TABLEof CONTENTS
Message from the CEO Message from the CNO Regional West Health Services Mission, Vision, and Values STAR Nursing Awards for 2011 2011 Star of the Year 50-Year Nursing Staff Members Regional West CNA Wins State Award Nurses Week Celebration Nurses Day Awards Magnet Steering Team & Magnet Journey 2011 Magnet Fair Patient Safety & Accreditation Unit Reports Behavioral Health Unit Acute Rehabilitation Unit Medical Surgical Services Birth & Infant Care Center and Pediatric Unit Restorative Care Unit Perioperative Services Operating Room
4 5 6 8 10 11 12 13 15 19 20 21 22 22 23 24 26 29 30 30
Pre-Admit Testing
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Outpatient Surgery
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Post-Anesthesia Care Unit
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Endoscopy
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Scottsbluff Surgery Center
Quality Resource
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Risk Management Trauma Services Wound/Ostomy Care Report 2011 Shared Governance Council Reports Care and Practice Council
54 55 56 58 58
Evidence Based Practice (EBP) Council
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Nurse/Physician Council
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Quality and Safety Council
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Professional Practice Council
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Education Department Patient Satisfaction Scores 2011 Regional West Medical Center Certified Nurses Breakfast with Shirley Residency Classes American Nurses Association Code of Ethics for Nurses Bill of Rights for Registered Nurses
62 64 65 66 68 69 69 69
Critical Care and Emergency Services 36 Air Link 38 Home Care 40 Imaging Services 42 Cardiac Cath Lab 43 Cardiac and Pulmonary Rehabilitation 45 Case Management 46 Community Health 47 Detention Center 47 Pharmacy Medication Reconcilliation Nurses 49 NURSING ANNUAL REPORT
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MESSAGE from THE CEO
To my patient care colleagues: You are terrific! The year 2011 was marked by big swings in activity, from a brimming full hospital to wondering where the patients went, but through it all, we have managed to reduce our Serious Safety Event Rate by greater than 50 percent from its peak in December 2010. This has required the diligent work of applying the safety tools we all learned in safety training while remaining attentive to every detail. It is appropriate to take a moment to celebrate achievement of this magnitude on our journey to becoming a high-reliability organization. While it is good to pause for a moment of reflection, it is important to remember that the work we do is very complex, with plenty of potential for error that could harm our patients, so we must remain vigilant. During the month of March, we will begin training safety coaches‑one for each unit and each shift, and April will see them in full force. The safety coaches will be available as a resource for staff and will assist with application of the safety tools. This is the next big step on the journey.
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Health care reform remains in the forefront of attention in the United States. The Supreme Court will hear the constitutional challenges to the law this spring, and has promised a ruling by summertime. But even if the Court finds the law unconstitutional, we still will not have solved the basic problem, which is that health care is so expensive that many people simply cannot afford it. This is more a problem of the delivery system than of the financing (insurance) system, and so the challenges will fall to us as providers. While we don’t yet fully understand the implications of the law, we do know that providing care that is of uncompromised safety, quality, and efficiency will be the absolute best thing for our patients and, therefore, for us as well. Thanks for all you do!
Todd Sorensen, MD, MS President and CEO | Regional West Health Services
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MESSAGE from THE CNO
Thanks to your hard work we had a long, productive year with many accomplishments. We are now a safer, higher quality, more efficient organization. This is reflected in the dramatic decrease in serious safety events, improvemed quality measures, and progress in our bottom line. Thank you. At the heart of what makes a caregiver get out of bed and go to work is the patients we serve. If we take the “I� out of what we do and keep our focus always on better patient care, we will continue to strive to greater accomplishments. What better reward would there be than to have no serious safety events, to lead the nation in quality outcomes, and to earn top scores in patient satisfaction? We have the talent to set the standards, not just to meet them. Teamwork is the key ingredient in the recipe that will take us from good to great. If we support each other and use every opportunity to speak highly of others, assuming good intentions, we will see a dramatic improvement in teamwork. Talent and teamwork can take us to the places we want to go. Sincerely,
Shirley Shirley Knodel, RN, MS Chief Nursing Officer and VP of Patient Care
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Mission Regional West Health Services is dedicated to supporting safe, comprehensive, and innovative health care services for the people and communities in our region.
Vision Regional West Health Services will be the first choice for innovative health care solutions, providing value to our patients, physicians, and employees through safety, quality, and service that set us apart.
Nursing Mission Nurses at Regional West Medical Center provide individualized patient care in a culture of trust and respect for all.
Nursing Vision Nurses at Regional West Medical Center provide quality patient care through evidence based practice and research. This will be the foundation that inspires nursing professional growth and attainment of Magnet Recognition.
Values Respect for all persons Genuine, empathetic care Integrity in relationships Competency
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Tracy Meyer and Michelle Powell at the National Magnet Conference in Baltimore, MD.
2011 STAR Awards presented to nurses 8
Cody McLellen
Surgery Aide | Surgery
Cody’s nomination: “Cody was given a new position among the OR aides as the designated Neuro Aide. His co-workers and supervisor were very pleased with how Cody fully embraced the new role by learning everything there is to know about setting up for Neuro cases, including pulling the case, setting up the room, and assisting the nurses as well as getting the patient's bed ready and cleaning the rooms. Cody has learned and been trained to open sterile supplies to help decrease turnover times. He stays for long hours to help make sure that Neuro cases continue to run smoothly long after he has put in his regular hours for the day. Cody has not only embraced this new role, but he has continued to perform his regular duties of being a center core aide. Cody shows amazing amounts of teamwork by supporting his co-workers in the center core and instrument room, as well as all the nurses and the physicians. No matter what time of day it is or how many hours Cody has put in he always has a very positive attitude and continues to have a smile on his face and even cracks a joke when everyone else is down. Cody has definitely shown amazing teamwork which has exceeded not only my expectations but that of all the Neuro services staff.”
Shereen English, BSN, RN Medical/Oncology 3E
Shereen’s nomination: “It can be difficult to meet patients’ expectations, let alone exceed them. Seemingly effortlessly, Shereen English exceeds expectations. Shereen received two nominations in one quarter. One very satisfied patient called Shereen a good caring person, who was always there when needed–even before she would turn on her call light. Shereen made the patient feel comfortable and cared for, always treating her with dignity and respect. “She is good at what she does, her caring manner, her humor, personality and over all quality - she needs to be recognized for not only being an amazing nurse, but for also being an amazing person,” the patient said. “She is truly one in a million.” Because of Shereen, the patient said she felt like she was important, not just one of many patients in the system.
Cindy Mcgaughy, bsn, rn, crrn Acute Rehab Unit 4E
Cindy’s nomination: “How appropriate that a patient would call Cindy an angel and begin her nomination letter saying that she “floated” to the third floor. The patient said she is forever indebted and grateful to the hospital staff but it was Cindy who made the biggest impression. She met Cindy on the day she was dismissed and she believes it is because of Cindy’s attention to consistent effort, monitoring, and teaching that she was able to go home that day, safe and alert. Cindy didn’t hesitate to call the physician when the patient didn’t feel well and stayed close by until she had improved. “Some people show concern because it’s their job but Cindy did her job cause she was very concerned,” the patient said. “What an Angel!”
A nomination from a colleague commended Shereen for keeping her head during a very stressful emergency event, adding that, "she always takes time with her patients, talking and carefully listening to them.”
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Tracy Meyer, BSN, RN, CFRN, NREMT Air Link
Tracy’s nomination: “Another return Star of the Quarter, Tracy Meyer continues to exceed expectations–this time with a patient. The patient’s mother said it best: “When my daughter was in the emergency room, Tracy stopped to say hi to my husband and I. At that point, my daughter started getting sick, and she saw my daughter needed a nurse’s attention; she was very quick to act, talking with the Emergency Department staff. Tracy spoke to my teenage daughter like a human being, instead of just talking with my husband and I. Tracy sat down with us to explain anything that we had questions on and treated the three of us with compassion and care. The next day Tracy went out of her way to check on my daughter, husband, and I. Again she sat down with us. She really went above and beyond. Being a nurse myself, I know compassion, I know caring, and it warms my heart to see that someone in Tracy's position has not forgotten that.”
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Linda Fowler, BSN, RN, CCRN
ICU/PCU/ER
Linda’s nomination: A staff member had this to say: “Linda is someone who has kept our unit together for many years–too many to count. She is someone who has all the answers to any question day or night and can walk you through any procedure if she is not here. She does not have "NO" in her vocabulary when it comes to RWMC's interests, especially in ICU, PCU, and ER. Linda is the strength of the unit, highly respected and trusted. She spends countless hours here and never leaves her staff in a lurch.” A colleague says that Linda has “dedicated many hours to training and being instrumental in creating our culture of safety at RWMC. Thank you.”
Liz Ossian, BSN, RN
Medical/Oncology 3E
Liz’s nomination: “One patient had this to say about Liz: “I have been a patient in this hospital a lot of times in the last eight or nine years and Liz has been my nurse many many times in those years. It is very obvious that Liz cares very much about her patients. When Liz comes into your room she has the smile that lets you know that she is here as a nurse because she loves her job and her patients. Liz is great at what she does and you always feel that she is here because she wants to be not because she has to be. We need a lot more nurses like Liz that "care." Thanks Liz, you are a wonderful nurse and person.” Another patient said: “I was impressed with Liz as she took care of a lady that was in the next bed. The lady had problems following Liz's directions. Liz was so caring and patient with her. It was awesome to watch. Don't overlook this young lady as she showed so much class and heart. You are so lucky to have her and the real winners are the sick patients.”
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2011 STARof THE YEAR John’s nomination: “John received multiple nominations, but all with the same theme. He consistently exceeds expectations of his patients and colleagues. One patient said, “Doctor (sic) John Beard is a good doctor and a good person. He is a doctor that goes the extra mile. He makes it so we don’t hurt as much when we get an IV and is real kind and explains everything so we patients understand.”
John Beard, Bsn, rn
Infusion Center/PICC Team
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A colleague relayed the following about John. “John is such an asset to Regional West because of the wonderful care that he provides to all the patients that he helps with the Infusion Center. John is phenomenal when it comes to helping the Pediatric staff with difficult IVs and is always willing to assist with and help with an IV or PICC procedure. When called on a Sunday morning for an emergency question regarding a 23 day-old on the Pediatric Unit, John talked the
Joanne Krieg | Contract Marketing Specialist & Teresa Clark | Contract Marketing Specialists
nurse through the procedure and answered questions regarding current treatment and the PICC line. John was so calm, polite, and concerned that the nurse got all the information that she needed that he even called back to check that everything went okay and to see if he could further assist. The patient was later transferred to ICU where the staff had difficulty with the current PICC line and was unable to get another peripheral line but needed one for the best plan of care and current treatment. That evening John was called for assistance and immediately came into the ICU. While John was setting up, he mentioned that he was currently on vacation but was so willing to help. I'm always so impressed with John and how his care for patients is well beyond what is expected. John is a role model for how he provides service with detail by providing the best possible care.”
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rEGIONAL WEST RECOGNIZES TWO 50‑YEAR NURSING STAFF MEMBERS Joanne Krieg | Contract Marketing Specialist & Teresa Clark | Contract Marketing Specialists
In 2011, Regional West Health Services recognized two nursing employees as they each marked 50 years of service to the organization Joellen Campbell, RN, and Betty Castaneda, CNA, began their Regional West careers in 1960. “In today’s world, choosing to remain employed at one place for 50 years is a monumental accomplishment,” said Regional West President and CEO Todd Sorensen, MD, MS. “I think I speak for us all when I say a very big thank you to Joellen and Betty for your dedication, support, and commitment to Regional West for the past five decades.” Joellen Campbell, RN
When Joellen Campbell went to work at the old West Nebraska General Hospital in downtown Scottsbluff, the second floor had wards only – no private or semiprivate rooms and only two bathrooms. Nurses wore dresses, white hose, white shoes, and of course, their caps. When they left the building, even in the summertime, they were required to cover up their uniforms with a coat or a cape. The first time Joellen wore pants as a nurse was in 1972. She broke her leg and it was set with a 14-pound cast that extended to the hip. Ten days after surgery, she returned to work in the OB on crutches, and was allowed to wear pants only because of the cast. It wasn’t until 1977 that nurses were finally permitted to wear uniform pants as long as they were white.
Despite the rules, regulations, and demands of her early career, Joellen has always loved being a nurse. Over the past 50 years, she has worked post-surgery, medical, ER, ICU, OB, as a House Supervisor, and taught at the School of Nursing. Today she works in Pre-Admit Testing, a department that she actually helped to develop back in the 80s. Betty Castaneda began her career as a nurse’s aide at St. Mary Hospital. In 1977, she began working on West Nebraska General Hospital’s OB unit with the encouragement of OB nurse Eleanor Barkdoll, RN. She thanks Joe Salazar, RN and Ramona Giles, RN, for convincing her years ago to become a C-section scrub nurse; a position she holds to this day. Betty greatly enjoyed the years when one of her responsibilities was giving newborn babies their first bath. She used the time as a teaching tool for first-time moms and dads. In addition, she taught new parents everything from how to swaddle and burp their babies to the importance of talking to their newborns. In recognition of her hard work and dedication, Betty was recognized as Regional West’s Employee of the Month in November 2005 and was named Employee of the Year in 2006. She was also one of 12 Nebraska health care professionals featured in a 2006 statewide poster campaign promoting diversity in Nebraska’s health care workforce
Betty Castaneda, CNA
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REGIONAL WEST CNA wins STATE AWARD Joanne Krieg | Contract Marketing Specialist, Marketing and Public Relations Dept.
Mary Acosta’s positive, optimistic attitude and attention to customer service have led to statewide recognition as the winner of the Direct Care Staff Award from the Nebraska Health Care Association. Acosta, a Certified Nurse Aide with the Restorative Care Unit at Regional West Medical Center, was presented with the Direct Care Staff Award at the recent Nebraska Health Care Association/Nebraska Assisted Living Association convention in Kearney, Neb.
Mary Acosta
“Mary was great. She would laugh with you or just listen to you. If she had you on her shift, she was right there to help if she could. She is a very good aide, she needs to be recognized.” This comment from one of Mary’s patients which, along with many others, were submitted to the judges with Mary’s nomination.
According to her supervisor, Sarah Shannon, BSN, RN, Director of Regional West RCU, “Mary is a prime example of someone who exhibits exemplary team work. This past year we found ourselves in need of a unit secretary and Mary immediately volunteered to cross train and help out,” said Shannon. Acosta has been actively involved in developing the bowel and bladder program at Regional West Medical Center as it relates to her duties as a Certified Nurse Aide. She is currently working on prerequisites to pursue an Associate’s Degree in nursing.
CNA
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nurses week celebration Nurses Trusted to Care In honor of Nurses Week, a workshop was held at the Gering Civic Center on May 11 with a repeat session on May 12. The speaker was Margo Karsten, BSN, MSN, PhD, RN from Creative Healthcare Management. The workshop was titled The Spirit of Caring: “To Love What You Do, To Know That It Matters, How Can There Be Greater Joy?” Objectives were to: • Identify actions to integrate caring behaviors in your relationships with co-workers and patient/ families. • Understand the unique value each person brings to the hospital, to each other, and to the patients you serve. • Describe the importance of humor and humility into your life.
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• Reflect and recognize the joy that you find in your work. • Create a specific plan on how to maintain your energy and enthusiasm for yourself/ department/team. There were 226 people in attendance; an increase from 2010 when 126 attendees attended the Nurses Week Workshop. Service Excellence Luncheon Nursing Leadership hosted a Service Excellence Luncheon on May 6 in honor of Nurses Week as a way of thanking everyone who works in the hospital for their dedication to quality patient care. Two $50 gift cards were given away in a raffle. A total of $245 was raised from this raffle and donated to the Nursing Scholarship Fund through the Foundation.
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Cindy Francisco, Lactation Educator in the Birth and Infant Care Center.
NURSESAwards DAY
The Nursing Shared Governance Professional Practice Council sponsored Nurses Day Awards for the first time in 2011. The awards honored Registered Nurses, LPNs, and a Friend of Nursing.
