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Exemplary Professional Practice
Core to every Magnet®-designated institution is exemplary professional practice within nursing . ChristianaCare’s nursing and HomeHealth teams deeply understand the role of nursing as it applies to patients, families, communities and caregivers . Always applying new knowledge and evidence-based approaches, our caregivers embody the essence of Magnet: determined to be exceptional today and even better tomorrow.
Hospital care at home
ChristianaCare has joined an elite group of health systems nationwide offering at-home hospital care . Clinical research studies show patients receiving in-home care experienced fewer readmissions, lower mortality rates, reduced falls and lower costs than those receiving hospital-based care .
Offering the highest level of in-home acute care in Delaware, our Hospital Care at Home program launched in December 2021. A team of physicians, nurse practitioners, registered nurses and others provides a combination of virtual and in-person care, paired with mobile imaging and lab services, delivery of meals and nutrition and pharmacy medication and management. Virtual technology and home health equipment brought into the patient’s home ensure 24/7 monitoring and care that mirror a traditional hospital setting.
Evidence-based care in real time
During the pandemic, nursing professional development specialists and clinical nurse specialists quickly developed evidence-based guidelines and education materials for caregivers working at the bedside to help non-intubated COVID-19 patients learn to turn themselves with minimal assistance. Called awake self-prone positioning (ASPP), the process is used with COVID-19 patients showing early signs of respiratory failure. Christiana Hospital’s Rapid Response Team worked closely with unit charge nurses and intermediate-care nurses to help implement ASPP with patients. The ASPP guideline has become an established part of caring for patients with COVID-19 and is fully integrated into practice in units caring for them.
Love and excellence offered virtually
The ChristianaCare Center for Virtual Health goes far beyond video visits. The Center’s team of nurse practitioners, physicians, specialists and pharmacists offers via phone or text about 95% of what’s done at an office visit . In total, last year, ChristianaCare caregivers counted more than 51,000 virtual visits across the system.
Serving through crisis
When the omicron variant resulted in an unprecedented demand for services, ChristianaCare implemented Crisis Standards of Care for several months . For crisis situations only, Crisis Standards of Care guide decision making when demand for care surpasses available resources and other contingency strategies have been exhausted. Our extraordinary nursing caregivers adapted swiftly and fluidly to the standards that allow flexibility and support in care models, documentation requirements, workflows, admissions and discharge criteria, supply allocations, staff redeployments and resource distributions. Through it all, they were unrelenting in their attention to safety for our patients and caregivers .
Making > Tomorrow > Happen
Making Tomorrow Happen is ChristianaCare’s model for putting our core values of love and excellence into every action, every day . Our dedication to Making Tomorrow Happen guides us 24/7, 365 days a year. The model is evidenced in 14,000 caregivers across all roles working together to remove problems and inefficiencies that prevent us from achieving joy in our work and best outcomes for the people we serve. Grounded in Making Tomorrow Happen, nursing caregivers commit to being exceptional today and even better tomorrow through continuous improvement and embodiment of all Magnet pillars.
Teach-back grows
ChristianaCare’s evidence-based Teach-back initiative continues to move forward, stewarded by nurses. In FY 22 nursing caregivers: • Conducted nearly 100 presentations for ambulatory practices and community outreach teams . • Trained more than 300 nurse leaders in observations. • Completed more than 2,400 Teach-back rounds.
Systemwide Teach-back screensaver
Civility, safety and respect — our top priority
ChristianaCare’s nurses join other caregivers in addressing violence against health care workers. In FY 22, nursing caregivers are leading the design and implementation of multiple initiatives that support health care workers and create a safe work environment across all our campuses, including: • Training hundreds of caregivers in Nonviolent Crisis Intervention® with Advanced
Physical Skills, an evidence-based de-escalation and crisis prevention training developed by the Crisis
Prevention Institute . • Working with external affairs to create public-facing signage to communicate that caregiver safety is a top priority . • Developing a pilot using a validated screening assessment called Dynamic Appraisal of Situational
Aggression to identify aggression, objectively and proactively, among patients . • Expanding the use of staff duress badges to additional inpatient units and in our emergency departments to non-nursing caregivers • Standardizing the process for caregivers to press charges in the event of violence and direct verbal threats against them .
