ST. LUKE’S
Patient Care Services Annual Report 2012
Focusing on patients and quality care
UnityPoint Clinic | UnityPoint at Home | UnityPoint Hospice
Table of Contents
1 -3
Preparing for the Future
4 Patient Care Services Strategic Plan 2012 5-9 Exemplary Professional Practice 10-12 New Knowledge 13-15 Structural Empowerment 16-19 Transformational Leadership 20-21 Community
Contributions
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Dear Collea
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A sborn, RN, M Mary Ann O ical Officer C and Chief lin t en id es Pr e Vic
UnityPoint Clinic | UnityPoint at Home | UnityPoint Hospice
Preparing for the Future Nurses guide renovation
Our mission
A newly designed orthopedic and neurosurgical unit opened at St. Luke’s in early January. Patients and their families are benefiting from the efforts of frontline nursing staff, who were a driving force behind incorporating specific elements to support patient-centered care.
To give the healthcare we’d like our loved ones to receive.
“Direct care nurse champions gave input and gathered feedback from their peers. They advocated for bedside workstations, nursing workspaces that most efficiently accommodate patient and nursing workflow, and additional supply and equipment storage that’s easily accessible to nurses when caring for patients,” said Carmen Kinrade, RN, MSN, director of St. Luke’s Nursing Operations.
Best outcome for every patient every time.
Safety features in each of the 23 private rooms include nonslip flooring in bathrooms, gently sloping shower floors, pull-down shower seats that reduce the risk of falls, special lighting and the ability to easily accommodate specialty beds and equipment. Whiteboards allow staff members to post key messages and plan-of-care goals to keep patients, family members and the multidisciplinary team informed. Direct care staff and patient care leadership worked together on the set-up for patient rooms and support areas, such as the nurses’ station, medication and storage rooms, assuring supplies and equipment were
Our Vision
Our Values Patients first – We are here to serve patients. We put patients’ needs above all else. The patient is the center around which the entire organization revolves. Doing the right thing – Do the best possible good for all we serve because it’s the right thing to do. Care in our heart – It is our personal mission to help others, not only in work but also in life. It is in our hearts.
Carmen Kinrade, RN, MSN Director, St. Luke’s Nursing Operations
arranged to support the most logical flow of care. “It’s a beautiful and functional unit for patients and staff. We can thank our direct care nurses and healthcare team for setting the standard,” Kinrade said.
Respect for all – We value all people. We treat all with dignity, courtesy and attentiveness. We listen. Teamwork – “We” before “me.” No one stands alone. We are committed to teamwork as teams of people outperform individuals.
Prepping a new inpatient hospice unit Planning the new Ed and Joan Hemphill Hospice Unit for St. Luke’s involved more than architects and administrators. The hospice supervisor and frontline staff – to be working with patients in the new inpatient hospice unit when it opened – were involved at an early stage, making important decisions about equipment, processes and ambience. “We went through every need patients may have,” said Denise Abel, RN, BSN, OCN, hospice inpatient manager. “Unit processes came from the frontline staff. They made suggestions for items such as waste stations for narcotics.” They also considered the ambience. “We wanted to make it like home,” Abel said. Now the unit offers quilts on the beds and cookies for patients and family members. Education was another area of focus for frontline staff. They specifically recommended books and educational material for the unit. In preparation for the opening, nurses received symptom management education from pharmacists and attended orientation with the unit’s social worker, chaplain and medical director.
Nearly 1,000 individuals annually will receive the best possible end-of-life care.
1
Preparing for the Future
A five-time Top 100 Hospital
Intraoperative Electron Radiation Therapy (IOERT)
For the fifth year, St. Luke’s has been named to the Truven Health Analytic’s 100 Top Hospitals list. St. Luke’s achieved Top 100 status nine years ago and then in 2005, 2009, 2012 and 2013.
St. Luke’s is leading technological advancements in cancer care by offering IOERT for early stage breast cancer patients through an international clinical trial. IOERT allows patients to receive a concentrated dose of radiation during surgery. After the surgeon removes the tumor, a radiation oncologist applies a concentrated dose of electron beam radiation directly to the tumor bed. A shield and cone protect healthy tissue from unnecessary radiation.
If all Medicare inpatients throughout the country received Top 100 Hospital award-winning care, then:
“A core group of St. Luke’s associates (RNs, surgical techs, sonographers, radiation therapists and a radiation physicist) have trained to use IOERT,” said Callie Engelbrecht, RT (R) (N), CNMT, manager of Imaging Services. During the initial start-up phase in October, these nurses attended group training and went through a dry run. They also traveled to Sioux Falls, South Dakota, to witness IOERT at Avera Healthcare.
