2014
Nursing Annual Report Nursing Excellence
2014
The American Heart Association and American Stroke Association recognize this hospital for achieving 85% or higher adherence to all Get With The GuidelinesŽ Stroke Performance Achievement indicators for consecutive 12 month intervals and 75% or higher compliance with 5 of 8 Get With The Guidelines Stroke Quality Measures to improve quality of patient care and outcomes in addition to achieving Time to Intravenous Thrombolytic Therapy ≤ 60 minutes in 50% or more of applicable acute ischemic stroke patients (minimum of 6) during one calendar quarter.
Table of Contents
A Message From Our Leadership Dear dedicated nursing associates, I continue to be proud of the great things that I see happening at Kenmore Mercy Hospital each and every day.
Leadership Messages 2
Message from James M. Millard, President & CEO
Message from Cheryl W. Hayes, Vice President of Patient Care Services
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2 West Renovation Expansion of Surgical Services
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Structural Empowerment James M. Millard
Transformational Leadership 6 7 7 8 9 10 11
Shared Governance Preceptors Guiding the Future Nurses and Higher Education Recognizing Nursing Excellence Daisy Award Meeting Community Needs Academy of Medical Surgical Nurses
Exemplary Professional Practice 12 13 13 14 14 15
Crisis Services & SANE Nurses Palliative Care Program Nonviolent Crisis Intervention Training Operation Walk USA Work Life Balance Certifications
New Knowledge, Innovations, & Improvements 16 17 18 18 19
ABCDE Bundle Ebola Protocol Hands Free Defibrillation Continuous Renal Replacement Therapy STOP Light Initiative
Empirical Outcomes 20 21 22 23
Patient Experience Infection Rates Infection Rates Readmission Rates
Editorial Staff
Dawn M. Cwierley, AS, BS Cheryl W. Hayes, MS, ANP, NEA-BC Amanda Kramer, RN, BSN Heather Telford, RN, MS, CEN Lisa Smith, MSN, RN, CCRN Laura Verbanic, PT, BB, CPHQ Kathleen Vitthuhn, RN, MSN
It is evident that we work with an exceptional nursing team, committed to quality outcomes and evidence based practice. You have played a key role in our past successes, and you continue to play a key role in leading this hospital into the future.
Your input, which comes in many forms, has been invaluable to Kenmore Mercy’s leadership team, helping us to identify opportunities for improvement and growth. The feedback that we receive from Shared Governance, the Voice of the Associate survey, the Culture of Safety survey, and through one-on-one conversations helps us to shape the hospital into one that we can be proud of, and one that we’d recommend to our family and friends. The year 2014 was a busy one for Kenmore Mercy Hospital, as we continued to upgrade and update the campus. We opened the remodeled our 2 West Patient Care Unit, build two new operating rooms, and began the design of our new Ambulatory Surgery Unit. All of these projects were developed with significant contributions from our nursing staff.
And, 2015 will be just as busy, as we still have much work to do and many goals to accomplish. These include the completion of the pre-surgical and post anesthesia care units, the recertification by The Joint Commission of our total knee, total hip, and stroke programs, and the continuation of our journey to achieve Magnet designation. I want to thank and to commend each of you for the work that you do here at Kenmore Mercy Hospital. It is certainly not easy work, but it’s important work that positively impacts the thousands of patients that come to us each year for care. This annual report reflects many accomplishments of the past year for which all of Kenmore Mercy Hospital’s nursing team should take great pride. Sincerely,
James M. Millard, R.Ph. President & Chief Executive Officer
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Dear friends and colleagues,
On behalf of our nursing leadership team, I’m pleased to present to you our 2014 Annual Report. The stories and images - this report reflect the commitment that our nurses demonstrate each and every day as they build, achieve, and maintain excellence in patient care. This report highlights how our amazing nursing team has provided key input through Shared Governance and Unit Based Councils to enhance their work areas and patient environment. A number of these individuals have been recognized for the care they provide to our patients, as well as the mentorship and leadership they provide to their peers.
They also expanded their outreach in the community by participating in a variety of charitable walks; collecting gifts of food and clothing for those in need; and sharing their knowledge with the community. Our nurses have led the way in a number of innovative new projects that are making a difference in patients’ lives.
Kenmore Mercy Hospital’s Nursing leadership team, Heather Telford, director of Nursing, Critical Care and Emergency Services; Kathy Vitthuhn, director of Inpatient Nursing; Cheryl W. Hayes, vice president of Patient Care Services; look ahead to another positive year in 2015.
In 2014, we continued our journey to achieve Magnet status. An enormous amount of work went into the preparation of the document describing how Kenmore Mercy Hospital met the components of Magnet: Transformational Leadership, Structural Empowerment, Exemplary Practice, and New Knowledge & Innovation Improvements.
While our application was accepted, our first attempt in achieving Magnet did not come to fruition. However, the reviewer noted that Kenmore Mercy Hospital is Magnet-worthy and has encouraged us to try again. With nursing leading the way, we continue our journey, working towards quality and excellence for our patients. Thank you for your ongoing support of Kenmore Mercy Hospital and all you do to help achieve and maintain excellence in patient care and outcomes. With deep appreciation to our entire nursing team,
Cheryl W. Hayes, MS, ANP, NEA-BC Vice President of Patient Care Services
Nursing leadership team members - Kristen Parisi, Elaine Schrutt, Linda Butski, Cheryl Hayes,, Amy Baker, and Carole Woomer - gathered in December for a training session. Kenmore Mercy Hospital, 2014 Nursing Annual Report
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Transformational Leadership 2 West Patient Care Unit Gets Face Lift In late December, Kenmore Mercy Hospital celebrated the blessing and dedication of its renovated 2 West Patient Care Unit. Staff began receiving patients in November.
The patient wing was temporarily closed from October 4 – November 22 to permit remodeling of the unit which, among other updates, features new patient televisions, call systems, whiteboards and new patient furniture, made possible by the Kenmore Mercy Foundation. Other work included a modern color scheme, as well as a new nurses’ station, counter tops, sinks, and updated signage. There are also new side tables, chairs, window sills, cubicle curtains, and bedside tables in patient rooms.
