Shining the light on St. Michael's Best Practice Spotlight Organization Achievements

Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements This annual newsletter highlights some of St. Michael’s best practice achievements with examples of how our nursing teams are implementing, evaluating and sustaining best practice guidelines (BPGs) into standardized processes that support evidence-based nursing practice.

2015-16 success story: Helping fracture clinic patients speak up about abuse at home

By Emily Holton After a 2011 St. Michael’s study revealed that one quarter of our fracture clinic patients were victims of abuse at home, Josie Rockman (RN), Ines De Campos (RN) and social worker Mari Vella (MSW) looked to the RNAO BPGs for an evidencebased response. They knew that we needed a formal process to assess our patients’ safety at home, and that the BPGs would be an important tool to guide their work.

Fall 2016

In this issue: • • • • • • • • •

Success Story BPSO Intranet Page Q&A with Sonya Canzian 31 BPGs & Counting Communities of Practice Nursing Week Our 2015-16 Champions Fast Facts Stay Tuned

Rockman, De Campos and Vella referred to the same RNAO BPG, and the following recommendations: 1.0

Nurses implement routine universal screening for woman abuse

2.0 Routine universal screening be implemented for all females 12 years of age and older 3.0 Nurses develop skills to foster an environment that facilitates disclosure 4.0

Nurses develop screening strategies and initial responses that respond to the needs of all

5.0

Nurses use reflective practice to examine how their own beliefs, values, and experiences influence the practice of screening.

6.0

Nurses know what to document when screening for and responding to abuse

7.0

Nurses know their legal obligations when a disclosure of abuse is made

8.0 Mandatory educational programs in the workplace be designed to: increase nurses’ knowledge and skills; and foster awareness and sensitivity about woman abuse.

Continued on page 2

BPSO stands for Best Practice Spotlight Organization, the designation awarded by the Registered Nurses’ Association of Ontario (RNAO) to organizations upon successful implementation, evaluation and knowledge translation of established nursing best practice guidelines (BPGs). St. Michael’s has been a proud designated BPSO since 2012.

Continued from page 1

Their goal was to develop a screening tool to be given to every patient at every visit. All the above recommendations played a role in how the team designed the tool, process and related staff education.

Rockman, De Campos and Vella began with a staff questionnaire to assess the knowledge base and comfort level on the front-line, and moved on to an in-service for staff based on the needs the survey identified. They developed an abuse screening tool, and educated staff on the abuse screening pathway for the Outpatient Mobility Program. Posters in patient

and staff areas furthered the education strategy and prepared patients for the screening process.

The team also made sure that supports were in place for staff, to help them respond to a positive patient disclosure.

Starting in Spring 2016, every patient now receives the screening assessment during their Fracture Clinic appointment. The team continues to provide education and resources for staff to create an environment that facilitates disclosure and supportive care.

NEW & IMPROVED BPG Intranet Site Check our new and improved BPSO intranet page to learn about quality improvements initiatives that have been underway this past year to support the integration of best practices.

2 I November 2016

with Sonya Canzian Executive Vice President, Programs, Chief Nursing Executive and Chief Health Disciplines Executive (Interim)

Q: What does being a BPSO mean to SMH? Our patients are benefitting from higher quality care and safety thanks to the collaborative initiatives undertaken across St. Michael’s to bring new best practices into our various clinical settings. During our 3 year BPSO candidacy journey and our ongoing sustainability work we have created new ways of operating and sharing across programs. BPSO champions, nursing and clinical staff have shared valuable insights, innovations, education programs and tools that have benefited the entire organization and ultimately our patients. It is exciting to continue to build on our past successes. Currently, there are 26 different BPG initiatives underway led by 38 BPG Nurse Champions from 21 different clinical areas.

Q: What changes has BPSO brought to SMH? While the BPSO designation is viewed as a nursing best practice initiative the journey has engaged nurses and other professionals from various disciplines to actively collaborate in implementing evidenced based practice.

