Within REACH

Volume 12│Issue 4│Winter 2021

A Final Note from Kim Carter Kim Carter, PhD, RN, NEA-BC - Former Sr. Director of Nursing Research As I reflect on this speeding train of my career from graduating with a diploma in nursing, to 8 more years of undergraduate and graduate education, to practicing in med-surg nursing, public health, a private health promotion business, consulting, academia, and then research, it is difficult to find words that capture how grateful I am to my Carilion family for these last 8 years. What a ride it has been, and I couldn’t have chosen a more wonderful group of people for the last leg of my journey. Your kindness, energy, passion, and devotion to providing the best care for patients inspires me. Thank you for your courage, curiosity and compassion for me – for each other – for our patients.

My advice for your career journey: •

Take care of yourself - it’s not selfish, it’s vital

•

Take care of your colleagues, especially the newest ones entering nursing. Let them help you remember when you had a dream to be a nurse and how excited you were. Do everything you can to fan the flame of their aspiration to be a nurse.

•

Do the same for your colleagues in healthcare, regardless of the position they hold. Treat every colleague from every role with respect.

Even if you are having a “bad day”; set your goal to help a colleague to have a “better day”, and your “bad day” will magically change.

•

Take care of your family and friends outside of work and separate those relationships from work - they are an important support system.

Build these personal relationships around nonwork - related conversations and experiences.

•

Remember that your patients may be experiencing one of the most challenging, frightening, and vulnerable times of their life. They are someone’s father, mother, sister, brother, son, daughter, or friend. Or they may have absolutely no one else in the world who cares about them. Care for them as one of your own. Remember that they live their healthcare experience every day and have built expertise around that - hear them and learn from them. Find out who they really are: someone with histories and dreams, regrets and ambitions. And then learn new and better ways to take care of them ......through EBP & Research!

I believe that by doing these things you will connect with your own spirit and be refreshed. My Carilion friends, thank you for making a difference in my life, as a colleague, a patient, and a family member of a patient. Thank you for being here, for caring for our communities, and for finding better ways. With love, gratitude, and deep respect, Kim

Here’s to the New Year!

Christine Fish-Huson, PhD, RN, CNE - Sr. Director of Nursing Research Another year has gone, and a new year has begun. I always look forward to the New Year as an opportunity to evaluate where I have been and where I am going, both personally and professionally. I find the new year offers hope, opportunity, and an appreciation for all the possibilities that life has to offer. These are characteristics that are much needed at this time, year three of the pandemic.

I feel fortunate to be part of Carilion and a member of a nursing community with a demonstrated commitment to professional development and the provision of quality care. The Winter edition of Within REACH is typically a conference edition used to highlight points learned from the conferences attended by nurses throughout the year; to provide a space for them to share their experiences and conference takeaways. The pandemic and resulting travel restrictions have impacted nurses’ ability to attend conferences and thus limited our submissions for these professional development experiences. Still, our nurses have persevered and have made it possible for us to share the knowledge gleaned from their attendance. We hope you enjoy the stories and find them beneficial.

May this new year bring you balance and fulfillment in all aspects of your life. May you continue to embrace curiosity and continue to ask the question, “is what I am doing best practice?”. Happy New Year and Best Wishes for all 2022 has to bring!

Thank you, Chris

Carilion Clinic Roanoke Campus

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ARTICLES/NOTIFICATIONS 1 A Final Note from Kim Carter - Kim Carter, PhD, RN, NEA-BC & Here’s to the New Year 3 4 5 6

Chris Fish-Huson, PhD, RN, CNE 2021 ANCC Magnet Nurse of the Year - Empirical Outcomes Reflections on Induction to the American Academy of Nursing Phyllis Whitehead, APRN/CNS, ACHPN, PMGT-BC, FNAP, FAAN Virginia Association of Clinical Nurse Specialists - Annual Affiliate of the Year Award

Nursing Care and Considerations with Granulomatosis in the Emergency Department Ann Jimenez, BSN, RN, CCRN, CEN 8 Battery Evaluation and Impact on Nursing - 2022 Magnet Abstract Adam Church RN, ASN, CCRN; Donna Bond RN, DNP, CCNS, AE-C, CTTS, FCNS; Sara Wohlford, RN, MPH, Tonja Locklear, PhD, Marina Sotelo, M.Eng, MA ED, Kim Carter, PhD, RN, NEA-BC, Sean McGinnis, PhD. 9 Conference Corner: Conference Summary - Virginia Nurses Association 2021 Fall Conference - Chris Monk, MSN, RN, NEA-BC 10 Nurse-Led OPAT (Outpatient Parenteral Antimicrobial Therapy) Care-Coordination Program to Improve Outcomes in Adult Osteomyelitis Patients Temitope Ajani, BSN, RN (DNP Student - Radford University) 14 Innovation at Work! Development of a Female Urinal by Carilion Staff Amy Lucas, MSN, RN, CCNS, CCRN-K

RECOGNITION/EVENTS 15 Citations & Recognitions 16 Additional Recognition 18 Virtual Healthcare Hot Topics Journal Club 19 Classes & Events 20 See Where Our Nurses Have Presented Their Work 21

External Conference information

Carilion Nursing Research Editorial Board: Deirdre Rea, DNP, RN-BC, PMH-CNS - Interim Editor-in-Chief Reviewers Nancy Altice, DNP, RN, CCNS, ACNS-BC Desiree Beasley, MSN, RN, CCNS, CCRN-K 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, PhD, RN, CNE

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

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CONGRATULATIONS! ***************************

2021 ANCC Magnet® Nurse of the Year Empirical Outcomes

Watch Ellen receive her exciting award!