Leonard kautz
KATHY MACKRILL, LPN
The Friend of Nursing Award recognizes individuals whose contributions are essential to the work nurses do. It recognizes non-nurses who are, "Friends of Nursing." The nominee must be a current Regional West Medical Center employee who consistently supports nursing to help give our patients superior service. The 2011 award winner is Leonard Kautz, Housekeeping Project Tech. Here are some comments that helped Leonard win this award:
The Outstanding LPN Award recognizes a Licensed Practical Nurse who provides outstanding care to patients and exhibits an attitude of teamwork. The 2011 winner is Kathy Mackrill. Kathy has worked in the Endoscopy Unit for 26 years. Here is the nomination that helped her win the award:
• • • • • • • •
“Kathy exemplifies an exceptional LPN who provides outstanding care to each and every patient she comes into contact with. What I admire about Kathy is how she personalizes her care to her patients, always calling them by name, and demonstrating respect for each person as an individual. Kathy also demonstrates a teamwork approach in the daily care she gives. Kathy is the type of nurse you do not have to ask for help, she has the instinctive nature to know beforehand. I have never worked with such a sincere, knowledgeable, kind, eager, and enthusiastic nurse as Kathy. Kathy is the LPN you want on your shift and working beside you. She is the nurse you can trust to get the job done and have it done right. Kathy demonstrates ethics and professionalism.”
“Leonard takes pride in his job. He is pleasant to work with.” “Leonard is truly an asset to the Restorative Care Unit.” “He anticipates needs before he is asked.” “Tracks equipment. He notices and tags it if repairs are needed.” “Greets everyone with a smile.” “He never has to be asked twice to do something.” “Leonard is very kind, friendly, and helpful. He always says, “Whatever the patients need.” “Leonard is wonderful. He is hard-working, always there when needed, very dependable, and never complains. He is a jewel.”
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The Registered Nurse (RN) Awards honor nurses that exemplify one of the five components of the Magnet Model: Transformational Leadership; Structural Empowerment; Exemplary Professional Practice; New Knowledge, Innovations, and Improvements; and Empirical Outcomes.
REBECCA MONTANEZ, BSN, RN Transformational Leadership: A leader (formal/informal) who conveys a strong sense of advocacy and support on behalf of staff and patients. This is a leader who is visible, accessible, and communicates effectively. The 2011 Transformational Leadership award winner is Rebecca Montanez. At the time of the award, Rebecca was night CRN on the Adult Post-Surgical Unit (2W). She is currently the manager of the Adult Post-Surgical Unit and the Ortho/Neuro Unit (2W & 2E). Here is he rnomination: “Rebecca is always available and willing to help anyone. She is a great advocate for nurses and patients. She listens to their concerns and relays them to the doctor as needed. She is very caring to her patients. She is very attentive to everyone’s needs. She is an excellent RN!”
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Michelle Powell, rn‑c Structural Empowerment: A nurse who is involved in selfgovernance and decision-making structure and processes that establish standards of practice and address issues of concern. A nurse who extends his or her influence to professional and community groups, advancing the nursing profession and supporting organizational goals, and personal and professional growth and development. The 2011, Structural Empowerment Award winner is Michelle Powell. Michelle works as a RN staff nurse in Outpatient Surgery. Here is her nomination: “Michelle fully supports staff seeking to be better at their profession. She puts in hours of independent work, as the chair of the Professional Practice Council, to make the RN Clinical Ladder a fair and equitable tool. She has a passion for nursing and is an influential force on committees. She represents nursing well in the community and takes opportunities to encourage others who are thinking about a career in nursing."
john beard, bsn, rn Exemplary Professional Practice: A nurse who is autonomous and accountable for clinical decision-making and outcomes. This nurse promotes and participates in patient safety, quality monitoring, and quality improvement activities. He or she promotes continuous, consistent, efficient, and accountable delivery of nursing care and works in collaboration with inter-disciplinary partners to achieve high-quality patient outcomes. The 2011 Exemplary Professional Practice winner is John Beard from the Infusion Center. Here is his nomination: “John was the driving force to get the Infusion Center for IV insertions and monitoring started at RWMC. He is always willing to help with difficult IV starts, inserting a PICC line or PICC line changes. He is continually monitoring for new or improved products to enhance the IV therapies at RWMC. He is very collaborative with nurses on the floor, physicians, lab, etc. to ensure patients get what they need for IV access and care.”
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Kim meininger, rn, ONC New Knowledge, Innovations, and Improvements: A nurse who is educated about evidence-based practice and research, enabling him or her to appropriately explore the safest and best practices for patients and practice environment, and to generate new knowledge. The 2011 winner is Kim Meininger, Ortho/Neuro (2E) and Adult Post Surgical (2W) Clinical Coordinator. The following is her nomination: “Kim is the epitome of a nurse who uses and advocates for evidence-based practice (EBP). She has guided committee members to become users and advocates of EBP, enabling them to take this skill and knowledge back to their various units throughout the hospital. She exhibits a positive enthusiasm for the profession of nursing. She demonstrates exemplary nursing skills and strives to educate and mentor new nurses.”
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Tracy meyer, bsn, rn, cfrn, nremt-p Empirical Outcomes: A nurse who serves as a mentor and leads the way in the provision of quality patient care and helps create an environment that contributes to the well-being of the work force and the community-at-large. The 2011 Empirical Outcomes winner is Tracy Meyer, Interim Chief Flight Nurse for Air Link. Her nomination is below: “Tracy has been instrumental in being an advocate for the Air Link Flight Team. She leads the team to continue improving despite any setbacks or new developments in order to provide the highest quality patient care. Her visibility, accessibility, and communication abilities are all intertwined to provide the team with a leader they can trust. She continually strives to improve the process for the betterment of the patients and community she serves.”
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Lori Hovseth, Megan Anderson, Sue Schoeneman, celebrate breast cancer awareness.
Magnet steering team & magnet journey Susan Backer, MSN, APRN‑CNS, ACNS‑BC | Magnet Coordinator
This has been a busy and productive year. Here are the highlights of the work accomplished by the Magnet Steering Team in 2011:
• Stuart Fulks, VP of Marketing and Strategic Planning, was invited to talk to the group about the Strategic Planning Process. Great insight was gained from the information Mr. Fulks brought to the team.
• Set up a folder to post minutes from Shared Governance Divisional Councils and Unit Practice Councils. This has Susan Backer, MSN, made for easy access for anyone who APRN‑CNS, ACNS‑BC wants to read the minutes to obtain information about current work from each council.
• It was identified that by January 1, 2013, 100 percent of our managers and directors must have a Bachelor of Science degree in Nursing (BSN) in order for Regional West to be eligible to apply for Magnet Recognition. Ongoing discussion took place with Nursing Leadership about meeting this measure. Currently just under 75 percent of our managers and directors have their BSN degree. The decision was made to give an appropriate amount of time for these key managers and directors to obtain their BSN. The goal was set that all managers and directors must have their BSN degree by December 31, 2017. That gives everyone five years to meet this goal.
• Membership to the Magnet Steering Team was reviewed. It was found that many units did not have representation and a membership sub-committee was formed to address this challenge. Janice Casey, Janet Lewis, Tina Delgado, and Mary Lockwood worked hard to get representation from all the nursing units. Several members were added to the team as a result of their work. • The Marketing Department, with input from the Magnet Steering Team, developed a poster of our Magnet Journey. The poster was titled “Around the World in 92 Steps.” The 92 steps reflect the number of sources of evidence we must describe and demonstrate when we apply for Magnet Status. Kaitlynn Sova, Graphic Designer from the Marketing Department, did a beautiful job creating the poster.
• A gap analysis was performed by the Magnet Steering Team. It was determined that we still need to implement our professional practice model, Relationship-Based Care, plus our outcomes need to improve. The 2017 goal to meet the educational requirements gives plenty of time to improve our outcomes, implement Relationship-Based Care, and allow maturation of programs we have in place to meet Magnet criteria.
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2011
magnet fair
Follow the Yellow Brick Road The Magnet Fair was held on October 31. Some 218 people followed the Yellow Brick Road to sign up for prizes and view the 14 posters that were on display. • “Keep your feet on the ground: Don’t fall” by the Susan O’Brien, Falls Team. • "Patient Access Intake Specialists: a poster describing their work flow process" by Micki Anderson. • “IV Insertion Protocol” by UNMC Accelerated Students, Dana Sampson, instructor. • Cardiac Rehab – "Application process and criteria for national certification by the American Association of Cardiovascular and Pulmonary Rehabilitation" by Lynn Macken. • Post Anesthesia Care Unit – "Focusing on the unit’s RNs and the excellent care they provide" by Tracy Payne.
• “Prevention of Catheter Associated Urinary Tract Infections,” by the Care and Practice Shared Governance Council. • "Outpatient Surgery Unit Practice Council" by Shon Peterson OPS. • “Safe use of Coban,” by Barb Lundgren and Austin Engel. • “Observations of RN Medication Interruptions in a General Medical-Surgical Rural Hospital,” by Principle Investigator Trina Aguirre with UNMC first semester students. • “Clinical Rescue Team” describes the new Float Pool Unit by Professional Practice Shared Governance Council. • “Champion for Safety” – Information about the Safety Culture Initiative. • “Preventing Unplanned Hospital Care,” by Home Care.
• “Breast Beginnings” by Cindy Francisco and Stacy Ingersoll.
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NURSING ANNUAL REPORT
Patient Safety & Accreditation Avis Rogers, MSN, RN, CSHA | Patient Safety and Accreditation Officer
Avis Rogers, MSN, RN, CSHA
This was the year the Annual Quality and Safety Fair made the local news. We were all able to see our posters on live television and share why patient safety is a core measure at Regional West. Safety Behavior training for all providers, leadership, and staff was a giant step forward for patient safety this year! The new behaviors we learned will help prevent us from making errors.
• Patient Identification project
The Culture of Safety survey was taken by frontline staff for the fifth time. Results emphasize the fact that safety issues impact everyone. Our ongoing patient safety goals are to raise awareness and encourage the engagement of patients, families, staff, providers, and the public, to participate in safe health care. Patient and family engagement is critical to ensuring safe care. The end of 2011 brings new opportunities for 2012, but first let’s review a few of our 2011 accomplishments.
• Safety Rounds
• Third annual Quality and Safety Fair • Resource Fair for Culture Awareness/Special Needs • Commission on Accreditation of Rehabilitation Facilities (CARF) survey, Acute Rehab Unit • Magnet Fair participation • Health Safety/Unnatural Causes • Achieving Continuous Excellence (ACE) mock surveys • Culture of Safety survey
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• Language Line and Hearing Impaired Education • Environmental tours • Construction risk assessments • Hazards Vulnerability Analysis (HVA) • Continued our journey to Zero Events of Harm • Increased incident reporting • Decreased our Serious Safety Event Rate • Center for Medicare and Medicaid Services (CMS) surveys, Restorative Care Unit (RCU) • Plan of Care tracers • 2011 National Patient Safety Goals (NPSGS) • Yearly report to The Joint Commission Remember, the more we work together to promote patient safety, the more we all benefit. How do we change our attitudes and behaviors in health care to do no harm to our patients? We support a culture of safety and practice our safety behaviors until they become habits. We will continue on our path to create a culture of safety to ensure safer patient care in 2012.
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DEPARTMENT REPORTS > BEHAVIORAL HEALTH UNIT
bEHAVIORAL hEALTH uNIT Mary Armstrong, RN | Director
Mary Armstrong, RN
Safety has always been a primary concern on the Behavioral Health Unit and with the hospital-wide safety initiative in 2011 we learned that we could do much better with the right tools. In the past year, leadership and staff throughout the organization were educated in safety behaviors and the safety toolkits. The training was great but I think the greatest lesson learned is that there is a big difference between knowing what we should be doing and doing what we should be doing. Our challenge this year has been exploring ways to embrace the safety initiative while incorporating the tools into the work we do everyday. The Behavioral Health Unit leadership and staff now have a daily safety discussion, focusing on safety concerns from a staff, patient, and environmental level. Items discussed at the dayshift meeting are recorded with dailies for the nightshift. Nightshift is encouraged to add comments or new suggestions. The sheets are kept on a clipboard within easy reach of all staff for an extended period of time so everyone has a chance to read and comment. We revisit previous discussions to see how we are doing with follow through and compliance. It is amazing the things that surface when you discuss safety every single day. These discussions have led to procedural changes as well as environmental changes • We are in the process of implementing a new visitor log and visitation guidelines to more effectively monitor the potential for contraband to be brought to the unit. • We are redefining and clarifying staff roles in emergency situations to eliminate confusion and chaos. • We have been researching new and more valid tools for suicide assessment as well as procedures for prevention. We are also looking at implementation of the Columbia University Suicide Severity Rating Scale as an adjunct to the tool already in place
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on the Behavioral Health Unit. This tool has specific rating scales for different populations including adults, adolescents, and military personnel or veterans. As a team we are looking forward to learning more about Cause Analysis in 2012 and its utilization to look at events retrospectively, turning potential and real errors into learning opportunities and action items that will make the unit an even safer place for staff and patients. In 2011, the Behavioral Health Unit reestablished a Unit Practice Counsel to work on improving patient care. The team’s first mission was to improve medication safety on the unit. New processes have been put in place to decrease missed doctors’ orders and delays in order entry which result in missed medication doses and other related medication errors. The unit took on two RN interns in 2011, and one stayed as a staff member on the unit. We currently have two transition students starting, one of whom is also a staff member. Students are the future of nursing and we are pleased to have them on the unit and delighted when they choose Behavioral Health as a place to start their career. In the fall, Behavioral Health received a surprise survey from CMS. We were pleased to have no deficiencies! This is a tribute to the great job the staff does in caring for our patients. Although health care in general is looking at more changes in 2012, we look forward to the year with optimism. As long as we have patients who need us and the support of the organization, we can do what we do best and that is putting patients first and continuing on the journey to safe, high quality, efficient care.
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DEPARTMENT REPORTS > BEHAVIORAL HEALTH UNIT
Acute rehabilitation unit Tami Bokelman, MSW | Program Director & Pam Cover, RN, CRRN | Nurse Manager
Tami Bokelman, MSW
Pam Cover, RN, CRRN
The Acute Rehabilitation Unit at Regional West Medical Center underwent many changes in 2011.
screening process, and in consultation with the rehab physician, is able to complete the ARU screen with a quick turnaround time.
Margaret Coon, MD, Physical Medicine and Rehabilitation, joined the Acute Rehabilitation Unit (ARU) as Medical Director in March 2011. She has been a great addition to the unit, and staff and patients are glad she is here.
Bobbi Turner, LPN, has taken on the position of our PPS Coordinator. She is responsible for in-depth medical record review and the completion and transmission of the Inpatient Rehabilitation Facility Patient Assessment Instrument (IRF-PAI), which drives reimbursement for the ARU. She is also cross-trained to help with the pre-admission screening process.
Pam Cover, RN, CRRN, accepted the position of Unit Manager after seven years of caring for our patients on the unit. She is a Certified Rehabilitation Registered Nurse and brings a wealth of knowledge to her current position. She is responsible for decision making in relation to clinical issues, functions as a professional role model, and serves as a clinical resource in the development of our nursing staff. Pam is truly an asset to the program. Bob Frost, RN, CRRN, came to the ARU in March 2011 as Interim Program Director to assist the program in moving forward and to help lead the unit. Tami Bokelman, MSW, returned to the Program Director position in October. She is responsible for the day to day operation of the Acute Rehab Unit, including planning, directing, and coordinating all program activities to ensure that patient, unit, and organizational goals are met. We have added two new positions to the unit; the Clinical Assessment Coordinator and the Prospective Payment System (PPS) Coordinator. Sundae Clay, RN, has taken on the role of the Clinical Assessment Coordinator and has helped to implement the new pre-admission screening process. With ARU screens now being called to the ARU referral line, Sundae initiates the
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Cara Tucker, PsyD, Psychologist, also joined the ARU team. Dr. Tucker offers assistance to patients who need help adjusting to their disability through supportive counseling, maximizing their cognitive function, and helping the interdisciplinary team find appropriate therapeutic interventions for these patients. The ARU Patient Advisory Council has continued to meet and add members throughout the year. The members continue offering peer support visits to patients and families, which has been a great asset to the unit. The ARU went through its fourth CARF (Commission on Accreditation of Rehabilitation Facilities) accreditation survey in November with much success. Strengths were identified in areas of leadership and strategic planning, medical director involvement, high levels of patient satisfaction, and our interdisciplinary team meetings. We continue to be accredited as a Stroke Specialty Program through CARF. 2011 has been a great year of change for the Acute Rehab Unit.
