Providence Holy Cross 2009 Nursing Annual Report by Providence Health & Services

Nurses of PROVIDENCE

2009 Nursing Annual Report

The PROVIDENCE Commitment The work of the Nurses at Providence Holy Cross Medical Center is guided by the following foundational precepts:

Mission As People of Providence, we reveal Godâ&#x20AC;&#x2122;s love for all, especially the poor and vulnerable, through our compassionate service.

Core Values Respect All people have been created in the image of God. Genesis 1:27 We welcome the uniqueness and honor the dignity of every person. We communicate openly and we act with integrity. We develop the talents and abilities of one another.

Compassion Jesus taught and healed with compassion for all. Matthew 4:24 We reach out to people in need and give comfort as Jesus did. We nurture the spiritual, physical and emotional well-being of one another and those we serve. We embrace those who are suffering.

Justice This is what the Lord requires of you: act with justice, love with kindness and walk humbly with your God. Micah 6:8 We believe everyone has a right to the basic goods of the earth. We strive to remove the causes of oppression. We join with others to work for the common good and to advocate for social justice.

Excellence Much will be expected of those who are entrusted with much. Luke 12:48 We set the highest standards for ourselves and for our ministry. We strive to transform conditions for a better tomorrow while serving the needs of today. We celebrate and encourage the contributions of one another.

Stewardship The earth is the Lordâ&#x20AC;&#x2122;s and all that is in it. Psalm 24:1 We believe that everything entrusted to us is for the common good. We strive to care wisely for our people, our resources and our earth. We seek simplicity in our lives and in our work.

P R O V I D E N C E H O LY C R O S S M E D I C A L C E N T E R was founded in 1961 to provide healing and health care to the San Fernando, Santa Clarita and Simi Valleys. A 254-bed, not-for-profit facility, the medical center offers both inpatient and outpatient health care services, including state-of-the-art Cancer Centers, a Heart Center, Orthopedics, Neurosciences and Rehabilitation Services as well as Womenâ&#x20AC;&#x2122;s and Children Services. Located in the San Fernando Valley of Southern California, Providence Holy Cross Medical Center has a medical staff representing more than 600 physicians and nearly 50 specialties.

SERVICES INCLUDE:

STATISTICS OF INTEREST (2009):

Cancer

Employees: 1,700+

Heart & Vascular

Medical Staff: 600+

Womenâ&#x20AC;&#x2122;s Services

Licensed Beds: 254

Orthopedics

Births: 2,938

Neuroscience

Admissions: 15,229

Rehabilitation

Average Daily Census: 230.9

Subacute

Outpatient Visits: 59,501

Surgery

Emergency Room Visits: 61,591

Digestive Disorders

Trauma Cases:1,588

Trauma & Emergency

Inpatient Surgeries: 5,469 Outpatient Surgeries: 1,912 Average Inpatient Length of Stay: 4.59

Our Nursing Vision Statement

2009 Nursing Leadership

Providence nurses embrace their heritage of compassion, courage, and leading-edge care as a steadfast, sacred presence in protecting and easing the way for those in need. Our Providence Holy Cross Medical Center Nursing Philosophy Statement reflects the unique theoretical underpinnings of our approach to nursing care and professional development: In concert with the mission and core values of Providence Holy Cross Medical Center, our professional nursing staff is dedicated to the promotion of health and wellness as the basis for nursing practice. In collaboration with the healthcare team our nurses attend to patient needs with the highest level of ethics, judgment, confidentiality and respect for human rights, dignity and diversity. It is our belief that a holistic and caring environment nurtures and supports the patient on a journey toward self care. We are responsible for illuminating the path and competently leading the way.

• Betty Newsom, RN, MS, CNAA, Chief Nursing Officer • Jerilyn Brown, RN, OCN, Director Patient Care Support Services • Linda Coale, RN, BSN, MBA, Magnet Program Director, and Transformation of Care Project Leader • Tricia Burkholder, RN, BSN, Director Maternal Child Health • Annette Cordero-Britton, RN, BSN, Director of Occupational Safety, Health and Wellness • Jane Flaherty, RN, MSN, CNS, PCCN, CCRN, Director Education • Ken Archulet, RN, Manager Epidemiology and Infection Control • Yvonne Gaffney, RN, BSN, MBA, CNOR, Director Perioperative Services • Patty Mayberry, RN, Director Clinical Project Implementation • Debbie Bergida, RN, BSN, OCN, CMSRN, Manager Medical Surgical • Missy Blackstock, RN, Manager Emergency Department • Kate Connolly, RN, Manager Sub Acute and Acute Rehabilitation • Cindy Damboise, RN, BSN, MSN, MHA, PCCN, CCRN, Manager Telemetry • Jennifer Fulton, RN, BSN • Sherri Friedrich, RN, MSN, FNP-BC • Tim Gilmore, RN, MHA, Manager Special Projects/Data Support • Joanna Kuzmak, RN, BSN, CCM, Manager Case Management • Pam Rick, RN, BSN, Manager Intensive Care Unit • Barbara Rozewicz, RN, MSN, CCRN, CMC, NP-C, Manager Cardiology • Carrie Sayeski-Reid, RNC, BSN, BC-In Patient OB, Manager Outpatient Diagnostic Center

Table of Contents

• Ronda McPhail, RN, Clinical Nurse Leader Labor and Delivery • Barbara Thomas, RN, CMSRN, Clinical Nurse Leader Medical Surgical

Message from CNO

Introduction

Transformational Leadership

Structural Empowerment

Exemplary Professional Practice

New Knowledge, Innovations & Improvements

Empirical Quality Outcomes

Awards & Accomplishments

• Cathy Yee, RN, MSN, CCRN-CSC, Clinical Nurse Leader Cardiology Wellness • Crystal Akao, RN, BSN, CCRN, Modified Clinical Nurse Leader Telemetry • Heinrich Huerto, RN, BSN, ONC, Modified Clinical Nurse Leader Medical Surgical

Message from CNO Dear Colleagues, As we move into our third year of being a Magnet Organization, the drive for nursing excellence remains a major focus at Providence Holy Cross Medical Center despite the downturn in the national economy and California’s growing financial problems. Larry Bowe, who came in April to Providence Holy Cross Medical Center as our new Chief Executive, has been very supportive of Magnet. His focus is on patient satisfaction, driven by excellent care, provided by nurses. At Providence Holy Cross, the strong positive culture that exists enhances our ability to adapt to change and to move forward with innovative ideas spurred by shrinking financial resources, regionalization of operations within Providence’s California facilities and a growing list of regulatory requirements. The achievement of high quality outcomes and other successes continue to bring awards and other accolades to Providence Holy Cross as demonstrated by the following pages in the 2009 Annual Nursing Report.

“

Caring, Compassion and

Sincerely, Betty Newsom, RN, MS Chief Nursing Officer Providence Holy Cross Medical Center

Competence are three words that carry a special meaning for the nurses of Providence Holy Cross Medical Center. These three C’s are integral to our nursing philosophy

”

and our model of care.

Nursin g a s in nd e u s He s lI

TRANSFORMATIONAL LEADERSHIP

EMPIRICAL OUTCOMES

EXEMPLARY PROFESSIONAL PRACTICE

C a re

Glo

STRUCTURAL EMPOWERMENT

Introduction

NEW KNOWLEDGE, INNOVATIONS & IMPROVEMENTS

Magnet Model Characteristics of Our Physicians, Nurses & Staff First community hospital in Los Angeles County to receive Magnet Status for Nursing Excellence from the American Nurses Credentialing Center (ANCC) Recognized by HealthGrades® as being among the top 5% of all hospitals in the nation for clinical excellence—four years in a row Nurse vacancy rate remains below the national and state average at 2% (as of February 2010) Total number of certified nurses: 130 (as of March 2010) More than 650 physicians on staff, representing more than 50 specialties

Characteristics of Our Communities Providence Holy Cross serves more than 2 million people: San Fernando Valley: Densely Populated; Highly Ethnically Diverse; Growing Uninsured Population Santa Clarita Valley: Young Families; Highly Educated; One of the Fastest Growing Areas in Southern California

SAN FERNANDO & SANTA CLARITA VALLEYS’ DEMOGRAPHICS Total Population: 2,089,774 Children (0-17 years) Adults (18-64 years) Seniors (65+ years)

SFV 25.1% 63.7% 11.2%

SCV 28.1% 64.3% 7.6%

Ethnic Composition Caucasian Latino Asian/Pacific Islander African American Other

