Nursing Quality, Patient Safety, and Patient Experience

Abnormal. New normal. New abnormal. Whatever label you assign to the past two years, they were anything but normal. While we had hoped we would return to some sense of normalcy, we were again presented with incredible challenges: COVID-19 surges, staffing shortages, Hurricane Ida, and the “invisible” personal battles that we had to overcome.

“Rather than focus on what went wrong or what we wish didn’t happen,” BRUCE WEINBERG, VP of Nursing Workforce Management, said “I would rather rejoice in how we met these unprecedented obstacles and what we did to overcome them.” The Collaborative Staffing Resource Center (CSRC) was created to provide the organization with flexible and adaptable clinical staff to meet the highly variable patient care needs. Flexibility and adaptability describe the CSRC staff and its culture as a department. Even while experiencing workforce and staffing-related challenges, the CSRC grew its staff by nearly 50% in 2021. Employment offerings were expanded by creating a new In-House Agency, while also increasing clinical services to include respiratory therapy, lab and radiology. Not only has this program brought in over 200 new clinical employees to the organization, but it has also offered current employees an alternative opportunity to continue caring for our patients.

Flexibility is an essential part of the CSRC experience. Beyond its growth of clinical staff, new options provided to staff gives them an opportunity to expand their exposure to patients in all types of settings, including clinic, infusion, pre/post-procedure areas, cardiac cath lab and PACU. Through these growth opportunities, clinical staff has the chance to work with a larger and more diverse patient population at varying intensities.

“It can be taxing to work at a high-intensity level every shift, but now we are able to offer staff more variety and a mix of intensity, hopefully leading to a richer and satisfying employment experience,” says BRUCE WEINBERG, VP of Nursing Workforce Management.

Providing flexible options for employees is foundational to the CSRC and is becoming increasingly important as we strive to continue growing to serve more patients. While the past year presented many challenges, we courageously faced them head-on. Together, as a team, we adapted and adjusted to meet our patients’ needs. This task, however, could not be accomplished without addressing and meeting our employees’ needs as well.

Providing Lifesaving Vaccines Through Collaboration

From the very moment emergency use authorization was approved for the Pfizer vaccine and the first Louisiana citizen was vaccinated on December 14 at Ochsner Health, the Ambulatory Nursing team sprang into action leading efforts to vaccinate the community and help bring us one step closer to ending the pandemic.

“We expeditiously recruited, hired and trained 400 employees to work as COVID-19 vaccine administrators,” says JLYNN WESTLEY, MSN, ASN, RN, AVP Clinic and Clinical Resource Ambulatory Nursing

Much like the entire country, Ochsner Health navigated through uncharted territory through the use of innovative ideas, tenacity and resilience. Through the help of our team members, leaders and government officials, we were prepared and equipped to meet the mounting vaccination needs and demands.

Leveraging the emergency proclamation issued by the governor, Ochsner Health garnered additional staffing resources through retired nurses, pharmacists, medical assistants, physicians and advanced practice providers to help increase the velocity and bandwidth of vaccination operations.

In partnership with our nursing educators and ambulatory practice coordinators, we rapidly developed a systemwide process to launch and operationalize 16 competency validation sites across the organization, extending from the Bayou, to North Louisiana, and as far away as Hancock, Mississippi, to ensure that we had fully trained and competent personnel administering vaccines. We collaborated with our Nursing Workforce Management colleagues to improve vaccinator scheduling efficiency, reduce the workload of vaccination site leads and improve employee engagement.

Identifying untapped scheduling resource capabilities in our clinic divisions, we activated self-scheduling functionality to support vaccine operations. This enhancement proved to be of significant value to vaccine site leads, as they faced the overwhelming challenge of sorting through approximately 500 emails a week related to scheduling, prior to leveraging the Kronos feature.

“All of these efforts facilitated the organization’s ability to deliver over 600,000 COVID-19 vaccines to our patients, employees and the communities that we are honored to serve.” -

JLYNN WESTLEY, MSN,

ASN, RN, AVP Clinic and Clinical Resource Ambulatory Nursing.

