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2 013 N u r s i n g Annual Report

Nurses Transforming Care Working together to Empower, Innovate and Lead

“Medical Center nurses are dedicated to the highest quality of care, distinguishing themselves as leaders, educators, care providers and scholars.� Lisa Rowen, DNSc, RN, FAAN Senior Vice President for Nursing & Patient Care Services Chief Nursing Officer University of Maryland Medical Center

2013 Nursing Annual Report

Table of Contents 3

Letter from the CNO

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Overview

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People

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Service

Annual Operating Plan Strategic Priorities Governance Professional Practice Model Leadership

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Safety & Quality

26

Stewardship

30

Innovation

36

Nursing Scholarly Publications & Presentations

40

Promotions to SCNI and SCNII

University of Maryland Medical Center 22 S. Greene Street Baltimore, MD 21201 umm.edu/nursing

On the cover: Alexis Andino, BSN, RN, and Ruth Sakala, RN, ACRN; This page: Marva Simon, RN

Letter from the cno “The privilege of making a difference in a patient’s life is the intrinsic reward of our profession and one we hold sacred.”

Lisa Rowen, DNSc, RN, FAAN Senior Vice President for Nursing & Patient Care Services Chief Nursing Officer University of Maryland Medical Center

Every day, nurses at University of Maryland Medical Center fulfill our mission to create an atmosphere of exemplary patient care. They carry this mission into every corner of the Medical Center — the procedural areas, the intensive, intermediate and acute care units, and the ambulatory clinics. They shape and refine the UMMC mission as they conduct innovative research, translate findings into best practice and utilize evidence-based practices to improve patient care and care delivery. Medical Center nurses are dedicated to the highest quality of care, distinguishing themselves as leaders, educators, care providers and scholars. As demonstrated by the exceptional feedback we receive on a regular basis from our patients, families, colleagues and surveyors, Medical Center nurses are the embodiment of excellence. Every day, we witness the talent, skill, knowledge and expertise of Medical Center nurses and a strong nursing leadership team. The privilege of making a difference in a patient’s life is the intrinsic reward of our profession and one we hold sacred. Our Nursing Annual Report is a wonderful opportunity to celebrate Medical Center nurses: Nurses who are willing and able to share their passion for excellence in patient care delivery. Nurses who bring merit and recognition to the Medical Center. Nurses who, in both quiet and heroic ways, are inspirational each and every day. Sincerely,

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A Foundation for Nursing Practice Aligns with a

Commitment to Excellence

“Our governance structure is designed to have broad participation across the organization, including staff nurses, nurse specialists, and other patient care partners who are experts in their respective fields.� Jee Young Choi, BSN, RN Clinical Nurse II 13 EW

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Annual Operating Plan, Strategic Priorities, Leadership, Governance and Professional Practice Model The Nursing and Patient Care Services Strategic Plan is built upon the mission, vision, values, and philosophies that we share as a Medical Center and as part of the University of Maryland Medical System. We strive to transform the patient experience by providing safe, high-quality care, exceeding patient expectations, and becoming the employer of choice. The Commitment to Excellence (C2X) philosophy is the foundation for what we value and guides our daily commitment to creating a culture of excellence and safety, selecting and retaining employees, developing leaders, and hardwiring success with systems of accountability. Strategic planning at UMMC includes a long-term, fiveyear plan that drives the goals and objectives of the Annual Operating Plan (AOP). The Nursing and Patient Care Services Strategic Plan and Nursing Annual Operating Plan are developed in alignment with the organization-wide plan. Each year, the staff nurses who serve on the UMMC nursing governance councils (see page 4) help to develop annual strategic priorities for nursing, then take ownership of the process to transform these priorities into achievable goals and communicate these goals to the nursing staff on all units. A nurse leader is paired with each strategic priority, championing the staff nurses and governance councils as they transform priorities into goals, and then achieve these goals in the form of improved outcomes. UMMC has just concluded the 2008–2013 Strategic Plan, Raising the National Profile, whose three major strategic objectives were: growth in clinical services, transformation to a high-performing organization, and strengthened relationships with University of Maryland schools, the University of Maryland Medical System, and the community. Top priorities included patient safety and quality, patient satisfaction, employee satisfaction, and performance excellence.

The Rope

We have achieved and exceeded many of our goals, as detailed in this annual report, and look forward to beginning a new five-year plan in 2014. Nursing and Patient Care Services Governance Structure The strategic plan and operating plan drive the work that is then carried out by the governance councils and unit committees. Our governance structure is designed to have broad participation across the organization, including staff nurses, nurse specialists, and other patient care partners who are experts in their respective fields. Professional Practice Model When values and expectations are clear, nurses understand the culture in which they practice and the standards to which they must aspire. In 2008, task force members of the UMMC Nurse Coordinating Council developed the Medical Center’s professional practice model (PPM), based on a review of the published literature and of PPMs from other organizations. The model grew from a consensus that every part of our practice revolves around the patient, and is adapted from Hoffart and Woods (1996). UMMC nurses identified five strands of the model, representing standards, values, care delivery, leadership and development. These strands function together to provide excellent and safe patient care. We aligned these strands with the pillars in our organization-wide Commitment to Excellence. From our earliest graphic representations of the model, nurses began to call it “The Rope.” After further refinement by nurses, The Rope was adopted as the PPM in spring 2009, and updated in fall 2012.

Professional Standards (Yellow) ANA Scope & Standards, Maryland Nurse Practice Act, professional organizational standards, regulatory standards, ethical standards Patient Care Delivery (Blue) Relationship Based Care; Care Delivery across the Continuum; Evidence Based Practice Excellent and Safe Patient/Family Care (Core)

Professional Values (Orange) Commitment to Excellence, UMMC Behavioral Standards, interprofessional collaboration, educational partnerships (UMNursing), community partnerships, healthy work environment Advancement of Nursing Practice (Green) Clinical inquiry (research, EBP and QI), professional advancement model, certifications, continuing education

Leadership and Governance (Red) Transformational leaders; shared governance structures

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FY13 Nursing & PCS

Governance Council Structure Nursing Coordinating Council (NCC)

Advanced Practice Council (APC)

Clinical Education Council (CEC)

UMNursing

Med-Surg/Critical Care Value Analysis and Technology, Equipment, & New Products (TENP)

Skin Care Committee

Falls Committee Clinical Information Council (CIC)

Pain Task Force

Clinical Practice Council (CPC) Medication Process Improvement Committee

Medication Oversight Council (MOC)

Medication Management Committee

Perioperative Medication PI Committee Nursing Research Council (NRC)

Key Groups: Pharmacy and Therapeutics Committee (Subcommittees: Antimicrobial, Anti-neoplastic, Nuclear, Nutrition, MEADE, IV Infusion, USH)

Patient & Family Education Council

Patient Education On-Demand

Professional Advancement Council (PAC)

Professional Advancement Review Team (PART) Certification Committee

Charge Nurse Council

Staff Nurse Council (SNC)

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Magnet Champion Group

Department of Nursing & Patient Care Services

organizational chart Lisa Rowen, DNSc, RN, FAAN

Senior Vice President for Nursing & Patient Care Services and Chief Nursing Officer

Tina Cafeo, DNP, RN Director of Nursing, Surgery, Medicine, and Dialysis

Sherrie Stephens-Hunt, MBA Director, Business Management

Karen Doyle, MBA, MS, RN, NEA-BC Vice President, Nursing and Operations for Shock Trauma Center and Adult Emergency Services

Suzanne Leiter Executive Assistant

David Hunt, MSN, RN Director of Nursing, Cardiac Care and Interventional Radiology

Kerry Sobol, MBA, RN Director, Patient Experience, Commitment to Excellence, Volunteer Services, Patient Transportation Services

Nancy Gambill, MS, CRNP, OCN Director of Nursing, Oncology

Carmel McComiskey, DNP, CRNP Director, Nurse Practitioners Linda Goetz, MHS, CRNA Director, Nurse Anesthetists

Diana Johnson, MS, PT Director, Rehabilitation, Respiratory Care, and Clinical Nutrition

James McGowan, DHA Vice President, Perioperative, Procedural, and Rehabilitation Services

Margie Stickles, MSN, MBA, RN, CCRN Director of Nursing, Perioperative and Procedural Areas

Greg Raymond, MS, MBA, RN Director of Nursing, Clinical Practice, Professional Development, NeuroCare and Behavioral Health

Patricia Woltz, MS, RN Director, Nurse Research

Mary Taylor, MS, RN Director of Nursing, Pediatrics, Obstetrics, and Gynecology Ingrid Connerney, DrPH, RN * Senior Director, Clinical Effectiveness, Social Work and Human Services Benjamin Laughton, MBA, MSN, CRNP * Senior Director, Clinical Informatics

Sue Ostovitz, MBA, BSN, RN * Transplant Administrator

Joanne Riley * Vice President, Ambulatory Care Marcia Stalter * Senior Director, Maryland ExpressCare and Post-Acute Services

Leadership and Accountability Our organizational chart represents the Patient Care Services leaders who are accountable for the quality of care at UMMC. Lisa Rowen, DNSc, RN, FAAN, is the Senior Vice President for Nursing & Patient Care Services and Chief Nursing Officer, and oversees a staff of 4,200, including more than 3,000 nurses — includes advanced practice nurses, administrators, and other various roles — of whom 2,200 are direct care, bedside RNs. Dr. Rowen also oversees allied health professionals and other professional partners, such as rehabilitation, respiratory and clinical nutrition services.

