We are NURSES of PROVIDENCE
2011 Nursing Report
This is Our Journey to Excellence: Charting the Course to Magnet
Contents Message from CNO 3
One Ministry Committed to Excellence:
Inspired by our heritage, we work together to deliver excellent health care in the communities we serve.
Message from CE 4 Transformational Leadership 5 Structural Empowerment 7 Exemplary Professional Practice 23 New Knowledge, Innovations and Improvement 26 Empirical Outcomes 30 Friends of Nursing (Philanthropy) 34
Message from our CNO
Kathy Harren,
RN, MHA, MSNc
Providence Little Company of Mary Medical Center Torrance
As nurses of Providence Little Company of Mary Medical Center Torrance (PLCMMCT), we have the ongoing opportunity to “make visible a healing presence” for every patient in our care. This fourth edition of our Nursing Annual Report beautifully reflects our continued commitment to link compassionate care with clinical excellence. Together, we strive for discovery and innovations as we build the systems, structures and processes that advance both the art and science of caring for others. As we journey toward ANCC Magnet Designation, we celebrate the exceptional work of our Shared Governance (SG) coordinating councils and teams. This past year, the councils presented their achievements through four nursing congress sessions. For the first time, two of the congress sessions were “mobile” sessions making it possible for staff, regardless of their shifts, to share in the great teamwork and outcomes. More than 500 employees participated in the congress sessions reflecting our highest participation to date. There is much to share on our meaningful journey and this annual report reflects the depth of work including our nursing strategic plan, as well as the goals and successes of the Professional Practice, Clinical Practice, Technology and Informatics, Research and Education and Quality and Safety councils. The amount of work completed by these Shared Governance councils is impressive, including many first-time achievements such as: the National Daisy Award for nursing excellence, the implementation of Patient and Family-Centered Care as a professional practice/patient care delivery model and the improved access to our Nursing Policies and Standards as we moved from printed manuals to the intranet site. Other firsts include the Providence nurses embrace their addition of patient and family advocates to the Patient and Family Advisory Council, CAMIS 6.0 deployment, new KRONOS nursing workforce heritage of compassion, courage, scheduling system, full deployment of electronic team collaboration sites and a and leading-edge care as a steadfast, number of evidence-based practice changes using our Rosswurm and Larrabee sacred presence in protecting and EBP tool. Together, we also shared an exceptional National Certification easing the way for those in need. Nurses Day celebration where more than 70 nurses were recognized for their specialty certifications in practice. The 13 Unit-Based Councils (UBCs) had tremendous advancements as well, and their SMART goals were strongly articulated. More than 150 nurses are participating in various Shared Governance councils throughout the organization. This type of nurse engagement is what drives our organization’s outcomes to continually improve. Thank You!
Our Nursing Vision
As 2011 came to a close, I made the important decision to respond to the call for a different way to serve Providence as a member of the Southern California regional team. After 25 years as a nurse leader at Providence Little Company of Mary Medical Center Torrance, it was my privilege to serve with each of you as my nurse colleagues in caring for the health care needs in our community. It has been my great professional privilege to pass the baton forward to our new Chief Nurse Executive, Jessica Rivas RN, MSN. Jessica is a passionate, expert nurse leader who will take our organization forward to achieve our goal of excellent patient care and ANCC Magnet designation no later than 2014. As nurses of Providence we will keep a steadfast commitment to our patients and families who are relying on us to “know them, care for them and easy their way.” Thank you for being a part of the sacred calling at Providence Little Company of Mary. The joy of our work is truly in our journey to pursue excellence in all we do for our patients, their families and this beloved fellowship called nursing.
2011 Nursing Annual Report 3
Message from our CE
Liz Dunne Providence Little Company of Mary Medical Center Torrance
Each day, I encounter the nurses at Providence Little Company of Mary Medical Center Torrance living and breathing the Mission and spirit of our Founding Sisters. Our nurses are genuinely dedicated to compassion in caring for the patients who entrust us with their lives. Providence Little Company of Mary Medical Center Torrance nurses also are committed to continued excellence, as reflected in our pursuit of Magnet designation. I take great pride in our unit-based nursing initiatives and the participation of our nurses in decisions that strengthen the care we deliver to patients and their families. We know that 2011 was a challenging year across the nation for health care organizations. The hard work and commitment of our nursing team helped ensure that Providence Little Company of Mary Medical Center Torrance remained a strong and vibrant force in the community and enabled us to continue serving those who came through our doors. Through the contributions of our nurses, we delivered nearly 3,000 babies, cared for more than 20,000 people who come here with acute conditions and successfully managed 65,000 emergency room visits. I am proud of our accomplishments and look forward to continuing our journey together.
As People of Providence, we reveal God's love for all, especially the poor and vulnerable, through our compassionate service. 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
4 Providence Little Company of Mary Medical Center Torrance
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
Stewardship The earth is the Lord’s and all that is in it. Psalm 24:1
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
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
transformational leadership
20072014
Nursing Division Strategic Plan Summary
PH&S Core Strategy ď‚Ą One Ministry Committed to Excellence: Inspired by our heritage, we work together to deliver excellent health care in the communities we serve.
Nursing Mission Through collaboration, excellence and innovation, Providence Little Company of Mary Medical Center Torrance nurses embrace life-long learning, respect diversity and make visible a compassionate and healing presence for each patient and family in our care. Nursing Division Strategic Priorities
Transformational Leadership
Structural Empowerment
Exemplary Professional Practice
New Knowledge, Innovation and Improvements
Nursing Values Making a Difference Quality Compassion Caring Advocacy
Goals
Professional Advancement: Leaders are visionary risk-takers who engage in life-long learning to maintain competency Advocacy and Influence: Nurse leaders engage in succession planning, leadership development and mentoring services. Visibility, Accessibility and Communication: Nurse leaders must be visible, accessible and approachable. Magnet Recognition: Strong leadership team and interdisciplinary collaboration to achieve Magnet designation by 2014 and maintain enculturation of Magnet. Image of Nursing: Nurses are perceived as essential team members and are integral to the delivery of excellent patient care. Collaborative Decision-Making: Structures and processes enable nurses to actively participate in organizational decision making and effectively influence system-wide processes. Education Development: Support, recognize and improve continuous education among staff members Commitment to Community Involvement: Support and recognize the participation of nurses at all levels in service to the community, continue to establish partnership with community. Nursing Excellence: Nurses are celebrated and recognized through multiple media in the organization, the nursing and healthcare community. Advancement of Nursing Practice: Utilize infrastructures and resources to support workforce development and advancement of nursing practice. Academic Affiliations: Collaboration with our academic colleagues to develop/teach the next generation of healthcare professionals. Professional Advancement: Provide opportunities through structures and processes that enable professional and career advancement.
Professional Practice Model: Professional nurses are accountable for excellent practice through continuity of care as well as for providing individualized and interdisciplinary patient- and family-centered care. Healthy Practice Environment: Exceed median of national/or comparative benchmark on nursing satisfaction targets three out of four quarters annually. MD Satisfaction: Exceed median of national/or comparative benchmark on nursing satisfaction targets three out of four quarters annually. Patient and Family Satisfaction: Exceed median of national/or comparative benchmark on nursing satisfaction targets three out of four quarters annually. OE/Six Sigma Projects: Nurses are actively involved in Operational Excellence (OE) (performance improvement) activities at all levels. Performance Appraisal Process: Create opportunities for ongoing performance evaluation through informal/formal avenues in order to create a culture of accountability. Nursing-HR Partnership: Nurses and HR collaborate to improve recruitment and retention of nurses. Monitoring and Reporting: Quality data is collected and disseminated through various processes and structures in collaboration with Department of Performance Improvement (PI) and nursing leadership. Interdisciplinary Collaboration: Healthcare team members are observed in collaborative and healthy working relationships that achieve positive patient outcomes. Nursing Outcomes: Nurse-sensitive outcomes are monitored, evaluated and improved on an ongoing basis.
