Making nursing remarkable
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Making nursing remarkable 2014 nursing annual report Novant Health Prince William Medical Center Table of Contents Table of contents Welcome from Bebe Holt, RN 3 Novant Health northern Virginia market chief nursing officer and Novant Health Prince William Medical Center chief operating officer 2014 nursing vision 4 2014 hospital statistics 5 2014 nursing goals 5 Magnet 6 Journey to Magnet 7 Transformational leadership 8 Structural empowerment 11 Celebrating nursing excellence 14 Nursing clinical ladder 16 Circle of Excellence 17 Nursing shared governance 17 Commitment to our community 19 Heart of caring 22 Exemplary professional practice 23 Novant Health nursing professional practice model 26 New knowledge, innovations and improvements 27 Empirical outcomes 28 Closing from Polly Roush, RN 32 Novant Health Prince William Medical Center senior director of nursing 2014 nursing annual report • 3 Welcome from Bebe Holt, RN Colleagues, Bebe Holt, RN Reflecting on the many achievements of nursing in 2014 is a time to celebrate with our nursing teams. The many accomplishments and recognitions noted in the nursing annual report will make you proud to be part of the NH Prince William Medical Center Nursing team. The annual report is a celebration of your dedication to our patients, your focus on safety and pursuit of excellence. 2014 was an exciting and challenging year as we saw change in many areas with a focus on adoption of new care models. In addition, we continued to prepare for our facility tri-­‐annual Joint Commission and Disease Specific surveys all the time maintaining quality scores with central lines, core measures and ventilator-­‐associated p neumonia (VAP). Because of your commitment to our patients and excellence we have continued to improve process and programs ensuring we are providing a remarkable experience for our patients. Our focus continues to move forward with goals of increasing the nurses’ time at the bedside and constantly evaluating how we have our nurses working at the top of their license. As healthcare reform continues to move forward, it is exciting to be part of a team that is focused on improving patient outcomes, participating in research, seeking best practice and strengthening our shared governance councils. It is exciting to be part of these changes as we move forward in this uncertain healthcare environment. As you read and share the accomplishments listed in our annual report, let’s pause for a moment and recognize each of our nursing colleagues for their commitment to the team. Thank you for your relentless focus on the remarkable p atient experience. It is an h onor to be a part of this great team. Sincerely, Bebe Holt, MSN, RN, MHA, NEA-­‐BC Chief Operating Officer Novant Health Prince William M edical Center Chief Nursing Officer Northern Virginia Market 2014 nursing annual report • 4 Novant Health nursing vision Novant Health nursing will be a world-class driving force for transformational change through a patient-centered evidence-based approach to care in an authentic, collaborative and healing environment. 2014 nursing annual report • 5 2014 hospital statistics Novant Health Prince William Medical Center Discharged 8,202 patients. Had 31,598 patient days. Delivered 1,687 babies. Treated 56,115 emergency department patients. Performed 3,977 surgeries. 2014 nursing goals Transform clinical care to deliver on our promise of the remarkable patient experience. Retain and develop staff at the bedside to support the advancement into leader roles for those who are capable and desire it. Enhance competency to adapt and drive transformational change. Accelerate the adoption of a nursing foundation comprised of nursing theory, Novant Health professional practice model and a shared governance model to elevate nursing best practice throughout Novant Health. Optimize nursing efficiency across Novant Health. 2014 nursing annual report • 6 Magnet These five Magnet components are central to excellent patient care. Novant Health facilities have a long history of quality and performance improvement initiatives. The five Magnet components include: ! ! ! ! ! Transformational Leadership Structural Empowerment Exemplary Professional Practice New Knowledge, Innovation & Improvements Empirical Quality Results The Magnet Recognition Program was developed by the American Nurses Credentialing Center (ANCC) to recognize healthcare organizations that provide nursing excellence. The program also provides a vehicle for disseminating successful nursing practices and strategies. Recognizing quality patient care, nursing excellence and innovations in professional nursing practice, the Magnet Recognition Program provides consumers with the ultimate benchmark to measure the quality of care that they can expect to receive. Nurses consider Magnet designation