The unit was built 40 years ago and has a rich history. According to Cheryl W. Hayes, MS, ANP, NEA-BC, vice president of Patient Care Services, “It was originally a skilled nursing facility, then a medical rehabilitation unit. In recent years, it changed specialties to include stroke and hospice care.” This unit is also home to Kenmore Mercy Hospital’s new bariatric suite. The suite was made possible by a grant from Assemblyman Robin Schimminger.
With the number of bariatric patients on the rise, it has become necessary for hospitals to routinely take care of patients weighing up to 500 pounds or more. This room and its special equipment will assist the hospital staff in safely caring for this patient population while reducing their own risk of injury. “We continue to maintain our focus on quality of patient care and continuous improvement, which defines us as an organization,” added Cheryl.
The renovation of Kenmore Mercy Hospital’s 2 West Patient Care Unit is just one more example of that continuous improvement.
The 2 West Patient Care Unit staff joined administration for a dedication and blessing of the renovated unit. Kenmore Mercy Hospital, 2014 Nursing Annual Report
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Hospital Expanding Surgical Services Area With the number of orthopedic and neurosurgery cases on the rise, nurses in Kenmore Mercy Hospital’s Surgical Services Department have been busy. Over the past year, plans to enhance the growing department began to take shape. In late 2014, the hospital was approved by the New York State Department of Health to relocate and modernize its Preoperative Holding and Post Anesthesia Care Units. The project calls for the renovation of the hospital’s old Emergency Department, space that was vacated when it opened its new ER in 2013.
“The new space will help to improve efficiency, increase the amount of work space, and enhance patient safety and patient satisfaction,” noted Anne Hedges-Creighton, RN, MS, BSN, director of Nursing Perioperative Services. When complete, the 18-month project will enable Kenmore Mercy to increase its Preoperative Holding Unit from 22 patient bays with six private rooms to 30 patient bays with 11 private rooms. The Post Anesthesia Care Unit will increase from 10 to 11 patient bays, plus an isolation room.
The nursing team’s contributions influenced the design, look, and flow of the new perioperitive area. “The planned construction of our holding and recovery areas, will support the growth we are seeing in orthopedics, neurosurgery, and general surgery, while giving our surgeons and OR staff a more modern and efficient work environment,” said hospital president & CEO James M. Millard, R.Ph. The pre-surgical holding area is expected to be completed by late 2015 and the recovery area by mid-2016.
This rendering provides a glimpse of what the new pre-surgical unit will look like.
This $10.5 million phase two of the facility’s surgical services expansion is the latest addition at the hospital, which opened two new operating rooms last summer and its Knee & Hip Center in 2013.
In addition to the construction of the two surgical suites, a new nursing station was built in the Surgery Department.
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Structural Empowerment Shared Governance Providing Valuable Input The Shared Governance Committee had a very productive 2014. Meeting monthly on Committee Day, the members of Shared Governance represent Kenmore Mercy Hospital’s various nursing units and provides them with a voice. Amanda Kramer, RN, BSN, Emergency Department nurse manager, was the nursing leadership advisor and Melissa Caldwell, RN, BSN, from the 3 East Patient Care Unit, was elected the chair of the committee.
The committee participates in and facilitates the implementation of nursing projects and processes. This included the following in 2014:
• Serenity Room – This relaxing location opened in May 2014. The Shared Governance Committee chose the furniture, music, and color scheme with the nursing staff’s needs in mind. • Daisy Award – The committee decided on the key locations to place nomination boxes throughout the hospital. They have also been responsible for reviewing nominations and choosing the 2014 Daisy Award winners. • Preceptor Program – The committee met with the Catholic Health preceptor coordinator to provide feedback about what is going well and what needed improvement with the preceptor program. Their ideas were incorporated into the Kenmore Mercy Hospital preceptor program. • Nurses Week – The committee provided input into the celebration and recognition of Nurses’ Week. • Patient Experience Nurse Sensitive Indicators – The committee made suggestions and implemented plans to improve patient satisfaction scores about the question “Nurses listen carefully.” • Medication Lists – The group worked with the Pharmacy Department to develop a list of formulary and non-formulary medication for the Emergency Department and Pharmacy. • White Boards – The committee provided input on the contents of this patient communication tool. • Patient and Family Responsibilities – The Patient & Family Advisory Council requested that Shared Governance provide feedback to the content of a patient and family responsibilities guide. The members of the Shared Governance Committee should be proud of their valuable input and insight into the delivery of patient care and nursing experience
Kristen Parisi, RN; Theresa Hanel, RN; Amanda Kramer, RN; Kristen Nazaruk, RN; Maria Roberts, RN; Carole Woomer, RN; Elizabeth Kaminski, RN; and Elaine Schrutt, RN; have helped to make significant changes to benefit nursing.
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Preceptors Are Guiding the Future In 2014, Kenmore Mercy Hospital’s own Deborah Micholas, RN, BSN, was honored with the University at Buffalo School of Nursing Distinguished Preceptor Award. It is given to recognize an outstanding clinical preceptor for the School of Nursing. Deborah was nomination quoted one of the students in her nomination letter as saying, “Debbie is an amazing educator. She challenges us to ask important questions and likes to quiz us on our clinical judgments and priority assessments.” She continued, “With this she always communicates positive feedback and shares her knowledge so we can improve. Debbie also sets a fabulous example by advocating for her patients… and handling patients with extreme compassion. She is an exemplar of the type of nurse I hope to become.” Congratulations Deborah and thank you for guiding the future of nursing.
Marsha Lewis, Dean of the University of Buffalo School of Nursing, presented Deborah Micholas with the preceptor award.
Nurses Pursue Higher Education Kenmore Mercy Hospital encourages its nurses to pursue higher levels of education. In fact, in today’s healthcare marketplace, there’s a huge demand for nurses with their Bachelor of Science degree in nursing, or more, in advanced nursing or leadership education.