Innovation-Informatics: Nurses are involved with evaluation and allocation of technology and information systems, and participate in
architecture and space design to support practice. Nursing Accessibility to Electronic Information: Nursing staff have access to PLCMMCT nursing information, resources and documents. New Knowledge Dissemination: Nurses disseminate and generate knowledge through nursing research to internal and external audiences. Evidence-Based Practice/Nursing Research: Infrastructure and resources are in place to support the advancement of evidence-based practices.
2011 Nursing Annual Report 5
transformational leadership
Nurse Leaders Participate in State, National and International Education
In 2011, recognized as experts in their field, our nurses gave the following presentations around the world: Amy Dugan, adn, rn
International Association for Human Caring Annual Conference, poster presentation, “Transitioning with a Caring Touch”, San Antonio, TX Kathy Harren, mha, rn
UCLA MSN and BSN students presentation, “Health Policy and Contemporary Impact Issues for Nurse Leaders”, Los Angeles, CA California State University Dominquez Hills: MEPN students presentation, “Contemporary Impact Issues for Nurse Leaders”, Carson, CA Collaborative Alliance for Nursing Outcomes (CALNOC) Annual state-wide program: podium presentation, “Regional and National Forces Shaping CALNOC’s Strategic Evolution”, Long Beach, CA Melissa Punnoose, msn, rn
International Association for Human Caring Annual Conference, poster presentation “Using Simulation to Promote Compassionate Care at the End of Life”, San Antonio, TX Sue Revero, msn, rn, ccrn
International Meeting on Simulation in Healthcare, podium presentation: “Simulation to Advance Quality and Safety”, New Orleans, LA
6 Providence Little Company of Mary Medical Center Torrance
Heidi Traxler, msn, rn
International Meeting on Simulation in Healthcare, podium presentation: “Simulation to Advance Quality and Safety”, New Orleans, LA Providence Excellence Conference, podium presentation: “Leveraging Technology to Reduce Mortality using Simulation”, Seattle, WA California Institute for Nursing & Health Care (CINHC) Level 1 Course: Co Facilitator Torrance, CA September 6-7, 2011 Providence Little Company of Mary, Torrance CINHC Debriefing Course: Co-facilitator September 20, 2011 Long Beach City College Southern California Healthstream User Group Meeting poster “Implementing A Simulation Program”, Torrance, CA
Our Journey to
Structural Empowerment
con
g r e s s
unitbased councils (UBC)
con
unitbased councils (UBC)
quality & safety
unitbased councils (UBC)
technology & informatics
Shared governance Coordinating council
professional practice
unitbased councils (UBC)
research & education
g con ress
gress
clinical practice
unitbased councils (UBC)
Q uality caring advocacy compassion making a difference n u rse manag emen t co u ncil n u r se e x e c u t i ve c o u n c i l
Our Shared Governance Model 2011 Nursing Annual Report 7
structural empowerment
Shared Governance Big 5 Councils’ Main Accomplishments Professional Practice Council Researched and developed the framework of the RN Professional Portfolio. Participated in the Professional Nurse Excellence Nomination Selection Committee and Award/ Ceremony Planning Committee. Hosted a successful National Certified Nurses Day celebration breakfast on March 18th. Rolled out the National Daisy Award during 1st Quarter 2011. Hosted four quarterly award presentations honoring four outstanding compassionate nurses. The President of Daisy Award, Bonnie Barnes, presented the 2nd quarter award. Started the “Busy Beads” project (jewelry made solely by the council members) and began selling the beads in the Gift Shop. All sales go back to the organization. Clinical Practice Council Developed the 1st Phase plan to roll out the Professional Practice Model of Patient- and Family-Centered Care. Hosted a Magnet Professional Practice Model Education and Awareness Day in June. Reviewed nursing policies and reduced redundancies. Finalized location of all nursing policies. Identified two sources: Lippincott and PLCMMCT intranet site. Active advocates for patients and families by involvement with Patient and Family Advisory Council and attendance at Patient- and Family-Centered Conference in July. Providence Little Company of Mary Medical Center Torrance nurses continue to look for creative ways to give back to the community. One example is the “Busy Beads” project that raised funds to benefit at-risk women and children. Chris Farnham, RN, had an idea to make beaded bracelets and lanyards not only for certified nurses, but also to sell in the Gift Shop. Professional Council members eagerly volunteered their time to learn how to make the beautiful beaded creations and went on to raise more than $1,500. Their work on these items further signifies the spirit our nurses have to give back to the community both on and off the job.
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Revised and finalized "Talking the Talk" elevator speech of the Professional Practice Model.
structural empowerment
Technology and Informatics California Advanced Medical Information System (CAMIS): Members served Core Trainers and as Super Users to promote a successful implementation on June 1, 2011. Collected input from staff post go-live in regard to CAMIS concerns for submission to CAMIS Educator. KRONOS Workforce Manager: Representation from Technology and Informatics Council to launch Part 1 of KRONOS. Educated staff at Magnet Congress in regard to utilizing existing features of KRONOS. Team Collaboration Sites (TCS): The council has committed to work on optimization of the TCS sites. This will begin by gathering staff input at Magnet Congress to determine what staff would find valuable on these sites. Quality and Safety Designed the first mobile Congress: Educated more than 90 staff in the first mobile Congress regarding Nurse Sensitive Indicators (NSI), HCAHPS. Designed poster of puzzle pieces to incorporate the NSI and how it leads to Family-Centered Care. Educated staff members on data analysis, databases (e.g. CalNoc, NDNQI, NHSN, etc.) and each unit’s NSIs (included two Mobile Unit Education Tours in June and October). Identified, provided guidance and made recommendations to areas where the quality indicators were not performing at the benchmark. Assisted with Pressure Ulcer Reduction Campaign – Inspect 2 Prevent. Together with our WOCN (Wound Care Specialist), the council educated staff members house-wide on “inspect and prevent” to improve quality outcomes. Research and Education Council Supported staff in utilizing EBSCO database effectively, teaching the following via Congresses, printed handouts and information tables Incorporated EBP into Department-based Competencies. Reviewed and revised Nursing Research Strategic Plan. Assisted the Education staff in research proposal (using PICOT template) for Simulation Project with new graduate RNs. Two R&E Council members attended the Providence Holy Cross Medical Center Research and EBP annual conference with two of our posters displayed and two information tables. Four R&E Council members attended the UCLA Annual Research and EBP conference Collected four Rosswurm and Larrabee Worksheets summarizing details of successfully implemented EBP Practice Changes at PLCMMCT. Initial support and planning for Carol Glenn’s wound care project, which has since been approved by the IRB members and the study will continue through 2012.
2011 Nursing Annual Report 9
structural empowerment
Unit-Based Councils’ 2011 Achievements Elizabeth Bruner, RN, RN Quality Specialist, at Providence Home Health, helped lead the development of the UnitBased Council for Home Health. Elizabeth was transferred to the department from Labor and Delivery where she also participated in the Unit-Based Council (UBC). This enabled her to quickly put
Surgery/PACU/SDS/GI Goal: By August 2011, the skin of 75 percent of patients will be assessed using the “Pressure Ulcer Prevention Assessment Tool”
3. Staff will have increased knowledge regarding ICU and nursing policies as evidenced by post-test results at quarterly staff meetings.
