HOUSTON
METHODIST NURSE JANUARY 2014 | A Magazine for Nurses
TRANSPLANT
Recipients
Ride
in the
ROSE PARADE
Matt Katsarelis pictured in center
Sophie’s Story
A Patient’s Start on a NEW LIFE Page 12
Page 8
Spotlight on
INFECTION Control
Page 13
Leaders in Nursing
I
A Message from
Ann Scanlon McGinity
Senior Vice President and Chief Nurse Executive
Happy New Year to All in 2014!
I’m delighted to begin the journey into 2014 with each of you, my companions and colleagues. Our work as leaders is to create a stimulating environment that advances all of our contributions to the clinical and economic environment of our organization. Couple this environment with a clinical ladder structure designed to catalyze the work of our clinicians, I believe we are well positioned to advance our values, research, and professional development. Our goal this year is to provide you with opportunities for development that advance your own professional goals in the delivery of patient and family centered care. In our strategic plan we have created a vision for our future. This plan extends
2014 EDITORIAL BOARD MEMBERS Rosario Alvarado ShuntĂĄ Fletcher Donna Esposito Elizabeth Gigliotti Elizabeth Himes
Beverley Lamoth Robert Moorehead Carlette Patterson Joy Shiller Robyn Washington
MAGAZINE EDITOR Elizabeth Himes
GRAPHIC DESIGNER Phyllis Gillentine
PHOTOGRAPHERS Phyllis Gillentine Scott Weersing
to all of our community hospitals and the exciting discussions we are having centering around care redesign, creating efficiencies through standardization and patient centeredness, and achieving nurse sensitive clinical outcomes. With all the challenges we face in this dynamic healthcare market, I believe we are poised to promote interdisciplinary teamwork, evidence based practice, expert professional development and career coaching, and most importantly, the achievement of quality outcomes. Our vision is to expand our internationally recognized centers of nursing excellence and practice which drive innovation in care, education, and research. It is a privilege to work with such incredibly talented, dynamic, and committed colleagues. . . and know that I eagerly look forward to our collaboration this coming year.
Do you have a
STORY
that you would like to post in the
METHODIST NURSE MAGAZINE? Please submit your articles or ideas to Phyllis Gillentine at pmgillentine@houstonmethodist.org
Houston Methodist Hospital
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Comfort Bath by Sage
This product is not meant to be flushed; simply toss in the garbage can.
Houston Methodist San Jacinto News
Jane DeStefano
Vice President and Chief Nursing Officer
The New Year Means New
LIFE
HOUSTON METHODIST SAN JACINTO HOSPITAL is looking forward to welcoming new life in the New Year with the implementation of Couplet Care. Couplet Care officially launched in September and now it’s hard to imagine a time when it wasn’t around. Couplet care promotes stronger family bonding and assists with attachment while reducing anxiety after discharge. The nursing staff assists in educating new parents about newborn care, sleep, breathing sounds and eating patterns before going home. Since moms and babies stay together during and after birth, family members of the baby also can be involved from birth to discharge. Couplet care has shown to lower blood pressures, pulse rate, respirations, lessen crying, maintain stable temperature, and improve breast feeding. Nurses at the hospital are able to provide teaching to mothers and families. Because couplet care promotes family bonding, families are provided immediate awareness of their newborn’s individual patterns and needs.
4 METHODIST NURSE
Houston Methodist Sugar Land News
Janet Leatherwood RN, MSN, VP / Chief Nursing Officer
NEW YEAR, NEW GOAL As we move forward into 2014, it’s important to take a few minutes to reflect on all of the hard work and accomplishments achieved during 2013 by our nurses. What a year of major accomplishments throughout each area of the hospital! These last 12 months reflect huge milestones as some have completed their graduate education. We also saw a 2 percent increase in the number of certifications representing the expertise of a nurse. Our professional nurses have shared their expertise at symposium and retreats. Several of our nurses are now serving or will assume lead roles in their professional organizations during 2014. Thank you for all of your hard work and dedication to our nursing profession and I congratulate each of you on your achievements during 2013.
2013 AWARDS AND ACCOLADES
Houston Methodist Sugar Land Hospital EDUCATION BSN, RN-TO-BSN • Ron Malit, RN MSN • Gilbert Barrera, RN • Judy Jacob-Mathew, RN • Luz Malit, RN • Philomena Valson, RN NEW RNs and GNs • Ainy Ali, RN • Sumaiyyah Amir, RN • Rosanne Applewhite, RN • Andre Bennett, RN • Adrienne Carl, RN • Helen Cosare, RN • Kristen Dang, RN • Phillip Eldridge, GN • Selina Franco, RN • Jeena George, RN • Binu Kurian, RN • Riya Kottor, RN • Shellsea Machachek, RN • Shermel Edwards-Maddox, RN • Gwynne Masalta, RN • Mariamma Mathews, RN • Obi Mbachu, RN • Alnasir Mohammud, GN • Thao Nguyen, RN • Uju Obilo, RN • Jack Ruchirushkul, RN • Jasmine Sanchez, RN • Nelson Stratton, RN • Ibene Tamuno, RN • Gery Thomas, RN • Merlin Thomas, RN • Stuti Trivedi, RN • Anam Virani, RN NEW LVN/LPN • Jessica Anderson, LVN 2013 CLINICAL CAREER PATH ADVANCEMENTS RN II to RN III • Tiffany A. Bittner, RN • Brigit Mathew, RN • Tracy McManaman Bridges, RN • Irene Morrison, RN
CERTIFICATIONS, EXAMINATIONS ACNP-BC ACUTE CARE NURSE PRACTITIONER • Reginald Haynes, RN • Benson Wekesa, RN
CPEN – Certified Pediatric Emergency Nurse • Marissa Ramirez, RN
DAISY CHAMPIONS
CPHQ - Certified Professional in Healthcare Quality • Bonnie Riley, RN • Barbara Bartlett, RN
2013 NURSING AWARDS