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DEPARTMENT REPORTS > MEDICAL SURGICAL SERVICES
Medical Surgical Services Diana-Jean Baratta, MSN, MA, RN | Director
Diana‑Jean Baratta, MSN, MA, RN
The Medical Surgical Services Department includes the adult inpatient areas of Orthopedic and Neurological Surgery, General Adult Inpatient Surgery, Medical/Oncology, and the Infusion Team. These areas strive to deliver safe, compassionate, and competent nursing care to the patients we serve. The nursing staff works hard to deliver proficient clinical and quality customer service. Our patients frequently comment about how satisfied they are with the attention and care they receive. The department has experienced multiple leadership transitions during the year and ends the year with a new director, new manager for Ortho/Neuro/Adult Surgical on the second floors, and a new clinical coordinator for Medical/Oncology on the third floor. The current leadership is: Diana-Jean Baratta, MSN, MA, RN – Director; Chris Buhr, BSN, RN – Asst. Director; Rebecca Montanez, BSN, RN – Manager; Kim Meininger, RN – Clinical Coordinator; Joe Salazar, BSN, RN – Clinical Coordinator. Enhancing the service and function of the units is a strong, competent group of clinical resource nurses who manage the daily staffing, serve as a clinical resource and support, and problem solve as needed throughout the days and nights to help ensure safe patient stays. These clinical resource nurses are instrumental in coordinating communication between a team of care which consists not only of the nurses and nursing assistants but also case managers, social workers, pharmacists, discharge nurses, physicians, and other ancillary staff.
2011 highlights include: • The implementation of bedside report on Ortho/Neuro and Adult Surgical. This evidenced-based nurse-to-nurse hand-off report at the bedside enhances communication between patients and caregivers and has been shown to improve safety through a more thorough and visual information exchange. Medical/ Oncology will be adopting a similar hand-off report in 2012. • Leadership rounding, wherein the director, managers, and clinical resource nurses visit with patients to ensure that care needs are being met, has been enjoyable and effective. Leadership rounding improves communication, problem solving, and safety. • Weekly leadership meetings were established and include our dismissal nurses, Amy Campbell, BSN, RN, and Mary Barraza, BSN, RN, in order to stay coordinated and on top of the issues and improvement projects. • Largely due to the efforts of the dismissal nurses, the units reached 100 percent for CHF core measures by the end of the year. • A weekly e-mail communication to staff was implemented to improve information flow and reinforcement of important clinical and procedural aspects of our work. • Unit Practice Councils, chaired by Stacey Powell, BSN, RN ,for the second floor units and by Lenae Snyder, BSN, RN, for Medical Oncology, have actively worked to improve practice, processes, and satisfaction throughout the department. • Peer support is evident. Ortho/Neuro and Adult Surgical implemented STAR boards for staff to compliment and thank
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NURSING ANNUAL REPORT
DEPARTMENT REPORTS > MEDICAL SURGICAL SERVICES
one another. Medical Oncology continues their Angel of the Month award, pooling donations and selling pop cans to award the honoree with a nice gift.
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• Our nurses’ care extends beyond the walls of the hospital as clearly shown by the staff’s adoption of families during the Christmas season as well as a generous donation made to Capstone. • The department continuously works towards improving patient safety. An example of one improvement we initiated was locking our scales to weigh only in kilograms. This eliminates the need to convert from pounds in order to prevent medication error for medications that are formulated according to patient weight. • The infusion team, John Beard, BSN, RN and Mike Bokelman, BSN, RN, experts at ultrasound-guided PICC/IV placement, introduced the Power Wand, an intravenous device that decreases the number of IVs a patient needs to receive while hospitalized. The infusion team follows the strictest standards when placing PICC lines, successfully placing hundreds of lines yearly. • John Beard, BSN, RN, earned the Regional West Medical Center distinction of Star of the Year. • Medical/Oncology continues to support and develop a chemotherapy nursing specialty group coordinated by Susan Schoeneman, BSN, RN, Oncology Certified Nurse. These nurses work both in Regional West Physicians Clinic Oncology Clinic and in the Medical
Center. Amanda Miller, BSN, RN achieved her Oncology Certification this year. In addition to treatment provided on the Medical/Oncology Unit, the chemotherapy team provides the majority of treatments in the outpatient setting, averaging approximately 10 treatments daily. The chemotherapy treatment provided is driven by the Oncology Nursing Society standards, guidelines, and safety measures.
We are looking forward to a productive year in 2012, working toward achieving externally driven goals such as core measures and meaningful use. Equally important, we are working toward internally driven desires to offer safe, quality, competent, and compassionate care in a supportive, team-oriented, considerate environment.
• Mona Urwin RN, Certified Bariatric Nurse, coordinates bariatric training and education with inpatients as well as helping communities in the surrounding areas develop support programs. Mona creatively works to develop positive lifestyle changes with the patients she serves. Her efforts contribute to sustaining the hospital’s Bariatric Center of Excellence designation. The Medical Surgical Department has additionally collaborated with the University of Nebraska Medical Center (UNMC) in hosting students through the Dedicated Education Unit, providing an on-site clinical experience for nursing training. Also in collaboration with UNMC, the Medical/Oncology Unit has participated in a research study to describe the frequency of interruptions nurses experience while administering medications. A second phase of this study in 2012 will trial an intervention to decrease the frequency of those interruptions, which may help to reduce medication error.
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DEPARTMENT REPORTS > BIRTH & INFANT CARE CENTER & PEDIATRIC UNIT
Birth & Infant care center & Pediatric Unit Connie Rupp, BSN, RN | Director
Safety Improvements:
Connie Rupp, BSN, RN
Pediatrics • Staffing: We increased our minimum staffing to two RNs whenever there is one or more patients in the unit. The second RN may be on Peds or in BICC and serves as a resource. We also added some new faces in 2011; Jami Kumm, RN; Marlee Peluso, RN; Brittany Phillip, RN; Nina Grubbs, RN; Jennifer Komarek, RN, and Emily Stull, CNA. • Admission policy: We revised the policy to reflect the dynamic pediatric population. The policy included criteria for safe placement of each child admitted to Regional West Medical Center. • Acuity guidelines: These guidelines further enhance the safe staffing model by providing justification for increased staffing with high acuity patients. • Monitoring: In response to a need for more sophisticated monitoring of pediatric patients, the Pediatric Unit received the loan of two Spacelab monitors. Pediatric patients can now be monitored by telemetry in the Progressive Care Unit (PCU). This was a joint patient improvement between the Pediatric Unit and PCU. This has enhanced patient safety by ensuring that alarms are not being missed. We have budgeted for pediatric Spacelab monitoring in 2012.
Team members must also complete two days of cross training on the Pediatric Unit. Neonatal Intensive Care Unit (NICU) • Retinopathy of Prematurity (ROP): The process of ROP screening has been formalized. This increases safety for our smallest patients by decreasing the likelihood that this important screening would be missed. Birth and Infant Care Center (BICC) • High risk medications: Implemented a nurse double check on high risk medications in Labor and Delivery (L&D). • Magnesium sulfate: Changed loading dose procedure to reduce chance of overdose during the loading dose. • Staffing guidelines: Implemented the new Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) staffing guidelines for patient to staff ratio. We continue to review staffing to see if we need more staff to support these guidelines. All Areas • Initiated Hourly Rounding with a Purpose • Initiated Bedside Report: This was implemented for both safety and patient satisfaction. It is going fairly smoothly and staff are refining the process
• Kids Kare Team: The Kids Kare Team has undergone restructuring and is now operational. There are no more levels, just one Kids Kare Team. The entire staff of the BICC/ Pediatrics plus 11 others from around Regional West Health Services attended training days held in October. Kids Kare
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NURSING ANNUAL REPORT
DEPARTMENT REPORTS > BIRTH & INFANT CARE CENTER & PEDIATRIC UNIT
Patient Satisfaction All Areas • Leadership rounding: Every patient is visited at least once during his or her stay by the director or someone in a leadership role. • Patient satisfaction scores: These are reviewed at every meeting and staff has an interactive discussion on ways to improve. A formal action plan has been developed and staff has reviewed and agreed to the plan. • White boards: Have been placed in every patient room. Used for communication and plan of care. Staff Satisfaction All Areas • Unit Practice Council (UPC): Started in March to give staff the opportunity to make decisions and implement changes at the bedside. • RN Satisfaction survey and Culture of Safety survey: Reviewed with each area and an action plan was developed for improvements. • Education: Staff helped identify education needs. Several Continuing Education Units (CEU) and Continuing Medical Education (CME) workshops were held throughout the year. Six nurses traveled to Denver’s Presbyterian St. Luke’s (PSL) Hospital to work in either the Pediatric Unit, Neonatal Intensive Care Unit (NICU), or Labor and Delivery. They spent
NURSING ANNUAL REPORT
three days working along side PSL nurses and brought back some very good information to share with staff. We purchased a Fetal Monitoring On-line Educational package with which all labor and delivery nurses and physicians are working. We have several nurses working to obtain their RN, BSN, and MSN degrees. Jade Malcolm earned her advanced degree in December. She will be working as a Nurse Practitioner at the Women’s Center. • Evidence-based practice changes: Gestational Age Assessments are now only done in the absence of a first trimester ultrasound, when the physician orders one, or when the nurse feels it is necessary. When the assessment is necessary, it is no longer done immediately after the baby is born, to allow the infant and mother to remain together. "Skin to Skin" was implemented through UPC as a collaborative practice change between the NICU and L & D nurses. Skin to skin has been shown to stabilize the newborn’s body temperature and blood sugar, and facilitates breastfeeding success. This change in practice is also a big patient satisfaction factor. • Drawing labs in the NICU: This was a collaborative effort between Lab and the NICU to improve both patient satisfaction and staff satisfaction. It is going well and we are looking at expanding this practice to postpartum infant lab draws.
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Tracy Meyer, Shirley Knodel, Susan Backer, Sarah Shannon, and Michelle Powell at the National Magnet Conference in Baltimore.
DEPARTMENT REPORTS > RESTORATIVE CARE UNIT
Restorative Care Unit Sarah Shannon, BSN, RN| Director
Our 2011 accomplishments include: • Bedside shift-to-shift report was implemented in RCU, utilizing the SBAR format.
Sarah Shannon, BSN, RN
• RCU, in conjunction with Case Management, developed and implemented an algorithm for the RCU admission process. The algorithm delineates the appropriate and necessary steps for admission based on CMS recommendations. The benefit of implementing this algorithm has been a more formal and efficient admission process. • An Outbreak Policy was developed to facilitate detection of infections and prevent transmission of organisms throughout the health care environment, while providing a process for collecting, managing, analyzing, and disseminating information related to the patient’s health status. Information gathered throughout the month is reviewed at our monthly Quality Assurance/Staff meeting in conjunction with our medical director. • Mary Acosta, CNA, in the Restorative Care Unit, was presented the Direct Care Staff of the Year award by the Nebraska Health Care Association/Nebraska Assisted Living Association. • The Patient Satisfaction survey for RCU was updated to reflect the new Quality Indicator Survey Process by Centers for Medicare and Medicaid Services (CMS). Patients are surveyed 48 hours after admission to the RCU. Questions include topics related to activities of daily living. Concerns identified through the survey are addressed promptly in order to improve patients’ satisfaction prior to discharge. • A new software program, Point Click Care, was purchased for RCU. Point Click Care provides a standardized approach for assessing resident care requirements, developing care plans, and calculating reimbursements and funding. From
NURSING ANNUAL REPORT
pre-admission to discharge, our integrated approach to EHR streamlines and connects clinical, billing, and administration processes to maximize reimbursements, enhance quality of care, improve operational efficiencies, and increase staff productivity and satisfaction. • The Patient Discharge Summary has been updated to reflect CMS recommendations. The summary includes a recap of the patient’s stay including admission diagnosis, systems review, functional status, diagnostic procedures, medical history, consults, and discharge plan. • Health and Life Safety Code (QIS) surveys were conducted in RCU on Dec. 6 and 7, 2011. The QIS is a two-stage process used by surveyors to systematically review specific nursing home requirements and objectively investigate any regulatory areas that are triggered. The process begins with offsite survey preparation activities including review of prior deficiencies, current complaints, ombudsman information, existing waivers/variances, and Minimum Data Set (MDS) data for the facility. Upon arrival at the nursing home, an entrance conference is conducted during which the team coordinator requests facility information. Concurrent with the entrance conference, surveyors conduct a brief tour to gain an overall impression of the facility and the resident population being served. The survey takes two days to complete. Surveyors hold an exit conference to review the finding with members of the leadership team. During the 2011 survey exit conference, RCU was found to be deficiency free. • I would especially like to recognize Annette Reichert, RCU Unit Manager, for her dedication and tenacity in bringing these projects to fruition.
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DEPARTMENT REPORTS > PERIOPERATIVE SERVICES
PERIOPERATIVE SERVICES Janet Lewis, MA, BSN, RN | Director
Operating Room
By Kim Brown, BSN, RN, CNOR | Unit Manager
Complex cases and high acuity procedures continue to be the major part of our surgical volumes. To accommodate our neurosurgical technology, such as the O-arm, as well as provide scheduling flexibility, renovation of OR # 1 was completed. Now the hospital surgical suite consists of nine rooms. Janet Lewis, MA, BSN, RN
Safety remains the top priority in the Perioperative area for all patients and staff. Safety stories are shared among the staff and a team approach is used to address each issue with staff education as indicated. Our process improvement activities include monitoring the frequency of flash sterilization, hand hygiene, and on-time starts for 7 a.m. cases. The Operating Room staff has worked as a team to increase efficiency with the goal of improving patient and physician satisfaction by starting the first case of the day on time and decreasing room turnover times. Additionally, 50 chart audits are performed monthly to monitor appropriate documentation and compliance to quality measures. Education is a vital factor for the Operating Room due to ever changing technology, new procedural techniques and the acquisition of new equipment. Every Monday morning from 6:30 to 7:30 a.m., an educational activity is presented to staff. Specialty competency testing for 2011 included neurosurgery, orthopaedics, and general surgery competencies. As a part of new staff orientation, each RN must review modules and complete a test in the AORN Periop 101 educational program. Other RNs are also completing this program which will help to establish a base line competency for all. We were fortunate to have staff attend national conferences. Janet Lewis attended the AORN Congress in Philadelphia, along with Dayna Dondelinger, Colleen Kelly, and Rhonda Groshans. Each one was
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awarded an Association of Perioperative Registered Nurses (AORN) Foundation scholarship that paid for registration and other fees. Surgical Technologists Chris Crisman and Kelsie Rose attended the National Association of Surgical Technologists (AST) meeting in San Francisco in 2011. Educational sessions and exhibits for both conferences provided the latest in technical and research based information to enhance the care of the perioperative patient. Dayna Dondelinger BSN, RN, and Kim Mann, BSN, RN passed a national certification exam and received the designation of Certified Nurse of the Operating Room (CNOR). They join Kim Brown, Rhonda Groshans, Darcy Haslam, Janet Lewis and Mary Lockwood in achieving certification status. Certified Scrub Technologists in the Operating Room are Marcene Wiegand, Tara Albright, and Hope Dubs. The Operating Room is dedicated to a “Growing Our Own� initiative by encouraging staff to further their education. Marcene Wiegand and Chris Crisman are enrolled in RN nursing programs. Cody McLellan is attending Western Dakota Tech and will become a Certified Scrub Technologist. Additionally we have welcomed summer professional nurse interns and have hired nursing students as Operating Room (OR) assistants. This gives the nursing students the opportunity to have intensive first hand experience with the internal processes of an OR. A Unit Practice Council has been initiated in the OR and members include: Jason Beals, chairperson; Kim Mann, co-chairperson; Joy Stuckert; Peg McFarland; Joleen Gompert; and Tim Pate. The council meets monthly and strives to develop plans to improve processes related to patient and staff satisfaction and perioperative standards of practice. A Positive Spark Award was initiated as a way for staff to recognize positive contributions by their peers and celebrate our team members. A small traveling trophy is passed to the next winner each month.