Results: From August 2011- December 2011, we maintained a 75% and above compliance in the use of the “Pressure Ulcer Assessment Tool” in the peri-operative Areas.
Results: Certification - From January 1, 2011, to December 10, 2011, nine nurses achieved new CCRN/CSC certification, which increased our unit to 44%, or a 15.3% increase.
Goal: Improve peri-operative ranking in the large Press Ganey database by at least 10 points each quarter. The overall goal is to achieve and maintain a ranking of greater than 80 by January 2014. Results: The planning phase started in 3rd Q 2011. The development and implementation phases will take place in 2012 – it will be our UBC’s main focus in 2012.
Elected chair, Elizabeth worked
Women’s Health Goal: Increase women’s health patient satisfaction, as reflected in the HCAHPS top box results (12 month average) for the “Pain Management” composite roll-up score to a top box of 78%, by the end of 2011.
with the team to establish goals:
Results: We have met our goal of 78%
her experience in the Labor and Delivery UBC to work to help Home Health establish its first UBC.
educate the staff regarding the UBC motivate participation in the UBC focus the unit specific indicators to
for three out of the last six months of 2011. We plan on continuing this goal of 78% throughout May of 2012.
decrease re-hospitalizations, and
After educating the clinical staff created and work began.
Results: Developed Care Management Recognition Program “I Care” poster, nominating cards and written process.
The UBC continues to help empower clinicians with shared decision-making related to practice, competency, work environment and patient safety. Over
encourage good communication, increase accountability and improve processes and quality outcomes within the department.
Case Management Goal: Create Care Management Handoff communication form by October 2011.
Goal: Develop Care Management Recognition Program poster by October 2011.
about the UBC, a charter was
will increase staff confidence,
ICU Policy - “Policies of the Month” were selected by UBC members throughout the year and were posted in the lounge for staff to review. A posttest was given at the ICU October staff meeting for the five POMs from May to September. All questions turned were answered correctly.
Results: Created Care Management Handoff Communication form and guidelines for use.
improve pain management.
the long term, UBC participation
As of the third quarter ending September 30, 2011, ICU received four HCAHPS surveys which showed overall nursing communication scores to be greater than 50% in the “always” category. There were four indicator questions with two questions resulting in 100%
Communication score -
ICU
Goal: 1. To increase the number
of CCRN, CSC & CMC certified nurses in the ICU by 5% (about three RNs), by December 31, 2011.
2. ICU Quarterly nursing communication scores will be greater than 50% in the “always” category of HCAHPS Survey.
10 Providence Little Company of Mary Medical Center Torrance
4th Med Card Goal: Increase morale on 4th MedCard, by end of 2011, by 50% based on the survey results. Results: There was an increase greater than 50% of staff that felt the morale on the unit had improved.
structural empowerment
ED
Goal: Increase ED’s Press Ganey score to
70% in three months, 80% in six months and 90% in nine months starting May 2011 Results: Press Ganey scores greater than 70% for two consecutive months in fall 2011. Goal: Increase ED’s numbers of certified nurses and numbers of nurses in school (more than five) by December 2011. Results: Currently four CENs and greater
than 15 total number of RNs in school for advanced education by December 2011. 1st Surgical Goal: Four RNs from 1st Surgical to become Med/Surg certified in 2011. Results: Ludy Chang, Aldrin DeSantos, Mark Motio and Lety Vega became Med/Surg certified in 2011. Goal: Increase personnel baseline knowledge on 1st Surgical unit on proper Continuous Passive Motion (CPM) use by 80% by November 31, 2011. Results: CPM poster board was
created and displayed at the Magnet Congress November 2011. 100% of the participants stated gaining knowledge on proper CPM use. Goal: Improve employee morale and teamwork on 1st Surgical by 1% by January 2012. Baseline data are 80%. Results: In the 2011 Employee Opinion Survey, 81% of 1st Surgical employees agreed with the statement “I feel I am part of a team.”
Children Services Goal: Increase knowledge of the Peds and NICU staff of Magnet process by 10% by November 2011. Results: Using Survey Monkey, the data indicated that staff showed an improvement of knowledge on Magnet of about 13%. Goal: Increase in morale of team members by 10% by November 2011. Results: There has been a range of 6-12% increase based on a survey that contained eight questions.
AOU Goal: AOU to develop and adapt a standard Room Readiness Checklist by December 2011. Results: Results showed we performed better than our baseline study in 2010. Poster created.
Angio-Recovery
Angio-Recovery Goal: Uncomplicated A-line pulls will be achieved in 90% of Angio-Recovery patients at year end 2011. Results: From third quarter 2011 data, our uncomplicated A-line pulls have reach over 90% Cath Lab Goal: Safe RN to MD handoff report will be done in 100% of angiogram patients by the year end 2011. Results: From third quarter 2011 data, our RN to MD safe hand-off report is between 85%-99%.
4th Med Onc Goal: Decrease foley catheter usage by 60% by December 2011. Results: Decreased number of device days by more than 60% (from 141 in May to 41 in December 2011). Goal: Improve responsiveness of staff to call lights 15% by December 2011. Results: “Call button help soon as wanted” reached 100% from December 2011 HCAHPS score (top box national benchmark: 63%).
2011 Nursing Annual Report 11
structural empowerment
Recognized for Advancements in Safety
Emergency Department
As one of the Emergency Department’s Unit-Based Council (UBC)’s SMART goals, the department partnered with security to ensure the safety of patients, families and employees during the daily Emergency Department operation. This effort in collaboration and improvement of work environment was captured by Advance for Nurses (January 17th 2011 issue) as the cover story for the issue. Surgery Department
The surgery department at Providence Little Company of Mary Medical Center Torrance began utilizing the World Health Organization (WHO) Surgical Safety checklist, a successful research project that has proven to cut death rates in half and non-fatal complications by one-third in facilities that have used it. After implementation of the WHO Surgical Safety checklist, our compliance rate improved significantly from 53% in 2010 to 97% in 2011. This notable improvement led to our surgical team’s selection as one of the top finalists for ADVANCE for Nurses’ “2011 Best Nursing Team” contest.
12 Providence Little Company of Mary Medical Center Torrance
structural empowerment
Advancing Education RNs Who Completed BSN or MSN in 2011
Providence Little Company of Mary Medical Center Torrance is committed to supporting nurses at all levels in professional advancement and continued formal education.
Jennifer Massimo, MSN (NICU) Jinsook Lee, BSN, RN (AOU) Joann Bernier, BSN (ED) Lindsey Yuen, RN, MSN, FNP (1st Surg) Lori Bischoff, RN, BSN Robbie Lee, BSN, RN (4th Med Onc) Rosely Werner, BSN, RN (AOU) Sachiko Tatsuno, BSN (Women’s Health) Samantha Ryan, BSN (ED) Sara Kranke, BSN (ED) Rachel Bruce-Carothers, MSN in Nursing Leadership (4th Med Card mgr) Kathy Sliff, MSN (ICU) Beena Philipose, BSN (ICU) Affiliate Nursing Instructors
Melissa Punnoose, MSN, RN, Los Angeles Harbor College Karen Walter, BSN, RN, El Camino College and Cerritos College Linda Scott, BSN, RN , El Camino College and Los Angeles Harbor College Paula Grimaud, RN, Mount St Mary’s College Joan Gahan, MSN, RN, El Camino College Linda Mason, MSN, RN, Cal State University Dominguez Hills Sue Endicott, MSN, RN, El Camino College Newly Graduated RN Residency Program
Providence Little Company of Mary continues to provide and improve our award winning comprehensive, evidence-based Newly Graduated RN Residency Program. The retention rate for the 34 new grads hired in 2011 is 100%. Specialty Residency Programs
Providence Little Company of Mary offers specialty training programs for advancing the clinical practice of experienced registered nurses. Seventeen RNs completed specialty training in the ICU, ED and/or OR. Our Academic Nursing Partners
Providence Little Company of Mary continues to maintain strong affiliate relationships with both undergraduate and graduate nursing programs. Every day of the week, as many as 100 RN students help provide direct patient care. 2011 Students Cal State University Dominguez 30 Cal State University Los Angeles 20 Cal State University Long Beach 4 Cal State University Fullerton 4 UCLA 10 Mount St Mary’s College 20 El Camino College 120 Los Angeles Harbor College 120 Loma Linda University 1 West Coast University 1
We are committed to nursing students being successful in their final semester preceptorship experience and in their graduate program rotations at Providence Little Company of Mary.