The United States Bureau of Labor Statistics job outlook for nurses stated that registered nurses with at least a bachelor’s degree in nursing will have better job prospects than those without one. With the number of nurses expected to increase 19% from 2012 to 2022 – from 2,711,500 to 3,238,400 – nurses will enjoy a faster growth rate than any other occupation in the United States.
In 2014, eleven of the hospital’s nurses - Amy Baker, RN; Johana Boyd, RN; Christine Clark, RN; Sidney Dirk, RN; Nicole Faulkner, RN; Heather Fell, RN; Jessica Klug, RN: Leigh Skrzynski, RN: Jacob Walck, RN; Michelle Yeates; and Kathleen Walsh, RN - received their BSN. Amy, Christine, Leah, Michelle, and Nicole completed the Niagara University “RN to BSN” program, through which Catholic Health chooses individuals to participate. As members of the Niagara University cohort, the system paid for their tuition and necessary materials to accomplish their degree. According to Cheryl Hayes, MS, ANP, NEA-BC, vice president of Patient Care Services, “A record number of new graduate nurses were hired in 2014, 100% of which had Bachelor of Science degrees in nursing.”
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Recognizing Excellence in Nursing Outstanding Associates Honored During Nurses’ Week
Nurse Shares Knowledge Nationally Jessica Klug, RN, from the 2 West Patient Care Unit, published an article on frontotemporal dementia in the August edition of Nursing2014, a well-known national nursing journal. While attending SUNY College at Brockport to complete Bachelor of Science in Nursing, Jessica was encouraged by her instructor to write this article.
During National Nurses Week, that starts each year on May 6, Kenmore Mercy Hospital recognized three members of its nursing team who have gone above and beyond in their jobs.
Congratulations to Nancy Chojecki, BSN, MS, RN-BC, Nurse of Distinction; Melissa Caldwell, RN, BSN, 3 East Outstanding Staff Nurse; and Eric Reid, NA, Emergency Department - Outstanding Nurse’s Assistant.
Jessica Klug
Medical Staff Associate of the Year Physicians chose Mary Willis, RN, from the 3 East Patient Care Unit, to receive the hospital’s Annual Medical Staff Associate of the Year Award.
Nancy Chojecki
Melissa Caldwell
Mary Willis, RN, and Elaine Schrutt, 3 West nurse manager
Eric Reid
LOVE Award Honorees Show Strong Values Over the past year, Kenmore Mercy Hospital honored two nurses with the LOVE (Living Our Values Effectively) Award.
Congratulations to Brett Sullivan, RN, from the Intensive Care Unit (2nd Quarter) and Bobby Gross, RN, from the 3 East Patient Care Unit (4th Quarter).
Brett Sullivan
Bobby Gross
Pulmonary Rehab Celebrates 25 Years In 2014, the Pulmonary Rehabilitation Program at Kenmore Mercy Hospital celebrated its 25th Anniversary. More than 2,500 patients later, the program continues to thrive.
The Pulmonary Rehabilitation Program provides structured exercise and education to help their patients increase stamina and manage their lung disease. The Pulmonary Rehabilitation staff includes registered nurses Ann Carroll; Lisa Finn, and Karen Hamp, (pictured here left to the right); as well as Diane Clark; and Tracy Trifilo.
These specialized nurses work closely with patients who have respiratory problems, such as emphysema, asthma, pulmonary fibrosis, pulmonary hypertension, and pre- and post lung transplant patients.
Their responsibilities include counseling the patient and the patient’s loved ones, especially when it comes to helping them come to terms with a chronic lung condition. Kenmore Mercy Hospital, 2014 Nursing Annual Report
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DAISY Award Introduced to Recognize Extraordinary Nursing Kenmore Mercy Hospital’s nurses introduced the DAISY Award in 2014, recognizing two nurses – Sue Conover, RN, from the Intensive Care Unit, and Matt Winiarski, RN, from the Knee & Hip Center. The DAISY Award is part of a national program to recognize the compassionate and skilled efforts nurses perform every day.
It was established in 2000 by the family of J. Patrick Barnes who died of complications of the auto-immune disease Idiopathic Thrombocytopenia Purpura (ITP) at the age of 33. (DAISY is an acronym for diseases attacking the immune system).
Susan was the hospital’s first winner of the DAISY Award over the summer. Her nomination from a patient’s family explained that, she, “is a very special person. She is kind, caring and compassionate beyond compare. She treated my father with dignity and respect ... Susan respected our grief and privacy Cheryl Hayes, vice president of Patient Care and she kept my mom comfortable with her kindness.” The letter goes on to say, “she touched our lives and our hearts. Our family will never forget her and all she did that long day.”
Services, and Kristen Parisi, nurse manager of the Intensive Care Unit present Susan Conover (center) with a DAISY Award certificate.
Matt was honored in fall of 2014. His nomination from a patient’s family explained that he, “is possibly the most efficient, professional and thorough nurse I’ve observed.” They continued, “Matt was exemplary; he made me feel like my loved one was well cared for and in excellent hands.” Each DAISY Award honoree receives a hand-carved stone sculpture, entitled “A Healer’s Touch,” as well as a certificate, and a DAISY Award pin. Additionally, everyone in the unit celebrates with Cinnabons, a favorite of Patrick’s during his illness.
Nominations for the DAISY Award can be made by anyone. The winner is selected by the hospital’s Nursing Shared Governance Committee.
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Matt Winiarski was presented his award by Mary Hojnacki, nurse manager of 2 South/2 East.
Nursing Helping Fulfill Community Needs The nursing team at Kenmore Mercy makes a difference to its patients each and every day in the hospital. Their efforts to make a difference in the lives of others doesn’t stop there though. Throughout the year, associates have contributed to the welfare of others in many ways.
Walk a Mile in Her Shoes
In support of the Crisis Services’ Advocate Program, nurses and associates participated in Walk a Mile in Her Shoes, a community march against gender violence, held annually in April. They were joined by Kenmore Mercy Hospital’s president & CEO, Jim Millard, and chief operating officer, Walt Ludwig, who demonstrated their support by wearing women’s high heeled shoes. The walk is meant to put participants literally “in someone else’s shoes” as a show of support and solidarity behind the goal of ending sexualized violence against women.
