N E W K N O W L E D G E , I N N O V AT I O N S ,
A N D I M P ROV E M E N T S
Nurses conscientiously integrate evidence-based practice and research into clinical and operational
processes at North Hills Hospital in order to advance patient care delivery and innovation to the
highest level possible.
Partnership
with TCU for
Perioperative
Nurses
N
orth Hills Hospital partnered
with Texas Christian University
to sponsor an elective for student
nurses who are interested in becoming
perioperative nurses. This innovative
elective is the first time TCU or any
other school of nursing in the DFW
area has partnered with a hospital for
this specific purpose. Our goal is to
develop these nurses to help meet this
critical need in healthcare.
Kelly Boren, Director of Surgical Services Dolly Adams, RN, Surgical Services TCU Student Nurses
Myra Trotchie, Assistant Director of Surgical Services Laura Thielke, TCU Faculty
Unit-Based Council Research to Improve the Care of Our Patients and Infants
T
he Women’s Services Unit-Based
Council (UBC) began June 28,
2010. The council members involved
include Vickie Doss, Theresa Elakattu, Jill
Frost, Camie Holman, Summer Hughes,
Sharon Leon, Megan Monroe, Peggy Rice,
Georgie Sampang, Misty White, Stephanie
Wilson, and Debbie Cates. Upon
initiation of the council, several ideas
were presented regarding practices and
processes in need of change. The first
meeting included education regarding
shared governance, evidence based
practice, and research. A unanimous
decision was made to begin researching
infant skin care. The council agreed to
survey the appropriate staff using a five
question voluntary survey that would
gather feedback on the most common
practices and processes where change
was needed. The results reflected the
need for practice changes in all areas
and requests for materials. The council
made a list of the top five practices
and processes to work on with a goal
to complete each one by the end of
the year. After six months of work, the
council approved and passed the three
following process or practice changes:
•
•
•
Cessation of triple dye and alcohol for umbilical cord care
Early post operative ambulation
Rapid HIV screening upon
admission if no third trimester screening available
The UBC meetings are held monthly
for 60-90 minutes which allows time
to discuss progress on projects, review
articles, and develop an action plan
initiating the proposed change to
the staff.
Council members voted and
determined that each member would
research articles, coordinate with
nurses from other facilities, and
determine the cost of current practice
versus proposed practice. Each person
was assigned duties to work on and
to bring findings to the next UBC
meeting. The baseline was initially
measured by the staff survey. The need
for continuing education regarding
shared governance was determined, and
evidence base practice is needed for
every staff member to understand that
they have a voice that can help change
the practices and policies around them
and not “just keep doing it that way
because that is how it has always been
done”. Outcomes are being measured
by the accomplishment goals that
were set.
Employees Bond with
Patient’s Family in ICU
by Dorie Bennett, Unit Supervisor, CCU
W
e have had several hypothermia
patients in the CCU unit since the beginning of the year, and we are proud of their successful outcomes.
Evidence-Based Practice and
Research Council
DESCRIPTION OF COUNCIL
• Promotes scientific inquiry related to best practice and patient care, education, and leadership.
• Evaluates and provides expert opinion on hospital-wide clinical policy development to ensure clinical practices are evidence based.
• Provides resources for dissemination of knowledge gained from research.
• Provides mentoring and support to promote research and EBP throughout the organization.
PURPOSE
• Builds culture of evidence-based practice and research.
• Promotes scientific inquiry.
• Facilitates publications and presentations.
• Provides support to staff involved in research and
EBP projects.
• Approves, monitors, and reviews research and EBP projects.
C O M P L E T E D E B P P RO J E C T S F RO M 2 0 0 9 – 2 0 1 0
Susan Duboskas, RN, BSN, CCRN
Assistant Director of Critical Care
Multidisciplinary Rounds (MDR) in CCU and ICU
However, one particular patient stands out. He was admitted when his wife found
him unresponsive after collapsing in
the bathroom. Several months prior to this event, he was
diagnosed with ischemic cardiomyopathy. His wife is a nurse and
immediately began CPR after 911 was called. She states that the
paramedics arrived within five minutes and found the patient
to be in VFIB, and he was shocked approximately seven times at
home before being transferred to the ER without being intubated.
He was immediately taken to the Cardiac Cath Lab, where it
was found that he did not have any coronary blockages that
caused his arrest, but rather his ischemic cardiomyopathy was
the cause. Once he was transferred to CCU, the hypothermia
process began. After the completion of the protocol, the patient
awakened and was without any neurological deficit. He was in
the hospital until he received his AICD and was discharged to
his home.
During the hypothermia time, we all became close with his family.
His wife and daughter shared the same birthday, which occurred
during the time the patient was being sedated. It was discovered
that the patient always went above and beyond on celebrating
the dual birthdays. We provided a birthday cake and had a small
celebration for them since they were adamant about not leaving
their loved one’s side. When he was fully alert and aware of the
entire situation, the patient stated that his family being taken care
of was what meant the most.
We have since seen the family and were informed that he
continues to do well and thanks us immensely. We are proud
to share this story not only because of the successful outcome
for the patient, but because our staff responded in such a
compassionate way to the family’s needs.
Julie Ragle, RN
Unit Supervisor of Medical Surgical
Knee-high vs.Thigh-high Compression Hose
Joint Replacement Program Takes Off
Amanda Robbins, RN, MS, CNS
Assistant Director of Clinical Excellence
L.A.M.P. Team “Look At Me Please!” Systematic Approach to Assess Patient Falls
• 27 patients have completed the program in six months.
• Average length of stay is 3.4 days, which is less than the national average of 4-5 days.
