2020 Nursing Annual Report by Independence Health System

2020 OUTCOMES REPORT The Timeless Essence of Nursing

NURSING

A LETTER FROM THE CNO Helen K. Burns, PhD, RN, NEA-BC, FAAN Senior Vice President and Chief Nursing Ofﬁcer

As 2020 dawned and we prepared to recognize the Year of the Nurse and Midwife, there was no way to have imagined what would lie ahead. Originally designated by the World Health Organization to honor the 200th birthday of Florence Nightingale, the parallels of the Lady with the Lamp who treated soldiers in battle and the nurses who mounted daily battles against COVID-19, are simply undeniable. The year presented challenges not unlike those Nightingale faced in the 1850s; to improve hygiene practices, stop the spread of disease, and lower the rate of death. All while revealing the “Essence of Nursing” and the strong words that continue to define the circumstance and the profession – Courage, Resilience, Pressure, Empowerment, Flexibility, Crisis, Innovation and Teamwork. Nightingale is known for her deep compassion for the sick and revolutionary approach to hygiene that influenced the quality of care for centuries to come. As much as she was a nurse, Nightingale went far beyond the work in caring for the sick. She was a passionate statistician, who championed the importance of tracking and trending data, and the need to turn those data into information that would drive decisions. During the Crimean War, seven-times as many soldiers died in-hospital from their wounds as on the battlefield. An evidence-based thinker, Nightingale understood the importance of understanding these statistics and the implications of the information, so the necessary changes could be made. In 2020, nurses all over the world and in our own communities faced the uncertainty of facing an unknown disease that was spreading at an alarming rate. Nurses were on the frontlines treating patients, developing quality measures, tracking disease spread, exploring measures for innovative care, and providing ongoing crisis management, as the COVID-19 pandemic raged on. Just as the Lady with the Lamp organized corps of nurses to care for sick and fallen soldiers, the nurses of Excela Health were mobilized to identify and care for, not only the COVID positive patients, but all those in need of critical and customary healthcare across the system. The “Essence of Nursing” is the bond that holds together the health system and reaches out to save and improve the lives of others. As we close the chapter on 2020, the pandemic, and the year as a whole, we have witnessed brilliant nurse leadership and extraordinary nursing practice, we have demonstrated the agility of nursing to pivot and evolve as needed in the face of crisis and the ability for nurses to answer the call of history, which is the very essence of nursing.

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Nursing is a progressive art such that to stand still is to go backward. ~ FLORENCE NIGHTINGALE

SUMMER

WINTER

SPRING

FALL

CRISIS MANAGEMENT TURNPIKE ACCIDENT | HELP IN THE MIDST OF CRISIS In times of crisis, Fred Rogers reminded us to ‘look for the helpers.’ On Jan. 5, 2020, the helpers came to the Excela Health Frick Hospital Emergency Department (ED) following a fatal accident on the Pennsylvania Turnpike that killed 5 people and injured at least 60. The ED had been extremely busy on that snowy, winter night recalled Clinical Coordinator Ruth Fox, RN.

“We had just settled a family in from a previous Turnpike accident; a mother and ﬁve children,” said Ruth. “Three of the children were sleeping in ED room 5; the toddler and baby were sleeping in a crib at the nurses’ station, while the mother completed her testing.” At approximately 4:40 a.m., Westmoreland County Emergency Dispatch phoned stating EMS was in route to the 17-bed ED with multiple injuries following the accident that involved a tour bus and two tractor trailer trucks. The 52-passenger bus was traveling downhill in icy conditions when it struck an embankment and ﬂipped on its side causing the chain reaction crash. “The staff began to prepare the ED for intake of several patients by moving a patient from the ED trauma, discharging patients, and notifying the respiratory therapists,” said Ruth. Dispatch phoned again to inform staff that there were casualties at the scene and patients would be sent to Frick. In a subsequent phone call, 911 would inform the clinical staff that the majority of the patients did not speak or understand English.

A Code Triage was initiated and Ruth began to look for the helpers. At one point the single word “HELP” was sent in a group message to alert her colleagues for assistance. She contacted the ED director and third floor nursing staff, as well as registration staff and radiology, while clinical staff began assembling supplies at the nurse’s station. “We did not know the number of patients we were going to receive, less than 10 was the count,” Ruth said. “The first EMS notification came over the radio with five patients being transported to the ED with numerous injuries. Within minutes, two other EMS units notified of an additional 10 patients being transferred.” As the patients began to arrive, Ruth directed placement of the patients based on the paramedic’s report. Physicians divided up and began assessing the patients and the helpers began to appear. Nicole Komenda, DNP, RN, Clinical Nurse Coordinator, FH said when she arrived at approximately 0500 there were patients everywhere, the regular beds were full, there were multiple patients in the rooms, in the hallways, and in the waiting room.

“There were vital signs, allergy information, and orders written in Sharpie on the patient’s bed sheets. The department smelled of diesel fuel,” said Nicole. “Respiratory therapists were going from room to room taking vital signs and documenting pertinent information like past medical history and allergies on Post-it notes and leaving them with the patients.” While nurses and physicians continued to round on the injured, Ruth noted more and more patients continued to arrive. All in all, the clinical staff would treat more than 30 patients involved in the crash. “The smell of diesel fuel was totally overwhelming. The patient’s clothes were saturated in fuel. Their fear and pain exhibited in their faces. They had just

experienced a horrible accident, didn’t speak English and were hurt,” recalled Ruth. As the night went on more and more assistance came from other departments including case management, volunteers, clergy, and members of administration. “There were staff from the PCU & ICU units in the department helping in any way they could. There were so many people ready and willing to help,” said Nicole. Dispatch called again looking for an 8-year-old child named “Jeremy,” who was unaccounted for at the scene. Ruth went room to room and scoured the waiting room looking for the child but did not find him. “I was later notified that Jaremy (Vasquez) was a girl and had died at the scene,” Ruth said. “The child’s mother and siblings were in our ED. She spoke very little English. She was sobbing as she knew her child was missing.” A translator came to help communicate the difficult news to the family and a nurse stayed with the family through their agonizing meeting with the coroner. There were frantic calls coming into the ED from family members looking for loved ones and translator machines were utilized to overcome the language barrier between patients, family, and staff. Another child who was traveling alone would capture the hearts of the nurses. “He had quite the personality,” Ruth smiled. “After being medically cleared, he tried to get a Mountain Dew and a Hershey bar for breakfast. When I told him ‘no’ he said I was bossy.” Nicole recollected, “When his father arrived hours later to get him, I remember his face when I opened the door for him. He was trying, unsuccessfully, not to cry and I’ll never forget the relief when he got to hug his son.” Ruth and Nicole agree, there are a flood of memories from that frigid night, both sorrowful and jubilant.

“How overwhelmed and scared these patients had to be. They lost their belongings, identifications, and passports. Some were separated from their family at the scene. They did not know where their family was and if they were alive. They were cold and even lost the clothes they were wearing,” said Ruth. “Our team needed to provide excellent care with the best outcome for these patients. I truly feel our Excela team succeeded!” She continued, “The collaboration of all the departments and the compassion shown to the patients and each other was amazing. All staff worked together in an organized and efficient manner. Not only was care provided to the patients, but to each other as well.” The impact of the accident on first responders was difficult but the nurses, physicians, and other staff at Excela Health Frick Hospital helped to lift the burden. “Our community hospital stepped up in a huge way,” said Mt. Pleasant Mayor and Fire Chief Gerald Lucia. “From the care and compassion given to the victims, to the support provided to county emergency management, the response can serve as a crisis model.”

2020 Year of the Nurse Strategic Priority Contribution – Nursing Group

Nightingale Award Presented to

Excela Health Frick Emergency Department In recognition of excellence in nursing care through their contribution in addressing the strategic priorities of Excela Health.

February 2020 Presentation Date July 13, 2020

Helen K. Burns, PhD, RN, NEA-BC, FAAN Senior Vice President and Chief Nursing Officer

Mary Mantese, DNP, RN, CENP Director, Professional Practice/Care Transformation, Associate Chief Nursing Officer

TEAM HONORED FOR EXCEPTIONAL RESPONSE Traci Fick, DNP, RN, NEA-BC Vice President, Patient Care Services, Frick and Westmoreland Hospital

Maryann Singley, MSN, RN, NE-BC Vice President, Patient Care Services, Latrobe Hospital

Nurses that worked in the Frick Hospital Emergency Department during the aftermath of the Jan. 5, 2020 horriﬁc and fatal chain reaction crash on the Pennsylvania Turnpike were commended for their exceptional response to victims of the accident. Helen Burns, PhD, RN, NEA-BC, FAAN, Senior Vice President and Chief Nursing Ofﬁcer honored the nursing staff with the 2020 Year of the Nurse Strategic Priority Contribution Nightingale Award, Nursing Group Contribution recognizing their success in coordinating quality care and support to the victims of the deadly tragedy. The nurses honored for the care of the 31 injured patients are John Dolan, Edith Spinneweber, Brandi Hall, Lorraine Cam, Chelsea Coughenour, Ruth Fox, Kaylee Gessler, Richard Holden, Kerri Humes, Nicole Komenda, Carrie Manning, Brandy Martz, Polly Beal, Brittany Crail, Kaylee Kooser, Shannon Rowles, Harry Jenkins, and Amanda Connors.

SAFETY THE URGENT CALL FOR COVID TESTING Excela Health staff from across the multiple disciplines banded together to provide safe and efficient COVID testing. As residents of Westmoreland County anxiously studied their news feeds awaiting confirmation of the first case of COVID-19 here in Western Pennsylvania, Excela Health leaders were brainstorming for ways to provide COVID testing, screening, and care for patients presenting to physician offices and hospitals while maintaining a safe environment for staff, visitors, and other patients. Stacey Bush, BSN, RN, AMB-BC, Practice Manager EHMG and the Residency Program and Rhonda Anderson, Regional Practice Manager, EHMG, were tasked with coordinating the opening of a new EH COVID-19 Testing and Evaluation Center located on Frye Farm Road and shared how quickly the center was operationalized. “We had 4 days to prepare,” Rhonda said. The building had been vacant and therefore needed equipment, supplies, technology, and staff. A specialized work flow was developed that ensured safety from the point in which the patients pulled into the parking lot through to when the last person exited the facility. Stacey recalled that the processes they were creating were outside the realm of their previous experience and they needed to design “workarounds” such as safe locations for donning and doffing PPE and to accommodate infection control guidelines within the less than ideal layout of the examination rooms. They realized that they would need to frequently refine the processes to adjust to the steady influx of new guidance. Stacey and Rhonda were redeployed on a full-time basis and Dr. Michael Semelka, Family Practice and Dr. James Masterson, Sports Medicine/Concussion Management Center served as “point physicians” for the center. Clerical support, RNs, MAs, Advanced Practice Providers (APPs), physicians, and athletic trainers were pulled from EHMG offices, surgery 8

• On March 6, 2020, the PA Department of Health published an alert indicating that the first two positive cases were reported in PA in the northeastern portion of the state near the border to New York. • On March 14, 2020 neighboring Allegheny County reported its first 2 positive cases of COVID-19. • On March 19, 2020 the first two positive cases were confirmed in Westmoreland County. • On March 20, 2020 Excela Health opened the doors to the new COVID-19 Testing and Evaluation Center located on Frye Farm Road.

MONTH

TOTAL COVID TESTS

POSITIVE RESULTS

DRIVE THRU

CLINIC

IV INFUSIONS

MARCH

538

351

187

APRIL

1,388

807

534

MAY

2,833

2,584

216

JUNE

2,055

1,911

153

JULY

2,093

205

1,773

352

AUGUST

1,254

906

351

SEPTEMBER

1,137

104

891

251

OCTOBER

2,461

376

2,042

420

NOVEMBER

3,297

1,066

2,913

DECEMBER

4,631

1,691

4,168

490

TOTAL

21,637

3,749

18,346

3,482

centers, and clinics to offer temporary staffing at the center in the first few months of operation. “The system was very supportive,” said Stacey. “Dr. Fox, Judy Haliko, our VP and other leadership got us whatever we needed.” Stacey and Rhonda shared that nearly every department contributed to the success of the center, including but not limited to the Lab, Physicians, Education, Infection Control, IT, Security, Facilities, the EHMG staff who worked at the center as well as the EHMG staff who worked short staffed while colleagues were staffing the center.

