METHODIST NURSE MARCH 2014 | A Magazine for Nurses
Leading Nursing
TAKE
Charge of your
HEALTH Page 8
Houston Methodist Puts
FOCUS on Patient Safety
Page 15
A Message from
Ann Scanlon McGinity
Senior Vice President and Chief Nurse Executive
Celebrating Successes
2014 EDITORIAL BOARD MEMBERS
Well, it looks like spring is finally here! It’s been an interesting winter, to say the least,
Rosario Alvarado Shuntá Fletcher Donna Esposito Sarah Fleming Elizabeth Gigliotti Elizabeth Himes Beverly Hughes
but now we’re ready to see those flowers blooming and put away those coats. This month was a busy one…we celebrated Certified Nurses Day, thanking all of you for
Beverley LaMoth Robert Morehead Carlette Patterson Verna Simmons-Robinson Joy Shiller Robyn Washington
the hard work and dedication you give every day and encouraging and aiding those who don’t have certifications to get one. We also had a record number of nominees
MAGAZINE EDITOR
for the Houston Chronicle’s Salute to Nurses award. That speaks volumes about how
Kelli Gifford
wonderful you all are!
GRAPHIC DESIGNER
As I am each year, I am excited to announce that our latest annual nursing report is completed and you will be seeing it in your units soon. This report showcases our extraordinary work and accomplishments over the past year and truly captures
Phyllis Gillentine
PHOTOGRAPHERS Phyllis Gillentine Kelli Gifford
the high level of nursing excellence exhibited by our nursing enterprise. I hope you review this report with great pride and take a moment to appreciate our unique stories, programs and achievements that continue to establish us as a top-notch nursing organization. With Nurses Week coming up in May, don’t forget to nominate your favorite colleagues for our annual awards. Happy spring to all!
Do you have a
STORY
that you would like to post in the
HOUSTON METHODIST NURSE MAGAZINE? Please submit your articles or ideas to Kelli Gifford at kagifford@houstonmethodist.org
C
CERTIFIED NURSES DAY™ honors nurses
worldwide who contribute to better patient outcomes through national board certification in their specialty. On March 19, Houston Methodist joined health care providers nationwide to celebrate and publicly acknowledge nurses who earn and maintain the highest credentials in their specialty. Houston Methodist hosted a breakfast and an afternoon reception to honor all nurses, but to also spread the word on the importance of certification. “Attaining a nursing certification allows nurses to exhibit their expertise and knowledge to their patients, colleagues and employers,” said Mary Silas, MSN, RN, BC. “Here at Houston Methodist Hospital the celebration allowed certified nurses to share their accomplishments while discussing best practices and sharing their stories.”
“It was a cheerful event full of smiles, hugs, laughter and an overall sense of respect.” - Mary Silas
Houston Methodist Sugar Land Hospital
Houston Methodist West Hospital
Houston Methodist San Jacinto Hospital
LEADERS IN NURSING 3
Houston Methodist San Jacinto News
Jane DeStefano
Vice President and Chief Nursing Officer
Working to
ADVANCE Patient Safety
March 2-8 was Patient Safety Awareness Week. Nursing staff celebrated the education and awareness campaign for health care safety, a national observance week sponsored by the National Patient Safety Foundation. Houston Methodist San Jacinto Hospital proudly participated in this annual campaign to promote and create awareness in the hospital and community. It is important that we communicate that patient safety is our No. 1 priority. Houston Methodist San Jacinto strives to advance patient safety through effective communication, education and support of personnel and providers. Eliminating missed diagnosis, practicing proper hand hygiene and chasing zero are some of the steps our nurses and staff take to ensure world-class patient-centered care. The hospital displayed safety booths in the cafeteria area and distributed safety information on proper sanitation, zero tolerance for infections and proper patient identification amongst many more safety tips. All hospital staff was able to go through the educational booths and ask questions about safety information. The people manning the booths provided information and explanation of the patient safety standards and goals at Houston Methodist San Jacinto. It is important to encourage personal commitment to patient safety. Thank you to all the nurses and hospital employees who take the necessary steps to improve patient safety. Patient safety starts with you and will remain our priority.
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Houston Methodist Sugar Land News
Janet Leatherwood RN, MSN, VP / Chief Nursing Officer
Addressing Sensory Overload Sensory overload can happen to any of us in any setting, whether it is at a park, driving in your car, in your home and even at work if you are constantly bombarded by excessive sounds. In the hospital, particularly in the critical care units when alarms continue to sound, studies have shown desensitization to these sounds can occur, resulting in what has been coined as “alarm fatigue.” This situation of alarm fatigue, like any excessive sensory overload, can result in a nurse or tech becoming desensitized to the warning bells and consequently delaying their response to the alarms or, perhaps as noted in studies, failing to address the alarms altogether. In 2013, The Joint Commission published a Sentinel Event Alert on Alarm Management to draw attention to patient deaths that had been reported and attributed to alarm fatigue. The practice alerts related to alarm management suggested the following be considered when addressing this very sensitive concern:
Address electrocardiographic (ECG) practice by providing proper skin preparation and daily replacement. Customize alarm parameters and levels by collaborating with an interprofessional team. Customize delay and threshold setting on oxygen saturation or oximetry monitors.
