Mercy hospital nursing annual report 2016 by Catholic Health

Our Nursing Journey 2016 Nursing Annual Report

Professional Practice Model

Table of Contents

A Message From Our Leadership

Our Journey Continues...

Exemplary Professional Practice

12 18 20 24

Transformational Leadership Structural Empowerment New Knowledge, Innovations, & Improvements Awards & Recognitions

Annual Report Acknowledgements

Annual Report Coordinator: Martha Metz, MSN, RN, CMSRN Annual Report Assistant Coordinators: Vicky Loretto, BSN, RN Barbara Lawrence, BSN, RN Annual Report Contributors: Melanie Griffis, Editor Marsha Nowak, BSN, RN Laura Thornsberry, BSN, RN Joan Vetter, BSN, RN Pauline Blake, BSN, RN Michelle Wild, MSN, RN, NE-BC

Dear Mercy Hospital Nursing Colleagues,

All of our nurses and patient care staff continue to lead the way on our Journey from Good to Great. Your dedicated work has helped our hospital earn nationally-recognized quality ratings in heart surgery and heart attack care, stroke care, orthopedics, gynecologic surgery, and skilled nursing care among many others.

Leadership Message

A Message From Our Leadership

To keep pace as a growing tertiary care hospital offering specialized WNY regional services and the highest level of cardiac and stroke care, we have made significant investC.J. Urlaub, President & CEO, ments in our facility in 2016. These Mercy Hospital multi-million dollar projects included the relocation and replacement of the switchgear electrical equipment; a ten-bed expansion of the ICU; the addition of a new, state-of-the-art cardiac catheterization lab; the opening of the Catholic Health Referral Support & Transfer Center, and we will soon begin construction of a new cardiac operating room addition. At the same time, we have been focused and working diligently on increasing our staffing to meet this change in our service level. While these investments are important, we owe our real success to you for meeting and exceeding the challenges we face in our evolving healthcare environment. We would like to express our deep appreciation to you for your professionalism and contributions to the patient experience.

One of our ongoing priorities at Mercy Hospital is to find ways to improve communication, and it continues to be a request that comes up often on our Voice of the Associate surveys. With a workforce of over 3,000 associates and volunteers in a 24/7 environment, effective communication can be challenging. However, we have looked to the growing internet and social media forums at our disposal, and came up with the idea of using video podcast messages. You now can keep updated on all the news and happenings around Mercy by viewing these video podcasts on a private Mercy YouTube page or via our Mercy home page on the Catholic Health intranet. We hope that these podcasts will be successful in improving the flow of information. Once again, congratulations on all your achievements in 2016! Our journey continues as all of your hard working efforts outlined in this report are helping us make great strides in the patient experience, quality care and patient safety. Sincerely,

C.J. Urlaub President & CEO

We have had a very busy year with much to celebrate as we continue the journey of developing a professional practice environment in which we can provide excellent care to all patients and families with the best staff in the safest environment.

I want you to know that I am proud of the work being done by nurses throughout the Department of Nursing. Clinical nurses are actively engaged in making decisions about issues that influence their ability to provide care, and the voice of the nurse has become essential in informing and influencing my thinking and decisions in shaping our future. In this issue of the Nursing Report, you’ll read about some of the many ways this happens and about the past year’s accomplishments. Shari McDonald, RN, MSN, Vice President of Patient Care Services, Chief Nursing Officer

Last fall, we were proud to present the Professional Practice model and the nursing strategic plan. This nursing model reflects how we integrate what is depicted in the professional practice model into our daily practice. Our nurses are experts with clinical knowledge, exquisite practice, and skill in meeting the needs of patients and families. Their dedication to teaching the next generation of nurses is simply inspiring.

Each nurse makes a significant contribution to patients, families and staff each and every day. I am inspired by their stories and proud to call them Mercy nurses. Our role, as nurses, extends beyond clinical excellence: we advocate for our patients; accept new roles and responsibilities as health care is transformed; lead and advance patient care; lead our new nurses from novice to experts; lead our patients to an improved quality of life; and we do all of this with the essence of care, compassion and empathy. Mercy nurses are essential advocates for our patients – the voice of the patient is often best heard through the trained and caring words of the nurse. Our nurses promote health, prevent disease, and care for the sick and injured. They are relentless innovators and creative problem solvers. At Mercy we have an innovative culture, where our mission, vision and values come to life, where excellent patient outcomes and the patient experience are the focus of the work that we do. Nursing excellence starts with a commitment and a passion – passion for the profession and a strong commitment to our patients. Mercy Nurses, Aides, ITA’s and clerical staff have both commitment and passion for our patients and families.

My sincere appreciation goes out to all of you. As your chief nurse, I work hard to listen to your voice, and will continue advancing our work and creating an environment for clinical excellence that is characterized by mutual respect. Looking forward to sharing our nursing journey together with you.