Gisele Stevenson, MS, RN * Manager, Patient Placement Center

*Leaders who report to other senior vice presidents as well as to the CNO for nursing.

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People Excellence, Compassion, Leadership

“I am one of many nurses who have been afforded the opportunity to continue my professional growth at the Medical Center. Thanks to generous education benefits, I have attended conferences and advanced from a diploma nurse graduate to a masters-prepared nurse practitioner.� Treza James, MS, NNP-BC Clinical Practice & Education Specialist Neonatal Intensive Care Unit

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Recognizing excellence, compassion, leadership among nursing staff points to UMMC’s ongoing drive for the finest in nursing care. Recognizing Excellence Across the Nursing Spectrum This year held great recognition of nurses at all levels at UMMC, by regional and national organizations as well as in the greater community. In 2013, The Daily Record, a statewide newspaper in Maryland, named Lisa Rowen, DNSc, RN, FAAN, Senior Vice President for Nursing & Patient Care Services and Chief Nursing Officer at UMMC, to the Maryland’s Top 100 Women Circle of Excellence, an honor reserved for the select few women who have been named one of Maryland’s Top 100 Women for at least three years. In addition to her faculty appointment as Associate Professor at the University of Maryland School of Nursing, Dr. Rowen has also been appointed Clinical Associate Professor of Nursing at the University of Virginia and adjunct nursing faculty member at Johns Hopkins University in Baltimore and Northeastern University in Boston. Dr. Rowen was invited to serve as a CEO Councilor on the Maryland Hospital Association’s Executive Council. In addition, she was invite to serve as a member of the American Academy of Nursing’s Diversity and Inclusion Committee of the Board. National Leadership in Trauma Nursing Karen Doyle, MBA, MS, RN, NEA-BC, Vice President of Nursing and Operations, R Adams Cowley Shock Trauma Center was elected president of the Society of Trauma Nurses, where she has also served on the board of directors. She took office in spring of 2013. During this same year, she was also finalist in the Nurse.com Nursing Excellence Awards in the category of Volunteerism and Service. Also this year, the Society of Trauma Nurses recognized Kathryn T. Von Rueden, MS, RN, ACNS-BC, FCCM, Associate Professor at the University of Maryland School of Nursing and Interim Specialty Director of the Trauma/ Critical Care/ED Advanced Practice Nurse graduate program with the 2012 Trauma Leadership Award. The award recognizes outstanding leadership through practice, research, publication, education, patient advocacy, injury prevention, system development, or legislative involvement.

2013 Nurse.com Nursing Excellence Regional Finalists Three UMMC nurses were among those named as 2013 Nurse.com Nursing Excellence regional finalists for the District of Columbia, Maryland, and Virginia. Finalists in education and mentorship are recognized for important contributions to nursing scholarship or for impacting nursing career development in measurable ways. Finalists in volunteerism and service are recognized for giving of themselves in outstanding humanitarian and/or heroic ways by providing nursing care, skills and expertise in outreach to the community, either at home or abroad, and to improve the lives, well-being, and healthcare of others. • Karen Doyle, MBA, MS, RN, NEA-BC, Vice President of Nursing and Operations, R Adams Cowley Shock Trauma Center, for the category of Volunteerism and Service. • Treza James, MS, NNP-BC, Clinical Practice & Education Specialist, Neonatal Intensive Care Unit, for the category of Education and Mentorship. • Michele Zimmer, MS, RN, CCRN-CMC, Senior Clinical Nurse II, Cardiac Progressive Care Unit, Education and Mentorship.

Wienshet Teku, BSN, RN, CNII, and Ashley Elliot, BSN, RN, CCRN, CNII

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People Leadership in Sustainability Practices In 2012, Denise Choiniere, MS, RN, Director – Sustainability and Materials Management was awarded the first annual Nursing Leadership in Environmental Health Award by Maryland Hospitals for a Healthy Environment. Originally a cardiac care nurse, her leadership in promoting sustainable practices on her unit grew to a larger role as the first full-time sustainability manager in a Maryland hospital. She has since been promoted to a more comprehensive role as a director in Facilities, as sustainable practices are integrated across all hospital operations. SICU Innovation The UMMC Surgical Intensive Care Unit (SICU) Supportive Care Team received the Society of Critical Care Medicine (SCCM) Family-Centered Care Innovation Award in 2012. Recognized at SCCM’s annual Scientific Congress for developing an evidence-based practice program to improve family satisfaction through participation and shared decisionmaking, the team comprises experts across the spectrum of family-centered care. CCU Beacon Shines in All Directions Last year, the Cardiac Care Unit received Beacon status from the American Association of Critical-Care Nurses (AACN) recognizing exceptional care for patients and their families. Top critical care nurses want to work in Beacon CCUs. A Silver level winner, the CCU at UMMC is one of two clinical units in a Maryland hospital with Beacon status.

Kim Larabee, BSN, RN, CNII; Alexandria Stargenberg BSN, CNA, PCT

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University of Maryland Nursing UM Nursing is an innovative and unique partnership between the University of Maryland School of Nursing (UMSON) and UMMC. In 2012, UM Nursing saw unprecedented levels of collaboration in creating opportunities for research, practice, and education. Lisa Rowen, DNSc, RN, FAAN, Senior Vice President for Nursing & Patient Care Services and Chief Nursing Officer and Jane M. Kirschling, PhD, RN, FAAN, Dean of the School of Nursing are helping to shape the future of their profession.

Xiping Ma, BSN, RN, MS, CNII; Peter Purcell, PCT, and Emily Knepp, BSN, RN, CNII

When Going Viral is a Good Thing Using social media to attract and recruit nurses, UMMC Nurse Ambassadors now share their experiences online. The goal is to engage new nursing talent with the richness of a career at UMMC. Ambassadors include UMMC nurses, nurse practitioners and other advanced practice nurses. Visit Facebook.com/MarylandNursing.

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People Therapeutic Pet Visits in Child Psychiatry The Child Inpatient Psychiatry Unit (PG4) serves patients between 5 and 12 years old with behavioral challenges such as impulsivity, mood regulation, post-traumatic stress disorder, and depression. Many of these children are exposed to violence at home, presenting signs of fear and anxiety. Animals have the potential to be perceived as less threatening, allowing these children to become aware of their feelings and develop a sense of self. Pet therapy, which is valuable throughout the hospital, is especially helpful for the children the staff on this unit serves. Throughout history, animal companionship has been used as a source of comfort and as a mechanism to relieve suffering. Health care professionals have studied the impact pet therapy has on an individual’s emotional well-being and quality of life. Additionally, pet therapy has been used in clinical programs to treat social or emotional difficulties and communication disorders. The physical stimulation associated in animalassisted therapy provides individuals with increased pleasure that encourages relaxation and promotes a positive well-being. Pet therapy finds positive uses with all ages, but is particularly useful with children and the elderly. The staff on P4G is no stranger to the use of pet therapy in increasing emotional welfare of their patients. Unfortunately, due to infection control concerns, the program was stopped many years ago. In June 2012, Kim Sadtler, MSN, RN, CNSBC, Nurse Manager for Inpatient Child Psychiatry, and staff nurse Denise O’Donnell, RN, CNII, began talking about resurrecting the program. UMMC policy does have a pet visitation policy, provided the animal is the personal pet of a patient in the facility. After navigating the legalities and creating patient consent forms,

the nursing staff of P4G reached out to the Pets on Wheels (POW) program, a non-profit volunteer organization providing friendly visits to patients in hospitals, nursing homes and institutional settings since the 1980s. The staff of P4G implemented bi-weekly one-hour visits with Cassie, a rescue greyhound, in August 2012. During these sessions, without prompting from staff, children encourage each other to meet Cassie while helping those who are afraid ease closer to Cassie, until they are fully engaged in participation. Nursing staff on P4G report that after these sessions, the children exhibit less aggression and disruptive behaviors, increase their attention span, and have more positive peer interactions. Encouraged by their early results, the P4G staff intends to continue the pet therapy program with their patients. Plans are to incorporate Birdie, one of POW’s newest therapy dogs, as well as secure pet visits for the other weekends per month. The nursing staff is also investigating ways to objectively measure the benefits of pet therapy application in the clinical setting.

