AdventHealth Hendersonville
2020 Annual Nursing Report
Welcome Dear Reader, The World Health Organization (WHO) named 2020 the International Year of the Nurse and the Midwife in recognition of Florence Nightingale’s 200th birthday. What an honor that the nursing profession received such distinction during a worldwide pandemic. As we reflect over this past year, it’s apparent that ensuring safety, quality, compassion and innovation in patient care never mattered more. As nursing leaders, we must be willing to step out on a ledge with our decision-making when the direction and outcomes are not always clear, and when we are dealing with higher levels of fear, confusion and anxiety. This was the case many times over the past year. Critical situations forced us to abandon our comfortable routines and take on tasks that were unfamiliar and far outside of our comfort zone. The famous leader Winston Churchill once stated, “We should never let a crisis go to waste.” This statement seems to ring true with our team, as evidenced by the many workarounds and ingenious adaptations for patient care that the AdventHealth nursing team has implemented over the past several months. This year’s Annual Nursing Report is one way we remember all of the great work completed by the AdventHealth Hendersonville nursing team in 2020. In the midst of the pandemic, our valued nursing colleagues and their clinical support partners continued to perform at extremely high levels of competency. Despite the disruption of COVID-19, patient and team safety remained a priority. As you read the following report, I hope you do so through eyes of understanding and amazement. This work was completed during a worldwide crisis. Team members accomplished incredible patient outcomes while being diligent with physical distancing, personal protective equipment, handwashing and isolation techniques – all while living our mission of Extending The Healing Ministry of Christ. I proudly present to you the 2020 Annual Nursing Report for AdventHealth Hendersonville.
Roland Joy, MSN, BSBA, RN Vice President of Clinical Services Chief Nursing Officer
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Table of Contents 2 Welcome 4 Florence Nightingale: Angel in the Dark 5 2020 is the Year of Nurse 6 You’re Invited: Nurse Practice Council 7 Navigating a Public Health Crisis: The Early Days of Managing an Emergency with Incident Command
One way we are attempting to commemorate the year 2020 is one of opportunity, rather than crisis.
8 Clinical labor pool cross-trains staff to prepare for COVID-19 surge 8 Drive-thru COVID-19 Testing Site Serves Hendersonville and Surrounding Regions 9 Team Members Receive Training for Best Practice Care of COVID-19 Patients 9 Special Mock Code Training Readies Team Members for Coronavirus Cases 10 Surge Training Prepares Nurses Across Departments for Pandemic Response 11 Homemade PPE Factory 12 When Nurses Become Family 13 Baby Friendly Designation 14 Cardiac Rehabilitation 2020 15 Multidisciplinary Rounds Redesigned 16 Quality Improvements 2020 17 Acknowledging Unconcius Bias 18 Home Health Offers New Services 19 Wound Care and Hyperbaric Medicine Team Improves Safety, Efficiency and Standards of Care 20 New Programs to Improve Behavioral Health Care in WNC
DANGER
OPPORTUNITY
The Chinese symbol for “crisis” contains two characters: one for danger, the other for opportunity. John F. Kennedy once stated, “During a crisis, be aware of the danger, but also the opportunity.” This thought was sent to team members at AdventHealth Hendersonville this year – both to nurses and to all ancillary team members – with the goal of helping them see not only the crisis, the pandemic, but also the opportunity, or positive potential, within it.
21 Oncology Social Workers Go Above & Beyond 22 2020 Daisy Award Winners 23 Clinical Ladder Growth 3
Lo! In that house of misery A lady with a lamp I see Pass through the glimmering gloom, And flit from room to room.
Florence Nightingale: Angel in the Dark
– Henry Wadsworth Longfellow
By Jenn Kennedy, BSN, RN, PMH-BC Clinical Nurse Educator/ANR Chair The legacy of Florence Nightingale has never been more important than during this year: the 200th since her birth. Also dubbed the International Year of the Nurse and Midwife, 2020 has been a climactic year for everyone in health care. Also called the Lady of the Lamp and Angel of the Crimea because of her work in the Crimean War, Nightingale was a light in dark times for many. During the current pandemic, the work of nurses and other medical caregivers has similarly become like a light in the dark. And they continue to prioritize something of which Nightingale was the first nurse to insist: “Every nurse ought to wash her hands… frequently” (Glasper, 2020).
In letters to her sister, Nightingale mentioned calls from God to devote her life to the service of others. While in Cairo, she wrote, “God called me in the morning and asked me would I do good for him alone without reputation” (Chaney, 2006). She viewed her mission from God as so important that she never married or had children, fearing it would hinder her work. Nightingale was a ray of hope for the soldiers in Crimea, much like nurses have been for patients and families this year. Medical professionals have been on the front lines of the COVID-19 pandemic and have guided the way through the fear and unknown like lamps in the darkness. As we honor the 200-year-old legacy of Florence Nightingale, let’s continue to shine. Article References Glasper, A. (2020). Celebrating Florence Nightingale and her contribution to nursing. British Journal of Nursing, 29(13), 790–791. (2020) Tribute to... FLORENCE NIGHTINGALE. Community Practitioner, 93(3), 21. Chaney, E. (2006). Egypt in England and America: The Cultural Memorials of Religion, Royalty and Revolution. Sites of Exchange: European Crossroads and Faultlines. Amsterdam and New York: Rodopi.