with evidence-based practices to prevent alarm fatigue. This prompted us to ask ourselves: How do we keep our patients safe and reduce potential alarm fatigue? What potential strategies have been studied and proven to reduce this concern and keep our patients safe? This question was taken to our Evidence-Based Practice Council (EBP) by several of our critical care nurses to study and research solutions to address this concern. Noted research in Critical Care Units reflects that the number of alarms have increased from approximately six alarms 20 years ago to more recent data reflecting up to 40 different alarms in some settings. Our EBP nurses agreed this was a concern and sought ways to effectively manage the number of alarms on the unit reducing alarm fatigue, and consequently improving patient safety. After studying the evidence, the project team started looking closely at our rate of false or clinically insignificant ECG alarms that occur in their practice area. According to the studies, a surprising 80-90 percent of false or clinically insignificant alarms occur with the ECG monitor, which can contribute to alarm fatigue. They found we had room for improvement.
First steps to addressing and adopting the solutions included understanding current practice Provide initial and ongoing education about and then reporting on the effects of actions devices and alarms. adopted by the AACN. The team studied the Develop interprofesssional teams to address before and after-effects of changing telemetry issues related to alarms as it relates to policy electrodes on a daily basis combined with focus on and procedures. proper skin preparation, and whether this would result in a decrease in the number of telemetry Monitor only those patients with clinical alarms related to technical issues. The initial indications for monitoring. collection of data of those patients on telemetry Furthermore, the American Association of Critical showed that prior to adopting these changes, Care Nurses (AACN) published a Practice Alert 56.5 percent of telemetry electrodes were being
changed daily. There were 2.4 average technical alarms per bed per day, and 3.4 average total alarms per bed per day. Following education of the nursing staff regarding proper skin preparation for placement of ECG electrodes, coupled with daily electrode change, the efforts resulted in an 81% decrease in the average technical alarms per bed and a 72 percent reduction in alarm noise. This quality improvement project has inspired other staff nurses to look closely at our practices to evaluate if changes are needed in other areas. Currently further quality improvement initiatives being done include looking at glucose monitoring post-CABG, hourly rounding and their effect on HCAHPS, and implementing a tool for evaluating patients withdrawing from alcohol. Steven Covey, author of Seven Habits of Highly Effective People, has said, “We may be very busy, we may be very ‘efficient,’ but we will also be truly ‘effective’ only when we begin with the end in mind.” As evidenced by the alarms project, the end result was a win-win situation for nurses and patients. Thank you for being effective hands whose excellence is the very heart of what keeps our patients safe.
LEADERS NURSING 5 LEADERS ININNURSING
Houston Methodist Willowbrook News
Sheila Fata
Vice President & Chief Nursing Officer
Focusing on Patient Satisfaction
HCAHPS is an acronym used daily in meetings, newsletters, emails and in conversations among staff at Houston Methodist Willowbrook Hospital (HMWB). HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) is the survey tool developed by the Agency for Healthcare Research and Quality to measure patients’ perspectives on hospital care, including several domains directly related to nursing, from communication with nurses and responsiveness of staff to communication about medications and discharge needs. A key word is “perspective” or rather “perceptions” of care. While patient satisfaction is an important measure of our work as nurses, managing a patient’s perception of care can be a challenge. To patients, anyone in scrubs can be perceived as a nurse. To patients, anything that happens from the time they enter the building to the time they receive a bill can impact their perception of care. First and last impressions matter, and for that reason patient satisfaction is not solely the job of nurses but of every Houston Methodist employee. Why are we so focused on HCAHPS? First and most importantly, providing care that anticipates and meets patient needs, involves the patient and family in care decisions and ensures the patient is well-informed are core elements of our culture, particularly as a Magnet® hospital! Patient satisfaction scores are a reflection of how well we are meeting the high standards of a Magnet institution and how well we are living our ICARE values. Second, there is a very real financial cost for underperforming on HCAHPS in the form of reduced Medicare reimbursements. This reduced payment has a domino effect that can impact our day-to-day resources, such as the ability to finance new equipment or add additional staff. In 2013, we rolled out the Methodist Experience across the hospital — remember attending the
6 HOUSTON METHODIST NURSE
special class? We all learned about initiatives that were aimed at providing a “WOW” experience for every patient, every time — AIDET, Managing Up, and Key Words at Key Times. We also implemented several evidence-based initiatives in our nursing organization over the past 18 months, such as hourly rounding, My Daily Care Plan, Commit to Sit and the No Pass Zone as part of the Methodist Experience to improve our HCAHPS scores. Because we have found that the use of these important initiatives vary greatly among staff and among nursing units, we have set an important goal for 2014: to achieve consistency in the execution of tools and tactics that we have discussed, educated and committed to as an organization. To achieve the hospitalwide “hardwiring” that we desire, you will see a lot more of your leaders and colleagues visiting patients, observing staff and auditing results. Structured leader rounding is already in full force and is providing nurse leaders the opportunity to speak directly with patients about their care and to address any concerns immediately. Staff will be receiving real-time feedback on patient interactions. More frequent audits of patient satisfaction initiatives will help ensure consistent compliance by staff. Finally, we will be rolling out some helpful tools, such as PAUSE to ROUND, to make it easier for staff to remember processes like hourly rounding as well as what to look for during rounds beyond the usual “potty, position, pain.” Houston Methodist Willowbrook has earned the reputation as a leader in patient care, and we want our patient satisfaction scores to reflect this! By delivering exceptional patient experiences and by holding each other accountable for best practices, we will truly provide the Methodist Experience and continue to earn the confidence of our patients and community.
