Welcome from Cheryl Reinking, CNO - El Camino Hospital · 2017-05-02 · 2017 El Camino Hospital...

©2017 El Camino Hospital E-2127_NursingAnnualReport_May17

www.elcaminohospital.org/NAR2017

Welcome to the 2017 Nursing Annual Report. I’m Cheryl Reinking, the Chief Nursing Officer at El Camino Hospital. This year we chose “collaboration” as our theme, inspired by the nurses and other members of our team working together. I’m going to showcase those for you today.

One of our most unique collaborations this past year occurred with the University of San Francisco graduate-level nursing students. The students, working with our Safe Patient Handling Committee, worked with Greg Guanlao from Rehabilitation Services and 4A Surgical Pediatrics nursing staff. They developed and piloted education for safe lifting and assessing patients’ mobility. We look forward to a research study in 2017 which will validate this new mobility assessment tool.

A strong collaboration was vital to the successful implementation of new assessment tools and physician order sets to manage patients with Alcohol Withdrawal Syndrome. The team included nurses, physicians and the information technology staff, working together on this enterprise initiative.

Welcome from Cheryl Reinking, CNOA new team was developed this year to focus on improvement of pain management for our patients. Nursing, pharmacy, informatics staff, and a member of our community meet weekly to develop methods to improve pain management. Their work has yielded a 30% increase in compliance with pain reassessment documentation.

Finally, this past December we accepted nominations for our Inaugural Teamwork in Action Award. With 11 nominations received, it was difficult to select just one winner. In the end, the Pressure Injury Prevention and Skin Care Committee was named the winner for their on-going dedication to improving patient care. The team is led by our Wound and Ostomy Certified Nurses and includes representation from direct care clinical nurses, dietitians, Purchasing, and Central Supply. This intraprofessional team has led to sustained improvement in reportable Hospital Acquired Pressure Injuries.

Because we empower our nurses and clinicians, we are able to provide excellent patient and family centered care. I look forward to seeing what we can do together to achieve positive patient outcomes.

NURSING ANNUAL REPORT 2017 Empowering Excellence Through Collaboration

The Magnet Recognition Program is managed by the American Nurses Credentialing Center (ANCC) throughout the United States and the world. El Camino Hospital has a long history of Magnet Recognition, dating back to 1991 as one of the original 41 Magnet Hospitals, designated after a nationwide study.

We renewed our commitment to the Magnet Journey in the early 2000s, and in 2005 became the first Bay Area Magnet Hospital. We received our second designation in 2010. In June 2015, we became a part of an elite group of just over 100 hospitals to receive a third designation. This designation would not have been possible without the hard work of the Magnet Committee and every nurse at El Camino Hospital as well as the support of all employees.

Magnet Committee MessageLETTER

Magnet Committee MessageCOMMITTEE MEMBERS

Jennifer Borrelli, RN

Jody Charles, RN

Pamela Fiehmann, RN

Bonnie Gebhart, RN

Monica Hite, RN

Sherrie Karleskind, RN

Jackie Keane, RN

Athena Lendvay, RN

Vivian Low, RN

Kelsey Martinez, MPA

Audrey Prairo, RN

Cheryl Reinking, RN

Chris Tarver, RN

Catharine Walke, RN

Magnet Committee

The Magnet Model consists of Five Model Elements which provide a framework for practice. Within this report, you will find nursing highlights for each Model Element:

• Transformational Leadership

• Structural Empowerment

• Exemplary Professional Practice

• New Knowledge, Innovation & Improvements

• Empirical Outcomes

The Magnet Committee is proud to honor our nurses and the excellence they have achieved. This was reflected in our Magnet Documentation and Site Visit, and is also reflected in this 2017 Nursing Annual Report. Please enjoy exploring this site and join us in celebrating nursing at El Camino Hospital!

– Magnet Committee


Research

The Effect of Music Intervention on CAM Scores in Hospitalized Older Adults Experiencing Delirium by Mae Dizon, NP

Nursing Knowledge and Perceived Competence Regarding Inpatient Diabetes Management by Jennifer Meaney, RN

Chemotherapy Induced Peripheral Neuropathy (CIPN): Assessment of Oncology Nurses’ Knowledge and Practice by Kathleen Hall, RN

Counting Sheep, A Good Night’s Sleep: Mindfulness in Noise Reduction Strategies to Improve the Quietness of the Care Environment by Jessiree Primitivo, RN


As an independent, nonprofit community hospital with campuses in Mountain View and Los Gatos, El Camino Hospital takes a dynamic approach to healthcare and is redefining what it means to be a community hospital. Combining the latest thinking, treatments and technology, we bring passion to our work and deliver care in the most personal way possible. Our team is driven to create programs and services that never existed before to meet the unique challenges people sometimes face. Our medical specialties include cancer care, heart and vascular services, mental health and addictions, men’s health, orthopedics, rehabilitation services, senior health, spine surgery, urology, and women’s health including mother-baby care.