Copy and paste the link into your browser: MNOY_Empirical Outcomes_2021.mp4 (dropbox.com)

Join us in congratulating our very own Ellen Harvey, DNP, RN, ACNS-BC, CCRN, TCRN, FCCM - Neurotrauma Clinical Nurse Specialist who has been awarded the 2021 ANCC National Magnet® Nurse of the Year Award - Empirical Outcomes!

Press Release: November 2021

On November 12, 2021, The American Nurse Credentialing Center (ANCC) Magnet Program awarded Ellen M. Harvey the prestigious Magnet Nurse of the Year award for Empirical Outcomes. This is a yearly award that is given to a nurse employed by a Magnet designated hospital for their contribution to the nursing profession exemplifying nursing excellence.

Dr. Harvey was nominated for her leadership of a nurse-led interprofessional surgical team to decrease the incidence of post-op surgical infections in patients who received emergency placement of an External Ventricular Device (EVD) for the removal of excess cerebrospinal fluid to promote healing.

In June of 2020, Ellen and the team noted that the prevalence of infections associated with EVD placement ranged between 15.2 and 35.7 per 1000 EVD device days during the 5 months prior to project implementation.

While looking to lower the infection rate, Dr. Harvey and her team noted that the literature was not clear related to the process to prevent this type of infection in the neuro-surgical patient. With development and implementation of an EVD care bundle, Dr. Harvey and her team immediately saw EVD-related infection rate decrease to 0% and the facililty has maintained an EVD infection rate of 0 for greater than 15 months. The ANCC commissioner presenting Dr. Harvey with her award stated, “this is truly an empirical outcome”.

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Reflections on Induction to the American Academy of Nursing Phyllis Whitehead, PhD, APRN/CNS, ACHPN, PMGT-BC, FNAP, FAAN I am humbled to have been inducted as a Fellow in the American Academy of Nursing (FAAN) earlier this year. The Academy serves both the nursing profession and public by advancing health policy through organizational excellence and effective nursing leadership. The Academy and its more than 2,800 members, nationally and internationally, known as Fellows, create and execute evidence-based and policy-related initiates to advance health care.

Academy Fellows are nursing's most accomplished leaders in education, management, practice, and research. Fellows include association executives; university presidents, chancellors, and deans; state and federal political appointees; hospital chief executives and vice presidents for nursing; nurse consultants; researchers; and entrepreneurs. (https://www.aannet.org/about/aboutthe-academy) It has been a lifelong professional goal to be recognized for my impact by the Academy. My primary areas of impact are practice as a palliative clinical nurse specialist (CNS) and research in mitigating moral distress (MD) across healthcare professions and enhancing palliative care conversations.

I have been honored to work with so many talented nurse leaders throughout my career. It has been humbling to journey with nurses and other professionals who care for dying and suffering patients. My work with the Virginia Nurses Association and Foundation, Virginia Association of Clinical Nurse Specialists, National Association of Clinical Nurse Specialists, Hospice and Palliative Nurses Association has been so incredibly enriching to me.

Many thanks to everyone who has been so encouraging and supportive of me over the years.

~ Phyllis

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CONGRATULATIONS! Virginia Association of Clinical Nurse Specialists Annual Affiliate of the Year Award!

Amy Lucas Suzanne Beels

Donna Bond Desiree Beasley

Cindy Ward

Monica Coles

Ellen Harvey

Phyllis Whitehead

Kim Ramsey

Jennifer Bath

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Nursing Care and Considerations with Granulomatosis in the Emergency Department Ann Jimenez, BSN, RN, CCRN, CEN - Carilion Giles Community Hospital Emergency Department

Mrs.G presents to the emergency department with complaints of shortness of breath and worsening voice hoarseness. She was quickly assisted into her wheelchair while her spouse, who accompanied her, was questioned about her health history. He explained that she has Wegener’s Granulomatosis.

Granulomatosis with polyangiitis (GPA, formerly known as Wegener’s Granulomatosis) is an autoimmune small-vessel vasculitis causing inflammation. It is a rare multisystem disease, often affecting the sinuses, lungs, and kidneys. It has no known etiology and requires several studies to confirm the diagnosis. Many factors play a role in diagnosing GPA. Symptoms that support a diagnosis include a runny nose, hemoptysis, dyspnea, and fatigue, all of which conspicuously do not improve (Lutalo, D’Cruz, 2014).

Early diagnosis is essential in beginning treatment because GPA can worsen rapidly. A patient can be diagnosed by a common blood test called anti-neutrophil cytoplasmic antibody (ANCA), which identifies a specific antibody in serum. A positive ANCA test alone cannot confirm the diagnosis, so a tissue biopsy may still be needed. Once a GPA diagnosis is confirmed, treatment regimens will be dictated by the particular organ systems involved, as well as by medications that treat systemic inflammation (Falk, Merkel, King, 2019).

Treatment regimens will include glucocorticoids and immunosuppressive medications. Nurses will be familiar with most of the medications that are used in the treatment of GPA because these medications are frequently seen on medication lists of patients with organ transplants, rheumatoid arthritis, lupus, and irritable bowel disease, in addition to other autoimmune diseases.

