electronic signatures. n Medication list sharing across the continuum of care. n Upgrade needed to stay consistent with Meditech upgrades. n Better reporting due to task being created by system for things to do. n Ease of flow billing, easier and faster documentation due to protocols. n Better reports for faster management decisions and quality outcomes.

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Nurse Innovator Award Presentation Often the words creativity and innovation are used interchangeably. While creativity implies coming up with ideas, it’s the bringing these ideas to life that defines innovation.

Innovation can be defined as the act or process of inventing or introducing something new or simply a different way of doing something or making changes in something already established. Innovative organizations are those that know how to make good use of creative minds to achieve its’ goals in a more efficient and effective way. Innovation requires hardwork and dedication and it is equally as important to recognize these efforts.

We presented our first Augusta Health Nurse Innovator Awards to celebrate 3 RNs who have shared innovation in their respective fields.

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INNOVATOR IN CLINICIAL EXCELLENCE:

PAMELA MATHEWS Because of Pam Mathew’s passion for hospice and the care of children, Hospice of the Shenandoah now serves the pediatric population. Pam is an incredible nurse for all patients but it is through her work with the pediatric patients that one can easily witness Pam’s clinical excellence. Pam attended a national hospice conference in California last year that focused on concurrent care in pediatrics and this year on her own, Pam elected to go to another national hospice conference in Florida with a pediatric focus. Pam works closely with the palliative care nurse practioner at UVA to learn about the techinal care of our pediatric patients plus she received special training on administering enzyme infusions so that they could be done in the home setting. Pam has embraced the pediatric program and shown great vision. She is working constantly on ideas to help this program grow— she researches the diseases of our patients, provides educational materials to the staff, looks for ways to make holidays and birthdays special for our patients, supported one of our patient’s family’s blood drives in honor of their child, facilitated an inservice on concurrent care from the nurse practioner at UVA for our staff, and takes time to express her own emotions and listen to other’s emotions. Not only does Pam manage highly technical needs of children, but she makes sure other team members are also trained and have the information they need to provide good care in her absence or on call. Through Pam our entire team has embraced the program even if they are not directly involved in the care of pediatric hospice patients. Pam understands the medical aspects of an illness, but more importantly, she understands the impact of a devestating life threatening diagnosis for a family of a child. Pam’s vision of what hospice can be is only outdone by her vision of what a family needs to manage the terminal care and anticipated loss of the most precious asset in their lives-their child.

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INNOVATOR IN NURSING LEADERSHIP:

CINDY KELLY Cindy (trailblazing Chamelon) has worked in the Augusta Health Cardiac Catheterization Laboratory since it’s inception in the Fall of 2009, currently serving in a charge nurse capacity. She is a pioneer for Augusta Health in advocating and accomplishing cross training of RNs as Scrub Assistants. In March of 2012, one of our Technologists sustained an injury requiring inability from wearing lead for seven months. This posed a problem for covering evening and weekend STEMI call. Hospital policy requires a qualified X-ray Technologist be present. It was too much to expect our other two Technologists to cover this much call and work during the day for seven months. Our cath staff already were taking more call than most labs. One of the Techs, part-time, had already agreed to cover full-time during the day. Our search for a part-time, temporary Tech, was unsucessful. Cindy offered her unique skills as a capable scrub assistant for on-call duty. Her innovative thinking and willingness opened the door for discussion between Cardiovascular Director Mark Masonheimer and Radiology Director Rader Dodd. A creative compromise was negotiated by the Directors for an on-duty X-ray Tech to cover the radiological oversite of the after hours cath procedures while the Cath Lab Cross Trained RNs scrub assisted. Cindy cheerfully covered 13-15 days of call with every other weekend, while still maintaining her day work schedule and other leadership duties.

Cindy’s genuine desire to learn and serve her patients is fueled by her can-do attitude and clever adaptivity. This single innovation allowed the hospital to safely and cost-effectively cover STEMI call during this time, preventing the need for costly travel Tech coverage. Cross training improves cath staff knowledge, satisfaction, case coverage and safety.

