Within Reach Spring 2021

Volume 12│Issue 1│Spring 2021 Carilion Medical Center, 1906 Bel leview Ave, Roanoke, VA 24014 https://www.insidecarilion.org/hub/nursing -research-evidence-based-practice nursingresearch@carilionclinic.org (540)266 -6216

Farewell from a CNS: 4 Decades of a satisfying and rewarding career Cathy Jennings, DNP, RN, ACNS-BC, FNAP

Nursing colleagues and friends, I have been asked to share some thoughts with you as I prepare to retire from Carilion after 38 incredible years. It is so very bittersweet to leave the place and people who have shaped my career and raised me from a baby nurse! While I have limited wisdom to give to you, I want to take this opportunity to tell you how very proud I am of the huge progress we have made in Nursing research, quality improvement, and evidence-based practice (EBP) work here over the past 4 decades.

This year, I am celebrating my 41st year in nursing since completing my BSN. Though it happened so many years ago, I still recall taking the nursing research course, a class in which I had little interest but was required to complete to graduate. “I cannot imagine ever being a researcher because I want to TAKE CARE OF PATIENTS, not do research,” I believe I said on more than one occasion! Little did I know then that years later I would BECOME a nurse researcher to take EVEN BETTER care of patients. I did not realize then how much I would grow to appreciate the critical importance and broad reach of clinical nursing research.

As a Clinical Nurse Specialist (CNS), my career focus has been the clinical care, education, navigation, and support of the cardiac surgery patient population and care team. My CNS colleagues and I have been leaders or participants with our nurses in many quality improvement and evidence-based practice projects over the years. Carilion nurses have historically loved learning, growing, thinking creatively, and supporting patients and their families to manage their own health. In the early 2000s, however, the focus on nursing inquiry intensified here.

In 2003, Carilion Medical Center received its first MAGNET® designation. Implementation and incorporation of clinical research and inquiry are pillars of the American Nurses’ Credentialing Center’s MAGNET Recognition Program®.

In 2006, several nurse colleagues and I entered a Doctor of Nursing Practice (DNP) degree program. This education, supported by Carilion, had long been a dream of mine, and it provided the tools and ignited my interest in conducting clinical nursing research. In 2007, with the encouragement and full support of forward-thinking Nurse Executive Nancy Agee and Chief Nursing Officer Carolyn Webster, a new nursing role was introduced at Carilion to encourage and mentor our nurses in research and inquiry. The first Senior Director of Nursing Research and Evidence-Based Practice, Dr. Rebecca Culver Clark, solidified Carilion’s research agenda by forming the Nursing Research Council (which included frontline, leadership, and nursing faculty members) and founding the Nursing Research Fellowship.

Now led by Dr. Kimberly Ferren Carter, Senior Director of Nursing Research, EBP, and Excellence, the Nursing Research Fellowship is in its 11th year and has showcased the work of more than 30 Nursing Research Fellows to date.

As nursing research work at Carilion has grown, so has our culture of inquiry. Carilion nurses have completed an astounding number of research and quality improvement projects, and the body of work only continues to grow!

Study topics include postoperative hypothermia, cardiac rehabilitation, pain and delirium assessment, interprofessional team work, yoga therapy, influenza vaccinations, chest tube dressings/care, unplanned extubations, sleep enhancement, sternotomy dressings, specialty readmissions, moral distress, and breast supports … and the list goes on and on! The 2019-2020 Magnet Research Chart (ask Magnet Coordinator Pam Lindsey to share it with you if you have not seen it) includes 24 Nursing studies. Without a doubt, Carilion has become a solid center of excellence for Nursing research, quality improvement, and evidence-based practice work.

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Carilion Clinic Roanoke Campus

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ARTICLES/NOTIFICATIONS 1 Farewell from a CNS: 4 Decades of a satisfying and rewarding career.

Cathy Jennings, DNP, RN, ACNS-BC, FNAP 3 The impact of the influenza vaccination on the orthopedic surgical patient.

Ellen Dalton-Ward, MSN, RN, WCCC & Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC 4 Article Review: Purposeful hourly rounds to prevent inpatient falls.

Kayla Douberley, BSN, RN 6 Article Review: Role of emotional intelligence in conflict management strategies of nurses.

Stacia Engelhardt, BSN, RN & Kelby Smith, ADN, RN 10 Article Review: Nursing Teamwork.

Taylor Haskins, BSN, RN 12 Improving sustainability and cost savings through pulse oximetry probes product change.

Bobby Dingus, BSN, RN, CCRN

RECOGNITION/EVENTS 14 Recognitions 18 Carilion Nursing Research Virtual Poster Fair Summary 21 Carilion Nursing Research Classes & Event Information 22 Citations and Recognitions 23 Week of the Nurse Art & Science of Nursing Showcase - Call for Posters 24 See where our nurses have presented their work!

