news views Winter 2014
A Publication of the Department of Nursing and Patient Care Services University of Maryland Medical Center
The Interventional Radiology Department First Annual “Unity Day:" Building a Stronger Team Melisha Spahr, RN, CCRN, SCNI, Interventional Radiology
On November 2, 2013, the Interventional Radiology Department staff came together for their first annual team bonding event known as “Unity Day." Due to the vast amount of change made in the Interventional Radiology Department, it was identified by leadership and staff that a much needed boost in morale and relationship building was needed. Although not mandatory, a large percentage of staff dedicated their personal time to participate in this amazing event. Forty highly motivated participants, including physicians, nurses, radiology technologists, and ancillary support staff, came together to solidify a stronger bond with their fellow team members. This fun filled day began with a well-organized light breakfast followed by three hours of exhilarating outdoor team-building activities. These activities focused on fostering collaboration and communication between team members. The day ended with individual team prizes and a catered lunch. The goal of “Unity Day” was to assist the team in creating a work culture that values communication and teamwork by building positive relationships. A productive team builds a collegial environment that fosters meaningful and positive communication, problem solving methods, trust building, and coping strategies amongst team members.
Members of the planning team: Patty Wall, BSN, RN, CCRN; Melisha Spahr, RN, CCRN, SCNI; and Dominique Feldman, BSN, RN, CCRN, SCNl
This team-building event has already proven to be successful, as evidenced by the interactions between the staff and the patients and families receiving care in the department. Staff members are faced with many challenges daily and are able to overcome many obstacles by utilizing the skills learned at this event. Effective communication and building trust allows the staff to work together in unison to promote positive patient outcomes. The Interventional Radiology Team has strong leaders that are committed to creating a positive work environment to promote the success of the organization. A special thanks goes out to the planning team including Fred M. Moeslein, MD, PhD, Assistant Professor of Radiology, Interim Director, Vascular and Interventional Radiology; Patty Wall, BSN, RN, CCRN, Nurse/Operations Manager for Radiology and PICC Team; Melisha Spahr, RN, CCRN, SCNI, Interventional Radiology; and, Dominique Feldman, BSN, RN, CCRN, SCNI, Interventional Radiology. The planning team was instrumental in making this event a success, and they provided a great example of physicians and nurses going above and beyond for the good of the team and the organization. Due to the success of this event, the Interventional Radiology Department plans to hold an annual “Unity Day” event to maintain a positive work environment for the promotion of employee satisfaction and excellent patient outcomes.
In This Issue Radiology Department "Unity Day" Lisa Rowen's Rounds Adult Rapid Response Team "Hey Respiratory" Spotlight on Pharmacy Falls Prevention Program Journal Club The Magic of Magnet 2013 Carmel McComiskey Wins Book Award Karen Vojtko's Life Celebrated Risk Management and Incident Reporting 20 Orientation Tools for Preceptor 22 Neonatal Rehab Services 24 New Presentation & Publication Review and Approval Policy 25 I Was Noticed 26 Kids to Farmer's Market 27 Achievements 28 Doctor of Nursing Practice Option 29 A Cancer Center Christmas 30 Trends in Nursing Practice 2014 31 Nurses Week Calendar 32 Clinical Practice Update 1 3 4 6 7 8 10 12 18 18 19
UMMC’s upcoming Magnet site visit is scheduled for April 2–4, 2014. The goal is for UMMC nurses and staff to celebrate and describe all of the great work that is occurring in the organization to improve patient care outcomes and the work environment. Show your pride in the care we deliver!
Find News&Views online at http://www.umm.edu/nursing/newsletter.htm and on the UMM Intranet at intra.umm.edu/ummc/nursing-dept/newsviews.htm
Carolyn Guinn, MSN, RN Magnet Director, Clinical Practice & Professional Development Associate Editor
Mike Costello, MHA Project Specialist, Clinical Practice & Professional Development Editorial Board
Lisa Rowen, DNSc, RN, FAAN Senior Vice President of Patient Care Services and Chief Nursing Officer Suzanne Leiter Executive Assistant to the Senior Vice President of Patient Care Services and Chief Nursing Officer Greg Raymond, MS, MBA, RN Director, Nursing and Patient Care Services Clinical Practice & Professional Development, Neuroscience, Behavioral Health and Supplemental Staffing Chris Lindsley Director, Communication Services University of Maryland Medical System Anne Haddad Publications Editor University of Maryland Medical System
NEWS & VIEWS is published quarterly by the Department of Nursing and Patient Care Services of the University of Maryland Medical Center. Scope of Publication The scope of NEWS & VIEWS is to provide clinical and
professional nursing and patient care services practice topics that focus on inpatient, procedural, and ambulatory areas. Submission Guidelines
Send completed articles via e-mail to firstname.lastname@example.org. Please follow the guidelines provided below. 1. Font – Times New Roman – 12 pt. black only. 2. Length – Maximum three double spaced typed pages. 3. Include name, position title, credentials, and practice area for all writers and anyone named in the article. 4. Authors must proofread the article for spelling, grammar, and punctuation before submitting. 5. Provide photos and embedded images in separate .jpg files. 6. Submit trend data in graphic format with labeled axes. 7. References must be numbered consecutively and provided at the end of the article. 8. Editor will seek expert review of articles to verify and validate content. 9. Articles will be accepted based on appropriateness of content and availability of space in each issue. 10. Articles that do not meet the above guidelines will be returned to the author(s) for revision and resubmission.
ISSUE Spring 2014 Summer 2014 Fall 2014 Winter 2015
DUE DATE May 12, 2014 July 8, 2014 October 6, 2014 January 6, 2015
The UMMC Standard for displaying of credentials is based on the ANCC Guidelines. The preferred order is: • highest earned degree (can list more than one if in different fields) • licensure • state designations or requirements • national certifications and honors • other recognitions Nurses with two or more nursing degrees (MSN, BSN) should only list their highest nursing degree, along with other degrees obtained. Example: Betty Smith, MSN, MBA, RN. Why this order: The education degree comes first because it is a “permanent” credential, meaning it cannot be taken away except under extreme circumstances. The next two credentials (licensure and state designations/requirements) are required for you to practice. National certification is sometimes voluntary. Awards, honors, and other recognitions are always voluntary. If you would like additional information, please visit http://www.nursecredentialing.com and search using the word “credentials.”
news &views Lisa Rowen’s Rounds: Remembering the Why If we are fortunate, we have someone in our life who “keeps it real” for us. This is a person who is open, honest and direct, and who tells us what we need to hear, not just what they think we want to hear. In my life, the person who extends herself in this way is my daughter, Emily, a PICU nurse. A couple of nights ago, my phone rang and Emily’s name popped up on the screen. I had an immediate sense of Lisa Rowen, DNSc, RN, FAAN, concern because I knew she was working the night shift, and unless something was terribly wrong, would not call Senior Vice President of Patient Care Services and while she was at work. I answered with “Are you okay?” Chief Nursing Officer and she responded “No, it’s a horrible night at work and I just need to talk for two minutes so I can return to it.” I am Emily’s “safe place” just as my own mom is my “safe place.” The safe place is where you can go, say whatever you need to say without fear of judgment or retribution, know your confidante will quietly store it away in the vault of their heart, and usually offer words of solace, comfort or meaning. It’s understandable that the “keep it real” person is so inextricably linked with the “safe place” person. The exchange of trust and vulnerability provides a rich, symbiotic environment for the two to co-exist. As Emily shared her thoughts and spoke about her feelings related to what she was experiencing on an emotionally brutal evening at work, I couldn’t help thinking, “Why do we choose this profession? Why are we nurses?” Emily had said, “I don’t know if I can keep doing this….,” and I wondered how and from where bedside nurses draw the strength, courage, and conviction to carry on in these incredibly challenging situations, day after day, month after month, and year after year. It is a heroic venture, to say the least. So why be a nurse? It certainly is not easy. It is often painfully difficult work under extreme pressure. Imagine the job criteria of a nurse if it were re-written: ◗◗ Provides care for patients while their loved ones stand by, observe, and frequently question every decision you make and every action you take. ◗◗ Appropriately functions while remaining aware that mistakes made can result in another person’s death or permanent injury. ◗◗ Appropriately processes feelings and emotions while witnessing and supporting another person at their most raw, desperate and vulnerable point in life and during heartbreaking decisions and situations, and continues to provide safe care even if emotionally exhausted. ◗◗ Goes with the flow regardless of what the flow brings with it, including broken equipment, missing medications or supplies, incivility, tight staffing, incessant documentation requirements, and new technology.
◗◗ Maintains the dignity of the patient during moments of extreme medical intimacies. ◗◗ May be unexpectedly or unknowingly exposed to others’ bodily fluids and harmful pathogens. ◗◗ Can unexpectedly cover for colleagues who are ill, absent, off the unit, or unable to leave their duties, while continuing to safely carry out assigned responsibilities. ◗◗ Smiles, is polite and respectful, and offers compassion and empathy to everyone regardless of any reciprocation. ◗◗ Staves off hunger or bathroom requirements whenever necessary. ◗◗ Remains the stationary, primary caregiver for a patient at the bedside, even if colleagues in different roles are able to move in and out of the room or on and off of the unit. ◗◗ Does whatever it takes, within the legal bounds of licensure and policy, to help people in need. ◗◗ Continuously educates some friends and family members, both one’s own and that of the patient’s, who wonder why nursing, rather than medicine, is the chosen profession. Seriously? Why do this? And that is exactly the question – why do this? Every nurse has to reacquaint himself and herself with the answer to this question of Why, because if not, the role is likely unsustainable. It’s just too difficult. Our Why is the only way to continuously re-inspire and re-energize ourselves; finding it and feeling it is the path forward 1. I’m not talking about what you do or how you do it, but rather why you do it. The Why cuts through cynicism, exhaustion and hopelessness, and infuses immediate meaning, sanity and value to our work. When Emily said “I don’t know if I can keep doing this…,” and I heard the anguish in her voice, I asked, “Why do you do it?” She silently reflected and her personal Why flooded through her mind in response to my question. Emily was moved to the necessary place where she was able to pull from within herself to get her through the shift. But Emily, as all nurses, wants more than just to get through the shift. There is a much deeper reason why nurses do what they do. This reason is the North Star of our profession, our purpose and raison d’etre, our reason for existence. In the relationship between “keeping it real” and being a “safe place”, Emily and I both remembered, and honored, our Why. And we both continue to think about it every day, and every day as nurses, we are inspired. Reference 1 Sinek, S. (2009). Start with Why. Penguin Group, New York, NY.
UMMC’s Adult Rapid Response Team Celebrates Two Years of Service Erika Hebden, BSN, RN, CCRN, SCNI; Saprina Mickey, BSN, RN, SCNI; Lisa Petty, BSN, RN, CCRN, SCNI; and Dana Simmons, BSN, RN, CCRN, SCNII
On December 5, 2013, the University of Maryland Medical Center’s Adult Rapid Response Team celebrated its two-year anniversary. In that time, the team’s relationships with inpatient units and diagnostic areas have grown strong. Some call the team members “the ninjas,” others “the men/women in black;” and, many times, “thank goodness you are here!” is the expression used once the team arrives.
