Mercyhealth Fiscal Year 2017 Nursing Annual Report
inside cover
MESSAGE FROM THE PRESIDENT/CEO AND CNO.......................................1, 2
04
TRANSFORMATIONAL LEADERSHIP
08
STRUCTURAL EMPOWERMENT
TRANSFORMATIONAL LEADERSHIP
TRANSFORMATIONAL LEADERSHIP at Mercyhealth ..................................4
Strategic Planning............................................................................................6
STRUCTURAL EMPOWERMENT
STRUCTURAL EMPOWERMENT at Mercyhealth..........................................8
Shared Governance.......................................................................................10
EXEMPLARY PROFESSIONAL PRACTICE
12
EXEMPLARY PROFESSIONAL PRACTICE
24
NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS
EXEMPLARY PROFESSIONAL PRACTICE at Mercyhealth .........................12
Relationship-Based Care...............................................................................14
Nursing Professional PRACTICE Model .......................................................17
PRACTICE Values..........................................................................................18
2017 Nursing PRACTICE Excellence Award Winners...................................19
Magnet Redesignation..................................................................................22
NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS
NEW KNOWLEDGE at Mercyhealth.............................................................24
Process Improvement...................................................................................26
Nursing Research..........................................................................................28
It is my pleasure to present the 2017 Mercyhealth Nursing Annual Report. The articles and features are snapshots of the passion our nurses have for touching lives and providing an exceptional patient experience. I am proud of the way our nurses continually set the bar high, embrace new technologies, resolve emerging issues, and accept often-changing roles in their profession. Their passion for providing the highest quality of care propels Mercyhealth forward to ever-increasing levels of care. 2016 was another busy and exciting year for our organization. We began building our new women’s and children’s hospital, adult hospital and medical center campus in Rockford. With this new campus, we will increase access to specialty and sub-specialty services for the residents of southern Wisconsin and northern Illinois. We also received approval to build a small hospital and clinic in Crystal Lake that will bring much-needed emergency care, as well as primary and specialty care services, to area residents. Our nurses will certainly play a critical role in the exceptional care that will be provided at both new hospital campuses. In 2015, the Board of Directors also approved and funded nursing education that will lead us closer to Magnet certification as one, combined organization—a significant goal. Magnet status is an important part of signaling to our communities that we have the most passionate and educated nurses caring for patients every day. I am proud to be a part of this important journey. Sincerely,
Javon R. Bea Mercyhealth President/CEO MERCYHEALTH / 1 / NURSING ANNUAL REPORT FY 2017
I am proud to see all the accomplishments we have made in Nursing at Mercyhealth during the last year. It is a pleasure to have this Nursing Annual Report to highlight those accomplishments. Our organization has dedicated nurses who use evidenced-based practice as the basis for the care they deliver to our patients and their families. As we continue on our Magnet journey—seeking redesignation in 2018—we will accomplish this task as a unified group of Mercyhealth nurses. We have combined nursing committees and councils, and work within the framework of a common Nursing Professional PRACTICE Model. We must always hold true to the foundation of our Nursing Professional PRACTICE Model—Relationship-Based Care. We build upon that foundation by delivering Patient and Family-Centered Care; having Respect, Accountability, Competence, Transformational Leadership, Interdisciplinary Collaboration, Caring; and using Evidence-Based Care. All of these concepts, together with a Shared Governance system, help us achieve our Mercyhealth nursing mission: “Meryhealth nurses serve with a passion for making lives better using clinical expertise to deliver state-of-the-art care to patients and their families.”