Sincerely, Shari McDonald, RN, MSN Vice President, Patient Care Services/Chief Nursing Officer

Exemplary Professional Practice 5 East (Medical, Telemetry, Hospice)

5 East has had a wonderful year! It started with winning the Most Improved Patient Satisfaction scores in Mercy Hospital and included: • Falling-Leaves falls initiative - A visual leaf is located on the white board at the desk as well as on the doorframe of the room to alert staff that there is a patient at risk for falls. Our yellow blanket/yellow sock initiative alerts us to patients at risk after we enter the room, however the falling-leaf alerts staff before entering. • Hospice Butterflies – an initiative where we place a butterfly on the door of our Hospice rooms after the patient has passed to alert staff that there is a grieving family inside the room and allow privacy as able. • Diabetic Tip Sheet- Tonna Hinton, a graduating Niagara University cohort nurse developed a Diabetic Tip Sheet to be used to provide diabetic patient education as a part of her final project for her BSN. This was so well-received on 5-East that it was rolled out to the other units in the hospital as well as the other Catholic Health sites. Kudos to Tonna! • Medication Side Effects Sheets- Staff developed two folders kept at the nurses station filled with side effect sheets of the most commonly used medications to be given to patients at discharge. • Patient Experience Rounding Book- used daily to track patient rounding, issues, complaints, and develop a plan of action and follow up. • Unit Practice Council - completely and independently run by the 5 East staff with the leadership of Jennifer Driscoll, Charge Nurse.

who have joined the team. Along with collaboration and teamwork, many nurses have concentrated on their own professional growth by continuing their education in BSN and Master’s programs. Elizabeth Clark obtained wound care certification in 2016. With all of this growth in professional, collaborative practice and teamwork in 2016, 2017 is sure to be the best year yet!

5 West (Stepdown, Stroke and Ventilator Unit)

The 5 West Unit staff have continued the goal of providing the best patient care to stroke patients and their families in 2016. The Stroke Coordinator, Alexandria Foley, meets with each nurse daily to discuss all aspects of the stroke patient’s hospitalization which is a successful endeavor preparing for Joint Commission stroke certification. Also, Wednesday is Stroke Rounds involving neurologists, nursing, and all disciplines involved in the care of the stroke patient. The staff has successfully led great process improvement through collaborative efforts and initiated extensive cleaning for the ventilator rooms to keep hospital acquired infections down. Informative and dynamic communication continues on 5 West with bedside reporting and unit communication huddles with all disciplines encouraged to participate. Bedside reporting has strengthened the collaboration between day and night shift. Everyone on 5 West improves the patient experience from the ITAs who check proper placement of oxygen tanks, glucometer supplies dates, kitchen cleanliness, and food labels to the secretaries who are an essential component of daily care, discharge process, and extending much courtesy and assistance to the staff, visitors, families, and patients. The theme for 5 west is “Kindness”, which is extended to patients, families, and each other. Making our patients feel that they are important to us and we care about them is our goal. Saying “thank you” to our patients, families and each other with a smile is a great gift. It has been a successful year on 5W and we are so excited to see what 2017 has to offer!

It’s been a great year and we are all looking forward to 2017!!

6 West (Surgical) 5 North/Center (Medical, Telemetry)

The past year on 5 North/Center has been one of positive change and collaboration. It began with the remodeling of 5 North and the teamwork it took to move the unit from 5 North to 4 North and back again. Nursing has collaborated with Buffalo Medical Group (BMG) to make 5 North a POD 1 patient area with multidisciplinary rounds with BMG, nursing, case management, social work, and physical therapy to improve patient care, flow, and outcome. Multidisciplinary rounds occur with the Sound Group on 5 Center as well. Also, nursing collaborated with pharmacy to ensure that a pharmacist is stationed on the floor to help the nursing staff during rapid responses, expedite physician orders, help educate patients about their new medications, and perform pain rounds. Staff led the practice to utilize shift huddles to discuss every patient’s plan of care and barriers to discharge with nursing, nursing aides, unit manager, cardiac educator, and case manager. The Unit Practice Council led by Allison Revelas has focused on teamwork and how the entire team can make positive changes for the floor. All staff have been vital in welcoming the many new staff members

6 West has concentrated on improving not only patient care but also patient experience in 2016. We continue shift huddles, use of the communication book to improve communication, and actively improving the Quiet at Night scores. Nurses are handing out medication tip sheets every shift to explain the purpose and side effects of common medication used. They are also using an additional white board for PRN medications. If patients request it, the RN will put medications up on the white board and when they are due to be administered next. This has greatly reduced the patient’s anxiety. 6 West was also the pilot floor for the Length of Stay Project. This project includes multidisciplinary rounds on all patients to increase communication between disciplines. This project has decreased the patient’s length of stay in the hospital. It has been a busy 2016, we can’t wait to see how great 2017 will be!

6 East (Surgical telemetry Unit)

It was a very busy 2016 for 6 East staff! They brought on a new Nurse Manager in Jon Delay who has helped to stabilize the staff through active hiring of 11 RNs and 1 NA. They have improved staff engagement through bedside report, quality board designed by staff, reinforcing positive actions and behaviors, improved teamwork and camaraderie, and maintaining a positive atmosphere on the unit. The staff have a greater awareness and focus on patient experience that is apparent by the thank you cards that are signed by all staff members that cared for the patient and mailed to the patient’s home one week post-discharge. All RNs and NAs are actively and purposefully rounding on each patient. On top of all of these staff led initiatives, quality improvement has remained a focus through decreasing patient falls and immediate, appropriate discontinuation of Foley catheters and central lines. It has been an incredible year and we are all looking forward to what 2017 brings to 6E!

7 East/8 East (Medical)

There has been a lot of movement for the staff and patients of 7 east and 8 east in 2016! The unit started on 4 north and successfully moved to 8 East. The move was successful due to the teamwork and collaboration of the staff with all disciplines to maintain patient safety. The staff have effectively implemented bedside reporting to increase communication not only between shifts but also with patients and families. The engaged staff of 7E/8E hold positions in Nursing Peer Review, Professional Practice Council, and Nursing Research Council in order to help improve nursing practice at Mercy Hospital. They also celebrated a year with zero CAUTIs and zero CLABSIs! With a great 2016 behind us, we can’t wait for 2017’s adventures!