Thanksgiving Basket Donations
Nursing units and other departments also participated in the hospital’s annual Thanksgiving food basket collection. Each year, associates and staff gather to bless and distribute Thanksgiving food baskets that were prepared to help local needy families. In 2014, baskets were prepared for nearly 70 families, including some who work at Kenmore Mercy Hospital.
Grieving Through the Holidays The Bereavement Council, represented by nursing and an interprofessional team, organized Grieving through the Holidays in November. The informational forum featured professionals who specialize in grief and loss, as well as a speaker from UNYTS. Buffalo City Mission
Kenmore Mercy Hospital supported the Buffalo City Mission in 2014. On May 12, a hygiene drive brought in 10 bins of soap, shampoo, deodorant, toothpaste and other items that were donated to help families. On July 30, fifty packages of new socks and underwear were donated by Kenmore Mercy Hospital associates.
Adopt a Family
At Christmastime, nursing departments purchased gifts for “adopted” families. The overwhelming joy of these families was an unforgettable memory for everyone involved.
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Nurses Establish WNY’s First AMSN Chapter Kenmore Mercy Hospital’s nurses were integral in organizing Western New York’s first chapter of Academy of MedicalSurgical Nurses (AMSN) in the last year. In fact, all but one member of the organization’s committee board are nurses at Kenmore Mercy Hospital - Annette Gillies, RN, president; Carole Woomer, RN, vice president; Brenda Cramer, RN, treasurer; Johanna Boyd, RN, secretary; and Nancy Chojecki, RN, board member.
The specialty nursing organization serves the eight counties Kenmore Mercy Hospital nurses, including members of the AMSN board (in the back row), enjoyed an AMSN presentation about of Western New York — Allegany, Cattaraugus, Chautauqua, infection control. Erie, Genesee, Niagara, Orleans, and Wyoming. The organization hopes to attract those interested in medical-surgical nursing, which represents a diverse group who care for patient populations in hospitals, long-term care facilities, home health agencies, pediatrics, hospice, and community health clinics.
“AMSN WNY is dedicated to developing medical-surgical nurses both personally and professionally,” said AMSN president, Annette Gillies, RN, a staff nurse on the 2 West Patient Care Unit. Today, they have fourteen members and continue to draw high attendance at their events, which have covered such subjects as palliative care, advanced directives, deep vein thrombosis, pulmonary embolism, and infection control.
Members of the AMSN board include Mimi Haskins, as well as Kenmore Mercy registered nurses: Annette Gillies, Carole Woomer, Nancy Chojecki, Brenda Cramer, and Johanna Boyd.
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Exemplary Professional Practice Partnership with Crisis Services Supports Sexual Abuse Victims In April of 2014, Kenmore Mercy Hospital hosted a press conference to officially announce an important partnership between Catholic Health and Crisis Services.
Through this partnership, Crisis Services now provides all Catholic Health hospitals with 24/7 availability of specially trained Sexual Assault Nurse Examiners (SANE). This service is available at Kenmore Mercy Hospital, Mercy Hospital of Buffalo, the Mercy Ambulatory Care Center, and Sisters of Charity Hospital and its St. Joseph Campus.
“Emergency Department staff is prepared to handle every emergency that walks through our doors, from a stroke to a splinter. We are trained in how to mend the human body. But when that body is also a crime scene, as it is with a sexual assault victim, we recognize the need for specialized care that can be best delivered by Members of Crisis Services – Holly Franz and Robyn Wiktorski-Reynolds – joined a SANE nurse,” said Amanda Kramer, RN, BSN, nurse Kenmore Mercy’s James M. Millard, Dr. Mark Weissman, and Amanda Kramer in manager of the Emergency Department and a trained making this special announcement. SANE. According to the 2012 data from the New York State Division of Criminal Justice Services, there were 211 forcible rapes reported to the police in Erie County. Fewer than 10% of victims report their assault. Catholic Health is hoping to make an impact on these statistics through its Sexual Assault Nurse Examiner Program.
“Having these nurses available around the clock, is a valuable asset for victims of sexual assault who seek care in our Emergency Departments, as well as the ER staff who care for them,” added Amanda. “With the support of Crisis Services, we can ensure these patients receive the attention they deserve to care for their physical and emotional needs, as well as manage the collection of forensic evidence and police reporting.” SANE programs improve patient care and increase reporting and conviction rates for sexual abuse crimes. Sexual assault nurse examiners are specially trained to provide comprehensive care to sexual assault survivors. They are trained to obtain a medical and forensic history; perform a physical assessment; identify, collect, preserve and document forensic evidence; provide information for referrals; and provide fact and expert witness testimony. Four of Kenmore Mercy Hospital’s Emergency Department registered nurses – Loretta Crane, Ann Marie Hawn, Laura Carpenter, and Amanda Kramer – are trained as sexual assault nurse examiners. T-shirts made by victims of sexual abuse as part of Crisis Services’ Clothesline Project were displayed at the press conference.
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Nurses Addressing Chronic Illness with Palliative Care Program No one wants to be admitted to the hospital if their concerns
can be addressed effectively at home. Nurses at Kenmore Mercy Hospital realized that individuals with chronic illnesses were admitted in a revolving door cycle, causing patients to express a downturn in quality of life and depression.
Concurrently, an Institute for Healthcare Improvement project team was addressing readmission rates by developing a palliative care program to improve the continuity of care and ensure this patient population had more opportunities to be treated at home. Kenmore Mercy’s Palliative Care Committee includes individuals from various disciplines, including Lisa Smith, RN; Annette Gillies, RN; Cheryl Tumia,
These two differing perspectives to the same problem shared the RN; James Fitzpatrick, MD; John Ingraham, RN; Rev. Nancy Faery; and goal of providing the best ethical care and best quality of life for Deborah Micholas, RN. this fragile patient population. The groups combined and a UnitBased Palliative Care Champions (UBPCC) program was created.