Sue Ripsch, MS, MBA, BSN, RN, NEA-BC Mercyhealth VP, CNO, COO
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Mercyhealth Hospital–Rockton Avenue Rockford, IL Services: ED Trauma Center, Women’s and Children’s, Medical-Surgical, Intensive Care, Ortho, Peri-Operative Services, Behavioral Health Mercyhealth Hospital and Trauma Center–Janesville Janesville, WI Services: ED Trauma Center, Maternity, Medical-Surgical, Ortho, Peri-Operative Services, Behavioral Health, Treatment Coordination, Rehab and Transitional Care Mercyhealth Hospital and Medical Center–Harvard Harvard, IL Services: ED, Medical-Surgical, Treatment Coordination, Peri-Operative Services, Long-Term Care Mercyhealth Hospital and Medical Center–Walworth Lake Geneva, WI Services: ED, Maternity, Medical-Surgical, Treatment Coordination, Peri-Operative Services
Mercyhealth Ambulatory Clinics McHenry County, IL Rock County, WI Walworth County, WI Winnebago County, IL
Coming soon: I-90/Riverside Hospital and Medical Center campus Rockford, IL Opening 2019
Coming soon: Mercyhealth Hospital and Medical Center–Crystal Lake Crystal Lake, IL Opening 2020
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TRANSFORMATIONAL LEADERSHIP Strategic Planning Professional Practice Model
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TRANSFORMATIONAL LEADERSHIP
Nurses want to work in environments where they believe their voices are heard, their input is valued, and their practice is supported. Our nursing leaders are strong advocates for their nurses, and the patients and families they serve. They support their clinical nurses in their participation on councils and task forces, and inspire them to innovate and achieve extraordinary outcomes. Our clinical nurses demonstrate their leadership as they empower their patients and families by providing the education and resources they need to remain as healthy as they can be in their own homes and communities. Transformational leaders have a clear vision and inspire those around them to carry out the mission of their organization. It is a privilege to be a part of this exceptional professional nursing team with all we have accomplished together in support of the Mercyhealth nursing mission: Mercyhealth nurses serve with a passion for making lives better using clinical expertise to deliver state-of-the-art care to patients and their families. Sincerely, Deb Potempa, MSN, RN, NEA-BC VP and CNO, Mercyhealth Hospital and Trauma Center–Janesville ANCC Magnet® Empirical Outcomes
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Strategic Planning: Mercyhealth nurses partner with McHenry County community agencies for training in behavioral health On August 8, 2017, Mercyhealth Hospital and Medical Center–Harvard’s nursing leadership partnered with several McHenry County community agencies. Recognizing changing community needs, including an increase in mental illness, suicidal ideations and substance abuse, we responded in support with education for nurses, specifically to impact the care they provide. We combined this with an opportunity to review pediatric respiratory and cardiac arrest in the form of a pediatric mock code. Mercyhealth partnered with the McHenry County Substance Abuse Coalition, the National Association for Mental Illness (NAMI) and our own Emergency Management Team which included an MD-1 physician partner to provide education. The event started with the Pediatric Mock Code experience. The Mercyhealth Emergency Management Team, with the help of MD-1, put together a simulation in which a teenager overdosed on heroin and was brought into the hospital not breathing. Mercyhealth RNs had the opportunity to work through the scenario as a team to gain experience and confidence with using the crash cart, administering emergency medications, and utilizing other pediatric equipment. Next, Laura Crain from the McHenry County Substance Abuse Coalition offered an educational discussion on common street drugs found within McHenry County. She discussed what health care professionals could expect to see within the hospital setting, as well as some risks that health care professionals need to consider when working with patients and these drugs. She also presented what resources are available within the county for patients addicted to drugs. With her was a former patient who spoke to the audience about his experience with addiction, and what was helpful for him through the recovery phase. Finally, representatives from NAMI spoke from both the professional and patient perspective on mental illness. They discussed what NAMI offers and its availability to patients within McHenry County. A former patient who suffers with mental illness who has used NAMI resources also spoke about her experience within the health care setting. She offered suggestions to the health care team about what was helpful for her from the perspective of the patient. Theresa Hollinger, MSN, MHA, RN, NEA-BC Tracy Perkins, MSN, RN, NE-BC MERCYHEALTH / 6 / NURSING ANNUAL REPORT FY 2017
Cost Pillar: Value Analysis Team (VAT) This multidisciplinary committee is charged with improving patient care and controlling product costs with an emphasis on the purchase and utilization of cost-effective, high-quality products through an approved process of determining clinical efficacy, product evaluation, and financial impact to Mercyhealth.
