Nursing Annual Report

2012

NURSING ANNUAL REPORT

Compiled by | Jordan Colwell, MHA, BSN, RN Contact | Jordan Colwell, MHA, BSN, RN P 308.630.1450 E Jordan.Colwell@rwmc.net 4021 Avenue B Scottsbluff NE 69361

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Table of Contents Message From The CEO 4 Message From The CNO 5 Shared Governance Magnet Update 6 Breakfast With Shirley 7 Nurses Day Winners 8 Star Award Winners 10 Patient Safety 12 Behavioral Health Unit 13 Acute Rehabilitation 14 Medical Surgical Services 15 Birth And Infant Care 16 Pediatrics 16 Wound Clinic 18 Float Pool 18 Restorative Care Unit 18 Dialysis 18 Endoscopy 19 Perioperative Services 19 Outpatient Surgery 20 Perianesthesia Care 21 Operating Room 22 Scottsbluff Surgery Center 23 Critical Care/Emergency Services 24 Air Link/Transfer Center 26 Homecare 28 Imaging Services 29 Cardiac Cath Lab 30 Cardiac & Pulmonary Rehab 31 Case Management 32 Community Health 33 Lean Six Sigma 33 Pharmacy Med Reconciliation Nurses 34 Quality Resource 35 Risk Management 36 Trauma Services 36 Wound/Ostomy Care Report 37 Shared Governance Reports 39 Education Department 42 Certified Nurses 43

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MESSAGE from THE CEO

Todd Sorensen, MD, MS | President and CEO, Regional West Health Services

To My Patient Care Colleagues:

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n 2012, the dominant feature in health care was the ongoing focus on reforming the health care system. During 2012, we saw some continued softness in inpatient volumes, consistent with national trends that emphasize for us the importance of efficiency as we deliver services to our neighbors. Regional West is very much involved in efforts to modify the health care system so it can do a better job of providing necessary care, and of identifying and eliminating care that might not be necessary. To support this effort, we are exploring options for collaboration with other organizations, since the resources required to engineer and implement these changes will be quite substantial.

We have been challenged by the national information technology requirements (“Meaningful Use”), and are making good progress in this regard, though not without some minor trauma along the way. Virtually every organization with whom I have the opportunity to confer is experiencing similar challenges with IT, yet developing competent electronic records systems is an absolutely essential component of making the move from the episode-based care we’ve known from the time

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of Hippocrates to the continuing care systems of the future. We will prove equal to these challenges.

We continue to make progress in our efforts to improve the safety of the care we provide for our patients. 2012 saw the occurrence of a few serious safety events, which we studied for understanding and insight into causes. In each situation, we were able to identify and correct system problems, thus making future similar events much less likely. We must continue with our intense focus on safety, and we can do so with confidence that the knowledge we have gained in application of safety techniques has made Regional West a much safer care provider.

Thanks for all you do, for our patients and for Regional West.

Todd Sorensen, MD, MS

MESSAGE from THE CnO Shirley Knodel, MS, RN | Chief Nursing Officer/Vice President Patient Care

Regional West Medical Center

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f I were to select one thing that I would celebrate for nursing accomplishments at Regional West in 2012, it would be Shared Governance. Every single council has been comprised of dynamic nurses who are dedicated and goal oriented. It has been a true joy to watch their accomplishments.

This was validated in the RN satisfaction survey that showed improvement in all areas of the Adapted Index of Work Satisfaction scores, and improvement in two of three of the Nursing Work Index T-scores, with the third remaining essentially the same. In both scales, the results were in the moderate to high satisfaction score ranges. The Job Enjoyment Scale measurement overall improved and is in the moderate range of 75 percent, with 204 of our RNs completing the survey. What this means is that on our journey to having highly satisfied nurses, we made some progress and know what areas to work on. The Shared Governance Councils, along with the Nursing Leaders, will focus this year on “Professional Development” and “Meal Breaks.” We hope that the 2014 survey continues to show further improvement in RN satisfaction. We need input from all RNs to make sure we stay on the right track!

One of the additional challenges we have to overcome for Magnet designation is the 2013 requirement that all nursing managers and directors have a bachelor’s degree in nursing.

The deadline for this to be accomplished is December 31, 2015.

Additionally, for the first time we have slipped slightly below the required 80 percent of our RNs being bachelor’s prepared.

This is something that will continue to be addressed by the Professional Practice Council and the Nursing Leaders. We need associate degree RNs to continue to achieve their bachelor’s degree in order for Regional West to be eligible to apply for Magnet status.

Many of you are probably wondering “How can we focus on Magnet when we are being faced with all of the challenges and changes in health care and in our US and local economies?”

I will respond by asking, “How can we afford not to?” Magnet designation has been shown to increase staff satisfaction, increase retention, lower vacancy rates, and reduce costs to the organization through lower turnover rates, reduction in RN agency use, as well as improving patient satisfaction and quality and safety outcomes. Drenkard’s study on Magnet versus nonMagnet hospitals showed non-Magnet hospital RN turnover rates at 15 to 18 percent compared to 11.14 for Magnet hospitals and RN vacancy rates of 3.64 percent at Magnet hospitals while it ranged from 8 to 16 percent at non-Magnet hospitals. In a rural area where it is even harder to recruit and retain nurses the case for Magnet becomes even stronger.

Shirley Knodel, MS, RN Drenkard, K., The Business Case for Magnet, JONA June 2010, Vol. 40, No. 6, Lippincott Williams and Wilkins, and Lacey, S. et al. Nursing Support, Workload, and Intent to Stay in Magnet, Magnet-Aspiring, and Non-Magnet Hospitals, JONA April 2007, Vol. 37, No.4 Lippincott Williams and Wilkins).

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2012 SHARED GOVERNANCE MAGNET Update

F. Jordan Colwell, MHA, BSN, RN | Survery Preparedness/Magnet Coordinator

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012 marked my first year as Magnet Coordinator for Regional West Medical Center. Throughout the year, I was busy immersing myself into the Magnet Culture and language. I attended a Magnet Workshop in Ft. Collins, Colo. in September 2012 and the Magnet Conference in Los Angeles, Calif. in October 2012. During these two meetings, I learned a lot about the Magnet program and have a passion for it. I continue to work hard making sure that staff knows that Regional West is still on the journey towards Magnet status. By December 1, 2015, 100 percent of our managers and directors must have a bachelor of science degree in nursing (BSN) in order for our hospital to apply for Magnet designation. Currently, 75 percent of our managers and directors have their BSN. The American Nurses Credentialing Center states that 80 percent of registered nurses must obtain a degree in nursing (baccalaureate or graduate degree) by 2020.

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2012 was also a busy year for the Patient Services Shared Governance Councils, including adding a new council to the model, which is called Night Shift. The Night Shift Council’s mission/vision is: Will focus on evidence-based behavior, environment, and practice changes to influence patient satisfaction scores, consistently achieving top-box score in all areas. This council evolved with its first organizational meeting in December 2012. I am excited to see how this council grows in 2013. I am also excited for you to read each council report in this publication.

We will continue striving towards our overall goal of becoming a Magnet designated hospital, but we cannot do it without everyone’s support and help.

All the best, Jordan

Snapshots from 2012: Breakfast With Shirley

FROM TOP: June Breakfast With Shirley, July Breakfast With Shirley, November Breakfast With Shirley, September Breakfast With Shirley, October Breakfast With Shirley.

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2012 NURSES DAY AWARDWinners Virginia is recognized by the Emergency Department staff for this award because of all she does to improve patient care while ensuring a clean and safe environment while brightening the gloomiest of days with her presence.

Friend of Nursing

Outstanding LPN

Virginia Salazar Environmental Services

Teresa Elliot, LPN Imaging Services

Sheri was given this award for excellent mentoring to “old� and new staff in the Emergency Department.

She is knowledgeable, approachable, and the epitome of a caring nurse.

Empirical Outcomes Sheri McDonald, RN Emergency Department

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Teresa was recognized by her co-workers for her professionalism and genuine caring attitude toward patients. She is a team player and is willing to help out whenever and wherever she is needed.

Nina works hard to improve staff efficiency and patient outcomes. She consistently works in collaboration with inter-disciplinary partners to achieve high-quality patient outcomes.

Exemplary Professional Practice Marina Palomo, RN Interventional Radiology

Susan was been heavily involved with the establishment of the Shared Governance Councils in Nursing as well as preparing for Magnet Status. She is a role model for how to participate in the shared governance process.

Structural Empowerment

Susan Backer, MSN, APRN-CNS, ACNS-BC Clinical Nurse Specialist/ Patient Safety Officer

Transformational Leadership

Karna Kleager, RN Perianesthesia Care Unit and Outpatient Surgery Manager

Karna is a supervisor of two busy departments and does an excellent job of guiding her staff. She is an advocate for patient satisfaction, involves staff in decision-making processes, and stays very visible on the units.

Student nurses wanted to recognize RNs who have done an outstanding job precepting them in their clinical experience. Here’s what one student had to say about Chris: “She honored my approach to learning and provided me with resources and experiences to help me better understand important concepts.

She has supported me while encouraging me to find ways to improve. Chris has taught me to think, to trust my intuition, and has consistently demonstrated how to treat all patients with respect and kindness.”

Linda was given the New Knowledge, Innovations and Improvement award by staff and pharmacy for working hard to keep up with the latest evidencebased practice, educating staff on new practices, and working collaboratively with physicians and pharmacists to develop protocols for care in the ICU/PCU setting.

Outstanding Preceptor of Nursing Students Chris Micheels, RN Perianesthesia Care Unit

New Knowledge, Innovations, and Improvement

Linda Fowler, RN Clinical Coordinator Cardiac Intensive Care Unit

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2012 STAR AWARDS PRESENTED TO Nurses

Joe Salazar, RN 3rd Floor, Medical/Oncology

Chris McNurlin, RN House Supervisor

Will Branham, RN Emergency Department

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Don’t try to hide from Joe Salazar! He will track you down! That is what happened when a patient was accidentally sent home with the wrong medicine: Joe and a pharmacist contacted the physician and then tried to reach the patient by phone but were unsuccessful. So what did Joe and the pharmacist do? Jumped in the car and went to the patient’s home to straighten out the medications. Without their diligence and

persistence, the patient may have had an adverse reaction due to the error. Joe was also nominated as a STAR for his willingness to pitch in whenever and wherever needed.

The weekend crew thought he went above the call of duty when they were short staffed and he came in and helped tremendously, even though working a shift like that is not technically his job as a clinical coordinator.

It can be a very difficult situation when you are both a hospital employee and a patient’s family member at the same time. One of our nurses found herself in that situation when her grandmother was a patient at Regional West. Although the nurse was on duty on a different floor, she knew as soon as she heard the Rapid Response call that it was for her grandmother. Chris McNurlin, a house supervisor, was walking by and encouraged the nurse to go with her to the Rapid Response. With Chris’s guidance, the nurse suddenly transformed into granddaughter and waited outside

the patient’s door. When the patient had stabilized, Chris took the granddaughter into the room and went over the plan of care with her. When the granddaughter could see that her grandmother was going to be fine, she transformed back to nurse and returned to her unit. Later in the shift, Chris stopped by to make sure the “nurse” and “granddaughter” were both doing okay. Later in the week, Chris sent her a message to let her know that she had been thinking about her. For those reasons, the nurse/granddaughter says Chris is her Shooting Star.

The most common patient fear is probably that of needles, yet needles are necessary for the majority of our patients. When caregivers master the art of giving shots and inserting IVs, they become a patient favorite. Will Branham has obviously learned the trick.

One patient said that Will “Put in the most comfortable IV that I’ve ever had.” Another

patient called the experience almost painless.

Everyone agreed that it is his sweet, kind, and caring nature that won them over. Will is a clinical and customer service STAR!

“When Liz comes into your room she has a smile that lets you know that she is here as a nurse because she loves her job and her patients,” said a patient. Another patient told us that we are lucky to have her, but the real winners are the sick patients. “Liz was so caring and patient; she was awesome to watch. Don’t overlook this young lady as she

showed so much class and heart,” she said. Liz received two nominations from patients in one quarter.

Linda Fowler has embraced our dedication to creating a culture of safety at Regional West and serves as a safety trainer. It has been said that Linda does not have the word “no” in her vocabulary when it comes to the interest of Regional West, the ICU, Progressive ICU, and Emergency Department. “Linda has all the

answers to any question, day or night, and can walk you through any procedure if she is not here,” said the employee who nominated Linda for STAR of the Quarter.

Liz Ossian, RN 3rd Floor, Medical/Oncology

Linda Fowler, RN Clinical Coordinator Cardiac Intensive Care Unit

Kelly is a mild mannered, quiet, seemingly shy young nurse but a bulldog when it comes to caring for her patients. After a routine surgery, one of Kelly’s patients was experiencing escalating pain and increased abdominal distension. Kelly contacted the surgeon and first suggested that he come to check on the patient. Kelly’s concern increased after providing the appropriate care resulting in no relief for the patient. She again called the

physician and this time insisted that he come.