Staff nurses volunteered to be a part of the program and attended a two day multidimensional education event covering care issues associated with palliative care and chronic illness. The UBPCC nurses focus on early identification. They also use a Geisinger inspired checklist to identify potential palliative care candidates, communicate directly to the physician to obtain palliative care team evaluations, and help the patient complete a MOLST form. As a result of the UBPCC program Kenmore Mercy Hospital has been able to demonstrate a decrease in time to a palliative care consult, increased enrollment, and an increase in MOLST forms completed. This interprofessional approach enables us to serve our patient community by meeting the needs of the patient and their family in-the home setting, avoiding needless hospitalizations.
Nurses Prepare for Violent Interactions with Intervention Training Nurses never know what patient they will encounter next. These days they cannot ignore the possibility of violence from these patients and the people who accompany them. It is necessary for staff to know how to defend themselves and how to work as a team to prevent crises at Kenmore Mercy Hospital. “Nurses are particularly vulnerable because they spend the most time with patients,” said Amanda Kramer, RN, BSN, nurse manager of the Emergency Department. “Emergency nurses are especially at risk, because they are so accessible to patients who may have abused alcohol and drugs, and who are in severe distress. In addition, families and friends of emergency patients are often frustrated and afraid for loved ones because of long waits and crowded emergency departments,” she added.
Nurses participated in Nonviolent Crisis Intervention training, which focused on working with people before they get to the “acting out” phase. The emphasis of the training was on preventive techniques, how to address a person’s early warning signs, and verbal de-escalation. Safe, non-harmful physical techniques to prevent associates from getting hurt were also taught. This included how to get out of a choke hold, a bite, or a hair pull. The training not only keeps associates safe, but also the aggressor.
Just knowing that there are safe options builds staff confidence. This leads to fewer disruptive incidents because more behavior is defused before it becomes physical. Kenmore Mercy Hospital, 2014 Nursing Annual Report
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Orchard Park Man Thankful for Free Hip Surgery Snowvember took his home, years of working in a train yard damaged his hips, but Orchard Park resident Melvin Bluhm is still a thankful man.
On December 2, 2014, he received a very special gift, the gift of mobility. Thanks to Operation Walk USA; John Repicci, MD, DDS; and Kenmore Mercy Hospital, Melvin received a free hip replacement. “I just don’t know how to thank them,” said Melvin. “It’s impossible to thank them for what they gave me.”
His treatment – including surgery, hospitalization and preand post-operative care – was provided at no cost to him as part of this national volunteer effort. However, prior to the surgery, his roof collapsed during the November snowstorm that impacted Buffalo’s Southtowns, and his home was condemned.
Melvin Bluhm has his blood pressure checked by Marsha Cleland, RN, in Pre-Admission Testing. Mark Mulville/The Buffalo News
The surgery went on as scheduled, and Melvin continued his physical rehabilitation with McAuley Seton HomeCare at his sister’s home in North Tonawanda. Fortunately, he did have homeowner’s insurance and as luck would have it, his son is a contractor who will help build a new home. Kenmore Mercy’s nursing staff was pleased to be part of this special program from pre-admission testing to surgery, and postoperative care in the Knee & Hip Center to discharge planning.
Hospital Making Efforts to Enhance Workplace Almost everyone can agree, achieving a work-life balance is a good thing. But many nurses have a hard time achieving this balance due to job demands, work schedules, and family obligations. While no one can escape stresses altogether, Kenmore Mercy Hospital has placed a strong emphasis on finding ways for its associates to relax and better juggle their commitments.
Stress and fatigue are on-the-job challenges for nurses. The Serenity Room, located on the fifth floor, gives associates a relaxing and tranquil space. Nursing mothers now have a private and dedicated Lactation Room. This is part of a systemwide effort to support working mothers.
“Work-life balance is important, and providing opportunities for employees to do the things that matter in other parts of their lives is important to us,” explained Cheryl Hayes, MS, ANP, NEA-BC, vice president of Patient Care Services.
Kenmore Mercy Hospital also acknowledges that eating healthy and getting enough sleep can be a struggle when you’re working different hours than family and friends. The hospital has added healthier food and beverage choices in the cafeteria vending machines. They are stocked with new healthier product alternatives, such as baked chips, granola bars and dried fruit. Initiatives like this help Kenmore Mercy Hospital to develop its most critical resource – its associates. Kenmore Mercy Hospital, 2014 Nursing Annual Report
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Certified Emergency Nurse (CEN) Heather Telford, RN
2014 Certifications
Interventional Radiology Nurse Certification Deborah Arnet, RN Kathleen Daley, RN Christine McGee, RN Robert Morello, RN
Board Certified Nurse Practitioners (CNP) Rita Colicchia, NP Susan DePlate, NP Mary Dowd, NP Elizabeth Grundtisch, NP Andrea Schmitt, NP Esther Sprehe, NP Sister Mary Walter, NP
Med-Surg Certification (CMSRN) Johanna Boyd, RN Nancy Chojecki, RN Janelle Colquhoun, RN Brenda Cramer, RN Annette Gillies, RN Carole Woomer, RN
Certification in Cardiac Medicine (CMC) Sandra Conti, RN
Nurse Executive, Advanced-Board Certified (NEA-BC) Cheryl W. Hayes, MS, ANP, NEA-BC, RN
Certified Gastroenterology Nurse (CGRN) Heidi Frushone, RN Janet Gonzalez, RN Jane Weidner, RN
Nurse Executive, Board Certified (NE-BC) Elaine Schrutt, RN Kathleen Vitthuhn, RN
Certification for Nurse Managers and Leaders (CNML) Margaret Donofrio, RN
Oncology Certified Nurse (OCN) Cheryl Lewandowski, RN
Certified Nurse Operating Room (CNOR) Rachel Achtziger, RN Linda Butski, RN
Orthopedic Nursing Certification (ONC) Delretta Billips, RN Alan Chittley, RN Christine Clark, RN Nicole Faulkner, RN Briana Geddis, RN Mary Hojnacki, RN Pamela Koetzle, RN Betty LoFaso, RN Deborah Micholas, RN Susan Wasielewski, RN Suzanne Zeisz, RN
Certified Post Anesthesia Nurse (CPAN) Scott Berube, RN Margaret Donofrio, RN Pam Farrell, RN Sue Hartl, RN Rene Marriott, RN
Certification in Wound Ostomy Nursing (CWON) Mary Applegate, RN Certification in Diabetic Education (CDE) Irene Haefner, RN
Certified Case Manager (CCM) Alison Albert, RN Jodie Cwiklinski, RN Nina DiCarlo, RN Deb Hurd, RN Sandy Olear, RN
Critical Care Registered Nurse (CCRN) Julie Bajor, RN Scott Berube, RN Jessica Bohlman, RN Melissa Borgese, RN Sandra Conti, RN Jason Kiska, RN Mary LaMartina, RN Lori Ann Meder, RN Tom Nader, RN Kristen Parisi, RN Maria Richardson, RN Lisa Smith, RN Bridget Walborn, RN Elizabeth Wood, RN
This list includes certifications completed prior to December 2014.
