The Advocate Nurse Empower. Serve. Thrive.
2015
Nursing Annual Report
Brand Promise The Advocate Nurse
is skilled in the art of healing and serves as the face of patient care.
The Advocate Nurse brings years of research, education and experience to patients. They are the center of clinical innovation and the heart and soul of Advocate Health Care.
The Advocate Nurse
is part of a diverse community of proud, dedicated individuals who
Empower. Serve. Thrive.
Table of Contents: Nursing by the Numbers 1
Structural Empowerment 10
Transformational Leadership 3
New Knowledge, Innovation and Improvements 34
Nursing Strategic Map 2
Exemplary Professional Practice 24
Message from the Chief NursingNursing Executive by the Numbers I am pleased and honored to present the Advocate BroMenn Medical Center 2015 Nursing Annual Report. In the following pages, you will find accomplishments that are both impressive and impactful, emphasizing advances in patientcentered care, professional growth and development, and compassion for our community. In 2015, we continued to sharpen our focus on eliminating healthcare associated conditions such as infections, pressure ulcers and falls. A commitment to the elevation of nursing professional practice was demonstrated through increased professional certifications, clinical ladder advancement, and achievement of advanced degrees. We focused on the continued pursuit of excellence and I am proud of our nurses and interdisciplinary partners who have led initiatives to improve the patient experience and clinical outcomes by incorporating evidence-based practice into the care they provide to our patients and their families. These accomplishments represent the impact of a strong infrastructure, processes and outcomes that support our ongoing Magnet journey, a formal, recognized measure of organizational excellence. This report aligns accomplishments with the Magnet model components of Transformational Leadership, Structural Empowerment, Exemplary Professional Practice, and New Knowledge, Innovations, and Improvements. As we move forward in 2016, we will continue to strengthen participation of front-line associates in shared governance, identify best practices for our patients, and bring up more High-Reliability Units as we journey to become a High Reliability organization. We will continue to encourage and support professional development and growth in an effort to enhance patient care and our profession practice. Nurses play a vital role in improving the quality of life for the patients we serve in a challenging health care environment, while consistently delivering safe, high quality nursing care. We elevate the practice of nursing through empowerment, autonomy, nursing education and the implementation of evidence based nursing best practice. Please take time to celebrate our outstanding achievements in 2015! It is a privilege to serve as your Chief Nursing Executive. I would like to thank our dedicated team of nurses and interdisciplinary partners for the outstanding work you do.
About Advocate BroMenn Medical Center Advocate BroMenn Medical Center is a 221-bed, full-service, teaching hospital dedicated to serving our patients, their families, and our community. BroMenn Medical Center is designated as a Level II Trauma Center and a Level II Nursery; and is accredited as a primary stroke center, a chest pain center and STEMI receiving center.
2015 Awards • Recognized among America’s Best Hospitals for Obstetrics by Women’s Certified, Inc. (Jan) • Earned 4 star HCAHPS rating from Center for Medicare and Medicaid Services (April) • Received Greenhealth Emerald Award from Practice Greenhealth (May) • Received 2015 Gold Plus Stroke Award and Target: Honor Roll recognition from the American Heart Association (May) • Designated Mission: Lifeline Gold Plus Receiving Center by the American Heart Association (May) • Recognized for 100 years of service to the community by Mayor of Normal (July) • Earned 4-star HCAHPS rating from Center for Medicare and Medicaid Services (Oct)
Nursing by the Numbers Total Number of Nurses
431
Nurse Turnover Rate
11.93%
Nurse Vacancy Rate
5.62%
Nurse Tenure Average New Nurse Hires in 2015
11.72 years 66
Percentage of BSN Prepared Nurses
60.3%
Percentage of MSN Prepared Nurses
9.6%
Sincerely,
Percentage of Nurses with BSN or higher degrees
70%
Laurie Round, RN, BSN, MS, NEA-BC Vice President and Chief Nurse Executive
Number of nurses currently enrolled in school
46 1
Nursing Strategic Map The Strategic Map represents Advocate BroMenn Medical Center’s established nursing priorities from 2013-2016. Additional details related to these priorities are found throughout this report.
Fostering a healing environment that is patient and family centered, ensuring patient safety and quality through the elevation of professional nursing practice. A
B
C
D
Develop Nurses as Leaders Who Practice at the Top of Their Licenses
Partner with Patients and Coordinate Care Across the Continuum
Fiscal Responsibility
Build an Accountable, Empowered Nursing Culture
1
Clearly define Care Delivery Model
Identify target populations and multi-disciplinary strategies by population
Efficiently manage resources
Expect professionals to be competent, accountable
2
Clearly define roles/responsibilities across all related disciplines
Improve access to and communication of patient health information
Free nurses from non-nursing tasks to increase time with patients
Foster a commitment to lifelong learning, mentoring and clinical expertise
3
Increase percentage of certifications and higher degrees
Identify strategic non-traditional partnerships
Leverage technology to support nursing practice
Professional responsibility for communication and a healthy work environment
4
Provide consistent evidence-based practice based on the nursing process
Add the voice of the patient to conversations and decision-making
Utilize FTEs effectively within and across departments
Implement tools and support for professional development; define professional image
5
Interdisciplinary collaboration and role optimization through clinical growth and expertise
Identify interventions that promote coordinated care across the continuum
Standardize supplies/storage
Implement the Nursing Professional Practice Model
A culture of Shared Governance that empowers RNs to use their clinical knowledge and expertise to impact decisions regarding their professional practice in the delivery of nursing care guided by compassion and patient centeredness.
Achieve Magnet Designation
2
Transformational Leadership
“I am proud to be an Advocate nurse because excellence is the standard of care and safety is a priority. I am grateful for Advocate’s commitment to ongoing education with the tuition reimbursement program. With this assistance, I am working toward reaching my goal of earning my BSN.” – Toni Winks, RN-BC
Our Magnet Journey
The Magnet Program recognizes health care organizations for quality patient care, nursing excellence, and innovations in professional nursing practice. Magnet designation is the highest national and international recognition granted to health care organizations for combined nursing and organizational excellence. The nurses at BroMenn Medical Center were hard at work in 2015 preparing the Magnet application. Five work groups were formed with nurses from across the hospital to gather evidence and write examples of how BroMenn nurses meet and exceed the Magnet standards.
3
Transformational Leadership
Exemplary Professional Practice I Front row – Jenny Messier, Stephanie Moore and Laurel Mode. Back row – Logan Frederick, Theresa Bailey, Janet Sutter, Donna Schweitzer and Amanda Parrish. Not pictured – Heather Jackson, Rachel Koerner, Meg Noreiko, Tami Olson and Melissa Reidy.
Magnet Work Groups • Exemplary Professional Practice I • Exemplary Professional Practice II • New Knowledge and Innovations • Structural Empowerment • Transformational Leadership
4
Exemplary Professional Practice II Front row – Alicia Allen, Lori Ritter and Jenny Messier. Back row – Kristi Wolfe and Toni Winks. Not pictured – Aaron Barclay, Lisa Gossmeyer, Angela Harrison, Susan Kaufman, Shelly Malin, Yvonne Rees, Cindy Schaumburg and Sonia Vercler.
Transformational Leadership
New Knowledge and Innovations L-R – Jenny Messier, Teresa Gimbert, Wendy Woith, Trayce Bartley, Todd McCartney and Pam Bierbaum. Not pictured – Crystal Bricker, Denise Hammer, Janet Hood, Michael Mandrell and Heather Meece.
Structural Empowerment Front row – Penny Rathbun and Lori Harper. Second row – Jenny Messier, Shelly Yoder, Barb Hancock, Stephanie Wollenberg and Victoria Steinkoenig. Back row – Dana Robbins, Jo Samara, Chrissy Jennings and Jennifer Ringsby. Not pictured – Renee Donaldson and Kristin Remmers.
Transformational Leadership Front row – Mark Lareau, Jenny Messier and Jennifer Steinhausen. Back row – Mike Mueller, Peggy Watkins, Linda Wahl, Stacy Barclay, Ann Frederick, Angela Turner and Ra’Net Bye. Not pictured – Teresa Novy, Kristin Peterson and Laurie Round.
5
Transformational Leadership Magnet Coordinator Jenny Messier, BSN, RN, ACM began her role as Magnet Program Coordinator in June 2014. In this role, she • provides education to nurses about Magnet Recognition • facilitates Magnet workgroups • serves as a resource for the Shared Governance Councils • assesses Magnet readiness • verifies that all of the stringent Magnet requirements are met. In 2015, Jenny focused on assuring that BroMenn Medical Center outperformed the required metrics for nursing sensitive indicators, patient satisfaction, RN satisfaction, and preparing the documentation required for Magnet recognition. She also assisted with the implementation of the new Advocate Professional Practice Model at BroMenn. Through her work, key nursing initiatives such as Shared Governance, Peer Review, Nursing Professional Development and the Magnet application was prepared for Spring 2016 submission.
THE ADVOCATE NURSE 2020 Our Vision
To be a faith based system providing the safest environment and best health outcomes, while building lifelong relationships with those we serve.
Our Role
The Advocate Nurse transforms care delivery throughout the patient and family journey, creating the safest environment and resulting in the best health outcomes.