Coronary Care Unit (CCU) 7 West (Stepdown Cardio-Thoracic and Telemetry Unit)

It has been an innovative and busy year on 7 West. The staff-run Unit Practice Council meetings are held on the second Wednesday of each month at 6:30am so that day and night shift may attend. A concern regarding the education channel 13 was identified and with the help of Shari McDonald, CNO and Melanie Griffis, Public Relations the channel was customized to the direct needs of our patients here at Mercy Hospital. Now it is much easier to meet the 60 minute CHF teaching goal! Also, walker hooks were put up on the walls in each patient room to easily store the walkers. 7 west also trialed disposable telemetry wires that are used for post-CABG or post-valve replacement patients. These new wires are designed to enhance the patient’s safety and to help with infection prevention. New clippers were also started on 7 West, which have a vacuum source that helps to lower infection rates as well! 7 West continues to be a leader in patient satisfaction and are always striving for excellence! We had a great 2016 and are striving for an even better year in 2017!

The Coronary Care Unit (CCU) has been transforming care at the bedside in order to enhance the safety and quality of care delivered to our patients. Since the beginning of 2016, the staff have embraced unit huddles and are actively participating in bedside shift to shift hand off reports which have greatly enhanced the communication amongst the care team.

One of the biggest initiatives we began in 2016 was to incorporate end-of life protocols into our culture. In the critical care environment, most patients and families don’t realize they can end up on life sustaining equipment. They don’t always understand how we can’t force the body to heal or respond to the medical treatment plan. When this happens we meet with the patient’s loved ones and family members in order to collaborate and gather information regarding what the patient’s wishes are and how to best to proceed with their care. Based on the patient’s wishes, we partner with other members of the care team to adapt the plan of care. This sometimes means providing palliative care or symptom management from a medical management perspective. Our end-of-life protocol focuses on creating a home-like environment for the patient and family. We work together to minimize the harshness of the Critical Care environment. We replace bright ICU lights with a simple soft-lighted lamp, we provide a colorful blanket based on the patient’s favorite color(s), we give the family an angel pin (if they are spiritual), and encourage playing music the patient enjoyed. Spiritual care and emotional support are provided along with symptom management and comfort measures in order to promote and maintain the patient’s dignity. The CCU team collectively supports the family through this process. At the passing of the patient, each of the staff sign a sympathy card that is sent to the family. This program has helped to ease the grief felt by loving members of a patient’s circle of family and friends by providing a warmer and more caring environment during an emotional time.

Open Heart Unit (OHU)

In 2016, the Open Heart Unit (OHU) multidisciplinary team continued to grow and advance in the delivery of high quality care to their patients. We welcomed both Dr. Harsh Jain, a new cardiothoracic surgeon to Mercy Hospital as well as Denise Goodberlet, RN, MSN, NP, CCRN, CNS into the role of a cardiac Clinical Nurse Specialist. Her focus is to assist in the educational development of our team and patients. Throughout the year, the OHU was able to accomplish a number of initiatives. They completed their first year of recovering Transcatheter Aortic Valve Replacement (TAVR) patients in collaboration with the interventional cardiologists and cardiothoracic surgeon, Dr. Stephen Downing. The OHU staff began the first dedicated educational unit (DEU) with nursing students in order to promote learning and provide educational opportunities in this unique and fast paced environment. The team also looked at how they could minimize hospital acquired infections. The staff of the OHU trialed and then eventually converted to using disposable EKG lead sets for post open heart patients. The OHU nursing team is committed to providing quality care to their patients and have a “can do” attitude with a strong focus on exceeding their patients’ expectations. With this approach, they have positively impacted the care provided and enhanced patient satisfaction.

Medical Rehab Unit (MRU)

The Medical Rehab Unit (MRU) had an incredible 2016 filled with fun and education. MRU nurses participated in the RN Skills Day for the first time, and the teamwork was great! During the year, RNs and NAs completed their FIM certification exams, which are given every two years. There was a 100% pass rate! Incredible accomplishment and illustrates the caliber of staff in the MRU. In November, 6 MRU nurses took the rehab nursing certification review course and plan to take the exam in June 2017. We are so excited to see what accomplishments are coming our way in 2017!

Mercy Comprehensive Care Center (MCCC)

The Mercy Comprehensive Care Center was busy in 2016 creating a dynamic team! We have all worked hard to create a team atmosphere with fully engaged staff. Last year, the MCCC nurses were involved in a hot dog social, scrub sale, and a bake sale in which the nurses helped with baking. The nurses and staff are also involved with the Heart Smart community outreach and wellness program. On top of this, the nurses and clinicians help needy families each year for Christmas! We are very excited to see what great work our team will do in 2017!

Intensive Care Unit (ICU)

The ICU’s $10 million dollar expansion opened June 30, 2016. The unit features rooms designed with our critical care patients and their families needs in mind. Large rooms with supplies at the nurses fingertips, along with flat screen tv’s, and new patient beds are in use to provide excellent nursing care to our critically ill patients. Glass doors and windows that can be shaded with a flick of a switch to ensure patient privacy and can be opened fully to allow for easy movement in and out of patient rooms are also in place. Members of the ICU team were actively engaged in designing the ICU and the equipment that was purchased - a wonderful example of shared governance! Over the past year, with grants from the Mercy Hospital Foundation, ICU has increased the amount of certified nurses to eight nurses who successfully completed their CCRN or SCRN certifications. Nursing certifications are important as they validate the knowledge and practice nurses have in caring for specific patient populations. Certification achievement shows our patients and families that we are experts in our field of expertise. We are proud of all the ICU certified nurses!