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2020 is the Year of the Nurse By Shanna Myers, BSN, RN Clinical Nurse Supervisor
NURSING IS A HIGHLY RESPECTED CAREER: one in which people train and educate themselves to a higher level of awareness. The COVID-19 pandemic has put this calling to the ultimate test. When the virus began affecting the vulnerable in our community in early 2020, nurses were called to be at the front lines – to take care of people when we understood little about how the virus affects the human body. In our hospital, we’ve seen a range of patients from those with symptoms like a common cold needing supplemental oxygen, to others requiring ventilation by a machine with a grim prognosis. This year, I’ve seen my coworkers struggle with many different fears: that they will succumb to this illness; that they won’t be able to protect themselves or their families; and that they will be unprepared for the unknown future of nursing. The COVID-19 pandemic has awakened many questions with quickly changing answers. For a time, we could expect that information and procedures would change hourly, and as a result, we all felt anxiety and mistrust – and asked ourselves, “Why?” “2020 is the Year of the Nurse.” I have seen this statement in action. I have seen my work family pray for all affected by COVID-19. I have seen one nurse take a travel assignment to work in New York at the epicenter of tragedy. I have seen one educator spend valuable time readying team members for a code situation in case of a positive patient or Patient Under Investigation (PUI). Director Christy Harwood has gone to great lengths to support her teams with modified staff assignments. She has worked with Engineering to convert as many rooms as possible into negative pressure rooms and provide needed access to Personal Protective Equipment (PPE). This is all to ensure we are kept safe. This year more than ever, we are so thankful to be a part of AdventHealth. The teamwork and heart that went into preparing for the pandemic was stressful, but also rewarding. The rapidly changing details and procurement of necessary equipment has probably made more than one leader’s head spin. But despite this kind of pressure, Clinical Nurse Supervisor Staci Jackson says in the ICU, she has seen a cohesive change in their practice – namely, with how helpful team members are to each other when working with a patient in isolation. “The camaraderie is back,” says a nurse named Melissa. Our nurses are laughing and working together to create a joyful environment for everyone on the unit. COVID-19 is a new frontier for all of us. It has shown the world that nurses are here to serve with our knowledge, our hands, and our hearts. 5
You’re Invited: Nurse Practice Council By Jo Comaris, BSN, RN, and Brittany Hughes, BSN, RN The Nurse Practice Council at AdventHealth Hendersonville is a collaborative, cross-functional team that meets once a month to discuss various issues encountered in our facility and on each unit. The Nurse Practice Council has a mission to serve, support and advocate for our patients and each other through solving problems, removing barriers to facilitate change, developing policies to encourage and improve patient outcomes, and inspiring education and growth for all nursing professionals. Each unit is encouraged to send representatives to share their triumphs and challenges at Nurse Practice Council meetings. The Council has been responsible for many positive changes in all areas of our hospital and physician enterprises over the past few years. It has also helped form committees that actively look at patient safety and safe staffing. To further improve collaboration, in September the Nurse Practice Council held its first meeting that included night shift team members. On a quarterly basis, the Nurse Practice Council votes on submissions for the DAISY Award to honor nurses who have gone above and beyond to make a difference. This year, we wanted to find a way to reward Certified Nursing Assistants and ancillary team members for their exceptional service, as well. After all, we couldn’t do our jobs without them! We have created the following awards to be distributed quarterly for commitment to striving for excellence and enhancing the experience of our patients, their family members and guests while Extending the Healing Ministry of Christ: • The Sunflower Award for Certified Nursing Assistants who consistently deliver patient-centered, whole-person care with integrity while embracing the opportunity to learn and grow. Winners of the Sunflower Award are also recognized for integrating change to improve the health and well-being of our patients, their family members and guests. • The Sunshine Award for ancillary team members who consistently deliver exceptional care, uphold the highest standards, and collaborate with nursing team members to enhance the experience of our patients, their family members and guests. We hope you can join us on the second Tuesday of every month to represent your unit at Nurse Practice Council.