NURSING ANNUAL REPORT
DEPARTMENT REPORTS > PRE-ADMISSION TESTING (PAT)
Pre‑Admission Testing (PAT) Judy Bowllin, BSN, RN| Unit Manager
Pre-Admission Testing (PAT) continues the quest to contact all scheduled surgical patients prior to their procedure. We conducted over 6,700 visits in 2011, with over 1,000 visits conducted via telephone with patients prior to their procedure. Ideally we would like a face-to-face evaluation of all patients, but that is not always an option for our out-of-town patients. Several Regional West Physicians Clinic physicians have satellite clinics in surrounding areas such as North Platte, Gordon, Sidney, Ogallala, and Chadron, to name a few. On the day of their procedure, all surgical patients are seen by PAT staff to make sure there are no changes in health status and to verify that the patient followed instructions given to them by PAT staff when they had their evaluation or phone call. We also see all “in-house” surgical patients either the day before their procedure, the day of their procedure, or both. During the course of any of our evaluations or patient visits, we bring specific concerns to the attention of Anesthesia. Likewise, on the day of surgery, if we discover there have been changes in health status, patients didn’t follow instructions, or any other unusual or unforeseen circumstances, we consult an anesthesiologist to discuss the issue with him or her and get further instructions. On a quiet surgery day, each PAT staff member averages between 7,000 to 8,000 steps, or approximately three to four miles. Of course, as with any patient care area, the busier the day, the more steps one takes.
Aureus (MRSA). Patients are given a packet of information about MRSA during their PAT visit that explains the reason for screening and what steps they need to take prior to their day of surgery if their surgeon calls to inform them that they had a positive result. June brought the first meeting of our Unit Practice Council. The council has implemented the use of “implanted electronic device” stickers to alert other caregivers that the patient has a pacemaker, dorsal column stimulator, or other implanted device. This method of alert was instituted to ensure a patient’s safety when electrosurgery or other electrical equipment is being used, which may interfere with the device during their surgical procedure. The PAT staff has also revised the pre-op instruction sheet and implemented some PAT process changes to more efficiently and effectively prepare patients for their surgical procedure.
In May, we began screening all spinal surgery, total joint replacement patients and patients for Methicillin-Resistant Staphylococcus
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DEPARTMENT REPORTS > OUTPATINT SURGERY (OPS)
oUTPATIENT sURGERY (ops) Karna Kleager, BS, RN | Unit Manager
The care of surgical patients remains the main focus of Outpatient Surgery (OPS). Other services continue to grow including caring for patients who require periodic transfusions of blood and blood products, antibiotic therapy, or infusions for medical conditions, which continues to grow. Statistics indicate that the average number of infusions has increased by over 30 percent. (For example, in the month of April 2011, 183 infusions were done in OPS.) We want to extend a huge expression of appreciation to the 2W staff for the 30 infusions they did on days when OPS unit was closed. This is an important service to provide to our customers, the patients. Process improvement activities include: • Participation in a process to improve on-time starts for 7 a.m. surgical cases by decreasing the time from the OPS admission to the time patients are transferred to the Pre-op room. • With the newest data from Health Streams, we are striving to improve patient satisfaction scores related to the overall rating of staff, overall rating of physicians, overall rating of facility, and likelihood to recommend Regional West Medical Center for care. • Hand hygiene monitoring. Additionally the OPS staff continues to maintain their professional activities: • Michelle Powell, RN was selected to receive the Nurses’ Day award for Structural Empowerment.
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• Kathi Yost, BSN, RN, plays an important role as a member of the Nebraska State Board of Nursing. • Alicia Gonzales-Longoria, BSN, RN, is in the UNMC Masters of Nursing degree program. • Michelle Powell maintains her Medical Surgical Nursing Certification. • Kathi Yost maintains her Gerontological Nursing Certification. • Shared Governance Councils members include Kelsey Judy, Kathi Yost, Michelle Powell, Roxie Shaul, and Shon Peterson. • Shon Peterson and Michelle Powell attended the National Magnet Conference in Baltimore, Md. • Naomi Pickinpough and staff from Post-Anesthesia Care Unit (PACU) and PAT attended the 30th Annual American Society of PeriAnesthesia Nurses (ASPAN) National Conference in Seattle, Wash., in April. OPS Unit Practice Council (UPC), chaired by Bobbi Decker, RN, meets the second Thursday of each month. Members include Janice Strauch, Aggie Collopy, Kendra Vera, and Michelle Powell. Meetings have focused on setting goals and developing a mission statement. The list of goals include: new signage for the reception area to better guide patients and families, working with surgery staff to develop an orientation process for transport staff, and developing a job description specifically for the Outpatient Surgery Charge Nurse. Subcommittees of the UPC are focusing on opportunities for improvement identified from the Employee Participation surveys.
NURSING ANNUAL REPORT
DEPARTMENT REPORTS > POST ANESTHESIA CARE UNITY (PACU)
Post Anesthesia Care Unit (PACU) Karna Kleager, BS, RN | Unit Manager
The PACU faced an interesting challenge this past year when major reconstruction required the unit to relocate to an area adjacent to OPS for several months. The PACU staff remained focused, providing the highest possible level of care to patients as they worked in a different and unique setting. Performance improvement activities include: • Hand hygiene monitoring • Improvement in on-time starts for 7 a.m. surgical cases by having the patients in Pre-op ready for transport to the OR suites by 6:50 a.m. • Completion of Point of Care chart audits Professional status activities: • Andrea Ray and Kay Lemons achieved ASPAN national certification, Certification in Peri-Anesthesia Nursing (CPAN).
• Shared Governance Council members include Mandi Barry, Kay Lemons, Sandy Hebbert, and Colynn Beaver. • Colynn Beaver and Andrea Ray attended the 30th Annual ASPAN National Conference in Seattle, Wash. • PACU continues to be a popular unit for students in which to complete their transition rotations and summer internships. PACU UPC, chaired by Sandy Hebbert, meets the third Monday of each month. Members include Ginny Blackburn, Kay Lemons, Andrea Ray, Jessica Conn, Tracy Payne, and Sandy Hebbert. Information on MRSA was obtained and staff was updated on the latest information from the Centers for Disease Control (CDC). Changes were implemented to improve the care of PACU patients. Improvements have also been seen from work being done with the anesthesiologists and surgeons to reduce the number of verbal orders and provide the necessary written orders. UPC continues to work on the identified opportunities for improvement related to the Employee Participation surveys.
• Sandy Hebbert, Chris Micheels, and Tracy Payne maintain their CPAN certification. Jessica Conn is Critical Care Registered Nurse (CCRN) certified. • Jina Nemnich will graduate in May from the UNMC master's degree program. Jessica Conn is also in the UNMC master's degree program.
NURSING ANNUAL REPORT
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DEPARTMENT REPORTS > ENDOSCOPY
Endoscopy
Scottsbluff Surgery Center
Lucrecia Spady, BSN, RN | Unit Manager
Crystal Kildow, BSN, RN | Clinical Coordinator
The Endoscopy nurses provide the majority of their nursing care to patients at the Scottsbluff Surgery Center-Endoscopy Unit. In addition, they also provide endoscopy services to inpatients at Regional West Medical Center; thus they strive to be knowledgeable of hospital protocols. One way to do so is to participate in chart audits and other performance improvement activities in order to stay current and compliant with procedure documentation.
The Scottsbluff Surgery Center (SSC) has continued efforts to incorporate additional volume, especially in the areas of pain management and orthopedics. The nursing staff takes great pride in managing quick, efficient turnover of procedures with a high level of patient and physician satisfaction. One of the two operating rooms was equipped with an equipment boom, necessary equipment was installed in the second room in order to have identical set ups in both. Additional staff was hired so two surgical procedures can be scheduled at the same time. A unit secretary position was also developed to provide additional support to nursing staff.
A major project this year for the Endoscopy Department was to improve percutaneous endoscopic gastrostomy (PEG) tube teaching and educational packet. Missy Johnson and Lucrecia Spady were part of a group that included our dieticians and oncology nursing staff. Together we completed orders and an educational packet to help provide a better experience for our patients. The nursing staff helped promote the health of the community concerning Colon Cancer Awareness with their booth at the Festival of Hope. They also set up a booth in the Regional West Medical Center cafeteria and had a “Dress in Blue Day” that raised over $700; proceeds went to the Festival of Hope. Promoting continuing education and certification is an ongoing nursing goal, which was evidenced by:
Systems used in the hospital are being developed at the SSC for consistency in supportive services. A Pyxis system for drug management was instituted at the SSC in 2011. It provides the same consistent method for medication distribution that is used in the hospital. Support is now available from Materials Management when ordering stock supplies. The SSC Unit Practice Council is now organized and is focused on addressing issues from the Staff Satisfaction survey and the Safety Culture survey. Quality measures monitoring includes chart auditing for compliance and completeness of documentation.
• Unit Manager Lucrecia Spady received her Certification for Gastroenterology and is now a Certified Gastroenterology Registered Nurse. • Lucrecia Spady, Connie Kirchner, and Rebecca Robles represent Endoscopy on the Nursing Shared Governance Councils. • Unit Manager Lucrecia Spady is working on her master's degree in Nursing. • Endoscopy supports the schools of nursing and is a prime choice for students to complete their rotations and get intravenous (IV) access experience.
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NURSING ANNUAL REPORT
DEPARTMENT REPORTS > Critical Care and Emergency Services
Critical Care and Emergency Services Nancy Hicks‑Arsenault, BSN, MBA, RN | Director
Nancy Hicks‑Arsenault, BSN, MBA, RN
Critical care and emergency nurses are of a special make-up they love controlled chaos and are prepared to utilize crisis management skills every shift. Regional West Medical Center is blessed to have this talent. Our nurses promote and help patients achieve the highest possible health outcomes with efficiency and adaptability to optimize individualized care. Leadership to promotes the advancement of knowledge and skills through continued education, reviewing current knowledge, and passing knowledge onto new students and professionals. Linda Fowler, BSN, RN, continues in her role as clinical coordinator for Critical Care and Emergency Services. She coordinates advanced education and mentoring. Our physician colleagues are wonderful in providing just-in-time education through patient care rounds and case reviews. Bringing evidence into practice positively impacts hospital culture. Linda has been instrumental in encouraging staff to return to school and/or become certified in their specialty. Specialty certification is one way competency is recognized among nurses. This year Linda Borelli, RN; Amanda Lashley, BSN, RN; Alice Leider, BSN, RN; Sarah Paetow, BSN, RN; and Jessica Slaught– Langworthy, BSN, RN all received their Certified Emergency Nurse (CEN) certification ; bringing the total to 35 percent of Emergency Department nurses certified in their specialty. Jessica Slaught–Langworthy also achieved Certified Pediatric Emergency Nurse (CPEN) this year. Max Bull, BSN, RN, is the fourth nurse in ICU/PCU to receive Critical Care Registered Nurse (CCRN) certification.
Linda Borelli, RN, and Amanda Lashley, BSN, RN, attended the Scientific Assembly for Emergency Nurses, returning with practice protocols to introduce in emergency services. Leigh Miller, BSN, RN and Linda Fowler BSN, RN attended the AACN (American Association of Critical Care Nurses) conference in Chicago, Ill. and shared new learning with staff. Erin Holcomb, BSN, RN, Jessica Slaught–Langworthy, BSN, RN; Alice Leider, BSN, RN, Amanda Lashley, BSN, RN and Jesse Whetham, BSN, RN are pursuing advanced nursing degrees. We appreciate the continued influence of nursing education. With help from the Unit Practice Council, Linda Borelli, RN, implemented a time out procedure in the Emergency Department. Now all team members can receive reports from pre-hospital care givers in an organize method. This was implemented in December and results to validate effectiveness are being collected. Many projects for 2012 are under discussion and prioritization is taking place at the Unit Practice Council. Trisa Gonzolas, BSN, RN, joined the Emergency Services Leadership Team as the manager in August. Trisa brings a strong focus to patient and family excellence through the concept of treating others as you want your most loved family member to be treated. Experience as an Emergency Department, critical care, and behavioral health staff nurse, house supervisor, and clinical coordinator fostered knowledge and skills Trisa utilizes in being an excellent teacher, mentor, and leader.
Networking and learning new processes and procedures were both cited as valuable benefits by employees who attended national conferences.
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NURSING ANNUAL REPORT
DEPARTMENT REPORTS > Critical Care and Emergency Services
Analysis of documentation and feedback to staff in a timely manner by Kathy Jacobsen, BSN, RN, and Joanne Arends, RN, continues to assist the staff in improving electronic documentation of patient care. Through this process appropriate coding and accurate billing is achieved. Sheila Webb-Bowles, MD continues as Medical Director for the Emergency Department. In 2011, the department provided care to over 15,000 patients. Our commitment to departmental improvements and excellent patient outcomes continues as we set goals for the coming year with new nursing leadership. The Critical Care and Progressive Care Units changed leadership structure this year. A Critical Care Unit manager was hired and will begin duties in January 2012. Nurses from Critical Care Services teamed with administration representatives from Human Resources and Finance to adopt a recruitment and retention plan. The plan focuses on decreasing traveler nurses and filling registered nurse positions to reduce the revolving door effect. This effort has lead to decreasing the vacancy rate from 40 percent to 15.6 percent. It is noteworthy that the staff continues to focus on quality patient outcomes and continues to perform well. They are very dedicated to providing excellent patient and family care. This reflects the quality of the nurses. Although many are young in their careers, they are motivated to learn from experienced nurses and share their new talents.
NURSING ANNUAL REPORT
Caring is the essence of nursing ‑ Jean Watson
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DEPARTMENT REPORTS > air link
air link Tracy Meyer, BSN, RN, CFRN, NREMT‑P | Interim Chief Flight Nurse
Tracy Meyer, BSN, RN, CFRN, NREMT‑P
Air Link continues to provide services in partnership with Med-Trans Corporation. In 2011, we welcomed a new pilot to our team, Colin McGurk. Colin has been a tremendous asset to our program and we feel so fortunate to have him on board. Colin has recently taken over as Safety Officer for the aviation side. Simon Enrich continues to serve as our Base Aviation Manager and is also an instructor pilot for MedTrans. The leadership team of our department was restructured. The Air Link Communication Center and the flight team were placed under the leadership of Doug Carrell. Doug has many years of experience in the flight and EMS industry and was one of Air Link’s original paramedics at the inception of the program in 1995. Tracy Meyer continues as Interim Chief Flight Nurse. Trish Garner continues as the Clinical Educator for the flight team, Sean Shirley is our Safety Officer, Wade Wells collects continuous quality improvement data, and Clint Dunker coordinates the Quality Management team and works on a paramedic clinical ladder. Natalie Arnold coordinates the team’s mentoring program with EMS agencies and hospitals. Jason Rairigh and Howard McCormick coordinate the equipment and inventory needs of the program. Dee Vogel assists with CAMTS (Commission on Accreditation of Medical Transport Systems) preparation and policy, procedure, and protocol development. Ward Krichau is instrumental in the respiratory and ventilator management education of the team. Holly Anderson continues to play an important role in the program’s marketing and public relations. As demonstrated, every member of the flight team has added responsibilities and it is
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this hard work and dedication that make us such a cohesive and high functioning team. The crew was busy in 2011 kicking off our “You Can Toucan” video series. Holly Anderson proposed the idea and each crewmember participated in making an educational and entertaining video. Check out the videos on our Air Link Facebook page. We will begin a new video series in 2012. We would love to hear your ideas and suggestions for topics. Air Link continues to place an emphasis on quality patient care, continued learning, “raising the bar,” and mandatory advanced certifications. Natalie Arnold and Clint Dunker achieved their FP-C (Flight Paramedic-Certified). Allen Simons achieved his CFRN (Certified Flight Registered Nurse) and CEN (Certified Emergency Nurse) in 2011. One hundred percent of the team is either CFRN or FP-C certified, with the exception of Teri Wilcox, who was a new flight nurse hired in 2011. She has 18 months from time of hire to achieve her advanced certification. We welcome Teri and her vast ICU background. In 2012, she will begin coordinating our PAIP (Post Accident Incident Plan). The third annual Air Link EMS conference was held in April. A variety of topics and national presenters were brought in. The conference was very well attended and we are already putting together ideas for our 2012 Air Link EMS conference based on ideas for topics from past attendees. The conference will be held in the fall of 2012.