Organizational OverviewABOUT EL CAMINO HOSPITAL

El Camino Hospital, Mountain View

El Camino Hospital, Los Gatos

Nurses worked side by side with IT clinical analysts and report writers to improve the pain reassessment documentation method. This work included development of a column on the Epic Patient List and audit reports to monitor progress.

Transformational LeadershipPAIN MANAGEMENT REASSESSMENT

Aletha Santos, RN, discusses patient care need with Jonathan Johansen, Pharm D

The process of documenting the reassessment of pain improved greatly by the end of 2016 through a collaborative effort spearheaded by an intraprofessional “A3” team.

Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar 15 15 16 16 16 16 16 16 16 16 16 16 16 16 17 17 17

0%

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A3 teamkick off

meeting

Final testingof new design

for nursingdocumentation

Roll out of new

workflow

Percent Pain Reassessment Documented 5-60 Minutes After PRN Pain Medication Administered

New electronichealth recordimplemented


Pam Coye, RN and Therapist Angela Player co-teach the pre-op Spine Class.

In 2016, El Camino Hospital took its first solid steps to improve care of our diabetic patients treated with subcutaneous insulin. Jenn Meaney, RN, Medical Services applied for the Diana K. Russell Leadership grant in order to study nurses’ knowledge regarding diabetic care. Jenn teamed with our Diabetic Educator Beya Sioson, RN and dietitian Mary Dierdre Martin to team teach classes on diabetes management for our staff. In 2017, we look forward to implementation of insulin basal-nutritional-correctional method of diabetes management.

Transformational LeadershipDIANA K. RUSSELL LEADERSHIP GRANT

Jenn Meaney, RN and Diabetes Educator Beya Sioson teach staff regarding diabetes management.

Transformational LeadershipORTHOPEDIC JOINT COMMISSION CERTIFICATIONS

Led by our Orthopedic Surgery Program Coordinators Pam Coye, RN and Debbie Smyth, RN, our nursing staff, rehabilitation therapists, orthopedic and neurologic surgeons united to support a successful four-day recertification survey in Summer 2016. The result was recertification for six programs: Total Hip Replacement and Total Knee Replacement at both campuses, Hip Fracture Surgery at the Mountain View campus and Spine Surgery at the Los Gatos campus.


Structural EmpowermentMEDICAL SURGICAL ONSITE REVIEW COURSE

22014

New Medical Surgical Certifications

12015

92016

Grace Nabas, RN, Educator and Mae Dizon, NICHE NP wanted to continue their 2015 efforts to bring certification review courses onsite. The two designed a survey for nurses to find out the top two certifications that the nurses wished to obtain, thereby guiding which review courses to offer. The survey revealed that Medical-Surgical and PCCN/CCRN were the top two certification choices. It became the first time a Medical-Surgical review course was held at El Camino Hospital. The result was nine new certified nurses within six weeks of the conclusion of the course!

Structural EmpowermentNEW CERTIFICATIONS 2016

• 42% of all El Camino Hospital nurses are certified RNs

• Units/departments with 100% certified RNs: Lactation Services and NICU, Los Gatos

• 46 different certifications are held by El Camino Hospital RNs

486 Certified NursesTop three units with most certified nurses by campus*

Mother-Baby Unit: 48 Labor & Delivery: 16

Labor & Delivery: 43 Emergency Department: 15

Critical Care Unit: 39 Intensive Care Unit: 13

*As of December 31, 2016

Mountain View Los Gatos

2016 Certification Facts

New CGRNs in 2016: Endoscopy nurses Berit Marcum and Patrick Kelly


Structural EmpowermentNEW NURSING DEGREES 2016

New BSN Degrees 2016

Patti Lanet, RN, Medical Services Thelma Bazil Thomas, RN, Medical Services

New MSN/Doctorate Degrees 2016

Sara Bahl, RN, Patient Care Resources Yenari Chung, RN, MBU Pamela Fiehmann, RN, ICU Alison Gorman, RN, L&D Jessiree Primitivo, RN, PCR Jane Truscott, RN, Clinical Effectiveness Kirsten Zimbelman, RN, L&D

Doctorate of Nursing Practice

Mae Dizon, NP, NICHE Geriatric NP Veronica Palustra, RN, Emergency Department

2C Medical Services nurse Thelma Bazil-Thomas was thrilled to earn her BSN.