2011 Nursing Annual Report 13
structural empowerment
Honoring Excellence Providence Little Company of Mary Medical Center Torrance Nurse Excellence Annual Celebration
Campus Awards & Recognition Winners in Red
Critical Care Nursing
Young Cho, bsn, rn Maria Victoria Liwanag, bsn, rn Karen Lofstrom, adn, rn Amy Polvani, bsn, rn Sherry Samson, bsn, rn-icu
Womens & Childrens Health
Marie Halls, diploma, rn Tracy Hall, bsn, rn Blanca Landman, adn, rn Elisabeth Rios, bsn, rn
Advanced Medical Surgical Nursing
Jeremy Bounds, adn, rn Aldrin Delos Santos, bsn, rn Rainbow Stephens, bsn, rn Casey Vastano, bsn, rn Suh Young, adn, rn
Friends of Nursing
Stephanie Crane
Patient Relations Coordinator
David Dinh
PACS Manager
Andrea Flores
Clinical Informatics/ Translation Leader
Rookies
1st Medical Surgical/Oncology Jeni Varghese, rn AOU Gina Scachetti, msn, rn Emergency Department Sara Sarhangian, adn, rn icu Tracee Suntharaphat, bsn, rn Medical Cardiology Jayna Kwon, rn Surgical Jennifer Sabbagh, adn, rn OR Emma Schwab, rn Post Partum Jessica Sharman, bsn, rn TCC/TCU Hyo Shim Yang, rn
Dr. Denise Ishimaru Salvador Jimenez
Imagining PACS Administrator
Danny Le
Cardiac PACS Administrator
Richard Partyka
Education Program Coordinator
Dr. Elliot Sumi Julian Villaescusa OR Support Tech
14 Providence Little Company of Mary Medical Center Torrance
Ambulatory Care + Distinct Sub Specialty
Jean Bunten, adn, rn Sherry Kim, adn, rn Jennifer Lastimosa, adn, rn Lucy McRae, bsn, rn Sarah Park, diploma, rn Melissa Punnoose, msn, rn Cynthia Rohrer, adn, rn
Humanitarian Award
Jo Ann Birdsong, rn Rita Wadhwani, msn, rn
structural empowerment
California and Professional Organization Positions and Memberships AACN
Jennifer Bee, rn Aphiradee Chaiweerathai, rn AACN, Sigma Theta Tau and ACNL
Julie Baker, rn Rachel BruceCarothers, msn, rn Maria Chan, rn Kelene Degrell, rn Maritess Dignadice, rnN Ellen Liu, rn Melissa Garth, rn Jennifer Herz, rn Melanie Marriot, rn Michael Mizuta, rn Lori Mullenhour, rn Catrice Nakamura, rn Rosemarie Navarro, rn Andie Nordstrom, rn Gem Oga, rn Theresa Parks, rn Kimberly Patel, rn Rachel Rolince, rn Sherry Samson, rn Evelyn Sanchez, rn Leona Sandrik, rn Maria Luisa Santonil, rn Julian Schiesser, rn Kathy Sliff, rn Tracee Suntharaphat, rn Kimberley Thach, rn Yani Thomas, rn
AORN
Kum Cho, rn Christine Constable, rn Diane Dragotto, rn Sheli Hicks, rn Arlene Howe, rn Cara Lazarus, rn Cindy McDonald, rn Susan Medlicott, rn ASPAN
Chris Disario, rn Mary Olszewski, rn Jeanna Peshl-Amaro, rn AWHONN
Susan Balou, rn Ni-Wei Chu, bsn, rn, Linda Mason, rn, rnc-ob Audrey Stempel, bsn, rn, rnc-ob, mnn Sachiko Tatsuno, rn California Society for Cardiac Rehabilitation (CSCR)
Yvonne Hashimoto, bsn, rn Debbie Lawlor, adn, rn Estela Uchima, bsn, rn ENA
Nikki Durepo, rn Ruth Jeffery, rn Courtney Kosnik, rn Melanie Marriot, rn Lori Mullenhour, rn, cen Sara Sarhangian, rn
2011 Nursing Annual Report 15
structural empowerment
California and Professional Organization Positions and Memberships (cont.)
Oncology Nursing Society Members
Statewide Awards & Recognition
Association of California Nurse Leaders Best Practice – Clinical Nursing
Carol Glenn, bsn, rn, cwocn Best Practice-Education
Heidi Traxler, msn, rn
Catholic Health Care Leadership Life Time Achievement award (finalist)
Kathy Harren, mha, rn
NurseWeek/Nursing Spectrum, Nursing Excellence Finalist - Community Service
Rita Wadhwani, msn, cns, rn
Sameena Adamjee, rn, ocn Kerry Blazevich, rn Eleanore Bley, rn Maria Britton, rn Christine Canceran, rn, ocn Julia Farfan, rn Luningning Floresca, rn Visesh Mohan, rn Casey Vastano, rn, ocn Ellen Gorbunoff, msn, rn-bc
Association of California Nurse Leaders, Nurse Leadership Development Team Chair Patti Hamaguchi, msn, rn
Association of California Nurse Leaders, Voice of Nurse Leadership Team Geri Harmon, bs, rn, cde
Association of California Nurse Leaders American Association of Diabetes Educators Coastal Area of Southern California Diabetes Educators Association, President Advisor & Board Member Kathy Harren, mha, rn
CALNOC Board of Directors Founding member California Hospital Assessment and Reporting Taskforce (CHART) Board member California Institute for Nursing and Health Care (CINHC): Board member California Action Coalition (CAC) IOM Future of Nursing Council member Association of California Nurse Leaders (ACNL) Health Policy Committee member Derlyn Hudson, msn, rn, cde
American Association of Diabetes Educators Coastal Area of Southern California Diabetes Educators Association - Secretary Coastal Area of Southern California Diabetes Educators Association Board Member
16 Providence Little Company of Mary Medical Center Torrance
Maria Sibal, bsn, rn-bc, cde, ocn
American Association of Diabetes Educators Coastal Area of Southern California Diabetes Educators Association Carol Sukimoto, adn, rn
California Society for Cardiac Rehabilitation (CSCR), Executive Board member and Education & Research Chair. California Society for Pulmonary Rehabilitation (CSPR) American Association of Cardiovascular and Pulmonary Rehabilitation. Heidi Traxler, msn, rn
Association of California Nurse Leaders Society for Simulation in Healthcare International Nursing Association for Clinical Simulation and Learning California Statewide Simulation Alliance Steering Committee California Simulation Alliance Research Committee Southern California Simulation Collaborative Operating Committee Southern California Simulation Collaborative (SCSC) Co-chair Lindsey Yuen, msn, np, rn
American Academy of Nurse Practitioners American Nurses Association Sue Revero, msn, rn, ccrn
Association of California Nurse Leaders, Voice of Nursing Leadership Team Association of Critical Care Nurses California Institute for Nursing and Health Care, Centralized Clinical Placement System Advisory Board
structural empowerment
