Patient Care Services 2015

ST. LUKE’S

Patient Care Services REPORT 2014 - Quarter 1 2015

Focusing on patients and quality care

Dear Colleagues, Welcome to the 2014-15 Patient Care Services Report. We are well on our way with 2015 efforts, but it is important to pause and remember the many contributions of the past 18 months. It also provides me the opportunity to thank you one more time for the exceptional care you provided in 2014. As you read through this report and reflect on the many accomplishments, I hope you feel a sense of pride. One of the things that struck me is how the exceptional care is spread across the organization and divisions. There is no one corner of excellence, but rather a culture of aspiration and striving to provide excellent care in all settings.

Table of Contents 1 -4

Preparing for the Future

5

Patient Care Services Strategic Plan 2014 Quarter 1, 2015

6-11

Exemplary Professional Practice

12-14 New Knowledge 15-17 Structural Empowerment

18-21 Transformational Leadership

22-25 Community

This culture has led to another year of external recognition, such as Truven Health Analytics Top 100 Hospital designation for the sixth time and Top 50 Heart Hospital designation for the fifth time! This past year we also celebrated Magnet redesignation which continues to convey to our colleagues and the community that we are committed to exceptional nursing care and positive work environments. Our Inpatient Rehabilitation Unit achieved its 25th CARF accreditation. These external validations are important because it conveys to our patients and community that they can trust us to provide the very best care.

Throughout the report you will see examples of Exemplary Professional Practice, such as the tremendous way associates throughout the organization stepped up and responded to the Ebola scare. The infection prevention and disaster preparedness team led us to use this situation to prepare for any public health emergency. The Palliative Care team introduced an outpatient clinic to facilitate discussions and decisions regarding goals of care. Hospital Acquired Pressure Ulcer rates were driven down to all-time lows and remain there. And the Ronald McDonald Family Room® takes Family-Centered Care to a new level in the Helen G. Nassif Center for Women’s and Children’s Health.

Also highlighted are Innovations in Care, such as the introduction of Integrated Care Management training to develop clinician’s expertise in goal setting and coaching with

patients. Another example is the introduction of a Comfort Room in Behavioral Health to help patients decrease anxiety and agitation. Grief support programs, such as the Angel Gowns for families of our Birth Care Center and Hospice sponsored Children’s Bereavement Camp provide much needed assistance to grieving families.

St. Luke’s nurses and colleagues are also contributing to New Knowledge development through participation and leadership in research studies.

The accomplishments illustrated throughout the report reflect the impact of Shared Governance and Transformational Leadership. The department-based Unit Practice Councils have been instrumental in improving care at the unit level, while the interdepartmental councils drive organizational improvements.

Opportunities for celebration, reward and recognition occur throughout the year and are highlighted in the Annual Report. This past year we introduced the Daisy Award, surprising and delighting individual staff members, their families and the entire team. We feel very fortunate to partner with the Barnes family in their efforts to honor nurses. We are also very proud to have added nine St. Luke’s nurses, over the past twelve months, to the Top 100 Great Iowa Nurses roster. Nursing Excellence Awards, new certifications and degrees, as well as other accomplishments, are signs of individual and organizational commitment. I hope you enjoy reading about your colleagues and their achievements, as well as seeing your own efforts recognized and celebrated. St. Luke’s continues to be successful and patients benefit because of you, as individuals and as teams, committed to our mission: to give the health care we’d like our loved ones to receive. Thank you and enjoy!

Sincerely,

Mary Ann Osborn, RN, MA Regional Senior Vice President and Chief Clinical Officer

PREPARING FOR THE FUTURE Ronald McDonald Family Room® opens at St. Luke’s St. Luke’s Hospital is now home to eastern Iowa’s first Ronald McDonald Family Room®. With this new facility, which opened in January 2015, moms and dads of children receiving treatment at St. Luke’s have all the comforts of home while remaining just steps from their child’s bedside.

St. Luke’s Ronald McDonald Family Room is one of five programs operated by the Ronald McDonald House of Eastern Iowa & Western Illinois. It features three sleeping rooms, two shower rooms, kitchen, laundry, dining and living areas. It is expected to serve up to 1,800 families per year.

“We are delighted to partner with the Ronald McDonald House,” says Dr. Andrew Nordine, medical director of St. Luke’s Neonatal Intensive Care Unit.

“We believe when mom and dad are well-cared for, the family will thrive. This is a win-win for the entire community.”

The Ronald McDonald Family Room is open to children’s families regardless of how far they are from home, at no cost to the family. Its purpose is to allow them to rest and regain their energy so they can focus on what matters most—their child.

St. Luke’s receives Magnet recognition for nursing excellence St. Luke’s Hospital achieved Magnet recognition for the second time, signifying successful implementation of the national Magnet standards for nursing excellence.

The American Nurses Credentialing Center’s Magnet Recognition Program® for hospitals recognizes excellence in nursing and is considered the gold standard in patient care. Only about four percent of U.S. hospitals are mMagnet certified and fewer are redesignated. St. Luke’s is the only hospital in Cedar Rapids recognized as a Magnet Nursing Excellence organization.

“The Magnet redesignation is the highest honor nursing can receive and is a testament to the hard work our associates put forth each and every day,” says Mary Ann Osborn, St. Luke’s Hospital regional vice president and chief clinical officer. Hospitals that achieve Magnet status go through a rigorous review process that includes a comprehensive site visit by appraisers.

Carmen Kleinsmith, vice president of nursing excellence at St. Luke’s, points to achievements in quality and safety during the Journey to Magnet Excellence, including a 10 percent reduction in readmissions, 20 percent reduction in falls and a 43 percent reduction in hospitalacquired pressure ulcers. Kleinsmith says, “This designation is an affirmation that St. Luke’s has extraordinary patient care.”

St. Luke’s named a Top 100 Hospital for the 6th time St. Luke’s Hospital has been recognized as one of the best hospitals in America.

The Truven Health Top 100 Hospitals® designation is considered the industry gold standard and is based on the objective evaluation of nearly 3,000 hospitals across the U.S. What is even more exceptional is St. Luke’s has received this honor six times since 2004. Jean Chenoweth, senior VP for performance improvement and the 100 Top Hospitals program at Truven Health Analytics says, “The 2015 100 Top Hospitals set the benchmarks for peers around the country, consistently delivering outstanding quality, satisfaction and community value at a reasonable cost.”

St. Luke’s president and CEO Ted Townsend calls receiving the award again “something to be very, very proud of,” adding, “In an era of great change within the health care industry, to be able to demonstrate top performance time after time in multiple key performance parameters means we must be doing a whole lot right.”

St. Luke’s a Top 50 Heart Hospital St. Luke’s Hospital has been named a 2015 50 Top Cardiovascular Hospitals® by Truven Health Analytics. It’s the fifth time St. Luke’s has achieved this elite status based on results in key performance areas.

“This is truly an honor for our entire cardiovascular team,” says Dr. Todd Langager, UnityPoint Clinic Cardiology. “Their dedication to excellence has truly made St. Luke’s a leader in heart care.”

St. Luke’s is one of only two hospitals in Iowa named one of America’s best heart hospitals. The study shows that if all heart hospitals in the U.S. performed at the level of the Top 50, nearly 9,500 additional lives could be saved, while cutting health care costs by more than $1 billion.

2014 | A Year in Review JANUARY

▪

Named one of the 100 HOSPITALS WITH GREAT HEART PROGRAMS

by Becker’s Hospital Review.

FEBRUARY

▪ Earned 50 BEST

HOSPITALS designation from Healthgrades.

AWARD FOR EXCELLENCE IN NURSING for the second time.

JUNE

▪ UnityPoint Clinic locations earn HIGHEST LEVEL OF RECOGNITION by the National Committee for Quality Assurance for PATIENT-CENTERED MEDICAL HOME.

selected to join the MAYO CLINIC CARE NETWORK. UnityPoint Health was named to 150 GREAT PLACES TO WORK IN HEALTHCARE list

by Becker’s Hospital review.

▪ Named ONE OF

▪

▪

MOST SOCIAL MEDIA FRIENDLY HOSPITALS by NurseJournal.org.

2014/2015 CONSUMER CHOICE AWARD - National Research Corporation.

AMERICA’S HIGHPERFORMING HOSPITALS in five specialties - U.S. News & World Report.

One of the nation’s MOST WIRED HEALTH SYSTEMS - Hospitals & Health Networks magazine.

St. Luke’s PALLIATIVE CARE OUTPATIENT CLINIC opened.

Designated one of ▪ the nation’s 50 TOP

▪ ▪

CARDIOVASCULAR HOSPITALS® by Truven Health Analytics St. Luke’s Outpatient Services hit ALL-TIME HIGH FOR PRESS GANEY scores.

UnityPoint at Home named to 2014 HOMECARE ELITE.

GREAT HOSPITALS IN AMERICA by Becker’s Hospital Review.

Achieved RADIATION THERAPY CERTIFICATE OF NEED (CON) from state.

AUGUST

▪ RONALD ▪ ▪

NOVEMBER

MCDONALD FAMILY ROOM® announced at St. Luke’s.

SURGERY CENTER CEDAR RAPIDS EXPANSION project completed.

Breast and Bone Health certified as a QUALITY BREAST CENTER OF EXCELLENCE.

DECEMBER Construction starts ▪ on the ALBERT G.