as the gold standard when looking for a practice environment where autonomy, control over practice and professional development are emphasized. Hospital benefits from receiving the Magnet designation: ! ! ! ! Attract and retain top talent Improved patient care, safety and satisfaction Foster a collaborative culture Advance nursing standards and practice The Magnet Vision Magnet organizations will serve as the fount of knowledge and expertise for the delivery of nursing care globally. They will be solidly grounded in core Magnet principles, flexible, and constantly striving for discovery and innovation. They will lead the reformation of health care; the discipline of nursing; and care of the patient, family and community. – The Commission on Magnet Recognition, 2008 2014 nursing annual report • 7 Journey to Magnet Novant health Prince William Medical Center’s Magnet Journey officially began in 2011 under the guidance of Polly Roush, Senior Director of Nursing, with the formation of the Magnet Steering Committee. This team participated in a gap analysis to understand our strengths, weaknesses and areas for improvement. November 20th, 2013 Novant Prince William Medical Center received notification that our application filed with the American Nurses Credentialing Center had been accepted. The acceptance of our application began the NHPWMC Magnet team’s journey to capture our nursing excellence story in a document. February 2nd, 2015, our Magnet document is due to be submitted to the American Nurses Credentialing Center. 2014 nursing annual report • 8 Transformational leadership Represented by the RED oval in the Magnet Model, Transformational leadership requires vision, influence, clinical knowledge, and a strong expertise relating to professional nursing practice. It also acknowledges that transformation may create turbulence and involve atypical approaches to solutions. One example of Novant Health Prince William Medical Center Transformational leadership Magnet Standard: TL 3EO -­‐ Advocacy and Influence The CNO influences organization-­‐wide change beyond the scope of nursing. Background Transformational Leadership Professional certifications illustrate achievement in specialized knowledge, skills and abilities against national standards. Third quarter 2012, Beatrice Holt, MSN, RN, NEA-­‐BC, CNO identified a barrier in staff advancement towards professional certification at Novant Health Prince William Medical Center (NHPWMC). Staffs reported they were unable to afford the costs associated with professional certification and recertification. Understanding the importance of professional certification, Bebe advocated for staff by approaching the Medical Staff and Foundation and asked for support in developing a fund to decrease the financial burden for all hospital disciplines seeking certification. Description of the Intervention Supported by funding from the Medical Staff and Foundation at NHPWMC, Bebe championed the implementation a new policy at NHPWMC: The Professional Development Fund (PWMC/HAMC-­‐LD-­‐AD-­‐005). Effective July 15, 2013, the Professional Development Fund encourages professional growth and development of all hospital disciplines by providing financial reimbursement to achieve national certification. 2014 nursing annual report • 9 Evidenced by Bebe’s support of lifelong learning, the professional development fund originated with a generous grant from the NHPWMC Medical Staff of $50,000.00. The Medical staff donation clearly demonstrates the staff support in all disciplines certification and continued professional growth. Bebe’s commitment to national certification is contagious, and through her leadership, leaders in all disciplines are more focused on professional development and supporting educational advancement and our culture of lifelong learning in Novant Health. Staff Eligibility The Professional Development Fund Committee determines staff eligibility according to the following requirements ! Eligible staff must meet the requirements of working at NHPWMC for one year prior to certification or recertification ! Must be a part time or full time staff member receiving benefits without disciplinary actions in the previous twelve months ! Must not be receiving any other reimbursement for certification The process to access the Professional Development Fund is without barriers. The process includes: ! Take the desired nationally recognized specialty certification or recertification exam o Certifications -­‐ For a certification to be considered eligible for the reward it must follow the following criteria: ! Must be conferred by an accrediting body such as ANCC for nursing certifications ! Must be a National Professional Certification in Specific Area of Practice (Examples include all areas of clinical practice: Nursing, Radiology, Rehab, Laboratory, Respiratory) include current credentials card with application ! Upon confirmation of exam passage, complete the application found online ! Provide a copy of the original receipt stating the cost of the exam, preparation course and study materials to your manager ! Submission for reimbursement form will then be completed by your manager ! Applications are reviewed by the Professional Development Fund Committee on a monthly basis to confirm or deny the request ! Staff will receive a letter within 30 days to notify application approval or denial ! Reimbursement will be paid out within 60 days of receipt of the application 2014 nursing annual report • 10 The manager will complete the submission for reimbursement, providing up to $750.00 per calendar year for the costs of an initial certification and up to $350.00 per calendar year for an existing certification renewal. Participants The Professional Development Fund Committee meets monthly to determine appropriateness of applications review applications, and determine reimbursements. The NHPWMC Foundation is responsible for maintaining records for the Professional Development Fund application requests, approvals, and financial disbursements for staff. Programs reports are provided to the Executive Team Leaders by the Executive Team Member residing on the committee. The Professional Development Fund Committee members include: ! At least 1 Nursing Manager or Director ! At least 1 Manager or Director from clinical areas (Radiology, Rehab, Lab) ! An Executive Team Member (Human Resources, Senior Leadership) ! Foundation Director Outcomes In the first six months following policy approval, eleven staff members had obtained national certification utilizing the Professional Development Fund. With the elimination of financial barriers to national certification, NHPWMC staffs are excited and encouraged to pursue continuing education and professional milestones. 2014 nursing annual report • 11 July 20 Structural empowerment Represented by the Green oval in the Magnet Model, Structural Empowerment requires that solid structures and processes are developed by influential leadership who provide an innovative environment where strong professional practice flourishes and where the mission, vision and values come to life to achieve the outcomes believed to be important for the organization. Professional Nursing Certification Recognizing our nationally certified nurses Certification in Critical Care Nursing (CCRN) Julia Burgess, RN Rene Ernest, RN Jan Griffin, RN Sarah Herbert, RN Katie Hoffman, RN Oi-­‐Mei Yau, RN Alicia Marie Ruiz, RN Carlos Bernal, RN Deana Coy, RN Jacinta Gomes, RN Donna Rea, RN Jamie Stern, RN Umu Benjamin, RN Cardiac Medicine Certification (CMC) Julia Burgess, RN Certified Nurse, Operating Room (CNOR) Kathleen Abromavich, RN Ancy Kulakkattolickal, RN Oakjoo Lee, RN Amelia Atwell, RN Linda Stohon, RN Mar Tortajada, RN Structural Empowerment Certification in Emergency Nursing (CEN) Debra Oakes, RN Joanne Broomer, RN Melissa Morin, RN Tricia Sutherland, RN Christel McGovern, RN Victoria Scott, RN 2014 nursing annual report • 12 Certified Pediatric Nurse (CPN) Jeanie Barlow, RN LeeAnne Green, RN Dawn Harris, RN Illana Naylor, RN Dolores Torres, RN Jessy Tramontana, RN Carin Ashbrook, RN Kathy Stevens, RN Oncology Certified Nurse (OCN) Certified Nurse Executive, Advanced (NEA-­‐BC) Certified in Neonatal Intensive Care (RNC-­‐NIC) Beatrice Holt, RN Eileen Caulfield, RN Maryann Savage, RN Patricia Irvin, RN Kadi Kanu, RN Schelly Harrison, RN Jan Griffin, RN Stephanie Fournier, RN Kim Gibbs, RN Certified Medical-­‐ Surgical Registered Nurse (CMS-­‐RN) Gail Behrle, RN Christine Keaveny, RN Jillian Powers, RN Sally Randall, RN Orthopedic Nurse Certification (ONC) Certification in Inpatient Obstetric Nursing (RNC-­‐ OB) Theresa Alicea, RN Claudia Barnish, RN Marylou Soto, RN Jan Dagenhart, RN Leann McMullen, RN Christen Grimes, RN Susan Coxson, RN Certified Post Anesthesia Nurse (CPAN) Brenda Primus, RN Mary Pat Blanchette, RN Cheryl Philistin, RN Certified Gastrointestinal Registered Nurse (CGRN) Progressive Care Certified Nurse (PCCN) Adult Care Nurse Practitioner (ACNP-­‐BC) Jan Griffin, RN Michele Dominguez, RN Adult Clinical Nurse Specialist (ACNS-­‐BC) Mark Rubin, RN Julia Burgess, RN Certified in Low Risk Neonatal Nursing (RNC-­‐LRN) Psychiatric & Mental Health Clinical Nurse Specialist (PMHCNS-­‐BC) Leeann Brown, RN Michelle Curran, RN Patricia Irvin, RN Judy Jenkins, RN Shanna Leary, RN Constance Rickerson, RN Sheryl Roloff, RN Lisa Whitmer, RN Carrie Banks, RN Susan Campbell, RN 2014 nursing annual report • 13 Adult Nurse Practitioner (ANP-­‐BC) Legal Nurse Consultant Certified (LNCC) Rene Ernest, RN Tina Stoernell, RN Michele Poblador, RN Lily Batayola, RN Betty Wood, RN Miriana Gomez, RN Certification in Nursing Professional Development (RN-­‐BC) Certified Case Manager (CCM) Certified Wound and Ostomy Nurse (WOCN) Tracy Fields, RN International