2013 Nursing Annual Report
Culture of Excellence
St. Francis Hospital
2013 Nursing Annual Report 1
Index
03 Message from the Senior VP, Patient Care Services, Chief Nursing Officer
Transformational Leadership 04 Tomorrow’s Nurse Leader Program 05 Cancer Institute / Infusion Unit 06 Electronic Medical Record - Epic 06 Nurse Practitioner Role in Pre Admission Testing 08 Transitions of Care 08 GSHMC Open Heart Surgery Program 09 Bariatric Surgery 09 Beacon Award for Nursing Excellence 10 Nurse-Led Strategies for Preventing Readmissions
Structural Empowerment 12 Medical Mission – Jamaica 13 Hospital Statistics 13 Registered Nurse Demographics 14 Certified Registered Nurses 16 National Professional Certification 16 Partner in Care 17 Promoting the Role of the Advanced Practice Nurse 18 Perioperative Nurse Liaison 19 Diabetic Nurse Champion Program 20 Palliative Care 21 Nurses Serving the Community
Exemplary Professional Practice 22 Stroke Care 23 Heart of Caring Nurse Excellence Awards 24 Our Commitment to Patient Satisfaction 24 RN Satisfaction 25 Six Sigma Project to Address Patient Turnaround 25 Care of Patients with Myocardial Infarction 26 Sepsis 27 Center for Advanced Cardiac Therapeutics 28 South Bay Cardiovascular 28 Skin Champions to Nurse Leaders 29 Arrhythmia and Electrophysiology Update 30 Performance Improvement – Perspectives on 2013
New Knowledge and Innovations 31 Improving Patient Safety Through Bedside Reporting 32 “MyChart” 33 Autologous Blood Reinfusion System 33 Care of the Sickle Cell Patient 34 Chemotherapy “Red Card” 35 Lifelong Learning and Certification 36 Clinical Trial: Transcatheter Aortic Valve Implantation 37 Endoscopic Ultrasound 37 Comparison Study of Blood Pressure and Arial Fibrillation 38 Presentations at National/Regional Conferences 39 Diagnosing Acute Coronary Syndrome: Do Women Wait Longer? Cover: Michael Ehrie, BSN, R.N., CEN; Eileen Kenney, MSN, R.N., ANP-C; Latoya Bucknor, BSN, R.N.; Ingrid Collimore, BSN, R.N.; Rosalia Francucci, BSN, R.N. CCRN, OCN; Rosauro Maray, BSN, R.N.; and Claire Greenblatt, BSN, R.N.
A Message from the Senior VP, Patient Care Services, Chief Nursing Officer
For all of us, 2013 has been an exciting year. This Nursing Annual Report provides the opportunity to highlight our major accomplishments and recognize our unique contributions. Our nurses are guided by the St. Francis Hospital Professional Nursing Practice Model, which ensures patient and family-centered care to achieve quality outcomes. This model also promotes a safe environment, and commendable service through exemplary professional practice, nursing care delivery, shared governance, and collaborative relationships. We practice in an environment where exceeding quality standards, balancing tight budgets, and providing the ideal patient experience are important, as well as responding to competitive challenges and providing service excellence. The world of health care is ever changing, but the expectation to improve quality with complete transparency is constant, as is the imperative to reduce health care costs even as the complexity of care increases. As a twice designated Magnet hospital two times in a row, our nursing
Ann Cella, MA, MEd, R.N., NEA-BC
staff has demonstrated our commitment to excellence through evidencebased practices. We constantly strive to be the best of the best and together we have earned many distinctions and awards: Francis was top-ranked on Long Island, and the only hospital to be na• A gold-level Beacon Award for Excellence to the MICU 2 and SICU
tionally ranked in any of the 12 data-driven adult specialties.
by the American Association of Critical-Care Nurses (AACN).
Over the past year we have accepted many challenges and made signifi-
• The American Heart Association/American Stroke Association’s Get
cant progress. Going forward, nursing at St. Francis will continue to focus
®
With The Guidelines -Stroke Gold Plus Quality Achievement Award as
on efficiency and coordinated care across the continuum for our patients.
well as the Get With The Guidelines®–Heart Failure Silver-Plus Quality
We will also focus on the clinical processes of care to improve outcomes
Achievement Award for implementing specific quality improvement
and provide the ideal patient experience. Internally, we will continue our
measures outlined by the AHA and American College of Cardiology Foun-
shared governance structure, provide a healthy and happy work environ-
dation secondary prevention guidelines for heart failure patients
ment, as well as reward and recognize the accomplishments of our nurses.
• For the fourth consecutive time, an ‘A’ on The Leapfrog Group’s na-
I am extremely proud of our nursing staff and very grateful to work
tional safety score that rated hospitals on the quality of their care.
alongside men and women who continuously and tirelessly provide exceptional care to our patients. They are the fabric of St. Francis Hospital,
In addition to these accolades, for the seventh consecutive year, St.
and they have my sincere thanks and admiration.
Francis was named one of the best hospitals in the nation by U.S. News &
I would also like to thank the entire St. Francis Hospital healthcare
World Report. St. Francis ranked among the top 10 hospitals in the coun-
team, particularly our remarkable medical staff. I would like to thank the
try for cardiology and heart surgery and we were also rated among the
St. Francis Hospital board and leadership for their guidance. I am also
best in the U.S. in seven other specialties: ear, nose and throat; gastroen-
thankful for the Sisters of Franciscan Missionaries of Mary and our
terology and GI surgery; geriatrics; neurology and neurosurgery; and for
Bishop, the Most Reverend William F. Murphy, for their prayers, compas-
the first time orthopedics; pulmonology; and urology. Once again, St.
sion, and inspiration.
St. Francis Hospital
2013 Nursing Annual Report 3
Transformational Leadership Tomorrow’s Nurse Leaders Program
“Excellence is not an exception, it is a prevailing attitude.” –Colin L. Powell
Erinn Strom, BSN, R.N., CMSRN, and Kristen Nunez, BSN, R.N., CMSRN
Professional nurses demonstrate the ability to be transformational leaders. Every day the professional nurse serves as a role model and team leader who engages in teamwork to create a healthy work environment. The professional nurse participates in shared decision making at St. Francis Hospital by participating in councils, committees and teams, and by their commitment to continuous lifelong learning for themselves and their patients. • Applying evidence-based practice
Ann Cella, MA, MEd, R.N., NEA-BC, founded the Tomorrow’s Nurse Leaders Program to provide an opportunity for nurses to journey into the
• Decision making and autonomy in the practice of nursing at St. Francis Hospital
field of nursing management and administration. A nurse can spend a day with one of the nurse managers, clinical experts, or nurse executives
Nursing is a dynamic profession in which nurses engage in various roles.
for a firsthand experience of the rewards and challenges of nursing lead-
At St. Francis, the professional nurse is positioned at the forefront of
ership. The program’s goals are to provide exposure to the structure and
expanded roles and career opportunities resulting from a dynamic health
processes of:
care environment. Beyond their role of providing care, nurses can emerge
• Human resource management
as leaders who represent their profession and advocate for nursing and the
• Fiduciary responsibility
hospital in excellence in care, patient safety and quality.
• Creating the ideal patient experience St. Francis Hospital
2013 Nursing Annual Report 4
The Cancer Institute at St. Francis Hospital/Infusion Unit “Do ordinary things extraordinarily well.” –Gregg Harris nizing their ability and potential to provide competent, skillful, and compassionate nursing care to cancer patients and their families. A dynamic team of nurse leaders: Ann Cella, MA, MEd, R.N., NEA-BC; Donna Rebelo, MSN, R.N., NE-BC; and nurse managers Leah Apil, BSN, R.N., and Eileen Dwyer, BSN, R.N.,OCN, in collaboration with Bhoomi Mehrotra, M.D., Director of Oncology and Director of the Cancer Institute, and Dilip Patel, M.D., Director of Malignant Hematology, established a consistent drive for excellence in a supportive and nurturing culture. Our remarkable infusion staff and oncology practice staff face many challenging patient care interactions—from diagnosis, complex treatment regimens, psychosocial counseling, and so much more. So why do we do it? Because we found meaning and purpose in what we do from a vision inspired by our leaders. It takes a committed, collaboraHeidi Bentos-Pereira, MSN, MBA, R.N., OCN; Charlotte Swain, CCP; Teresa Donaldson, BSN, R.N.; Dorothy Radovich, BSN, R.N., OCN; Helen Birdsong-Abate, BSN, R.N., CCRN, OCN; Marzanna Bendeth, AAS, R.N.; Adrian Wise, BSN, R.N.; Patricia Zant, BSN, R.N. OCN; and Eileen Dwyer, BSN, R.N., OCN
tive, and supportive team to learn from our patients, as well as adapt our practices, and challenge ourselves to exceed expectations. Our leaders are there every step of the way listening intently to our feedback and empowering us to make process changes that would improve
St. Francis Hospital, embarked on an exciting and groundbreaking venture by opening the new Cancer Institute, which includes a 14-bed/chair outpatient infusion unit. Transformational leaders at St. Francis recognized the trends in cancer care delivery systems including an increase in outpatient oncology services resulting from an aging population, increased cancer diagnosis, complex treatment regimens, technology and screening advancements, and cancer survivorship needs.
patient care including, but not limited to, scheduling improvements, creating a shot room to expedite turnaround time, and developing a “My Journey” binder to help guide patients through their care. This incredibly rewarding journey, the challenges we face, and the impact we make in the lives of our patients are all reflections of the team we have become because of the guidance, support, and mentorship we have received from our transformational leaders at St. Francis.
In alignment with our mission to be committed to excellence in caring for the body, mind and spirit of each patient we serve, and our strategic organizational goal of expanding oncology services, hospital leaders were risk takers when answering the demand for oncology outpatient services. The investment in our new Cancer Institute/Infusion Unit included not only the development of a physical space, but developing an oncology team as well. Transformational leadership played a vital role in the successful implementation of the Cancer Institute/Infusion Unit. A vision and a passionate plan inspired a motivated team, from diverse disciplines, to unite as dedicated oncology caregivers. St. Francis Hospital clinical nurses stepped up to the challenge of learning a new specialty, recogSt. Francis Hospital
Mary Perez, BSN, R.N. 2013 Nursing Annual Report 5
Transformational Leadership
Nurse Practitioner Role in Pre-Admission Testing
Electronic Medical Record - Epic In December of 2012, St. Francis Hospital, implemented Epic, an electronic medical record system (EMR). While the exceptional care provided to patients by St. Francis nurses has remained unchanged, the manner in which that care is documented has been transformed and modernized. With a great deal of preparation and education, St. Francis nurses have been able to incorporate this new technology into their nursing practice. All aspects of patient care are now electronic from admission to discharge and even beyond with the implementation of MyChart , a patient communication tool and the Epic solution to a patient portal. The Epic journey is far from over as opportunities for additional device integration are explored and the implementation for Optesia, the perioperative system of Epic, is under way. Additionally, Epic offers an inte-
Robin Friedberg, MSN, R.N., ANP-C; So Young Kim, MSN, R.N., ANP-C; and Karen Carini, MSN, R.N., FNP-C
grated suite of health care software including, clinical systems for physicians, nurses, emergency personnel, and other care providers; ancillary systems for laboratory technicians, pharmacists, and radiologists all implemented simultaneously. In 2014, it is expected more physician offices and South Bay Cardiovascular will be utilizing Epic. The system itself is dynamic and constantly evolving based on input from direct care clinical nurses who coordinate with an inter-professional Practice Optimization Committee to ensure that care is provided safely and efficiently by optimizing the use of the electronic medical record.
The observation of the multiple handoffs in Pre-Admission Testing (PAT) revealed a reiteration of data collection among the physician assistants, assistant nurse manager, clinical nurses, and patient educators. The redesign of PAT was an opportunity to improve efficiency and quality of the patient experience by streamlining the patient data collection, avoiding repetition of collected information and decreasing the number of handoffs among the PAT staff. The redesigned model led by nurse practitioners would decrease the number of handoffs as the nurse practitioner holds both a nurse practitioner and registered nurse license. The redesigned plan included replacing the physician assistants, clinical nurses, and patient educator with nurse practitioners. This decrease in the number of handoffs for the patient was accomplished by the nurse practitioners bundling and absorbing the responsibilities of the physician assistants, clinical nurses, and patient educator, thus avoiding the patient repetition of information, reducing throughput time and promoting a therapeutic relationship with one health care provider. Additionally, the redesign included one nurse practitioner coordinator to assume the administrative tasks, while performing the responsibilities of a nurse practitioner. Ann Cella, MA, MEd, R.N., NEA-BC, in collaboration with other nurse leaders, which included Diane Mamounis-Simmons, MS, R.N., NEA-BC,
Michelle Nesbith-Sykes, BSN, R.N.
CNOR, Director of Perioperative Services, and Kathleen Engber, MA, RN-BC, NE-BC, Director of Nursing Education and Clinical Informatics, guided the transition during this time of planned change. St. Francis Hospital
2013 Nursing Annual Report 6
Areas of focus for the nurse practitioners include: • Assessing patients and completing history and physicals. • Screening and assessing patients for psychosocial needs, fall risk, functional status, and nutritional needs. • Educating patients with regard to planned procedure or surgery and any necessary preparation for the procedure or surgery. • Ensuring there are no missing elements (diagnostic results, medical clearance, consents) prior to the day of surgery or procedure. • Ensuring clinical review of test results prior to day of surgery. • Identifying abnormal test results for early intervention. • Educating office staff in surgeons’ offices about pre-operative requirements and patient preparation. • Collaborating with key individuals in central scheduling and patient access department. Tanya Cherofsky, BSN, R.N.
Focused on Care
early interventions. The nurse practitioner led PAT service provides advanced
Patients are assessed and educated about a procedure or surgery by one nurse practitioner, providing better continuity of care. The same nurse practitioner who performed a history and physical and educated the patient is able to review the patient’s clinical results to ensure the patient is prepared for the procedure or surgery. When a patient is identified as having a high risk for falls or has functional or nutritional needs, the nurse practitioner plans the care based on the nursing assessment, thereby, providing the patient with
practice nurses with increased autonomy, accountability and control over the care provided and the environment in which nursing is practiced. The outcomes achieved through transforming access and processes for PAT include the following measures which demonstrate improved efficiencies within the pre-admission testing department: • Patient turnaround time • Patient satisfaction with the following measures: • Overall rating of pre-admission process • Wait time in pre-admission testing • Instructions/pre-admission testing/preparation for surgery Through the adoption of best practices, St. Francis Hospital progressed from “good” to “best” in those areas where opportunities for improvement have been identified.