▪

AND HELEN NASSIF RADIATION CENTER. St. Luke’s launches PROJECT SEARCH PROGRAM for individuals with disabilities.

130 YEARS 100,000 VOLUNTEER HOURS 4 DAISY AWARDS 2,898 EMPLOYEES

$361,489 iCARE DONATIONS 356 GUARDIAN ANGELS 2,560 BABIES BORN

15 SPIRIT CUP HONOREES 2 | PREPARING FOR THE FUTURE

▪ Named one of the 100

JULY

▪

OCTOBER ▪ SEPTEMBER GROUNDBREAKING ▪ Named one of the ▪ for Jones Regional nation’s TOP 100 Medical Center EXPANSION PROJECT. GRAND OPENING of the UnityPoint Clinic Diabetes and Kidney Center.

▪ Achieved MAGNET

APRIL

▪

MAY

▪ First health care ▪ organization in Iowa

MARCH

27 iGRANTS

Ebola outbreak prompts immediate response The 2014 Ebola epidemic in West Africa was the largest on record. On September 30, 2014, a Liberian man newly arrived in Dallas, TX, became the first patient in the U.S. to be diagnosed with the disease.

The UnityPoint Health response was immediate. An overall plan for dealing with potential Ebola patients was developed at the system level and led by Mary Ann Osborn, regional senior vice president and chief clinical officer at St. Luke’s Hospital. The strategy was then shared with infection control leaders throughout the health system to implement at their respective institutions.

You can’t get Ebola through air

Facts about

Ebola You can’t get Ebola through food

You can’t get Ebola through water

Ebola Prep Team

Under Osborn’s direction, St. Luke’s assembled an Internal Response Team consisting of physicians, nurses, respiratory therapists, lab technicians and environmental service associates.

The team received intensive training on how to care for Ebola patients, including the crucial process for putting on and removing personal protective equipment.

St. Luke’s also shared supplies with clinics and critical access facilities, like Jones Regional Medical Center, to ensure they were prepared as well.

In addition to the response plan within the health system, St. Luke’s collaborated

with local Emergency Medical Services (EMS) representatives and Linn County Public Health officials to make sure any threat was approached as a team effort.

Today, the Ebola crisis has lessened but the training and protocols remain in place at St. Luke’s. “Our strategy evolved over time so we are ready, whether it’s Ebola, another disease, even bioterrorism,” explains Lori Townsend, Infection Prevention program manager.

“We continue to keep our master trainers involved and make sure we have processes and equipment in place.”

Demonstrably Better Quality Engagement. Webster’s Dictionary says it’s a noun – a formal agreement to get married; an arrangement to do something or go somewhere at a fixed time; the action of engaging or being engaged; a pledge or obligation. The Thesaurus goes on to list synonyms and phrases related to engagement – absorption, concentration, immersion, intentness, involvement, alliance, collaboration, connection, cooperation, partnership, relations, support.

Carmen Kleinsmith, RN, MSN Vice President, nursing excellence

No matter how we use it, engagement implies a commitment, an obligation, a partnership. The best engagements take a lot of work, but create great outcomes! And that’s what we have here! It’s demonstrated in the care delivered to our patients and families and in the collaborative relationships

among our health care team members that ensure we’re meeting our patient’s needs.

It is also evident in the engagement made by hundreds of our associates through involvement in shared decision making councils, performance improvement activities, evidence-based practice projects, and career development opportunities.

It is this engagement that allows us to respond to the rapidly changing healthcare environment, yet remain compassionate and expert in our care. Quality – the patient experience and the clinical outcomes achieved, benchmark with some of the best in the country. Because of your commitment and engagement, we deliver the healthcare we’d like our loved ones to receive! You make me proud every day!

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Collaborating with Mayo Clinic for exceptional care UnityPoint Health Cedar Rapids is the first health care organization in Iowa to be selected to join the Mayo Clinic Care Network.

This international network works with Mayo Clinic to improve health care by sharing knowledge and promoting physician collaboration.

UnityPoint Health Cedar Rapids joined the Mayo Clinic Care Network in May 2014. Through the network, doctors at both organizations work together to provide the highest level of care to patients in eastern Iowa. UnityPoint Health Cedar Rapids providers also have access to Mayo Clinic resources, including best-

practice care guidelines, treatment recommendations and reference materials.

“By working with the worldrenowned experts at Mayo Clinic, we enhance the quality of care and the quality of life in our community,” said Ted Townsend, president and CEO of UnityPoint Health St. Luke’s Hospital.

Thanks to our collaboration with Mayo Clinic, more patients in our community can avoid travel for answers to complex medical questions. In the first year of collaboration, an average of 20 patients each month received Mayo eConsults without leaving their doctor. Local providers used “Ask Mayo Expert”

Post-Op Glucose Control Post-operative glycemic control in cardiac patients is essential to quality health care. Nearly all patients who undergo cardiac surgery experience hyperglycemia, which makes them more vulnerable to infection and slows the healing process. The Joint Commission’s Surgical Care Improvement Project (SCIP) calls for controlled post-operative blood glucose (less than or equal to 180 mg/dl) within 18 to 24 hours after anesthesia end time.

At St. Luke’s, we identified less-than-optimal control of this important measure. In November 2012, our observed rate of post-op glucose control was 86.2 percent. Melissa Collier, ARNP, Inpatient Diabetes, led a team that examined our approach and developed a standard protocol for all cardiac surgery patients. The result? We saw immediate improvement to 94.1 percent the next quarter. Since 2013 we’ve maintained rates greater than 96.9 percent including achieving the 100 percent target throughout the last three quarters of 2014.

“Standardization of care is what’s made the difference,” says Collier. “We implement the protocol in every case. We also limit the number of people who manage glucose control to ensure standardization.”

The approach has been so successful that in October 2014, Collier led a system-wide team in developing a standardized order set for all UnityPoint Health affiliates.

The new protocol will roll out in June 2015.

4 | PREPARING FOR THE FUTURE

&

UnityPoint Health

Mayo Clinic

An Extraordinary Relationship patients

EACH month

received Mayo

eConsults without leaving THEIR doctor

3,338

As the exclusive member of the Mayo Clinic Care Network in Cedar Rapids, UnityPoint Health experts can access Mayo Clinic expertise to give you extraordinary, coordinated care.

$

271 *Data is from May 2014 – July 2015

Visit unitypoint.org/mayo to learn more.

2,636 times to access Mayo Clinic knowledge. And patients benefited from two high-quality teams focused on patient-centered care—all at

zero dollars in additional cost to the patients.

UnityPoint Health affiliates.

The new protocol will roll out in June 2015.

New Palliative Care Outpatient Clinic focuses on quality of life St. Luke’s Palliative Care team helps patients with serious, ongoing medical conditions to improve their quality of life. In 2014, palliative care services were expanded with the opening of the community’s only Palliative Care Outpatient Clinic.

Julie Shaw, ARNP and Kimberly “It’s all about accessibility,” Roberts,LMSW, OSW-C explains Jill Morgan, director of Hospice, Palliative Care and Spiritual Care at St. Luke’s. “The Clinic represents another opportunity to make ourselves available to our patients.”

Morgan says there has been a growing awareness of the benefits of palliative care, which focuses on providing patients with relief from the symptoms and stress of a serious illness. The palliative care team works with the patient as a “whole person,” helping individuals and their family members understand the illness and treatment options, while managing the symptoms associated with that condition. The team includes Dr. James Bell, medical director, two advanced practice nurses, registered nurses, social workers, chaplains and volunteers.

In addition to the Clinic, which is located within St. Luke’s Hospital, outpatient palliative care services are provided at long-term and assisted living facilities, in the patient’s doctor’s office and in the patient’s home.

PATIENT CARE SERVICES STRATEGIC PLAN 2014-15 Based on the organizational pillars of Demonstrably Better Quality, Partnership with Associates and Strengthen the Core.

Demonstrably Better Quality

Partnership with Associates

Strengthen the Core

Patient & Family Experience

Great Place to Work

Sustainability

• Focus on “What concerns or worries you?”

• Develop patient care tech roles for acute care & home care.

• Video monitoring for patient safety.

• Pain management.

• Maximize staff development programs.

Care Coordination

o

• Facilitate warm hand-overs for high-risk patients.

• Consistently use after-visit summary and validate its accuracy.

• Establish consistent & reliable discharge process.

Evidence-Based Practice • Implement NICHE (Nursing Improving the Care of Health System Elderly) program.

• Achieve CMS targets. Focus on catheter-acquired urinary tract infections (CAUTI) & multi-drug resistant organisms (MDRO).

CE Direct, Bridges to Excellence, BSN Cohort, Scholarships.

o

Invest in preceptor/charge education (incorporate learning from Magnet conference).

o

Continue refinement of residency/on-boarding.

• Achieve length of stay/efficiency of patient stay targets by focusing on throughput & case management best practice.

Keeping Care in the System • Speak confidently to patients about UnityPoint Health services. Support referral to our own partners while respecting patient choice.

• Reduce associate injury. o

Exposure-type injuries and needle sticks/mobility aids.