Members of the Adult Rapid Response Team
The Rapid Response Team utilizes both critical thinking and evidence based practice to assist inpatient teams to rescue deteriorating patients or to provide bridge management for patients who require a higher level of care. Unit rounds are conducted every shift on every unit in an effort to regularly interact with staff members, provide education about the team, and discuss early signs of patient clinical deterioration. At times, the incidental identification of patients who require rapid response assistance can occur during rounds. Since December 2011, the Rapid Response Team has responded to a total of 1,729 calls. Whew, what a ride! In an article by Berwick, Calkns, McCannon, and Hackbarth (2006), the Institute for Healthcare Improvement in 2004 outlined an initiative to improve patient safety, coined “The 100,000 Lives Campaign.” This initiative supported the deployment of rapid response teams at the first sign of patient decline. The Rapid Response Team’s mission at University of Maryland Medical Center (UMMC) is to provide a service to staff and patients that will result in decreased mortality and morbidity rates of non-intensive care unit (ICU) patients. Additional goals include decreasing the incidence of
cardiopulmonary arrest calls, decreasing the number of unplanned ICU admissions, and reducing the number of sentinel events. The multi-disciplinary adult Rapid Response Team was born out of the ingenuity to combine resources from the already established Mobile Practitioner Team (MPT). Under the leadership of nurse manager, Marie Fortuno, BSN, RN, CAPA, the team successfully continues to realize the vision of MPT/RRT’s biggest champion, Margie Stickles, MSN, MBA, RN, CCRN, Director of Nursing, Perioperative Services. The Medical Center’s MPT, which includes the Rapid Response Team, is 22 members strong with registered nurses and critical care patient care technicians (PCTs) that provide critical care transport services, operating room transport support for anesthesia services, and rapid response services. The Rapid Response Team is the critical care nursing support arm of MPT. Rapid Response Team members focus on assisting inpatient units by providing early intervention to prevent clinical deterioration of patients prior to cardiopulmonary arrest or other life-threatening events. The Rapid Response partnership with Respiratory Therapy completes the registered nurse/PCT team when responding to a rapid response call. Rapid Response Team members have various critical care clinical expertise and backgrounds including trauma medicine, medicine, cardiology, neurosurgery, and surgical intensive care. A number of our registered nurses have flight and ground transport expertise, and several of our critical care PCTs have critical care experience as emergency medicine technicians and/or military medics. One of the landmarks of a rapid response call is early identification of an untoward clinical change. Ludikhuize, Smorenburg, de Rooij, and de Jonge (2012) showed in their study that 81% of patients exhibited signs of clinical deterioration within 48 hours of a severe adverse event, such as cardiopulmonary arrest, an unplanned ICU admission, emergency surgery, or unexpected death. It is notable that these patients typically demonstrated some alteration in vital sign parameters prior to clinical decline. UMMC’s Rapid Response Team collects data to identify time points at which patients have shown to demonstrate signs of clinical deterioration. By comparing vital sign parameters twenty-four hours continued on page 5.
news &views Rapid Response Team,
continued from page 4.
prior to a rapid response call, UMMC’s data has identified opportunity for earlier intervention, and our team has the ability to tailor educational opportunities to the nursing units served. The following graphs illustrate a few of the data points collected to support early intervention education: (Figure 1) percentage of patients by outcome; (Figure 2) percentage of calls received by service grouping; and, (Figure 3) average time from abnormal vital sign to team arrival between December 2012 and November 2013. In the past two years, UMMC’s Rapid Response Team has played an important role in preventing further clinical deterioration in patients by positively impacting favorable patient outcomes. Patient safety is of the utmost importance, and the Rapid Response
Team will continue to strive for excellence in patient safety through its partnerships with nursing and physician colleagues. Many thanks to all of the units and their staff who have supported our team, our mission, and our vision—all in the name of safe quality patient care. References Berwick, D.M., Calkins, D.R., McCannon, C.J., and Hackbarth, A.D. (2006). The 100,000 Lives Campaign: Setting a goal and a deadline for improving health care quality. JAMA, 295 (3), 324-327. Ludilhize, J., Smoernburg, S.M., de Rooij, S.E., de Jonge, E. (2012). Identification of deteriorating patients on general wards; Measurement of vital parameters and potential effectiveness of the modified early warning score. J Critical Care, 27 (4), 424-427.
Figure 1 % of Patients by Outcome of Calls
% of Patients by Outcome of Calls 0.6
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Figure 2 % of RRT Initiated Calls Received by Service Grouping (n=469)
% of RRT Initiated Calls Received by Service Grouping (n=469) %Units of RRT Initiated Calls Received by Service Grouping (n=469) Surgery Surgery Units 23% 23%
Medicine Units 77% Medicine Units 77%
Average Time from Abnormal Vital Sign to Team Arrival (hours) Average Time from abnormal vital sign to Team Arrival (Hours) 32 24 16
8 0 Dec '12
PATIENT CARE SERVICES | RESPIRATORY
“Hey Respiratory” – Getting To Know Us Better Christopher D. Kircher, MS, RRT, Associate Director, Respiratory Care Services
The University of Maryland Medical Center (UMMC) has a very progressive and dedicated group of respiratory therapists that work in all areas of the hospital. From our smallest patients in the NICU and PICU to the many special needs of our adult patient population, the respiratory therapists are a vital part of the critical care team. Conditions such as asthma, COPD, congenital defects, traumatic injury, neurologic impairment and surgical intervention often require an added level of finesse when supporting some of our sickest patients who require oxygen and mechanical ventilation weaning, pulmonary medication adjustments and secretion management. The UMMC Respiratory Care Services Department is comprised of over 160 respiratory therapists, with the majority of those professionals holding the Registered Respiratory Therapist (RRT) credential. UMMC supports best practice modalities and individual professional advancement, making the department a preferred destination for new graduates and seasoned respiratory therapists. Our therapists gain valuable experience by practicing autonomously within a wide range of patient care protocols that are focused on interdisciplinary team collaboration. Beginning with a robust orientation program, therapists are trained to work in all adult areas with the ability to expand their practice into pediatric and neonatal areas. Once joining the regular assignment rotation, they are able to effectively advance patient flow and enhance the education and resources for our patient care partners. In one of the next editions of News & Views, we will highlight some of the unique programs and practices provided by Respiratory Care Services in four key areas: trauma, pediatric/neonatal, surgical/ neuro, and medical/cardiac. Contributions from respiratory therapists, department supervisors, and key members of our interdisciplinary team will offer a closer look at the intricacies of respiratory care services. The goal is to enlighten others about the profession and provide a glimpse into a “day in the life” of a respiratory therapist (RT) at UMMC. The first area to be highlighted is the role of the respiratory therapist in the R Adams Cowley Shock Trauma Center. In this area, RTs face many challenges with patients requiring mechanical ventilation due to severely injured lungs and other body systems that can affect pulmonary health and function. In years past, patients with the sickest lungs were supported with inverse ratio pressure control. This mode of ventilation required the administration of heavy sedation and paralytics to prevent the patient from “fighting,” a treatment that allowed for little patient synchrony and comfort. Today’s technology affords RTs the ability to mesh ventilator modes while allowing for spontaneous breathing efforts at the highest levels of support. This has prevented the need for paralytics, which greatly reduces the need for sedation. Clinicians now have the ability to care for patients in a way that decreases the chance of ventilator induced lung injury and earlier discontinuance from mechanical ventilation, both leading to better outcomes. In concert with these ventilator advancements, the introduction of many new secretion clearance modalities have greatly expanded the RTs ability to keep airways clear and in the best condition to provide ventilation and oxygenation.
Historically, the philosophy was to adapt the patient to “the ventilator and control their breathing. With advanced technology in mechanical ventilation, we can now adapt the ventilator to the patient and promote early, safe spontaneous breathing. This leads to an increase in patient comfort, reduced sedation, increased mobility and secretion clearance. The team approach at the Shock Trauma Center with respiratory therapists, physicians, nurses and occupational and physical therapists provides an integrated approach to the patient on mechanical ventilation which improves overall patient care. Nader Habashi, MD, Associate Professor of Medicine and Medical Director of Multi Trauma Critical Care
With the expansion of the R Adams Cowley Shock Trauma Center, the number of critically ill patients in need of mechanical ventilatory support has increased significantly. As part of this expansion, the respiratory care department assisted in the evaluation of several leaders in mechanical ventilation to support the final selection of a platform that could provide life support from neonates to adults. Extensive education and positive relationships with product vendors promoted a smooth conversion of the platforms that provided uninterrupted care at the highest level.
Having participated in one of the most extensive product “evaluations that UMMC has completed to date, we were proud to have partnered with many disciplines, including physicians, nurses, clinical engineering, and information technology professionals to help assure all aspects affecting the mechanical ventilator were addressed. Following the evaluation, the selected vendor commented that they will mirror the experience they had at UMMC when introducing their platform at other facilities conducting a similar evaluation. Christopher Kircher, MS, RRT Associate Director, Respiratory Care Services
continued on page 11.
news &views Spotlight on Pharmacy
On-call Clinical Pharmacy Services at the University of Maryland Medical Center: Improving Patient Care by Expanding Access Edward Knapp, PhD, P4 Pharmacy student at the University of Maryland School of Pharmacy and Carla Williams, PharmD, BCPS, Interim Assistant Director of Pharmacy Operations, University of Maryland Medical Center
Recent studies confirm that the involvement of clinical pharmacists in patient care during hospitalization improves outcomes in both ICU and general medical patient populations.1,2 From identifying potential drug interactions to optimizing antibiotic regimens for patients, access to clinical pharmacist expertise enables medical teams to make better informed decisions about therapeutics.3 Having a clinical pharmacist on antimicrobial stewardship teams is associated with reduced incidence of C. difficile infections and lower rates of inappropriate antibiotic use. In an era where medical institution services and reimbursement are increasingly measured against standards of excellence in practice and outcome, there is a clear role for clinical pharmacists on the medical team to improve outcomes and maximize patient value. Unfortunately, there are too few clinical pharmacists to routinely cover every service at the University of Maryland Medical Center (UMMC). The challenge of making clinical pharmacist expertise more widely available to all medical personnel and healthcare providers at UMMC has led to the introduction of three new clinical pharmacy services within the past 3 years: The pharmacokinetics (PK) consult service, the anti-coagulation (AC) consult service, and the PILL pager (BEEP 7455) on-call clinical pharmacy service, all of which are staffed by clinical specialists and residents. Together, these services resulted in 24,987 clinical interventions from July 2012 through June 2013. The most common consult placed during this time period was for vancomycin dosing, representing 72.89% of all consults.4 This is noteworthy, as clinical pharmacist-guided dosing of vancomycin and aminoglycosides is associated with significantly lower patient mortality, rates of adverse reactions, and shorter hospital stays.1 Anti-coagulation with warfarin was the second-most common consult placed, representing 13.55% of all consults.4 As with antibiotic stewardship, clinical pharmacist-guided management of inpatient anticoagulation is associated with significant reductions in patient mortality, the need for blood transfusion, and hospitalization length of stay.1 Mehrnaz Pajoumand, PharmD, BCPS, Clinical Pharmacy Specialist who covers these pharmacy services, says the PK and AC consult services at UMMC function similarly to other types of clinical consults, with some additions. Prescribers can order the service as they would any other consult. A clinical pharmacist or pharmacy resident then provides an initial assessment and recommendations, and documents in the electronic medical record. Each day the pharmacist follows up with the team, adjusting dosing and placing orders for laboratory monitoring as needed as well as providing patient education, discharge counseling, and documenting interventions. Both services also address alternative therapeutic options and administration routes when clinically warranted. PK consults can be placed on adult patients for vancomycin, aminoglycoside antibiotics, digoxin, lithium, theophylline, and anti-convulsant medications. The AC service covers inpatient management of any anti-coagulant, as well as transitions in therapy between agents.
The electronic documentation of the assessment and plan allows the prescriber and nurse taking care of the patient to determine when levels should be drawn as well as the rationale in case there is concern regarding appropriateness. The therapeutic goals for the patient are also specified so that anyone caring for the patient is aware. The notes can be found on the form browser under the heading of Pharmacokinetic Consult Service, Pharmacy to Dose or Antithrombosis Progress Note for PK and AC consults, respectively. While the AC and PK services are ordered consults, the PILL pager (x7455) is a free on-call service that can be accessed by anyone at UMMC who has a question related to pharmacotherapy. Dr. Pajoumand reports that call volume for the PILL pager is heaviest during the holidays, but the pager is staffed year-round 24 hours a day, 7 days a week. From July 2012 to June 2013, PILL pager calls represented 11.5% of all clinical pharmacy service requests.4 Brian Grover, PharmD, BCPS, Clinical Pharmacy Specialist, notes that while tracking precise usage of the PILL pager is difficult, due partly to the lack of a documentation mechanism for forwarded calls, the PILL pager has been generally well-received by a diverse cross-section of clinical staff and medical services, and is showing increasing popularity and usage over time. In conclusion, the PK and AC clinical consult services and the PILL pager represent innovative programs that extend access to clinical pharmacy services to all UMMC clinicians and their patients. Due to the high volume of consults over the past year, it is expected that the use of these services will only continue to grow. References 1 Preslaski CR, Lat I, Maclaren R, et al.Pharmacist contributions as members of the multidisciplinary ICU team.Chest 2013;144:1687-95. 2 Tan EC, Stewart K, Elliott RA, et al.Pharmacist services provided in general practice clinics: A systematic review and meta-analysis.Res Social Adm Pharm2013. (epub ahead of print) pii: S1551-7411(13)00179-4. 3 Cappelletty D, Jacobs D. Evaluating the impact of a pharmacistâ€™s absence from an antimicrobial stewardship team. Am J Health-Syst Pharm2013;70:1065-9. 4 Williams C. Clinical pharmacy consult services FY12 â€“ FY13. Personal communication;October 28, 2013.