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Dottie Muskovin, Director of Adult Inpatient Services Mercyhealth Hospital– Rockton Avenue Rockford, IL
STRUCTURAL EMPOWERMENT Shared Governance
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STRUCTURAL EMPOWERMENT
Structural empowerment is one of five core Magnet components and acts as a framework to promote open communication, lifelong learning and career advancement. It can be described as the councils, policies and processes within our organization that empower our nurses to practice in a professional and autonomous manner to achieve the highest degree of clinical excellence and professional achievement. Structural empowerment creates an innovative environment where the mission, vision and values of our discipline, as well as those of the organization, come to life and allow Mercyhealth to achieve exemplary outcomes reflective of our quality care, some of which are highlighted in this annual report. It allows us to build relationships and foster positive partnerships across the health care continuum to promote a positive image of nursing and to recognize our nurses for their efforts. Nurse leaders play a key role in supporting career development and recognition by empowering our nurses to actively engage in the development of themselves and others, to share knowledge and provide continuous feedback for ongoing improvement, and to use their expertise to strengthen the nursing profession and contribute to the growth and sustainability of the organization. Each day, nurses are defining and designing professional practice through shared decision-making and problem-solving. They are making a difference one patient at a time. We continue on our journey to nursing excellence with one united Mercyhealth nursing mission, “To serve with a passion for making lives better using clinical expertise to deliver state-ofthe-art care to patients and their families.” ANCC Magnet® Empirical Outcomes
It is my privilege to work with such a dedicated group of nurses who give freely of their time and talents in order to act as advocates for each other, our patients, and Mercyhealth. With thanks and appreciation for all you do,
Jan Botts, MHA, BSN, RN, CPHQ, NEA-BC CNO, Ambulatory Services MERCYHEALTH / 9 / NURSING ANNUAL REPORT FY 2017
ing Shared Gover Health Nurs nance Mercy
Mercyhealth Nursing Shared Governance Model Nursing Mission: Mercyhealth nurses serve with a passion for making lives better utilizing clinical expertise to deliver state-of-the-art care to patients and their families.
Nursing Coordinating Council
provides a framework of standards and practices to facilitate shared governance communication and collaboration among all councils; is accountable for continuous assessment of the shared governance councils, reviews and assesses their impact on quality and empirical outcomes; and serves as a clearinghouse for issues needing follow up and intervention within the various councils.
Nursing Practice Councils
supports collaboration among peers and charged with defining, implementing and maintaining the highest standards of clinical nursing practice quality and patient care initiatives utilizing a shared governance structure.
Clinical Informatics Council
assists in developing a technology based environment that supports the nurse clinicians. The council is committed to mentoring and coaching nurses to understand and use technology, including the electronic medical record, to support their practice.
Nursing Leadership Councils
facilitate continuous development and evaluation of an environment conducive to delivery of patient care meeting the mission and objectives of Mercyhealth. All matters relating to the allocation, distribution and assignment of human, fiscal and material resources to the individual units, and the department as a whole, shall be determined, defined and undertaken by the NLC.
Nursing Research and Quality Council
creates an environment that assures the integration of evidencebased practice and research into clinical and operational processes.
Advanced Practice Nursing Council
assists Mercyhealth advanced practice nurses in providing excellent, evidence-based care to patients and promote health and wellness across the continuum of care.
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Partnering Pillar Partnering at Mercyhealth embraces communication and collaboration of the team to achieve our common goal of serving with a passion to make lives better.
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Leann Wasemiller, BSN, RN RN Program Coordinator Quality Initiatives
EXEMPLARY PROFESSIONAL PRACTICE Relationship-Based Care PRACTICE Values Professional Practice Model 2017 Nursing PRACTICE Excellence Award Winners
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EXEMPLARY PROFESSIONAL PRACTICE
Nurses at Mercyhealth work diligently and in collaboration with the interdisciplinary team to ensure coordinated and comprehensive care. Our shared governance structure has strengthened and nursing has embraced the Relationship-based Care delivery system, leading to an engaged work environment and outstanding quality outcomes.
Danielle
Marcia
Mercyhealth nurses across our organization have contributed to the use of evidence-based practice and achievement of our nursing and organizational goals. In October 2017, the application for Magnet designation as an organization was submitted to the American Nurses Credentialing Center (ANCC). In the coming year, our nursing excellence and our above-benchmarked quality outcomes will be showcased as we write our Magnet document for submission in October 2018. We have much to celebrate! The Magnet team is excited and proud to be on this journey with you all.