Houston Methodist West News
Vicki Brownewell
Vice President & Chief Nursing Officer
PATIENT SAFETY CULTURE
is Moving and
Shaking
Patient Safety at Houston Methodist West Hospital does not stop with the patients and the nursing staff. Every HMW employee actively participates in patient safety: family members and visitors are encouraged to get involved to keep their loved ones safe. In addition to Houston Methodist systemwide initiatives, such as hourly rounding, many nursing units are taking ownership of unit-based safety programs. By: Sarah Fleming HMW’s telemetry unit has revamped its safety program, specifically around falls, to incorporate all members of the health care team as well as the patient and caregivers. They campaigned to their manager after seeing an increase number of falls on the unit, declaring they could do better. This desire led to the 6W Fall Prevention Plan. This multi-scope plan begins with a pamphlet provided to the patient and family upon arrival to the unit discussing the fall program and expectations of the patient and staff.
Operating Room nurses and staff are doing their part to provide patient safety in the procedural area as well. HMW reports and tracks any safety concern or incident via PSN (Patient Safety Net). The OR, wanting to be proactive instead of reactive to patient safety, willingly reports PSNs in order to track and trend incidents. They recognize that PSN is not a punitive report mechanism but encourages a “just culture” where staff is comfortable identifying concerns and creating action plans to resolve the issue. PSNs provide opportunities to learn and share best practice. The director of Clinical Effectiveness brags that she has never seen such great immediate reporting from a perioperative staff. Recently HMW was surveyed for ISO designation from DNV. ISO Certification attests to the processes West has put in place to ensure transparency and efficient and safe practice. ISO’s goal is to minimize variation throughout the hospital. Patients should expect and receive the same safe care wherever they travel during their visit. Streamlined patient-centered functions, such as bedside shift report and computers in the rooms and between patient rooms, help minimize patient safety incidents by allowing staff to be close to patients. Currently underway is an assessment of all facets of our “Time-Out” process. The ISO internal auditors are examining our policies and staff competencies for completeness and standardization. Next, staff will be doing observational audits throughout the hospital to verify compliance with the Time-Out process.
6W Movers and Shakers Fall Huddle
The team also has fall huddles at the beginning of each shift to identify high-fall-risk patients, cleverly named the “Movers and Shakers Fall Huddle.” If a patient were to fall, the staff insisted on an immediate, in-depth debrief and follow-up action items to prevent another incident. Positive outcomes come from each debriefing. For example, the staff realized that the cords connecting to the alarm system often went missing if a patient traveled off the unit. Working with the facilities department and LEAN principles, the alarms cords are now permanently faceted to the bed. Patient fall statistics are reviewed at monthly staff meetings to ensure all 6W staff knows the facts about outcomes as they relate to the fall prevention program. This knowledge allows for deliberate necessary adjustments such as fall alarm sensitivity.
Houston Methodist West does not plan to stop innovating and modifying Patient Safety Goals anytime soon. The hospital strives to create a safe culture for the patients and well as visitors and staff. Our staff recently completed the ARHQ Safety Survey. Results from this survey will help Hospital Leadership speak to the concerns of the staff and continue to implement measures that are important to the patients and employees. Participating in NDNQI reporting on staffing levels and falls gives the hospital applicable benchmarking. Shared Governance plays an integral part in Patient Safety Culture at HMW as well. The Quality and Patient Safety Committee, consisting of front-line staff, work diligently to identify the needs of the staff and patients. With support from leadership, the committee is able to create new processes or projects that make Houston Methodist West a hospital that provides excellent care and fosters a culture of safety.
LEADERS IN NURSING 7
TAKE CHARGE of your
WELLNESS GOALS
Nutrition Bootcamp puts you in the driver’s seat By: Kelli Gifford, Nurse Marketing Analyst
W
ellness Services at Houston Methodist has a wide number of programs that are built around putting the participant in complete control — clients get to choose what goals they want to work on and when. And research shows that this approach is extremely effective for long-term change. “I love that the client’s goals and desires take the front seat in these programs,” said Kristen Kizer, RD, LD, a Clinical Dietitian Specialist.
for a lot of people, some like structure and clear direction, so Kizer created a class that would give just that.
“I wanted a class that called people to action. Most of our classes are educational, but don’t require participants to do anything with their new-found knowledge,” Kizer said. “Bootcamp not only educates, but “Bootcamp is designed for people who like also gives participants daily and structure and challenge, and who are ready weekly challenges to complete.”
to dedicate six weeks to better nutrition.” Kristen Kizer, RD, LD
Kizer recently finished her first six-week Nutrition Bootcamp, which came about after several clients were asking for a specific format with specific rules for healthy eating. While client-centered coaching programs work well
Bootcamps by nature are highintensity, so Kizer made the program six weeks because it’s short enough to prevent burnout, but long enough to promote a true lifestyle change, she said. Rather than focus on weight loss, she wanted to highlight nutrition to keep the class open to anyone who wanted to improve their diet regardless of weight-loss goals. “I enrolled because I wanted a jump start to my diet that began in January of this year,” said Thomas Wong, an Integrated Systems Specialist at Houston Methodist. “By myself I was losing weight, but felt I could do better than one pound a week. After joining bootcamp, I followed our instructions and drastically cut out the processed foods in my diet, employed portion control while increasing my meals per day, and made sure I ate my fruits and veggies for the day. My first two weeks showed a loss of 5 pounds and a couple pounds each week thereafter!”