OLV Family Care

Throughout the year, staff at OLV Family Care are extremely active in the care they provide to their patients. They work hard to create an environment of caring that helps to decrease anxiety and make the patient’s experience less stressful. They have created care plans that improve the patients’ health and quality of life with the goal to keep patients from having to be hospitalized. As a team they work together to maintain a smooth flow for their providers which has helped to enhance patient satisfaction. Along with the providers of OLV Family Care, staff make sure the patients’ needs are met and work diligently to facilitate referrals and handoffs to other agencies when appropriate. Post-visit, the staff conduct follow-up phone calls to ensure patients are completing the appropriate follow-up tests to keep them healthy and to make sure that the care they received met their expectations. The staff are committed to their patients and as such participate in the April Open House as well as attended a number of community outreach events. They participated in a green belt project to increase depression screens and intervention, and they regularly attend Catholic Medical Partners meetings in order to have a voice in care management of their patients. The staff also work together as a team to raise money for Helping Hands and the Food Bank. They participate in community events such as the United Way Day of Caring, Go Blue for Colon Cancer screening and the mammogram screening buses. Together with the students from Timon High school, they have set up the Father Baker Closet which provides clothing to patients. The staff at OLV Family Care are a great team and work hard to make the clinic a warm and welcoming environment.

Operating Room (OR)

Implementation of nurse service line leaders- OR service leaders interact with and contribute to the professional growth of peers, colleagues and others. Annie Falbo, RN, is overseeing the General, GYN and Urology service lines and Mary Fogelsonger, RN, is over the Neuro and Ortho service lines. Each acts as a clinical leader and resource for not only their respective services, but the Surgical Department as well. They work collaboratively with OR leadership, staff, physicians, sterile processing and vendors to streamline processes and procedures to assure efficient functioning of the unit and achievement of optimal patient outcomes. With the addition of the latest robotic platform this year, the Davinci Xi, we were committed to providing our staff with a formal introduction and training process to best learn and understand how to operate the system. Our Davinci coordinator, Julie Everhart, RNFA, in conjunction with Intuitive, worked endlessly to ensure all of the robotic staff were fully educated and trained on the new system prior to use. This was a hands-on and computer based learning approach that fully engaged all members of the team and built excitement as we prepared for our first case. Introduction and utilization of Periop 101: A Core Curriculum to enhance the orientation pathway for novice operating room nurses. The program was developed by AORN and is considered the gold standard in perioperative education, combining a standardized evidence based online curriculum with hands on skills labs. Many of our RN’s starting a new career in the OR have no experience in an OR setting, therefore this program gives them the education they need to have a solid understanding of concepts relating to surgery and perioperative nursing. It also empowers them to advocate for patients and act as leaders in the operating room.

Peri-Op (PACU)

The PACU is a dynamic unit specializing in recovering surgical patients from anesthesia. In November of 2016, the peri-op management team was restructured such that Laura Thornsberry RN, BSN is now the manager of ASU and PST, and Michelle Wild, RN, MSN is the manager of PACU. Having individual leaders for these areas will allow each unit to focus on specific goals, improving efficiencies and enhancing quality patient care. The PACU has been very excited to work directly with the new Intensivist program to provide the proper level of care immediately post-op for each patient. In an effort to do so, the PACU has collaborated with the OR, anesthesia and the critical care teams to directly transfer patients from the OR to the appropriate critical care unit, bypassing the recovery room. As a joint commission accredited hospital for stroke care, we have now initiated a minimum of four hours of stroke education for each RN in the PACU. This knowledge and information will assist the nurses in recognizing signs and symptoms of a stroke post-operatively, to ensure prompt diagnostic testing and treatment. Education continues to be a main emphasis for the staff in the PACU as they care for all types of patients with different diagnoses and co-morbidities. It is imperative that staff feel empowered to provide safe, excellent care to all the patients they recover.

Ambulatory Surgery Unit (ASU)

The “nose-to-toes” program was implemented earlier this year. Ambulatory surgery is actively working with the rest of the hospital team to help reduce surgical site infections. There has been success with the program and we will be expanding the types of surgeries that will be part of the program in early 2017. With the closing of the Pediatrics Department, ASU has embraced caring for pediatric patients in need of outpatient surgery.

Starting in late December, ASU has embarked on an aesthetic transformation with the beginning of Phase 1 of a “face-lift”. This is a two phase project. When the project is complete, the department will have all new floors and ceilings in the hallways. Patient rooms and hallways will be painted. Carpeting and handrails will be removed and there will be new dividing curtains in all the patient rooms. It will be a fresh look for ASU and a fresh outlook from ASU.