Advocate Experience 1. Establish culture of accountability at all levels of nursing 2. Implement Advance Practice Clinician strategy 3. Standardize Nursing Practice around interdisciplinary plans of care 4. Develop consistent, evidencebased educational platform to support patient outcomes
Access & Affordability 1. D evelop cost-effective care delivery model utilizing lean 2. D evelop integrated workforce management strategy evidence based practices
AdvocateCare 1. Implement acute care component of care management model 2. Enhance team-based approach to care delivery 3. Optimize EHR
Transformational Nursing Leadership 1. Create a professional practice environment based on Magnet principles 2. Define the core competencies and professional development standards of the Advocate Nurse 3. Strengthen succession planning and leadership development The Nursing Strategic Plan was developed by the System Chief Nurse Executive and the Chief Nurse Executives of the sites to lead nursing to 2020.
6
Transformational Leadership
PR
OFESSION
LEADERSHIP
O
Y
C
RI
O
NG
The
N
M
O
Advocate Nurse ®
EL
SH
D
A
R
EN TI OL PA H W
ED
G
V O
N ER
E
N
IT
A
T C IS EN TI C TER CA E D RE
IN VA TI
AL
GN I T I O N CO
CLI NI C EXC EL LE
C
S
PATIENT, FAMILY AND COMMUNITY
N
L UA
September – NPC members worked with their units to identify, through words and phrases, the daily activities of the nurse that reflect the caring factors of our nursing theorist. These words were used to create “word clouds” to be displayed on each unit.
IP
CE N
ONAL ESSI OF PR ROWTH G
IO
Q
The Professional Practice Integration workgroup (consisting primarily of clinical nurses) developed the implementation plan. It began with educating nurses about the theorist, the Advocate PPM and how their nursing practice reflects quality and caring. The August/September 2015 Quarterly Education sessions were dedicated to the Quality Caring Model and PPM. Next, a monthly activity was planned to reinforce the model. The next step was to identify the caring factors that exist in each unit.
LATIONSH
L A
PROFESSI
RE
RE
A
L
CO M PASS
The implementation of our new Professional Practice Model (PPM), began in 2014 with its introduction to the Nurse Practice Council (NPC) at the September 2014 NPC meeting. Members agreed to read and discuss Joanne Duffey’s book, Quality Caring in Nursing and Health Systems. Over the next year. NPC members read one to two chapters per month and discussed the material at each meeting. Shelly Malin, endowed professor from Illinois State University’s Mennonite College of Nursing, led the monthly discussions. By June 2015, NPC was ready to develop a housewide implementation plan.
ON
Advocate Health Care Professional Practice Model
A
N
The Advocate Nurse Professional Practice Model
October – The workgroup held a toothbrush drive in response to community oral health needs. Over 1500 toothbrushes were collected and distributed through the emergency departments at BroMenn Medical Center, Eureka Hospital and other local agencies.
7
Transformational Leadership Next came the monthly Caring Awards. The Caring Award started in the Mother Baby Unit but was then implemented across all nursing units. The goal is to recognize a peer for their caring behaviors. It is intended to let each nurse reflect on who consistently displays caring behaviors and to recognize them within the department. Caring Award winners were:
8
Emily Anderson, ICU
Patti Mayer, Medical Oncology Specialty Unit
Bet Atkins, Nursing Resource Pool
Jodi McCombs, Emergency
Stacy Barclay, Nursing Office
Beni McNaught, Progressive Care
Betty Benedino, Quality
Angela Miller, Medical Oncology Specialty Unit
Tiffany Boyd, Emergency
Cindy Mounce, 6W Surgical
Leslie Carter, Emergency
Marilyn Nelson, Emergency
Heidi Castleman, Mental Health
Amanda Parrish, Acute Rehab
Colleen Chandler, Nursing Resource Pool
Jason Pate, ICU
Brittney Decroix, Mental Health
Ariel Pearson, Acute Rehab
Katie Denney, Nursing Resource Pool
Carolyn Peden, Medical Oncology Specialty Unit
Codee Delagrange, 6W Surgical
Kristin Remmers, Medical Oncology Specialty Unit
Maggie Durbin, Mother Baby
Angie Robbins, Mental Health
Stefanie Esme, Emergency
Melanie Salisbury, ICU
Lindsey Etheridge, Progressive Care
Amy Short, Nursing Office
Scott Farquhar, Nursing Resource Pool
Jessica Sinks, Cardiovascular Care Unit
Stephanie Fuller, ICU
Christine Stauter, Social Work
Jeannie Gaddis, Cardiovascular Care Unit
Jillian Stiles, Cardiovascular Care Unit
Nichelle Gavin, Quality
John Titus, Quality
Angie Harrison, 6W Surgical
Lori Troyer, Mother Baby
Kim Helgeson, Acute Rehab
Clara Veal, ICU
Susan Henkel, Quality
Linda Wahl, Quality
Sheron Howard, Cardiovascular Care Unit
Peggy Watkins, Nursing Office
Julie Hyland, Acute Rehab
Lisa Wetzel, 6W Surgical
Ashley Johnson, Mental Health
Suzanne Wilcox, Nursing Office
Dayna Krowlek, Acute Rehab
Toni Winks, Mental Health
Mark Lareau, Quality
Courtney Yoder, ICU
Kevin Lee, 6W Surgical
Kacie Zielsdorf, Mental Health
Amy Loveless, Quality
Shelly Zobrist, Quality
Transformational Leadership
November – Nursing Practice Council “hit the road” with cake and badge cards.
The layered cake was a representation of the relationship of our nursing theory and our professional practice model. The bottom layer of the cake represented the theory or “base” for our practice. The top layer represented our professional practice model. NPC members brought their peers this sweet treat along with badge cards with the eight caring factors.
In December each department was challenged by NPC to participate in at least one “pay it forward” activity during the month. Activities ranged from recognizing and giving “treats” to other departments, to adopting families for Christmas. Hundreds of “pay it forwards” happened during the month. Nurses across Advocate BroMenn Medical Center exemplify the caring behaviors and model the professional practice model every day, in every encounter. The model has truly given a name and a depiction of the way that our nurses care for our patients, for each other and for our organization.
9
Structural Empowerment
“I am proud to work at Advocate BroMenn Medical Center because of the beliefs and values instilled in the culture that create a positive work environment in which to provide excellent care to the community.” – Rebekka Prokup, BSN, RN Nursing Practice Council and Unit Shared Governance The Nursing Practice Council (NPC) at Advocate BroMenn Medical Center has accountability for establishing and maintaining the standards of nursing practice. Nurses come together to share best practices and to problemsolve the challenges that come with working in a complex health care environment. Council participants include clinical nurses who chair their Unit Shared Governance Councils, nurse educators, and nurse leaders from across the organization.
Nurse Practice Council members 10
Shared Governance Highlights Pain Management
• Same Day Surgery continued to identify opioid tolerant patients pre-operatively, in an effort to pre-operatively evaluate effectiveness of interventions to better control pain of the patient. • 6W Surgical established a pain order set to achieve better pain control as measured by patient satisfaction scores. Patient Experience
• Same Day Surgery determined the impact on patient perception of nursing IV insertion skills. • Mental Health Unit implemented hourly rounding to decrease falls and keep those who are at risk for self-harm safe. • Progressive Care Unit created an educational brochure for patients to take home in their stroke education folders, along with a “Mediterranean diet grocery shopping list.” • Medical Oncology Specialty Unit created a file system for patient education materials on the most frequently seen diagnosis and (new) medications. • Same Day Surgery began actively warming (Bair Huggers and Foil caps) patients prior to surgery if they had a temperature equal to or below 36.5 degrees Celsius. Data showed a significant increase in patients going to surgery warm, staying warmer during surgery and meeting criteria of a temperature of 36.5 degrees Celsius or above upon arrival to PACU. Improvement of Work Flow
• Same Day Surgery redesigned the layout of patient rooms with the goal of making RN movements more efficient and reducing instances of being in patients’ family members’ space. Clinical Outcomes
• Emergency Department identified the need to evaluate low risk chest pain patients in the ED and then collaborated with multiple disciplines to create early morning openings for stress testing of ED patients. This resulted in earlier discharge from the ED when tests are negative. • Mother Baby Unit implemented EBP changes with a newborn hypoglycemia protocol, delayed bathing, immersion baths and transcutaneous bilirubin monitoring. • Wound Healing Clinic collaborated with physicians on chart review to ensure everything possible is being done to heal their patients’ wounds in the shortest amount of time. Professional Development
• Neuroscience Nursing Grand Rounds – Progressive Care Unit assembled Neuroscience Nursing Grand Rounds to expand the neuroscience knowledge among nurses throughout the hospital. • Acute Rehab improved assessment of their patients’ functional outcomes through professional development activities. • Medical Oncology Specialty Unit utilized resources and reimbursement through the professional development program to encourage peers to attend more conferences, thus obtaining more CE’s.