Kizer began her second bootcamp on March 10. “Bootcamp has been going great, but it’s also not for everyone. Each class I do has participants who decide not to continue. If people are looking for education without having to take action outside of class, then our Wellness @ Work© interactive nutrition class would be the place to start. Bootcamp is designed for people who like structure and challenge, and who are ready to dedicate six weeks to better nutrition.” Kristen Kizer teaching nurses and staff about nutrition. 8 HOUSTON METHODIST NURSE
Q&A
with TERUMI HARRIS, RN Q: What Wellness program did you use? A: I have been using the nutritional/dietician service through Wellness Services and work with Kristen Kizer. Q: Why did you choose that particular program?
“I highly recommend the bootcamp for every employee of Houston Methodist,” said Cynthia Ryan, a Help Desk Analyst who completed the first bootcamp. “We were guided to really take a look at what we were eating and drinking, and how important sleep and exercise all go together. The class is focused on adding nutritional foods to your diet, and by the time you add the recommended fruits and vegetables and drink water, you were content and satisfied and desired fewer non-nutritional fatty foods.” Many of the array of wellness options for Houston Methodist employees and their spouses are offered free of charge. “I’m still amazed at the number of wellness programs Houston Methodist offers to employees,” said Kizer. “I don’t know of anywhere else were employees and their spouses can see a dietitian for free, receive free personal training sessions for high cholesterol or blood pressure, or participate in free stress management counseling. We have a highly skilled, professional staff, from certified wellness coaches to licensed massage therapists and acupuncturists, all on hand to serve employees and their spouses. “
METHODIST WELLNESS SERVICES PROGRAMS • • • • • • • • •
Healthy Lifestyle Coaching Tobacco Cessation Nutrition and Weight Management Managing Health Conditions Stress Management Health Screenings and Assessments Fitness Educational Programs and Events Relaxathon
A: I chose this program because I wanted to be healthy and lose weight. My personal obstacle has always been food; I love food but wanted to have a healthy relationship with it so that I could learn to enjoy it but still make choices that were beneficial to my body. Before starting the program, I had a real problem with that. Although I am a nurse, there are so many myths and so much information about food on the Internet that I felt completely overwhelmed and didn’t know where to start. Shortly after being hired at Houston Methodist, I started meeting with Kristen, and we have been meeting weekly for a year now. Q: What successes did you see? What helped you the most? A: To date, I have lost 45 pounds (Whoo-hoo!). Although I lost some weight prior to going to the Wellness Center, it really was not a sustainable method. I was very strict with my food selections, eating the same things over and over, and then I would get frustrated and binge. I had reached a point where my weight loss was stagnant. With Kristen, I have lost about 30 pounds. I have learned so much and this process has been much easier than I thought it would have been. Mostly, I have learned that this is a journey; it won’t happen overnight. I am able to enjoy real food without the guilt yet still hold myself accountable. I have had tremendous success and felt completely supported throughout the process, even when I had my mental tantrums and told Kristen, “I just want to eat what I want and still lose weight.” Her approach is always honest but gentle and she meets me wherever I am without making me feel like I just took two steps back. Q: Why would you recommend this to your colleagues? A: Actually, I have recommended Wellness services and
Kristen, specifically, to anyone and everyone who mentions “health” or “food” in the same sentence on my unit! Whatever your goals are — weight loss, cleaner eating, etc. — I believe that there are options for everyone. Plus, it’s free! Why not take advantage of an opportunity to improve your health? I am a healthier person now than I was a year ago. I have achieved some of my goals and I am still working toward others; they continue to grow and change every time I accomplish one. LEADERS IN NURSING 9
Be Sure tote… a Sav20e14 tRheseearcD h and
Turning a “Light Bulb Moment” into an Evidence-Based Practice Project
ed Evidence-Bas sium po ym S e Pract ic
Every day, nurses and health care professionals th, 2014 September 26 practice new and innovative changes in care delivery. Whether that change reduces central line blood stream infections or helps to identify patients at risk for falling, each evidencebased practice change is the result of applying published research studies in response to someone’s “light bulb moment.” The examples described above are just two of the many recent interprofessional evidence-based practice projects implemented at a Houston Methodist facility. The Institute of Medicine (2012) set a goal in 2008 that by 2020, 90 percent of all health care decisions are evidencebased. What is a light bulb moment? A light bulb solution begins with identification of a problem. Light bulb moments seek to answer why we are performing certain activities. Start by looking at practices in your work environment. Do you know which every day practices are evidence-based? Are our actions based on evidence or because of traditional practices? Examples of traditional practices might be taking frequent vital signs on stable patients. Is there evidence that this practice contributes to early recognition of problems or is this practice a tradition, because we’ve always done it that way? A typical light bulb moment
is that point that turns a question about a problem into a search for a solution using evidence-based practice. In this search for answers, health care professionals turn to authoritative references such as about why, how or when to provide care. Sometimes the first query may be via a search engine, although the response will be too varied and not always authoritative. We are extremely fortunate at Houston Methodist to have 24/7 online access to a comprehensive medical library. The HMH librarian, Linnee Girouard, is available to help answer questions about literature searches. A future article, as well as one of the Clinical Scholar classes, will introduce how to perform literature searches. For further assistance please contact: HMH: HMSL: HMSJ: HMWB: HMW:
Shannan Hamlin Tricia Lewis, Betty Gonzales, Gilbert Barrera Kathy Arthurs Robin Howe Laura Espinosa, Kahla LaPlante
Reference
Institute of Medicine. (2012.) Institute of Medicine Roundtable on Evidence-based Medicine Workshop.