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Navigating a Public Health Crisis: The Early Days of Managing an Emergency with Incident Command By Gretchen Nicholson, MBA, MT, CPHRM, CPHQ AdventHealth Hendersonville Director of Office of Collaborative Improvement & Medical Staff Services
On Feb 26, 2020, when COVID seemed like a distant, but looming threat, our wise Chief Medical Officer pulled together our leadership with the clear direction that we needed to start preparing immediately. Our Emergency Management Team quickly assembled a large group from across our service lines and departments and led them through planning and response to a pandemic surge. On March 2, 2020, North Carolina confirmed its first COVID-19 case. That same day, AdventHealth Hendersonville conducted a gap analysis and set in place the action plans to prepare our system for what was becoming a global pandemic unlike any we had seen before. Weekly preparedness meetings followed with a multi-disciplinary team of clinical leaders, including nursing. By March 7, screening stations were placed at entrances. Every patient and visitor entering any AdventHealth facility was screened for travel history and symptoms. Employee screening for the same soon followed. Any person screening positive was masked before proceeding. To prevent transmission of COVID-19 in our facility, we quickly implemented visitor restrictions. By mid-March, North Carolina had 58 cases of COVID-19. AdventHealth Hendersonville administrators made tough decisions for the safety of our workforce. We became the first
hospital in the region to cancel elective surgeries. We did this on March 13, a day before the Surgeon General advised all hospitals to do this. We activated Incident Command on Mar 13, 2020. With much uncertainty, Incident Command leaders were guided by the quote, “In the end, it will be impossible to know if we overreacted or did too much, but it will be quite apparent if we underreacted or did too little.” — Darrin M. Peppard, EdD Superintendant of West Grand School District 1. And so, AdventHealth Hendersonville became one of the most proactive hospitals in its response to COVID-19, both in our community and in our hospital system. Incident Command assigned nursing and other key leaders across the organization to serve as Unit Leaders for the many planning and oversight areas. As the needs of the organization grew, project teams and Incident Command structure expanded. Incident Command leaders worked daily out of the Executive Board room, tracking key state, county and hospital statistics. They engaged key stakeholders to roll out COVID-specific operations, troubleshoot issues, and acquire needed supplies. Incident Command has and will continue to adjust to meet the changes of the pandemic to maintain the access to safe and effective health care our community is counting on from us, now more than ever. 7
CLINICAL LABOR POOL CROSS-TRAINS STAFF TO PREPARE FOR COVID-19 SURGE By Bethany Dixon, BSN, RN, CNOR When the Incident Command Center was set up at AdventHealth Hendersonville in response to the pandemic, redeployment of staff in the event of a COVID-19 surge was high on the list of its priorities. Bethany Dixon BSN, RN, CNOR, Giorgie Vining BSN, RN, and Kasey Caldwell BSN, RN, led the formation of a clinical labor pool to manage staffing and ensure our team members were trained in the event of redeployment – assignment to a different area of service based on an emergent need. After collecting information regarding previous work experience, clinical labor pool leadership arranged education and training for team members with backgrounds in Surgical Services, Imaging and Physician Enterprise. Brittany Hughes, BSN, RN, and Purvi Patel, Emergency Department Administrative Coordinator, along with leadership from Med-Surg, ICU, ED and The Baby Place created staff education as well as educational and training opportunities for team members with a background in those areas. Additionally, nurses with backgrounds in ED, ICU and Labor and Delivery were redeployed back to those areas of service, while other nurses were sent to train on Med-Surg, so they became familiar with the units and felt comfortable and supported. The special training provided to our team was essential in laying the groundwork for a potential team nursing situation. Team nursing would involve assigning an RN to supervise all team members and assign tasks as needed. As an example, if a behavioral health nurse was floated to the Emergency Department, the ED nurse would likely assign him/ her to behavioral health patients in the ED. If there were no behavioral health patients in the ED, the assignment would likely switch to have this nurse cover lower acuity tasks, freeing the ED nurses to cover the higher acuity care needs. The Clinical Labor Pool also staffed and scheduled 24-hour-a-day PPE Observation and provided ED assistance for screening and triage. Countless team members demonstrated selfless dedication by working in units they were unaccustomed to and being flexible with their scheduled shifts.
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Drive-thru COVID-19 Testing Site Serves Hendersonville and Surrounding Regions In March 2020, AdventHealth Hendersonville’s Incident Command and Physician Enterprise partnered to create the COVID-19 Drive-Thru Test Collection Site located behind the hospital and next to the Medical Office Building. The impact of this service was quickly felt within our local community as well as far beyond Henderson County. In addition to all 18 counties in Western North Carolina, the test site continues to serve people from South Carolina, Tennessee and Georgia. AdventHealth team members from across the Hendersonville campus work hard to maintain this venture and extend the healing ministry of Christ through this important service. While patients are at the heart of all we do, the COVID-19 Drive-Thru Test Collection Site also provides a unique opportunity for team members. Redeployment as a result of necessary steps to keep our community safe and an ever-changing patient census give AdventHealth team members an opportunity to show our community what we can achieve when we come together and work toward a common goal. To see this project in action really proves we are Greater as a Whole.
Team Members Receive Training for Best Practice Care of COVID-19 Patients In early April, AdventHealth Hendersonville launched efforts to prepare team members for an anticipated surge of patients with COVID-19. At the time, many COVID-19 patients in other cities were being placed on ventilators and treated in the ICU. One technique that can be very helpful in treating patients in acute respiratory distress is to place them in the prone position, which is when the patient is lying on their stomach. Placing a patient in the prone position can be very challenging, as the patients are often sedated and may have many lines and other equipment attached, including artificial airways, that can be dislodged in the process. In order to prepare our ICU team to perform the maneuver safely, Clinical Nurse Educator Tara Richardson, BSN, RN, CCRN, worked with ICU leaders to craft a policy and training plan for prone positioning. The policy reflects evidence-based best practice in how to care for a patient requiring this treatment.