In addition to improving clinical outcomes, the initiatives we undertook empowered and invigorated nurses and other health disciplines, strengthening our commitment to interprofessioal care and raising the

profile of nurses as knowledge professionals. It has been intensive work and it speaks to the commitment and perseverance of our health care professionals and their dedication to providing the very best care for our patients.

Q: What is one of your top BPSO stories?

When we started our journey towards becoming a BPSO I was a member of the steering committee that helped support the implementation of 17 best practice guidelines across the hospital. I recall one of the early meetings where we reviewed the program submissions that indicated which BPGs the various units wanted to implement. The submissions resulted in 23 unique teams implementing 14 different BPGs across units.

This was of course in addition to the 3 corporate BPGs each unit was also adopting. It was at that meeting that I truly appreciated the enormous undertaking we were about to embark on and became energized by the excitement in the room at the opportunity to create practice environments that actively support clinicians in applying best evidence to practice. I was continually inspired by the work of the local teams and the steering committee and their tireless efforts to achieving our designation and the culture of best practice that lives in all our units as we continue our sustainability work.

November 2016 I 3

31 BPGS & Counting…!

St. Michael’s is one of the few BPSO organizations that have implemented a total of 31 RNAO BPGs 1.

Assessment and Management of Pain

2.

Assessment and Device Selection for Vascular Access

3.

Assessment and Management of Foot Ulcers for People with Diabetes

4.

Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour

5.

Breastfeeding Best Practice Guidelines for Nurses

6.

Caregiving Strategies for Older Adults with Delirium, Dementia and Depression

7.

Care and Maintenance to Reduce Vascular Access Complications

8.

Care Transitions

9.

Client Centred Care

10. Crisis Intervention 11. Developing and Sustaining Effective Staffing and Workload Practices 12. Developing and Sustaining Interprofessional Health care: Optimizing patients/clients, organizational and system outcomes 13. Embracing Cultural Diversity in Health Care: Developing Cultural Competence 14. Establishing Therapeutic Relationships (ETR) 15. Integrating Smoking Cessation into Daily Nursing Practice 16. Interventions for Postpartum Depression 17. Nursing Management of Hypertension 18. Person and Family Centred Care 19. Preventing and Managing Violence in the Workplace 20. Prevention of Falls and Fall Injuries in the Older Adult 21. Preventing and Mitigating Nurse Fatigue in Health Care 22. Professionalism in Nursing (PIN) 23. Promoting Safety: alternative approaches to the use of restraints 24. Promotion of Continence using Prompted Voiding 25. Risk Assessment & Prevention of Pressure Ulcers 26. Screening for Delirium, Dementia and Depression in Older Adults 27. Strategies to Support Self Management in Chronic Conditions 28. Supporting and Strengthening Families through Expected and Unexpected Events 29. Stroke Assessment Across the Continuum of Care 30. Woman Abuse: Screening, Identification and Initial Response 31. Workplace Health, Safety and Well-Being of the Nurse

4 I November 2016

Highlights from last year (2015-2016) Best Practice Guidelines (BPG) communities of practice (CoP) One lesson learned through our BPSO journey is that supporting BPG Nurse Champions leads to success.

Communities of Practice (or CoP) have been used as a method to support BPG champions and teams at St. Michael’s. Based on the positive feedback we heard from past champions and teams, Nursing Professional Practice decided to reintroduce CoP for the 2015/16 year. “We wanted to provide a supportive space where champions from across the hospital could come together once a month and share their experiences, successes and any challenges that they were having and, with support of other champions and nursing leaders brainstorm practical solutions. In addition to the informal learning that occurs in a CoP we also wanted to include mini learning sessions on topics that would provide champions with knowledge, tools and resources that we hoped would be helpful for them in implementing

BPG communities of practice kick-off, October 2015.

their BPG initiative” says Ashley Skiffington, Professional Practice Leader, Evidence Based Practice. Topics of the learning sessions ranged from learning about the Model for Improvement, change management concepts to best practices in developing and delivering education. Nursing Professional Practice also tried to incorporate some fun into the learning sessions. For example, Mr. Potato heads were used to teach BPG Nurse Champions about the fundamentals of the Model for Improvement and testing changes on a small scale using Plan-Do-Study-Act (PDSA) cycles.