Press Ganey Patient Satisfaction Mean Scores 100 95 90 85 80 75 70 Ann Cella, MA, MEd, R.N., NEA-BC; Kathleen Engber, MA, RN-BC, NE-BC; Kathleen Gilligan-Steiner, MA, R.N., NE-BC; Donna Rebelo, MS, R.N., NE-BC; and Diane Mamounis-Simmons, MS, R.N., NEA-BC, CNOR
St. Francis Hospital
65
13Q1
13Q2
13Q3
Info you rec’d prior to surgery
Overall rating pre-admit process
Waiting time in registration
Wait time PAT
2013 Nursing Annual Report 7
Transformational Leadership
Transitions of Care Research has demonstrated that focused attention makes a significant difference in enhanced quality and efficiency. Length of stay was significantly reduced when dedicated nurses cared for these patients. Cella understood that creating a designated unit for these patients would have many benefits. Creation of a CDU allows for expeditious evaluation of out-patients who are expected to require more than a 6-hour Emergency Department (ED) visit, but less than a 24-hour hospital stay. With Cella’s key input, it was determined that 10 beds on a medical surgical telemetry unit would be allocated for the CDU patients. Protocols for observation patients were developed and approved by the St. Francis Hospital Medical Executive Committee. The protocols included patients with chest pain, congestive heart failure, transient ischemic attack, syncope, and altered mental status. Order sets that are individualized for each patient were developed for the same diagnoses. Timothy O’Keefe, BSN, R.N.; Christine Pinto, AAS, R.N.; Natalyia Polishchuk, BSN, R.N.
As a participating and active member of the Short-Stay Admissions/RAC Work Group, Ann Cella, MA, MEd, R.N., NEA-BC, was able to influence the decision to create a Clinical Decision Unit (CDU). Early identification of patients for this level of care and assignment to outpatient status was crucial to this endeavor. The care managers are educated about observation status and are instrumental. in identifying these patients, communicating with and educating the physicians.
Cella recognized that the clinical nurses working in the CDU required advanced assessment and documentation skills. Nursing care provided to the CDU patient is consistent with ED outpatient care. Dedicated, knowledgeable clinical nurses are able to advocate for more timely testing and decision making through the development of procedures to expedite treatment. The 10-bed CDU is staffed with a 1:5 nurse/patient ratio, plus ancillary and support staff.
GSHMC Open-Heart Surgery Program Approximately two years ago, Catholic Health Services of Long Island initiated a move to extend St. Francis Hospital’s open-heart surgery program by bringing it to Good Samaritan Hospital Medical Center in order to provide Suffolk residents with cardiac care. Many executive planning meetings and work group sessions went into this interdisciplinary collaboration to extend St. Francis’ highly successful program to another location on Long Island. In addition to introducing the program to a new environment, there was considerable planning involving St. Francis’ inter-professional team, in-
Surgery and Director of the St. Francis Open-Heart Surgery Program. Policies were developed and a consensuses reached on clinical param-
cluding cardiothoracic surgeons, anesthesiologists, clinical nurses, physi-
eters and approaches to patient management for the open-heart pro-
cian assistants, nurse practitioners, and perfusionists. After receiving the
gram. Table top drills were also run to simulate the first case at GSHMC,
green light from the New York State Department of Health, open-heart
which was on January 21.
surgery began at Good Samaritan, in January of 2014, with Christopher
St. Francis and Good Samaritan are both Magnet-designated hospitals.
La Mendola, M.D., named Chairman, Department of the Cardiothoracic
“He who has health, has hope. And he who has hope, has everything.” –Benjamin Franklin St. Francis Hospital
2013 Nursing Annual Report 8
Bariatric Surgery operate exclusively via a single entry point through the navel. Surgeons create just one small opening rather than the five small incisions required for traditional laparoscopic surgery. The benefit for patients is less discomfort, faster recovery and a single scar that is hidden in the navel. Weight-loss surgery brings radical changes to an individual—both physically and psychologically—and it is important that patients are equipped with the tools needed to sustain their weight loss and live successfully in their communities. St. Francis’ support groups conducted by a multidisciplinary team (nutrition, bariatric clinical nurse and psychology) are offered monthly at the DeMatteis Center.
Beacon Award for Nursing Excellence
Laura Jean Bonventre, BSN, R.N.; Allison Festa, BSN, R.N., CMSRN; and Mary BradyCostello, BSN, R.N., CNOR
Within the healthcare system, bariatrics refers to the treatment of obesity and its associated conditions. The Centers for Disease Control and Prevention estimates that over one-third of Americans are obese, with an annual medical cost in excess of $150 billion. Bariatric surgery, which modifies the stomach or intestines to restrict the amount of food consumed, or the amount of calories and nutrients the body absorbs, has been performed for the past 50 years. However, it is only in the last 10 years that the number of surgeries has grown significantly, due in large part to the development of safer, less invasive procedures. Nonetheless, the procedures are not without risk, and St. Francis Hospital’s bariatric team carefully evaluates the risks and benefits for each patient. In 2013, an interdisciplinary team of surgeons, anesthesiologists, clinical nurses, mid level practitioners, respiratory therapists, clinical dieticians and pharmacists collaborated to implement a bariatric program according to the American Society of Metabolic and Bariatric Society guidelines to establish a center of excellence. This team of experienced and credentialed professionals is committed to helping patients improve their health. The surgical procedures currently performed at St. Francis are laparoscopic adjustable gastric (Lap Band), laparoscopic sleeve gastrectomy and laparoscopic gastric bypass. Additionally, surgeons at St. Francis now perform Lap Bands and sleeve gastrectomies using a technique known as single incision laparoscopic surgery (SILS).
Established in 2003, the Beacon Award for Nursing Excellence is a significant milestone on the path to exceptional patient care in a healthy work environment. The American Association of Critical Care Nurses (AACN) has awarded St. Francis Hospital the gold level Beacon Award for all three of our critical care units. The AACN has recognized 122 hospitals nationwide with the Beacon Award, among which 34 have received Beacon Gold. St. Francis Hospital accounts for three of those gold level Beacon Awards. The gold level Beacon Award for Nursing Excellence earned by St. Fran-
Single-incision Lap-Band and gastric sleeve gastrectomy are advanced minimally invasive approaches for weight loss surgery in which surgeons St. Francis Hospital
Carol Tambasco, MSN, R.N., OCN; Noelle Mastracovi, BSN, R.N.; Asha Phillips, BSN, R.N., CCRN; and Richard Curdo, BSN, R.N.
cis signifies excellent and sustained unit performance and patient outcomes. Our critical care units earned the gold award by meeting the
2013 Nursing Annual Report 9
Transformational Leadership
following evidence-based Beacon Award for Nursing Excellence criteria:
to work together to meet and exceed the high standards set forth by the
• Leadership Structures and Systems
Beacon Award for Nursing Excellence. Our dedicated professional nurses
• Appropriate Staffing and Staff Engagement
join other members of the exceptional community of nurses who set the
• Effective Communication, Knowledge Management, Learning
standard for optimal patient care. We recognize our nurses in stellar units whose consistent and system-
and Development, Best Practice • Evidence-Based Practice and Processes
atic approach to evidence-based practice optimizes quality patient out-
• Patient Outcomes
comes. Clinical nurses in our critical care units who have received
We applaud our Cardiothoracic Intensive Care Unit, our Medical Inten-
national recognition serve as role models to others in their journey to excellent patient care.
sive Care Unit, and our Surgical Intensive Care Unit in their commitment
Nurse-Led Strategies for Preventing Readmissions many departments including nursing, care management, social work, pharmacy, mid-level practitioners, food and nutrition, physical therapy, palliative care, home care, and medicine. In 2013 the PI team identified that reduction in heart failure readmission could be accomplished by developing a readmission prevention strategy including: • Assessment upon admission for risk of readmission and post acute care needs • Enhanced teaching and learning utilizing the Teach-Back method • Patient and family centered hand-off communication • Post acute care follow-up
Identifying patients at greatest risk for preventable readmission
Patricia Maddox, BSN, R.N., CCM; Elaine Halloran, BSN, R.N., CCM; and Veronica Kemmett-Shanahan, BSN, R.N.
Hospitals across the United States, from large academic centers to small community hospitals are focusing resources on strategies and methods to prevent patient readmissions. Heart failure is the leading cause of hospital readmissions within 30 days. St. Francis Hospital provides care to approximately 80 to 90 heart failure patients per month. Therefore, there is a tremendous opportunity to improve the quality of life for our patients and to prevent readmissions.
A “Hearts at Home” subcommittee was formed to research several tools and a decision was made to use a modified LACE Index Tool. The tool identifies and stratifies patients at risk for readmission. Nursing, food & nutrition, pharmacy and care management continue to educate patients to improve self-management and care managers assess patients for post acute care needs and refer patients for home care. However, it was identified that there is a need to ensure that the education and post acute care needs of these complex patients are met.
Implementing Heart Failure Patient Navigator Role Given that the patient navigator role has been used successfully in the care
The Performance Improvement Steering Committee, which Ann Cella, MA, MEd, R.N., NEA-BC, is a member, chartered the Heart Failure Read-
coordination of cancer patients, Halloran, suggested to the Heart Failure
mission Reduction Performance Improvement (PI) team. Cella appointed
Readmission Reduction PI team that heart failure patients would benefit
Elaine Halloran, BSN, R.N., CCM, Director of Care Management, as chairper-
from the role of a nurse as patient navigator. Veronica Kemmet-Shanahan,
son of this PI team. The team is comprised of clinical professionals from
BSN, R.N., Care Manager, participated in the development of the LACE tool
St. Francis Hospital
2013 Nursing Annual Report 10
and was enthusiastic about the use of the tool, the education of the heart failure patient and committed to ensuring the best possible transition plan for the patient. Kemmet-Shanahan was assigned the role of Heart Failure (HF) patient navigator. When a patient scores “moderate–high” or “high” on the modified LACE tool, the care manager refers the patient to the HF patient navigator. Upon referral, Kemmet-Shanahan meets with the patient and caregiver, assesses the educational needs of the patient and care giver, reinforces the education given and refers the patient to the appropriate clinician, such as, clinical dietitian or pharmacist. Kemmet-Shanahan assesses the patient for transition planning barriers and assists the unitbased care manager or social worker with the transition plan.
Patient Education Self-management is a key factor in heart failure patient’s health status and well-being. Education for patients with heart failure is offered in a variety of ways. Our patient education on demand video library offers five topics related to heart failure in both English and Spanish. The topics include
Jincy Joseph, BSN, R.N.
daily management, nutrition and exercise, medications and discharge. An
closely with the Center for Advanced Cardiac Therapeutics (CACT) and refer
educational booklet on “Managing Your Heart Failure” is provided and
patients for outpatient management. The CACT offers a comprehensive
reviewed by the clinical nurse or patient navigator with all heart failure
approach to the diagnosis and management of all stages of heart failure.
patients. Individualized information about the patient’s medications for HF
Physicians with specialized training work closely with an interdisciplinary
is also provided to each patient. The unit-based pharmacist is consulted
team to provide all-inclusive care to this high-risk patient population. The
on an as-needed basis.
team includes cardiologists, nurse practitioners, nurses, clinical dietitians, and ancillary staff, specially-trained in this subspecialty of cardiovascular
Strengthening Coordination of Care Across Multiple Settings
disease.
Heart failure patients are encouraged to accept home care services follow-
Enabling Safe Transition Home/Post Discharge Follow-up
ing discharge. Catholic Home Care enrolls the heart failure patient in the
An important element of the HF patient navigator’s role is the post dis-
Telehealth Program which provides daily electronic home monitoring of
charge follow-up with patients. Patients who have elected not to accept
vital signs, weight and symptoms. This allows the home care clinical
home care services receive a post discharge phone call from either Kem-
nurses to identify patient needs, detect changes in their condition, and fa-
met-Shanahan or the assistant nurse manager/charge nurse to ensure the
cilitate early intervention. Providing care in this manner not only enables
patient has a follow-up physician appointment, prescriptions are filled, diet
the home care clinical nurse to improve the quality of clinical and humanis-
instructions are understood and, to again, offer a home care referral. The
tic outcomes, but also empowers the patient to participate in the manage-
HF patient navigator also follows-up with the post acute care providers
ment of their own care, optimizing their quality of life and preventing
that partner with us in caring for these patients.
readmissions. Kemmet-Shanahan and the entire healthcare team work
“Excellence can be attained if you care more than others think is wise, risk more than others think is safe, dream more than others think is practical, and expect more than others think is possible.” –Author Unknown St. Francis Hospital
2013 Nursing Annual Report 11
Structural Empowerment Medical Mission - Jamaica
“Perfection is not attainable, but if we chase perfection we can catch excellence.” –Vince Lombardi Novlett Davis, MSN, R.N., ANP-C; Elise Aufiero, BSN, R.N.; Ava Forbes, MSN, R.N.; Heather Collins, BSN, R.N.; Anna Haugen, AAS, R.N., OCN
Novlett Davis, MSN, R.N., ANP-C, a nurse practitioner at St. Francis Hospital, established the Loretta, Jacqueline, Donald and Rohan (LJDR) Foundation, a non-profit organization created in the memory of her four siblings who died as a result of the lack of medical care in Jamaica, West Indies. The foundation’s mission is to provide free, invaluable, unbiased medical treatment to families who cannot afford health care in the northern area of Clarendon, Jamaica. In July 2013, Davis recruited a healthcare team – 75 percent of which were St. Francis Hospital staff and physicians, to participate in a medical mission to Jamaica. This healthcare team was comprised of two
diabetes, hypertension, stroke, and skin disorders. All expenses for the trip were generated through fundraising. The LJDR Foundation’s first medical mission was a huge success and the
physicians, six nurse practitioners, a pharmacist, a pharmacy student,
team returned to New York with a sense of accomplishment. The volun-
13 registered nurses, and several aides, techs, and support staff.
teers who participated in this mission said that being a part of this project
Under Davis’ leadership, a school in Jamaica was converted into a
was a life-changing experience. They returned to St. Francis and shared
clinic and the team was able to provide quality care to over 600 pa-
their experience with their peers and immediately began making plans for
tients in a four-day period. The volunteers performed numerous
a second medical mission. Several nurses have already expressed great
echocardiograms, electrocardiograms, and blood draws, while assess-
interest to participate in the next mission, tentatively set for July 2014. This
ments were performed and appropriate referrals were made. In addi-
experience touched the lives of those who participated in a great way, and
tion, walkers, wheelchairs, diapers, and medications were distributed
inspired many of them to become involved in other community outreach
and registered nurses held teaching sessions on topics such as
programs and volunteer opportunities.