Mother Nature No Match for Ochsner Nursing: Hurricanes and Ice Storms Can’t Stop Us

Ochsner Nurses Cared for Patients and One Another with Strength, Unity and Resilience Through Hurricane Ida and the Ice Storm in North Louisiana

In the wake of Hurricane Ida, the strongest storm in Louisiana on record, Ochsner’s Patient Flow Center (PFC) transported 120 patients out of harm’s way from the Bayou Region. Leonard J. Chabert Medical Center and Ochsner St. Anne Hospital endured the brunt force of Hurricane Ida. Lying in hard hit Terrebonne and Lafourche Parishes, they were forced to evacuate patients, as both hospitals sustained significant structural damage. The PFC team was faced with their own personal hardships while focusing their efforts on the community. Team A took shelter in the Flow Center at the Elmwood campus throughout the storm. In the days that followed, team members not only battled power outages and extreme heat, but also remained in the dark in regards to the safety of their families and homes. They carefully monitored their water usage, preserved battery supply and rationed meals, while answering the calls of those in need. “Despite the challenges nurses have faced over the last two years, it is the determination to come together and serve that persists,” says AMBER HEBERT, BSN, RN-BC, Unit Director, Patient Flow Center, Ochsner Health. “As part of a connected healthcare system, our hospital and caregivers were empowered to make a greater impact on the entire Bayou Region,” says JENNIFER WISE, MHA, BSN, RN, Chief Nursing Officer, Ochsner St. Mary. Following the hurricane, Ochsner St. Mary accepted more than 30 inpatients from neighboring hospitals, Leonard J. Chabert Medical Center and Ochsner St. Anne Hospital. “We were also able to redeploy staff and physicians who were displaced from the impacted hospitals,” says JENNIFER. As one of only two fully functioning hospitals remaining in the Bayou Region, Ochsner St. Mary saw an unprecedented number of patients in the Emergency Department (ED). To meet the increased patient needs, the nursing staff designed a separate fast-track area for lower acuity patients. Supplies, equipment and staff were deployed to what was once vacant space in the hospital business office, and within a few hours, a fully functioning Emergency Department Fast Track was in place. YVETTE BOUDREAUX, RN, Clinical Educator, volunteered to work in what became known as the Business Office Clinic. YVETTE shared, “It was amazing to see staff from different units, clinics and hospitals come together for a common purpose, to care for a community in need. That is what healthcare is all about. Every bad situation will have something positive. Lots of people in the region suffered a loss during this time, but that loss brought us all together to learn and to serve.”

The nursing team in the Behavioral Health Unit (BHU) at St. Charles Parish Hospital (SCPH) along with staff from the medical surgical unit and intensive care unit evacuated patients and cared for them on units at Ochsner Medical Center – Kenner and Ochsner Medical Center — New Orleans, while the ED team stayed at the hospital working through the aftermath of the hurricane without interrupting services. “The staff and leaders at St. Charles Parish Hospital were able to accomplish these amazing acts because we learned to trust and rely on each other, despite the fact that many of our staff and leaders had significant damage to their homes, their children’s schools were closed, and their daily lives were disrupted, they came to work with a commitment to our patients and to each other. The foundation of trust that has been strengthened this year is essential to our ability to improve quality and patient outcomes and continue to create an environment where staff feel welcomed and valued.” - JARRETT FUSELIER, MBA, BSN, RN, AVP of Nursing Administration, St. Charles Parish Hospital.

Polar Vortex in North Louisiana

In the midst of a pandemic and a historic polar vortex during February 2021, Ochsner LSU Health Shreveport team members continued to show up for our patients and community. Many in our area were left without heat and water and faced dangerous travel conditions; however, from transporting colleagues to work safely then staying overnight in the hospital, to serving warm meals to patients and staff. Our #OchsnerLSUHeroes proved that we could get through it together. Nurses from the entire Ochsner Health organization also stepped up to show their support, traveling by bus from South to North Louisiana. During the polar vortex, many of our staff worked long hours and stayed multiple nights at the hospital to provide patient care throughout the winter storm.