She told the doctor (loosely quoted), “You can yell at me when you get here if you didn’t need to come, but you must come!” He did come and immediately arranged to take the patient back to surgery to look for and resolve the issue.

Because of Kelly’s persistence, trust, and belief in herself and her skills as a nurse, she made a difference in the outcome for that patient.

It was a cold, snowy, windy Nebraska morning.

The kind of morning when employees pull their hood up or hat down, and forge ahead into the building. The kind of morning it would have been easy to not notice the young man with a cane struggling to stay upright on the slippery parking lot surface. But Karen Perkins is not the kind of person to miss something like that. She seemed to appear out of nowhere to provide assistance to the visitor. Once she got him to the sidewalk, he thanked her and told her he could make it the rest of the way on his

own. Karen wouldn’t hear of it. She continued to assist him until they were in the building.

“I was so impressed with Karen’s actions that morning; I doubt he could have made it in without falling if it weren’t for Karen’s help.

I could hear parts of Karen’s interactions with this young man and she was very kind and considerate, and I believe she even encouraged him to use our valet services on future visits if the conditions are bad,” said the employee who nominated Karen.

Kelly Moscrip, RN 3rd Floor, Medical/Oncology

Karen Perkins, RN Pharmacy

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2012 Patient Safety Annual Report

Susan Backer

Susan Backer, MSN, APRN‑CNS, ACNS‑BC | Clinical Nurse Specialist/Patient Safety Officer

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he Patient Safety Initiative continued to move forward in 2012 with the addition of a new program and maturing of those already in place. Here are the 2012 highlights: • We started 2012 with a Serious Safety Event Rate (SSER) of 1.19 and ended at 0.86. Though we did not meet our goal of 0.48, the SSER continues to steadily decrease from the 2.42 baseline established in 2010. This reflects all the hard work everyone is doing to keep our patients safe.

• Patient Safety Behavior Training was initiated in general orientation for all new hires in January. New Leader Safety Behavior Training and Physician Safety Behavior Training were incorporated into orientation for new leaders and new physicians.

• Cause Analysis has developed into a robust program that helps determine causes of errors. We use three areas of Cause Analysis: Root Cause Analysis (RCA), Apparent Cause Analysis (ACA), and Common Cause Analysis (CCA). RCA and APA information are put into the big pot called CCA. This gives us information of common causes of error across all different types of errors and departments. CCA results as of September 2012 included 34 cases.

Here are the top six Common Causes of error from this report: Compliance Critical Thinking Attention to Detail

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23.4 percent 23.4 percent 11.7 percent

NURSING ANNUAL REPORT

Knowledge and Skill 11.7 percent Process 8.6 percent Communication 7.8 percent There is much work being done to address these common causes of error.

Margo Ferguson, Director of Quality Resources, heads up this program.

• Safety Coaches is a new program, started in the spring of 2012. This program is co-led by Dylan Cardiff, Safety Officer, and Susan Backer, Patient Safety Officer. Safety Coaches started with 80 participants representing almost every Regional West Medical Center department, as well as representatives from Regional West Physicians Clinic.

Safety Coaches are front line staff who are committed to patient, staff, and environmental safety. They meet monthly to discuss safely issues and learn how to apply the safety behavior tools. The purpose of Safety Coaches is to complement and partner with leaders to help establish peer accountability. Following is a list of roles and responsibilities of Safety Coaches: Communicator and Coach Safety Coaches provide just-intime coaching to help co-workers understand behavior expectations for safety.

Educator Safety Coaches ensure co-workers have a practical knowledge of how to practice these behaviors by providing educational events to their units at least once per quarter.

Role Model Safety Coaches demonstrate and lead the way in our culture change, consistently practicing the safety behaviors and safe practices.

Observer Safety Coaches positively reinforce, by real time interaction with co-workers, the expectations for preventing errors. Observations of use of these behaviors were completed weekly.

Storyteller Safety Coaches seek out opportunities to share our patient safety stories with team members while highlighting error prevention tools.

Partner Safety Coaches, managers, and directors partner to help reach our goal of a Zero Serious Safety Event Rate (SSER).

• Safety Stories continue to be used at the beginning of meetings. Telling the stories helps to convey that safety is a core value and reinforces how to effectively use the safety behavior tools in a variety of situations.

• SSER data shows that the Safety Culture Initiative is working to help us all provide safe care to our patients.

“Individual commitment to a group effort; that is what makes a team work, a company work, a society work, a civilization work.”

Vince Lombardi

Behavioral Health Mary Armstrong, RN | Director, Behavioral Health Unit

Mary Armstrong

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he Behavioral Health Unit (BHU) faced many challenges in 2012. In the midst of shrinking reimbursement, everincreasing regulatory requirements, and additional changes in health care looming just over the horizon, we managed to keep safety and patient care at the forefront.

Rich Dermer functioned as our first safety coach in 2012 and we appreciate his contribution to the safety initiative. We continue to analyze each precursor and near miss safety event to increase our prevention efforts. As a result of this, we changed various processes in 2012 including management of prisoner patients upon admission and increased security processes for visitation on the unit.

Ongoing safety concerns on all behavioral health units include management of the suicidal patient, restraint utilization,high-risk psychotropic medication, and patient falls. 2013 brings more opportunity to work on these key elements of safety through research, analysis, and prevention.

In addition to safety, patient satisfaction is a key concern for the BHU. Unit staff and management are working diligently to increase satisfaction results through post discharge phone calls, daily rounding by a member of the management team, and timely follow up of all patient or family concerns. Patients have responded favorably to these interventions and we are hoping to see the results of our efforts reflected in our satisfaction scores.

Safe and efficient staffing is a challenge everywhere in health care and the BHU is no exception. I am pleased to say that in the past year the BHU maintained “closed unit staffing” (no staff floating in or out), without resorting to travelers or outside staffing assistance. I think this is an indication of the loyalty and commitment of BHU staff for their patients, co-workers, and the organization.

them. Several interns have applied for positions or been hired on the unit which is very exciting. The key to having enough staff for the future lies not only in recruiting but also in “growing your own.” We have several staff members who are continuing their education including two nurses, Penny Thomas and Sherri Shaw, who are pursuing master’s degrees.

Although caring for behavioral health patients is not a calling for everyone, those of us who make the choice to specialize in this area have a passion for our patients and recognize that they are some of our most vulnerable citizens who often face stigma, prejudice, and rejection. Our goal is to act as advocates and improve quality of life for each patient who entrusts us with his or her care.

We have had the pleasure of working with various nursing and therapy interns during the year as well as students from four different nursing programs. We enjoy teaching, but we also learn so much from each of

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acute rehabilitation Tami Bokelman, MSW | Program Director Pam Cover, RN, CRRN | Nurse Manager

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he Acute Rehab Unit (ARU) was fortunate to see growth during 2012. When looking at our patient population, we grew in the areas of patient referrals, patient admissions, total patient days, and our average daily census. We were able to return 76 percent of our patients to their home setting, and only 7.5 percent of our patients returned to an acute care setting. That is almost four percent lower than the national average.

Safety continues to be an important focus on the ARU. Our staff has embraced the consistent use of the SBAR (Situation, Background, Assessment, and Recommendation) and made it a functional tool for our shiftto-shift report. The room-to-room report is an organized process that uses the SBAR as the outline for the sharing of information among staff. Along with this report, the ARU interdisciplinary team meets three times per week to discuss all patients on the unit and to create and follow their Plan of Care.

Part of the Performance Improvement activity on ARU includes the scoring

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Tami Bokelman

of the Functional Independence Measurement (FIM) of each patient.

The FIM instrument is a seven level scale that measures a patient’s level of independence. It is used, in part, to determine revenue, and to measure performance outcomes. All licensed nursing and therapy staff must test annually. In 2012, our average FIM gain per patient was 30 points, which was higher than the national average, and more importantly, this gain has grown over seven points in the last three years.

We attribute this growth to the constant training and testing that staff are completing on an annual basis.

During the year, the ARU Patient Advisory Council was active and supportive in many ways on the unit.

We added three new members during the year, and they continue to meet quarterly to discuss improvements that can be made to increase patient satisfaction. Many of our members continue to offer peer support to current patients. They provided 28 peer visits this year, totaling 23 hours of volunteer time. We wouldn’t know what to do

Pam Cover

without their continued commitment to our unit.

The Acute Rehab Unit celebrated National Rehab Week in September. We held an open house and also hosted a Service Excellence luncheon. During the luncheon we held a 50/50 raffle in which the proceeds went to the ARU Foundation Fund. This fund allows the ARU to assist patients who have medical equipment or other needs with no other resources with which to obtain them.

We were able to add $125 to our fund during this event.

During 2012, three of our nurses renewed their specialty certification.

Congratulations to Pam Cover, Cindy McGaughy, and Darlene Gjovik for keeping their Certified Rehabilitation Registered Nurse (CRRN) current!

medical surgical services Diana-Jean Baratta, MSN, MA, RN | Director, Medical Surgical Services

Diana-Jean Baratta

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he Medical Surgical Services Department includes Orthopaedic/Neurological Surgical Unit, Adult Post-Surgical Unit, Medical/Oncology Unit, and Vascular Access Team. While keeping focus on the patient as the center of our mission of care, our staff of licensed, professional nurses and nursing support personnel strives to provide high quality, safe, compassionate nursing service in collaboration with the Interdisciplinary Team, essential for comprehensive care delivery.

Augmenting the service and function of the units is a dedicated, competent group of clinical resource nurses who serve as clinical resource and support, manage daily staffing, and intervene as needed throughout the days and nights to help ensure safe patient stays. These clinical resource nurses are instrumental in coordinating team communication on and off the units.

Recognition With the initiation of discharge phone calls to follow-up on patients’ wellbeing after dismissal, we are pleased at the frequency with which patients report high satisfaction with their nursing care. Many identify their nurses and aides by name in gratitude and recognition. This is an indication of the quality of service provided. A few of the staff members who deserve additional recognition in 2012 include:

Megan Anderson Medical/Oncology and Chemo Clinic, who achieved board certification in Oncology Susan Schoeneman Medical/ Oncology and Chemo Clinic who matriculated to Nurse Practitioner with Oncology Specialty Elizabeth Ossian Medical/Oncology, Star of the Quarter Award Joe Salazar Medical/Oncology, Star of the Quarter Award Kelly Moscrip Medical/Oncology, Star of the Quarter Award and Internal Star of the Year Award Other RNs who continue to hold board certification in their area of expertise include: Tara Shallenberger Adult Post-Surgical Christie Walters Adult Post-Surgical Lisa Fabricius Adult Post-Surgical Kim Meininger Ortho/Neuro Mona Urwin Adult Post-Surgical/ Bariatrics Highlights of 2012 Accomplishments Cooperation and collaboration in providing extensive clinical expert consultation to the Informatics Team for meeting meaningful use objectives.

Incorporation of a modified Total Care Staffing Model on Ortho/Neuro and Adult Post-Surgical for increased patient safety and staff satisfaction.

Completion of a process improvement effort along with Pharmacy and PeriOperative Services to ensure that patients receive an antibiotic within

one hour of the start of surgery during off-hours and on weekends.

Participation in the Emergency Department Decision to Out project to help ensure timely transitions for patients being admitted into the hospital from the Emergency Department. This is ongoing.

Education and training for experienced RNs who precept new grad RNs with improved competency verification of the new nurse’s ability to deliver safe care.

Initiation of Bedside Report to improve safe nurse-to-nurse hand-off, with involvement by the patient, on Medical/Oncology.

Provision of nursing support for the On-Q pump implementation on Ortho/ Neuro, which is a method for pain relief using a localized anesthetic as opposed to a generalized narcotic.

Education Daze competency training which included stimulating presentations in skin care by Jeanette McFeely, customer service by Karla Edwards, and emotional intelligence

by Mark Anderson as well as hands-on demonstrations.

Cooperation with the University of Nebraska Medical Center (UNMC) in supporting the second phase of the Medication Interruptions Study on Medical/Oncology. ► Continued to page 17

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Birth and Infant Care Center and Pediatrics

Connie Rupp

Connie Rupp, BSN, RN | Director, Birth and Infant Care Center and Pediatric Unit

Pediatrics

Staff We welcomed some new faces in 2012: Kami Brunz, RN; Lynn Clapper, RN; and Alana Szymonski, RN. Equipment and Monitoring Six new Spacelab monitors were added to be able to better monitor pediatric patients. In addition, the monitors allow an alarm watch feature that alerts on a monitor located at the nurses’ station.

Education Kids Kare Team was held again this fall. Seventeen nurses attended the training held by Tammi White, Clinical Coordinator. Amanda Sabo also helped with the training and taught about infection control.