Hands-on training sessions were conducted for all ICU team members using the simulation mannikin “Sam.” Participants performed the maneuvers of turning a patient safely into the prone position and back to the supine position. Training cards and pictorials about the maneuvers are now on the unit as ongoing resources for team members. These tools combined with the hands-on training provided a solid foundation for team members should they need to successfully place patients with COVID-19
Special Mock Code Training Readies Team Members for Coronavirus Cases By Tara Richardson, BSN, RN, CCRN AdventHealth Hendersonville clinical nursing team members on the Medical-Surgical and Intensive Care units are certified in Advanced Cardiac Life Support. This training prepares them to treat patients facing a medical emergency such as cardiac or respiratory arrest. A Code Blue situation is by its very nature a complex and adrenaline-inducing experience – and the coronavirus pandemic further complicates this process, as it is important for team members to be protected from exposure to the virus while treating the patient.
An important aspect of minimizing exposure to COVID-19 is donning – or putting on – personal protective equipment (PPE), such as a respirator and face shield, prior to entering a patient’s room. As a result, AdventHealth Hendersonville developed a training plan to educate team members on the procedural changes required to protect our workforce with this precaution. For the training, nurses, respiratory therapists, hospitalists and special care techs participated in mock codes that walked through the steps of donning PPE; handing necessary items into a patient’s room; and working through the challenges of communicating effectively through a doorway that is 3 to 4 inches deep. Team members from both day and night shift took part in these mock codes to better prepare for actual events.
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Surge Training Prepares Nurses Across Departments for Pandemic Response By Brittany Hughes, BSN, RN This past spring, the COVID-19 pandemic hit our hospital like a hurricane. In anticipation of any possible surges related to COVID-19, leadership directed me to prepare a training course for nurses from other departments conducted on the Med-Surg and ICU units. Providing the surge education and training was a blessing in that it gave me a purpose when everything was in question, including our work, our lives and our place during such uncertainty. I’m grateful I was able to connect personally with the nurses in training and be a voice and advocate for them. Between April 4 and April 30, 39 nurses attended classes and sessions as part of surge training. The course included a scavenger hunt on both Med-Surg and ICU to familiarize nurses with the layout of the units; Cerner Powerchart training in collaboration with Clinical Informatics; and education on how to create a custom patient list. Using various tools provided by the education department, I was also able to offer hands-on experience with IV pumps, IV tubing and IV starts. Participating nurses also learned about Sound-Alike-Look-Alike Drugs (SALAD) likely to be pulled and administered on the units. Furthermore, the training included education on admissions and transitions on Med-Surg and ICU; medication administration and scanning; blood products transfusion; and specimen scanning. It was also important to familiarize the participating nurses with a team nursing process. In the event of a surge,
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these nurses would be assigned a group of patients along with an ICU or Med-Surg nurse who would direct the patients’ care. Participating nurses would be instrumental in helping the assigned nurse administer medications, educate patients, admit and transition patients, and complete any other patient care tasks. Additionally, as part of surge training, many nurses shadowed Med-Surg and ICU nurses in order to better understand the workflow throughout a shift.
Staff and Community Volunteers Mobilize to Set Up Homemade PPE Factory By Holly McCrary, LSSGB Operational Excellence Manager At the onset of the COVID-19 pandemic back in March 2020, as team members and leadership at AdventHealth Hendersonville were entertaining the idea of how to address the PPE shortage with homemade masks, community volunteer Pat Reed (the mother of a team member) was thinking the same. We came together, settled on a pattern, purchased material and – with the help of some redeployed team members – quickly created mask-making kits. Soon, other members of the community started calling offering to make masks as well. AdventHealth coordinated delivery of the mask-making kits to these volunteers and drop-off/pickup locations when they were complete. Once we received the completed masks, our central sterile department sterilized them. Then each mask received a filter and was packaged for delivery. Not long after this volunteer effort started, a shortage of isolation gowns became apparent. With the help of community businesses that donated plastic and heat guns, we started making plastic isolation gowns.
As census at AdventHealth dropped and more staff were redeployed, we opened a “Homemade PPE Factory” in the basement of our Professional Services Building. Team members from our clinics and hospital departments contributed their efforts to make plastic isolation gowns. While making the gowns for hours at a time wasn’t always easy, everyone involved said they were proud to participate in a worthwhile cause. All totaled, the AdventHealth team and volunteers made more than 2,300 cloth masks and more than 2,500 plastic gowns. Our sterile processing department is still requesting these specialized gowns. The homemade masks are distributed to patients and team members in need. It has been rewarding to see the community and our team come together to be part of a project that centers on our “Keep Me Safe” service standard promise.
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Nurses Become Family In Isolating Times By Shanna Myers, RN, BSN Clinical Nurse Supervisor Med-Surg As nurses, we make an impact on the lives of the patients who heal and are then discharged. But with those who are at the end of their lives, we share an extra special bond. When the COVID-19 pandemic began, none of us were prepared for all the changes that were happening as a result. New policies were implemented and changed every other day, it seemed. What none of us foresaw was the patients we would care for through their last moments of life – with families unable to visit. I worked with ICU nurse, Kim Colston, RN, BSN, who made it her priority to care for a patient who was passing due to complications from COVID-19. Wearing all the required PPE, she shared her time with him in his room. When the patient’s time was imminent, I heard her singing to him. The family expressed their appreciation for the peace that Kim offered to him by inviting her, along with the chaplain, to a time of prayer that afternoon. Another nurse, Matt Young, RN, brought peace to a patient when she was on hospice – in her last days – during isolating restrictions. Each time he worked in the patient’s room, he made extra time to hold her hand. Despite the demands on his time from other patients and tasks, he took time to be with her when her family could not be.