Doreen Sincerely, Your Magnet team Danielle Brotherhood, MSN, RN Marcia Donaldson, MSN, MHA, RN, CCRN Doreen Timm, MSN, RN, APN/CNS-BC
ANCC MagnetÂŽ Empirical Outcomes
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Relationship-Based Care: A Cultural Transformation Model Relationship-Based Care (RBC) is an operational framework that improves safety, quality, patient satisfaction, and staff satisfaction by strengthening every relationship within an organization. In RBC cultures, clinicians reconnect with the purpose and meaning of their work. Teamwork is based on deep commitment rather than surface-level compliance. Patients and their families feel safe and cared for as clinicians commit themselves to making authentic human connections with all people in the care environment. RBC Improves 3 Critical Relationships: 1. The relationship between caregivers and the patients and families they serve. In RBC, the caregiver-patient/family relationship is one in which the caregiver consistently maintains the patient and family as his or her central focus. In an RBC culture, no caregiver activity is ultimately independent of this relationship, and the definition of caregiver is broad. For example, caregivers from environmental services change their focus from maintenance of a physical environment to providing the most comfortable surroundings possible for people who are suffering. When we change how we see the meaning and purpose of our work, our work changes. 2. The caregiver’s relationship with self. This relationship is nurtured by self-knowing and self-care. Without a clear understanding of one’s self, a person’s emotional reactions may adversely affect their capacity for partnering and teamwork. The relationship with self is fundamental to maintaining each individual’s optimum health, to having empathy for the experience of others, and participating as a productive member of the organization. 3. The relationship among members of the health care team. The delivery of compassionate quality care requires a commitment by all members of the organization within all clinical disciplines to accept responsibility for establishing and maintaining healthy interpersonal relationships. Quality care occurs in environments where the standard among members of the health care team is to respect and affirm each other’s unique scope of practice. In a culture of committed teams—a culture in which people are deeply committed rather than simply compliant—patients and their families are far more likely to commit to their own care rather than merely comply (or fail to comply) with their plans of care. The RBC model supports the American Nurses Credentialing Center’s requirements for practice, collaboration, and communication. Legacy Rockford and Legacy Mercy nurses, through our shared governance model, have committed to Mercyhealth nursing excellence. RBC’s emphasis on building authentic relationships within the care environment will nurture the transformative energy required to build our mutual nursing future. This transformative energy will radiate from our shared governance councils. MERCYHEALTH / 14 / NURSING ANNUAL REPORT FY 2017
Quality Pillar Sue Kautz, RN, shares her favorite quote regarding quality: “Quality is never an accident, it is always the result of high intention, sincere effort, intelligent direction, and skillful execution: It represents the wise choice of many alternatives.” -William A. Foster
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Sue Kautz, BSN, RN, Clinic Quality Process
Improvement Coordinator,
Mercyhealth Hospital and Medical Center– Walworth
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Mercyhealth PRACTICE Values
Mercyhealth’s nursing mission and model of care are guided by eight dynamic and integrated core values that infiltrate the organization and are reflected in the work of nurses throughout the organization. Each value is supported by behaviors defined by clinical nursing partners.
P: Patient- and Family-Centered Care R: Respect A: Accountability C: Caring T: Transformational Leadership I: Interdisciplinary Collaboration C: Competence E: Evidence-Based Care See this year’s PRACTICE Awards Winners on pages 18-21.
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2017 NURSING PRACTICE EXCELLENCE AWARD WINNERS
Nursing PRACTICE 2017 Excellence Award Winners
These nurses were nominated by their peers and selected for superiorly modeling the behavior in the value category for which they were selected. They were honored with a celebratory luncheon, PRACTICE Excellence lapel pin and a framed certificate (see photos on page 18 and 21). The PRACTICE Awards are sponsored by the Nursing Recruitment and Retention Committee.
P-Patient and Family-Centered
Jennifer Garcia Mercyhealth Hospital and Trauma Center Patient Navigator Excerpt from nomination: “She spends so much time listening, coordinating and truly helping her patients not just through their hospitalization but beyond. She really motivated and empowered the patient and the only family member she has to get back on track and take responsibility for her own health outcomes. To me this is what nursing is and advocating relentlessly ensuring the best outcomes for patients is truly a passion for this nurse. She exudes this trait with all her patient interactions.” Sharon Peters Mercyhealth Hospital–Rockton Avenue Neonatal Intensive Care Unit Excerpt from nomination: “She took time to write out a detailed history of the infant’s five-month stay in the NICU at Mercyhealth Hospital–Rockton Avenue. She included the parents and answered their questions thoroughly.”