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EXEMPLARY PROFESSIONAL PRACTICE

NICHE GRT team

NICHE designation focuses on needs of older adults Our commitment to older adults has resulted in NICHE designation for UnityPoint Health St. Luke’s Hospital. NICHE (Nursing Improving the Care of Health-system Elderly) is the leading nurse-driven program to help hospitals and health care organizations improve the care of patients age 65 and up. The vision of NICHE is for all older adults to receive sensitive and exemplary health care. With nearly 16 percent of Iowans already over 65, the designation reflects St. Luke’s commitment to this fast-growing segment of the population.

Seven St. Luke’s employees completed the NICHE leadership program and submitted a 2015 action plan specifying interventions to enhance care of the 65 and up age group.

One major initiative is the Geriatric Resource Team (GRT), who will play a key role in preventing, assessing and addressing common geriatric syndromes. Barb Haeder, advanced practice nurse, says, “The GRT will augment staff’s knowledge of geriatric care, which will help everyone be more sensitive to the needs of the patient.”

Adds Haeder, “Older adults account for about 42 percent of our adult hospital discharges, compared to 36 percent nationally. Through NICHE, we’re helping our staff understand this older population has special needs. We want to meet those needs so we can give patients the very best care we can.”

Targeted Temperature Management After Cardiac Arrest In 2002, two landmark studies demonstrated patients who suffer an out-of-hospital cardiac arrest had better neurological outcomes when treated with therapeutic hypothermia. Now known as targeted temperature management (TTM), the treatment was first introduced at St. Luke’s in January 2003.

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Since that time, protocols for TTM have been refined. In 2011, involvement of the intensivist in the ED substantially improved identification of eligible patients, resulting in the ability to implement treatment sooner.

Intravascular temperature management was introduced in 2012, providing precise temperature control and reduced nursing time. It also minimized shivering, which can interfere with maintaining targeted

temperatures, cause patient discomfort and drastically increase metabolic demand and oxygen consumption. In 2014, we further refined our process by creating an evidence-based order set in Epic, including the American Association of Critical-Care Nurses’ (AACN) Step-wise Guide to Shivering, using surface counter warming and less invasive methods to control shivering.

Positive neurological outcomes for St. Luke’s patients treated with TTM continues to rise. In 2011, 11 out of 26 total patients had a positive neurological recovery and the survival-to-discharge rate was 42 percent. In 2014, those numbers had climbed to 16 out of 29 positive neurological recovery and a 55 percent survival rate.

Championing a reduction in pressure ulcers Hospital-acquired pressure ulcers (HAPUs) are a national concern. For the patient, they can cause pain and infection, slow down recovery time and result in permanent damage. HAPUs are also expensive. The Agency for Healthcare Research & Quality estimates that pressure ulcers cost the U.S. health care industry as much as $11.6 billion annually.

technicians formed a skin care champions committee that spearheaded education and training initiatives. Departments with the highest incidence were paired with a certified wound care nurse who helped them develop appropriate action plans.

And the inpatient skin care team rolled out a recognition program that instilled pride in units that met their HAPU goals.

At St. Luke’s, the inpatient skin care department, consisting of four certified wound and ostomy nurses, identified a need to improve the hospital’s HAPU rates. Beginning in 2012, this team developed a three-part approach to reducing the incidence of pressure ulcers.

Using root cause analysis of every HAPU, a problem-solving team identified the main causes of pressure ulcers at St. Luke’s. A frontline group of nurses and patient care

“By the end of 2014, we reached a HAPU rate of 1.4 percent, versus 3.9 percent in 2012,” says Brenda Oehler, director of nursing operations. “That exceeded our goal of getting under two percent.” Oehler credits the root cause analysis for helping staff identify the key areas to focus on. She says, “Now instead of being reactive, we can be proactive. It’s something our staff takes a lot of pride in.”

Nurse practitioners improve care at Living Centers St. Luke’s Living Centers is helping more patients return home quickly and safely—and avoid rehospitalization—thanks to the addition of onsite nurse practitioners.

Erin Claar, ARNP

Two nurse practitioners with acute care backgrounds are onsite five days a week. “We see our short-term skilled nursing patients on a regular basis and work with the team to follow their rehabilitation closely,” says Jessica DeBlois, ARNP. “If we need to change anything and/or address acute problems, we can do so in a timely manner and save an unnecessary trip to the hospital or Emergency Department. We work closely with Dr. Clete Younger, the facility medical director.”

Since the arrival of the nurse practitioners, Living Centers in Cedar Rapids has cut hospital readmissions by 50 percent. Emergency Room visits have seen a 35 percent decrease from this patient base. The average length of stay for skilled nursing care at Living Centers is just 22 days. Erin Claar, ARNP, says, “Credit is given to the care coordination efforts of our team.”

Long-term patients at Living Centers also benefit from the presence of the nurse practitioners. Says Claar, “By offering an onsite presence, we have come to know our patients and their families very well, which has led to overall improved care, quicker response times and decreased hospital visits.”

Jessica DeBlois, ARNP

Adaptive Design Team Wins Spirit Cup

Adaptive Design: Not just another improvement tool First introduced at St. Luke’s in 2009, Adaptive Design is a methodology that uses the creativity, knowledge and problem-solving ability of frontline associates to address problems whenever care is not ideal.

This physician-created methodology moves the performance improvement process out of the conference room and onto the frontline to solve problems where they happen.

St. Luke’s master coaches trained in Adaptive Design lead efforts to learn about problems in depth – one problem at a time. When an incident occurs—for example, an associate suffers a work-related injury, the Adaptive Design coach, a department leader and the frontline caregivers or associates respond with A3 problemsolving. They work together to determine the root cause, then design countermeasures and test and refine their solution.

“Because Adaptive Design is done where the work happens, it really is driven by the frontline,” explains Gretchen Aschoff, Performance Improvement advisor.

In December 2014, this work was highlighted in a storyboard at The 26th Annual Institute for Healthcare Improvement National Forum in Orlando, FL. Going forward in 2015, Adaptive Design will be applied to key strategic initiatives addressing patient falls with injuries, associate injuries and prevention of hospital-acquired pressure ulcers.

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Integrated Care Management training

Digestive Health Colon cancer is the second leading cause of cancer deaths.

Fortunately, it is also one of the most treatable forms of cancer when found early.

March is National Colorectal Cancer Awareness month. Help slash these stats by joining St. Luke’s Hospital and the Colon Cancer Alliance’s Dress in Blue Day movement, which aims to raise awareness about colon cancer screenings. St. Luke’s Digestive Health Center doctors and nurses are encouraging people who are age 50 and older to be screened regularly for the disease.

The American Cancer Society’s estimates for the number of colorectal cancer cases in the United States for 2015 are: 93,090 new cases of colon cancer 39,610 new cases of rectal cancer Combined, they are expected to cause about 49,700 deaths during 2015. Younger adults can develop colorectal cancer, but the chances increase markedly after age 50: About nine out of ten people diagnosed with colorectal cancer are at least 50 years old. Testing can help doctors find (and remove) these growths before they become cancerous. And even if the test finds that colon cancer has already developed the chances of beating it is greater if it is found early.

Who should get tested? People 50 years or older or someone with a family history. Colon cancer can be cured if it is discovered early.

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EXEMPLARY PROFESSIONAL PRACTICE

In 2012, Barb Haeder, advanced practice nurse, and Marilyn Gerhold, licensed medical social worker, participated in an intensive one-day training program in Integrated Care Management (ICM) and became certified trainers through The Sutter Center for Integrated Care. This patient-centered, evidence-based program focuses on critical aspects of integrating care throughout the continuum.

Haeder and Gerhold became ICM program coordinators at St. Luke’s, rolling out training in 2013 to about 80 key staff members who have frequent contact with patients during care transitions, including nurses, social workers, care coordinators, hospice, palliative care and spiritual care personnel.

Unit champions were identified and continue to hold monthly meetings focused on initiatives like “K.I.S.S.” (Keep It Super Simple), “Roll With It” (identification of patient barriers/concerns) and “Connect the Dots” for hardwiring care coordination.

In 2014, more than 700 front-line nursing staff completed the two-hour introductory ICM course; 35 Therapy Plus and Children’s Therapy staff took a 90-minute class. These were followed by skill-building classes for the front-line nursing staff that focused on helping staff utilize open-ended questions and teach-back to engage patients and families in actively listening and asking questions about discharge instructions. Haeder and Gerhold also observed nurses giving discharge instructions to actual patients to help identify gaps or best practices.

Marilyn Gerhold

Barb Haeder

The goal for 2015 is to operationalize the ICM concepts of patient/family activation and engagement. Initiatives include a new hire ICM Introductory Course, discharge instruction video for staff training, posters and worksheets to help get patients and families engaged, and possible ICM training for ancillary staff.

Clinically Indicated IV Starts Routine replacement of peripheral IVs every four days has been standard practice at St. Luke’s and around the country. But recent research indicated that peripheral IV catheters can remain in place as long as the site does not show signs of complications. In May 2014, St. Luke’s medical/surgical patient care units, 5 Center and 3 West, participated in a pilot program to measure the safety and efficacy of replacing peripheral IVs only if they showed signs of potential complications.

Based on the results, in September 2014 we implemented clinically indicated

IV starts for adults house-wide, with exceptions for certain patients at higher risk of infection. Nurse Manager Cheryl Mahoney says, “Our goal was to improve patient care. This is better for the patient—after all, no one enjoys needle sticks.” The new protocol also reduces nursing time and decreases supply costs.