SFV 40.2% 41.6% 10.3% 3.6% 4.3%

SCV 63.0% 23.3% 6.7% 3.3% 3.7%

Payor Mix Medi-Cal Medicare HMO PPO Other Percent of Uninsured Children (0-17 years) Adults (18-64 years)

SFV 24.6% 34.0% 19.4% 10.5% 11.58% SFV/SCV 8.0% 20.0%

SCV 14.2% 25.7% 30.7% 20.6% 8.8%

The Dance

by Linda Harrington, RNC This poem was written by a Providence Holy Cross nurse, Linda Harrington, for the Magnet Art Room. Many of the nurses who read this poem were inspired and some even cried because of its powerful message. This poem expresses the Providence Holy Cross nursing belief in the development of nurses through Benner’s Novice to Expert Theory. I am a new grad. Fear and anxiety are my constant companions. I am often on the brink of tears: my feelings of inadequacy are overwhelming at times. I am positive that I learned nothing in nursing school. I am filled with doubt. The nurses around me are moving to music I cannot hear. Gracefully and efficiently they complete their tasks. I watch this ballet of competency, fearing I will never learn the dance. For now, I will mimic the steps as best I can. Time passes…… A metamorphosis occurs. Experience dispels the uncertainty I once felt. I realize it was not expected that I feel comfortable. A novice never does. Mentors emerge; acting as choreographers, they demonstrate the intricacies of the dance. They insist on perfection and practice. They move aside when they are sure I’ve learned the steps. I’m beginning to hear the music. Humming the melody, I join in the dance. Time passes………… The music has become a symphony and I dance with confidence. Proficient and specialized, I am considered an expert now. I thrive on the complexities of this Art Form called Nursing. As a mentor I seek center stage; I share my skills, I teach. Knowledge is handed down and passed on. As the performance continues, so too, does the expertise of the dancers.

This evolution of excellence cannot be stopped. Time passes…………. I’ve been dancing for a long time now. On some days the music is faint or even mute. Perhaps it’s time to leave the theater. I close my eyes and can’t help wondering why I still do this. I decide to relax and take refuge in the silence. The brief intermission is interrupted by a request for help. An anxious new grad has a question about her patient’s deteriorating status. We discuss theory and collaborate on a new strategy. Without missing a step, the dance continues. The novice nurse takes action and the patient’s condition improves. The patient senses relief and whispers, “Thank you”. The novice smiles, a new skill has restored her confidence, gratitude has restored her spirit. I walk away feeling fortunate to have been a part of this magical exchange. I didn’t notice exactly when it resumed, but I hear the music again. The reward of the moment reminds me why I still do this… I’m addicted to the music….. ....I love the dance.

Global Issues in Healthcare PROVIDENCE HEALTH & SERVICES EL SALVADOR IMMERSION TRIP Tricia Burkholder, RN, BSN In November 2008, I had the opportunity to participate in an immersion trip to El Salvador with Providence Health & Services. Our group consisted of clinical and nonclinical staff from Providence facilities in Southern California, Washington and Oregon. While there, we provided health screenings and basic medical care during home visits in rural areas in addition to working on community service projects. We screened and treated many with chronic health conditions such as hypertension, diabetes, kidney failure and malnutrition. We also provided treatment for acute illnesses and participated in a lot of health education. It was a gift to practice the

very basics of nursing with minimal supplies but still accomplish so much. Poverty was rampant, but a clear sense of community was evident. We interacted with a number of grassroots agencies that were dedicated to improving health care and education. We were able to assist with financial support and donated medical supplies. Highlights of the trip included visits to a local hospital, an HIV clinic and a community organization making natural medications. We had many opportunities to interact with the local people to discuss their struggles and hopes for the future as well as observe and learn about their culture.

PROVIDENCE HEALTH & SERVICES TIJUANA IMMERSION TRIP Ken Keller, Regional Director of Physician Business Services The day before a team of Providence California leaders headed to Tijuana to help families build homes, we asked Ken Keller, Regional Director of Physician Business Services, to send us occasional updates: On Friday morning, 16 Providence California Region leaders headed to Tijuana for an annual Ministry Leadership experience helping a community development fund that works with families to build homes. The backdrop is one of extreme poverty, but one tempered by a strong sense of community and a shared drive to work together for a better future. Ken called in Monday with poignant messages of the group’s first few days of their five-day project south of the border. The first thing that hit the group as they crossed the border was the contrasts, Ken said. From the lush hills of San Diego to the barren ones of Tijuana, the scenery drew a line between the “haves” and the “have nots.” And once in Mexico, the crew saw further contrasts in the new sparkling factories that were built among Tijuana’s shanties.

But it wasn’t long before this crew realized the riches these families share. “We’re realizing after three days of work that we’re gaining so much more from this experience than we can give these people,” Ken said. The Providence group was split to work on two different homes. One group spent the day digging foundations and trenches in very compacted clay, grueling work under the hot sun. The second group laid blocks with cement, backbreaking yet very satisfying labor, the kind where the sense of accomplishment is immediate. The lessons learned this day centered on Community and Family. “The group is forming into a family,” Ken said. “We, as people of Providence, came down to help as part of a larger group. Even though these families don’t have a lot, they are very proud of what they do have and they are supportive of each other. They work harder than all of us out here. They’re open, willing to give, charitable – again we took away more than we gave.

Transformational Leadership Managers involve staff at all levels of the organization. Nurse leaders make an effort to communicate with staff, and staff members feel their opinions are heard and valued by management. Accountability & evidence-based standards of care are chief among the leadership standards at Providence Holy Cross Medical Center. Under the guidance and mentorship of our Chief Nursing Officer, Betty Newsom, nursing leadership has helped propel our nursing staff towards several beneficial changes in 2009. Betty Newsom, RN, MSN, CNAA, Chief Nursing Officer and Linda Coale, RN, BSN, MBA, Magnet Program Director led our Magnet Committee through a review of our foundational nursing philosophy and theoretical base. There was a high level of learning and recommitment to our continuing Magnet Journey as we prepare for our re-designation in 2011. Our strategic plan for nursing, with input from and finally presented to nurses at every level allows our leadership to work within the department of nursing to promote excellence and continuous improvement. Our patient satisfaction scores, nursing employee satisfaction scores and our physician satisfaction scores demonstrate a shared commitment to provide outstanding patient care and to promote a healthy work-place environment.

Transformational Leadership

MAGNET RETREAT - OCTOBER 2009 Patient and Family

PHCMC Nursing Philosophy Achieving Excellence in an Evidence Based Practice Environment PH&S Nursing Vision Statement

Mission and Core Values

Our Magnet Retreat began with our experienced Magnet champions pinning green Magnet ribbons on our newest Magnet champions. Thus began an exciting day of renewed commitment, learning, discussion, planning and shared decision-making. Agenda items included icebreakers for welcoming in our new champions, and trivia games to help energize us in the morning. Educational sessions on shared governance and nursing philosophy were followed by active discussion and planning. An especially meaningful session centered on revising our visual model of nursing care from the 3Cs of Nursing at PHCMC: Caring; Compassion and Competence, to the 4Cs of Nursing at PHCMC: Caring; Compassion; Competence and Collaboration. Our overall objectives were certainly realized: 1. List the Magnet Components and the 14 Magnet Forces that reside within them. 2. Discuss aspects of their department that fit into two different Magnet Forces. 3. Discuss the vision and philosophy as it currently exists and proposed changes. 4. Identify the model of care and discuss application of each aspect to nursing care at PHCMC. 5. Compare and contrast the nursing theories of Patricia Benner and Jean Watson 6. Define shared governance. 7. Discuss two aspects of shared governance in a nursing department at PHCMC. 8. Compare and contrast the concepts peer review and peer evaluation. The following is a comment received by a newly Magnetized participant: I just wanted to thank you all so very much for all of your time and efforts that went toward hosting such a FABULOUS meeting. As a â&#x20AC;&#x153;newbieâ&#x20AC;? I learned so much and how fortunate and grateful am I to work with such an incredible group of experts!! Thank you AGAIN!!