Staff had the opportunity to practice high risk, low volume skills during simulations held at the UNMC College of Nursing in Scottsbluff.

Safety Focus The Pediatric staff implemented Independent Double Checks (IDC) of all medications given in Peds. We are now working on compliance and using this as our Performance Improvement for 2013.

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Neonatal Intensive Care Unit (NICU) Staff We welcomed some new faces in 2012: Danielle Ybarra, RN; Anissa Drake, RN; Meggan Jones, RN; and Eliana Rai, RN. Remodel NICU went through a transformational remodel in 2012. Over a four month period of time, the NICU was gutted and remodeled into a beautiful and more functional space. Two new NICU beds were added, in addition to a procedure room and a more formal nurses’ station. Regional West Foundation raised $90,000.00 for new equipment for the two new beds.

NICU staff helped make decisions along the way, which resulted in a very functional space. They seem to be very happy with their new space and state-of-the-art equipment.

Education STABLE education was provided to all NICU staff. STABLE is the most widely distributed and implemented neonatal education program to focus exclusively on the post-resuscitation/ pre-transport stabilization care of sick infants. Based on a mnemonic to optimize learning, retention and recall of information, STABLE stands for the six assessment and care modules in the program: Sugar, Temperature, Airway, Blood pressure, Lab work, and Emotional support.

NICU Lactation Nurse Keara Brunner, RN, CLC, a former NICU nurse, was hired as a part time lactation nurse for NICU. Keara’s specific focus is the breastfeeding moms of babies in the NICU. Keara successfully obtained her CLC (Certified Lactation Counselor) Certification in September.

Birth and Infant Care Center (BICC)

Staff We welcomed some new faces in 2012: Labor and Delivery-Amber Sandine, RN; Jessica Brumbaugh, RN; and Debbie Watson Allen, RN. Postpartum-Taylor Anderson, RN, CRN; Sara Parks, RN; Amanda Heilbrun, RN; and Megan Wagoner, RN. Practice Changes Because of the success of nurses drawing labs on the babies in NICU, we implemented the same process for the nursery babies. Competencies were completed and this seems to be working well and is a patient satisfier.

Cesarean Section (C/S) RecoveriesDr. Morgan (Anesthesia) worked with staff to change where we do C/S recoveries. There was a need identified to turn over the C/S room quicker than what was happening.

Recoveries are now done in a labor and delivery room. Care is still oneto-one and no one is allowed in the recovery room except the baby and the baby’s nurse during this time.

Neonatal Glucose ScreeningImplemented the new AAP guidelines for glucose screening.

Education Car seat safety training was attended by all staff.

Star Legacy Foundation came and presented on stillbirth.

Simulations/Drills were attended by all staff and included shoulder dystocia, postpartum hemorrhage, obstetrical Code Blue, and precipitous delivery.

Breastfeeding We have continued to implement Skin to Skin after birth. As research proves, our breastfeeding latch scores have improved as well as our breastfeeding duration due to this practice change.

This also has been a patient satisfier.

Our mothers report this has been such a wonderful experience they wish they could have done this with their other babies. Breastfeeding is on the rise because of the known benefits and the health care reform. Nationwide the breastfeeding rate is 75 to 80 percent.

Here at Regional West we are happy to report that our breastfeeding initiation rates are 85 to 90 percent.

World Breastfeeding Week is held nationwide the first week of August. This past year we held a Cookie Tea in celebration of this along with a breastfeeding walk for the community. It was very well attended and had media coverage as well.

Unit Practice Council

• Employee of the Season nomination and awards a STAR nomination is completed for the person with the most recognition/ votes.

• Unit Practice Council staff formulated float ‘welcome’ packets to assist those that help out our units from other areas of the hospital.

• Page gate communication is utilized each night with the pediatricians informing them of the number of circumcisions they have the next day. This leads to increased patient satisfaction if they can be done prior to the day of dismissal.

• A system of communication and passwords is now in place for the patients who choose to be a “no” in the directory.

All Areas

Patient Satisfaction Karla Edwards, Service Excellence, attended several staff meetings to help staff understand the importance of patient satisfaction and reviewed tips on ways to increase patient satisfaction.

We changed our gift to our moms. We added a “Birth” Day cupcake that is given to the parents on the day of the birth of their baby and also a reusable tote that we fill with all the free items that are donated to us.

Discharge phone calls began in October. Feedback is being relayed to staff on a weekly basis through our Friday update.

Leadership Rounding-Designated time set aside daily for the Director and Assistant Director to round on patients. CRNs round on patients over the weekend.

► Continued from page 15

medical surgical services Continued cooperation and collaboration of UNMC’s Dedicated Education Unit project to improve nursing student experience in clinical rotations.

Continued daily rounding on patients

by Leadership with tightened process resulting in successful personal conversation with at least 95 percent of all patients admitted to the department.

Looking Forward Initial efforts in 2013 include restructuring staff meetings/ education days to more efficiently and dependably communicate with all of the department’s nursing personnel towards an aligned, cohesive team and improved standardization of practice.

Unit Practice Councils are also restructuring towards developing and delivering more robust performance improvement projects.

Clinical Resource Nurse Leadership development will occur bi-annually.

We welcome Melissa Snyder and Stacey Powell as Clinical Coordinators and congratulate Kim Meininger in her advancement to Unit Manager of Ortho/Neuro.

Staff Satisfaction Team Huddles The Unit Practice Council worked to implement team huddles at the beginning of each shift. These are led by the CRN and include a safety story, dailies, a quick snap shot of the units, and any other pertinent information.

Team Building Sessions All staff attended a team building session held by Connie and Erika.

These sessions focused on working ► Continued to page 18 REGIONAL WEST MEDICAL CENTER ￭ 308.635.3711

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► Continued from page 17

together, communication, perceptions/ differences, and the ideal team.

Everyone had a good time and those who could do so went out to dinner after the training.

Unit Practice Council members coordinated several team building activities throughout the year: a doctors’ appreciation lunch, a girls’ night out at the movies, a Family BBQ, Corn maze and festivities, and a Christmas party. In addition, they

organized a coat and food drive and adopted a family in December.

Wound Clinic, Float Pool, House Supervisors, Restorative Care, and Dialysis Sarah Shannon, BSN, RN | Director, Wound Clinic, Float Pool,

House Supervisors, Restorative Care Unit, and Dialysis

Wound Clinic Wound Clinic remodel and expansion was completed. The remodel included the expansion of two additional exam rooms and relocation of the office space for staff.

Sheila Kilhthau, RN, joined the Wound Clinic Team in March.

Rachelle Noe, RN, attended Emery University School of Medicine and obtained her Wound Ostomy Certification.

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Scottsbluff Surgery Center, Cardiac Rehab, PCU, Peds, and Postpartum.

Float pool continues to grow.

House Supervisor Barb Goldman, RN, retired in February after 44 years of service.

John Furman, RN, joined the team in April.

Restorative Care Unit (RCU) RCU celebrated a deficiency-free survey.

Float Pool/House Supervisors We currently have eight CNAs in the float pool who are cross-trained to cover 2E, 2W, 3rd, 4th, ICU/PCU, and the Emergency Department.

Dialysis Pyxis and Horizon Clinical access has been set up for Dialysis nurses to view pertinent patient information.

Seven RNs have been hired and are currently helping cover shifts on 2E, 2W, 3rd, 4th, Outpatient Surgery, PACU,

We have established a good working relationship with the DaVita staff and look forward to further developing that partnership.

NURSING ANNUAL REPORT

Sarah Shannon

Endoscopy Lucrecia Spady, BSN, RN, CGRN | Unit Manager, Endoscopy

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ndoscopy nurses provide the majority of their nursing care to patients at the Scottsbluff Surgery Center–Endoscopy Unit.

However, they also provide support to Regional West in-patients who need endoscopic procedures. Thus they strive to be knowledgeable of hospital nursing protocols by being involved with PCS’s nursing activities such as PI interventions for monitoring if the procedure record is complete.

A major Endoscopy Department project this past year was computer changes that have been developing with the transition from paper charting to computerized documentation.

The nursing staff helped promote the health of the community for Colon Cancer Awareness by setting up a

booth at the Farm and Ranch Expo in February and also had involvement with the Super Colon in March. They also manned a booth in the Regional West cafeteria and had a “Dress in Blue Day,” raising over $600 that went to Festival of Hope.

Lucrecia Spady

Promoting continuing education is an ongoing goal of the nurses which was evident by: Lucrecia Spady and Rebecca Robles represent Endoscopy on the Patient Services Shared Governance Councils.

Lucrecia Spady, Unit Manager, is working on her master’s degree in Nursing with an emphasis in nursing management and will graduate in October 2013.

Perioperative Services Judy Bowlin, BSN, RN | Pre-Admit Testing

Janet Lewis, MA, BSN, RN, CNOR | Director, Perioperative Services

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n 2012, the Pre-Admit Testing (PAT) Department saw over 6,300 patients. Twenty-one to 27 percent of these were visits that were initially done over the phone, followed by a face-to-face visit with PAT staff on the day of surgery. This is a reflection of the fact that several of our surgeons have satellite clinics and they accommodate those patient needs if they can by not requiring them to travel to Scottsbluff once to have a

Judy Bowlin

Pre-Admit visit and then again to have surgery.

The Unit Practice Council updated the instruction sheets given to patients when they leave our department.

These instructions provide the patients with a list of the medications to take the day of surgery as well as phone numbers to call with questions or concerns, and other basic instructions for the day of surgery.

Janet Lewis

April brought the introduction of PreAdmit Testing orders. These orders are sent from the surgeon’s office, and are sent for every patient seen in the PAT Department.

Working closely with the anesthesia providers, the PAT nurses provide a very valuable service to assure that the surgical patient is properly prepared for a safe, surgical encounter.

REGIONAL WEST MEDICAL CENTER ￭ 308.635.3711

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Outpatient Surgery OPS Karna Kleager, BS, RN | Unit Manager, Outpatient Surgery

Karna Kleager

W

hat does one think when they hear the title ‘Outpatient Surgery?’

Many would think of a place where people go for surgery, which does not mean an admission to the hospital and patients going home right after their surgery. However, in addition to preparing patients for surgery and discharging them to home the same day, Outpatient Surgery also begins the surgical process for most patients who will need to stay in the hospital after their surgery, i.e. total joint replacement, laparoscopic gastric band, gastric bypass, laparoscopic cholecystectomy, hysterectomy, and decompressive lumbar laminectomies, to name a few. We refer to these processes as a.m. admits. Other outpatient service that we provide in OPS are the transfusion of blood and blood products, outpatient antibiotic infusions, and infusions for medical conditions, i.e. Multiple Sclerosis and immunosuppressive disorders, etc. The OPS staff also maintains a close working relationship with Cardiopulmonary nurses for the care of patients undergoing cardiac catheterizations and pacemaker generator changes.

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NURSING ANNUAL REPORT

2012 Highlights Michelle Keener and Roxie Shaul achieved Perianesthesia Ambulatory Nurse Certifications. Other certified nurses are Kathi Yost, Gerontological Nursing, and Michelle Powell, Medical Surgical Nursing.

In April, Kathi Yost, along with staff from the Perianesthesia Care Unit and Pre-Admit Testing, attended the national American Society of Perianesthesia Nurses (ASPAN) conference in Orlando, Fla. Kathi Yost has served on the Nebraska State Board of Nursing for the past five years, representing over 28,000 nurses.

Carrie Herr, a BSN graduate from Creighton University in Omaha joined OPS on July 9. Carrie has jumped right in and immersed herself as the Chair-elect for Shared Governance Evidence-Based Practice Council.

Alicia Gonzales-Longoria will graduate on May 4 with a master’s degree in Nursing from UNMC and will move on in a new role as an APRN. OPS said good bye to three retirees who have served Regional West Medical Center for many years: Barb Siedenburg, LPN, 35 years; Janice Strauch, Perioperative

Assistant, 24 ½ years, and Naomi Pickinpough, LPN, 18 years.

As we continue to focus on patient satisfaction, we find great value in making phone calls to patients discharged from OPS. Using a consistent format established for all nursing units, we attempt to reach as many patients as possible to follow up on their postoperative recovery, pain control, knowledge of plan of care, understanding of medications, what we could have done to improve their stay, etc.

Participation in a process to improve on-time starts for first cases of the day at 7 a.m. moved to a different level of care called Pre-op One Stop.

The focus is to bring services to the patient and reduce the number of transfers for the patient. The One Stop process involves transferring the patient directly into the Operating Room after full pre-op preparation in the OPS. Patients’ families are able to spend a bit more time with the patient prior to surgery. As with all new processes, change creates challenges but lends itself to staff collaboration and problem solving in an effort to deliver safe, compassionate, and competent nursing care to the patients we serve.