ACNS-BC – Adult Clinical Nurse Specialist CSC – Cardiac Surgery (Subspecialty) • Scott Stover, RN Certification CAPA – Certified Ambulatory • Rose Sullivan, RN Perianesthesia Nurse CVRN – Cardiovascular Nurse • Emilie Castillo, RN • Arsenia (Geri) Braza, RN • Usha Pillai, RN • Sanila Enchackal, RN • Kathleen Steward, RN • Flavia Fatima Esmas, RN CCM – Certified Case Manager • Yasmin Patel, RN • Karen Fuller, RN • Kumar Yesudoss, RN • Melissa Guerro, RN FNP-BC Family Nurse Practitioner CCRN – Critical Care RN • Maureen Lall, RN • Ambereen Ali, RN NEA-BC – Nurse Executive, Advanced • Blaire Enser, RN Board Certified • Reginald Haynes, RN • Becky Chalupa, RN • Abigail Martin, RN • Janet Leatherwood, RN • Katherine Sarkaria, RN OCN – Oncology Certified Nurse CEN – Certified Emergency Nurse • Elizabeth Brown, RN • Paula Froelich, RN • Rajani Joseph, RN • Gina Grosser, RN • Arlene Ong, RN • Agnieszaka Kuszynski, RN • Virginia Rodil, RN • Laurie Sweet, RN CGRN – Certified Gastrointestinal Registered Nurse • Bella R. Gumbayan, RN CMSRN-Certified Medical Surgical Registered Nurse • Nimisha Abraham, RN • Anifa Andrade, RN • Daisy Del Rosario, RN • Dolly Varghese, RN CNML – Certified Nurse Manager and Leader • Patricia Lewis, RN COHN-S – Certified Occupational Health Nurse-Specialist • Maureen Lall, RN CPAN - Certified Post Anesthesia Nurse • Molly Mathew, RN • Paschale Dorismond Parks, RN
RN-BC – Medical Surgical Registered Nurse • Edna Akemu, RN • Robin Smith, RN
RNC-LRN – Low Risk Neonatal Nursing • Patti Shaver, RN
• Patricia Lewis, RN • Sally Shen, RN
• Luz Malit, RN “Nursing Innovation”, ICU • Tracy McManaman Bridges, RN “Outstanding Nurse Clinician”, Birthing Center • Irene Morrison, RN “Outstanding Preceptor”, OR Services • Peter Re, RN “Outstanding New Graduate”, Main 6 East • Emilyn Rodriguez, RN “Nursing Leadership”, Main 6 West
GOOD SAMARITAN FOUNDATION 2013 -
Clinical Practice-Small Hospital, Bronze Award • Wanda Butaud, RN • Joy Fey, RN • Judy Jacob-Mathew, RN • Ann Maguire, RN
GOOD SAMARITAN FOUNDATION 2013 -
Nursing Administration and Leadership, Bronze Award • Mona Seele, RN • Sally Shen, RN
POSTER PRESENTATIONS & PANEL MEMBERS
• Lijo Saji, RN; Shared Governance: Engaging Staff Through Shared RNC-NIC-Neonatal Intensive Care Nursing Governance, panel member at the Shared Governance Conference, • Carmelita Amado, RN November 2013 RNC-OB – Inpatient Obstetric Nursing • Lijo Saji, RN & Ancy John, RN; “Bedside • Yamuna Alex, RN Shift Report” • Bridget Amos, RN • Bing Advincula, RN; EBP Journal Club • Rosalie Beckwith, RN Change In Practice • Aleyamma Varghese, RN • Katie Vos RN: panel discussion developing the PICOT question, WCC- Wound Care Certifed selecting a team, and getting started at • Flavia Fatima Esmas, RN HMH Research Institute September, 2013 • Ambereen Ali RN: panel discussion DAISY AWARD WINNERS regarding analyzing and dissemination • Joy Fey, RN – Main 4 East of the results • Maria Rillera, RN – Intensive Care Unit • Phillip Fisher, RN – Intensive Care Unit Continued on page 14 • Suresh Thampi, RN – House Coordinator
LEADERS IN NURSING 5
Houston Methodist Willowbrook News
Sheila Fata
Vice President & Chief Nursing Officer
IT’S A NEW YEAR! The feeling of a New Year… a chance to renew,
Methodist Experience: As you know, we experienced transform, and revitalize; a fresh start that compels us to reflect challenges with patient satisfaction in the first half of 2013. Our Methodist Experience committee members and Shared on a year gone by and make resolutions for the year ahead. Governance leaders responded, launching several key Now that the new year has begun, each of us has the chance initiatives to improve our patients’ perceptions of care and to prioritize, set goals, and take charge of our lives. 2014 gives to enable our support staff to be as responsive as possible to us the opportunity to continue to grow, enrich, and improve patient needs. Bedside reporting, hourly rounding, and My ourselves. It reminds me of the slogan “be all that you can be.” This applies not only to our personal lives but to our work lives Daily Care Plan have been implemented to various degrees in some nursing units. In 2014, we will be working diligently to as well! hardwire these results-proven processes consistently across all The nursing organization at Houston Methodist Willowbrook units, thereby creating the best care environment possible for Hospital had a tremendous 2013. Most remarkable was our our patients. attainment of the prestigious ANCC Magnet designation in Shared Governance: Shared Governance is one of our most October! And while we have much to celebrate from the year effective process improvement tools. In 2013, our hospitalpast, our accomplishments themselves compel us to continue our dedication, focus, and important work to further promote wide Shared Governance and Nursing Congress tackled challenges and opportunities in patient care with innovative the profession of nursing in our hospital and our community. initiatives. However, there is a tremendous opportunity for To that end, 2014 gives us an opportunity for new resolutions further development of shared governance processes at the -- to set new goals in pursuit of further excellence. Here are unit level, including consistent representation of the nursing just a few goals nursing will be focused on achieving in the staff driven initiatives at unit staff meetings. In 2014, we will New Year: focus our attention on these opportunities and challenge Nurses as Scholars: In 2012, we made HMWB history both our staff level and management colleagues to increase when two nurses completed our first original research study. collaboration in unit based councils. Throughout 2013, several others undertook this challenge, We are poised for this new year to be a great year for nursing generating new nursing knowledge through evidenceat Houston Methodist Willowbrook! Each of you is vital based practice and research. As a matter of fact, several of to the highly talented, compassionate and skilled nursing our nursing colleagues will be presenting at ANA’s Quality organization that makes us unique in Northwest Houston. Conference in February and at AACN’s National Teaching I challenge you to reflect on how you can personally contribute Institute and Critical Care Exposition in May. In 2014, we are in 2014 to the ongoing innovation and excellence that makes committed to continuing the growth of nursing research and us a Magnet Designated organization! the Clinical Scholars program is helping immensely with this goal. We also plan to expand the sharing of new knowledge with the nursing community at-large via publishing and presenting more of our best practices at professional meetings.