Transformational Leadership

A SAMPLING OF THE PHCMC NURSING STRATEGIC PLAN 2009 By 2011, Nursing at Providence Holy Cross Medical Center will strive to achieve 7% net operating income while achieving 90th percentile performance on all national quality measures. COMMITMENTS

STRATEGIES

Continue development and expansion of Advance Care and Palliative Planning Program

Hire RNs and MD for program

Continue to identify Foundation grant support opportunities

Employee capital campaign

Integrate services in the PH&S Valley Service Area

Standardization process and documentation

Prepare staffing model for hospital expansion

In partnership with human resources, form teams for specialty areas to explore, discuss and plan staffing

Stroke Program/Certification

Hire NP for stroke program, develop policies and procedures based on best practice; develop and implement education program for staff; submit application for certification

ADA Recognition/Certification for Diabetic Services

Work with manager of diabetes services and diabetes educators to address standards for compliance

Construction of new patient expansion

Nurses at the bedside will be involved as appropriate in decision-making for equipment, technology, processes and models of care delivery

Outpatient services such as radiology and lactation will be expanded to Porter Ranch

Construction in progress

Reduce premium pay management

Reduce use of registry and traveler support by filling vacancies and reduction in turnover rate

Implement initiatives to achieve Corporate Quality Strategic Plan Clinical Reliability Index â&#x20AC;&#x201C; 94% (AMI, SCIP, Pneumonia, HF) Nursing sensitive indicators above the mean or median Patient Safety Index (Falls, Critical Values, Medical Records) Observed vs. Expected Mortality â&#x20AC;&#x201C; OE Ratio < 1 (.73)

Enhance quality audit team and tracer committee; develop and distribute Falls newsletter; expand email to all employees at PHCMC and distribute selected quality measure data for increased awareness; utilize quality improvement processes

Magnet re-designation 2011

Gap analysis completed with action plan developed and leads designated for each component

Transformational Leadership

PHYSICIAN, NURSING & PATIENT SATISFACTION Despite increasing patient volumes, our satisfaction scores remain high.

PHYSICIAN SATISFACTION* 99th Percentile for overall quality of care 99th Percentile for Emergency Department 94th Percentile for quality of nursing staff

NURSING SATISFACTION 85% would recommend Providence to others as a great place to work 87% are extremely satisfied with Providence as a place to work

PATIENT SATISFACTION 92.1% of patients would recommend the hospital to others (Press Ganey)

* 2008 Survey

Structural Empowerment Nurses are seen as essential to the hospitalâ&#x20AC;&#x2122;s delivery of patient care.

The professional practice environment at Providence Holy Cross Medical Center is based on our Mission, vision and core values to achieve exemplary patient outcomes with a nursing staff that recognizes its vital role within our hospital as well as our larger community. Continuing programs in 2009 toward these objectives included our Nursing Clinical Ladder program and reimbursement for education and certifications. These programs recognize the importance to the individual nurse and the organization of continuous professional growth. A Perinatal Collaborative has been formed among the five Providence Hospitals in Southern California. It is a forum for nurses and physicians in the perinatal areas to share best practices, plan improvements in information technology, human resources and quality as they relate specifically to perinatal care. A highlight of this initiative has been a regional plan for perinatal documentation that will deploy early in 2010. Another program that has begun to unfold with great success is our palliative care program. These structural improvements will be followed in 2010 with our long-awaited structural achievement-our new addition. As we watch the construction we know that the active planning by nursing staff will allow us to provide the optimum care for our community.

Structural Empowerment

EMPLOYEE CAMPAIGN FOR NEW PATIENT CARE WING

In 2009, we celebrated the ongoing construction of our new patient care wing by signing beams that would become part of the framework of the project. This community event brought our physicians, nurses, staff, community leaders and community members together to celebrate the new patient wing. The 138patient bed expansion will help us care for the increasing number of patients who have been coming to the hospital over the past few years. Additional medical-surgical beds, telemetry beds, a GI Lab and a new Womenâ&#x20AC;&#x2122;s Pavilion featuring Labor/Delivery/Postpartum suites and a 12-bed NICU will be part of this new wing. The incredible excitement of our staff at Providence Holy Cross was evidenced by the successful employee campaign to support our new wing. Our employee campaign was led by Carrie Sayeski-Reid, RN, BSN, and Sherri Mendelson, RNC, CNS, PhD, with the assistance from a multidisciplinary group of employees from various departments in the hospital. There were 77 employees who formed fundraising teams. Through this four-week employee campaign, nearly 600 employees offered personal donations to raise more than $600,000 for the new patient wing.

Structural Empowerment

CLINICAL LADDER FOR NURSES Last year we introduced our Clinical Ladder for non-exempt Registered Nurses. The Clinical Ladder policy and application process includes five levels based on Patricia Bennerâ&#x20AC;&#x2122;s novice-to-expert theory. Level I RNs are at the novice level that includes newly graduated RNs. Level II RNs have an expectation of competent clinical practice. Level III, IV and V RNs demonstrate additional achievements at increasing levels of competency and involvement in four categories: clinical practice, shared governance, research and education. We proudly present our 2009 Clinical Ladder Participants: Kimberly Crabtree-Loyd, PACU, Clinical Ladder Level V Sherri Mendelson, Education, Clinical Ladder Level V Cynthia Funakoshi, Education, Clinical Ladder Level IV Terri Gately, Education, Clinical Ladder Level IV Tanya Haight, Education, Clinical Ladder Level IV Melinda Gruman, Labor and Delivery, Clinical Ladder Level IV Linda Harrington, Labor and Delivery, Clinical Ladder Level IV Yajaira Angulo, Labor & Delivery, Clinical Ladder Level IV Debbie Welch, Telemetry, Clinical Ladder Level IV Sherri Friedrich, Telemetry, Clinical Ladder Level IV Kathy Cadden, ICU, Clinical Ladder Level IV Carole McKennan, ICU, Clinical Ladder Level IV Christina Consolo, ICU, Clinical Ladder Level IV Terrie Bybee, Medical Surgical/Oncology, Clinical Ladder Level IV Barbara Russo, Special Care Nursery, Clinical Ladder Level III Kristina Shannon, Labor & Delivery, Clinical Ladder Level III Teodora Tiongson, Medical Surgical/Oncology, Clinical Ladder Level III Ingrid Blose, Medical Surgical/Oncology, Clinical Ladder Level III Sylvia Pacis, SubAcute, Clinical Ladder Level III Terri Halverson, Emergency Department, Clinical Ladder Level III Aurora Tweddell, Education, Clinical Ladder Level III

Structural Empowerment

PALLIATIVE CARE PROGRAM GROWS Our Palliative Care Program at PHCMC has been significantly enhanced this year through the leadership of Barbara Whitlatch, Manager, and Leah Phillips, RN, BSN, PHN, Palliative Care Clinician. The program aims to work with physicians to provide symptom management, pain management, end-of-life care, advanced care planning, and to serve as a liaison for other support services offered to patients. The following was an education posting for telemetry staff: Palliative Care Versus Hospice Debbie Welch, RN, PCCN, Assistant Manager, Telemetry Palliative care can be defined as, “an approach that improves the quality of life of patients and their families, facing the problems associated with life-threatening illness, through the prevention and relief from suffering, by means of early identification, impeccable assessment, treatment of pain and other problems physical, psychosocial and spiritual” (Sepulveda et al., 2002; World Heath Organization, 2002).

The goal of palliative care is to prevent and relieve suffering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. This care is provided by an interdisciplinary team who identify physical, psychological, spiritual, and practical burdens of illness. Goals include; enhancing quality of life for patients and family members, helping with decision-making, and providing opportunities for personal growth. Palliative care can be rendered along with life-prolonging treatment or as the main focus of care. Hospice care is a service delivery system that provides palliative care for patients who have a limited life expectancy and require comprehensive biomedical, psychosocial, and spiritual support as they enter the terminal stage of an illness or condition (National Quality Forum, 2006). Hospice supports the patient through the dying process and the surviving family through the dying and bereavement processes. Hospice provides comprehensive medical and supportive services across a variety of settings and is based on the idea that dying is a part of the normal life cycle. Traditionally, the current practice of Hospice and Palliative Care is: terminally ill patients have a long trajectory of curative treatment(s), followed by palliative care (if all treatment is deemed to be futile) and then a short period of time with hospice. The goal is for palliative care to receive the same focus as curative care. Patients receive attention to the prevention and relief of suffering by means of early identification and impeccable assessment. The goal is not always specifically about cure, but rather improving the quality of life for both the patient and his/her family. The patient may be actively receiving treatment for symptoms of the disease (e.g. surgery, radiation, etc) at the same time they are receiving palliative care. When the patient is at the terminal phase of their illness then hospice care would take over along with bereavement support. “You matter because you are you. You matter to the last moments of your life, and we will do all we can, not only to help you die peacefully, but to live until you die” Dame Cicely Saunders

Structural Empowerment

LIBRARY SUPPORTS NURSING EDUCATION AND RESEARCH The Strazerri Library at PHCMC is fortunate to have Caroline Elman, MLS, and Pam Gay, Library Assistant, serving our nurses. Through our nursing journal collection, nursing books, and their assistance with securing on-line resources, our nurses are supported as they delve into evidence-based practice, nursing research or in continuing their education.