A nurse is photographed arriving for a shift at Ochsner LSU Health Shreveport during the ice storm.

Ochsner’s Flight Care Team performed 11 transports - a record in the 20+ year history of the department. The team transported patients throughout Louisiana, Mississippi and Texas. A group of nurses and volunteers photographed as they traveled to support our North Louisiana colleagues during the ice storm.

Patient safety and healthcare quality are an integral part of every nurse’s role across Ochsner Health. Ochsner nurses’ dedication to high quality and safe patient care has resulted in impressive quality outcomes and safer patient care environments across the system. Nurses have unique perspectives for complex healthcare barriers and use this perspective to develop and implement creative solutions. Ochsner Medical Center (OMC) — New Orleans exceeded its target reduction rates by decreasing Catheter Associated Urinary Tract Infections (CAUTI) 18% between 2020 and 2021. Nurses focused on increasing bundle compliance and obtaining appropriate urine cultures to decrease CAUTI rates. Bundle compliance and urine cultures are patient care components most often performed by nurses. This successful quality outcome is strongly associated with excellence in nursing practice. In the Surgical Intensive Care Unit (SICU) at OMC — New Orleans, the team decreased pressure injuries by 60%. In conjunction with the systemwide preventative measures, the team implemented an innovative nursing process, referred to as the SICU “HAPI Toolkit” that includes:

• Standardized tracking binder, logging each skin integrity issue for each patient • Standardized process of rounding with a team on patients listed in the tracking binder biweekly with consistent follow-up and feedback to staff after patient rounding • Established criteria for use of specialty beds after certain surgical procedures January through May of 2022, Ochsner Health was already seeing remarkable results in Target Zero Measures. Systemwide improvements in quality outcomes include:

• Catheter-Associated Blood Stream Infections are down 28.57%.

• Catheter-Associated Urinary Tract Infections are down 11.11%.

• Clostridioides difficile infections are down

26.32%.

• Methicillin-resistant staphylococcus aureus infections are down 40%.

DEBORAH FORD, MSN,

RN, Chief Nursing Officer — Ochsner Medical Center New Orleans states, “Our amazing SICU nursing team worked together to prevent patient harm.” Nurses working across the Bayou region have used Ochsner Health’s Lean Program to drive patient safety and quality outcomes.

• LACEY PERCLE, BSN, RN, Manager of MedSurg and Intensive Care Unit, Ochsner St. Anne Hospital, focused on patient safety, increasing the inpatient experience nurse responsiveness score from 51 to 76 through the implementation of Spectralink assignments and monitored usage. Nursing staff were made more accessible by carrying an assigned

Spectralink phone throughout their shifts. In addition, a call bell log was implemented to ensure messages were getting to appropriate staff members in a timely manner.

• ANGELA PLAISANCE, RN, Ochsner St. Anne

Hospital, completed a Root Cause Investigation (RCI) targeting the reduction of sepsis-related Rapid

Responses through proactive provider rounding. She implemented proactive rounding and early sepsis identification tools in January 2022, where the goal was to decrease rapid responses related to sepsis by 75%, and we achieved 100% decrease in sepsisrelated rapid responses (none in February, March, or

April 2022).

“Nurses are fierce patient advocates, relentless champions of quality and innovation, and exceptional caregivers, and they continue to humbly take care of the sick and will be remembered by those who they have helped.” - LYNN NECAISE, Director of Quality for Ochsner Medical Center — Hancock,

Population Health focuses on making improvements to preventive health strategies and creating new programs to help manage chronic diseases. Population Health places importance on improving patient experience and healthcare outcomes while decreasing healthcare costs. These goals are achieved through provider and patient engagement, education, and promotion of preventive care, such as cancer screenings, blood pressure management, and diabetes control. Population Health utilizes nursing informatics to operationalize and standardize the quality and delivery of care for patients.