Once GPA symptoms are controlled, patients may be required to take medications to prevent a relapse, like methotrexate and rituximab. The hallmark medication combination is prednisone and Cytoxan, which provide insight into whether remission can be achieved. However, there are side effects that must be considered, including hair loss, nausea, and diarrhea. In particular, severe immunosuppression will need to be taken seriously. Regular monitoring of complete blood count, renal function, liver function, urine studies, and clinical symptoms is recommended. Plasma exchange, known as plasmapheresis, may be considered in those patients where medication treatment has failed. Plasmapheresis works by eliminating ANCA from the body circulation in those patients with life-threatening renal vasculitis (Lutalo, D’Cruz, 2014).

Initially, nursing care of a patient with GPA will always focus on airway, breathing, and circulation.

This may sound elementary but should guide an emergency department nurse’s care. The nurse should place the patient on the heart monitor, blood pressure, and oxygen saturation monitors and establish IV access. Anticipated care includes oxygen, nebulization treatments, IV corticosteroids, and possibly anxiolytics since anxiety can potentiate symptoms. The physician and respiratory therapist should be called to the bedside promptly.

Mrs. G was quite anxious and breathless with audible stridor, caused by GPA-induced subglottic stenosis and supraglottic inflammation. Joining the team at the bedside, the ED physician guided her care. While the nurses connected her to heart and vital sign monitors and started a saline lock, the respiratory therapist treated her with a racemic epinephrine nebulizer.

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The patient was injected with dexamethasone and a small dose of lorazepam. Fortunately, Mrs. G’s worrisome symptoms reversed quickly, with her dyspnea subsiding and hoarseness lessening. She was monitored closely for return of symptoms and transferred expeditiously to a tertiary care center.

Nursing implications include caring for those life-threatening airway symptoms that prompt quick intervention. Another consideration is monitoring for acute kidney injury requiring emergent hemodialysis. Emergency nurses should recognize that immunosuppressed patients can develop overwhelming infections with serious implications. Nurses must also be aware of the psychological and emotional impact this illness carries when patients fail outpatient treatment, or outpatient treatment renders complications. The need for tracheostomy placement, hemodialysis, and critical care treatment for sepsis can be devastating news for the GPA patient. The need to adapt to breathing through a tracheostomy tube, the limitation it imposes on communication, and the tube's appearance can all have an immensely negative impact on such patients.

However, nursing care for patients while in the emergency environment can positively affect psychological well-being. Facilitating communication between the healthcare team, patients, and their families, when appropriate, is a vital role for nursing. Explaining care and interventions, reassuring patients about the transfer, and providing patients with information about inpatient care before admission all serve to reduce anxiety that can exacerbate their condition. Working towards providing optimal psychological care will positively influence patients' psychological recovery and may also help physical rehabilitation after inpatient care (Pattison, 2005).

Mrs. G arrived at a small critical access hospital in extremis but was transferred with an improvement of her acute symptoms. Though her journey for recovery is uncertain, there is one comforting prospect worth noting. Seriously ill patients arrive at the emergency department daily, requiring critical thinking skills and collaboration from team members. Nursing gratification occurs when patient acuity improves, and goals of delivering quality care and enhancing patients’ condition is accomplished.

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Battery Evaluation and Impact on Nursing - 2022 Magnet Abstract

Adam Church ASN, RN, CCRN; Donna Bond DNP, RN, CCNS, AE-C, CTTS, FCNS; Sara Wohlford RN, MPH; Tonja Locklear PhD, Marina Sotelo M. Eng, MA Ed; Kimberly Carter RN, PhD, NEA-BC; Sean McGinnis PhD Purpose: Identify the 9-volt battery (Ultralife® Lithium (UL), Energizer® Lithium (EL), or Energizer® Alkaline (EA) with the longest life cycle for inpatient telemetry modules to reduce the number of batteries and low battery alarms with attention to cost and environmental impact.

Relevance/Significance: When new telemetry modules were initiated at our organization, the number of battery changes increased significantly. This resulted in a surge in phone calls to the units from the virtual center requiring frontline staff to redirect their focus from patient care to change batteries. There was also an increase in low battery alarms contributing to alarm fatigue. The issues surrounding battery life introduced patient safety concerns and a need to identify potential solutions.

Strategy/Implementation/Methods: This IRB-determined quality improvement project examined data sets for 15 adult patients who had a projected length of stay (LOS) of greater than 5 days in a progressive care unit. The sample size was sufficient for statistical power using the Kruskal-Wallis test and descriptive statistics.

Data collection included battery type, time battery was placed and removed, telemetry module number, and patient physiological parameters. The average monthly battery cost was calculated by adding the number of monthly batteries and median salary of the Registered Nurse and the Virtual Monitor Technician. Staff installed batteries in a set order and recorded the begin and end times.

Evaluation/Outcomes/Results: Battery life of EA was 16.4 hours, EL was 27.4 hours, and UL was 40.8 hours. Using the unit monthly mean LOS of 144 hours, with 100 patients per month, it was determined that 900 EA, 600 EL, and 400 UL batteries would be used per month. Median time for staff to change a battery was 3.57 minutes. The average monthly battery cost was $1977 for EA, $4107 for EL, and $2191 for UL. The UL battery is $214 a month higher but saves 30 hours a month of staff time and results in 500 fewer low battery alarms. Lowering the interruption frequency of critical and vigilance tasks decreases probability for errors as well as environmental waste by 600 batteries.