UMMC Falls Prevention Program – A Review of the Past and a Look into the Future Luizalice Lima, MS, BSN, RN-BC, Professional Development Coordinator Clinical Practice & Professional Development, Falls Committee Facilitator
The University of Maryland Medical Center continues to be fully committed to improving patient safety, particularly as it pertains to reducing falls. During the fiscal year 2013, there were 321 falls with 83 injuries.1 Preventing patient falls is challenging for every unit. Many organization-wide and unit-based initiatives have been implemented during the past year to reduce the incidence of falls. In October 2012, the fall prevention program (“falls bundle”) was launched hospital wide adopting the best practices developed by the Vascular Progressive Care Unit-C5E. Its objectives were standardization of fall prevention approach, enhancement of knowledge related to contributing factors and prevention measures, nurturing of a sense of pride and ownership in falls prevention, and achievement of excellence in patient satisfaction scores for staff responsiveness to call lights. The program achieved most of these objectives; however, call light response time and ownership in falls prevention are still the focus of our attention and efforts. During the last fiscal year, the Falls Committee deployed many initiatives. The focus was to provide real time data to unit leadership and fall champions so that immediate action could occur. This data provided valuable insight into the circumstances of each fall, identification of prevention interventions in place (or not) before a fall, as well as monthly fall rates. In addition, members of the committee performed monthly audits on different items, such as the last time hourly caring rounds were performed, use of bed/chair alarms, patient/family education about falls, use of non-skid socks, and the use of yellow bracelets on high and critical risk patients. It is clear that improvements in patient/family education about falls and the use of appropriate alarms is needed. The committee created the quarterly flyer, “Facts about UMMC Falls Events." The flyer included NDNQI quarterly fall rates, examined trends based on post-fall huddles forms received, and recommended actions. In July 2013, the Office of Clinical Practice and Professional Development started to provide a monthly report based on RL Solutions to leadership and champions with unit-specific data in the form of graphs and tables. Additionally, the Falls Committee submitted a weekly analysis of all falls with recommendations for staff education and practice changes to managers and champions.
Call Don’t Fall
Following up on the most recent recommendations from The Joint Commission mock survey conducted in May of 2013, the committee started reviewing the falls policy2 and the Morse electronic form. The committee performed an extensive review of the literature to obtain best practices to support changes. These changes are (refer to policy for full content): 1. Update of the NDNQI 2013 fall definitions: assisted fall, unassisted fall, physiological fall, suspected intentional fall, baby/child drop, developmental fall, and fall during play. 2. Nurses, independently of unit location and patient population, will document appropriate fall prevention interventions on the electronic medical record (Morse electronic form). 3. Further clarification of the meaning of the Morse tool subscales was included to foster standard interpretation and greater inter-rater reliability. 4. Simplification of risk levels from three levels (standard, high, and critical) to two levels (standard and high). 5. Manipulation of the Morse scoring system to adapt levels to specific high-risk populations3. Patients in ICUs, the Adult ED, procedural areas performing moderate sedation or anesthesia, and behavioral health units will always obtain a high-risk score. See example screen shots at right from EMR. 6. Addition of interventions to standard and high-risk precautions. 7. Development of an ambulatory services and pediatric fall assessment policy on attachments A & B respectively. In the future, the Falls Committee plans on concentrating on the best prevention interventions and modes of available technologies corresponding to the patient’s fall risk score and condition (gait, mental status, etc.). As identified by data analysis, staff is very conservative in implementing interventions. Other areas of concentrated efforts by the committee are the engagement of patients and families in fall prevention and improving the utilization of current resources, such as the Intranet fall prevention handouts (in English and Spanish), and the fall prevention video on the on-demand system titled as “Your Care – Speak Up”4. continued on page 9.
news &views Falls Prevention Program, continued from page 8. Staff ownership in fall prevention is crucial to the success of any initiative. The key to improving patient safety and fall rates is â€œbuy inâ€? and focused efforts in combining assessment and identification of the most effective interventions using critical thinking skills. As a Magnet organization, nursing staff must take an active part on improving this nursing sensitive indicator and providing a safe environment to all our patients. If your unit does not have a fall champion and you would like to know more about it, please contact Kate Keefer at email@example.com or Jennifer Motley at firstname.lastname@example.org. A link for the UMMC Fall Prevention Program information is located on the UMM intranet Nursing page at the following address: http://intra.umm.edu/ummc/nursing/falls-prevention-program.htm. Source: UMMC FY13 NDNQI Report. http://intra.umm.edu/ummc/policies/hospital/cop-006.pdf 3 Morse Janice M. Preventing Patient Falls. Sage, CA, 1996. 4 http://intra.umm.edu/ummc/patient_ed/docs/on-demand-pat-ed-video-guide.pdf 1
Survival of Bacterial Pathogens on Paper and Bacterial Retrieval from Paper to Hands Anne Johnston, BSN, RN, CCRN, SCN II
Anne Johnston, BSN, RN, CCRN, SCN II from Interventional Radiology (Gudelsky 2 West), hosted the November Journal Club meeting to review the article “Survival of Bacterial Pathogens on Paper and Bacterial Retrieval from Paper to Hands: Preliminary Results” (Hubner et al., 2011). The purpose of this study was to investigate how long bacterial pathogens can survive on regular office paper and to quantify the proportion of pathogens transferred from hand to paper and back to another hand.
Although the University of Maryland Medical Center utilizes electronic charting and record keeping, paper is still widely used in the hospital setting. Bedside flow sheets, procedure consent forms, and progress notes are just a few examples of paper charting completed by clinical staff each day. Disinfection of paper, unlike other medical equipment, is impractical due to “its porous surface and incompatibility with liquid disinfectants” (Hubner et al., 2011, p. 30).
While there have been many studies done on the transmissibility of pathogens from hands to money and other inanimate surfaces, those examining the survival of pathogens on regular commonly used office paper are scarce. Based on the findings of the study presented in this article, the findings indicate that paper may be a vehicle for cross-contamination and the spread of infection. Study Findings This was a two-step experimental study of bacterial survivability and transmission under laboratory conditions. The investigators simulated a “worst-case scenario” by using a highly concentrated bacterial solution, moist conditions to optimize transmission, and practicing hand hygiene techniques without soap. In the first step, four strains of organisms were tested to see how long they could survive on paper. For each strain, 18 steam sterilized paper swatches were inoculated, using established standard techniques for preparation and storage, with 0.25 ml of bacterial test suspension and grown on agar plates. Samples were tested three times for bacterial growth at specific intervals. In the second step, one set of volunteers washed their hands without soap and had their fingertips inoculated with a test suspension of noninfectious strain of E. coli, which were then allowed to air-dry. These volunteers pressed their inoculated fingertips onto sterilized paper swatches. A second group of volunteers, whose hands were moistened with 0.9% saline to simulate the habit of licking a finger before turning a page of paper, pressed their fingertips onto the contaminated paper swatches. Their fingertips were then cultured. This procedure was repeated six times, and the transmission of the test organisms was detected in all six experiments. The experiments revealed that there were differences in the survival rates of bacteria over time. For part one of the study, all four strains survived on the inoculated paper and were stable for 24 hours and cultivable for up to seven days. In part two of the studies, sufficient quantities of bacteria to cause infection or disease were transferred from one volunteer’s finger to the next volunteer’s finger. The results of this study indicate that paper can serve as a vehicle
for cross-contamination in medical settings. The investigators demonstrated that bacteria not only survive on paper, but also can be transferred from person to person if the paper is contaminated. Study Limitations One limitation of this study was that in order to assess whether paper can promote crossinfection, a “worst-case” scenario was created to test transmission of bacterial pathogens. This is not representative of current hospital conditions. Much effort is expended to ensure proper hand hygiene occurs in clinical settings, and it is very unlikely that health care professionals would wash their hands without using soap or an alcohol-based solution. Another limitation to be considered is that only one type of paper (uncoated) was used in the experiment. Uncoated paper binds most of the bacteria by absorption and adsorption, thus reducing the transfer of bacteria. Coated paper (used in printed materials) absorbs and adsorbs fewer bacteria, which might imply a higher rate of transmission. Both coated and uncoated types of paper may be present in clinical settings. The rate of pathogen transmissibility should be examined on both types of paper to more accurately represent the potential risks of paper contamination. Due to these limitations, further research needs to be conducted to examine the transfer of bacterial pathogens using realistic conditions in which standard hand hygiene practices are performed. In the meantime, it is recommended that hands be washed using soap and water or alcoholbased solutions after handling paper in a clinical setting as is done before and after entering a patient’s room. Group Discussion ◗◗ The group agreed that the article was relevant and timely, as paper is handled by many individuals in the hospital setting. Some papers (consents and flow sheets) are carried into isolation rooms by caregivers potentially serving as a vehicle for cross-contamination of bacteria. Patients also bring in paper items from their homes that are touched by hospital personnel, which can pose another risk for contamination. continued on page 11.
news &views “Hey Respiratory”, continued from page 6. At UMMC a detailed set of ventilator management protocols and treatment algorithms have been developed to support the various new ventilator modes and approaches to pulmonary hygiene. These pathways provide the respiratory therapist with the tools to systematically advance ventilation settings and alter care to best meet patient needs. The pathways promote critical thinking and support autonomous and collaborative practice which is highly desired by seasoned RTs with strong assessment skills.
With the ventilator pathways, we have given the therapists “the tools to make appropriate changes as needed to facilitate weaning from the ventilator. I am very proud of the difference we have been able to make with the Spinal Cord Injury (SCI) patients using the SCI treatment pathway. We are looking forward to publishing our success with decreasing respiratory complications to allow early liberation from mechanical ventilation. Maria Madden, BS, RRT-ACCS Trauma Supervisor Respiratory Care Services
Over the past two years, cutting edge technology has provided the respiratory therapy team with a unique opportunity to work with physician leaders in caring for some of the most complex patient cases in trauma. Though many trauma patients recover from the time spent on a mechanical ventilator, there are those whose spine injury has left them with little or no ability to manage involuntary actions of the diaphragm and accessory muscles. A spinal cord injury at the C2 or above level will leave patients with complete paralysis and little hope for the return of spontaneous ventilation, requiring a lifetime of mechanical ventilation. What now is referred to as “DPS” in the healthcare community is a revolutionary opportunity for this group of spinal cord injury patients. DPS or the “Diaphragmatic Pacing System” consists of several implanted wires that, in conjunction with a diaphragm pacer, stimulate the diaphragm in a way similar to the absent brain stem signal that is usually delivered by the phrenic nerve.
The role of the respiratory therapist in this revolutionary therapy begins in the operating room where the appropriate initial settings are determined and programmed into the patient’s external pacer. Once recovery has begun in critical care, an aggressive combination of secretion clearance modalities and weaning trials help to determine the patient’s ability to sustain ventilation and to identify minor adjustments to pacer settings that maximize the diaphragm’s stimulus.
The use of the DPS system has really revolutionized the way “patients with high cervical spinal cord injury are managed. It provides the opportunity for patients who previously would have been ventilator-dependent for the rest of their life to be liberated from mechanical ventilation for some or all of the day and night and markedly improves quality of life. Our Respiratory Therapy Department has done a truly remarkable job of developing a unique expertise in caring for this patient population. The collaborative effort between the physicians, nurses, and therapists to care for these patients has resulted in tremendous patient satisfaction, as well as some remarkable outcomes. Deborah Stein, MD, Associate Professor of Surgery, Medical Director of Neuro Trauma Critical Care and Chief of Trauma
In the next edition of News and Views, work focused on therapist to patient ratios in the Cardiac Surgery and Medical ICUs will be highlighted. The ratios have significantly increased efficiency, promoted interdisciplinary collaboration, and reduced costs through aggressive patient screening and treatment selection.
continued from page 10.
◗◗ There was discussion on the presence of bacteria on surfaces that are not readily visible to health care workers, including the undersides of bedside tables and bedrails. The group discussed the importance of cleaning these surfaces and the important role of Environmental Services in the cleaning process to prevent cross-contamination. ◗◗ General cleanliness at the Medical Center was discussed. Patient satisfaction survey results indicate that patients are dissatisfied with the cleanliness of
their rooms. The group is aware of the challenges nurses face with ensuring room cleanliness. Members of the group emphasized the important role that the Environmental Services staff plays in providing a clean and safe environment. They are a partner in patient care and need to be acknowledged for their important work. Nursing continues to work on solutions with Environmental Services to improve these processes; to not only improve patient satisfaction but overall patient outcomes.
The group agreed that this important topic deserves further examination. They recommend that an evidence-based practice project be conducted and this topic be presented at Nursing Grand Rounds at UMMC. Reference Hubner, N., Hubner, C., Kramer, A., Assadian, O. (2011). Survival of bacterial pathogens on paper and bacterial retrieval from paper to hands: Preliminary results. American Journal of Nursing, 111(12), 30-34.