UMMC’s pet therapy program has shown benefits to people of all ages.

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“Animal companionship has been used as a source of comfort and as a mechanism to relieve suffering. Health care professionals have studied the impact pet therapy has on an individual’s emotional well-being and quality of life.”

Reverend Susan Roy, Director of UMMC’s Department of Pastoral Care, also manages the hospital’s Personal Pet Visitation Program. Pet therapy encourages relaxation and promotes a positive well-being.

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Service Tradition of Caring

“Service excellence is the cornerstone of all that we do. Understanding service behaviors, including the ability to communicate in an empathetic way, is a core competency at UMMC. Our patients and staff deserve service that not only meets their needs, but is delivered with compassion, care, and knowledge.� Kerry Sobol, MBA, RN (pictured far left)

Director Patient Experience, Commitment to Excellence, Volunteer Services, Patient Transportation Services

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Gena Stanek, MS, RN, CNSBC, Anne Naunton, MS, RN-BC, Lucy Miner, BSN, RN

Nurses and their colleagues at the Medical Center extended a tradition of caring by establishing new collaborative partnerships, recognizing great service, and honoring individuals who work tirelessly to improve patient care. Every Hour … Every Day … Every Patient — Hourly Caring Rounds Come to UMMC UMMC nursing successfully launched hourly caring rounds in 2012. Also known as purposeful rounding, the practice focuses on activities that ensure patient safety, comfort, and proper positioning; that assess, evaluate, and effectively control pain; assess and implement necessary toileting or elimination activities; and ensure the patient’s desired possessions and the call light are always within reach. Nurse leaders assembled a team to train managers and all patient care staff in caring hourly rounds. They also presented a skit at the 2012 Nursing Grand Rounds to highlight the benefits of caring rounds. Everyone on the care team — especially those with extensive contact with families and patients — has a part to play. And hourly caring rounds improve patient safety. Team resources include an intranet page with educational materials, scripting for managers, audit tools and information on collecting data, and video. Improving Service: A Collaborative Approach Launching UMMC’s first patient and family advisory group in years, the UMMC Commitment to Excellence Patient Experience Team in 2012 convened the inaugural meeting of the newly formed Patient and Family Partnership Council (PFPC). Established to improve and sustain the UMMC journey to excellence, the PFPC brings together patients, family members, and staff to generate ideas, provide perspective, and explore the experiences and opinions of patients and families. They learn about UMMC and explore multifaceted approaches to operations and service improvement. Great Stories Tell of Nursing Leadership Sponsored by the Commitment to Excellence Employee Engagement Team, the Great Stories program recognizes individual or teams of employees whose stories exemplify skill and behaviors that significantly enhance the patient experience — in short, great stories.

Each Great Story is nominated by staff, usually with origins in a letter or e-mail from a patient or a member of his or her family, and vetted by the team, which then develops the story with the nominees. Selected Great Stories are highlighted three to four times a year at a Great Stories Recognition Event. Honorees, supervisors, and patients are invited back to celebrate each Great Story. Current Great Stories can be found in the hospital newsletter, UMMC Connections, or on the website, www.umm.edu.

Great Stories honoree Blake Smyle, MSN, RN, CEN, with Jim Brown whose niece, Rita Davis, was treated in at the Shock Trauma Center; Marichu Barcena, BSN, RN, ACRN, CNII, and Donna Praileau, RN, CNII

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Service Recognizing Extraordinary Service Among the many thank-you cards and letters UMMC nurses received throughout the year from grateful patients, one stood out because it came from a colleague at the University of Maryland School of Nursing. Marjorie Fass, MA, assistant dean for student and academic services, knows a thing or two about exceptional service in healthcare settings, so her glowing review of the care she received at UMMC speaks volumes. Invited to be the guest speaker at the annual UMMC Service Awards Gala in April, she said “When I think back to the words of the University of Maryland Medical Center — ‘a way of working not found anywhere in the world’ — I think of all of those nurses who touched my life and all the arms that extended to me warmth, knowledge, and the touch of human kindness like a mother for a child. Please know that those acts of kindness did not go unnoticed.”

Marjorie Fass, MA; Arielle Turner, Student Nurse; Hourly Caring Rounds Brochure

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Paul Sacamano, RN, MSN, MPH, ACR, and Yoonhung Yun, MS, RN, CNL; Visitacion Casal, BSN, RN; Oluyemisi Ogunyemi, BSN, RN, CNII, and Damon Marshall, RN, CNI

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Service I Am a Boston Marathon Nurse Alexander E. Halstead, BSN, RN, CCRN, Clinical Nurse II, Surgical Intensive Care Unit UMMC was honored that one of our nurses from the Surgical Intensive Care Unit, Alexander E. Halstead, BSN, RN, CCRN, Clinical Nurse II, (pictured below) acted as a medical volunteer for the 2013 Boston Marathon. The account of this tragic day is provided in the following story. On April 14, 2013, I hopped onto a northbound plane to return home to Boston to see family and again volunteer my services for one of the biggest events of the year. I am a marathon nurse. I arrived in downtown Boston to prepare for my day. As in previous years, I spent the morning with my fellow volunteers and some of Boston’s leading sports medicine physicians, who gave us valuable information for treating runners. They explained the treatment protocols and some of the ailments we might come across. We prepared our respective sections of the tent to receive runners. Each section was made up of a physician, a few nurses, a physical therapist, and a few podiatrists — a truly well-rounded medical team. The cheering began as the wheelchair winners were the first to cross the finish line, and some of them passed through our tent on their way to the Copley Square Hotel. Soon after, the men and women elite runners walked through the tent after their amazing feat — usually needing minimal care because they train so well. At 2:50 pm, I heard a blast not unlike the mock cannons that are fired every Sunday from Fort McHenry. Shortly after, I heard another blast. I walked over to one of the physicians, who voiced the thought in the back of my head — that it could have been a bomb. Boston EMS personnel had been stationed in the respiratory care section of the tent, and all of their radios went off simultaneously. Some of them sprinted out of the tent while others stayed and frantically prepared

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their equipment. I knew something had to be seriously wrong. I discharged as many runners as I could from the tent. I told them that if they could walk, they should get out. The first victim to come into the tent was an image I would never forget: a young man was wheeled in with both of his legs amputated by the blast. He was awake and had mere strands of flesh hanging down from both of his legs. It was surreal. The patients started rushing in, filling every corner of the tent. All ages were present among the victims. It was mass pandemonium. Triage sections were set up in the tent so that the victims with more severe injuries would be transported first. A subsection of the tent was assigned as the morgue. I snapped into gear. I had the training, and now I just had to use it. I walked up to one of the victims awaiting transport. He already had tourniquets on both of his leg amputations, and the bleeding was controlled. I started an IV and hung fluids. But what else could I do for this man? He needed surgery, and we could not do that in the tent. There were four other doctors and nurses around his stretcher, so I stepped back for a moment to collect my thoughts. Could this all be real? Or was this just a horrible nightmare that I would surface from soon? About 25 minutes after the blast, we had all 97 of the blast victims who came through our tent transported to hospitals. This tragedy, for me, was a major reality check. It emphasized for me the importance of family, friends, and — most importantly — life. My heart goes out to the families and the victims of the Boston Marathon bombing. That said, without such a well-trained, organized and dedicated group of first responders that day, there would have been more casualties. The medical professionals in Medical Tent A, Boston EMS, Boston Police, and a countless number of bystanders saved many lives that day. I am proud to have worked among such a great group of people. I am proud to be a Boston Marathon Nurse.