In 2020, the center performed a total of 21,637 COVID tests and Advanced Practice Providers (APPs) (Certiﬁed Registered Nurse Practitioners and Physician Assistants) provided follow-up calls providing results to these individuals. In the beginning, the APPs called each person with a positive result for at least 14 days to offer support and guidance.

Stacey and Rhonda both agreed that the biggest challenge was training new staff each morning along with keeping up with the ever-changing guidance on policies, procedures and practice guidelines. “Every morning was like the movie Groundhog Day where you faced four or ﬁve new people who were scared to death and you also had several additional new tasks to add to the day’s routine” Rhonda shared. Limited testing supplies necessitated judicious use and thus testing and evaluations at the center were performed by appointment only, which included both drive-thru testing as well as face to face evaluations. 9

COMFORTING A FRIGHTENED COMMUNITY “Looking back, this experience was very fulfilling,” Stacey recalled, “particularly the opportunity to do something to support a frightened community”. Rhonda and Stacey relayed that both the staff reporting for duty as well as the patients presenting to the center expressed their gratitude and appreciation upon leaving for the extremely safe and organized work flow. A PA Department of Health representative on site for a review communicated to EH leadership that the Frye Farm Road site was remarkably efficient and indicated that other similar sites in the region could benefit from using this location as an example for success. Both Stacey and Rhonda shared that staff at the center worked extremely hard, including standing out in the rain, snow, heat, and cold to perform the drive-thru testing in their full PPE. Regardless of their own fears or discomfort, they managed to foster a sense of calm for patients and a personal sense of pride for the work accomplished. “I have to relay one story in particular, though,” said Rhonda. 10

“One day I heard singing coming from inside the center.” She shared that upon investigation, she found Nicole Fluker, RN singing “You are My Sunshine” as she swabbed her patient. Nicole stated that she felt the simple songs helped to comfort and relax patients during the uncomfortable procedure, especially those who were nervous and feeling sick. In December of 2020 the center began to administer infusions of monoclonal antibody treatments for eligible patients in the community, which required additional training and coordination. Deb Moffa, MSN, RN, Nurse Educator came on site to provide training to nursing staff and the Mutual Aid Ambulance Service provided paramedics to assist and support the efforts. Once again, patients presenting to the center voiced their heartfelt appreciation. At the end of the day, the center was an “all hands on deck” project for Excela Health. Staff working there shared that it was an honor to serve the community during this overwhelming crisis.

TEAMWORK. PRESSURE. TRIUMPH. EXCELA HEALTH HOSPITALS RESPOND TO PANDEMIC

The impact of the COVID-19 pandemic on the staff of Excela Health’s three hospitals was extraordinary. However, it was their response that would prove invaluable.

TEAMWORK Westmoreland 3AB Assembles Extraordinary Team

Historical in its nature and often compared to the 1918 Spanish Flu pandemic, COVID-19 presented the Health System with a myriad of challenges that required a team of dedicated clinical professionals to solve. For their collaborative efforts, the nursing team on 3AB at Westmoreland Hospital was nominated for the DAISY Team Award for demonstrating commitment to the strategic priority of the organization and received a 2020 Year of the Nurse Strategic Priority Contribution Nightingale Award for achieving the strategic goals of Excela Health. “As we prepared the organization to care for patients that were victims of the COVID-19 pandemic, the staff became the ﬁrst PCU unit to prepare to receive patients. The team worked together, embraced the challenge, and created work processes and set up necessary equipment to keep staff and patients safe as they cared for both positive and pending COVID-19 patients,” said Traci Fick, DNP, RN, NEA-BC, Vice President, Patient Care Services, Westmoreland and Frick Hospitals.

The team was lauded for their efforts, which included implementing the use of baby monitors as a tool to keep patients safe; utilizing technology such as video phone calls to keep patients connected to their families at home; identifying opportunities for isolation gown conservation by developing tracking sheets to evaluate trends in room visits by staff thereby identifying opportunities for bundled care; and welcoming to the unit staff from other areas of the hospital and onboarding the team to the personal protective equipment and other measures necessary for safe, quality care. In her nomination, Traci acknowledged the Westmoreland 3AB team had met the core principles of the DAISY Team Award, which honors nurse-led collaboration by multiple people, and who identify and meet patient and/or patient family needs by going above and beyond the traditional role of nursing. The efforts of the 3AB team were also acknowledged by the daughter of a 93-year-old dementia patient who succumbed to COVID-19 in April 2020. In a letter to Excela Health System’s CEO John Sphon, and Senior Vice President/CNO Helen Burns, Cynthia Black writes of the pain of being separated from her dying mother and the critical role the team played in keeping her connected.

“During the 5 days Mom was in 3AB, every single nurse that cared for Mom became my family as they helped me visit via FaceTime, prayed with me, cried with me, and comforted Mom as she was dying. The nurses were my hands, my arms, my voice and my love,” Cynthia, daughter of COVID patient writes.

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PCU exempliﬁes Nightingale qualities from compassion to clinical skills.

PRESSURE Latrobe PCU Responds To Pandemic Pressure Providing exceptional clinical care during a pandemic takes an exceptional staff. The Latrobe Hospital PCU nursing team received a 2020 Year of the Nurse Strategic Priority Contribution Nightingale Award for the compassion, respect, and dignity the unit demonstrated to patients and families. “PCU exempliﬁes Nightingale qualities from compassion to clinical skills,” said Maryann Singley, MSN, RN, NE-BC, Vice President, Patient Care Services, Latrobe Hospital. “This team looks at change as a way to improve the already excellent care they provide. Not only to our patients but their families and the team as well. PCU Latrobe has set the standard for caring for COVID patients. The ease with which they transition from one patient to the next is remarkable.” At the start of the pandemic, the PCU nursing team were concerned about communication with patients, so they began using dry erase boards to help the patients communicate their needs while making

sure family members had the most up-to-date information. In addition, they offered video chats to keep patient and family connected. The Latrobe PCU staff also accepted the challenge to change and adapt as needed and worked together to welcome and acclimate new staff to the ﬂoor, while still operating smoothly and efﬁciently. Beyond providing clinical care, the PCU team demonstrated a sense of humanity sorely needed during a time of crisis. Maryann recalls the PCU had many married couples on the unit and due to COVID issues these patients were in separate rooms. “For one such couple, the husband’s birthday was the next day. The wife was so upset because she has always gotten him a card and cake every year. PCU staff provided her with paper and tools to make a card,” said Maryann. “They called dietary and had a cake sent to the unit. While the patient was off the unit for testing, they decorated his room. Upon his return the wife was able to view via FaceTime his reaction and sing “Happy Birthday” to him. This is just one of many special memories the staff have helped to provide to our patients and their families.”

“NOT TODAY COVID” TRIUMPH Frick PCU Winning A Battle COVID-19 would win many battles, but ‘not today.’ Staff and family cheered as an 89-year-old patient left Frick Hospital after a 30-day stay due to the novel coronavirus. His message was simple and delivered via the sign he held, “Not today COVID.” James Toth’s daughter cried as he was being discharged, while ICU and PCU nursing staff who cared for him also held signs with messages of their own. “We made signs when he left that said ‘Your Frick Family Will Miss You.’ After 30 days, he and his family became part of our family,” said Kim Wystepek, BSN, RN, Clinical Nurse Coordinator. “I felt extremely proud that day watching him leave the hospital. Proud that he was a COVID survivor and proud that he was leaving, because every single staff member had touched his life in some way during his stay.” Over the course of his isolated COVID care, nursing staff were keenly aware of all the time James was missing with his family. When the Easter holiday came, Kim wanted to offer him the opportunity to connect with his family. “I asked his permission to take his picture and send Easter cards from him to his kids, since they hadn’t seen him in so long,” said Kim. “His response was, ‘yes, but only if you send one to my wife too!’”

She prepared the cards, and with the help of Rita Martin, RN, got James ready for his handsome photo, which was included in the cards that Kim sent to his family. Kim notes prior to the COVID-19 pandemic, there was no other diagnosis or disease process that would require a 30-day length of stay in the Frick units. “The typical patients we would care for were hospitalized for this such as congestive heart failure, pneumonia, dehydration, renal failure, etc. and would require a hospital stay more like 2-5 days,” she said. “COVID had a negative impact on several of our clinical outcomes. Length of stay was also extended as discharge planning became difﬁcult because a lot of the patients were weak and debilitated and required placement to skilled nursing facilities. Some facilities required one or more negative COVID swabs.” In addition, Kim outlines further negative clinical outcomes including increases in pressure injuries due to the disease process, ventilator-associated pneumonias, mortality rates, falls, hospital psychosis and delirium, as well as growing inpatient bed times within Emergency Departments due to negative air room or private room availability in the hospitals. However, despite the negative effect COVID had on clinical outcomes and patients, staff refused to let it break their spirit according to Kim. “When our 89-year-old gentleman was discharged, we celebrated him and celebrated our entire team.” 13

PIONEERING CARING FOR THE FIRST POSITIVE PATIENTS Case managers for the ﬁrst COVID patients pioneered new protocols while struggling with anguish related to the crisis. As inpatient teams cared for patients requiring hospitalization for their symptoms related to COVID-19, Excela Health assigned a team of nurses from the Clinical Informatics department to reach out on a daily basis to those who received a positive test result and were convalescing at home. The goal was to assess current symptoms, provide guidance for managing those symptoms, education for them and their families with regard to quarantine, isolation, contact tracing, and testing as well as what symptoms to report that might indicate a need to present to the hospital for expanded treatment. “No one really knew anything about the disease back then.” Kennette Grohal, MSN, RN-BC, Clinical Informatics Coordinator, remembered. “The patients didn’t know what to expect and neither did we.” Kennette shared that while those early days were ﬁlled with a myriad of unanswered questions and a fair amount of uneasiness, as time went on patterns began to emerge, such as the frequent loss of taste and smell. She reiterated that they spent a lot of time reaching out to individuals’ PCPs as well as to clinicians in various specialty departments within the health system for advice and collaboration as everyone collectively learned more about the virus and how best to treat the associated symptoms. Sally Backus, MSN, RN-BC, Clinical Informatics Coordinator, recalled one particular gentleman that she followed. She relayed the anguish that she and her team experienced in determining when to make the decision to recommend an evaluation in the Emergency Department. Sally encouraged this particular man to proceed to the hospital and she continued daily calls with his wife throughout his inpatient stay to provide 14

updates on his condition as visitation was not permitted at that time. “This guy was so sick and the prognosis was not good at all”, Sally recalled. She shared that he hovered between life and death for a long period of time. “All I could think about was if I had told him to go in one day sooner, would it have made a difference?” Sally shared that she developed a bond with this man’s wife during those dark days. “I knew all about them and their family. Their daughter worked in the system and was expecting a baby.” Sally shared that she and her teammates lost a lot of sleep over patients such as this man, agonizing as to whether there was anything they could have done differently to improve outcomes during a time when the world had more questions than answers. After being on a ventilator for ﬁve weeks, this gentleman began to show improvement and after being in the hospital for seven weeks, he was reunited with his wife and discharged to home as Excela staff members cheered them on and celebrated his remarkable recovery.

This patient’s wife expressed her heartfelt appreciation for the care that Excela staff delivered to her husband as well as the support she received by launching a GoFundMe page with funds directed to the Westmoreland/Frick Foundation’s Pandemic Fund. The initiative raised more than $11,000.