Magnet Conference 2013: “The Magic of Magnet” Carolyn Guinn, MSN, RN, Magnet Program Director, Department of Clinical Practice and Professional Development
In October 2013, I had the privilege, along with many other Medical Center nurses, of attending the 2013 American Nurses Credentialing Center’s (ANCC) Magnet Conference in Orlando, Florida. The conference theme this year was “The Magic of Magnet,” and magical it was! With more than 7,000 nurses in attendance from all over the world, Orlando provided the perfect setting to bring the magic of Magnet to life. The conference supports an atmosphere of sharing and camaraderie with an energy that is palpable. With 135 concurrent sessions and just as many poster presentations, Magnet hospitals are allowed to share how they are improving patient care and creating positive work environments. The attendees from Magnet hospitals are proud of their accomplishments and are willing to share with everyone in attendance. From the podium and poster presenters to the keynote speakers, the passion and energy never abated. Keynote speaker Barry Posner, PhD, inspired us to find the “magic” in taking the leadership challenge. Maggie McClure, EdD, RN, FAAN, shared her involvement as one of the pioneers who built the Magnet program that started over 30 years ago. Absolutely amazing—what commitment from Dr. McClure and her colleagues who paved the way for our profession! Dr. McClure shared the impact of the Magnet program to include the empowerment of nurses, professionalism in practice (evidence-based practice), increased advanced degrees and certifications and innovation. Dr. McClure was one of the five recipients of the Magnet Nurse of the Year Award this year, which was well-deserved. Being new to my role since July 2013, I was very excited to be attending and representing the University of Maryland Medical Center (UMMC). Over the years, I have attended many Magnet conferences, which are always energizing, educational, and rejuvenating, but I was looking forward to this experience even more than usual. This excitement was sparked because of the opportunity to further build relationships with all of my new colleagues at UMMC. Of course, my expectations were high, but the conference exceeded them. I was able to expand the current relationships with those in official leadership roles, plus foster brand-new relationships with many direct care staff nurses who were in attendance. It was exciting to be in the audience supporting our own Kristin Seidl, PhD, RN, Director of Quality and Safety, and Meg Johantgen, PhD, RN, University of Maryland School of Nursing, during their podium presentation, “Using Statistical Process Control for Outcomes Measurement and Evaluation.” Together, these ladies “wowed” a packed room of very intrigued nurses interested in using this process to evaluate outcomes relevant to our Magnet journey in the future. It was also exciting to see Cindy Dove, MS, RN, Manager of SICU/PSCU, and Meredith Huffines, MSN, RN, SCN II, SICU, presenting their poster, “Transformational Leadership: An Interdisciplinary Approach to Mortality and Morbidity Meetings.” Many nurses were very interested in this work done in the SICU to improve communication among the health care team members to impact patient care outcomes. Our presenters did a fabulous job and should be very proud of representing UMMC in fine fashion. What an excellent and magical time we had in Orlando. It was a great learning experience for all. Please read on to learn about the experiences of those who attended the conference. As a program director, the reflections of the attendees affirm the conference impact and professional growth this opportunity provides. continued on page 13.
Poster Presentation Cindy Dove, MS, RN, Manager of SICU/PSCU, and Meredith Huffines, MSN, RN, SCN II, SICU
Podium Presentation Kristin Seidl, PhD, RN, Director of Quality and Safety, UMMC, and Meg Johantgen, PhD, RN, University of Maryland School of Nursing
news &views 2013 Magnet Conference Attendee Reflections, continued from page 12. Reflections from:
Abby Keller, BSN, RN, CNII Labor and Delivery
Initially, I will admit, I was a little apprehensive when my nurse manager suggested that I attend the annual Magnet conference. To be honest, I was not up to date with what it really means to be a Magnet organization; therefore, I was feeling unprepared. I quickly learned that Magnet designation is an amazing honor for hardworking hospitals and their nurses, in institutions small and large, community and teaching alike. During the conference, I became increasingly excited about UMMC’s Magnet journey and proud to be a nurse from a Magnet designated hospital. It was very heartwarming to see the excitement of other nurses who had been recently designated at their individual institutions and, quite frankly, I wanted to be in their shoes. After attending multiple seminars, I gained ideas that I could share with my unit colleagues and manager to aid in our continued (hopefully) obstacle-free journey. Overall, the conference was one that I will never forget. I do believe it would have been slightly more beneficial to me if there had been more topics relating to my area of expertise; however, I understand now that Magnet is a nurse’s journey not an individual unit’s journey. I understand that as a cohesive nursing unit we must apply the general Magnet attitudes and standards, join as a family, and make the journey to Magnet re-designation together. I am ready to help champion my unit toward our goal, and I am proud to have a step above the rest after attending the ANCC Magnet conference.
Chanelle Lake, RN, OCN, CNII Oncology Unit
The American Nurses Credentialing Center’s (ANCC) Magnet Conference was a tremendously valuable experience for me. All of the seminars held throughout the conference were well-rounded and extremely helpful to me in my current professional role. According to the ANCC, the Magnet Recognition Program recognizes health care organizations for quality patient care, nursing excellence, and innovations in professional nursing practice. Consumers rely on Magnet designation as the ultimate credential for high-quality nursing. Developed by the ANCC, Magnet is the leading source of successful nursing practices and strategies worldwide. Magnet status for a facility means that the nurses they employ not only enjoy their jobs, but also provide excellent care. I attended several courses. I particularly appreciated “Live, Laugh, Lead! Creating a World-Class Culture,” but I believe that UMMC already possesses a world-class culture. Other seminars that I attended included, “Innovative Leadership: Model to Achieve Strategic Outcomes Related to Operations, Performance and Clinical Practice,” “Against All Odds: Building a Model of Care Delivery into
the Electronic Health Record,” “Translating Research into Practice: An Innovative Process to Engage and Disseminate Research at the Bedside,” “Clinical Peer Review: Would Your Peers have Acted Similarly in the Same Situation?” and “Is Your Professional Development Model Enough? The Evolution of a Novice-to-Expert Model.” I went to Orlando not knowing any of my nursing colleagues because we were all from different departments. I was nervous at first, but after just one group meeting of all UMMC staff, I realized that I was among friends. My roommate, Sheila Lee, was awesome. She is an experienced nurse in an outpatient clinic that I had never heard of before the conference. I think it is amazing that my hospital is so big and I don’t know all the departments; yet, I have been working at UMMC for over three years. My roommate had attended other conferences, including Magnet conferences, and she showed me the ropes. She even helped me think through the process of planning a project for my unit. Sheila has completed several projects, and I could not have wished for a better roommate. She is a true inspiration and I value her experience tremendously. As for my other coworkers/new friends, they are great too. We all went out to dinner one night and had a blast. One of the most wonderful things about the conference was that everyone knew and respected the University of Maryland Medical Center. Whenever another nurse or vendor would see my badge, they would say that they know it is an excellent place to work, and some of them were almost envious. While I enjoyed all of the seminars, I really believe that my facility already incorporates and utilizes many of the things I learned about during the conference. In other words, one of the highlights of attending the conference was learning about the principles and quality of care standards of the Magnet program that we already utilize at UMMC, confirming our Magnet status.
Ariel Q. de Vera, BSN, RN, CCRN Senior Clinical Nurse II University of Maryland eCare (Tele-ICU)
The recent Magnet Conference in Orlando made me realize how supportive our institution is to the nurses and other bedside clinicians. It made me appreciate the liberty that the organization provided for us to freely shape our evolving roles in health care through structured nursing committees and shared governance councils. This also provided opportunity for me to further develop my management and leadership skills not only as a Senior Clinical Nurse in my former local unit, the MICU, but also as chair of my hospital-wide committee, the Clinical Information Council. As I took a different direction with my career path when transitioning to eCare, I brought with me the ideals and principles that are basically aligned with what Magnet stands for – empowering nurses to partake actively in their own practice. In eCare, we have nursing staff who are very involved in identifying and delineating our own practice in distinct environment. Inspired by what we do, we are preparing to submit an abstract for the next Magnet conference focusing on shared governance in Tele-ICU practice. continued on page 14.
2013 Magnet Conference Attendee Reflections, continued from page 13. Reflections from:
Cindy Dove, MS, RN, Nurse Manager Surgical Intensive Care, Surgical Intermediate Care, Surgical Progressive Care
After submitting several abstracts, I was thrilled to finally have one accepted for poster presentation at the 2013 ANCC Magnet Conference. This brought a whole new meaning and excitement to the trip to Florida for the conference. This would be my third time attending, and I felt very honored to be attending yet again, and even more so to be presenting this time. My first experience at the Magnet conference was during a transition in our Magnet journey. I was overwhelmed with excitement with all that I had learned and at the opportunities we had back at the Medical Center. This excitement drove me to become very involved in our original quest for Magnet designation. The second time I attended the conference was the year we celebrated our designation. This experience will always stay with me as it was a time when I felt most excited, engaged, and proud of my profession, and even more so, of nursing at UMMC. As I reflect on my third and most recent experience, I once again feel a source of pride. I truly enjoyed presenting my poster and teaching others about the great things we do at UMMC. I felt so proud to tell “our story” to anyone that would listen. Nurses were so impressed by our poster and asked great questions. It was also a great opportunity to network and learn from others. Additionally, I felt proud as most of the sessions I attended presented on ideals and topics that we were already doing or had in the works at UMMC. As I discussed this with my colleagues who attended, many felt the same way. I thought, “We are so MAGNET.” I did want to share some of the items I took away from two of the sessions I enjoyed most at the conference. Session: Transformation Leadership Strategies for Increased Employee Satisfaction
• Dashboard of Unit Base NSQI so staff can be more engaged in outcomes and action planning. • Day in the life of a leader: Having staff share time with manager so they can appreciate and understand the work managers do. • Having a unit based or hospital wide “concierge” service to meet employee needs and questions. • Importance of increasing leadership rounds. • Town Hall meetings. • Acknowledging staff with weekly hand written thank you notes. Session: NP Partnership (with the implementation of the new NP model in the SICU, I found this session to be informative.)
• NPs can have huge impacts on patient satisfaction, staff satisfaction, and readmission rates. • NPs and unit leaders need to partner to improve these outcomes. • Unit manager and NP partnership is key and is important to align goals, outcomes, PI, and safety.
Sheila Lee, BSN, RN, ACRN, SCNI and Chanelle Lake, RN, OCN, CNII
Meredith Huffines, MS, BSN, RN Senior Clinical Nurse II Surgical Intensive Care Unit
I always enjoy going to nursing conferences for the opportunity to learn new ideas that I can bring back to UMMC. It always validates, too, that I am working at an organization that is, indeed, cutting edge. Many of the sessions that I attended at the ANCC Magnet Conference® proved to me again that UMMC is top notch in that we were already doing the best practices that the presenters were describing. The presentations at the conference once again corroborated that the leadership at UMMC supports innovative ideas and processes for providing patient care. I was proud that our nurses are on the front line in creating and implementing best practices. One of the sessions that I attended was a program called “I’m 4 Safety,” that was implemented in a hospital. There were four model behaviors demonstrated in this program: practice with a questioning attitude, communicate clearly, focus on the task, and support each other. What I found unique about this particular program was that nurses volunteered to become safety coaches. Each nurse attended thorough training on how to become a safety coach which involved education on both patient and staff safety. The training included infection control education, as well as safety in terms of the environment, and staff safety, such as proper lifting techniques. The coaches rounded on various clinical and non-clinical units and provided feedback and reinforcement on various safety behaviors they observed. They felt empowered to hold others accountable to the safety standards that were set forth by the organization. Safety coaches acted as a “portal of communication from the bedside to administration and education departments." The SICU has many different champions on the unit (i.e. hand hygiene, CLABSI, CAUTI champions which are effective), but I liked the idea of having nurses on the unit educated on all different aspects of safety to ensure a safe environment for patients, families, and staff. I also found it very fulfilling to present a poster with Cindy Dove, titled “Transformational Leadership: An Inter-professional Approach to Morbidity and Mortality Meetings,” to the many Magnet attendees. Knowing that we were educating others on our poster topic and possibly impacting another organization was inspiring. continued on page 15.
news &views 2013 Magnet Conference Attendee Reflections, continued from page 14. The ANCC National Magnet Conference 2013 ended up being an enlightening experience for me. The conference itself was very informative about the future of medicine, nursing practice, and health care nationally, as well as internationally. Jeff Broski, BSN, RN, CCRN, SCNI Overall, the conference gave me new insight about the University of Maryland Medical Multi-Trauma Critical Care Center (UMMC). Listening to some of the concurrent sessions showed me how the Medical Center really is advanced. I walked away from the conference knowing and understanding how we have grown as an institution. The advancement of nursing practice, excellent nursing care, and research is one of the main contributing factors for the success of a medical system. The concurrent sessions that I attended reinforced how important nursing is for the future of health care. It also reinforced that UMMC is far more advanced than many of the hospital systems that are already Magnet-designated or on the journey to designation. One of the concurrent sessions that interested me most was the innovation of electronic care, or telepresence. The main focus was having a smooth transaction and communication between hospitals to decrease readmissions to the primary health center. Telepresence improved communication between acute care facilities and skilled nursing facilities for better patient centered care. The objective of this type of care is to decrease readmissions through open communication, continuation of care, and preventive medicine on a real-time basis. UMMC started an electronic health care system which coordinates patient care between hospitals on an ICU level. This collaboration between hospitals helps to prevent an ICU patient needing to be transferred to an advanced facility like UMMC. Skilled ICU nurses oversee patient care in real time, resulting in better patient care. The advancement of trauma medicine and care has come a long way. Trauma medicine usually is time-sensitive (the golden hour) care. Implementing electronic care in trauma medicine could facilitate care “in the field,” which could improve patient survival. Having an open communication channel with the EMS provider via voice, camera, and real time vital sign information could give an edge to the facility that will receive the patient. In medicine, it is always important to “paint the picture” for the next person who will take care of the patient. Real-time electronic care will do that. Nurses and physicians could direct patient care in the field and better prepare for the arriving patient.