Excellence Through Certification Certified Nurses contribute to better patient outcomes through national board certification in their specialty. Certification affirms advanced knowledge, skill, and practice to meet the challenges of modern nursing. Sara Abuddyhea, acm Sameena Adamjee, ocn Cindy Allen, ccm Lisa Amour, cohn Emily Anderson, ccrn Nino Arlene, cen, cpen Nicole Artiano, cmsrn Marianne Ayala, chpn Jeong (Lori) Bang, pccn Shannon Bell, cnor Lori Bishoff, rnc-nic Mary Jo Bongard, ccm Alison Bonk, ocn Rachel Bruce-Carothers, ccrn Jean Bunten, cgrn Erin Cameron, cen Anke Campanella, cphq Christine Canceran, ocn Dee Dee Chaiweerathai, ccrn Maria Chan, ccrn Ludy Chang, cmsrn Ni-Wei Chu, cnm Raeann Colburn, rnc-ob Christine Constable, cnor Ginaya Crooks, ccrn Maryjane Dacanay, cmsrn Jean Dahdah, rnc-nic Emma Delacerna, acm Lori Delgado, rnc-nic Aldrin Delos Santos, cmsrn June Delrosario, ccrn
Sheri DeMaagd, cen Kathy Demar, ccrn Valerie Deverman, rnc-nic Claudette Dorsey, cnor Diane Dragotto, cnor
Bonnie Kerber-Louvet, cen Michelle Kershaw, ccrn Madonna Kielty, rnc-nic
Victoria Pniel, rnc-nic Melissa Punnoose, rn-bc
Maria Eclevia, cmsrn
Jane Lindner, rnc-nic Ellen Liu, ccrn April Marones, rnc-mnn, ibclc Joanne Masalle, phn Linda Mason, rnc-ob Melanie Marriott, cen Sher Mc Gann, cohn Lynette McCoy, rnc-nic Cindy McDonald, cnor Joan McIntosh, cphq Susan Medlicott, rn-c Toni Meek, rnc-ob Michael Mizuta, ccrn Bethany Mota, pccn Marc Motio, cmsrn
Sue Revero, ccrn Jessica Rivas, cenp
Marie Fischer, rnc-nic, ne-bc Teri Fox, rnc-nic Caroline Gallego, rnc-ob Carol Glenn, cwon Mila Glodoveza, ccrn Ellen Gorbunoff, bc Joan Gahan, rnc-ob Hilary Gray, rnc-nic, rnc mnb Paula Grimaud, rnc-ob, cnm Jodi Hadden, ccrn Geri Harmon, cde Sue Herbert, rn-c Jennifer Herz, ccrn Arlene Howe, cnor Debbie Harder, rnc-peds Debbie Hudson, rnc-peds Derlyn Hudson, cde Marie Hynes, ccrn Ruth Jeffery, cen Sally Jenkins, rnc-nic Michael Jongsma, ne bc Rebecca Keeton, rncMae Keltner, cohn-s, cm
Catrice Nakamura, ccrn Rose Navarro, csc, cmc, ccrn Gloria Noell, ccm, hcqm, cpum, cmac Eden Oblepias, rn, ccrn Gem Oca, ccrn Mary Olszweski, cpan Michelle Owens, rnc-nic Nicha Panich, rnc-nic Kim Patel, ccrn Jeanna Peshl-Amaro, cpan Fereshteh Pirayesh, cnm
Stacy Quintana, ccrn
Emma Schwab, cnor Cecile (Maria) Sibal, ocn, cde Jillian Schiesser, ccrn Jodie Senter, rnc-ic Nancy Skifstrom, cgrn Kathy Sliff, ccrn Marilyn Cejka Steinberg, rn-bc, nnp-bc Audrey Stempel, rnc-ob, rnc mnn Lilia Stephenson, rnc-ob, np Ellie Tamargo, ccrn Iris Tamashiro, rnc-ob, np Yani Thomas, ccrn Casey Vastano, ocn Lety Vega, cmsrn Corazon Villacarlos, rnc-mnn Rita Wadhwani, rnc-nic Julie Walker, rnc-nic Cathy Wassenberg, rn-c Nicole Weber, rnc-mnn Mary Black Williams, rnc-ob, fnp-bc Carol Yokoyama, rnc-nic Sue Yoon, ccrn
2011 Nursing Annual Report 17
structural empowerment
Honoring Our DAISY Nurses The DAISY Award is a nationwide program that celebrates the extraordinary clinical skills and compassionate care given by nurses. A DAISY Nurse is one who always goes above and beyond, is sensitive to patients’ needs, is positive and professional, listens not only with his or her ears but with his or her heart as well. The DAISY award was developed by the Daisy Foundation, which was formed in 2000 by the family of J. Patrick Barnes who died at age 33 of complications of Idiopathic Thrombocytopenic Purpura (ITP), an auto-immune disease. DAISY gets its name from the acronym for Diseases Attacking the Immune System and was created by Tena Barnes, the patient’s widow and co-founder of the DAISY Foundation. Providence Little Company of Mary Medical Center Torrance is proud to be a DAISY Award Hospital Partner recognizing one of our nurses with this special honor every quarter. Patients, nurses, physicians, visitors and employees can nominate that very special and deserving nurse.
Daisy Honoree 1st Quarter 2011
Debbie Nowak, RN - First Surgical Debbie goes the extra mile for her patients. For instance, she cared for a patient who was in medical, social and spiritual crisis. She spent a lot of time sitting bedside and listening to the patient and would go and purchase flowers for this patient to encourage her. Each day, Debbie goes above and beyond her call of duty treating her patients as if they are her family. She is an example of a truly compassionate, caring and committed nurse.
Daisy Honoree 2nd Quarter 2011
”
Annie Flores, RN - Angio Recovery Annie exhibits compassion and outstanding daily care for patients and their families and serves as a role model. For instance, the husband of an Angiocenter nurse was suddenly stricken with Acute Myeloid Leukemia (AML). The nurse and her husband had two small children. During her off hours, Annie drove the family to the hospital, provided emotional support and comforted them while the husband underwent treatment. During the treatments, Annie never left the side her co-worker; she prayed with her and provided food, financial help, safety, childcare, emotional and spiritual support. In addition to helping this co-worker and her family, Annie has also helped many families who have come to PLCMMCT including a teenager from the Philippines who had a heart problem. Annie stands out in her quiet compassionate nature and demonstrates compassion every day.
18 Providence Little Company of Mary Medical Center Torrance
structural empowerment
Daisy Honoree 3rd Quarter 2011
Ketty Scaroni, RN Women’s Health Ketty is a PM charge nurse who is always upbeat and encouraging to her team. One night she heard that a patient’s baby was not doing well in NICU and went to pray for the baby. Days later we received news from the mom that the baby was doing better. The patient was very grateful for Ketty’s extra touch. This is just one example of how Ketty goes above and beyond every night she works. When the hospital is busy, Ketty is the peace in the midst of the storm. Her famous words are, “It’s OK, we can do it.” She is never upset, negative or discouraging and is a walking example of all of our core values.
Daisy Honoree 4th Quarter 2011
Claudia Olvera Lopez Claudia goes over and beyond with all of her patients. She is extremely passionate in her care for all of the hospice patients. For instance, we had a very young gentleman who was at TCU for end-of-life care. She took excellent care of him and provided compassionate care and support to his 21-year-old daughter and wife. She took extra time to explain to the daughter what was happening and reassured her that her father was no longer suffering. Claudia is an excellent RN and cares for patients like they are family.