Mahoney adds, “To make this successful, nurses have to keep a careful eye on the IV site and that’s what we’re doing.”

Karen Ratz, lead nurse, IV Team, aids this effort by watching to ensure there’s no increases in complications with this new process.

Patient & Family Advisory Councils Patients and their loved ones have a voice in decisions that affect patient care and the family experience at St. Luke’s. Byy participating in Patient/Family Advisory Councils, they help us “give the health care we’d like our loved ones to receive.”

The Center for Women & Children’s Health Advisory Council cil launched in 2007. Since then, the number of Patient/ Family Advisory Councils has grown to include Med/Surg, Rehabilitation, Cancer, Total Joint and Diabetes. Peg Bradke, e, vice president of Post Acute Care, says the groups average 14 4 to 16 attendees at any given meeting.

Participants in the Councils provide feedback on topics ranging from facility improvement to the development of new programs. The groups have helped in the creation of patient education tools, provided input on how to display comfort options for pain control and offered suggestions on n how to better engage patients in self-care. They were also instrumental in developing the new My Health Care Log rolled out to inpatients in January. They have also assisted in the development of the Patient/Family handbook for hospitalized patients and those in our post acute care settings. Says Bradke, “We use their input constantly to help us determine how we can exceed expectations and improve the patient/family experience.”

Dear Peg, Since Linda didn ’t know we’d resi gned from the Pa Family Experienc tient/ e Committee I’m assuming our le reach you – I’m tter didn’t sorry!

It’s been getting hard mental condition er for Gene to attend – his phys ic has been gettin g slowly worse an al and two hospitalizat d with ions in the last two months (eve he was so well ca n though red for at St. Lu ke’s) it just got to him and we’re re o hard for signing the volu nteer job as wel replacements ca l, as soon as n be found.

We have loved being part of th e committee an delighted to see d we are so suggestions beco me part of the ho We’ve learned so spital. much and have been able to be advocates for St better . Luke’s because of all we have le so proud to be pa arned. I was rt of the last Mag net Hospital re get a chance to view and talk about the co mmittee.

Thank you for le tting us be a pa rt of this excitin letting us contin g group and ue beyond our tw o year term. It ha terrific experienc s been a e and certainly reinforced our lo St. Luke’s and its ve for amazing staff.

What a great gr oup!

Wishing you m any more years of productive di scussions.

Fondly and with regrets, Dot and Gene H inman

Health care logs facilitate patient involvement

Charge Nurse Enrichment Classes

Patients with complex medical conditions can find it overwhelming to keep track of doctor appointments, medications and test results. But now a simple tool originally designed for home health and palliative care patients is making that process easier for other high-risk patients and their families.

Effective charge nurses are key to our ability to deliver outstanding patient-centered care at St. Luke’s. With that in mind, a multi-divisional work group was established to look at the role of the charge nurse, including position description and educational needs assessment. A survey completed by almost 300 charge nurses in 2013 identified the “Top 10” educational needs.

It’s called My 2015 Health Care Log. Advanced Practice Nurse Barb Haeder says this booklet is a valuable tool for helping patients manage their health. “It has sections for patients to jot down their personal health information, health care provider information and any questions they may have for upcoming appointments,” explains Haeder.

“There’s a calendar with space to record appointments for doctor visits and diagnostic tests. They can also keep track of key indicators like daily weight or blood pressure.” My 2015 Health Care Log also includes information on medical equipment and community resources utilized by patients.

The initial rollout in January 2015 focused on high-risk patients including those with heart failure, diabetes, renal disease, COPD and stroke, as well as total joint replacement, heart attack or open heart surgery with co-morbidities.

“We’re encouraging patients to take this log to their medical appointments and hospitalizations,” says Haeder. “Our goal is to engage and activate patients and families in managing their health.”

From that, a four-course curriculum was developed and offered to a pilot group. The classes focused on: • Leadership and the Charge Nurse Role • Staffing and Patient Assignments • Delegation, Prioritization and Organization • Communication and Conflict Management.

Forty-three charge nurses, both experienced and novice, participated in at least one class of the enrichment program.

Based on their feedback, Communication and Conflict Management will be split into separate classes. Once the schedule is finalized, the classes will be offered to all current and new charge nurses in all divisions.

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Sharing our expertise Throughout the year, St. Luke’s associates, managers and directors speak at conferences and events around the country to share their expertise and success stories with peers and various groups and organizations.

Tammy Dietrich, BSN, CWOCN Enterotherapy Nurse Inpatient Skin Care

Renee Garbe, LMSW Jennifer Owens, LMSW Social Workers, Social Services

• Establishing a Wound Therapy Associate Program Des Moines, IA

• Effect of Enhanced Psychosocial Assessment on Readmissions of Patients with Chronic Obstructive Pulmonary Disease Published in “Social Work in Healthcare”

Diane Handler, MSN, RN, ANVP-BC Advanced Practice Nurse, Nursing Support

Gretchen Aschoff, BSN, RN, CPHQ Performance Improvement Advisor, Performance Improvement

• Retention of Stroke Education Provided During Hospitalization: Increasing Stroke Knowledge or Wasting Resources.

San Diego, CA

• Adaptive Design and A3 ProblemSolving: Not Just Another Improvement Tool.

Orlando, FL

Aimee Traugh, MSN, RN Manager, 4W Telemetry

Cheryl Mahoney, MSN, RN, CMSRN Manager, 3C Surgical Karen Ratz, RN, VA-BC Lead Nurse, Critical Care Float Pool Carrie Van Houten, BSN, RN Nurse, Hospitalist Program Chelsea Benters, BSN, RN Coordinator, Clinical Services, Community Cancer Services

• Transfer of Trust; Improving Intra-Hospital Hand-off Quality for the Critically Ill Patient.

Des Moines, IA

• Clinically Indicated Peripheral IV Replacement Cedar Rapids, Iowa City, Des Moines Michelle Jonas, MA, RN, CCRN-CSC Advanced Practice Nurse, Nursing Support • Creating a CRRT Program: From Start to …….

Cedar Rapids, IA

10 | EXEMPLARY PROFESSIONAL PRACTICE

Bev Minear, RN, CEN, CFRN, CPEN Nurse, ED/Lifeguard Cathy Ross-Garron, MSN/Ed, RN, CEN, CFRN, NREMT-P Program Manager, Lifeguard • Sick or Not Sick…..Sepsis Cedar Rapids, IA

Peg Bradke, MA, RN Vice President, Post Acute Care Services

Joanie Copper, DNP, RN Staff Development, Staff Development

• St. Luke’s Case Study for Reducing Readmissions • ACO Minicourse Presentation-Engaging Care Settings • Building Effective Acute and Post-Acute Care Partnerships to Reduce Readmissions” Orlando, FL

• Nurse Residency Programs: Implementation Processes Dubuque, IA • Nurse Residency Programs: Measuring Program Effectiveness Des Moines, IA, Iowa City, IA • Nurse Residency Programs: Evolution, Implementation & Evaluation Cedar Rapids, IA

Deb Klein, RN Nurse, 3W Surgical

Mary Ann Osborn, MA, RN Senior Vice President/CNE, Administration

• Turn and Position System (TAPS) Cedar Rapids, IA

• Technology Enabled Evidence Based Nursing Care Cedar Rapids, IA • Care Coordination Cedar Rapids, IA • UPH Ebola Preparedness Des Moines, IA

Behavioral Health Comfort Room Demonstrates Effectiveness In 2012, the St. Luke’s Behavioral Health team implemented a Comfort Room to help patients in the older adult unit relieve stress and improve their self-soothing skills. Nurses had been looking for healing alternatives to medication for their anxious and agitated patients. Literature suggested that providing a calm environment could offer an alternative to medication. It might also relieve symptoms of agitation between doses for patients waiting for their next PRN medication.

After a nurse committee reviewed literature about Comfort Room design, an interview room was converted to a patient Comfort Room. Colors, a mural, essential oils, textures, sounds, music, television, hard candies and gum are all part of the experience, so that each sense can receive relaxation and calming.

Cathy Keys-Andrys, BSN, MA, says the Comfort Room is part of the unit’s new

patient orientation. “Nurses can offer the room’s use for patients who are showing signs of agitation or anxiety,” explains KeysAndrys. “The patients can also request its use when they experience stress.”

Since the room opened, qualitative and quantitative evaluations have been ongoing.

An initial pilot study of six subjects involved using the Agitated Behavior Scale to evaluate agitation levels directly before and after Comfort Room use. All subjects showed a marked decrease in agitation.

A random study of 20 subjects is now underway.

Qualitative data, collected by Melissa Moeller, BSN, also supports use of the Comfort Room. The results showed that nurses see the room as a positive alternative to restraints, seclusion and medication.

During 2014, the Comfort Room was used between five and 56 times per month.

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NEW KNOWLEDGE

RN to BSN Program 2015

RN to BSN Partnership with Mount Mercy University St. Luke’s has partnered with Mount Mercy University to provide an expedited RN to BSN program onsite at the hospital.

The initial cohort of 10 students began their curriculum in February 2015 and will complete the required 21 nursing credit hours in less than a year.

Classes are offered in five-week sessions— an innovative format allows students to focus on one class at a time. Classes are

held at St. Luke’s on Tuesday evenings from 5:30 to 9:30 p.m. In addition to the nursing credit hours, Mount Mercy requires students to complete core classes to achieve their degree; depending on the student’s academic history, this could require nine to 27 credit hours. Core classes are taught on Mount Mercy’s campus.