As a first-time attendee of the ANCC National Magnet Conference I was not quite sure of what to expect when I was invited by my director, David Hunt. I had been aware Lesli Bennett, MSN, MBA, RN of the importance of Magnet designation for our institution; however, it wasn’t until I Nurse Manager experienced “The Magic of Magnet” and attended the conference to see first hand the In-patient Cardiology Magnet concepts being applied throughout the nursing community that it solidified my personal commitment to the Magnet goals. From my personal perspective, the day-today journey toward excellence in the nursing care provided here at UMMC is one not to be taken for granted. In preparation for the conference, I chose to attend several concurrent sessions that related to topics of interest or benefit for the in-patient Cardiology nursing units, as well as those that would complement my transformational leadership experience. I attended a “Live, Laugh and Lead” session which focused on the development of a culture rather than a focus only on strategy when building teams. Another session focused on the association between positive leadership practices, increased patient satisfaction, and reducing adverse outcomes. These were topics that I immediately related to and have several new ideas to implement on my units. The Welcome Party at Disney’s Hollywood Studios was a great way to keep the UMMC group together for the evening, which provided me the opportunity to meet UMMC leaders from all different areas of the hospital. From my perspective, Wednesday, October 2nd was the best day of the conference. Again, as a first-time attendee, the excitement and energy of the “Awards and 2013 Magnet Prize Winners General Session” was palpable in the large auditorium. I found myself so excited for those hospitals gaining Magnet designation. I celebrated with them what it truly means to be proud of the impact that nursing has on healthcare and the nursing excellence influence that Magnet designation has on everyone employed in those organizations. I could only imagine how exciting it would be when UMMC is announced at the award session! The additional sessions that I attended included; “Reinventing Shared Leadership,” “The Journey of Restructuring a Shared Governance Model,” “Collaborative Care for Patients with Heart Failure,” “Becoming a Transformational Leader,” and “Transforming Nursing Practice.” All presenters gave their first hand accounts of moving their teams or leadership to new levels and implementing the Magnet forces to strive for nursing excellence. The one that stood out the most for me was the seminar titled, “Helplessness, Hopelessness, Unconsciousness and the Death of Compassion.” Understanding compassion fatigue and how this differs from “burn out” hit home for me as I manage many nurses who feel that they may be reaching “burn out.” It was with compassion and a true understanding of the nurse’s experience that Noel Holdsworth introduced the idea that a nurse is “not always being responsible for fixing it but to be responsible for caring” which can be an antidote for feelings of helpless and hopelessness, again something that many nurses experience. I could relate to Noel’s approach and how important it is for me as a leader to discuss with my teams the importance of ventilation, validation, and education. The discussion also included the topic of self-care and the importance of self-awareness. I plan to explore this topic with my CCU team in the near future. During our last evening together, the UMMC team went out for dinner, providing us with a chance to meet and socialize with each other and learn about new perspectives amongst our UMMC peers. It was a great event and one that expressed the value that the UMMC PCS Leadership Team had in their identified attendees. I greatly appreciated this gesture of support. Now armed with new ideas and approaches from the speakers at the general sessions, in addition to the seminars of the 2013 ANCC National Magnet Conference, I feel empowered to continue to reach for new opportunities for my teams and myself. Thank you for offering me this opportunity to fully realize the impact of “The Magic of Magnet.” continued on page 16.
2013 Magnet Conference Attendee Reflections, continued from page 15. Elements of Transformational Leadership
2013 Magnet attendees
Sharon Lesser, RN, SCNI Pulmonary Procedures Pulmonary & Critical Care Medicine
The following describes the “Pearls of Magnetism” that I gained at the conference and will share with my colleagues and possibly implement: • Magnet is the gold standard for nursing excellence and is associated with improving quality patient outcomes. • Magnet hospitals must meet stringent quantitative and qualitative standards that define the highest quality of nursing practice and patient care. In today’s health care world, patients are more educated and are seeking objective benchmarks that will aid them in choosing a health care provider. Magnet-designated hospitals provide patients and their families with a benchmark by which to measure the quality of care they can expect to receive. Magnet recognition can help patients identify hospitals where they can expect to find satisfied nurses and expect to receive a higher level of care. • Magnet designation means that a “Magnet culture” has been created within the organization. This environment encourages the nurse to flourish as a professional, focuses on professional autonomy and decision-making at the bedside and within the work environment provides professional education and promotes leadership. It means that collaborative working relationships are fostered. Teamwork and positive relationships among different departments and disciplines are demonstrated. • The true spirit of a Magnet organization stems from commendable professional practice within nursing. This entails an all-inclusive understanding of the role of nursing and the purpose of that role with patients, families, communities, and the interdisciplinary team, and the application of new knowledge and evidence. The goal is the establishment of a strong professional practice. • Transformational leadership is one of the Magnet model components. The standards of this component must be met in order to achieve designation. • Transformational leadership enhances the motivation, morale, and performance of followers through a variety of mechanisms. This includes the leader connecting the follower’s sense of identity and self to the project and the collective identity of the organization. A transformational leader must inspire others to be interested in bringing about change and challenges followers to take greater ownership of their practice/work. To be an effective role model, these leaders must understand the strengths and weaknesses of those they are leading, in order to assign duties and tasks to enhance their performance.
1. Individualized Consideration – The degree to which the leader attends to each follower’s needs, acts as a mentor or coach to the follower and listens to the follower’s concerns and needs. The leader gives empathy and support, keeps communication open and places challenges before the followers. 2. Intellectual Stimulation – The degree to which the leader challenges assumptions, takes risks and solicits followers’ ideas. Leaders with this style stimulate and encourage creativity in their followers. They nurture and develop people who think independently. The followers ask questions, think deeply about things and figure out better ways to execute their tasks. 3. Inspirational Motivation – The degree to which the leader articulates a vision that is appealing and inspiring to followers. Leaders with inspirational motivation challenge followers with high standards, communicate optimism about future goals, and provide meaning for the task at hand. Followers need to have a strong sense of purpose if they are to be motivated to act. Purpose and meaning provide the energy that drives a group forward. 4. Idealized Influence – Provides a role model for high ethical behavior, instills pride, gains respect and trust. Possible Plan for Implementation
1. Continue to build and foster teamwork within my area. 2. Maintain positive relationships within my department, other departments and disciplines. 3. Continue to focus on my own professional autonomy as well as enhancing others. 4. Continue to work on and build my portfolio. 5. Continue to maintain a strong professional practice model. 6. Become a transformational leader within the organization.
Tia L. Milburn, BA Project Specialist Clinical Practice & Professional Development
The ANCC National Magnet Conference was full of nursing professionals from all around the world who were eager and excited to learn about ways to further their profession and their organizations. I attended sessions where nurses provided examples of best practices and innovations that contributed to their own professional practice and to positive patient outcomes. I had an opportunity to cheer on our own Kristin Seidl, PhD, RN, during her presentation, in which she did a phenomenal job. I had the opportunity to meet briefly with the ANCC accreditation program director and was able to receive excellent pointers on the development of applications for continuing education credits. Overall, I am glad that I was able to learn new things, meet people, and begin great relationships. I realized that the University of Maryland Medical Center is truly a cut above all of the rest. I believe that we have nursing leaders and staff who could present UMMC’s cutting-edge programs, practices, and research to nurses around the world who would appreciate and benefit from our work. continued on page 17.
news &views 2013 Magnet Conference Attendee Reflections, continued from page 16. The ANCC Magnet Conference 2013 engaged 7,000 nurses from various hospitals and organizations throughout the country and around the world. The conference Sheila Lee, BSN, RN, ACRN, SCNI concurrent sessions were very informative and presented the most current information Evelyn Jordan Center for professional nursing practice. The conference promoted an environment for Infectious Disease and Ambulatory Dept. professional networking, and colleagues were able to share innovations in patient care. I plan to integrate information that I learned into my clinical area, such as nursing leadership information, QI Projects, EBP research, insurance and reimbursements, care coordination models, and education and career advancement. I had a wonderful Magnet conference experience and I can summarize it in one word, “MAGNIFICENT.”
M A G N I F I C E N T
Magnet Nurse of the Year Award recipient Dr. Maggie McClure spoke about the history of early Magnet and the evolution/transformation to the current Magnet program. Award-winning co-author of The Leadership Challenge, Dr. Barry Posner presented the opening general session. Global health nursing strategies to ensure nursing excellence worldwide (concurrent session). Nursing leadership (concurrent sessions). Innovative quality improvement projects and poster presentations. Falls-prevention strategies and tools to prevent falls (concurrent session). Integrating Performance Improvement with Publicly Reported Quality Metrics, Value-Based Purchasing Incentives, and ISO 9001/9004 (concurrent session) Creativity and compassionate care that is expressed in the Magnet art gallery exhibits. Exhibit hall health care vendors, innovative products, and services. New Concepts of Inpatient Care: Acuity-Adaptable Patient Room Promotes a Healing Environment (concurrent session). Tele-presence technology used in preventing avoidable readmissions for patients discharged to skilled nursing facilities. It allows communication between care settings to occur flawlessly resulting in better patient centered care (concurrent session).
Attending the Magnet Conference is an enriching experience to me, educationally and professionally. I am honored each time I am selected to attend. The initial kick-off of the conference is energizing and establishes the tone for the Gisele S. Stevenson, MS, RN entire conference, to include general sessions and keynote speakers, the designation Manager of Patient Placement Center of Magnet hospitals and awards celebration, and concurrent and poster presentations. Concurrent sessions provide the opportunity to attend sessions that will provide knowledge enhancement and insight from other health care organizations. I utilize information from the sessions to grow as a leader in my current role and bring about change to enhance structures, processes, and outcomes across all of UMMC. Some of the topics I attended and that were beneficial for my role and UMMC include: • A new Concept of Inpatient Care: Acuity-Adaptable Patient Room Promotes a Healing Environment; • Innovative Leadership Model to Achieve Strategic Outcomes Related to Operations, Performance, and Clinical Practice; • Developing a Community Care Team to Reduce Emergency Department Readmissions: Structure, Process, Outcomes; • Building a Business Case for Quality and Safety in Practice: Moving From Assessment to Application; • How to Structure a Large Magnet Organization to Achieve an Exceptional Patient Experience; • Our Expedition Everest: Conquering the Staffing and Scheduling Yeti; • Show Me the Money!; • Disaster Preparedness: Nurses Partnering With the Community to Influence Policy and Response; and, • Risk Adjusted Staffing to Improve Patient Value and Financial Performance.
There is an air of camaraderie that exists at this conference and can be experienced through the interactions with not only other professional nurses from UMMC, but with nurses who come from all over the country and world to attend. During the new and re-designation celebration of Magnet hospitals, the audience became energized while honoring the accomplishments of these organizations and understanding the journey to achieving this status. Education is also provided through the vendor exhibits. The vendors that participate in the conference display the latest innovations that one can review and share with their organizations post conference. As an attendee, the “welcome party” affords me organized time to have further interactions with Magnet colleagues in a festive atmosphere. The closing session then summarizes the conference and establishes the tone for the next year. In summary, I enjoy every Magnet conference that I have been fortunate to attend and always leave the conference energized. The conference was truly the “Magic of Magnet.”
Nursing Care of the Pediatric Surgical Patient By Nancy Tkacz Browne, Laura M. Flanigan, Carmel A. McComiskey, and Pam Pieper 3rd edition. Burlington, MA, Jones and Bartlett Learning
Advancements in knowledge and technology are fast paced and lead to new and more complex surgical procedures. Growth in pediatric surgical subspecialties is exponential. This advanced growth demonstrates the need for educational resources to support this burgeoning field. The book is divided into chapters ranging from the uniqueness and needs of the pediatric surgical patient to the specifics of each subspecialty. The information is derived from the initial sharing of best practices by dedicated pioneer pediatric surgical nurses who had the vision to recognize pediatric surgical nursing as a unique specialty and had the need to share and collaborate to build a knowledge base from which to grow. • Builds on the foundation of nurses’ commitment to best practice in this unique specialty. • A resource for the pediatric surgical nurse, the pediatric surgical subspecialty nurse, and the general pediatric nurse. • Includes diagnosis-specific teaching sheets for reproduction in three languages from the American Pediatric Surgical Nurses Association.