Conclusions/Implications for Practice: Monthly, UL costs $214 more but results in 30 hours saved staff time and 500 less low battery alarms. Lowering the interruption of critical and vigilance tasks decreases probability for errors and environmental waste by 600 batteries. More study is needed to examine impact with shorter LOS. Acknowledgements: The authors acknowledge the support of Beth Assenat and Emily Sullivan for the administrative assistance, John LaCoy and Jordan Ashby for technical support, Iona Holland BSN, RN, Case Manager, Christina Dehart, 8MPCU staff. *Batteries used for this study were supplied by Carilion Clinic and General Electric Check out a video of Adam’s video presentation on our Nursing Research hub on Inside Carilion: (follow the path below) Inside Carilion/Nursing Research & Evidence Based Practice/Featured Topics/Educational Presentations

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Conference Summary - Virginia Nurses Association 2021 Fall Conference - Virtual Chris Monk, MSN, RN, NEA-BC - Carilion Nursing Practice Administrator As a result of a partnership between the Nursing Center of Excellence and HR Education and Organizational development, every nurse at Carilion was afforded the opportunity to take advantage of the on demand VNA fall conference, “Fostering Recovery by Creating Moral Community in the Wake of a Pandemic” from September thru December. I took advantage of the conference and would like to share my thoughts. The conference was brimming with information on how the pandemic has affected nursing, ways to take care of self while taking care of others, the importance of self-reflection, and the need to foster recovery through moral communities.

All healthcare workers have been affected in this pandemic. It is important to take time to unpack our thoughts, feelings and more importantly move on towards the future. The future is precisely where I choose to focus. To look toward fostering recovery via moral community, we must first define moral community. According to William Spohn (n.d.) the John Nobili Chair of Religious Studies at Santa Clara University, moral community refers to the network of those to whom we recognize an ethical connection through the demands of justice, the bonds of compassion, or a sense of obligation. A moral community in healthcare is necessary for ethical practice of nursing. Nurses are bound to each other through common ethical commitments, whose purpose extends beyond, but must include self-care (Wocial, 2018). Self-care with a strong sense of moral community were two key takeaways for me that I found encouraging.

As we move forward and shift our focus to recovery, we will need a strong moral community that encourages conversations, encourages different perspectives, and challenges the status quo. Nursing is at the forefront of patient care. While the rest of the world continues to focus on the narrative of awfulizing how bad things are for healthcare workers, nursing is there at the bedside forging ahead and forming a new narrative. That new narrative is nurses showing up for work every day who find joy. People continuing to enroll in nursing school to be a part of the workforce for humanity in the fight against COVID. Tenured nurses continuing to train and orient new nurses despite increasing workloads, so that the profession continues to grow and serve. Nurse leaders who are focusing their efforts on ensuring there is a network that has a strong ethical connection, where the bonds of compassion and a sense of obligation thrive.

Personally, I am thankful to be in a moral community of healthcare workers who have stumbled together, helped each other work to be the best we can be for our patients and no matter the obstacles, continued pushing forward in what sometimes felt like impossible situations. Working collaboratively towards justice, through the bonds of compassion with a sense of obligation, is exactly where I choose to focus the narrative moving forward.

Professional nursing is well-positioned to move us there. We are grounded in standards of practice, professional performance elements and a code of ethics that depict a strong moral community, honors our Carilion mission, values, and our professional practice model REACH. Fostering a strong moral community where we advocate for all patients; vaccinated, unvaccinated, practicing healthy behaviors or with too many chronic conditions to count, is our future work. I am so proud to be a part of Carilion’s nursing team and the broader moral community where this work takes place. I am humbled by the commitment, compassion, courage, and curiosity I see every day. Moving forward, let us not lose sight of the moral community within which we reside and let us collaborate to foster an even stronger community where we can change the narrative from one of awfulizing, and hopelessness, to one of overcoming, innovating, making a difference against all odds and fostering recovery.

References Spohn, William (n.d.) Who Counts?: Images Shape Our Moral Community https://www.scu.edu/mcae/ publications/iie/v7n2/spohn.html Wocial, L.D., (January 31, 2018) "In Search of a Moral Community" OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 1, Manuscript 2.

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Nurse-Led OPAT (Outpatient Parenteral Antimicrobial Therapy) CareCoordination Program to Improve Outcomes in Adult Osteomyelitis Patients.

Temitope Ajani, BSN, RN (DNP student - Radford University) Background: Outpatient parenteral antimicrobial therapy (OPAT) describes the administration of parenteral antimicrobials without hospitalization (Norris et al., 2019). There are numerous benefits as well as associated complications. (Bodycot, et al., 2021; Chapman et al., 2019; Huang, Ruhe, Lerner, & Fedorenko, 2018; Keller et al., 2018). Complications that are often encountered in OPAT include hospital readmissions, adverse drug reactions, or problems with central venous access devices, (Lai et al, 2012). Formal OPAT programs have been proposed to mitigate these risks, but there exists a paucity of evidence regarding the specific design of these programs (Mansour, et al., 2018; Norris et al., 2019). Nurse care coordination has been proposed to improve patient outcomes in OPAT (Huck et al., 2014; Jingping Xing, Goehring, & Mancuso, 2015; Marbach et al., 2018; Altfeld et al., 2013; Luu et al., 2019; Shrestha et al., 2018).