St. Francis Hospital
2013 Nursing Annual Report 12
Registered Nurse Demographics
2013 St. Francis Hospital Statistics
Services to Patients
At St. Francis Hospital, there are 774 full-time registered nurses, 226
Operating Room Procedures (Including Cardiac Surgery) • Open-Heart Surgery • General Surgery • Ambulatory Surgery • Other Cardiothoracic Surgery
16,418 1,398 7,144 11,028 3,150
Cardiac Catheterization Patients • Inpatient Catheterizations • Outpatient Catheterizations • Coronary Interventions
10,276 4,389 3,008 2,879
Non-Invasive Cardiac Lab Procedures
part-time registered nurses, and 49 per diem register nurses. Of the direct care registered nurses, 84 percent have a bachelor’s degree in nursing or greater. The average number of years a registered nurse has worked at St. Francis is 12 years. Below is a breakdown of the average years of service:
Years of Service Range 0-5 years
340
14,312
6-10 years
230
Cardiac Rehabilitation Visits
59,656
11-15 years
149
Cardiac Arrhythmia Procedures • AICDs • Pacemakers • EP Studies
3,646 840 721 2,085
16-20 years
121
21-25 years
82
26-30 years
64
Patient Care Number of Beds (in service) Patient Admissions Days of Patient Care Average Patient Stay (Days) Bed Occupancy Rate Emergency Room Visits (Gross)
31-35 years
40
306 16,418 98,223 5.9 88% 23,167
36-40 years
21
41 or greater years
2
St. Francis Hospital
2013 Nursing Annual Report 13
Structural Empowerment
Certified Registered Nurses
Andrea Adler, R.N., CMC, PCCN Keri Affonso, R.N., CMSRN Stephanie Ajudua, R.N., CCRN Eileen Alessandro, R.N., FNP-C Karen Allen, R.N., CPAN Kathleen Anderson-Arnopp, R.N., CPHQ Roslynn Aquino, R.N., ANP-C Juliette Arrastia, R.N., CCRN Warlita Au, R.N., CCRN Regina Bakota, R.N., CMSRN Joana Balsamo, R.N., CMSRN Anna Baracchini, R.N., CPHQ Sandra Bastidias, R.N., CEN Cathleen Barthel, R.N., CCDS Julia Bebry, R.N., CMSRN Mary Bell, R.N., CCM Kara Benneche, R.N., CEN Maria Benner, R.N., CCRN, ANP-C, CPAN Heidi Bentos-Perira, R.N., OCN Christine Biesecker, R.N., CCRN Helen Birdsong-Abate, R.N., CCRN, OCN Kelly Bitran, R.N., FNP-C Suzanne Bove-Bast, RN-BC Erina Boyle, R.N., CCRN Mary Brady-Costello, R.N., CNOR Donna Brennan, R.N., CCDS Lori Brush, R.N., CCRN Angela Bryan, R.N., CMSRN Nicole Buscarino, R.N., CPAN Elizabeth Busi, R.N., CEN Laura Buszko, R.N., CMSRN Lara Caniano, R.N., CCRN Cesira Caparella, R.N., CCRN Evelyn Capriotti, R.N., CNOR Theresa Caputo, R.N., CMSRN Karen Carini, R.N., FNP-C Laurence Carlin, R.N., CCRN Rosario Carlin, R.N., CCRN, ANP-C Christine Carman, RN-BC Lenore Carroll, R.N., ANP-C
Mary Carroll, R.N., CNOR Patricia Carroll, R.N., CMSRN Valerie Castiglione, R.N., ANP-C Jennifer Cavallo, R.N., CMSRN Ann Cella, R.N., NEA-BC Tiffany Chaffee, RN-BC Debra Chalmers, R.N., ANP-C Minjuan Chen, R.N., CMSRN Dorothy Ciano, R.N., CCRN Danielle Cincinelli, R.N., ANP-C Camille Colletti, R.N., FNP-C Barbara Colligan, R.N., CMSRN Natalia Constantino, R.N., ANP-C Catherine Corcoran-Grey, R.N., CCM Laura Costa, R.N., CMSRN Lori Costello, R.N., CCM Elizabeth Cotter, RN-BC Rachel Cowan, R.N., CMSRN Valerie Cox, R.N., CCM Nicole Cregan, R.N., CCRN Ellen Cummings, R.N., CNOR Margaret Cunneen, R.N., OCN Rose Cuoco, RN-BC Novlet Davis, R.N., ANP-C Maryann DeFalco, R.N., ANP-C Melissa DelGiorno, R.N., CCRN Gwendolyn Del Valle, R.N., FNP-C Gina Depietro, R.N., CNOR John Depietro, R.N., ANP-C Melanie Diaz, R.N., ANP-C Girannie Dilchand, R.N., CNOR Elizabeth Divittorio, RN-BC Tara Donlon, R.N., CCRN Christine Dougherty, R.N., CCRN Theresa Drucker, R.N., CCRN Eileen Dwyer, R.N., OCN Michael Ehrie, R.N., CEN Kathleen Engber, RN-BC, NE-BC Cindy Espinosa, R.N., CMSRN Michelle Esposito, R.N., CCRN Virginia Fallon, R.N., CNOR St. Francis Hospital
Deborah Feil, R.N., CMSRN Eileen Felice, R.N., CCDS Catherine Feliciano, R.N., ANP-C Melissa Fengler, RN-BC, ANP-C Allison Festa, R.N., CMSRN Ann Fioresi, R.N., ANP-C Dawn Focazio, R.N., FNP-C Mitzi Forman, R.N., CCRN Mary Beth Forness, RN-BC Rosalia Francucci, R.N., CCRN, OCN Karen Freeman, R.N., CCRN Cynthia Freundlich, R.N., CPHQ Robbin Friedberg, R.N., ANP-C Maria Jose Fuschetto, R.N., ANP-C Mary Gallagher, R.N., CHFN Colleen Garr, R.N., CCRN Maureen Gaus, R.N., CPHQ Lesli Giglio, R.N., CPHRM Sharon Gilligan, R.N., CPAN Rosemary Gilligan-Holmes, R.N., CMSRN Kathleen Gilligan-Steiner, R.N., NE-BC Mary Jane Glander, R.N., CCRN Kathleen Gliganic, R.N., CCRN Kimberly Go, R.N., ANP-C Jennifer Gomez, R.N., CNOR Beth Ann Grady-Acker, R.N., CDE Jill Grimaldi, R.N., CCRN Lynn Grimaldi, R.N., PCCN Michelle Grippo, R.N., CEN Philomena Grossmann, R.N., CCRN Gisella Guichard, R.N., CCRN Susan Gunaydin, R.N., CMSRN Elizabeth Haag, R.N., CCRP Barbara Haberman, R.N., CAPA Eileen Hague, RN-BC Elaine Halloran, R.N., CCM Donna Handle, R.N., CNOR Deborah Harabedian, RN-BC Anna Haugen, R.N., OCN Anne Marie Helmke, R.N., CMSRN Patricia Hendershot, R.N., CMSRN, CHFN
2013 Nursing Annual Report 14
Marjorie Hermsted, R.N., CMSRN Arlene Hilado, R.N., CCRN Marianne Hill Day, R.N., CCRN Lauren Hills, R.N., CCM Donna Hobbs, R.N., CNOR Sherma Holder, R.N., FNP-C Sean Holland, R.N., CCRN Tina Hong, R.N., CCRN Holly Hynes-Morales, R.N., CNOR Joann Iaboni, R.N., CCM Jennifer Iniego, R.N., CMSRN Carol Insardi, R.N., CCDS Carla Intrabartola, R.N., CNOR Svetlana Iskhakova, R.N., ANP-C Lisa Jahrsdoerfer, R.N., CSC, CCRN Miriam Janov, R.N., CCRN Jennifer Jennings, R.N., CMSRN Alicia Johnson, RN-BC Antoinette Jordan, R.N., NE-BC Catherine Kaestel, R.N., CPAN Amanda Kassan, R.N., CCRN Katherine Katz, R.N., CNOR Patrice Keenan, R.N., CMSRN Patricia Keller, R.N., ANP-C Victoria Kelliher, R.N., CNOR Peter Kelly, R.N., ANP-C Eileen Kenney, R.N., ANP-C Maura Kenney-Kieran, R.N., ANP-C SoYoung Kim, R.N., ANP-C Maureen Korn, R.N., CMSRN Celeste Koske, R.N., CMSRN Patricia Krug, RN-BC Ildiko Kutasi, R.N., CMSRN Mary Ellen Lagnese, R.N., CPAN Karen Lamberti, R.N., CCM Patricia Lee, R.N., CCM Sherri Lee, R.N., ANP-C Young Joo Lee, R.N., CNOR Cheryl Liesau, R.N., CMSRN Louise Lindquist, R.N., CCRN Kathy Ann Lobmeyer, R.N., CNOR
Joan LoMonaco, R.N., CCDS Kathleen Lynch, R.N., CMSRN Patricia Maddux, R.N., CCM Susan Magro, R.N., ANP-C Diane Mamounis-Simmons, R.N., NEA-BC, CNOR Maranda Manieram-Arjune, R.N., ANP-C Rosauro Maray, R.N., CNOR Jamie Marcello, R.N., CCRN Judith Marcic, R.N., CCRN Erin Markey, R.N., ANP-C Jerrold Marshall, R.N., CCRN Princess Martinez-Bangay, R.N., ANP-C Barbara Martino, R.N., CCRN Mary Marvel, R.N., ACNP-C Jeanna Masano, R.N., ANP-C Pamela Mason, R.N., CEN Mary Mastrandrea, R.N., CCDS Karen Maul, R.N., CNOR Tara Mautner, R.N., CMSRN Catherine Maynard, R.N., FNP-C Andrea McCloy, R.N., FNP-C Mary Anne McCoy, R.N., ANP-C Kathleen McGarry, R.N., CNOR Jeannette McLaughlin, R.N., CCRP Mary McMahon, R.N., CMSRN Mary Anne McNamara, R.N., CPHQ Linda Mendick, R.N., CMSRN Jessica Mennella, RN-BC Geraldine Michel, R.N., ANP-C Kirsten Minerva, R.N., CCRN Donna Mohr, RN-BC Maureen Mondics, R.N., CNOR Cristina Moravec-Kossegi, R.N., CEN Dalia Mordekai, R.N., FNP-C Judith Morrison, RN-BC Kathleen Morrison, R.N., OCN Irene Moser, R.N., CNOR Michele Motekew, RN-BC Elaine Munoz, R.N., CNOR Kathy Muratore, R.N., ANP-C Deborah Murawski, R.N., CMSRN
Sr. Katherine Murphy, RN-BC, CCRN, CHPN, ANP-C Meghan Murray, R.N., CMSRN Christine Nelson, RN-BC Fanny Ngai, RN-BC Doris Nolan, R.N., ANP-C Kristen Nunez, R.N., CMSRN Michelle Obuchowski, R.N., CMSRN Margaret Ochotorena, R.N., NE-BC Karen O'Brien, R.N., CCRN, ANP-C Hannah O'Connor, R.N., CMSRN Patricia O'Connor, R.N., CCRN Lisa O'Hara, R.N., CCM Barbara O'Reilly, R.N., CMSRN Patricia O'Reilly, R.N., CCDS Ann O'Shea, R.N., CCRN Jillian Oswald, R.N., ANP-C Victoria Owens, R.N., CMSRN Roberta Palmeri, R.N., CMSRN Suzanne Palo, RN-BC Lorraine Panella, R.N., CCRN Mary Pavlounis, R.N., CCRN Meynaleen Pelaez, R.N., CMSRN Laura Penfold, R.N., CNOR, CAPA Kim Pensabene, R.N., CNOR Kathleen Peppard, R.N., CMSRN Barbara Petrosino, R.N., CCRN Casey Pettersen, R.N., CCRN Asha Phillips, R.N., CCRN Catherine Pirolo, R.N., NE-BC, CMSRN Judit Porter, R.N., CNOR Maureen Powers, R.N., CCRN Meredith Pujdak, R.N., CCRN Lorraine Quirk, R.N., FNP-C Dorothy Radovich, R.N., OCN Donna Ramharrack, R.N., ANP-C Margaret Raylman, R.N., CCRN Donna Rebelo, R.N., NE-BC Heather Rechtweg, R.N., CCRN Ruth Reed, R.N., CEN Sherry Reill, R.N., ANP-C Linda Reynolds, R.N., CCDS St. Francis Hospital
Christine Rice, R.N., CMSRN Elizabeth Ring, R.N., ANP-C Linda Rivenburg, R.N., CNOR Karline Rocha, RN-BC Eileen Roddy, R.N., CMCN Danielle Rodriguez, R.N., CMSRN Tara Rogan, R.N., NE-BC Geraldine Rohan, R.N., CCM Jeanmarie Roth, R.N., CCDS Sandra Roth, R.N., CCRN Allison Rudkin, R.N., CMSRN Danielle Ruggiero, R.N., CCRN Jennifer Ryan, R.N., CMSRN Kelley Ryan, R.N., CEN Yasmine Sacristan-Kramer, R.N., CCRN Anne Sanger-Conigliaro, R.N., CCRN Suzanne Sanidad, RN-BC, CMSRN Joseph Santarpia, R.N., ANP-C Lyn Santiago, R.N., CCRC Luisa Santos, R.N., ANP-C Michelle Sayson, R.N., CCRN Nonette Schafer, R.N., CCDS Linda Scharp, R.N., CCRN Michelle Schettino, R.N., CCRN Roberta Schieda, R.N., ANP-C Sonia Schwenk, R.N., CMSRN Youngmi Seo, RN-BC Anne Shea-Flynn, R.N., PCNA Janet Sica, R.N., CMSRN Dana Shapiro, RN-BC Jeannemarie Shore, R.N., CNOR Susan Siegel, R.N., CNOR Barbara Smith, RN-BC Dolores Smoot, R.N., CNOR Linda Sollecito, R.N., CCM Mary Lou Solliday, R.N., CIC Jacqueline Squicciarini, R.N., CCRN Elaine Stevens, R.N., NE-BC Katherine Stevko, R.N., ANP-C Theresa Strain, R.N., CCRN Carol Streppel, R.N., CMSRN
2013 Nursing Annual Report 15
Erinn Strom, R.N., CMSRN Cindy Sukhoo, R.N., CNOR Irene Sullivan, R.N., ANP-C Steve Sweeney, R.N., CNOR Carol Tambasco, R.N., OCN Lina Tan, R.N., CGRN Gail Taylor, R.N., CNOR Remedios Teston, R.N., CCRN Rebecca Tfelt, R.N., CNOR Rory Theobalt, R.N., CCDS Patricia Toolan, R.N., FNP-C Maureen Torpey, R.N., ANP-C, CCRN Allison Trevellini, R.N., CWOCN Patricia Trimboli, R.N., CCRN Amanda Tryon, R.N., CMSRN Sloan Vahldieck, R.N., ANP-C Nancy Van Nostrand, R.N., CMSRN Sheena Varghese, R.N., FNP-C Karen Venice, R.N., CCRN Cathy Vieira, R.N., CCM Doris Villagonzalo, R.N., CNOR Maria Vitsentzos, R.N., ANP-C Joan Wallace, R.N., CCRN Mary Walquist, R.N., CMSRN Noreen Walsh, R.N., OCN Bobby Jo Ward, R.N., CMSRN Linda Weiner, R.N., CCM, NE-BC Christine West, RN-BC Elizabeth White, R.N., CAPA Michelle Worrell, R.N., FNP-C Jenna Wrzec, RN-BC Marina Yusupova, R.N., CMSRN, CCRN, FNP-C Patricia Zant, R.N., OCN Carole Zarcone, R.N., ANP-C Dawn Zioba, RN-BC
Structural Empowerment
National Professional Certification Promoting National Professional Certification is an important part of St. Francis Hospital’s commitment to professional nursing development. As of April 2014, there are 321 nationally certified St. Francis registered nurses. St. Francis encourages, supports, and values a lifelong professional learning culture by providing assistance for nurses who obtain and maintain certification as evidenced by: • Reimbursement for the cost of the certification exam, when evidence
certification
of a passing grade is received and the certification is awarded
In 2013, 27 percent of eligible direct care registered nurses were
• Reimbursement of an annual stipend for maintaining the current
certified and 84 percent of the nurse leaders were certified.