Structural Empowerment

NEW CERTIFICATIONS 2016 Congratulations to all our certified nurses! Below is a partial list of new certifications achieved in 2016.

Case ManagementMarianne Zavareh, RN,

Care Coordination

CENDahlia Said, RN, ED

CGRNPatrick Kelly, RN, EndoscopyBerit Marcum, RN, Endoscopy

Certified Lactation CounselorMaria DeJose, RN, MBUPauline Li, RN, MBU

Certified Lactation EducatorMichelle Fithian, RN, MBUKohar Kourouyan, RN, MBUJenny Wan, RN, MBUJinghua Zhang, RN, MBU

CNORDeborah Pilger, RN, OR

CRRNAngela Fraser, RN, Inpatient

Acute Rehabilitation

CPANPepito Arendela, RN, PACUIlana Fishkov, RN, PACUMichele Guzman, RN, PACULori Story, RN, PACU

External Fetal MonitoringAllison Gorman, RN, L&D

Inpatient OBMichele Barroso, RN, L&DMelissa Keim, RN, L&DYvonne Longobardy, RN, L&DKira Maximovich, RN, L&DYessica Riles, RN, L&DAugust Rodiack, RN, L&DBelinda Takahama, RN, L&DDebra Terry, RN, L&DLisa Wagner, RN, L&D

Lactation Educator CounselorCielo Demesa-Virola, RN, MBUTanti Usong, RN, MBU

Maternal Newborn CertificationCyndi Gyugyi, RN, MBUMarcia Meijaard, RN,

Patient Care ResourcesKirsten Zimbelman, RN, L&D

Medical-Surgical NursingCorry Alvarez, RN, Surgical &

Pediatric ServicesMay Balmonte, RN, Surgical &

Pediatric ServicesJudy Chan Huang, RN, Surgical &

Pediatric ServicesMelissa DeLeon, RN, Surgical &

Pediatric ServicesAmy Duke, RN, Medical ServicesJudy Li, RN, Surgical & Pediatric ServicesErik Lumbert, RN, Surgical &

Pediatric ServicesJulia Navero, RN, Telemetry/StrokeJennifer Straight, RN, Surgical &

Pediatric Services

Neonatal Intensive Care CertificationRebekah Babcock, RN, NICUClaire Hoff, RN, NICUTerri Muench, RN, NICULeia Posas, RN, NICU

Nurse Executive AdvancedMeriam Signo, Medical Services

Oncology Certified NurseSharon Struna, RN, Radiation Oncology

Pain ManagementJudy Moreno, RN, PACU

PCCNEbony Boles, RN, Telemetry/Stroke Julissa Coss, RN, Cardiac Cath LabVictavian Jackson, RN, Patient Care

ResourcesEunissa Kang, RN, TelemetryCindy O’Connor, RN, Telemetry/StrokeAngelina Restijo, RN, Telemetry/StrokeGina Sobetado, RN, Telemetry

Psychiatric/Mental Health CertificationDapinder Kaur, RN, BHS

Radiology Nurse CertificateNancy Parsin, RN, Radiation OncologyJeanne Stark, RN, Radiation Oncology


Exemplary Professional PracticeCARING NURSE AWARD

Caring Nurse Award Winner: Sherrie Karleskind Sherrie has been an exemplary clinical nurse on the Mother-Baby Unit and has been instrumental in improvement efforts for all of our patients, including:

• Leading a team of bedside nurses in the lean project for timely discharge

• Developing an in-room checklist for new parents which illustrates what to expect for their new baby from the time they arrive from Labor & Delivery to discharge

• Participating in a taskforce that examined how to create a successful breastfeeding experience and advocate for additional lactation support for our new moms

• Meeting with the lead Lactation Consultant and Chief of Pediatrics to discuss offering the right instruction at the right time so moms can nourish their babies the best way possible

• Becoming an expert in Epic to support her colleagues

• Being an active member of the Peer Review Committee and the Magnet Committee who reminds co-workers how to have crucial conversations

• Being one of the first nurses to achieve the Certification as a Maternal Newborn Specialist and mentoring others in this certification

Caring Nurse Award Winner Sherrie Karleskind, BSN, RN-BC


Exemplary Professional PracticeCLABSI

“Give Our Babies a Hand” Campaign Sustains Zero Harm Formed in May 2013, a new committee outlined NICU best practice measures to prevent Central Line Associated Blood Stream Infections (CLABSI). After a staff in-service, the workflow evolved to standard practice starting in July 2013 and the “Give Our Babies a Hand” campaign was underway. The campaign included guidelines for staff and visitors such as enforcing the use of instant surgical hand antiseptics for all visitors and limiting unnecessary traffic through the unit.