“Our team has been instrumental in improving numerous workflow processes, such as a systemwide approach to access and standardization of the diabetic eye camera workflow to aid in diabetic retinopathy prevention,” said KIM R. HARRIEL, LPN, Supervisor - LPN Performance Improvement, Ochsner Center for Primary Care and Wellness.. “In addition, we are working with the endoscopy team to enhance the referral and case request process, which will ensure timely scheduling of colon cancer screenings and promote early intervention. We have partnered with Primary Care to provide rooming standards training to clinical support teams. During the rooming process, nurses are trained to capture a patient’s vital signs, depression-screening responses, immunizations, medication adherence, and social determinants of care. This information is used by providers to identify resources and patient education opportunities that improve patient compliance with their healthcare regimen. Population Health also promotes patient engagement and education through programs like diabetic education, Ochsner digital medicine, and utilizing the MyOchsner app, which has allowed us to introduce A1C home testing.”

Ochsner Health is revolutionizing the role of Population Health nursing by changing our approach to care from a reactive to proactive approach.. Ochsner empowers nurses to develop additional skills in the areas of operations, business, and education. The application of these skills enhances policies and procedures and improves quality outcomes. As health disparities and inequities threaten our communities, Population Health nurses will lead Ochsner into the future by focusing on performance improvement processes, supporting our clinical team members, and promoting patient engagement.

Top National Performance Through Kind and Compassionate Nursing

When the nation saw a downturn in experience results, our nurses kept their focus on Patients First. Our patients noticed. Thank you for your continued gracious guidance and support to all of those around you.

Our patients know the truth, and thankfully they are willing to share how our nurses make them feel:

• “The staff was so nice!!! The nurse who took my weight/vitals was an absolute gem. This was my first time going to an endocrinology appointment by myself (as well as first time at Ochsner). I was super impressed with all of the staff for their positive and wanting-to-help energy.”

• “My nurses and assistants were great to me. I felt comfortable and ready to heal.”

• “Our nurses were INCREDIBLE. I cannot say enough good things about them. They helped answer all of my questions, they were gentle, they were kind, they took the time to talk to my little girl and listen to her and colored and played with her. They praised her every chance they got through the hard, tough parts. They explained to her what was going on the best that they could. We were so sad to leave them. They really love their jobs and love being there, and you could tell. They made every situation better. We could not have had a better team. Such a blessing they were to our family!!”

In 2021, we had 69 units performing above the 75th percentile nationwide for the Communication with Nurses domain and 45 units above the 90th percentile!!

“When faced with extraordinarily difficult situations this year, our nurses continuously found a place within themselves to discover more and more kindness that they shared with our patients. We should all learn from them on how to display this level of empathy Every. Single. Day.”

– ALISON SOILEAU, MA, FACHE, CPXP, Vice President of Patient Experience and Service Excellence, Ochsner Health

Nurses have received a unique spotlight since 2020. This spotlight has highlighted to other professions what we as nurses have always known — our work as nurses is essential, our work is rewarding, and we are resilient.

BETH ANN LAMBERT,

MS, CIC, Director of Infection Control says, “In the recent years, nurses have been more innovative than ever, and we are carrying the momentum forward in infection control prevention.”

Capturing nurses’ ideas and creative problemsolving to keep patients safe

Recognizing that the more nurses are involved in creating and designing solutions to improve care, the better care becomes for our patients, the Infection Prevention team hosted a hackathon event to capture frontline nurses’ creative ideas to prevent hospital-acquired infections (HAI) in COVID-19 positive patients. Nurses were asked: What innovations do you have in store to keep patients safe from infection? How can we make hand hygiene compliance easier? What would you change about the PPE options on your unit? “We were grateful to collaborate with a group of frontline staff on the COVID-19 HAI Rapid Cycle Improvement Project in 2021,” shares BETH ANN LAMBERT, MS, CIC, Director of Infection Control. The workgroup met virtually in the midst of ongoing COVID-19 surges to identify opportunities to improve infection rates. The dialogue helped the team clarify solutions needed, which included reinforcing infection control policies to help decrease HAIs in the four locations that were hit early by COVID-19.

