2019 Nursing Annual Report by Independence Health System

NURSING OUTCOMES

2019 NURSING

We’ve demonstrated in many innovative ways that we’re able to favorably impact this vision with efficient, high-quality nursing care that is patient and family centered. The year’s reflections of your accomplishments shared in this 2019 Annual Nursing Report demonstrate once again the power and influence of Excela nurses to provide excellent care to the patients and families we serve.

2019

HIGHLIGHTS Dear Excela Nurses and Interprofessional Team, Driven by the values defined in the Excela Health Nursing Professional Practice Model and our vision to deliver on the promise to improve the health and well-being of every life we touch, the outstanding nurses of Excela consistently step forward to partner with our interprofessional colleagues to take on new initiatives and continuous quality improvement activities. Through collaboration, the ambitious care transitions agenda of 2019 has improved coordination and continuity of patient care and achieved superior outcomes.

On December 20, 2019, we celebrated! We received our notification call that the ANCC Magnet Recognition Program Commission on Magnet unanimously voted to credential Excela Health Frick Hospital, Latrobe Hospital and Westmoreland Hospital with initial Magnet designation. This designation recognizes that you are among the very best in the country as we outperform national benchmarks. The designation confirms that as an interprofessional team, we are one of 523 exceptional hospitals in the country that have this designation and one of 39 hospitals in Pennsylvania. What a wonderful closure to a year of outstanding nursing successes. This annual report highlights the flexibility, creativity and tenacity of Excela nurses to create positive change. These qualities are reflected in many of the stories and recognitions of nurses who are passionate about their work and focused on individualized, patient-centered care. Innumerable

to capture in one report, the 2019 report shares examples of nurses leading planned and unplanned change across campuses; nurseled interprofessional initiatives favorably impacting clinical outcome measures; and, the Nursing Professional Governance Councils and Committees that are critical to this overall clinical performance. This annual report showcases many of the initiatives and outcome metrics. It has been an amazing year of accomplishments and an exhilarating end to the year with our initial Magnet designation. Recognition of an amazing nursing and interprofessional team! Congratulations on a job well done. Our initial Magnet designation affirms to our community, our patients and their families – and to one another – our commitment to high quality, safe patient care, service excellence, and a professional work environment in which nurses thrive and want to practice. Thank you for this commitment and for helping establish an enduring culture of nursing excellence. Excela nurses bring our mission and values to life. With deep gratitude and appreciation,

Helen

John

The shining moment of 2019 for our nurses was achieving Magnet designation! Westmoreland Hospital, Latrobe Hospital, Frick Hospital, along with the associated Norwin Surgical Center, Laurel Surgical Center and the Home Care & Hospice program comprise our system designation.

“

Magnet is about being beer

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today than we were yesterday.

MAGNET RECOGNITION

What it means for Excela Health. What it means for the patients we serve. individuals outside of healthcare would be hardpressed to come up with an answer if asked what Magnet Recognition® is or means, and the positive impact it has on our region. Therefore, we offer some context that will help to provide insight as to the significance of Magnet Recognition®.

This past December, Excela Health announced that it had achieved Magnet Recognition® from the American Nurses Credentialing Center (ANCC). In 2014, Excela Health began a journey for the system to earn what is considered the highest and most prestigious distinction a healthcare organization can receive for nursing excellence and superiority in patient care. Just 8 percent of the nation’s 6,300 hospitals have garnered Magnet status. In Pennsylvania, only 35 of nearly 250 hospitals carry the recognition. Our Magnet journey represented a paradigm shift at Excela whereby we moved our nursing focus from one centered primarily on structure and process to one that put, at the forefront, indicators for clinical quality, patient satisfaction and the overall nursing environment. We no longer simply examine “what we do.” Now, we ask, “What difference have we made?” While we in the Excela family take great pride in this latest accolade for our three hospitals, we suspect

The Magnet program was formed in 1990 as the Magnet Hospital Recognition® Program for Excellence in Nursing Services. Its criteria were based on findings from a study conducted by a task force of the American Academy of Nursing, which identified 14 characteristics that created an environment conducive to attracting and retaining well-qualified nurses who promoted quality care. Essentially, Magnet Recognition® is a road map for nursing excellence. It is not a “prize” or an “award.” Rather, it is a performance-driven recognition credential that is earned only after participating in a rigorous and lengthy review process that demonstrates qualitative and quantitative evidence regarding patient care and outcomes.

Just 8 percent of the nation’s 6,300 hospitals have garnered Magnet status. In Pennsylvania, only 35 of nearly of nearly 250 hospitals carry the recognition.

Growing data and research demonstrate that Magnet status has a dramatic and positive impact on quality of care, levels of service and control of costs in the hospital setting. Moreover, research also indicates that the Magnet culture stimulates quality and positive organizational behavior that ultimately improves outcomes such as lower patient-fall and hospital-acquired infection rates. Safety is also enhanced at Magnet hospitals. The Gallup organization found nurses in Magnet organizations to be more engaged in their work, which has a direct correlation to patient safety. Gallup estimates Magnet hospitals, on average, experience over seven percent fewer safety-related incidents than the industry norm. Their survey also found Magnet hospitals have fewer RN workplace injuries and lower blood and body fluid exposure. Nurses in Magnet facilities spend more time at the bedside. This high level of interaction often contributes to a faster recovery and higher patient satisfaction scores. Magnet Recognition® is also used as a criterion by U.S. News & World Report when it determines its annual listing of “America’s Best Hospitals.” The overwhelming majority of the list’s Honor Roll hospitals are Magnet recognized. Being a Magnet hospital also enhances the ability to recruit and retain the best and brightest nurses in their respective specialties. It is important to underscore that our journey to Magnet Recognition® has been as important as the destination. It built visionary nurse leaders at all levels. It catalyzed the development and dissemination of extraordinary nursing strategies and practices. It made us better – as nurses and as a health system. The hospitals of Excela Health — Frick, Latrobe and Westmoreland — have each served our county and our region for more than 100 years. Over those decades, we have endeavored to grow and enhance our capabilities to meet the evolving needs and expectations of our patients and their loved ones – not just in nursing but across the spectrum of our clinical and support teams, physician expertise and technology. Those endeavors have most recently resulted in a U.S News & World Report designation in their 2019-2020 “Best Regional Hospitals” list and now Magnet Recognition® by the ANCC. These achievements actualize the Excela mission to improve the health and well-being of every life we touch. They are a tangible expression of our commitment to the communities we serve. They are a reflection of that commitment being met.

MAGNET EXEMPLARS The Commission on Magnet recognized Excela Health’s initial designation as a Magnet organization. The Commission also identified several exemplars from our written narratives. An exemplar is “a concept, practice or program worthy of imitation.”

CLINICAL NURSE INVOLVEMENT IN COMMUNITY HEALTHCARE OUTREACH FOOD BACKPACKS | Nurses serving on the Professional Image Committee at Excela Health established a program to provide backpacks full of food to hungry children in a local school district. This program provides food for 52 percent of the children in the community. Each backpack contains $30 worth of food. Annually, the organization supports 900 nursing hours to pack the bags which amounts to approximately $23,400 per year. RAISING FUNDS FOR PANCREATIC CANCER | Eight nurses on the GI/Endo unit held fundraising events raising $50,000 over the course of five years for pancreatic cancer research in memory of a colleague who died of pancreatic cancer. EXCELA’S FAMILY ADDITIONS MATERNITY CENTER | Forty-two Excela RNs volunteered over three years in collaboration with the Westmoreland/Frick Hospital Foundation to raise funds on behalf of the health system’s Family Additions Maternity Center. As Planning Committee members, the nurses worked to host Black-Tie events, which raised $270,000 for the purchase of resources. Their efforts also provided an opportunity to showcase the Center and its Special Care Nursery to more than 1,000 community guests and supporters of the events.

NURSES PARTNER WITH PATIENTS AND FAMILIES TO DEVELOP AN INDIVIDUALIZED PLAN OF CARE TO BENEFIT THE PATIENT: REHAB | The discussion of rehab placement for an elderly gentleman post CVA transpired between the patient, rounding team and patient's wife. GROCERIES | In preparing for discharge, nurses bought a two-week supply of groceries for an elderly gentleman with limited resources and sent them home with him in a transport vehicle. PACEMAKER | An elderly woman in the Pacemaker Clinic had extreme difficulty setting up her device. A nurse went to her home and helped her personally and left written instructions. AMA | Patients were leaving AMA due to concerns for their pets. Nurses worked with local animal shelter to create “Hospaws”, a program providing care for pets while owners are hospitalized.

AN IMPROVEMENT THAT RESULTED FROM AN INNOVATION IN NURSING: NURSING PROFESSIONAL PRACTICE EVALUATION COMMITTEE | The creation of a committee to oversee the process of promoting professional education and professional development without punitive implications assures the evaluation actually occurs. The NPPE process was designed to support nurse autonomy and accountability with a goal of tracking, trending and improving adverse patient safety events. The NPPE Committee is courageous, cutting edge and effective in improving outcomes. Each case reviewed provides an opportunity for the Committee to impact patient outcomes. Nurses were empowered to provide evidence-based practice solutions while collaborating with interdisciplinary colleagues. The NPPE Committee is unique and has not been adopted by other organizations in Pennsylvania or the nation. Committee members presented the steps to formation and implementation at the American Organization of Nurse Executives and they are in the process of publishing. Between 2014 and 2018, the NPPE Committee reviewed 1,713 events -- top three themes were medication errors, (n=534, 39.4%), protocol deviations (n=366, 27%) and clinical practice deviations (n=210, 15.5%). An innovative, impressive and effective process, the NPPE Committee drives improved outcomes.

MAGNET MAESTROS Champions for Excellence The champions of Magnet throughout our System are fondly referred to as Magnet Maestros. Stacy Gibson, MSN, RN, NPD-BC and Joyce Croce, BSN, served as the Chairs of the Maestros on the final leg of our journey to Excellence. Maestros created education, games, tools and activities to help teams apply the Magnet Components to daily practice. In addition, the Maestro group conceived the “Come On Get Magnet” bus as well as “Magnasaurus Rex” as played by the exceedingly popular Joanne Reeve, Executive Assistant, Education and Magnet Program, to help drive momentum.

Joyce Croce, BSN, RN (left) and Stacy Gibson, MSN, RN, NPD-BC

The Maestros took the Magnet Bus and “Rex” on the road to Magnet festivals, professional governance fairs, safety fairs, employee picnics and as many other Excela Health events as possible across the System to bring attention and awareness to how Excela Health personifies the principles of Magnet excellence in daily practice.

We have Magnet Maestros from all disciplines as we believe that it takes the entire team working together to achieve true excellence.

During the site visit, appraisers shared that the fabric of teamwork across the disciplines at Excela was among the best they’ve seen.

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OUR TIME TO SHINE

I wish I could bottle up what you have here and take it with me.

Beth Beckman, RN, DNSc, FNP, NEA-BC, Chief Nursing Executive Yale New Haven Health Magnet Appraiser

The team of Magnet Escorts (pictured above) led appraisers throughout our health system as they explored the many facets of excellence at Excela Health. The 2019 Magnet site visit included: • 3 Appraisers • 4 Days • 41 Unit Tours • 18 Council and Specialty Topic Interviews • 17 Meal Interviews • More than 900 EH Staff members met with Appraisers, including 668 RNs

The Journey Continues ... Magnet Maestros continue to educate, inspire and celebrate excellence at Excela Health. We look forward to cultivating our culture of caring for our patients, one another and the community we serve. We continue to strive for outstanding quality and safety outcomes for patients and staff, thriving inter-professional collaboration and professional practice methods. We continue to work to assure that both patient and staff satisfaction rates top national averages.

We are a community of Excellence. Magnet Maestro in the Emergency Department at Latrobe Hospital, Abbey Gruss, BSN, RN – pictured here with Diane Davis, RN, CEN and Vanessa Gruss, BSN, RN – liken the Magnet Components to “The Game of LIFE” as they use this board on their unit to reinforce the ways in which Magnet principles come to life in every day practice.

Professional and compassionate nursing is at the heart of our patient care mission, and nurses play an integral role in Excelaâ&#x20AC;&#x2122;s ability to deliver high-quality care and achieve success.