Board Certified Lactation Consultant (IBCLC) Teresa Baltuano-­‐Post, RN Rosemary Wlaschin, RN Gigi Dann, RN Sharon Gough, RN Monica S. Noonan, RN Susan Wolfe, RN Certified Diabetes Educator (CDE) Linda G.McMillan, RN Jane C. Suliga, RN Certified Hospice and Palliative Nurse (CHPN) Christel McGovern, RN Lamaze Certified Childbirth Educator (LCCE) Kathryn Orski, RN Rosemary Wlaschin, RN National Certified School Nurse (NCSN) Schelly Harrison, RN Roxanne Scipio, RN Certified Professional in Healthcare Quality (CPHQ) Kathryn Moss, RN Certified Infection Prevention and Control (CBIC) Kathryn Moss, RN Certified Professional In Healthcare Management (CPHM) Accredited Case Manager (ACM) Dorothy Mullenix, RN Family Nurse Practitioner – Board Certified (FNP-­‐BC) Evelyn Saldana, RN 2014 nursing annual report • 14 Celebrating nursing excellence Implemented in 2010, the Nursing Excellence Award serves as meaningful recognition of our nurses at Novant Health Prince William Medical Center who model Novant Health’s mission, vision and values. Nurses who consistently strive to deliver the most remarkable patient experience, in every dimension, every time. Registered Nurses are nominated by their peers by the use of the Nursing Excellence application. Eligibility for this prestigious award required the nominee to meet criteria illustrating how they support and implement within their practice Duffy’s Quality-­‐Caring Model through use of the eight caring factors (Mutual problem solving, attentive reassurance, human respect, encouraging manner, appreciation of unique meanings, healing environment, affiliation needs, and basic human needs). Applicants must also represent at least three of Novant Health’s core values and excellence categories (service excellence, teamwork, personal excellence, diversity, community contribution and quality, safety and performance measures. Completed applications are then sent to unit leadership for approval and subsequently sent to the Shared Governance Partners council for voting. 1st Quarter 2013 Sally Randall, RN, OCN -­‐ Outpatient Infusion 2nd Quarter 2013 Tiffany Fischer, MSN, RN -­‐ Emergency Services Pictured: Sally Randall, RN Outpatient Infusion Pictured: Tiffany Fischer, MSN, RN Emergency S ervices Department 2014 nursing annual report • 15 3rd Quarter 2013 4th Quarter 2013 Jennifer Shirk, RN -­‐ Emergency Services Maureen Turner, RN -­‐ Northern Virginia Market Resource Team Pictured (Left to Right): Teddy Schanes, Cara Wittenauer, RN, Ken Reck, PA-­‐C, Jennifer Shirk, RN, Christ Smith, Katy Brown, Pam Poulton, BSN,RN and Marie Danforth, RN Pictured (Left to Right): Julie George, MSN, RN Manager o f Behavioral Health Inpatient Unit, Penny Winstel, MSN, RN Manager of Women’s and Children’s Services, Mandy Ward, R N, ESD Clinical Nurse a nd Maureen Turner, RN Clinical Nurse Northern Virginia Market Resource Team 1st Quarter 2014 2nd Quarter 2014 Mandy Ward, RN -­‐ Emergency Services Belinda Lew, BSN, RN – Northern Virginia Market Resource Team Pictured: Michelle Blesi, BSN, RN Nursing Supervisor, Oi Mei Yau, BSN, RN Northern Virginia Market Resource Team, Belinda Lew, BSN, RN Market Resource Team, Julie George, MSN, RN Manager of Behavioral Health Inpatient Unit a nd Robin Ferguson, BSN, RN Senior Director of Market Operations Pictured (Left to Right): Polly Roush, MSN, RN –Senior Director of Nursing and Mandy Ward, R N 2014 nursing annual report • 16 Nursing clinical ladder The Clinical Ladder Program is to recognize Novant Health Prince William Medical Center and Novant Health Center registered nurses who demonstrate clinical excellence at the bedside, the achievement of positive patient outcomes and leadership in the clinical setting. These nurses are committed to professional development, evidenced based practice and personal excellence. Registered Nurse Level III Registered Nurse Level IV Kathleen Abromavich Elaine Corsino Dawn Harris Sukhdip Lahar Carita Parks Sally Randall Connie Rickerson Catherine Vetal Maria Zenaida Delos Angeles-­‐Ramos Meina Cook Rebecca Hanlon Linda Green Donna Kirk Imelda Murray Allison Karrels Devon Richardson Ancy Kulakkattolickal Jeanie Barlow Claudia Barnish Tiffany Fischer LeeAnne Green Susan Guzman Christine Keaveny Debra Oakes Anne Patullo Jillian Powers Jessy Tramontana Casie Young Steffany Williams Leann McMullen Teresa Baltuano-­‐Post Frances Meeker Sarah Herbert Registered Nurse Level V Illana Naylor Anne Patullo 2014 nursing annual report • 17 Circle of excellence award The Circle of Excellence program recognizes engaged employees who consistently demonstrate excellence in Novant Health’s core values and work to deliver the most remarkable patient experience in every dimension, every time. ! Sandy Lauber, Emergency Services ! Belinda Lew, BSN, RN, Northern Virginia Market Resource Team Nursing shared governance Shared governance leadership Partners council Chair: Cathy