Mount Mercy has one of the longestrunning baccalaureate nursing programs in

Iowa and is accredited by the Commission on Collegiate Nursing Education.

Keech Scholarship funds, a scholarship program managed by St. Luke’s Foundation and funded by the Keech family, are available to offset the tuition expenses for the nursing courses in this program. To be eligible for the scholarship, students must be employed at St. Luke’s Hospital and continue to work for the hospital for two years.

NDNQI Workaround Study Nurses know the more time they spend with their patients, the better care they provide. But throughout the day, internal supply chain problems—with medications, materials, information and human resources—can pull nurses away from the bedside. It’s estimated at least 10 percent of a hospital nurse’s time is spent on these non-patient care duties.

St. Luke’s is one of approximately 60 hospitals chosen to participate in a nationwide study of the impact of workarounds on patient outcomes.

Dr. Anita Tucker of Brandeis University is the principle investigator for the study, which is being done in collaboration with the National Database of Nursing Quality Indicators (NDNQI). Over 84 nurses in St. Luke’s oncology/neurology and

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orthopedic units were invited to complete the survey earlier this year, with results expected to be released in Fall 2015.

Advanced Practice Nurse Debra Johnston, MSN, RN, co-chair of St. Luke’s Research Council, says the NDNQI is one of the leading benchmark organizations for important quality indicators. By being part of this study, St. Luke’s helps meet Magnet requirements for research participation.

Above all, the study helps St. Luke’s and other hospitals identify challenges to the quality indicators for which we’re all being held accountable.

Through this project, NDNQI seeks to quantify the impact of workarounds on patient outcomes, including falls, pressure ulcers and catheter-associated urinary tract infections, as well as nursing satisfaction and turnover. By providing evidence to support investment in improving hospital supply chains, the study can ultimately help nurses spend less time searching for supplies and more time caring for patients.

$ Advanced degrees and certifications

$

In 2014, we had 282 certified RNs, or 27 percent of our nurses with certification and 579 or 56 percent of our nurses with a BSN degree or higher. Certification and advanced degrees are validation of the knowledge and critical thinking skills our nurses bring to our patients with each interaction. Our patients benefit each day from their commitment to excellence

Advanced Degrees: Emily Basile, BSN, 4C Ortho

Kristin Moore, BSN, 6W rehab

Sheri Bosch, MSN, Nursing support

Trista Pattison, BSN, Cardiac Cath Lab

Kayla Clasen, BSN, Home Care skilled nursing

Sue Rowbotham, BSN, Hospice

Michelle Divoky, BSN, NICU/Peds

Ikami Sasa, MSN, 1W, geriatric psych

Christine Gray, BSN, 6W rehab

Carrie Scoggins, BSN, Surgicare

Mallory Gritton, BSN, PACU

Brooke Shivers, MSN, 4W telemetry

Amanda Heeren, BSN, 4C Ortho

Emily Slattery, RN, BSN, Emergency Trauma

Terra Koenig, MSN, Birth Care Center

Lisa Stiles, MSN, Surgicare

Ashley Kramer, DNP, NICU/Peds

Kim Woods, MSN, Birth Care Center

$

Carly Roskop, BSN, Emergency Trauma

$

New Certifications: Stephanie Asmussen, BSN, NVRN-BC (Neurovascular Nurse), 5C Neuro/Oncology Sandra Bills, BSN, RN-BC (Psychiatric and Mental Health nurse), 2E Adult Psych Katie Cooper, RN, CMSRN (Certified Med-surg nurse), 5C Neuro/Oncology Rebecca Duffy, MSN, SANE-A and SANE-P (Sexual Assault Nurse Examiner- Adult and Peds), Child Protection Center Cassie Garvin, BSN, CNRN (Certified Neuroscience Registered Nurse), 5C Neuro/Oncology Dana Gilleland, RN, CEN (Certified Emergency Nurse), Emergency Trauma Susain Goldberg, RN, SANE-A (Sexual Assault Nurse Examiner-Adult), Emergency Trauma Morgan Hanson, BSN, CEN (Certified Emergency Nurse), Emergency Trauma Brooke Hochstetler, RN, NVRN-BC (Neurovascular Nurse), CCU Jamie Jones, BSN, CCRN (Acute/Critical Care Nursing), ICU Kristen Kasner, BSN, SANE-A (Sexual Assault Nurse Examiner-Adult), Child Protection Center Emily Lenhart, BSN, CEN (Certified Emergency Nurse), Emergency Trauma Heidi Mangold, BSN, CMSRN (Certified Med-surg nurse), 5C Neuro/Oncology Shawna Meyer, BSN, RNC-OB (Inpatient Obstetric Nursing), Birth Care Center Kris Noring, BSN, CDE (Certified Diabetes Educator), Diabetic Ed Heidi Oltmann, RN, RNC-OB (Inpatient Obstetric Nursing), Birth Care Center Amber Orr, BSN, CCRN (Acute/Critical Care Nursing), ICU Nicole Rudzki, BSN, RNC-OB (Inpatient Obstetric Nursing), Birth Care Center Linda Schweibert, BSN, CHPN (Certified Hospice and Palliative Nurse), 6E Inpt Hospice Emily Slattery, BSN, CEN (Certified Emergency Nurse), Emergency Trauma Amanda Staab, MSN, RNC-OB (Inpatient Obstetric Nursing), Birth Care Center Andrea Watkinson, BSN, OCN (Oncology Certified Nurse), Community Cancer Center Amelia Wenner, RN, CEN (Certified Emergency Nurse), Emergency Trauma

Success Pays We are committed to the development of our staff to meet the current and future needs of the ever-changing health care environment.

With the support of Tuition Reimbursement, Scholarship Support, Certification & Re-certification Reimbursement and CE Direct, many of our frontline clinical associates have chosen to advance their practice. Additional programs and program enhancements introduced in 2015 will provide even more support for our associates pursuing further educational or certification opportunities.

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Diabetes Center Ribbon Cutting

UnityPoint Clinic Diabetes and Kidney Center Diabetes is the leading cause of kidney failure in the U.S. and Canada. Now St. Luke’s has made it more convenient for patients with kidney disease and diabetes to receive the care they need. UnityPoint Clinic Diabetes and Kidney Center opened in 2014 to bring the full continuum of diabetes services under one roof, from diagnosis, education and treatment to dialysis and kidney care.

or three places for specialized care, patients now have one location to see their doctor, visit with a diabetes educator and dietitian, even receive dialysis, all in one day.

Located at 1002 4th Avenue SE, the new Center houses UnityPoint Clinic Multi-Specialty, Endocrinology and Nephrology providers, St. Luke’s Diabetes Education and Health Promotion, and DaVita Dialysis. Instead of going to two

The Center also includes the Medical Weight Loss Clinic for evaluation and treatment of individuals struggling with weightrelated issues. It provides medically supervised options for safe and effective weight loss with an emphasis on lifestyle changes.

“We designed this Center with the patient’s needs in mind,” says Dr. Abba Saxena, UnityPoint Clinic Multi-Specialty. “It’s going to hopefully make their lives a little easier.”

Patient and Family Diabetes Advisory Council St. Luke’s mission calls for us “to give the health care we’d like our loved ones to receive.” One way to ensure we’re doing that is to ask patients and their family members what they think of their care.

That’s the philosophy behind the Patient and Family Diabetes Advisory Council. Launched in 2014, it provides a forum for those affected by diabetes to help improve the patient and family experience.

“It’s important to keep the patient and family at the center of what we do,” explains Sandra Cooper, program manager for Diabetes Health Management.

Patients of all ages, from adolescents to older adults, as well as parents and spouses, have participated in the Council. While it’s not a support group, Cooper says attendees enjoy being with others who

14 | NEW KNOWLEDGE

understand their situation. “I see a camaraderie developing,” says Cooper. “And they enjoy being asked for input.”

Dietitian Sara Claeys facilitates the meetings and Melissa Collier, advanced practice nurse, Inpatient Diabetes and Cooper attend to capture feedback and occasionally share information from a nursing perspective. But above all, she says, “Our job is to listen.” Feedback from the group has inspired initiatives, including a comprehensive diabetes resource book currently under development, with Council members continuing to review content.

Adds Cooper, “This group’s voice has been very important in providing valuable information for evaluating care across the continuum.”

“ This group’s voice has been very important in providing valuable information for evaluating care across the continuum.”

- Sandra Cooper

STRUCTURAL EMPOWERMENT DAISY Award The DAISY Foundation was started by the family of J. Patrick Barnes, who passed away from Idiopathic Thrombocytopenia Purpura. During the last stages of his life, he and his family witnessed extraordinary examples of compassionate nursing care. After his death, Patrick’s family wanted to create a way to recognize those and all nurses who exemplify the very best of their profession. Thus, the DAISY Award was created. DAISY, an acronym for Diseases Attacking the Immune System, is a great way to recognize nurses and the education, skill, and caring with which they deliver their care.