Carmel A. McComiskey, DNP, CRNP, Director, Nurse Practitioners and Physician Assistants
On January 13th 2014 we celebrated the life of Karen Vojtko David G. Hunt, MSN, RN
Daughter of an IBM Computer Engineer and a Social Security Clerk, Karen Patricia Vojtko was born in Baltimore and raised in Catonsville. She attended St. Mark Parochial School for eight years and graduated in 1975 from Catonsville High School. After earning an Associate Degree in Nursing in 1978 from what is now the Catonsville campus of the Community College of Baltimore County, she began her nursing career at Bon Secours Hospital, working in the general intensive care unit. Karen (“KV” to those who knew her well) was a highly respected and well-loved nursing leader in the Division of Cardiology. When she retired, she left a strong legacy of excellence and achievement. Having arrived at UMMC in 1980, Karen worked for many years as a front-line provider in the CCU where she became a Full Partner in 1990 and then a Senior Partner in 1995 and was very active in unit-based education. Karen was a great partner in collaboration; she was admired and trusted by physician colleagues and consistently fostered an inter-professional approach
to patient care. She was always able to smile in spite of challenge and adversity. During her time as a bedside clinician, Karen mentored many newer nurses into Critical Care and considered this one of the highlights of her career. In August 2008, Karen was promoted to Senior Clinical Nurse II and in this role she became exposed to more opportunities to lead and guide teams of nurses in the in-patient units. In 2007, Karen became a member of the Chesapeake Chapter of the American Association of Critical-Care Nurses and served as Chapter treasurer-elect between 2008 and 2010. In March of 2009 Karen was promoted to Nurse Manager for the CCU and PCU. She was outstanding in this role and led both units to unparalleled success with Beacon designation for nursing excellence. She was happiest when “in the units working through issues with the troops” and considered her in-patient teams close friends and family. Karen helped develop a strong and highly capable leadership group of nurses and considered herself blessed to have had this opportunity late in her career.
"Those of us who worked most closely with Karen consider ourselves blessed to have had the opportunity to work with someone with tremendous integrity and an ability to always see the better side of people and challenges." David G. Hunt
news &views Risk Management and Incident Reporting: What Happens to the Information? Julia Sibley, RN, BSN, CPHRM, Claims Manager Maryland Medicine Comprehensive Insurance Program
Do you ever wonder what happens to the information provided for incident reports? Does it disappear into a black hole? Rest assured that absolutely does not happen; in fact, the exact opposite occurs. The information in incident reports is critical to a healthcare organization like University of Maryland Medical System (UMMS). The reports are reviewed by a series of people within the organization, and depending on the incident, an evaluation and investigation occurs at varying levels. This information can have a significant impact when reviewed in aggregate promoting identification of patterns and trends. This is important because more often than not, incidents are not isolated events. It is important that employees complete these reports when an incident occurs, as these reports help us identify the contributing factors that are useful in exposing the root causes of issues that impact patient safety. After a thorough and detailed analysis, we can identify where to focus our resources to prevent and negate unsafe clinical situations. The following are examples of how event reporting had a positive impact on patient safety and clinical practice: Alaris Infusion Pumps: A focused effort was initiated to report every time an infusion pump failed during normal use. The scope and numbers of event reports were staggering which led to the formation of an interprofessional task force to analyze the problem. It was discovered that the method of cleaning the pumps led to malfunctions, and new cleaning and maintenance practices were implemented. Laboratory Specimens: A trend of consistently high numbers of event reports of mislabeled lab specimens occurred. A project was initiated to identify specific causative factors, and new processes for specimen collection were piloted in the three units with the highest incidence of mislabeled specimens. Initial pilot results showed a decline in mislabeled lab specimens. Insulin Administration: A policy requiring an independent double check for the administration of IV insulin was instituted after identifying a trend in administration errors. As a result, the number of errors decreased. PCA Pumps: There was a trend in reports of patients with PCA pumps who sustained a respiratory arrest. A new policy was implemented requiring continuous pulse oximetry monitoring for patients with PCA pumps and screening of surgical patients for obstructive sleep apnea.
Blood Transfusions: There were consistently high numbers of blood transfusion documentation errors reported. A task force was formed to examine the problem, and later developed a more efficient, electronic documentation method to reduce errors. As a result of the team’s analysis, they discovered other issues related to blood product dispensing and administration in event reporting. Patient Falls: The high numbers of unwitnessed falls prompted a system-wide approach to fall reduction and the implementation of fall prevention strategies. The number of unwitnessed falls has decreased after these interventions.
RL Solutions Incident Reporting System
There are situations when it only takes one event report event to identify a patient safety concern that warrants immediate attention. Examples of these events are as follows: ◗◗ An RN confused Ephedrine with Epinephrine. As a result, Ephedrine has now been relabeled, repackaged and relocated far away from Epinephrine during storage. ◗◗ A syringe was reused on a patient. As a result, the pharmacy switched to the use of tamper evident caps to allow the provider to easily distinguish between used and unused syringes. ◗◗ A lab specimen from a UMMS facility was lost at an outpatient location, and it was discovered that specimens were not being tracked when picked up by the courier. In response, a log is now used to track chain of custody for all specimens in and out of the lab. Bar-coding is also being considered. Event reporting is a crucial component of patient safety and loss prevention at UMMS. Thank you for your commitment to improve the safety and quality of patient care which starts with the timely reporting of risk events to the Office of Risk Management. If you would like additional information about incident reporting, please contact the RL Help Desk at 410-328-0643, send an email to email@example.com, or visit www.mmcip.org.
Orientation Tools for Preceptor: Keys to Retention Kristy Gorman, MS, RN, OCN and Donna Huffer, MA, RN, OCN, Clinical Practice and Professional Development
The Joint Commission requires organizations to put into practice a process for initial and ongoing assessment of staff competencies. The previous competency management process at University of Maryland Medical Center (UMMC) was burdensome, difficult to maintain, and more time-consuming than required. Many may “fondly” remember the numerous skills checklists and summary documents. Competency is an intangible construct that is an essential characteristic required to act effectively in a nursing setting (Dunn, 2000; Harding, 2013). Competency is best defined as the application of knowledge, skills, judgment and behaviors to role performance in the clinical environment (Wright, 2005). Skills checklists fall woefully short in measuring competency. All boxes checked on a skills checklist do not ensure clinician competence. The new education model at UMMC addresses the education needs of Registered Nurses (RN) and Unlicensed Assistive Personnel (UAPs) at initial hire and throughout employment. This model includes the Core Orientation Blueprint and valuable, practical companion tools for the preceptor. Unique features of the model include: all expected behaviors are linked to current policy resources, encourage self-directed/self-regulated professional practice and is maintenancefree to unit staff (automatic evidence-based quarterly updates to the online textbook and direct link to UMMC policies). When orienting a new employee, practicing the principles of adult learning is critical to success. Knowles’ Adult Learning theory addresses distinct assumptions about adult learners: need to know, foundation, self-concept, readiness, orientation, and motivation. The new orientation model offers such guidance on the preceptee’s performance assessment and evaluation. Applying Knowles’ Adult Learning Methods to the Orientation Model Assessment Methods Knowles’ Adult Learning Assumptions
Suggested Assessment Method (Blueprint)
Adults need to know why they are learning
Online modules, discussion/ reflection, links to policies
Adults are problem solvers
Adults learn through doing
Adults will learn better if they can immediately use the material they learn
Observation/evidence of daily work, return demonstrations
Orientation Blueprint Details There are four essential abilities (for both core and population criteria) that are required of RNs and UAPs at UMMC: I. Ability to observe/assess, manage and maintain the patient and their environment; II. Ability to effectively communicate; III. Ability to respond effectively in an emergency; and, IV. Ability to adapt to the changing clinical environment. A variety of verification methods are offered for each competency, considering differences in staff learning styles and preferences. RNs and UAPs must competently demonstrate these abilities at the end of orientation and remain current in these abilities. Using the Blueprint There are Core Blueprint versions for both the RN and UAP. The document builds on where care is delivered: Ambulatory, procedure areas, Acute Care, Telemetry, IMC, ICU, and Emergency Department. The blueprint is available on the intranet page “Clinical Education/ Orientation.” (http://intra.umm.edu/ummc/nursing/orientation.htm) Key Features ◗◗ Functions as a “living document” directly hyperlinked to current UMMC policies, procedures, UMMC Intranet and internet references. ◗◗ Includes links to our on-line reference tool (Lippincott) that is updated quarterly. ◗◗ Up-to-date, electronic, consistent and maintenance-free orientation manual. ◗◗ Resources are grouped together to provide a “one stop shop” to various resources related to expected behaviors and skills. ◗◗ Standardizes orientation throughout the organization. ◗◗ Reduces orientation time and re-assessment of validation for staff transferring between units. Population specific Blue Prints (Part B) creation and management are the responsibility of the content experts at the unit/division level. Many areas have completed and are using their Part B blueprints: Adult Emergency Department, Labor & Delivery, Trauma Critical Care, Cancer Center, Trauma IMC, CCU, CS Step Down, Perioperative services, SICU, MIMC, Neurocare ICU, MICU, SIMC, NICU, Ambulatory services, PICU, Vascular Surgery, and ASCU. Congratulations to these areas for a job well done! continued on page 21.
news &views Orientation Tools for Preceptor,
continued from page 20.
Orientation Blueprint Timeline: Take a look at our journey to get here!
Tools for the Preceptor All orientation companion tools are available on the UMMC Intranet for download. ◗◗ Preceptor Requirements ◗◗ Learning Contract for Preceptee and Preceptor ◗◗ Bi-weekly Status Report (guaranteed to take 5 minutes or less to complete!) ◗◗ Preceptor Feedback ◗◗ Preceptor “to do” list ◗◗ CNA/PCA/PCT Skills Comparison table
Preceptors trained since February, 2013: in Figure 2, below.
352! See the units they represent
Preceptor Boot Camp The CPPD training spot for all preceptors, Preceptor Boot Camp, teaches the art of precepting, skills for providing practice feedback, use of companion tools, and so much more! Boot Camp is an eight hour class that will be offered monthly in 2014. See the CPPD course calendar on the UMMC intranet for details. Sage advice on orientation from some of our boot camp participants: “Contact new person before the first day to welcome them and answer questions” “Model the behavior and practice standard that you expect 24/7” “Make your expectations and evaluation method clear on first day” “Take time to assess their learning style and preferences on first day” “Provide feedback sooner rather than later” “Utilize all staff on the unit to assist with orientation… it takes a village” One of the best predictors of staff retention is the satisfaction of new hires with the quality and consistency of their unit orientation. We have 353 talented, newly trained or re-trained preceptors at UMMC. Let’s strive to precept for retention, precept for safety, precept for highly reliable care for our patients and families.
Figure 2 References Dunn, S.V., Ehrich, L., Mylonas, A., & Hansford, B. (2000). Students’ perceptions of field experience in professional development: A comparative study. J Nurs Educ, 39(9), 393-400. The Joint Commission. (2010). Comprehensive accreditation manual for hospitals, human resources standards. Oakbrook Terrace, IL: Harding, A., Walker-Cillo, G., Duke, A., Campos, G. & Stapleton, S. (2013). A framework for creating and evaluating competencies for emergency nurses. J Emerg Nurs, 39,252-64. Knowles, M.S. (1968). Andragogy, not pedagogy: Adult leadership. Need publisher, city and name. Cambridge Adult Education, Prentice Hall Regents, Englewood Cliffs, NJ. Merriam, S. B. (2008), Adult learning theory for the twenty-first century. New Directions for Adult and Continuing Education, 2008: 93–98. doi: 10.1002/ace.309 Wright, D. (2005). The ultimate guide to competency assessment in health care (3rd ed.). Minneapolis, MN: Creative Health Care Management
PATIENT CARE SERVICES | REHAB
Rehabilitation Services in the Neonatal Intensive Care Unit Cheryl Zalieckas, OTR/L, Pediatric Senior Therapist Department of Rehabilitation Services
One of the roles of the pediatric rehabilitation team is to provide care for UMMC’s smallest and most fragile patients, the neonates. While rehabilitation services in the acute care setting typically focus on assisting the medical team in making appropriate discharge recommendations for patients, the role of rehab in the Neonatal Intensive Care Unit (NICU) is quite unique. The goal for these highly specialized therapists is to support the long term development of the neonatal population and prevent functional sequelae in addition to providing support and training for the neonate’s caregivers (Sturdivant, n.d.). According to Dina El-Metwally, MD, PhD, Medical Director of the NICU, “Speech-Language pathology, occupational therapy and physical therapy are indispensable in the NICU, as they complement the medical management to provide holistic care to the infants. Rehabilitation services alleviate the delay in the normal development that is inflicted by intensive and invasive interventions.” Collaboration with the medical team and nursing staff is key to creating individualized care plans for each patient in the NICU. In addition to the daily interactions with the NICU team, rehabilitation services works together with consulting physicians from divisions such as orthopedics, pulmonology, cardiology and pediatric surgery in order to tailor specific interventions to meet each patient’s needs. The Multidisciplinary Rehabilitation Care Team Inherent to the nature of the services provided in the NICU, there are areas of overlap between the three rehabilitation disciplines of occupational therapy, physical therapy, and speech-language pathology. The advantage of this shared knowledge and skill set is the ability to address various needs of this patient population. Melissa Covington, MA, CCC-SLP, CLE, UMMC’s pediatric speechlanguage pathologist (SLP) describes the collaboration between the rehabilitation and medical team, as “Perhaps one of the most fluid and beautiful elements of working in the NICU is the interaction and cooperation between disciplines. Occupational therapists (OTs) were some of the pioneers in the NICU. Within our NICU, both OTs and SLPs work collaboratively to facilitate safe feeding and swallowing. In a typical situation, the primary OT will diagnostically treat our babies
with early feeding problems. When red flags regarding patient stability and potential swallowing dysfunction begin to emerge, the partnership begins. OTs will speak with our physicians and nurse practitioners to obtain orders for a modified barium swallow evaluation, which will then be completed by the SLP. Prior to and following the study, feedback and suggestions regarding interventions during the evaluation are shared between the OT and SLP.” Our physical therapists (PTs) and OTs work to facilitate developmental milestone acquisition with the NICU population as well as address components of atypical development. Interventions include establishing positioning recommendations which serve to improve pulmonary hygiene and promote increased periods of sleep which sets the stage for brain development and assists with typical head shaping (Graven & Browne, 2008 and Sweeney & Gutierrez, 2002). Custom splints are fabricated to manage atypical muscle tone or to improve the general resting position of extremities for optimal development. Infant massage is provided to promote relaxation, assists with normalized muscle tone development, and increased nutrient absorption (Field, Diego, & Hernandez-Reif, n.d.). All interventions are taught to the caregiver(s) in order to promote bonding with their infant which can at times be difficult in the neonatal setting. The goal is to assist the caregiver(s) in understanding how to read and respond to their infant’s cues and to empower the caregiver(s) to be part of their infant’s care plan process. Professional Collaboration Beyond UMMC Equally as important to the care provided to the NICU infants is the involvement of the UMMC rehab team in the collaborative program development that spans across the care continuum designed to benefit the patient and family. UMMC Rehabilitation Services is part of the UMMS rehabilitation service line, the University of Maryland Rehabilitation Network (UMRN). Through UMRN, our system rehabilitation departments have been able to interact in a more meaningful way. This fiscal year the UMMC rehab therapists have been able to partner more closely with the rehab therapists of Mt. Washington Pediatric Hospital (MWPH) in order to improve the services offered to our patients. Many of the patients from UMMC’s NICU are transferred to MWPH for continued rehab prior to going home. For the parents of children who are unable to go directly home from the NICU, fear and anxiety often exists with this change due to establishing relationships and trust with a new care delivery team. The goal of our two departments was to make this transition as smooth as possible. The initiative was two-fold. First, we looked to establish a continuum of care from a rehabilitation perspective so that the patients’ NICU plans of care could be carried over more seamlessly when the patient is transferred to MWPH. The second part of the initiative focused on streamlining and enhancing handoff communication between the rehab NICU and MWPH caregivers at the time of transfer. This enhancement includes the parents/family in the process, as it is imperative for parents to understand the difference in the levels of care as their child no longer requires the intense medical intervention necessary in the UMMC NICU. Diana Johnson, MS, PT, Director of Rehabilitation Services, UMMC, felt these changes should positively impact parent/family satisfaction. “We plan to keep the lines of communication open in order to capitalize on future opportunities to standardize and continued on page 23.