R-Respect
Caitlin (Johnson) Heth Mercyhealth Hospital and Trauma Center Medical Unit Scope of nomination: After Caitlin’s patient passed away and was taken to the morgue, the patient’s daughter requested an opportunity to say goodbye to her father. Caitlin requested an empty room on the unit and made sure to respect the daughter’s wishes by providing a quiet, peaceful environment for her to say her goodbyes, rather than the morgue. Josh Samorian Mercyhealth Hospital–Rockton Avenue Emergency Department Excerpt from nomination: “Josh is revered in the Emergency Department for his clinical excellence, sense of compassion, and cool head in high-pressure situations. Due to the respect he shows to his coworkers and to the patients and families we serve, Mercyhealth is a better organization. When our staff feels supported and respected by their charge nurse, they are willing to work harder and are inspired to provide the very best care to their patients and families.”
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A-Accountability
Mary Koller Mercyhealth Hospital and Trauma Center Patient Navigator Excerpt from nomination: “She works to assess her own practice and participates in activities to improve practice. She works to provide safe, appropriate and ethical care to patients on a daily basis. She is very transparent with her patients, which is why so many of them trust and like her. She is always trying to help with the most cost-effective way and ensure that the patients are aware of the cost and alternatives to treatment and therapy.” Beth Westlund Mercyhealth Hospital–Rockton Avenue Operating Room Excerpt from nomination: “Beth demonstrates professional accountability to be responsible for Open Heart Call staffing and scheduling in addition to other Hours Committee responsibilities. She fosters authentic relationships with staff, and they look to her for guidance and support.”
C-Competence
Rebecca Johnson Mercyhealth Hospital and Medical Center–Harvard ICU Excerpt from nomination: “Her care demonstrates her ability to deliver exceptional care by using the nursing process as she integrated theoretical knowledge and clinical expertise in the care of her patients. Becky has had numerous situations where she has identified key information and persisted in providing exceptional care.” Jamie Laubach Mercyhealth Hospital and Medical Center–Walworth Med/Surg Excerpt from nomination: “Her zest for more responsibilities, new knowledge, and willingness to accept more work above her job title is endless. She exemplifies the next generation of successful nursing practice. She is committed to her practice and she is passionate about her fellow nurses’ practice environment.”
T-Transformational
Corrine Kohn Mercyhealth Ambulatory Quality Excerpt from nomination: “This nurse has gone above and beyond to lead PNCC. She works tirelessly to ensure that nurses are able to participate in panels, get interviewed to be staged, and organizes trainings. This nurse influences and encourages other nurses in professional development.” Laura Leahey Mercyhealth Hospital and Medical Center–Harvard Excerpt from nomination: “She has raised awareness of the problem of workplace violence (WPV), and has been instrumental in promoting a culture of safety. She is an advocate for nurses and is actively involved in the assessment of the WPV problem, solutions to the problem, and nursing education.”
I-Interdisciplinary Collaboration
Kelly Howard Mercyhealth Hospital and Medical Center–Harvard Surgical Services Excerpt from nomination: “Kelly engages in community outreach programs to provide education and promote community health. She not only engages in these activities, but she includes the entire hospital and collaborates with McHenry County nursing to exemplify exquisite interdisciplinary collaboration.” Sue Kautz Mercyhealth Hospital and Medical Center–Walworth Quality Excerpt from nomination: “She works with all personnel to provide the best practice delivery of care through her daily chart review, frequent partner reminders, and follow-up with nursing leaders. Her actions were heavily responsible for the first successful certification of an Acute Stroke Ready Hospital.” MERCYHEALTH / 20 / NURSING ANNUAL REPORT FY 2017
C-Caring
Melissa Mikkelsen Mercyhealth Hospital and Trauma Center Medical Unit Excerpt from nomination: “She will sit down at the bedside and crack jokes with the grumpiest patient to get that glimmer of a smile from them. She will take any negative situation and try to turn it into a positive one. No matter what kind of day this nurse is having, she will come to work with a smile and a happy-go-lucky mentality. She brings laughter and smiles to those around her. This includes each patient she cares for.” Karin Riggle Mercyhealth Hospital–Rockton Avenue Peds/Gastro Excerpt from nomination: “You can find the result of her exemplary caring on the faces of every mother and child she encounters. Mothers will call specifically requesting her. They will tell the other staff how amazing she is and all that she has done for them. She is my inspiration of what and how a nurse should care for all of her patients.”