NURSING ANNUAL REPORT
DEPARTMENT REPORTS > AIR LINK
In August, the flight team had two days of education pertaining to transporting highrisk obstetrical patients. The Air Medical Transport Conference (AMTC) was held in October in St. Louis, Mo. Peter Meyer, MD and Tracy Meyer were selected to present at the conference. They gave a lecture entitled, “Should Your Medical Director Be Allowed Anywhere Near Your Aircraft?” As Air Link’s Medical Director, Dr. Meyer has flown as an active crewmember with the flight team since 2009. In addition to speaking at AMTC, Dr. Meyer was also awardedthe 2011 Air Medical Physicians Association Medical Director of the Year Award. Air Link and the Regional West Anesthesia staff hosted a day in December dedicated to learning about advanced airway management in the complicated patient. Attendees came from throughout the region. The course was a combination of didactic and “hands on” learning. The Air Link Communications Center welcomed three new employees in 2011: Meghan Cook Thiele, Jordan Carrizales, and Jim Lawson. Seven Air Link Communication Specialists attended the NAACS (National Association of Air Communication Specialists) certification class. The purpose of the certification is to enhance professionalism of the Air Medical Communication Specialists through education, recognition, and standardization. In February 2011, 100 percent of the Communication Specialists were NAACS certified. New employees will be certified within a year of hire. The leadership team completed numerous “Circuit Tours” throughout 2011. The tours are designed to promote Regional West Medical Center and the Air Link flight service. We constantly strive for ways to improve our service and continue to serve the needs of our community and our customers. We are proud of our staff and we would like to thank both our internal and external customers for the support ythey have shown us throughout 2011.
NURSING ANNUAL REPORT
“Nursing is an art: and if it is to be made an art, it requires an exclusive devotion as hard a preparation, as any painter’s or sculptor’s work; for what is the having to do with dead canvas or dead marble, compared with having to do with the living body, the temple of God’s spirit? It is one of the Fine Arts: I had almost said, the finest of Fine Arts.”
- Florence Nightingale
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DEPARTMENT REPORTS > HOME CARE
HOME CARE Diana Rohrick, RN | Director
Diana Rohrick, RN
Regional West Home Care once again faced regulatory changes and ended this year in compliance with and better understanding of these changes.
Regional West Home Care has been diligently working with all physicians to make enforcement successful and have had few problems with implementation.
The two most significant changes placed on home health agencies in 2011 were as follows:
2) Therapy assessments On July 23, 2010, the Centers for Medicare and Medicaid Services (CMS) published the proposed rule to update the Prospective Payment System for calendar year 2011. A driving force behind several of the provisions is an attempt by CMS “to mitigate vulnerabilities such as payment incentives to provide unnecessary services.” One target is therapy services. An article posted on the following website recently highlighted some proposed billing and operational requirements: http:// www.beaconhealth.org/individual_article.php?articleID=392
1) Home Health Face-to-Face Encounter: A new Home Health certification requirement A new Medicare home health law went into effect on January 1, 2012 that affirms the role of the physician as the person who orders home health care based on personal examination of the patient. Effective in January, a physician who certifies a patient as eligible for Medicare home health services must see the patient. The law also allows the requirement to be satisfied if a non-physician practitioner (NPP) sees the patient, when the NPP is working for or in collaboration with the physician. As part of the certification form, or as an addendum to it, the physician must document that the physician or NPP saw the patient, and document how the patient's clinical condition supports a homebound status and need for skilled services. The face-to-face encounter must occur within the 90 days prior to the start of home health care, or within 30 days after the start of care. While the long-standing requirement for physicians to order and certify the need for home health remains unchanged, this new requirement assures that the physician's order is based on current knowledge of the patient's condition.
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The proposed rule also includes almost one full page on therapy services documentation. Here’s a look at a few of those requirements: • To improve, and there is the expectation that the patient will improve, in a reasonable and generally predictable period of time. • A therapist (not a therapy assistant) must initially assess and periodically reassess the patient’s function. • The method to assess the patient includes objective measurements, such as OASIS ADL data elements, enabling comparison of successive measurements to determine progress (OASIS = Outcome and Assessment Information Set. ADL = activities of daily living).
NURSING ANNUAL REPORT
DEPARTMENT REPORTS > Home Care
• The plan must describe a course of therapy treatment and goals that are consistent with the evaluation and relate directly to the patient’s illness or injury and functional status.
One of our RNs, Sheli Goodwin, continues to work with the Regional West Medical Center Medication Reconciliation Committee to resolve issues within the continuum.
• Goals must be measurable and relate to the patient’s illness or injury and subsequent functional impairments.
Our ongoing Palliative Care endeavor with Prairie Haven Hospice has been successful on several counts including: symptom management, decreased hospitalization, and increased awareness and critical thinking on the part of the clinical staff that care for patients with chronic diseases. One goal for 2012 is to continue our education of stakeholders within Regional West Health Services on this effective program and the benefits to both patient and provider.
• Clinical notes must include objective measurements or descriptions of changes in status relevant to the goals of treatment. CMS believes these new criteria will support the necessity of therapy services and lead to documentation that demonstrates patient response and progress. CMS does not believe this will create additional burdens because “a prudent home health agency would self-impose these requirements in the course of doing business.” As stated above, Regional West Home Care has faced these challenges and has come out in compliance with these regulatory changes. Our new Unit Practice Council (UPC) is up and active, having already resolved issues with guideline compliance, and is ready to move on to other projects. The council continues to seek input from the rest of the group in their endeavor to work in conjunction with the entire Home Care team. This council is comprised of part time, full time, RN, LPN, and office staff. Our Acute Care Hospitalization committee (ACH) continues an active role in determining best practice for keeping patients at home and alleviating unnecessary hospitalizations. A major part of this effort is to educate the remaining staff on their findings and devise value-added processes for successful decrease in our percentages for hospitalizations. Our current Home Care Compare Report from CMS shows that we have decreased our percentage this year from 24 to 23 percent. Actual cost savings have not been calculated but the effort to do this will be a part of the 2012 goals. This committee includes part time, full time, RN, LPN, and office staff.
NURSING ANNUAL REPORT
Regional West Home Care has two certified RNs: Sheli Goodwin, who is certified in Psychiatric and Mental Health, and Mary Coon, a certified Inpatient Obstetrics nurse. Our marketing efforts continue as the new roster of Regional West physicians grows. We are now part of the orientation process for all new physicians and hope to see an increase in admissions from this referral base. The Alliance area has maintained its average daily census of 18 to 20 patients while Scottsbluff has dropped a little, going from 120 patients in 2010 to 115 in 2011. Diana Rohrick, Director of Home Care (HC), is working with David Holdt, MD. and the Regional West Physicians Clinic to educate physicians on the benefits of home care for their patients. Working with the Regional West nursing directors on the nursing strategic plan for 2012 has also been helpful in fusing our care delivery with that of the continuum and solidifying our goals for our patient care and focus.
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DEPARTMENT REPORTS > imaging services
imaging services Kari Gift, RN
Kari Gift, RN
This was a busy year filled with many changes. We utilized multiple travelers, but were finally able to fill our open positions. We work closely with radiologic technologists to provide the best possible care for our patients while obtaining the best images. The following are categories and rounded figures of our outpatient workload. We had 360 biopsies, 260 drain placements or aspiration of fluid, 183 arterial cases, 80 venous cases, 1,235 pain management cases, 95 vertebroplasties, 330 MRIs, and 335 miscellaneous cases. These cases are done in all modalities (CT scan, interventional radiology, ultrasound, fluoroscopy, nuclear medicine, and MRI), some require moderate sedation and some not. Some cases were for diagnostic purposes only and some required immediate treatment such as stents, angioplasty, embolization, or thrombolysis. This doesn’t include all of the inpatient cases that we add to our schedule on a regular basis.
We work closely with and are a resource for the radiologic technologists. We are putting together presentations to take to the general nursing units for better teamwork, which will result in better patient outcomes. This year we will do our part to successfully integrate the new group of radiologists into our system to make us the best interventional suite in the country. Our goal is to have all of our nurses certified through the Association of American Radiologic and Imaging Nursing within five years.
Our accomplishments this year include having a Unit-Based Shared Governance Council that meets weekly to increase team work and problem solving while optimizing patient outcomes. We have worked together with ICU and set up an algorithm for ICU patients in the Imaging Services Department that will best serve the patients.
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NURSING ANNUAL REPORT
DEPARTMENT REPORTS > cardiac cath lab
cardiac cath lab Lenna Booth, BSN, RN
The past year has been one of change and growth for the Cardiac Cath Lab. In addition to performing coronary angiograms, we saw a marked increase in the number of pacemaker procedures that are performed in the Cath Lab. Our staff assisted with more than 500 pharmacological stress tests, and more than 60 cardioversions, transesophageal echocardiograms, and bubble studies. We also saw an increase in the number of tilt table studies. In addition to Gangaram Rasa, MD, (who joined Regional West in July 2010) we welcomed Herbert Lee, MD in July 2011. The focus of the Cath Lab staff continues to be to provide safe, current, competent, and compassionate care not only to people in the valley but to those who reside in the surrounding communities of the greater Nebraska panhandle. There are five staff members in the Cardiac Cath Lab (two RNs and three Radiologic Technologists) who work closely together to provide a wide variety of cardiac services to our patients. Patient safety: • The Nurse-to-Nurse Handoff communication form was revised and used for all patient transfers from the Cath Lab. • All pacemaker and heart cath patients are called by a Cath Lab RN prior to the day of their scheduled procedure; this verifies that lab work is complete and ensures patients know the appropriate check-in time. In addition, current medications are verified and the plan of care for pre- and post-procedure is reviewed. Patients are given an opportunity to express any concerns and ask questions. This process not only improves the safety and efficiency of care, but also serves to reduce patient anxiety. • In addition to working with our two cardiologists and the Heart Center of the Rockies cardiology providers, staff worked closely with Outpatient Surgery, PCU/ICU, Adult Post-Surgical Unit (2W), Nuclear Medicine, Cardiopulmonary,
Heart Center office staff members, and our pacemaker representatives to provide comprehensive care for our patients. • We implemented the direct transfer of patients in need of interventional services from the Cath Lab to the transport agency to decrease the time from diagnostic to interventional services. Current practices: • Dr. Rasa and the Cath Lab staff worked with the Nuclear Medicine Department to streamline the scheduling of stress tests and to improve the use of staff resources and more efficiently serve our patients. • Dr. Rasa also worked with Administration to increase the awareness of the need to expand cardiology services to our patients and possibly include interventional cardiology services in the future. • New echocardiogram equipment was purchased with plans to upgrade equipment to include 3-D echo capabilities in 2012. Dr. Rasa has also worked closely with the echocardiographers to improve quality of the echos studies. • ECG carts have been updated and now communicate with CPACS throughout the facility. This system network enables physicians on the floors and in the clinic to have immediate access to ECGs. • Plans to upgrade the Cath Lab hemodynamic system have been reviewed, and are ongoing. • Physician order sets were updated. • A pacemaker procedure was created with current evidenced-based practice. There are ongoing continued efforts to update procedures to remain current with best practice. • The Cath Lab has RN representation on the Shared Governance Councils.
NURSING ANNUAL REPORT
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DEPARTMENT REPORTS > cardiac cath lab
Competency: • ACLS certified staff members. • Chart audits completed to monitor compliance of informed consent for sedation plan. • RN staff participated in the Safety Behavior Training initiative. • Cath Lab RN staff taught ongoing Safety Behavior Training classes to new hires. • One RN and one radiologic technologist were sent to Denver for pacemaker interrogation training as we begin efforts to expand technical support to our pacemaker patients. • We support the education of nursing students from the University of Nebraska Medical Center and Western Nebraska Community College.
Compassion: • RN staff volunteered their time to teach heart disease prevention presentations to civic groups throughout the community. • Follow-up phone calls were made to our patients post-procedure to ensure safety, and to look for opportunities to improve the over all experience of Cath Lab/Heart Center patients.
Back row left to right: Nel Robison RT; Kim Fenning RT; and John Vidlak RT. Front row left to right: Michelle Rairigh, BSN, RN, and Lenna Booth BSN, RN.
• All patients are sent a letter encouraging them to let us know what we can do to better serve them!
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NURSING ANNUAL REPORT
DEPARTMENT REPORTS > CARDIAC AND PULMONARY REHABILITATION
Cardiac and pulmonary rehabilitation Lynn Macken, MSN, MA, RN
Lynn Macken, MSN, MA, RN
The year 2011 was exciting for the Cardiac Rehab program. We successfully completed a rigorous application process and received national program certification from the American Association of Cardiovascular and Pulmonary Rehabilitation. Program certification recognizes achievement of national practice standards. We continue to monitor patient and program outcomes including quality of life, depression, physical function, dietary behaviors, heart disease knowledge, and several other outcome measures to improve our processes. Cardiac Rehab is a small department with six nurses and every nurse is actively involved in achieving certification status.
• Patti Edwards, LPN, continues to provide Rehab Center gym orientations for employee use and health promotion. Patti also completed an intense training course as a community CASA volunteer. • Colleen Kennedy continues to work on her MSN degree and Lynn Macken completed the comprehensive exam for her PhD degree in Nursing. • All Cardiac Rehab nurses completed nine CEUs for Pulmonary Rehabilitation evidence-based practice in December. Revising our Pulmonary Rehab processes will be our 2012 program focus.
Other activities included: • Received “Most Educational Poster Award” at the Third Annual Quality and Safety Fair for the “Cardiac Rehab and the Ventricular Assist Device Patient” poster. Colleen Kennedy, BSN, RN, developed a staff education program for competency with this high-risk and low-volume type of patient. • Pam Zitterkopf, BSN, RN, provided several community health presentations for women’s heart health and volunteered at local health fairs. Pam attended the national American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) conference in September.
NURSING ANNUAL REPORT
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DEPARTMENT REPORTS > Case Management
case management Danielle Rose, BS, RN
Case Management is a multifaceted position responsible for daily clinical review of each patient case within the hospital in order to coordinate and facilitate the flow of a patient’s stay throughout his or her continuum of care. The case manager promotes quality of care in a cost-effective manner from time of admission through time of discharge. They work with a third party such as private/commercial insurance, Medicare/Medicaid, and the Financial Assistance Department for self pay patients, to arrange and secure reimbursement of services rendered on behalf of the patient. Case managers consulted in-house physician advisors Diana Turner, MD, and Bartley Mueller, MD, as well as a physician advisory company, Executive Health Resources, in order to determine appropriate level of care and medical necessity compliance. They continually communicate and interact with physicians, nurses, and other interdisciplinary staff in order to determine the severity of illness/diagnoses being treated, intensity of services/means of treatment, and risk of mortality. The case manager identifies areas of improvement in documentation through close monitoring of clinical documentation, collaboration with physicians and other staff members, and through consultation with the Coding Department. They are able to assist in clarifying documentation to better capture the reason the patient is hospitalized and the kind of treatment is being provided during hospitalization. Case management also works closely with social work ers in order to confirm a timely discharge, while assuring that patient needs are being met.