11
Structural Empowerment Professional Development Clinical Ladder Success through Excellence in Practice (STEPS)
The STEPs program is Advocate’s professional development program for full and part-time Registered Nurses who provide direct patient care. The program recognizes nurses who exemplify professional practice and clinical skill in their areas of expertise. In 2015, ten deserving nurses were promoted to Nurse Clinician III (NCIII) status within the STEPs program. Promotion to NCIII requires completion of an application, peer reviews, completion of 15 contact hours of continuing education, a written case study and presentation of the study to the Clinical Career Advancement Board. Congratulations to these deserving nurses who were promoted in 2015: Emily Ruedi
Emergency Dept
Ashley Johnson
Mental Health
Diane Crouch
Medical Oncology Specialty Unit
Cindy Wells
Progressive Care Unit
Emily Wall
Emergency Dept
Lindsey Zummallen
Progressive Care Unit
Sarah Magee
Progressive Care Unit
Paula Dapkus
Progressive Care Unit
Lori Troyer
Mother Baby Unit
“Nurses validate their mastery of skills, knowledge and abilities through certification and meet ongoing learning and practice requirements through recertification. Patients and families, employers and nurses all benefit from certification.” – American Association of Critical Care Nurses 12
Professional Certified Registered Nurses Advocate Health Care and Advocate BroMenn Medical Center support continuous professional development including the attainment of professional nursing certification in one’s area of specialty. Certification signifies the licensed professional has mastered a body of knowledge and acquired skills to meet certain predetermined standards specified by that profession for specialty practice. Advocate Health Care’s Education Assistance Program provides reimbursement for review courses and materials, as well as examination fees following successful completion of a certification.
Structural Empowerment Nurses at BroMenn Medical Center with Magnet-Recognized Certifications ACM (Accredited Case Manager) • Brandie Anderton, Care Management • Tena Bliss, Care Management, new Nov 2015 • Lisa Crane, Care Management, new Oct 2015 • Nichele Gavin, Care Management • Susan Henkel, Care Management • Jenny Messier, Magnet • Jeff Smith, Care Management, new Feb 2015 • Cindy VanDusen, Care Management, new Nov 2015 • Laura Wiley, Care Management, new Sept 2015 • Shelly Zobrist, Care Management, new Oct 2015 ACNS-BC (Adult Clinical Nurse Specialist) • Victoria Steinkoenig, Clinical Education AGCNS-BC (Adult Gerontology Clinical Nurse Specialist) • Candice White, Nursing Resource Pool CAPA (Certified Ambulatory Perianesthesia Nurse) • Corinn Desmond, Same Day Surgery CCNS (Critical Care Clinical Nurse Specialist) • Donna Schweitzer, Clinical Education CCRN – Adult (Critical Care Registered Nurse) • Grace Fisher, Cardiology • Michael Mandrell, Emergency Dept • Bridget McClusky, Intensive Care • Michael Mueller, Cardiopulmonary Service Line • Marilyn Nelson, Emergency Dept • Emyli Quain, Cardiovascular Care Unit • Mindy Ruan, Emergency Dept • Donna Schweitzer, Clinical Education • Marissa Smith, Intensive Care • Megan Threm, Cardiovascular Care Unit • Suzanne Wilcox, Nursing Resource Pool CCRN – Pediatrics (Critical Care Registered Nurse) • Michael Mandrell, Emergency Dept CCTN (Certified Clinical Transplant Nurse) • Shannon Hurliman, Nursing Resource Pool CDE (Certified Diabetes Educator) • Linda Avery, Diabetes CEN (Certified Emergency Nurse) • Penny Boser, Emergency Dept • Kathy Brown, Nursing Office • Leslie Carter, Emergency Dept, new Aug 2015 • Mike Kelly, Emergency Dept • Michael Mandrell, Emergency Dept
• Marilyn Nelson, Emergency Dept • Amber Painter, Emergency Dept, new Feb 2015 • Lori Ritter, Emergency Dept • Mindy Ruan, Emergency Dept • Emily Ruedi, Emergency Dept • Jennifer Toohill, Emergency Dept CGRN (Certified Gastrointestinal RN) • Cheryl Hart, Same Day Services • Betty Kaupp, Post Anesthesia Care Unit • Yvonne Rees, Same Day Services • Sonia Vercler, Perioperative Services CHPN (Certified Hospice & Palliative Nurse) • Gay Shoot, Palliative Care, new July 2015 CHRN (Certified Hyperbaric Registered Nurse) • Melanie Evelsizer, Wound Healing • Jennifer Perry, Wound Healing • Missy Smith, Wound Healing CIC (Certified in Infection Control) • Pam Bierbaum, Quality CNM (Certified Nurse Midwife) • Peggy Jacobs, Mother Baby Unit CNOR (Certified Nurse Operating Room) • Crystal Bricker, Operating Room • Barbara Hancock, Operating Room • Cindy Hauk, Materials Management • Michael Hoeft, Operating Room, new Jan 2015 • Laura McCartney, Operating Room • Todd McCartney, Surgical Services, new Mar 2015 • Meg Noreiko, Operating Room, new Jan 2015 • Rayford Rattley, Operating Room, new Apr 2015 • Nicole (Niki) Tracy, Operating Room, new Jan 2015 CPAN (Certified Post Anesthesia Nurse) • Betty Kaupp, Post Anesthesia Care Unit, new Apr 2015 • Heather Meece, Post Anesthesia Care Unit, new Apr 2015 CPEN (Certified Pediatric Emergency Nurse) • Michael Mandrell, Emergency Dept CPHQ (Certified Professional in Healthcare Quality) • Ann Frederick, Quality • Tami Olson, Quality • Cindy Schaumburg, Quality CPN (Certified Pediatric Nurse) • Michael Mandrell, Emergency Dept
13
Structural Empowerment CPPS (Certified Professional in Patient Safety) • Kristie Wolfe, Patient Safety CRN (Certified Radiology Nurse) • Janet Sutter, Radiology CRRN (Certified Rehabilitation RN) • Dayna Krowlek, Acute Rehab – new July 2015 • Amanda Parrish, Acute Rehab – new July 2015 CWCN (Certified Wound Care Nurse) • Linda Bergren, Wound/Ostomy CWOCN (Certified Wound, Ostomy, Continence Nurse) • Becky Hatfield, Wound/Ostomy CWON (Certified Wound Ostomy Nurse) • Linda Bergren, Wound/Ostomy FNP-BC (Family Nurse Practitioner) • Miranda Gonzalez, Mother Baby Unit GCNS-BS (Gerontological Clinical Nurse Specialist) • Candice White, Nursing Resource Pool IBCLC (International Board Certified Lactation Consultant) • Lucinda Edgren-Gebhardt, Mother Baby Unit NEA-BC (Nurse Executive Advanced) • Laurie Round, Chief Nurse Executive NE-BC (Nurse Executive) • Lori Harper, Nursing Practice • Stephanie Moore, Critical Care/Emergency Svcs NP-C (Family Nurse Practitioner) • Miranda Gonzalez, Mother Baby Unit • Rachael Hudgins, Mother Baby Unit OCN (Oncology Certified Nurse) • Jeanne Aden, Medical Oncology Specialty Unit • Patty Omahana, Cardiovascular Care Unit ONC (Orthopedic Nurse Certified) • Angie Le, 6W Surgical, new Oct 2015 • Cindy Wells, Progressive Care Unit PCCN (Progressive Care Certified Nurse) • Bet Atkins, Nursing Resource Pool
RN-BC (Nursing Professional Development) • Alicia Allen, Medical/Surgical • Dana Robbins, Clinical Education RN-BC (Psychiatric & Mental Health Nurse) • Patricia Kruse, Mental Health • Sara Purfield, Mental Health • Margaret (Peggy) Vanhorn, Mental Health • Toni Winks, Mental Health RNC-LRN (Low Risk Neonatal Nursing) • Linda Baer, Mother Baby Unit • Michelle Braun, Mother Baby Unit, new Sept 2015 • Lisa Gilmore-Riess, Mother Baby Unit • Angela Philpott, Mother Baby Unit • Lori Troyer, Mother Baby Unit, new Sept 2015 RNC-MNN (Maternal Newborn Nursing) • Brenda Drury, Mother Baby Unit • Susan Kaufman, Mother Baby Unit • Kathy Macy, Mother Baby Unit • Joan Yoder, Mother Baby Unit RNC-NIC (Neonatal Intensive Care Nursing) • Denise Hammer, Mother Baby Unit RNC-OB (Inpatient Obstetric Nursing) • Jessica Baker, Mother Baby Unit • Lucinda Edgren-Gebhardt, Mother Baby Unit • Melissa Eskridge, Mother Baby Unit • Mary Finley, Mother Baby Unit • Ann Groonwald, Mother Baby Unit • Peggy Jacobs, Mother Baby Unit • Lori Pearson, Mother Baby Unit • Keli Sidebottom, Mother Baby Unit • Susan Wilkins, Mother Baby Unit • Stephanie Wollenberg, Mother Baby Unit SANE-A (Sexual Assault Nurse Examiner-Adult) • Tammy Vandegraft, Emergency Dept SCRN (Certified Stroke Registered Nurse) • Victoria Steinkoenig, Clinical Education
RN-BC (Gerontological Nurse)
WCC (Wound Care Certified)
• Teresa Novy, Wound/Ostomy
• Teresa Novy, Wound/Ostomy
RN-BC (Medical/Surgical Registered Nurse) • Jennifer Abraham, Medical Oncology Specialty Unit • Donna Anderson, Medical Oncology Specialty Unit • Gayle Guffey, Quality
14
• Kristin Remmers, Medical Oncology Specialty Unit, new Nov. 2015 • Angie Schoon, Cath Lab
Structural Empowerment 2015 Summer Interns
Reward and Recognition
For the past 16 years Advocate BroMenn Medical Center has offered a paid internship program for student nurses who are entering their last year of nursing school. These students work side-by-side with a preceptor, gaining valuable hands-on experience.