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INNOVATOR IN NURSING RESEARCH:

LAURA DUNNING Laura recognized a high hemolysis rate as well as chances for blood exposure with the method ED collects blood with INT draws. Thus with her research and partnership with BD, Laura started a research trial in our ED that involved a new closed INT system. She began by obtaining formal approval and forming a working task force. She identified a pilot study group and has educated staff in the ED and throughout the hospital. The trial is currently ongoing, in the second stage. If the study indicates that there is a reduction in hemolysis; there will be a significant positive impact to patient satisfaction. Lower hemolysis translates to lower instances of performing a second phlebotomy procedure; less patient discomfort and less wait time for testing turn around time. There is also an effect on ED throughput time as staff would not have to repeat the test, thus taking time and effort away from other needed care and tasks. There is a positive financial impact as less labor and equipment is needed to run repeated tests. This is a perfect demonstration on how innovation from staff involved in the patient’s care can impact Augusta Health on many different levels.

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Innovations in Education Covidien Surgical Innovation Tour Van spent the day on May 23 at Augusta Health!! The van is a hands-on lab that travels the country providing medical professionals with the opportunity to use simulated trainers to gain hands-on experience with incision instrumentation and closure methods. It focuses on SILS (single incision laparoscopic surgery) procedures. Staff had the opportunity to “experience” instruments used with minimally invasive surgical techniques such as single-incision laparoscopic surgery. It stops at about 80 hospitals each year; with four stops in Virginia during 2012.

Magnet Gap Analysis On Tuesday, October 23-Thursday, October 25 Augusta Health hosted Terry Anderson, EdD, MSN, RNC-OB, NE-BC from the American Nurses Credentialing Center (ANCC) to conduct a Magnet Gap Analysis or on-site readiness assessment.

Based on the 5 Magnet Components (shown here), Terry, with the help of many nursing groups examined where our organization is compared to the program’s required elements to measure its’ current state. Results of the gap analysis help us identify our strengths and weaknesses, identify needed resources, and develop a realistic timeframe in which to transform opportunities into excellence before application and document submission.

Terry acknowledged our strong, shared governance foundation and passion for such high level of nursing care and quality nursing outcomes. Under the guidance of Magnet Program Director, Patra Reed, we will continue to engage and empower nurses in professional and personal development as they effect change and decisions that impact care provided at the hospital.

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Most Important: Magnet is about providing the best care to the patients at all times with engaged and involved nurses! This is not about an award or recognitation…this is about what is best for our patients and what is best for our profession of nursing!

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2012 Attendance at National Conferences NURSING QUALITY CONFERENCE ANA – NDNQI January 25-27, Las Vega, Nevada Pat Benson, BSN, RN-BC JOINT COMMISSION RESOURCES-CONTINUOUS SERVICE READINESS PROGRAM SCHA & JCR CSR EDUCATIONAL WORKSHOP March 28-29, Asheville, North Carolina Pat Benson, BSN, RN-BC Aimee Karnes, MSN, RN Ruth Jones, RN SYMPOSIUM ON ADVANCED WOUND CARE April17-21, Atlanta, Georgia Dianne Moody BSN, RN, CWON AACN’S ANNUAL NATIONAL TEACHING INTITUTE (NTI) May 21-24, Orlando, Florida Linda Kite Carline Powell NATIONAL WOUND OSTOMY AND CONTINENCE SOCIETY’S ANNUAL CONFERENCE June 11-15, Charlotte, North Carolina Dianne Moody BSN, RN, CWON AMERICAN NURSES CREDENTIALING CENTER NATIONAL MAGNET CONFERENCE, “REACHING FOR THE STARS” October 9-12, Los Angeles, California Kira Griffin BSN, RN Yvonne Eisenberg BSN, CNOR, CRNFA, CFA Michele Davis BSN, RN, BC Patra Reed MSN, RN, CNML