Perianesthesia Care PACU Karna Kleager, BS, RN | Unit Manager, Perianesthesia Care Unit

Karna Kleager

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erianesthesia nursing focuses on providing a critical level of care to patients emerging from anesthesia/sedation following a surgical procedure. Challenges include caring for patients of all ages following a variety of complex surgical procedures. Attending national ASPAN conferences, participation in Shared Governance Councils, and obtaining certification provides staff with opportunities to learn, implement, and teach best practices in the care of their patients.

2012 Highlights In April, Tracy Payne and Sandy Hebbert attended the national ASPAN Conference in Orlando, Fla. Chris Micheels was the first time recipient of the 2012 RN Magnet Award for Outstanding Nurse Preceptor. UNMC BSN student Jannene Zobel recognized significant value of bedside nurses as preceptors, which prompted her to pursue the creation and presentation of this award.

PACU’s popularity has grown in the student transition and summer internship programs with students and staff thriving in an environment of teaching and learning.

Karna Kleager was awarded the 2012 RN Magnet Award for Transformational Leadership, a true

testament of her strong involvement in advancing nursing practice and her collaborative skills within all areas of nursing.

It was an honor to have Sandy Hebbert and Chris Micheels, staff members from PACU, join Shirley Knodel, our CNO/Vice President of Patient Care Services, and other nursing colleagues at the National Magnet Conference in Los Angeles, Calif.

The PACU staff has been instrumental in the development of the Pre-op One Stop process. The PACU staff provides pre-op care to the first patients of the day in the OPS versus having them relocate to the Pre-op Unit. The patient can be directly transported into the Operating Room.

Jina Nemnich graduated in May from the Master of Nursing program at UNMC and accepted an APRN position at Regional West Physicians ClinicEar, Nose, and Throat. Colynn Beaver transferred to the Float Pool, which allows her to be assigned in PACU at times when needed.

Six out of the 13 RNs in PACU have their certifications. We are very proud of Sandy Hebbert, Kay Lemons, Chris Micheels, Tracy Payne, and Andrea Ray for obtaining/maintaining CAPN certification, and Jessica Conn with CCRN.

A’ndrea Spracklen-Hogan, BSN, made a smooth transition from OR to PACU in July.

The very active Unit Practice Council keeps busy reviewing policies and procedures vital to providing evidence-based care and practicing within the ASPAN and National Patient Safety Goals guidelines. Adjustments were made in the practice of antibiotic administration to comply with national Surgical Care Improvement Project (SCIP).

To enhance our Competency in Practice, a decision was made for each of the staff to complete the ASPAN Competency Based Orientation Program (20 modules) in the year 2013.

Both OPS and PACU are looking forward to a productive 2013.

Externally driven goals such as Core Measures and Meaningful Use keep all staff and especially a dedicated group of super users (Michelle Keener, Nancy Ross, Kris Ferguson, Roxie Shaul, and Kendra Vera) busy with HED, HHS, CPOE, and HEP. Karna Kleager has been instrumental in the mapping of nursing processes for the development of our IT projects.

REGIONAL WEST MEDICAL CENTER ￭ 308.635.3711

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Operating Room OR

Kim Brown, BSN, RN, CNOR | Unit Manager, Operating Room

Kim Brown

I

n 2012, the Operating Room staff provided intraoperative care for over 5,000 inpatients and outpatients undergoing simple to complex, high acuity procedures. As a Level II Trauma Center, the OR staff is “On Call” to perform emergency procedures for victims of traumatic injuries.

Highlights for 2012 Safety Coaches Kim Mann and Nate Walker guided the staff’s journey to improve safety. Prioritizing safety as the Patient First–Every Time is our goal. Utilizing our “Time Out” process involves the entire surgical team to incorporate safe practices for patients and our staff in the OR’s dynamic and highly technical environment.

Process Improvement activities include hand hygiene, monitoring the frequency of immediate use sterilization, and on time starts for 7 a.m. cases. The frequency of immediate use sterilization has decreased as a result of diligent research and budget planning

by Clinical Resource Nurses. The processes for On-Time starts for 7 a.m. are evaluated on a daily basis with follow-up as appropriate. The OR staff is responsible for helping assure compliance with Surgical Care Improvement Project (SCIP) quality measures which includes appropriate timing of antibiotic administration,

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NURSING ANNUAL REPORT

DVT prophylaxis, beta blocker use, and temperature regulation of the patient in the surgical environment.

Fifty chart audits are performed monthly to ensure compliance with quality measures through appropriate documentation with resultant feedback to our staff.

Monday morning meetings provide staff with educational opportunities as well as competency testing.

Clinical Educator Rhonda Groshans coordinates presentations with various company representatives to educate on the use of their equipment. In 2012, two Nebraska State Patrol officers presented a program on “Mechanism of Injury.” With safety as a major goal throughout the year, annual staff education was conducted on emergent craniotomy procedure, Hana Fracture table set-up, mock Code Blue, fire safety and drills in the OR, sharp safety, and medication administration, decontamination and sterilization processes, massive transfusion protocol, patient advocacy, necrotizing fasciitis, tourniquet use, hand-off communication, and specimen handling, as well as changes in processes such as electronic charting.

The Periop 101 program (25 online learning modules) is used for training the novice OR nurse in conjunction

with clinical preceptorship. There are six graduates of the program.

In an effort to keep staff updated on policies, a departmental or hospital policy is posted monthly for all staff to “Read and Sign.”

The Unit Practice Council has been working on reviewing and updating the Perioperative Staffing Guidelines to ensure consistency throughout Perioperative Services.

Cody McLellan, who was previously an Operating Room Assistant, completed his Surgical Technologist program and now works as a Certified Surgical Technologist (CST).

The Operating Room was pleased that Marcene Wiegand, CST, was awarded a $10,000 nursing scholarship from the Regional West Foundation.

Jason Beals, Kim Mann, Rhonda Groshans, and Janet Lewis attended the national Association of Perioperative Registered Nurses (AORN) Congress in New Orleans, La. Marcene Wiegand and Hope Dubs attended the national Association of Surgical Technologists (AST) meeting in Washington D.C. Both conferences provided staff with education related to the safe care of the Perioperative patient, updates on technology, and advances in surgical techniques.

Scottsbluff Surgery Center SBSC

Crystal Kildow

Crystal Kildow, BSN, RN | Clinical Coordinator, Scottsbluff Surgery Center

S

cottsbluff Surgery Center (SBSC) has focused on recruiting more outpatient elective cases to the center with current and new physicians at Regional West Medical Center. Our specialty list now includes Gynecology procedures with Dr. Brunner, Pain Management with Dr. Clodfelter and Dr. Wilroy, Dental with Dr. Combs and Dr. Black, ENT with Dr. Massey and Dr. Henley, as well as Orthopaedic procedures with Dr. Scheer, Dr. Sauerbrey, Dr. Sanchez, and Dr. Gardner.

Our staff is focused on providing the best surgical experience possible for patients and their families. We thrive on the efficiencies we can provide for the patients, staff, and physicians we serve in this community. In 2012, our surgical volumes soared to 1,439

patients. We are hoping to increase this number greatly with the new physicians we have coming on board in 2013 to include Dr. Coots, Plastic & Reconstructive Surgery, as well as new surgeon Dr. Sarin, Orthopaedic Surgery.

Identification of Safety Coach, Danielle Brown.

We have continued to provide a holistic approach to scheduling patients for their surgical procedures with screening each and every patient before they come through our doors.

This is done by a telephone interview to help identify whether the patients’ health meet ambulatory surgery criteria. We work in close connection with the Anesthesia Department to help accomplish this goal.

Concurrent chart reviews by Marie Pace.

Unit Practice Council (UPC) Committee, consisting of Spring Sherrell, Carmen Benavides, and Danielle Brown.

Highlights for 2012: Implementation of staff scheduling committee, Peg Jackson and Danielle Brown.

In-servicing of new equipment and technology by Tara Harpold.

Beginning phases of McKesson HSM clinical documentation.

Transition to PHS scheduling and charging with Cheryl Darst.

CSI training for RNs precepting UNMC nursing students.

REGIONAL WEST MEDICAL CENTER ďż­ 308.635.3711

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Critical Care and Emergency Nancy Hicks-Arsenault, MBA, BSN, RN | Director, Critical Care and Emergency Services

Nancy Hicks-Arsenault

C

ritical Care and Progressive Care staff are unique in their desire and love for controlled chaos and the utilization of crisis management skills every shift. Regional West Medical Center is blessed to have this talent. These nurses promote and help patients to achieve the best healthy outcomes possible while being efficient and adaptable to optimize individualized care. Leadership continues to promote advancing knowledge and skill through continued education, review of current knowledge, and passing knowledge to new students and professionals.

Stephen Matthews, BSN, RN joined the leadership team as nurse manager for CICU/PCU in January 2012. Stephen has brought his clinical expertise and leadership skills to the team. Work on building the team was a priority. Quality, safety, and patient and staff satisfaction are top priorities that have been worked on in 2012.

Linda Fowler, BSN, RN continues in her role as clinical coordinator for Critical Care Services, coordinating 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 is an exciting time and positively impacts the culture. Linda has been instrumental in encouraging staff to return to school and/or become certified in their specialty.

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Specialty certification is one way competency is recognized for nurses.

The CICU/PCU have eight nurses who have achieved the CCRN certification.

This achievement is recognized as the “Gold Standard” of excellence in critical care nursing. Congratulations to Stephen Matthews, Linda Fowler, Leigh Miller, Cheryl Patrick, Cheryl Hoxworth, Teal Smith, Jessica Slaught-Langworthy, and Marilyn Stoddard.

Staff members in school pursing higher degrees include Nancy Hicks-Arsenault, Stephen Matthews, Linda Fowler, Kristen Ferguson, Meghan Baylock, and Travis Hargreaves. Congratulations to all who balance work, school, and home life!

The CICU/PCU has an active Unit Practice Council. They are currently working on a sedation vacation protocol, sepsis order sets, and managing delirium in the ICU patient. The council also sets guidelines to assist management in selecting professionals to attend conferences.

The Scheduling Committee has been active in balancing schedules and advising management leaders as we incorporate a flexible staffing model to match census that can vary greatly in 12 hours. They are very much appreciated!

The unit worked with Marketing and Recruiting to establish testimonials, recruiting photos, and other materials.

Recognition of being in rural Nebraska adds to difficulty in recruiting experienced nurses. A transition class to critical care was developed and implemented with great success. We are now training our own nurses for critical care nursing. They are very dedicated to providing excellent patient and family care. This is a testimony to the quality of our nurses; although many are young in their careers, they are motivated to learn the perils from experienced nurses and share their new talents.

Emergency Services

The Emergency Department had a record year in the number of patient visits, topping 17,000. With increased volume came the need to utilize hallway beds more than ever. This has been an added concern for us in providing quality, safe care privately in the hallways.

Alice Fillingham, BSN, RN became our clinical coordinator and has been amazing. She works very hard to bring quality education programs to the unit and hospital-wide audiences. These opportunities have included quarterly education tied to our staff meetings, pediatric case reviews with CEUs and CMEs, and simulation training. ‘Thank you’ seems so small for all the work Alice has done.

We have nine nurses who have obtained specialty certification. Congratulations

to Alice Fillingham, Linda Fowler, Lorrie Joplin, Sheri McDonald, Sarah Paetow, Laura Wolfe, Jessica SlaughtLangworthy, Amanda Lashley and Linda Borelli. This makes 50 percent of our RN staff who is certified!

The Unit Practice Council has worked diligently on improving our pediatric care, from implementing best practice of pediatric medication double checks, setting all scales to kg weight, and making sure we have appropriate pediatric equipment to care for our patients.

The council is also working on subcutaneous rehydration in appropriate cases.

The council worked hard to ensure a week full of celebration during nurses’ week and coordinated many activities.

The celebration also included an EMS week celebration with a cook out!

Stephen Matthews BSN, RN is interim manager and has been instrumental in bringing the scheduling committee into active status again. The committee is helpful in balancing schedules and setting the holiday schedule rotation for the next three years. Other activities included drawing names of staff to work the future holidays, adjusting the track schedules for fairness of weekends, etc.

Dr. Peter Meyer assumed interim medical director duties from July through December. He worked hard to help manage the hallway overflow patient concerns. He was also instrumental in finding additional physician staff to fill our needs until we hire permanent staff.

The Emergency Department continues to have better than national averages for: door → triage→ exam room → discharge decision → out for discharged patients. Much work is being done to improve our decision to admit → discharge.

The Emergency Department nurse’s station did undergo a refurbishment and looks much better. It also provides privacy to discussions of care plans yet remains very visible to patients.

The physicians have a new area that will be the center of the department as we expand. A safe room for our patients in need of a quiet environment is planned for 2013.