2015 Certified Nurses Day
March 19th is Certified Nurses Day each year. A Certified Nurse has taken an additional exam that demonstrates their expertise in their area of specialty. We celebrated with a Certified Nurses Day breakfast.
Front row left to right – Ashley Segerstrom, Taylor Orr, Cami Westfall, and Luke Bachtold. Back row, left to right – Katilyn Ramey, Alyssa Polen, Melanie Anderson and Nicole Nonnemacher.
2015 Nurses’ Week Highlights Nurses Week (May 6-12) is a time to acknowledge and recognize our nurses for the service that they provide for patients, families and the community. Nurses Week 2015 began with an ice cream social hosted by Nurse Practice Council. Chaplains performed a Blessing of the Hands in our nursing units and in the Chapel for our caregivers. The Shared Governance councils displayed their work in a poster session held in the hospital lobby for employees and the public to see. On May 11th the nurses were treated to a pancake breakfast. Nursing directors and managers served as cooks and servers. A great time was had by all!
15
Structural Empowerment
Our Nursing Excellence Awards were presented to four very deserving nurses.
Patient Advocacy Chrissy Jennings, BSN, RN, Mental Health Unit
Clinical Care Amanda Parrish, BSN, RN, CCRN, Acute Rehab Unit
Leadership Heather Jackson, BSN, RN, Mother Baby Unit
Mentoring Crystal Bricker, BSN, RN, CNOR, Operating Room
Nursing Story Awards were presented for the third year. Mary Ann Bottles, Addiction Recovery, “The Influence of Mildred”
Peggy Watkins, Nursing Office, “A day in the life”
Jasmine Harris, Mother Baby Unit, “Receiving Quality Care”
Susan Zobrist, Advocate Eureka Hospital, “Illuminating the Way”
Teresa Novy, Wound/Ostomy, “A Story of a Life Time” 16
Structural Empowerment Whitney Butikofer
Patient Safety Award
Each year Advocate Health Care recognizes Patient Safety Award Winners from each site. In early 2015, the 2014 BroMenn Medical Center Patient Safety Award Winner, Whitney Butikofer, was honored. Whitney, a new nursing graduate, used a questioning attitude when a patient she was caring for started to exhibit signs of severe sepsis. Concerned with the patient’s deteriorating condition, Whitney used ARCC to escalate her concerns. As a result of her persistence, the patient received earlier treatment and recovered successfully with the best outcome possible.
New Graduates: Nurse Residency For new graduate nurses at Advocate BroMenn Medical Center the end of orientation is only the beginning of ongoing support and mentoring through the Nurse Residency Program. The Nurse Residency program is a one-year program that begins the month following the conclusion of the new graduate nurses’ unit orientation. Colleen Ewen, BSN, MBA, RN, Clinical Development Specialist, leads the Nurse Residency program and its monthly four-hour sessions. These sessions are devoted to educational/professional development topics such as lab values, respiratory and rapid response codes. They also provide the opportunity to debrief, network with peers, discuss the transition into the health care environment, provide support, and address concerns or difficult situations.
“I enjoyed hearing the things others struggled with and where they succeeded. This helped me feel like I wasn’t the only one still finding my way!” – Nurse resident Mentoring: Laurie Round, MS, BSN, RN, NEA-BC, Vice-President, Patient Services and Chief Nursing Executive, recognized that the first year nurse turnover rate was higher than expected. She identified an additional level of support for new graduate nurses: a formalized mentoring program. Laurie, together with the nursing directors, identified potential mentors. Those identified were experienced nurses who demonstrated interest in nurturing and supporting new graduate nurses. The goal of the program was to connect new graduate nurses to experienced nurses outside of their direct practice area. This would afford them the opportunity to discuss personal needs and concerns, develop a broader network, feel connected to other nurses in the organization, and allow them to learn about other areas of practice. The potential mentors met with Laurie in November 2015 to discuss their interest and support for the program. The mentors enthusiastically endorsed the program and agreed to serve in this capacity. The program will begin in 2016.
17
Structural Empowerment Nursing’s Value Leaders Four nurses were honored this year as Quarterly Value Leaders because of their display of one or more of our five core values: Compassion, Equality, Excellence, Partnership and Stewardship.
Compassion Teri Hill & Julie Lemons Palliative Care & Intensive Care Julie and Teri spent many hours with a patient, helping her arrive at a decision about withdrawing care as she faced end stage respiratory disease. They thoroughly explored the possibilities with her, making sure that she felt in control over her situation and was at peace with her decision. In the end, the patient trusted that she would be kept comfortable and had a peaceful death.
Compassion Tena Bliss, Quality Resource Management Tena assisted a patient in obtaining authorization for a medication and when the patient was unable to find a ride back to the hospital pharmacy for her medication, Tena made arrangements to pick up the medication and personally deliver it to the patient’s home. She recognized the importance of the medication being available to the patient and even followed up several days later to discuss pick-up of further doses with the patient. 18
Equality Sherri Pearson, Emergency Department
Sherri advised perioperative leaders and connected them with a pediatric abuse clinic who could provide more appropriate and comprehensive care for a patient that was thought to be a victim of abuse. Sherri’s willingness to collaborate with perioperative leaders allowed for the patient’s rights to be protected and [for her] to receive the psychological and physical care she deserved.
Structural Empowerment Community Partnership
AHA Heart Walk
As the presenting sponsor for this year’s event, Advocate BroMenn Medical Center was very proud of the amazing turnout of our associates, their families, and friends at the 2015 McLean County Heart Walk! Our goal was to have 240 registered walkers, and we had 255. We raised in excess of $24,000, an increase over the 2014 total.
Nurses’ Community Involvement 4H Sonia Vercler, Surgical Services ALS Walk Chris Waters, Medical Oncology Specialty Unit Alzheimer’s Walk Christine Hammond, Operating Room Sam Munk, Medical Oncology Specialty Unit Melanie Walker, Nursing Office American Diabetes Association Linda Avery, Diabetes Ellen McComb, Same Day Surgery – walk Stacy Thomas, Cardiovascular Care Unit – walk American Heart Association Mike Mueller, Cardiopulmonary Service Line Peggy Jacobs, Mother Baby Unit
American Heart Association Heart Walk Alicia Allen, Medical/Surgical Theresa Bailey, Medical Oncology Specialty Unit/ Pediatrics/Infusion
Aaron Barclay, Emergency Dept Stacy Barclay, Nursing Operations Trayce Bartley, Surgical Services Kimberly Crutcher, Cardiopulmonary Service Line Conni Cunliffe, Mental Health Diane Forrest, Preadmission Testing Bev Glendon, Cardiopulmonary Service Line Lisa Gossmeyer, Quality Lori Harper, Nursing Practice Heidi Heite, Cardiopulmonary Service Line Jen Kjeldgaard, Cardiovascular Care Unit Rebekah Lavicka, Cardiopulmonary Service Line Laura McCartney, Operating Room Todd McCartney, Surgical Services – co-chair Stephanie Moore, Critical Care/Emergency Svcs Michael Mueller, Cardiopulmonary Service Line – committee and walk 19
Structural Empowerment American Heart Association Heart Walk...continued
Ellen McComb, Same Day Services – Health care fair
Sam Munk, Medical Oncology Specialty Unit
Nicole McDonald, Nursing Office – church camp nurse
Kathy Ott, Nursing Office
Teresa Novy, Wound/Ostomy – wellness committee
Kristin Peterson, Progressive Care Unit
Peggy Watkins, Nursing Office – church camp
Dana Robbins, Clinical Education
Cindy Wells, 6W Surgical – Health fair
Laurie Round, Chief Nurse Executive
Michael Zobrist, Nursing Office – mission trips, Team 224 Co-Founder/Co-President and Chairman of the Board
Marie Smith, Cardiovascular Care Unit Tori Steinkoenig, Clinical Education Angela Turner, Surgical/Rehab Tammy Vandegraft, Emergency Dept Melanie Walker, Nursing Office Suzanne Wilcox, Nursing Office Laura Wiley, Care Management Stephanie Wollenberg, Mother Baby Unit Shelly Yoder, Critical Care Bloomington/Normal Community Campus Committee Tammy Vandegraft, Emergency Dept BLS, CPR, PALS Instructors