25 Nursing Research Hub information 26 2021 Virtual Nursing Conference information **If you are interested in becoming a member of the Carilion Nursing Research Editorial Board, please email your CV or Resume to Kim Carter (kfcarter@carilionclinic.org) for review!**

Carilion Nursing Research Editorial Board: Kim Carter, PhD, RN, NEA-BC - Editor-in-Chief Deirdre Rea, DNP, RN-BC, PMH-CNS - Co-Editor Reviewers Nancy Altice, DNP, RN, CCNS, ACNS-BC Desiree Beasley, MSN, RN, CCRN, CCNS Ann Beheler, ADN, RN Sarah Browning, DNP, RN-BC Charles Bullins, DNP, RN, AGACNP-BC Monica Coles, DNP, RN-BC, ACNS -BC Sarah Dooley, MPH, BSN, RN Christine Fish-Huson, MSN, RN Donna Goyer, BSN, RN, CPAN, CAPA

Cindy W. Hodges, BSHS, RNC, FCN James Ingrassia, MSN, RN Pam Lindsey, MSN, RN Margaret Perry, MSN, RN-BC Laura Reiter, MSN, RN, CCRN, CNRN Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC Vivian Wilson, BSN, RN, CCRP

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Farewell from a CNS: 4 Decades of a satisfying and rewarding career - (Continued from page 1) Cathy Jennings, DNP, RN, ACNS-BC, FNAP While our nurses have truly grown, developed, and learned through the research process, the most important outcome of these efforts is the significant impact on our practice and our patients. Add the dissemination of these projects through presentations and publications, and it is also rewarding to see the potential REACH of our work.

As I look at my Carilion career, the privilege of being a part of just a few of these efforts has been both a highlight and a tremendous honor. I am so proud of us!

Colleagues, by asking questions and searching for answers, you can make significant strides for our profession and for our patients. If this is a new thought for you, jump out of your comfort zone and give inquiry and research a try! Ask questions, keep exploring, and keep seeking better ways to provide care.

Your efforts are respected and valued.

I wish for you a career of continued success and achievement, and you can be certain that I will be anxiously awaiting the formal announcement of your 5th Magnet® designation! For Carilion nurses, learning and inquiry never, ever ends!

“Let us never consider ourselves finished nurses. We must be learning all of our lives.” ~ Florence Nightingale, 1820-1910

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The impact of the influenza vaccination on the orthopedic surgical patient Ellen Dalton-Ward, MSN, RN, WCCC & Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC

Editor’s Note: Ms Dalton-Ward completed this study as a Nursing Research Fellowship with Dr. Ward serving as mentor.

Background Carilion orthopedic surgical patients undergoing elective or emergent procedures including total knee arthroplasty, total hip arthroplasty, hemi-arthroplasty and intramedullary nailing were not receiving the influenza vaccination prior to hospitalization or prior to discharge. Elective orthopedic surgical patients, typically 65 and older, are at highest risk for developing complications from surgery such as pneumonia. The main concern of the surgeons was the possibility of the vaccine causing an immune response which mimics the beginning of a surgical site infection by increasing the patient's temperature or white blood cell count leading to possible readmissions.

Only two relevant publications related to contraindications for influenza vaccination for orthopedic surgery patients were located. Authors of a 2016 retrospective study1 concluded that patients receiving the influenza vaccine had no increased risk of adverse outcomes compared to those not receiving the influenza vaccination. A 2017 study 2 found that patients over 65 receiving the vaccine had decreased postoperative intensive care admissions, shorter hospital stays and decreased medical expenditures than those patients unvaccinated.

Research Aims The primary study aim was to detect differences in temperature, white blood cell count and 30-day readmissions in those patients who received the influenza vaccination compared to those who did not in the elective and emergent groups. The second aim was to detect differences in temperature, white blood cell count and readmission within 30-days in those receiving the vaccine two weeks preoperatively compared to those that received the vaccine during hospitalization.

Methodology The Carilion Institutional Review Board approved the study as exempt. This retrospective, noninferiority study extracted data from the electronic medical record for orthopedic surgical patients 18 years and older who had a total knee arthroplasty, total hip arthroplasty, intra medullary nailing or hemi-arthroplasty during the influenza seasons between March 2014-March 2019 at Carilion New River Valley and Roanoke Memorial hospitals. Comparisons were made between emergent (who received the vaccination) and elective patients (who did not receive the vaccination) within two weeks of surgery using an a priori alpha of 0.05 for t-tests, nonparametric equivalent variations, and chi-square tests.

Findings There were no statistical or clinically significant differences in temperature, white blood cell count or readmission status between specific orthopedic surgical patients receiving the influenza vaccine and those who did not. There were no significant differences in study outcomes between groups based on time of the vaccination. Patients who received the influenza vaccination greater than two weeks preoperatively had a higher readmission status.