6 METHODIST NURSE
Happy New Year!
Houston Methodist West News
Vicki Brownewell
Vice President & Chief Nursing Officer
New Year | New Goals
As a new year begins, many folks look to tackle their goals as part of their New Year’s resolution. Here at West we wrapped up 2013 ignited as we experienced growth and expansion and many challenges with it. Year 2014 is unfolding as it should, bringing forth the remnants of last quarter of the previous year. Having been through a multitude of challenges, it is safe to say that Houston Methodist West nurses are agents of change and the only constant here at West is the constancy of vision “Leading Medicine in the West Houston and Katy communities by delivering The Methodist Hospital System standard of high quality, advanced technology and personalized care.” We remain consistent with purpose by advancing the culture of professional nursing through the department’s strategic areas which are in alignment with the System’s 5 Pillars of Excellence and the Magnet components of the American Nurses Credentialing Center.
The Magnet designation is the ultimate goal but embarking on the journey takes us to the specific areas we will work on for in 2014. It is fitting then to tie our goals with the Magnet components indispensable to the designation. TRANSFORMATIONAL LEADERSHIP • Increasing Nursing Certification is a goal for 2014. National Certified Nurses Day is on March 19, and a celebration is planned to increase awareness and support. Certification is an essential element of a transformational leader as part of the nursing development opportunities. • Continuing the efforts of the Professional Development Council, the next DAISY Awardee will be announced in the coming days and a quarterly winner thereafter. This is in support of our nurses’ extraordinary care transforming patient experience through their holistic approach in practice. • Integrating several St. Catherine team members as we welcome them early this year to the Houston Methodist’s culture of ICARE and collaborative mindset. STRUCTURAL EMPOWERMENT • Focusing on the departments’ Unit- Based Council is a vehicle of accountability in nursing practice. Although we had hospital-wide Collaborative Shared-Governance success, the emphasis is going back to the unit by beefing up the unit-based councils. This will only be possible by the support and work of our clinical nurses participating in every aspect of decision-making thereby impacting patient care and our community in general. EMPIRICAL OUTCOMES • Integrating evidence-based practice and research into clinical and operational processes is essential for attaining excellent outcomes. Sepsis will be a focus this year as we advocate for early recognition and acting on the sepsis continuum in all areas in nursing. Sepsis education and evidence-based practice, continued support, collaborative effort will play vital roles in achieving optimum outcomes.
• Continuing the trend for superior ratings for patient satisfaction will meet its challenge with all the changes, movement of staff, expansion and integration of new employees. We will need to stay focused on our vision to achieve higher patient satisfaction. EXEMPLARY PROFESSIONAL PRACTICE • Enhancing evidence-based practice through facilitation and support of our Evidence-Based Practice (EBP) Scholar Program is another goal for 2014. The EBP Program is a 12-week platform design to assist our scholars in conducting evidencebased research and establishing an EBP culture through continued process improvement projects, mentorship and integrating research findings with clinical practice. NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS • Advancing patient care through new knowledge and innovations continues to be a focus. Here at West, we are taking this Magnet component in a different sight this year. Improvements, expansions and building out new areas will bring more excitement. We will have a facility expansion in the Emergency Department, building out 5 East, Infusion Suite and expanding the Mother Baby Unit on the 5th floor. Lastly, as we get on board with these goals, we appreciate the efforts of our sister hospitals in their continued Journey to Excellence in Nursing. Excellence is inspiring and contagious and we are catching it here at the West…. LEADERS IN NURSING 7
Methodist Transplant Patients Help “Light Up The World” at the Rose Parade
By: Donna Esposito, rn
Many people start their New Years Day with traditions such as eating cabbage & black eyed peas but for two Houston Methodist transplant recipients, 2014 kicked off with the ride of a lifetime. Brian Gilliam who received a heart in 2008 and Matt
Photos By: Scott Weersing
For Katsarelis, this was a return to the Rose Parade some 35 years later. “I was in the Rose Parade at 15 years old with my high school band” he said. “That instance doesn’t come close to the experience of being a transplant recipient riding on The Donate Life America Float. It was a monumental experience I will never ever forget.” Matt expressed how everyone there became an instant family no Katsarelis who received a liver in 2010 were among the organ and matter whether they were a recipient, living donor or donor family tissue transplant recipient riders on the Donate Life America float member. “Transplant is a recycling of sorts and what I witnessed entitled “Light up the World” in the 125th Rose Parade in Pasadena, was a recycling of love and humanity shared by California. Along with 28 other grateful everyone involved.” Matt was sponsored by Donate “Transplant is a recycling of recipient riders, Brian & Matt were seated in 4 Life, a Katy area non-profit started by Michael sorts and what I witnessed was the dedication garden which holds thousands and Sheree Jones after the death of their son Chad, a recycling of love and humanity of messages of love, hope and remembrance. in June of 2009. “It was our honor and privilege to shared by everyone involved.” The float also featured 12 living donors sponsor Matt as he is an example of the miracle of Matt expressed. walking alongside the float throughout the transplantation made possible by organ donation” five mile parade route to demonstrate their said Sheree Jones. On the second anniversary of ongoing vitality. The float’s five enormous Chad’s death, the Jones’ created the Organ Donor Hall of Fame, an lanterns were adorned with 81 memorial floragraphs depicting online website and physical display which showcases the stories and organ, eye and tissue donors whose legacy of life continues to shine photographs of true, lifesaving heroes…organ and tissue donors. For brightly. The Donate Life America float is unquestionably the most more information, go to www.organdonorhalloffame.org. emotionally moving entry in the event.
8 METHODIST NURSE
STATISTICS
Although there have been advances in medical technology and donation, the demand for organ, eye and tissue donation still vastly exceeds the number of donors. For more information, read the summary below or create a detailed data report on the UNOS Web site.
More than 120,000 men, women and children currently need lifesaving organ transplants.
Every 10 minutes another name is added to the national organ transplant waiting list.
An average of 18 people die each day from the lack of available organs for transplant.
In 2012, there were 14,013 Organ Donors resulting in 28,052 organ transplants.
In 2012, more than 46,000 corneas were transplanted.
More than 1 million tissue transplants are done each year and the surgical need for tissue has been steadily rising.