Community Health Care Clinic Jo Samara, Information Systems, President of the Board 2012-2014, Executive Committee, Resource Development Community Health Fairs Kelsey Anderson, Nursing Resource Pool – John Warner Health Fair Carrie Alexander, Emergency Dept Linda Avery, Diabetes Crystal Battaglia, Medical Oncology Specialty Unit Lisa Bova, Progressive Care Unit – flu clinic
Le Ann Galbraith, Emergency Dept – PALS
Tonia Cannon, Mother Baby Unit
Tami Olson, Quality Resource Management – BLS, CPR
Conni Cunliffe, Mental Health
Tammy Vandegraft, Emergency Dept. – CPR
Julie Cuppini, Quality
Brain Health Fair Stephanie Moore, Critical Care/Emergency Kristin Peterson, Progressive Care Unit Victoria Steinkoenig, Clinical Education BroMenn Delegate Church Association Jo Samara, Information Systems – executive committee Boys/Girls Club Patricia Kruse, Mental Health Buddy Walk Shelly Yoder, Cardiovascular Care Unit/Intensive Care Carlock Fire Protection Mark Lareau, Quality – Trustee Car Seat Checks Sara Mounce, Mother Baby Unit Chase for Champions Trayce Bartley, Surgical Services Christie Clinic Run Jeffrey Smith, Care Management Church Volunteer
20
Shelly Zobrist, Quality
Karen Dodd, Cardiopulmonary Service Line Lucinda Edgren-Gebhardt, Mother Baby Unit – Baby Expo Melanie Evelsizer, Wound Healing Center Bev Glendon, Cardiopulmonary Service Line – Concerns of the Heart committee member Miranda Gonzalez, Mother Baby Unit Denise Hammer, Mother Baby Unit – Ridgeview Pre-K Health Fair Heidi Heite, Cardiopulmonary Service Line Teresa Hogan, Nursing Office Kelly Johnson, Emergency Dept – BP screens Jessica Lee, Wound Healing Claire Mojica, 6W Surgical Bryan Nally, Operating Room Tami Olson, Quality Amanda Parrish, Acute Rehab – Brain Matters, Concerns of the Heart Kristin Peterson, Progressive Care Unit – Concerns of the Heart, Senior Expo, John Warner Health Fair Sharon Plante, Mother Baby Unit Kaley Rinkenberger, Mother Baby Unit Jodi Robbins, Operating Room – ISU fair, community flu clinic Keli Sidebottom, Mother Baby Unit – Baby Expo
Michelle Braun, Mother Baby Unit – church camp nurse
Tori Steinkoenig, Clinical Education
Patricia Kruse, Mental Health Unit – Blood Pressure checks and blood drives
Natasha Wattleworth, Clinical Informatics – Bloomington Jr. High
Nanci Liniger, Same Day Services – Blood Drive, health education
Chris Waters, Medical Oncology Specialty Unit – flu clinics
Structural Empowerment Easter Seals
NAMI Walk
Theresa Bailey, Medical Oncology Specialty Unit/Peds/ Infusion Laurie Round, Chief Nurse Executive
Nichele Gavin, Care Managementet Therapy
Stephanie Wollenberg, Mother Baby Unit – walk
Theresa Bailey, Medical Oncology Specialty Unit/Peds/ Infusion
Eighth Grade Career Day
Paula Dapkus, Progressive Care Unit
Barb Hancock, Operating Room
Lauren Evans, Operating Room
Emergency Management Systems
Faith Community Nursing/Health Ministries Trayce Bartley, Surgical Services Julie Cuppini, Quality Becky Hatfield, Wound/Ostomy Patricia Kruse, Mental Health Marilyn Nelson, Emergency Dept Jo Samara, Information Systems Shelly Zobrist, Quality Illinois State University-Mennonite College of Nursing Ann Frederick, Quality LeRoy High School Academic Week Theresa Bailey, Medical Oncology Specialty Unit/Peds/ Infusion March of Dimes Theresa Bailey, Medical Oncology Specialty Unit/ Peds/Infusion Brenda Drury, Mother Baby Unit Ann Groonwald, Mother Baby Unit Lori Harper, Nursing Practice Peggy Jacobs, Mother Baby Unit Susan Kaufman, Mother Baby Unit Laurie Round, Chief Nurse Executive Stephanie Wollenberg, Mother Baby Unit – Steering Committee (walk & auction) Michael Collins Walk Trayce Bartley, Surgical Services Missy Hardesty, Critical Care Jen Kjelgaard, Critical Care Todd McCartney, Surgical Services Stephanie Moore, Critical Care/Emergency Courtney Yoder, Critical Care
Mary Ann Kirchner, Quality New Life Pregnancy Center
Stacy Thomas, Cardiovascular Care Unit
Laurel Mode, Quality – EMS education, disaster preparedness drills
Brittney Decroix, Mental Health
Pray for the Cure Susan Henkel, Care Management – Committee Jenny Messier, Magnet Race for the Cure Theresa Bailey, Medical Oncology Specialty Unit/Peds/ Infusion Susan Henkel, Care Management Joy Kusturin, Nursing Resource Pool Laurie Round, Chief Nurse Executive Region 2 EMS Meeting Kristin Peterson, Progressive Care Unit Victoria Steinkoenig, Clinical Education Relay for Life Alicia Allen, Medical/Surgical Stephanie Anderson, Nursing Resource Pool Bet Atkins, Nursing Resource Pool Theresa Bailey, Medical Oncology Specialty Unit/Peds/ Infusion Corinn Desmond, Same Day Surgery Brenda Drury, Mother Baby Unit Taylor Greico, Same Day Surgery Susan Henkel, Care Management Shelly Jimenez, Cardiovascular Care Unit/Intensive Care Jessica Miller, Medical Oncology Specialty Unit Julie Morton, Medical Oncology Specialty Unit Sally Ohmart, Preadmission Testing Kristin Remmers, Medical Oncology Specialty Unit Emily Ruedi, Emergency Dept Red Cross Laura Deisher, Cardiovascular Care Unit Patricia Kruse, Mental Health Kathy Ott, Nursing Office Darla Schwertfeger, Operating Room Melanie Walker, Nursing Office
Midwest Food Bank volunteer Lori Harper – Nursing Practice
21
Structural Empowerment Right to Life March Brenda Drury, Mother Baby Unit Safe Harbor Theresa Bailey, Medical Oncology Specialty Unit – meals Jessica Miller, Medical Oncology Specialty Unitl Jessica Lee, Wound Healing Center St. Jude Lindsay Kaiser, Emergency Dept – B/N to Peoria run State Stroke Advisory Task Force Victoria Steinkoenig, Clinical Education Stroke Education Jennifer Steinhausen, Quality Jenny Messier, Magnet Tami Olson, Quality Kristin Peterson, Progressive Care Unit – State Farm, Country Companies, Senior Center, Chase for Champions Committee, B/N EMS, State Stroke Advisory Task Force, MCHD, Eureka College Reagan Run, Eureka Jr. High Victoria Steinkoenig, Clinical Education – State Farm, Senior Center, Chase for the Champions, B/N EMS, MCHD, Eureka College Reagan Run, Eureka Jr. High United Way Aaron Barclay, Emergency Dept Ann Frederick, Quality – Chair Lori Harper, Nursing Practice
Academic Partnerships Shelly Malin, PhD, RN, NEA-BC, and Wendy Woith, PhD, RN, FAAN, shared the Advocate BroMenn Endowed Professor role. The Professorship is focused on excellence in nursing, research, and EBP (evidence-based practice). Dr. Malin led the implementation of the professional practice model, based on Joanne Duffy’s Quality Caring Model, and guided leadership development through her work with the Nursing Practice Council. Dr. Woith mentored nurses in the development and execution of research and evidence-based practice projects. She partnered with Trayce Bartley, MS, RN, director, Perioperative Services, to implement a Nursing Research Council. Both Dr. Malin and Dr. Woith served on the Advocate Health Care Research Council and actively participated on the annual Nursing Research Symposium planning committee.
22
Todd McCartney, Operating Room Stephanie Wollenberg, Mother Baby Unit Women’s Health Night Melanie Evelsizer, Wound Healing Center Young Hearts for Life Bet Atkins, Nursing Resource Pool Theresa Bailey, Medical Oncology Specialty Unit/ Pediatrics/Infusion Stacy Barclay, Nursing Operations Tonia Cannon, Mother Baby Unit Leslie Carter, Emergency Dept Joelle Felumlee, Post Anesthesia Care Unit Miranda Gonzalez, Mother Baby Unit Denise Hammer, Mother Baby Unit Susan Kaufman, Mother Baby Unit Karen King, Nursing Resource Pool Jen Kjeldgaard, Cardiovascular Care Unit Kelly Krise-Evans, Nursing Resource Pool Patricia Kruse, Mental Health Unit Joy Kusturin, Nursing Resource Pool Emyli Quain, Cardiovascular Care Unit Keli Sidebottom, Mother Baby Unit Jessica Sinks, Cardiovascular Care Unit Stacy Thomas, Cardiovascular Care Unit Shelly Yoder, Critical Care
Structural Empowerment Springfield Nurse Advocacy Day On April 29, 2015, nurses from Advocate BroMenn Medical Center joined 60 other direct-care Advocate nurses at the State Capitol in Springfield. Crystal Bricker, Kristin Remmers, Brenda Drury, Denise Hammer, Ron Bartlett and Jane Patterson had the opportunity to talk with legislators and Governor Rauner about critical issues that impact their profession and their patients, including the Nurse Practice Act, mandated nurse to patient ratios, and the Nurse Licensure compact.