EXEMPLARY PROFESSIONAL PRACTICE Quality of Care, Safety, Staffing, Scheduling, Budgeting, Accountability, Competence, Autonomy and Interprofessional Collaborative Practice

EXEMPLARY PROFESSIONAL PRACTICE is evidenced by nurses interacting with patients, families and communities to identify ways to improve patient outcomes and then collaborating with the interdisciplinary team to affect positive change. At the department and unit levels, direct care nurses claim accountability for and constantly evaluate quality metrics and are empowered to brainstorm ways to make a positive difference.

QUALITY OF CARE | Improving Bariatric Surgery Success through Smoking Cessation Program

Excela Health’s Weight Management Center provides state-of-the-art support and treatment to combat obesity, including bariatric surgery options. The process a patient undergoes to prepare for bariatric surgery is comprehensive and often lengthy. There are numerous criteria that patients must adhere to prior to the scheduled surgery to increase the likelihood of success in battling this chronic disease. Among those criteria, patients must be nicotine- and tobacco-free for eight weeks prior to their surgery date. That is among the surgical criteria in battling this chronic disease. In 2018, 15 cases were canceled or delayed due to smoking. Upon recognizing the prevalence of this issue, the team implemented some simple steps to help change these numbers. • Instituted Smoking Cessation Program. • Enrolled affected patients in Smoking Cessation at initial visit, or educated them to seek assistance from their primary care physician. • Set “Target Quit Date” for 10 weeks prior to surgery at initial visit. • Followed up with phone calls. • Documented progress in medical records for team evaluation/ intervention These simple interventions yielded positive results. In 2019, the number of patients who delayed or canceled bariatric surgery due to smoking or tobacco use was reduced to 10. 33% IMPROVEMENT

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The intention of our bariatric team always is to help get our patients to surgery, unless, of course, patients decide that they no longer wish to proceed. Our patients put in a lot of time, hard work and dedication throughout the program, so it is always sad when we need to cancel or delay surgery.

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Obesity is a chronic disease that often leads to an array of health concerns posing serious threats to the well-being of the patients, families and communities we serve.

- Melanie Jones, RN, Clinical Coordinator, Weight Management Center (pictured below)

ICUs Battle Infection with AHRQ CAUTI Reduction Project RESULTS | There were ZERO CAUTIs in the ICU at Westmoreland Hospital from November of 2018 through September of 2019.

DISSEMINATING THE WORK | Members of the Excela Nursing team from the Westmoreland Hospital ICU presented their work at HAP in Harrisburg this year.

ZERO CAUTIs Five Consecutive Quarters!

Action was taken when data revealed that Westmoreland Hospital’s Intensive Care Unit (ICU) had a catheter-associated urinary tract infection rate (CAUTI) that was higher than the national average. Westmoreland Hospital set a goal to reduce CAUTIs and committed to participating in a program that is funded and guided by the Agency for Healthcare Research and Quality (AHRQ) and managed by the Hospital & Healthsystem Association of Pennsylvania (HAP). Bonnie Barnhart, MBA, BSE, RN, CPHQ, Quality Analyst, was assigned to co-lead the project and served as liaison between AHRQ and the Excela interdisciplinary treatment team. During the third and fourth quarters of 2018 and the first quarter of 2019, Barnhart guided team education using the AHRQ toolkit. The toolkit offered principles of effective teamwork and communication from the national TeamSTEPPS program. As a result, the ICU has experienced a change in culture. • Training empowered staff to participate in rounds and to speak up about Foley catheter necessity. • There was an increased use of Foley removal protocol. • There was an interest to explore and support alternative strategies, such as external products when appropriate. • Staff did not accept that every patient admitted to the ICU needed a Foley catheter. • Nurses became more cognizant of the importance of appropriate placement indicators for a Foley catheter with specific order and with a closed system product.

Amanda Brown, TP, Kathy Radocaj, MSN, RN, CCRN, along with Bonnie Barnhart, MBA, BSE, RN, CPHQ, and Carrie Horner, MSN, RN, CPHQ, present work on CAUTI reduction at HAP in Harrisburg.

ICU staff continued to audit the process to ensure positive results and communicated with all members of the interdisciplinary treatment team. ICU staff from Latrobe and Frick hospitals participated as well, and the changes were adopted system-wide.

Nursing Professional Practice Evaluation Leads to Traumatic Foley Injury Reduction The Nursing Professional Practice Evaluation Committee (NPPEC), under the Nursing Professional Governance structure, is a committee that holds nursing practice at Excela Health to the highest standards of care. Supported by evidence-based research, clinical protocols and guidelines, NPPEC helped Excela Health nurses reduce the number of nursing-associated traumatic Foley injuries in 2019. Noting the number of traumatic Foley insertion cases in calendar year 2018, the nurse-led committee analyzed and identified root causes of reported events. The committee worked with an interdisciplinary team to develop a protocol founded on evidence-based practices for clinical bedside nurses to utilize a coude catheter if indicated on the anatomical male, per algorithm indications.

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I have always been proud to be a nurse, but the input we all have as bedside nurses in the NPPEC process has made me even more proud. Nurses led the process when Foley catheter injuries were noted, helping to create an evidence-based algorithm that has improved outcomes and care for our patients. Our knowledge and expertise is truly valued. Bridget Rafferty-Himler, BSN, RN, CCRN ICU, Excela Health Westmoreland Hospital, Chairperson, NPPEC.

Enhancing the Patient Experience At Excela Health, we put patients first. No Passing Zone Project Increases Patient Satisfaction At the onset of 2019, clinical nurse coordinators on unit 1E at Westmoreland Hospital Geralyn Susko, BSN, RN, and Kathy Riggle, RN, (pictured) noted that patients returning post-hospitalization surveys rated “Response of Hospital Staff” lower than in previous months. The concern was explored by the Unit Based Council and the “No Passing Zone” was conceived, based on similar projects highlighted in nursing literature. The project basis is simple. If a patient call bell is on, no clinical staff person (regardless of discipline or patient assignment) is permitted to pass that patient’s room without stopping in to help. Nursing staff enlisted the support of all members of the healthcare team working on the unit to help address patient needs more efficiently. The effort was a clear success. HCAHPS score for “Responsiveness of staff” jumped 13 points the first month. The unit sustained scores that exceeded Excela Health thresholds for the remainder of 2019.

Room Standardization Benefits Patients and Staff The hospital environment can be chaotic. Patients returning surveys after an admission to unit 3N at Latrobe Hospital consistently rated “Cleanliness of Hospital Environment” below the target threshold. The Nursing team derived a plan to affect change which included:

HCAHPS score up 16.4 points

• Eliminating clutter in halls and rooms • Reorganizing space • Creating standardized room expectations, including equipping each room with needed supplies • Creating diagram of rooms for Nursing and Environmental Services (EVS) staff reference

Saved 5 minutes 53 seconds per patient

• Collaborating between Nursing and EVS regarding plans and new standards • Auditing regularly to assure that standards are being maintained

RESULTS | HCAHPS scores for “Cleanliness of Hospital Environment” rose by 16.4 points immediately after the project was implemented and the average score throughout the remainder of 2019 remained above the CMS threshold.

BONUS |

Saved 672 steps per patient

• Standardizing rooms not only gave the patients the sense of a cleaner space, it was a time-saver for staff. Staff calculated that it took an average of 5 minutes, 53 seconds and 672 steps to gather supplies for patient care. Now, the supplies are right at their fingertips and stocked in each room. • Nursing teams expressed appreciation for the time and steps they save and are enjoying a sense of accomplishment.

HCAHPS score for “Cleanliness of Hospital Environment” rose 16.4 points and maintained an average score throughout the remainder of 2019 above the CMS threshold.

Perfect HCAHPS Scores

Frick Hospital Ambulatory Surgery Laurel Surgical Center Westmoreland Hospital Ambulatory Surgery Excela Square Norwin Ambulatory Surgery Westmoreland Hospital ICU/SDU

Patient satisfaction surveys provide measurable results that assist in transforming the patient experience across the health system. The following patient care units achieved perfect HCAHPS scores on at least one month of reporting during 2019:

Westmoreland Hospital Family Additions Maternity Center Westmoreland Hospital 4D Westmoreland Hospital 4AB Latrobe Hospital Neuro Joint Works Latrobe Hospital 2 East Frick Hospital PCU/ICU

CULTURE OF SAFETY Employee Safety We take the health and safety of our employees very seriously.

2019 OSHA Recordable Injuries: (Based on 4,700 employees)

OSHA Recordable Injuries Rate per 100 Employees

4 0 1 0 5 11

Slip/Trip/Fall Other Lift/Push/Pull Combative Patient Patient Handling Contact with Objects Blood/Body Fluid Exposure

Recordable Injuries EH Target OSHA Target 0

Employee Health Nurse Advocates Safe Patient Handling Single-Patient Use HoverMatt® contributes to ZERO patient handling injuries To Eileen Kantorik, RN, COKN, CEASIII, a nurse in the Safety Services Department and Ergonomics Coordinator (pictured), advocating for the addition of Single-Patient Use (SPU) HoverMatts® was more of a mission than a job. Several years ago, Kantorik’s husband was injured in a motorcycle accident resulting in very serious injuries and fractures. “Every time the nurses pulled him over from bed to cart and vice versa, he would scream in pain. It broke my heart. I swore to myself I would do what I could to protect staff and patients from pain and injury.” A HoverMatt® is an inflatable mattress that floats on a cushion of air allowing for safe patient transfers without lifting or straining. Excela had used the device for years. However, recently the supply had drastically dwindled and they were not readily available to use when needed. Kantorik learned about the disposable model and organized a pilot program at Latrobe Hospital where every patient room was equipped with an SPU Hovermatt®. The pilot was a success. Through her hard work, dedication and persistent advocacy, staff has been trained on the proper use of the product systemwide and it is included in the two-bin system for supplies. Our Employee Safety Data verifies zero injuries related to patient handling. These mats also reduce the risk of cross contamination and the need for outside laundering.

PATIENT SAFETY Fall Prevention Targeted Solutions Tool (TST) Excela Health nurses strive to maintain a culture of quality and safety by using national standards as a guide to facilitate excellence in nursing practice. Bedside nurses take active roles in tracking quality data as well as interpreting the results and designing improvement initiatives. One such initiative was the systemwide incorporation of the Fall Prevention Targeted Solutions Tool (TST), an online resource released by The Joint Commission Center for Transforming Healthcare to prevent inpatient falls and falls with injury. This tool provides a step-by-step process to assist hospitals in measuring falls and falls with injury rates, identifying barriers to fall prevention, and implementing the Centerâ&#x20AC;&#x2122;s proven solutions for falls prevention that are customized to address specific barriers.

REDUCTION IN FALLS WITH INJURY WESTMORELAND

74%

LATROBE

71%

FRICK

38%

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Bedside RN Voluntary/ Involuntary Turnover Rate FY 2019

Staffing, Scheduling and Budgeting

Excela Health | 13.62%

Excela Health Responds to National Nursing Shortage

aNurse Residency Program aEngaging Local Nursing Schools aSeasonal Nurses aNew Recruiting Process aAdditional Job Fairs aNursing Pathway

National Benchmark | 14.8%

IN 2019 EXCELA HEALTH HIRED |

Creative Programming to Support Nursing Teams Through Expanded Roles With the goal of supporting nursing teams and caring for patients, particularly in light of the national nursing shortage, the organization created a Nursing Career Pathway encouraging Excela Health Patient Transport staff and Patient Safety Associates to participate in an inhouse training program preparing them to become Technical Partners. The pathway also was designed to continue to support staff to become RNs, BSNs, MSNs and DNPs utilizing Excela Health education assistance and tuition reimbursement resources.