Case Management has added three new employees to its team. The team now consists of Julie Kautz, RN; Irma Walter, RN; Lois Cannell, RN; Shannon Brown, RN; Shelley Thomas, BSW; Mollie Thompson, RN; Danielle Rose, RN; Vicki McLamb, RN, and Jackie Carter, RN. Supervisor Stephanie Hawley, RN, has transitioned into a newly created position of Audit and Denials Manager while Case Manager Karen Houk, RN, has stepped into the position of Supervisor of Case Management. Pam O’Neal continues to be Director of the Revenue Cycle, overseeing the work of Case Management. Case Management has expectations for the year of 2012 of setting goals to forge ahead with continuing education involving Clinical Documentation Improvement and the case management process. Case Management is also striving to become fully staffed in order to better serve the hospital and concurrently code all Medicare cases daily.
Over the past year, staff members from the Case Management Department have had the opportunity to participate in professional conferences, providing the means to bring back new concepts, strategies, innovations, and knowledge pertinent to the daily workings of the case management process. Stephanie Hawley, RN and Michael Wharton, RN, attended The American Case Management Association (ACMA) National Conference in Orlando, Fla. held last April. Shannon Brown, RN, attended the “Case Management Along the Continuum Conference,” held in Las Vegas, Nev, in October. Regional West was fortunate to hold a Clinical Documentation Improvement (CDI) seminar December, hosting CDI expert Charles Terzian, MD, MPH, MJ.
Case Management staff seated left to right: Julie Kautz, RN; Mollie Thompson BSN, RN; and Danielle Rose BS, RN. Standing left to right: Jackie Carter, RN; Shannon Brown BSN, RN; Shelly Thomas,BSW; Irma Walter, RN; and Karen Houk, RN. Not pictured: Stephanie Hawley, BSN, RN; Lois Cannell, BSN, RN; Vicki McLamb, BSN, RN; and Director Pam O’Neal
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NURSING ANNUAL REPORT
DEPARTMENT REPORTS > Community Health
Community Health Martha Stricker, BSN, RN | Nurse Manager
Martha Stricker, BSN, RN
The Community Health Department at Regional West Medical Center is unique in that the staff, consisting of a Nurse Manager and two RNs, provides services to both the hospital and the county health department. This creative contract arrangement allows for both entities to be active in the public health of Scotts Bluff County. Multiple programs were coordinated for the community and hospital this year.
to leave their car. A walk-in flu clinic at St. Mary Plaza provided an additional 150 more residents with flu shots.
The Nebraska Kids Fitness and Nutrition Day was held on September 20. This event invites 500 plus third graders to the YMCA Trails West Camp where they learn about physical activity and nutrition. Many area businesses provided assistance through the Adopt-A-School program as well as WNCC and UNMC College of Nursing.
The Every Woman Matters program is also housed in Community Health. Terri Allen, Outreach Coordinator, attends numerous community events to promote this program, which assists women in the areas of breast and cervical cancer, diabetes, and cardiovascular health.
A colon cancer awareness and screening kit distribution campaign was held to share information on risk factors and FOBT (fecal occult blood test) kits that were being distributed throughout the community. Over 146 kits were distributed; a state award-winning return rate.
New to the department in the role of Injury Prevention Coordinator is Holly Johnston, BSN, RN. In partnership with Trauma Services, Holly reaches out to the community with information on the top 10 traumas in the region she also educates the community on current hot topics such as concussion legislation and distracted driving.
Community Health is an active partner in Panhandle Regional Medical Response System (PRMRS) staff attends monthly meetings and assists with the coordination of both the county and hospital bio-terrorism and all-emergency preparedness plans. Throughout the year, Community Health also coordinates the quarterly Genetics Clinic, seeing 73 clients and their families. The department coordinated 10 health screenings at area businesses through its involvement with the Panhandle Worksite Wellness Council. Over 300 people received a variety of preventative screenings including lab work, bone density screening, glaucoma checks, and blood pressure checks. Nurses held routine immunization clinics on Wednesdays with both day and evening clinic hours available. Approximately 3,000 vaccines are delivered to children age birth to 19 years. Community Health partnered with Regional West Physicians Clinic to provide another annual drive-thru influenza clinic. This event allowed over 600 residents to receive flu shots without ever having
NURSING ANNUAL REPORT
Community Health also focuses on providing flu shots at area worksites. In 2011, 31 businesses had on-site flu shot clinics for their employees. This resulted in over 500 more flu shots being delivered to residents of Scotts Bluff County.
DETENTION CENTER Martha Stricker, BSN, RN
The Detention Center Medical Services staff spent the last year learning the policies and procedures of a medical oversight company called Advanced Correctional Health Care (ACH). This company works with over 200 jails across the country and provides established protocols and care delivery systems for the corrections environment. It provides health care provider coverage in person or by phone on a 24/7 basis for assistance with medical issues. This company delivered their services beyond what was expected and as such, Regional West Health Services terminated its contract with the Detention Center as of January 20, 2012. This allowed the nursing staff to become employees of ACH and for the hospital and Community Health to focus on the public health needs of the facility.
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Sarah Shannon, Shon Peterson, Michelle Powell at the National Magnet Conference.
DEPARTMENT REPORTS > PHARMACY MEDICATION RECONCILIATION NURSES
Left to right: Consuelo Loera, RN; Candy Hellyer, RN; Ron Ward, BSN, RN; Connie Morrill BSN,
Pharmacy Medication Reconcilliation Nurses
RN; and Karen Perkins, BSN, RN. Not pictured is Tammy Cox, BSN, RN.
Nancy Sloan, PharmD, RPh | Assistant Director
Activities for 2011 Pharmacy Med Reconciliation nurses help maintain a safe environment for patients by: • Obtaining an accurate and complete list of home medications for patients admitted to the hospital for prescriber use.
Historical Statistics: • When Pharmacy Med Rec. began in 2006, pharmacists completed the home medication list started by the admitting nurse. • Pharmacists added, deleted, or clarified 50 to 70 percent of home medication entries.
• Obtaining an accurate and complete list of allergies and their reactions for prescribers, nurses, and pharmacist use.
• Pharmacists added, deleted, or clarified 40 to 50 percent of allergy entries.
• Comparing the patient’s home medications to medications ordered at hospital admission and then notifying prescribers of major discrepancies.
• Pharmacists saw only about 200 patients per month (<30% of admissions).
Statistics: • Pharmacy increased the number of Pharmacy Med Rec. Nurses from three to six in October 2011. • Since then, there is a Pharmacy Med Rec. Nurse in the Emergency Department every day from 8 a.m. to 4 p.m. They see from eight to 25 patients daily. • Since then, there are two Pharmacy Med Rec Nurses on the inpatient floors every day from 8 a.m. to 6 p.m. They see from 14 to 27 patients daily. • The Pharmacy Med Rec Nurses provide Warfarin education for an average of eight to 10 patients weekly.
NURSING ANNUAL REPORT
• Pharmacists completed interventions with prescribers in about 20 percent of patients. • Pharmacy hired three Pharmacy Med Rec. nurses in 2007 to help with the Admission Med Rec. task. • Pharmacy Med Rec. nurses were able to increase the number of patients seen to about 60 percent of admissions during 2008 to 2011. • Today, with six Pharmacy Med Rec. nurses, they see nearly all admissions, and miss less than four percent of patients who are admitted and discharged on the same day. • The number of interventions completed by contacting the prescriber is about 10 to 20 percent of patients seen.
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DEPARTMENT REPORTS > Quality Resource Department
Quality Resource Janice Casey, RN
The Quality Resource (QR) Department assists Regional West Medical Center with Performance Improvement and related quality and safety issues and activities. The department has 10 full time employees, all dedicated to improving quality and safety at Regional West. Seven employees are registered nurses. Each RN has a separate area of focus within the department. All are linked together in a unified effort.
• Patient Safety Executive Rounds project
Janelle Schroeder, MSN, RN Clinical Quality Improvement (CQI) Nurse Coordinator
• Informatics Committee
Janelle has been with the department since November 2006. She obtained her MSN degree in Nursing Informatics from UNMC in 2009. Janelle serves as quality expert, abstractor, data analyst, consultant, and collaborator to all service lines within Regional West Medical Center. As technology and our use of it changes, so do Janelle’s duties. She is the MIDAS + System Administrator and directs the operational aspects of the implementation, maintenance, and on-going use of assigned software applications used in quality processes at Regional West. This includes the provision of ongoing application support for all departments utilizing computer software applications to support quality functions, including risk management, guest services, utilization management, infection control, and several clinical departments. She participates in the orientation and training of all users on accessing computer systems, application updates, changes, and security processes. Janelle is dedicated to research, education, and collaboration on projects that will help Regional West reach optimum quality and safety for our patients.
• Patient Care and Clinical Practice Council Co-Chair
• Healthcare Acquired Infection (HAI) Quality Measures ‑ SSI Surveillance project ‑ CLABSI Surveillance project • Shared Governance Coordinating Council member ‑ CAUTI Evidence-Based Practice (EBP) project ‑ Fall Prevention EBP project • Nurse Pharmacy Committee ‑ Medication Incident Data Analysis • Regional West Foundation Employee Campaign Committee • Meaningful Use Team ‑ CPOE Project and Super User • Cause Analyst • Yellow Belt
Projects and Activities for 2011 and 2012 • Midas+ system upgrade to v2011 • Midas+ DataVision & StatIt implementation • Midas+ Live implementation • Q-Net Administrator ‑ Data review and submission to Q-Net, NHSN, etc. • Electronic Risk reporting
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NURSING ANNUAL REPORT
DEPARTMENT REPORTS > Quality Resource Department
Jeanie Miller, RN, BC Clinical Data Quality Analyst
Linda Armstrong, BSN, RN Clinical Data Quality Analyst
Vicky Stoll, RN Clinical Data Quality Analysis
Jeanie is the newest member of our team. She recently transferred into QR from her position as Regional West Physicians Clinic Family Medicine Nurse Manager. Her job focus is three-fold. She abstracts information from the medical records on global immunization measures, blood utilization review and quality management entries. Jeanie’s knowledge of various aspects of safety and quality measures are a great asset to our team.
Linda has been a valued employee at Regional West Medical Center for 21 years. She has directed her efforts towards improving the inpatient pneumonia, heart failure, and acute myocardial infarction (AMI) core measures as well as outpatient chest pain and AMI core measures for the past five years. Linda is committed to the education of nursing and medical staff and excellence of patient care. Her extensive nursing experience makes her a trusted resource for the QR staff.
Vicky has been employed at Regional West Medical Center for many years. She has been a member of the QR team for over four years. She is a champion for quality and safety in the surgical arena. Her main focus is directed toward the Surgical Care Improvement Project (SCIP) and the Hospital Outpatient Project (HOP). Vicky’s knowledge and experience combined with her dedication to teamwork brings balance to the QR department.
Projects and Activities for 2011 • Implemented new Global Immunization measures
Projects and Activities for 2011
• Prepared QME (Quality Management Entry) reports
• Implemented changes in Core Measures
• Prepared OFI (Opportunity for Improvement) reports
• AMI, CHF, and Pneumonia Inpatient Core Measures
• Blood Utilization reviews
• AMI and Chest Pain Outpatient Core Measures
• Member of Root Cause Analysis team
• Collaborated on revising Policy and Procedures for QR Department electronic reviews
• Back-up for IC in Environmental Infection Control study with UNMC
• Initiating electronic chart reviews to medical staff • Participated in Ethics Committee • Participated in Medical Chart Review Committee • Participated in Medical Committee • CHF Discharge Instruction project • Assisted in training new RN staff with Quality Reviews • Prepared QME reports (Quality Management Entry) • Prepared OFI reports
NURSING ANNUAL REPORT
Projects and Activities for 2011 • Surgical Care Improvement Project (SCIP) core measure abstraction • Hospital Outpatient Surgical (HOPS) core measure abstraction • Implemented changes in SCIP and HOP core measures • Assisted in core measure training and surgical staff education • Collaborated on revising policy and procedures for QR department electronic reviews • Assisted in nursing orientation • Participated in Surgical Committee • Participated in Surgery chart review meetings • Prepared QME reports • Prepared OFI reports • Member of Utilization Review Committee
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DEPARTMENT REPORTS > Quality Resource Department
Kris Henkel, RN Clinical Data Quality Analyst
Janice Casey, RN Clinical Data Quality Analyst
Kris is in her second year as a QR Analyst. She has been a Regional West employee for over 23 years. Her past experience in Utilization Management/Discharge Planning and as an Intake Specialist are valuable and useful to the entire team. Kris has been assisting the Emergency Department with their improvements in safety and delivery of quality care. Kris has a desire to learn as well as to share quality and safety knowledge with others, and that makes her an excellent addition to the QR team.
Janice joined the QR team four years ago as the Perinatal Core Measures Analyst. Her aim is to improve quality and safe care for obstetric, newborn, and pediatric patients. She focuses on collaboration with medical and nursing staff to bring evidenced-based practice to our patients. Janice has added her enthusiasm for patient advocacy to the QR team.
Projects and Activities for 2011
Projects and Activities for 2011 • Perinatal core measure abstraction • OB and Neonatal entries
• Emergency Department (ED) inpatient and outpatient core measure abstraction
• Prepared QME reports (Quality Management Entry)
• ED Audit abstraction
• On-going core measure education and training for OB and Pediatric staff
• Implementation of new Emergency Department quality measures
• Prepared OFI reports
• Participated in Perinatal/Peds Committee
• Member of Root Cause Analysis team
• Participated in Perinatal/Peds chart review meetings
• Prepared QME reports (Quality Management Entry)
• Coordinated and presented nursing orientation education regarding performance improvement, core measures, and electronic incident reporting
• Prepared OFI reports • Member of the volunteer Hospice team • Certified Professional in Utilization Review
• Collaborated with other departments to present Quality and Safety Fair 2009, 2010, and 2011 • Served on the Magnet steering team • Participates annually on Regional West’s in-house United Way Campaign Committee
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NURSING ANNUAL REPORT
DEPARTMENT REPORTS > Quality Resource Department
Amanda Sabo, BSN, RN Infection Prevention and Epidemiology Nurse Amanda became our seventh RN last year when the Infection Prevention Department was integrated into the Quality Resource team. Amanda joins us in our quality and safety efforts by providing daily support and guidance to front line staff. Projects and Activities for 2011 • Daily surveillance of lab reports. • Identified and reported any potential NHSN event including CAUTIS, SSIs, MDROs, VAPS, CLABSIs, etc. to QR analyst.
Hospitals study. This study is a collaborative effort with 3M Corporation and the Department of Defense. • Collaborated and involved in presenting a re-draft of the Infection Prevention Policy Manual. The nurses in the Quality Resource Department are part of a continuous effort to facilitate on-going quality and safe care to our patients.
Quality Resource staff, back row left to right: Amanda Sabo, Janice Casey, Vicki Stoll, Kent Anders, Kris Henkel, Linda Armstrong, and Jeanie Miller. Seated left to right: Margo Ferguson (Director), Janelle Schroeder, and Cleta Gable-Nuss
• Reported communicable diseases to appropriate entity such as local and state health departments. • Weekly environmental rounds as scheduled for Safety and Occupational Health. • Construction-renovation risk assessment meetings as needed for projects within the facility. • General and patient services orientation and training for all incoming staff. • Staff resource for infection prevention questions or training. • Resource for Emergency Management/HICS such as recent black water intrusion. • P and T Committee • Quality and Safety Committee • Currently involved in the University of Nebraska Medical Center Environmental Infection Control in Military
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DEPARTMENT REPORTS > Risk Management
Risk Management Austin Engel, BSN, RN | Risk Manager
Austin Engel, BSN, RN
The Risk Management Department added staff in 2011. With the expansion of physician integration there was a growing need for a Risk Manager Coordinator at the Physicians Clinic. Barb Lundgren, who served as the Risk Manager for Regional West Medical Center, has switched her focus to the Regional West Physicians Clinic. Austin Engel is now the Risk Manager for Regional West Medical Center. Risk Management now reports to Paul Hofmeister, VP/General Counsel. Austin will continue to work closely with the Quality Department on root cause analysis investigations, and the review of all risk incident reports. Risk management also continues to support the ongoing culture of safety initiative in an effort to provide the safest care to our patients. Risk Management works very closely with Connie Ruff in Guest Relations to address and resolve patient complaints, concerns, and grievances to promote patient satisfaction. This relationship with Guest Relations allows for early detection of issues that may lead to litigation later. The Mountain States Healthcare Reciprocal Risk Retention Group risk assessment is planned for April 18 and 19. This will be an on-site visit to evaluate our risk management program.