CREATING A HEALTHY WORK ENVIRONMENT By: Lenis Sosa, BSN, RN, OCN Co-Chair, Research and Evidence-Based Practice Council
A healthy organization requires a positive work environment, motivation among workers, effective leadership and open communication. Encouraging these characteristics of a healthy organization is important for the companies’ progress and success. Providing a safe and pleasant environment allows personnel to come to work happy and willing to provide excellent quality of care, which is the organizations ultimate priority. Employee motivation is critical to excellence in patient care and achieving organizational goals. Having effective leadership can be challenging due to the diversity of people. Sometimes managers must deal with a difficult employees who are not team players, argue and complain constantly, have attendance issues, fail to meet expectations and instigate dissatisfaction*. Because of the aforementioned issues, a good leader will motivate that person to ensure he or she will be part of the team and will work together with the employee to improve their behavior. One strategy to accomplish this goal is to allow the employee to work on a multidisciplinary team project as a way to assess their interactions with others. A proactive approach will lead to employee success in the workplace environment. Finally, listening to all employees’ questions and concerns, and keeping them informed of organizational changes and other important news are good examples of open communication. 10 HOUSTON METHODIST NURSE
*Lynch. (2008), Motivating challenging employees. Biomedical Instrumentation & Technology, 42(3), 203–204.
A C T I O N STAT
NURSE PRACTITIONER/PHYSICIAN ASSISTANT BOOT CAMP
An Accelerated Conference for the Hospital-Based Clinician
Pharmacology Pre-Conference Friday, April 4, 2014
Houston Marriott Medical Center, Houston, Texas
Weekend Course Saturday-Sunday, April 5-6, 2014
Houston Marriott Medical Center, Houston, Texas
NURSES: DON’T LET THIS CE OPPORTUNITY PASS YOU BY Action STAT, an accelerated conference for the hospital-based clinician, is April 5-6 at the Houston Marriott Medical Center with a Pharmacology Pre-Conference April 4. This conference is a bootcamp-style weekend course that offers the need-toknow information for hospital-based clinicians. Action STAT is designed to enhance knowledge in patient management and will present the latest in the diagnosis and treatment of important topics such as cardiology, gastroenterology, emergency medicine, endocrinology and gerontology. The course is intended for hospital-based nurse practitioners and physician assistants in all specialties, nurse practitioner and physician assistant students, registered nurses and pharmacists. Houston Methodist is an approved provider of continuing nursing education by the Texas Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Up to 17.75 continuing nursing education contact hours, including 5.0 pharmacotherapeutic contact hours, may be earned by attending sessions in their entirely and completing the corresponding evaluation tool. The Physician Assistant Review Panel has approved 16.75 hours of AAPA Category 1 CME credit.
Sophie Gets Her
Happily Ever After By: Beverly Hughes
Sophie at the wedding shower held on Dec. 16, 2013, on Main 8 Northwest collaborated for her by her family and nurses at Houston Methodist.
Sophie Hoelscher and Aaron Long were married on January 11 in a ceremonial Mass with their families in attendance. Sophie, who was treated for Hodgkin’s Lymphoma at Houston Methodist Hospital last year, was a beautiful bride and Aaron a handsome groom. I was deeply honored to be invited to the wedding and I was struck by the fact that I had never seen Sophie with hair (she was bald when she transferred to the hematology/oncology unit on Main 8 Northwest). Her wig was made and donated by a KTRKChannel 13 viewer and was a near perfect match to her hair before she was diagnosed. Their wedding was a celebration of her survival and heir new life together.
LEADERS IN NURSING 11
DISCHARGE PLANNING: Another Level of Patient Safety By: Verna Simmons-Robinson
D
ischarge planning is as important in the safety of patients as the care they receive in the hospital. It is imperative that the nurse and the case manager work together in the transition process from the acute care to home. Although they provide separate functions during the discharge process, the ultimate goal of the team is safe discharge for the patient and help for the patient’s caregiver at home. Discharge planning begins the day a patient is admitted to the hospital. According to the ACMA Standards of Practice & Scope of Services for Health Care Delivery System Case Management and Transitions of Care Professionals, discharging involves providing information to the health care team, patient/ family/caregiver regarding available resources and benefits
for the acute and post-acute services that ensure patient choice and safe and timely transition. Case Management stated that they are trained to do an initial assessment to establish the needs of a patient during the initial interview with the patient. The consistent reminder from the case manager also assists the patient in the preparation of discharge. The most important role between the case manager and the nurse is communication, which enables the care of the patient to be followed as instructed by the providers treating the patient. The plan of care is established upon admission and revisited daily during huddles by each unit. Once a plan for discharge is established, the case manager and the nurse should be in constant communication to ensure safe discharge.