LPN

Techs

PSA

183

158

CRNA CRNP 4

New Nurses Enrolled in the Nurse Residency Program Cassandra E. Ackerman

Cassandra Federer

Shania D. Barkley

Lisa M. Fiedor

Kaylene Baum

Alexa Frontio

Austin J. Belzer

Matthew Garrett

Emily Biddle

Kaylee Gessler

Jennifer M. Bittinger

Jillian N. Gettemy

Shannon K. Boring

Timothy J. Giles

Brianne E. Bosich

Chantel R. Glasser

Danielle L. Brnilovich

Juliene C. Goehring

Jessica Bulebosh (Checca)

Cody Grimm

Sydney M. Campbell

Jennie Halula

Jaynee Cardiff

Faith Harter

Marian M. Chearney

Gail Hepler-Daley

Natalie R. Church

Jayme E. Herrle (Todd)

Nicole M. Clark

Jason P. Hersh

Kellie L. Craig

Lisa M. Hoffman

Courtney M. Curren

Taylor R. Holt

Emily R. Daum

Shelby Homanics

Melinda H. Dean (Kinnan)

Emily C. Horwatt

Erika L. DelRosso

Randi L. Hostetter

Madison Deluca

Taylor T. Howell

Travis S. Dominick

Alexis R. Irwin

Miranda M. Donaldson

Anna E. Jacobs (Goodwin)

Danielle G. Dratch

Shianne Jenkins (Harr)

Meagan Duckwort

Abraham Jung

Anna Marie Eckman

Lacie Keffer

Amy L. Elling

Lindsey Kelly

Kari L. Faychak

Christina D. Kempff

Kacey M. Klein

Shelbie L. Roman

Kaylee E. Kooser

Samantha J. Rubin

Kristina M. Koza

Maura Rusch

Stephanie M. Kuhns

Nina M. Schick

Caitlin R. LaBute

Noah M. Schick

Jeanine A. Lukas

Arielle L. Schneider

Brandy L. Lutz

Danielle R. Schrift

Mercedez A. Lynn

Rachelle Schultz

Theresa A. MacBlane

Mackenzie Sendro

Sarah R. Marinchak

Brynley Shannon (Hershall)

Janelle Marshall

Amanda K. Short (Capelle)

Lindsey M. Mathews

Brooke R. Sieminkewicz

Alicia M. McCutcheon

Kacie K. Sisti

Christian J. McNeish

Margaret R. Smith

Morgan L. Miller

Melissa D. Snyder

Amanda J. Miller

Rebecca J. Soike

Shane E. Miner

Madelyn Soles

Zachary J. Montenary

Desiree J. Stikkel

Courtney N. Morrison

Alyssa R. Stinebiser

Alicia Morrow

Abigail J. Stoner

Austin Morton

Kalyn Stutzman

Nichole Nadeo

Daniel H. Thomas

Megan N. Nicholson

Kearston A. Turner

Samantha M. Nolan

Abigail Wade

Justin J. Overly

Paige M. Weaverling

Magdalena Perez

Lindsey T. Webb

Amanda Piccolino

Chasity M. Weiers

Sara C. Pigan

Brieana J. Weimer

Carey A. Proctor

Alexis White

Meghan M. Raygor

James Wirt

Molly M. Reese

Bailey E. Worthing

Jessica M. Richter

Colleen M. Zufall

Tiffany A. Ritenour

Growing Educational Partnerships The need for Registered Nurses (RNs) in the U.S. is expected to intensify as Baby Boomers retire and the need for healthcare grows. According to the Bureau of Labor Statistics, RN is listed among the top occupations through 2026, and the RN workforce is expected to increase by nearly 204,000 – or 15 percent annually. The drive to fill open nursing positions necessitates the need for strong partnerships between healthcare systems and nursing schools.

Excela Health helped to grow the effort by establishing additional undergraduate nursing programs in other institutions within close proximity to the health system’s three hospitals. “Excela was very instrumental in assisting our program to obtain its initial approval through the Pennsylvania State Board of Nursing,” said Diane Kondas, DNP, RN, CRNP, Nursing Program Director at Seton Hill University.

In order to respond to the need for qualified nurses, Excela Health has continued to grow relationships with area colleges and universities and assist in the development of new, four year nursing programs at the University of Pittsburgh at Greensburg, Seton Hill University, and Saint Vincent College. The connection between Excela Health and its education partners has been dynamic for all entities. “The relationship with Excela has been so ben eficial in so many ways. Our students are doing their clinical rotations at all three hospitals, learning to provide excellent patient care,” said Marie Fioravanti, DNP, RN, Director of Nursing at the University of Pittsburgh’s School of Nursing at Greensburg. In addition, according to Fioravanti, support from Excela’s Nursing Leadership includes mentoring, offering expertise, guest lecturing, and providing specialized teaching for obstetric courses. The Bachelor of Science in Nursing (BSN) undergraduate program at Pitt-Greensburg, the first in Westmoreland County, began in April 2017 with 18 students and has grown to the current enrollment of 80 in less than three years.

Second-year students from the University of Pittsburgh at Greensburg enjoy clinical experience at Excela Health.

Alissa Wilkins, BSN, RN on unit 3N at Latrobe Hospital takes a moment to share with students from the University of Pittsburgh at Greensburg.

Seton Hill’s Daniel J. Wukich School of Nursing, a traditional four-year BSN program, opened in the fall of 2019 and is the newest addition to the university’s health sciences programs. “Our purpose is to prepare safe, competent, professional nurses guided by ethics, critical thinking, evidence-based practice, and practice standards,” said Kondas. “Our graduates will work to transform the quality of healthcare in the world and demonstrate respect and compassion for every person.” The BSN program at Saint Vincent College in Latrobe also welcomed its first cohort of nursing students in August 2019. The newly established program is associated with a well-known Pittsburgh nursing education partner, Carlow University. “Students are offered small class sizes that allow for a high-quality, personalized educational experience utilizing Carlow’s nursing curriculum while living on the Saint Vincent campus,” said Carla Tomas, MSN, RN, is the BSN Coordinator of the program at Saint Vincent and faculty member at Carlow. Excela was immediately on board to offer educational support to the 27 students, who are part of that inaugural nursing program. “When the idea was proposed, Excela Health graciously committed to providing our nursing students with a wide variety of clinical experiences to enrich their learning. It is our hope that our graduates will contribute to the workforce at Excela Health,” said Tomas. Kondas anticipates a direct correlation in the program growth at Seton Hill and the relationship with Excela. “The Nursing Education Department at Excela Health is a wonderful resource for our university,” she said. “The clinical affiliation meetings hosted by the Nursing Education

Department provide excellent information and support. Additionally, the Annual Evidence-Based Practice Research Day (at Excela) was very well done and I look forward to bringing students in the future.” Kondas hopes to grow the current enrollment of 26 students to 40 each fall with the help of nursing leaders at Excela Health. “In all of our interactions and planning, (Nursing Administration) has provided enthusiastic support for our program development,” she said. Beyond expectations of growth in education, the BSN programs at all three institutions will turn nursing students into qualified, patient-centered providers. “We are grooming some of the students to be the future leaders at Excela,” said Fioravanti. “It’s wonderful to provide intra-professional health care and teach students with a variety of perspectives just how (healthcare professionals) think and why they think the way that they do.”

We are commied to advancing the profeion of

nursing..

Excela Nurses Contribute to Profession by Taking on Roles as Clinical Instructors Many Excela nurses participate in academic practice partnerships with local schools to teach as well as provide clinical instruction for students. A noteworthy example is the partnership between Deb Lewis, DNP, RN, CNE, a senior educator, and Mackenzie Wargo, BSN, RN-OB, a nurse on the Family Additions Maternity Unit at Westmoreland Hospital. Lewis and Wargo worked together to support students at the University of Pittsburgh School of Nursing at Greensburg. Lewis created the course content and provided classroom instruction while Wargotendered the clinical instruction on the OB unit. Students working with them showed exceptionally high Kaplan test scores.

NURSE LEADERS HONORED The University of Pittsburgh School of Nursing at Greensburg honored Excela Health Senior Vice President and Chief Nursing Ofﬁcer Helen Burns, PhD, RN, NEA-BC, FAAN, at the commencement ceremony with the presentation of the President’s Medal for Distinguished Service. She was honored for her expertise in the area of nursing and the guidance that she provided to Pitt-Greensburg as it developed a program for a Bachelor of Science in Nursing, the ﬁrst accredited BSN program in Westmoreland County. Through Dr. Burns’ efforts, the next generation of nurses are able to learn, live and serve in Westmoreland County. Dr. Burns was also the keynote speaker for the school’s White Coat ceremony in August of 2019.

Deb Lewis, DNP, RN, CNE

Director of Professional Practice and Care Transformation / Associate Chief Nursing Ofﬁcer Mary Mantese, DNP, RN, CENP, was the guest speaker at the Sigma Theta Tau Eta Chapter induction ceremony for nursing students from both the Pitt-Greensburg and Pitt- Johnstown campuses.

Interprofessional Collaborative Practice Interprofessional Approach to Creative Solutions Excela Nursing teams are constantly collaborating with various other disciplines to reach solutions to day-to-day issues. • Nurses in the GI Lab at Excela Square at Norwin’s Ambulatory Surgery Center discovered four errors in colon/gastric biopsy specimens. They collected thousands of colon/gastric biopsies over the course of the year, but these four generated a concern. Even one is too many. Upon further investigation, it was discovered that there were similar errors across the system (10 total) and the probable cause was identified. A team was created, including representatives from Nursing, Anesthesia, Physicians, Laboratory and Quality. A process change was identified and implemented systemwide. There were zero additional errors in 2019. • Nurses in the Short Stay Unit at Latrobe Hospital were struggling with admitting the first cases to the OR and with having to prepare required IV antibiotics because the Pharmacy wasn't open until after the surgery was scheduled to begin. Supervisor Karin Yesho, BSN, RN collaborated with the Pharmacy, which agreed to schedule the IV tech in the Pharmacy 30 minutes earlier to prepare and deliver the required meds to prevent delays in the OR schedule.

Accountability, Competence and Autonomy Workflow Modifications Maximize Efficiency Excela nurses are continually working to improve the efficiency and effectiveness of day-to-day life in the units/departments. As patient care needs and process challenges arise, Excela nurses continue to strive for excellence.

Color-Coding Pediatric Name Badges in Preparation for Emergencies The Ambulatory Surgery Center at Excela Square at Norwin experienced a vast increase in the number of pediatric cases. To assure expedient care in the event of an emergency, nurses agreed to measure every child entering the center for treatment with the Broselow® Tape as part of the pre-operative process. A colored dot is placed on the child’s name badge that corresponds to the drawer in the cart that would be used for that specific child in the event of a medical emergency. This simple step saves valuable time in an emergency and has succeeded in allowing staff to feel more prepared for the influx of pediatric patients.

“

Continually Driving Efficient and Safe Patient Flow

Latrobe Hospital has initiated bedside triage to increase patient flow through the Emergency Room. — Melinda Dean, BSN, RN

At Laurel Surgical Center, if our census is low, we admit and recover in the PACU to increase productivity and contain cost. — Maureen Cutrell, BSN, RN

In the PACU at Westmoreland Hospital, we work together to promote a quick turnover time by getting report from the OR nurse and the CRNA in a timely manner, which frees them up to begin the next case. — Kimberly Riggen, BSN, RN

“

We are committed to being better today than we were yesterday.

We initiated an OR first case on time start challenge, which the whole staff staff has worked on together. — Brandy Deal, BSN, RN Westmoreland Hospital OR

60-DAY READMISSION RATES 16.4% 15.9%

CMS BENCHMARK

EXCELA HEALTH

Two New RN Clinical Transitional Liaisons Support Patientsâ&#x20AC;&#x2122; Shift to Skilled Home Health Care Kristen Barber, BSN, RN, and Heather Rosky, BSN, RN (pictured) are Excelaâ&#x20AC;&#x2122;s pioneer Clinical Transitional Liaisons within our Home Care program. In their roles, they meet and greet patients and their families before the transition to the community under skilled home healthcare. They identify patients at high risk for readmission and communicate their findings with the interdisciplinary treatment team. They are working with the skilled nursing facilities to make the transition to the home easier and safer while being able to provide education to patients and their families on the skilled home health benefit and what to expect from the Home Care team. By coordinating care and maintaining frequent contact with the patient and the treatment teams, they have been successful in diverting many hospital readmissions. Readmission rates for patients under their care are lower than the agency percentage for this vulnerable patient population. They also have become valuable resources for Excela treatment teams. The program had a 60-day readmission rate of 15.9%, which was better than the Centers for Medicare and Medicaid Services (CMS) benchmark of 16.4%.

The patient and family are the center of our professional practice and actively participate in planning their own care.

Whatever the setting – in one of our three hospitals, at one of our community practice sites, diagnostic and surgical facilities, or in the patient’s home – Excela Health nurses are passionate about their practice and committed to making a difference every day in the lives of the patients and families we serve.