PROVIDENCE CALIFORNIA REGIONAL PERINATAL COLLABORATIVE AND PERINATAL DOCUMENTATION PROJECT A Providence California Region Perinatal Collaborative was formed in 2009 to maximize resource sharing and standardization of best-practice processes. Among the significant work that has resulted from the team effort, a wide area network perinatal documentation project was proposed to regional administrative groups and funded in 2009. Documentation consumes excessive amounts of nursing time and directly influences the quality of clinical practice, research, administration and education. Poor documentation of care not only impedes communication among providers, but often complicates defense against malpractice claims. This project has significant IS implications. The intention was to form a clinical/IT partnership to maximize use of perinatal documentation systems in each of the five California ministries. This partnership developed best practice for perinatal documentation, maximized computer efficiency within our region and created the algorithms to deploy these evidence-based documentation practices. A perinatal computer documentation process must make best use of information technology and clinical practice. A perinatal steering committee from all five hospitals within the Providence Health & Services region was formed. Best practice for Labor and Delivery care is represented by the steering committee to translate into the perinatal documentation program. The project directors interfaced with a multidisciplinary team to implement the documentation system and assure that needs were met in diverse areas such as medical records and pharmacy.

Exemplary Professional Practice Nurses are allowed and expected to work autonomously, consistent with professional standards as members of a multidisciplinary team.

Patient and family advocacy within a framework of nursing excellence is the key to nursing role satisfaction leading to excellent patient outcomes. Providence Holy Cross Medical Center is a Magnet Designated hospital for excellence in nursing, as well as Baby Friendly Designated for promotion of breastfeeding as the optimal method for infant nutrition. During our yearly Nurseâ&#x20AC;&#x2122;s Week Celebration we recognized peer-nominated nurses in several key categories. Members of the Magnet Committee and some interdisciplinary leaders were asked to share their thoughts on nursing. They answered the question: what do you believe about nursing? An example of the outstanding interdisciplinary collaboration at PHCMC is shared in a heartfelt letter from Maternal-Child Nursing to the Critical Care Nurses. Also in 2009 our efforts to reduce catheter-related urinary tract infections and to recognize and provide early treatment for those present on admission was a resounding success, again demonstrating the exemplary profession practice of the nurses at PHCMC.

Exemplar y Professional Practice

NURSES WORKING TOGETHER AS A TEAM The following communication was sent by a nursing director following a successful outcome on an unusual high-risk obstetrical case. This highlights the wonderful teamwork at all levels and across disciplines enjoyed at our hospital.

â&#x20AC;&#x153;Birthing Babies in the ICUâ&#x20AC;? I would like to recognize the teamwork and efforts by ALL involved in the care of a very high-risk OB patient yesterday. This woman came in thru the ER and was transported to L&D. She had a very complicated history with many high-risk factors and could not safely be transferred to another facility. The decision was made to care for her in the ICU with both L&D and ICU nurses providing care to meet all her needs. A plan was formulated to be able to deliver the preterm infant in ICU in order to safely monitor and provide care for the mother as well. The patient progressed so quickly that the baby was actually delivered by the L&D nurse. Special Care Nursery and Respiratory Therapy attended to stabilize this preterm infant who is currently being cared for in SCN. Mom remains in ICU for observation and care. A safe outcome was achieved for both Mom and baby with the help of all involved. A special thanks to the ICU resource nurse and the anesthesiologists involved in this case. They were actively involved in assessing her risk and assisting in formulating her plan of care and were readily available to assist in any way necessary. An anesthesiologist was present for the actual delivery. The teamwork demonstrated in this unusual case is what PHCMC is all about. Please recognize and express my thanks to all the individuals involved in the care of this patient and her baby.

Tricia Burkholder RN Director Maternal Child Health Providence Holy Cross Medical Center

Exemplar y Professional Practice

NURSES WHO INSPIRE Nurses on our Magnet Committee, as well as various members of the multidisciplinary team were asked to write a short statement on THIS I BELIEVE ABOUT NURSING: “Like orchestra conductors, nurses coordinate our patients’ care in a harmonious melodic fashion. Unforeseen staccato surprises may arise, yet our nurses draw us through with their compassionate leadership, thus setting the tone for our patients’ care experience.” Edna Banayat, RD, Manager, Patient Clinical Nutrition Services

 “To be a nurse is to be a compassionate being ready to care for those who need healing. I believe it’s the critical thinking skills, clinical experience and most importantly the ability to communicate and educate clearly that makes for this brave profession. In an industry filled with multiplying duties, advanced technology and endless expectations, it is a nurse who shines the excellence of care.” Eddie Avedekian, PharmD, Manager Pharmacy Operations



“Would you ask a bird to explain why it flies? The bird flies because he was born to fly. It is a gift the bird possesses, he simply does it. I practice nursing because I was born to do this. Nursing is a gift I was given, I simply share it.” Linda Harrington, RNC, Labor and Delivery

 “Nursing is a profession that allows for ingenuity, passion, critical thinking, autonomy, collaboration and personal growth while caring for individuals, families and communities ….this I believe is nursing.” Ronda McPhail, RN, CNL, Labor and Delivery

“Nursing is the skeleton of a body. The skeleton (nursing) provides the structure (coordinating medications and treatments), support (human touch and compassion) and movement (implementing the treatment plan) of the body. Some see the beautiful face (the building),or handsome body (the physician) that could not exist without the skeleton. ” Barbara Lange MS, CCC-SP Supervisor, Speech Pathology

 “Nursing sometimes means you get a lot more letters after your name than RN. I believe that education is an ongoing process for nurses, that nurses have a responsibility to learn and question new patient care procedures and treatments. Nursing education and practice should be evidence-based. Nurses are the primary source of healthcare delivery and patient advocacy, they need to stay current with education and best practice.” Terri Gately RN, BS, MS, CRRN, RN-BC, DSD, Acute Rehab/SubAcute



“Nursing is a calling that is not for everyone. Nursing is about health and wellness; a belief that relationships, caring and education can heal the body and the spirit. Nurses combine caring, technical skills, critical thinking and teamwork for success in patient care. Nursing is the ultimate love for mankind.” Sherri Mendelson, RNC, CNS, PhD, Nursing Education

New Knowledge, Innovations & Improvements Staff nurses participate in the quality improvement process and believe that it helps improve patient care within the organization.

Quality outcomes are the end result of increased nursing education, support for nursing innovation and research, and continuous quality improvement that are the expectation of all nurses at Providence Holy Cross Medical Center. We encourage educational attainment through tuition reimbursement programs and on-site bachelorâ&#x20AC;&#x2122;s degree and masterâ&#x20AC;&#x2122;s degree programs. Our education department offers a full complement of continuing education programs to keep our nurses up to date on current evidence-based knowledge in many specialty areas as well as comprehensive didactic and practicum programs for new graduate RNs. Our educators work within their specialty to mentor and teach nurses both in the classroom and in the clinical environment. Our disaster planning for the entire community demonstrates our commitment to implement our new knowledge. The excellent results we attained through the 4A transformation of care project will be shared throughout PHCMC as innovative programs are trialed on a small scale and then implemented house-wide as improvements are demonstrated.

New Knowledge, Innovations & Improvements

PREVENTING FALLS WITH TEAM ROUNDING PREVENTING FALLS ON THE ONCOLOGY UNIT was a very successful program instituted on the Oncology Unit by Tanya Haight RN, OCN, MSRN, ONC; Kathy Christian, RN, BSN, OCN, CMSRN; Ingrid Blose, RN, CMSRN; and Mona Rojas, RN with the support of their Manager, Debbie Bergida, RN, MSN, OCN, CMSRN. Significance and Background: Among patients with cancer, the risk of falls increases. This can occur as a result of the disease process itself and of cancer treatment. Older adults undergoing cancer treatment have a significantly higher risk and occurrence of falls compared to oncology patients not undergoing cancer treatment. The Joint Commission has identified the need to reduce patient falls and implement risk reduction strategies. It has identified root causes as related to caregiver communication issues and environment of care. Purpose: The purpose of this 45-day pilot study on the Oncology unit was to introduce an evidence-based intervention that identified patients at increased risk for falls and ultimately prevent falls, while improving both caregiver and patient communication. Team Rounding was suggested as a risk reduction strategy that would comply with the Joint Commission recommendations. Intervention: The interdisciplinary team was composed of the Oncology/Medical-Surgical staff. The Rounding Team observed the patient, the room environment and assessed the patient for the â&#x20AC;&#x153;Three Pâ&#x20AC;&#x2122;s (pain, potty and positioning). Lead nurses on the pilot study provided weekly feedback on a designated form and offered suggestions for improvement. Based on this feedback, Team Rounding was scheduled every two hours during day shift and every hour during night shift. Evaluation: After 45 days the Team Rounding pilot study was anonymously evaluated by the Oncology/ Medical-Surgical staff using a four-point Likert Scale measuring six elements pre and post implementation. Staff compliance with Team Rounding was 100%. Team Rounding increased general awareness of patients at increased risk for falls, unit acuity and individual patient needs, in addition to preventing actual patient falls. Patient satisfaction scores increased and falls decreased 80% over the course of the study and 65% for six months afterward. Discussion: Because of the significant reduction in falls on the Oncology unit, Team Rounding was successfully implemented hospital-wide with the same positive results. In addition to significantly preventing patient falls and resultant injuries, Team Rounding provided the added benefits of improved interdisciplinary communication, safe nursing practice and quality patient care.