Partner in Care stress environment of an Intensive Care Unit setting. This topic resonated with the St. Francis Hospital nurses, encouraged them to think differently about family participation and empowered them to develop a completely different approach to patients’ families and friends. The CTICU critical care nurses who attended the NTI exposition returned to St. Francis enthusiastic to share the ideas with their colleagues. At a CTICU staff meeting attended by Ann Cella, MA, MEd, R.N., NEA-BC, and Donna Rebelo, MS, R.N., NE-BC, AVP for nursing, the clinical nurses, who had attended NTI, shared their thoughts and ideas for involving the patient and family into a partnership in care. Linda Scharp, BSN, R.N., CCRN, articulated the concepts of partnering: the benefits for the patient and family by reducing anxiety and stress, the increased opportunity for patient and family education, the potential for increased patient satisfaction as well as staff satisfaction and the challenges the clinical nurse faces in incorporating these concepts into
Patricia O’Connor, AAS, R.N., CCRN, and Mary Jane Glander, MSN, R.N., CCRN
practice.
In May 2013, nurse managers, a clinical nurse specialist, and nine clinical nurses from the Cardio-Thoracic Intensive Care Unit (CTICU) attended the National Teaching Institute (NTI) & Critical Care Exposition in Boston. This five-day educational event was sponsored by the American Association of Critical Care Nurses (AACN) to showcase advanced evidence-based practice and nursing research for critical care nurses from across the country. The 2013 theme of the AACN was “Dare To…” and it challenged nurses to be innovative, empowered, autonomous, and creative, so that they could “dare to” change their practice and their practice environment. The selection of seminars and workshops available to all members over
Program Implementation Cella advocated for these ideas and encouraged and supported the clinical nurses to develop a pilot program for Partner in Care. Cella requested that the clinical nurses present the program at a monthly department head meeting to elicit support of the health care team. The CTICU nurses’ work group further developed the Partner in Care concept and how it would be implemented at St. Francis. Development of the concept was a challenging endeavor. A literature search was conducted to gather evidence-based practice that addressed patient and family involvement in care, bedside reporting that included the patient and family, and unrestricted visiting in the critical care setting. Decisions regarding the Partner in Care initiative and the role of the partner were made in consensus with the healthcare team and the CTICU clinical nurses. It was
the course of the five days was extraordinary. One seminar, “Facilitating
proposed that a Partner in Care be at least 18 years of age and be a family
Family-Centered Care Through the New AACN Practice Alert Guidelines”
member, spouse or domestic partner, sibling, child, or close friend. The key
focused on how to incorporate the patient and their family into the high-
is that the patient identifies the individual as the primary source of support.
St. Francis Hospital
2013 Nursing Annual Report 16
The patient may appoint an alternative Partner in Care in case the partner
• Acts as primary contact for the healthcare providers
is unavailable. The Partner in Care may or may not be the patient’s
Bedside reports include the patient and Partner in Care. The level of
healthcare proxy.
information providers share with the partner is previously determined
The Partner in Care:
by the patient. To protect the patient’s privacy, the Partner in Care acts
• Is provided with a badge and a security code so that information can be
as gatekeeper with regard to information provided to other family and
communicated via the phone
friends based on the patient’s preferences. The Partner in Care may
• Is considered a patient advocate who is an active member of the health-
also control the flow of visitors by informing other family members
care team
when the patient is not feeling well enough for visitors. The name and
• Is welcome to stay with the patient around the clock and may assist with
contact information of the Partner in Care is documented in the med-
the delivery of care
ical record. The Partner in Care pilot began in October 2013 in CTICU.
• Provides emotional support, comfort, and assistance to the patient
Based on the positive feedback from the CTICU nursing staff, the health-
• May accompany and support the patient during select tests and
care team and the patients and families the Partner in Care Program was
procedures
implemented hospital wide in December 2013.
Promoting the Role of the Advanced Practice Nurse Ann Cella, MA, MEd, R.N., NEA-BC, supported an open-heart surgery initiative at Good Samaritan Hospital Medical Center (GSHMC), a sister hospital within the Catholic Health Services of Long Island (CHSLI). St. Francis Hospital’s cardiac surgeons, perfusionists, cardiothoracic intensive care unit nurses, heart center operating room nurses, and midlevel practitioners were needed to provide care to these patients. The decision was made to staff the GSHMC Open-Heart Surgery program with experienced St. Francis employees only. This required the hiring and education of current employees to fill the vacancies at St. Francis. A total of 5.5 full-time equivalent (FTE) critical care MLPs were needed to safely staff the GSHMC program. Recruitment for experienced critical care MLPs became a challenge. Cella has always created and supported a culture of lifelong learning that promotes academic achievement and career advancement. Patrick
Michelle Worrell, MSN, R.N., FNP-C
As a result of increased demands for 24/7 coverage in critical care units, across the country, the role of mid-level practitioner (MLP) has increased. MLPs contribute to patient care management and other aspects of critical care, including quality of care and implementation of best practices. The MLPs are involved in rapid response calls and cardiac arrests. They perform many of the complex procedures that are required for
St. Francis Hospital
tants employed by St. Francis to participate in the education program. In the spirit of lifelong learning and career advancement, Cella asked Reynolds to inquire if Montefiore Medical Center would consider accepting nurse practitioner’s (NP) into their program. Montefiore, along with their academic affiliate, University Hospital of Albert Einstein College of Medicine, offers a unique six month residency program in cardiothoracic surgery and critical care for mid-level practitioners. After negotiations, Montefiore agreed and amended the contract to include nurse practitioners.
critical management. The Critical Care Physician- MLP model is a strong model that is recognized by the Society of Critical Care Medicine.
Reynolds, RPA-C, Director of MLP Services, recruited two physician assis-
Cella, Reynolds, and Donna Rebelo, MS, R.N., NE-BC, were successful in recruiting four NPs who were currently working in critical care and
2013 Nursing Annual Report 17
Structural Empowerment
Perioperative Nurse Liaison IMCU for the training program. These NPs enjoyed working at St. Francis and did not want to leave for NP positions at other institutions and had remained at St. Francis as direct care nurses in critical care. Each NP was endorsed for the program by the nurse managers of the critical care units and selected by Reynolds after interviews. Rosario Carlin, MSN, R.N., CCRN, ANP-C; Gwendolyn Del Valle, MSN, R.N., FNP-C; Marina Yusupova, MSN, R.N., CMSRN, CCRN, FNP-C; and Michelle Worrell, MSN, R.N., FNP-C, are the NPs who enrolled in the training. The program focuses on all aspects of the MLPs role including patient care, methods of communication, professionalism, and systembased practice. Individualized clinical experience offers the best means for success by supplementing acquired skills and knowledge with relevant critical care scenarios. The role development and career advancement of these NPs plays an important part in the success of the St. Francis Hospital Open Heart Surgery program at GSHMC. The NPs who were afforded this education are very grateful for the opportunity that St. Francis provided. The program provides career advancement for the NPs while remaining at the institution where they have enjoyed working.
“In separateness lies the world’s great misery, in compassion lies the world’s true strength.” –Buddha
Theresa Gilsenan, BSN, R.N.; Barbara Dumont, BSN, R.N.; and Karen Allen, BSN, R.N., CPAN
In the first quarter of 2013, Unit-Based Council members from the Post Anesthesia Care Unit (PACU) decided that one of their goals for the year would be the development and implementation of the Perioperative Nurse Liaison role. Council members felt strongly that the role would be extremely beneficial to patients and their families by decreasing their anxiety and keeping them well-informed on the day of surgery. Three key areas that the council members identified were defining the objectives of the role, outlining a job description, and delineating the criteria for applicants. Literature from peer-reviewed journals demonstrated that the Perioperative Nurse Liaison makes a significant contribution to the patient’s family during surgery, resulting in less anxiety and improved communication at all levels. Studies show that the provision of information, especially as it relates to the progress of the surgery, is of great importance to family members. Relatives who receive information about the patient, as well as psychological support from perioperative nurses, reported lower levels of anxiety and an increased ability to cope with stressful situations. Receiving concrete information regarding the surgery’s progress and the patient’s condition has been found to significantly contribute to the well-being of the family. The Perioperative Nurse Liaison role officially started at the begin-
St. Francis Hospital
2013 Nursing Annual Report 18
Diabetic Nurse Champion Program ning of the second quarter in 2013. A defined set of patients was needed to evaluate the effectiveness of the role. For the purposes of the pilot, the Perioperative Nurse Liaison concentrated on the ambulatory orthopedic patients. The importance of communicating with other members of the healthcare team before implementing a new program was recognized. A letter was sent to all of the orthopedic surgeons describing the new Perioperative Nurse Liaison pilot, and feedback from the surgeons was obtained. A daily tracking tool was developed to facilitate the Perioperative Nurse Liaison’s ability to track and interact with families and to provide effective hand-off communication to the assistant nurse manager or charge nurse.
Keeping Score Press Ganey Ambulatory Services scores were selected to measure the success of the Perioperative Nurse Liaison role. The goal of this initiative is to improve family members’ satisfaction by enabling them to be more involved in the patients’ care. This can be accomplished by keeping families informed about the progress of their family mem-
Sonia Schwenk, AAS, R.N., CMSRN; Tara Anne Rogan, MSN, R.N., NE-BC; Catherine Crews, BSN, R.N.; Barbara Martino, MSN, R.N., CCRN; Mary Anne McCoy, MSN, R.N., ANP-C; Nancy Van Nostrand, BSN, R.N., CMSRN; and Margaret Larigan, BSN, R.N.
ber’s surgery at regular intervals, facilitating visiting of the patients postoperatively in the PACU, and always being available by phone for family members to immediately address any concerns they might have. Success of the pilot would be measured by selected ambulatory surgery patient satisfaction scores, including information on the day of surgery, information given to the family, information about delays, overall rating of care, degree to which staff worked together, and likelihood of recommending. An increase in the mean score for the following patient satisfaction questions occurred: information given to family, overall rating of care, and information about delays, thus validating the success of the role.
Always striving for continued excellence, the Nursing Education Department, under the leadership of Ann Cella, MA, MEd, R.N., NEA-BC, collaborated with Lucille Hughes, MSN/ED, R.N., CDE, BC-ADM, FAADE, Director of Diabetes Services for Catholic Health Services, in May 2013 to expand and improve St. Francis Hospital’s clinical nurses’ knowledge of glycemic control in the diabetic patient. In order to initiate this educational improvement, Hughes met with Kathleen Engber, MA, RN-BC, NE-BC, Director of Clinical Education and Informatics, and Barbara Martino, MSN, R.N.,CCRN, Clinical Nurse Specialist, to discuss the development of a Diabetic Nurse Champion Program at St. Francis. With the program’s goal to decrease the readmission rate of the diabetic patient through utilization of the Diabetic Nurse Champions, diabetic education folders are distributed to each diabetic patient along with the SAFE (signs and symptoms of hypo and hyperglycemia, administration of oral hypoglycemic and insulin, finger stick education and emergency numbers and diabetic education center numbers) education brochure. Also included in the diabetic education folder are dietary handouts and a flyer providing information regarding our diabetic education centers.
Barbara Haberman, AAS, R.N., CAPA St. Francis Hospital
2013 Nursing Annual Report 19
Structural Empowerment
Palliative Care Clinical nurses who participated in the Diabetic Nurse Champion program are: Melissa Brancati, AAS, R.N.
2 East
Lynn Burke, AAS, R.N.
FP2
Deirdre Capozzolli, BSN, R.N.
Community Health
Catherine Crews, BSN, R.N.
Surgical Intensive Care Unit
Vanessa Deliso, BSN, R.N.