Vetal, RN, Women’s and Children’s Services Co-­‐Chair: Kim Gibbs, BSN, RN, PCCN, Northern Virginia Market Resource Team Safety and quality council Chair: Christine Keaveny, BSN, RN, OCN, Outpatient Infusion Unit Co-­‐Chair: Karen Vargas, RN, Surgical Services Clinical practice council Chair: Tiffany Fischer, MSN, RN, Emergency Services Co-­‐Chair: Connie Rickerson, BSN, RN, RNC-­‐LRN, Mother Baby Unit Research council Chair: Jessy Tramontana, BSN, RN, CPN, Pediatrics Unit Professional practice and education council Chair: Steffany Williams, BSN, RN, Northern Virginia Market Resource Team 2014 nursing annual report • 18 Shared governance accomplishments Partners ! ! ! ! ! Immunization recognition event 3rd quarter 2014 Valentine’s Day Love Our Nurses Event-­‐breakfast for day/night shift on the units Nurses Week events-­‐basket drawing, lunch and learns, pizza on the units and spirit week Annual school supply drive-­‐ donated more than $1000 of supplies to Nokesville Elementary Thanksgiving food drive 2013-­‐ In collaboration with our community partners, we donated 7,188 items to NVFS/SERVE food pantry to serve our community for Thanksgiving! Safety and quality ! ! ! Continuous quality monitoring and review of 22 unit dashboards for success and improvement oppertunity Quarterly reporting of quality data to National Database for Nursing Quality Indicators Implemented NHPWMC facility fall team Clinical practice ! ! ! ! ! Corporate representation on Clinical Policy Author Support Team (CPAST) Development of Clinical Policy review subcommittee consisting of clinical nurses review of nursing related policy’s Developed focused education and department specific procedures for ESD nurses to safely administer IM Methotrexate Revised Medication Safety and Patient Placement Assignment Decreasing improper waste in Bio hazardous waste receptacles Research ! ! Sponsored eight Journal Club Events discussing articles on the following topics September 2013 and May 2014 offered the Research Fellowships with 9 staff members taking part. Professional practice and education ! ! Facilitated 12 nursing grand rounds sessions with nursing representation from each service line. Nursing Wide Skills Day: Oct 26, 2013-­‐ Dec 2013 including 10 staffed education stations, 8 poster stations and self-­‐directed learning: via Net Learning/Self learning packets 2014 nursing annual report • 19 Commitment to our community Novant Health Prince William Medical Center (NHPWMC) has a long-­‐standing commitment to community involvement. The organization’s mission statement shapes our commitment to community by declaring that Novant Health exists to improve the health of communities, one person at a time. We accomplish that mission by providing excellent healthcare facilities and physician practices, and also by making a commitment to community outreach and employee giving and service. Thanksgiving food drive In partnership with our community partners, E.E. Wine, Prince William County Fire and Rescue, Manassas City Fire and Rescue, Manassas Park Fire and Rescue and Kloke Group, we were able to provide Northern Virginia Family Services (SERVE) 7,188 total items beating our goal of 6,000 by 19.8%!!! We delivered 111 boxes to the Manassas Adventist Preparatory School that houses SERVE’s sorting area. American Heart Association Heart Walk Thank you to everyone who has participated in walking and fundraising for the American Heart Association Heart Walk!! 2014 nursing annual report • 20 Relay for Life Manassas Thank you to everyone who walked and donated to Relay For Life Manassas. Novant Health participated with nearly 100 walkers and raised over $3,700 for Relay For Life American Cancer Society. DEA Drug Take Back Day With the support of Prince William County Police Department, Drug Enforcement Agency and Manassas City Police Department, we were able to collect a total of 938 lbs. of unused and expired medications from our community! Thank you to all who participated in Drug Take Back Day! 2014 nursing annual report • 21 Pictured (right to left): Dawn Byrne, BSN, RN, Kathy Garrison, MSN, RN, David Rupert Principal, Cara Mitchel, Guidance Counselor, Jill Powers, RN, Teresa Baltuano-­‐Post, BSN, RN and Illana Naylor, MSN, RN. Illana Naylor MSN, RN teaching a Kindergarten classroom about what they might see a Nurse wear while caring for patients in the hospital! Students at Weems Elementary learned about what nurses do, education required for our careers, personal hygiene from Jill, Illana, Kathy, Teresa and Dawn. 2014 nursing annual report • 22 Heart of caring How often are you, as a caregiver, able to hear feedback from a patient you have cared for? Established in 2013, Novant Health Prince William Medical Center hosts an evening focused on our caregivers called the Heart of Caring. The Heart of Caring event was developed in response to multiple requests from our patients asking