Discussion Orthopedic surgical patients in this study who received the influenza vaccination were not at greater risk for symptoms that mimic surgical site infection: elevated temperature or white blood cell count. Vaccination within 2 weeks peri-operatively or during hospitalization may decrease re-admissions for patients having total knee arthroplasty, total hip arthroplasty, intra medullary

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nailing or hemi-arthroplasty during the influenza season.

Clinical Implications The Orthopedic surgeons at the September 2020 Carilion Joint Council reviewed the study findings and voted to change the current practice of withholding influenza vaccination to begin to offer and administer influenza vaccination to elective and emergent orthopedic surgical patients.

References 1. Tartof, S.Y., Qain, L., Reig, G.K., Yu, K.C., Sy, L.S., Tseng, H.F., Hechter, R.C. & Jacobsen, S.C., (2016). Safety of Seasonal Influenza Vaccination in Hospitalized Patients: A Cohort Study. Annals of Internal Medicine,164(9), 593-599. doi: 10.7326/M15-1667 2. Lui, W.C., Lin, C.S., Yeh, C.C., Wu, H.Y., Lee, Y.J., Chung, C.L., Chen, T.L. & Liao, C.C. (2017). Effects of Influenza Vaccination against Postoperative Pneumonia and Mortality for Geriatric Patients Receiving Major Surgery: A Nationwide Matched Study. The Journal of Infectious Disease, 215(5), 816-826. doi: 10.1093/infdis/jix618 Acknowledgements: The support of the following people is gratefully acknowledged: •

Kimberly Carter, PhD, RN, NEA-BC - Senior Director Nursing Research EBP, & Excellence

•

Mariana Salamoun, BS, MA - Data Analyst, Health Analytics Research Team

•

Hunter Sharp, BS, MS - Biostatistician, Health Analytics Research Team

•

Ryan Harris, DO, Orthopedic Surgeon Champion

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Article Review: Purposeful hourly rounds to prevent inpatient falls Kayla Douberley, BSN, RN - 10M PCU

Editor’s Note: Ms. Douberly wrote this paper as part of her Carilion Nurse Residency experience.

Article Reviewed: Grillo, D., Firth, K. and Hatchel, K., 2019. Implementation of Purposeful Hourly Rounds in Addition to a Fall Bundle to Prevent Inpatient Falls on a Medical-Surgical Acute Hospital Unit. MEDSURG NURSING, 28(4), 243-261.

Introduction Citing 2018 statistics from Agency for Healthcare Research and Quality, Grillo, Frith, and Harchel (2019) note that “patient falls are a leading cause of injuries in hospitals in the United States” (p.

243). Patient falls are not only injurious to the patients, but also increases hospital costs and decreases patient satisfaction. By utilizing evidence-based practice, policy and procedures, nurses can improve the patient’s experience and prevent injuries from falls. Grillo, et al. note that fall safety practices commonly implemented include “fall wristbands, color-identified non-slip socks, and bed/chair alarms” (p. 244). However, for this study the authors focused on implementing hourly rounding to decrease falls.

Study Summary The authors evaluated the effectiveness of implementing hourly rounding to their existing fall prevention program with a goal of decreasing falls by 50%. According to Grillo et al., thirty to fifty percent of patients who fall are injured, “including fractures, lacerations, or internal bleeding” (p. 243) costing up to $14,000 per fall. Care for the injuries from hospital falls are not reimbursed.

Grillo, et al.’s review of the literature supports that purposeful hourly rounds are effective for fall reduction in an acute setting. Hourly nurse rounding addresses patient needs of the 5 P’s of fall prevention: “pain, potty, position, possessions, and plan of care” (p. 244). Utilizing a teach-back method, nurses can include patients and their families in fall prevention strategies and the expectations that occur with purposeful hourly rounding.

Nurse Leader Rounds are proposed as an important component of hourly rounding by verifying that the rounds are occurring. A Plan, Do, Study and Act (PDSA) method was utilized. The study took place on a 26-bed medical-surgical unit at a 701-bed inner city hospital. Patients who were at a high risk for falls “due to mental-illness, dementia, delirium, and the inability to care for themselves” (p.244) were included. Data collection involved assisted and unassisted patient falls.

The quality improvement initiative was led by the unit’s nursing director in conjunction with nursing staff to implement hourly rounding. During the rounds, it was expected that a nurse addressed the 5 P’s and evaluated the patients’ awareness of fall precautions. If the patient was unaware, re-education was provided until the patient was able to teach-back the information to ensure the patients understood the information. By doing this, nurses are assessing the patients’ recall and comprehension. Validation of these techniques occurred by the nurse leaders and their conversations with the patients and documented on a nurse leader form that was then submitted to the unit director. This allowed for trending of responses and enabling the provision of feedback to the nurses when needed.