The emergency team continues to amaze me with their focus on improving our quality and safety care initiatives.

Our quality markers for patients experiencing a STEMI are great. Our door to cath at Medical Center of the Rockies in Loveland, Colo. is just 90 minutes! That includes the flight time!

Our documentation analyst, Kathy Jacobsen BSN, RN, continues to do a fabulous job giving feedback to staff appropriately after 100 percent chart review. Our documentation reviews demonstrate an improvement year after year.

The Emergency Department prepares to expand by adding five rooms, four to replace hallway beds and one additional bed. The new area will be universal beds and include a medication room, supply room, and nurse’s station.

REGIONAL WEST MEDICAL CENTER ￭ 308.635.3711

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Air Link and Transfer Center Doug Carrell | Director, Air Link and Transfer Center

Transfer Center/Air Link Dispatch

The department was known specifically as Air Link Dispatch in the past, and then in May 2012 the name was changed to the Transfer Center to reflect the expansion of duties handled by the center. All of the Air Link tasks are still handled in the Transfer Center in addition to many more after the Transfer Center became operational in May 2012. Many hours of meetings and traveling to other transfer centers in Texas and Colorado to define best practices helped determine the model used. The management team for the Transfer Center includes: Doug Carrell, Director; Peter Meyer, MD, Medical Director; and Frank Solano, Supervisor. The Transfer Center handles a wide variety and number of tasks on a daily basis.

Transfer Center duties include: facilitating/coordinating patient transfers both to and from Regional West Medical Center as well as assisting other hospitals with patient transfers not coming to or transferring from Regional West; dispatching and flight following Air Link at Regional West, Air Link at Medical Center of the Rockies and EagleMed 31 (Fixed Wing) located at the Scottsbluff airport; staffing the switch board 24/7/365; handling after hours IT answering services; announcing all overhead pages and codes; and monitoring all alarms, to name just a few of the tasks. The staff also

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NURSING ANNUAL REPORT

monitors emergent events not only locally but also outside of the local area. By monitoring these events, in the event additional resources are needed to handle the situation, the Transfer Center will be able to address those needs in a timely manner when requested to assist. Some of the typical events that are monitored include: weather emergencies and emergent ambulance and law enforcement radio traffic. The Transfer Center is staffed 24/7 with three staff from 8 a.m. to 8 p.m., and two staff from 8 p.m. to 8 a.m.

Transfer Center

The development of the Transfer Center as stated above involved many hours of work. New job descriptions had to be developed, new policies and procedures needed to be written, and new staff orientation processes needed to be developed as well as training. Frank Solano was hired to supervise the Transfer Center and was instrumental in developing the Transfer Center standards. Ongoing education and training continued to take place throughout the year.

With Frank’s guidance and the participation of a dedicated staff, the Transfer Center had a very good first year. The Transfer Center staff handled over 830 transfer requests, with 98 percent of those calls resulting in admissions into Regional West Medical Center. The calls were received from other hospitals, physician clinics, and off-site clinics.

When a transfer request is received, the Transfer Center Specialist triages the call to determine if the call is medical or trauma in nature. Once the call has been triaged, the Transfer Center Specialist conferences in the House Supervisor and the appropriate physician and passively monitors the call. If others are determined to be needed on the call, the Transfer Center Specialist will conference them in as well. This process has truly made a difference in the time involved and number of phone calls a referring physician/facility previously had to make to admit a patient into Regional West Medical Center. If, during the call monitoring, it is stated that air medical transport or ground transport is needed, the Transfer Center Specialist, who has been documenting patient information, asks for some additional patient information. He or she then passes the info to a coworker who will immediately contact the appropriate air program or ground unit to initiate the patient transfer.

The Transfer Center has a goal that no call should last more than eight minutes from the time it is received until the patient has been accepted.

Once the call has been completed and the patient has been accepted, the Transfer Center Specialist will the make calls to Admitting, Case Management, and ER Admitting.

These additional calls were calls the House Supervisor had to make prior to the Transfer Center. The Transfer Center will also connect the House

Supervisor and the Charge Nurse of the area the patient will be going.

The Transfer Center has truly had a positive and measurable impact on the ease of entry for patients coming into Regional West Medical Center.

Air Medical Dispatching

The Transfer Center also handles all flight requests for Air Link at Regional West, Air Link at Medical Center of the Rockies, and EagleMed 31, a fixed wing aircraft located at the Scottsbluff airport. In 2012, the Transfer Center received 1,215 requests for service between the three flight programs that are dispatched by the Transfer Center.

Requests are received via the flight programs respective 800 numbers or via radio. These requests are received from EMS agencies, hospitals, EMS dispatch agencies both locally and also in Colorado.

In some cases, requests are also received from other flight programs that are not able to handle a request due to weather, maintenance, or being already committed on another flight. The Transfer Center visually monitors (onsite and offsite cameras) the helipads at Regional West Medical Center as well as the helipads at Medical Center of the Rockies for safety.

Once the flight has been accepted, the Transfer Center staff uses web-based programs to follow the aircraft from beginning to the end of the flight. There is a dedicated flight follower for each flight who only takes care of tasks relating to that particular flight. All Transfer Center staff are trained to handle any inflight emergency. Safety calls are made by the Transfer Center staff for each flight to other flight programs, alerting them that we have an aircraft flying in their area. Not all hospitals have helipads, which requires the Transfer Center staff to arrange for ground transportation to pick up the flight

team in those instances. The Transfer Center staff has to have an intimate knowledge of the available resources in each flight programs service area.

We look forward to having another successful year in 2013.

Air Link Annual Report

certifications. Holly Anderson continues to assist the flight team with marketing and public relations.

Every member of the Air Link flight team has additional responsibilities that directly relate to the quality of the service we provide.

The Critical Care Transport Medicine Conference (CCTMC) was held in April 2012 in Nashville, Tenn. Dr. Peter and Tracy Meyer presented the lecture, “Practicing beyond Your Scope or Just Thinking Outside the Box,” a lecture showcasing on-scene amputations performed by the flight team.

Air Link continues to provide service in partnership with Med-Trans Corporation. In 2012 there was a change in the leadership of the Air Link pilots. Gil Watkins accepted the position as Base Aviation Manager, and Air Link welcomed a new pilot to our team, Tom Cislo.

The Air Link leadership team consists of Doug Carrell, Director; Tracy Meyer, Chief Flight Nurse; and Dr. Peter Meyer, Medical Director. Dr. Meyer continues to fly as an active crewmember of the flight team.

Sean Shirley continues to be Air Link’s Safety Officer and Safety Coach. Trish Garner is very active as the flight team Clinical Educator, and has been instrumental in coordinating ongoing educational events, such as the 4th annual Air Link EMS Conference, a Difficult Airway Course, and High Risk Obstetrical training. Clint Dunker and Wade Wells work hard collecting quality improvement data. Natalie Arnold coordinates public relations events and the Air Link Mentoring Program (which includes over 80 hospital and EMS agencies). Jason Rairigh and Howard McCormick continue to coordinate the program’s equipment and inventory needs.

Dee Vogel assists with policy review and time and attendance, and is also Air Link’s representative for the Nebraska Association of Air Medical Services (NEAAMS). In 2012, Air Link hired a new flight paramedic, Dan Hughes. During his time with Air Link, Dan has spent much of his time preparing for required advance

The Air Medical Transport Conference (AMTC) was held in Seattle, Wash. in October 2012. Due to the high demand from last year’s AMTC conference attendees, once again Peter Meyer, MD and Tracy Meyer, CFN were asked to present at the conference. Together they presented a lecture entitled “Should Your Medical Director Be Allowed Anywhere Near Your Aircraft?” Tracy presented a lecture entitled “Beating The Odds…A Mother’s Fight to Survive An Amniotic Fluid Emboli.”

Tracy also presented an instructor update for TNATC (Transport Nurses Advanced Trauma Course) instructors.

Air Link places an emphasis on quality patient care, continued learning, and mandatory advanced certifications. One hundred percent of the Air Link flight team is CFRN (Certified Flight Registered Nurse) or FP-C (Flight Paramedic Certified) certified, with the exception of Dan Hughes, who was hired in 2012. Dan will be taking his FP-C certification exam in 2013.

Air Link had a very busy year, as more patient missions were flown in 2012 than any other year in our history. We look forward to having a successful and SAFE 2013.

REGIONAL WEST MEDICAL CENTER ￭ 308.635.3711

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Home Care Diana Rohrick, RN | Director, Home Care

Diana Rohrick

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egional West Home Care gained proficiency regarding the regulatory issues imposed in 2011 and continued with some changes in 2012. These were the face-to-face forms for Medicare patients coming into Home Care; the second regulation involved therapy documentation changes. Home Care administrative staff implemented the changes and ongoing auditing of these vital regulations. Lack of accurate documentation at key times disallows payment for the visit and all subsequent visits until it is rectified but payment is not retroactive.

Home Care also gained several new referral sources such as treatment with new subcutaneous infusions; instruction for injections related to RA, MS, and immunosuppressed patients; and new contracts for health assessments for long term care. We are also seeing referrals from new physicians at Regional West, including Orthopaedics, Internal Medicine, Family Practice, and the Pain Management Clinic.

Clinical staff continued to make strides in efficiency and productivity with the use of the in-home protime/ INR portable machines. The few glitches that were seen were corrected quickly and did not impact patient care.

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NURSING ANNUAL REPORT

Regional West Home Care began discussions with Kimball Health Services in regard to home health in their area and possibly contracting for physical therapy services through them. Coverage for that area would improve as well as increasing possible referrals.

Our Unit Practice Council (UPC) continued in 2012, working on scripting for improvement in HHCAHPS scores with noted improvement seen in our latest scores.

Sheli Goodwin, RN and Mary Coon, RN actively participated in Shared Governance. These same RNs are certified in Psychiatric Nursing and Newborn Care, respectively.

Shelly Meisner, RN/QI Coordinator obtained her certificate in OASIS Specialist-Clinical after grueling instruction and testing. Bravo, Shelly!

Shelly has also begun classes to obtain her bachelor’s degree in nursing.

Despite ongoing participation by the Acute Care Hospitalization Committee, our readmissions to the hospital have continued to be similar to or above the national rankings. Ongoing discussions and serious focus will be the intent for 2013.

Our participation in Palliative Care was impacted by the loss of a provider.

We are hopeful that 2013 will bring

us either a physician or a nurse practitioner to revive this important program.

Beginning in 2012, Regional West Home Care and Prairie Haven Hospice began discussions regarding a possible partnership due to Linda Rock’s retirement and the changes foreseen with the future of health care.

In April, Home Care successfully completed our state survey, with one deficiency related to therapy visits beginning during the same week as the start of care (SOC) date.

Regional West Home Care continues to utilize evidence-based/best practice and Lean Six Sigma methodology while promoting a culture of safety.

The Florence Prescription……a project of changing our culture in Home Care was a big part of this last year.

Learning about and then signing up for the commitment to the Florence Prescription was one of our greatest moments in 2012. It has help make a good team great and a caring team one who values other’s values.

“We must do better than this” was the mantra of Florence Nightingale in 1854 during the Crimean War, when she arrived to care for British soldiers who were casualties of the Crimean War. The conditions were

IMAGING SERVICES Kari Gift, RN | Nursing Supervisor, Imaging Services

Kari Gift

awful, and no one seemed to care. But Florence Nightingale did, and she set out to change health care by creating hospitals, pharmacies, nursing schools, and even recruited a French chef to start the first hospital nutrition service to try and make things better… to care.

What she did then and what she is encouraging now through a fictional work simply called “The Florence Prescription” is to urge us all to care, to take accountability, and to change our lives through seven simple promises. Written by Joe Tye (with Dick Schwab), it is a look into the modern day world of an urban hospital system trying to be better but missing the mark.

I

n 2012, we successfully integrated Radiology Imaging Associates (RIA) interventional radiologists into our lab. With the modification in physicians, we have seen many changes.

We are a team of six RNs (one is a working supervisor who also takes call) and one LPN. Our workload is comprised of phone interviews with all interventional patients prior to arrival, pre- intra- and post-care for procedures, follow-up phone calls, and management of the newly-formed RIA Clinic within our physical department.

We are on call 24/7 for patient and staff emergencies or questions.

We have seen this book through the eyes of the Home Care staff that read and discussed each chapter weekly.

Every staff person in this department has taken the Pickle Pledge, “I will turn every complaint into either a blessing or a constructive suggestion,” thereby promising to no longer waste time or energy blaming, complaining, gossiping, or commiserating with those who steal energy with these activities. They have also signed their commitment to the Self-Empowerment Pledge. …to renewed Responsibility/ Accountability/ Determination/ Contribution/Resilience/Perspective/ and Faith.