to come back and tell each staff member they encountered during their stay how much they appreciated all that you do. Twice a year the Magnet team hosts the Heart of Caring Event. To date, NHPWMC has hosted 14 patient families who have chosen to share their stories of our care at these events. Units that have been recognized include: ! ! ! ! ! ! ! ! ! ! ! ! ! ! Emergency Services Progressive Care Oncology Unit Neonatal Intensive Care Mother Baby Unit Medical Surgical Unit Cardiac Catheterization Lab Rehab Services Orthopedics Unit Outpatient Infusion Unit Labor and Delivery Critical Care Unit Behavioral Health Inpatient Unit Behavioral Health Outpatient We would like to acknowledge each of you, our clinical and support staff for the care you provide and your dedication to the Novant Health Mission, Vision and Values. Thank you for all that you do. Members of the NHPWMC Magnet team with Sean Keyser, Vice President of Organization Development. Members of the NHPWMC Magnet team pictured (left to right): Randall B rownlee, RN, Shauna Bendix, RN, Kim Gibbs, RN, Dawn Byrne, RN, Kathy Garrison, RN, Tori Scott, RN. 2014 nursing annual report • 23 Exemplary professional practice Represented by the Purple oval in the Magnet Model, Exemplarily professional practice entails a comprehensive understanding of the role of nursing; the application of that role with patients, families, communities, and the interdisciplinary team; and the application of new knowledge and evidence. The goal of this Component is more than the establishment of strong professional practice; it is what that professional practice can achieve. One example of Novant Health Prince William Medical Center Professional practice model Magnet Standard: EP 18EO – Culture of Safety Workplace Safety for nurses is evaluated and improved. Provide two examples, with supporting evidence, of workplace safety for nurses resulting from the safety strategy of the organization. Decreased Injury Assaults in the Behavioral Health Inpatient Unit Exemplary Professional Practice Background Novant Health Prince William Medical Center has always held staff and patient safety in high regard. Staff safety policies such as the Workplace Violence policy (NH-­‐HR-­‐6050) states that the organization is committed to providing a safe working environment that is free of intimidation, coercion, threats and violence. Novant Health also supports a zero tolerance for acts of violence in the workplace committed by or against employees or others, either on company premises or during the performance of work-­‐related duties. As an organization, we are committed to in our work to reduce the risk and exposure to violence in the workplace. Second Quarter 2012, our Behavioral Health Inpatient Unit noted an elevation in nurse injury related to patient assault events. Understanding our organizational commitment to safety, carefully planned interventions were implemented to increase staff safety and reduce the risk of violence on the Behavioral Health Inpatient Unit. Goal ! Novant Health Prince William Medical Center aims to reduce or eliminate nurse injuries related to behavioral health inpatient assault. 2014 nursing annual report • 24 Description of the Intervention Beginning in third quarter 2012, with organizational support, the following interventions were established prioritizing safety in the Behavioral Health Inpatient Unit to reduce the risk of injury from patient assault and providing staff with tools/education in crisis intervention and de-­‐escalation techniques for behavioral health patients. Mock Code Purple Initiative Leadership in the Behavioral Health Inpatient Unit (BHIP) began an initiative in third quarter 2012 to engage BHIP nursing staff in mock Code Purple exercises. At NHPWMC, Code Purple is called for an escalating or violent situation to summon Public Safety and additional unit nursing staff to provide a team approach for de-­‐escalation attempts and crisis intervention. The mock Code Purple exercises feature a Behavioral Health staff person playing the role of an escalating or acting-­‐out patient and allow staff to practice de-­‐escalation techniques and interventions with the goal of preventing violence. The care recommendation was often the use of restraint and/or seclusion as the only option to assist the patient in regaining control over his/her behavior. BHIP staff participated eagerly but realized they did not have all the tools and training to perform consistently and with confidence. The Code Purple training initiative consisted of staff education, policy and procedure review, simulation and training. By first quarter 2013, staff competency in dealing with the violent, disruptive patient was evidenced by the decrease in the injury assault rate. Behavioral Health Unit Comfort Room Recognizing and understanding the unique needs of the behavioral health patient population, our Behavioral