Maternal Child

The Maternal Child team was notified in late May of a construction project which would interrupt daily operations in the NICU as well as the Mother Baby unit during July and August. The placement of a new air handler for the Perioperative construction, requiring 6 braces drilled in the roof directly above the areas, would occur during the busiest time of the year for our departments. Every option for alternatives was discussed and vetted. In the end, there were no other options, but to complete the project on the original timeline. Our priority was clear: providing the safest patient care in an appropriate environment. We were also very concerned with the patient care team attending to patients during this time of tumult. Very quickly we assembled a multidisciplinary team comprised of Nursing, Medical Staff, Facility Planning, Food and Nutrition and Patient Experience staff to meet and review our priorities. Ultimately, the plan had many different moving parts to achieve the goal for both patients and staff. The patient unit of 4 North was prepared to become the temporary NICU for a period of 7 days while a small former nursery was retro fitted with 4 headwalls to become an alternative NICU room. The main room of the NICU was entirely closed down for the entire 2 months. We vacated the Maternity Unit rooms 420 to 429 for this entire time as well. The nursing staff worked diligently to assure patient comfort during this time. They distributed comfort bags consisting of a Mercy bathrobe, flip flops, a specially designed onesie for the baby and a beautiful gift pack from the exquisite Re New store on Elmwood Avenue. The Food and Nutrition Department prepared a Specialty Food Bar each day to provide additional hot foods for our patients. Taco Tuesdays and Artisanal Pizza were the biggest hits with our patients and families. Mercy’s Security Department provided a 24/7 security guard at both entrances to 4 North to provide an additional layer of infant security. Each guard received additional competency evaluation in the fine art of infant security. The staff also worked through drills using additional evacuation techniques necessary during the temporary move. Great teamwork and the consistent goal of providing patient comfort and safety allowed our patient satisfaction to remain constant during this period of time. We are truly proud of the entire team and their dedication to our patients and their families.

Transformational Leadership

Driving Nursing Professionalism through the Creation of a Professional Practice Model Jarrod Atkinson, RN, BSN, MSN, NE-BC, CCRN-K; Diane Glowacki, RN, BSN, MSN, CNRN-CMC; Darby Hardy, RN, BSN; Judith Humes, RN, BSN; Joy Kent, RN, BSN, CLC; Barbara Lawrence, RN, BS; Vicky Loretto, RN, BSN; Jennifer Sawulak, RN; Laura Thornsberry, RN, BSN

PURPOSE / BACKGROUND: The Professional Practice Model (PPM) aligns and integrates nursing practice with the nursing mission, vision, values and philosophy of nursing. The PPM guides the nursing strategic plan and identifies clear goals and expectations for all professional nurses to achieve optimal outcomes. A PPM is a schematic that symbolizes our nursing beliefs, values, theories and systems for nursing practice. The Model describes how nurses practice, collaborate, communicate, and develop professionally to provide the highest quality care to our patients, families, and community. The PPM is developed to drive current and future nursing practice at Mercy Hospital of Buffalo. METHODS: A workgroup was charged with researching, reviewing, and updating our current practices and drafting beliefs that would be reflective of our changing environment. The Nursing Research Council was tasked with identifying the Nursing Theorists that would support our nursing mission, vision, philosophy and professional practice principles. Visual images encompassing our innovative beliefs and philosophies were drafted keeping at its core patient/person centered care. This was shared with our Nursing Councils and Nursing Leadership for discussion, input, and recommendations. RESULTS & CONCLUSION: Nursing at Mercy Hospital is moving forward to create an environment in which the professional nurse will lead the culture of exemplary practice and provide exceptional patient/ person centered care. A formal introduction of the model was developed for the education of the nursing staff. Nurse and Bedside Leaders will utilize the nursing unit huddles and Unit Practice Councils to share the new Nursing Mission, Vision, and PPM. Professional Practice Council members will assist with the implementation to the staff. IMPLICATIONS FOR PRACTICE: The nurses will be empowered to “tell their story” of Nursing using the PPM and integrate it into the daily care provided to patients, families, and the community we serve. Developing an environment where decision making is conducted at the bedside is necessary in creating an empowered professional workforce that practices shared governance principles. This environment is critical in achieving the transformation of the PPM so that it will be reflective of our new vision.

TREE: Ever changing and adapting to the seasons (EBP) • Strength • Growth • Power, Courage SUPPORTIVE HANDS: Caring, Compassion, Support – for the Patient by the Nurse; and for the Nurse by Leadership • The core of nursing is the practice of CARING. • This is what we need to hold it all together. ROOTS: Catholic Health Values • Our values provide what our tree needs for growth, development and repair. • Anchors the tree – keeping it straight and stable. • Feeds the tree. SOIL/GRASS: Nursing Mission, Vision and Values • Growing healthy grass under a shaded tree can be challenging. • Need to water this with EBP to make it grow. TRUNK: Patient/Person/Family • Most important/main part of a tree – sturdy axis. • Important for tree identification. BRANCHES: 2016 Top Mercy Priorities • Trees have branches and branching patterns to spread the leaves and prevent shading earlier growth. • There is a high cost to growing taller that must be off-set by the advantage of finding more sunlight. WHERE IS THE SUNLIGHT? Part of the tree’s environment outside of nursing Professional Practice Model • Transformational Leadership • Caring Collaborative Practice • Shared Governance • Evidence-based Practice • Knowledge • Diversity • Fiscal Responsibility • Mind-Body-Spirit-Transcendence • Professional Development • Nursing Research • Relationship Based Care

Exemplary Professional Practice continued Patient and Family Advisory Council (PFAC) The Patient & Family Advisory Council (PFAC) members are committed volunteers, comprised of patients, family members, caregivers, community representatives and hospital staff. PFAC members help promote patient-centered care. Serving as key advisors, they inform leadership on those issues that are most important to patients, family members and the community. The group also collaborates with department leadership on ways to improve patient and family satisfaction.