One change was a decrease in total number of patients for the year. We assisted with 2,613 patients, broken down as follows: 245 biopsies, 115 drain placements or fluid aspiration, 338 arterial and venous cases, 963 pain management cases, 82 vertebroplasties, 228 MRIs, 335 miscellaneous cases, and 102 clinic patients. 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.

“We must do better than this.” Let’s see if we do!

Another change was to redo all our “protocols,” patient education

materials, and order sets to accommodate RIA. This was a major accomplishment that allowed us to update utilizing EBP and gold standards.

Our Unit-Based Interdisciplinary Shared Governance Council that started last year continues to meet monthly. As we work together with the Imaging Services team members, we are not only optimizing patient outcomes, but streamlining processes to be more efficient and cost effective.

This year we are making physical changes to the department that will move our prep and recovery area closer to our procedural rooms. This will further enhance our efficiency and help us continue to grow.

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Cardiac Cath Lab Lenna Booth, BSN, RN | Cardiac Cath Lab

PICTURED L TO R: Brooke Borgman, Michelle Rairigh, Lenna Booth.

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012 was a time of transition for the Cath Lab staff. Dr. Strote and Dr. Oldemeyer introduced the radial access approach for coronary angiograms. In April, we welcomed Brooke Borgman, BS, BSN, RN to the Cath Lab staff. The end of the year brought news that Dr. Rasa would be leaving us to pursue a fellowship in Interventional Cardiology and negotiations were in progress for Colorado Health Medical Group cardiologists to step in to provide cardiology care to the Valley.

Policy changes were made to decrease delays in care that included implementing direct transfer from the Cath Lab by transport agencies

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for patients needing a higher level of cardiovascular care.

Other All staff maintain ACLS certification.

Other changes included moving the Cath Lab office to a larger room and changing the old office into the physician reading room. Handoff communication between Cath Lab staff and Outpatient Surgery staff was reviewed and updated by creating a communication sheet to better improve the coordination of cardiac patients. In addition, cost containment measures were made

by Kim Fenning, RT and Nel Robison, RT who worked to revise the contents of our pacemaker and angio-packs.

Approval was also given for new treadmill equipment for our stress room.

Brooke Borgman teaches three classes for the New Grad Nurse Residency program: Recognition of Patient Deterioration, Lines/Drains and Tubes, and Cardiac Assessment.

Brooke Borgman is currently working on her master’s degree in Adult Acute Care Nurse Practitioner with plans for a 2015 graduation.

Lenna Booth teaches safety behavior training in new hire orientation and Cath Lab Procedures and Groin Management for the New Grad Nurse Residency program.

Cardiac and pulmonary rehabilitation

Pam Zitterkopf

Pam Zitterkopf, BSN, RN | Cardiac and Pulmonary Rehabilitation

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he year 2012 has been a year of changes for the Cardiopulmonary Rehab program. Our long time manager Lynn Macken earned her PhD in nursing research and moved to Portland, Maine on December 3 to work as a nurse researcher. Nancy Leisy is the new manager who started in March. We are excited to have a new manager and look forward to working with her. We have had several float nurses helping us during our shortage of nurses. They include: Colynn Beaver, RN; Patti Grimm, RN; Vicky Schmall, RN; Deb Keener, RN; and Jake Talley, RN. We cannot thank these nurses enough for their help.

Other staff activities and certifications include: Nance Leisy, RN, the new manager of Cardiopulmonary Rehab, has

a master’s degree in Health Education. She is also a Certified Health Education Specialist. She has experience in Cardiopulmonary Rehab management and has served on the Education Committee for the National AACVPR organization for Cardiopulmonary Rehab as well as the Outcomes Committee for the Nebraska-NCVPRN. Pam Zitterkopf, BSN, RN received her certificate as a Clinical Health Coach. This is a new certification that utilizes motivational interviewing to coach patients with chronic diseases to help them to better manage their medical regimen. She helped manage the cardiac rehab program during the interim. Pam headed the cardiovascular screening for the Summit to Summit health fair in May 2012.

Patty Edwards, LPN continues with the community CASA program. She continues to be a part of the wellness program.

Glenda Davis, RN has also helped to manage the cardiac rehab during the interim. She did blood pressure screenings for the Summit to Summit health fair in May 2012. Glenda also does blood pressure screenings for her church.

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Case Management Irma Walter, RN | Case Management

PICTURED L TO R: Alane Britt, Julie Kautz, Lois Cannell, Karen Houk, Shannon Brown, Nichole Hoesing, Irma Walter. Not pictured: Shelly Thomas

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ase management is a multifaceted position responsible for daily clinical review of each patient in the hospital to coordinate and facilitate the flow of a patient’s stay through the continuum of care. The case manager promotes the quality of care in a cost effective manner. The first thing that needs to be looked at is the level of care. This involves having an order on the chart for inpatient or observation and that the level is correct and supported by InterQual criteria or the secondary physician advisor, or the payer source.

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in determining level of care when InterQual criteria are not met.

Once level of care has been met, the clinical review continues, to ensure the patient receives the care they should and to help anticipate any post discharge needs, whether the patient is returning home or to another level of care. The case managers work closely with the social workers to achieve this goal.

Case managers deal with Medicare, Medicaid (which is now contracted out to private insurance companies), private, and commercial insurance companies. For self-pay patients, the FAST office is notified to assist in arrangements for payment or financial assistance.

The nurse case managers are Karen Houk, RN, supervisor; Julie Kautz, RN; Irma Walter, RN; Nichole Hoesing, RN; Shannon Brown, RN; Lois Cannell, RN; Alane Britt, RN; and Shelley Thomas, BSW. Pam O’Neal, Director of the Revenue Cycle, oversees the work of case management. Our coverage is from 7 a.m. to 10 p.m. Evening coverage is provided by Shelley Thomas, who acts in a dual role as a social worker and case manager.

Regional West Medical Center contracts with Executive Health Resources for secondary physician advisor services including in-house advisors Dr. Erika Gelgand and Dr. Lisa Scheppers. They assist

Continuing education is an important part of our role. Each year members of the team go to the ACMA convention to network and learn about new updates. As the laws change, so does our job.

NURSING ANNUAL REPORT

Another integral piece to the case management puzzle is the Clinical Documentation Improvement (CDI) RN case managers. They review charts daily to facilitate opportunity for enhanced provider documentation in order to accurately reflect the severity of illness (SOI) and risk of mortality (ROM) in the medical record. This is achieved through concurrent coding, ongoing provider communication, and education throughout the organization.

The CDI RN case managers are Jackie Carter, RN, who routinely covers the surgical service lines, Vicki McLamb, RN, who is assigned to the hospitalist program service line, and Mollie Thompson, RN, who assists with the general medical service lines. Stephanie Hawley, RN, ACM oversees the CDI program and also coordinates the appeals for medical necessity denials for the organization. All of the CDI RN case managers will begin working towards their professional certification (CCDS, Certified Clinical Documentation Specialist) in the coming year.

Community Health and Lean SIx sigma

Martha Stricker

Martha Stricker, BSN, RN | Nurse Manager

Community Health

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 to the Scotts Bluff County Health Department. This creative contract arrangement allows for both entities to be active in the public health of Scotts Bluff County. This past year, multiple programs were coordinated for the community and hospital.

In 2012, the Community Health Department saw many changes to the services it provides. First, the medical services provided by contract to the Scotts Bluff County Detention Center were stopped in January 2012.

Second, in October 2012, a federal mandate led the Immunization Clinic to start filing claims with insurance companies for services provided. A billing clerk and a new process flow were added to accommodate the new tasks.

the coordination of both the county and hospital’s bio-terrorism and allemergency preparedness plans.

employees. This resulted in over 800 more flu shots being delivered to residents of Scotts Bluff County.

Throughout the year, Community Health also coordinated the quarterly genetics clinics, seeing 73 clients and their families.

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.

The department also coordinated 12 health screenings at area businesses through its involvement with the Panhandle Worksite Wellness Council.

In 2012, over 380 people received a variety of preventative screenings including lab work, bone density screening, glaucoma checks, and blood pressure checks.

Nurses also held routine immunization clinics on Tuesdays with both daytime and evening clinics available. Approximately 3,300 vaccines are delivered to children from birth through age 19.

Colon cancer awareness and screening kit distribution campaign was held with information being shared on risk factors, and 178 FOBT (fecal occult blood test) kits were distributed throughout the community.

Community Health partnered with Regional West Physicians Clinic clinics to provide another annual drive-thru influenza clinic. This event allowed over 500 residents to receive their flu shot without ever having to leave their car. A walk-in flu clinic at St. Mary’s Plaza provided 350 more residents with their flu shot.

Community Health is an active partner in PRMRS (Panhandle Regional Medical Response System), attending monthly meetings and assisting with

One area that Community Health focuses on is providing flu shots at the worksite. In 2012, 28 businesses held onsite flu shot clinics for their

The injury prevention coordinator continues to function in partnership with Trauma Services. Holly Johnston reaches out to the community with information on the top 10 traumas in the region as well as educating on current hot topics such as concussion legislation and distracted driving.

Regional West Medical Center is one of 100 hospitals across the nation that is contracted with the Consumer Product Safety Commission (CPSC) to review Emergency Department visits for accidents and trauma related to commercial products. This data is supplied to the CPSC and utilized to develop safety recalls for consumers.

LEAN Six Sigma

In 2012, a process improvement program called LEAN Six Sigma began. Headed by Martha Stricker, BSN, RN, and currently consisting of seven trainees, projects are identified and then addressed through an established methodology. The ► Continued to page 34

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► Continued from page 33

methodology focuses on reducing variation and eliminating waste. The central focus and drive utilized in defining the project is the “Voice of the Customer.” Teams are looking for ways to reduce complexity and use an integrated team approach to problem solving. This means that a project team will include front line staff that performs the process on a regular basis. They will help find variation and waste and improve the current

processes to a controlled state, which is re-usable and timely. A control plan is developed after improvements are put into place so that the process can be managed and not slip back into inefficiency.

in process at Imaging Services, and turnaround times on Troponin lab work between the Emergency Department and Lab as well as overall Emergency Department throughput.

Projects completed in 2012 included: the billing process in Patient Financial Services, notification of patients with Multiple Drug Resistant Organisms (MDRO’s) to necessary staff, check-

Pharmacy medication reconciliation nurses

Nancy Sloan

Nancy Sloan, Pharm D, RPH | Interim Directory, Pharmacy

Activities for 2012-2013 Pharmacy has six RNs who work from the Pharmacy Department to obtain the patient’s home medication list at admission.

There is one nurse in the Emergency Department daily and two nurses up on the floors from the hours of 8 a.m. to 6:30 p.m. daily.

The nurses obtain a complete list of the patient’s home medications and allergies and update the electronic medical record for all inpatients.

The nurses make calls to outpatient pharmacies for information regarding medications and dosages.

They also search multiple electronic medical record databases to

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determine the medications the patient took at home (NextGen, NeHII, NRX-QS1, Home Health, Hospice, and HPF).

Historically, the pharmacy medication reconciliation nurses screen more than 7,600 patients annually. They are here every day, including holidays!

After comparing the patient’s home medications with the medications ordered in the hospital, the pharmacy medication reconciliation nurses intervene when needed by making calls to the physician to clarify any medication discrepancies.

Our pharmacy medication reconciliation nurses include:

The pharmacy medication reconciliation nurses also complete initial screening for influenza and pneumococcal vaccines and forward information obtained from the patient and from NESIIS to the pharmacists for review and follow-up to order needed vaccinations.

Tammy Cox, RN

Karen Perkins, RN Ron Ward, RN Consuelo Loera, RN

Marilee Monohon, RN Karla Biberos, RN

QuALITY RESOURCE Margo Ferguson, MT (ASCP) | Director, Quality Resource

PICTURED FRONT L TO R: Cleta Gable-Nuss, Margo Ferguson, Anita Schlager, Kris Henkel. BACK L TO R: Janelle Schroeder, Vicky Stoll, Amanda Sabo, Janice Casey, Linda Armstrong, Jeanie Miller. Not pictured: Kent Anders

T

he Quality Resource Department consists of 11 employees who support performance improvement, infection prevention, and related quality and safety activities throughout Regional West Medical Center. Seven of the 11 employees are RNs with distinct areas of focus within continuous quality improvement initiatives and regulations. Department staff RNs are: Janelle Schroeder, MSN, RN Clinical Quality Improvement (CQI) Nurse Coordinator Linda Armstrong, BSN, RN Clinical Data Quality Analyst Vicky Stoll, RN Clinical Data Quality Analyst Kris Henkel, RN Clinical Data Quality Analyst Janice Casey, RN Clinical Data Quality Analyst

Jeanie Miller, RN, BC Clinical Data Quality Analyst

New Core Measures: Stroke, VTE, and Inpatient-based Psychiatric Measures

Amanda Sabo, BSN, RN Infection Prevention and Epidemiology Nurse

Education and training for new Core Measures Meaningful Use collaboration

The nurses have responsibility for aspects of Centers for Medicaid and Medicare (CMS) and Joint Commission (JC) quality reporting requirements including Core Measure chart abstraction, provider and staff education, and Opportunity for Improvement (OFI) reporting. Nurses prepare documents and/or reports for review at a variety of committee meetings, including Medical, Surgical and Perinatal/Peds, M&M, and committee meetings. Additionally, nurses participate in the Root Cause Analysis Team. Each nurse in the department serves as a content expert, resource, and support to other departments.