Runner Up 4th Quarter
3rd Quarter
2nd Quarter
1st Quarter
1st runner up: Tammy Majik, 4th Medical Cardiology 2nd runner up: Rosely Werner, AOU 3rd runner up: Juliet Phillips, 1st Surgical
1st runner up: Jen Tran, AOU 2nd runner up: Gina Scachetti, AOU 3rd runner up: Gary Carnes, AOU
1st runner up: Wendy Pestano, Endoscopy 2nd runner up: Christine Canceran, 4th Med Oncology 3rd runner up: Debbie Harder, Pediatrics
1st runner up: Rea Ricafort, AOU 2nd runner up: Joan Tierney, SDS 3rd runner up: Tammy Majik, 4th Med-Card
2011 Nursing Annual Report 19
structural empowerment
Living Our Mission Our Nurse Volunteers Making a Positive Impact Jo Birdsong, RN (ED)
Humanitarianism missions to Haiti in January and July 2011 Darcie Bohl BSN, RN
Gaitors Walking Club Connie Chung RN (PACU)
PLCMMCT Simulation Program
Medical supply donation to clinic in India. Cynthia Rohrer ADN, RN
Gaitors Walking Club
Leona Sandrik, RN (4th Med Card)
Torrance Mission Health Center Medical mission with her church to rural China.
Venice Family Clinic in Santa Monica
Valerie Deverman, NICU RN
Gaitors Walking Club Speaker at one event for 2011.
No One Dies Alone” (NODA) TrinityCare Hospice
Carol Sukimoto ADN, RN
Geri Harmon, BSN,RN,CDE
Speaker: Type 2 Diabetes: Basics and Beyond community lecture, March/April 2011 Speaker: Teledyne Diabetes lecture, May 2011 Speaker: Diabetes Awareness Day, November 2011 Diabetes screening and Speaker for community lecture, November 2011 Yvonne Hashimoto BSN, RN
Teaches CPR for friends and family, community classes. Derlyn Hudson, MSN, RN (CDE)
Speaker: Cardiopulmonary Diabetes community lecture, February 2011 Ambassador for African American Initiatives in the Los Angeles Area Maria Liwanag (Victoria) RN (PACU)
Global Community Outreach: Medical mission to the Philippines. Bonnie Louvet, RN (ED)
No One Dies Alone (NODA), St Lawrence Martyr Church Community High School volunteer/fund-raising
As People of Providence, we reveal God’s love for all, especially the poor and vulnerable, through our compassionate service. 20 Providence Little Company of Mary Medical Center Torrance
Breast Cancer Awareness Fair: Leah Glavan, RN, worked with a local Girl Scout to help her earn her Gold Award and provide education to women about breast cancer. The Girl Scout wanted to hold a Breast Cancer Awareness Fair at the scout center in honor of her grandfather whom she had lost to stomach cancer a few year prior and went to Leah for help. Working with the Providence Women's Imaging Center, the Girl Scout received fun and educational materials to hand out. Leah attended the event to support the scout, passing out Advance Directive information and provided information about the form. The event was educational and helped everyone learn while demonstrating that the nurses at PLCMMCT not only give during their work hours but also after hours to help the community. Leah Glavan, RN (1st Surgical)
structural empowerment
Relay for Life in 2011: Approximately 60 PLCMMCT employees attended the Relay for Life including 40 medical oncology nurses. The local event requires participants to walk for 24-hours at a nearby park. Together with millions of others across the globe, PLCMMCT nurses participated in a life-changing event that helps communities celebrate the lives of people who have battled cancer, remember loved ones lost, and fight back against the disease. PLCMMCT employees, including medical oncology nurses
Manhattan Beach Hometown Fair 5K Race: PLCMMCT nurses helped out at the annual Manhattan Beach Hometown Fair 5K race. In 2011, three RNs, two techs and Dr. Baldridge from the ER, set up a “mini ER” at the finish line to provide wound care, start IVs for those requiring rehydration, and offered moral support to participants. As appropriate, the team sent them to PLCMMT for additional care if required. Chris Farnham, RN (ED) and other ED nurses
2011 Nursing Annual Report 21
structural empowerment
Nursing Profession to be Honored at Rose Parade For the first time in its history, the 2013 Rose Parade will feature a float recognizing nurses and the nursing profession. In honor of the nurses at Providence Little Company of Mary Medical Center Torrance (PLCMMCT), funds are being raised to support this float. An initial contribution was made in the nurses of PLCMMCT. To continue to support the nursing float, PLCMMCT nurses sold baskets created by nurses from each unit. The baskets were then displayed and sold, raising more than $3,000 for the Rose Parade Nurses Float. The check was handed over at an event attended by four Tournament of Roses Committee members, more than 150 nurses, countless employees and executive leaders.
22 Providence Little Company of Mary Medical Center Torrance
Our Journey to
Exemplary Professional Practice The Patient- and Family-Centered Care Professional Practice Model is aligned with our nursing mission, vision and values which sets the professional standards for all nurses. The five components of this model are compassion, communication, collaboration, professional advancement and quality care. These are the components of our practice which we use every day in caring for our patients and their families.
“Providence Nurses are here to give you and your family a helping hand.�
ENT
ARE
PAT I E
DC
NT
RE
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.
M
FU
N
H LT
Nursing Vision
I LY FA M - C E N T D E N
HEA
Through collaboration, excellence and innovation, Providence Little Company of Mary Medical Center Torrance nurses embrace life-long learning, respect diversity and make visible a compassionate and healing presence for each patient and family in our care.
A
Nursing Mission
LC
A RIN G E N V
IR
O
Nursing Values Making a Difference Quality Compassion Caring Advocacy
Our Nursing Professional Practice Model 2011 Nursing Annual Report 23
exemplary professional practice
Satisfaction Survey In 2011, 99% of our 511 direct care provider nurses took the national NDNQI (National Database of Nursing Quality Indicators) RN satisfaction survey. We used the Practice of Environment Scale survey tool, which reflected the voice of nursing on priority areas that impact their practices.
The profile of those who responded were:
94% Female 42 years in average age 54% practiced nursing for more than 10 years 43% Associate degree 48% Baccalaureate degree 5% Master’s degree and higher 15% nurses with national certifications
Key findings: National Benchmark
PLCMMCT Score
Nurse Participation in Hospital Affairs
2.84
2.86
Nursing Foundations for Quality of Care
3.08
3.05
Collegial Nurse-Physician Relationship
2.94
2.87
Survey Categories
Staff Level Adjusted Shift to Shift
Our Strengths
4.2
Improvement of quality of care:
4.1
Nurses agreed that staffing level adjustments are done appropriately shift-to-shift Nurses received adequate orientation (outperform the national average)
4.06 4.05
3.95
Mean Change Over Past Year 0.37
PLCMMCT
National
Magnet
Orientation Adequacy 4.96
0.37
4.94
0.36 0.35
4.94 4.92
4.92
0.34
4.9
0.33
4.88
0.32
0.31
0.31
0.31
0.3
4.87
4.86 4.84
0.29 0.28
4.02
4
3.9
0.38
4.18
4.15
4.82
PLCMMCT
National
Magnet
24 Providence Little Company of Mary Medical Center Torrance
PLCMMCT
National
Magnet
exemplary professional practice
Together We Achieve Higher Standards Inpatient
In 2011, our Ministry initiated a plan to improve Patient Experience/Patient Satisfaction including the formation of an HCAPS steering committee to focus on results. By the end of 2011, PLCMMCT outperformed more than 50 percent of the hospitals across the country on two of the eight HCAHPS measures. Our effort to improve Patient Experience/Patient Satisfaction continues in 2012 with the adoption of standard work for key nursing communication pieces like white boards, bed shift hand-off and hourly rounding. In addition PLCMMCT will continue to strengthen how nurses and others show more gratitude to employees and for nurse leaders to round on patients and their direct reports to strengthen patient care and nurse accountability. Some Highlights for our Inpatient Team’s Accomplishments:
Rate the Hospital: 72% Communication with Nurses: 75% 4th quarter improvements: o Rate the Hospital: 78% o Communication with Nurses: 79% o Hospital Environment: 63% o Discharge Information: 85% 2011 Trends for Inpatient
Emergency Department
Our emergency team has one of the highest volumes in Providence and their mean score is 59%, demonstrating that a majority of patients rate ED care as very good. The graph below depicts part of the 2011 and the 2012 overall rating score as of March 2012.