The PFAC had nine meetings and added three new former patients and one new staff member in 2016. Many department leaders have attended the PFAC meetings to discuss new programs, ask for the group’s insight and input into changes and receive their support. The PFAC enjoys developing collaborative relationships with Mercy Hospital leadership and actively supports Mercy Hospital in the community. Topics that have been reviewed at the Patient & Family Advisory Council meetings are: • • • • • • • • • • • • • • • • • • • • • •

White Wreath Program in CCU/OHU Surgeon “Baseball cards” to be given to patients with physician information Bedside patient reporting, Hourly patient rounding and White Boards Wayfinding signage Welcome signs on the nursing units Administrative Huddles Introduction of the Patient Experience Supervisor role and focus Review and discussion related to the NRC patient experience/satisfaction scores Food Service – Room service menus and food selection Quiet at Night initiatives Unit Tours – ICU & 6W Nurses Support Group Expansion programs – Cath Lab, Surgical Suite, Nursing Strategic Plan and Professional Practice Model Meeting new managers/directors Brainstorm expectations of Hospital and Provider staff Visit to Grace House ED updates Review of Mercy Hospital patients by zip code location Education Programs: Care of the Chemically Dependent Women & Her Baby and information from the NRC Conference Review of the 2016 Top Priorities for MBH Updates from MHB Leadership: C.J. Urlaub - President & CEO, Eddie Bratko - COO, and Shari McDonald – VP Patient Care Services & CNO

The members of the PFAC are seeing a positive difference when they are visiting patients and out on the nursing unit. Staff are more professional, friendly and engaging! The goal for 2017 is to be involved in a testimonial video from the patients, family and community perspective. This video will be placed on the MHB website and used during staff orientation.

The committee meets on the fourth Tuesday of the month and is always looking for new volunteers to take part in the meetings.

National Database of Nursing Quality Indicators (NDNQI) Mercy Hospital has participated in NDNQI since 2006. NDNQI allows us to benchmark to similar hospitals in relation to quality indicators and staffing. We have made great improvements in falls and pressure ulcers with both being below the mean.

Pursuing Excellence – “Continuing our Journey from Good to Great!” Patient experience continues to be a focus for the professional nurses at Mercy Hospital of Buffalo. Nurses have continued to drive nursing practice by becoming more involved in issues and concerns that affect their practice. Various councils like the Professional Practice, Charge Nurse and Peer Review Councils provide a venue for staff to have a voice in the issues that affect their practice. Nurses are continuing to drive their practice at the bedside every day.

In 2016, Nursing practice was directed at hard-wiring initiatives such as: nurse leader rounding; bedside report; utilization of white boards; shift huddles and emphasizing purposeful patient rounding. In the spring, the department of nursing went through and completed bedside report and rounding competencies on all nursing staff in the medical/surgical areas. Evidence based research shows that purposeful hourly rounding increases patient safety by decreasing falls and skin breakdown while increasing patient satisfaction. Patient satisfaction is measured many ways. One indicator which reflects patient satisfaction are compliments. For 2016 patient/visitor compliments were up as shown below: 2014 2015 2016

647 1467 1497

Staff continue to find ways in which to make their patients more satisfied. Unit practice councils have been established on many of the units. Their primary focus is to look at the practice they deliver on their floors and to improve how they meet their patients’ needs. Kudos boards were hung in many of the nursing units so that patients and visitors could openly thank the staff who have taken care of them in a meaningful way. Welcome signs were created and hung where patients can see them when they get off the respective floor’s elevators. 7 West Unit’s Kudos Board. The welcome signs identify the unit name, room numbers, specialty and Nurse Manager’s name and floor telephone number.

Recognizing each other and working together as a team is an integral part in the future practice of nursing here at Mercy Hospital of Buffalo. The professional staff of Mercy Hospital strive to provide the best care possible to their patients.

Patient Experience Steering Committee

ANA National Conference

The primary focus of the Patient Experience Steering Committee is to guide and support measures that will improve the Mercy Hospital patient experience.

Diane Glowacki MSN, RN, CNRN-CMC, Clinical Nurse Specialist at Mercy Hospital presented a poster titled ”Effective Pain Management and Improvements in Patients’ Outcomes and Satisfaction”, at the American Nurses Association (ANA) 2016 National Conference in Orlando, Florida on March 9, 2016. It was one of 128 posters accepted nationwide for presentation.

The MHB Patient Experience Steering Committee has adapted the Beryl Institute definition of Patient Experience which is: The patient experience is the sum of all interactions, shaped by an organization’s culture, that influence patient perceptions across the continuum of care. The Beryl Institute is the global community of practice dedicated to improving the patient experience through collaboration and shared knowledge. The Steering Committee is responsible for approving patient experience projects by: • Prioritizing project objectives and outcomes • Establishing timelines • Identifying obstacles to the project’s success • Evaluating outcomes • Communicating and educating as needed

The Steering Committee developed five workgroups to identify and work on different components that would have an impact on improving patient experience at Mercy Hospital. The focus areas of the workgroups and some of their activities are: • Recognition & Adherence to CHS Values and Behavioral Standards • Use of Language of Caring techniques • Holding each other accountable • Nursing Recognition Wall • Recognition of staff

• Hospital & Department Warm Welcome and Fond Farewell • Quiet at Night initiative • Improved hospital wayfinding • Use of the Studer 10/5 Rule of engagement when encountering people in the hallways and making eye contact at 10 feet and greeting at 5 feet • Internal & Public Communications • Development of the Patient Education TV Channel • Message on the patient education channel from MHB President & CEO, C.J. Urlaub and VP Patient Care Services & CNO, Shari McDonald

NRC Symposium The 22nd NRC Patient-Centered Care Symposium held in August of 2016 was attended by Martha Metz, RN Supervisor- Hospital Experience and Joan Vetter, RN Nurse Manager 7 West. The symposium was held in San Diego, CA and attended by representatives of the other Catholic Health System hospitals and a variety of hospitals nationally. The symposium concentrated on how to utilize patient experience feedback, personalize care to the patient/ family, and maintain patient safety through effective hand hygiene. The symposium featured patient testimonials and multiple expert speakers.