While utilizing the nurse leader round form as a metric for feedback, the authors also audited patient fall occurrences for 31 days before implementing hourly rounding and 31 days after implementation between January 2018 through May 2018. They also trended Press Ganey Patient Experience scores for nurse courtesy.

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In the Act stage of their methods, data supported that reduced falls with their implementation of hourly rounding. Nurse courtesy scores also improved during this time. They used these results to support a practice recommendation to the hospital’s Patient Safety Committee to further implement these methods across the hospital.

In January 2018, 16 patient falls were reported for 14 patients. Following implementation of hourly rounding, the patient fall rate dropped from 5.31 patient falls per 1,000 patients to 2.58 per 1,000 patients, or 8 reported patient falls for March 2018. The numbers continued to decrease for a May 2018 rate of 1.46 per 1,000 patients, or 4 falls.

Press Ganey Nurse Courtesy scores improved from 61.7 in January 2018 to 68.7 in March 2018 and exceeded their goal of 75 in April with a score of 85.3. These improvements reflect increased patient satisfaction with nursing care and visibility.

Through nurse-driven interventions of preventing patient falls with hourly rounding, the unit decreased falls and increased patient satisfaction scores. Hourly rounding had a positive impact on the occurrence of falls. A limitation of the study is the possibility of unreported falls. Further, limitations in the forms used by the nurse leaders did not allow for capture of whether the 5 P’s and safety were being addressed during hourly rounding.

Discussion & Implications Falls are a preventable patient event. Grillo et al.’s study demonstrated an effective collaboration between frontline nurses implementing hourly rounding and unit leadership providing ongoing accountability, leading to reduced falls rates and improved nurse courtesy patient experience scores. The staff embraced improving patient care and took ownership by being knowledgeable about how patient education, falls scores, Press Ganey scores affect their nursing care and reputation.

This study provides guidance for nurses who desire to protect the safety of their patients.

Carilion Clinic has an opportunity to improve patient fall rates. While hourly rounding is frequently discussed and highly recommended by Carilion nurse leaders, nursing staff struggle to perform hourly rounds consistently. Grillo and colleagues’ study provides evidence that hourly rounding can prevent patient falls. Nurses are key to implementing strategies for prevention and education.

Involving patients in their care improves care and overall healthcare perceptions.

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Article Review: Role of emotional intelligence in conflict management strategies of nurses.

Stacia Engelhardt, BSN, RN - Rehab 3, Carilion Pediatrics and Adolescents Behavioral Health Unit & Kelby Smith, ADN, RN - CRMH 9S ICU

Editor’s Note: Ms. Engelhardt and Ms. Smith wrote this paper as part of their Carilion Nurse Residency experience.

Article Reviewed: Başoğul C, Özgür G. (2016). Role of Emotional Intelligence in Conflict Management

Strategies of Nurses. Asian Nurs Res, 10(3), 228-233. doi: 10.1016/j.anr.2016.07.002. https://www.asiannursingresearch.com/action/showPdf?pii=S1976-1317%2816%2930047-0.

Introduction This is a review of a research study (Başoğul & Özgür, 2016) that examined the correlation between emotional intelligence levels and conflict management strategies of a stratified random sample of nurses from two units at a Turkey university hospital. Findings will be useful to inform appropriate education for nursing staff to ensure optimal conflict management, thereby improving job satisfaction and improving quality patient care.

Study Summary This Institutional Review Board (IRB) approved cross-sectional study used a correlational design. The target population included 560 inpatient and 383 surgical nurses (total of 943 nurses).

A total of 450 inpatient and surgical nurses were invited to participate in the study. Of those, 277 (61.5% response rate) provided verbal consent and fully completed the questionnaires. Using a sample size calculator, the researchers determined that a sample of n=273 was needed for a representative sample; therefore, the 277 respondents was sufficient for this study.

The survey included three questionnaires, including personal information form, the Rahim Organizational Conflict Inventory-II, and Bar-On's Emotional Quotient Inventory (EQ-I). Validity and reliability studies were conducted on the Conflict Inventory and EQ-I with Cronbach α between .84 and .92.

•

•

•

Personal Information. A researcher-developed personal Information form included questions related to age, education, marital status, working years, years of nursing experience, hours worked per week, nurse to patient ratio, state that the nurse is working and conflict experienced, the topic of conflict and with whom.

Rahim Organizational Inventory-II (ROCII-II). This measure features 28 questions to determine strategies used during work-related interpersonal conflict. Conflict management strategies are defined by the following subscales integrating, obliging, dominating, compromising and avoiding.

Bar-On Emotional Quotient Inventory (EQ-I). The 87-item EQ-I uses five metafactors of emotional intelligence reflected through 15 subscales.

Metafactors of the study include intrapersonal skills, interpersonal skills, adaptability, stress management and general mood.