“This tragedy, for me, was a major reality check. It emphasized for me the importance of family, friends, and — most importantly — life.”

“I had the training, and now I just had to use it.”

Alexander Halstead’s marathon nurse volunteer badges

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Safety & Quality Improving the Patient Experience

“Our CNO has transformed our culture of safety to an environment of transparency. Nurses are advocates for speaking up and sharing their safety concerns. This is evident in the work of all the nursing councils. Nurses know that immediate action will take place and have seen results that improve patient and worker safety, as well as the quality of care.� Christine Byerly, BSN, RNC-NIC (pictured left)

Senior Clinical Nurse II Neonatal Intensive Care Unit

Kristin Seidl, PhD, RN Director of Quality and Patient Safety Officer

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Working on the front lines of safety and quality improvement, UMMC nurses are playing a critical role in improving patient experience and care delivery every day. Reducing Incidence of CAUTI Urinary tract infections (UTIs) account for more than 15 percent of infections reported by acute care hospitals, and most are catheter-associated urinary tract infections (CAUTI). Our internal data indicate that 75 percent of CAUTIs occur in the intensive care units (ICUs). So in 2012 UMMC nurses began exploring efforts to reduce the incidence of CAUTIs in the intensive and critical care units at the Medical Center. Efforts already underway include establishing standardized goals for catheter removal in the ICU, reducing false-positive results, and implementing use of a new all-in-one catheter kit that includes additional infection prevention tools.

The hand-hygiene campaign has been multi-modal: Nursing staff helped produce a fun and engaging music video to drive home the messages. The video featured dozens of nurses, as well as physician and executive leaders, with all of them demonstrating cheerful compliance with a serious safety guideline. And staff on specific units have also devised strategies to improve hand hygiene among their colleagues.

Preventing Falls Patient falls pose a great risk to safety. Fortunately, they are largely preventable. At UMMC, using the example of the Medical-Surgical Progressive Care Unit on Gudelsky 5 East, where the nursing staff led an effort resulting in 91 consecutive fall-free days, we are working to expand on their success. A new Falls Prevention Program focuses on decreasing falls by engaging clinical and non-clinical staff, patients, and visitors. Implementation of the program hospital-wide was completed in autumn of 2012. Hygiene Improves Safety, Hands Down Led by nurses on a hospital-wide and unit level, a recent public information effort underway at UMMC is improving the rate of hand washing among staff and patients. A placard reminds patients in clinic areas to wash their own hands. It also provides space to note hand-washing behaviors of staff and caregivers. A box is provided to collect responses. Results are tallied and reminders sent out to staff to keep washing and sterilizing hands. Staff on specific units have also devised strategies to improve hand hygiene among their colleagues.

Paul Thurman, RN, MS, ACNPC, CCNS, CCRN, and Shannon Burton, Student ACNP, CCNS; Lacy Harris, BSN, RN, OCN, CNI, and Jennifer Motley, BSN, RN, PCCN, SCNII

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Safety & Quality Improving Enteral Feeding Tube Management The placement of nasogastric (NG) feeding tubes is a common practice for patients unable to take oral feedings or medications. Over the past year, improper placement of blindly inserted NG tubes has caused patient harm at UMMC. As a result, a task force was formed to draft a management policy to reduce risks. Reviewed by a team including nursing, providers, radiology technologists, radiologists, clinical nutrition, risk management and pharmacy, the resulting policy is comprehensive, coherent, and designed to improve safety and quality of care at UMMC. Reducing Incidence of Medication Error Medication errors can occur in all stages of the medicationadministration process. To reduce these errors, UMMC has acquired AU Meds, a direct observation method of detecting errors developed at Auburn University. Four UMMC nurses and two pharmacists have been trained in the AU Meds observation technique. Observations are now underway and promise to improve the medication administration process at UMMC. Seeing Stars to Manage Wounds With UMMC’s new Enterprise Aranz Wound Management System, UMMC’s Wound Ostomy Nurse Team now has a powerful new tool to improve wound assessment, staging, healing, and documentation. Key to the system’s success is the SilhouetteStar, a small handheld camera that UMMC nurses use at the point of care for imaging and taking 3D measurements of wounds. SilhouetteStar connects via USB to a computer, capturing in a single photograph all the information required to measure a wound.

Eric Horne, RN, CNI; Simone Odwin-Jenkins, MBA, BSN, RN

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Lynmarie Figert, BS, RN, CNII, and Michelle Willis, ACNP, Lead NP; Andrea Morrissey, BSN, RN, CNII, and Daniel Lunde, BSN, RN, CCRN, CNII; Heather Spencer, RN, Bert Adams, RN, CCDI, and Jennifer Murphy, RN

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Safety & Quality NICU Staff’s Temperature Control Advances Reduce Incidence of Hypothermia in Very Low Birth Weight Infants The incidence of preterm birth in the United States has continued to increase and the percentage of infants born with very low birth weight (VLBW) (less than 1,500 grams) has also increased. Temperature control is essential to survival, and studies since the 1950s show that hypothermic infants are at increased risk for significant morbidities. Hypothermia in VLBW infants can lead to a number of co-morbidities that decrease the likelihood of infant survival. The staff in the Neonatal Intensive Care Unit (NICU) at University of Maryland Medical Center has developed a hypothermia prevention bundle that aims to decrease the percentage of VLBW neonates admitted to the NICU with a body temperature less than 36ºC. Through an extensive analysis of both literature and institutional data, the NICU staff was able to target the modifiable factors associated with hypothermia in VLBW infants, including environmental temperature and the prevention of heat loss. By maintaining the delivery room temperature between 75-78ºF for all deliveries less than 32 weeks, the staff was able to stem the loss of heat post delivery of VLBW infants. This factor change, coupled with placing a transgel warmer mattress in the resuscitation bed of every infant born less than 32 weeks old, and wrapping the infant in Neo-wrap, a polyethylene plastic wrap that prevents evaporative heat loss, further reduced the percentage of VLBW neonates admitted to the NICU. Additionally, the creation of a new role, a thermoregulation nurse, participating in all deliveries less than 30 weeks gestation and responsible for ensuring infants remain warm, has resulted in a further decrease in hypothermic infants admitted to the NICU. The staff was provided reminders during bi-weekly meetings as to the new standards outlined in the hypothermia prevention bundle, further ingraining the new tactics into their daily routines. The result speaks for itself. In just over one year, the NICU at UMMC has been able to reduce the incidence of

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admitting hypothermic VLBW infants to the NICU from 59% to 9%. Through the implementation of best practices, inclusion of new products and the constant monitoring by NICU staff, neonates at UMMC can expect to receive a higher quality of care and an expectation for improved patient outcomes.

The NICU staff’s temperature control advances have reduced admitting hypothermic VLBW infants to the NICU from 59% to 9%.

“Through the implementation of best practices, inclusion of new products and the constant monitoring by NICU staff, neonates at UMMC can expect to receive a higher quality of care and an expectation for improved patient outcomes.”

“The NICU at UMMC has been able to reduce the incidence of admitting hypothermic VLBW infants to the NICU from 59% to 9%.”

Temperature control is essential to the survival of VLBW infants, and UMMC’s NICU staff’s hypothermic prevention bundle has shown positive results.

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Stewardship Commitment to Service

“As UMMC nurses, it is our obligation to cultivate a sense of well-being in our community. With the conscientious support from our leadership and diligence of our team, we are committed to enrich the health of our communities — in the state, in the country, in the world.” Nathan Shapiro–Shellaby, BSN, RN Clinical Nurse II Cardiac Surgical Intensive Care Unit

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UMMC nurses’ commitment to service includes community and international service as well as to our individual patients. Projects in 2012 took UMMC nursing leaders and service-minded professionals to destinations around the globe to improve health care infrastructure, implement programs, provide training, and more. World-Class Trauma Center in a World Cup City The complex planning for the World Cup Soccer Games in 2014 and the Summer Olympics in 2016 in Brazil includes the creation of four new trauma centers in the state of Rio de Janeiro. Working with the state of Rio in 2012, UMMC nursing professionals developed an intensive training program in Adult and Pediatric Trauma for a team of 17 Brazilian nurses and physicians. A combined effort of the R Adams Cowley Shock Trauma Center (STC) and the Children’s National Medical Center (CNMC), training concluded with the joint nurse and physician group presenting their plan for opening three additional trauma centers in Rio.

of health related topics. The American Heart Association and Stork’s Nest was represented. The education and information for the attendees included accident prevention, HIV/AIDS awareness, organ transplant, women’s health, stress management, blood pressure and BMI screening, cholesterol education, child safety, stroke prevention, smoking cessation, cancer prevention, nutrition and diabetes, farmer’s market, physical therapy, and hand hygiene.