More than
164,000 lives could be saved
82,000
additional patients could be complication-free
6 billion
$
could be saved
The average patient stay would decrease by half a day
St. Luke’s among Top 50 Heart Hospitals St. Luke’s joined an elite group as Truven Health Analytics pared its nationally recognized list from 100 to only 50 Top Cardiovascular Hospitals. This is the fourth time in a decade St. Luke’s has been nationally recognized for Heart Care by Truven Health. St. Luke’s is one of only three Iowa hospitals honored. Top 50 Heart Hospitals have:
41%
fewer deaths
Lower
complications
Lower
hospital readmission rates higher
30-day survival rates 2
IOERT allows doctors to administer high doses of radiation without exposing healthy organs to radiation. In one to two minutes, patients receive radiation equal to five to seven daily radiation treatments, enabling them to spend only three weeks on follow-up radiation treatments instead of six. Studies show IOERT offers low recurrence rates because it treats the precise area where most breast cancers recur. Costs are 26 percent less than traditional radation treatment.
da Vinci surgical robot St. Luke’s has been using surgical robots for minimally invasive procedures since 2005, first for urology and then gynecology in 2008. In late 2011, St. Luke’s began using surgical robots for general surgery – which expanded the knowledge and expertise of the Operating Room (OR) team because new sets of people were trained in robotics. In 2012, the FDA approved single-site surgery for general surgery, which involved more changes and training. St. Luke’s robotics team performed the first single-site robotic gallbladder removal in Cedar Rapids on April 5, 2012. “We have branched out with robotics, involving a new team and new procedures,” said Kiley Stineman, RN, OR supervisor. “Colon resections have always been done in an abdominal approach, and with the robot we are now able to get the patient back to normal activities quicker with smaller incisions. We’ve taught a whole new team from the beginning. We have had many in-services, mentoring of staff, and cross-training with those who already used robotics. We also have sent many people to train with the doctors, flying to Atlanta, Houston and Cincinnati. This not only helps the staff, but helps show our doctors we are engaged in what they are doing.” For patients, robotic surgery is dramatically different from traditional surgery – incisions are smaller, pain is minimized and recovery is much faster. St. Luke’s first single-site robotic gallbladder patient, Sylvester Kafer, said he had no pain after his surgery. “I had surgery on a Thursday and I was back to driving the school bus by Tuesday, mainly because they didn’t have school on Monday,” Kafer said. “I had aortic surgery and recovery took a long time. This made me feel like – did I even have surgery?”
“ We have branched out with robotics, involving a new team and new procedures.” Kiley Stineman, RN, OR Supervisor
Community Anticoagulation Therapy Clinic In April 2012, the freestanding Community Anticoagulation Therapy (CAT) Clinic became a department of St. Luke’s, after seven years as part of the Cedar Rapids Healthcare Alliance. “We were surviving on donations. St. Luke’s recognized we were providing a service that fit into their mission and with the goals of their outpatient clinics,” said Carla Huber, MSN, ARNP, certified in anticoagulation management.
The CAT Clinic cares for 550 patients taking a variety of anticoagulation medications, all of which are high risk and can cause problems if not managed closely. Clinic nurses have extensive experience in critical care and other areas of nursing. “The clinic is important to the community because we prevent hospitalizations related to clotting or bleeding. We provide extensive education to our patients about their medications and conditions. We assist patients that need to stop their anticoagulation medications for procedures,” Huber said.
Neonatal outreach into other communities St. Luke’s newborn intensive care unit (NICU) neonatal nurse practitioners, nurses, outreach personnel and doctors are helping in the NICU at Allen Hospital in Waterloo, Iowa, and Trinity Sandi Lathrup, RN, BSN, Health System in RNC-NIC Moline, Illinois, and Bettendorf, Iowa. St. Luke’s provides neonatologists and educates the existing care teams to build on current competencies and improve perinatal culture, enabling the NICU to handle more complicated cases that may have been transferred to another facility in the past. “Allen nurses were unfamiliar with the use and care of PICC lines,” explained Sandra Lathrop, RN, BSN, RNC-NIC, St. Luke’s neonatal outreach coordinator. “We provided our protocols and then met with the staff to educate them on the care after placement of the PICCs. We provided a mannequin that had a PICC and supplies to do dressing changes. We discussed different issues that could arise and problem-solved together. The practice change of using PICC lines has allowed Allen to provide better pain control to infants by eliminating multiple needle sticks with IV starts.”