Lights! Camera! Action!
Q&A Where does discharge planning begin and end? Discharge planning begins at time of admission. We assess the patient as a whole and identify any concerns that could surface after discharge. For the hospital Case Manager/Social Worker, discharge ends when our patients leave the building. If they have been referred to an outside agency, then the continuity of care would become that agency’s priority. How important do you see discharge as a part of patient safety? Discharge planning always takes patient safety into account. We intervene, make recommendations, and refer to post-acute agencies to make sure that patients do not “get lost in the system.” How do you feel the role of case manager and nurse interact with discharge planning? Case Manager/Social Worker spearheads discharge planning, but the staff nurse helps to close the loop as they are physically discharging the patient from the hospital. How do you educate and coach the staff to communicate with the nurses regarding discharge planning? Case Manager/Social Worker should communicate daily with nursing staff to keep them updated as the discharge plan comes to a close. Where do you feel Case Management has the most impact? Case Manager/Social Worker has multiple areas that we affect. There is the financial impact in that we are responsible for the clinical reviews; we serve as patient advocates in formulating a discharge plan; and we are educators to all the ancillary staff we work with, i.e., physicians, staff nurse, PT/OT/ST/RT, unit secretary, etc.
Video brings dangers of sepsis to light
Some of you may have seen the bright lights, the cameras rolling, and the flash mob dancing in the Crain Garden and other sites throughout Houston Methodist Hospital (HMH) in the beginning of February and were wondering what was going on. Under the leadership of Dr. Faisal Masud, Maureen Disbot, MS, RN, CCRN, Dr. Stuart Dobbs, and the Sepsis CMPI, Houston Methodist Hospital made a short public service video about sepsis that will be shown at various internal events and locations. The group had a lot of fun doing this project! A great spin on Michael Jackson’s Bad was taken and made for a very catchy theme song. Participants included Dr. Marc Boom, Roberta Schwartz and staff from multiple departments such as pastoral care, medical records, nursing and transportation, just to name a few! Sepsis is a systemic response to an infection that if not identified and treated early often can lead to devastating consequences and even death. Sepsis is one of the leading causes of death in the United States and abroad and fewer than 50 percent of people in the U.S. are even aware of what sepsis is. Since 2009, HMH has been diligently working to decrease sepsis-related morbidity and mortality. Sepsis is viewed as an emergency and should be treated with the highest priority, similar to that of a Code Blue or Code STEMI, because early identification and treatment translates into better patient outcomes. Bedside nurses play an essential role in recognizing and alerting care providers to subtle changes that may indicate early sepsis. So don’t forget to screen your patients utilizing the sepsis screening tab in Method and page the number EVERY time your patient has a positive screen. Look for the video coming to a screen near you! 12 HOUSTON METHODIST NURSE
INFECTION CONTROL SPOTLIGHT Keeping Patients Safe By Robert Morehead, RN, ICP Infection Prevention and Control Houston Methodist Hospital
As we celebrate Patient Safety Awareness Week, let’s think about how preventing infections is an important way to keep our patients safe. To prevent bloodstream infections, for example, we use a CLABSI Prevention Bundle (Central Line Associated Bloodstream Infection). Have you ever wondered about the science behind using this bundle? Research in 2006 and 2008 in more than 100 ICUs in Michigan showed that applying grouped interventions as a single “bundle” was effective in reducing and preventing CLABSIs. These interventions led to a nearly 40 percent reduction in the CLABSI rate, and was sustained over 18 months*:
(1) Hand hygiene before CVC insertion (2) Avoiding insertion of CVCs in femoral sites (3) Preparation of the skin insertion site using chlorhexidine (4) Using maximal sterile barriers when inserting CVCs (5) Removing the CVC as soon as possible Of course, these aren’t the only things we do to prevent CLABSIs. We also follow these hospital policies: (6) “Scrubbing the Hub” (7) Labeling and tracking line insertion and central line dressing change dates (8) Changing dressings with CHG, and changing early if needed when moist or no longer adherent (9) Labeling and tracking tubing change dates
Thank you, Houston Methodist Nurses, for your daily service and attention to these important details that create a safe environment for our patients! *Pronovost P, Needham D, Berenholtz S, et al. An intervention to decrease catheter-related bloodstream infections in the ICU. N Engl J Med 2006;355(26):2725–2732. *Pronovost P. Interventions to decrease catheter-related bloodstream infections in the ICU: the Keystone Intensive Care Unit Project. Am J Infect Control 2008;36(10):S171e1–S171e5.
INTERVIEW: This month we introduce you ICP Jackie Trotter of Houston Methodist Sugar Land Hospital. Q: What other health care roles have you filled? Staff Nurse, Case Manager, PI Coordinator and now Infection Prevention and Control Nurse.
Q: How long have you worked as an ICP? Two years.