Additionally, three ChristianaCare nurses — Mike Knorr, MSN, RN, PCCN, Amanda Williams, MSN, RN-BC and Christopher Otto, MSN, RN, CHFN, PCCN, CCRN — advocated in the Delaware General Assembly for the passage of HB 324. The legislation, which the governor signed in June, applies the felony offense of assault in the second degree to those who intentionally cause physical injury on health care workers while the caregivers are performing work-related duties .
Caring for patients, protecting caregivers
ChristianaCare nursing is also leading the launch of a screening assessment — Dynamic Appraisal of Situational Aggression (DASA) — that identifies aggression, objectively and proactively, among patients. The screening will enable caregivers to create interventions and individualized care plans that help patients and protect frontline caregivers . DASA is a collaborative effort among nursing’s Workforce Connection Council, iLEAD, Nursing Informatics, Psychiatric/Behavioral Health Services and the Workplace Civility steer and subcommittees. In the coming year, two units on our Newark and Wilmington campuses will implement DASA, with a systemwide rollout to follow .
The info patients need when they need it
Two years after selecting a new partner for patient education content, ChristianaCare has seen fantastic adoption of our strategic content vendor Healthwise, a nonprofit that develops health content and patient education for health care providers and others .
• More than 655,000 leaflets provided to patients and families. • More than 136,000 visits to the Healthwise library via ChristianCare.org and the patient portal . • 650 CareVio-ordered education resources delivered to patients — 85% of which were digitally delivered .
Empirical Outcomes
ChristianaCare’s mission is to serve our community as expert, caring partners in health . We do this through love and excellence, which calls us to always consider innovation and clinical outcomes in our practices, organization and care for patients and their families .
Preventable harm rates
Through FY 22, our Nursing Quality and Safety Council continued to engage caregivers in monitoring and preventing harm in several areas: catheter-associated urinary tract infections, hospital-acquired pressure injuries, central line–associated bloodstream infections, and falls. Overall, our harm rate for the year decreased from 1.94 in FY 21 to 1.85 this year.
Nursing Practice Bundle
The success of ChristianaCare’s Nursing Practice Bundle takes full stakeholder engagement . To encourage active involvement among all groups, our Nursing Excellence team recently revised nursing’s RACI chart, a project management tool that identifies who is responsible, accountable, consulted and informed on projects . Based on input from all involved caregivers, it clearly outlines everyone’s role in the design, maintenance and implementation of the Nursing Practice Bundle. The chart is being piloted in Acute Care with plans to eventually expand to ChristianaCare HomeHealth and the Medical Group.
Transforming pain preference protocols
Recently, the Joint Commission updated its medication standards, allowing patient preference in medication administration practices. Welcomed by caregivers, the policy empowers nurses to accommodate a patient’s preference for medication . For ChristianaCare, a team of Nursing, Pharmacy, IT, providers, Medication Safety and Accreditation revised ChristianaCare’s pain preference protocol . Their work involved changing medication orders, nursing documentation and health system policy and process in pain medication administration practices. This practice change was implemented in December 2021 and feedback from caregivers has been overwhelmingly positive — nurses appreciate the ability to honor patient preference .
Zero Harm Awards
ChristianaCare’s Zero Harm committee awarded a total of 145 Zero Harm Awards across our three campuses and HomeHealth in FY 22. The awards are for areas with zero cases of preventable patient harm for 12, 24, 36, 48, 60, 72, 84 or 96 consecutive months. Our patients are safer because of our caregivers’ commitment to zero harm, and we are proud to acknowledge all 2022 Zero Harm awardees at our Wilmington (W), Newark (N) and Cecil County (C) campuses and HomeHealth (HH).