E-Evidence-Based Care
Peggy Schuyler Mercyhealth Hospital and Trauma Center Patient Navigator Excerpt from nomination: “She is pushing and enhancing practice change and ensuring stability of work within the organization. This nurse is key in any practice change implemented in our unit. She uses her practical knowledge with new evidence to keep our department up to date in a changing market.” Judi Trites Mercyhealth Hospital–Rockton Avenue Neonatal Intensive Care Unit Excerpt from nomination: “She helped lead a year-long project to open a small baby unit within our existing NICU. She set an assertive timeline, obtained a grant to train over 25 caregivers in infant massage and handling, obtained organizational support at the administrative level, gained buy-in from their peers in the NICU, and interviewed and accepted over 40 RNs from within the NICU to be part of the group to be trained and regularly care for these babies. The unit opened on January 10, the original goal date.”
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Magnet Redesignation Timeline Magnet Re-designation Timeline
2017
• Mercyhealth hospitals in Lake Geneva, Harvard and Janesville and ambulatory clinics submit interim monitoring report inclusive of demographic data • Collect Magnet stories and write Magnet document • Submit application of intent to redesignate as Mercyhealth, including all hospitals and clinics
2018
• October: Submit Mercyhealth Magnet document to ANCC
2019
• Early spring: Magnet appraisers visit
2020
• Interim report submission
• Spring or summer: Magnet Office will announce if we have met requirements for redesignation
• Next steps will be determined regarding redesignation
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Service Pillar It is evident in the care provided that Mercyhealth partners are committed to providing high-quality service. I see examples every day of how partners go above and beyond to ensure the satisfaction of all those they encounter, including patients, families, visitors, and fellow partners. It is a unique culture and I feel blessed to be a part of it!
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Tracy Perkins, RN, MSN, NE-BC, Unit Supervisor, Mercyhealth Hospital and Medical Center–Harvard Medical Unit
NEW KNOWLEDGE, INNOVATIONS AND  IMPROVEMENTS Process Improvement Nursing Research
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NEW KNOWLEDGE, INNOVATIONS AND IMPROVEMENTS
Mercyhealth nurses have the ability to be involved in research and evidence-based practice (EBP) to change their nursing practice, policy and patient care outcomes. Using the Magnet component of new knowledge, innovations and improvements, nurses are able to advance the science of nursing, learning and to discover new ways to achieve quality and efficiencies that produce effective outcomes. The purpose of the Mercyhealth Nursing Research and Quality Council is to create an environment that assures the integration of evidence-based practice and research into clinical and operational processes. The council is committed to mentoring and coaching the nurse to understand, conduct and actively participate in nursing research and to review pertinent quality nursing outcomes to identify opportunities for improvement. This past year, as Mercyhealth combined practices from Janesville, Rockford, Walworth (Lake Geneva), Harvard and our ambulatory settings, we have noted a combined strength within our Nursing Research and Quality Council. Each entity has engaged in individual research and evidence-based practice projects, effectively changing nursing practice at the bedside. Sincerely, Caryn Oleston, MSN, MHA, RN, NEA-BC, FACHE CNO, Mercyhealth Hospital and Medical Center–Walworth CNO, Mercyhealth Hospital and Medical Center–Harvard
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Process Improvement:
SMALL BABY UNIT
The Team • • • • • • • • • • • • •
Rhonda Gale, NICU Educator Judi Trites, Lead Preceptor Pam Allen, NICU Manager Susan Andrews, RN, Staff Nurse Danielle Brinkmeier, RN, Staff Nurse Ashraf Baeshu, MD Linn Carter, APN/CNS-BC Sandy Damon, APN/NNP Carrie Hagen, Transport Coordinator Gillian Headley, Medical Director Crista Herebia, Transport Nurse Anne Herkert, Developmental Therapist Annette Janecke, Clinical Shift Coordinator
• • • • • • • • • • • • •
Ashley Johnson, Family Advisory Council Dawn Karcz, Quality Lauren Keen, Family Advisory Council Melissa Lewis, Respiratory Therapist Tina Popielarczyk, RN, Clinical Shift Coordinator Laura Rissman, RN, Clinical Shift Coordinator Diane Simon, Dietitian Sue Swanson, APN/NNP Tammy Stichter, Peds/NICU Lead Therapist Renee Voltz, Physical Therapist Kathy Way, RN, Clinical Care Coordinator Kristina Weber, Dietitian Melissa Woods, RN, Staff Nurse
Goals of the Team
• Implementation of the Small Baby Unit (SBU) for care of infants born at less than 27 weeks gestation and as space allows, for very low birth weight infants that would also benefit from the practices • Add trained and experienced staff to care for the infants in the SBU • Incorporate developmental care practices and evidence-based guidelines to decrease comorbidities and improve long-term outcomes for this vulnerable population
Why create a Small Baby Unit?