Q: What led you to this role?
To Houston Methodist? What keeps you here?
I had assisted the previous Infection Prevention nurse. When the position opened, I felt this would be a great opportunity to do something that I felt was very important for patient and hospital safety. I also felt I could bring my background in Performance Improvement to assist with HAI prevention and reporting. I am currently preparing for my CIC certification.
Q: What do you like about being an ICP? I enjoy being an ICP because it involves so many aspects of nursing. It involves teaching, performance improvement, data reporting, benchmarking and working hand in hand with leadership, nursing, ancillary staff, physicians and patients. I enjoy the support from my fellow ICPs in our system, who have helped me when I started and who continue to be a great support group, sharing their experiences and learning activities with me.
Q: What would you like to share that is not job-related? I have three children and three grandsons. All three of my children have followed my footsteps in health care. I have one daughter who is a Nurse Practitioner, my other daughter is in nursing school and my son is going for physical therapy. I enjoy horseback trail riding.
Q: What message do you have for Houston Methodist nurses? Houston Methodist is a great place to work; I’ve been encouraged and supported to grow throughout all the years. I have been with Houston Methodist since 1993, and I received my 20-year pin this year! I have enjoyed being a part of the Houston Methodist team.
LEADERS IN NURSING 13
CAREER COACH’S CORNER
BUILDING A STRONG FOUNDATION
By ShuntÁ Fletcher, MSN, RN, NE-BC, CVRN-BC
Career Coaching started for Terrie Mitchell, RN, before she ever became a nurse. “It was my blessing that I became a student in Ms. (Shuntá) Fletcher’s Saturday clinical rotation in 2010,” Terrie said. “She was one of the first people that motivated me to continue on the path of becoming not just a nurse, but also a thorough, responsible, professional and accountable nurse.” From then on, “(Fletcher) remained a strong foundation in the nurse that I am today,” she said. “There are no words to express the gratitude for how much she has helped and mentored me as a confused nursing student, an eager graduating nurse, a new nurse and now an experienced nurse looking for growth.”
“She always took in account of my personal and professional factors and helped me find a solution for them all.” - Terrie Mitchell
Terrie started as a student at Houston Methodist in her second semester of nursing school. She later became a MAPP student on M6SW, and after graduation — with the help of career coaching — she was hired by the same unit as a GN. She soon will be promoting to RN II, as she has completed all the requirements.
Terrie said that as her career coach, Fletcher always offered a listening ear and the upmost professional opinion to whatever Terrie brought her way. “She always took in account of my personal and professional factors and helped me find a solution for them all,” she said. “From the beginning I told her my goals as a nurse and ever since she has made sure I took the appropriate steps and actions to make way to my goals. It is always good to have support for yourself; however, it is always encouraging to see someone you strive to be like encourage and support you even more!” 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 email at cpecareercoaching@houstonmethodist.org.
DID YOU KNOW?
March is National Colorectal Cancer Awareness Month? Colon cancer is the third most common cancer in both men and women. There will be 96,830 new cases of colorectal cancer is U.S. in 2014, or 8 percent of all cancers in both men and women. • Diet high in red or processed Signs & Symptoms: meat / diet low in fruits and • Asymptomatic vegetables • Rectal bleeding / blood in stool • Change in bowel habits / change • Obesity / physical inactivity in stool caliber (more narrow than • Alcohol consumption • Long term smoking usual) • Feeling that bowel is not completely empty What You Can Do to Detect • Cramping pain in lower Colorectal Cancer Early abdomen • Flexible sigmoidoscopy every 5 • Anemia years* • Decrease appetite • Colonoscopy every 10 years • Weight loss • Double-contrast barium enema every 5 years Risk Factors: • CT colonography (virtual • Those older than 50 years colonoscopy) every 5 years account for 90 percent of cases Tests that mainly find cancer: • Personal history of colorectal polyps or chronic inflammatory • Fecal occult blood test (FOBT) every year bowel disease (e.g. ulcerative colitis or Crohn’s disease) • Family history of colorectal References: American Cancer Society cancer, colorectal polyps or Screening Guidelines, www.cancer.org other colorectal diseases 14 HOUSTON METHODIST NURSE
MICU Committee Gets Creative The MICU’s End of Life Committee hosted a “Comfort Blanket Making Party,” using polar fleece donated by Tanya Lazorwitz, RN, to make no-sew tie lap blankets for the comfort of dying patients. The blanket can be placed across their laps, and it serves as a soft surface for their hands to rest on. The sense of touch is one of the last senses to go so they wanted patients to have something soft to feel. The family can take home the blanket as a memento. They made 33 blankets and will tell the patients that the blankets were made with love by MICU nurses, PCAs, pharmacists and volunteers. At the party they had s’mores-themed treats and hot chocolate and listened to music. What a fun time! The committee also implemented a new project called a “thumbprint card.” They took a business card-sized card that has a poem on it and make a thumbprint from the patient on it. They then laminate the card and give it to the family for a keepsake. These cards are so special, giving the family and friends of patients a keepsake to cherish.