Additional guidelines included:

• No jewelry or long sleeves below the elbows

• No artificial nails

• No use of electronic personal devices

• Sterile technique for central line tubing changes

• Standardized practice for central line dressing changes

The campaign was shared with families to ensure a total cultural environmental change. A pledge was created for all staff to sign, and informational memos were shared hospital-wide. Using the principles of peer review, staff audits were conducted to maintain compliance.

NICU nurses take extra care with our neonates who have central lines in place.

• There has been no incidence of CLABSI in the NICU since August 2013

• Peer review of the practice changes implemented deemed them successful with audits showing 99.5% compliance with the central line sterile tubing change procedure

• After the implementation of the “Give Our Babies a Hand” campaign, hand hygiene compliance remains steady at 98%

02014

No Incidence of CLABSI in NICU for 3 years

02015

02016


Exemplary Professional PracticePROFESSIONAL PRACTICE MODEL

El Camino Hospital’s nursing Professional Practice Model (PPM) emphasizes the patient being at the center of all care. Words chosen by nurses to reflect their professional practice - Caring and Family - spiral outward from the patient. Excellence refers to the goal to deliver the highest quality care to patients. Next, Community represents the hospital’s history as a community-built organization and its future: broadening delivery of care across the continuum and into the community. Next in the outward spiral is Compassion: a word nurses often use to describe how they and their colleagues deliver care. Science and Innovation reflect our legacy as the first hospital in the world to implement an Electronic Medical Record in 1971, and the current strong support of Nursing Innovation through the Nursing Research Council. Patient Care Team captures the collaborative nature of care at El Camino Hospital. Four key aspects of care enclose the labyrinth: Preventative, Restorative, Psychological-Spiritual, and Growth-Collaboration-Education.

Nursing Professional Practice Model

New Knowledge, Innovation & ImprovementsSIMULATION

OB Simulation Improves Patient Care

A team of RNs and OB hospitalists designed and implemented OB simulations for Labor & Delivery. One round of training was a uterine rupture scenario in a TOLAC (trial of labor after cesarean) patient. Behavioral criteria included early identification of rupture, quick transfer to the L&D operating room, and assembly of all needed staff for the emergency surgery. Included in the scenario was an introduction to a new “code cesarean alert”. In the first sim session, it was determined that the new alert was not working, as the medical providers (OB and anesthesiologist) were not receiving the page. It was determined that a PDSA (plan-do-study-adjust) cycle was needed to address implementation of the alert. Subsequent OB Sim sessions were used to test the changes. RN team members partnered with the nurse manager and hospital operators to identify

An essential component to improve practice are simulations of a “crash c-section”.

paging problems which were solved by providers receiving the direct page and/or overhead page, thereby assuring the entire team would assemble for the patient in crisis.


New Knowledge, Innovation & ImprovementsSAFE PATIENT HANDLING

Graduate Nursing Students, Physical Therapy and Nursing Team Partner to Improve Safe Patient Handling and Trial Mobility Assessment Tool

In a unique collaboration, students from USF School of Nursing have partnered with El Camino Hospital physical therapists and key members of the Safe Patient Handling Committee to develop a program to meet regulations set forth in OSHA’s Musculoskeletal Injury Prevention Program.

The students worked with staff to develop educational materials, door and room signage, badge buddies, and teaching tools, all in an effort to increase use of safe patient handling equipment and to disseminate usage of the Patient Mobility Assessment Tool (PMAT), adapted from Banner Health’s tool. El Camino Hospital will conduct a research study in 2017 to look at the effectiveness of this new tool.

University of San Francisco nursing students, along with nurses and therapists, trained staff on use of safe handling equipment.


New Knowledge, Innovation & ImprovementsBEHAVIORAL HEALTH SERVICES

The inpatient and outpatient BHS staff work with their physician to make a plan for patient’s transition to outpatient treatment.