New Knowledge, Innovations & Improvements

INNOVATIVE SOLUTIONS TO CRITICAL EMERGENCY PREPAREDNESS NEEDS Our Disaster Committee has demonstrated continuous commitment to planning for safety during any of the potential disaster situations that may occur in Southern California. A Magnet-designated Level II Trauma hospital in Southern California has helped create and implement several innovative solutions to critical emergency preparedness needs. One of these innovative solutions addresses the need of educating both clinical and non-clinical staff on how to safely conduct mass decontamination operations. The training curriculum includes 16 online training modules coupled with 8 hours of practical training. The training modules are computer-based and Continuing Education Unit (CEU) accredited. The online training provides staff members with Just-in-Time (JIT), annual refresher and competency-based training with it being accessible by staff at any computer. Two other areas have also been addressed. The first addressed providing the hospital with a back-up emergency oxygen delivery system to back-feed their patient care areas with oxygen from their bulk storage in the event the hospital’s rigid underground oxygen-delivery pipes are severed during an earthquake. The second addressed providing hospital staff with a multi-use mobile hospital command center trailer. As an alternate or back-up hospital command center complete with its own multi-facetted communications room or as an area to triage victims of a mass casualty or pandemic event are just a couple ways in which this trailer can be used. The mass decontamination training program, oxygen back-up system and mobile hospital command center trailer have been identified by several agencies as being hospital-based “Best Practices.” A writer for the Joint Commission, Environment of Care News interviewed emergency preparedness management staff for published articles on these innovative solutions; published dates scheduled for January and February 2010.

New Knowledge, Innovations & Improvements

PREVENTING VENOUS THROMBOEMBOLISM A variety of educational techniques were utilized in 2009 at PHCMC to assist our nurses in achieving exemplary professional practice including newsletters and on-line education programs through Healthstream. One example is our VTE Newsletter by Terri Gately, RN, BS, MS, CRRN, RN-BC, DSD.

VTE—Update PROVIDENCE HOLY CROSS MEDICAL CENTER

NEWSLETTER DATE: JUNE 2009

Monitoring for VTE x National Quality Forum (NQF) Safe Practices for Healthcare Update 2009

x Safe Practice 28: Venous Thromboembolism Prevention

Evaluate each patient upon admission, and regularly thereafter, for the risk of developing venous thromboembolism Utilize clinically appropriate, evidence-based methods of thromboprophylaxis

Did you know that VTE is still considered the n u m b e r o n e preventable cause of hospital deaths? That VTE is the most common cause of readmission to the hospital after hip replacement surgery? Prevention is the key to reducing the risk of developing VTE and death. The National Quality Forum recommends regular assessment of patients for risk factors. Last year PHCMC adopted a risk assessment tool for VTE. The tool is filled out each shift on the Meditech screen and a

risk score of 0, 1, 2 or 3 x is determined. x

If the patient is at risk and there is no order for VTE prevention, an MD x Order Set is placed on the chart by the nurse.

There are also check-off boxes for contraindications to Pharmacologic prophylaxis. The items on the VTE risk assessment filled out by the nurse, are listed on the back of the MD Order Set.

If the existing order is not consistent with x NOTE: Remember to fill in prevention guidelines, the reason the patient is on an order set needs to be an anticoagulant if one was placed on the chart as ordered prior to admission well. x There is more information on Nurses need to have a the Internet, here are a few conversation with the good sites: physician to make sure http://www.vteconsultant.com/ they are aware of the vteconsultant/VTE-patients.html order set and guidelines http://cme.medscape.com/ for prophylaxis. viewarticle/560804

Guidelines for thromboprophylaxis and contraindications are listed on the order set for the physician to check off.

http://www.redorbit.com/news/ health/509941national_quality_foru m_edorses_consensus_standards_for _prevention_and_care

If the patient’s risk factor is 1 x (low risk) the recommendation is:

Enoxaparin (Lovenox 30 x mg SubQ Daily (Renal dosing)

Enoxaparin (Lovenox 30 mg SubQ every 12 hours (for obese patient BMI x >30)

Early Ambulation

Nurses can also refer to the Healthstream education on VTE Assessment and prevention

SCDs

Heparin 5000 units SubQ every 8 hours

Enoxaparin (Lovenox) 40 mg SubQ Daily

Other ——— (physician to x fill in)

If the patient’s risk factor is 3 (high risk) use SCDs and one x of the following:

VTE—UPDATE

Anticoagulation Education for the Patient and Family

Please remember to document Anticoagulant Education in Meditech. It is mandatory

Recommended Guidelines for Ordering Thromboprophylaxis

If the patient’s risk factor is 2 (moderate risk) the recommendation is to choose x one of the following:

PAGE 2

Heparin 5000 units SubQ x every 8 hours

Enoxaparin 40 mg SubQ Daily

that this education provided be documented at least once !

Enoxaparin 30 mg SubQ Daily (renal dosing) Enoxaparin 30 mg SubQ every 12 hours BMI>30) Warfarin (Coumadin) __mg x1 then adjust dose per daily INR (goal 2-3)

Is your patient on:

Warfarin (Coumadin) Protocol

Coumadin

Other _____________

Heparin

Lovenox

If So, x Print patient information from Micromedix x Educate the patient and family x Document in Meditech under Process Intervention: Education: Anticoagulation Help keep your patient safe while they are on an anticoagulant

Empirical Quality Outcomes Nurses believe they are giving high quality care to their patients, and their organization sees high-quality care as a priority.

Evidence-based standards of care in nursing involve taking the lead to find the evidence, evaluating the strength of that evidence, as well as producing the evidence when appropriate. Our Nursing Research Committee has been actively seeking knowledge and engaging in the research process. We recognize the importance of not only producing new knowledge to produce optimal outcomes but also the necessity to disseminate that knowledge to a wider audience. Our nurses conduct independent research as well as partner with nurse researchers from neighboring academic centers. Our table of current Nursing Research Studies is presented on the next page. We are especially proud of our nurses for the knowledge acquisition and practice changes they have adopted to encourage optimal empirical outcomes.

Empirical Quality Outcomes

PHCMC NURSING RESEARCH PROJECTS 2009 PROJECT NAME

STATUS

Smoking Cessation for Patients and Staff at IRB Approved a Community Hospital 12/04; 10/05; 10/06; 10/07; 10/08 Data Collection and Analysis COMPLETE FOR PILOT Renewed 10/09 The Identification and Prevalence of IRB Approved Patients with Chronic Wounds/Ulcers in the 4/07; 4/08; 4/09 Hospital Setting Prevalence of Chagas Disease in Pregnant IRB Approved 8/08 Women From Latin America Renewed 6/09

Care Redesign Using ZynxCare

DESCRIPTION

Terri Gately, RN, BS, MS, Staff survey on knowledge; CRRN, DSD /Sherri focused interviews on views; Mendelson, RNC, CNS, PhD patient smoking on readmit post information on last visit

Monica Tweddell, RN, WCC Prevalence Study

Sherri Mendelson, RNC, Prevalence Study CNS, PhD (In collaboration with Olive View Medical Center) IRB Approved 10/08 Sherri Mendelson, RNC, Outcomes Study Renewed 10/09 CNS, PhD

One Touch TGC GateWay Usability and Human Factors

IRB Approved 6/08 completed

Donna Ryan, RN RD, MPH, CDE, Kathy Cadden, RN, MSN, Cathy Yee, RN, MSN

Validation Study

Effectiveness of Nurse Manager Training Study

IRB approved 8/08 completed

Sherri Mendelson, RNC, CNS, PhD Site PI

Doctoral Study of Jane Rosati: University of Phoenix

Evaluation of the Pediatric Assessment Triangle (PAT) as an Assessment Tool for Children in the Prehospital Setting (PAT Project) Diabetes Prevalence and Outcomes Study of Patients at PHCMC