• Average patient satisfaction scores, collected by an impartial party, rated us at 11.42 out of 12 possible points, with 100% of the patients stating they would absolutely recommend our Joint Replacement Program to a friend if they needed joint replacement surgery.
Dorie Bennett, RN, BSN, CCRN
Unit Supervisor of CCU
FemoStop vs. Manual Pressure in Sheath Pulls What Does the Evidence Show?
We are proud to share these performance measurements:
N E W K N O W L E D G E , I N N O V AT I O N S , A N D I M P R O V E M E N T S
The Art of
Questioning
T
he Art of Questioning was a
presentation by our nurse research
consultant at our Certified Nurse
Celebration. Diane Hawley, PhD, RN,
CCNS, presented on the importance
of certification for nurses and how
clinical advancement in knowledge is also
connected to developing the art clinical
questioning. The Art of Questioning
project was conducted by the EBP&R
Council in order to promote clinical
questioning by the direct care nurse.
Each council member provided inservices
to various clinical areas. Nurses were
encouraged to write a clinical question
and submit it for an opportunity to
develop a poster and win a prize at the
Certified Nurses Celebration. Six posters
were presented and three winners were
chosen. Each winner received $50 to
apply towards a continuing education
course to either gain or maintain their
clinical certification.
Standardized Format
for Asking Questions - PICO
• Population of Interest
Who or what is at the center of the issue?
• Intervention or Issue
What is the issue?
• Comparison or Current Practice
Is there a comparison/alternative intervention
(may not be any)?
• Outcome to Consider
What outcomes would be beneficial and/or harmful?
Excerpt from The Art of Questioning presentation
PRIZE-WINNING POSTERS
1st Prize - Annette Berry, RN, BSN, CCRN
Does use of endotracheal tube holders enhance improved clinical outcomes as
compared to tape stabilization, as evidenced by: prevention of migration of the
tube, unplanned extubation maintenance of alignment in the trachea, reduction in
localized trauma, and maintenance of skin integrity?
2nd Prize - Angela Junker, RN
In laboring women patients, are preloads prior to
epidural anesthesia associated with symptoms of
fluid overload, delayed pain management, decreased
frequency of contractions, breast edema, and/or
increase in newborn birth weight?
3rd Prize - Jason Cain, RN, BSN, CCRN
Would patients’ time in critical care be less if doctors called their
own consults rather than nurses?
N E W K N O W L E D G E , I N N O V AT I O N S , A N D I M P R O V E M E N T S
L.A.M.P. TEAM – Look At Me Please
PURPOSE: To assess the effect on inpatient fall rates in an
acute care hospital when a designated team responds at the
time a patient fall occurs.
OBJECTIVES: 1. Immediate alert and rescue if a patient falls.
2. Accurate assessment and reassessment of a patient’s fall risk.
3. Implementation of individualized fall risk interventions and
care plan. 4. Collegial support for the prevention of falls and
identification of fall-related injuries.
INTRODUCTION: In October 2010, a review of the
literature on falls prevention found that few fall risk assessment
tools exhibit widespread validation and useful operational
characteristics. Additionally, a high percentage of patient that
fall are not captured with current methodology. Therefore,
traditional approaches to reduce inpatient falls that focus on
fall risk assessment tools require follow-up assessment of
those patients who fall, despite assessed risk.
METHODS AND INTERVENTIONS: A designated team
(LAMP Team) consisting of three nurses (the patient’s primary
care nurse, the unit supervisor, and the nursing supervisor)
respond to a patient fall to perform a timely debriefing of the
occurrence, thereby providing on-site education and safety.
The LAMP Team is notified if a patient fall occurs through the
hospital emergency alert system. Any employee of the hospital
may activate the LAMP code at the first knowledge of a patient
fall. Overhead paging of the code includes the location of the
event. Due to the dynamic nature of the LAMP team, often
times the primary care nurse and unit supervisor may not
attend at the same time. Debriefings by the LAMP Team include
participation of the patient and family in addition to hospital
staff to provide on-site education and safety.
Team to review circumstances surrounding a patient fall.
Desired results post-implementation of the LAMP team include
a measurable decline of the inpatient fall rate over a three
month initiation period with ongoing stabilization of the fall rate
below the hospital and national benchmark. Additional outcomes
to be considered for their impact include accountability,
communication, education, multi-disciplinary referrals, modifiable
risk factors, and individualized fall preventions.
Team approaches to fall risk and injury reduction as a result of
patient falls are suggested by organizations, such as the IHI in
Transforming Care at the Bedside, to supplement fall risk and
injury program success. Patient falls, though once considered
as a never event, are an intrinsic risk to all hospitals due to the
wide range of factors placing patients at risk.
Amanda Robbins RN, MS GCNS-BC (pictured below) is
the Patient Safety Officer and Assistant Director of Clinical
Excellence at North Hills Hospital for more than four years.
She is also a ANCC certified Gerontological Clinical
Nurse Specialist.
RESULTS AND IMPLICATIONS FOR PRACTICE:
Data collected from the LAMP Team is collected on all patient
falls in the facility. An analysis form is utilized by the LAMP
Stroke Center Certification
W
e are proud to announce that North Hills Hospital
began functioning as a Primary Stroke Center on
July 19, 2010. We submitted our application to The Joint
Commission for Primary Stroke Certification and received our
certification in January 2011.
As a result of our new policies, we have designated ICU
and Med/Surg 3rd floor as our units for stroke patients. All
employees in both areas have been specially trained to care for
our stroke patients. All RNs have completed the NIH Stroke
Scale Certification, and all RNs, LVNs, and PCAs have attended
an extensive stroke skill lab.
Nursing employees participate in Stroke Skill Lab program.
Our hospital, in partnership with the Texas Stroke Institute,
shares the vision of commitment to providing high quality
primary and comprehensive stroke care.