According to research, 98% of all adults have heard about organ donation and 86% have heard of tissue donation.
90% of Americans say they support donation, but only 30% know the essential steps to take to be a donor.
Brian Gilliam works tirelessly spreading the word about organ and tissue donation. Brian is a Vital Volunteer for LifeGift as well as being Manager of Team Texas for the Transplant Games of America. When asked about his experience Brian commented “I cannot even begin to tell you what the coolest moment was as there were so many. What I can tell you is I haven’t cried this much since losing Chad.” (referring to his son Chad who died in a car accident) “I feel like I represented every person that I have come into contact with since my journey into the world of transplantation and organ donation began. I have not met my donor family but it is my sincere hope that whereever they are that they were watching. It’s not important that they see or know me only that they know that they made a difference in someone’s life because of the gift that their loved one gave” remarked Gilliam.
understatement. He is a true champion of donation in every sense of the word. He was deserving of the honor to be a rider on the Donate Life Rose Parade Float. It was fitting that he represents Donate Life Texas in this way.”
Kevin Myer, President and CEO of LifeGift and member of Donate Life Texas who sponsored Gilliam’s ride said of him “To say that Brian is passionate about donation is an
Also onboard the float representing the Lone Star state was Neferterius McPherson from Killeen, Texas who had a liver transplant in November 2011.
Brian Gilliam pictured in center
LEADERS IN NURSING 9
2013 YEAR END REVIEW:
Reflective Thinking By Kathy Arthurs, MSN, RN-BC, RNC-OB
HOUSTON METHODIST SAN JACINTO HOSPITAL Reflective thinking allows one to learn from the past in order to generate new knowledge and understanding for the future. In reflection, 2013 was a very productive year for the Houston Methodist (HM) Research and Evidence-Based Practice (EBP) Council. The council was formed with representatives from each of the HM hospitals who shared a mission to create, support and encourage a culture of scientific inquiry through research and evidence-based practice by establishing an infrastructure which fosters collaboration and communication both within nursing and other healthcare disciplines across Houston Methodist and beyond. In April the Emerging EBP Scholar Program began. It was developed by HM Research and EBP Council with a core curriculum to equip HM healthcare professionals with advanced EBP skills to lead EBP initiatives at a unit, department and hospital-wide level. Through participation in the year long program, EBP Scholars conducted literature reviews for selected topics, appraised existing evidence using the Iowa Model of Evidence-Based Practice and convened and managed interprofessional EBP teams.
REFLECTIONS FROM EBP SCHOLARS ABOUT THEIR JOURNEY... “Joining the EBP Scholar program was a trail-blazing journey for me because it validated the essential role of inter-professional team collaboration in improving patient quality outcomes. In today’s contemporary health care environment, whether nurses are interested in being consumers of research or being creators of change, the EBP Scholar Program became an excellent vehicle for me to instill a research-minded culture that fosters the values of clinical excellence and transformational leadership. Overall, the EBP Scholar program gave me the essential roadmap to drive my evidence-based decision-making journey, into full gear.” Jennifer A. Luna, MSN MBA RN CCRN, Houston Methodist San Jacinto Hospital “Participating in the EBP Scholar Program has provided me with not only skills and knowledge but the initiative to collaborate and contribute to nursing research. I have gained a profound respect for each component of the process and not just the action piece!” From Cindy Barefield, BSN, RN-BC, CWOCN, Houston Methodist San Jacinto Hospital
MEET THE EBP SCHOLARS HOUSTON METHODIST HOSPITAL MEDICAL CENTER Facilitator: Shannan Hamlin PhD, RN, ACNP-BC, AGACNP, CCRN Pictured L-R: Larry Johnson BS, MLA, BSN, RN Project Title: Bridging the Gap Renato Revilla, RNBC, BSN, CNN Project Title: In Adult Literacy Dialysis Patients, How does Teach-Back Compare to Written Information Enhance their Adherence to Dialysis Treatment Regimen 10 METHODIST NURSE
Lenis Sosa BSN, RN, OCN Project Title: Effect of Communication in Healthcare Administration, Patient’s Satisfaction and Research Not pictured: Susan Bionat, MSN, RN, ACNP-BC, APRN, CNS, CCRN Project Title: Does NP Medication Education Improve HCAP Scores? HOUSTON METHODIST SAN JACINTO HOSPITAL Facilitator: Kathy Arthurs MSN, RN-BC, RNC-OB Pictured L-R: Mary Grace Zamora, Kathy Arthurs, Jennifer Luna, Cindy Barefield, Melanie Navos, Farouk Hariri Project Titles: Early Ambulation for Critically Ill Patients by Farouk Hariri MSN, RN, OCN, Christine Pieper-Johnson PT, DPT, Mary Grace Zamora MSN, RN, CEN, Jennifer Luna MSN, RN, CEN, Melanie Navos PT,DPT Project Title: Nurses Knowledge of Pressure Ulcers Prevention and Staging by Cindy Barefield, BSN, RN-BC, CWOCN Pictured L-R: Christine Pieper Johnson PT, DPT and Farouk Hariri MSN, RN, OCN
Facilitators: Kahla LaPlante MHA and Laura Espinosa PhD RN Pictured L-R: Steve Hightower, Meka Smith, Amy Gustin Mary Schramm, Lisa Mauricio, Marsha Ozdenvar, Evarista Inikori, Nancy Jo Goldie, PROJECT TITLES: A Systematic Review Comparing Length of Stay Outcomes Between
Transurethral Resection of the Prostate (TURP) and Green Light Laser (GLL) Surgical Procedures for the Treatment of Benign Prostate Benign Prostatic Hyperplasia (BPH) by Mary Schramm and Meka Smith A Retrospective review on Acute Respiratory Distress Syndrome patients at a Community Hospital in order to Institute an EBP Protocol in the Intensive Care Unit by Lisa Mauricio
A Retrospective Analysis of the Correlation in Cardiac Surgery
Patients Between Length of Time from Extubation And First Activity to their Discharge Activity Level and Post Operative Length of Stay by Marcia Ozdenvar
A Retrospective Review of Outcomes of Therapeutic Hypothermia in
a Community Hospital by Steve Hightower
A Retrospective Look at Outcomes of Sepsis Patients Identified by
Primary Diagnosis/Sepsis Screening Tool by Amy Gustin
The Attitudes, Perceptions, and Education of Nurses on Early
Initiation of Skin-to-Skin Contact Immediately After Birth by Lacey Helmke and Brandy Perez
A Retrospective Comparison Study of Tight Control IV Insulin Verses
Subcutaneous Insulin in CV Surgical Patients in the First 48 Hours Post-Operatively by Nancy Jo Goldie, and Eva Inikori
A Retrospective Study of the Outcomes of Cardiac Surgery Patients
with a Smoking History Utilizing a Fast Tract Extubation (FTE) Program by Jozeliza Tan
The Effectiveness of an Inpatient Education Support Group for Heart