IRB Approved 1/08; Theresa Lacroix, RN- Site PI 1/09

Validity and Reliability Study

IRB Approved 6/08; Donna Ryan, RN RD, MPH, 8/09 CDE, Reza Bonabi, MD, Kathy Cadden, RN, MSN, Cathy Yee, RN, MSN, Sharon Elliston, RD, CDE IRB Approved 9/07; Reza Bonabi, MD, Robert 8/08; 8/09. Robertson, MD, Donna Ryan, RN RD, MPH, CDE, Terri Gately, RN, BS, MS, CRRN, DSD, Sylvia Pacis, RN, BSN-PI IRB Approved 12/08 Susie Parker, LVN, Sherri Renewed 10/09 Mendelson, RNC, CNS, PhD, Debbie Tsunoda, ACNP-BC IRB Approval 8/09 Terri Gately, RN, BS, MS, CRRN, DSD, Sylvia Pacis, RN, BSN-PI

Prevalence and Correlation Study

Insulin Therapy in Diabetic Patients Receiving Enteric Tube Feedings in a Sub Acute Unit: A Case Series Study

In-Patient Nursing Education Home Blood Pressure Monitoring To Manage Hypertension Do We Need to Hold Continuous G-Tube Feeding During Patient Repositioning

LEAD(s)

Case Series Study

Interventional one-group study

Outcomes study

Compassion Fatigue and Spiritual Caring in IRB Approval 10/09 Ingrid Blose, RN, OCN, Oncology Nursing Staff CMSRN, Dory Tiongson, RN, OCN, CMSRN Terrie Bybee, RN, CMSRN Tanya Haight, RN, OCN, CMSRN Project HOPE: Health Promotion for a IRB Approval 10/09 Sherri Mendelson, RNC, Healthy Pregnancy and Family CNS, PhD

Interventional one group pre and post intervention outcome study

CALNOC Interdisciplinary Nursing Quality Research Initiative Study

Prevalence and correlation study

IRB Approval 10/09 Donna Ryan, RN, CDE, CPH, RD

One group Pre and Post intervention longitudinal outcome study

Empirical Quality Outcomes

4A REDESIGN PROJECT OUTCOMES Through a generous grant from UniHealth Foundation, our Telemetry Unit embarked on the Health Systems Enhancement Patient Care Redesign Project at Providence Holy Cross Medical Center in 2009. The purpose of the project was to design reliable processes of care that assure consistent and timely delivery of evidence based patient care each and every time, thus improving patient satisfaction and outcomes. The Patient Care Redesign pilot project involved a 20-bed unit with patient care processes designed by patients, nursing staff , a clinical nurse manager and ancillary personnel providing care on the unit, physicians, facilitated and lead by a process engineer (Six Sigma Black Belt). The redesigned patient care unit provided patients and clinical staff with an environment of collaboration and innovation based on Watson’s Caritas Principles to promote the development of reliable care delivery along the continuum of care. The project allowed healthcare providers to deliver excellent quality care, each and every time by: Serving as an alpha site for development and implementation of an electronic “key process indicator status board”—an add-on module to our electronic medical record that provided caregivers with visual, real time cues indicating the status of key clinical processes. Assuring consistent adherence to evidence-based practices as a result of the ability to monitor key processes in real time. Hardwiring evidence-based practices. Understanding and focusing on patient needs. Addressing sustainability.

Empirical Quality Outcomes

Quality Dashboards Quality outcomes come from evidence based practice in the hands of knowledgeable nurses working within a supportive interdisciplinary environment. Our quality outcomes for our Rapid Response Team demonstrated that we could be doing better to identify patients with significant changes prior to arrest outside of the ICU. With this information and a review of the literature, a position was created to monitor vital signs changes and critical lab values for patients who had left the ICU and others identified with highrisk conditions. This addition to the Rapid Response team was implemented at the end of 2009. Another quality improvement success was with our fall rates on the acute care units. Our falls decreased from 3.39 per 1000 patient days January â&#x20AC;&#x201C; November 2008 to 2.7 per 1000 patient days January â&#x20AC;&#x201C; November 2009. Since then, our fall rate has been below the CalNOC mean for like hospitals since June of 2009. In addition, only one case of ventilator-associated pneumonia has been identified in the Medical/Surgical ICU since March 2008. Also the Hospital Acquired Pressure Ulcer rate was zero (0) for Q3 2009; below CalNOC like-hospital mean 7 out of 8 quarters since Q4 2007.

Rapid Response Team 2009 4.5

PHCMC ACUTE FALL RATE 2009 4.5

PHCMC RRT Calls/1000 Discharges PHCMC Mean Target

3.5

Fall Rate per 1000 Pt. Days

Calls Per 1000 Discharges

HC Falls per 1000 Pt. Days PHCMC Mean CalNOC All Hosp Mean

2.5

1.5

2.5

1.5

0.5

0 1

Months

0 1

Months

Awards & Accomplishments The nurses at Providence Holy Cross Medical Center share their knowledge through publications, presentations and nurse-directed research studies. Our nurses are committed to advancing the nursing practice and making a difference in the lives of others. OUR NURSES ARE HEROES AWARDS - 2009

Linda Coskran Nominated by Anita Reinhardt There is a family out there who can take comfort in knowing that even though they lost a loved one, they passed on the gift of life to others. Nurse Linda Coskran of the Critical Care Unit here at

Cathy Carter Nominated by Jennifer Lindskog and Carol Carter Cathy Carter is passionate about the care she gives her Emergency Department patients and refused to stand by while politics blocked the expansion of Providence Holy

Providence Holy Cross helped this grieving family through

Cross, which threatened to delay new badly needed beds to

the selfless act of organ donation.

alleviate the current overcrowding.

In supporting this family, devastated and in despair, Linda

Before initiating her personal campaign, she educated

proved heroic in working with them through the process

herself about the issues then set about informing the Los

of organ donation. She was very patient, understanding

Angeles City Council, her co-workers, her patients, the

and supportive as the family dealt with the stages of grief,

community and even the opposition about the impacts of

including the anger over their loved one’s death

the delay of the 138-bed expansion.

Linda understood their sorrow and spent time with them, showing empathy, compassion and respect. The family did decide to donate the organs of this loved

Cathy courageously voiced her opposition by megaphone during a rally for the project and she printed flyers directing patients to call to urge support for the expansion. One patient

one and by doing so saved lives – and helped ensure other

called a reporter, prompting a Page 1 newspaper story about

families might not experience the tragedy of losing their

our crowded ED. And within weeks, the council voted

loved ones to organ failure.

unanimously to allow construction to resume. In a few weeks, construction will resume, in part because of Cathy’s efforts. Cathy is a dedicated caregiver like all of our nurses here, but she took an extra step, took a risk, in fact, to ensure work resumed on the new Patient Care Wing so future patients won’t wait in the hallways for a room.

Awards & Accomplishments Amalia Choy Nominated by Cindy Damboise A year ago one of our certified nursing assistants fell tragically ill. While all of us were sympathetic and prayed for Isabel Castro, CNA Amalia Choy from Telemetry stepped forward and cared for her. Amalia exhibited to Isabel the tender loving care and compassion she shows to all of her patients and to their families. She proved to us all how her vocation is much more than a career, much more than a job. She donated her time to care for Isabel, her beloved friend, both in the hospital and at home. She rose the ranks of hero in sacrificing her own time to show compassion for a co-worker, who passed away in November. Isabel was blessed to have a friend like Amalia. And we are blessed to have her both as an example and as a reminder of why we were motivated to become caregivers.

Laurie MacArthur Nominated by Missy Blackstock At the beginning of a night shift in the ER, a Code Blue in the Nursery was paged overhead. Our hearts sank as we waited for it to be canceled, but that page never came. Thank goodness Laurie MacArthur was on that night. Without thinking, Laurie said “going to the nursery,” grabbed the hand of our ER doctor and hurried on a mission. About 30 minutes later our doctor returned shaking his head, obviously upset. He explained a tragedy that had unfolded in the nursery and how he was stunned by Laurie’s expertise in working with the nursery staff and the neonatologist who had tried in vain to save the newborn. Laurie didn’t come back to the ER for several hours. She worked with the SCN staff, who appreciated for Laurie’s calm demeanor, how she knew when it was time to stop resuscitation and how she tenderly helped the parents deal with the loss of their baby. Laurie works full-time in the NICU at UCLA and unfortunately sees these situations frequently. She also works here at Holy Cross, a single mom who takes the night shift so she can spend time with her children during the day.