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New Knowledge, Innovations & Improvements ICU Learning ABCs of Critical Care Associates at Kenmore Mercy are learning their ABCs …
In February 2014, the Intensive Care Unit implemented the ABCDE Bundle – Awakening and Breathing Co-ordination, Choice of medication, Delirium management, and Early mobility – getting the hospital’s sickest patients up, moving, and off ventilators more quickly. Growing evidence reveals the majority of critically ill patients are at risk for developing two common and potentially dangerous conditions, delirium and weakness.
In fact, up to 74 percent of critical care patients develop delirium and weakness during their ICU stay and continued acquired weakness persists in 60 percent of patients after one year. Additionally, 34 percent of patients with delirium scored at a functional level of traumatic brain injury, and 24 Lisa Faulhaber, PT; Mary LaMartina, RN; and Erik Diringer, percent scored at an Alzheimer’s level. DO; are a few of the key players who helped to implement the ABCDE Bundle.
The ABCDE bundle uses the best available evidence on delirium, immobility, sedation and analgesia, and interventions tested in clinical trials that have been adapted for everyday use in the ICU. Recent studies have shown that mobilization of mechanically ventilated patients significantly decreased both ICU length of stay and overall hospital length of stay. “Our goal is to help patients avoid potentially long-term problems, and prevent readmissions,” said Mary LaMartina, RN, CCRN, who along with ICU nurse manager Kristen Parisi, RN, CCRN, is leading education efforts in the ICU.
This nurse driven effort has been successful for patients: patients able to get out of bed increased from 23 percent to 78 percent; the use of restraints decreased from 46 percent to 19 percent; family presence at the bedside increased from 31 percent to 90 percent; and ventilator days decreased from 5.53 to 5.26.
A multidisciplinary team of nurses, respiratory therapists, pharmacists, physical therapists, and intensivists, collaborated on this project, which became the standard protocol for all critical care patients at Kenmore Mercy Hospital. Elements of this protocol have since been implemented at Catholic Health’s other hospitals, too.
Registered nurses Maureen Audino, Mary LaMartina, and Kathleen Walsh are among many important members of the ICU team.
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Healthcare Workers Update Protocols to Fight Ebola As we faced the worldwide threat of the Ebola virus this past year, Kenmore Mercy Hospital implemented new safety protocols in several areas throughout the hospital. This included the Emergency Department and Ken-Ton FamilyCare preparing to recognize the threat here at home in case it made its way to Western New York. Since Ebola had never occurred in the United States, nurses were engaged in an extensive exchange of best practices, including the choice and use of protective equipment; the use of decontamination; the safest methods of transport to the correct receiving hospital; the most effective treatment; and the most efficient ways to prevent others from getting the infection.
In the height of flu season, it became necessary for them to be sure to screen people who came in with fevers for the Ebola virus. The flu and the Ebola virus in their early stages can present with similar symptoms: fever, cough, and sore throat. “Every patient that comes to the emergency room and the clinic now, and in critical entry points in the hospital gets asked screening questions for Ebola that have some through the CDC and most everybody knows now,” said Amanda Kramer, RN, BSN, nurse manager of Kenmore Mercy Hospital’s Emergency Department. “Particularly, we ask about their travel history, and if they have even been to West Africa.”
Michelle Lasker, RN, BSN, and Dawn Campbell, LPN, demonstrate PPE in the clinic setting.
The hospital posted large signs at all entry points, advising anyone who had traveled to Liberia, Guinea, Sierra Leone, Laos, Nigeria, China or the Arabian peninsula who had complaints of fever over 100.8, malaise, headache, vomiting, diarrhea or flu-like symptoms to put on a mask and notify a healthcare worker immediately. Masks and gloves are available at displays next to the signs. All ER and clinic nurses completed training to prevent the virus from spreading in case it arrived at Kenmore Mercy. The hospital also conducted drills to practice dealing with Ebola patients. In the event an Ebola patient presented, the patient would be isolated and all healthcare workers must wear protective clothing that is removed and discarded after every patient interaction.
“Emergency Room and Ken-Ton FamilyCare nurses learned how to properly wear this protective equipment, which ensures that no open skin is exposed when caring for patients who have, or are suspected to have, contracted the virus. Nurses in these clinical areas are also learning the procedures to notify local health departments and the Centers for Disease Control and Prevention if they suspect someone has the Ebola virus,” noted Michelle Lasker, RN, BSN, clinical coordinator at the Ken-Ton Family Care.
Sue McClure, RN, was part of the PPE training in the Emergency Department.
Although the chances of Ebola spreading to Western New York are slim, lessons learned in Dallas after two healthcare workers got sick were part of the reason this training was vital.
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“Hands Free” Defibrillation Comes To Kenmore Mercy Research from the American Heart Association demonstrated that patient outcomes may be improved if defibrillation is administered as quickly as possible in a pulseless ventricular tachycardia or ventricular fibrillation cardiac arrest situation. Additionally, the research has demonstrated that interruptions in chest compressions contribute to poorer patient outcomes. As a consequence, the decision was made to convert all of the cardiac defibrillators at Kenmore Mercy Hospital to the “hands free” system as the default and only use the defibrillator paddles as a back-up system.