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AdventHealth Hendersonville Continues Progress Toward Baby-Friendly® Designation By Andrea Detwiler, BSN, RN, IBCLC, LCCE At The Baby Place and AdventHealth Medical Group Obstetrics and Gynecology offices, we continue our efforts to earn the Baby-Friendly® designation. This designation is a part of a quality improvement program administered by Baby-Friendly USA, Inc. (BFUSA), which provides independent validation that a hospital has created an optimal environment for evidence-based infant feeding and mother-baby bonding.
THIS ROBUST TRAINING CONSISTS OF THE FOLLOWING:
• Orientation to infant feeding policies. • More than 20 hours of education on breastfeeding and parent teaching for formula feeding (online curriculum). • Five-hour supervised clinical competency check-off completed with International Board-Certified Lactation Consultant (IBCLC). After the disappointment resulting from delays caused by COVID-19, we look forward to completing the last few hurdles to obtain the Baby-Friendly® designation.
• Designation as a Baby-Friendly® Hospital will establish our facility as a leader in providing evidence-based maternity care practices to support optimal infant feeding. • Obtaining Baby-Friendly® designation is recommended by the CDC, American Congress of Obstetricians and Gynecologists (ACOG), American Academy of Pediatrics (AAP) and the Academy of Breastfeeding Medicine (ABM). • On average, more than 90 percent of our patients initiate breastfeeding compared to the state average of 80.3 percent. AdventHealth Hendersonville invited the BFUSA survey staff to complete our site visit last December. However, site visits were delayed due to the COVID-19 pandemic. BFUSA has recently developed a plan to move forward with two-part hybrid assessments: The first part will be completed virtually within the next few months, and the second part will be conducted on site once travel is safe again. Over the past year, we have focused on maintaining patient education and care practices consistent with Baby-Friendly® requirements. We also continued to train The Baby Place nursing team to provide evidence-based infant feeding care to our patients. New hires are fully trained in these practices within six months of beginning work in The Baby Place.
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Cardiac Rehabilitation Meets 2020 Challenges with Innovative Solutions By Tabitha Byas, BSN, RN A cardiac and pulmonary rehab program builds on itself with each completed exercise. Every day the patient's exercises allows them to get stronger and more likely to return to their pre-interventional state. Rehab is not just about healing by exercise: It offers a wholistic approach, covering other areas including dietary and psychosocial needs. Many of these patients need encouragement and a social component more than they need a professional to help them exercise. This year has been a very challenging year for our team due to the shutdown associated with the COVID-19 pandemic. From March until June 2020, our Cardiac Rehabilitation facility was closed, along with all other gyms throughout the state. Because of this, patients were denied the ability to exercise and an important social outlet. Upon receiving the news our gym needed to close, our team immediately called an emergency meeting. At the meeting, the rehab team proposed to their manager and AdventHealth Cardiologist, Jeffrey Hardin, MD, MBA, FACC, a virtual solution to stay in contact with the patients. This idea would include team members providing our patients with one-on-one instruction for exercise – along with a familiar face offering encouragement and praise – from a distance.
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Knowing most of our patients do not have gym equipment such as bicycles or treadmills at home, the rehab team decided to get creative. They compiled videos to demonstrate types of exercise that could be completed daily within each patient’s home. In the videos, nurses and an exercise physiologist perform exercises using everyday objects such as canned vegetables for weights, a chair for simple muscle strengthening, and resistance bands. Once the videos were produced, we proceeded to the next step of distributing the program. Our team called each patient to explain they would be receiving the instructional videos by email and how to use them. They were also informed to be on the lookout for a package from the rehab team in the mail: a “care package” consisting of resistance bands and an exercise log for daily use, along with a handwritten note of encouragement from one of the rehab team members. The cardiac rehab team has worked incredibly hard to keep their patients engaged and exercising throughout the pandemic. I could not be prouder!
Multidisciplinary Rounds Redesigned to Shorten Length of Stay By Barbara Kenney, MS, RN, ACM, CCM Director of Care Management AdventHealth Hendersonville
A few years ago, AdventHealth Hendersonville launched interdisciplinary rounds, which involve a full complement of service providers including physicians, care managers, a charge nurse and an administrative supervisor, as well as team members from therapies, dietary, pharmacy and palliative care. Our challenge was to expand the focus of our rounds to address patient throughput that stood to impact hospital efficiency. Efficient patient throughput identifies and removes barriers so a hospital can function at optimal speed. As a result, we redesigned multidisciplinary rounds to address readiness for discharge, missing elements to a successful execution of the discharge, and barriers to discharge for each patient. The AdventHealth corporate office provided a comprehensive packet of tools to get us started. The project team, lead hospitalist, director of nursing and director of care management to review the toolbox, outline goals and draw a timeline. Additionally, we formed a taskforce to socialize the idea of involving the bedside nurse as a pivotal member of daily rounds. While the charge nurse and RN care manager had a broad knowledge of each patient’s care, the bedside nurse was an unleveraged asset. The bedside nurse is most aware of the patient’s current condition. To our delight, the taskforce generated excitement around this idea and designed a strategy to tee up each nurse to present their patients in an efficient manner. Like any process improvement project, we didn’t quite meet our goals with the first iteration of the plan but learned and adjusted along the way.