Foreign Surgical Missions Offer Unique Experiences and Challenges For Darlene Carco, BSN, RN, MHA, CNOR, SCN II, Operating Room, STC, service and travel are passions. Her first surgical mission was to Guayaquil, Ecuador in February of 2006, with the Ecuadent Foundation. In June of the same year, she traveled to Esmeraldas, Ecuador. Since 2006 she has participated in surgical missions every February. She has also traveled twice on UMMC missions to Haiti. In 2011, she worked with the Healing Hands Foundation in Guatemala providing underprivileged children and adults with such surgical care as cleft lip and palate repairs, burn scar revisions, and corrections of congenital deformities. “It is wonderful to see the look on the faces of the parents when we correct their child’s cleft lip,” she says. Celebrating Nurses Week by Serving the Community On May 10, 2013, the third annual nurses week community health fair was held. The health fair, organized by direct care nurse Nathan Shapiro–Shellaby, BSN, RN, was staffed by UMMC employees who contributed 525 total hours to provide support. It is estimated that over 1,000 members of the community attended the fair that consisted of 31 tables

Group with poster (left to right): Michelle Emerick, BSN, RN, CIC, Manjari Joshi, MD, MBBS, Ellyn Tennyson, ACNP, RN, Karen McQuillan, MS, RN, CNS-BC, CCRN, CNRN, FAAN, Carla Aresco, ACNP, RN, Linda Byrne, MS, RN, and Kathryn Von Rueden, MS, RN, CNS-BC, FCCM

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Stewardship UMMC’s Sustainability and Waste Reduction Efforts Yield Impressive Results University of Maryland Medical Center is one of many organizations developing and implementing “Green” initiatives and sustainability programs. Not only is UMMC able to reduce its environmental impact; it is also able to reduce costs by developing more efficient programs requiring fewer resources to fulfill UMMC’s needs. One such program is the reduction in biohazardous waste within the facility, championed by Denise Choiniere, MS, RN, Director of Sustainability, Materials Management, and In-house Construction as well as Leonard Taylor, Senior Vice President for Operations and Support Services. Prior to 2010, all waste at UMMC was treated as regulated medical waste (RMW). Regulated medical waste — a contaminated article that releases liquid or semiliquid blood or another potentially infectious material if compressed — requires special handling and treatment during disposal. After instituting separation policies, UMMC determined that 50% of the waste stream and 60% of waste removal costs were from RMW. In an effort to further reduce RMW, UMMC engaged with Reduction in Motion to enhance waste separation procedures through LEAN methodologies. The result: a reduction in RMW through hands-on procedural enhancement in the trash room and dock, an increase of recycling bins, a reduction in RMW bins, and providing numerous educational presentations. The three effective interventions developed by both UMMC teams and Reduction in Motion — waste separation, creating a centralized RMW collection model, and reducing the amount of containers — have shown a consistent downward trend of RMW, as UMMC aims to reduce its RMW to the national average of 15%. In addition to waste reduction, UMMC has also brought costs associated with RMW removal down from $4.80 per adjusted patient day (apd) in 2010 to an all-time low of $1.87/apd in 2012. The team expects these positive results to continue as it spreads these programs hospital wide.

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Denise Choiniere, MS, RN, Director of Sustainability, Materials Management, and In-house Construction

“Not only is UMMC able to reduce its environmental impact; it is also able to reduce costs by developing more efficient programs requiring fewer resources to fulfill UMMC’s needs.”

“UMMC has also brought costs associated with regulated medical waste removal down from $4.80 per adjusted patient day (apd) in 2010 to an all-time low of $1.87/apd in 2012.”

Leonard Taylor, Senior Vice President for Operations and Support Services

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Innovation Pushing the Boundaries

“The Vascular Surgery Progressive Care Unit is a team of individuals who are constantly looking for ways to improve their clinical environment and take on challenges in order to keep their practice current, evidence-based and innovative. The Fall Bundle, one of many initiatives the unit has undertaken, uses teamwork and brainstorming strategies to reduce falls on the unit. We take ownership of the journey by holding each other and ourselves accountable with open communication, support and a culture of quality and safety.� Visitacion Casal, BSN, RN (pictured right)

Senior Clinical Nurse I Vascular Surgery Progressive Care Unit

Simone Odwin-Jenkins, MBA, BSN, RN

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Innovation at UMMC comes in many forms. From repurposing ancient traditions to conducting new research to inform the latest best practices in process improvement, UMMC Nursing continues to push the boundaries of innovation in caring. Nursing Research Advances the State of the Healing Arts and Sciences UMMC Nursing Research contributes to the science and evidence base of professional nursing practice. Research staff evaluates, educates, mentors, coordinates, and leads nurses in process improvement, EBP, and research to identify gaps in the evidence, translate evidence to practice, measure meaningful outcomes, and generate new evidence. In 2012, the UMMC Nursing Research team oversaw a range of activities including a review of nursing research studies. The team reviewed and approved 67 abstracts and manuscripts, of which 57 were accepted for external presentation or publication. The Appendix lists nurses’ external scholarly works that were accepted for presentation and publication. Of 18 open research studies this year, 10 were funded, four were initiated, and six were closed. Other activities included a reinvigoration of the UMNursing Research partnership and a redesign of UMMC nursing intranet to improve usability, models and methods elaboration, and knowledge management of content, links, archives, and exemplars. The Fine Art of Healing This year, UMMC’s newest C2X team, the Healing Arts Team, is partnering with the National Arts Program® to plan an exhibit of artworks by UMMC employees and family members. The Healing Arts Team provides opportunities for integrating art into daily life and promoting art as a vehicle for personal growth, self-expression, and healing. Participating artists were selected to exhibit their work in shows planned for later in 2013. Cash prizes provided by the National Arts Program® will be awarded in several categories, including amateur, intermediate, professional, youth (age 12 and under), and teen (ages 13 to 18).

Integrative Care Promotes Healing and Relaxation UMMC’s Integrative Care Team taps traditional and nonWestern therapies to offer complementary services that have been shown to advance relaxation and healing. Composed of a team of medical professionals including nurses, Reiki master and top practitioners in yoga, acupressure, and more, the team offers these relaxation and healing sessions to patients and their family members at no charge, throughout the day.

Carol Joy Loeb, BSN, RN, HNB-BC, CMP; Nana Fatima, MUSA, RN and William Teeter, MD; Donna Audia, RN

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Innovation Healing modalities include: • Reiki: Japanese technique for relaxation that can either be done with light touch or be without touch just above the body. • Live therapeutic music: Relaxing music performed live by musicians trained in music therapy. • Acupressure: Applying light pressure on energy points along the body to stimulate relaxation. No needles. • Guided imagery: Meditation practice focused on visualizations of the body and the senses to focus attention on relaxation. • Yoga breath work: Gentle breathing for relaxation and calm. • Expressive arts: Therapeutic visual and written expressions of the emotional lives of patients as they face difficult issues.

Matthew Peroutka, Live Therapeutic Musician; Donna Audia, RN

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You & UMMC With the launch in 2012 of www.youandummc.org, UMMC Nursing takes a significant online step forward to welcome new team members and promote positive relationships among co-workers and colleagues. Under the direction of Lisa Rowen, DNSc, RN, FAAN, Senior Vice President for Nursing & Patient Care Services and Chief Nursing Officer, a small group of nurses and Clinical Practice & Professional Development staff developed the plan that led to the new website, which is filled with information useful to both new and existing staff. New nurses are welcomed to view the website when they receive their job offer. The site provides a range of resources, such as information about housing and roommates, city neighborhoods, UMMC culture and involvement, recreational activities, transportation, childcare, and much more. This reservoir of information is indispensable, especially to these new members of the UMMC team.