Data were analyzed using descriptive statistics, t tests, and Pearson correlation analyses with SPSS software. The importance of gathering data for this subject, was to address the important causes of conflict among nurses. Chief causes of conflict include varying management strategies, perceptions of employees, staff shortages, differences in objectives, and competition between co-workers.

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The results showed that the nurses reported conflicts between nurses working in the same unit (38.3%), doctors (32.5%), manager nurses (15.2%), auxiliary staff (10.8%), and nurses in other units (3.2%). Some common complaints that surfaced from this study were inadequate communication, an imbalance of authority and responsibility, a lack of job descriptions, a lack of opportunities for promotion, a lack of feeling of appreciation for achievements, a lack of job satisfaction, insufficient income, and incompatibility between tasks and training and workaholism.

In a study of 92 of the nurses, there was a positive relationship between a high level of emotional intelligence and an integrating strategy with intrapersonal skills, while there was a negative relationship between a high level of emotional intelligence and a conflict avoidance strategy.

The study authors concluded that skills requiring a high level of emotional intelligence, such as problem solving, interpersonal relations, and stress management, play a key role in effective conflict management. The authors recommend development of training problems designed to improve conflict management and emotional intelligence for nurses, so that conflicts can be effectively managed. Future studies that include manager nurses and investigating differences related to the work environment are recommended. The results of this study showed a significant, but weak correlation in the same direction between the integrating, obliging, dominating, and compromising, conflict management strategies and emotional intelligence scores. There was also a negative but weak correlation between the avoiding strategy and emotional intelligence scores.

This study concluded that nurses’ emotional intelligence levels need to be improved.

Discussion and Implications Stacia Engelhardt: The results from this study are relevant to practice because conflict management in the workforce causes dismal working conditions, negative power trips, patient complaints, quality of care reduction, and inevitable increases in healthcare costs. Because conflict arises from human emotions, being educated and trained on emotional intelligence is an excellent way to develop intuitive thinking and awareness of emotional processing. If nurses can gain competency in their individual emotional intelligence, positively adapting to interpersonal relationships will follow suit, thus reducing the negative effects of conflict management issues in the workplace. Because the foundation of emotional intelligence is necessary for all professional nurses, this study is pertinent for psychiatric nursing, as well as any field of nursing where collaboration and professional interpersonal communication is vital for successful patient care.

As this study notes, patient care suffers due to inadequate conflict management, therefore the results are conducive to helping develop efficient collaboration to better care for each patient receiving care.

Kelby Smith: There is a strong need for training for nurses and all healthcare personnel for each aspect of emotional intelligence and conflict management styles. Nursing is a career where all involved need to be on the same page, with the same goal to deliver the highest level of care to all patients. With the knowledge gained from the research review we can ultimately increase the quality of patient care, workplace satisfaction and performance and healthcare expenses.

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Article Review: Nursing Teamwork Taylor Haskins, BSN, RN - 10M PCU

Editor’s Note: Ms. Haskins wrote this paper as part of her Carilion Nurse Residency experience.

Article Reviewed: Goh, P. Q. L., Ser, T. F., Cooper, S., Cheng, L. J., & Liaw, S. Y. (2020). Nursing teamwork in general ward settings: A mixed‐methods exploratory study among enrolled and registered nurses. Journal of Clinical Nursing, 29(19-20), 3802–3811. https://doi.org/10.1111/jocn.15410

Introduction Goh, Ser, Cooper, Cheng, and Liaw (2020) examined the functionality among nursing staff and the effect of teamwork from both a staff and patient perspective. The authors were hoping to understand how RNs and assistive personnel feel about their ability work together and the effect it has on the care they provide to their patients. To determine this information, a mixed-methods approach was used, including both a quantitative and qualitative approach.

Critique The participants were from a single hospital, with 248 participants in the survey portion.

From those participants, 16 were chosen to participate in the group interview sessions. These individuals were selected from the group to ensure that there were people from various specialties and with various education backgrounds.

A Likert scale was utilized for the quantitative survey containing questions pertaining to team leadership, team orientation, backup, trust, and shared mental model. The qualitative portion of the study was conducted through interviews. These methods of data collection are appropriate as it gives the opportunity for many to participate in the surveys, while others were chosen to represent various groups throughout the facility during the interview portion. However, it may have been less biased to have had the individuals who participated in the interview portion be selected randomly so that one individual did not have a greater chance of being selected than another.

One of the main areas of conflict identified by RNs and assistive staff was expectations of roles. Goh et al. found that RNs and assistive staff had different ideas when it came to the responsibilities of the others’ role. This can lead to frustration between unit staff and could contribute to errors if a task is not completed due to role confusion. Ineffective communication about care roles can lead to poor patient care coordination and could contribute to potential errors.