Behavioral Health Services (BHS) Guesting Program

Approximately 40% of BHS inpatients are transitioned into BHS outpatient programs. Inpatients have the ability to “guest” (trial) the outpatient program while still admitted, thereby allowing the staff and patients to decide whether or not it’s a good fit. With the growth of the outpatient programs, it became more difficult to coordinate “guesting”. This impacted patient and staff satisfaction, length of stay, and productivity. Thus, BHS formed a task force which included the inpatient clinical manager, inpatient charge nurses and social workers, outpatient manager, outpatient program therapists, and BHS psychiatrist. The task force discussed barriers, and then developed standard of work for each discipline.

A new, shared document, the Inpatient Outpatient Guesting Form (IOGF), was developed. During set times throughout the day, the outpatient staff reviews referrals and enters the time of guesting into the IOGF. The inpatient social worker and charge nurse check the IOGF, confirm the time of guesting, and ensure that the patient is notified and escorted to the outpatient group. At the end of the guesting day, the outpatient staff enters a note on the patient’s progress and also provides a discharge appointment into the program as appropriate.

This standard workflow has improved satisfaction and increased the number of patients able to “guest” outpatient programs.


Empirical Quality OutcomesPIPSC

Marissa Szyslowski, WOCN, teaches ICU staff how to protect patients’ skin.

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5

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FY 2011 FY 2012 FY 2013 FY 2014 FY 2015 FY 2016 FY 2017

626 days withouta reportable HAPI

Reportable HAPIs Enterprise

First Winner of the New El Camino Hospital Teamwork in Action Award

The Pressure Injury Prevention and Skin Care Committee (PIPSC) was selected for the inaugural Teamwork in Action award due to the intraprofessional collaboration that has led to reduction of Stage 3 and Stage 4 Hospital Acquired Pressure Injuries (HAPIs) from a high of 25 annually to 0-2 annually for the last three years, representing an organizational commitment. Led by a dedicated group of individuals, prevention of HAPIs has risen to the level of “hard wired” operationalization. The commitment to Evidence Based Practice and the partnerships with so many departments and fellow committees has helped us achieve this outcome.

Highlights in 2016:

• Education for CNAs on HAPI prevention was conducted in April 2016

• “Guideline for Prevention of Medical Device Related HAPIs” was developed and distributed

• Specialty mattresses were trialed and a new product was selected

• Education on pressure ulcer prevention occurred at the annual Elder Summit — reaching staff and community members

• One focus of 2016 was preventing medical device related injuries including nasal bridge injuries from respiratory equipment.


Empirical Quality OutcomesAWS

Collaborative Team Sets New Standard for Treating Alcohol Withdrawal Syndrome

Led by Clinical Manager Kyle Daniels, a team of nurses, physicians, risk management and IT staff worked

Michael Montgomery, RN assesses an ED patient using the CIWA scale.

diligently to adopt and implement a new screening tool for alcoholism, a new tool for ongoing assessment of alcohol withdrawal (CIWA), and a new order set for treatment of alcohol withdrawal. Implemented in the summer of 2016, preliminary results demonstrate improvements:

19.3% Pre-CIWA-Ar screening tool (OLD AWS protocol/order sets)16.7% Post-CWIA-Ar screening tool (NEW protocol/order sets)

27.14% Pre-CIWA23.61% Post-CIWA

17.62% Pre-CIWA12.50% Post-CIWA

2.6%IMPROVEMENT

3.53%IMPROVEMENT

5.12%IMPROVEMENT

Percent of Patients with CCU Stay

Percent of Patients with a Sitter

Percent of Patients with Restraints

Empirical Quality OutcomesBABY FRIENDLY

Baby Friendly Designation Site Survey — One Step Closer

In December 2016, culminating years of work and collaboration between nurses, lactation consultants and physicians, the Mother-Baby, L&D and NICU units at the Los Gatos campus welcomed surveyors for the Baby Friendly designation. A site survey can only be granted if the outcomes for breastfeeding and infant care are the highest possible. Three outstanding items are being reviewed/updated, and then we anticipate “Baby Friendly” designation will be achieved. If designation is granted, the Los Gatos campus will be the first Baby Friendly designated organization in the Bay Area.Olga Dzhulay, RN supports a new mother and infant in

skin-to-skin bonding.

Welcome from Cheryl Reinking, CNO - El Camino Hospital · 2017-05-02 · 2017 El Camino Hospital...

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