As the project unfolded, experienced nurse champions served as role models for less experienced nurses. The initiative provided each nurse with a forum through which to relay patient safety concerns resulting in prompt adjustments to the care plan. Team members from therapies, respiratory, pharmacy and palliative care offered their expertise when relevant, and RN care managers took the lead to facilitate meetings to help keep the group on task with concise reporting. To further increase efficiency, the participating hospitalist set a goal of an additional two discharges before noon each day, while remaining flexible and proactive in anticipating the discharge day so the care team could plan accordingly. Overall, the initiative to redesign multidisciplinary rounds has proven to be an advancement for patient safety and multidisciplinary teamwork, and it continues with the goal to identify and remove barriers that impede patient progression of care. This should lead to improved patient outcomes and result in appropriate lengths of stay.
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Quality/Risk Improvements 2020 By Bethany Dixon, BSN, RN, CNOR
Onboarding binders “Make It Easy” for new hires at Surgical Services and The Baby Place Setting new team members up for success by making their onboarding and orientation process as easy as possible was my motivating factor for creating the New Hire Binders for Surgical Services. Binders for each discipline in each department contain pertinent information, including the leadership structure within Surgical Services; dress codes, how to request time off; and how to access time sheets, paychecks and the AdventHealth Learning Network (ALN). The binder also houses new team member competencies, along with pages where the team members can take notes during their orientation. Having the most important information in one place where each new team member can easily access it and refer to it helps “Make it Easy” for that person and their team.
“Keep Me Safe:” Innovation and education decrease risk of surgical site infections Surgical site infections are costly and can lead to detrimental, long-term effects for the affected patient. That is why in late 2019, I started working with the clinical educator at BD – the manufacturer of Chloraprep – to see how we could improve our team member education and skin prepping techniques in the operating room. I worked with hospital leadership to arrange for BD to conduct a program onsite called Power in Prevention. The program involved observations of surgical procedures followed by evidence-based solutions to help improve patient safety and processes in the operating room. As a result of this working relationship with BD, we brought in a product called the ClipVac, which helps eliminate 98.5% of hair and airborne contaminants when clipping a surgical patient’s hair. The use of this device helps decrease the potential for contamination from a patient’s hair or techniques previously used to clean up clipped hair. AdventHealth Hendersonville also worked together with BD to provide prepping education to the operating room team to ensure manufacturers’ instructions for use were being followed on all skin prep solutions used at our organization. I provided the same education to nurses at The Baby Place to help ensure surgical areas throughout our entire organization are taking the measures necessary to decrease risk of infections.
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ACKNOWLEDGING
UNCONSCIOUS
BIAS
TheUnderstanding following is a discussion between Stephen Wilson, MSN, RN, CCRN, Bias to andUnleash SharonPotential™ Campbell, MRHM, PHR, Director of Human Resources. STEPHEN: It has been so sad to turn on the news and see wrongful treatment of another human being. The sadness, anger and hurt so many have felt caused a response and has also emboldened leaders to acknowledge unfairness based on skin color. SHARON: “What is important in what occurred earlier this year along with COVID is that it brought awareness of what our employees bring to work with them. For people of color, senseless killing and other racial tension across the country weighs heavily on [them]. When our CEO, Terry Shaw, sent [an] email [that] spoke so openly about it, he acknowledged that unfair treatment exists. Our corporate CEO also said that we are not going to be silent, and in so doing he challenged us.” At AdventHealth Hendersonville, our new leader, Cory Reeves, brought us together to acknowledge what was happening – that horrible things do happen based on no more than a differently colored pigment – and he began a commitment to talk about how we treat each other … here. Cory asked you to take the lead on four initiatives and establish a Diversity Equity Inclusion Program. At its roots, it can empower employees to speak up when they are treated unfairly. Can you describe these initiatives? “FIRST, we developed an employee resource group – a minority employee network, about 20 participating – with the intention of having all executive leaders attend from time to time to hear from minority employees in an open forum for discussing the climate at AdventHealth Hendersonville. Any time we share, we put ourselves out there. Our minority employees want their peers to understand this journey for equal treatment and fair playing ground and how we walk it. SECOND, leadership training. With the support of Carolyn Hopper and Katie Grotzinger, we are developing a leadership training program. The first offering is Unconscious Bias – subconsciously we may not assume that we each have bias. Todd Gothberg and LaToya Ellis will facilitate the sessions. We must acknowledge that unconscious bias exists and then work together to learn how to suspend judgement and truly appreciate each other for our individuality. Otherwise, how can we as individuals see each other beyond skin color?