Failure Patients on 30-Day Readmission Rate in a Community Based Hospital by Anila Varghese
HOUSTON METHODIST SUGAR LAND HOSPITAL Facilitators: Betty Gonzales DNP, RN, ACNP-BC, Patricia S. Lewis, PhD, RN, and Gilbert Barrera MSN, RN Project Titles:
Hourly rounds will decrease call lights and increase patient satisfaction and HCAHPS scores by Ann Maguire, Ancy John, Yves Senat, nuj Joseph, Rizwana Sunesra, and Elsie Kurian
Alarm reduction with telemetry electrode protocol by Katherine
Vos,Teri Pulanco, Maria Querido, and Stella Tomy
Implementing a Sepsis Tracking Tool by Allison Damron, Betty
Gonzales, Bonnie Riley, and Scott Stover
Impact of a rapid recovery program on outcomes by Christopher
Rappel, Teresa Gonzales, and Betty Cheung
Continued on page 13
A LOOK AHEAD AT 2014: STRENGTH FOR THE JOURNEY Shannan Hamlin, PhD, RN, ACNP-BC, AGACNP-BC, CCRN, Houston Methodist Hospital
“Be strong...that you may be successful wherever you go.” Joshua 1:6-7 The anticipation of every new year brings a sense of excitement as we contemplate changes that will bring positive results in our lives; a bold, stronger new you in 2014. As Houston Methodist nurses, we too must decide our path to better care for our patients more efficiently, with reduced cost, using the best available evidence. Through our collective strength and perseverance, Houston Methodist nurses have the power to change the healthcare landscape one patient at a time.
LOOKING AHEAD: 2014
HOUSTON METHODIST WEST HOSPITAL
In 2013, the Houston Methodist Research and EvidenceBased Practice (EBP) Council had a vision to create an annual comprehensive program that would assist clinicians in obtaining the knowledge and skills necessary to bring evidence to the bedside. The success of the EBP Scholar Program is centered on empowering individuals and groups to make meaningful changes in patient care no matter how small the impact. With collaboration as the focus, new skills were learned, unique individual strengths emerged, and lasting partnerships were formed. As we work to increase our collaborative EBP partnerships, our nursing organization is strengthened by a shift in culture from one mired in traditional, antiquated practices to one at the frontlines of scientific inquiry in which progressive, bold thinking is the expectation; not following but leading the EBP movement. Simply stated, a strong, confident nursing workforce is our mission in 2014. No doubt there is strength in numbers as more clinicians are knowledgeable about best practices. However, we cannot afford to stagnate as we celebrate our accomplishments of 2013. We must do more in our mission to be the best at providing care for our patients. As a nursing organization we must resolve to discourage timidity and mediocrity while focusing on cultivating our strength and confidence in caring for our patients. As such, the Research and EBP Council will broaden our mission in 2014 to include (a) developing clinicians as experts in their field both clinically and professionally, (b) encouraging practice engagement through local, state and national professional organizations, and (c) dissemination of ideas through presentations and publications. Our purpose is to help develop a unique nursing workforce with the expertise, knowledge, skills and excitement necessary to bring evidence to the bedside and the confidence to use it; strength for the journey. The best of Houston Methodist nursing lies before us. We invite you to join us. “...to reach the port of heaven, we must sail sometimes with the wind and sometimes against it - but we must sail, and not drift, nor be at anchor.” Oliver Wendell Holmes LEADERS IN NURSING 11
Sophie’s Story By Beverly Hughes, MS, RN, AOCNS, CHPN and Dr. Swaminathan P. Iyer, Houston Methodist Cancer Center
I
n February of 2013, Sophie Hoelscher was a very bright, beautiful and vivacious 23 year old college graduate who was starting her first job with a medical sales company. The plans were in place to marry her high school sweetheart, Aaron Long. However, about 1 month before their wedding, just after a couples wedding shower. Sophie developed some neck swelling and itching. She went to see a doctor who recommended doing a biopsy. Soon after the procedure she developed “breathing problems” and was rushed to the emergency room, where she had to be placed on a ventilator (breathing machine). She soon discovered that her breathing problem was actually due to a football sized cancer in her chest. Sophie was subsequently diagnosed with Hodgkin Lymphoma at Houston Methodist Hospital Texas Medical Center. Hodgkin Lymphoma is a type of malignancy that affects the lymphatic system which is composed of the body’s lymph nodes, the liver and the spleen. Hodgkin Lymphoma is one of the most curable types of malignancy. The illness is named for the a British pathologist named Thomas Hodgkin who, in 1832, first described the disease as a cancer involving the lymph nodes. The illness frequently presents as a painless swelling of one of the superficial lymph nodes perhaps in the chest, neck area or possibly in the groin. Sophie’s presenting symptom was her neck swelling, itching and difficulty in breathing.
Sophie described that she went in for surgery on February 19th [2013] but did not wake again until March 20th treatment. She underwent a tracheal stent, tolerated the breathing machine for almost two months, experienced a problem with the right eye and endured frequent episodes of pain. In order to treat her Hodgkin Lymphoma, Sophie first received some chemotherapy agents, which did not help her breathing status. Therefore, when they consulted Dr. Swaminathan Iyer, they heard about the newly developed drug called brentuximab vedotin. This cutting-edge “missile technology” drug is the monoclonal antibody that not only works against one of the key proteins called CD30 in Hodgkin’s lymphoma cells, but also has “payload” capability of carrying very strong chemotherapy called aurastatin. This allows this cutting-edge drug to preferentially kill lymphoma cells while sparing the normal cells. A new study had just combined this with the conventional chemotherapy with dramatic responses. So Dr. Iyer recommended this treatment to Sophie’s parents as she was found in the position to make decisions. After careful Sophie and Aaron consideration they desire to proceed with this treatment. This treatment worked so quickly that even after the first course of his treatment she was able to be weaned off the ventilator and after another treatment her PET scan showed no activity in the cancer cells. This was a very promising sign that Sophie was going to do well with more treatments. She then subsequently went on to receive this treatment combination for the next 4 months and the following CAT scan showed a complete shrinkage of the “football sized tumor.” The combination chemotherapy was followed by radiation treatments with Dr. Snehal Desai in order to prevent local recurrence.