Clinicians and patients alike bravely battled COVID-19 and bonds were created that will never be forgotten. A few months after his discharge, this man’s daughter sought Sally out in her ofﬁce. Sally shared that the daughter came in and introduced herself, once again thanking Sally for supporting their family through that awful time. “I thought you might like to see a picture of my dad now”, the girl said as she showed Sally a photo of her dad happily holding her new baby. Sally smiled and shared that when the daughter left, she burst into tears as she recalled the emotional turmoil of those early days in the war against COVID-19.

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Apprehension, uncertainty, waiting, expectation, fear of surprise, do a patient more harm than any exertion. Remember he is face to face with his enemy all the time.

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~ FLORENCE NIGHTINGALE

WINTER

SUMMER

SPRING

FALL

VIGILANCE NEW AND EVER- CHANGING POLICIES, PROCEDURES, PROTOCOLS, AND PRACTICES Nursing teams were instrumental in drafting and communicating practice changes as new information emerged Many changes were required to standard operating procedures in order to ensure safety from an infection control perspective. A few of the initial topics included, but were not limited to the following:

Appropriate use of PPE Patient Safety and Infection Prevention staff presented clear written instructions and videos for all staff related to the appropriate safe use of PPE for various clinical scenarios as well as providing ﬁt testing for N95 and P100 respirators.

Visitor Guidelines As community spread grew it became necessary to decrease the foot trafﬁc in our hospitals and outpatient sites. Nursing leaders played a pivotal role in determining what level of visitation would be manageable as well as in outlining the visitor screening process based on direct feedback from staff on nursing units. When visitors were not permitted in patient care areas, nurses across the system worked with determination to communicate with families on progress updates, include family in treatment decisions, provide discharge instructions as well as to help patients and families connect with one another electronically, particularly in end of life scenarios.

VIGILA

Isolation/Quarantine As staff began to experience exposures to individuals with COVID-19 and in some cases to contract COVID-19 themselves, there was an avalanche of questions and decisions to be made related to isolation and quarantining for seemingly unlimited and various scenarios. EH Employee Health nurses worked with Nursing Infection Preventionists and leadership to create guidance and ﬁelded thousands of calls from staff.

In the coming days and months, as clinical experts around the world would learn more about the virus, teams from acros Helen Burns, Senior Vice President and Chief Nursing Ofﬁcer and Carol Fox, Senior Vice President and Chief Medical Ofﬁ detailed measures were instituted to ensure staff safety as well as to preserve supplies. Leaders met as often as twice a FAST FACTS, a daily newsletter designed to communicate with staff the latest statistics and trends, inform them of practic

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I feel like this organization pivoted really well from ﬁnding ways to deal with the shortage of PPE and the way they communicated the solutions to each challenge throughout the pandemic. Mary Mogle, RN, Case Manager, LH Emergency Department

Emergency Alerts Transmission-based Precautions/Isolation For COVID-19, the necessary transmission-based precautions did not align with established droplet or airborne transmission-based guidelines. Transmission-based precautions prescribed for COVID-19 were a new precaution type and staff would need to know exactly which items of PPE would be required in speciﬁc scenarios. Nursing Education created new signage for this form of isolation for all clinical areas.

ANCE

New emergency alert categories were adopted to communicate with responding staff that the patient was COVID positive and thus the PPE requirements would be different. Staff were instructed to notify the switchboard that there was a “Code Blue - 19” if the patient was COVID positive. There were also adjusted workﬂows designed to minimize the number of individuals in the rooms during emergency responses and adjusted communication strategies to overcome the noise of the negative airﬂow units.

Trash and Linen Changes were necessary to initiate with respect to the handling of trash and linen for COVID positive patients.

Cleaning Both routine cleaning and enhanced cleaning strategies were a focus throughout the system. At one point disposable antiseptic wipes became on short supply from vendors and our teams innovated ways to create a “home-grown” solution. EVS teams worked diligently, as did every EH staff member, to assure that PAPR hoods, protective eyewear and other equipment as well as high-touch surfaces, including pens were effectively sanitized.

ss the Health System would revise protocols to reﬂect the latest guidance from CDC and other external experts. ﬁcer met weekly with regional CNOs and CMOs to brainstorm strategies for the growing crisis. A multitude of day to strategize, and the nursing team worked with the marketing team to create the Excela Health COVID ce changes and safety measures, and to provide encouraging messages.

INGENUITY DANGEROUS GLOBAL PERSONAL PROTECTIVE EQUIPMENT SHORTAGES THREATEN HEALTHCARE WORKER SAFETY

MARCH

As the number of patients with conﬁrmed or suspected COVID-19 multiplied the WHO announced a shortage in PPE endangering healthcare workers world wide On March 3, 2020, the World Health Organization (WHO) announced that a shortage of endangering healthcare workers worldwide.

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Healthcare workers rely on personal protective equipment to protect themselves and their patients from being infected and infecting others. But shortages are leaving doctors, nurses and other frontline workers dangerously ill-equipped to care for COVID-19 patients, due to limited access to supplies such as gloves, medical masks, respirators, goggles, face shields, gowns, and aprons. Without secure supply chains, the risk to healthcare workers around the world is real.

“

APRIL

On April 3, 2020, the PA Department of Health issued an ALERT that strongly recommended the implementation of universal masking for all healthcare workers.

• While governing bodies pressed industry to increase production of these necessary supplies, it would take months to deliver them into the hands of healthcare workers and market manipulation was widespread with available products frequently being sold to the highest bidder. • In many areas of the country hard hit by coronavirus infections, clinicians were wearing the same N95 mask for a week at a time or longer and many of them were becoming ill themselves as a result. • Excela Health received allocations of PPE from Pennsylvania Emergency Management Agency (PEMA) as well as from regional resources designating supplies for local healthcare use while the EH procurement team worked relentlessly with existing vendors as well as to uncover new sources of PPE to facilitate deliveries.

While this change in practice was designed to keep healthcare staff safe, it would further stretch and stress the stock of available PPE.

• Despite these efforts, at that time, Excela staff were using four facemasks for every new one being received.

In March and early April of 2020, the CDC provided guidance for extending the use of PPE to help address concerns about availability during the COVID-19 pandemic. The FDA issued Emergency Use Authorizations (EUA) for certain PPE products including face shields, other barriers, and respiratory protective devices such as respirators, including safe and approved strategies for decontaminating or “reprocessing” used N95 masks.

• To address shortages in N95 masks, Excela Health utilized an existing supply of PAPR hoods and secured an allocation of P100 elastomeric respirators for use in high risk areas. P100 masks are designed to be cleaned, reused, and decontaminated. As such, one P100 can do the work of hundreds, if not thousands, of disposable N95 masks.

N95 MASK REPROCESSING Denise Addis, MSN, RN, CPQ, as the Director of Value Based Quality developed a team to ﬁnd the best way for Excela Health to reprocess used N95 masks in-house and mobilized staff and existing equipment for which the FDA granted EUA to accomplish this. The team outlined the process by which individuals across the Health System in both hospital, clinic, and outpatient settings would label their N95 masks and submit the used masks at the end of each shift (or prior if needed) for reprocessing. N95 masks were reprocessed a maximum of three times and these sterilized masks were returned for re-use by their original owners. Excela Health reprocessed a total of 7,478 used N95 masks in-house from early April through mid- August. While some of the masks submitted for reprocessing were not able to be salvaged, a total of 6,340 N95 masks were saved and able to be safely re-used. Beginning at the end of June of 2020, Excela Health transitioned to using an outside vendor for N95 mask reprocessing as a cost saver. External re-processing accounted for saving an additional 3,685 N95 masks. Forging the way to mask reprocessing, both internally and externally, not only signiﬁcantly boosted the stock of available N95 masks for staff use until supplies of new masks became available but also contributed to a substantial cost savings across the organization.

THE LITTLE SHOP OF SEWERS Stitching together a local solution for a global problem required a level of resourceful creativity. In the spring of 2020, in the throes of national PPE shortages, cloth face masks were adopted nationwide for multiple uses. In addition to reprocessing used N95 masks, expert guidance suggested that protecting these devices from surface contamination would also prolong their use. As a result, Excela Health adopted the use of cloth (homemade) masks as coverings for other FDAapproved facemasks, N95, and P100 masks. These homemade masks were not to be used as primary protection, but rather as a protective covering. Bonnie Barnhart RN, BSE, MBA, CPHQ Analyst, Regulation/Accreditation, Quality, and Liz DiLembo, Clinical Documentation Specialist, coordinated a team of volunteers and redeployed staff (including nurses) who would become known as “The Little Shop of Sewers”. Using donated fabric as well as re-purposed materials such as the covers to sterile equipment packs, furniture wrappings, and shower curtains, the team labored throughout day and night shifts to cut, glue and sew N95 mask covers and cloth

facemasks, which would be used by non-patient facing staff as well as patients and visitors. They also created several styles of isolation gowns, which were in high demand in clinical areas but also in extremely short supply, and assembled face shields. These hand-crafted supplies were produced in accordance with CDC guidance, tested by the Excela Health Infection Control team for safety, and piloted by inpatient nursing teams for quality. The Little Shop of Sewers received high praise for their ingenuity, their productivity, as well as the quality of their products. In many cases the hand-crafted items were more user friendly than the items purchased from external vendors. Throughout their call to service, The Little Shop of Sewers produced:

32,270 4,101 5,580 4,700

Blue/White Masks Cloth Isolation Masks N95 Masks Covers Blue/White Isolation Gowns

INNOVATION TELEHEALTH AND NURSING

Telehealth launched as virus spreads As COVID-19 cases were rising in Westmoreland County and shelter in place orders went into effect, it became crucial to determine a way to provide care to many of the most vulnerable while keeping them safe from exposure to the coronavirus. Across the Health System, nurses and clinical leadership collaborated to create telehealth solutions by using a variety of HIPAA and CMS compliant methods and software platforms in order to manage patient care and decrease cancelations in the middle of a pandemic.

ADVANCED WOUND CENTER USES TELEHEALTH FOR HIGH-RISK POPULATION Many of the patients in the Advanced Wound Center (AWC) are among the most vulnerable to COVID-19 as they are elderly, diabetic, and with many comorbidities, putting them in a high-risk category. “Because weekly monitoring of wounds is critical to wound healing, telehealth plays a vital role in monitoring those chronic wounds and allows patients to receive care from the safety of their homes,” said Laurie Christner, CRNP. “Weekly wound debridement plays a critical role in some of the underlying causes of chronic wounds. Removal of necrotic and non-viable tissue from the wound bed facilitates 22

wound healing. However, there are various methods of wound debridement that can be used, and these additional methods are utilized with telehealth visits.” Many AWC patients are homebound and receive care from home health nurses. Laurie and Kay South, CRNP, also collaborated with home health nurses to schedule and navigate telehealth wound care in conjunction with the patient’s home health visit. From April 1 through May 18, 2020, Laurie and Kay used FaceTime and GoogleDuo to see patients 2-3 times per week and walked their patients through the telehealth process to allow for the patient to become familiar and comfortable with the virtual visit process, while also providing care virtually. AWC continues to keep telehealth open as an option to serve patients as needed, which Laurie cites as another option in delivering high quality care and improving patient outcomes and satisfaction.

EHMG SEEING PATIENTS, DURING MANDATED STAY AT HOME POLICY AND BEYOND At Delmont Family Practice, part of the Excela Health Medical Group, Keri George, CRNP, had never used telehealth. That changed in the spring of 2020. “We used it exclusively in May with only 2-3 patients coming into the office for pre-op work ups or significant ortho issues,” said Keri. Patients scheduled for wellness exams, acute visits, and chronic follow up visits were given the option to be seen virtually via FaceTime or FollowMyHealth, which according to Keri was much-appreciated by the patients. “They like the availability and outcomes. I have rarely had to see a patient return to the office for an acute issue,” she said. In addition, Keri notes the impact telehealth has had on her clinical practice and processes. “I feel as though we rely on the patient for the majority of the exam. We need their input since we cannot rely on a hands-on physical exam. I also think this has reiterated the fact that we can diagnose with patient reported symptoms, Past Medical History and clinical experience without physically seeing a patient in the office as our physical exam is only a very small part of this all.” Keri continues to see on average two patients per week via telehealth and EHMG continues to grow its telehealth program.