Derek Eckenrode BA, RN, SCNI, Martha Lefferts, BSN, RN, CNII, John Volcy, RN, CNII, Rachel Hercenberg, BA, Cyndy Ronald, BA, and Justin Graves, BSN, RN; You & UMMC website; Carol Joy Loeb, BSN, RN, HNB-BC, CMP

To access the You & UMMC website, go to www.youandummc.org

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Innovation Social Media to the Rescue! Janet Gripshover, MS, CRNP, a nurse practitioner at UMMC’s Liver Transplant Service, noticed poor attendance at UMMC liver transplant support group sessions. Upon investigation, recipients cited several reasons for not attending the session, including the cost of parking, inconvenience of meeting at night, and being too far to travel. In looking for a solution that enabled participants to communicate with others regarding their situation, Janet turned to social media. Pew Internet research findings indicate that individuals seek out online resources to connect with other people, look up answers to questions, and in particular, find pertinent medical information. Roughly twothirds of individuals who use the Internet use some form of social media. To date, only about 20% of all hospitals use social media, creating a large void in resources available to those seeking medical information. Janet, through collaboration with the UMMS Communications Department, created a Facebook “group.” Using this platform, Janet created a forum for discussion that provided 24/7 access, and that facilitates group discussions on topics generated by the group while removing all issues around an in-person meeting. By providing the group with “terms and conditions” relating to the privacy and professionalism expected in the group discussions and outlining the “permanent” nature of postings, Janet created a valuable and safe tool for participants to share their experiences and connect

with others in coping with the circumstances surrounding liver transplants. Serving as the group moderator, Janet leads by example in her interactions with group discussions by remaining neutral on “hot button” topics, while offering support to help patients cope with being ill. Janet says that “a virtual pat on the back goes a long way!” Janet also provides answers to general questions that relate to all members, thus allowing her to share with information with all group members with minimal effort. The role and use of social media is increasing within healthcare. UMMC now hosts eight Facebook groups for UMMC patients. As the use of social media becomes more enhanced, education regarding the safe, private, and effective use of this communication tool will be required. Janet and other clinical moderators at UMMC are well positioned to lead the way.

UMMC’s liver transplant patient group on Facebook offers many advantages over an in-person support group.

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“Janet created a forum for discussion that provided 24/7 access, and that facilitates group discussions on topics generated by the group while removing all issues around an in-person meeting.”

“UMMC now hosts eight Facebook groups for UMMC patients.”

UMMC, a leader in social media, now offers eight Facebook groups for patients.

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Nursing Scholarly Publications & Presentations Alton, S., Grau, D., MacHamer, J., Mayzel, M., & Shippen, C. (2012). Improving labor support for patients in an urban, academic medical center — an evidence based practice project. Abstract Association of Women’s Health, Obstetric and Neonatal Nurse Convention, Washington, DC. Retrieved from https://awhonn.confex.com/awhonn/2012/webprogram/Paper7682.html Armstrong, C., & DiBlasi, C. (2012). Improving the effectiveness of diabetes care visits through computer-assisted analysis of blood glucose readings. American Nurse Credentialing Center National Magnet Conference 2012, Los Angeles, CA. Retrieved from http://www. softconference.com/ancc/sessionDetail.asp?SID=290672 Bigelow, B., Channing, S., Hearson, L., Nguyen, T., Nickel, J., & Snow-Kaiser, K. (2013). Standardization of neurologic assessments for patients receiving high-dose Cytarabine. 38th Annual Oncology Nursing Society Congress, Washington, DC. Brumbles , D., & Meister, A. (2013). Psychiatric elopement: Using evidence to examine causative factors and preventative measures. Archives of Psychiatric Nursing, 27(1), 3-9. Retrieved from http://www.psychiatricnursing.org/article/S0883-9417(12)00129-X/ fulltext Brumbles, D., & Meister, A. (2011). Psychiatric elopement: Using evidenced based practice to examine causative factors and preventative measures. American Psychiatric Nurses Association 25th annual conference, Anaheim, CA. Retrieved from http://www.psychiatricnursing.org/article/S0883-9417(12)00129-X/fulltext Couchman, C., Mather, C., Salvato, C., & Spencer, M. (2013). Heart code 201: Taking your heart code to the next level. [https:// healthstream.webex.com/ec0606l/eventcenter/recording/recordAction.do?theAction=poprecord&AT=pb&renewticket=0&isurlact=t rue&recordID=18424642&apiname=lsr.php&rKey=b368454f77f03819%20&format=short&needFilter=false&&SP=EC&rID=1 8424642&siteurl=healthstream&actappname=ec0606l&actname=%2Feventcenter%2Fframe%2Fg.do&rnd=9782414785&entap pname=url0108l&entactname=%2FnbrRecordingURL.do]. Esoga, P., & Seidl, K. (2012). Best practices in orthopaedic inpatient care. Orthopaedic Nursing, 31(4), 236-240. doi: 10.1097/ NOR.0b013e31825dfe23 Faddoul, B.; Connerney, I.; Murphy, L.; Gottlieb J.; Rowen, L. (2012). Understanding the Second Victim: An Organizational Responsibility. University Healthcare Consortiums Annual Conference. Gent, P. (2013). The importance of screening for obstructive sleep for Obstructive Sleep Apnea (OSA). Society of Gastroenterology Nurses and Associates 40th Annual Course, Austin, TX. Retrieved from http://www.sgna.org/Events/2013AnnualCourse/PosterAbstracts.aspx Gent, P. (May, 2012). The importance of screening for obstructive sleep apnea (OSA) in the endoscopy suite. Student Graduate Nurses Association 39th Annual Course, Phoenix, AZ. Gent, P., Grasso, G. & Deli, S. (2012). Educational program for endoscopy nurses on obstructive sleep apnea. Student Graduate Nurses Association 39th Annual Course, Phoenix, AZ. Retrieved from http://www.csgna.org/news/2012_April_CSGNA.pdf Han, K., Trinkoff, A., Storr, C., Geiger-Brown, J., Johnson, K. (2012). Comparison of job stress and obesity in nurses with favorable and unfavorable work schedules. Journal of Occupational and Environmental Medicine, 54(8), 928-932. doi: 10.1097/ JOM.0b013e31825b1bfc Hanif, A., Johnson, V., Lewis, A., & Rosales, V. (March, 2012). Bedside blood glucose monitoring and coverage: When should insulin be given after blood glucose test? 2012 Nurse Resident Program Annual Meeting, Amelia Island, FL. Hastings, E., Hartman, A., & Rachbeisel, J. (2012). Integrating physical and mental health treatment in the seriously mentally ill population. Annual convention, Pittsburgh, PA. Huffines, M., Ralls, M & Calderon, D. (2012). To clot or not to clot: Demystifying the coagulation cascade. National Teaching Institute, Orlando, FL. James, T. (2012). An evidence based approach to minimizing oxygen injury in neonates. Nursing excellence through transformational leadership & innovation, Baltimore, MD. Joyell, A. (2011). Reducing health disparities in African — American communities. Association of Black Psychologists Conference, Arlington, VA.