Another area of concern was related to delegation. Some felt that RNs were not being sensitive to the number of tasks already assigned to assistive personnel. Others believed that assistive personnel did not acknowledge their requests for assistance if they were a young RN. When a team cannot function in unity, patient care is compromised. Improvements for effective communication and delegation can alleviate frustration while promoting patient safety.

Another area of conflict was lack of trust between RNs and assistive personnel (Goh et al., 2020).

A lack of trust hinders the ability of the team to work together. Without trust in the other individual, there could be an issue with the quality of care that is provided to the patient. At that point, it is important that actions be taken to resolve issues of mistrust so that patient care is not in jeopardy.

The study is limited by sample size and being conducted at only one facility. More work is needed at a range of facilities and with larger sample sizes to gain better understanding about nursing teamwork.

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The results from this survey are relevant to patient care and the quality of care as well as peer collaboration. A healthy working environment between staff is vital in order to provide care that is of utmost quality for each patient. Delegation is something that can be difficult as all staff members have a great number of responsibilities; however, if needs are discussed with assistive personnel, I believe that responsibilities can be shared appropriately.

Overall Assessment After analyzing this study and the results, I will be more aware of these potential barriers between staff members and try to avoid them by being proactive in communicating and coordinating care with staff. This article may be helpful for a journal club or team discussion in raising awareness to potential issues among staff members and how poor teamwork could contribute to poor patient care or errors. I would recommend this article as a way to identify barriers between communication and delegation among staff so that errors may be avoided in the clinical setting.

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Improving sustainability and cost savings through pulse oximetry probes product change Bobby Dingus, BSN, RN, CCRN - Unit Director 10M PCU

In the progressive care environment one of the leading expenses for a unit’s budget is pulse oximetry probes, which are utilized to measure the oxygen saturation level in a patient’s blood.

This was the case on 10 Mountain PCU where pulse oximetry probes were the most expensive item in the unit’s non-billable supply budget. This was further compounded in May 2020 when 10 Mountain PCU transitioned to the ApexPro FH Telemetry System for patient ECG monitoring which utilized the Masimo Neo – 3 pulse oximetry probes, a more expensive probe than was utilized previously. As a result, for 9 out of 12 months in Fiscal Year 2020, 10 MPCU was over the target goal for non-billable medical supplies. The purpose of this project was to reduce cost and waste related to pulse oximetry probes.

Seeking ways to improve, unit leadership met with a Masimo representative to discuss the new product and identify opportunities. From this meeting the group identified inefficiency and waste resulting from the current process of replacing the probe whenever the probe came off the patient or was soiled. The Masimo Replacement Adhesive Tape, another product supplied by Masimo, was proposed as a potential solution. The replacement tapes are utilized in replacing only the adhesive portion of the SpO2 probe when removed, rather than replacing the entire probe. The probes cost approximately $12.00 per probe, while each replacement tape was $0.02.

Based on this new information, the Masimo Replacement Adhesive Tapes were ordered from Materials Management for the unit supply. In August 2020 staff meetings and in 1:1 discussion with unit leaders, 10 MPCU staff received education about the new product along with the savings and waste reduction potential. Unit leadership monitored non-billable supply expenses and SpO2 probe expenses, providing monthly updates to staff about the outcomes of the implementation.

Implementation of the Masimo Replacement Adhesive Tapes on 10 MPCU resulted in reduction of SpO2 probes used monthly and decreased monthly expenses (Table 1). In August 2020, there were 292 probes used on 10 MPCU at an expense of $3,109.80. Implementation of the replacement tapes started in the last week of August. In September, 179 probes were used at an expense of $1,906.35, and in November 110 probes were used at an expense of $1,171.50.

November demonstrated a 62.3% reduction in the number of probes utilized along with a $1,939.30 reduction in expenses as compared to August (Table 1).

Calculating the amount of waste diverted was accomplished by establishing a baseline of the amount of waste generated by the probes before intervention. We then compared this baseline to the weight of wasted generated post intervention by the probes and the replacement tapes.

In total the calculated amount of waste diverted since project implementation was 20.49 lb. with an average of 6.83 lb. diverted per month.

Implementing the use of replacement tapes resulted in significant reductions in cost and waste.

If the average results of implementing this product were duplicated across all 292 PCU beds at Carilion Roanoke Memorial Hospital the potential savings would be approximately $228,000 per year with, an annual waste diversion of 1,196.61 pounds. This project improved staff efficiency and patient safety. By carrying a set of strips during their work shift, it allows staff to more readily replace SpO2 probes that have come off patients, thus reducing the amount of time that patients are unmonitored and does not require staff to retrieve a new probe from the unit’s supply pyxis.

This project supported our commitment at Carilion Clinic to the purpose of better patient care, better community health, and lower cost.