• Wayfinding and Environment of Care • Administrative morning huddles • Bedside trifold tent card with Environmental Services information, how patients can better participate in their care, and Quiet at night supplies available • Physician/NP/PA Engagement • Sharing individual NRC scores with the physicians • Physician “baseball card” with physician information

The Patient Experience Steering Committee is always looking for new ideas that will have an impact on MHB patient and staff satisfaction. Any staff member who is interested in becoming part of this team, please contact Vicky Loretto, Manager of Hospital Experience.

Structural Empowerment Nursing Professional Practice Council (PPC): The Professional Practice Council continues to flourish with meetings held the first Monday of every month. Members of all the various nursing areas attend and contribute practice recommendations, unit updates, and information sharing to the group to learn and share best practices. Members of our multidisciplinary care team attend upon request to navigate through concerns and collaborate to ensure the voice of the bedside nurses is heard. Please reach out to your manager if you would like to participate. We would be happy to have you join!

Nursing Research Council The Nursing Research Council identified that a more effective and efficient admission process of a patient has a direct impact on improved patient outcomes and the provision of a safer continuum of care.

The team implemented a three-month pilot study with two dedicated admission nurses in collaboration with the Emergency Room Department, Patient Access Center, pharmacy and transport. This resulted in an improved patient flow process for admitted patients in the Emergency Department. The outcomes of the study demonstrated less interruptions during the admission process for the nursing staff on the units, improved communications with the patient/family, a seamless safe hand-off to the next level of care, improved patient and staff satisfaction and reallocation of additional time for the unit nurse to deliver patient care.

Nursing Peer Review Council The Nursing Peer Review Council, comprised of registered nurses from each unit and department, has been meeting monthly since 2013. Meetings are conducted in a non-punitive and non-judgmental manner, looking for opportunities to improve patient outcomes and safety. Letters to individual nurses are sent when standards of practice are not met along with recommended actions for improvement. The most frequently occurring issues that have come to the council are: • • • •

Lack of documentation that SCDs have been applied when ordered Incomplete blood transfusion documentation Failure to utilize the critical value tool Lack of SBAR communication when a patient is transferring from the ED to a unit, resulting in missed or delayed following of orders • Medication errors

Charge Nurse Council The Charge Nurse Council continues to be very successful with great attendance on a monthly basis. The Council is run by Marsha Nowak, Nurse Manager 5 West, and Barbara Lawrence, Director of Nursing. Each monthly meeting has a set agenda with specific topic information that is discussed. Topics may include discussion of concerns from any department throughout the hospital directly affecting nursing. Guests from departments are invited to attend to discuss various issues and help find resolutions in a collaborative manner with the Charge Nurses. Meeting minutes are recorded diligently and reviewed at the next monthly meeting. The minutes are valuable in determining resolutions and continuous issues. Every meeting provides time for each charge nurse to have an opportunity to speak about their unit in a general round table discussion. Ideas are shared, creating cohesiveness with all nursing units. All viewpoints are honored and valued.

Brenda Ripple, BSN, RN, left, and Kate Murphy, BSN, RN, display their board at the WNY Professional Nurses Association Research Day.

New Knowledge, Innovations & Improvements Look Up and Smile In the midst of a busy Mercy day sometimes we forget to see the world around us. As a reminder, the “Look up and Smile” campaign was initiated by Mary Rose Graham and Joy Kent. The campaign was rolled out with cake outside the cafeteria bringing smiles to many faces. Also, chocolate was given to those that looked up and smiled when walking through the building.

Quiet at Night Florence Nightingale defined nursing as “The act of utilizing the environment of the patient to assist him in his recovery.” While the science and art of nursing has advanced considerably from Ms. Nightingale’s time, the necessity of a calm, quiet environment promoting restful sleep continues to be recognized as an essential component to healing.

Working together, the evening: clinical, patient experience, and Transfer Center supervisors developed and implemented strategic process improvements aimed at helping our night associates provide a healing environment. These plans included: 9pm “Quiet at Night Rounds” when batteries are changed in telemetry units and IV poles are plugged in to prevent night time avoidable alarms and the inclusion of headphones in patient admission packages to decrease TV noise. To engage staff, a contest was held to redesign nighttime door hangers. The winning slogan and design was submitted by the nighttime nursing staff of 6 East and will go into production in the first quarter of 2017. These efforts resulted in measurable improvement in patient HCAHP responses for each of the last three quarters of 2016.

Catholic Health Referral Support and Transfer Center

Located on the third floor of Buffalo Mercy Hospital is the CH Transfer Center. Opening in 2016, the Center is designed to improve access to care for our community.

5th Annual Passport to Mercy Fair

Registered Nurse Supervisors staff the Center 24/7. This staffing model and the technology utilized work together to create continuous situational awareness as well as demand and capacity projections for all of our acute care sites. This efficiency in resource management is an important tool helping us get the right care, at the right time, in the right place for all of our community.

In the true spirit of the Olympic Games in Rio, the 5th Annual Passport to Mercy Fair with a “Going for the Gold” theme, provided an opportunity for multiple departments to come together. Each department showcased their specific initiatives to improve the patient and family experience, and provided department specific education. There were games at each event with prizes. Fun was had by all!