2011 Nursing Annual Report 25
Our Journey to
New Knowledge, Innovations and Improvement
Assess Link Synthesize Design Implement & Evaluate Integrate & Maintain Assess need for change in practice
Link problem, intervention and outcomes
Synthesize best evidence
Design practice change
Implement and Evaluate change in practice
Integrate and Maintain change in practice
• Include stakeholders (individuals or groups affected by change).
• Use standardized language based on Nursing Classification Systems (ex: NANDA).
• Search for best-evidence through a literature review.
• Define proposed change.
• Pilot study demonstration
• Identify needed resources.
• Evaluate process and outcome.
• Communicate recommended change to stakeholders.
• Plan implementation process.
• Decide to adapt, adopt, or reject practice change.
• Collect internal data about current practice. • Compare internal data with external data.
• Identify potential interventions and activities. • Select outcomes indicators.
• Critique and weigh evidence. • Synthesize best-evidence. • Assess feasibility, benefits and risk.
• Define outcomes
• Present staff in-service education on change in practice. • Integrate into standards of practice. • Monitor process and outcomes.
Our Conceptual Model for Translating Nursing Evidence into Clincal Practice Rosswurm & Larrabee Model 26 Providence Little Company of Mary Medical Center Torrance
new knowledge, innovations and improvement
The Schneider Institute for Nursing Simulation Program (ISAQS) (Unihealth Grant funding):
Training of faculty at Center for Advanced Perinatal Education at Stanford University Dinner and simulation demo for administration, physician leaders and other key leaders to introduce simulation and ISAQS Held 20 ISAQS sessions in ED and Periop areas About 200 RNs, techs, and RTs attended 41 MDs attended Metrics: Decrease sepsis mortality in the ED by increased utilization of the Severe Sepsis protocol (11.1% reduction) Increased utilization of the WHO Surgical Safety checklist in the OR (in the OR consistently 100% except for one month) ISAQS practice changes
Sepsis order set, the abxs should be listed in order of priority Suggestion to put laminated copy of the sepsis orders at the bedside in ED Since there is only one Broselow laryngoscope handle, we should have fresh batteries stocked right next to the handle in the top drawer Removed pediatric intubation tray that sat on top of Broselow cart Need laminated color coded pediatric broselow guide put in chart for pediatric patients coming straight up from surgery. ED notify peds for emergency admits and peds RN brings laminated broselow sheet to OR. Laminated code blue phone number in each OR Simulation to Advance Quality and Safety (SAQS):
WH SAQS focused on Pre-eclampsia and an OR scenario focused on the WHO surgical safety checklist and disruptive behavior.
The Nursing Institute encompasses programs and support systems to enhance the quality of nursing practice that will grow and advance our nursing workforce. Our goal is to consistently attract and retain dynamic, committed nurses to give great patient care in the is exciting, thriving workplace.
Our Vision Statement
To inspire men and women to excel in both the art and science of nursing with compassion, commitment, and the spirit of inquiry.
Project Smartie:
2 new grad programs NODA
28 volunteers attended NODA training in the simlab TCC/TCU
Simulation Skills Training - All of the RNs from TCC/ TCU attended and focused on IV starts, CL dressing changes, blood cultures and the hospira pump.
2011 Nursing Annual Report 27
New Knowledge, innovations and improvement
Transforming Care Through EvidenceBased Practice and Technology
Evidence-Based Practice Professional Health Care Providers at PLCMMCT searched the EBSCO Research Database over 2,500 times in 2011 ensuring that the care delivered reflected the latest clinical guidelines. In addition, the team used 1,700 research articles, including 120 Cochrane Systematic reviews, the highest level of research supporting clinical practice in patient care and reviewed an additional 750 clinical guidelines and patient education information articles.
Technology and Informatics ƒƒ California Advanced Medical Information System (CAMIS): Technology and Informatics Council members served as Core Trainers and as Super Users to promote a successful implementation on June 1, 2011. Collected input from staff post go live in regards to CAMIS concerns for submission to CAMIS Educator.
28 Providence Little Company of Mary Medical Center Torrance
Special Thanks to CAMIS Smart Team members: 1st Surgical: Letty Vega, Leah Glavan, and Lindsay Yuen; AOU: Rea Ricafort; 4th Med Card: John Flynn; 4th Med Onc/ Heritage: Sharon Aaron and Visesh Mohan; ICU: Stacy Quintana and Andrea Nordstrom; SDS: Andrea Reed; Education: Karen Walter; TCC: Joan McIntosh
new knowledge, innovations and improvement
Technology and Informatics Council members contributed to launching part one of KRONOS Workforce Manager. Council members also educated staff at Magnet Congress in regards to utilizing existing features of KRONOS.
Pyxis automated medication management system went live on 1st Surgical in December. Turnaround times for getting medications has greatly decreased.
2011 Nursing Annual Report 29
Our Journey to
Empirical Outcomes
Making a Profound Difference in Our Quality of Care 30 Providence Little Company of Mary Medical Center Torrance
empirical outcomes
Celebrating Outcomes Embracing Best Practice to Reduce Readmissions for Congestive Heart Failure In April 2010 we developed a heart failure program to reduce Congestive Heart Failure (CHF) readmissions using evidence-based information and recommendations from the Institute for Healthcare Improvement and American Heart Association. In 2011, we saw a 30% decrease in the rate of O/E readmissions within 30 days.
Healthy Heart Habits
How We Did It
We held regular CHF committee meetings that involved a CHF champion. As a result, our heart failure patients received education from admission to discharge by the bedside nurse and the heart failure navigator. We scheduled a physician appointment within seven days from discharge, as well as a home health RN visit. We provided each of our patients with a “Healthy Heart Habits” calendar and an action plan, a scale for those that could not afford it as well as a medication box and an education video to take home. Our heart failure navigator followed up with each patient to review education including diet, weight management, medication compliance, and reminded patients of their physician appointment. High-risk patients were called weekly for two months or until stable. If the patient was noncompliant or high risk, a case manager was assigned to follow the patient until they were stable. Core measure for Heart Failure has been 100% compliance for four quarters.
f i r s t
2.0 1.64
1.6 1.13
1.2 0.8
0.0
451 79 17.52% 20.79% 0.84 1.06
e d i t i o n
PLCMMCT CHF Readmission O/E - PHS Objective to Date
0.4
QSP YTD Thru Oct 2011 Cases Readmissions Readmission Rate Expected Readmission Rate CHF Readmission O/E 2011 CHF Readmission O/E Target
2011 Calendar
1.17 0.97
1.00
0.99 0.69 0.77
1.12 0.79
0.66
0.90 0.70
0.43
Jan - Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec YTD Dec Total 2010 O/E Ratio Target
2011 Nursing Annual Report 31
empirical outcomes
L&D, Mother/Baby
% Pain Assessments Conducted
L&D Pain Assessment 100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00
The L&D and Postpartum Unit-Based Council led by Raeann Colburn, RN, worked diligently to improve the assessment and reassessment of pain in patients with cesarean sections. They created a video to educate all staff on hourly rounding, white boards, and pain assessments. As a result pain assessments improved 20% from 80% in Q4 2010 to 96% in Q4 2011.