Legislative Forum The Nurse Advocacy Council representatives from Advocate BroMenn Medical Center and Advocate Eureka Hospital hosted the 5th Annual Legislative Forum for associates and volunteers in September. Co-hosting the event were Nurse Advocacy Council members Ron Bartlett, MSN, RN, nurse manager, Eureka Hospital and Stephanie L. Moore, RN, MSN, NE-BC, director, Emergency Department and Critical Care Services). Clinical nurses directed health carerelated and general questions to five panelists via pre-recorded video. Legislators at the event were Representatives Tom Bennett, Keith Sommer, Dan Brady and Bill Mitchell, and State Senator Jason Barickman. Following the formal presentation, legislators remained to discuss with nurses other concerns for today’s health care professionals.
23
Exemplary Professional Practice
“I am proud to work for Advocate BroMenn Medical Center because of the high standard of nursing professionalism. I really like the fact that Advocate wants all nurses to have the same training so other RN’s and patients can expect the same nursing care throughout their experience with us.” – Yvonne Rees, RN Quality of Care and Improvement In support of Advocate Health Care’s vision to be a faith-based system providing the safest environment and best health outcomes, the core value of excellence is fundamental. Excellence is seen as empowering people to continually improve the outcomes of service, to advance quality, and to increase innovation and openness to new ideas.
ISO 9001 Certification Our safety and quality goals by the end of the decade are to eliminate all serious safety events, and to consistently achieve top decile performance in our health outcomes and service. The achievement of these ambitious goals relies on Advocate BroMenn Medical Center becoming a highly reliable organization. This is a journey involving a transformation of culture, leadership, and process. BroMenn Medical Center’s Quality Management System (QMS) is the framework for quality improvement used by nursing and others within the hospital to enhance process reliability through Consistency of Service, Customer Satisfaction, and Continual Improvement. 24
Three C’s: • Consistency of Service • Customer Satisfaction • Continual Improvement This framework, which is outlined within the ISO 9001 standards, aids us in our pursuit of excellence and helps us to achieve the Advocate Experience outcomes of “Safety, Quality and Service Always.” BroMenn Medical Center was recognized along with six other hospitals within the Advocate system for the strength of its Quality Management System, as demonstrated through the achievement of ISO 9001 certification.
Safety and Health Outcomes Overall Advocate Health Care utilizes a systematic approach to achieving and sustaining excellence which is supported through the use of a balanced scorecard. Within the Safety & Quality Scorecard, a number of safety/quality outcomes and nursing-sensitive metrics were tracked in 2015, including serious safety events, the safety event reporting rate, unassisted falls, inpatient core measure performance, and a variety of infection prevention statistics. All of the safety and quality measures are aggregated into an overall Safety & Quality Health Outcomes Composite Score. During 2015, BroMenn Medical Center’s Health Outcomes Composite score exceeded goal nine of twelve months.
These patient safety metrics and our Health Outcomes Composite score were impacted substantially by several nursing-sensitive metrics included in and impacting these measures.
Unassisted Falls The Fall Prevention Committee continues to oversee the falls prevention program at BroMenn Medical Center. In addition to clinical nurse representation from all departments, the committee includes the therapies, pharmacy, risk management, patient safety and radiology. In response to a number of falls initiatives implemented this year, and the weekly auditing of falls program compliance, BroMenn Medical Center’s unassisted falls rate continued to decline in 2015 and achieved 84th percentile performance nationally by the end of the year.
Inpatient Core Measure Composite
Safety event reporting, including “near miss” and “good catch” events, increased in 2015 from 3.5 events/patient day to 6.7 events/patient day. Near miss and good catch events are events that are caught and corrected before reaching the patient and/or before patient harm occurs. Near miss and good catch reporting gives us the opportunity as providers to proactively improve our processes, thereby reducing the risk of harm to patients. In 2015, as a result of process improvements made over the course of the year, BroMenn Medical Center’s serious safety event rate (SSER) declined by 47.2%.
Core measures evaluate the extent to which evidencebased care is provided to inpatients within the hospital. Core measures evaluated in 2015 included influenza immunization, four stroke care measures, and five venous thromboembolism prevention measures. Core measure performance demonstrated sustained improvement from the beginning to the end of the year, meeting goal eight of twelve months.
Infection Prevention Composite Measures within the infection prevention composite included central line bloodstream infections (CLABSI), catheter associated urinary tract infections (CAUTI) and four surgical site infections. In 2015 there were no CLABSIs, representing 112 months without an ICU CLABSI and 34 months without a non-ICU CLABSI. Although urinary catheter device days were reduced by 14% in 2015, seven CAUTIs were unable to be prevented, and there were six surgical site infections. There were no ventilator associated events in 2015. 25
Exemplary Professional Practice Individualized Plan of Care and Pain Management In addition to metrics tracked on the Safety & Quality Scorecard, the nursing units monitored a variety of metrics applicable to all nursing areas and several departments as well as diagnosis-specific metrics. Of note, considerable improvement was noted over the course of the year in individualization of the plan of care. Patient satisfaction with pain management hovered around the 75th percentile and ended the year at the 88th percentile.
Stroke Care This year the Stroke Collaborative Practice Team, including representation from nursing, medical management, pharmacy, therapies, radiology, laboratory, dietary, social work and others, demonstrated remarkable outcomes achieved through sequential process improvements made over time. Through the efforts of this group, stroke patients consistently receive high quality, evidence-based care. Time to treatment with TPA meets best practice guidelines nationally, providing patients the best opportunity for improvement of symptoms.
In addition, as a result of the Stroke Collaborative Practice team’s work with the area’s emergency management system, time from symptom onset to door has been reduced by 74 minutes (43%) since 2013.
Back – Thomas Grobelny, Dr. Herman Dick. Front – Kristin Peterson, Victoria Steinkoenig, Dr. Sunil Chauhan.
26
Exemplary Professional Practice High Reliability Units In 2015, Advocate BroMenn Medical Center continued moving forward in the systemwide journey to eliminate unintended serious patient harm by the year 2020 by becoming a High Reliability Organization (HRO). Focus of training shifted to front line associates through development of High Reliability Units (HRUs). A HRU is a patient care unit focused on eliminating serious preventable harm through an enhanced culture of safety at the unit level. This involves an intensive three-month focus on error prevention techniques to strengthen individual performance and incorporate high reliability principles to improve systems and processes. The first HRU was the Mother-Baby Unit, followed by the Progressive Care Unit and Radiology.
Led by Brenda Downen, Radiology Safety Coaches are Virgil Foreman, Kari Gattung, David Honegger, Lori Sherman, Janet Sutter, and Edie Weber. The Mother Baby Unit, Progressive Care, and Radiology saw increases in reporting rates of 152%, 67%, and 127%, respectively, following the threemonth HRU education. All HRUs initiated at least one process/quality improvement project focused on improving a unit safety concern. Units planning for an HRU rollout in 2016 include Intensive Care, Cardiovascular Care, Medical Oncology Specialty Unit, Peds and Infusion, Perioperative Services, and 6W Surgical. 2015 Key Process/Quality Improvement Achievements • Standardization of the direct admission process through policy revision. • Implementation of Advocate system dysphagia recommendations. • Improvement in early identification and treatment of sepsis. • Implementation of tele-psychiatry and standing order treatment set for behavioral health patients in the Emergency Department. • Establishment of a Safe Patient Handling Program. • Management of patients receiving TAPP blocks for post-procedure pain management.
Mother-Baby Unit Safety Coachs – Katie Brown, Susan Kaufman, Jaime Carpenter, Justine Lee and Racheal Keighin. Not pictured – Jessica Baker, Amanda Huber, Hillary Watkins, Katie Thomas, Janice Westpfahl and Caitlin Wilson.
• Revision of the surgical counts policy to ensure process standardization and alignment with best practices. • Additional resources and process changes for PICC line management.
Progressive Care Unit Safety Coaches – Samantha Correll, Sarah Smithson, Stacy Carden, Sarah Magee and Samantha Stover. Not pictured – Lindsey Etheridge.
27
Exemplary Professional Practice Nurse Experts Sharing Their Expertise
In late 2013, the Heart Failure Nurse role was established to provide patients with education to not only understand how to manage, but also how to accept their diagnosis. Beka Lavicka, RN, BSN, CHSN has been the primary nurse in this position since its implementation. Beka moved into this role after working as a summer nursing intern and a staff nurse on the Medical Oncology Specialty Unit.
It’s a beautiful thing when
a career and a passion come together.
28
The heart failure nurse receives referrals on, as well as seeks out, inpatients that have a primary diagnosis of heart failure. The nurse • rounds on inpatients and provides them with the tools and education that they need to assume an active role in managing their heart failure. • reviews what heart failure means, signs and symptoms to monitor for and report, and importance of medication and dietary compliance. • works with patients who have been readmitted to identify what further assistance or education they need to help them succeed when they transition back home. • collaborates with the patient’s multidisciplinary care team to address the patient’s needs both while in the hospital as well as at discharge. • makes multiple discharge calls (within 2-3 days of discharge, again at 5-7 days post discharge, and then weekly for one month) to prevent readmission. • troubleshoots potential issues with the patient and contacts home health or the patient’s primary care nurse if needed.