Since 2014, these extraordinary nurses were recognized with the DAISY Award. They include: Tara Weir, BSN, RN, 6W Physical Medicine & Rehabilitation Amber Hoyt, BSN, RN, CWON, Inpatient Skin Care Angela Rook, RN, Continuing Care Hospital Bev Minear, RN, LifeGuard Bennett Springer, RN, Children’s Specialty Services

St. Luke’s Shared Governance Councils Patient Care Delivery Council, chaired by Cheryl Mahoney, MSN, RN 1. Researched best practices in caring for patients with behavioral health needs on non-behavioral health units; developed resource guide.

2. Enhanced Patient and Family Experience through unitbased reinforcement of initiatives to support compassion and empathy in care.

Performance Improvement & Nurse Peer Review Councils, chaired by Sherrie Justice, MA, RN 1. Reviewed nurse sensitive indicator data, such as falls, pressure ulcers, blood stream infections and hospital performance against national benchmarks.

2. Unit Practice Councils reported quarterly on department progress on patient and family experience and quality indicator performance.

3. Twenty-six case studies were presented with a focus on general learning.

4. Twenty cases on unplanned transfers to a higher level of care underwent peer review; additional cases were presented at division meetings and CEU offerings.

Practice Council, chaired by Brenda Oehler, MSN, RN 1. Oversaw review, revision, implementation and approval of Evidence-Based Practice standards.

2. Reviewed and evaluated patient care process improvements, including pain management menus, timing of blood glucose monitoring with insulin administration, and EMR documentation.

3. Discussed safety initiatives and shared learnings housewide. Safety initiatives discussed in 2014: Needle stick safety, safe ampule usage, tubing misconnection awareness.

Professional Development Council, chaired by Diane Seelau, BSN, MBA, RN The Career Achievement Program (CAP) was developed in 2009 to recognize nurses, respiratory care technicians, social workers and dietitians who are engaged in housewide councils and projects. In 2014, 42 individuals received the Gold Award, 137 received Silver and 82 received Bronze for a total of 261 participants. The Professional Development Council evaluates entries and determines award level.

Research Council, chaired by Sandi McIntosh, MA, RN, NE-BC 1. Reviewed and revised functions, membership and meetings. All members completed Human Subject Training.

2. Revised toolkit to include poster creation and publication information.

3. Identified resources to support associates’ poster development.

Top left to right: Tara Weir, BSN, RN; Amber Hoyt, BSN, RN; Bottom left to right: Angela Rook, RN; Bev Minear, RN; Bennett Springer, RN

4. Supported eight evidence-based projects through Research Council.

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Extraordinary people – exceptional care Every year during Nurse Week, St. Luke’s holds a Nursing Awards ceremony to recognize, celebrate and thank nurses in our organization who were nominated by their peers for nursing excellence. The awards and scholarships give our hospital an opportunity to say a heartfelt thank you to nurses who are living our mission every day. The awards and scholarships are provided by generous donors in our community who believe in the mission of St. Luke’s Hospital and St. Luke’s Foundation.

Nursing Awards and Scholarship Recipients

100 Great Iowa Nurses Alana Berger, Intensive Care Unit Mary Greif, Staff Development Whitney Grimm, Continuing Care Hospital Jennifer Houlihan, Nursing Support Deb O’Neil, Cardiac Care Unit Mary Springsteen, Nursing Support Kelsi Taggart, 4 West Telemetry Jessica Thomas, Behavioral Health

The DAISY Award Amber Hoyt, Inpatient Skin Care Services Bev Minear, LifeGuard Angela Rook, Continuing Care Hospital Johanna Secl, Administration, Daisy Champion Bennett Springer, Children’s Specialty Services Tara Weir, 6 West Rehabilitation

16 | STRUCTURAL EMPOWERMENT

Patient Care Excellence Award Recipients C.A.R.E. Award Kelsi Risk, Continuing Care Hospital

Dale & Ruby Morgan and Mable Ray Award Mary Bailey, Pediatrics

Darrell Dennis Pulmonary Medicine Award Jordan Kelly, LifeGuard

Carroll H. & Lena Nelson Critical Care Award Morgan Hanson, Emergency Department

Excellence in Behavioral Health Award Nurse: Sally Vervaecke-Koenigs, 2 East Mental Health Professional: Kathy LaDue, 3 East Support Staff: Linda Schorg, 1 West Anna Purna Ghosh Oncology Nursing Award Heidi Mangold, 5 Center / OP Infusion Center LaMorgese Award for Excellence in Neurological Nursing Brooke Hochstetler, Cardiac Care Unit

Smulekoff Family Award for Nursing Excellence Joni Broughton, Operating Room Kathleen Jeffries, Emergency Department Annie Lloyd, Interventional Pain Services Melissa Moeller, 1 West

Bev Minear, LifeGuard

Julie Supple, 5 Center

Donna Prier, Intensive Care Unit Kelsi Taggart, 4 West

Social Worker Award Kimberly Roberts, Palliative Care

Outstanding New Graduate (Rookie) Elijah Stairs, Operating Room

Gail Stork Emergency Medicine Nursing Award Bonnie Lunsford, Emergency Department

Nancy Lamb Skogsbergh & Edna Lamb Nursing (Clinical) Leadership Award Kent Jackson, Behavioral Health

Dr. Stephen & Peg Vanourny Award for Excellence in Obstetrical & Gynecological Nursing Amanda Staab, Birth Care Center Elaine Young Leadership Award Cathy Ross-Garron, LifeGuard

Karma Smith Healthcare Pioneer Award Michelle Wenzel, IP Skin Care Services

Ron Mahany Award (awarded in 2014) Jill (Hendricks) Kienzle, Sports Medicine Jill Kreitman, Therapy Plus Kristie Middendorf, Witwer Children’s Therapy

Natalie and Joe Cohn Scholarship Erica Bernard, 3 West Dawn Cook, 4 West Ted and Lillian Feder Scholarship Katelyn Price, 4 West May G. Gortner Scholarship Jessica Cizmadia, 4 West Keech Scholarship Ann Currie, Birth Care Center Ashley Dodge, Emergency Department Michelle Ernst, Post-Anesthesia Care Unit Kallie Griffin-Gutierrez, Operating Room Benjamin Hanson, 3 West Nichole Morgan, LifeGuard Ruth Schlabach, 1 West Kiley Stineman, Operating Room Amy Vincent, Post-Anesthesia Care Unit Beatha Kuntz Scholarship Taryn Eilers, 3 Center Courtney Harmon, Inpatient Hospice Unit Lydia Molitor, Adolescent Life Program Dr. E.L. Mansfield Scholarship Barbara Peterson, Hospice

Dr. J. Stuart McQuiston Scholarship Joan Deluhery-Wagemester, Adolescent Life Program Katrina Thomas, Witwer Children’s Therapy Michelle Wenzel, Inpatient Skin Care Services

2015

2015 Scholarship Recipients

Patient Care Excellence Award

& Scholarship Ce remony

Thursday, May 7, 2015 | 2 – 4 p.m. | Nassif Heart Cen ter

Norma Newmeister Scholarship Jaclyn Hall, Physical Therapy Nursing Scholarship Sandra Bills, 2 East Mallory Gritton, Post-Anesthesia Care Unit Shelley Marsden, 2 East Greta Schuchmann Scholarship Barbara Nannelli, Operating Room Dr. Charles Schwartz Scholarship Elizabeth McCormick, Birth Care Center St. Luke’s Auxiliary Scholarship Courtney Harmon, Inpatient Hospice Unit Morgan Hejda, Intensive Care Unit

St. Luke’s Hospital

| St. Luke’s Foun

dation | Unit yPoin t Hospice

Classrooms

TRANSFORMATIONAL LEADERSHIP New Care Coordination Initiatives Care coordination continues to be our highest priority. Fragmented care increases stress on patients and families, as well as on those providing care. At its worst, it leads to unsafe situations.

Our elderly patients may be confused about which medications to take, or forgo seeing a specialist because of transportation issues. The parent of a child with chronic illness struggles to balance multiple doctors’ appointments and therapy sessions with attendance at school and work.

Our challenge is to decrease the burden of illness through well-coordinated efforts. Our most complex patients are already benefiting from initiatives such as the Emergency Department Consistent Care Program (EDCCP), RN navigators, outpatient social workers and most recently, outpatient pharmacist support with medication therapy management. In addition, Patient-centered medical homes and coordinated referrals are helping patients newly diagnosed with chronic disease.

In 2015, St. Luke’s associates and colleagues from across UnityPoint Health are coming together to build on these first steps. Our goal is to develop new programs and workflow processes that will help us live up to our promise of coordinated care.

New care coordination initiatives include transitions of care processes that always include clear communication between the sender and the receiver; next-generation hospitalist care and patient-centered medical homes; and the development of a Common Care Plan accessible to all clinicians and patients at all sites of care.

The Common Care Plan includes key information about the whole person— from individual goals and care team, to advanced directives, current medications, and social and environmental factors.

This work is exciting because we know we are making health care better for our patients, our families and ourselves.

By devoting our time and resources to improving care coordination, we will decrease the burden of illness—something we can all be proud of.

Study shows social workers can impact COPD readmission rates Chronic obstructive pulmonary disease (COPD) is a leading cause of hospital readmissions. At St. Luke’s, Social Workers Jennifer Owens and Renee Garbe led a study to look at the role social workers can play in reducing those rates by helping COPD patients successfully transition to a post acute care setting.

“Social workers’ understanding of how a patient’s social context impacts their health uniquely qualifies them to address many causes of readmission,” explains Owens. Social workers are trained to look at the complex system that surrounds a patient, including social, psychological and economic needs.