STRUCTURAL EMPOWERMENT Teaching and Role Development, Commitment to Community, Professional Development and Recognition of Nursing

Structural Empowerment encourages shared decision-making that creates decentralized, lifelong professional development and strong community relationships. Structural Empowerment allows empowered nurses to shine.

Teaching and Role Development ! ! !

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Bleeding events with PCI were trending upward. Robin Weyandt, BSN, RN, CCRN, Clinical Nurse Coordinator Quality, Heart Center, investigated and found that education was needed on management of a “bleeding” femoral access site, quick recognition of hematoma development and a more thorough documentation of required assessments. She created and conducted education on units that care for post-cath patients, which included hematoma identification methods to control bleeding, and she worked with Information Technology to improve documentation. Weyandt’s efforts were successful and bleeding events stabilized.

Innovative Strategy for Stroke Care Nurse Educators enlisted the help of Excela Health volunteers to conduct “Mock Codes” to enhance stroke training. Volunteers were coached on symptoms that mimic a stroke and were placed in a patient room, pretending to exhibit the symptoms. A rapid response team (RRT) alert was called and staff who responded were able to hone their skills through the training exercise. The use of “standardized” patients in education has proven valuable in decreasing clinician anxiety as well as enhancing critical thinking and communication skills. The mock codes took place at all three hospital campuses. “There are always opportunities when we do mock codes. We provide staff education, change the scenario to emphasize certain points and select the location based on other factors,” said Deb Jenkins, MSN, RN, NPD-BC, CCRN-K. Escape Rooms, “Safety Nightmare” Rooms and a Journal Club are other avenues used to encourage continuing education for nurses.

Vascular Access Orientation Workshop Vascular Access Team nurses identified education inconsistencies across the system, including identifying IV lines, IV starts, CVAD dressing changes, CVAD blood draws, documentation in the EMR and erratic shadowing experiences. Due to the recent large volume of newly hired nurses, the team created a four-hour IV/CLAB workshop for all RN/LPN new hires. The class takes place during CORE orientation, is taught by Vascular Access Team members and is standard IV education with hands-on training and simulation. New nurses now begin work on their units with a better overall understanding of peripheral and central lines, dressing changes, blood and culture draws from a central line and confidence to start a peripheral line.

Commitment to

COMMUNITY

We are stewards of our finances and community resources.

Excela Nurses Give Back to the Community Relay for Life Staff from units 3D and 3E at Westmoreland Hospital showed their #ExcelaPride by participating in the Greensburg Relay for Life. The team raised $300 on the day of the event and $1,000 total for the American Cancer Society. The team hopes to encourage other departments to join them next year, increase their fundraising to help support research efforts, facilitate rides to and from treatments and provide education and awareness about the incidence of cancer and preventive measures in the community. Latrobe and Frick Hospitals Partner with Rotary International on Wellness Check Initiative Latrobe and Frick hospitals work with Rotary International to offer low-cost health screenings to the community. The screenings function outside of the constraints of health insurance coverage, allowing those with little or no medical coverage, or with high-deductible plans, to seek much-needed health services and to connect with physicians who can help manage underlying conditions identified by the testing. Screenings help to detect many potential health problems including anemia, bleeding disorders, electrolyte imbalance, diabetes, heart, kidney, liver, neuromuscular and parathyroid diseases. Participants can choose the standard blood screening or request additional screenings for other conditions. The Wellness Checks occur in the spring and fall of each year and all community residents are welcome to stop by for screening. In 2019, nearly 500 participants were seen. Maryann Singley, MSN, RN, NE-BC, is the coordinator of the project for Latrobe and Traci Fick, DNP, RN, NEA-BC, is the coordinator for Frick. Fick also served as the vice president of the Mt. Pleasant Rotary in 2019. Christmas Food Drive benefits Derry Area School District With the help of Derry Area community businesses, staff from Latrobe Hospital and Excela Square at Latrobe donated 150 boxes of food staples and fixings for Christmas dinner to families with children in need throughout the Derry Area School District. Nursing coordinated the project, but all departments at Excela as well as the Latrobe Area Hospital Aid Society, collected donations including boxed stuffing, jars of gravy and spaghetti sauce, canned green beans, corn, cranberry sauce, yams and soup as well as boxed pasta and macaroni and cheese. Hospital staff delivered the boxes to Derry Area High School and students unpacked the cars.

Excela Nurses Give Back to the Community ... Often in Unexpected Situations Everyday Heroes | Frick Nurse Saves Life of Motorcycle Accident Victim Amber Anderson, RN, had just completed a 12-hour shift in the Emergency Department at Frick Hospital. On her way home, a motorcycle passed her as she drove up a mountain road. Just as she reached the top of the mountain and began her descent, her car struck some debris. She saw more debris scattered along the road, but couldn't see anyone or any evidence of an accident along the remote stretch of highway. She recalled the motorcycle, and shared that: “I just had this instinct telling me to turn around for a better look.” She returned to the area amid darkness and fog and saw a man leaning against the guardrail with his leg in the air. It appeared that his foot was missing. The area was so isolated that no homes could be seen and cellphone service was problematic. Anderson created a tourniquet to control the bleeding and called 911 to dispatch Emergency Management Services to the scene. “The same EMS service that brought me my last patient showed up to help,” she said. Together they stabilized the man for transport to a trauma center. A few days later, Brandi Hall, MSN, RN, NE-BC, Clinical Director, Patient Care Services, Frick Hospital, received a call from the victim’s father sharing that one of her nurses had saved his son’s life, for which he was eternally grateful. As she recapped the story, Anderson smiled and said, “It’s a night I won’t forget.”

Everyday Heroes | Nurses Offer Emergency Support to a man in a Restaurant Three members of the Excela Health Perianesthesia Leadership Team – Jessica Stack, MSN, RN, Le Ann Kaltenbaugh, MSN, RN, CNOR, CSSM, and Brian Berry, CRNA, MBA, MS – were attending an off-site meeting and went to a nearby restaurant during a break. A man dining there fell and was unresponsive. The three Excela nurses immediately provided assistance and stayed with him until EMS arrived and he was transferred to a local hospital. These individuals were awarded “Employee of the Month” in acknowledgement of their help.

Excela Nurses Give Back to the Community Everyday Heroes Muddy Princess Run Several nurses from the Gastrointestinal Lab at Westmoreland Hospital and the Laurel Surgical Center participated in the Muddy Princess Run, which benefits breast cancer charities such as “iGoPink.” Jessica Stack, MSN, RN, along with Jessica Stas, RN, and Wendy Mica, BSN, RN, (right) were proud to be covered from head to toe in dirt as they completed the rigorous obstacle course while wading through pits of mud. Afghans Warm the Hearts of Grieving Families While many of the things we do to “give back” to the community benefit charities and organizations at large, the yarn drive by unit 2 East at Latrobe Hospital directly supports patients and families that nursing teams care for personally. Nursing staff held a drive to collect yarn, which hospital volunteers crocheted into afghans. These hand-made blankets are then given to patients who are sick and dying as a gift of love and support. The response has been extremely positive, as evidenced by the following post from the Across Westmoreland Facebook page.

I also want to acknowledge the person that crocheted this blanket for my mom that was with her when she passed and gifted to me. The level of care and compassion of all the nurses made this difficult time possible for me, my mom and my family. In no other place have I seen this level of genuine loving and compassionate care. To the person who made this, I thank you so much! Words can’t express how much it means to me.

“

My mother passed away a month ago after a 20-month battle with cancer. Throughout this time, she was admitted to various hospitals and we met with many doctors, nurses and other healthcare professionals. The care my mother received at Latrobe Hospital by far was the most exceptional we experienced. She was on the oncology floor called 2 East and was lovingly cared for by some of the most amazing nurses I have met. Lois Wozny and Donia Wills were like angels sent from heaven, and I will never forget them and what they did for mom in her last days.

COMMITMENT TO PROFESSIONAL DEVELOPMENT Professional Governance Council and Committee Highlights

NURSING PROFESSIONAL PRACTICE EVALUATION COMMITTEE (NPPEC) Rena Piper, BSN, RN (LEFT) | 2019 Chair and Bridget Rafferty-Himler, BSN, RN, CCRN (Right) | 2020 Chair

Nursing Professional Practice Evaluation Committee Awarded with Magnet Exemplar The Excela Health Nursing Professional Practice Evaluation (NPPE) Committee was awarded the distinguished honor of being named an “exemplar” by the Commission on Magnet. An exemplar is a concept, practice or program worthy of imitation. The nursing professional practice evaluation process was designed to promote peer review as well as professional and educational development without punitive implications. The Committee was created to support nursing autonomy and accountability with a goal of tracking, trending and improving adverse patient safety events. The Commission on Magnet referred to the EH NPPE Committee as “courageous, cutting-edge and effective in improving outcomes. The NPPE Committee is unique and has not been adopted by other organizations in Pennsylvania or the nation.” The EH NPPE Committee was presented at the American Organization of Nurse Executives (AONE) and we are in the process of publishing. Excellence in nursing practice, exemplary quality outcomes, and an environment that fosters shared leadership and decision-making are the components that define Excela Health Nursing.

2019 Professional Governance Council and Committee Model and Accomplishments COMMITTEE

CHAIR

ACCOMPLISHMENTS • Assured Excela Nursing’s mission, vision, values and strategic plan are aligned with the organization’s priorities to improve patient outcomes and organizational performance

NURSE EXECUTIVE COMMITTEE

Helen K. Burns, PhD, RN, NEA-BC, FAAN

• Optimized nursing care delivery systems and multidisciplinary collaborations to allow all nurses to work at the top of their education/training and licensing • Established standards for nursing practice consistent with state, regional and national regulations and professional standards as recommended by professional organizations

ADVANCED PRACTICE PROVIDER (APP) COUNCIL

PRACTICE EXCELLENCE COUNCIL

• Initiated inaugural APP educational conference

Rebecca Sullivan, DNAP, MHS, CRNA

Chantel Glasser, BSN, RN

• Increased presence of APP through community projects • Increased cohesiveness of APPs through joint initiatives with Excela Heath System • Created practice alerts to remind staff of care standards after a serious event has occurred • Created Chemotherapy/Oncology Workgroup to improve and standardize overall cancer care • Advanced new Cardiac Monitoring and Skills Competency

MANAGEMENT COUNCIL

Kathy Radocaj, MSN, RN, CCRN

• Reviewed operational needs that support clinical and professional nursing practices across the Excela Health System • Implemented Medication Error Workflow • Facilitated Peer Review Process • Instituted the council review of Grievance Summaries and Ethics reports and facilitated interaction and idea-sharing

LEADERSHIP COUNCIL

Heather Mascarello, MSN. RN

• Presented LEM Goals and goal descriptions at monthly meetings to facilitate active dialogue that enhances and ensures patient safety • Engaged in Magnet accreditation process with creation of sources of evidence and participated in site visit survey

COMMITTEE

CHAIR

ACCOMPLISHMENTS • Revised and updated by-laws

PROFESSIONAL GOVERNANCE COMMITTEE

PROFESSIONAL IMAGE AND COMMUNITY PARTNERSHIPS WORKGROUP

Charity Patterson, RN-BC

• Collaborated with Magnet Maestros, Unit Based Council Chairs, Educators and Nurse Residents to Summer Showcase Boards highlighting excellence • Moved to change name from “Shared Governance” to “Professional Governance”

• Collected food donations for the Caring Cabinet

Angela Miller, RN

• Gathered toiletries and distributed to families in the Jeannette School District • Organized a basket raffle with proceeds benefitting Excela Cardiovascular and Women’s Health • Approved scheduling guidelines

STAFFING COMMITTEE

Michelle DeLancey, BSN, CCRN

• Implemented employee survey regarding staffing issues • Analyzed the impact of non-clinical tasks being performed by direct patient care staff and resolutions to decrease time away from patients • Participated in 5th Annual EBP and Research Forum

EVIDENCE-BASED PRACTICE AND RESEARCH COMMITTEE

Jessica Love, MSN, RN, CNL

• Met goal to provide educational opportunities for Nursing Management, EBP committee members and champions, and nursing staff by approving and releasing the final set of EBP Net Learning modules, which covered submission and dissemination of EBP projects • Tracked and assisted with capstone projects, including eight DNP projects