Why research is needed: To evaluate the effectiveness of OPAT program design.

Current State of Knowledge: Huck et al., (2014) found that unavailable laboratory test results were linked to a higher probability of unplanned readmission. Similarly, Marbach et al., (2018) recorded a higher incidence of 30-day readmissions in patients who did not receive post discharge care. A transitional care program reduced the rates of readmissions, and mortality (Altfeld et al., 2013), while another nursemanaged OPAT program recorded a significant reduction in readmissions (Mansour, Heslin, & Townsend, 2018).

Research Question and Outcome Variables: Does a Nurse-led OPAT Care Coordination program decrease the rate of 30-day hospital readmission, incidence of adverse drug and central line events in adult osteomyelitis patients enrolled in a formal OPAT program compared with those who received only the traditional post discharge care?

Research Objectives: To evaluate the impact of a nurse–led OPAT care coordination program; identify risk factors; and provide recommendations for improvement.

Methods: This is a retrospective, Quality Assurance/Quality Improvement (QA/QI) project.

Study Design: The Intervention Group received the OPAT care coordination while the Control Group received only the traditional post discharge care. The groups received post discharge antimicrobial therapy from July 2018 to December 2019.

Population, Inclusion, and Exclusion Criteria: Adult patients, 18 years old and above, with a diagnosis of osteomyelitis, discharged with a minimum of 2 weeks parenteral antimicrobial therapy to Carilion Clinic home health agencies.

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Description of OPAT Care Coordination The OPAT nurse introduced the program expectations prior to discharge and contacted the patient by phone within 48 hours post discharge to verify orders and schedule follow up appointment.

The nurse reviewed and documented the laboratory test results while performing other assigned duties.

Description of Measures of Variables: The 30-day readmission included non-OPAT causes. The central line events included defined episodes that interrupted therapy. The adverse drug events were a serum creatinine level greater than 1.4mg/dL or blood urea nitrogen greater than or equal to 25nmlo/L and white blood cell count less than 1500/microliter (Keller et al., (2018).

Data Collection Methods, and Secure Data Storage: The patient record was extracted from the EPIC Clarity Database using SQL Developer (Muthukattil, 2021). The study data was stored in the Research Electronic Data Capture (REDCap) program hosted at CRMH. A manual chart review of the 456 extracted patient records was also completed.

Institutional Review Board (IRB): The CRMH IRB determined that the project did not meet the definition of human subjects’ research and therefore does not require IRB oversight or approval.

HIPPA Waiver The entries were de-identified prior to storage in REDCap. Statistical Analysis: The Carilion Health Analytics Team conducted statistical analysis using the Statistical Analysis Software -SAS 9.4 (SAS Institute, Cary, NC). Fisher’s-exact tests were performed with a P-value of less than 0.0167 using a Bonferroni adjustment for the multiple enrollment category.

Findings: There were a total of 67 patients; 54 in the OPAT group and 13 in the Traditional group. The OPAT group had a 12.96% 30-day readmission, while the Traditional group had 7.96%. The percentage distribution for central line events was 11.11% and 7.96%; adverse drug events was 22.22% and 7.96% in the OPAT and Traditional groups respectively. The results showed no evidence to suggest a statistical association between nurse-led care coordination and 30-day readmissions (p=1.00000), central-line events (p=1.0000), and adverse-drug events (p=0.0437).

Discussion and Conclusions: The 30-day readmission rate for the OPAT group was 12.96% which is lower than the Carilion hospital-wide rate of 15.7%. Keller et al., (2013) had a similar result with no association between OPAT transitional care and 60-day readmissions. The measurement of nursing interventions to intercept adverse drug events, rather than abnormal labs, could be a more sensitive measure of nurse care coordination (Puumalainen et al., 2020; Vaz et al., (2018). Similarly, an assessment of central line care may indicate significant association with nursing interventions rather than actual Continued next page

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CLABSIs (Russell et al., 2019). The outcome variables could also have been impacted by confounding variables (Bugeja, Stewart, Strath, & Vosper, 2020; Durojaiye et al., 2021).

Potential Benefits to Science and/or Society: The study suggests that the use of performance measures may not be an appropriate measure of nursing interventions. However, nurses’ roles are pivotal to OPAT and research to evaluate OPAT programs and assess nurses’ contributions is recommended.

References: Altfeld, S. J., Shier, G. E., Rooney, M., Johnson, T. J., Golden, R.L., Karavolos, K., Avery, E., Nandi, V., Perry, A.J. (2013). Effects of an Enhanced Discharge Planning Intervention for Hospitalized Older Adults: A Randomized Trial, The Gerontologist, 53(3), 430–440. doi-10.1093/geront/gns109 Bodycot, J., Mashonganyika, L., Kucziw, N., Ingham, C., Bhukera, S., & White, H. A. (2021). Maximising the opportunity of a self administration outpatient parenteral antimicrobial therapy pathway. Vascular Access, 15(1), 15–23. https://doiorg.radford.idm.oclc.org/10.5737/cvaa-1511523 Bugeja, S. J., Stewart, D., Strath, A., & Vosper, H. (2020). Human Factors approaches to evaluating outpatient parenteral antimicrobial therapy services: A systematic review. Research in Social & Administrative Pharmacy, 16(5), 614–627.