Extremely low birth weight (ELBW) infants are at a high risk of increased mortality and morbidity. The micro-preemie population is at the highest risk for developing comorbidities associated with their extreme prematurity. In an effort to minimize the risk and impact health care costs associated with comorbidities, we needed to standardize the practices and management and change the environment to limit the neurological, respiratory, and vascular impact during care while integrating developmental care practices and supporting families in care.
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SMALL BABY UNIT (CONTINUED)
The Process
An interdisciplinary SBU core leadership team was developed and the evidence was presented to the group. The team completed a chart outlining the problem, current data, goals, financial case, and plan. The entire team met with a Black Belt Six Sigma-trained facilitator to develop a timeline and a plan from beginning to implementation. Several members of the team visited two other centers that had implemented an SBU to learn what worked and their barriers. As nurses working to make improvement, we must always think about how we can measure our work. After seven months since opening the SBU, here are just a few of our improved outcomes: Blood transfusions Pre-work Post-work % Change
Average number of transfusions 4.15 3.00 27.71% decrease
POC lab testing Pre-work Post-work % Change
Average number of POC Lab tests 250 164 34.4% decrease
Length of stay Pre-work Post-work % Change
Average Length of stay (days) 141 112 20.57% decrease
The SBU team anticipates continued improvement as their NICU partners become more comfortable practicing in the SBU. The SBU team believes there is also an increase in the number of times parents are providing skin-to-skin care to their baby. Evidence tells us that skin-to-skin is best for premature infants to improved bonding, improve growth and improve temperatures.
Long-term improvement
The follow-up clinics’ developmental therapists have noted improvement in the infants being able to self-regulate themselves post-discharge. We look forward to seeing future developmental outcomes from the SBU. We will continue to measure these outcomes in the High-Risk Follow-up Clinic.
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As we move forward to become a more integrated organization, we will become stronger and better. Our organization fits well with each other with contiguous boundaries, not overlapping geography. Our cultures are ones of quality and service. It is an exciting time as we take this Magnet journey together!
Sue Ripsch, MS, MBA, BSN, RN, NEA-BC Mercyhealth VP, CNO, COO
Nursing Research:
Mercyhealth Ambulatory Nurse Residency Research Study - ongoing
Update: Data collection is complete and the write-up of research is being completed. The results of this research will be shared throughout the organization and at the Nurse Expo in Rockford.
Mercyhealth Critical Access Hospital Fall Prevention Research Study - completed Update: Despite the difference between the two fall risk tools in assessing fall risk, there was no difference with the tools predicting falls. The research will be disseminated throughout the organization during the Poster Fair and Nursing Grand Rounds as well as at the spring Nurse Expo in Rockford.
Mercyhealth Hospital–Rockton Avenue Research Study - completed Interdepartmental Transfers and Patient Experience
Update: The results of the study showed statistically significant relationships between HCAPHS scores and the number of transfers a patient has during an admission. The final results will be shared throughout the organnization in 2018.
Mercyhealth Ambulatory Chemo-infusion Nursing Research Study - ongoing Update: Once all data is collected, the results will be shared throughout the organization.
Mercyhealth Hospital and Trauma Center READI Research Study - completed
Update: The results of this study were shared at the 2017 ANCC Magnet Conference in Houston, Texas, and will be shared throughout the organization this spring.
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