Laurie personifies our core values, living excellence, compassion and respect to ensure the best care for her patients. Her attitude is exemplary. I don’t think I’ve ever seen her have a “bad day.”

Ramona Rojas Nominated by Debbie Bergida A nurse can do everything right, but still our patients’ care is compromised if we can’t ensure their safety. Ramona “Mona” Rojas of the Medical Surgical team took that to heart, worried about the issue of patient falls and determine to help find a solution. After attending a System-wide initiative on falls, Mona brought back information she shared and helped implement. Initially patient falls did not decrease. In fact we had a record number one weekend. So Mona started talking to the staff about how we could reduce the falls to protect our patients. One staff member gave her an idea, which Mona implemented on 3B as a pilot program. One caregiver would go on rounds hourly, checking on patients and ensuring they understood the hazards of trying to get out of bed on their own. So far, the results have been remarkable and the practice since has been adopted throughout the hospital

Pamela Abdulnour Nominated by Debbie Bergida Pam wanted to become more involved in the goings-on of the Medical Surgical Unit. As a CNA there are not too many opportunities but she joined the Falls Committee and has made it her personal mission to ensure that the night shift had the tools it needed to keep patients safe. Pam, a preceptor on her unit for new employees, is one of those people who likes to come to work. She’s extremely dedicated. On her own, she took the rounding idea that had worked so well on 3B to guard against patient falls, and introduced the proposal in her unit. Because Pam takes initiative, nurses love to work with her. Her style of motivation makes her a hero.

Awards & Accomplishments

PROVIDENCE HEALTH & SERVICES PRESIDENT’S AWARDS - 2009 Care for Gestational Diabetes through Teamwork-Parish Nurses and Diabetes Educators Rise to the Challenge Executive Sponsor: Betty Newsom Team Members: Sherri Garber Mendelson, RNC, CNS, PhD; Donna Ryan, RN, MPH, RD, CDE; Sharon Elliston, MS, RD,CDE; Juanita Arvisu, RN, BSN; Grace Cahoon, RN, BSN; Jennie Rosales, RN, BSN; Sylvia Duncan, RN, BSN; Marlene Mancia, RN, BSN; Deborah Benada, RN, MSN; Marian Oliver, RN, MSN; Connie Cruz, RN, BSN; Estevan Solarte, BS; Marc Incerpi, MD; Patrick Mullin, MD; Richard Lee, MD. Interdisciplinary Approach to Improvement in Core Measure Compliance Leadership Award – Improved Hand Hygiene Practice Among Healthcare Workers Executive Sponsor: Betty Newsom Team Members: Frankye Baurle, ANM PACU; Debbie Bergida, Nurse Manager, M/S; Missy Blackstock, Manager ED; Jeri Brown, Director of Patient Care Support Services; Karen Broggie, QM; Charles Chidsey, General Surgeon; Brigitte Condie, Pulmonary NP; Kim Crabtree-Lloyd, Staff RN PACU; Cindy Damboise, Nurse Manager, Telemetry; Yvonne gaff ney, Director, Periops; Karen Klein, QM; Kelly Kurcz, Director of Emergency Services & Clinical Outcomes; Becky Lee, Clinical Coordinator, Pharmacy; Patty Mayberry, Clinical Project Implementation Director; M. Reza Nahed, Pulmonologist; Kelly Pagel, ANM Short Stay; Judy Pharris, Interim Manager, Critical Care; Marianne Plakas, QM; Sheila Ritchie, QM; Carole Rozner, QM; Cyndie Speen, QM; Steve Tanner, Director QM; Debbie Tsunoda, Cardiology, NP; Dan Worthen, Staff RN, Surgery; Ting Yee, Cardiologist. Hospital Acquired Pressure Ulcer Reduction on Telemetry Executive Sponsor: Betty Newsom Team Members: Cynthia Damboise, Sherri Friedrich, Debbie Welch, Barbara O’Reilly, Wendell Garcia, Lourgelie Vergel De Dios, Marilyn Sluka, Anu Randhava, Monica Tweddell, Robert Mejia, Karen Sinnet-Frydman. Improved Hand Hygiene Practice among Health Care Workers Executive Sponsor: Kerry Carmody Team Members: Ken Archulet, Manager, Infection Prevention; Providence Holy Cross Medical Center Staff and Volunteers.

Awards & Accomplishments

Other Awards & Accomplishments The Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) presented its Best of JOGNN Writing Award to Sherri Garber Mendelson, BSN, MSN, PhD, Clinical Nurse Specialist, for the paper she co-authored titled “A Community-Based Parish Nurse Intervention Program for Mexican-American Women with Gestational Diabetes.” The award was presented at AWHONN’s annual convention in convention in San Diego. Trauma Program at PHCMC celebrated its 25th anniversary on May 16, 2009. The celebration featured a reunion of staff, former patients and recognition from civic and government officials. PHCMC received a “Certificate of Excellence” award from the California Hospital Assessment and Reporting Taskforce (CHART) for achieving “Superior” or “Above Average” results across the majority (7 of 8) of outcomes and process measures publicly reported by CHART. PHCMC was one of only 35 California hospitals to receive this recognition and ranked second in terms of overall percentage. PHCMC was certified by the American Diabetes Association for diabetes care. This is a 3-year certification. Two podium presentations were accepted at the National Association of Diabetes Educators Conference in August 2009: “What your CEO Needs to Know” by Donna Ryan, RN, CDE, RD, MPH, and “A Community-Based Parish Nurse Intervention Program for Mexican-American Women with Gestational Diabetes” by Sherri Mendelson, RNC, PhD, CNS. Terri Gately, RN, was appointed to the California Hospital Association Medical Safety Committee. Ken Archulet, RN, will be president-elect in 2010 and president in 2011 of the San Fernando Valley Chapter of APIC. Sherri Mendelson, BSN, MSN, Ph.D, Clinical Nurse Specialist, was appointed to the California Breastfeeding Roundtable delegation for 2009-2012.

Awards & Accomplishments

2009 CERTIFICATIONS ICU

NURSING MANAGEMENT

PERIOPERATIVE

Kathy Cadden, CCRN

Ken Archulet, CFRN

Frankye Bauerle, CPAN

Chris Consolo, CCRN

Debbie Bergida, OCN, CMSRN

Ed Betker, CNOR

Shirley Ibarra, CCRN

Jerilyn Brown, OCN

Kim Crabbtree-Loyd, FNP-BC, CPAN

Melissa Tell, PCCN

Cindy Damboise, PCCN, CCRN

Renee Dove, RNFA, CNOR

Carole McKennan, CCRN

Jane Flaherty, PCCN, CCRN

Lisa Eberhart, CNOR

Brenda Mitchell, CCRN

Sherri Friedrich, ANCC-FNP

Maria Gelato,RNFA

Melanie LaMadrid, CCRN

Yvonne Gaffney, CNOR

Karen Kelsey, RNFA, CNOR

Amy Rosengran, CCRN

Joanna Kuzmak, CCM

Elizabeth Klein, CNOR, RNFA

Betty Newsom, CNAA

Nora Lucas, CPAN

MEDICAL-SURGICAL /ONCOLOGY

Barbara Rozewicz, CCRN, CMC, NP-BC

Elizabeth Pleasant, CNOR

Lois Agler, CMSRN

Carrie Sayeski-Reid, RNC-OB

Marilyn Seckar, CPAN Louisa Singer, CNOR, RNFA

Suzanne Bart, CMSRN

Roxanne Smith, CNOR

Pamela Baylon, CMSRN

EMERGENCY DEPARTMENT

Ingrid Blose, OCN, CMSRN

Sue Baunsgard, CEN

Dee Dee Bubalo, OCN, CMSRN

Cathy Carter, CEN

Terrie Bybee, CMSRN

Jennifer Dodson, CEN

Cynthia DaSaad, OCN

Terri Halverson, CEN

Eileen Diaz, OCN

Deanna Hayden, CEN

NURSE PRACTITIONERS

Marisia Duarte, ONC

Heidi Krause, CEN

Brigitte Condie, ANCC-ACNP

Riza Estranero, OCN, CMSRN

Alicia Lopez, CEN

Deborah Tsunoda, ANCC-ACNP

Barbara Farrar, OCN

Rosanna Macklin, CEN

Gemma Francisco, ONC

Marjorie Moon-Weitz, CEN

Kathy Gilmore, CMSRN

Melissa Parsons, CEN

Christian Gonzalez, CMSRN

Melanie Ridgley, CEN

Heinrich Huerto, ONC

Anaya Rosen, CEN

Dary Hult, OCN

Jacquie Siddens, CEN

Vener Lineses-Diaz, CMSRN Veronica Lozano, CMSRN Mary Mahn, CMSRN Bilma Mathew,CMSRN Cathy Millan, CMSRN