PROFESSIONAL DEVELOPMENT COUNCIL

Becky Breegle, BSN, RN

• Educated staff on Professional Practice Model and collected stories on how staff represent components of the Guiding Principles • Combined PDC with Professional Image Committee and Professional Advancement Committee • Increased number of certified nurses and continued to work on strategies to encourage certification • Grew council in inaugural year (2019) from just RNs to include PICs, MAs, and LPNs to represent all aspects of the EHMG team

PRIMARY CARE COUNCIL

Kim West, RN

• Implemented preceptorship program • Organized group to volunteer in the community by helping Otterbein United Methodist Church with weekly meal called Feeding the Spirit

Summer Showcase Boards Highlight Excellence Systemwide At the center of the Excela Professional Governance Model are the Unit Based Councils (UBC). During the summer of 2019, UBC chairpersons teamed up with Magnet Maestros, the Professional Governance Committee, and Nurse Residents and Educators to create Summer Showcase Boards that highlight systemwide excellence. Nurses across the system voted for a winner. The winner of the Summer Showcase Board contest was the PCU / ICU unit at Frick Hospital. Their board highlighted: • Quiet times for patient satisfaction • Strategies that improved C. diff rates • Successful fall-prevention efforts • Themed days during Nurses Week, such as “Franks-a-lot Hot Dog Day” and “Have a Slice Day” pizza party • Donations to the local food bank

Other Examples |

SDU, Westmoreland

Quality

Heart Center, Westmoreland

PerioOp, Westmoreland

PCU, Latrobe

ICU, Latrobe

NURSING CERTIFICATIONS 17 percent of Excela Health RNs have specialty certifications Excela Health was the 2019 Success PaysÂŽ Video Contest Winner. Winners of this contest are hospitals enrolled in the Success PaysÂŽ program of the American Nurse Credentialing Center that provide abundant opportunities for their nurses to earn board certification. Thanks to Chris Kravetsky, BSN, RN, PHRN as well as the Professional Advancement Committee for creating and submitting the winning video.

NURSING CERTIFICATIONS Certiﬁed Case Management Joyce Hodczak

Wound Care Certiﬁed Christine Maust

Certiﬁed Diabetes Educator Michele Axelson

Certiﬁed Wound, Ostomy and Continence Nurse Sarah Vanderelli SandraLee Hartman Abby Johnston

Certified Emergency Nurse Laurie Dearmitt Diane Davis Kelly Bedner Nicole Komenda Paul Blycheck Certified Hospice and Palliative Nurse Sarah Klaum Certified Hospice and Palliative Nurse Mary Jo Bellush Deborah Schotting Certified Occupational Health Nurse and Certified Occupational Health Case Management Megan Kapolka Eileen Kantorik Patricia Vomish Certified in Professional Healthcare, Quality Denise Addis AnneMarie Scekeres Bonnie Barnhart Jessica Spiker Carrie Horner Certified Wound Care Nurse Patti Hutchinson Lori Crawford Kimberly Strashensky Certified Ostomy Care Nurse Patti Hutchinson

Certified Wound, Ostomy Nursing Abby Johnston Certified Wound Specialist Darlene Brottish Anna South RN Certified Inpatient OB Barb Bumar Wendy Reynolds Sharon Andreani Colleen Dyche Krystelle Syster Mackenzie Wargo Nicole Hall International Board Certified Lactation Consultant Tracey Downs Amy Little Taylor Stiffler Kelly Garvin Certified Unified System Data for Medical Rehabilitation Michelle Stevens Childbirth Educator Susan Patula Certified Medical-Surgical RN Kortnee McGinnis Donna Ross

Jacquelyn Crowe Kacie Klimchock Rebecca Breegle Cari Reidmiller Patricia Hobaugh Samantha Lorincz Jill Como Registered Cardiovascular Invasive Specialist Elizabeth Dell Certified Executive Nursing Practice Mary Mantese Certified Progressive Care Nurse Virginia Iscrupe Jennifer Kruel Elizabeth Kulick Certified Gerontological Nursing Dawn Henry RN-BC Nursing Informatics Sally Backus Mike Widmann Karen Edmunds Kennette Grohal Shirley Brandon Certified Professional in Patient Safety Jennifer Gregory Nurse Executive, Advanced Traci Fick Helen K. Burns Nursing Professional Development Deborah Jenkins Sheila Farina Kristine Szarejko Stacy Gibson

Certified Nurse Operating Room Leann Kaltenbaugh Chad Toth Lisa Ponko Certified Psychiatric Mental Health Nursing Randy Pritts Deborah Barricklow Heather Miller Patricia Yorko Katie Brant Rachel Prettiman Rhiannon May Certified Maternal-Newborn Nursing Jessie Hall Janine Wright Certified Nurse Educator Deborah Lewis Certified Ergonomics Specialist Eileen Kantorik Certified Oasis Specialist Jacqueline Peterson Cheryl Johnson Jennifer Faris Laura Davis Patricia Lebin Certified Professional in Healthcare Risk Management Denise Smail Certified Nurse Executive Michelle Lewis Maryann Singley Brandi Hall Glenn Repko Elizabeth Labish Vickie Jellison Jennifer Barrick Wendy Reynolds

Certified Prospective Payment System Coordinator Michelle Stevens Cardiac Vascular Nursing Amanda Urosek Certified Flight RN Lori Lorenzi Clinical Nurse Leader Jessica Love Certified Surgical Services Manger Leann Kaltenbaugh Certified Ambulatory Care Nursing Stacey Bush Prehospital RN Nicole Komenda Christopher Kravetsky Jeffrey Siegel Carrie Oshie Certified, Electronic Fetal Monitoring Wendy Reynolds Certified Critical Care RN Michelle Delancy Bridget Rafferty-Himler Debbie Jenkins Glenn Repko Benjamin Collins Christen Stercho Mike Widmann Kala Hutchinson Karen Scanlan Terry Walker Jamie Kimmick Chantel Glasser Michelle Garlena Melissa Anderson Erika Mough

Kathy Radocaj Alexandria Kopco Brittany Lubinsky Robin Weyandt Josilyn Burnsworth Chad Toth Lisa Tomko Bridget Matthews Earl Gardner Lori Lorenzi Taylor Holt Certiﬁed Registered Nurse Anesthetist Amy Acie Michele Bailey Lisa Berdar Linette Copelli Cynthia Donatelli Patricia Eisner Lou Ann Forish Lisa Groft Deborah Hill Mark Kantola Megan Lazur Beverly Nickelson Yvonne Rafter Heather Scanlon Rebecca Sullivan Renee Wilson Staci Alexander Terri Baker Brian Berry Melissa Cunningham Terry Doney Jennifer Ellena Cynthia Gladora David Guidry Brian Holt Rae Ann Kozinko Kelly Malone Tammy Nuzzo Donna Ross Kristen Schnauber Susan Tranchine Jessica Angeliccio

Melissa Baras Danielle Cooley Carol Curry Joseph Dorazio Diane Fair Amy Graham Cara Haines Todd Hrtyanski Patrica Kuster Leslie McClarren Theodore Oshie Joelle Sabatine Nicholas Shinsky Vicki Vecvhiolla William Antonucci Robin Bell Sarah Copanzzi Michael DeBroeck Lori Droschak Deborah Ferriero Danielle Gray Joseph Herman Julie Hutchinson Jillian Lager Stephen Miller Amanda Pierce Victor Sansing Megan Spivak Lisa Vittone CertiďŹ ed Nurse Practitioner Mary Augustine Ashley Batsa Vicki Beal Kimberly Beck Matthew Beckman Emily Bele Brittany Brown Elizabeth Byers Maria Chichilla Laurie Christner Sally Cline Amanda Connors Lauren Cowan

Erin Dieter Kayla Ellis Kelly Emswiler David Geiger Keri George Mallory Gergely Tami Judy Family Nurse Practitioner Toni Maline Lydia Manzini Charlene McFeeley Janine Meneghini Mandee Mikeska Rebecca Monteparte Diane Navarre Shiela Otwane Dawn Repak Shawnaa Rutkowsky Beth Ann Schmidle Bernadette Sherman Leslie Skweres Rene Smail Danielle Smith Kelly Snively Anna Kay South Jennifer Stewart Chantel Trice Tara Welsh Leanne Wiltrout Neo-Natal Nurse Practitioner Regina Oâ&#x20AC;&#x2122;Leary Kathleen Campbell Kathleen Eisensmith Karen Ewing Mary Kish Merry Kruger Ann Marie Becquet Amy Medved Lisa Sontheimer Susan Barbarossa Lisa Sontheimer

Woman's Health Care Nurse Practitioner Mary Draghi Cathy Piper Acute Care Nurse Practitioner Marybeth Mazur Chad Toth Advanced Oncology Certified Nurse Practitioner Ray Paronish Adult Gerontology Acute Care Nurse Practitioner Jerod Smith

LIFELONG LEARNING: Nurses Earning Advanced Degrees BSNs Lynn A. Adamrovich Lisa M. Bertolino Kristy L. Bianco Susan M. Campbell Angelina M. Cantos Gena R.Gena R. David Melinda H. Dean Tyler W. Dickey Shelby M. Emert Brenda S. Frank Kaylee M. Gessler Jodi L. Glesk Vanessa M. Gruss Gabrielle M. Himes Amanda L. Hribal Kimberly M. Kanala Ashleigh E. Kinkead Regina G. Kintz Kacey M. Klein Staci A. Klimchock Melinda L. Kopper Kayla L. Kukurugya Carol A. Lipinski Lori J. Lorenzi Lindsey M. Lowe Theresa A. MacBlane

Melanie Markle Christine D. Maust Lauren L. Mildren Randall L. Miller Jr. Heather L. Miller Courtney L. Milsom Casey L. Neal Lindsay Odonnell Rachael M. Pataky Lyndsie T. Porter Bridget M. Rafferty-Himler Emma C. Rockwell Katelyn M. Rudick Gail M. Santone Ryan A. Schake Julie L. Shultz Madelyn M. Soles Melissa A. Sulkosky Cassandra R. Thomas Kristin A. Von Briel Sarah A. Washburn Sarah B. Weir Jason R. Wojciechowski Kerri A. Worthington

Masters John M. Giesey Jennifer M. Gregory Patricia A. Lebin Heather R. Mascarello Amanda Pierce Justine R. Reinbold Krystelle D. Syster Chad T. Toth Jennifer L. Yanits Doctorate Traci M. Fick

58%

of Excela Health RNs have a BSN degree or higher.

Scholarship Awardee Congratulations to Jordan Culler, BSN, RN, Emergency Department, Latrobe Hospital, on winning the Thomas P. Gessner, MD, Healthcare Scholarship. This scholarship is awarded to Excela Health employees who are currently enrolled in an accredited institution of higher education for one of the healthcare professions requiring education beyond an undergraduate degree.

RECOGNITION OF NURSING

SPECIAL HONORS Pittsburgh Magazine 2019 Excellence in Nursing Each year, Pittsburgh Magazine highlights the unsung heroes of the healthcare field – nurses – in its December issue. This year’s Excellence in Nursing honorees are shining examples of individuals who are working hard to build the future of nursing in a wide variety of settings and disciplines. Receiving Honorable Mention under the Leadership category was Excela’s own Traci Fick, DNP, RN, NEA-BC, Vice President, Patient Care Services at Frick Hospital and Westmoreland Hospital (pictured left with Helen Burns, PhD, RN, NEA-BC, FAAN, Senior Vice President and Chief Nursing Officer). Fick also earned her DNP from Waynesburg University this year.

Excela Health Named Top-Performing Health System in Pennsylvania In Donate Life Hospital Challenge for 2nd Consecutive Year Nurses from Excela Health attended the 2019 HAP Donate Life Pennsylvania Hospital Challenge Awards Luncheon. This event honors individual hospitals as well as hospital systems in the western Pennsylvania, West Virginia and New York areas for their involvement with the Center for Organ Recovery and Education (CORE). This involvement includes hosting, facilitating, and organizing activities within the hospital, health system and community aimed at increasing organ donor awareness. Westmoreland, Frick and Latrobe hospitals each achieved Platinum awards for the work done at their campuses. For the second year in a row, Excela Health attained the Top Performing Health System. Those attending the luncheon were Kathy Radocaj, MSN, RN, CCRN; Karen Scanlan, MSN, RN, CCRN; Heather Samide, BSN, RN; Micaela Hough, RN; Cynthia Allison, BSN, RN; Brandi Hall, MSN, RN, NE-BC; Kelly Gribschaw, RN and Christine Snyder, RN.