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K. Kaiser, D. McGuire, K. Soeken, J. Reifsnyder, T. Keay (2011). Assessing pain in 321 nonresponsive hospice patients: Development and preliminary testing of the multidimensional 322 objective pain assessment tool (MOPAT). Journal of Palliative Medicine, 14(3):287-92. Lee, M., Johnson, K., Newhouse, R., & Warren, J. (2013). Evidence-based practice process quality assessment: EPQA guidelines. Worldviews on Evidence-based Nursing, 1-10. doi: DOI: 10.1111/j.1741-6787.2012.00264.x Lima, L. (2012, July). In Sara Levin, MSN, RN-BC (Chair). I have done the work how do I showcase it for professional advancement. National Nursing Staff Development Organization: Revolutionizing healthcare education, Boston, MA. Retrieved from http://c. ymcdn.com/sites/www.anpd.org/resource/resmgr/convention/nnsdo2012_advanceprogram_fin.pdf McFadden-Cain, J., Fenton, J., Pumfries, Y., Widmer, C., & Rodriguez, J. (2011). A nurse initiative to improve population health through timely colorectal cancer screening. 2011 American Nurses Credentialing Center National Magnet Conference , Los Angeles, CA. Retrieved from http://www.softconference.com/ancc/sessionDetail.asp?SID=245800 McGuire, D. B., Reifsnyder, J., Soeken, K., Kaiser, K. S., & Yeager, K. A. (2011). Assessing pain in nonresponsive hospice patients: Development and preliminary testing of the multidimensional objective pain assessment tool (MOPAT). Journal of Palliative Medicine, 14(3), 287-292. DOI: 10.1089/jpm.2010.0302 McQuillan, K. (2013, April). International nursing collaborative to reduce central line acquired blood stream infections. Society of Trauma Nurses 2013 Annual Conference, Las Vegas, NV. Retrieved from https://netforum.avectra.com/eWeb/DynamicPage.aspx?Site=STN &WebCode=EventDetail&evt_key=3fe5488a-d1ab-4391-a51e-6b06bb5fe253 McQuillan, K., Thurman, P., Von Rueden, K., McDavid, B., Gilmore, R., & Bayne, T. (2012). Impact of nursing council participation in reducing CLABSI. 2012 American National Credentialing Center National Magnet Conference, Los Angeles, CA. Retrieved from http://www.softconference.com/ancc/sessionDetail.asp?SID=291484 Moen, M. (2011). In B Smith (Chair). Post-graduate HIV-ID nursing education in Haiti: Immersion learning in high- and low-resource setting. 24th Annual Association of Nurses in AIDS Care Conference. doi: Baltimore, MD. Retrieved from http://anac2008.org/ anac2011/content/?presentation=210_moen Moen, M. (2011). In B Smith (Chair). Developing discharge coordinator nurse position for improved inpatient care of persons living with HIV: Collaboration between two urban teaching hospitals. 24th Annual Association of Nurses in AIDS Care Conference. doi: Baltimore, MD. Retrieved from http://www.nursesinaidscare.org/i4a/pages/index.cfm?pageid=4003 Nahm, E., Stevens, L., Scott, P. & Gorman, K. (2012). Effects of a web-based preoperative education program for patients undergoing ambulatory surgery: a preliminary study. Journal of Hospital Administration, 1(1), 21-29. doi: 10.5430/jha.v1n1p21 Nickel, J. (2013, April). Obtaining Tacrolimus levels through a central line vs. peripheral blood draw: An evidenced based review. Oncology nursing society 38th annual conference, Washington, DC. Noll, C. (2011). New graduates in psychiatric nursing: Establishing best practices from the start. American Psychiatric Nurses Association 25th Annual Conference, Anaheim, CA. Retrieved from http://www.meetingproceedings.com/2011/posters/apna/iewarning.asp Noll, C. (2012). Best practice by design: Anti barricade doors — inpatient psychiatry. American Psychiatric Nurses Association Annual Convention, Pittsburgh, PA. Noll, C. (2012). Safety, violence and recovery in the psych emergency department: Paradigm changes and the reduction of seclusion and restraint. American Psychiatric Nursing Association 26th Annual Conference, Pittsburgh, PA. Noll, C. (2013). Implementing a peer support program: Making the recovery model real, relevant and vibrant. American Psychiatric Nurses Association, 27th Annual Conference, San Antonio, TX. Page, J. (2012). Medical emergencies in inpatient psychiatry: Preparedness for best possible outcomes. American Psychiatric Nursing Association 26th Annual Conference, Pittsburgh, PA. Rowen, L. (2012). Childhood Obesity: A Call to Action through Collaboration. Bariatric Nursing and Surgical Patient Care 7(2) 45-47.

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Nursing Scholarly Publications & Presentations (continued) Rowen, L. (2013). The Ethics of Substance Abuse Among Nurses. Advanced Practice Nursing Grand Rounds, University of Maryland Medical Center, Baltimore, MD. Rowen, L. (2013). Disruptive Behavior in the Workplace, Keynote address for Nurses Week, UM St. Joseph Medical Center, Baltimore, MD. Rowen, L. (2013). The Ethics of Substance Abuse Among Nurses. Trends in Nursing Practice Annual Conference, Baltimore, MD. Rowen, L. (2013). Keynote address: Care Suffers when communication fails. First Annual Interprofessional Education Conference, UMB, Baltimore, MD. Rowen, L. (2013). Innovative use of Prezi for presentations. University of Maryland School of Nursing DNP Executive Track, Baltimore, MD. Rowen, L. (2013). Leadership to transform the culture. University of Maryland School of Nursing DNP Executive Track, Baltimore, MD. Rowen, L. (2013). Promoting Safety and Quality. Scottsdale Healthcare System, Scottsdale, AZ. Rowen, L. (2013). Transformational Leadership. Scottsdale Healthcare System, Scottsdale, AZ. Rowen, L. (2013). A Model for Advanced Practice Nursing. Scottsdale Healthcare System, Scottsdale, AZ. Rowen, L., & Facteau, L. (2013). Leadership from the Perspective of the Chief Nursing Officer. University of Virginia School of Nursing, Charlottesville, VA. Rowen, L. (2013). Serving in the Role of the Transformational Leader. Maryland Organization of Nurse Executives Conference, Baltimore, MD. Rowen, L. (2013). Co-worker Civility: How it affects safety, satisfaction and service. Special Topics in Pediatric Nursing, Baltimore, MD. Rowen, L., & Doyle, K. (2013). Can Structured Leadership Rounds Improve Patient Outcomes? American Organization of Nurse Executives Annual Conference, Denver, CO. Rowen, L., Hunt, D., & Johnson, K. (2012). Managing obese patients in the OR. OR Nurse, 6(2), 26-35. doi: 10.1097/01. ORN.0000412324.97287.aa Rowen, L., Seidl, K., Raymond, G., Hercenberg, R., & Cafeo, C. (2012). Can a brief intervention increase awareness of disruptive behavior in the workplace? 2012 American Nursing Credentialing Center National Magnet Conference, Los Angeles, CA. Retrieved from http://www.softconference.com/ancc/sessionDetail.asp?SID=291013 Royster, K. (2013, April). Developing, implementing, and evaluating a survivorship program that begins with diagnosis. Oncology Nursing Society 38th Annual Congress, Washington, DC. Sattler, B., Randall, K., & Choiniere, D. (2012). Reducing hazardous chemical exposures in the neonatal intensive care unit: A new role for nurses. Critical Care Nursing Quarterly, 35(1), 102-112. doi: 10.1097/CNQ.0b013e31823b2084 Scala, M., & Tran, K. (2012). Will the combination of a comprehensive isolation procedure and continued education improve nursing compliance with initiating isolation precautions from triage? Nurse residency program annual meeting, Amelia Island, FL. Retrieved from http://www.umm.edu/nursing/docs/spring-2012.pdf Seidl, K., & Newhouse, R. (2012). The intersection of evidence-based practice with 5 quality improvement methodologies. The Journal of Nursing Administration, 42(6), 299-304. doi: 10.1097/NNA.0b013e31824ccdc9 Smith, D. (2013, June). Holistic nursing leadership within an academic medical center: Launching a hospital-based AHNA chapter for education and support. American Holistic Nurses Association Conference, Norfolk, VA. Snow-Kaiser, K., Bennett, M., Bower, C., & Watson-Evans, S. (2012). Development & evolution of an evidence-based protocol nurse directed pain service. American Society for Pain Management Nursing Presentation, Baltimore, MD. Retrieved from http://www. aspmn.org/Conference/documents/330DevelopmentandEvolution_Kaiser.pdf