Health Inpatient Unit opened a patient Comfort Room in third quarter 2012. The comfort room serves as a supportive and therapeutic environment to assist patients in self-­‐calming techniques by introducing them an environment conducive to relaxation. The Comfort Room is designed and furnished to provide an area of low-­‐stimulus and an absence of interpersonal interactions for the purpose of tension reduction. Behavioral Health staff utilize multisensory and relaxation interventions in the comfort room to promote a calming environment for patients including a beach scene mural painted on the walls, a glider chair, bean bag chairs, music (including sounds of the ocean), squeeze/stress balls and an aromatherapy fan. This room also includes self-­‐esteem, art and sobriety “kits”. The “kits” contain exercise that aid the patient with relaxation and coping skills. The entire room, from the calming blue color and scenic beach scenes on the walls to the carefully chosen relaxing furnishings, has been designed to facilitate the process of self-­‐calming and soothing. Two of the many BHIP clinical nurses who have used the comfort room as a calming intervention, Dwindy Eppard, RN and John Wilson, LPN, provided feedback that stating the environment allows a convenient alternative in times of crisis for their patients. Participants ! Bebe Holt, MSN, RN, MHA, NEA-­‐BC-­‐ Chief Nursing Officer NH NVM, Chief Operating Officer NHPWMC ! Eileen Caulfield, Ph.D., RN, NEA-­‐BC-­‐ Director Nursing Practice Education and Research ! Polly Roush, MSN, RN-­‐Senior Director of Nursing. ! Sonja Flood, LCSW-­‐Intake/Therapist Clinical Supervisor ! Julie George, MSN,RN, MBA-­‐Nurse Manager Behavioral Health Inpatient Unit ! Karyn O’Brien, Ph.D.-­‐Clinical Psychologist, Director of Behavioral Health Programs NHPWMC 2014 nursing annual report • 25 ! Patricia Cole, MSN, RN-­‐Clinical Nurse Educator Behavioral Health Inpatient Unit ! Tori Scott, MSN, RN-­‐Clinical Nurse Educator/NVCI Instructor ! Carl Clark, Behavioral Medicine Technician/NVCI Instructor ! Vanessa Cooper, Recreation Therapist Coordinator Outcomes Trended Injury Assault Data for NHPWMC reported to NDNQI illustrates a consistent improvement in staff injury assault rates per 1000 patient days. Collectively, these interventions established in the Behavioral Health Inpatient Unit have allowed this care area to remain below the NDNQI benchmark Injury Assault Mean the majority of the time. Safety is always an organizational priority as is the practice of process improvement. With the support of the organization and dedication of the Behavioral Inpatient Unit nursing staff, safety for nursing staff in this care area is consistently maintained. 2014 nursing annual report • 26 Novant Health nursing professional practice model At the center of our care are the patient and family. Our loving hands support them and give them remarkable care. Joanne Duffy is our nursing theorist. Her quality-­‐caring model includes eight caring factors: Mutual problem solving We work together with our patients and families so they can participate in their care and healing. Attentive reassurance We offer a positive outlook to patients and help them feel secure while in our care. Human respect We value each individual and show them respect through our actions. Affiliation needs Our patients are provided access to their families and friends who support them. Basic human needs At the foundation of our care we continue to make sure we are meeting the basic human needs of our patients. Encouraging manner We provide care with a supportive demeanor. Appreciation of unique meanings We acknowledge what is significant to our patients and make efforts to accommodate personal and cultural needs. Healing environment We surround our patients in a quiet and calm healing environment. Our Shared Governance councils support our clinical practice through the five councils of Professional Practice and Development, P artners, Research, Safety & Quality and Nursing Leadership. Encompassing our remarkable care is the belief and practice in Novant Health’s mission, vision and values. 2014 nursing annual report • 27 New knowledge, innovations and improvements Represented by the Blue oval in the Magnet Model, New Knowledge, Innovations and Improvements includes new models of care, application of existing evidence, new evidence, and visible contributions to the science of nursing. This component requires that organizations drive change through strong leadership, empowered individuals and exemplary nursing practice. Examples of Novant Health Prince William Medical Center New knowledge, innovations and improvements Research ! ! Active participation in Institutional Review Board (IRB) through Presbyterian Health Care IRB Four completed and nine active research studies Evidence-­‐based practice ! Clinical nurses disseminate research findings and knowledge to improve