INNOVATION TELEHEALTH AND NURSING

BEHAVIORAL HEALTH KEEPS PATIENTS CONNECTED The Excela Health Outpatient Behavioral Health staff understands the consistent medication management required for the mentally ill to maintain function in community and avoid hospitalization, particularly during extreme periods of high stress. “Telehealth became an absolute need versus an option,” said Toni Maline, CRNP. The department went from zero telehealth visits to approximately 32 per week, improving patient compliance and lessening wait times. During the height of the pandemic, staff completed telehealth visits by calling their patients on the phone. Moving forward, the department now uses the software application FollowMyHealth for virtual video visits with patients and regular telehealth visits are now built into the schedule. Members of the Outpatient Behavioral Health Team were awarded a 2020 Year of the Nurse Strategic Priority Contribution Nightingale Award for creating the telehealth process that helped patients stay connected to their treatment teams. Nurses recognized included Tim Hollar, RN; Randy Pritts, BSN, RN; Lorrie Saylor, RN; and Christina Horwat, LPN.

HOME CARE ADDS VIRTUAL LAYER OF SUPPORT Excela Health Home Care and Hospice provided an additional layer of support to their in-person visits with virtual visits to review and educate patients while limiting their threat of exposure to COVID-19. Patti Lebin, MSN, RN, Manager, Quality and Value Based Performance explained that about 30 percent of the home care population were determined to be eligible for virtual visits, either visual or audio, to supplement their treatment plans. “One example I can think of is a virtual visit that occurred after the patient left the home to get labs done. Knowing the patient would be fatigued, the nurse was able to perform a virtual visit and give advice on how to adjust the rest of their day to accommodate the current situation and symptoms from the outing,” Patti said. Eligible home care patients were able to utilize virtual visits in nursing, therapy services, and medical social work. Matthew Parry, RN, highly utilizes telehealth for Excela Health Home Care and Hospice and explains how his approach to virtual visits. “The nature of home health visit is an intimate one,” said Matthew. “We meet patients in their homes and render skilled physical care in person. Virtual visits however, have added a different perspective to this somewhat one-dimensional approach. I have found that during this alternative approach I'm allotted an opportunity to address my patient's care from a different angle. I have come to ﬁnd that patients are more relaxed and candid discussing matters of their health that they'd withhold or otherwise forget to discuss due to all the working pieces of a physical visit.”

The agency has built telehealth into its daily schedules and capacity management and expects to have this as a permanent option in the home health landscape, while also tracking how virtual visits impact the 60-day readmission rate according to Patti.

”

I attribute my success to this - I never gave or took any excuse. ~ FLORENCE NIGHTINGALE

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FLEXIBILITY COLLABORATION

Excela Health teams take part in regional collaboration As the storm of COVID-19 continued to batter the sails of healthcare, alliances were forged to prepare and protect the most vulnerable population. Excela Health, worked in conjunction with University of Pittsburgh Medical Center and Allegheny Health Network along with the PA Department of Human Services (DHS) and Department of Health (DOH), the Pennsylvania Emergency Management Agency (PEMA), and the Centers for Disease Control (CDC) as part of the Regional Response Health Collaborative Program (RRHCP). The aim of the initiative is to directly assist long term residential facilities such as skilled nursing facilities and personal care home providers in Westmoreland County to mitigate the risk of spread of COVID-19 to staff and residents. Among the Excela teams taking part were Home Care and Hospice, Infection Prevention, Physicians, Safety, Occupational Medicine, and Lab personnel, all of whom were widely recognized for their efforts. Excela teams provided an array of crucial services including a 24/7 call center for providers to access clinical consultation and technical assistance and in some cases rapid response teams were deployed in conjunction with DOH, DHS, and PEMA. In addition to the call center and rapid response teams, as part of the RRHCP, Excela Health teams provided assistance with testing, contact tracing, PPE coordination, and expertise in infection control and prevention. Infection Preventionists, Mary Jo Bellush, MSN, RN, CIC, FAPIC, Deborah Schotting, MSN, RN, CIC, and Suzanne Mamrose-Hunt, MPH, MT, (ASCP), CIC provided frequent in-person consultations with frontline staff and leaders at long term residential facilities throughout the county.

Their expertise was essential in assessing and advising policies and procedures, standard workflows and protocols from an infection control perspective. Each facility’s policies, procedures, and hazard response plans were examined to assure best practices in the event of a COVID-19 outbreak. Software and technical support were also offered to assure two-way communications between residents and their families, while staff augmentation was also provided as needed. During the pandemic the work of Excela teams and the RRHCP was cited as a life-saving resource for the community. Kristen Barber, BSN, RN and Heather Rosky, BSN, RN are Clinical Liaisons for Excela Health Home Care and Hospice. The pair were instrumental in the effectiveness of the RRHCP. Kristen explains that flexibility has been key. “Having a few flexible nurses (as part) of the Rapid Response Team (RRT), in the event of an outbreak the RRT is to respond within 24 hours to help with the immediate needs of the facility. This has grown to become an essential resource of both residents and staff,” she said. Patricia Lebin, MSN, RN, Manager, Quality and Value Based Performance for Excela Health Home Care and Hospice, outlines the important role that Kristen and Heather played in this valuable community partnership. She explains how the clinical liaisons pivoted from planning transitional care to providing much needed support to the mitigation collaboration. “They have been a pillar of support for the skilled nursing community and have worked around the clock to assure their needs were met,” said Patricia. “They have assumed the role of professional nurse, teacher, friend, confidant, and enforcer. They have worked as a team in collaboration with the regional taskforce to provide stability during a public health crisis emergency,” said Patricia. “They will forever be known as heroes in the fight against COVID-19.”

Kathleen (Kate) Rosatti, MSN, RN, Director, Clinical Outcomes Management; Patient Safety; Infection Control; Regulatory and Accreditation, was honored by Pittsburgh Magazine in 2020 as a “Pandemic Response Hero” for her leadership and community response as the second wave of the infection proved to be far worse than the initial wave. In the beginning Kate emphasized open communication with frontline staff to begin implementation of CDC and state Department of Health guidelines. Then as part of the RHCP, addressing the problems skilled nursing facilities in the region faced as a result of COVID-19, Kate and her team faced the challenges of helping the facilities reduce the spread while keeping team members motivated during difﬁcult times. Kate told Pittsburgh Magazine, “You always have to remind people there’s light at the end of the tunnel, and you have to ﬁnd the success story … whether it’s a positive impact on a patient, one family, or a whole building of residents, everything we’re asking you to do is making a difference. You are truly saving lives.” 27

EDUCATION AND INSPIRATION INTENSIVE CARE UNITS OFFER HIGH TECH AND HIGH TOUCH INTERVENTIONS High Demand of ICU Nursing Care In 2020, Intensive Care Units (ICUs) across the world were ﬁlled with patients suffering from and dying of complications related to COVID-19. ICU beds were in critical demand and ICU nurses faced difﬁcult daily assignments with record numbers of patients under isolation precautions, on mechanical ventilation, and requiring a myriad of new and complex treatment protocols. ICU staff faced an alarming number of patient deaths despite valiant efforts.

EDUCATION Specialized Training Required in Evolving Environment Karen Scanlan, MSN, RN, CCRN, Educator, Critical Care and Cardiovascular Services stated that there was much education that needed not only for the nursing staff but also for the multidisciplinary teams. Specifically, the policies, protocols, and procedures related to emergency situations involving patients with either confirmed or presumptive COVID-19 were amended and the notifications were reported as “RRT- 19” or “Code Blue- 19” to alert responding staff of the required changes to traditional operating procedures. The Cardiopulmonary Resuscitation (CPR) policy was revised to reflect many changes, including administering CPR to patients in the prone position. Revised workflows for the Code Blue and Rapid Response alerts were analyzed and choreographed to ensure the correct resources were available for the patient in a safe manner at the bedside. Deb Jenkins, MSN, RN, NPD-BC, CCRN-K, Nurse Educator, Frick Hospital shared that holding mock codes to practice the changes was an effective way to disseminate and reinforce the new guidance. Education was provided on mechanical ventilation, donning and doffing PPE; new medications, many of which held only Emergency Use Authorization (EUA) and required vigilant monitoring and frequent titrations; advanced oral hygiene regimens for patients receiving non-invasive ventilation; new treatments such as awake proning to mobilize lung secretions, which although was not a newly identified treatment, was new to many staff nurses; heightened measures to prevent pneumonia, infections, pressure ulcers and much more. While the world worked furiously to identify therapies to effectively treat ailing patients, at the end of the day, in the high- tech environments of the ICUs, the high-touch interventions provided by the nursing staff offered some of the most consistent outcomes.

I will never be able to explain The things my eyes have seen Or the feelings I have felt. My family may not understand Why I chose to care for strangers over them. Why I jumped without thinking… I could be playing on the ﬂoor with my son Or watching a movie with my husband. But I don’t let these thoughts stay too long. I don’t regret the decision I made. Because as much as I miss them, I am where I need to be. And in a short time, I will be with them again. I have a long life ahead of me And my patient today did not. Every minute counts in this new world And she only had minutes left. As I try to wrap my head around the events of today, I can not help but replay her ﬁnal minutes, Those minutes I knew were her last… I jumped up from my computer as her heart rate began to slow. I hurried to put on all my attire: My gown, my gloves… I was trying to keep an eye on her heart rate. Her blood pressure was dropping. She was already maxed on all pressors. Her family had already decided: Do Not Resuscitate.

No extraordinary measures. I walked fast to her room, Pushing my mask against my face. I got to the small space that separated her from the nurse’s station. I peered through the small window then unzipped the plastic barrier. I prayed I was protected in my haste. But I had to get in there, No one should die alone. I stepped inside and the monitor was alarming, Her heart rate was in the 30’s. I placed my hand on her back I closed my eyes and my head dropped down. A different alarm was sounding. And I did not have to look because I knew. I had made it. She did not die alone. … I got to talk to my family that night. I got to FaceTime my son before he went to bed. She did not But I was there with her And I hope she was okay with that— Amanda Urosek, RN, BSN, CVRN-BC, Structural Heart Nurse Navigator

I wrote this my ﬁrst week helping in the Latrobe ICU last April. I had no idea what to expect so I decided it would be best to stay in a camper to try to keep my family healthy. I only worked there for a month and I give all the credit in the world to the nurses who have been doing it a year now. 29

INSPIRING HOPE Battling the Ravages of Isolation If you ask an ICU nurse what the most challenging part of 2020 was, the list could easily go on forever. Yet always near the top of the list was the profound effects of constant barriers and isolation. Patients who were conscious were often fearful and struggling to breathe, likely wearing an oxygen mask or BIPAP, which severely limited the ability to communicate their needs. Visitors were limited and often not permitted. Staff were encouraged to bundle care and when clinically appropriate, to limit the frequency in which they entered the rooms of COVID patients to conserve PPE and reduce the risk of exposure. The amount of protective equipment staff was required to wear when entering patient rooms made not only verbal communication difficult, but eliminated the ability for patients to see a warm smile or feel a comforting touch. Curtains and doors were constantly closed and the loud whirring sound made by the fans on the negative airflow machines created an environment that could be very taxing. Nurses worked hard to uncover creative ways to communicate with patients, to offer encouragement, and to afford patients the opportunity to visit with their loved ones and families the option to participate in cyber rounds and treatment planning. In addition to the variety of COVID related stress on the body’s systems, many isolated patients suffered from ICU related delirium, depression, anxiety and panic attacks. Constant isolation can be traumatic and it was not unusual to find a patient crying, “I have to rip this mask off”. For many patients, the fight to breathe, fear, physical illness, infection, isolation, and the inability to communicate made it very hard to maintain hope. Nurses worked insistently trying everything possible to creatively engage necessary support systems and to inspire a feeling of hope. “For some patients, supporting their emotional and spiritual healing made a real difference in whether they lived or died,” relayed Earl Gardner, D.Ed., MSN, RN, CCRN, Nurse Educator, Latrobe Hospital. “For so many, in the face of all the fear and illness, hope and spiritual faith is what they would cling to; it’s what kept them from simply giving up. Everything we have to offer medically works only if their spiritual health is good.”Earl continued, “you have to have hope in order to be able to inspire it.” Earl relayed that nurses in the ICUs, the nurse educators, physicians, and the entirety of the multidisciplinary team worked to care for the patients as well as one another in the heroic effort to preserve hope. “We were trying to comfort patients and families during some of the worst days of their lives and it took a village in life jackets to keep each other above water during the darkest of days.” 30