Owens developed a comprehensive assessment tool used with hospitalized COPD patients.

Owens and Garbe then followed up by phone after discharge to check if patients were taking their medication, scheduling and going to follow-up appointments and continuing to use

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self-management techniques they had learned in the hospital. “The goal of the intervention,” says Garbe, “is to increase the likelihood of a successful transition home.”

The study group had a significantly lower number of readmissions in the 90 days post intervention.

Within the 90 days prior to the enhanced assessment the group had a combined total of 66 inpatient admissions, 90 days post enhanced assessment the group had a combined total of 16 readmissions.

Owens’ and Garbe’s study suggests that an enhanced assessment, combined with post acute follow-up, can help reduce readmissions and improve the patient’s quality of life.

Their research was published in March 2015 in Social Work in Health Care and is titled Effect of Enhanced Psychosocial Assessment on Readmissions of Patients with Chronic Obstructive Pulmonary Disease.

Renee Garbe, Social Worker

Jennifer Owens, Social Worker

St. Luke’s certifications and accreditations Bridges to Excellence The Bridges to Excellence (BTE) program provides associates and affiliates funding to attend conferences for professional and career development by paying expenses up to $2,000.

In 2013, 109 St. Luke’s associates, including more than 60 RNs, used BTE funds, totaling almost $125,000. In 2014, nearly $130,000 was used to benefit 123 associates, including more than 70 RNs, in their career growth.

Advanced Certification in Palliative Care: Awarded by The Joint Commission July 9, 2014 – valid for two years.

St. Luke’s is the first health care provider in Iowa to receive this certification, which is based on review of compliance with national standards, clinical guidelines and outcomes of care. In addition, the requirements include:

A gentle “pull” improves intra-hospital transfers In the fall of 2012, the Telemetry Unit Planning Committee identified a need to improve communication during handovers from the Cardiac Care Unit (CCU).

Telemetry Manager Aimee Traugh says the committee decided to try a new process that was in its infancy nationwide— “pulling” patients to their next level of care. “It was so successful,” says CCU Supervisor Ashley Gutschmidt, “it took off like wildfire!”

Today, almost all patients are pulled rather than pushed to their new unit.

Under the old “push” method, the patient was transferred to the next unit by a patient care tech and the report was received by phone. The lack of face-toface communication between nurses on both units increased the possibility of bad handovers, including incomplete information, unprepared staff and increased anxiety for patients and families.

With the “pull” methodology, the new unit’s charge nurse is notified of the impending transfer and assigns the incoming patient to a nurse. That nurse takes a wheelchair to the patient’s current unit at a pre-arranged time and meets with the nurse, patient and family for a bedside report. “It helps develop a higher level of

trust for the patient and family,” explains Gutschmidt, “because they’re in a room they are already comfortable in. And they get to know their new nurse on the way to the next unit.”

Traugh says the goal of pulling patients is to promote the transfer of care as a positive step and to strive toward a seamless transfer of trust.

Gutschmidt admits there was some initial pushback as nurses learned to reprioritize their work. But she adds that staff quickly saw the benefit. “It’s going the extra mile, getting to know the patient and family where they are most comfortable. We’re doing it for them.”

 A formal, organized palliative care program led by an interdisciplinary team whose members possess the requisite expertise in palliative care  Leadership endorsement and support of the program’s goals for providing care, treatment and services  A special focus on patient and family engagement  Processes that support the coordination of care and communication among all care settings and providers  The use of evidence based national guideline or expert consensus to guide patient care Advanced Certification in Stroke (Primary Stroke Center): Awarded

by The Joint Commission September 24, 2014 – valid for two years.

St. Luke’s was first awarded Advanced Certification in Stroke and designated a Primary Stroke Center in 2006 and has received five consecutive certifications since then.

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St. Luke’s certifications and accreditations

A home within the hospital for end-of-life care Our community’s only dedicated Hospice Inpatient Unit recently celebrated its first anniversary of providing comfort and dignity for end-of-life patients and their families.

This “hospice house” within the walls of St. Luke’s Hospital offers a peaceful, homelike environment for patients who must be in the hospital for their last days.

Commission on Accreditation of Rehabilitation Facilities (CARF): Surveyed by CARF December 11-12, 2014. Accreditation valid for three years in the following programs:  Inpatient Rehabilitation – adults  Inpatient Rehabilitation – children and adolescents  Inpatient Rehabilitation – brain injury adults  Inpatient Rehabilitation – brain injury children and adolescents  Inpatient Rehabilitation – stroke specialty program – adults St. Luke’s Inpatient Rehabilitation unit received their 13th consecutive three-year accreditation for the unit.

St. Luke’s is the first rehabilitation program in Iowa to receive the Commission on Accreditation of Rehabilitation Facilities (CARF) Inpatient Rehabilitation Stroke Specialty Program accreditation.

St. Luke’s Inpatient Rehabilitation unit received their twelfth consecutive three-year accreditation for the unit.

Advanced Certification in Heart Failure: Awarded by The Joint Commission September 25, 2014 – valid for two years.

Certification in Joint Replacement – Hip – Knee: Awarded by The Joint Commission September 30, 2014 – valid for two years.

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TRANSFORMATIONAL LEADERSHIP

“Many, if not most, patients want to be at home, and if that is possible, we still absolutely advocate for getting them there,” explains Dr. James Bell, medical director of UnityPoint Hospice. But he adds, “Sometimes the best place for a patient to

receive care is in the hospital, because the patient requires more intervention to be comfortable than can be provided at home.”

The Ed and Joan Hemphill Hospice Inpatient Unit was made possible by a gift from Ed Hemphill in memory of his late wife.

Nearly 500 patients have been cared for in the unit since its opening in March of 2014.

Oversized private rooms with sleeper sofas allow loved ones to stay near. Family space within the unit includes a kitchen, laundry facilities, meeting rooms and quiet spaces.

In addition to hospice doctors and nurses, the inpatient unit team includes social workers, aides, chaplains, volunteers, and music, massage and pet therapists.

Post Acute Care Handbook is all-in-one reference The Post Acute Care Patient and Family Handbook and Guide is coming soon to a home near you. Modeled after inpatient handbooks, the new post acute version is designed to be an all-in-one patient, family and provider reference.

Especially with older patients, we’ve found more than one family member at a time may be benefitting from post acute care. That can lead to information overload when they receive multiple materials—from a home health folder stuffed with literature to individual brochures for home medical equipment and Lifeline. By putting everything in one streamlined, easy-to-use reference, the handbook helps provide better care for all family members across the post acute continuum.

It also supports our strategic pillar, Strengthen the Core, by keeping care within the system. For example, a patient receiving home care after hip surgery may have a loved one who could benefit from St. Luke’s Palliative Care Outpatient Clinic or UnityPoint Hospice. Post Acute Services and Marketing Communications developed the new handbook, which includes information on our services, patient and family safety, rules and regulations, and department-specific information. The handbook is now available.

UnityPoint at Home cares for patients where they are most comfortable Home care is at the heart of care coordination for St. Luke’s patients and their families. Through UnityPoint at Home, our providers help children, adults, new moms and older adults receive care where they feel most comfortable—in their home.

Each year, the St. Luke’s Home Care team keeps people in their home by completing more than 60 visits a day, 23,000 visits per year. The home care staff works closely with hospital associates to ensure coordinated care while helping patients improve their health and live better.

Home Care offers Birth Care Beginnings home visits for new moms and their babies, as well as maternal child services through Area Substance Abuse Council’s (ASAC) Heart of Iowa program. Adult services include skilled nursing, therapy, home health aides, homemaker and medical social services.

Free senior health clinics at housing complexes and meal sites help chronically ill seniors improve the way they care for their own health. And telehealth monitors help patients take better control of their health so they can detect problems early and avoid the need for hospitalization.

Angel Gowns comfort grieving parents When a baby dies at birth, it’s heartbreaking. And for grieving parents, dealing with the details of laying their child to rest is overwhelming. That’s why a group of St. Luke’s nurses, other associates and volunteers have devoted their time and talents to make that process a little easier.

It’s called the Angel Gown project.

Volunteers use wedding dresses donated

by St. Luke’s employees and others to create burial gowns for babies who never make it home from the hospital.

Maternal Child Educator Deb Oldakowski says of the 2,500 babies born at St. Luke’s each year, about 25 families will need an Angel Gown. “We can’t take away the pain of losing a child, but we hope the Angel Gowns will help them with the grieving process and provide them a small sense of comfort.”

In January 2015, Oldakowski collaborated with Angela Burns, Volunteer Services program manager, to organize the hospital’s first Angel Gown Sew-In. That event garnered media attention that in turn led to an outpouring of

wedding gowns from as far away as New Hampshire. “It’s overwhelming how generous people have been,” says Oldakowski.

Many who donated gowns have lost a child themselves, or know someone who did. Others simply want to help make something good out of a tragic event. One wedding gown came with a note that said, “To all the babies I’ll never meet, but will forever hold in my heart.”

A second Sew-In was held in April. In addition to infant gowns, volunteers have begun making hearts from the material.

Oldakowski says several families have already received the items and were “so, so appreciative.” The garments are most often used for burial gowns, but the hearts can be held and cherished as keepsakes.