Nursing Portfolios To show our pride in our professional accomplishments, each nurse at Mercy Hospital will begin to develop a portfolio. The portfolio contains: • • • • • • • • • •

professional statements, letters of recommendation, clinical accomplishments, professional goals, exemplars, kudos, complimentary letters from patients, certifications, research accomplishments, service accomplishments

These portfolios will provide our nurses with a space to keep all of their past and future accomplishments, as well as a way to reflect back on all the lives they have touched throughout their career.

Expansion of ICU and Opening of New Cath Lab Respond to Growing Patient Volume

In December 2016, the Heart Center at Mercy Hospital expanded its interventional cardiology services with the opening of a fourth cardiac catheterization lab. The $4.3 million project was designed to further enhance services and accommodate the center’s growing interventional cardiology program, which has experienced a 32% increase over the last six years. Located adjacent to the hospital’s existing cath labs, the new lab features a stateof-the-art digital X-ray system that offers precise, real-time imaging for physicians to perform minimally-invasive cardiac procedures, including coronary angioplasty, device implants, and other advanced care to diagnose and treat cardiovascular disease. In June 2016, the hospital completed a $5 million renovation and expansion project of its Intensive Care Unit (ICU) on the 8th floor. The project created ten additional private ICU patient rooms, increasing the total to 28, and modernized the clinical support areas. Over recent years, the hospital has evolved into a tertiary referral hospital, providing highly specialized medical care and the highest level of cardiac and stroke care for patients throughout Western New York. With these changes, comes the need to care for more patients requiring critical care services. This major project was designed to accommodate the growing critical care patient volume in neurosurgery, heart surgery and other complex procedures.

Staff gathered for a blessing ceremony of the new cath lab in December.

In June, ICU nurses and staff participated in a blessing ceremony for ten new state-of-the-art patient rooms.

Awards and Recognition Outstanding Staff Awards Each year the Professional Nurses Association of WNY and The Buffalo News looks for candidates to be honored and recognized for their outstanding contributions to the nursing profession and exceptional nursing care. Mercy Hospital continues to support the activities of the Professional Nurses Association of WNY and is committed to recognizing our staff for the following awards: Nurse of Distinction Award – The individual must meet the following criteria for this award: • Outstanding contributions to the nursing profession. • Significant achievement within a particular area of nursing, clinical practice, research or administration. • Demonstrated leadership that provides a role model to inspire other nurses to improve and assists other nurses in their development. • Participation in activities that foster a positive public image of nursing as a profession. 2016 Carol Latona, MBA, BSN, RN, NEA-BC

Nursing LOVE Award Recipients In 2015 and 2016 nursing staff were recognized for their caring, compassion and commitment to their patients: • • • • •

Ashley Hardy, RT Kim Lelonek, RN Shannon Delaney, RN Afnan Mohamed, RN Nick Long, Supervisor, Material Distribution

PeriNatal Bereavement Network Nurses of the Year In May of 2016, two of Mercy Hospital’s finest Labor & Delivery nurses were recognized by the Western New York Perinatal Bereavement Network as Nurses of the Year. Linda Pollinger, BSN, RN, and Debbie Ziemianski, BSN, RN, both long term Mercy Hospital nurses, were honored for their dedication, support and compassion given to parents during a very difficult time of their lives — the loss of a child. Both nurses exemplify the best there is when it comes to helping parents. Linda Pollinger wrote: “Sometimes a gentle touch, a hug, sharing of tears, a prayer or just a quiet presence is more meaningful. Your lives are forever changed by this loss and the loss of the future you dreamed of.”

Deborah Ziemianski wrote: “Today we have come so far in our attitudes, compassion, and understanding for those who have suffered the heartbreaking loss of their infant. It has been my privilege to be a part of that growing support system.”

Being recognized by a regional organization of this magnitude is an honor. We are honored that they represent Mercy Hospital of Buffalo in such a kind, caring and compassionate manner. Outstanding Staff Nurse - The individual must meet the following criteria for this award: • Provides exceptional nursing care within acceptable nursing standards. • Excels in patient, family, and/or staff education as an integral part of nursing care. • Interacts in a caring, supportive manner with their peers. • Acts as a role model for their peers. • Demonstrates continuing interest in professional growth and development. 2016 - Laura Siener, RN

Congratulations to our “RN to BSN” Nurses Congratulations to our Mercy Hospital nurses who graduated in May 2016 as part of Cohort #3 of the “RN to BSN” program, a partnership with Catholic Health/Mercy Hospital and Niagara University to provide staff nurses a tuition-free opportunity to obtain their BSN degrees. Our 2016 graduates include: Alexandria Foley Nicole Frick-Taher Jacklyn Sobecki Maryanne Hanley Tara Hatrick Tonna Hinton Jami Liebner Kim Marts Allison Revelas Madonna Shriver Valerie Stone

Nurses Honored at Autumn Ball

Autumn Ball honorees, from left, Laura Siener, RN, 2016 Mercy Hospital Nurse of the Year; Sister Sheila Marie Walsh, 2016 Friend of Distinction and former longtime Mercy Hospital Administrator (1976-1992); and Carol Latona, RN, MBA, 2016 Nurse of Distinction and Director of Nursing Operations, display their awards during this annual fundraising celebration held in November at the Atrium at Rich’s. The 8th Annual Autumn Ball was the most successful in Mercy Hospital Foundation’s history, raising $174,000 to benefit the Empowering Buffalo program at the Mercy Comprehensive Care Center (MCCC).

And Our Journey Continues