2 East
Stephanie Fortunato, BSN, R.N.
SICU
Danielle Kyrillidis, BSN, R.N.
Oncology Infusion Unit
Margaret Larigan, R.N.
Operating Room
Barbara Martino, MSN, R.N., CCRN
1 East (CNS)
Tara Mautner, BSN, R.N., CMSRN
2 East
Mary Anne McCoy, MSN, R.N., ANP-C
1 East
Erin Morrissey, BSN, MS, R.N.
Emergency Department
Danielle Rodriquez, BSN, R.N., CMSRN 2 West (ANM) Tara-Anne Rogan, MSN, R.N., NE-BC
FP2 (NM)
Sonia Schwenk, AAS, R.N., CMSRN
K2
Ruth Sorg, BSN, R.N.
Community Health
Jillian Oswald, MSN, R.N., ANP-C; Kimberly Go, MSN, R.N., ANP-C; and Kelly Bitran, MSN, R.N., FNP-C
Obstructive pulmonary disease, congestive heart failure, renal disease, cancer, and depression are all chronic illnesses that have individual defining characteristics. How these and other diseases manifest and how they respond to treatment is unique as each human being is unique.
Nancy Van Nostrand, BSN, R.N., CMSRN FP2 (ANM) Christinia Zachariah, BSN, R.N.
2 East
The role of the Diabetic Nurse Champion is to be the unit-based expert in diabetic management. The Diabetic Nurse Champion will facilitate unitbased education through posters, articles pertaining to diabetic management, and peer-to-peer sharing of knowledge on an as-needed basis. They will participate in performance improvement by creating a data collection tool to track and trend glycemic control, hypoglycemic events and hyperglycemic events. The Diabetic Nurse Champions plan to meet on a quarterly basis to discuss additional opportunities to expand the program and identify any potential areas that may need to be addressed.
Along with the implementation of medical management, palliative care nurse practitioners work together with the attending physician and prescribed treatment modalities. Palliative care consultations are time intensive, and focus on 'the person' and symptoms experienced in response to a clinical diagnosis. As palliative care approaches its first decade here at St. Francis Hospital, it has seen tremendous growth. Surprisingly, however, some people continue to wonder what is palliative care and if it is the same as hospice care?
“Wisdom, compassion, and courage are the three universally recognized moral qualities of men.” –Confucius
There is always palliative care in hospice care; however hospice care is for the person with a terminal prognosis. Palliative care has a wider breath and can span the lifetime of a patient living with chronic illness. Palliative care can be initiated during an acute or chronic illness exacerbation while medical management continues to be aggressive, or as a person approaches the end of their life and goals of care need to be redefined. A palliative care consultation includes physical assessments, evaluations of the emotional response to illness and prescribed treatments, identifying psychosocial concerns and unmet spiritual needs, initiating
St. Francis Hospital
2013 Nursing Annual Report 20
discussions about advanced directives and focusing on establishing
tification of individualized goals of care, a decrease in total ventilator
individualized goals of care. During a consultation the burden of symp-
days and in ALOS for patients when consulted upon within the first
toms that a person experiences is identified and treatments to im-
seven days of their admission. The decision to institute a palliative care program at St. Francis was
prove quality of life are initiated. The family meeting, an essential component to every consultation, optimally occurs on the very first
made by Ann Cella, MA, MEd, R.N., NEA-BC. The program began as a
day of consultation and multiple times thereafter.
pilot in 2005 and within the first year, its success was recognized and accepted by the St. Francis medical staff as a service that would be
The Annual Palliative Care Report boasts success of the Palliative Care program and attributes this success to the rise in palliative care
available to all patients at the Hospital. The program has continued to
referrals, a decrease in the burden of patients symptoms, timely iden-
grow in acceptance and in demand.
Nurses Serving the Community Serving the community has always been an important part of the mission of St. Francis Hospital. Community Outreach nurses provide screenings, health counseling, and lectures, and function as patient advocates. The role of the St. Francis community outreach nurse is diverse. Provision of high quality health care to the community has been possible due to the efforts of our Community Outreach staff. Here are some of the community programs and services provided by St. Francis Community Outreach nurses: Blood Pressure Screenings: Hypertension has been called the “silent killer” because a patient can have a blood pressure reading that is too high for many years, but not be aware of what his/her readings are, or of the silent damage that it may be doing to body organs and functions. St. Francis nurses provide blood pressure screenings and health counseling on a regular basis. Corporate Screenings/ Health Fair Participation: St. Francis Community Outreach nurses provide cardiovascular health screenings and information to local corporations. Lectures: Community lectures are provided at libraries, to seniors and
Theresa Kelly, BSN, R.N.
other community groups on topics such as heart health and prevention,
brief cardiac history, blood pressure checks, and blood tests for cho-
diabetes, fall prevention, and women and heart disease.
lesterol and glucose. Patient education and referrals are provided as
Prostate Screenings: Prostate blood screening tests are provided at off
needed. In response to the increasing rates of obesity and Type 2 dia-
site locations as well as at the DeMatteis Center. Screenings are empha-
betes, St. Francis has added height/weight/BMI screening and weight
sized in June around Father’s Day, and in September, which is Prostate
counseling to the cardiovascular screenings provided. Outreach
Awareness month.
nurses are also able to provide flu immunizations to people in commu-
Student Athlete Screenings: St. Francis Community Outreach nurses are
nity settings who may not be able to access or afford the cost of a flu
crucial to the planning, scheduling and implementation of the Student
vaccination.
Athlete Screening program. They assure that proper patient information is
Healthy Sundays: The Healthy Sundays program manifests the commit-
collected, screening tests are performed, and that necessary information
ment of Catholic Health Services of Long Island (CHSLI) by proactively
is forwarded to the pediatric cardiologist for evaluation and follow-up.
providing preventive screenings and flu immunizations to populations
Community Outreach Bus Screening: As part of the St. Francis mission
that would most likely otherwise not receive them. The program reaches
to serve the community, the Hospital provides mobile cardiovascular
out to communities of need. Screenings and flu immunizations are pro-
screenings at various community locations. The screenings include a
vided on the weekends at parish site locations.
St. Francis Hospital
2013 Nursing Annual Report 21
Exemplary Professional Practice Stroke Care
'./# &#()./( ' +*/%, ./,)/-( ).& .!/+*"/-(/)'( $( #+)),(*/+*" -'./ ,%%/-(/'.%# (-'.&) % ! $ ' $" $
Doris Kilgannon, BSN, R.N.; Elizabeth Miller, BSN, R.N.; Dina Fontana, BSN, R.N.; Erin Markey, MSN, R.N., ANP-C; and Arlene Hilado, BSN, R.N., CCRN
St. Francis Hospital is a national stroke care leader and remains dedicated to patients needing stroke care. Under the leadership of Ann Cella, MA, MEd, R.N., NEA-BC, the Hospital’s clinical nurses incorporate regulatory and evidencedbased practice guidelines. Exceptional, superior care is the primary focus at St. Francis and crucial for leading to improved patient outcomes after a stroke. Relationship based care integrated with the primary nursing model
care in 2010, 2011, 2012 and 2013. The award is a Quality Pillar goal in
allows clinical nurses at St. Francis to be autonomous and accountable
Quint Studer’s Five Pillars of Excellence, on which St. Francis’ organiza-
for clinical decision-making and quality outcomes. Partnerships with
tional and nursing strategic plans are based. At the Hospital, clinical
patients, families, and healthcare providers strengthen individualized
nurses play a critical role in the care of patients diagnosed with stroke.
patient care. Relationship based care addresses patients’ physical, spiri-
Stroke Coordinators, Erin Markey, MSN, R.N., ANP-C, and Nicole Cregan,
tual, emotional, and social needs. St. Francis clinical nurses who provide
BSN, R.N., CCRN, are the facilitators of the interdisciplinary stroke commit-
evidence-based patient care enables the Hospital to excel with stroke
tee meetings. Members ensure policies and protocols reflect current
care.
guidelines and regulations. The committee has implemented the follow-
St. Francis Hospital, a New York State Department of Health (NYS DOH)
ing initiatives:
designated Stroke Center since 2008, won the American Heart Associa-
• Emergency Medical System notifies the Emergency Department (ED)
tion/American Stroke Association’s Get with the GuidelinesŽ-Stroke
of suspected stroke patient arrivals and help ED physicians prepare pa-
“Gold Plus Quality Achievement Award� for the delivery of quality stroke
tient assessments within 10 minutes of arrival.
St. Francis Hospital
2013 Nursing Annual Report 22
• Clinical nurses demonstrate their autonomy by activating the Neuro
• Clinical nurses lead interdisciplinary care coordination rounds and
Rapid Response Team (RRT).
educate patients on stroke care.
• Interprofessional collaboration facilitates utilization of the acute stroke
• Unit-based care managers participate in interdisciplinary care coordi-
algorithm to ensure appropriate and timely care. After neurologists
nation rounds and bedside patient assessment. Care management’s
administer fibrinolytic therapy (goal of less than 60 minutes from arrival),
communication with physicians, patients and families ensure appropriate
stabilized patients are transferred to a specialized stroke unit.
transition of care.
• Committee members maintain education per NYS DOH requirements.
• Stroke Coordinators share their expertise with the nursing staff as they
• Utilization of a stroke packet which includes an Acute Stroke/TIA work-
make rounds on all stroke patients (helping to ensure exemplary care is
sheet and supporting documents to assist the healthcare team in com-
provided and documentation is completed).
pleting the NIH stroke scale. • The electronic medical record includes evidence-based physician stroke order sets and nursing documentation in the Doc Flow Sheet section labeled Stroke Assessment.
Heart of Caring Nurse Excellence Awards
Cynthia Freundlich, R.N., CPHQ; Leah Apil, BSN, R.N.; Sr. Katherine Murphy, MSN, RN-BC, CCRN, CHPN, ANP-C; Kayla Dooley, BSN, R.N.; Heather Allen, BSN, R.N.; Mary Jane Glander, MSN, R.N., CCRN; Deborah Murawki, BSN, R.N., CMSRN; Catherine Pirolo, BSN, R.N., NE-BC, CMSRN; Patricia Hendershot, AAS, R.N., CMSRN, CHFN; Katherine McGrath, BSN, R.N. CCRP; Jean Valentino, BSN, R.N.; Marianne Hill Day, BSN, R.N., CCRN; and Elizabeth Busi, BSN, R.N., CEN St. Francis Hospital
2013 Nursing Annual Report 23
Exemplary Professional Practice
Our Commitment to Patient Satisfaction Providing our patients with an exceptional patient experience is viewed as a core strategy for achieving and sustaining the mission of St. Francis Hospital. The effectiveness of our Professional Nursing Practice Model is evident in the outstanding patient satisfaction results we have achieved. The commitment from the St. Francis staff to provide our patients with quality care is evident throughout the entire organization. Our patient satisfaction results are a reflection of the staff’s dedication to our mission which is, “St. Francis Hospital is committed to excellence in the care of the body, mind and spirit of every patient we serve.”
What Our Patients Say….. I wanted to take the time to let you know how impressed we were with your entire staff. Everyone, without exception, was attentive, concerned, warm, and friendly. You are fortunate to have such professional people on your staff. Obviously, the orientation and training you give your staff makes a significant difference. Sincerely Yours, Steven Kussin Merrick, NY Once again St. Francis Hospital “sets the bar” for what health care should be. It’s no wonder that St. Francis is consistently ranked amongst the best on several New York and Long Island lists. With Sincere Thanks and Appreciation, Mark Jayson Bayside, NY
My experience with the professionals at St. Francis Hospital has been a very good one. I wish to express my sincere gratitude to the entire staff and the fantastic crew in the Emergency Department. The superior care and professionalism were unmatched. Sincerely, Edna Shohet Great Neck, NY I want to commend St. Francis Hospital on living up to its reputation as the best in patient care. I was a guest at your hospital last week and was extremely pleased with the level of caring and compassion administered by your staff. The nurses were always at the top of their form regardless of the hour and how frequently the need. Additionally, their caring encouraging conversation was particularly welcomed at times when things were not going smoothly. Sincerely, Samuel Selig Port Washington, NY
R.N. Job Enjoyment Scores
R.N. Satisfaction
59.8
The National Database of Nursing Quality Indicators® (NDNQI®), a project of the American Nurses Association (ANA), provides national data in which hospitals can confidentially compare nurse sensitive indicators to other hospitals across the nation. NDNQI® offers their nurse satisfaction survey to direct care registered nurses in member hospitals. As a member, St. Francis Hospital participated. In September 2013, there were 706 St. Francis registered nurses from 25 units who participated in the survey process.
59.6 SFH Score
59.4
National Mean
59.2 59.0 58.8 58.6 58.4 58.2 58.0 Job Enjoyment
The results obtained are intended to give an accurate picture of the R.N.
Overall, St. Francis Hospital outperformed in comparison to all the other
work climate on participating units. The responses are anonymous and the
hospitals. Above is a graph showing St. Francis Hospital’s R.N. Job Enjoy-
completed questionnaire is submitted electronically directly to NDNQI.
ment score.
St. Francis Hospital
2013 Nursing Annual Report 24
Six Sigma Project to Address Patient Turnaround
Care of Patients with Myocardial Infarction
Hanna Ryono, AAS, R.N.
Karline Rocha, BSN, RN-BC; Brian Sayers, BSN, R.N.; and Angela Bush, BSN, R.N.
Left Without Being Seen (LWBS) is one of the many performance indicators monitored monthly and quarterly in the Emergency Department (ED). St. Francis Hospital has an annual volume of 23,000 ED patient visits. Many emergency departments across the nation are implementing Lean Management initiatives to address the issue of patients who leave prior to being seen by a physician. In 2013, the St. Francis ED carried out a Lean Six Sigma project to address turnaround times for “treat and release” patients in an effort to decrease LWBS occurrences.
In 2006, the American College of Cardiology (ACC) recognized an urgent need to reduce time to revascularization during an ST elevation myocardial infarction (STEMI). With the goal to achieve a coronary revascularization time of less than 90 minutes for at least 75 percent of non-transfer Percutaneous Coronary Intervention (PCI) patients presenting with STEMI, evidenced-based core strategies were identified by the ACC that organizations could use to improve outcomes associated with STEMI and reduce Door to Balloon Time (STEMI patient’s arrival in the Emergency Department to percutaneous revascularization in the Cardiac Catheterization Lab).