...their wedding was a“double celebration of her survival and their new life together.”
Her parents, Althea and Mark Hoelscher, rarely left her bedside during that first month and also for the remainder of Sophie’s lengthy first hospitalization. Aaron Long provided comfort to Sophie’s parents during that hospitalization which include the Medical Intensive Care Unit, Main 8 East and Main 8 Northwest. On December 16th, the nursing staff on Main 8 Northwest, outpatient Cell and Gene Therapy and the staff in Dr. Iyer Clinical Hematology office collaborated to plan a surprise wedding shower for Sophie to help carry out the intended surprise shower, we enlisted the help of her Mom, Althea Hoelscher. We were very lucky that her maternal Grandmother, Nancy Harris, was able to attend along with Dr. Iyer, Dr. Desai and Dr. Ann Scanlon McGinity, Senior Vice President and Chief Nurse Executive. Sophie was actually surprised when she opened the door to her wedding shower on Main 8 Northwest. Dr. Iyer recently told Sophie that her “tumor is gone” and he credits the new combination chemotherapy with the “missile technology” and radiation therapy for Sophie’s remission. Dr. Iyer stated “considering where she was, her clock has been set back to where [the wedding] should be full of joy and hope for the future.” In an interview with Channel 13 News, Sophie Hoelscher said “I think just having a big party, where we can let our hair down and just be normal again.” Sophie and Aaron’s wedding was held on January 11, 2014; Sophie was a beautiful bride and Aaron a handsome groom; the couple commented that their wedding and reception was a “double celebration of her survival and their new life together.” References: Hodgkin Lymphoma. (2011). Leukemia & Lymphoma Society. What You Need to Know about Hodgkin Lymphoma. (July 2013). U.S. Department of Health and Human Services: National Cancer Institute.
12 METHODIST NURSE
SPOTLIGHT ON INFECTION PREVENTION WELCOME TO “Spotlight on Infection Prevention”. In this spotlight, we will provide you with: timely infection prevention news answer your questions highlight ICPs (Infection Control Practitioners) across the Houston Methodist network explain what ICPs do, and why FLU IS A HOT TOPIC RIGHT NOW! Here are some things you can do to help yourself, your coworkers, and your patients: get vaccinated (you did this already) offer influenza and pneumococcal vaccines to eligible patients always practice hand hygiene use droplet precautions (ear loop or surgical mask) with flu patients keep yourself healthy (get enough sleep) if you should get influenza, seek treatment; don’t come to work sick
INTERVIEW WITH SHAWNETT JOUBERT, ICP Q: What other healthcare roles have you filled? A: PCA, Medical Technologist, Blood Bank Specialist, Laboratory Manager, Area Laboratory Director Q: How long have you been an ICP? A: 5 Years
Shawnett Joubert, ICP Houston Methodist Hospital
Q: What led you to this role? To Methodist? What keeps you here? A: I was born to be an ICP but didn’t know it. I’ve always identified what’s clean and dirty and looked in the hardest area to clean to determine if things were clean or dirty. I came to Methodist because I heard it was a great place to work and I wanted to lead medicine. I stay here because I’ve gained more expertise and knowledge here than most ICP’s get in a lifetime. Q: What do you like about being an ICP? A: Every day is different and I have the opportunity to see and learn about everything! I know more about construction than my husband because of my job. Q: Something you can share that is not job related? A: I am a true Cajun. Born and raised in Louisiana. What message do you have for Methodist Nurses? Q: You are amazing. You have incredible compassion. Even when we are reminding you to wash your hands, asking you to wear isolation attire, and expecting you to go hungry and thirsty because we won’t let you eat A: and drink in the nurse’s station, we appreciate you. We and our patients are lucky to have you.
Continued from page 9 Early Nutrition in Critically Ill Patients by Patricia S. Lewis,
Jenifer Henderson, Kathleen Murphy, and Aileen Velasquez
Massive Transfusion Protocol by Cristina Martin, Mona Seele,
Brigitte Tomek, Seema Mullick, MD, Donna Hermis, and Rosalie Thornblom
Newborn Screening for Critical Congenital Heart Defects
by Dr. Sonia Chauhan, Tracy Bridges, Amy Cheng, and Mona Seele
Project Titles: Reducing Self-Extubation in ICU Patients by Robby Bruner,
BSN, RN, CCRN
A System Collaboration to Improve VRE Assessment and
Documentation by Robby Bruner, BSN, RN, CCRN, (ICU Manager) and Mona Cockerham, MSN, RN
Impact 24-hour MRI Availability Has on Observation Units by
Angelic McDonald, MSRS, CRA, RT
HOUSTON METHODIST WILLOWBROOK HOSPITAL
Hemolyzed Lab Specimens in the Emergency Department on
Facilitator: Robin Howe MSN, RN, RNC-OB Pictured L-R: Angie McDonald MSRS, CRA, RT, Heather Mathey, and Heather Bowen RN-BC MHA MBA.
Process Development of a Nurse-Driven VTE Protocol by
Not pictured: Robby Bruner BSN, RN, CCRN, Cristina Dimafiles, BSN, RN , and Mona Cockerham MSN, RN
Adult Patients by Heather Bowen RN-BC MHA MBA and Christina Gonzalez RN
DeMonica L. Junious, PhD, RN, CNE and Mona Cockerham, MSN, RN
Chlorhexidine Bath to Reduce Incidence of CLABSI by Christina
Dimafiles, BSN, RN
Reducing CHF Readmissions by Heather Mathey BSN, RN
LEADERS IN NURSING 13
CAREER COACH’S CORNER
A CAREER ON COURSE
І Career Coach’s Corner
By ShuntÁ Fletcher, MSN, RN, NE-BC, CVRN-BC
R
osemary Williams, CST II started out working at Houston Methodist Hospital in 1995 as a patient care assistant (PCA) and is now a Certified Surgical Technician II (CTS II) at Houston San Jacinto Methodist Hospital in the OB/Gyn OR, thanks to the guidance from her career coach. Rosemary was introduced to nursing here at Houston Methodist hospital. She was inspired by the reward this line of work had on the patients and their families, which lead her on a course to search for her niche. While working as a PCA she sought a job offer to promote to unit secretary still trying to make a decision to go further, but not exactly sure what change would look like or what her next step would be. After completing a pharmacy technician program, Rosemary still had no clear path of how or what she needed to do to find out exactly what she had a passion for in the healthcare field.