INSPIRING SPIRITUAL CARE Death with Dignity For some patients, providing hope empowered them to get better and for others it inspired a peaceful death. So many local families were faced with the decision to transition to comfort measures only, accepting that regardless of the most recent technological advances in medicine, their loved one was not improving and would likely not win their unique battle with COVID-19. Nurses cared for record breaking numbers of dying patients in 2020. “It’s exhausting …you work so hard and do everything you can think of to keep someone alive…you spend time keeping their families up to date on their progress…and then you see the obituary in the paper. It makes you feel so sad.” – Maureen Cutrell, BSN, RN, Laurel Surgical Center/WH ICU Tammy Vogel, MSN, RN, Director Nursing Services and Quality, Latrobe Hospital, reported “the personal and professional effects of patient deaths were different during COVID”, citing that the frequency of multiple deaths within short windows of time as well as the fact that families were unable to be at the bedside contributed to the increased stress for ICU staff. “Our goal was to assure that patients were able to die with dignity,” Tammy said. Tammy shared that she and her team took special care to assess for signs of pain or discomfort and to administer measures quickly to relieve any suffering of dying patients. “We contacted families and provided them the opportunity to spend time with loved ones either through compassionate care visits or using phones, iPads and technology.” Tammy recalled that “nurses would often hold a phone to a patient’s ear while families said their ﬁnal goodbyes while holding the patient’s hand and staying with them so that they did not die alone.” Spiritual care is always important, however throughout the pandemic, it played a vital role for a larger percentage of patients. Nurses frequently coordinated pastoral care visits with clergy and prayed with patients and families. Many nurses as well as families conveyed that special bonds were forged through those very difﬁcult times, bonds that will never be forgotten. One former patient in the ICU at Latrobe Hospital wrote in to thank the team that cared for him. “These people were my family when I couldn't see my own. They were my friends when I needed one. I will forever be grateful! God bless!"

KNOWLEDGE EVIDENCE-BASED PRACTICE AND RESEARCH

Excela Health nurses celebrated nurse-led research and evidence-based practice (EBP) projects throughout the system through the 6th Annual Evidence-Based Practice and Research Forum: The 2020 Vision of Nursing.

• Implementation of a Focused Fall Risk Assessment to Improve Fall Rate for Emergency Department Patients by Lydia Marsh, MSN, RN (Clinical Nurse Coordinator, FH ED)

This year’s conference was coordinated by the EBP & Research Committee. Committee chair Jessica Love, MSN, RN, CNL, Clinical Nurse, Frick Hospital PCU and committee facilitator, Deb Lewis, DNP, RN, CNE, Senior Educator facilitated the event.

Doctor of Nursing Practice (DNP) • Implementation of EMS Feedback to Improve Stroke Identiﬁcation by Nicole Komenda, DNP, RN (Clinical Nurse Coordinator, FH ED)

KEYNOTE SPEAKER

• Trauma Informed Care in the Emergency Department by Amy Dennis, DNP, RN (Clinical Nurse, FH ED)

EH Nursing welcomed Lisa Bernardo, PhD, MPH, RN, Nursing Research Consultant as the keynote speaker. Dr. Bernardo described the crucial importance for healthcare staff to purposely nurture resilience both personally and professionally. Dr. Bernardo stressed that the COVID-19 pandemic has placed burdens on staff not only in the workplace but at home as well.

PLENARY SESSIONS Caring 4 You Program Maureen Cutrell, BSN, RN, Clinical Nurse, Laurel Surgical Center and Paula Aiello, BSN, Magnet Program Specialist provided an overview of a new evidence-based peer support program called Caring 4 You designed to support Excela Health staff in all departments to build resilience after an adverse event or during times of chronic stress. Nurse Resident Spotlight • 4 Eye Skin Assessment by Juliene Goehring, RN (WH PCU 1D/E) and Austin Morton, BSN, RN (WH PCU 1D/E) Academic Capstone Projects Master of Science in Nursing (MSN) • Stress Testing Educational Improvement Project by Christen Stercho, MSN, RN (Clinical Nurse, Nuclear Cardiology) 32

• EMS Identiﬁcation of Sepsis and Initiation of a Sepsis Handoff to Decrease Time to Appropriate Treatment by Jordan Culler, DNP, FNP-C, RN (Clinical Nurse, LH ED) • Optimizing Patient Flow Using a Multifaceted Approach by Mike Widmann, MSN, RN-BC, CCRN (Clinical Informatics Coordinator, Excela Health) • Empathy Training in the Emergency Department by Kelly Neubauer, DNP, RN (Nurse Navigator, Heart Failure, Excela Health Cardiology) • Using Purposeful Professional Development to Improve Bedside Nurse Retention: A Quality Improvement Project by Donna Steele, DNP, RN (Assistant Professor, Nursing, Westmoreland County Community College)

DISCOVERY

EVALUATION

APPLICATION

NURSING RESEARCH

QUALITY IMPROVEMENT

EVIDENCEBASED PRACTICE

KNOWLEDGE DEVELOPMENT

EMPOWERMENT PROFESSIONAL GOVERNANCE

Nursing Strategic Planning Helen Burns, PhD, RN, NEA-BC, FAAN, Senior Vice President and Chief Nursing Ofﬁcer reviewed the organizational strategic priorities based on market trends and stressed the key focus for this retreat was for everyone in attendance to contribute to the development of the 2020-2025 Nursing Strategic Plan. The Excela Health Mission, Vision and Values were reviewed by the group and discussions surrounded customizing complimentary nursing strategic goals to inspire organizational success moving into the future. The following aims will lead us through the next ﬁve years:

PROFESSIONAL GOVERNANCE CHAIR RETREAT The Professional Governance Committee hosted a retreat for all Professional Governance council and committee chairs, facilitators, and mentors. Charity Patterson RN-BC, Staff Nurse, FH PCU and Chair of the Professional Governance Committee shared that the meeting was a time of fellowship and reﬂection on the challenges presented during the pandemic and recognition for the excellent team work evident throughout.

Organizational Update and Executive Leadership Summary Excela Health CEO, John Sphon expressed his appreciation toward the nursing staff for the excellent care provided during the pandemic. Mr. Sphon provided an overview of the organization’s ﬁnancial and operational standings resulting from the impact of COVID-19, along with a recovery response plan set forth by the executive leadership team. Mr. Sphon stressed the positive impact of nursing and the importance of professional governance and the ability for these groups to dovetail strategic priorities of the organization. He emphasized the importance of frontline staff being aware of the issues as well as the signiﬁcance of including feedback from frontline staff in leading the organization forward, citing bedside care as the most important aspect of what we do as a health system.

AIM 1: Advance Nursing Practice Excellence and Transformational Leadership AIM 2: Enhance a Culture of Evidence-Based Practice and Research AIM 3: Promote Leadership, Excellence, and Career Development AIM 4: Foster Financial Stewardship and Workforce Management AIM 5: Nursing Image and Community Partnerships Mary Mantese, DNP, RN, CENP, Director, Professional Practice/Care Transformation, Associate Chief Nursing Ofﬁcer offered education related to the work required over the next several years to obtain Magnet re-designation. She provided education related to identifying potential Magnet narratives as well as the differences between process and outcomes goals. Traci Fick, Vice President, Patient Care Services, Westmoreland and Frick Hospitals and Maryann Singley, Vice President, Patient Care Services, Latrobe Hospital facilitated group dialog that began to identify actions outcomes metrics. The group enjoyed the exchange of thoughts and ideas and discussed strategies that would continue to frame the future responsibilities of all Professional Governance councils and committees.

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In June, the number of positive COVID cases had markedly decreased as had community spread in our region. As of June 8, 2020, there were no patients hospitalized at Excela Health who were COVID positive and only four inpatients, who are under investigation. The 14-day trend for new COVID positive cases in our area was only 5/100,000 people. While universal masking and social distancing remained in effect, statewide restrictions began to ease allowing select groups to begin to reconvene and shift the focus from COVID preparedness to moving forward with excellence.

Without strategy, execution is aimless. Without execution, strategy is useless.

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I think one’s feelings waste themselves in words; they ought all to be distilled into actions which bring results ~ FLORENCE NIGHTINGALE

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AGILITY FALL SURGE DEMANDS CALL FOR ACTION

As the month of October came to an end, evidence of the surge in cases was clear. Data analytics revealed that the month of October recorded: • 42% of Excela Health’s total number of unique positive COVID cases since the first documented case in March Urgent Need for Additional Staffing and Inpatient Beds As the number of COVID cases surged, so did the demand for inpatient beds. Healthcare staff were not immune to the impact of the community spread of COVID-19, resulting in a staffing crisis across the Health System. A higher than average inpatient census, coupled with a marked number of healthcare staff in quarantine or isolation and unable to report to work, necessitated immediate adaptations to meet direct patient care needs. Executive leaders strategized to re-allocate resources to meet emergent requirements. Numerous adjustments were implemented across the Health System, all designed to adapt to the changing needs and to assure safe, quality care for patients. Elective surgeries, particularly those requiring a follow up hospitalization were limited to make inpatient beds available for the medically ill patients as well as Certified Registered Nurse Anesthetists (CRNAs) and operating room and peri-anesthesia staff from all entities, including the surgery centers, to assist in the ICUs and PCUs. A system-wide call out for help to Excela Health staff who were interested and available to be crosstrained and redeployed to other departments was circulated.

• 51% of the total number of COVID related hospitalizations • 43% of all COVID related inpatient mortalities • The 14- day average of positive cases per 100,000 people in Westmoreland County was 304, compared to 73/100,000 in September and 5/100,00 in June. Throughout November and December, COVID related statistics continued an upward trend and by 12/24/20, the 14- day average of positive cases in Westmoreland County was 1,447/100,000 people.

STAFFING COMMAND CENTER Coordinating Logistics Sue Campbell, BSN, RN, Nursing Supervisor, Care Support Center and Telecommunication Center shared that during the ﬁrst wave of the pandemic, the Care Support Team was inundated with calls from staff willing to be redeployed to other areas. “It quickly became overwhelming as people were calling from areas with downsized hours such as the EHMG ofﬁces and surgical centers with the hours they were available to work.” Sue recalled that while the team attempted to place individuals where the needs were the greatest, the calls with staff were time consuming. She recalled that people were anxious about working in other areas, unsure about what would be required of them to do.

STAFFING CROSS TRAINING AND REDEPLOYMENT True meaning of teamwork Throughout the busiest days of the pandemic individuals from nursing teams worked anywhere and everywhere there was a need. Not only did staff accept assignments to other nursing units, but they helped to support the Environmental Services staff, they helped Patient Transport teams, they helped to reprocess N95 masks and worked to manufacture hand- made face coverings and isolation gowns to combat global PPE shortages. Members of nursing teams covered the front desks and served as patient and visitor concierges. The role of the concierges was so effective that they evolved into permanent positions at each of the three hospital campuses. Karin Yesho, BSN, RN, Supervisor, Perianesthesia LH shared, “at the beginning of the COVID-19 crisis we knew that our unit (SSU and PACU) would undergo drastic changes, but we had no idea what was in store for us.” Emergency planning generated rapid changes, continually evolving focus and unpredictable schedules.