Shared Governance Coordinating Council-Chair Concurrent Infection Prevention and MDRO surveillance Infection Prevention policy revisions and development of the Infection Prevention Dashboard Annual Infection Prevention Risk Assessment Implementation of the Midas DataVision and Stat It modules Development of the Clinical Orderset coordinator position with a focus evidence-based content

Work highlights of 2012 for the Quality Resource Department:

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RISK MANAGEMENT Austin Engel, BSN, RN | Director, Risk Management

Austin Engel

2

012 began with our Risk Assessment, which was conducted on March 6 and 7.

The survey went very well and the information collected was extremely useful. We found some areas where we can improve, but also areas where we excel. I want to thank all of the staff and leadership who participated in the assessment. Areas included in the assessment this year were: Behavioral Health Unit, Obstetrics, Perianesthesia Care Unit, Operating Room, Emergency Room, Human

Resources, and Regional West Physicians Clinic. Richelle Heldwein, who conducted the assessment, was very complimentary towards the Regional West Health Services staff and leadership.

Education Department to offer more opportunities for staff in other areas to attend this presentation. More detailed information of times, dates, and locations will be posted once arrangements have been made.

In January, a “Defensive Documentation” presentation was presented to 2 West, 2 East, and 3rd floor staff. The discussions and questions that were raised during this presentation were very beneficial.

Work has been begun with the

If you would have any questions or concerns regarding Risk Management or want to report any concerns please feel free to call Austin at 308.630.2895.

Trauma Services

Shermaine Sterkel, BSN, RN, CCRN | Trauma Nurse Coordinator

R

egional West Medical Center is a Level II Trauma Center, and has been verified by the American College of Surgeons since 1996. Regional West is the lead Level II Trauma Center in Region 4 of the State of Nebraska.

In 2012, the top 10 causes of injury from most to least were: Falls • Motor Vehicle Crashes (MVC) Livestock related • All-Terrain Vehicles (ATV) • Assault • Motorcycle Crash (MCC) • Bicycle • Sports related Gunshot wounds • Stab wounds

The Trauma Services Department includes Rommie Hughes, MD, Trauma Medical Director; Shermaine Sterkel, RN, Trauma Program Manager; Deana Spreier, Trauma Registrar and Performance Improvement (PI) Coordinator; and Holly Johnston, RN, Injury Prevention Coordinator.

In March 2012, Deana Spreier was hired as the Trauma Registrar and PI Coordinator. Deana enters all 586 trauma patients into the trauma registry and performs 100 percent review of the cases for performance improvement opportunities. This information determines the trauma cases that go to review at Trauma PI and Patient Safety (TPIPS) as well as to Trauma Peer Review (TPR). Deana also has responsibility and oversight of approximate 275 trauma patients and their data that is entered into the trauma registry of the 10 Region 4 regional hospitals.

In 2012, Regional West Medical Center treated 586 trauma patients. Of those patients, 216 were trauma team activations with 61 full trauma team activations and 155 partial trauma team activations.

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Shermaine Sterkel

The Trauma Service at Regional West Medical Center has been busy educating and training our region’s new trauma nurse coordinators/registrars. We held our Region 4 PI meeting in June 2012 at Regional West Medical Center.

Holly Johnston, Injury Prevention Coordinator, made presentations to students at Scottsbluff High School about teens and seatbelt usage, organized an injury prevention theme for the Oregon Trail Days Kiddie Parade, and obtained a driving simulator for a booth at the Scotts Bluff County Fair.

Trauma Services is preparing for our next re-verification as a Level II Trauma Center in November 2013.

Wound/Ostomy Care Report Jeanette McFeely, BSN, RN, CWOCN | Skin Integrity Team Committee

Jeanette McFeely

T

he Skin Integrity Team meets to discuss and educate staff concerning factors that compromise skin integrity, whether it is due to a pressure ulcer, disease process, skin tears, etc. They discuss education, charting screens, reporting, bed surfaces, products (new, house-wide, and/or samples), data collection, PI projects, and pilot projects. Members assist with the Quarterly Magnet Prevalence Pressure Ulcer studies, keep their units informed of education opportunities offered for wound and ostomy care, and update their units on new skin care and pressure ulcer prevention strategies. There is representation from the following units: RCU, ICU, 2W, 2E, 3rd, 4th, Dietary, Education, and Purchasing. Goals of the Skin Integrity Team are to educate staff to focus on skin issues; not only the issues that are present, but interventions needed to prevent skin breakdown.

Attendance: Of the 18 active members, six to 16 members make it to each meeting, with an average attendance of nine (50 percent).

Educational opportunities coordinated and presented for employees included: “Skin care tips” article written for each Magnetic Times newsletter.

New Sage Comfort Shield washcloths.

Coordinating KCI wound care and hands-on VAC training.

pressure redistribution devices, and Braden Scale.

The Hollister rep was here to demonstrate new ostomy appliances and wound dressings.

Bi-yearly presentation to nursing residency program on ostomy care, wound care, and pressure ulcer staging.

Changed surgical sterile ostomy appliances to Hollister-teaching and demonstration for nurses.

Ostomy information added to the Regional West website.

“Getting Serious About Preventing Facility Acquired Heel Pressure Ulcers.”

Reporting topics to care and practice.

NDNQI Quarterly Prevalence Pressure Ulcer Studies.

Prevalon heel off-loading boots are taking the place of blue pillow and plastic air boot.

Z-flow positioning device.

“Measuring Wound” video.

Powdered peanut butter was shared and we discussed the benefits of a high protein diet with wound care.

Swank courses for Excel Care bed and bariatric bed.

“Moisture Associated Skin Damage” presentations for competency days, with 1-CEU. “Wound Care, Pressure Ulcer Staging, Ostomy Care” presentation to residency class bi-yearly.

Bi-monthly presentations to newlyhired nursing staff, including pressure ulcer staging, how to make referrals,

At each quarterly study, the auditing nurses review pressure ulcer staging along with the importance of providing an accurate study 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 this year’s results: Participation in Hill-Rom National Study.

February 21, 2012 • 11 skin team members participated • Assessed 66 out of 82 patients • Eight patients with nine pressure ulcers

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YEAR Consults (Initial appt) F/U with physician Wound/Ostomy F/U TOTAL

• Seven Present on Admission pressure ulcers in hospital • Two Hospital Acquired

2010 151 (8%)* 348 (20%) 1,254 (72%) 1,753

October 23, 2012 • Pink gloves worn for breast cancer awareness • 10 skin team members participated

April 24, 2012 • 13 skin team members participated

• Assessed 56 out of 69 patients

• Assessed 50 out of 55 patients

• Five patients with pressure ulcers

• Four patients with six pressure ulcers

• Two Hospital Acquired

• Six Hospital Acquired • Zero Present on Admission

July 24, 2012 • 11 skin team members participated • Assessed 72 out of 88 patients • Five patients with five pressure ulcers • Three Hospital Acquired • Two Present on Admission

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2009 165 (16%)* 118 (12%) 726 (72%) 1,009

NURSING ANNUAL REPORT

• Three Present on Admission • Outpatient Wound/Ostomy Clinic • Number of patient appointments/ year The Outpatient Wound/Ostomy Clinic is located at Regional West Medical Plaza North, Suite 1400. Clinics are held Monday, Wednesday, and Friday of each week. The rotating medical staff sees new patients and followup visits are scheduled as needed.

The medical staff includes: Melissa Stade, MD and Jason Walsh, MD, FACS with Regional West Physicians Clinic-Surgery, Vascular Diagnostic; and Mark Willats, DPM, FACFAS with Western Plains Foot Center. Dr. Walsh

2011 209 (11%) 376 (19%) 1,374 (70%) 1,959

2012 255 (12%) 369 (17%) 1,522 (71%) 2,146

remains the medical director and is certified as a wound specialist. The nursing staff includes: Rachelle Noe, BSN, RN; CWOCN, Amy Mosteller, NA-C; Jeanette McFeely, BSN, RN, CWOCN; and Sheila Kihlthau, RN. PRN 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, nonhealing wounds. We see ostomy patients who have skin breakdown or pouching issues, and counsel patients with incontinence issues.

Ostomy Report A total of 37 ostomy patients needing ostomy instruction were seen this year.

Shared Governance Reports Janelle Schroeder, MSN, RN | Chair, Coordinating Council

Chair, Patient Care and Clinical Practice Council

Care and Practice Council Janelle Schroeder, MSN, RN Chair Mission Promote, facilitate, and coordinate patient care.

Vision statement The council is actively seen and utilized as a resource for patient care issues to ensure superior clinical performance resulting in outcomes that outperform benchmark data.

In 2010 and 2011, a number of patients at Regional West Medical Center experienced falls with moderate to severe injury.

Inconsistencies throughout the falls prevention process, including the application of the fall risk assessment, fall risk interventions, and post-fall interventions have been identified. Implementation and adherence to an evidence-based fall prevention program facilitates the reduction of patient falls through consistent identification of patients at risk to fall; initiates appropriate interventions to prevent harm; and provides a safe, therapeutic environment. Therefore, the council’s focus for 2012 has been the evidence-based redesign of the fall prevention program to include practices, education, intervention strategies, and evaluation tools that

assist bedside clinicians in safe care delivery.

Medical Center’s strategic plan and performance improvement plan.

What we’ve done Gap analysis.

Where we’re at Develop evidence-based practice.

Fall prevention practices vary greatly.

Revise policy and procedures.

Regional West Medical Center does not utilize an evidence-based fall risk assessment tool.

Develop job aids.

Procedure 150.2 does not provide clear guidance on appropriate risk interventions.

Revisions of processes based on pilot data.

Post-fall care protocol does not exist.

Analyze current processes.

Current fall prevention processes mapped.

Where we’re headed ARU pilot testing beginning June 1.

All-staff education.

Collaboration with Education will allow Upright™ computer-based education program access using Swank Health.

House-wide implementation.

Process steps evaluated for high-risk, high probability of failure, low value, or redundancy.

Transition of falls prevention oversight to Multidisciplinary Team.

Process modified to improve effectiveness.

Select a valid and reliable risk assessment tool.

Hendrich II Fall Risk Model® is a valid, research-based assessment tool created to predict fall risk. The H2Model identifies appropriate fall risk interventions according to the patients’ areas of risk.

Feasibility evaluation and contract with AHI of Indiana, Inc. Establish baseline data.

Outcomes and process metrics identified and linked to Regional West

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Evidence-Based Practice Council Alicia Kunz, MSN, RN Chair In 2012 the Evidence-Based Practice (EBP) Council decided on a shared leadership model. Billy Harris facilitated the meetings, Joe Salazar recorded minutes, and Susan Backer sent out the agenda and represented the council at the Coordinating Council meetings.

2012 work included Copyright issues for posting articles for Journal Club were explored. Several different options were looked at.

The council investigated how to expand Journal Club to a broader audience. Billy Harris researched implementation through the Information Systems Department.

Representatives from Go-To-Training were contacted. Benefits of this service are the ability to provide inclass quizzes, monitor attendance, and attend from off-site. Limitations include price and a limited number of off-site attendees allowed.

EBP Classes were offered twice during 2012 with a total of 11 attendees.

Classes were offered in three parts: Session I: Creating a Vision Session II: Searching for Evidence Session III: Evaluating the Evidence In October 2012 a new Chair, Alicia Kunz and Co-Chair, Carrie Herr were elected. Kelsey Winger volunteered to record minutes. The mission and vision of the council were reviewed at this time.

The EBP Council is currently researching the effects of fatigue in the work place in hopes to provide a recommendation to leadership

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regarding back-to-back 12 hour work days. An EBP survey has been distributed to nurses across the facility. After reviewing survey results, the council will look for the most effective direction to take the Journal Club and the EBP classes this year.

Nurse/Physician Council Paulette Schnell, BSN, RN Chair This past year the Nurse Physician Council has continued to work to improve communication between nurses and physicians. The council has finished up details of the standardize rounding. This has seen an improvement in coordination of patient care and a reduction in phone calls to health care providers.

The council has had several new members who are being introduced to the shared governance process.

Education in how the shared governance and the council process works were provided. Dr. Todd Sorensen provided a presentation on a historical background of health care from past to present. A publicity promotion of Doctors’ Day was planned and implemented March 25 through 29 that encouraged staff, visitors, and patients to thank our physicians for the caring, compassionate, and professional care they provide.