CELEBRATING

50 YEARS OF SERVICE In 1969, astronaut Neil Armstrong landed on the moon, a new house could be purchased for $15,000 and Walmart and Wendy’s took off. At Excela Health, one employee was inspired to begin a nursing career by her sister, then a nurse at Latrobe Hospital. Bernadette “Bunny” Wallace celebrates a half century with Excela Health this year. She started nursing in Pediatrics and worked on several floors over the years; she is currently assigned to Neurosurgery and Joint Works. Bunny’s coworkers often recognize her for putting her heart and soul into nursing and going the extra mile to comfort and care for patients at their bedside. Staff also acknowledge Bunny’s unwavering dedication to and knowledge of nursing, especially considering the changes in the field over the last five decades. Bunny has made many memories, met many patients and impacted many lives throughout her career, but she did not expect to be recognized for what she said was ‘simply doing her job.’ She is a gift to our health system and community, the epitome of #ExcelaPride.

CELEBRATING

40+ YEARS OF SERVICE Debra Bayura Ruth Burns Kathy Coffman Gretchen Cramer Marsha Dovyak Evelyn Echard Katherine Goldberg Mary Gorecki Sally Guerrieri Michelina Hair Sherry Holzer

Melanie Jones Rosemary Jordan Kathy Kiliany Wendy Kish Mary Legas Melanie Lunko Gail Marion Rita Martin Susan Melenia Kimberly Mikeska Laura Pizzola

Marianne Povlik Roseann Rudy Dennis Scrabot Wendy Shaffer Loretta Shearer Anna Sikora Debra Stahl Diana Vasinko Elizabeth West Cindy Weston Randi Wichrowski

RECOGNIZING NURSES WEEK AWARDEES Cameos of Caring速 The Cameo of Caring速 program was created in 1999 by the University of Pittsburgh School of Nursing to honor exceptional nurses who demonstrate excellence in nursing care, serve as an advocate for both patients and their families and embody the essence of the nursing profession. Overall, Cameo of Caring速 recognizes the versatility that a nursing career offers and the fact that nurses shine in facets of care. The Cameo of Caring速 goal, simply put, is to honor outstanding nurses for their dedication to quality patient care, increase public awareness of the nursing profession by highlighting career rewards and recruit a new generation of nurses to offset the nursing shortage. Acute Care: Jamie Kimmick, BSN, RN, CCRN Ambulatory Care: Melissa Townsend, RN

Outstanding Care Team Honorees The award recognizes a healthcare team member who is instrumental in building quality practice environments. An outstanding team member may be a licensed practical nurse, technical partner/nursing assistant, nursing service clerk or escort. Escort: Sabrina Fulton

Technical Partner/Nursing Assistant: Patricia Campbell

Nursing Service Clerk: Lindsay Rose

LPN: Brad Showman

Outstanding Nurse Resident Introduced in 2016, the Outstanding Nurse Resident Award is presented to a Registered Nurse who is employed in the Excela Health System, has graduated from nursing school within the past two years and has completed the Excela Health Nurse Residency Program. Chantel Glasser, BSN, RN

Friend of Nursing Award This award recognizes a non-nurse member of Excela Health who has demonstrated leadership that has significantly impacted nursing practice, nursing education, nursing administration, and/or patient safety. Care Support Center staff

Daisy Award Winners

Extraordinary Nurses

Geralyn Susko, BSN, RN Westmoreland Hospital Unit 1E

Jason Wojciechowski, BSN, RN Latrobe Hospital ICU

Kaitlin Kozak, BSN, RN Latrobe Hospital ICU

Jason Scott, RN Westmoreland Hospital ICU

The DAISY (Diseases Attacking the Immune System) Foundation was established in 1999 to recognize extraordinary nurses everywhere who make an enormous difference in the lives of so many people by the work they do everyday. The award was established by the family of J. Patrick Barnes, who died of complications of Idiopathic Thrombocytopenia Purpura (ITP an autoimmune disease).

Travis Dominick, RN Latrobe Hospital ICU

Team Award |

Nurse Leader Award |

Leadership Award |

Neuro/Joint Works Latrobe Hospital

Katie Crovak, MSN, RN Latrobe Hospital Neuro/ Joint Works

Jessica Spiker, MSN, RN, CPHQ Quality

A good nurse leader is someone who can inspire others to work together in pursuit of a common goal.

TRANSFORMATIONAL LEADERSHIP Advocacy and Influence, Strategic Planning, Visibility, Accessibility and Communication

Transformational Leadership is a leadership style in which leaders encourage, motivate and inspire positive changes. Transformational leaders are generally enthusiastic and passionate about making a difference, while also striving to help every member of the team to thrive and succeed as well.

Advocacy and Influence Clinical Support Line: Using technology to bridge the distance gap for the remote workforce Supporting Home Care Nurses in the Community Inpatient stays are trending shorter and shorter. Patients are being discharged with increased clinical demands that our Home Care & Hospice nurses are challenged with meeting. The Excela Health Home Care & Hospice nurses are competent, capable and crafty problem solvers, but recently voiced a desire for a little extra clinical support, particularly outside general business hours.

CLINICAL SUPPORT LINE 724-858-6499

Patti Lebin, BSN, COS-C, Manager, Quality and Value Based Performance with the Excela Health Home Care & Hospice program, responded to this request with an additional layer of support. The Clinical Support Line is a nurse-led mobile telephone resource for traveling staff in the community that is available to render clinical assistance, case review suggestions and care coordination to attempt to avoid hospitalizations and maintain staff safety. It is a virtual lifeline for the clinical nursing team.

â&#x20AC;&#x153;

Throughout my career with Excela Health Home Health, the Clinical Support Line has proven many times to be an irreplaceable asset. With a single phone call, the primary concern is addressed within minutes and the workflow is undisturbed, even if an acute care need of a patient arises. As a clinician, I find a sense of security and in return, the patient is usually able to remain comfortable at home.

â&#x20AC;&#x153;

- Tia Veltre, BSN, RN

Visibility, Accessibility and Communication

Visibility, Accessibility and Communication Essential for Excellence At Excela Health, care delivery is based on a Modified Team approach, whereby patients and families are at the center of the treatment plan and all of the disciplines work together toward achieving positive outcomes. For this model to be effective, all members of the healthcare team must be visible and accessible and interprofessional communication is critical. Nurses at Excela lead the coordination and continuity of care. Nurses assist the patient in navigating the medical system to get the care and treatment they need and identify any gaps in patient care. Strategies such as Nurse Knowledge Exchange (NKE), structured interdisciplinary bedside rounds (SIBR), and purposeful hourly rounding from nurses and nursing support staff help to assure these goals are met.

CLINICAL LEADERS ADVOCATE, GUIDE AND DIRECT Leading the Teams Clinical Directors, along with Nursing Supervisors and Clinical Nurse Coordinators, are instrumental in leading the day-to-day operations of individual units during all shifts. Strategies such as routine leader rounding help facilitate visibility, accessibility and communication among healthcare team members. Nurse leaders work diligently to assure that these strategies are effective.

Ben Collins, MBA, BSN, CCRN

Brandi Hall, MSN, RN, NE-BC

Brian Berry, MBA, MS, RN, CRNA

Tammy Vogel, MSN, RN | Katie Crovak, MSN, RN | LeAnn Kaltenbaugh, MSN, RN, CNOR, CSSM | Vickie Jellison, MSN, RN, NE-BC Christy West, MSN, RN, NE-BC | Kathy Radocaj, MSN, RN, CCRN Jennifer Barrick, MSN, RN, NE-BC| Michelle Lewis, MSN, RN, NE-BC Wendy Reynolds, MSN, RN, RNC-OB, NE-BC | Megan Shearer, MSN, RN

Jessica Stack, MSN, RN

Elizabeth Labish, MSN, RN-BC, NE-BC Susan Overly, MSN, RN

John Giesey, MSN, RN

John Dolan, MBA, BSN, RN | Glenn Repko, MSN, RN, NE-BC, CCRN (right)

We are a family of great people dedicated to the art and science of nursing.

Traci Fick, DNP, RN, NEA-BC, Vice President Patient Care Services, Westmoreland and Frick hospitals and Kelly Neubauer, MSN, RN, Clinical Director in 2019, Westmoreland Hospital Emergency Department (ED), recognize the value of clinical nurse input into decision-making and make listening to staff a priority. A recurring theme heard from nurses in the ED was that the nurses' station was not conducive to effective communication, interdisciplinary teamwork, or efficient patient flow. The station was too small for the number of nurses on staff and physicians and advanced practice providers were located in a separate work station. The existing design did not promote interdisciplinary visibility, accessibility or communication.

Nurses Enjoy Active Roles in Remodeled Emergency Department Nurses Station New design more conducive to interdisciplinary visibility, accessibility and communication

The nursesâ&#x20AC;&#x2122; concerns were taken to Executive Leadership and plans were developed to create a new and updated design. Nurses from all shifts in the ED were able to review the plans and offer input, which included: a sit-to-stand workstation; a different configuration for the Clinical Nurse Coordinator workstation to allow for better visualization; an electronic assignment board to replace the white dry-erase board; the best location to place the assignment board; specific needs for the medication area, including adequate storage for supplies and an appropriate storage height for all nurses to easily reach; and the moving of a central cardiac monitoring viewing station from the corner to a central location so that nurses could see the monitors from anywhere in the station. Nursesâ&#x20AC;&#x2122; input was gathered throughout the building process and, when the remodel was completed in 2019, nurses voiced their immediate satisfaction.

PROMOTIONS TO NURSE LEADERSHIP John Giesey, MSN, RN Clinical Director, Emergency Department, Westmoreland Hospital Giesey has been on staff at Excela Health for 10 years, serving as a nursing supervisor at Westmoreland Hospital, as an RN in the Emergency Department at Latrobe Hospital, and in his new position as the Clinical Director of the Westmoreland Hospital Emergency Department. Adding to his list of qualifications, Giesey has been a nursing clinical instructor at Westmoreland County Community College and has spent some time in Home Care management. When asked about the most remarkable aspect of this new role, he shared that he is humbled and honored with how welcoming and supportive the entire ED team has been. His goal for the future? â&#x20AC;&#x153;I want to improve the emergency treatment process for our patients and our staff,â&#x20AC;? Giesey said.

Jodi Ramsey, BSN, RN Clinical Nurse Coordinator, ICU Frick Hospital

JoAnna Kintigh, BSN, RN Clinical Nurse Coordinator, ED Latrobe Hospital

Trevor Sheesley, BSN, RN Full Time RN Supervisor Westmoreland Hospital

Susan Campbell, BSN, RN Supervisor, Care Support Center Westmoreland Hospital

Brandy Deal Cockrell, RN RN Supervisor, OR Westmoreland Hospital

Jen Danyi, BSN, RN Cross Trained RN Supervisor Westmoreland Hospital

Rachel Kemp, BSN, RN Clinical Nurse Coordinator, PCU Latrobe Hospital

Karin Yesho, BSN, RN RN Supervisor, Perianesthesia Services Latrobe Hospital

Adrienne Alger, BSN, RN Clinical Nurse Coordinator, Behavioral Health Westmoreland Hospital

Emily Cope, BSN, RN Clinical Nurse Coordinator, 4N Latrobe Hospital

Kayla Jones, BSN, RN Clinical Nurse Coordinator, 4AB & 4D Westmoreland Hospital

Our nurses are committed to innovative strategies, lifelong learning and research to advance clinical nursing.

NEW KNOWLEDGE, INNOVATION AND IMPROVEMENTS Research, Evidence-Based Practice and Innovations

New Knowledge, Innovation and Improvements is a leadership style in which leaders encourage, motivate and inspire positive changes. Transformational leaders are generally enthusiastic and passionate about making a difference, while also striving to help every member of the team to thrive and succeed as well.