“As each new option was presented, without hesitation this team was happy to accept that challenge.”

Sue went on to say that “we learned a lot from the experience in March and how to coordinate and manage the logistics more efficiently for the second surge in the fall.” A centralized Staffing Command Center, operated by the Care Support Team, was initiated to manage the staffing needs for nursing team roles throughout the Health System. Sue relayed that a phone tree and designated email were created allowing staff to record all pertinent information, including their credentials, hours available, and specific areas in which they would feel most comfortable working. “The Command Center made things go much smoother,” said Sue. She also shared that specific education was coordinated for individuals being reassigned to other areas as well as an orientation protocol, pairing individuals with experienced staff in the specific areas they were assigned.

Staff from departments across the system accepted assignments in a variety of areas, including acute care settings, which was outside of the comfort zone for many. Karin shared that “some of our staff haven’t worked on an inpatient unit in greater than 10 years; some never worked a night shift or regular 12 -hour shifts; and above all else, documentation in the electronic record is very different on an outpatient unit.” Informatics teams quickly conducted Cerner training sessions, Nurse Educators provided clinical cross-training sessions, and Clinical Leaders adjusted assignment schedules (many shifting to team nursing strategies) to assure that redeployed staff were prepared to step into unfamiliar roles. Perianesthesia teams, along with many other departments provided 24-hour assistance to acute care units while also covering their routine responsibilities. “Life outside our comfort zone has produced enhanced comradery with all nursing units. We got to see care beyond the perianesthesia realm.” As a team, they have adopted the motto, “crisis doesn’t create character, it reveals it.” Vickie Vecchiolla, CRNA, FH thanked the FH ICU staff during her re-deployment there.

“

They are knowledgeable, caring, and dedicated professionals who work very autonomously with great critical thinking skills. They took great care of their patients and worked well together as a team. They all treated me with great kindness and respect and made me feel like one of them. This is the true meaning of teamwork! - Vickie Vecchiolla, CRNA

“

ARTIST: Rebecca (Bequie) Soike, MSN, MS, RN

EXPANDING AVAILABLE INPATIENT BEDS Strategic Adjustments to Meet Demand Along with the acclimatization of stafﬁng, EDs were overcrowded and ICU and PCU beds were in short supply. Hospitals across the region reported no available beds for the growing number of patients requiring inpatient care. Again, a myriad of strategies were executed, including tight communication between all three hospitals allowing patients presenting to Emergency Departments to be admitted wherever a bed was currently available. Nursing case managers worked closely with hospitalists to identify potential candidates for earlier discharge through heightened resource planning. A new home oxygen program was initiated in conjunction with MedCare Equipment allowing patients who would traditionally have remained in the hospital for higher ﬂow oxygen therapy to be discharged to home with specialized education and follow up services. John Dolan, MBA, BSN, RN, ACM-RN Director, Clinical Resource Management, coordinated efforts to amplify contractual pursuits with long

term acute care providers to facilitate adjustments to the insurance authorization process to expedite discharges for patients requiring this level of care. Existing nursing units were customized to accept patients requiring a higher level of acuity by relocating patient monitors and other required equipment from clinical areas not currently in use to support the implementation of ICU and PCU levels of care in additional areas of each hospital. Cohorting patients was done when possible, although COVID isolation restrictions along with the fact that negative airflow machines occupied a significant amount of space in hospital rooms, limited this option. Despite the vast number of environmental and procedural modifications, it became apparent that the number of patients was quickly outnumbering available beds. We needed to find more space.

REDESIGNING SPACES Adapting Physical Spaces to Yield Additional Beds LATROBE HOSPITAL As truncated OR schedules minimized the need for surgical beds, nursing teams on units 3N and 4S at Latrobe Hospital suggested trading spaces as a means to add PCU beds. Receiving administrative approval, 3N staff and patients were relocated to the larger unit on the 4th floor and 4S staff and patients took up residence in the smaller space on the third floor. FRICK HOSPITAL SPU space at Frick Hospital was adapted to accept up to six COVID patients when no PCU beds were available and staff were redeployed to that area as needed. Karen Soltez, MSN, RN, Manager of Perioperative Services, Norwin Ambulatory Surgery, Frick Hospital and Weight Management Center, shared that “Harry Jenkins, BSN, RN, CST, Supervisor of Perioperative Services Frick Hospital, took the lead in working with the Facilities department to turn the SPU into a negative pressure unit and he also worked closely with Brandi Hall, MSN, RN, NE-BC, Clinical Director, to configure the workflow and staffing on the unit at Frick.” Brandi recalled the challenges to staffing the extra unit considering that many of the nurses available to work were unaccustomed to caring for patients in a PCU setting. She shared that patient assignments were greater and nurse to patient ratios were higher than normal. “We triaged the patients and based on the severity of illness, we placed those who were the most stable in the SPU location.” Brandi shared that Frick PCU staff worked collectively with PCU nurses from Westmoreland Hospital to craft staffing schedules on PCU units at both hospitals that included sufficient numbers of experienced nurses assigned along with the less experienced staff redeployed from other areas.

WESTMORELAND HOSPITAL At Westmoreland Hospital, the GI Lab was successfully converted to an alternate care site for COVID patients. This space offered 12 additional monitored beds which greatly helped decrease the number of patients being held in Emergency Departments. “A multidisciplinary team led by the Westmoreland Hospital GI nursing team turned an outpatient procedural department into an inpatient nursing unit in 12 hours,” reported Jessica Stack, MSN, RN, Director of Perioperative Services. The renovation included a complete transformation of the physical department space, furniture, supplies, functionality, and stafﬁng. A team nursing approach was utilized to staff the unit whereby experienced PCU nurses worked alongside nurses from perioperative services teams from the Westmoreland Hospital GI Lab, Laurel Surgical Center, and Norwin Surgical Center. Jessica praised the Nursing Educators who “were a tremendous help in orienting the perioperative nurses to inpatient care.” Jessica shared that the educators worked directly with staff in the converted unit providing hands on education and support as well as valuable feedback on the progress to Jessica for the purpose of identifying additional support requirements. Jessica reiterated that the GI nurses not only worked to staff the temporary inpatient COVID unit 24/7, but they also remained on call for GI emergencies, citing Glenn Repko, Clinical Director Stafﬁng Support Team and the Care Support Team as instrumental in coordinating the custom schedules. “The GI team adapted well despite many reporting this was ‘the hardest thing they ever had to do in their nursing career’”.

“We worked together and we got through it.”

COURAGE CHALLENGES

“

I am of certain convinced that the greatest heroes are those who do their duty in the daily grind of domestic affairs whilst the world whirls as a maddening dreidel. Florence Nightingale

EMERGENCY DEPARTMENTS MOUNT COURAGE TO FACE PANDEMIC CHALLENGES

The madness created by the novel coronavirus whirled around the staff in the Emergency Departments of Excela’s three hospitals while they mounted the courage to face the daily grind, including a late autumn surge and stafﬁng shortages. Already exhausted from seven months of protocols and procedures related to suspected and positive COVID-19 patients, the staff in the EDs found themselves in unusual situations. The need for ICU beds and ICU staff created a challenge and patients were often held for days in the EDs where nursing staff would deliver inpatient care and charting while providing emergent care to COVID and non-COVID patients alike. Throughout much of November and December volumes climbed in the EDs at Frick, Latrobe and Westmoreland hospitals. All three departments intermittently recorded National ED Overcrowding (NEDOC) scores at Level 5 (Severely Overcrowded) and Level 6 (Dangerously Overcrowded) during the ﬁnal 60 days of 2020, requiring staff to care for more patients’ circumstance than normal. “High NEDOCS scores meant the department was extremely busy,” said Jim Jellison Jr, RN, Clinical Nursing Coordinator at Excela Health Latrobe Area Hospital. “The higher the score, the more likely you were to see patients in hallway beds getting ER treatments and boarding in the Emergency Department as admitted patients. High NEDOCS scores meant staff had to take more patients than they usually do.” 40

According to Jim, during the post-Thanksgiving surge, it was common for nurses to walk into a shift and be busy non-stop, caring for six or more patients, which were higher in acuity. And this would take a toll on staff. “Constantly watching patients fight for air, knowing they are in need of a ventilator and an ICU bed, which could be next to impossible to find. Nobody outside of the profession will ever truly know how it feels to not only watch fear and pain in the eyes of so many patients, but to walk into the nurse’s station and see the same look in the eyes of your colleagues,” he said. With high census and higher acuity patients across the system, staff became overwhelmed and shortages were a reality that had to be faced. They increased their pace, missed breaks and meals, and went home feeling not only exhausted, but sometimes defeated according to Jim. “Many days, messages were sent out asking for those who were off to come and lend a hand. Staff picked up shifts, came in early, stayed late, doubled back, and traded shifts to cover the schedules,” he said. “Many staff would bring in food or have deliveries made to make sure their coworkers got something to eat, even if it was a grab-and-go style meal.” From an education standpoint, Rebecca Soike, MSN, MS, RN, notes that during the pandemic, Evidence-Based Practices were changing constantly regarding COVID-19 policies and procedures, requiring staff to be flexible and adaptive.

“I think that COVID-19 taught us a lot about the Relationship Based Care model and how it relates to our practice. The positive human connections are very important between patients, families, and self and between colleagues. I think the stress created by COVID-19 made this more and more evident and forced us as providers to adapt and build awareness around this,” Rebecca said. The increased volumes and acuity combined with a lack of visitors to provide support information providers, therapeutic communicators, and safety monitors, presented a unique situation for nursing according to Rebecca. “Emergency departments started to use more posey sitters to keep an eye on wander risk and fall risk patients. Nurses made more phone calls to keep family updated and to obtain pertinent information when patients were poor historians and even utilized connecting patients via phone to their loved ones to foster the connection between patients and their families,” she said. Ultimately, it would be courage, teamwork, and inter-professional collaboration, that would get the ED teams through the surge. A kind word, a joke, a bowl of homemade soup, a pat on the back, and a helping hand, went a long way and held them together. “COVID has changed every single one of us, both good and bad, but the one thing it has undoubtedly done, was strengthen the bond between the members of the team,” Jim said.

RESILIENCE CARING 4 YOU PROGRAM

Healthcare staff “second victims” By the end of 2020, the pandemic’s emotional wear and tear on everyone was evident. Patients and families were more irritable than noted at the start of the pandemic and healthcare staff were becoming increasingly more physically and emotionally drained. The effects of chronic stress were taking a toll on every team throughout the Health System as day after day they absorbed the trauma around them. The risk for compassion fatigue and burnout were at an all- time high. \

THE SECOND VICTIMS IN HEALTHCARE Helen Burns, PhD, RN, NEA-BC, FAAN, Senior Vice President and Chief Nursing Ofﬁcer, introduced an evidence-based peer support program with proven national success. Background studies revealed that in the fast-paced, high-acuity environments in healthcare, there is minimal time for staff to process an adverse event before moving to the next duty. For the most part, staff are resilient and are able to successfully cope with stressors as they arise. But occasionally an unexpected adverse event or a series of events occur resulting in the staff themselves feeling traumatized. In times when stress levels rise above normal limits, even the most experienced and skillful professionals are not immune and can experience an emotional aftershock or stress reaction. In essence, healthcare staff become the “second victims”. While heroic efforts ensue to provide support for the “ﬁrst victims”, patients and families, healthcare staff often keep these feelings internalized and as a result suffer in silence.