To accomplish this conversion, the members of the Rapid Response Committee and the Critical Care Committee worked in conjunction with the Biomedical Department to upgrade all of the Kenmore Mercy Hospital defibrillators to ones that have the hands free capability. They also standardized the defibril- Bill Wessner, RN, and Melissa Caldwell, RN, from lator model used so a nurse who might float to another area would not have 3 East show the hands free defibrillators. to use differing models of this life-saving piece of equipment. The Quality & Patient Safety Team, in conjunction with Nursing Education, worked with the system Policy Standardization Department to create a new daily code cart checklist sheet that would include the hands free cable and multifunction pads as a column item and the Kenmore Mercy Hospital Quality & Patient Safety Team provided education to the staff on the correct process to complete the new form.
Education was then provided on the “hands free” cable and multifunction pad system and educational picture posters were placed above each monitor defibrillator to reinforce this new process. Sterile Processing, Pharmacy, and Education Departments then went to each code cart and converted the defibrillator to “hands free” and added extra cable and pads to each cart. As a result of this process, the intervention of defibrillation has now been standardized throughout Kenmore Mercy Hospital. In a cardiac arrest situation the time to deliver that first crucial shock has been decreased, hopefully helping to minimize or prevent any unnecessary delays in the resuscitation process.
CRRT Helps Improve Health of Kidney Patients Critically ill patients with acute kidney injury (AKI) have a new treatment option at Kenmore Mercy Hospital, Continuous Renal Replacement Therapy or CRRT. The goal of CRRT is to mimic, as best as possible, artificial kidney support for individuals who would not fare well on full dialysis.
“CRRT provides slow and balanced fluid removal that even unstable patients - those with shock or severe fluid overload - can more easily tolerate,” said Irene McNeill, RN, an Intensive Care Unit nurse. The ICU had its first patient go through the therapy in August. The major advantage of CRRT is the slower rate of fluid removal which is gentler for the patient. It takes place over an extended period of 24 hours, over several days. Conventional dialysis, on the other hand, lasts four to six hours.
Elizabeth Woods, RN, in the ICU, discusses some details about the new system.
While the concept has been around since the 1970s, more and more clinicians are prescribing CCRT for ICU patients with AKI due to recent evidence-based research.
CCRT has both short- and long-term benefits. It is a gentler means of removing waste and improving electrolyte and acid/base balance. In addition, it restores and maintains fluid balance, delivers continuous nutritional support without concern for fluid restrictions, and provides for optimized drug dosing. Recent studies have also indicated improved patient survival rates and increased renal recovery. Kenmore Mercy Hospital, 2014 Nursing Annual Report
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MRU Meets the Challenge of Falls Reduction Preventing patient falls is top of mind for every caregiver at Kenmore Mercy. The hospital’s Medical Rehabilitation Unit met that challenge head on this past year with its “STOP Light” initiative.
This new strategy has proven successful on the unit. Fall data on the inpatient medical rehabilitation unit has demonstrated a dramatic decrease in both the number of overall falls and falls with injuries. This has been a sustained improvement over the last two quarters and both these values remain statistically significantly below the NDNQI benchmark line for like sized hospitals. A multi-dimensional, interprofessional team determined the best ways to identify patients at highest risk for falls, develop falls-prevention strategies, and implement the initiative.
The “STOP Light” uses three removable color dots - red, yellow, and green to provide staff with immediate details about the patient’s level of fall risk and protocol that should be used. The concept was based on a model used by Cedars Sinai Hospital in Los Angeles.
Falls are a major contributor to a patient’s functional decline and increased healthcare use. While not every patient fall is preventable, the “STOP Light” initiative demonstrates that the right combination of technology, care processes, and focus can reduce the number of falls significantly and, more importantly, the injuries to patients they often cause.
Nurse attendants Deborah Henderson and Denise Chatt frequently use this board to track details about patients.
Mary Jane Lodico, RN, in the Medical Rehabilitation Unit, updates a patient’s status on the “STOP light.”
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Empirical Outcomes Kenmore Mercy Exceeding Patients’ Expectations The challenge of providing patients with a positive healthcare experience are undisputable. Recent patient surveys show that Kenmore Mercy Hospital’s dedication to meeting these high demands, while providing high quality care, is making a difference.
In 2014, 73.7 percent of inpatients surveyed rated their experience a nine or a ten. That’s an increase from the last two years. “We have been paying attention to survey comments and have implemented changes to improve the atmosphere at the hospital,” said Laura Verbanic, PT, BB, CPHQ, director of Quality & Patient Safety.
Patient Experience Overall Rating 100% 90% 80% 70%
69.8%
69.0%
2012
2013
60%
73.7%
50% Overall Rating Positive Response
Some of the common patient complaints include wait time, responsiveness to call lights, room cleanliness, manner of staff, and poor communication.
2014 2014 Target = 73%
A few of the tactics used in the past year to improve patients’ perceptions of the hospital include: implementation of “Picture Perfect” rooms, use luminometers to ensure patient rooms are clean, purposeful rounding by nursing, creation of a Patient & Family Advisory Council, the purchase of new furniture for both the patient floors and lobby, and use of the My Rounding Tool, and nursing units worked on nursing specific indications. Thank you to all of our associates for their work to achieve these impressive results!
Whiteboards Impact Communication
Regardless of your role in healthcare, communication is central to everyone’s job. Effective communication is not just verbal, it can take on many forms. In November, Kenmore Mercy Hospital introduced newly designed patient whiteboards on the 2 West Patient Care Unit and later installed them throughout the rest of the facility. These serve as a mechanism to both communicate with patients and engage them in their care. Nurses, as well as the Patient & Family Advisory Council, provided significant input into the look of the whiteboards Placed in easy view of the patient, whiteboards are a convenient place for many team members to communicate a wide range of information.
Esther Sprehe, NP-BC, RNFA; and Andrea Schmidtt, NP-BC, RNFA; check the white boards in rooms when rounding on patient units.