Research and Evidence-Based Practice 5th Annual EBP and Research Forum Now a yearly success for Excela Health Nursing, the fifth annual Evidence-Based Practice and Research Forum took place on September 26, 2019, at Westmoreland Hospital with a record number of 190 staff and nursing students in attendance. Sponsored by the Evidence-Based Practice and Research Committee, a part of Nursing Professional Governance, the forum is an all-day event developed as a vehicle to allow nurses and other members of the interdisciplinary healthcare team to disseminate evidence-based practice projects. The forum’s theme centered on Relationship-Based Care, a patientcentered healthcare model that is built on the premise that positive human connections support the healing process. Using an evidencebased approach to nursing care improves outcomes and helps nursing meet the Excela mission to improve the health and well-being of every life we touch. Jennifer Burgher Seaman, PhD, RN, faculty member at the University of Pittsburgh School of Nursing, was the keynote speaker and shared her research study of work in the Intensive Care Unit at Westmoreland Hospital titled “Interdisciplinary Family Meetings in the ICU.” Dr. Burgher Seaman co-presented with Julia Snickles, BSN, RN, an ICU clinical nurse and project participant..

FORUM PRESENTERS Interdisciplinary Family Meetings in the ICU

Communication Cards for New Medications

Jennifer Burgher Seaman, PhD, RN Associate Professor, Acute and Tertiary Care University of Pittsburgh School of Nursing Julia A. Snickles, BSN, RN Clinical Nurse Intensive Care Unit, Westmoreland Hospital

Brynley Shannon, RN Nurse Resident, Westmoreland Hospital, PCU 1E Morgan Dube, RN, Nurse Resident, Westmoreland Hospital, PCU 1E

Code Noelle Erika DelRosso, M.Ed., RN Nurse Resident, Family Additions Maternity Center

ABCDEF Bundle Samantha Nolan, RN Nurse Resident, Westmoreland Hospital, ICU

5th Annual EBP and Research Forum (continued) Postpartum Depression Screening Stacey Shankle, MSN, RN Clinical Nurse, Family Additions Maternity Center Motivational Interviewing Michael Rietscha, DNP, RN Clinical Nurse, Westmoreland Hospital, 3AB Workplace Violence Prevention: Building a Reporting System Jamie Malone, MSN, RN, CEN, WTA-C Advanced Clinical Education Specialist, UPMC St. Margaret Hospital Hot Topics in Pharmacology: Vancomycin, Opioids, and Marijuana Dean Matanin, PhD Director, Westmoreland Hospital Pharmacy Michael Sekhon, Pharm.D. Manager, Westmoreland Hospital Pharmacy Nursing Professional Practice Evaluation Committee Rina Piper, BSN, RN Clinical Nurse Coordinator, Latrobe Hospital, 3N Christine Wentzel, MBA, CPHQ, ARRT Quality Analyst, Westmoreland Hospital Bridget Rafferty-Himler, BSN, RN Clinical Nurse, Westmoreland Hospital, ICU Kathleen Rosatti, MSN, RN Director of Clinical Outcomes, Westmoreland Hospital Nutrition Focused Clinical Examination Anita Gallagher, MS, RD, LDN, CNSC Coordinator, Nutrition Support, Westmoreland Hospital W. Michael Widmann, MSN, RN-BC, CCRN Clinical Informatics Coordinator, Westmoreland Hospital Cathy Hunter Manager, Coding Body Explorer Douglas A. Nelson, Jr., PhD Adjunct Assistant Professor, Department of Nurse Anesthesia University of Pittsburgh School of Nursing, President & CEO Lumis Corp.

Poster wins 1st Place at the Clinical Nurse Leader Summit in Tampa, FL Impact of a CNL Emergency Navigator on Overutilization and Care Continuity in a Community Hospital Emergency Department Jessica Love, MSN, RN, CNL; Helen Burns, PhD, RN, NEA-BC, FAAN, Grace Campbell, PhD, MSW, CRRN

The aim of this microsystem project was to decrease overutilization (measured by 3, 7, and 30-day return ED visits) and improve care continuity (measured by completed primary care appointments post-ED visit) through implementation of a Clinical Nurse Leader (CNL) in the ED.

•  N = 289 •  178 completed follow-up phone calls •  111 patients unable to be reached after 2 attempts •  62% response rate !0=00?&

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•  Non-urgent utilization and overutilization of Emergency Departments (ED) comprise a significant amount of ED visits across the United States •  Avoidable ED visits increase healthcare costs, overcrowding, and care fragmentation •  Eliminating ED returns and inappropriate use could reduce spending by $32 billion/year •  ED visits across the U.S. have increased by 21% over the last decade (136.6 million visits in 2014) 4.5 – 8% of ED users

21-28% of all ED visits

Who are they?

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38% - patients presenting with a PCP treatable diagnosis (during time of pilot study) 70% - Female; average age 48.5 years ~66 patients/month with a 3-day ED Return visit 288 patients with 5 or more ED visits in CY2017

Characteristics of Frequent Users of Three Hospital Emergency Departments. Content last reviewed July 2017. Agency for Healthcare Research and Quality, Rockville, MD. http:// www.ahrq.gov/professionals/systems/hospital/ edenvironmentalscan/researchbrief.html

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Doupe, M. B., PhD, Palatnick, Wes, MD, FRCPC, Day, S., MA, Chateau, D., PhD, Soodeen, R., MSc, Burchill, C., MSc, & Derksen, S., MSc. (2012). Frequent users of emergency departments: Developing standard definitions and defining prominent risk factors. Annals of Emergency Medicine, 60(1), 24-32. doi:10.1016/j.annemergmed.2011.11.036

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49% - Poor physical health 36% - BMI’s > 30 23% - Utilize mental health services 82% - Have health insurance 56% - Do not understand discharge instructions 39.6% - Do not understand which symptoms would signal need to seek prompt medical advice

•  This study uncovered the health literacy needs of the population as well as the multiple factors for overutilization and inappropriate ED use in a rural, community ED •  Results of this pilot study suggest that CNL Navigators can positively influence post-ED discharge care utilization and care continuity •  Research examining the ongoing impact of a CNL functioning as an ED Navigator on patient outcomes and on institutional and insurance costs is warranted

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“

It is a true honor for my graduate work and that of Excela Health nurses to be recognized at the national level.

“

SCHOLARLY ENDEAVORS

improve outcomes. Journal of Nursing Management, 21(5), 733-739. doi:10.1111/jonm.12100

Enard, K. R., & Ganelin, D. M. (2013). Reducing preventable emergency department utilization and costs by using community health workers as patient navigators. Journal of Healthcare Management / American College of Healthcare Executives, 58(6), 412-427. doi:10.1097/00115514-201311000-00007

•  Patients aged 18 and older treated at a community hospital ED and discharged to home from June 2018 to August 2018 received follow-up via a phone call 24-72 hours post-discharge that addressed health literacy needs and provided transportation assistance, discharge education, and service recovery •  Call priority based on high utilization &/or PCP treatable complaint •  Referrals made from ED RN’s •  Daily Census •  Survey conducted using “yes/no” questions and ratings •  Initial calls performed by healthcareoriented team from Volunteer Services •  Needs identified and forwarded to appropriate care coordination •  All completed calls received Primary Care Weekend information via mail

Guss, D. A., MD, Leland, H., MD, & Castillo, E. M., PhD. (2013). The impact of post-discharge patient call back on patient satisfaction in two academic emergency departments. Journal of Emergency Medicine, 44(1), 236-241. doi:10.1016/j.jemermed.2012.07.074 Improving the Emergency Department Discharge Process. Content last reviewed July 2017. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/hospital/ edenvironmentalscan/index.html Population Health Advisor, 2017. Expanding the Role of Patient Navigation in the Emergency Department. Soong, C., Kurabi, B., Wells, D., Caines, L., Morgan, M. W., Ramsden, R., & Bell, C. M. (2014). Do post discharge phone calls improve care transitions? A cluster-randomized trial. PloS One, 9(11), e112230. doi:10.1371/journal.pone.0112230 Yang, C., & Chen, C. (2012). Effects of post"discharge telephone calls on the rate of emergency department visits in paediatric patients. Journal of Paediatrics and Child Health, 48(10), 931-935. doi:10.1111/j.1440-1754.2012.02519.x

Jessica Love can be reached for questions at jlove@excelahealth.org or 724-689-5740

Acknowledgements: University of Pittsburgh School of Nursing, Excela Health Volunteer Program, Frick Hospital Emergency Department

We seek new knowledge, ask for feedback and are open to change. Poster earns 3rd Place Honors at Southwestern Pennsylvania Organization of Nurse Leaders Annual Conference in Farmington, PA Use of a Targeted Solutions Tool® to Decrease Falls with Injury

Donna Ross, MSN, RN; Melissa Kelley, BSN, RN; Samantha Lorincz, BSN, RN; Rebecca Zolocsik, BSN, RN; Elizabeth Labish, MSN, RN; Lorrie Bickerstaff, MS-HSL, BSN, RN

•  Falls in hospitalized patients have a significant impact on morbidity and mortality. •  Patients who are elderly and who have co-morbidities are at an increased risk for fall-related injury. •  In patients who fall, up to 35% will develop an injury (The Joint Commission, 2019). •  NDNQI considers a fall with injury anytime the patient sustains injury, even a minor one such as an abrasion or bruise. •  The Targeted Solutions Tool® (TST®) is a “web-based application designed to help …understand the reasons why patients fall and implement evidencebased solutions that can help prevent them” (The Joint Commission Center for Transforming Healthcare, 2019).

The purpose of this project was to utilize The Targeted Solutions Tool® (TST®) as a strategic framework to: •  Compare falls with injury rate on a medical-surgical unit before and after implementation of TST®. •  Develop targeted interventions for the prevention of falls with injury.

•  Staff were educated on the use of the tool and the data collection process. •  Data-driven discussions about problems and “hot spots” (areas of greatest concern) occurred during daily unitbased meetings. •  Targeted interventions for fall-related injury prevention were created: •  Hourly rounding on all patients •  Standardization of Nurse Knowledge Exchange (NKE) bedside handover report •  Confirmation of bed alarm activation at every handover •  Fall risk assessment level noted on each patient’s bedside white board •  Validation with nurses’ initials on the whiteboard that the fall risk assessment level was reviewed

•  NDNQI definition was used for falls with injury. •  Patient data were entered into the tool after each fall •  Data were graphed and displayed on the unit’s continuous improvement board. •  Falls with injury rate was calculated as falls per 1,000 patient days. •  Baseline rate for falls with injury was 1.05%/1,000 patient days. •  Benchmark was set at 0.53%/1,000 patient days for a goal of 50% fall reduction in falls with injury.

•  There was an immediate decline in falls with injury. First month rate was zero. •  The fall reduction goal was exceeded, with a one-year post implementation fall with injury rate of 0.34%/1,000 patient days.

•  Validation of fall risk and fall prevention measures during NKE at the bedside empowered nurses to be drivers of the improvement project. •  Discussion of fall prevention during bedside NKE helps engage the patient and family. •  Exploration of “hot spots” on a daily basis kept fall prevention front and center.

•  Using the TST® to track falls in real time helped staff identify when the falls were occurring. •  Use of the tool and targeted interventions decreased the unit’s fall with injury rate. •  This tool is being deployed system-side.

Lorrie Bickerstaff, RN, MS-HSL; Melissa Clark, BSN, RN; Kelly Glaser, RN; Elizabeth Labish, MSN, RN-BC; Samantha Lorincz, RN, CMSRN; Donna Ross, BSN, RN, CMSRN; and Rebecca Zolocsik, BSN, RN were contributors.