Chapman, A. L., Patel, S., Horner, C., Green, H., Guleri, A., Hedderwick, S., Snape, S., Statham, J., Wilson, E., Gilchrist, M., & Seaton, R . A. (2019). Updated good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) in adults and children in the UK. JAC–Antimicrobial Resistance, 1(2), dlz026. https://doi. org/10.1093/jacamr/dlz026 Hospital Care Data. (2021). READMISSION RATES AT CARILION ROANOKE MEMORIAL HOSPITAL. Acute Care Hospital in Roanoke, VA 24014. Retrieved on September 14, 2021 from https://hospitalcaredata.com/facility/carilion-roanoke Huang, V., Ruhe, J.J., Lerner, P. et al. (2018). Risk factors for readmission in patients discharged with outpatient parenteral antimicrobial therapy: a retrospective cohort study. BMC Pharmacol Toxicol 19, 50 (2018). https://doiorg.radford.idm.oclc.org/10.1186/s40360-018-0240-3 Huck, D., Ginsberg, J. P., Gordon, S. M., Nowacki, A. S., Rehm, S. J., & Shrestha, N. K. (2014). Association of laboratory test result availability and rehospitalizations in an outpatient parenteral antimicrobial therapy programme. Journal of Antimicrobial Chemotherapy (JAC), 69(1), 228–233. doi.10.1093/jac/dkt303 Jingping Xing, Goehring, C., & Mancuso, D. (2015). PRIMARY CARE. Care Coordination Program For Washington State Medicaid Enrollees Reduced Inpatient Hospital Costs. Health Affairs, 34(4), 653–661. doi-10.1377/hlthaff.2014.0655 Keller, S. C., Williams, D., Gavgani, M., Hirsch, D., Adamovich, J., Hohl, D., …Cosgrove, S. E. (2018). Rates of and Risk Factors for Adverse Drug Events in Outpatient Parenteral Antimicrobial Therapy. Clinical Infectious Diseases, 66(1), 11. doi 10.1093/cid/cix733 Keller, S. C., Ciuffetelli, D., Bilker, W., Norris, A., Timko, D., Rosen, A., Myers, J. S.,Hines, J., & Metlay, J. (2013). The Impact of an Infectious Diseases Transition Service on the Care of Outpatients on Parenteral Antimicrobial Therapy. Journal of Pharmacy Technology, 29(5), 205–214. https://doiorg.radford.idm.oclc.org/10.1177/8755122513500922 Lai, A., Thuong Tran, Hien M. Nguyen, Fleischmann, J., Beenhouwer, D. O., & Graber, C. J. (2013). Outpatient parenteral antimicrobial therapy at large Veterans Administration Medical Center. American Journal of Managed Care, 19(9), e317-24. e Luu, Q., Baker, H. B., Nathan, R. V., Hengel, R. L., Bacon, A. E., Prokesch, R. C., Lo, C. T., Couch, K. A., Schroeder, C. P., & Aglen, L. J. V. (2019). 2081. Low 30-Day Hospital Readmission Rates in Medicare Patients Receiving Outpatient Parenteral Antimicrobial Therapy (OPAT) in Physician Office Infusion Centers. Open Forum Infectious Diseases, 6, S702. https://doi-org.lib proxy.radford.edu/10.1093/ofid/ofz360.1761 Mansour, O., Heslin, J., & Townsend, J. L. (2018). Impact of the implementation of a nurse-managed outpatient parenteral antibiotic therapy (OPAT) system in Baltimore: a case study demonstrating cost savings and reduction in re-admission rates.

Journal of Antimicrobial Chemotherapy (JAC), 73(11), 3181–3188. https://doi org.radford.idm.oclc.org/10.1093/jac/dky294

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Marbach, J. A., Johnson, D., Kloo, J., Vira, A., Keith, S., Kraft, W. K., … Whellan, D. (2018). The Impact of a Transition of Care Program on Acute Myocardial Infarction Readmission Rates. American Journal of Medical Quality, 33(5), 481–486. doi 10.1177/1062860618754702 Muthukattil, R.J. (2021). Carilion Health Analytics and Research Team. Norris, A. H., Shrestha, N. K., Allison, G. M., Keller, S. C., Bhavan, K. P., Zurlo, J. J., …Umscheid, C. A. (2019). 2018 Infectious Diseases Society of America Clinical Practice Guideline for the Management of Outpatient Parenteral Antimicrobial Therapy. Clinical Infectious Diseases, 68(1), e1–e35. doi 10.1093/cid/ciy745 Puumalainen, E., Airaksinen, M., Jalava, S. E., Chen, T. F., & Dimitrow, M. (2020). Comparison of drug-related problem risk assessment tools for older adults: a systematic review. European Journal of Clinical Pharmacology, 76(3), 337–348. https://doi org.radford.idm.oclc.org/10.1007/s00228-019-02796-w Russell, T. A., Fritschel, E., Do, J., Donovan, M., Keckeisen, M., Agopian, V. G., Farmer, D. G., Wang, T., Rubin, Z., Busuttil, R. W., & Kaldas, F. M. (2019). Minimizing central line–associated bloodstream infections in a high-acuity liver transplant intensive care unit. American Journal of Infection Control, 47(3), 305–312. https://doi org.radford.idm.oclc.org/10.1016/j.ajic.2018.08.006 Shrestha, N. K., So Lim Kim, Rehm, S. J., Everett, A., Gordon, S. M., & Kim, S. L. (2018). Emergency department visits during outpatient parenteral antimicrobial therapy: a retrospective cohort study. Journal of Antimicrobial Chemotherapy (JAC), 73(7), 1972–1977. doi-10.1093/jac/dky133 Vaz, L. E., Farnstrom, C. L., Felder, K. K., Guzman-Cottrill, J., Rosenberg, H., & Antonelli, R. C. (2018). Utilizing a Modified Care Coordination Measurement Tool to Capture Value for a Pediatric Outpatient Parenteral and Prolonged Oral Antibiotic Therapy Program. Journal of the Pediatric Infectious Diseases Society, 7(2), 136–142. doi-org.lib-proxy.radford.edu/10.1093/jpids/pix023