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DEPARTMENT REPORTS > TRAUMA SERVICES
Trauma Services
Shermaine Sterkel, BSN, RN, CCRN | Trauma Nurse Coordinator
Trauma Services had another busy year with 535 trauma patients entered into the Trauma Registry. Of those, 171 were trauma team activations with 64 full trauma team activations and 121 partial trauma team activations.
Shermaine Sterkel, BSN, RN, CCRN
Trauma outreach was coordinated by Katie Corey, Trauma Registrar and Performance Improvement (PI) Coordinator, and Shermaine Sterkel, BSN, RN, Trauma Program Manager, in Trauma Region 4 referral hospitals. This outreach consisted of training new trauma registrars and trauma nurse coordinators in our region and focused reviews to ensure the Basic Level Trauma Centers meet the state trauma criteria as set in the State of Nebraska rules and regulations. Region 4 Performance Improvement meetings were held in Chadron and Scottsbluff. These meetings were led by Rommie Hughes, MD, Trauma Medical Director of Regional West Medical Center and Region 4.
Katie’s position has been posted seeking a new trauma registrar and PI coordinator. Holly Johnston, BSN, RN, accepted the Injury Prevention Coordinator position. She is located in Community Health under Martha Stricker, BSN, RN. Holly is busy organizing educational presentations regarding Nebraska’s new Concussion Law (LB 260). Holly also enters data into the National Electronic Injury Surveillance System (NEISS). The NEISS system is statistically valid injury surveillance and follow-back system composed of 100 hospitals strategically located throughout the United States (U.S.). This system has been in place for over 30 years. The primary purpose of NEISS has been to provide timely data on consumer product-related injuries occurring in the U.S.
A Trauma Nurse Coordinator course was completed for on-line learning through the Academy at the Harms Center. Katie Corey had an especially busy year working full time as Trauma Registrar and PI Coordinator as she finished her final year at UNMC in the Bachelor of Science in Nursing (BSN) program. Katie graduated with her BSN degree on December 17, 2011. She is waiting to sit for boards and has accepted a position in Regional West’s Critical Care Unit.
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DEPARTMENT REPORTS > WOUND/OSTOMY CARE REPORT 2011
WOUND/OSTOMY CARE REPORT 2011 Jeanette McFeely, BSN, RN, CWOCN | Unit Manager
Jeanette McFeely, BSN, RN, CWON
Skin Integrity Team, chaired by, Jeanette McFeely, meets the second Tuesday of each month at 12 noon in the Goshen Room. The purpose of the Skin Integrity Team is to educate staff to focus on skin issues, not only the issues that are present, but interventions needed to prevent skin breakdown. This team meets to discuss and educate staff concerning factors that compromise skin integrity; whether that is due to a pressure ulcer, disease process, skin tears, etc. They discuss education, charting screens, reporting, bed surfaces, products, data collection, Performance Improvement projects, and pilot projects. Members assist with the National Database of Nursing Quality Indicators (NDNQI) Quarterly Prevalence Pressure Ulcer Studies, they keep their units informed of educational opportunities offered for wound and ostomy care, and they update their units on new pressure ulcer prevention strategies. The team won the “Most Original and Creative Poster” at the Quality and Safety Fair. The Skin Integrity Team has representation from the following units: RCU, ICU, 2W, 2E, 3rd, 4th, Radiology, Dietary, Physical Therapy, Education, Purchasing, OPS, Infection Prevention, and house supervisors. Of the 20 active members, seven to 13 members attend each meeting, with an average attendance of 10 to 50 percent. Educational opportunities coordinated and presented for employees included:
• “Getting Serious About Preventing Facility Acquired Heel Pressure Ulcers.” • “Basic Colostomy Care and Fistula Management.” • “Fruit of Pressure Ulcer Identification.” • “Mobility and Moisture Strategies that Drive Nurse and Patient Safety Outcomes.” • “WyoBraska Wound Care Conference” and “Hands On” time with vendors. CEUs available. • “Wound Care Education Opportunity for Professional Nurses.” CEUs available. • “Wound Care, Pressure Ulcer Staging, Ostomy care” presentation to the residency class biannually. • Bimonthly presentation to newly hired nursing staff, including pressure ulcer staging, how to make referrals, pressure redistribution devices, and Braden Scale. • Biannually presentation to Nursing Residency program on ostomy care, wound care, and pressure ulcer staging. • Ostomy information added to Regional West web site.
• “Care Plan Interventions for High-Risk Residents.” 1.5 CEUs available.
• Pressure Ulcer Prevention Turn Clocks use.
• “The Nursing Assistant Role in Positioning for Success in Pressure Ulcer Prevention.”
• Z-Flo positioning devices which are used to off load pressure on heels.
• “Identification of Wounds: Is it or is it NOT a Pressure Ulcer?” 1.5 CEUs available.
• Algorithm for heel pressure ulcer prevention.
• “Identification and Optimal Treatment of Perineal Ulcers.” 1.5 CEUs available.
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• Quality and Safety Fair. Presented a poster on Pressure Ulcer Prevention.
• KCI home VACs now available in CS for approved dismissals.
• “Skin News” in the Magnetic Times.
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DEPARTMENT REPORTS > WOUND/OSTOMY CARE REPORT 2011
NDNQI Quarterly Prevalence Pressure Ulcer survey: One day each quarter, all inpatients are assessed for pressure ulcers. The purposes of the pressure ulcer survey are to: 1.) Determine the rate of hospital-acquired pressure ulcer occurrence 2.) Determine the rate of unit-acquired pressure ulcer occurrence and 3.) Explore the relationship between nursing assessments performed, interventions used, and pressure ulcer development. At each quarterly survey the auditing nurses review pressure ulcer staging along with the importance of providing an accurate survey and doing a thorough assessment on all patients. Prevention interventions are recommended to staff nurses along with stressing the importance of charting ulcers present on admission (POA). Below are the statistics of 2011 results: 2011 Pressure Ulcer Prevalence Study Results # of Patiens Assessed
Total # of Pressure Ulcers
# of Present on Admission (POA)
# of Hospital Acquired (HA)
February
61
9
5
4
May
68
11
1
10
August
57
5
5
0
October
57
3
2
1
Date
These results have improved from 2010 data: February four POA and 12 HA; May 15 POA and 10 HA; August seven POA and three HA; and November seven POA and five HA. Our goal is to have zero hospital acquired pressure ulcers. Outpatient Wound/Ostomy Clinic Number of patient appointments/year 2009
2010
2011
Consultants Initial appt.
Year
165 (16%)
151 (8%)
209 (11%)
F/U with Physician
118 (12%)
348 (20%)
376 (19%)
Wound/Ostomy F/U
726 (72%)
1254 (72%)
1374 (70%)
1009
1753
1959
Total
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The Outpatient Wound/Ostomy Clinic is located at Regional West Medical Plaza North, Suite #1400. The clinic is held on Monday, Wednesday, and Friday of each week. New patients are seen by the rotating medical staff and follow-up visits are scheduled as needed. The medical staff include: Melissa Stade, MD and Jason Walsh, MD, with Regional West Physicians Clinic-Surgery-Vascular Diagnostics; and Mark Willats, DPM, FACFAS, with Western Plains Foot Center. Dr. Walsh serves as Medical Director. He achieved his Wound Specialist Certification this year. The nursing staff includes: Rachelle Noe, BSN, RN; Amy Mosteller, NA-C; and Jeanette McFeely, BSN, RN, CWOCN. As needed staff includes: Pat Takuski, BSN, RN, and Anna Robles, LPN-C. The Wound/Ostomy Clinic has increased the number of new patients seen each year, as demonstrated in the table above. We use advanced dressings and skin substitutes to facilitate closure in difficult non-healing wounds. We see ostomy patients who have skin breakdown or pouching issues.
Ostomy Report 2011 A total of 39 ostomy patients were seen this year for ostomy instruction Ostomy Patients seen in 2011 # of New Patients
# of Patients with Ostomy For >1 Year
Colostomy patients
17
3
Ileostomy patients
14
3
Urostomy patients
0
2
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Shared governance reports Care and practice council Rebecca Montanez, BSN, RN | Council Chair
Rebecca Montanez, BSN, RN
2011 was a busy year for the council. Most of the first part of the year was finishing up CAUTI (catheter-acquired urinary tract infection) education. In 2010, the committee succeeded in doing the research, making policy and procedural changes, and understanding and planning for work flow changes that would take place. The education was implemented house wide for anyone providing care to patients who had catheters, including RNs, LPNs, and CNAs. Seventeen classes were held over a two-month period. A urinary catheter removal protocol was also implemented to help nurses be more proactive in getting urinary catheters out sooner. The CAUTI rate dropped from 4.8 in the fourth quarter of 2010 to 1.75 in the fourth quarter of 2011.
Teaming up with the Education Department, the committee looked at the subjects that need be covered in the residency program and helped come up with educators who are experts in those particular areas. Co-Chair Billy Harris stepped down to pursue other opportunities. Janelle Schroeder from Quality Recourses stepped into the role and has done a fantastic job. The plan for 2012 is to look at Regional Westâ&#x20AC;&#x2122;s Fall Prevention Program and make some needed revisions and improvement.
The committee revisited Rounding with a Purpose to identify issues with the failed implementation on the pilot unit. Some modifications were made to the system as well as added education. The committee then took it to nursing leadership and there it was determined that it would be the Unit Practice Councilâ&#x20AC;&#x2122;s responsibility to educate each unit. Managers and directors would be responsible to hold staff accountable for using the system and available tools. Some of the tools include: pen lights, because flash lights were so intrusive; Pressure Ulcer Prevention (PUP) clocks, which help remind the staff to reposition patients every two hours; and pocket cards that help remind the staff of what to check when rounding. This education was completed in December.
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Evidence‑Based practice council Kim Meininger, RN, ONC | Council Chair
Kim Meininger, RN, ONC
The Evidenced-Based Practice (EBP) Council selected a model to guide Regional West Medial Center staff to better facilitate and utilize EBP. This model is known as the Iowa Model, and encourages nurses to question their practices and continually seek to improve quality and safety for patients and families, staff, and the organization. Practice questions or “triggers” start the EBP process by recognizing a problem in patient care or guiding staff members to gain new knowledge that makes them question their current standard of practice. Once the problem has been identified, the model then takes you step by step in the EBP process to the implementation phase.
Kim Meininger, RN, ONC; Susan Backer, MSN, APRN-CNS, ACNS-BC; and Librarian Michele Parks, BA teach these sessions. 2011 is the second year for our monthly Journal Club. Each month a research article is selected and staff learn how to critique and analyze the article. Regional West nurses are now able to recognize what type of research was done in the chosen article, and can decide if the research was reliable for practice change at the bedside.
Anyone can contact the EBP council for further assistance with an EBP project. The council has their own email, EBPC@rwmc.net, located on the Regional West Health Services home page<employee resources<nursing resources< Evidence-Based Practice Toolkit and Journal Club. One of the barriers with EBP is lack of knowledge related to the EBP process. To help overcome this barrier, EBP education was provided in three sessions. The first session focused on the seven steps of EBP and a problem question. Sessions two and three focused on literature research and critiquing research respectively. These sessions will be offered yearly.
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Nurse/physician council Amanda Miller, BSN, RN, OCN | Council Chair
This past year the Nurse Physician Council has continued to strive to improve communication between nurses and physicians. The council developed a standardized rounding system, Team Rounding. The goal is to have the physician and nurse round together on the patient 100 percent of Amanda Miller, BSN, RN, OCN the time. Desired results of Team Rounding are improved patient care, improved coordination of care, improved customer/employee satisfaction, reduced potential errors, and reduced phone calls to providers. The council also produced a hospital-wide nurse survey that asked about the top three barriers to providing safe patient care. Survey results were provided to each nursing director. From those surveys the council has been working to develop a more efficient and updated provider call list.
Quality and Safety Council Kim Meininger, RN, ONC | Council Chair
The Quality and Safety Shared Governance Council developed a sub-group to work on Unit to Unit Hand-Off Communication. Communication is the third most common cause for errors within our facility, so the purpose of this committee was to develop a standardized handoff between all caregivers. A handKim Meininger, RN, ONC off is a transfer and acceptance of patient care responsibility achieved through effective communication. It is a real-time process of passing patient specific information from one caregiver to another or from one team of caregivers to another for the purpose of ensuring the continuity and safety of the patientsâ&#x20AC;&#x2122; care. The hand-off communication process here at Regional West states that every time a physical hand-off occurs there will be a face-to-face interaction. When there is a change in level of care and/or a change in a patientâ&#x20AC;&#x2122;s condition, a verbal and/or written hand-off communication is required. Mandatory education classes began in February 2012 to share this process change to staff in our facility. The second project this council started to work on late in 2011 is hand hygiene. The group is using the Targeted Solutions Tool (TST) that was developed by the Joint Commission Center for Transforming Healthcare. This project focuses on improving and sustaining hand hygiene compliance. WNCC College of Nursing students began helping with observations in early 2012. In October, the group elected a new chair and co-chair. Liz Ossian, BSN, BS, RN, from the Medical/Oncology Unit was elected Chair and Christy Jay, BSN, RN, from Surgery was elected Co-Chair. Barb Lundgren stepped down as the Management Advisor and Austin Engel stepped into that role.
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Professional Practice Council Michelle Powell,RN‑C | Council Chair
We worked on several projects throughout the year, which included:
Two of the council members, Lenna Booth and Mary Lockwood, with input from the council, developed a professional poster explaining the CRT. This was presented at the Magnet Fair and will be displayed in the CRT Department.
The Nursing Clinical Ladder
First Annual Magnet Nursing Awards
The council scheduled an all day work session this year to complete the revisions/review in a timely manner so that we could focus our attention on other projects throughout the year. We had received several constructive suggestions regarding wording of the ladder and possible additional skill sets which we took into consideration during the review process. The newly revised ladder is more user friendly with several new positive additions made to the previous ladder.
The council was honored to recognize nurses/staff for their contributions to the hospital and our patients based on nominations from other staff. The first annual Magnet Nursing Awards were presented to the recipients during Nurses’ Week celebrations. Each winner received a framed certificate and a monetary award, as well as a cake to share with his or her co-workers. The awards were personally delivered to recipients by Shirley Knodel, Susan Backer, and various council members. Recipients were also recognized at the Nurses’ Day Workshop. We look forward to continuing this opportunity to recognize staff each year.
The Professional Practice Council’s mission is to promote and support the professional nurse through a positive work environment.
Michelle Powell, RN‑C
The Clinical Rescue Team (Float Pool) An exciting project was to help develop guidelines and recommendations for the new float pool, which we titled the Clinical Rescue Team (CRT). The group contacted several other hospitals that currently have float pools and asked a list of questions regarding how their pools functioned, etc. This data was put into a spreadsheet with a list of recommended guidelines for how we envisioned a Regional West float pool could operate. Sarah
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Shannon, CRT Director, reported to the council that she used many of our recommendations when developing the new department.
Details about the 2011 winners can be found on page 15. Upcoming agenda items will include researching and discussing the effects that staff wearing color-coded scrubs has on patient satisfaction and safety. There is an ongoing review and revision of clinical ladder every year.
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education department Julie Schaff, BS Ed, MS Ed Ad | Unit Director
Peer-reviewed nursing contact hours A little number crunching for you: • In 2010, 972 nurses participated in peer-reviewed nursing contact hour activities. • In 2011, 1,925 nurses participated in peer-reviewed nursing contact hour activities. This is a 195 percent increase! • In 2010, 26 different peer-reviewed activities were offered. • In 2011, 72 different peer-reviewed activities were offered. That’s an increase of 277 percent!