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Stanek, G., Mulligan, K., & Forsythe-Chisolm, L. (2012). The process of assessing and improving patient family centered care in the shock trauma center, University of Maryland Medical Center. 5th international conference on patient and family centered care, Washington, DC. Retrieved from http://www.ipfcc.org/events/dc12-brochure.pdf Stickles, M. (2012). Leveraging competencies to create a sustainable dedicated rapid response team. 7th International Conference on Rapid Response Systems and Medical Emergency Teams, Sydney, Australia. Retrieved from http://www.rapidresponsesystems.org/ sydney/program.pdf Tanguay, L., Dorsey, S., Couture, D., Renn, C., & Gambill, N. (2011). Bench to bedside: Current perception threshold testing (CPT) to measure sensory fiber changes after chemotherapy. Sigma Theta Tau International 41st Biennial Convention, Grapevine, TX. Retrieved from https://stti.confex.com/stti/bc41/webprogram/Paper49916.html Thurman, P., Gilmore, R., & McQuillan, K. (2012). Reducing catheter associated urinary tract infections: A nursing process improvement project. Nursing EBP Conference, Baltimore, MD. Retrieved from http://www.traumanurses.org/_resources/documents/ events/conference/STN_AC_12-Abstract_Syllabus.pdf Trotman, S., Han, N., & Lupisan, A. (2012). Nurse-led intervention to improve screening and treatment for substance abuse: An act of hospitals. Interdisciplinary Nursing Quality Research Initiative National Conference, Washington, DC. Retrieved from http://www. inqri.org/webinar/webinar-nurse-led-intervention-improve-screening-and-treatment-substance-abuse Von Rueden, K. (2013, April). Burnout, compassion fatigue, secondary traumatic stress: buzz words or the real deal? 16th Annual Society of Trauma Nurses Conference, Las Vegas, NV. Von Rueden, K., Doyle, K., Emerick, M., Joshi, M., McQuillan, K., Rabinowitz, R., Thurman, P. (2012). Delirium in trauma patients: Prevalence and predictors. American College of Surgeons 2012 Trauma Quality Improvement Program Annual Scientific Meeting, Philadelphia, PA. Retrieved from http://www.facs.org/trauma/ntdb/tqip-meeting.html Von Rueden, K., Thurman, P., Merenda, J., McQuillan, K., Wallizer, B., Blacklock, T., & Son, H. (2012). Delirium in trauma patients: Nurse-driven research and evidence-based guideline development. 2012 American Nurses Credentialing Center National Magnet Conference, Los Angeles, CA. Retrieved from http://www.softconference.com/ancc/sessionDetail.asp?SID=290978 Wall, M. (2013, April). Rapid improvement event in interventional radiology at the University of Maryland Medical Center. Association for Radiologic & Imaging Nursing 2013 Convention, New Orleans, LA. Retrieved from https://www.arinursing.org/2013convention/2013-convention-information.html Wallizer, B., McQuillan K., Thurman, P., Son, H., Blacklock, T., Merenda J., Hzke, S., & Dalendkoft, S. (2012). Delirium in trauma patients: Prevalence and predictors. National Teaching Institute & Critical Care Exposition, Orlando, FL. Retrieved from http://www.aacn.org/WD/NTI/NTI2012/docs/NTI_Program_Schedule_Booklet.pdf Wells, M. (2013). Elimination of immediate-use steam sterilization of radioactive seed implants. AORN Journal, 97(5), 515-520 515520. doi: 10.1016/j.aorn.2013.02.005 Wilson, T., Kaiser, K., McGuire, D., Pannullo, D., Russo, M., & Wiegand, D. (2012). Assessing acute pain in critically ill patients unable to communicate. National Teaching Institute and Critical Care Exposition , Orlando, FL. Witting, M., & Hydorn, S. (2013). Variation in orthostatic vital sign testing in an urban academic emergency department. Journal of Emergency Nursing, doi: pii: S0099-1767(12)00435-7. 10.1016/j.jen.2012.08.017 Woltz, P., Chapa, D., Friedmann, E., Son, H., Akintage, B. & Thomas, S., (2012). Effects of interventions on depression in heart failure: A systematic review. Heart & Lung, 41, 469-483. doi: 10.1016/j.hrtlng.2012.06.002 Yarbrough, K., Tuszynski, S., Bautista, M., & Blaber, B. (2013, February). Effectiveness in using a staff nurse coach for clinical trial implementation: A winning strategy. International Stroke Conference 2013, Honolulu, HI. Retrieved from http://stroke.ahajournals. org/cgi/content/meeting_abstract/44/2_MeetingAbstracts/ANS4

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Promotions to SCNI and SCNII Senior Clinical Nurse I Kelly Ables, BSN, RN Select Trauma Intermediate Care Margaret Aeschliman, BSN, RN Medical Intermediate Care Unit Tatiana Asuquo, RN General Operating Room Andrea Ball, RN, CCRN Trauma Resuscitation Unit Tonnette Branch, RN, CMSRN Medicine Telemetry Unit 13 East/West Jeff Broski, BSN, RN, CCRN Multi Trauma Critical Care Barbara Burns-McCoy, BS, RN, CNOR, RNFA STC Operating Room

Mari Shade, RN Multi Trauma Intermediate Care

Amanda Kelly, BSN, RN Medicine Telemetry Unit 13 East/West

Alison Shephard, BSN, RN STC Acute Care

Renee Kwok, RN, OCN Radiation Oncology

Kimberly Stago, MS, RN, CNL Cardiac Surgery Step-down Unit

Kathleen Lee, BSN, RN, CNOR STC Operating Room

Meghan Taneyhill, BSN, RN, PCCN Cardiac Progressive Care Unit

Laura Lunz, BSN, RN, OCN Radiation Oncology

Sonya Tanner, RN Medicine Telemetry Unit 10 East

Cheryll Mack, MPA, BSN, RN Adult Emergency Services

Courtney Turnbull, MS, RN Select Trauma Critical Care

Stacie Mann, RN, CCRN Multi Trauma Critical Care

Teresa Turska-Hughes, BSN, RN, CCRN Cardiac Surgery Intensive Care Unit

Sheila Marshall, RN Medical Intermediate Care Unit

Courtney Cioka, BSN, RN Select Trauma Intermediate Care

Kathryn Mello, RN, CMSRN Medicine Telemetry Unit 13 East/West

Catherine Dickel, RN, CNOR STC Operating Room

Christina Miller, BSN, RN Transplant Intermediate Care Unit

Cheryl Dodd, BSN, RN Medical Intensive Care Unit

Tiffanie Moran, BSN, RN, CCRN Medical Intensive Care Unit

Derek Eckenrode, BA, RN Medical Intermediate Care Unit

Jennifer Motley, BSN, RN Multi Trauma Intermediate Care

Kimberly Erwin, BSN, RN, CCRN, CPEN Maryland ExpressCare

Jane Munoz, RN, IBCLC Neonatal Intensive Care Unit

Nicole Fletcher, BSN, RN, CEN Adult Emergency Services Michele Frock, BSN, RN Medical Intermediate Care Unit Kristen George, MPH, RN, CNL Multi Trauma Critical Care Darlene Gray-Silver, BSN, RN Select Trauma Intermediate Care Megan Hansen, BSN, RN Pediatric Intensive Care Unit Elizabeth Henry, BSN, RN Electrophysiology Lab Stacy Hopkins, RN STC Acute Care

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Kate Keefer, BSN, RN Medicine Telemetry Unit 13 East/West

Virginia Nganga, BSN, RN Vascular Surgery Progressive Care Unit M. Tracey Penaloza, BSN, RN, CNOR General Operating Room Bobbie Perreault, RN Pediatric Intensive Care Unit Victoria Phelps, BSN, RN-BC Vascular Surgery Progressive Care Unit Kelly Powers, RN Cardiac Progressive Care Unit Melanie Priest, BSN, RN Interventional Radiology Kristen Rouse, BSN, RN STC Post Anesthesia Care Unit

Stacey Uddeme, RN, CPEN Pediatric Emergency Department Mary Caroline Weaver, MS, RN, CCRN Medical Intensive Care Unit Emily West, BSN, RN Multi Trauma Critical Care Sarah Woodring, BSN, RN Medical Intermediate Care Unit Tasha Zochert, RN, CCRN Select Trauma Critical Care Senior Clinical Nurse II Patricia Gent, MSN, RN, CCRN Endoscopy Victor Giustina, BS, BSN, RN, CLNC Trauma Resuscitation Unit Deborah Grau, MS,RNC-OB Labor & Delivery Shanna Hartman, BSN, RN STC Acute Care Lucy Miner, BSN, RN, PCCN Medical Surgical Administration Katrice Royster, MS, RN, OCN Hematology and Oncology Unit Katherine Vann, BSN, RN STC Acute Care

Elisa Jones, MS, RN, CNL Transplant Intermediate Care Unit

Cherry Joy Rumbaoa, BSN, RN, CMSRN Surgical Acute Care Unit

Latisha Jones, BSN, RN Medicine Telemetry Unit 11 East

Jessica Schneehagen, BSN, RN Medical Intermediate Care Unit

Breighanna Wallizer, BSN, RN, CCRN Multi Trauma Critical Care

Carla Kanaskie, BSN, RN Medical Intermediate Care Unit

Genna Sellers, BSN, RN Select Trauma Critical Care

Catherine Zei, BSN, RN, CCRN Medical Intermediate Care Unit

2013 UMMC N ur sin g A n n ua l R ep ort

Mary Patricia Wall, BSN, RN, CCRN Interventional Radiology

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