Nursing Professional Practice was very impressed with the quality of work that was produced by BPG Nurse Champions.

The feedback from BPG Nurse Champions about their experience of participating in the BPG CoP was positive.

Nursing Professional Practice sought specific feedback on what the BPG Champions found helpful, whether they felt adequately supported and how can the CoPs be improved.

Based on the positive feedback received from the BPG Nurse Champions, Nursing Professional Practice will continue to support the development of BPG Nurse Champions and their teams using the same CoP format in 2016/2017.

Here are a few comments from the BPG Nurse Champions about their experience participating in the CoP…..

“Great experience. Thank you for the mentors who provided a very positive learning environment and inspiring action in quality improvement” “I have not been at SMH very long. Being involved in BPSO made me feel part of the larger group of Nursing. Thank you for such a positive experience!”

“I am ready to challenge more projects. It was a great learning opportunity” “Excellent program-allowed my department to tackle an important issue and complete task”

November 2016 I 5

2016 Nursing Week BPG Sustainability Gallery Walk

Nursing Week BPG Poster Gallery Walk, May 2016

Our BPG Nurse Champions and their BPG initiatives were showcased and celebrated during St. Michael’s 2016 Nursing Week BPG Sustainability Gallery Walk. This event showcases quality improvement (QI) initiatives that are informed by RNAO BPGs and it celebrates the nurses and teams who lead these initiatives.

At this event, Irmajean Bajnok, Director of RNAO's International Affairs and Best Practice Guidelines Programs, provided opening remarks and referred to St. Michael’s nursing as ‘an exemplary BPSO model for other organizations’.

Each BPG Nurse Champion was recognized through a ‘pinning’ ceremony, where members of St. Michael’s 6 I November 2016

BPSO team walked around and awarded each BPG Nurse Champion a new custom designed St. Michael’s BPG Champion pin.

If you missed the BPG Sustainability Gallery Walk and want to learn about more about the BPG initiatives, BPG posters can be viewed on SMH BPSO intranet page

Who Were Our 2015/16 BPG Nurse Champions?

A BPG Nurse Champion is a registered nurse selected to lead, facilitate and inspire the BPG implementation and evaluation process in their local unit.

From October to March 2016, there were 35 BPG Nurse Champions from across 23 clinical areas who led BPG initiatives in their local areas/departments.

To learn more about our 2015/16 BPG Nurse Champions visit St. Michael’s BPSO intranet page.

What are key qualities of a BPG Nurse Champion?

•

A nurse who demonstrates initiative and commitment to best practices in their current role;

•

Passionate about a BPG topic, patient population and the potential outcomes that can be achieved;

•

Has the ability to lead, coordinate and facilitate an initiative/ project and, role models positive clinical leadership

November 2016 I 7

FAST FACTS Over the course of our 2014-2016 BPSO designation term…

(4)

1

St. Michael’s hosted four international BPSO visitors from Australia, Chile and Columbia to learn from St. Michael’s BPSO journey

2

Twenty one St. Michael’s nurses presented BPG work externally at national and international conferences

3

Sixty

(21)

(60) BPG initiatives led by BPG Nurse Champions were implemented across the hospital

STAY TUNED!

As of October 2016, a new group of BPG nurse champions have started to lead BPG initiatives in their local areas, check for updates on the BPSO intranet page.

Please send your comments or story ideas to Ashley Skiffington skiffingtonA@smh.ca or Marta Sliz slizm@smh.ca

Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements is an annual newsletter created by the Nursing Practice and Education Department at St. Michael’s Hospital.

Design by Marcelo Silles - Medical Media Centre, St. Michael’s Hospital