news &views Rehabilitation Services in NICU, continued from page 22. implement best practices.” Susan Dubroff, Director of Rehabilitation Services, MWPH, felt there was mutual learning for both rehab departments. “[Therapists] learned that both organizations provided high quality interdisciplinary care in a cost-effective manner to children, but the models of care varied as the infant was transitioned to the community. At both organizations the intent is to provide our patients and their families high quality, therapeutically appropriate care that is customer focused and that encompasses all of their medical, psychosocial, and rehabilitative needs." An additional benefit to rehabilitation services presence in the NICU is the ability to assist the patients/family once they have been discharged home. Therapists complete evaluations prior to discharge which are used to initiate services for infants post discharge via the state-run Maryland’s Infants and Toddlers Program. Infants who have a therapist evaluation and recommendations are more likely to be higher prioritized, and customarily receive home care/community
plans and improves outcomes. Their input also helps us [medical team] plan for appropriate outpatient care after discharge. They are essential members of the NICU team.” Brenda Hussey-Gardner, PhD, MPH, Associate Professor of Pediatrics and head of the NICU FollowUp Clinic stated, “The pediatric rehab team is a very valuable part of our multidisciplinary team in the NICU and following discharge in our NICU Follow-Up Clinic. The evaluations and therapy services that PT, OT and SLP provide greatly contribute to the well-being and development of the medically fragile and high-risk infants and toddlers that we serve. The manner in which these therapists integrate parents into NICU care and home programs following discharge fosters the family-centered care we value.” Conclusion The role of therapy in the NICU is one of clinical expertise as well as one of tremendous care and compassion. The holistic nature of rehabilitation assists patients as well as their families during a most critical and often stressful time. Through support and education, therapists strive to empower parents to have confidence in their abilities to care for their precious little ones when they are discharged home. Shauna Grimes, a mother of a former NICU patient, described her interactions with rehabilitation services. “Having a child with special needs is very hard on parents, not always knowing if you’re doing the right things. I absolutely loved all of the therapists that worked with my daughter, Kamryn. They were very knowledgeable, caring, and loving. They always made me feel comfortable and let me know that everything was going to be okay. I never left feeling confused and I always felt confident with what they had taught me.” The dedicated therapists serving the NICU at UMMC include three OTs: Loretta Ferrell, MS, OTR/L, CEIM; Joanna Stewart, MS, OTR/L, CEIM, CPST and Cheryl Zalieckas, OTR/L; three PTs: Laura Evans, PT, DPT; Kristin Murphy, PT, DPT, and Cassie Nohe, PT, DPT; and one SLP: Melissa Covington, MA,CCC-SLP,CLC. Gregory Mesa, MSPT, manages this program. References Field, T., Diego, M. & Hernandez-Reif, M. (n.d.). Preterm infant massage therapy research: A review. Infant Behavior and Development, 33, 115-124. doi: 10.1016/j. infbeh.2009.12.004 Graven, S., & Browne, J. (2008). Sleep and brain development: The critical role of sleep in fetal and early neonatal brain development. Newborn & Infant Nursing Reviews, 8(4), 173-179.
services more quickly than those without the evaluation. Not only does the infant receive much needed services, but Johnson feels that the relationship between the early intervention of home care/community services and the impact on readmission deserves closer study. The infant’s developmental status is also monitored post discharge by a screening that takes place in the UMMC Neonatal Intensive Care Follow-Up outpatient clinic. For other infants, as the need arises, recommendations are made for outpatient therapy services at UMMC. Rose Viscardi, MD, neonatologist at UMMC stated, “Rehabilitation services in the NICU are a tremendous asset to our smallest patients. Their expertise contributes to patient management
Sturdivant, C. (n.d.). A Collaborative approach to defining neonatal therapy. Newborn and Infant Nursing Reviews, 13(neonatal therapies), 23-26. doi: 10.1053/j. nainr.2012.12.010 Sweeney, J., & Gutierrez, T. (2002). Musculoskeletal implications of preterm infant positioning in the NICU. Journal of Perinatal and Neonatal Nursing, 16(1), 58-70.
New Publication and Presentation Review and Approval Policy Patricia Woltz, MS, RN, Director Nursing Research, Clinical Practice and Professional Development and Nelia Zhuravel, BS, Project Specialist, Clinical Practice and Professional Development
A new Patient Care Services policy has recently been implemented for the review and approval of scholarly works that are intended for submission outside of UMMC. This policy was adopted 1) to ensure quality scholarship commensurate with the reputation and mission of UMMC, and 2) to track scholarly works for Magnet re-designation applications. An externally submitted scholarly work is any work product (oral, printed, electronic, or any other form) that is disseminated to professionals who are not part of UMMC. Scholarly works that are intended for external submission must be reviewed if they are developed within the scope of the primary authorâ€™s employment at UMMC or the work was prepared or developed using UMMC or UMMS resources and/or branding.
If you are a PCS employee and submitting scholarly work outside the UMMC organization,
get recognized! Contact NZhuravel@umm.edu for more information.
The policy requires that prior to submission, the primary (first) author obtain approvals from his/her direct manager or supervisor, the Director of Nursing Research or the designated divisional scholarly reviewer, and the primary authorâ€™s director or VP. The entire review process takes about two weeks, so authors need to allow enough time in advance of submission deadlines. Completed signature routing forms are archived in the Office of Clinical Practice and Professional Development (CPPD). Importantly, the primary author is responsible for contacting CPPD after a juried review about whether the work was accepted or not. A list of publications and presentations will be shared biannually with the UMMC community in News & Views. Please take these opportunities to celebrate your own accomplishments and those of your colleagues! The Publication and Presentation Review and Approval Administrative policy (ADP-009) is posted on the Intranet at http://intra.umm.edu/ummc/policies/cpm.htm. For questions, contact Nelia Zhuravel, BS, Project Specialist, CPPD or Patricia Woltz, MS, RN, Director Nursing Research, CPPD. Designated scholarly reviewers by division are: Division or Group
Karen McQuillan, Paul Thurman or Kathryn Von Rueden
Carmel McComiskey, Deborah Schofield or Sherri Simone
Quality & Safety
Josephine Brumit, Ingrid Connerney, Badia Faddoul, Karen Kaiser or Kristin Seidl
Respiratory Care Services
Matthew Davis or Maria Madden
Karen McQuillan, Paul Thurman or Kathryn Von Rueden
All other areas
news &views I Was Noticed The I Was Noticed program, a long standing program sponsored by the C2X Employee Engagement Team, provides opportunities for patients, family members, and staff to recognize UMMC staff who are doing something great.I Was Noticed cards are located throughout the Medical Center and they can both be placed in an I Was Noticed box or faxed to 8-1880. Cards are entered in a monthly drawing and eligible employees win “free” vacation time! The Employee Engagement Team aims to recognize 36 employees annually. Listed are the winners from October and November of 2014.
Marleke East, Nursing Assistant A Supplemental Staffing Manager, Tonja Bell “Thanks for going above and beyond your duties with a patient needing some extra attention and helping nursing out a bunch.”
Tricia Carvalho, Clinical Nurse II Labor and Delivery Manager, Caryn Zolotorow “Thanks for being the best team player and staying to help out the night shift. You are the best!”
from Devin Williams
from Abby Keller
Karen Hill-Bruce, Plebotomist IV Tech Labc Laboratory Services Manager, Karen Dubose “Thanks for being so incredibly compassionate with the blood draw for an extremely needle-phobic patient. Your approach was loving and kind. You’re the most professional phlebotomist ever! from Marshell Smith
Julia Schartung, Clinical Nurse II eCare Manager, Nina Adkins “Thanks for being flexible and caring Tuesday night. Your compassion for your coworkers as well as your positive work ethic are very much appreciated. We are lucky to have you in eCare.” from Nina Adkins
Charmet Thomas-Garnes, Administrative Assistant, Cardiac Cath Recovery Managers, Deb Nolan-Reilly/Pam Walden “Thanks for being thorough and vigilant on checking patient transfer records. You make sure that all necessary documents are in patients’ charts. Charmet, you help a lot in speeding up the admissions and discharge process” from Nora Din
“Thanks for working with me and making life easier! You consistently go above and beyond expectations, helping outside of the CPRU. I appreciate it.” from Bill Meushaw
Elaine Rose Camonayan, Clinical Nurse II Newborn Nursery Manager, Caryn Zolotorow “Thanks for being a very good team player. You have done a very good job in responding to an emergency situation.” from Romena Meadoza
“Thanks for the exemplary level of care that you provided to me during my excruciating pain. You really defined what it means to be a nurse. I really appreciate you.” from Sadi Cohen-Barrett
Would you like to have your article published in News&Views ? Submitted articles should: • Present clinical and professional nursing practice topics in inpatient, procedural and ambulatory areas that are evidencebased, innovative, and outcomes driven. • Focus on divisional, departmental and/or organizational strategic goals. See page 2 for submission guidelines.