Susan Zavala, CCRN, CPAN Gail Zerby-Cook, CNOR, RNFA Melanie Ylagan, CNOR

MATERNAL CHILD HEALTH Yajaira Angulo, RNC-OB Pamela Appleton, RNC-MNN Debbie Felkel, IBCLC, RNC-MNN Alexis Fischer, RNC-MNN Therese Gass, IBCLC

ACUTE REHAB/SUB ACUTE

Melinda Gruman ,RNC-OB, C-EFM

Nadine Smeke, CRRN

Linda Harrington, RNC-OB

Terri Gately, CRRN, RN-BC

Marilyn Haro, RNC-MNN Jenni Kohl, RNC-OB

Janine Montero, CMSRN Johanna Ongjoco, OCN, CMSRN

NURSING EDUCATION

Nancy McClenaghan, RNC-LRN, NIC

Maria Rodriguez, OCN

Kathy Christian, OCN, CMSRN

Nanette Moffet, RNC-LRN

Leticia Salvador, OCN

Cynthia Funikoshi, PCCN

Arvy Quizo, RNC-LRN

Betsy Smith, OCN, CMSRN

Tanya Haight, OCN, CMSRN, ONC

Tenesa Reid, RNC-OB

Jackie Sullivan, CMSRN

Sherri Mendelson, RNCC-OB, NIC, C-EFM, IBCLC

Delores Relucio, RNC-OB, C-EFM

Barbara Thomas, CMSRN

Kristi Miura, CCRN

Sally Ritter, RNC-OB ; C-EFM

Dory Tiongson, OCN, CMSRN

Donna Ryan, CDE

Kristina Shannon, RNC-OB

Denise Wilmarth, OCN, CMSRN

Monica Tweddell, WCC

Danielle Silvieri-Anthony, IBCLC

Karen Watson, CMSRN; ANCC-MS

Julie Tannaci, RNC-MNN

Mary Ellen Hazle, CMSRN

TELEMETRY

FAITH COMMUNITY NURSING

Seta Velasquez, CMSRN

Crystal Akao, CCRN

Connie Cruz, RNC-OB

SUPER FLOAT POOL

Beverly Gumogda, PCCN

CASE MANAGEMENT Betsy Jansen, CHPN Kathy Menard, CPHQ, CPRM Jinky Rivera, CPUM

Linda Oâ&#x20AC;&#x2122;Reilly, PCCN

NURSING QUALITY ANALYSTS

Ulla Smith, PCCN

Karen Broggie, CPHQ

Therese Villanueva, PCCN

Sheila Ritchie, CPHQ

Debbie Welch, PCCN

Cyndie Speen, CPHQ, RN-BC Marianne Plakas, CCRN

Edna Tiongco, CRRN, CCM

CARDIOLOGY Hannah Rhodes, PCCN Cathy Yee, CCRN-CSC

Awards & Accomplishments

PUBLICATIONS, PRESENTATIONS & GRANTS Publications: b Kathy Cadden, MSN, RN, CCRN, Judy Pharris, BSN, RN, Donna Ryan, MPH, RN, RD, CDE, & Cathy Yee, MSN, RN, CCRN-CSC; Featured article, Advance for Nurses, April, 2009; Overcoming Barriers to Nursing Research in a Community-Based ICU: Correlation of Capillary and Arterial Blood Glucose Levels. b Sherri G. Mendelson, RNC, PhD, CNS, IBCLC; PACLAC Guidelines for Maternal Care, 2009. Los Angeles, CA.

Abstracts Submitted in 2009 for 2010 Conferences AWHONN 1. Regional Perinatal Documentation Project; Ronda McPhail, RN, Sherri Mendelson, RNC, PhD, CNS, IBCLC. (Accepted for Poster presentation). 2. Breaking Out of Our Silos; Adriana Basurco, RN, BSN, PHN, Yajaira Angulo, RNC, BSN, PHN, Sherri Mendelson, RNC, PhD, CNS, IBCLC. (Accepted for Poster presentation). 3. SLE: A 36 Year Longitudinal Case Study; Sherri Mendelson, RNC, PhD, CNS, IBCLC. (Accepted for Poster presentation). ACNL 1. ACNL Environment of Practice Standard and Instrument for Measurement Healthy Work Environment Assessment Tool Introduction; Round Table; Timothy Gilmore, RN, MHA. (Accepted for Round Table presentation). 2. For Your Information: Admission and Discharge Videotape; Cynthia Damboise, RN, MSN, MHA, PCCN, CCRN; Linda Coale, RN, MBA. (Accepted for Poster presentation). 3. Regional Perinatal Documentation Project; Ronda McPhail, RN, Sherri Mendelson, RNC, PhD, CNS, IBCLC (Accepted for Poster presentation). Arizona State University Research 1. Regional Perinatal Documentation Project; Ronda McPhail, RN, Sherri Mendelson, RNC, PhD, CNS, IBCLC (Accepted for Podium presentation). ONS 1. Team Rounding: Preventing Falls on the Oncology Unit. Kathy Christian RN, BSN, OCN, CMSRN, Tanya Haight RN, OCN, CMSRN, ONC. (Accepted for Poster presentation). 2. Improving Knowledge of Oncologic Emergencies; Kathy Christian RN, BSN, OCN, CMSRN, Tanya Haight RN, OCN, CMSRN, ONC. (Accepted for Poster presentation).

Presentations/Lectures: b Donna Ryan, RN, CDE, RD, MPH; National Association of Diabetes Educators Conference, Atlanta, Georgia; August, 2009; Podium presentation: What your CEO Needs to Know. b Sherri Mendelson, RNC, PhD, CNS, IBCLC; National Association of Diabetes Educators Conference, Atlanta, Georgia; August, 2009; Podium presentation: A Community-Based Parish Nurse Intervention Program for Mexican-American Women with Gestational Diabetes. b Tanya Haight, RN, OCN, CMSRN, ONC; Kathy Christian, RN, BSN, OCN, CMSRN; ONS 34th Annual Congress: San Antonio, Texas; April, 2009; Poster presentation: Improving Communication Using a Cancer Treatment Schedule Tool. b Kathy Cadden, RN, MSN, CCRN; Chris Consolo, RN, CCRN; Carla Hentz, MS. 5th National Learning Congress, United States Department of Health and Human Services; Grapevine, Texas, 2009; Podium presentation: Honoring Donor Families Through Collaboration. b Terri Gately RN, BS, MS, CRRN, RN-BC, DSD; National Magnet Conference; Louisville, Kentucky; October, 2009; Podium presentation: Do We Need to Check G Tube Residuals in Sub Acute? b Terri Gately, RN, BS, MS, CRRN, RN-BC, DSD; CMRS and HSCC 2009 Annual Conference: Transitioning Patients Transforming Care; San Diego, California; 2009; Poster presentation: Do We Need to Check G Tube Residuals in Sub Acute? b Karen Watson, RN, BSN, CMSRN, RN-BC, and Monica Tweddell, RN, WCC; National Magnet Conference; Louisville, Kentucky; October, 2009; Poster presentation: Save Our Heels. b Karen Watson, RN, BSN, CMSRN, RN-BC, and Monica Tweddell, RN, WCC; AMSN 17th Annual Conference, Nashville, Tennessee, 2009; Poster presentation: Save Our Heels. 1st Place Prize Winner. b Missy Blackstock, RN, Melanie Ridgley, RN, and Patricia Aidem; National Emergency Management Summit; Washington, D.C.; March, 2009; Podium presentation: PHCMCâ&#x20AC;&#x2122;s Response to the Metrolink Train Crash. b Sherri Mendelson, RNC, PhD, CNS, IBCLC; University of Iowa Research Conference, Iowa City, Iowa; April, 2009; Poster presentation: Development of an Instrument to Determine Risk of Hyperbilirubinemia. b Tanya Haight, RN, OCN, CMSRN, ONC, Presented a poster titled: Improving Communication Using a Cancer Treatment Schedule Tool at AMSN-Academy of Medical-Surgical Nurses, 18th Annual Convention, 9/9-9/14/2009, Washington, DC.

Grants Obtained: b California Department of Public Health: Birth and Beyond California Breastfeeding Promotion (continuing). b First 5 LA Best Babies Collaborative Case Management Program for Improvement of Maternal Child Health (continuing). b UniHealth Foundation: Transformation of Care Project (continuing).

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