THIRD, remove bias and prejudices throughout the hospital. This involves offering training to all employees to ensure that each one knows they shouldn’t accept unfair treatment from patients, families or even other employees. FOURTH, establish fair hiring practice – not one of meeting quotas, but one that involves always hiring the most qualified person while also reflecting our community. A question for each of us is, ‘As a diverse organization, do we look like our community?’ We could better represent our community by tapping into promoting health care careers within our Hispanic population, [in particular]. We are exploring how to bridge this gap. What I want for AdventHealth Hendersonville is that we will not have to use the words, ‘diverse, equity or inclusion,’ because it will be who we are. We will all need to open our eyes to what is around us. This is an AdventHealth Hendersonville issue that we as a community agree to [address]. We are not there right now, but we can get there. We have a leadership team that is committed to making this change.’”
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Home Health Adds Telehealth, Home Infusion to Service Offerings This year, while continuing to serve people living in Henderson, Buncombe, Polk and Transylvania counties, AdventHealth Home Care of Western North Carolina also focused on growing its services to include remote-monitored telehealth, and intermittent infusion needs in the home by December 2021. The new telehealth program focuses on patients with chronic care needs for congestive heart failure and chronic obstructive pulmonary disease using a system that allows remote monitoring of weight, blood pressure, oxygen saturation and heart rate. The patient is also asked a series of questions that can tell the reviewing clinician whether they are experiencing symptoms that might indicate an exacerbation of their disease. In addition, the system provides preloaded teaching modules and education modalities that are targeted to the diagnosis of the patient. A nurse reviews the patient’s data each weekday, calls the patient to discuss any issues or concerns and then reports any changes to the provider. This allows for interventions to be implemented early, potentially avoiding hospitalizations. The new infusion program, which will be fully implemented in December 2021, will allow providers to order intermittent, low-volume infusion for targeted intervention in the home setting. Intravenous fluids for the purpose of dehydration in homebound patients can be provided on a single-dose basis, preventing extra visits outside of the home that require considerable effort by the patient. In the home, nursing can place the IV, administer the infusion, monitor the patient during and immediately after the infusion and de-access the IV when the infusion is complete.
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Wound Care and Hyperbaric Medicine Team Improves Safety, Efficiency and Standards of Care By Jo Comaris, RN, BSN
Improving patient safety, efficiency and standards of care have been the focus of the Wound Care and Hyperbaric Medicine team over the past year. We have implemented case reviews on all patients who have been seen in our clinic for more than 90 days with the aim to provide the highest standard of care for these patients by assessing their progress and the need for any further interventions. Laura Chambers, RN, WOCN, BSN, and Krista Kaufman, RN, WOCN, BSN led these reviews. We are grateful to AdventHealth for helping advance the education of our wound, ostomy, continence (WOCN) nurses through a year-long educational and mentoring process at Emory University followed by National Board Testing. Inspired by the Global Leadership Conference, our team members have recently focused on increasing our efficiency and improving our teamwork. As a result, we have improved our workplace environment by decreasing clutter, purging the office of unnecessary and outdated material, organizing, consolidating nursing team workplaces into one room for better efficiency, and streamlining processes and communication between all team members.
Surveys of our wound care patients have consistently shown that wait times are an issue in our clinic. We found that one major reason for this is attempting to fit in late arrivals, which results in backups in the waiting room and negatively impacts those who arrive on time. We have recently addressed this issue by examining the culture of non-compliant patients (those who choose consistently to arrive late to their appointments). As a result, we have instituted a grace period for appointment arrival – and if a patient arrives outside of this grace period, they have the option to reschedule their appointment for the next morning or at a later date. This change has resulted in increased efficiency in the clinic and happier attitudes for patients and team members. At Wound Care and Hyperbaric Medicine, we are living out the goal to be “Greater As a Whole” daily with this kind of attention to patient safety, efficiency and standards of care.
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AdventHealth Hendersonville Forms New Program to Improve Behavioral Health Care in WNC By Beth Cassidy, DNP, MSN, NE-BC
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BEHAVIORAL HEALTH NAVIGATORS
EMERGENCY DEPARTMENT
We applied for and received a Duke Endowment for a Behavioral Health Navigator (BHN) program to assist with our behavioral health patients in the Emergency Department. The navigators are nurses with a strong behavioral health background. The program was developed to improve the management of the patients as they present to our ED. The navigators assist with their disposition, whether it is admission to inpatient, referral to another facility or discharge to outpatient care. The BHN works closely with the behavioral health providers to determine the best course for the patient. The program has been in effect since March 17th and has already shown a positive impact for the behavioral health patients in our ED. Most notable is the decrease in the length of stay for our behavioral health patients in the ED which translates to their receiving the care they need in a more efficient timeframe.
In June of this year, the ED received its Bronze level accreditation from the American College of Emergency Physicians or ACEP. The organization offers three levels of accreditation for geriatric readiness for quality care for the geriatric population. Our ED met all criteria and received our Bronze level after completing staff education, policy development and adding additional minor equipment to our ED inventory. We are the only ED in western NC with this accreditation and there ate less than two dozen facilities in the state with ACEP recognition. Our ED will be applying for Silver in 2021 then we will being going for the GOLD!