PATIENT CARE SERVICES | NUTRITION
Kids to Farmer’s Market Program: Combating Childhood Obesity Ellen Loreck, MS, RD, LDN, Director, Clinical Nutrition
According to the Centers for Disease Control and Prevention, more than one third of children and adolescents were overweight or obese in 2010. Obese youth are at a higher risk for type 2 diabetes, cardiovascular disease, bone and joint problems, and sleep apnea. Social and psychological problems such as poor self-esteem and being ostracized by peers also increase with obesity. In addition, obese youth are more likely to be obese as adults and are subject to the same health related risks. A healthy lifestyle, focusing on healthy eating and exercise, is the best strategy for obesity prevention. Communities, schools, medical providers, and schools can all influence these behaviors in children. To that end, and on behalf of Dr. Jay Perman, President of UMB, Jennifer Litchman, UMB Chief Communications & Vice President, and Special Assistant to the President, assembled a UMB/UMMC team to create a Kids to Farmer’s Market venture, focusing on improving the eating habits and physical activity of inner city school children on the west side of Baltimore. The team was initially assembled in 2012 and has successfully planned and executed two Kids to Farmer’s Market seasons. The initial goals of the program were to expose the children to local sustainable foods, teach them about the benefits of eating fresh fruits and vegetables, and to encourage them to taste locally grown food prepared by a chef. This past year, the team offered additional education sessions in two local schools with a focus on healthy eating and physical activity. Here’s how the program works: a UMB bus brings a fourth or fifth grade class to our Farmer’s Market, along with teachers and chaperones. Our team greets them, gives them a backpack stuffed with healthy eating information, seasonal fruit and vegetable recipes, and ten dollars of “Farmer’s Market Bucks” which they can use to purchase items at the Market. The children are divided into three groups; one group starts their shopping, one group goes to a chef’s demonstration, and one group goes to a nutrition education session led by a registered dietitian or nutrition intern. The groups rotate until all students have completed each activity. At the end of the session, the team members document the types of foods each student has purchased, and before leaving, each student receives a healthy lunch to take back to school. Here are a few program details and observations about each Farmer’s Market activity: The shopping: Our first year, the children were instructed to limit their Market purchases to fruit and vegetables. The first question we received was, “Can I buy the pickles?” Well, since pickles are a vegetable, the answer was “yes.” This definitely made our pickle vendor happy! This year, we decided to allow the children to purchase anything at the Market, with the hope that after educating them, they would make more fruit and vegetable choices. There were too many temptations, so next year we may need to rethink the rules. It was great to observe the children chatting with the farmers, asking them about the locations of their farms and the specific types of crops they grow. The farmers were quite generous, often giving the children one piece of fruit to try or reducing prices so the children could make a purchase. The children asked questions about odd-looking
vegetables and they talked about ways their families cook vegetables at home. Our team gave healthy cooking ideas as the kids shopped. The chef’s demo: Chef Dani, from CulinArt Catering, has developed an interactive component of our program. She prepared a seasonal recipe by going through each step while teaching the children cooking techniques and describing each ingredient as she goes. Some examples of the recipes prepared and tasted were: Watermelon Salad Kabobs, Cheesy Spaghetti Squash, and Pumpkin Dip with Fresh Apples. Chef Dani did an excellent job soliciting help from the students and encouraging them to taste unfamiliar food. One young man was quite hesitant to taste the spaghetti squash; however, after high-spirited cheering from his classmates, he declared that it was “pretty good.” After tasting, many of the children said they were excited to share the recipes with their family so they could make the food at home. The nutrition education session: UMMC dietetic interns and registered dietitians develop and present the content for this session, emphasizing the following goals: benefits of eating local and seasonal fruits and vegetables from a farmer’s market, eating a variety of fruits and vegetables of different colors, and the importance of making half of a plate fruits and vegetables (www.myplate.gov). Some of the interesting questions asked by the children were: “Are any fruits and vegetables good for your eyes?” “How do fruits and vegetables help us play sports?” What’s the difference between canned and fresh fruit and vegetables?” This conversation is always stimulating, as both continued on page 27. students and staff learn from each other.
news &views Farmer's Market Program, continued from page 26. This year, to supplement our healthy lifestyle messages, team members went to the two participating schools and led nutrition education, physical fitness, and herb and vegetable planting activities. In addition, our program offered a Foodplay school assembly program that showcased the benefits of healthy eating habits and active lifestyles through music, magic, and live theater. Our team is in the process of evaluating the effectiveness of the program and looks forward to continuing to develop and improve program content in time for next yearâ€™s Farmerâ€™s Market. Our hope is that through our joint UMB/UMMC initiative we can make a meaningful difference in childhood obesity right in our own neighborhood. The team members from UMMC and UMB are as follows: UMMC Team: Denise Choiniere, MS, RN, Director of Materials Management and Sustainabilty; Christine Dobmeier, RD, LDN, CSR, Senior Nutrition Specialist, Clinical Nutrition Services; Justin Graves, RN, BSN, Sustainability Manager; Ellen Loreck, MS, RD, LDN, Director, Clinical Nutrition Services; LaVette Jackson, Customer Service Program Coordinator; Anne Williams, DNP, RN, Senior Manager, Community Empowerment and Health Education University of Maryland, Baltimore (UMB) Team: Holly Baier, Marketing Specialist; Saifa Bikim-Edeze, Office Manager, Communications and Public Affairs; Nancy Gordon, Senior Director, University Events; Greer Huffman, Outreach Coordinator; Jennifer Litchman, Chief Communications & Vice President and Special Assistant to the President; Heather Graham Phelps, Communications and Marketing; and Brian Sturdivant, Director, Community Partnerships and Strategic Initiatives
Achievements Congratulations to the following Patient Care Services clinicians on their achievements from October to December 2013! RESPIRATORY CARE Certification Terry Goodwin, RRT Completed the NBRC Written Registry and Clinical Simulation Exams DEPARTMENT OF REHABILITATION SERVICES Certification Lauren King, OTR/L, CHT Achieved Certified Hand Therapist Maryland Occupational Therapy Association's Outstanding Practice Award Christine Greseth, OTR/L Lila Nappi, OTR/L Mark Karolkowski, OTR/L
Congratulations to the following UMMC nurses promoted in October 2013! Professional Advancement Model Promotions Senior Clinical Nurse I
Senior Clinical Nurse II
Kendall Gelston, BSN, RN, CNOR Shock Trauma OR
Genna Sellers, BSN, RN Multitrauma Critical Care
Gail Garner, BSN, RN Adult ED
Mary Perry, BSN, RN Ambulatory Surgery Care Unit
Erika Hebden, BSN, RN, CCRN Mobile Patient Transport
Kristen Ray, MSN, RN Trauma Resuscitation Unit
Maria Breganza, BSN, RN, CMSRN 13 East/West Louis Lee, BSN, RN, CCRN Critical Care Resuscitation Unit
School of Nursing to Launch New Doctor of Nursing Practice Option Jane Kapustin, PhD, CRNP, FAANP, Assistant Dean for the MS and DNP Programs, UMSON Nurse Practitioner, University of Maryland Center for Diabetes and Endocrinology
The University of Maryland School of Nursing (UMSON) is launching a new Doctor of Nursing Practice (DNP) option in fall 2014. It is designed as a post-BSN (or post entry level) clinical doctorate option for the advanced practice nurse, including nurse practitioner (NP), clinical nurse specialist (CNS), and certified registered nurse anesthetist (CRNA) currently offered by UMSON. The new DNP program will replace the traditional master’s degree program for advanced practice registered nurses (APRNs). So if your plan is to become an NP, CNS, or CRNA, this is the program for you. Graduates of the post-BSN to DNP option will be eligible for national board certification as a NP, CNS, or CRNA. UMSON’s post-master’s DNP option will also continue as the new post-BSN to DNP is introduced. So for the nurse who is already master’s prepared, the DNP degree is still just 36 credits away! UMSON is launching this new program to be in alignment with national recommendations from the American Association of Colleges of Nursing and other organizations to elevate APRN education to the doctoral level. The national recommendations to award the DNP will offer parity with all other clinical doctorates such as the medical doctor, optometrist, pharmacy doctorate, and others. The 2011 Institute of Medicine Report on the Future of Nursing also called for increasing the number of doctoral prepared nurses, and UMSON is well-positioned to meet the demands for educating those nurses. For post-master’s nurses, the DNP program provides an excellent opportunity to review skills in navigating the complex health care system. Today’s nurses need to master high level concepts of organizational behavior, informatics, evidence-based practice, and interprofessional education to help improve patient outcomes. Through evidence-based practice, nurses can make positive contributions to ensure patient safety and improved outcomes. The APRN curriculum has been redesigned and highly integrated with doctoral level courses in informatics, health care system leadership, translational practice, and outcomes to keep nurses well-positioned to meet current health care needs. Post-master’s students will complete at least 500 practicum hours as they finish a scholarly project to address a practice problem. They can spend practicum time immersed in a variety of settings for their “stretch experiences,” such as leadership development, informatics, health care policy, legislation, or direct patient care. For post-entry level students, advanced pathophysiology, pharmacology, physical assessment, health promotion, and health care systems are early core courses designed to give students a foundation for practice before proceeding to more advanced diagnosis and management courses. All students will be immersed in a practice project as they progress through their didactic and clinical courses, and all will complete more than 1,000 hours in their chosen clinical area.
D O C TO R O F N U R S I N G P R A C T I C E
For post-entry level DNP students, the program is designed as either three years of full-time or four or five years of part-time study. Each specialty for the NP and CNS plans of study includes at least 79 to 80 credits, and CRNA (92 credits) includes a full-time, three-year plan of study. All plans of study are posted on the UMSON website, and each specialty will admit a cohort once annually in the fall semester. DNP-prepared nurses can work in a variety of settings in direct patient care or other kinds of positions such as nursing management, informatics, public health, or education, and they are actively pursued for employment. In fact, many DNP graduates work in several settings, depending on their background. There are numerous DNP graduates at the University of Maryland Medical Center, and many of them are in lead APRN positions. There are more than 15 DNP-prepared nurses employed in faculty roles at UMSON. This bodes well for our students since DNP-prepared faculty members understand the nature of the DNP degree and can easily advise and direct DNP students. UMSON’s traditional master’s program for nursing informatics, community/public health, health services leadership and management, and the clinical nurse leader will remain. The PhD program for nurse researchers will also continue. If pursuing a DNP is the challenge you are looking for, please visit the UMSON website at http://nursing.umaryland.edu, contact our admissions office at 410-706-0501, and/or attend our virtual or faceto-face information sessions (dates available on UMSON website) for more details.
online at http://www.umm.edu/nursing/newsletter.htm on the UMM Intranet at intra.umm.edu/ummc/nursing-dept/newsviews.htm
news &views A Cancer Center Christmas Each year, the staff of the University of Maryland Marlene and Stewart Greenebaum Cancer Center coordinates “A Cancer Center Christmas,” a buffet dinner and party for patients and families who must celebrate Christmas in the hospital. A deep bond develops among the cancer center “family,” as patients and the relatives and friends who support them make frequent trips for care during this crucial period in their lives. On the day after this year’s Christmas celebration (2013), Peggy Torr, BSN, RN, OCN, a nurse who helped coordinate this year’s celebration, sent an email that perfectly illustrates the warm and loving atmosphere created by these nurses, patient care technicians, unit secretaries, physicians and other staff. Torr noted that much credit should go to her colleague, Anita Meddin, RN who, over the years, helped organize the annual celebration and make it better each time. Hi Everyone, We really hope that your holidays were merry and bright and time was well spent with family and friends. It was once again a wonderful effort by staff to make “A Cancer Center Christmas” a pleasant experience for our patients and their families. You continued to give the best of care to your patients both physically, emotionally and spiritually, and if you don’t mind me saying so, we were having a lot of fun. We broke a few rules, with children of all ages celebrating with their families and staff singing and dancing in the halls. The buffet generously donated by the Greenebaum Cancer Center was wonderfully received by our patients and their families. Shawntae and Kendra picked up the food from the kitchen, and with a little help, transformed the conference room into a beautiful buffet to be enjoyed by all. All the comforts of a holiday meal were there – from the turkey to the pumpkin pie. The kitchen did a great job with preparation, while numerous family members donated home-made cookies to add to the holiday cheer. There was a real camaraderie between the patients, their families and friends that was pretty incredible. People were eating and talking in the buffet room and the area outside – it was just wonderful. Cassie, thanks for taking the lead and getting everyone excited about making the Christmas packages. Your effort collecting monies, and personally doing some shopping to help fill the packages was greatly appreciated. Once again we send a special thanks to all at your mom’s church; the hand-crocheted items were just beautiful. Gifts from Donna of crossword puzzles, pens, hand cream and more are always a hit and this year was no different. Add to that a few pieces of chocolate, a candy cane and eye masks (great idea!) and the packages were a huge success. Sherlyn, thanks for taking the lead in filling the packages. Great job! With everyone now back to their rooms, the staff dressed in their Santa Caps, strange scarves (handmade though they were) and holiday eye wear, then danced and sang through the halls as we delivered these, our tokens of good cheer. Photos were taken, and a few tears along the way... made for a very special Christmas Day. A few special highlights include those patients and families who return year after year. The Beal family, treated 20 years ago, came as they do every year, with home-made cookies. The wife of Mr. J. Watts came with cupcakes and memories. I think the highlight for me was when the “Mayor,” Jimmy Myrick, rolled onto the floor with mom and dad in tow carrying bags of goodies. He shared that when he was here as a patient, he was given a blanket. He said, “it just helped to make everything better.” He, in turn, came with blankets and was able to hand deliver to each of our patients not only a blanket but, as only Jimmy could, that big, beautiful smile and wishes for a Merry Christmas. What a breath of fresh air, and the patients response to his visit.... priceless! A family member shared this morning that after 90 days of hospitalization, and all that they have been through, that when they look back years from now, they will remember this Christmas day with us as being very special. Best wishes for a health and happy New Year. Nobody does it like we do, you should all be very proud of the work you do and the loving care you provide. Where Hope is a Way of Life...You make a difference, everyday. Reprinted from UMMC Intranet with permission
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Clinical Practice Update