care and the practice environment. Examples include: o Nursing grand rounds o Nursing research symposium New Knowledge, Innovations & Improvements Innovation ! Innovative nursing practice at Novant Health Medical Center is demonstrated through clinical nursing involvement in improvement initiatives aimed at positive patient outcomes, nursing care, and the nursing practice environment. Examples include: o Immunization core measure compliance o NHPWMC CARE (Creating Authentic Relationships Everyday) call o Post fall nursing huddles 2014 nursing annual report • 28 Empirical outcomes Represented by the Orange oval in the Magnet Model, Empirical outcomes include new models of care, application of existing evidence, new evidence, and visible contributions to the science of nursing. This component requires that organizations drive change through strong leadership, empowered individuals and exemplary nursing practice. Empirical Outcomes February 18th 2014-­‐ Critical Care Unit Celebrating 365 days since their last Central Line Associated Blood Stream Infection (CLABSI) Pictured (Right to Left): Zan Zaidi, MD NHICS, Kari O’Coin, MHA, BSN, RN Nurse Manager ACS, Oi Mei Yau, BSN, RN MRT, Denise Skinner, BSN, RN Clinical Unit Leader, Kelly Martini, BSN, RN, Khiana Allen, RN CUL, Dorothy Bolton, Kathy Moss, MSN,RN Infection Preventionist, Stephanie Jones, MSN,RN CUL, Angela Wright, Ph.D. RN Director ACS, Maria Gabriel, RN and Mercedes McNeal, RN. 2014 nursing annual report • 29 Falls with Injury Rate: NHWPMC falls with Injury rate trend from 2010 through 2014 Novant Health Prince William Medical Center Falls with Injury Rate 2010-2014 Injury Fall Rate 24 20 16 12 8 4 0 Rate % N=28 N=27 2010 19.71 2011 16.47 N=28 2012 22.22 N=16 N=21 2013 20.19 2014 11.94 Injury Assault Rate (unwanted physical contact by a patient whether or not there is intent to harm): NHWPMC remains below the National Data base for Nursing Quality Indicators mean. Novant Health Prince William Medical Center Behavioral Health Inpatient Unit Injury Assault Rate per 1,000 Patient Days 3.50 Rate Percentage 3.00 2.50 2.00 1.50 1.00 0.50 0.00 2nd Q 3rd Q 4th Q 1st Q 2nd Q 3rd Q 4th Q 1st Q 2nd Q 2012 2012 2012 2013 2013 2013 2013 2014 2014 Injury Assault Rate 3.16 0.41 0.48 0.00 0.00 0.42 1.23 0.43 0.42 NDNQI Mean 0.65 0.62 0.80 0.77 0.80 0.65 0.91 0.76 0.73 2014 nursing annual report • 30 Central Line Blood Stream Infections (CLABSI): NHWPMC remains below the National Data base for Nursing Quality Indicators CLABSI mean. CLABSI Rate Novant Health Prince William Medical Center Central Line Blood Stream Infection Rates per 1000 Central Line Days 0.3 0.2 0.1 0 -­‐0.1 -­‐0.2 -­‐0.3 -­‐0.4 -­‐0.5 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Rate 0.23 -­‐0.07 0.06 -­‐0.03 -­‐0.41 -­‐0.4 -­‐0.39 -­‐0.35 NDNQI Mean -­‐0.03 -­‐0.09 -­‐0.07 -­‐0.01 -­‐0.04 -­‐0.04 -­‐0.08 -­‐0.03 Catheter Associated Urinary Tract Infection (CAUTI): NHWPMC rates below the National Data base for Nursing Quality Indicators CAUTI mean 5 out of 8 quarters. CAUTI Rate Novant Health Prince William Medical Center Catheter Associated Urinary Tract Infections per 1000 Catheter Days 0.2 0.1 0 -­‐0.1 -­‐0.2 -­‐0.3 -­‐0.4 -­‐0.5 -­‐0.6 -­‐0.7 -­‐0.8 Q4 2012 Q1 2013 Q2 2013 Q3 2013 Q4 2013 Q1 2014 Q2 2014 Q3 2014 Rate -­‐0.62 -­‐0.16 -­‐0.01 -­‐0.6 -­‐0.32 -­‐0.67 -­‐0.62 0.15 NDNQI Mean -­‐0.14 -­‐0.15 -­‐0.14 -­‐0.11 -­‐0.16 -­‐0.14 -­‐0.18 -­‐0.18 2014 nursing annual report • 31 July 2014 NHPWMC Critical Care Unit celebrates 4 years Ventilator-­‐ Associated Pneumonia (VAP) FREE!!! Pictured (Right to Left): Kari O’Coin, MHA,BSN,RN Nurse Manager ACS, Bebe Holt, MSN,RN CNO/COO, Sharon Fletcher, RT, Kristina Lama, BSN,RN, Jean Curry, RT, Julie Craiger, BSN, RN, Angela Wright, Ph.D, RN Director ACS, Kathy Moss, MSN, RN Infection Preventionist, Dogulas Wall, MD VPMA. 2014 nursing annual report • 32 Closing from Polly Roush, RN Colleagues, Our nursing annual report reflects many accomplishments of the past year for which all Novant Health Prince William Medical Center nursing team members should take great p ride! You are truly supporting our vision to deliver the most remarkable patient experience, in every dimension, every time. Polly Roush, RN Our commitment to focus our efforts on improving the patient experience, safety and quality outcome are noticeable in this report. As we continue our journey in 2015 and our pursuit of nursing excellence with a Magnet designation, I am convinced our team will strive to be adaptable to the ever changing forces that shape the future of health care. We truly appreciate our nursing team members and thank them for their passion and commitment to our patients. We also thank our patients, families and community members for the trust they place in us to provide safe, quality care each and every day. Polly Roush, RN Senior Director Nursing Novant Health Prince William Medical Center