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Innovation at Work! Development of a Female Urinal by Carilion Staff Amy Lucas, MSN, RN, CCNS, CCRN-K, Carilion Clinical Nurse Specialist The ongoing work to ensure that there are adequate products to manage urine output in patients highlighted a need for a product for immobile, continent women. While men can often use a urinal, bed bound women traditionally use a bedpan, but this is difficult when they are unable, or it is unsafe to turn. Also, it requires another person to help with placement which doesn’t allow for the same level of independence as what men experience. Currently at Carilion there is a female urinal, however the shape of the product is most conducive to women who can sit on the edge of the bed or in a chair and tends to spill for those who can’t sit upright. Staff will use a device intended for incontinent women instead of using a bedpan even at times when the plan of care includes mobilization. Unfortunately, this leads to more dependence and could lead to longer lengths of stay and poorer outcomes related to decreased mobility. This also contributes to higher costs as the incontinence product costs over fourteen dollars each day to use compared to a bedpan, bedside commode, or toilet, which are reusable and in the case of the bedpan, much less expensive.

After a fruitless search for an available product to meet this need, the clinical nurse specialist (CNS) partnered with the Carilion Innovation team to develop a functional female urinal. The Innovations Team evaluated the cost and marketability and secured a partnership with biomedical engineering students at Virginia Tech. This partnered the resources and knowledge of the students with the expertise of the CNS. This work included testing multiple versions of the product in a simulated environment to develop a product that diverted the urine away from the patient while in a flat position. At the end of the semester, they were able to successfully demonstrate a device that met this need and an application for patent was submitted.

The next steps will be to test and refine the product in a laboratory setting followed by evaluation in a real-world setting. As the CNS and students work on final improvements the Innovations Team will be investigating possible production and marketing options in the hopes of offering a functional product for women who are continent but have difficulty with mobility that will allow for proper management of urine in a way that encourages independence for the patient and is cost effective for the organization caring for the patient.

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October 2021 - January 2022 (& past presentations not noted prior to this edition) Bath, J. November 1-December 15, 2021. Using a Needs Assessment to Determine Nurses’ Knowledge Gaps in Trauma. 2021 Carilion Nursing Research Virtual Conference.

Church, A., Bond, D., Wohlford,S., Locklear, T., Sotelo, M., McGinnia, S., Carter, K. November 1-December 15, 2021. Lithium versus Alkaline Battery on a Telemetry Unit: Cost, Alarm Fatigue, Nursing Workflow, and Environmental Impact. 2021 Carilion Nursing Research Virtual Conference.

Jones, B. November 1-December 15, 2021.

Compassion Changes Everything: The Evidencebased Base for Compassionate Care for Patients AND Caregivers. 2021 Carilion Nursing Research Virtual Conference.

O’Conner, K., Hubbard, S., Brogan, T. November 1-December 15, 2021. Nursing Work Related Stress in the ICU and Aromatherapy 2020 Carilion Nursing Research Fellowship. 2021 Carilion Nursing Research Virtual Conference.

Dalton-Ward, E., Ward, C. November 1December 15, 2021. Impact of the Influenza Vaccination on the Orthopedica Surgical Patient.

2021 Carilion Nursing Research Virtual Conference.

White, L., Jeffreys, A., Conkling, M. November 1December 15, 2021. Effects of Moral Distress on Quality of Patient Care - 2020 Carilion Nursing Research Fellowship. 2021 Carilion Nursing Research Virtual Conference.

Hedge, V., Carter, K., Downey, W., Sharp, H. November 1-December 15, 2021. Diabetes Distress Among Adolescents with Type 1 Diabetes Mellitus. 2021 Carilion Nursing Research Virtual Conference.

Bath, J. October 28, 2021. Received the Medical Education Research Certification (MERC).

Parker, S., Browning, S. November 1-December 15, 2021. Cardiac Hospice Care Program - A Matter of Heart. 2021 Carilion Nursing Research Virtual Conference.

Reiter, L., Harvey, E., Taylor, O., Jatta, M., Plaster, S., Busch, C., McDaniel, B., Cannon, J., Moreno, H., West, K., Tackett, W., Thomas, B., Brendel, W., Hodges, C., Mittal, S. November 1December 15, 2021. Reducing External Ventricular Drain Associated Ventriculitis. 2021 Carilion Nursing Research Virtual Conference.

Wooldridge, A., Carter, K. September 2021.