BOOSTING RESILIENCE - Helen

assembled a system-wide multidisciplinary steering committee to propose operationalizing a peer support program to promote resilience within our Excela Health teams based on current models of success. The group included representatives from Employee Health, the Well-Being Center, Care Support, Behavioral Health, Human Resources, Nursing, Education, as well as Carol Fox, Chief

YOU You are not alone.

caringforyou@excelahealth.org | 724-832-4055

Medical Officer and Helen Burns, Chief Nursing Officer. Regional and local organizations implementing peer support programs were consulted, including Susan Scott, PHD, RN, CPPS, Manager of Patient Safety and Risk Management at the University of Missouri Health System, whose “forYou” program has achieved national acclaim for successfully supporting health care staff who may be struggling second victims. Dr. Scott’s research found that coaching peers to first, recognize when coworkers display behavioral changes suggestive of a second victim response and then, to provide them with general training to facilitate the support process, enabled these trained peer supporters to offer emotional first aid to struggling second victims right on the spot directly in departments and units as the needs arose. Using the guidance issued by Dr. Scott’s program, the team developed the Excela Health “Caring 4 You” Program. The program was approved by the Excela Health Operations Committee in November of 2020 and a team of Trained Peer Supporters was convened, educated and oriented. In December, education and promotional materials were distributed to all Excela Health staff across all entities. The goal is to provide support to individuals and/or teams as well as to bridge connections to both internal and external resources as needed both during the pandemic and into the future.

ADVOCACY EXCELA HEALTH NURSES IN THE MEDIA

Spotlight on the nursing experience As the public health emergency reached crisis levels, teams in every department excelled at ﬁghting the seemingly endless challenges, exhaustion, frustration, rapidly changing policies, extensive use of PPE, stafﬁng shortages, and distressed patients and their families while managing to provide exemplary care. \

Yet, there is something else Excela Health staff excelled at in the closing months of 2020, and that was in taking the time to share the sobering reality of their experiences in caring for patients with COVID-19 to increase community awareness for the urgent need to adhere to masking and social distancing recommendations to decrease the spread of the virus and preserve hospital resources. Dr. Carol Fox, Senior VP and Chief Medical Officer, appeared numerous times on local television news and in the newspapers. She and John Sphon, Chief Executive Officer, appeared on Facebook with State Sen. Kim Ward discussing the local impact of COVID-19. Public pleas for cooperation were not limited to executive leadership. Several Excela Health staff nurses were featured in the media to inspire members of the community to adhere to mitigation efforts. Monica Krinock, BSN, RN, a Clinical Nurse Coordinator on PCU units at Latrobe Hospital along with Dr. Kevin Bartolomucci were interviewed by the Pittsburgh Post-Gazette, where they described how caregivers on the frontlines were managing the crisis. “Everybody sometimes has to find a person to cry with, you know? I think that’s what we all know.

It’s not like one of us is going through it. We’re all going through it” said Monica.

James Wirt, RN, a staff nurse in the ICU at Westmoreland Hospital appeared on WPXI news to discuss the reality of diminishing ICU beds. “We’re not seeing Thanksgiving yet. We’re not going to see Christmas for another month or two. I think we should rethink everything we do. The simplest act of kindness you can do right now is wear a mask,” James shared.

Carly Thomas, BSN, RN, a Clinical Nurse Coordinator on unit 3AB at Westmoreland Hospital delivered a heartfelt testimony on WTAE news describing the challenges she and her colleagues face every day to care for COVID patients.

"I've held the patients' hand while they die," Carly tearfully shared. "I've FaceTimed with families so they could say goodbye to their loved ones. We just sit there and hold their hands. They want you to limit to 15 minutes in a room, but how do you walk away from someone that's saying they want to die?" 43

ADVOCACY EXCELA HEALTH NURSES IN THE MEDIA

Carly’s story was so compelling that it got picked up by ABC’s World News Tonight, and various news outlets throughout the country. On December 7, she participated in an interview with MSNBC’s Ayman Mohyeldin where she once again shared the grim reality facing healthcare workers every day as they report for work. Like her peers, Carly used the opportunity to reiterate that the pandemic has reached crisis levels right here in Western PA and to encourage viewers to please wear a mask. “You might think wearing a mask might not prevent you from getting sick but it might prevent a family member from getting sick. A grandmother, an aunt or uncle who is not at their healthiest might not make it through this.”

These testimonials advocated to the community that the harrowing visions of crowded hospitals, ICU bed shortages, and people dying from COVID were not just sensationalized in the media and limited to big cities great distances away, but playing out in stark reality right here at home. Click the photo below to watch the interview.

HOPE FIRST COVID-19 VACCINES ARRIVE Seeds of Hope The Food and Drug Administration (FDA) issued Emergency Use Authorization (EUA) for the PﬁzerBioNTech COVID-19 vaccine on December 11, 2020. On Friday, December 18, 2020, Excela Health rolled out the ﬁrst series in a large- scale plan of COVID Vaccine Clinics at each of the three hospital campuses, each location having received 975 doses of the ground- breaking vaccine. In accordance with both CDC and PA Department of Health mandates, Excela Health employees received the initial doses. \

Denise Addis, MSN, RN, CPHQ, Vice President, Cardiovascular Service Line partnered with Mike Sekhon, Director of Pharmacy, to coordinate the Vaccine Clinics and shared that approximately 500 employees across the Health System were inoculated that first Friday as shots were administered every 5 minutes. “It’s kind of like a big breath of fresh air,” Denise told local reporters that day. “It’s going to help the employees, it’s going to help their families, it’s going to help the community at large.” As a Magnet designated organization, one of the key aims is to demonstrate evidence of strong interdisciplinary collaboration. While teamwork was crucial throughout 2020, one of the most poignant examples of successful teamwork among the multiple disciplines at Excela Health was the vastly successful COVID-19 Vaccine Clinics. Though the initial vaccines were offered solely to Excela Health staff, they quickly expanded to include eligible community members based on state prioritization guidelines. There was an exceptional amount of careful coordination required by many departments in a very short amount of time to prepare for and ensure safety and efficiency between the arrival of the very first shipment of vaccine and the point when shots were delivered into arms.

• Carrie Horner, MSN, RN, CPHQ, Manager, Quality Analytics and VBP, shared that “the success of the clinics is a direct result of exceptional teamwork demonstrated by the talented professionals from many departments”. Teams from Information Technology, Pharmacy, Nursing, Medical Information Management, Quality, Leadership, Education, Volunteer Services, Environmental Services, Marketing, Facilities, Safety, Security, Human Resources, Call Center, clerical support, and many others worked to implement the clinics. • Bonnie Barnhart, RN, BSE, MBA, Analyst, Regulation/Accreditation, shared that “We have received many positive comments from the community. I think they had visions of what they had seen on TV of long lines and waiting.” She stated that meticulous attention to detail prior to and during the clinics and a strict scheduling process ensured that was not the case. • Josh Adams, MSN, RN, Stroke Coordinator, shared, “One comment I overheard at the community clinic on Sunday at Latrobe that I thought was the ultimate compliment was a woman tell her husband that the clinic was more efficient than Chick-Fil-A.” While many individuals across the world were ambivalent about receiving these first vaccines issued under EUA until longer term data were analyzed, staff at Excela Health receiving those first doses were jubilant, many citing “You feel hope”.

HOPE FIRST COVID-19 VACCINES ARRIVE

”

Let us never consider ourselves ﬁnished nurses. We must be learning all of our lives. ~ FLORENCE NIGHTINGALE

ACCOMPLISHMENTS Throughout the Year

2020 CAMEO OF CARING AWARDS

2020 NURSING AWARDS

PITTSBURGH MAGAZINE WINNERS

Each year Pittsburgh Magazine honors nurses from across the region for their exceptional contributions in nursing. This year, we are pleased beyond measure to congratulate three of our own special EH nurses receiving this prestigious honor! Charity Patterson, RN-BC, Staff Nurse PCU FH received top honors in the Clinician category for her passion in caring for older patients and for her creative interventions to decrease falls in dementia patients. W. Michael Widmann, MSN, RN-BC, CCRN-K, Clinical Informatics Coordinator received honorable mention in the Emerging Leader category for his work leading to optimizations and improvements to the EH Electronic Medical Record as well as his commitment to education and unceasing willingness to lend his expertise across our health system. This year, the panel of judges created a new category for honorees, entitled “Pandemic Response Hero” – in recognition of the remarkable innovation the nursing community showed while rising to meet the challenges of COVID-19. Excela’s Kathleen Rosatti, MSN, RN, Director, Clinical Outcomes Management; Patient Safety; Infection Control; Regulatory and Accreditation deservedly received this incredible distinction of nursing excellence! In the Pittsburgh Magazine article, Kate credits healthcare workers on the frontlines, stating, “the true heroes of the whole pandemic are those people at the front line implementing the guidance.” See page 27. Along side our entire EH leadership team, Kate has valiantly dedicated countless hours and heartfelt determination to battling the seemingly never-ending challenges of COVID-19. She has faced each challenge with professionalism and clinical expertise, as well as with sheer courage, kindness, and the commitment to never give up. “You always have to remind people there’s light at the end of the tunnel, and you have to ﬁnd the success story … whether it’s a positive impact on a patient, one family, or a whole building of residents,” she says. “Everything we’re asking you to do is making a difference. You are truly saving lives.”

2020 NURSING PROFESSIONAL PRESENTATIONS AND PUBLICATIONS Szarejko, K., Lewis, D., & Burns, H. (in press). The nurse residency education navigator: Educator, facilitator, and clinician. The Journal of Continuing Education in Nursing. Fick, T., & Neubauer, K. (2020, March). Workforce engagement through CARE. Accepted for Small Group Discussion at the 2020 AONL National Conference, Nashville, TN. (Conference cancelled due to pandemic). Bedner, K. (2020, June). I'm not throwing away my shot. Podium presentation at Horizons 2020 Pennsylvania Emergency Nurses Association Conference, Valley Forge, PA. (Conference cancelled due pandemic). Labish, E. (2020, August). Nursing leadership - Past, present, and future. Virtual expert panel presentation at the Southwestern Pennsylvania Organization of Nurse Leaders Annual Conference. Farina, S., Addis, D., Varsafsky, J., & Janoski, B. (2020, August) Nurse navigator enhances retention of patients post positive breast biopsy. Virtual poster session presented at the Southwestern Pennsylvania Organization of Nurse Leaders Annual Conference. (TOP THREE AWARD) Fick, T. (2020, October). Success pays…Our stories. Virtual panel presentation at the 2020 ANCC Virtual Summit Conference. Bedner, K., & Bedner, K. (2020, October) Educating ED staff on care of the LGBTQI+ patient. Virtual presentation at the Emergency Nurses Association Annual Conference, Las Vegas, NV.

Nurse Navigator Enhances Retention of Patients Post Positive Breast Biopsy Sheila Farina, MSN, RN-BC, CBCN; Denise Addis, MSN, CPHQ; Jamie Varsafsky BSN, RN; Beth Janoski , MS-HSL, RHIA, CTR, CHTS-IS

Expert Care. Here.

• In 2017, of the 299 women diagnosed with positive breast cancer biopsies, only 200 (66.8%) received treatment within our Breast Care Center (BCC). • Treatment for positive breast cancer biopsies includes lumpectomies, excisions, mastectomies, and implants. • These concerning data prompted us to initiate a Nurse Navigator (NN) program specific for women with a positive breast biopsy. • We posited that women who establish a therapeutic relationship with a NN are more likely to continue treatment within our BCC.

• The purpose of this QI initiative was to implement a Nurse Navigator program for our Breast Care Center with the outcome of retaining women with a positive breast cancer biopsy to receive treatment within our Center.