The interdisciplinary staff on this project analyzed the causes for delays in turnaround time and implemented improvements in process standardization, adequacy of equipment and supplies, as well as bed availability for
St. Francis Hospital, committed to high quality patient outcomes, suc-
fast track patients. The team also studied multiple data points in the pa-
cessfully achieved a favorable reduction in Door to Balloon (D2B) times for
tient flow process to identify opportunities for improvement. This included
the patients served through utilization of evidence-based practices (EBPs).
an analysis of fast track best practices by clinical nurses, mid-level practi-
These EBPs included: activation of the Cardiac Catheterization Lab (Cath
tioners, and physicians. Patients who leave without being seen by a physi-
Lab) by the Emergency Department (ED), arrival of the Cath Lab team
cian can pose both quality and financial concerns for hospitals. The St.
within 20 to 30 minutes, using a team-based approach, prompt data feed-
Francis rate demonstrated a downward trend in 2013 with a year-end rate
back to stakeholders, and senior leadership commitment to the initiative.
of 0.70 percent, which is below national benchmarks. This important initia-
In 2013, the year-to-date average D2B time was 68 minutes. There have
tive will continue to be a focus at St. Francis as we strive to improve patient,
been a total of 56 patients with a working diagnosis of acute STEMI who
family, and staff satisfaction as well as promote the Hospital as a commu-
presented to the ED and activated the STEMI protocol. Twenty-five of
nity facility of choice.
those patients received coronary revascularization with a PCI and were included in the D2B metrics. The staff from the Cath Lab and the ED collaborate on driving down D2B times for every patient seen with this diagnosis. Our goal is achieved by interdisciplinary collaboration and St. Francis Hospital
2013 Nursing Annual Report 25
Exemplary Professional Practice
-utilizing evidenced-based practice.
ance Improvement Department and Nursing Education Department
The multidisciplinary D2B Committee which consists of key individuals
needed to join forces. Nursing support is key in any performance im-
meets on a quarterly basis with a mission of providing outstanding pa-
provement activity. Kathleen Engber, MA, RN-BC, NE-BC, Director of
tient care for all St. Francis patients and achieving D2B times well under
Nursing Education and Clinical Informatics, was appointed to this Per-
the target set by the ACC of less than 90 minutes. St. Francis has demon-
formance Improvement (PI) team by Ann Cella, MA, MEd, R.N., NEA-BC.
strated a downward favorable trend in D2B times every year since 2006.
With Engber’s expertise in education, sepsis education took off.
This has been accomplished through an individual and organizational commitment using strategies that are proven to be effective and by way
The acronym F.O.C.A.L. was created as a way of remembering Sepsis intervention:
of ongoing dialogue. The staff at St. Francis remains dedicated to high
F = Fluid Resuscitation
quality patient care associated with exemplar outcomes.
O = Oxygen C = Cultures
Sepsis
A = Antibiotics L = Lactate levels A self-directed sepsis education module for Healthstreams™, the online learning management system utilized by St. Francis, was created. Posters were designed for the 2nd Annual World Sepsis Day on Sept 13, 2013 and displayed in the cafeteria. St. Francis Hospital leadership was involved and visited the sepsis display to congratulate everyone for their dedication and tireless efforts to stop sepsis. An article was also published in the September 2013 medical staff newsletter about the New York DOH Severe Sepsis and Septic Shock Mandate. Medical grand rounds, mid-level practitioner in-services and the September medical staff meetings supported the goals for early identification and treatment of sepsis.
Nardia Cooper, AAS, R.N.; Eileen Roddy, R.N., CMCN; Gennifer Losurdo, BSN, R.N.; and Evan Sorett, M.D., FCCP, FACP
Sepsis is a serious medical problem that affects millions of individuals around the world each year. As the 10th leading cause of death in the United States, sepsis has an enormous economic burden on the healthcare system, estimated at $16.7 billion annually. In severe cases, a septic patient’s blood pressure drops, prompting the body to go into shock, which can lead to organ failure. Early recognition and treatment of sepsis before a case becomes severe can improve a patient’s chance for recovery. As directed by the Department of Health (DOH), the protocols must
Greater New York Hospital Association (GNYHA) Sepsis Collaborative as part of Sepsis Awareness month. The virtual poster provided St. Francis with the opportunity to share the institution’s strategies and to celebrate the success. The poster is currently on display on the GNYHA web site (www.gnyha.org) so that others in the region can learn from the efforts of the St. Francis team. The revised sepsis protocols were approved by Jack Soterakis, M.D., Senior Vice President of Medical Staff Affairs and Medical Director; Cella; Steven Cabble, R.Ph., MS., Pharmacy Director; and Ruth Hennessey, Executive Vice President and Chief Administrative Officer; as well as the Pharmacy & Therapeutics Committee, and the Medical Executive Committee. The protocols were then submitted to the DOH and St. Francis received approval with no recom-
include initial and ongoing education to staff, as well as provide infor-
mendations for any changes or revisions in September 2013.
mation technology resources available to assist in the implementation of protocols and the collection of required data for reporting to the
The sepsis PI team created a virtual poster that was submitted to the
The team is currently updating the Stop Sepsis brochure, a reference tool designed to assist staff in the care of the patients with sepsis.
DOH. To meet these requirements, it was identified that the PerformSt. Francis Hospital
2013 Nursing Annual Report 26
The Center for Advanced Cardiac Therapeutics Patients come to this program from a variety of sources, for a variety of reasons. Some are referred directly after a recent hospitalization for decompensated heart failure in hopes of preventing additional hospitalizations. Some are referred directly after a recent hospitalization for decompensated heart failure, with the hope of preventing additional hospitalizations. In 2013, of the 123 new patients who joined the CACT Program, 100 (81 percent) did not require hospitalization for heart failure once they started the program. The CACT staff work closely with the St. Francis Heart Failure Patient Navigator to identify appropriate outpatient candidates, coordinate care, and reduce preventable hospitalizations. Some patients are referred by physicians who seek assessment of advanced care options while other patients are “self referrals” who want to join our highly respected program because of the demonstrated positive outcomes and high patient satisfaction scores. Established patients have become “our best advertisement” based on their satisfaction with the nursing care that they have received. Patients and Diane Alvarado, BSN, R.N., and Patricia Hendershot, AAS, R.N., CMSRN, CHFN
family members routinely give positive feedback, and have told us that
In addition to all of the good work performed every day by the nurses at St. Francis Hospital, patients discharged from the Hospital can find that same quality of work from the nurses dedicated to providing community-based care at the DeMatteis Center for Cardiac Research and Education. For the past 10 years, patients suffering from heart failure have had the opportunity to join the outpatient program at DeMatteis and receive the best in evidenced-based care.
prior to engaging with the CACT staff, they “felt lost.” Patients have also said that the support given by the nurses, both in person and during follow-up telephone conversations, is immeasurable.
New updated heart failure guidelines were published in 2013 and endorsed by both the American College of Cardiology (ACC) and the American Heart Association (AHA). These periodic updates incorporate new data and information gained from years of ongoing research. As new guidelines have emerged, the outpatient program has had to adjust and adapt to incorporate new clinical evidence in all treatments provided. Nurses at the Center for Advanced Cardiac Therapeutics (CACT) work collaboratively with three physicians to assess, plan, and administer care on a case-by-case basis, utilizing the basic framework of medication manage-
Mary Gallager, MA, R.N., CHFN
ment and compliance, diet modifications to minimize salt intake, and self care education. Since 2011 (the first year Heart Failure Nursing Certification became obtainable), three CACT nurses have been certified in this important subspecialty of cardiac nursing. In all of New York State, only 35 nurses are certified in heart failure and three are right here at St. Francis, and have become leaders in this program. St. Francis Hospital
2013 Nursing Annual Report 27
Exemplary Professional Practice
Improving Patient Safety: Skin Champions to Nurse Leaders
South Bay Cardiovascular Earlier this year, the clinical nurses at South Bay Cardiovascular in West Islip, began performing a new procedure: the Cardiac Pet Scan. While the clinical nurses were already trained in performing traditional exercise and pharmacological stress tests, the PET Scan brought new challenges. The increased patient load, along with the faster patient turnaround time (the Cardiac Pet Scan takes one hour, compared to the four-hour turnaround time of the nuclear stress test) required the nurses to quickly adapt to the new schedule. Effective communication between departments was key, because the test requires the clinical nurses, nuclear technologist, and nurse practitioner to be present for the duration of the test. The clinical nurses also
Stephanie Ajuda, BSN, R.N., CCRN; Philomena Grossmann, MSN, R.N., CCRN; Chenel Trevellini, MSN, R.N., CWOCN; and Cesira Caparella, BSN, R.N., CCRN
have to troubleshoot how to flexibly rotate through the different departments at South Bay Cardiovascular and were able to organize their rotations in order to maximize both efficiency and nurse satisfaction. In 2013, the nurse practitioners at South Bay Cardiovascular initiated a Shared Care Program for patients with end stage heart failure. Now patients who are implanted with left ventricular assist devices (LVAD) can have their devices interrogated at South Bay Cardiovascular. The nurse practitioners at South Bay Cardiovascular attended a specialized education program and collaborated with other LVAD nurse coordinators to develop this program. The nursing staff at South Bay Cardiovascular organized support groups for LVAD and defibrillator patients. During the support group sessions, these patients were given information from the clinical nurses, nurse practitioners, and St. Francis cardiologists, as well as the representatives from the device companies. Informative lectures were given by physicians, and since these patient populations are unique, significant time was allotted for the patients to share stories and have their questions answered. The support group meetings were held quarterly with wonderful turnouts and excellent patient feedback.
Pressure ulcers continue to be a highly recognized problem in the United States healthcare system. Each year, millions of dollars are spent to treat patients with acute and chronic pressure ulcers. The Centers for Medicaid and Medicare (CMS) recognizes a hospital-acquired pressure ulcer as an Avoidable Hospital Acquired Condition (HAC). Preventing HACs is a responsibility of the hospital and healthcare providers. Providing a safe and healing environment is a fiduciary responsibility of all hospitals. Healthcare institutions must implement systems and processes to encourage and support patient safety through pressure ulcer prevention. Preventing pressure ulcers is a top priority for St. Francis Hospital. Ann Cella, MA, MEd, R.N., NEA-BC, supports the Skin Champion Program as a platform utilized to provide evidence-based practice updates and strategies related to pressure ulcer prevention, while continuously monitoring clinical outcomes. The Skin Champion Program, developed to decrease the occurrence of HACs by providing continuing education combined with a
“Teach this triple truth to all: A generous heart, kind speech, and a life of service and compassion are the things which renew humanity.” –Buddha St. Francis Hospital
consistent data collection process, is lead by Allison Chenel Trevellini R.N., MSN, CWOCN. In 2012, Trevellini proposed an addition to the Professional Development Program to include a leadership option for clinical nurses who have completed the Skin Champion program 2010 – forward. This option was approved by nursing leadership and the Professional Development Council. The clinical nurse specialist (CNS) group assumed responsibility to encourage clinical nurses to apply and utilize the option for professional development. A pre-requisite included validation of the clinical nurse as 2013 Nursing Annual Report 28
Arrhythmia & Electrophysiology Center Update demonstrating consistent competency in the National Pressure Ulcer Advisory Panel staging system. In 2013, eight clinical nurses utilized the Professional Development Leadership option as part of their professional development. After meeting the pre-requisites to participate, each nurse assumed a leadership role during prevalence study and provided clinical leadership to their team by critically evaluating the assessment process, documentation of identified risks factors, and evaluating implementation of interventions of pressure ulcer prevention program on the days of the study. Each clinical nurse provided medical support in skin assessment, wound differentiation, and individualized treatment interventions to the unit Skin Champion Team members. Those clinical nurses were: Angela Bryan, AAS, R.N., CMSRN
Jane Millard, BSN, R.N., Lauren Somerville, BSN, R.N.; Diane Schultz, BSN, R.N.; and Valerie Boyce, BSN, R.N.
K2
Jean Valentino, BSN, R.N.
CTICU
Nina Rios, BSN, R.N.
Since its inception in 1988, the Arrhythmia & Electrophysiology Center at St. Francis Hospital has served a divergent population requiring cardiac device implantation, electrophysiology studies (EPS), and arrhythmia interpretation. Our patients come from across the nation, as well as world wide and the highly diversified nursing staff consists of one nurse practitioner, five clinical nurses, and seven technicians.
CTICU
Anne Sanger Conigliaro, BSN, R.N., CCRN
CTICU
Philomena Grossmann, MSN, R.N., CCRN
MICU2
Grace Mendelson-Licata, AAS, R.N.
SICU
Cissy Caparella, BSN, R.N., CCRN
SICU
Stephanie Ajuda, BSN, R.N., CCRN
SICU
These clinical nurses now serve as clinical experts on their units during everyday practice. The clinical nurses who have finished the program are
Our specialized training enables the clinical nurses and technicians to be
excited about the new knowledge they have obtained, and measurable im-
cross-trained within their scope of practice-including the lab, procedural
provements in patient outcomes related to pressure ulcers and moisture
area, and the office. The Arrhythmia & Electrophysiology Center serves
associated skin damage (MASD). Hospital-acquired pressure ulcer rates
over one hundred patients a day in its clinic, as well as another hundred
have continued to outperform the national benchmark each month and
virtual patients through our remote monitoring system.
have shown a steady linear decline. The MASD rates have also continued to show improvement compared to the internal benchmark 2012.