This includes details that are important for the patient to remember, like the name of their nurse, room number, and discharge plans. The whiteboards also have key information about the patient to assist caregivers, including diet restrictions, pain management information, and whether or not the individual is a fall risk. “Communicating effectively with patients and families is a cornerstone of providing quality healthcare,” said Laura Verbanic, PT, BB, CPHQ, director of Quality & Patient Safety.
The whiteboard project is an important step in Kenmore Mercy Hospital’s goal to better communicate with patients and promote a positive experience. Kenmore Mercy Hospital, 2014 Nursing Annual Report
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Hospital Making Strides to Reduce C. Diff Control of Clostridium difficile infection (C. Diff) outbreaks in hospitals presents significant challenges to healthcare workers. Kenmore Mercy Hospital has made major strides in the past year to reduce infections.
Catholic Health’s goal in 2014 was to reduce C. Diff by 20% or for Kenmore Mercy, 10 cases. As the chart to the right indicates, the hospital reduced cases by 15 cases.
C-Diff 12 10 8
9.65
6
10.37
5.90
4 2 0
2012 2013 2014 This reduction in incidence rate was an interprofessional collaboration, which included the following steps: C-DIFF Rate per 10,000 2014 Target = 8.30 • Cleaning high touch surfaces/non-critical equipment using bleach wipes, which are effective in destroying the C. Diff spore. • Using of the new NovaLum™ Luminometer which measures the amount of organic matter on a surface (measures how well a surface was cleaned). • Remembering the importance of hand hygiene with soap and water (specifically when interacting with C. Diff), with adequate friction, before and after patient care cannot be overemphasized. • As of March 3, stopped using electronic thermometers to obtain rectal temperatures. • Nursing placing patients in isolation at onset of symptoms.
According to the Centers for Disease Control and Prevention, 94 percent of C. Diff infections are related to receiving medical care. Hospital stays from this infection tripled in the last decade, posing a patient safety threat especially harmful to older Americans. The infection causes diarrhea linked to 14,000 American deaths each year.
Dannette Reed, NA; Kathy Stancliffe, RN; Bruce Franklin, RN; and Lisa Nikiel, RN; are members of the Ambulatory nursing team.
Elizabeth Kaminski, RN, and Nora Balon, RN, are part of the 3 East Patient Care Unit.
Kenmore Mercy Hospital, 2014 Nursing Annual Report
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CLABSI Cases Reduced in 2014 Central-line associated bloodstream infections (CLABSI) are serious infections that lead to long-term illness or even death. Kenmore Mercy Hospital set out to reduce incidents of CLABSI and in 2014 had only two cases. The Intensive Care Unit hasn’t had any cases since 2013. This success is a result of good hand hygiene, maximal sterile barrier precautions, appropriate insertion site selection, and prompt removal of unnecessary catheters. In the ICU, in particularly, they ensured patients received daily chlorhexidine baths.
Nursing has assisted the medical staff by giving daily reminders to discontinue unnecessary lines based on daily reports. This collaboration has worked well to improve patient safety.
CLABSI
1.0 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 0.0
0.92
2012
0.51
0.50
2013
2014
CLABSI RATE per 1,000
2014 Target = 0.51
Outstanding Year Shows No Ventilator Associated Pneumonia Cases The leading cause of death due to health care-associated infections is ventilator-associated pneumonia (VAP). Thanks to the efforts of the Intensive Care Unit – nursing, physicians, respiratory therapy, and infection control – Kenmore Mercy Hospital no VAPs in 2014.
In the past, the lack of clarity in the definition of VAP has made it difficult to execute and evaluate the effectiveness of prevention strategies. The ventilator associated events bundle was revitalized with the definition change in January 2013. The hospital implemented a new surveillance definition algorithm to identify ventilator-associated events (VAEs).
Probable VAP 1.0 0.8 0.6 0.4 0.2
0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00
0.0
PROBABLE VAP RATE per 1,000
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Kenmore Mercy Leading the Way in Lower Readmission Rates Through better care coordination and improved patient engagement, during and post discharge, Kenmore Mercy saw a 15 percent decrease per month in medical admissions in 2014. The hospital has remained ahead of the curve, addressing typical readmission issues through its clinical integration and quality initiatives.
Readmissions 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 0%
9.28% 8.69% 7.27%
Examples of recent initiatives include: Physician Initiatives 2012 2013 2014 • Standardization of testing for patients Readmissions (Overall) 2014 Target = 8.08% with congestive heart failure • Implementation of syncope protocol Patient Care Unit Initiatives • Proactive work with patients on their post-discharge care plan by: - Scheduling physician appointments prior to discharge - Reviewing medications and follow-up calls by nursing staff and pharmacists - Implementing in-house weight management for congestive heart failure patients Emergency Department Initiatives • Expansion of the Emergency Department discharge process by referring patients to: - Rehabilitation - Catholic Medical Partners’ physician offices - Clinics - McAuley Seton HomeCare • Increased use of observation status for appropriate patients Readmission rates are significant because they are used to determine financial penalties for hospitals that participate with the Centers for Medicare and Medicaid Services government healthcare programs.
Cardiac clinical advisor Amy Baker, RN, BSN, encourages patients suffering from congestive heart failure to weigh themselves daily by providing them with scales at discharge.
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OUR MISSION
We are called to reveal the healing love of Jesus to those in need.
OUR VISION
Inspired by faith and committed to excellence, we will lead the transformation of health care in our communities.
OUR VALUES
Reverence Nursing reflects our values and mission by the acknowledgement of the sacredness of human life and the individuality of their needs and goals. Compassion Nursing provides compassionate care by identifying the connectiveness of each person through the relationship with each other and their environment. Justice Nursing advocates for our patients to achieve their personal goals, respecting and recognizing the differences in each individual. Excellence Nursing continually strives for quality and excellence through the care we deliver through communication to our patients, families and the interdisciplinary team. Nursing strives to interact with our patients to achieve their goals, promote, maintain and sustain health and to ensure satisfaction of the care the patient receives.