INTERNATIONAL ATMO November 1- 4, West Virginia University Martinsburg, West Virginia Tammy Patterson, RN Dianne Moody, BSN, RN, CWON 2012 PRESS GANEY NATIONAL CLIENT CONFERENCE, “TRANSFORMING THE PATIENT EXPERIENCE” November 12-14, National Harbor, Maryland Kim Nelson BSN, RN Isaac Izzillo BSN, RN SOCIETY OF CARDIOVASCULAR PATIENT CARE CHEST PAIN CENTER ACCREDITATION WORKSHOP, CYCLE IV November 13-14, CSPC Headquarters, Dublin, Ohio Pat Benson, BSN, RN-BC

2012 Presentations THOMSON REUTERS 2012 HEALTHCARE ADVANTAGE CONFERENCE “MAKING THE LEAP: RETROSPECTIVE TO CONCURRENT CARE MEASURES” May 8, Orlando, Florida Ruth Jones, RN Suzanne Hicks Hostetter, BSN, RN, CPHQ JOINT COMMISSION RESOURCES CONTINUOUS SERVICE READINESS PROGRAM FOR THE CAROLINAS “THE SUPPORT PERSON – A BEST PRACTICE” November 7-8, Columbia, South Carolina Donna Hurst, RN, BSN, CEN Sandy Trujillo, RN, BSN

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“When I think about all the patients and their loved ones that I have worked with over the years, I know most of them don’t remember me nor I them. But I do know that I gave a little piece of myself to each of them and they to me, and those threads make up the beautiful tapestry in my mind that is my career in nursing.”

—Donna Wilk Cardillo, A Daybook for Beginning Nurses

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service quality people financial growth community 2nd Annual Nursing Excellence Summit: Relationship Based Care: Focusing on Patient and Family Centered Care through Compassion, Knowledge, Teamwork, and Excellence On November 15, 2012 Augusta Health nurses showcased exciting things that were happening at their community hospital.

All areas of the hospital displayed how they focus their care on compassion, knowledge, teamwork, and excellence — centering all of this around the patient and family. Augusta Health Human Resources was also available to help answer questions about tuition and certification reimbursement.

OUR 2ND ANNUAL SUMMIT ALSO FEATURED 6 NURSING SCHOOLS: Chamberlain College of Nursing Eastern Mennonite Universtiy Georgetown University James Madison University Liberty University University of Virginia

THE FOLLOWING PROFESSIONAL ORGANIZATIONS/CERTIFICATIONS WERE SHOWCASED DURING THE EVENT Academy of Medical-Surgical Nurses (AMSN) American Association of Critical Care Nurses (AACCN) American Association Diabetes Educators (AADE) American Nurses Credentialing Center (ANCC) American Psychiatric Nurses Association (APNA) American Society of PeriAnesthesia Nurses (ASPAN) Association of Women’s Health, Obstetric and Neonatal Nurses (AWHON) Certified Emergency Nurse (CEN) Emergency Nurses Association (ENA) Oncology Nursing Society (ONS) Sexual Assault Nurse Examiners (SANE) Sigma Theta Tau (STT)

March for Babies On Saturday, April 28, 2012 Team Augusta Health OB participated in the March for Babies, supporting the March of Dimes. With a great turnout, the team raised money to help fund research and programs for preterm babies and programs to help mothers have healthy, full-term pregnancies. The team started with a goal of $1500, but well surpassed their own goal by raising over $4400! In addition to surpassing their goal, they walked away with 3 awards from the event.

• #1 New Team • #1 Fundraiser • T-Shirt Design Contest It was an awesome morning for all involved. Great job, Team Augusta Health OB—you make us very proud!!

Team PCU hosts The Nurses Ball for All on Saturday, May 12 to wrap up Nurses Week with all proceeds going to Relay for Life. The PCU has raised a little over $3,100 in profits for the American Cancer Society/Relay for Life.

TOTAL NURSING COMMUNITY HOURS

5463

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“I’m not telling you its going to be easy. I’m telling you it’s going to be worth it.”

— Art Williams

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Augusta Health 78 Medical Center Drive Fishersville, VA 22939 Phone (540) 332-4000 Staunton Phone (540) 932-4000 Waynesboro Toll Free 1-800-932-0262 www.augustahealth.com