• The figures above do not include all of the Staff Safety Behavior classes that were offered. Every Regional West employee attended this three-hour class, which of course included all nurses! • Four peer-reviewed contact hour activities were offered via Telehealth and we had many facilities participate outside of Regional West. This serves our departmental goal of serving the region, not just Regional West Health Services. • Ten of the activities were open to outside facilities to attend in person, with three activities being presented at our critical access hospitals. • 191.25 non-peer reviewed contact hour activities were offered, and included 1,937 participants for non-peer reviewed contact hour activities.
• In 2010, a total of 58.15 contact hours were offered. • In 2011, a total of 135.29 contact hours were offered. Another significant increase: 233 percent!
Left to right: Dallas Schaffer, BS; Julie Schaff, BS Ed, MS Ed Ad, director; Brooke Borgman, BSN, RN; Marilyn Noel, BSN, RN; Michele Parks, BA; and Carol Gifford, BS. Not pictured: Kathy Scott, BSN, RN.
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2011 Educational Activities Provided for Contact Hours Total # of Participants 63
# of Sessions
Contact Hours (CH) per Session
9
1.0
EBP Session #1: Creating a Vision for Evidence-Based Practice
77
6
2.0
EBP Session #2: Literature Search Strategies
58
8
2.0
EBP Session #3: Evaluating the Evidence
56
6
2.0
Activity Journal Club
Implantable Nerve Stimulators
34
4
1.0
CAUTI (Catheter-Associated Urinary Tract Infection)
315
17
1.5
EMS Conference: Is High Flow Oxygen Killing our Patients? Where There’s Smoke There’s Fire: A Review of Burn Injuries
43
2
2.0
Nursing Education Days: Medical/Surgical Units Topics: Sepsis Hospice Care and Palliative Care; There is a Difference Family Witnessed Resuscitation
380
9
Nurses Day: The Spirit of Caring: To Love What You Do, to Know That It Matters. How Can There Be Greater Joy?
226
2
3.4
A Lifesaver from the Start: Recommendations for EvidenceBased Best Practices for Breastfeeding
149
2
3.0
Do You Hear What I Hear?
142
2
3.0
Kids Kare Team Training
59
2
2.25
Please Don’t Take My Breath Away
21
1
2.75
Who Are They and What Do We Do?
25
1
1.0
The Rhythms of Life
13
1
3.66
Transport of the High Risk OB Patient
15
1
9.75
Wyo-Braska Wound Care Conference
173
1
4.0
If a Stork Can Deliver Babies, So Can You!
30
1
3.0
Advanced Airway Management in the Complicated Patient
46
1
10.08
1,925
76
60.39
Totals
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1.0/topic 3.0 total
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The Education Department coordinated opportunities for panhandle health care providers to certify or renew certifications in the following classes. A large number of participants were Regional West nurses. They received this training at no charge. Advanced Cardiac Life Support (ACLS) Five provider and four recertification courses offered: Provider (Certification): 74 participants Renewal (Recertification): 59 participants Total: 133 Pediatric Advanced Life Support (PALS) Six sessions offered: Provider (Certification): 108 participants Renewal (Recertification): 53 participants Total: 161 Trauma Nurse Core Course (TNCC) Three sessions offered: Total: 59
 Patient Satisfaction Scores Patient Satisfaction Scores Composites (% Always) 2010 2011
Goal
Communication with nurses
81
80.3
>80%
Responsiveness of hospital staff
64
70.2
>80%
Pain management
74
77.1
>80%
Communication about medications
64
68
>80%
90
90.5
>80%
65
65.5
>80%
Overall rating of this hospital (nine or 10)
69
69
>80%
Willingness to recommend this hospital (Definitely Yes)
72
72.1
>80%
Discharge Information Composite (% Yes) Discharge information Hospital Environment Issues (% Always) Quietness of hospital environment HCAHPS Overall Ratings
Neonatal Rescusitation Program (NRP) Six sessions offered: Total: 60 At the end of 2011, one of our new directors requested that we also provide an Emergency Nursing Pediatric Course (ENPC) and she wanted to make it a staff requirement. The courses will also be offered in 2012. Our Education Department works with the Rural Nebraska Healthcare Network to provide these and other learning opportunities not only at Regional West, but also across the Panhandle.
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Regional West Medical Center Certified Nurses Nurse Susan Backer, APRN-CNS John Beard, RN Ione Beavers, RN Leslie Biggs, RN Mike Bokelman, RN Kim Brown, RN Chris Buhr, RN Max Bull, RN Jessica Conn, RN Mary Coon, RN Pam Cover, RN Robin Cushing, RN Rich Dermer, RN Dayna Dondelinger, RN Lisa Fabricus, RN Linda Fowler, RN Cindy Francisco, RN Trish Garner, RN Ramona Giles, RN Darlene Gjovik, RN Sheli Goodwin, RN Rhonda Groshans, RN Tania Hanks, RN Richard Harriger, RN Diane Hartwig, RN Darcy Haslam, RN Stephanie Hawley, RN Shawn Hays, RN Sandy Hebbert, RN Kristi Henkel, RN Stacy Ingersoll, RN Peg Jackson, RN Kathy Jacobson, RN Christy Jay, RN Lori Joplin, RN Julie Kautz, RN Sheila Kilthau, RN Donna Klein, LPN Billie Kniss, RN Amanda Lashley, RN Alice Leider, RN Tami Leis, RN NURSING ANNUAL REPORT
Certification Clinical Nurse Specialist Adult Health and Illness (ACNS-BC) Peripherally Inserted Central Catheter (PICC) Insertion Certification Oncology Certified Nurse (OCN) Oncology Certified Nurse (OCN) Peripherally Inserted Central Catheter (PICC) Insertion Certification Certified Nurse Operating Room (CNOR) Orthopedic Nurse Certified (ONC) Certification in Critical Care (CCRN) Certification in Critical Care (CCRN) Certified Inpatient Obstetrics Nurse (RNC) Certified Rehabilitation Registered Nurse (CRRN) Certified Inpatient Obstetrics Nurse (RNC) Psychiatric and Mental Health Certified (RMHN) Certified Nurse Operating Room (CNOR) Medical/Surgical Board Certified Nurse (CMSRN) Certification in Critical Care (CCRN) Certified Lactation Counselor (CLC) International Board Certified Lactation Consultant (IBCLC) Certified Emergency Room Nurse (CEN) Certified Flight Registered Nurse (CFRN) Certified Inpatient Obstetrics Nurse (RNC) Certified Rehabilitation Registered Nurse (CRRN) Psychiatric and Mental Health Certified (PMHN) Certified Nurse Operating Room (CNOR) Certified Emergency Room Nurse (CEN) Certified Flight Registered Nurse (CFRN) Medical/Surgical Board Certified Nurse (CMSRN) Certified Nurse Operating Room (CNOR) Accredited Case Manager (ACM) Certified Rehabilitation Registered Nurse (CRRN) Certified Perioperative Anesthesia Nurse (CPAN) Certified Professional Utilization Reviewer (CPUR) Certified High Risk Neonatal Nursing Certified Lactation Counselor (CLC) Certified Perioperative Anesthesia Nurse (CPAN) Certified Emergency Room Nurse (CEN) Certified Nurse Operating Room (CNOR) Certified Emergency Room Nurse (CEN) Certified Professional Utilization Reviewer (CPUR) Resident Assessment Coordinator - Certified (RAC-CT) GI Technical Specialist Certificate from Society for Gastroenterology Nurses and Associates (SGNA) Certified Perioperative Anesthesia Nurse (CPAN) Certified Emergency Room Nurse (CEN) Certified Emergency Room Nurse (CEN) Psychiatric and Mental Health Certified (PMHN)
Nurse Kay Lemons, RN Janet Lewis, RN Mary Lockwood, RN Barb Lundgren, RN Kathy Mackrill, LPN Mary Mai, RN Kim Mann, RN Sharon Marlow, RN Sheri McDonald, RN Jeanette McFeely, RN Cindy McGaughy, RN Kim Meininger, RN Tracy Meyer, RN Chris Micheels, RN Amanda Miller, RN Leigh Miller, RN Marilyn Noel, RN Sarah Paetow, RN Paula Hopkins RN Tracy Payne, RN Michelle Powell, RN Jason Rairigh, RN Krissa Randall, RN Andrea Ray, RN Donna Riesen, RN Avis Rogers, RN Susan Schoeneman, RN Tara Shallenberger, RN Sean Shirley, RN Allen Simons, RN Jessica Slaght-Langworthy, RN Lucrecia Spady, RN Shermaine Sterkel, RN Marilyn Stoddard, RN Mona Urwin, RN Dee Vogel, RN Christy Walters, RN Kathi Yost, RN
Certification Certified Perioperative Anesthesia Nurse (CPAN) Certified Nurse Operating Room (CNOR) Certified Nurse Operating Room (CNOR) Certified Professional in Healthcare Risk Management (CPHRM) GI Technical Specialist Certificate from Society for Gastroenterology Nurses and Associates (SGNA) Certified Neonatal Intensive Care Nurse Certified Nurse Operating Room (CNOR) Resident Assessment Coordinator - Certified (RAC-CT) Certified Emergency Room Nurse (CEN) Certified Wound, Ostomy, Continence Nurse (CWOCN) Certified Rehabilitation Registered Nurse (CRRN) Orthopedic Nurse Certified (ONC) Certified Flight Registered Nurse (CFRN) Certified Perioperative Anesthesia Nurse (CPAN) Oncology Certified Nurse (OCN) Certification in Critical Care (CCRN) Orthopedic Nurse Certified (ONC) Certified Emergency Room Nurse (CEN) Certified Vascular Nurse (CVN) Certified Perioperative Anesthesia Nurse (CPAN) Medical/Surgical Board Certified Nurse Certified Flight Registered Nurse (CFRN) Certified Inpatient Obstetrics Nurse (RNC) Certified Perioperative Anesthesia Nurse (CPAN) Certified Inpatient Obstetrics Nurse (RNC) Certified Specialist Healthcare Accreditation (CSHA) Oncology Certified Nurse (OCN) Medical/Surgical Board Certified Nurse Certified Flight Registered Nurse (CFRN) Certified Emergency Room Nurse (CEN) Certified Flight Registered Nurse (CFRN) Certified Pediatric Emergency Nurse (CPEN) Certified Emergency Room Nurse (CEN) Certification for Gastroenterology Nurse Certification in Critical Care (CCRN) Certification in Critical Care (CCRN) Certified Bariatric Nurse (CBN) Certified Flight Registered Nurse (CFRN) Medical/Surgical Board Certified Nurse (CMSRN) Geontology Nursing Certified (BC)
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Breakfast with shirley
May
Jen Madden, Cathy Reifschneider, Lupe Sabala, Keri Wigg. Back row l-r: Tina Hotes, Jessi Whetham, Andrea Spracklin, Brenda Martin, Shirley Knodel, Howard McCormick. Front row l-r:
July
Emily Stull, Shirley Knodel, Brandi Stoller, and Clint Dunker. Back row l-r: Susan Backer, Megan May, Jackie Delatour, Lucrecia Spady, Pam Cover, and Kay Lemons. Not pictured: Trish Garner. Front row l-r:
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June
Shirley Knodel, Lisa Descharme, Pam Cover, Mary Coon. Tammi White, Karen Nietz, Christina Couch, Tara Shallenberger, Trish Garner. Front row l-r:
Back row l-r:
August Front row l-r: row l-r:
Joellen Campbell, Amber Reynolds, Tammie Setter.
Back
: Debbie VanNoy, Becky Avila, Shirley Knodel, Cindy McGaughy,
Mona Urwin.
NURSING ANNUAL REPORT
Breakfast with shirley
September Front row l-r:
Roxie Shaul, Shelly Meisner Andrea Ray Cassie Haeffelin
Back row L-R : Natalie Arnold, Shirley Knodel, Jennifer Chasek, Sophie Dvorak, Cindy McGaughy, Hank Byrd Jamie Kumm Jake Collins, Dee Vogel Not pictured: Ruth Vasquez.
November Front row l-r:
Clint Dunker, Chris Micheels, Sean Shirley.
Whitney Luce, Megan May, Shawna Conn, Whitney Burch, Shirley Knodel, Kerrie Wigg, Joe Salazar.
Back row L-R :
October
Peg McFarland, Shirley Knodel, Elva Garcia. Michelle Dillon, Cindy Francisco, Nate Walker, Mary Sue Larson, Tracy Payne Not pictured: Leslie Biggs
Front row l-r: Back row l-r:
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Nurse Residency Class Number Six, Graduated May 2011
Front row l-r: Stephanie West, Jenny Stamen, Rich McGlynn, Lindsey Green, Kindra Rodgers, and Danielle Schell. Back row L-R : Rebecca Hubbard, Sarah Brunson, Mary Sue Larson, Travis Hargreaves, Laura Ulmer, Jessi Whetham, and Sara Maika. Not pictured: Laramie Johnson, Carrie Snygg, Jenny Mathine, Kristin Ferguson, Amee Jaskowak, and Jenny Baltz.
Nurse Residency Class Number Seven, Graduated November 2011
Whitney Burch, Megan May, Liz McKee, Chase Engel, Micki Votruba, Tanya Verbyla, and Susan DeBlieck.
Front row l-r:
Back row L-R : Brooke Borgman, Residency Coordinator; Megan Neely; Traci Wobbenhorst; Kylie Sauter; Michelle Dillon; Brittany Chlopek; Luke Osler; Michelle Cramer; Becca Burke; and Tammy Cox. Not pictured:Dustin Bruckner, Candice Lowry, Sarah Reinhardt, Nicole Rotert, and Rebekah Schoenecker
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NURSING ANNUAL REPORT
American Nurses Association Code of Ethics for Nurses 1. Respect for Others: The nurse, in all professional relationships, practices with compassion and respect for the inherent dignity, worth, and uniqueness of every individual, unrestricted by consideration of social or economic status, personal attributes, or the nature of health problems. 2. Commitment to the Patient: The nurseâ&#x20AC;&#x2122;s primary commitment is to the patient, whether an individual, family, group, or community. 3. Advocacy for the Patient: The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.
American Nurseâ&#x20AC;&#x2122;s Association Bill of Rights for Registered Nurses Registered nurses promote and restore health, prevent illness, and protect the people entrusted to their care. They work to alleviate the suffering experienced by individuals, families, groups, and communities. In so doing, nurses provide services that maintain respect for human dignity and embrace the uniqueness of each patient and the nature of his or her health problems, without restriction or regard to social or economic status. To maximize the contributions nurses make to society, it is necessary to protect the dignity and autonomy of nurses in the workplace. To that end, the following rights must be afforded.
4. Accountability and Responsibility for Practice: The nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurseâ&#x20AC;&#x2122;s obligation to provide optimum patient care.
1. Nurses have the right to practice in a manner that fulfills their obligations to society and to those who receive nursing care.
5. Duty to Self and Duty to Others: The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.
2. Nurses have the right to practice in environments that allow them to act in accordance with professional standards and legally authorized scopes of practice.
6. Contribution to Health care Environments: The nurse participates in establishing, maintaining, and improving health care environments and conditions of employment conducive to the provision of quality health care and consistent with the values of the profession through individual and collection action.
3. Nurses have the right to a work environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for nurses and its interpretive statements.
7. Advancement of the Nursing Profession: The nurse participates in the advancement of the profession through contributions to practice, education, administration, and knowledge development. 8. Promotion of Community and World Health: The nurse collaborates with other health care professionals and the public in promoting community, national, and international efforts to meet health needs. 9. Promotion of the Nursing Profession: The profession of nursing, as represented by associations and their members is responsible for articulating nursing values, for maintaining the integrity of the profession and its practice, and for shaping social policy.
NURSING ANNUAL REPORT
4. Nurses have the right to freely and openly advocate for themselves and their patients, without fear of retribution. 5. Nurses have the right to fair compensation for their work, consistent with their knowledge, experience, and professional responsibilities. 6. Nurses have the right to a work environment that is safe for themselves and their patients. 7. Nurses have the right to negotiate the conditions of their employment, either as individuals or collectively, in all practice settings.
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