12 months: HH New Castle Team 3, N 6B, N 5D, HH New Castle Team 7, N 6E, HH New Castle Team 5, HH Camden Team 3, N Surgical Critical Care Complex, N 6A 24 months: HH Private Duty Nursing, N 4D, W 5N, W 8S 36 months: W 4W, N 5E, W Intensive Care Unit, W Rehab (6W), N Medical Intensive Care Unit, N Transitional Neuro Unit, N Neuro Critical Care Unit, C Intensive Care Unit, C Progressive Care Unit 48 months: W 3M 60 months: N 3A, W 6S 84 months: N 7E, N Bone Marrow Transplant Unit, W 4N/5W 96 months: W 7S
12 months: N Medical Intensive Care Unit, N Neonatal Intensive Care Unit, C Medical Specialty Unit, N 6A, N 5B 24 months: N Bone Marrow Transplant Unit, N Transitional Neuro Unit, W Rehab (6W), N 6B, N 3A, HH New Castle Team 5, W 4N/5W, W 4W 36 months: HH New Castle Team 6, N 5D, C Progressive Care Unit 48 months: W Intensive Care Unit, W 3M, N Transitional Surgical Unit, HH Camden Team 1, HH CD Team 3, HH New Castle Team 2, HH New Castle Team 3, HH New Castle Team 4, HH New Castle Team 7, HH Private Duty Nursing 72 months: W 6S 84 months: N 2C, N 7E, W 7S
Methicillin-Resistant Staphylococcus Aureus (MRSA)
12 months: W 5N, W 4W, N Cardiovascular Critical Care Complex, W 4N/5W, C Progressive Care Unit 24 months: N 5A/4C, N 5D, N 6B, N Surgical Critical Care Complex, W 3M 36 months: N Bone Marrow Transplant Unit, N 5C, C Surgical Specialty Unit 48 months: N Transitional Surgical Unit, W Intensive Care Unit 60 months: N 4D 72 months: N 4B 84 months: N 2C, N 7E 96 months: N 3A, W 7S, W Rehab (6W)
Clostridium Difficile (C. Difficile)
12 months: N 5B/3B, W 4N/5W, N Surgical Critical Care Complex, C Clinical Decision Unit, N 5D, N Bone Marrow Transplant Unit, C Medical Specialty Unit, C Progressive Care Unit, C Surgical Specialty Unit 24 months: W 7N, N Medical Intensive Care Unit, N 6B, W 3M 36 months: N Transitional Neuro Unit, W Intensive Care Unit, C Intensive Care Unit 48 months: N Transitional Surgical Unit 60 months: W Rehab (6W) 96 months: W 7S
Falls With Major Injury
12 months: N Cardiovascular Critical Care Complex, W 7N, HH Camden Team 1, N 3A, N 6E, N 6A, W 4N/5W, N 4E, C Clinical Decision Unit, N 6A 24 months: Cecil Emergency Department, N 5B/3B, W Rehab (6W), N 5E, C Progressive Care Unit, C Medical Specialty Unit, N 5C 36 months: N Neuro Critical Care Unit, N 2C, C Intensive Care Unit, C Maternal Infant Child, Wilmington Emergency Department, C Behavioral Health Unit 48 months: N 6C Medical Observation Unit, N P6M 60 months: N 5A/4C, W 4W, N 6B, N Surgical Critical Care Complex, W 3M, N 6M/7M 96 months: N 4D, N 7E, N Cardiac Short Stay Unit, Middletown Emergency Department, N Medial Intensive Care Unit, N Transitional Surgical Unit, N 2M, W Intensive Care Unit
All Falls
12 months: N 2M, N OB Triage, C Intensive Care Unit 24 months: N Transitional Surgical Unit 72 months: N Neonatal Intensive Care Unit
Antenatal Steroids
36 months: N 2M