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Table 1. Quantity, Cost, and Calculated Weight of Waste of Masimo SPO2 Probes on 10 MPCU

Month

Calculated Weight

Quantity

Total Non-billable

239

$2,545.35

12.65 lb.

292

$3,109.80

15.45 lb.

179

$1906.35

9.47 lb.

136

$1,448.40

7.20 lb.

110

$1,171.50

5.82 lb.

of SPO2 Probe Waste

July (pre-Masimo Adhesive Replacement Tape) August (pre-Masimo Adhesive Replacement Tape) September (with Masimo Adhesive Replacement Tape) October (with Masimo Adhesive Replacement Tape) November (with Masimo Adhesive Replacement Tape)

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Curiosity!

Johnathan Phillips, MSN, MSEd, RN, NPD-BC Carilion Franklin Memorial Hospital - Intensive Care Unit Virginia Nurses Association 2020 Year of the Nurse Award Congratulations to Johnathan for his outstanding work on the 2019 project titled, Initiating Palliative Care PRN Medication Assessment and Reassessment. Even amid the pandemic, Johnathan continued to collect, analyze and present data. The project’s 3 interventions ultimately generated an increase in compliance for assessment prior to administration and reassessment following administration.

The Year of the Nurse Awards honor only 20 outstanding nurses throughout Virginia. *Note: John worked in CRMH Palliative Care unit prior to transitioning to Carilion Franklin Memorial Hospital ICU

Compassion!

Bobby Wimmer, RN Carilion Roanoke Memorial Hospital - 8M PCU Bobby Wimmer was the inspiration behind the fundraising campaign to bring a little bit of Christmas to the patients on our Covid-19 unit.

He poured his compassion for his patients into lifting their spirits and providing a small piece of home for them during their holiday spent in the hospital.

He decorated small Chritmas trees, filled stockings with goodies and words of encouragement from the staff and presented them to each patient on the Covid-19 unit.

Thank you Bobby for your care and committment to our patients!

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Collaboration!

Jennifer Bath, MSN, RN, AGCNS-BC, CEN, TCRN Clinical Nurse Specialist - Trauma Services Appointment to the Teaching Excellence Academy for Collaborative Healthcare Jen received her appointment to the Teaching Excellence Academy for Collaborative Healthcare in January 2021. She was accepted at the membership level of “Skilled”. The mission of TEACH is to promote learning excellence at Carilion Clinic, the Virginia Tech Carilion School of Medicine, Virginia Tech Carilion Research Institute, and Radford University Carilion by creating a community of educators and fostering their development as teachers, learners, and educational researchers.

Congratulations Jen!

Committment!

Stephen Holman, BSN, RN, CCRN-CSC-CMC, CSU-ALS Clinical Team Leader - 6S CSICU CMC-CSC Practice Exam and Question Development Committee - American Association of Critical Care Nurses Stephen has been chosen to participate on the CMC - CSC Question Development Committee for the American Association of Critical Care Nurses (AACN). This is an extremely valuable position at the national level that will allow for the pursuit of new ideas while developing new and lasting relationships with colleagues.This is a volunteer position highlighting Stephen’s willingness to share his knowledge and enthusiasm for the practice of acute and critical care nursing.

Well done Stephen!

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Collaboration!

Kristy Massey, BSN, RN, CCRN, CSC Unit Director CRMH 6S CSICU CMC-CSC Practice Exam and Question Development Committee - American Association of Critical Care Nurses Kristy has been chosen to participate on the CMC - CSC Question Development Committee for the American Association of Critical Care Nurses (AACN). Kristy will be able to collaborate with exceptional nurse leaders developing new and lasting relationships with colleagues. This is a volunteer position highlighting Kristy’s willingness to share her knowledge and enthusiasm for the practice of acute and critical care nursing.

Kudos Kristy on your participation!

Courage!

Katie Martin, RN CRMH NICU - Clinical Team Leader The Roanoker Magazine 40 Under 40 Class of 2021 Katie was recognized by The Roanoker Magazine as one of their Class of 2021 40 Under 40 for her caregiving leadership as the clinical team leader at the Carilion Children’s Hospital NICU. In her role as a clinical team leader, Katie mentors new nurses, serves as her units representative to Carilion’s “Green Team” and volunteers in the Ronald McDonald Room at CRMH. Outstanding work Katie!

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Commitment!

Phyllis Whitehead, PhD, APRN, ACHPN, RN-BC CRMH - Clinical Ethicist & Palliative Care National Association of Clinical Nurse Specialists (NACNS) Elected - President Elect The NACNS announced the election of Phyllis Whitehead as their President Elect of their Board of Directors. NACNS mission is to advance and support the unique expertise and value the clinical nurse specialist (CNS) contributes to health care in the United States.

Congratulations Phyllis!

Compassion & Courage!

Carilion Clinic Nursing Staff & other Healthcare Professionals!