• At the time of biopsy, the NN: • meets with women to establish a therapeutic relationship. • Post biopsy, the NN continues this relationship by: • contacting patients, informing them of their diagnosis and providing an appointment to consult with a surgeon within seven business days • providing emotional support • educating patients about what to expect and the team members who will participate in the plan of care • providing educational resources to enhance their understanding of diagnosis and treatment options • During treatment, the NN enhances the patients’ experience by: • expediting follow up testing to promote care continuity • providing social, financial, and emotional resources • Preoperatively, the NN: • provides general surgical instructions • demonstrates exercises to prevent lymphedema • teaches exercises to increase mobility and flexibility • discusses nutrition and wellness recommendations to prepare for surgery. • engages patients in the use of relaxation techniques including visualization and mindfulness • Post-surgery, the NN continues as the patients’ care coordinator, advocate and point of contact. • Post treatment, the NN: • provides a survivorship care plan • acts as a resource for the Health System • participates in community events • educates surgical nurses about breast cancer care

• From April 2018 to December 2019, 703 women had a positive breast cancer biopsy; 659 (93.7%) remained for treatment. • Anecdotal data from women post-biopsy reinforces the therapeutic value of the NN. 2nd 3rd 4th Quarter Quarter Quarter 2018 2018 2018

1st Quarter 2019

2nd Quarter 2019

3rd Quarter 2019

4th Quarter 2019

131

104

103

Number of 78 surgical appointments made

123

100

Retention percentage

90.6%

93.9%

95.8%

96.2%

96.6%

90.3%

Number of calls made to patients with positive pathology

92.8%

500

Breast Procedures*

450 400 350 300 250 200 150 100 50 0 FY 2017

FY 2018

FY 2019

• A Nurse Navigator dedicated to women with positive breast cancer biopsies improves retention for subsequent treatment. • Patients remaining in the health system for treatment increased from 66.8% to 93.7% . • Future initiatives should include the effect of the NN on patient health outcomes, long term follow up and treatment costs.

• …I have never felt so scared in my life, my husband was out of town and I could feel the fear pulling me under and had no idea how to keep myself together. I was a crying frightened mess,… the NN pulled me into her office. With her confident empathetic and positive personality, she was able to calm my fears. She even arranged for me to have the bx done that day. She gave me her card and told me I could call her with questions. I took her up on this and have made many phone calls since then. • She called a couple days later to deliver the bad news, even over the phone she was able to comfort and reassure me that she would get me through this nightmare….She was able to get me an appt …the next week…. I knew I was in the best of hands. • I credit as much of my healing to the NN who was able to provide the support that was essential for my mental and emotional health. …provided an integral source of communication between myself and the doctors. …made an extremely terrifying situation much more bearable and for that I will always be grateful. • Thank you so much for the information, and just as importantly, your positive attitude and kind words. ….I mentioned to my mum that you are living proof there are angels on Earth among us. • Ty for your kindness and support during my recent dx and surgery. Your compassion and sensitivity was so important during our first phone call when you told me about my breast cancer and all your availability and teaching were most appreciated.

Acknowledgement: Excela Health Educator Deborah Lewis, DNP, RN, CNE

2020 YEAR OF THE NURSE STRATEGIC PRIORITY CONTRIBUTION NIGHTINGALE AWARDS

In honor of Florence Nightingale’s 200th birthday, the World Health Organization (WHO) has deemed 2020 as the

“YEAR OF THE NURSE AND MIDWIFE”. What better reason to celebrate excellent nurses who work to meet the strategic priorities of Excela Health.

Individual Clinical Nurse Awards

Nursing Group Awards

Deborah Lewis, DNP, RN, CNE

Excela Health Frick Hospital Emergency Department

Mackenzie Wargo, BSN, RN, RNC-OB Charity Patterson, RN, RN-BC Taylor Stifﬂer, BSN, RN, IBCLC

Excela Health Latrobe Hospital Progressive Care Unit Excela Health Latrobe Perianesthesia Team Excela Health Westmoreland Hospital 3AB Inpatient Unit Excela Health Home Care and Hospice Leadership Team Excela Health Latrobe/Westmoreland Outpatient Behavioral Health 53

NURSES EARNING ADVANCED NURSING DEGREES AND CERTFICATIONS IN 2020 Bachelor’s Degrees

Lytle, Rebecca A.

Stercho, Christen M.

Hayden, Satannia

PCCN

Arthur, Kahlee

Marchlewski, Mandy J.

Weimann, Sara E.

Hunter, Yvonne

PEP

Barclay, Tera M.

Marvich, Baylee M.

Williams, Brooke A.

Bukovac, Anita.

Barrick, Brandi N.

Mathews, Lindsey M.

Belzer, Austin J.

McCallen, Janet M.

Hall, Nicole

Doctoral Degrees

Bowman, Clayton T.

Miller, Morgan L.

Repko, Glenn M.

Brehm, Ashley M.

Morrison, Courtney N.

Komenda, Nicole M.

Bukovac, Larissa S.

Murphy, Joanne

Neubauer, Kelly D.

Bush, Stacey L.

Neumann, Ashley M.

Busovicki, Lyndzey

Nichols, Kaitlyn B.

Cataldo, Libby E.

Piccolino, Amanda L.

Columbus, Madison M.

Piper, Marque L.

Davis, Julie C.

Pitzer, Sarah G.

DeWitt, Morgan L.

Pratt, Chrystal A.

Dingman, Sally A.

Rubin, Samantha J.

Dunlap, Kandace J.

Scarlett, Stephanie L.

Fabian, Alicia J.

Scott, Jason W.

Fetsko, Lea M.

Sheridan, Emily R.

Galper, Bailey E.

Steffey, Jessica

Garvin, Kelly E.

Stoner, Abigail J.

Gillis, Abigail L.

Stout, Megan E.

Glaser, Kelly L.

Urosek, Amanda N.

Hall, Tara R.

Weimer, Nicole L.

Hegedus, Michelle D.

Wilson, Erin R.

Hirsch, Jennie L.

Woodburn, Lauren

Kalmar, Carrie

Yost, Kathlene A.

King, Lynn L. Klorczyk, Jonathan Knopsnider, Victoria J. Koontz, Kacey S. Kraisinger, Laura M. Kuhns, Stephanie M. Leiford, Faith A. Lynn, Mercedez A.

RNC-OB

Wargo, Mackenzie RNC-OB Andreani, Sharon

Nursing Certiﬁcations Farina, Sheila

CBCN

Burkett, Jennifer

CCRN

Arthur, Kahlee

CCRN

Repko, Glenn

CCRN-K

Widmann, William

CCRN-K

Adams, Joshua

CCRN-K

Reynolds, Waynette C-EFM Adams, Joshua

CEN

Blycheck, Paul

CEN

Adams, Joshua

CPEN

Adams, Joshua

CPHQ

Adams, Joshua

CPPS

Pavlik, Danielle

CRNA

Hutchinson, Patricia CWCN Copney, Elaine

GC-C

Moffa, Debra

RN-BC

Master’s Degrees

Shearer, Megan

NE-BC

Furnival, Anna

Weimann, Sara

NP-C

Kraly, Natalie C.

Paul, Katie

NP-C

Miller, Heather L.

Kraly, Natalie

NP-C

Paul, Katie M.

Williams, Brooke

NP-C

Pavlik, Danielle L.

Dolney, Michelle

NP-C

Sipple, Angela M.

Noonan, Lois

NPD-BC

Soike, Rebecca J.

Szarejko, Kristine

NPD-BC

Gibson, Stacy

NPD-BC

Kim, Mija

RNC-LRN

RNC-OB

SPECIAL RECOGNITIONS BE STROKE SMART: CELEBRATING OUR SUCCESSES Congratulations Excela Health interdisciplinary stroke teams! • The American Heart Association/American Stroke Association announced that we met requirements for Get With The Guidelines Stroke Achievement Awards at ALL 3 EXCELA HEALTH HOSPITALS • These awards recognize hospitals that demonstrate at least 85 percent compliance in each of seven GWTG stroke achievement measures. Silver recognizes performance of 12 consecutive months; gold recognizes performance of 24 consecutive months or more. • Frick Hospital was awarded the Silver Plus Get With The Guidelines Stroke Award • Westmoreland and Latrobe Hospitals both were awarded the Gold Plus Get With the Guidelines Stroke Award

NATIONAL SAFE SLEEP HOSPITAL CERTIFICATION PROGRAM RECOGNIZES EXCELA HEALTH FAMILY ADDITIONS MATERNITY Awarded Silver Safe Sleep Leader Hospital Certification from Cribs for Kids® • Sleep-Related Death results in the loss of more than 3,500 infants every year in the US. The National Safe Sleep Hospital Certification Program was created by the Pittsburgh based organization, Cribs for Kids® to recognize hospitals that are taking an active role in reducing preventable infant sleep-related deaths. As a Nationally Certified Safe Sleep Hospital, Excela Health is recognized for following the safe sleep guidelines set forth by the American Academy of Pediatrics (AAP), and providing training programs for healthcare team members, and family caregivers.

EXCELA HEALTH FAMILY ADDITIONS MATERNITY Best Maternity Hospitals 2020 Newsweek • Newsweek partnered with The Leapfrog Group to recognize Excela Health among the list of the Best Maternity Hospitals 2020. Only 231 hospitals in 36 states were able to show evidence to support compliance with these standards for excellence in quality and safety in maternity care. EH was one of only two hospitals in Southwestern PA to earn this honor. The facilities cited by Newsweek as Best Maternity Hospitals 2020 are an elite group demonstrating excellence in maternity care. Thanks to this remarkable team EH is a great place to have a baby! 55

SPECIAL RECOGNITIONS

EXTERNAL AWARD OF DISTINCTION Center for Organ Recovery & Education (CORE) Intensive Care Unit nurse, Michelle Delancey, BSN, RN, received an External Award of Distinction by the Center for Organ Recovery & Education (CORE). To receive this distinction from CORE the recipient must demonstrate one or more of the organization’s core values including: integrity, compassion, quality, responsiveness and education. Throughout her interactions with Kayla Wyles, organ procurement coordinator with CORE, she demonstrated each of these values. Wyles described Delancey as “She was on top of her game… She was very helpful throughout the case and intrigued to learn as much as she could… Michelle showed so much compassion, love, care, thoughtfulness and dedication…” When asked what this recognition meant to her, Delancey said “The emotional impact these girls (CORE) make is incredible. Kayla was amazing, and it means so much that someone of her caliber would recognize us.”

NURSE SENSITIVE CLINICAL INDICATORS Q4 2018-Q3 2020

PINNING Excela Health nurses from across the health system proudly shared their well-earned nursing school pins for the Year of the Nurse.

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Remarkable people accomplish remarkable things! Throughout 2020, Excela Health nurses were indeed remarkable in their accomplishments. With passion for patient care and professional determination to overcome the challenges of the pandemic, nurses across Excela Health worked as expert and proﬁcient teams to lead so many aspects of the pandemic response. Clinical innovation, evidence-based practice and disciplined decision making remained the core of our nursing teams. Partnering with the interprofessional team, nurses accomplished their priorities of caring for patients, supporting families, and sustaining the moral courage and resilience of each team member. 2020 was a remarkable year, and I sincerely thank every single member of our nursing team for stepping forward and sharing their remarkable talents and passion for caring.

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Mary Mantese, DNP, RN, CENP Director, Professional Practice & Care Transformation/Associate Chief Nursing Ofﬁcer

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Many thanks to the nurses of Excela Health as they had the courage, conviction and compassion to care for our patients and community, during this pandemic. Teamwork was the guiding principle that brought all disciplines together to collaboratively assure the common goal of safety, quality and comfort for our patients. As we move forward to 2021, we look to ﬁnd a brightened spirit of wellness for our staff, patients and our communities.

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Maryann Singley, RN, MSN, NE-BC Vice President | Patient Care Services, Excela Health Latrobe Hospital

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It is with sincere gratitude that I recognize the Excela Health nurses for their dedication they have given while caring for our patients through the pandemic. They demonstrate resilience as they work through uncertainty and personal fears while staying committed to providing the best possible care to our community members and working as key members of the interprofessional Excela Health team. As we focus on our true north of quality, safety and the patient experience in 2021 and beyond, our healthcare heroes will continue to be the bright stars leading the way!

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Traci Fick, DNP, RN, NEA-BC Vice President | Patient Care Services Excela Health Westmoreland Hospital, Excela Health Frick Hospital