Exemplary Professional Practice Supportive Care Program
Throughout 2015 a group of palliative nurse clinicians and hospital leaders worked to create a new model of care that would expand the inpatient palliative care program beyond the inpatient hospital stay. The new model was designed to have the palliative care nurse follow up with the patient after discharge to reduce barriers to care. The target population for the program is patients with complex medical needs who may be suffering from uncontrolled chronic symptoms and encountering barriers to care. The Supportive Care Program is an 8-week program designed to support patients through transitions of care by:
a nurse attends a post-discharge provider office visit. The majority of patient interaction after the first week is by telephone. Desired outcomes for the program are: • Patient is knowledgeable about medications and has a solid administration process. • Patient maintains a record keeping system that ensures continuity of care across providers and settings. • Patient is aware of and uses appropriate community and health care resources. • Patient has established an Advanced Plan of Care.
• facilitating the development of personal goals around symptom management
• Patient has made life style changes to achieve optimum state of health.
• achieving functional recovery
• Patient is knowledgeable about indications that their condition is worsening and how to respond.
• teaching self-management skills • removing barriers • integrating community and health resources in the care plan The model is based on 4 fundamental elements of care, as established by Dr. Eric Coleman, a known expert in successful care transitions. The program starts while the patient is in the hospital. Within one week of discharge, an in-home visit occurs and
The program rolled out as a pilot in Spring 2016 with patients of Advocate Medical Group – Family Medicine, Normal. Once the program demonstrates a solid process and shows individual patient success, the pilot will extend to additional physician practices.
29
Exemplary Professional Practice Infection Prevention and Control Program
Interdisciplinary Partnership
Public health challenges continued in 2015. Following the Ebola scare of 2014, there was heightened awareness of risks related to travel as well as those related to failures in applying proper isolation and PPE usage promptly at the time of presentation. The infection prevention program addressed issues surrounding two mumps epidemics in the community, and preparation of the Emergency Department, local physician offices and urgent care staff for responding to ZIKA concerns and testing processes. This was in addition to maintaining the necessary preparation for Ebola.
Stroke Community Education Advocate BroMenn Medical Center has been a certified primary stroke center since 2007. One of the requirements for maintaining this status is to provide education to the community on stroke recognition, calling 911 when symptoms arise, risk factors and treatment options. In addition to this certification requirement, community education also aligns with the nursing strategic plan.
As a result of the travel related threats and other community concerns, employee safety was a focus. Training highlighting the consistent need for travel assessment and implementation of empiric precautions was critical and reinforcement essential. Practices including proper PPE use and hand hygiene as well as management/cleaning of devices were identified as key pieces of the culture of safety. These practices will remain a focus for 2016 and use of our Be Safe behaviors will be leveraged to embed infection control practices into the culture. A more defined methodology for internal consultations using a risk assessment approach to assess situations and processes was initiated in 2015. Risk assessments were completed on: • Radiology vaginal probes
• Acute Rehab isolation practices
• TEE Scopes
• Breath call cleaning
• Lab storage
• Equipment cleaning and management related to storage
• Fan use • Dialysis storage
Sterilization, high level disinfection, and cleaning continue to represent critical processes that are key for overall patient safety. Current processes were considered exemplary when reviewed by DNV during the Fall 2015 survey. We continued our journey to ensure there is clear separation of clean and dirty in all situations. Staff awareness and understanding of this principle increased considerably this year, and the level of engagement was outstanding. We completed an organizational wide assessment of the 18 DNV Managing Infection Risk (MIR) standards culminating in a DNV Gap Assessment in August. The program found to be largely ready for certification. 30
Stroke Program
Stroke continues to remain one of the leading causes of disability. The overarching goal of educating the community on stroke is to improve health knowledge. The stroke team at BroMenn Medical Center takes a multifaceted approach to education. The team partners with members of Community Wellness to access various venues in order to capture the largest audiences. These venues range from baseball games to health fairs to local businesses. One of the new education venues for 2015 was education for junior high schools. According to recent stroke literature, targeting this age group has proven successful. With this in mind, members of the Stroke Team – Nancy Allen, RN, MSN, Chief Nurse Executive and Nursing Director at Eureka Hospital; Kristin Peterson, RN, MSN, Stroke Coordinator; Victoria Steinkoenig, MSN, RN, CNSBC, SCRN Inpatient Neurology Advance Practice Nurse; and Jennifer Steinhausen, RN, BSN, Stroke Quality Care Coordinator provided an interactive education to the 5th grade class at Eureka Junior High School. The training incorporated an overview of stroke, how to recognize someone having a stroke and what to do. The stroke team provided real life situations that a stroke patient may experience and had the kids simulate what it is like to have a disability that stroke victims live with after a stroke. At the conclusion of the junior high education, each student was provided with a packet to share with their family on what was learned about stroke. As with every education effort, it is important to measure the success of the education. The stroke team measured their success through pre and post-tests at education events but more importantly by the amount of time from when a patient first experienced symptoms to when they arrived at the hospital.
Exemplary Professional Practice Since focusing community education efforts, the stroke team has seen an average of a 70-minute decrease in symptom onset to door time from 2014 to 2015, which ultimately leads to decreasing the rate of disability from stroke. Given these positive results, Kristin Peterson and Victoria Steinkoenig were accepted to present a poster at the International Stroke Conference in Los Angeles California in February 2016.
Tele-Psychiatry
Tele-psychiatry was implemented at Advocate BroMenn Medical Center in the Spring of 2015. An outstanding relationship has been developed between BroMenn and the tele-psychiatry staff at Advocate Christ Medical Center. These services have provided consultation to our Emergency Department associates, physicians and patients and have allowed us to either discharge patients to a recovery-focused setting or to start proactive treatment while in the ED. The Tele-Psych machine moves to multiple nursing units to meet our patients’ needs. It’s a fascinating and proactive way to wholistically care for our patients! Patients on our MedicalSurgical Units have received assistance for the development of coping skills strategies and/or for additional behavioral health emotional-focused support.
eICU
Advocate Health Care’s eICU provides increased monitoring of intensive care unit patients through continuous remote surveillance of real time patient data by ICU nurses and physicians located in Oak Brook, IL. The eICU program is clinically proven to reduce severity adjusted mortality and length of stay in the ICU. The eICU is not designed to alter nurse-to-patient ratios or replace on-site nurses or physicians. It adds a layer of care, virtually, a “second set of eyes” watching over the patient to provide support to the nurse and enhance care provided at the bedside. The eICU team proactively assesses and notifies our team on-site with changes noted in patient condition. This program was implemented at Advocate BroMenn Medical Center in Spring 2015.
Hospital Elder Life Program (HELP)
In an effort to help decrease hospital induced patient delirium—a mental state in which one is confused and not able to speak or think clearly—the Hospital Elder Life Program (HELP) was developed and initiated on the Medical Oncology Specialty Unit (MOSU) in January 2015. Delirium and functional decline are common results of hospitalization in the elderly population and can lead to increased length of stay, the inability for a patient to return to their home setting, and a higher risk for falls. The HELP program was initiated at BroMenn Medical Center by Laurie Round, RN, BSN, MS, NEA-BC. Current leads on the project are Stacy Barclay RN, BSN and Theresa Bailey, RN, MSN. What makes HELP so special and successful is its partnership between nursing and volunteers. Nursing assesses the needs and screenings of the patients, and the interactions are carried out by specially-trained volunteers. These interactions take place in intervals throughout the day and include cognitive stimulation, physical exercise, feeding assistance, and social interaction. To date, HELP volunteers have provided care to 421 patients. We have received an enormous amount of positive patient/family feedback regarding the program, and many volunteers have been able to fulfill their requirements for health degrees they are interested in pursuing. The program is truly a win-win for all involved by offering a way to get volunteers more involved and providing optimal care to our patients.
31
Exemplary Professional Practice Cardiac Collaborative and Awards
Advocate BroMenn Medical Center’s Cardiac Collaborative Team, led by Dr. Beth Tumilty and Bev Glendon RN, BSN, Chest Pain Center Coordinator, remains strong in “sustaining the gain.” Overall heart attack care is above the 90th percentile nationally. In 2015 the hospital again was awarded the Platinum Achievement Award for ACTION Registry Get with the Guidelines and Mission Lifeline STEMI Receiving Center—Gold Plus. The recognitions are for heart attack care. The care also reflects the work done with outlying hospitals to get STEMI (serious heart attack) patients to the cath lab to open a blocked artery within 120 minutes of arrival to the outlying hospital. These awards are sponsored by the American College of Cardiology and the American Heart Association. And, of course, BroMenn Medical Center is still an accredited Chest Pain Center with PCI (Percutaneous Coronary Intervention). Even though our heart attack care is above the 90th percentile, the Cardiac Collaborative always strives for improvement. Early activation of the Code STEMI is key. The sooner the arrival of the Cath Lab team, the quicker the patient can get to the Cath Lab to save heart muscle. In the first 6 months of 2015, 67% of the Code STEMIs from the field were activated from the field. This improved to 90% in the last 6 months of 2015. Through case reviews, education is provided to both EMS (ambulance personnel) and the ED staff on both calling the Code STEMI from the field and immediately activating the Code STEMI team once the ED is notified. The Cardiac Collaborative team focuses on care elements other than heart attack: • Reduction in Acute Kidney Injury: By adding documentation prompts proposed by nursing and through education, the cath lab at BroMenn Medical Center is now greater than the 90th percentile in avoiding acute kidney injury in patients exposed to contrast.