COVID-19 Vaccination Clinics Many thanks to all of the Carilion Nursing Staff and other Carilion staff members who volunteered their time to assist with the COVID-19 Vaccination Clinics at the Berglund Center in Roanoke. Carilion partnered with the Roanoke City and Alleghany Health Districts to host the clinics.

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*Continued on next page

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CLASSES & EVENTS MARCH 2021 Basic Research for the Healthcare Professional NR-CE333L March 18, 2021 - 1:00-5:00pm Advanced Research I: Appraising & Synthesizing the Literature NR-CE372L March 24, 2021 - 1:00-4:00pm

APRIL 2021 Basic Research for the Healthcare Professional NR-CE333L April 1, 2021 - 8:00am-12:00pm Carilion Research Day April 13, 2021– Registration is required. http://carilion.ca1.qualtrics.com/jfe/form/SV_0UhJlxwpo9Z88VE

MAY 2021 Art & Science of Nursing Showcase - Virtual Submit your poster intent on our hub on: Inside Carilon/Departments & Services/Nursing Research & EBP/Featured Topics/ Week of the Nurse 2021 Art & Science of Nursing Showcase.

May 6, 2021 thru June 17, 2021

JUNE 2021 Advanced Research III: Dissemination: Preparing for Presentation, Scholarly Writing NR-CE374L - June 1, 2021 - 1:00-4:00pm Basic Research for the Healthcare Professional NR-CE333L June 3, 2021 - 1:00-5:00pm

*All classes and events are virtual unless otherwise noted.

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October 2020 - March 2020 (& past presentations not noted prior to this edition) S. Wohlford. February 11, 2021. Environmental Sustainability in Healthcare, Session Title: Ask the Experts: Health Leadership for Climate Solutions.

2021 Protecting Human Health in Changing Climate (via Zoom).

Dalton-Ward, E., Ward, C. . November 10, 2020. Impact of Influenza Vaccination on the Orthopedic Surgical Patient. Virginia Henderson Research Symposium. (*Accepted, but did not present) Phillips, J. December 7-10, 2021. Palliative Care PRN Medication Assessment and Reassessment.

2x4 Virtual Conference, Center to Advance Palliative Care (CAPC).

Terrell, D., Echevarria, M., Carter, K. March 10-13, 2021. Mindfulness Training in Mitigating Implicit Bias: Improving Cultural Competency for Nurses Caring for LGBT Individuals. Virginia Council of Nurse Practitioners 2021 Annual Conferences, Virtual.

Wilson, V., Lockhart, E., Carter, K. November 2020. A Statewide Survey of Barriers and Supports for RN-BSN Program Enrollment.

Virginia Nurses Today, www.VirginiaNurses.com

Jatta, M., Harvey, E., Griggs, M. August 2020.

Catching CAUTIs Midstream: Impact of Nursedriven Infection Prevention Initiative in a Neurotrauma Intensive Care Unit. American Journal of Infection Control, 48 (8) S40-S41.

Bolling, K., Long, T., Jennings, C., Dane, F., Carter, K. January 2021. Bras for Breast Support after Sternotomy: Patient Satisfaction and Wear Compliance. American Journal of Critical Care 30 (1), 21-26. (CE Article)

Phillips, J. December 2020. Virginia Nurses Foundation 2020 VNF Year of the Nurse Award.

Whitehead, P. February 2021. National Association of Clinical Nurse Specialists - Elected President Elect

Tressler, A., Bowser, S. December 2020.

Awarded from the Chaplaincy Innovation Lab/ Building and Supporting Resilience among Frontline Spiritual Care Providers for the study titled Implementation of Code Lavender.

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To submit your Intent to Submit a Poster go to: Inside Carilion/Departments & Services/Nursing Research & Evidence Based Practice/Featured Topics/click on Week of the Nurse - 2021 Art & Science of Nursing Showcase/click on Intent to Submit Poster for Presentation

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“The World is a book, and those who do not travel read only a page.” – Saint Augustine United Kingdom

Nottingham

Natl. Harbor, MD Williamsburg

Palm

Anaheim

Greenville

Lake Buena Vista

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Follow us on our Nursing Research & EBP hub at Inside Carilion for updated information about: • • •

Nursing Research Classes for 2021!

Nursing Research Fellowship for 2022!

Copies of our Within REACH publication!

Login to Inside Carilion/Departments & Services/Nursing Research & Evidence Based Practice/Featured Topics & Top Resources

Need editorial support to publish your work?

Contact Nursing Research & EBP for: • Assistance with writing your abstract • Peer review • Manuscript submission nursingresearch@carilionclinic.org

2021 VIRTUAL NURSING CONFERENCE INFORMATION

V I R T U A L

May 22-25, 2021

In person or Virtual options

Carilion Clinic Roanoke Campus