Quality and Safety Council Liz Ossian, BSN, RN Chair In late 2011, the Quality and Safety Council took on a project aimed at improving hand hygiene practices.

This was an opportunity to implement an evidence-based practice change with the ultimate goal of reducing hospital-acquired infections. The Joint Commission developed this Targeted Solutions Tool to assist

health care facilities in assessing and improving hand hygiene compliance, which is one of the new 2013 Patient Safety Goals. During 2012, 2nd floor units Med/Surg and Ortho/Neuro, and 3rd floor Medical Oncology were chosen as the pilot units. We collected hundreds of hand hygiene observations, which were then entered into a database. By identifying the barriers to performing hand hygiene properly, we can choose the right interventions, whether that means education for staff, relocating foam dispensers, or other changes.

Currently we are working with 2nd and 3rd floor Unit Practice Council chairs to assist them in choosing interventions appropriate to their areas and specific barriers.

The Quality and Safety Council has spent a majority of the year researching how nursing peer review (NPR) would work for our facility.

Modeled after physician M & M, the goal of peer review is to improve nursing practice and identify improvements at the system or individual level by examining unusual events. Patient Safety Officer Susan Backer serves as chair for the NPR Committee. There have already been cases for peer review identified at our facility and two cases have successfully made it through the process. Most recently, in February, Nursing Peer Review Committee policy was officially approved by the Policy and Procedure Committee.

In the coming year, we will continue to work on rolling out NPR, identifying committee members, and educating all nurses about how the entire process works. The committee looks forward to continuing this important work in the coming year!

Professional Practice Council Lenna Booth, BSN, RN Chair Our mission is to promote and support the professional nurse through a positive work environment.

Clinical Ladder The Professional Practice Council began their annual work on the Nursing Clinical Ladder in late summer and met for an additional full workday to review and revise the ladder in early October. Revisions were made to reflect the need for critical thinking at all levels, and efforts were made to include areas for advancement up the ladder that focus on outcomes vs. a skills-based approach for nursing involvement in patient cares. Focus was placed on recruitment and retention of staff and changes were made in several areas to achieve this goal. A new employee now has the opportunity to apply for advancement on the clinical ladder after six months of employment.

The pay at each level was changed from a percentage of base pay to a differential. Making this change allows for experienced staff to be hired at a level of pay that better reflects their years of experience.

Second Annual Magnet Awards We were pleased to be able to recognize and honor outstanding nurses and co-corkers for their contribution to our hospital and patients based on the nominations of their peers. The second annual Magnet Nursing and Friend of Nursing awards were presented during the Nurses’ Week celebrations. An exciting addition this year was adding a category to honor an exceptional nurse preceptor. This was brought to our council by a nursing student who, when she heard about the Magnet Nursing awards, wanted an opportunity to honor her preceptor!

Winners were again honored by

Shirley Knodel, CNO, and the Magnet Coordinator with a framed certificate, a monetary gift, and a cake celebration in their respective units to share with their co-workers. We look forward to continuing this tradition in 2013!

New Projects Professional Practice Council members were excited to be asked to be a part of a pilot study for standardizing nursing uniforms. They have worked with UNMC master’s students Shirley Knodel, Connie Rupp, and Sarah Shannon to support them as they bring this study to our facility, and look forward to seeing the project to completion in the coming year.

Upcoming Projects Research reviews were completed on the use of social media networking in the health care setting. Plans are in progress to develop a social media network statement for nurses that will address the benefits and concerns related to the use of social media, both in and out of the work setting.

changes that may be possible. One major change we are considering is offering the night shift staff the option to call in a meal order to the cafeteria for themselves, just as the patients do. Lori Miller is looking into adding a vending machine with other food options to help in the meantime.

While that project is under way, the next project is to work with Pharmacy to help streamline the medication process. As this is just getting started there isn’t much to report. We plan on working with the Pharmacy closely to understand that department’s roadblocks and have Pharmacy understand nursing’s concerns. Please look for changes that may affect you.

If you have any suggestions for the Night Shift Council to consider, please contact us and we will be happy to look into it!

Night Shift Council John Furman, BSN, RN Chair The Night Shift Council organized in the last quarter of 2012. With such a short time of being active, the major accomplishments are recruiting members and voting in the Chair and Chair-Elect. John Furman is the new Chair and Matt Blaylock is ChairElect. Our secretary is Nikki Rotert from Medical/Oncology. We have ongoing membership needs, so if you are interested please contact either of these members.

Our core goal is to assist in making changes that directly affect the night shift staff. The first project that the committee has undertaken is directed at the food cart. With the help of Lori Miller, there are several

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Education Department Alicia Kunz, MSN, RN | Education Department

BOTTOM ROW, L TO R: Marilyn Noel, Kelsey Morris, Carol Gifford. TOP ROW, L TO R: Dallas Schaffer, Alicia Kunz, Julie Schaff, Michele Parks Regional West Health Services is an approved provider of continuing nursing education by the Nebraska Nurses Association, an accredited approver by the American Nurse Credentialing Center’s Commission on Accreditation.

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.

The Education Department includes a director, two nurse educators, three education coordinators, and a secretary.

Advanced Cardiac Life Support Five provider courses and four recertification courses were offered.

In 2012, 820 nurses participated in peer-reviewed nursing contact hours.

In 2012, 33 different peer-reviewed activities were offered.

In 2012, 73.64 different live peerreviewed contact hours were offered.

In 2012, 1,697 peer-reviewed nursing contact hours and physician CME’s were completed on SWANK health through Regional West Medical Center.

Provider (Certification)=92 participants Renewal (Re-certification)=81 participants Total=173 Pediatric Advanced Life Support Six provider courses and three recertification courses were offered.

Provider=85 participants Renewal=41 participants Total=126

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Trauma Nurse Core Course Three courses were offered.

Total=34 Neonatal Resuscitation Course Six courses were offered.

Total=29 Emergency Nurse Pediatric Course Six classes were offered.

Total=49 participants Our Education Department works with the Rural Nebraska Healthcare Network to provide these and other learning opportunities not only at Regional West but across the panhandle.

2012 Regional West Medical Center Certified Nurses Alice Fillingham, RN Certified Emergency Room Nurse (CEN) Amanda Lashley, RN Certified Emergency Room Nurse (CEN) Andrea Ray, RN Certified Perioperative Anesthesia Nurse (CPAN) Barb Lundgren, RN Certified Professional in Health Risk Management Cheng Wei-Kow, RN Certified Emergency Room Nurse (CEN) Chris Buhr, RN Orthopedic Nurse Certified (ONC) Chris Micheels, RN Certified Perioperative Anesthesia Nurse (CPAN) Christy Jay, RN Certified Nurse Operating Room (CNOR) Christy Walters, RN Medical/Surgical Board Certified Nurse Cindy Francisco, RN Certified Lactation Counselor (CLC),International Board Certified Lactation Consultant (IBCLC) Cindy McGaughy, RN Certified Rehabilitation Registered Nurse (CRRN) Darcy Haslam, RN Certified Nurse Operating Room (CNOR) Darlene Cooper, RN Certified Rehabilitation Registered Nurse (CRRN) Dayna Dondelinger, RN Certified Nurse Operating Room (CNOR) Dee Vogel, RN Certified Flight Registered Nurse (CFRN) Donna Klein, LPN GI Technical Specialist Certificate from Society for Gastroenterology , Nurses and Associates (SGNA) Ione Beavers, RN Oncology Certified Nurse (OCN) Janet Lewis, RN Certified Nurse Operating Room (CNOR) Jason Rairigh, RN Certified Flight Registered Nurse (CFRN) Jeanette McFeeley, RN Certified Wound, Ostomy, Continence Nurse (CWOCN) Jessica Conn, RN Certification in Critical Care (CCRN) Jessica Slaght-Langworthy, RN Certified Pediatric Emergency Nurse (CPEN), Certified Emergency Room Nurse (CEN), Certified Critical Care Nurse (CCRN) John Beard, RN Peripherally Inserted Central Catheter (PICC) Insertion Certification

Julie Kautz, RN Certified Professional Utilization Reviewer (CPUR) Kathi Yost, RN Geontology Nursing Certified (BC) Kathy Jacobson, RN Certified Emergency Room Nurse (CEN) Kathy Mackrill, LPN GI Technical Specialist Certificate from Society for Gastroenterology Nurses and Associates (SGNA) Kay Lemons, RN Certified Perioperative Anesthesia Nurse (CPAN) Keara Brunner, RN Certified Lactation Counselor (CLC) Kim Brown, RN Certified Nurse Operating Room (CNOR) Kim Mann, RN Certified Nurse Operating Room (CNOR) Kim Meininger, RN Orthopedic Nurse Certified (ONC) Krissa Randall, RN Certified Inpatient Obstetrics Nurse (RNC) Kristi Henkel, RN Certified Professional Utilization Reviewer (CPUR) Laura Wolfe, RN Certified Emergency Room Nurse (CEN) Leigh Miller, RN Certification in Critical Care (CCRN) Leslie Biggs, RN Oncology Certified Nurse (OCN) Linda Fowler, RN Certified Emergency Room Nurse ( CEN) Linda Fowler, RN Certification in Critical Care (CCRN) Lisa Fabricus, RN Medical/Surgical Board Certified Nurse Lori Joplin, RN Certified Emergency Room Nurse (CEN) Lucrecia Spady, RN Certification for Gastroenterology Nurse Marilyn Noel, RN Orthopedic Nurse Certified (ONC) Marilyn Stoddard, RN Certification in Critical Care (CCRN) Mary Coon, RN Certified Inpatient Obstetrics Nurse (RNC) Mary Lockwood, RN Certified Nurse Operating Room (CNOR) Megan Anderson, RN Oncology Certified Nurse (OCN) REGIONAL WEST MEDICAL CENTER ďż­ 308.635.3711

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2012 Regional West Medical Center Certified Nurses Michelle (Shelly) Meisner, RN Outcome Assessment Information Set Certified Nurse (OASIS) Michelle Keener, RN Certified Ambulatory Peri-anesthesia Nursing (CAPA) Michelle Powell, RN Medical/Surgical Board Certified Nurse Mike Bokelman, RN Peripherally Inserted Central Catheter (PICC) Insertion Certification Mona Urwin, RN Certified Bariatric Nurse (CBN) Pam Cover, RN Certified Rehabilitation Registered Nurse (CRRN) Pam Zitterkopf, RN Certified Clinical Health Coach (CCHC) Peg Jackson, RN Certified Perioperative Anesthesia Nurse (CPAN) Rachelle Noe, RN Certified Wound, Ostomy, Continence Nurse (CWOCN) Ramona Giles, RN Certified Inpatient Obstetrics Nurse (RNC) Rhonda Groshans, RN Certified Nurse Operating Room (CNOR) Rich Dermer, RN Psychiatric and Mental Health Certified Rob Cushing, RN Certified Inpatient Obstetrics Nurse (RNC) Roxie Shaul, RN Certified Ambulatory Peri-anesthesia Nursing (CAPA) Sandy Hebbert, RN Certified Perioperative Anesthesia Nurse (CPAN) Sarah Paetow, RN Certified Emergency Room Nurse (CEN) Sean Shirley, RN Certified Flight Registered Nurse (CFRN) Shari Rogers, RN Certified Fetal Monitoring Nurse (CFMN) Sharon Marlow, RN Resident Assessment Coordinator - Certified (RAC-CT) Sheila Kilthau, RN Resident Assessment Coordinator - Certified (RAC-CT) Sheli Goodwin, RN Psychiatric and Mental Health Certified Cheri Weinmeister, RN Certification in Critical Care (CCRN)

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NURSING ANNUAL REPORT

Shermaine Sterkel, RN Certification in Critical Care (CCRN) Sherry McDonald, RN Certified Emergency Room Nurse (CEN) Stacy Ingersoll, RN Certified High Risk Neonatal Nursing, Certified Lactation Counselor (CLC) Stephanie Hawley, RN Accredited Case Manager (ACM) Stephen Matthews, RN Certification in Critical Care (CCRN) Susan Backer, APRN-CNS Clinical Nurse Specialist Adult Health and Illness (ACNS-BC) Susan Schoeneman, RN Oncology Certified Nurse (OCN) Tami Leis, RN Psychiatric and Mental Health Certified Tara Shallenberger, RN Medical/Surgical Board Certified Nurse Teal Smith, RN Certification in Critical Care (CCRN) Tina Delgado, RN Medical-Surgical Board Certified Nurse (CMSRN) Tracy Meyer, RN Certified Flight Registered Nurse (CFRN) Tracy Payne, RN Certified Perioperative Anesthesia Nurse (CPAN) Trish Garner, RN Certified Emergency Room Nurse (CEN), Certified Flight Registered Nurse (CFRN)

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