Improvements in infection control across the system

“Not only are we getting back to pre-COVID-19 HAI rates, in some metrics, we’re doing better than ever before,” says BETH ANN. “Thanks to the improved compliance with MRSA decolonization, including daily CHG baths for COVID-19 patients and others at high risk for MRSA, the systemwide hospital acquired MRSA BSI rate is currently 0.05 infections per 1,000 patient days — the lowest it’s ever been since we started reporting the data.”

Ochsner Nurses Are Working to End Human Trafficking Here at Home

As with many challenging or potentially harmful situations, Ochsner nurses are often in the right place and right time to observe and maybe even provide guidance. Human trafficking is on the rise in the states we serve, and as with any issue, nurses are often at the forefront to implement processes that recognize and help victims feel seen. Ochsner trains our staff to watch for, observe or even flag anything we see in a patient’s visit for their safety. We do this for cases where different forms of potential abuse may be happening either real-time or outside our walls, including human trafficking. Since implementing a new program designed to stop human trafficking, the Ochsner LSU Health — Shreveport team has doubled the number of patient identifications and offers of assistance since introducing the Epic tool and process. Each identification impacts a person’s life directly and may potentially save lives from human trafficking. Ultimately, the goal is to ensure that the at-risk person feels seen and safe and is aware of resources available to them.

Human trafficking is defined by U.S. Homeland Security as the use of force, fraud or coercion to obtain some type of labor or commercial sex act. Every year, millions of men, women and children are trafficked worldwide — including right here in the United States. It can happen in any community, and victims can be any age, race, gender or nationality. Traffickers might use violence, manipulation or false promises of well-paying jobs or romantic relationships to lure victims into trafficking situations. Language barriers, fear of their traffickers and/or fear of law enforcement frequently keep victims from seeking help, making human trafficking a hidden crime.

What can Ochsner do to help?

Ochsner LSU Health — Shreveport implemented Operation

R.A.H.A.B., a program modeled after Henry Ford’s program that stands for Rescue, Assess, Heal, and

Break free and immediately wanted to work on a process to implement the program across the system. Ochsner Shreveport established a process to identify patients at risk for trafficking and increase the assistance extended to them. Based on the success of the program, Ochsner is adapting protocols to recognize and rescue victims of human trafficking, initially focusing on Ochsner Baptist. A systemwide committee and Ochsner’s project management office pulled together our colleagues from safety and security, nursing, legal, diversity and inclusion, Epic and other key stakeholders to work on a plan to roll out at all campuses over the course of the year. “Operation R.A.H.A.B. has impacted the lives of 24 individuals in North Louisiana to date, and I am so excited that through this initiative, we will be changing lives for the better, offering a healthy life, free of coercion,” says SHEREE STEPHENS, RN, MSN, CPHQ, VP of Quality, North Louisiana & CNO of Ochsner LSU Health Shreveport. “One of the individuals our team played a part in rescuing is now an Ochsner LSU — Health employee, living a happy, healthy life,” says SHEREE. “It is truly inspiring how a partnership with a community organization can allow healthcare organizations to impact and change lives outside the four walls of our hospitals,” she said.

Ochsner Baptist is preparing to launch the program in New Orleans.

DONNA MARTIN,

MSN, HCSM, RN, Chief Nursing Officer, Ochsner Baptist shares, “Knowing that New Orleans is a target for human trafficking, we are committed to implementing solutions to protect our community from harm. Our Ochsner LSU Health — Shreveport colleagues have built the foundation for the success of Operation R.A.H.A.B., and we are so grateful to expand this important work and bring the program to Ochsner Baptist.”

If you or someone you know is a victim of human trafficking call the National Human Trafficking Hotline: 1 (888) 373-7888 SMS: 233733 (Text "HELP" or "INFO") Hours: 24 hours, 7 days a week Languages: English, Spanish and 200 more languages Website: http://humantraffickinghotline.org