In 2013, approximately 900 implanted internal cardiac defibrillator (ICD) patients, 550 pacemaker (PPM) patients, and 8,000 arrhythmia patients were cared for at the center. In addition, nearly 4,000 patients are now
Hospital Overall Quarterly Rate of Hospital Acquired Pressure Ulcers
followed remotely by monitors that track their devices in their homes. The latest pacemakers and internal cardiac defibrillators come with this
1.20 # 0f patients seen
1.oo
Hospital Aquired PU
0.80 0.60 0.40 0.20 0.00 13Q1 715 1.12
13Q2 728 0.96
13Q3 702 0.85
13Q4 702 0.43 St. Francis Hospital
730 725 720 715 710 705 700 695 690 685
remote capability, in which the monitor scans the device nightly and, if there are any concerns, sends an alert through the internet to the device company. The clinical nurses download the information daily and address the alerts, as well as use the remote as a follow-up visit every three months between office visits. Around 2,200 electrophysiology studies are performed in our EPS cardiac catheterization lab a year. These studies diagnose life-threatening ventricular tachycardias, an indication of internal cardiac defibrillator implantation; tachy-brady syndromes requiring pacemaker implantation; and radio-frequency ablations curing aberrant heart rhythms which restore normal heart
2013 Nursing Annual Report 29
Exemplary Professional Practice
function. Direct current cardioversions for patients in atrial fibrillation/flutter are also performed.
nurses provide post-procedural liaison visits throughout the hospital. The Arrhythmia and Electrophysiology Center staff consistently strives to
Clinical nurses who work in the Arrhythmia & Electrophysiology Cen-
improve the management of our patient’s cardiac rhythm abnormalities in
ter also provide the following services hospital-wide: deactivation of
an effort to enhance their quality of life. The staff also hopes to pioneer a
ICD’s, downloading of information from the ICD’s and PPM’s, and reacti-
leadless implantable pacemaker called the Nanostim by St. Jude Medical
vation of ICD’s in conjunction with the physician. In addition, the clinical
sometime in the very near future.
Performance Improvement-Perspectives on 2013 New York State Partnership for Patients (NYSPFP) offered the opportunity to highlight the delivery of excellent patient care at St. Francis Hospital. Performance Improvement staff worked to support the recognition of the Hospital for excellence in preventing pressure ulcer, falls, adverse drug events, and ventilator associated pneumonia with the highest possible scores from Centers for Medicare and Medicaid Services. St. Francis was awarded $2,000 to work on preventing insulin adverse drug events. The NYSPFP supports a culture of safety and together with the Crew Resource Management (CRM) initiative that was originally implemented by St. Francis in the areas of perioperative services, the AHRQ Patient Safety Culture Survey was administered to hospital staff. When comparing the results to the NYSPFP, St. Francis was identified to be a strong performer in eight of the 12 domains and was above the NYSPFP mean. These areas included: Hospital Management Support for Patient Safety, Teamwork Across Hospital Units, Hospital Handoffs & TransiMaureen Gaus, BSN, R.N., CPHQ; Maureen Hill, R.N.; Tracy Monteleone, BSN, R.N.; and Colleen Garr, BSN, R.N., CCRN
One of the most notable changes in 2013 was the implementation of the electronic medical record (EMR). The EMR became the tool to abstract information for core measures, cardiac registries, The Joint Commission compliance monitors, and peer review. As the EMR was learned, it became apparent that the processes built in the paper world needed to be revised and further developed to support the electronic world of documenting how we cared for our patients. Documentation is becoming more important in the electronic era as hos-
tions, Overall Perceptions of Safety, Organizational Learning, Feedback and Communication About Error, and Frequency of Events Reported. CRM will be expanded to additional areas of the hospital in support of teamwork and patient safety. Also in 2013, performance improvement teams worked diligently to facilitate and develop improvements in the areas of glycemic control, patient flow, pain management, medication safety, preventing urinary catheter associated infection, reducing HF readmission and sepsis early recognition and treatment. The work of the Sepsis Team had significant importance as the New York State Department of Health mandated certain requirements and submission of data. In 2013, the Failure Mode Effects Analysis (FEMA) was completed for non-invasive ventilation as an electronic educational module on Healthstream for staff education. A FEMA on anticoagulation in
pital reimbursement will be affected by the accuracy and completeness of
the orthopedic patient undergoing total joint replacement and spine surgery
patient care documentation. In an interdisciplinary manner the Perform-
was also started. In addition, the Patient Flow Team participated in a Six
ance Improvement staff was integral in developing new work flows to sup-
Sigma Project in the ED to improve efficiency for the emergency department
port electronic documentation and assure regulatory compliance.
patient who is treated and discharged.
St. Francis Hospital
2013 Nursing Annual Report 30
New Knowledge and Innovations Improving Patient Safety Through Bedside Reporting
./+&./ '+-/ ./&.#.+-."% / "( / $.%%.*$.!/-'.*!/,)/*(-/+*/ +$-!/ -/+/'+ ,- % " # !$
Scott Sherrin, BSN, R.N.; Maura Fallon, BSN, R.N.; and Julia Bebry, BSN, R.N., CMSRN
There are many benefits of bedside reporting. Patient empowerment, patient involvement, and the patient as a partner in their treatment are a few potential outcomes. Bedside reporting allows nurses to make sure that patients understand the education that has been provided. The process enhances patient safety checks and assessments, and also promotes the patient-nurse relationship and a safer transition to the next caregiver. The process provides the clinical nurses with the opportunity to clarify
which included a bedside reporting “how to guide.” Here is how the process works: One hour prior to conducting a bed-
and reinforce communication with the patient and family, ultimately enhancing patient safety. In addition, bedside reporting assists St. Francis
side report, the clinical nurse educates the patient on the purpose of
Hospital in meeting The Joint Commission standards for improving the
the report. This allows the patient to opt out of the report at that time
effectiveness of communication among caregivers. Patients appreciate
or to request that the nurse ask any visitors to leave the room at that
meeting the clinical nurse at the beginning of the shift, and the patients
time. The SBAR (situation, background, assessment, recommendation)
and their significant others are grateful to know the plan of care.
handoff screen in the electronic medical record, is used to give report
The concept of bedside reporting was shared with the 1 West Unit-
because of its easy, focused way to set expectations and relay impor-
Based Council (UBC) as a way to increase staff and patient satisfaction.
tant information. The on-coming nurse is introduced and the patient’s
After an extensive literature review, the 1 West UBC agreed to transform
communication board is updated with the new nurse’s and ancillary
change of shift report into a more collaborative and supportive exchange
staff’s names, as well as the patient’s goal for the day and the patient’s
at the bedside with involvement of the patient/family in the process.
current pain level. The clinical nurses then discuss the patient’s condi-
Prior to implementing bedside reporting, the UBC utilized a number of
tion, plan of care, upcoming tests or procedures and the equipment
tools and strategies to introduce this new process to the clinical nurses.
and supplies in the room including intravenous drips, intravenous sites,
An education packet was developed for the clinical nurses of 1 West,
drains, and the functioning of other equipment in the room are
St. Francis Hospital
2013 Nursing Annual Report 31
New Knowledge and Innovations
checked. The patient is included in the discussions and prior to leaving
evidence-based practice of bedside reporting provides an opportunity
the room, is asked if he or she needs anything. When the clinical
for clinical nurses to answer each other’s questions, suggest additional
nurses leave the room, the work list, due and overdue medications,
interventions, and collaboratively troubleshoot specific challenges.
orders and a chart check are complete.
Bedside reporting was implemented on all of the medical surgical units
Patients who are sleeping are not awakened unless a request has
at St. Francis Hospital in 2013. In the spirit of collegiality and to ensure
been made. The on-coming nurse reviews the report with the patient
quality outcomes for all St. Francis patients, the UBC clinical nurses of
and family later on in the shift. If the patient is off the unit for a test or
1 West have attended the UBC meetings of the other medical surgical
procedure, a report is done in the room to ensure the room is ready for
telemetry units to educate other clinical nurses on the process. This is
the patient’s return.
an example of the commitment of the Hospital’s nurses to ensure
The bedside reporting pilot on 1 West began in August of 2013. This
patient safety and quality outcomes by basing practice on evidence.
MyChart MyChart is a patient portal that is available through the electronic medical record (EMR). St. Francis Hospital began the implementation of MyChart during the third quarter of 2013. This secure, online health connection in the EMR enables our patients to be further engaged in their care. Implementation of MyChart began in our hospital-based outpatient areas and then expanded to the inpatient care units. The clinical nurses are the key drivers in our patient centered education model. Before the patient is discharged the clinical nurse helps the patient create their portal and highlights key functionality. The benefits of MyChart include the ability to: • Review information captured from visits made at our hospital, our affiliated practices, and other Catholic Health Services (CHS) hospitals using the EMR. • Download information if they are seeing a provider not in CHS to a data storage device such as a flash drive, so they can bring the information with them to their office visit. • Appoint a MyChart proxy (forms are available for the patient to appoint) if they prefer a representative to manage their care. • Receive notification when new results have become available and are posted to this site. • Review lab and imaging results once final results are available. • Create a medical information wallet size card for patient reference. • Communicate with the doctor. • Request appointments. • Review current medications. • Receive important health reminders. • Request prescription renewals. St. Francis Hospital
2013 Nursing Annual Report 32
Autologous Blood Reinfusion System
Care of the Sickle Cell Patient Last year, a new patient population was introduced at St. Francis Hospital. The sickle cell population is a special group enduring a painful, debilitating and chronic sickle cell condition. The faith and trust the hematology patients have for their physicians transpired into the staff caring for their sickle cell patients, that’s why the hematology and oncology patients faithfully followed their primary care physicians, Bhoomi Mehrotra, M.D., Director of Oncology and Director of The Cancer Institute, and Dilip Patel, M.D., Director of Malignant Hematology, when they established their practice at St. Francis.
Carol Tambasco, MSN, R.N., OCN; Jennifer Giordano, BSN, R.N.; Tanya Louis, MSN, R.N.; Brenda Vasquez, BSN, R.N.
In 2013, the St. Francis Hospital orthopedic nurses implemented the use of the autologous blood reinfusion system, an innovation used for total join replacement patients. Reinfusion of one’s own blood after surgery is a great benefit to orthopedic patients because it reduces the need for blood transfusions and the small, but inherent risks, associated with transfusion are virtually eliminated. Another benefit of the system is that it remains closed throughout the period of blood collection and reinfusion, which eliminates the risk of introducing any outside contamination of the blood being reinfused.
vironment, opportunities to learn, and readily served as resource for the inter-
The reinfusion system is implemented by the operating room staff. When
professional team of nurses, pharmacists, mid-level practitioners, physicians,
Lyndsey Sonkin, BSN, R.N.; Samantha Palomba, BSN, R.N.; and Melissa Byrne, BSN, R.N.
Drs. Mehrotra and Patel quickly established a supportive and mentoring en-
the patient arrives in the Post Anesthesia Care Unit (PACU), the clinical
clinical dieticians and care managers pertaining to sickle cell management.
nurse checks the integrity of the system as part of her comprehensive pa-
Collaborative relationships developed as policies and educational sessions
tient assessment and monitors the quantity of blood collected in the sys-
were developed and Carol Bono, Pharm D., Manager of Clinical Pharmacy
tem. Both PACU clinical nurses and 1 West clinical nurses are skilled in
Services, in collaboration with Dr. Patel, and clinical nurse specialist
initiating the reinfusion of the patient’s own collected blood. The monitoring
Sr. Katherine Murphy, MSN, RN-BC, PCCN, CHPN, CCRN, ANP-C, recog-
of the patient receiving an autologous blood transfusion is the same as
nized the current pain management policy would be ineffective for a patient
monitoring any blood transfusion, although the risk of a transfusion reac-
in sickle cell crisis. The nursing and pharmacy policy “Pain Management for
tion is minimal. When the reinfusion is completed, the clinical nurse con-
Adult Patients with Sickle Cell Pain or Crisis” was developed, approved by
verts the reinfusion system back to a standard drainage system.
the Medical Executive Committee, and posted on the intranet for immediate use. Murphy and another clinical nurse specialist Heidi Bentos-Pereira, MSN, MBA, R.N., OCN, developed the “Care of the Sickle Cell Patient Standard of Care.” This standard of care along with a review of the pain manage-
St. Francis Hospital
2013 Nursing Annual Report 33
New Knowledge and Innovations
ment policy was part of an interactive online learning module offered to all
quate pain control, sequestration, or infection). The discharge summary
clinical staff. Dr. Patel also initiated a two-part learning session for mid-level
provides patients and families with instructions including post discharge
practitioners and both he and Dr. Mehrotra consistently offer valuable im-
appointments, laboratory testing, and referrals for community assistance. Implementing evidenced-based practice with the utilization of the
promptu learning discussions with the nursing team.
hematology and pain management services is key in the ongoing care
Evidence-based resources are also available for the interprofessional team when planning and implementing the care for patients with sickle cell
of sickle cell patients, through the continuum of care. This improves the
disease. The Sickle Cell Pain Policy is available on Lexicomp, St. Francis’
patients’ experience in efforts to achieve optimal outcomes. St. Francis
drug information database and the Hospital utilizes the Milliman Care
welcomed sickle cell patients and their pain management challenges into
Guidelines (MCG) for the plan of relevant diagnostic test, treatments, con-
our caring hearts. Our exceptional team dedicated time, patience, and
sultation and discharge planning. Members of the heatlhcare team strive to
knowledge to strategize changes in policy, foster ongoing learning oppor-
achieve the MCG recommended length of stay for sickle cell patients of two
tunities and support for all involved in the care of sickle cell patients and
days. These guidelines provide a specific rationale for extended stay to fur-
their families. The rewarding experience of making a difference in the
ther guide the care of sickle cell patients whose symptoms progress (inade-
lives of patients is a blessing.
Chemotherapy “Red Card” Striving for excellence requires a vision, process, and the ability to learn and adapt to evolving changes in health care. Sepsis protocols, for example, are routinely used hospital-wide. One might ask “What is new and innovative about sepsis at St Francis Hospital?” The introduction of a new ambulatory oncology patient population challenges our assessment, skill, and current knowledge of febrile neutropenia, an oncologic emergency. Oncology patients who receive chemotherapy are at risk of morbidity and mortality from febrile neutropenia that progresses into sepsis. Critical steps are needed to expedite the care of a febrile neutropenic patient presenting to the Emergency Department (ED), while any delay in treatment or prolonged exposure to pathogens in a crowded ED can mean the difference between life and death for this the card instructs the ED staff to give the oncology patient a mask and
high-risk patient population. In 2013, St. Francis Hospital’s oncology team identified the potential
to perform a rapid triage. The back of the card reinforces educational
risk of neutropenic patients developing sepsis. In collaboration with
information pertaining to specific symptoms, if experienced; the pa-
Mark Hoornstra, M.D., Chairman of the Emergency Department, the
tient is directed to immediately seek medical attention by notifying
team developed and implemented the chemotherapy alert card (Red
their oncologist or proceeding to the ED. Promoting a febrile neutropenia management plan for oncology pa-
Card). This innovative and proactive approach aims to prevent episodes of febrile neutropenia from progressing into life threatening
tients involved interprofessional collaboration between clinical nurses,
sepsis. This initiative fostered a new two-fold process. The “Red Card”
clinical nurse specialists, pharmacists, and physicians of inpatient
now serves as an alert for staff to identify a febrile neutropenic patient
oncology, outpatient infusion services, physician offices, and the ED.
as a high risk for sepsis immediately upon entering the ED, as well as
Educational sessions, presentations, and a Chemotherapy Alert Card
serving as an additional educational resource for patients. The front of
brochure communicated the new process hospital-wide. Staff eagerly
St. Francis Hospital
2013 Nursing Annual Report 34
participated in educational sessions, including St. Francis Hospital’s
care, and reduce patient risk by ensuring early identification and
Critical Care Sepsis Seminar last October, offering a podium presenta-
prompt treatment. The process of implementing the “Red Card”
tion on febrile neutropenia. The adoption of this innovative tool for on-
gained multidisciplinary acceptance demonstrating support for
cology patients has the potential to provide high-quality, consistent
change, learning, teamwork, and drive for optimal patient outcomes.