“To date, we have received 197 wedding gowns,” says Oldakowski, adding that the St. Luke’s project has all it needs. She encourages those who still want to donate gowns to reach out to hospitals and organizations in other communities that still have a need.

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COMMUNITY CONTRIBUTIONS

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Camp Embracing Memories helps children cope with death It’s never easy to lose a loved one. Coping with death can be more challenging for a child. That’s why UnityPoint Hospice established Camp Embracing Memories—a free, overnight grief camp for children and teens in eastern Iowa.

Now in its seventh year, the camp welcomes kids ages seven through 16 who have experienced the death of a loved one.

The goal of the camp is to help children effectively cope with death in a safe, accepting environment. Bereavement Coordinator Jamie Siela says the camp is designed to normalize kids’ feelings of loss so they know they are not alone. “Children who attend the camp learn that it’s OK to be sad, it’s OK to cry,” says Siela.

Trained Hospice staff and volunteers provide education and support. Children learn to express their feelings through an array of activities, from making memory pillows to music therapy and pet therapy. Speakers at the event include a chaplain and social workers. Student athletes have also been brought in to share the benefit of being part of a group and learning to lean on your teammates.

Siela stresses the camp is also designed to be fun. It’s held in September at YMCA Camp Wapsie in Coggon—“a fantastic campground,” Siela says they often hear from attendees about how much they enjoyed Camp Embracing Memories, adding, “One child said ‘it was so much fun, it helped me forget why I’m here.”

In 2014, UnityPoint Hospice introduced a year-long follow-up program to the camp experience. “Adding ongoing support was something we identified as a need for our families,” explains Siela. “We come together for a reunion in November to help kids and their families prepare for dealing with holidays and anniversaries. Then throughout the year, we mail activity kits to them that are designed to help start conversations about grief and healing.”

Participation in Camp Embracing Memories is free to children who have lost a loved one, whether or not the loved one was in Hospice care. Overnight lodging and meals are included.

The camp is made possible by the generous support of our community partner, Cedar Memorial.

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reaches over 6,500 students annually.

Children attending the program range from pre-school to fifth grade.

Bike helmet giveaways and fittings St. Luke’s Physical Medicine and Rehabilitation brain injury community outreach fits and distributes approximately 2,000 bike helmets every year. They began the program nine years ago because the acute inpatient rehab unit serves many patients who have experienced traumatic brain injuries. They felt it was important to prevent even one brain injury by keeping kids safe.

In 2014, five events were scheduled for St. Luke’s to distributed and fit kids for bike helmets. These events include: Safe Kids Linn County at Hoover Elementary, Tanager Family Fest, Cedar Rapids Farmer’s Market with Safe Kids Linn County, Safe Kids Linn County at Johnson Avenue Hy-Vee, and Stand Down Resource Fair at Veterans Memorial Stadium

All tests are performed at St. Luke’s during one appointment. Tests are reviewed by doctors and participants receive results through a consultation with a St. Luke’s heart care expert at that same appointment, same day.

This screening program is ongoing and done several times throughout the year.

The focus is on prevention and early recognition for heart, stroke and vascular disease. The program was created to help educate the local community about prevention of these diseases.

This program allows our local physicians to personally consult with the participant about their results, explain what the results mean, offer prevention education and answer questions.

Unfortunately, for some children this is the first and only discussion anyone will ever have with them regarding child sexual abuse prevention. We hope that children who attend the presentation will be able to identify good, bad and secret touches; describe what to do if someone tries to touch them in an unwanted manner; and explain what to do and where to go for help in the unlikely event they receive an inappropriate touch.

Thus, it is the ultimate goal of the Safetouch program to prevent child sexual abuse by educating children and providing them with the necessary skills to keep themselves safe.

Transportation Services When patients do not have family members to assist them or do not have the resources to pay for transportation, St. Luke’s Hospital is here to help.

Transportation services home after a trip to the hospital and transfer by ambulance to a facility for continued service are just a couple different circumstances when a patient may need assistance. St. Luke’s Hospital spent approximately $90,000 last year for transportation services for patients in need.

St. Luke’s Hospital offers Heart Check Screening

Parenting Group through Counseling Center

Heart Check is a series of five tests to assess heart, vascular and stroke health.

Testing includes:

The St. Luke’s Parent Education and Support Group provides weekly parenting classes for families who face mental health or behavioral struggles with their children.

These classes are free, confidential, and open to the public. Melea White, MSSW, LMSW, and Kim Steffensmeier, MSW, LISW provided educational presentations on different topics, and facilitated group discussions. Childcare is provided for those families who need it.

• Electrocardiogram (EKG)–measures the electrical activity of the heart • Echocardiogram (ECHO)–To assess the overall function of the heart muscle and heart valves.

• Abdominal aortic aneurysm test–An ultrasound screening to detect for aortic aneurysm • Carotid artery ultrasound–Used to tell if there is a narrowing in the arteries leading to your brain, which could increase stroke risk • Ankle-Brachial Index–To test for Peripheral Arterial Disease (PAD)

24 | COMMUNITY CONTRIBUTIONS

Child Protection Center offers child abuse prevention program As a part of the Child Protection Center’s outreach efforts we offer a school based child abuse prevention program called Safetouch. This presentation is offered to schools in Linn and surrounding counties and

Dental Health Center serves the children of Linn County St. Luke’s Dental Health Center, (DHC), a dental clinic for children from low income families and developmentally disabled people, takes pride in the outreach programs it provides. The DHC has six dental hygienists who provide preventive services and care coordination in local schools and Linn County WIC clinics.

At the WIC clinics, the hygienists provide dental screenings for children age 0 - 5 years, give dental referrals, apply uoride varnish, give oral health education to parents, and provide care coordination for those who need help ďŹ nding a dental home.

For 30 years, DHC hygienists have served the children in Linn County schools. In 2011, a partnership between St. Luke’s DHC and Hawkeye Area Community Action Program (HACAP) was created, allowing the hygienists to also provide preventive dental sealants and uoride varnish to children in local schools who have a higher number of at risk children.

This past school year, the six hygienists provided over 10,000 dental screenings and placed dental sealants on almost 5,000 permanent teeth! Thanks to St. Luke’s Foundation for helping secure grant funding to support the evergrowing prevention outreach programs.

Medicaid specialists help community with open enrollment The Medicaid Specialist team consists of four full time CertiďŹ ed Application Counselors (CAC’s), one part time, and one PRN employee. The CAC’s have to pass both training by the Department of Health and Human Services/Health Insurance Marketplace and UnityPoint’s training program prior to open enrollment. Open enrollment for coverage in 2015 was from Nov. 15, 2014 to Feb. 15, 2015. The federal government extended the deadline until Apr. 30, 2015 for certain individuals.

During open enrollment, the CAC’s enrolled 468 individuals in Medicaid/ Iowa Health and Wellness (Iowa’s Medicaid expansion program) and assisted 206 individuals with application and eligibility questions regarding Medicaid/Medicaid expansion. The Marketplace is the health insurance exchange where people may purchase health insurance and apply for tax credits and cost sharing. The CAC’s enrolled 31 individuals in The Marketplace during open enrollment.

Many people had questions about the process, tax credits, eligibility and enrollment. The Medicaid Specialist team (CAC’s) assisted 125 individuals with these questions.

went to ABBE Center for an outreach enrollment event. The CAC’s continue to assist UnityPoint Health patients and community members the rest of the year with enrollment and questions. In 2014, the Medicaid Specialist team assisted with assessing for eligibility on over 5,400 patient accounts.

Cooking with a Cardiologist Cooking with a Cardiologist began as a partnership between UnityPoint Clinic Cardiology and Hy-Vee area grocery stores in 2011. The heart healthy cooking sessions feature a cardiologist from UnityPoint Clinic Cardiology and a registered dietitian from Hy-Vee. More than 1000 participants at over 50 sessions have learned how to prepare dishes that are delicious and heart healthy. Participants enjoy complimentary samples of appetizers, entrĂŠes, side dishes and desserts along with a lively discussion about hearthealth, tips and tricks to enhance their recipes and their knowledge base.

To assist the community, the Medicaid Specialist team dedicated one CAC for two days a week during open enrollment to assist community members with enrollment and questions. The other four CAC’s worked with bedded and emergency department patients during open enrollment. The team also

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Here’s what our Magnet Champions are saying:

“ I could not be more proud to work here. St. Luke’s has been such

a wonderful part of my life and influenced me to become the individual and nurse I am today and pushes me to grow and strive for improvement each day. I feel so blessed to work here and be able to say ‘I love my job!’ every day.”

Michelle Wenzel, BSN, CWON

“ Magnet designation illustrations St. Luke’s is a great place to Magnet Champions Throughout the year, representatives from every area of the hospital meet to share news and innovations from their departments.

It offers inspiration and facilitates collaboration across disciplines.

work. We are, as an organization, constantly trying to improve our patient and family experience and the nursing input is actively sought out and valued.”

Joni Broughton, RN

“ I am pleased to work at a hospital with Magnet designation. It

indicates the hospital’s commitment to the highest standards of patient care. I appreciate that all staff members are involved with our Magnet journey, not just nurses. It is an honor, yet a responsibility, to be leaders in health care.”

Cathy Hunt, BSN, RN

Connect with St. Luke’s at unitypoint.org/cedarrapids

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1026 A Avenue NE | Cedar Rapids, IA 52402 | (319) 369-7211