Pediatrics and neonatal tracheostomy caregiver education with phased simluation to increase competency and ehnance coping. Journal of Pediatric Nursing, 60 (2021) 247-251. DOI:https:// doi.org/10.1016/j.pedn.2021.07.011

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Commitment!

Suzanne Tyler, MSN, RN Sr. Director Carilion Infection Prevention & Control The Roanoker’s 40 Under 40 Honoree Congratulations to Suzanne Tyler for her induction into The Roanoker’s 40 Under 40 Class of 2022! There were 135 nominations this year and Suzanne’s nomination described her as being “all in for the organization” during her 15+ years at Carilion. Suzanne has worked in various positions at Carilion including, nursing assistant, clinical team leader, unit director and now senior director. During this crucial time, Suzanne has helped shape policy to limit exposures/transmission to patients and staff while continuing Carilion’s vision of providing top-quality care. Suzanne stated “My goal has been to take what I have learned in both formal education as well as that handed down from seasoned nurses and medical professionals and use it to help my community thrive and flourish”.

For more on this topic use the link below to read the entire article: https://theroanoker.com/magazine/features/40-under-40-suzannetyler/

Compassion!

Lindsay Young, BSN, RN, CCRN CRMH 7S ICU Bringing Cheer to Single Mom and Her 3 Children!

Shout out to Lindsay Young, nurse on 7S ICU who for the second year, collaborated with a local elementary school guidance counselor to help a single mom in need this Christmas. The unit raised $400.00 in donations to spend on this family in need. The 7S ICU team bought Christmas gifts based off of their wish list, for the 3 children; grades kindergarten, fourth grade, and ninth grade. What a great way to ring in the holiday season with the gift of compassion and love!

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Courage!

Dianna Coffey, MSN, RN, CFRN Carilion Life-Guard Flight Nurse John Jordan Award for Excellence in Transport Medicine Journalism Congratulations to Dianna Coffey, Carilion Flight Nurse who received the John Jordan award at the Air & Surface Transport Nurses Association (ASTNA) 40th Anniversary Member Meeting in October 2021. This award recognizes an individual who has made a significant contribution to transport medical journalism. The National Flight Nurses Association (NFNA) developed the award to recognize exceptional leaders in the professions of flight nursing.

They determined that journalistic communication was an important factor in advancing the profession.

Commitment!

Carilion Giles Memorial Hospital Top Marks for Patient Satisfaction Published in Virginia Business - Richard Foster, December 21, 2021 Amid the worst days of the pandemic, Virginia’s patient satisfaction rate fell slightly in an annual nationwide survey, and just 2 hospitals in the commonwealth received top marks from their patients.

Carilion Giles Memorial, located in Virginia’s Mountain Playground, was one of the 2 hospitals that received top ratings by 80% or more of respondents.The patient satisfaction scores came from the annual Hospital Consumer Assessment of Healthcare Providers and Systems conducted by the Centers for Medicare & Medicaid Services (CMS) CGMH also received top marks in the 2016, 2017, 2018 and 2020 surveys.

Way to go CGMH Nursing Staff and other CGMH healthcare professionals!

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Introducing the Virtual Healthcare Hot Topics Journal Club!

Cindy Ward, DNP, RN-BC, CMSRN, ACNS-BC Research Council Unit Outreach Subcommittee The Unit Outreach Subcommittee of the Research Council has started a virtual journal club to provide an opportunity to read and discuss issues of concern in healthcare. The journal club is open to any employee. The most exciting thing about the Healthcare Hot Topics Journal Club is that it is virtual! Using the Teams platform will allow participants to post their comments and opinions when it is convenient for them.

A new discussion will be started every one to two months. There will be a channel for each new topic with the article posted in the Files section. Discussion questions for the article will be located in the Wiki.

A separate tab will give access to the evaluation form. Please complete the evaluation to let us know your opinion about the journal club and what future topics you’d like to discuss.

Participation in a journal club can be used to fulfill the Research criteria for RN 2. The subcommittee will discuss ways journal club participation could be added to RN 3 and 4 criteria and make recommendations to the CAP Committee.

Questions? Contact: Cindy Ward - Clinical Nurse Specialist email: cwward@carilionclinic.org phone: 540-224-2508

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CLASSES & EVENTS

Basic Research for the Healthcare Professional NR-CE333L

June 23, 2022 - 1:00-5:00pm August 18, 2022 - 8:00am-12:00pm October 20, 2022 - 1:00-5:00pm December 1, 2022 - 8:00am -12:00pm *Additional classes are being evaluated for 2022.

Keep an eye on Within REACH or go to our hub on Inside Carilion for additions to our Nursing Research Classes schedule for 2022.

*All classes and events will be virtual at this time.

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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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2022 NURSING CONFERENCE INFORMATION

CONNECT WITH NURSES! INSPIRING NURSE LEADERS!

AACN National Teaching Institute & Critical Care Exposition Date: May 16-18, 2022 Location: Houston, TX

Date: April 11-14, 2022 Location: New Orleans, LA Early Bird fees available through October 31, 2021

31st Annual AMSN Convention Date: September 29-October 2, 2022 Location: San Antonio, TX Speaker abstracts due 10/30/21 Poster abstracts due 5/15/22

ANCC 2022 MAGNET & PATHWAY TO EXCELLENCE CONFERENCE October 13-15, 2022 Philadelphia, PA

Carilion Clinic Roanoke Campus