Lifelong Learning and Certification registered nurses was recommended. The sample population consisted of 448 returned surveys. The anonymous survey consisted of demographic information that included: years of nursing, age, gender, nursing specialty, name of nursing certification (if applicable) and educational preparation, as well as current and future educational plans. The nurses also completed a Life Long Learning Scale (LLLS), comprised of 14 questions that focused on the following six sub-dimension competencies: self-management, learning how to study, initiative and entrepreneur, acquiring information, digital, and decision-making. The theoretical framework for this study is the Theory of Adult Learning by Malcolm Knowles. Learning in adulthood is autonomous and self directed, based on the accumulation of prior knowledge and life experiElizabeth Divittorio, BSN, RN-BC
ences. Adult learners are goal directed, work to achieve objectives, and
In 2013, principal investigators Erin Markey MSN, R.N., ANP-C and Elizabeth Cotter, Ph.D., RN-BC conducted a research study to compare the characteristics of certified nurses at St. Francis to all other nurses at the Hospital by using a survey to obtain several demographic variables and also include the Life Long Learning Scale (LLLS). This study was designed to analyze whether there are differences
fulfill a purpose in the learning process. The adult learner also needs to be motivated to learn. Results of the study demonstrated that certified nurses have higher lifelong learning scores than those who are not certified. Of the nurses that are certified, 73 percent achieved certification for reasons of selfactualization. The nurses that are not certified listed the following incentives as motivators: increase in salary, paid review classes, and more recognition.
between the characteristics of clinical nurses who are certified in a
Recommendations that have been implemented based on the study
national nursing specialty and the clinical nurses who are not certified.
results include:
These characteristics include a comparison of age, gender, years of
• When recruiting new hires obtain information as to whether their
nursing experience, educational preparation, nursing specialty, name of
three-year plan includes returning to school and achieving certification.
nursing certification (if applicable), and if they are a “lifelong learner.”
• During the interview process, include a question related to self actu-
Certification requires a nurse to be a lifelong learner as the nurse
alization and use as selection criterion. Nurses who desire to be self-ac-
must participate in some form of continuing education. During a review
tualized will be more likely to obtain certification.
of the literature it was noted that there is minimal research on lifelong
• Focus on the nurses who are finishing school. Since nurses in school
learning in nursing. In identifying lifelong learners, healthcare organiza-
are identified as lifelong learners, there may be interested in further
tions can identify new ways to foster lifelong learning in order to
development such as certification.
increase certification.
• Implement teaching strategies in all educational programs to
An anonymous survey was distributed to all St. Francis clinical nurses
develop lifelong learners.
(approximately 772) excluding nurses who are required to be certified
• Provide eligible nurses with information regarding certification and
as part of their job description. A sample size of a minimum of 350
review classes.
St. Francis Hospital
2013 Nursing Annual Report 35
New Knowledge and Innovations
Clinical Trial: Transcatheter Aortic Valve Implantation formation, provide education to the patient and family, and schedule required screening tests (CT scan, echo cardiogram, pulmonary tests, blood work and frailty assessments). The TAVI procedures are performed with the experienced staff of both the Cardiac Catheterization Lab and Cardiothoracic Surgery group including mid-level practitioners, clinical nurses, technologists and support staff. Both departments are intertwined with distinct and overlapping responsibilities to ensure optimal outcomes. Post-op care is provided in the cardiothoracic intensive care unit and medical surgical units of the hospital. The TAVI program will continue to evolve and grow at St Francis Hospital and the TAVI team continues to learn and strive to provide the best care for each patient consistent with our nationally recognized reputation as a leader in providing outstanding cardiac care.
Suzanne Sanidad, BSN, RN-BC, CMSRN; Linda Rivenburg, R.N., CNOR; Margaret Larigan, BSN, R.N.; Janet Cacioppo, MSN, R.N.; Eileen Hague, RN-BC; and Dolores Smoot, R.N., CNOR
St. Francis Hospital was one of the first sites in the United States activated to begin enrollment into the Medtronic CoreValve Pivotal Trial in December 2010. In three years, with over 175 Transcatheter Aortic Valve Implantation (TAVI) procedures performed, it has become a standard, optional treatment for patients suffering from severe, symptomatic aortic stenosis.
Joan Jennings, MA, R.N., and Lyn Santiago, BS, R.N., CCRC
Patients who are not operative candidates (extreme risk) or deemed
tional cardiology, cardiothoracic surgery, echocardiology, radiology and re-
“Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected.”
search physicians and staff. Prior to performing a TAVI procedure, several
–Steve Jobs
high risk for open heart surgery are now eligible to be evaluated for a TAVI procedure. The TAVI program at St. Francis resulted in several initiatives encompassing multiple departments and disciplines. All aspects of evaluation of a TAVI patient involves close interprofessional collaboration among interven-
meetings with the patient take place in order to obtain pertinent clinical inSt. Francis Hospital
2013 Nursing Annual Report 36
Comparison Study of Blood Pressure Measurement in Patients with Atrial Fibrillation
Endoscopic Ultrasound
Margaret Donnelly, AAS, R.N.; Barbara Suarez, PCA; Martha Tamayo, PCA; Lillian Ayala, PCA; Carolyn Broderick, BSN, R.N.; Heather Reilly, BSN, R.N.; Marilyn Piliere, AAS, R.N.; Karen Prashad, BSN, R.N.; Lina Tan, MSN, R.N., CGRN
Endoscopic Ultrasound (EUS) has become a valuable tool in the identification of gastrointestinal cancers and treatment decisions. EUS, an upper gastrointestinal procedure, has combined the endoscope with ultrasonography to enhance visualization of the gastrointestinal tract that is unlike a conventional ultrasonography. The endoscope with an oblique-viewing has an ultrasonic transducer built into the tip with high-frequency, ultrasonic beams that gives the physician the ability to target a lesion(s) and biopsy at the same time. This procedure enhances evaluation of histological structure of targeted lesion(s), while the lesions in the walls of esophagus, stomach, duodenum, colon, pancreas, gallbladder, and liver can be detected and staged, as well as any surrounding organs. In addition, an endoscopic
Maria Gil, BSN, R.N., and Jeff Maingrette, PCA
Limited research is available on the accuracy of non-invasive blood pressure (NIBP) measurement devices when used for patients with irregular heart rhythms. The purpose of this study was to examine the agreement between direct arterial blood pressure measurement (considered the gold standard) and noninvasive blood pressure measurements in a sample population of patients in atrial fibrillation.
ultrasound probe placed in the esophagus may be used to visualize
In a retrospective medical record review of patients in atrial fibrillation
lymph nodes in the chest surrounding the airways (bronchi) for the
who underwent a diagnostic cardiac catheterization, a comparison study
staging of lung cancer.
design was used to examine the agreement between two methods of
Clinical nurses play an important role in EUS procedures. They provide
blood pressure measurement: arterial (direct) and noninvasive cuff (indi-
education, assessment, comfort, assistance with the preparation of the
rect). Blood pressures were obtained via intra-aortic readings during the
patient both intra and post-procedure. In addition, the clinical nurse
cardiac catheterization procedure, as well as noninvasive readings using
meets the physical and emotional needs of the patients and families and
an automated oscillometric cuff.
provides safe and proficient care during the procedure.
Medical records from 59 males and 32 females were reviewed. All sub-
The procedure is performed by gastroenterologists who specialize in
jects had normal findings with no evidence of coronary artery disease. All
the examination, diagnosis, and treatment of disorders of the digestive
patients were greater than 18 years of age and in atrial fibrillation at the
tract. EUS provides essential information for oncologists and surgeons
start and end of the catheterization. Blood pressure measurements from
to make decisions about diagnosis and treatment.
both sources (direct and indirect) that were recorded within two minutes of
St. Francis Hospital
2013 Nursing Annual Report 37
New Knowledge and Innovations
each other were entered into the study. Differences and limits of agreement
significant difference was found for the diastolic BP obtained with the
between the arterial pressures and the NIBP were calculated and grafted
non-invasive device (consistently over-estimated the diastolic pressure)
according to the Bland-Altman method. Paired t-test was used to assess
as compared to the intra-arterial measurement.
differences in blood pressure measurements obtained by the two methods
The study confirmed that in the presence of atrial fibrillation there is a statistically significant difference in diastolic blood pressure as measured
as well as intra-class correlation coefficient (ICC) method of reliability.
with a noninvasive blood pressure device compared to intra-arterial dias-
Medical records were reviewed of patients who underwent cardiac catheterization, had normal cardiac findings, and had blood pressure
tolic blood pressure. The statistically significant discrepancy in diastolic
measurements (indirect and direct) within two minutes of each other dur-
measurement has implications for nursing practice. Noninvasive cuff
ing the procedure. Systolic, mean, and diastolic pressures were com-
pressures should not be used to correlate an arterial line.
pared between direct and indirect measurements. A statistically
Presentations at National/Regional Conferences Conference
Title of Presentation
Participants
ANCC Magnet and Adelphi Leadership Conference
A Culture of Collaboration; Implementation of a Nursing Peer Review Council
Ann Cella, MA, MEd, R.N., NEA-BC Donna Rebelo, MS, RN, NE-BC Cathy Pirolo, BSN, RN, NE-BC, CMSRN
ANCC Annual Magnet Conference
Professional Engagement Through the Implementation of a Peer Review Tool to Decrease Incidence of CLABS
Cathy Pirolo, BSN, R.N., NE-BC, CMSRN
ANCC Annual Magnet Conference
Role of the Circulator in Patient Safety
Diane Mamounis-Simmons, MS, R.N., NEA-BC, CNOR
ANCC Adelphi Leadership Conference
The Perfect Storm
Kathleen Engber, MA, R.N.-BC, NE-BC
31st Annual Rutgers Interprofessional International Technology Conference
Riding the Storm: Culture Shift to the EMR
Ann Cella, MA, MEd, R.N., NEA-BC Kathleen Engber, MA, RN-BC, NE-BC
ANCC Annual Symposium on Continuing Nursing Education
Preceptor Development: Evaluating the Outcomes Every Step of the Way
Elizabeth Cotter, MSN, Ph.D., RN-BC
AMSN Annual Convention
Reduce the Risk; Interprofessional Collaboration in the Development of Narcotic Audit Tool
Tara-Anne Rogan, MSN, R.N., NE-BC Ana Leah Apil, BSN, R.N. Jinnie Vattamala, Pharm.D
Good Samaritan Hospital Medical Center Research Conference
Life Long Learner
Elizabeth Cotter, MSN, Ph.D., RN-BC Erin Markey, MSN, R.N., ANP-C
Maimonides Medical Center
Life Long Learner
Elizabeth Cotter, MSN, Ph.D., RN-BC Erin Markey, MSN, R.N., ANP-C
St. Francis Hospital
2013 Nursing Annual Report 38
Diagnosing Acute Coronary Syndrome: Do Women Wait Longer?
Lara Caniano, MSN, R.N., CCRN, and Christina Tsoukalas, BSN, R.N.
Coronary heart disease is a leading cause of mortality for women in the United States. Research shows that women have more atypical symptoms of Acute Coronary Syndrome (ACS) that men do, however they wait longer to seek medical treatment for ACS symptoms. Do women also wait longer to have their symptoms evaluated after seeking medical treatment? At St. Francis Hospital, a random retrospective chart review was conducted and data was collected for 50 men and 50 women diagnosed with ACS (as defined by American College of Cardiologists/American Heart Association 2011 criteria). The data included atypical and typical symptoms present on Emergency Department (ED) arrival and the time from the patient’s arrival to the time of the initial EKG in triage. Excluded were patients who arrived by ambulance, had a history of ACS within the past year, or were referred from a physician’s office. The research found that women waited five minutes longer than men to have their initial EKG. When both men and women with atypical symptoms were excluded from the analysis, women still waited four minutes longer than men to have the initial EKG. This delays their treatment for ACS. Clinical nurses are responsible for triaging these patients and initiating the EKG. Factors responsible for the delay in triage could include clinical nurses not suspecting women are having ACS as often as men. Women may also express their symptoms differently than men do. Educational strategies are needed to eliminate this delay phenomenon.
St. Francis Hospital
2013 Nursing Annual Report 39
The St. Francis Hospital 2013 Nursing Annual Report was produced by the Nursing Department in collaboration with the Office of Development and Public Affairs. We would like to thank everyone who contributed to the success of this publication. The 2013 Nursing Annual Report is published by St. Francis Hospital, The Heart Center®. Questions or comments can be directed to St. Francis Hospital, Patient Care Services, 100 Port Washington Blvd., Roslyn, NY 11576 or (516) 562-6060. Copyright ©2013. All Rights Reserved. St. Francis Hospital is a member of the Catholic Health Services of Long Island, the healthcare ministry of the Diocese of Rockville Centre. Editor and Project Manager: LaShieka Hunter • Designer: Roger Gorman, Reiner Design • Photographer: William Baker • Contributing Photographer: Steve Moors, Steve Moors Photography
100 Port Washington Boulevard Roslyn, NY 11576 (516) 562-6000 www.stfrancisheartcenter.com A Member of Catholic Health Services of Long Island Founded by the Franciscan Missionaries of Mary