“My career coach did everything I needed to assist me in obtaining a job as a Certified Surgical Technician so at this point I plan to continue my career coaching with my current coach for a personal path to my next goal as R.N.” Rosemary Williams
She heard about the career coaching program offered at Houston Methodist Hospital and decided to seek help from one of the coaches. Rosemary teamed up with a coach who was able to help discover and nurture her natural abilities. Face to face time with her career coach gave them time to explore what area of healthcare she seem to have a passion for and how to best put those opportunities to work.
Rosemary and her coach developed the right plan to move her toward her current goal of becoming a CST. Her journey began by taking a program offered at Houston Community College while continuing to work fulltime as a unit secretary on Main 4 at the Houston Methodist Hospital. After completing her studies her career coach arranged for her to shadow and network in the OR here at HMH; She received help with fine tuning her resume, which resulted in a job in the outpatient center OR as a CST I. “My career coach was very encouraging and supportive. She provided everything I needed to assist me in obtaining a job as a Certified Surgical Technician. I plan to continue my career coaching with my current coach for a personal path to my next goal as R.N.” If you would like greater career success or need help in solidifying your vision for the future coaching appointments are flexible and are conducted by face-face interview or telephone. For more information please contact The Center for Professional Excellence at 713.441.4546 or via e-mail at cpecareercoaching@houstonmethodist.org. Continued from page 5 • Poster Presentation: “Implementing a Sepsis Tracking Tool” Allison Damron RN, Betty Gonzales RN, Bonnie Riley RN, and Scott Stover RN • Poster Presentation: “Impact of a Rapid Recovery Program on Outcomes” regarding the Joint Center-Chris Rappel RN, Terry Gonzales RN • Poster Presentation: “Early Nutrition in Critically Ill Patients” Patricia Lewis RN, Jenifer Henderson RN, Aileen Velasquez RN, and Kathleen Murphy RN • Poster Presentation: “Hourly Rounds will Decrease Call Lights & Increase Patient Satisfaction & HCAHPS Scores” Ann Maguire RN and Ancy John RN • Poster Presentation: “Alarm Reduction with Telemetry Electrode Management” Kate Vos RN, Stella Tomy RN, Maria Querido RN and Terry Pulanco RN • Poster Presentation (2): “Massive Transfusion Protocol” and “Newborn Screening for Critical Congenital Heart Defects” Women’s Services • Poster Presentation-Magnet–by Avid Salimi RN, Liza Kalu RN, and Agnieszka Kuszynski RN
SPEAKING ENGAGEMENTS
• Diane McGraw, RN-Presentation at AACN Chapter Meeting for Texas Team, May 2013 • Becky Chalupa, RN-Co-instructor for
14 METHODIST NURSE
Fundamentals of Surgical Energy course given to surgeons and nurses at King Fahad Medical City in Riyadh, Saudi Arabia, December 2013
PROFESSIONAL ORGANIZATIONS
• Janet Leatherwood, RN, Board Member, President’s Regional Advisory Board; University of Houston-Victoria • Diane McGraw, RN-Texas Association for Healthcare Quality Board Member, 2013 • Karen Tobin, RN President AORN, through September 2014 • Vincenza Jones, RN President-Elect AORN • Irene Morrison, RN Treasurer, AORN • Laurie Sweet, RN, Treasurer, ENA • Dan DiDonato, RN, President-Elect,
ENA
• Patricia Lewis, RN Board of Directors for Texas Nurses Association, District 9 • Scott Stover, RN Director-Texas Emergency Nurses Association, 2013 and Chair of Resolutions Committee, 2013 & 2014 • Scott Stover, RN Nominations Committee Region 2, Emergency Nurses Association • Diane McGraw, RN-Texas Team Member, 2013 Initiative on the Future of Nursing
• Becky Chalupa, RN-Texas Team Member, 2014
COMMUNITY INVOLVEMENT,
(City, County, State, International) • Kunjumol Varughese, RN-Coordinates The Immanuel Mar Thoma Church Health Fair, Stafford, TX, November 2013 Participants in The Immanuel Mar Thoma Church Health Fair • Ancy John, RN • Sibi Abraham, RN • Leema Malayl, RN • Scott Stover, RN Boy Scouts of America, Life/Eagle Advancement Coordinator • Scott Stover, RN Senior Enlisted Advisor, 1st Battalion Texas Maritime Regiment-Texas State Guard, 2013 & 2014 • Scott Stover, Volunteer Firefighter Paramedic - Willowfork Fire Department & Katy Fire Departments • Becky Chalupa, RN-Volunteered 40 hours on the Medical Committee for the Fort Bend County Fair, October 2013
OTHER AWARDS
• Judy Jacob Mathew, RN-Outstanding Masters Student at University of Houston-Victoria
Recipients of a Barnes Foundation Research Grant • Michelle Chable, RN • Melody Pakeltis, RN
PUBLICATIONS
• Maureen Lall, RN, Spine CenterManuscript to be published in the Journal of Neuroscience Nursing, “Opioid Therapy for Chronic Low Back Pain: Prescribing Considerations for Advanced Practice Nurses”. • Betty Gonzales, RN-Served as an expert blind reviewer for the “Journal of Trauma Nursing”
OTHER ACHIEVEMENTS, INDIVIDUAL & HOSPITAL WIDE
• Diane McGraw, RN-Lead Auditor ISO Training Course April, 2013 • Brooke Taylor, RN-Lead Auditor ISO Training Course April, 2013 • Patricia Lewis, RN-Chapter Awards Review Panel for the American Association of Critical Care Nurses, 2014 Fiscal Year • Patricia Lewis, RN-provided expert blind peer-review for Critical Care Nurse, Nursing Education Today, Journal of Continuing Education in Nursing, 2013
THE METHODIST HOSPITAL
School of Nursing ... A Short History By Joy Shiller, RN, BSN, MS, CAPA
E
ver since the memorabilia from the Methodist Hospital School of Nursing was put on display in the Dunn Tower it has been a point of interest to both our employees and visitors. Out of curiosity about our early school I researched its history and decided to share some of the information I learned.