Houston Methodist Hospital
Hosts Patient Safety Fair
PATIENT SAFETY AWARENESS WEEK
is an annual education and awareness campaign for health care safety led by National Patient Safety Foundation. The goal is to create awareness in the health care organizations and in the community concerning every patient receiving safe health care. This year’s theme was “Navigate Your Health…Safely.” The theme highlights the need to provide patients with health care literacy to promote better communication between patients and their health care providers. One program featured that addressed this need was Ask Me 3®! This is a patient education program sponsored by the National Patient Safety Foundation. Research shows people who understand health instructions make fewer mistakes when they take their medicine or prepare for a medical procedure. The Patient Safety Department partners with other disciplines and housewide committees to showcase patient safety initiatives that have been recently implemented, upcoming changes
and best practices that warrant highlighting, e.g., Policy Tech, Care Navigators, Advanced Directives and White Belt projects. Patient Safety Net (PSN) trends and DNV non-conformities are triggers used to determine what topics should be showcased. The primary focus is to ensure the health care provider is better equipped to meet the safety challenges necessary to promote positive outcomes for our patients. In addition, we focused on providing information and resources to patients and their families to identify when medical care is needed, questions to ask related to their care and resources for care after discharge
By: Brenda Mays
by the table in the Outpatient Center (OPC). The OPC is where the greater opportunity was presented to interact with patients and families and provide patient information. The perioperative staff was offered CEUs for attending a presentation of Team STEPPS, led by Patient Safety Specialist Sandra Prevost, MSN, RN, CPPS. More than 100 perioperative staff attended the sessions.
This year, Patient Safety hosted an Open House on March 3, and more than 50 individuals stopped by to meet the Patient Safety Team and to receive information and snacks.
Jean Baker, RN, Manager MICU, was instrumental in reaching out to approximately 120 nursing staff on the night shift on various units with the Patient Safety cart. Handouts and popcorn were provided to staff. The Patient Safety and Accreditation Readiness teams also visited some units during the day shift promoting the fair and passing out handouts.
The Patient Safety Fair at Houston Methodist Hospital was highlighted March 5 and 6. More than 200 staff members visited the exhibits in the Rio Grande, and more than 100 staff stopped
From the Patient Safety Team at HMH, thanks to everyone who attended the fair, including the White Belt poster display in Crain Garden. We are available to assist you; dial 1-SAFE (1-7233).
NURSING DASHBOARD: A NEW WAY OF MEASURING QUALITY The new Nursing Dashboard will add a new dimension to how Nursing Leadership interfaces with its data. The goal of the dashboard is to provide needed unit statistics in a format that is concise and easy to understand. Keeping in line with the vision of the Nursing Operations team to utilize technology to improve operations and assist in the care of Houston Methodist patients. The Nursing Dashboard will compile data across multiple platforms and converge into one seamless application providing a dynamic twist to the static reports that are currently emailed daily. At a glance the user can see aggregated volumes pertaining to their unit, and can drill down to more detail when necessary. LEADERS IN NURSING 15
Nursing News
Houston 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: kagifford@houstonmethodist.org.
Kimberley DuBose, project manager in Nursing
treatment of important topics in cardiology, gastroenterology,
Administration, and Amber Rabo, director of OD and Training,
emergency medicine, endocrinology and gerontology.
presented a session titled “Managing Change in the Right Direction: People vs. Project Management” at TMA’s 4th Annual People in Health Care Conference. Great work!
Thanks to your hard work and relentless pursuit of excellence, Houston Methodist is No. 6 in the rankings of most nursefriendly hospitals in the nation! The editors of TopRNtoBSN.
Tonya Austin passed the RNC-OB Exam and is now certified.
com, an online guide to the best RN to BSN programs, compiled
Congratulations, Tonya!
publicly available information regarding employee benefits,
Shannon White passed her AGAC-NP exam and is now certified. Way to go, Shannon! Congratulations to Ana Valle, who supports the CV Surgery
support teams and overall work environment to determine the top-ranked hospitals. Many of the chosen hospitals have received awards for the quality of their nursing staff and practices and many offer educational, training and career
clinic; she just received her CVRN-BC and is now an RNIII.
advancement programs as well. Sources included hospital
Katie Broadway, RN, BSN, CNRN, passed her SCRN (Stroke
Reports and others. Additional nursing networks such as
Certified Registered Nurse) exam! Way to go, Katie!
AllNurses.com, employee review message boards such as
Philomina George, RN, Jones 9, has successfully completed the BSN program. Great job! Congratulations to Connie Corpuz, RN BSN, Inpatient Dialysis, for passing her Certified Nephrology Nurses Exam! The fifth annual Action STAT: Nurse Practitioner/Physician Assistant Boot Camp is scheduled April 4-6 at the Houston Marriott–Texas Medical Center. Action STAT provides expert presentations on the latest evidence in the diagnosis and
awards and reviews from U.S. News & World Report, Consumer
Glassdoor.com and the hospital’s web site were cited. Barbara Bolling from APEC has passed her certification exam. She now has certification in MedSurg: MSNC. Great job, Barbara! Congratulations, Nena M. Bonuel, PhD, RN, CCRN-E, CNS, ACNS-BC! The abstract she submitted for Sigma Theta Tau International’s 25th International Nursing Research Congress, “Patient’s Perspective of the Acuity-Adaptable Patient Room: A Descriptive Study,” has been selected for an oral presentation.