32
• Management of the Low Risk Chest Pain Patient: A patient who comes to the ED with chest pain may not have initial test results that demonstrate a possible cardiac event. Therefore, many patients are kept for observation for further testing. It is important to review patient care processes in order to decrease delays in ED throughput and enhance patient satisfaction. More on this in 2016, but in January 2015 the average length of stay (LOS) was 29.1 hours and towards the end of 2015 the average LOS was as low as 19 hours with a goal of less than 16 hours. The Cardiac Collaborative will continue to work diligently in 2016 as we prepare for Chest Pain Center with PCI re-accreditation, now sponsored by both the American College of Cardiology and the Society of Cardiovascular Patient Care.
Realizing that the national goal is to decrease heart disease as the number one cause of death in the U.S., it is important to educate the community on early recognition of signs and symptoms of a possible heart attack and the importance of calling 9-1-1. Community education is done at senior events, Women’s Health Night and local business events, to name a few. The cardiac team also plays a part in organizing the annual “Concerns of the Heart.” In 2015 physicians spoke on the effects of sleep apnea on heart disease, including congestive heart failure.
Exemplary Professional Practice Critical Care Collaborative Current Initiatives/Recent Accomplishments: • RRT/Code Blue System Report • Review of readmission rates for COPD • Intraossious IV insertion
Health needs. We look forward to the remodel of our Inpatient Psychiatric Unit and to the relocation of one of the Advocate Medical Group outpatient clinics to the Advocate BroMenn Outpatient Center. Another focus is implementation of Tele-psychiatry at Advocate Eureka Hospital by the end of 2016.
• Review of system telemetry policy
Surgical Collaborative
• STOP BANG – BroMenn group developed and implemented a process, participating in and awaiting development of a system policy.
The goal of Advocate BroMenn Medical Center’s Surgical Collaborative Team was to achieve top decile patient health outcomes and satisfaction. During 2015, the Collaborative focused on developing the Quality Management Oversight Committee (QMOC) measurement reporting structure, creating a sedation documentation audit process, preventing surgical site infections (SSI), and realigning the Ambulatory Patient Experience Committee.
• eICU is in operation • Sepsis (June focus): May Sepsis Data reviewed emplate for physician sepsis documentation T is being created eviewed the BroMenn site sepsis R workgroup Reviewed Sepsis dashboard eviewed Sepsis policy – Plan group to R review/revise. ntibiotics – pharmacy will specify which A antibiotics can go together and which will need to start first.
Behavioral Health Collaborative Along with the implementation of tele-psychiatry, the group completed the following.
Highlights from the year include development and approval for quality measures reported to QMOC, development and implementation of SSI prevention bundles, using evidence based practice guidelines to reduce SSI occurrences and training to frontline Perioperative Services staff by the Ambulatory Patient Experience Committee on how to help drive improvement of patient experience results.
OB/Nursery Collaborative 2015 The OB/Nursery Collaborative was established in 2015 and focused on the following initiatives:
• Implemented a new and innovative fall protocol for inpatient population. An approximate 40% reduction in patient falls has resulted.
• In order for associates and physicians to more easily identify new associates, the collaborative developed a process to communicate and post a biographical form and picture of each new associate.
• To provide both associate and patient safety, a panic button was installed in the ICU for associate and patient safety.
• The Critical Safeguards Checklist used by the OR was revised for OB to facilitate the Time Out process.
• Collaboration by nursing staff from multiple units for standardization of care for behavioral health patients.
• Start times of the scheduled morning c-sections were monitored and the group worked with physicians to minimize late starts.
• A psychiatric ED order set was revised and implemented.
• Developed a process for physicians to refer families to the Atrium Pharmacy for Tdap vaccination and flu vaccination. Patient education materials were posted to encourage vaccinations.
• Through CNE support, an outside consultant was used to provide mental health education to staff from ED, ICU, MHU, CVCU and Public Safety. BroMenn remains committed to providing services to those patients that present with Behavioral
• Developed drills and simulations for high risk events that include the 24/7 obstetrician and anesthesia.
33
New Knowledge, Innovation and Improvements
I am proud to work at Advocate because we are a health ministry that merges faith with technology to provide optimal outcomes. – Rayford Rattley, BSN, RN, CNOR Advocate Research Symposium Nineteen nurses from Advocate BroMenn Medical Center attended the 3rd Annual Advocate Health Care Nursing Research Symposium, Collaborating to Advance the Profession, held at Advocate Sherman Hospital on April 22, 2015. Seventy abstracts were submitted for podium and poster presentations; 40 were accepted. Two of the abstracts accepted for poster presentations were from BroMenn Medical Center. Becky Hatfield RN, MSN, CWOCN; Alicia Allen, RN, MSN, BC; Linda Bergren, RN, WOCN; and Teresa Novy, RN-BC, MSN presented a poster entitled Quality Improvement: Eliminate Hospital Acquired Pressure Ulcers. This poster showcased work of the Skin Care Committee and their ongoing efforts to decrease hospital acquired pressure ulcers. The poster was also presented at the NPUAP Conference in February of 2015, and the WOCN conference in June of 2015. Yvonne Rees, RN, CGRN, Pam Bierbaum, RN, BSN, and Ara Peterson, RN, MSN, of the Perioperative Shared Governance committee, presented their poster, Minimizing Preoperative Heat Loss. Their poster described development and implementation of an evidence-based practice project to increase and 34
maintain temperatures of 36 degrees Celsius at the patient’s first intraoperative temperature check following post-anesthesia induction and again within fifteen minutes of arriving in PACU. The project was created following safety reports of three patient’s arriving in PACU with temperatures below 36 degrees Celcius, placing them outside the acceptable range in the SCIP protocol and increasing their risk for surgical site infections. For patients whose temperatures were 36.5 or below preoperatively, Same Day Services staff applied active warming blankets (Bair Huggers) to prevent redistribution of body heat to the periphery and Thermoflect caps on all patient’s going to surgery to reduce heat loss through the scalp. Shelly Malin, PhD, RN, Advocate BroMenn Endowed Chair, presented the plenary session on JoAnne Duffy’s Quality Caring Model when the guest speaker, JoAnne Duffy, fell ill and was unable to attend the conference. The program planning committee and symposium participants responded positively to Dr. Malin’s presentation, and her expertise on the model led to an interesting discussion session on use of the model to undergird Advocate Health Care’s Professional Practice Model.
National Mother-Baby Conference 2015 The MBU Shared Governance group was challenged with formulating a plan to reduce OB maternal and newborn Falls. The interventions identified by the staff were simple to implement and supplemented the fall prevention measures already in place. These measures are continually evaluated with reporting and review at the monthly shared governance meetings. There has been a significant decrease in falls in 2015. Brenda Drury developed and presented a poster on this topic to the National Mother-Baby Conference in Orlando, Florida in September 2015.
Teresa Novy, MSN, RN-BC, Wound Ostomy
Wound Care Nurses In 2015, the Wound Department was honored to display a poster at the Nation Pressure Ulcer Advisory Panel (NPUAP) in February, 2015 in Orlando, FL and in June at the Wound Ostomy Continence Nurse (WOCN) National conference in San Antonio, TX. Both presentations showcased the work completed by the Skin Care Committee in their ongoing efforts to decrease HAPU at Advocate BroMenn Medical Center. Nursing education is always a priority for this department. In 2015 this department identified the need for nursing staff education emphasizing the differentiation between pressure ulcers and other types of skin injuries in the buttocks/coccyx area. Education regarding Incontinence Associated Dermatitis (IAD), Moisture Associated Dermatitis (MAD), and intertriginous dermatitis and how these are different and require different treatment plans from pressure ulcers. Helping bedside nurses recognize skin injury and to identify correct etiology is important to wound care practice and patient outcomes. A significant practice change throughout the Advocate system took place in 2015. The bedside nurse now determines if a wound is a pressure ulcer, and if this pressure ulcer is partial versus full thickness during their assessment of all pressure skin injuries. The bedside nurse then stages the partial thickness PU as stage 1 or stage 2. The staging of all full thickness pressure ulcers is now provided by the Wound/Ostomy Nurse. This provides consistency of documentation and streamlines the process.
Brenda Drury, MSN, RNC, Mother Baby Unit
The Wound Ostomy Department continued educating the nursing staff about relevant practice issues. A collaborative continuing education program was presented in October in cooperation with the Advocate BroMenn Center for Wound Healing and Hyperbaric Medicine. This program provided 18 local nurses with updated information premiering current treatment for lower leg ulcers. As care moves to the community, external partnerships continue to be a priority for the wound care team. We see the education of nurses in all local care settings and the staff at the Center for Wound Healing and Hyperbaric Medicine as our wingman for the continued care of our wound and ostomy patients after they are discharged from our facility.
35
I would like to acknowledge and thank
the Advocate Charitable Foundation and their generous donors for making this annual report possible. The multitude of opportunities to elevate nursing professional practice are afforded to Advocate BroMenn Nurses by charitable donors who believe in the advancement of nursing practice, which ultimately impacts patient care. After all, the patient is in the center of all that we do. – Laurie Round, Chief Nurse Executive
36
The Advocate Nurse Empower. Serve. Thrive.
“To know even one life has breathed easier because you have lived. This is to have succeeded.” — Ralph Waldo Emerson
1304 Franklin Avenue Normal, IL 61761 309.454.1400 advocatehealth.com/bromenn 06/16 MC 0918