Social Workers Redeployed to Outpatient Oncology Go Above & Beyond By Kerry Irish, LCSW, Clinical Oncology Social Worker In June 2020, clinical social workers Lynne Norwood and Sarah Maull began working some redeployment hours with outpatient oncology social work. Lynne had previous but distant work experience in oncology, however, her exceptional clinical skills as a therapist were a very strong asset from the start. She was able to quickly establish therapeutic relationships with our cancer patients. Lynne also has a depth of community resource knowledge that made her a strong asset – in particular with patients in our Haywood County clinic – many of whom face significant challenges due to low socioeconomic status. Lynne consistently went above and beyond in her work, even contacting patients on her normal days off or in the evenings in order to ensure they received timely care. In one instance, Lynne offered to make a home visit when she was unable to reach a patient in need by either telephone or email. Sarah's willingness to jump right in to learn about a highly specialized field within clinical social work as well as a host of complex data
tracking systems – required for our cancer program accreditation – has been nothing short of incredible. Her clinical skills are excellent, and she has served our oncology patients with exceptional care and compassion, frequently going above and beyond to check in with patients struggling with emotional or concrete needs on her days off. The efforts of Sarah and Lynne to respond to every case referred or triaged to them in a timely manner coupled with their extension of exceptional care every time ensured that distressed cancer patients received timely and appropriate care. This also helped ensure our cancer program meets accreditation standards. I have had the pleasure of working with and supervising many excellent clinical social workers throughout my career, and I would place Sarah and Lynne right at the top of the list.
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2020Daisy Award Winners AdventHealth is proud to partner with The DAISY Foundation to honor nurses who go above and beyond their daily tasks to make extraordinary differences in the lives of our patients and their families. The DAISY Award was created by the family of J. Patrick Barnes to thank the nurses who cared for Patrick and for them as he battled an autoimmune disease. Patrick lost his battle, but his family realized the impact his nurses had on the final days of his life. For that they are forever grateful. They wanted to create an opportunity for all families who experience the benefits of the extraordinary care of nurses to show their appreciation.
2020 DAISY AWARD WINNERS (Pictured Left, top to bottum)
Anne Allen, RN, CCM Jessica Shuford, BSN, RN Matthew Young, RN, BBA, BSN
FOR EXTRAORDINARY NURSES IN MEMORY OF J. PATRICK BARNES
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Clinical Acheivment Professional Growth
Clinical Ladder Nurses
Leadership
Education
Clinical Ladder Growth 2020 The fourth quarter of 2020 saw implementation of a new Clinical Ladder format. The goals of this new format were many, but focused on increasing nursing activity on committees, education, leadership, process improvement and professionalism. In 2016, three members of the nursing staff were recognized for joining the previous Clinical Ladder. This year, eighteen nurses have joined the new Clinical Ladder! The year 2020 was a year of Clinical Ladder Committee. Chair Laura Chambers, BSN, RN, CWOCN, CFCN, co-chair Chelsea Fowler, RN, SANE and Stephen Wilson, MSN, CCRN welcomed Elizabeth D’Andrea, BSN, RN, C-EFM (from the Baby Place) and Meredith Barten, RN, OCN (from the Asheville Infusion Center). Both Elizabeth and Meredith immediately demonstrated their strengths in carrying on the activities of the committee and improving its effectiveness. Laura diligently served the committee throughout 2020, stepping away from the chair position to accept a managerial role on Wound Care. Great things are expected to continue in 2021, as Chelsea transitioned to chair the committee beginning the fourth quarter, 2020.
CONGRATULATIONS TO OUR NURSING CLINICAL LADDER RECIPIENTS FROM 2020: RN2 RECIPIENTS: Elizabeth D’Andrea, BSN, RN, C-EFM The Baby Place Meredith Barten, RN, OCN Hematology Oncology Infusion Services Asheville Laura Maier, BSN, RN | Behavioral Health Jeff Gugni, BSN, RN | Emergency Department Lauren Gatta, RN, OCN Hematology Oncology Infusion Services Asheville Abbey Garner, BSN, RN | Float Pool Matt Siegel, RN | Emergency Department Jo Comaris BSN, RN Vanessa Boris MSN, RN, RN-BC (MS) Medical Surgical Elizabeth Heier RN, BSN, MS-Ed Hematology Oncology Infusion Services Asheville Heidi McGuire, RN (ED) Holly Romero, RN (ED) Jessica Shuford, BSN, RN, OCN Hematology Oncology Infusion Services Asheville
RN3 RECIPIENTS: Chelsea Fowler, RN, SANE | Emergency Department Maria Blakeman, BSN, RN, CEN, SANE Emergency Department Ginger Stineman, BSN, RN | Emergency Department
RN5 RECIPIENTS: Laura Chambers, BSN, RN, CWOCN, CFCN Wound Care Kate Hubbard, MSN, RN, OCN Hematology Oncology Infusion Services, Education 23
This Annual Nursing Report was compiled to highlight the many ways the body of nursing strives to Extend the Healing Ministry of Christ inside and outside our organization. The Annual Nursing Report Committee – Jo Comaris, Shanna Myers, Susie Shipman, Stephen Wilson and Jenn Kennedy – would like to express our gratitude and thanks to all who contributed to this report.
We are thankful for all of you every day.
100 Hospital Drive | Hendersonville, NC | 28739 AdventHealthNC.com
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