Q3'10
Q4'10
Q1'11
Q2'11
Q3'11
Q4'11
PLCMMCT 75.61
80.00
82.32
86.18
89.00
96.00
Improving Patient Hand-Off Communication
Breakdowns in patient ‘hand-off’ communication continue to be a leading cause of preventable patient harm. Hospital hand-offs occur upon admission, at shift changes, before and after procedures, at transfer and discharge. Evidence clearly demonstrates that hospital hand-offs are high-risk, high frequency events where critical information must be transferred completely and accurately with a narrow margin for error in an environment that, in many ways, either allows or promotes failure. In 2011, nursing leaders developed a customized handoff checklist to enhance the accuracy of each handoff. As a result hand-off communication improved in the following departments from Q4 2010 to Q4 2011: SDS RN-RN Handoff
ARU Cath Lab RN MD Handoff 100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00
%RN-RN Handoff Complete
% RN-MD Handoff Complete
Angio Recovery/Cath Lab RN to MD (prior to procedure) - remained the same at 100% Same Day Surgery RN to RN – 76% GI Lab RN to RN – 84% Recovery Room RN to RN – 100%
Q3'10 Q4'10 Q1'11 Q2'11 Q3'11 Q4'11 PLCMMCT 0.00 100.00 90.00 85.00 97.00 100.00
100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00
Q3'10 Q4'10 Q1'11 Q2'11 Q3'11 Q4'11 PLCMMCT 0.00 0.00 26.00 58.64 100.00 76.27
PARR RN-RN Handoff
Q3'10 Q4'10 Q1'11 Q2'11 Q3'11 Q4'11 PLCMMCT 0.00 0.00 83.00 57.00 54.00 84.00
32 Providence Little Company of Mary Medical Center Torrance
% RN-RN Handoff Complete
% RN-RN Handoff Complete
GI RN-RN Handoff 100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00
100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00
Q3'10 Q4'10 Q1'11 Q2'11 Q3'11 Q4'11 PLCMMCT 0.00 0.00 88.00 100.00 99.00 100.00
empirical outcomes
Emergency Department
% IVF Documented
ED Sepsis IV Fluid Doc'd 100.00 90.00 80.00 70.00 60.00 50.00 40.00 30.00 20.00 10.00 0.00
Timeliness and appropriate amount of IV fluids are key in reducing sepsis mortality. The ED RNs focus on improving IV fluid documentation showed a 58% increase from Q4 2010 to Q4 2011. This increased focus assisted in reducing sepsis OE (observed/expected) mortality from 1.11 YTD 2010 to 1.00 YTD 2011, a 10% reduction.
Q3'10
Q4'10
Q1'11
Q2'11
Q3'11
Q4'11
0.00
55.00
64.00
72.00
74.00
87.00
PLCMMCT
Preventing Patient Falls on the Rise
Fall rates decreased on the following units from Q4 2010 to Q4 2011: ICU – 26% 1st Surg – 70.8% 4MC – 7.3%
ICU Falls 1.60 Fall rate p/1000 pt. days
In addition to unit rounding for fall signs and bed alarms, Falls Council and nursing leadership meet each month to discuss continuous improvement. A pilot program called CareView sets up an invisible perimeter around a patient’s bed and will trigger an alarm to the nursing station if the patient breaks the invisible plane. CareView has had great success in other hospitals and we hope to capitalize on this innovative solution to prevent patient falls.
1.40 1.20 1.00 0.80 0.60 0.40 0.20 0.00 Q3'10
Q4'10
Q1'11
Q2'11
Q3'11
Q4'11
NDNQI Mean
1.45
1.43
1.41
1.36
1.38
1.37
CalNoc Mean
1.09
1.15
0.97
1.12
1.06
1.16
PLCMMCT
0.96
1.36
1.33
0.48
0.52
0.00
Q4'11
4MC Falls
1st Surg Falls Fall rate p/1000 pt. days
Fall rate p/1000 pt. days
3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00 NDNQI Mean
4.50 4.00 3.50 3.00 2.50 2.00 1.50 1.00 0.50 0.00
Q3'10
Q4'10
Q1'11
Q2'11
Q3'11
Q4'11
Q3'10
Q4'10
Q1'11
Q2'11
Q3'11
2.79
3.03
2.90
2.74
2.74
2.67
NDNQI Mean
4.01
4.09
3.90
3.86
3.99
3.85
3.19
3.29
3.19
3.05
3.14
3.11
1.37
2.33
3.64
2.74
4.03
2.16
CalNoc Mean
3.19
3.29
3.19
3.05
3.14
3.11
CalNoc Mean
PLCMMCT
1.98
2.33
1.66
2.31
2.48
0.68
PLCMMCT
2011 Nursing Annual Report 33
philanthropy and friends of nursing
Blessed Are the Givers At Providence Little Company of Mary, the words philanthropy and nursing have become permanent partners in advancing patient care. Motivated by the nursing shortage, Providence Little Company of Mary Foundation has developed deep relationships with individuals, foundations and corporations to help advance the life-giving work of nursing. Generous benefactors have supported registered nurses at all levels of professional practice with gifts of more than $8 million in the past five years. In 2005, George and Virginia “Ginnie” Schneider, exemplary partners in philanthropy, led the way with a $3 million endowment to create The George W. and Virginia Schneider Institute for Nursing. Within a year, the work of the Institute expanded to include Providence Little Company of Mary Medical Center San Pedro. The goal of the Institute was clear: “to inspire men and women to excel in the art and science of nursing with compassion, commitment and the spirit of inquiry.” What we didn’t realize at the time was just how much the Institute would inspire the generosity of others. In 2011, we recognized the incredible contributions of the Schneider family by awarding Ginnie with the 2011 Mary Potter Humanitarian Award. This award honors an individual who reflects the spirit of Venerable Mary Potter, Foundress of the Sisters of Little Company of Mary, through their professional and personal accomplishments. A life devoted to humanitarian concerns, making a visible and positive difference to humanity by nature of works, deeds, example and being are the qualities of Mary Potter recognized in the recipient of this award. Ginnie dedicated her time, personal talents and philanthropic support to Providence Little Company of Mary for over half a century, and is unparalleled in her efforts to make the Sisters’ vision of Catholic healthcare a reality in the South Bay. She was an active member of the Volunteer Auxiliary in Torrance, taking special care of the hospital’s gift shop until moving to Oregon in June 2011. She also served as a Eucharistic Minister, as well as a charter member of Mary Potter and Company, a social service and fund-raising group. It is with deep gratitude that we take this opportunity to thank George, Ginnie and all our generous Friends of Nursing for their compassion, commitment and leadership.
34 Providence Little Company of Mary Medical Center Torrance
The goal of The George W. and Virginia Schneider Institute was clear: to inspire men and women to excel in the art and science of nursing with compassion, commitment and the spirit of inquiry.
Thank You
Virginia “Ginnie” Schneider 2011 Nursing Annual Report 35
Providence Little Company of Mary Medical Center Torrance 4101 Torrance Boulevard Torrance, CA 90503 310-540-7676 www.providence.org/torrance