2019

Professional Presentations and Publications in Nursing

PUBLICATIONS Hunter, Y. (2019, April). Ideas that work: Sterile techniques. Outpatient Surgery Magazine, XX (4), 17. PRESENTATIONS Schotting, D., & Grote, J. (2019, February). Engaging multi-disciplinary expertise to generate sustained improvement. Webinar Series of the Association for Professionals in Infection Control and Epidemiology (APIC). Berry Jr., B. (2019, March). Leadership and emotional intelligence. Podium presentation at the Annual Arizona Association of Nurse Anesthetists Sun and Fun 2019 Conference, Scottsdale, AZ. Berry Jr., B. (2019, March). Pharmacogenetics: The future of anesthesia? Podium presentation at the Annual Arizona Association of Nurse Anesthetists Sun and Fun 2019 Conference, Scottsdale, AZ. Berry Jr., B. (2019, March). The new healthcare buzzphrase: Value not volume. Podium presentation at the Annual Arizona Association of Nurse Anesthetists Sun and Fun 2019 Conference, Scottsdale, AZ. Barnhart, B., Horner, C., Brown, A., & Radocaj, K. (2019, April). Process and cultural interventions to reduce catheter use and CAUTIs. Podium presentation at The Hospital & Healthsystem Association of Pennsylvania Capstone meeting, Harrisburg, PA. Edmunds, K., & Widmann, WM. (2019, April). Weaving technology into nursing workflow. Podium presentation at American Nursing Informatics Association (ANIA) 2019 Annual Conference, Las Vegas, NV. Gregory, J. (2019, May). Behavioral health: One organization's journey to reduce the risk of suicide in the acute care, emergency department, and behavioral health setting. Podium presentation at the Pennsylvania Patient Safety Summit, Champion, PA. Schotting, D. (2019, May). Infection prevention: Reducing clostridium difficile infections in the acute care setting using lean methodology. Podium presentation at the Pennsylvania Patient Safety Summit, Champion, PA. Bedner, K. (2019, June). I'd like to check you for ticks. Podium presentation at Horizons 2019 Pennsylvania Emergency Nurses Association Conference, Hershey, PA. Burns, H.K., Glasgow, M.E., McLaughlin, M., Wolf, G.A., Zangerle, C. (2019, August). Expert panel: How leadership development for nurse leaders has changed and what is essential for nurse leaders for the future. Expert panel presentation at the Southwestern Pennsylvania Organization of Nurse Leaders Annual Conference, Farmington, PA.

2019

Professional Presentations and Publications in Nursing Continued ...

Burns, H.K. (2019, August). Keynote speaker. White Coat Ceremony, University of Pittsburgh at Greensburg, PA. Fick, T. (2019, September). Evaluation of a succession planning toolkit for nurse leaders. Panel presentation at the Pennsylvania Organization of Nurse Leaders Annual Leadership Conference, Harrisburg, PA. Fick, T. (2019, October). Professional architecture: What is certification and how is it a framework for lifelong learning. Panel presentation at the 2019 ANCC National Magnet Conference, Orlando, FL. POSTER PRESENTATIONS Love, J., Burns, H.K., & Campbell, G. (2019, February). Impact of a CNL emergency navigator on overutilization and care continuity in a community hospital emergency department. Poster session presented at the American Association of Colleges of Nursing CNL Summit, Tampa, FL. (Awarded First Place Ribbon) Rosatti, K., Piper, R., Wentzel, C., & Burns, H.K. (2019, March). Incident-related peer review: A thematic analysis of events. Poster session presented at the Sigma Theta Tau International Scholars Night, Pittsburgh, PA. Szarejko, K., Lewis, D., & Burns, H.K. (2019, March). Integrating evidence-based practice projects into a nurse residency program: A community hospital experience. Poster session presented at the Sigma Theta Tau International Scholars Night, Pittsburgh, PA. Love, J., Burns, H.K., & Campbell, G. (2019, April). Care navigation in a community hospital emergency department. Poster session presented at the American Organization of Nurse Executives Annual Conference, San Diego, CA. Squires, A., Fritz, M., & Barrick, J. (2019, April). Vascular access team (VAT) driven nurse orientation iv workshop. Poster session presented at the 47th Annual LITEVAN Conference, Farmington, PA. Bickerstaff, L., Gregory, J., Chew, R., Anderson, M., Hall, B., & Labish, E. (2019, May). Fall prevention: Using innovative resources to inspire ideas. Poster session presented at the Pennsylvania Patient Safety Summit, Champion, PA.

Lewis, D., Reynolds, W., Kremer, A., & Kepple, K. (2019, May). Impact of delayed newborn bathing on breastfeeding outcomes. Poster session presented at the 2019 UPMC St. Margaret Clinical Research Forum, Pittsburgh, PA. Lewis, D., Krinock, M., & Burns, H.K. (2019, May). Nursesâ&#x20AC;&#x2122; prioritization and completion of EBP projects: A comparative study. Poster session presented at the 2019 UPMC St. Margaret Clinical Research Forum, Pittsburgh, PA. Szarejko, K., Burns, H.K., & Bernardo, L. (2019, August). Education navigator: Innovation in nurse retention. Poster session presented at the Southwestern Pennsylvania Organization of Nurse Leaders Annual Conference, Farmington, PA. Bickerstaff, L., Clark, M., Glaser, K., Labish, E., Lorincz, S., Ross, D., & Zolocsik, R. (2019, August). Use of a targeted solutions tool to decrease falls with injury. Poster session presented at the Southwestern Pennsylvania Organization of Nurse Leaders Annual Conference, Farmington, PA. (Awarded Third Place Ribbon) Szarejko, K., Lewis, D., & Burns, H.K. (2019, October). Integrating evidence-based practice projects into a nurse residency program: A community hospital experience. Poster session presented at the 2019 Professional Nurse Educator Conference, Cleveland, OH.

INNOVATIONS Nurses partner with Information Technology Capacity Management — Solving the Patient Flow Puzzle The movement of patients and equipment throughout Excela Health’s three hospitals is a complex puzzle to solve due to its many moving parts. Cerner’s software solution CareAware Capacity Management incorporates both clinical and operational data to help staff place patients in the most clinically appropriate bed and automates requests and dispatch for Environmental Services (EVS) and Patient Transportation. INFORMATION TECHNOLOGY Excela Health’s Information Technology built and installed the Capacity Management software by aligning the components of Nursing, Care Support, Patient Transport and EVS. Analysts and Informaticists reviewed how the departments could standardize processes and use Capacity Management based on the individual needs of each department. CARE SUPPORT Care Support works with Patient Transport and EVS through Capacity Management to maximize staff and improve patient flow. Specialists monitor patient transport lists and assigns jobs to transporters according to transport zones with assignments based on patient location and destination. The Specialists also monitor the Capacity Management EVS Service List for requested jobs and locations, looking ahead at resources needed to expedite discharges, dispatch EVS, and monitor room status. PATIENT TRANSPORT Patient Transport receives physician order requests from Capacity Management through alerts that appear on transporter phones with the number of transporters needed, mode of transportation, and specific patient needs.

• Eliminated bottlenecks

• Decreased patient transport time from 28 minutes to 14 minutes, a reduction of 50%

• Standardized workflows

• Increased patient satisfaction

• Tracked patient volumes electronically reducing the need for paper solutions

• Enhanced workflow

• Reduced downtime for transporters • Expedited patient testing and discharges

• Expanded staffing patterns and reduced overtime

Improved commnication and efficiency between Nursing, Patient Transport and EVS through use of iPods

• Improved resource management and bed placement

ENVIRONMENTAL SERVICES (EVS) When a patient is discharged or transferred, EVS staff receive an alert via an iPod along with room needs for any ad hoc items such as paper towels. Supervisors, leaders and staff constantly monitor the Capacity Management bed board system to assign jobs and turn over the room in preparation for next patient.

INFORMATION TECHNOLOGY

PATIENT INFORMATION

WE WORK AS A TEAM

“

When building and installing Capacity Management software we immediately saw where we needed to adjust staff and identify zones for EVS and Transport, as well as improve communication between Nursing and the other three departments,” said Lisa Maginsky, BSN, RN, Manager, Clinical Applications, Information Technology.

ENVIRONMENTAL SERVICES (EVS)

“

Capacity Management has improved process of clinically selecting appropriate beds by providing real-time documentation of the patient status,” said Glenn Repko, MSN, RN, Clinical Director, Care Support. “The person assigning beds can see many attributes of the patient such as isolation and fall risk status. This prevents a patient from mistakenly being placed in a room not appropriate, greatly reducing calls related to bed placement.

“

End users received iPods to replace cell phones and pagers. They receive an assignment on the iPod with room information,” said Lisa Maginsky, BSN, RN, Manager, Clinical Applications, Information Technology. “It has improved both efficiency and communication between departments.

Care Support Team

“

CARE SUPPORT

“

Capacity Management improved our workflow by reducing the multiple phone calls to transporters and also to and from our nursing stations,” said Gail Marion, Supervisor, Patient Transport. “It has also decreased unproductive trips, and the option for us to delay with an explanation without calling the nursing stations or procedure areas is a huge time saver.

“

Point of Use Implantables Process Improvement Project The Point of Use Implantables Process Improvement Project resulted in a better system for tracking implanted devices and adhering to federal standards. “From a regulatory perspective for Stage 3, Promoting Interoperability (formerly known as Meaningful Use), there is a requirement to capture and access the implant’s unique identifier within the electronic medical record (EMR),” said project lead Michele Curcio, MSN, RN, a Senior System Analyst in Information Technology (IT). Improving the process was necessary because, as Curcio explained, “Prior to implementation, staff manually entered some information related to the device into the EMR.” Developing a process to scan all medical devices implanted inside the body involved Curcio and her IT team of Mike Thomas, RN, Senior System Analyst; Lisa Maginsky, BSN, RN, Manager Clinical Applications; Jim Emerick, Senior System Analyst, and from Clinical Informatics, Kennette Grohal, MSN, RN-BC and Shirley Brandon, MSN, RN-BC.

“Documentation of a medical device’s unique identifier within the EMR allows for reporting as needed to ensure patient safety,” Curcio said. “For example, if there is a device recall, a report can be run to determine if any patient had that specific device implanted. Also, if the device has expired and the staff scans it, an alert will display.” The IT nurses’ role in this process improvement helps front-facing providers with safety checks and balances and improves quality of care. “We are participating in patient recovery and improving care while supporting frontline staff,” said Thomas, a former intensive care nurse. Curcio believes it helps to have a nursing perspective when examining clinical software, or making improvements. “I think back to a time when I was taking care of a patient and ask 'does this make sense',” she said. “I also think it’s helpful for clinical staff to know that nurses are working on a system or process.”

“As Nursing plays a major role in utilizing the technology, it is important in IT that we have both clinical knowledge and technical knowledge during many projects. A nursing background is a benefit with any project because we have walked in those shoes and can provide clinical insight early in the project,” said Maginsky. The systemwide Implantables project kicked off January 24, 2019. During a three-day period in April, several teams participated in “Scan-Fest,” in which vendor consultants and staff from IT, Operating Room, Cath Lab, Interventional Radiology and Informatics scanned bar codes for all implantable devices throughout the organization. This allowed the implantable item to be captured within the EMR and viewed across all patient encounters.

Information Technology Senior Systems Analysts Mike Thomas, RN, and Michele Curcio, MSN, RN, (seated) as well as Lisa Maginsky, BSN, RN, Manager, Clinical Applications, led the proces improvement team.

Self-Care Strategies for Nurses Compassion fatigue and burnout are an unfortunate reality in nursing. Kindness Movement A Leadership survey was distributed in the Fall of 2018. The most commonly requested suggestion was an Act of Kindness program. Coupled with that, at the Nursing Professional Development Forums conducted by Nursing Education, when asked how they decompressed or how they coped with difficult situations in their day to day practice, it was apparent that the vast majority of nurses did not participate in any self care strategies.

“

Stacy Gibson, MSN, RN, NPD-BC, Nurse Educator, enlisted the help of the Excela Health Well-Being Center to create the Kindness Movement. A “kindness card” was developed and distributed to remind staff to pass along kindness.

In order for our nurses to care for others, they must ﬁrst care for themselves. Acts of kindness are important and help the entire care team work together.

Stacy Gibson, MSN, RN, NPD-BC

Well-Being Center Betty Minerva, BSN, RN, HSMI, CWHC and her team in the Excela Health Well-Being Center continually strive to create innovative strategies to help nurses carve out time to care for themselves. Some of these initiatives include:

unplug recharge

• Unplug and Recharge • Yoga

and

Betty Minerva, BSN, RN, HSMI, CWHC Holistic Stress Management Instructor, Certiﬁed Wellness Health Coach

Winning By Losing Brandi Hall, MSN, RN, NE-BC as an individual and the 3rd Floor team at Frick Hospital, represented here by Kim Wystepek, BSN, RN and Kim Crouse, BSN, RN, were winners of the “Biggest Loser” weight management contest in 2019.

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The Commission on Magnet is proud to recognize your 1st designation as a Magnet organization! This credential is a testament to the countless contributions your nurses, in collaboration with other team members, have made in their commitment to provide quality patient care through innovations in professional nursing practiceâ&#x20AC;Ś Congratulations to the entire organization on your significant achievement!

NURSING