During the early 1900’s hospital based schools of nursing proliferated throughout the United States. Nursing students provided a cheap source of labor. Every hospital wanted a program and Methodist was no exception. The school opened on September 15, 1924 with eight students. A high school diploma was not required until 1935. All students were females and had to be between the ages of 18 and 30. The program was three years in length. Tuition was $50.00 for the first year and $10.00 for the next two. Nursing students lived on the premises and were required to attend chapel services conducted by the house mother every morning in their living room. In addition to their classes nursing students worked a minimum of 50 1/2 hours per week in the hospital. This included not only nursing care but also dietary, housekeeping, central supply, and any other job necessary to run a hospital. They worked seven days per week, with only two weeks vacation and seven holidays each year. In return, students received their room, board, uniforms, and laundry. The Methodist Hospital opened its school of nursing in 1924. This was the 1936 graduating class. World War II led to a tremendous nursing shortage. Many nurses left the hospitals to serve in the military or to work in associated war industries where the salaries were higher. For the first time, the United States government began providing financial aid to institutions for nursing education. In cooperation with the new program the Methodist Hospital School of Nursing became affiliated with the University of Houston. Nursing students did their course work at the University and their practical work at the hospital. As a result, they were spending more time in the classroom and less in the clinical setting. The hospital was now being forced to employ nurses’ aides and other support services to take over many former duties of student nurses. In the post war period enrollment plummeted despite a vigorous campaign to recruit students. The school was costing the hospital more than it could afford and by 1950 the board began considering steps to phase out the program. When the University of Houston closed the school of nursing in 1955, an organization called the Good Samaritan Club donated a large sum of money to reinstate the school at the hospital. By the late 1950’s, there was an increased trend toward BSN degrees as opposed to hospital based programs. Combined with this trend and the heavy financial burden of the school on the hospital, the Good Samaritans, hospital administrators, and the trustees decided to establish a branch of Texas Woman’s University in the Texas Medical Center. TWU opened its doors in 1960 and a new nurses residence was built with $750,000 bequeathed by March Culmore’s estate. In July, 1961, the Methodist Hospital School of Nursing closed when its last class of 21 students graduated. During its 37 years of existence the school had produced 438 nurses. When I came to Methodist in 1970 there were still many graduates from the three year diploma program employed at the hospital. They were outstanding nurses who were easily recognizable by the large, heavily starched, white Methodist Hospital School of Nursing cap they each proudly wore – just like the one on permanent display in the Dunn Tower!! LEADERS IN NURSING 15
Nursing News
The Methodist Hospital is proud to have nurses who are dedicated to the nursing profession, driven to achieve growth in their professional development, and creative and always compassionate in their care for patients.
Accolades
The accolades page is an opportunity for the nursing staff to showcase a few of the many exciting tributes our nurses receive. Please submit kudos to: emlupinski@houstonmethodist.org.
Congratulations to the following RNs who were recently promoted from RN I to RN II : Alex Constantine, Kathlynn Russo, Jacqueline Stone, and Ryan Tran from Dunn OR, Teresa Amaya and Nicole Frank from Fondren OR, and Billy Wright from OPC OR. Congratulations to Linda Holifield (CVICU), Maura Rinehimer (SICU), and Shannon White (NICU) for recently obtaining their MSN (Acute-Gerontology Nurse Practitioner) from the University of Texas Health Science Center School of Nursing. Congratulations to Edna Cheng (CVICU) for obtaining a post master’s certification in Adult-Gerontology Nurse Practitioner from the University of Texas Health Science Center School of Nursing. Congratulations to Alison Mitchell, nurse practitioner, on receiving the 2014 AANP Nurse Practitioner Advocate State Award for Excellence from Texas. This prestigious award is given annually to a dedicated nurse practitioner advocate in each state who has made a significant contribution toward increasing awareness and acceptance of the NP role. Alison will be recognized at the 2014 AANP National Conference for this honor. Congratulations to the Care Navigator Team, Laura Moore, R.N., Isabel Kahn, R.N., Aprilrose Gonzales, R.N., Pam Udoetuk, R.N., Stephanie Harris, R.N., Mollie Hightower, P.S., Michelle Bell, E.S. , Kimberly Stanley, PCA, and our Clinical Pharmacist/presenter Rafael Felippi, Pharm.D , for winning first place at the Kelsey Research Foundation 14th Annual Health Services and Outcomes Research Conference, for their Poster Presentation on Timeliness of Care.
Amanda Kalivoda, BSN, RN-BC on Main 7SW for passed the ANCC Medical-Surgical Specialty Certification Exam. We are proud of you! Congratulations to Libby John, MSN, RN-BC for completing MSN, Adult-Gerontology Nurse Practitioner program at UTMB. What a great achievement! Kudos to Jillian Human, RN on Dunn 6W for passing the RNCOB certification. Congratulations to Amanda Kalivoda, R.N. on Main 7 SW, who obtained her AMSN certification just 2.5 years post graduation. What an amazing accomplishment! Congratulations to Betcy Babu, R.N., Skih Nyathi, R.N., Robin Rodriguez, R.N., Raquel Pereira, R.N., Muna Timsina, R.N., Myoung Rho, R.N., and Razia Iglesias, R.N., all from Dunn 9, for obtaining their CVRN certifications. This is an outstanding achievement! Nena Bonuel, PhD, RN, CCRN-E, CNS, ACNS-BC, Larry Johnson, BSN, RN, CCTN, Alicia Hernandez, MSN, RNBC, Susan Zylicz, RN, MBA, had their poster presentation “Comprehensive Transplant Transition Program: A Recruitment Strategy to Attract Nurses in the Transplant Coordinator Role” accepted to be presented at the 1st Global Summit of Filipino Nurses: Filipino Nurses Worldwide: Unite for Global Health and Nation Building and 9th International Nursing Conference “Promoting Solidarity for Global Health and Sustainable Social Action.” Joy Shiller, RN was selected to serve on the National Certified Ambulatory Nursing Exam Item Construction Committee which will be held in San Antonio January 23–26.