The main goal of the CAT Clinic is to provide patients with a better quality of service by improving communication between healthcare providers and implementing a process for quality assurance.
Making house calls In 2012, St. Luke’s acquired the Visiting Nurse Association (VNA), now called UnityPoint at Home. The organization specializes in comprehensive home care services for patients of all ages and has served Cedar Rapids and surrounding communities since 1919. St. Luke’s started working closely with VNA in 1989, providing management services, while VNA continued as a free-standing agency. Bringing VNA into the UnityPoint family helps provide a complete continuum of care for St. Luke’s patients, enabling us to focus on coordinated care at the doctor’s office, in the hospital and at home. UnityPoint at Home serves patients within a 50 mile radius of St. Luke’s, delivering services such as skilled nursing care, physical and occupational therapy, speech therapy, children’s health services, flu clinics, home health aides and social services.
Physical, occupational & speech therapy Skilled nursing care
Home health aides
UnityPoint at Home
Children’s health services
Social services
Flu clinics
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Patient Care Services Strategic Plan 2012
The organizational priorities for 2012 centered on the Big Five.
1
IQ4 implementation
Patient Care Services (PCS) Strategic Plan 2012 cascaded from the Big Five: • Workflow design and Epic clinical tools development • Training of certified trainers (CTs), super users and direct care providers • Establish training for new hires and students • Contribute to post IQ4 Go-Live optimization
2
Patient Family Experience
• Care Rounding • Bedside Report • Take 5/Take 2 • Teach Back
3
Productivity
• Add travelers during IQ4 Go-Live to ensure adequate resources for patient care while staff are adding new skills with the electronic health record • Reduce travelers within 30 – 60 days of IQ4 Go-Live • Reduce end-of-shift overtime • Add patient care techs to the resource pool for 1:1 sitter coverage
4
4
Operating Margin
5
Great Place to Work
• Monitor supplies and inventory in procedural areas • Create capacity for additional patients by managing patient flow and throughput • Create, implement and monitor department level action plans for improvement • Engage Unit Practice Councils in improvement efforts
Exemplary Professional Practice
•
Sociocultural – interpersonal, family and societal relationships, traditions and rituals What does this illness mean to the various roles that the patient has?
•
Environmental – hospital room, patient’s living situation once discharged Does the environment promote the patient’s healing and wellness?
The strength of this theory is that it applies to all disciplines and roles at St. Luke’s. Having the same beliefs about patient care allows multiple disciplines to speak the same language when discussing the patient and their needs. Every person from housekeepers and maintenance to nursing and respiratory therapists play a role in providing comfort to our patients and making sure all needs are met.
60
60
Psychospiritual – self-esteem, the meaning in one’s life, spiritual well-being What does this illness mean to the patient?
65
•
90
Lower is better. National benchmark
62
Physical – pain relief, symptom management How does the patient feel physically?
120
62
•
Opening heart blockages faster
68
We’re taking a holistic view of our patients, not just viewing them as their diagnosis or illness. Seeing our patients as whole persons helps us work to meet all of their needs, not just their physical needs. In order to provide this type of care, we consider four aspects of the patient’s experience:
78
Our Patient Care Practice model is the overarching umbrella that guides our culture, beliefs and practice. The Patient Care Delivery model is HOW we apply these principles.
Survival and quality of life after a heart attack depend upon the speed in which patients are treated after their heart attack begins. Door to dilation (D2D), or “doorto-balloon time,” measures the time it takes a heart-attack patient to get from entering the hospital to having blood flow restored to their affected heart muscle – through the inflation of a balloon in their blocked coronary artery.
109
Our Patient Care Delivery Council researched patient care theories to find a common vision for guiding the way we provide care to our patients. The council selected “Comfort Theory” by Katharine Kolcaba because it not only provides direction for our patient care, it reflects and builds on practices we already have in place.
Setting the standard for fast heart attack care
Minutes
A new way to CARE
30 0
Baseline 2007 2008 2009 2010 2011 2012
St. Luke’s average time to open blocked arteries.
The gold standard for getting a patient from the Emergency Department (ED) to opening a blocked artery is 90 minutes or less, a timetable that saves lives and leads to better outcomes. The average D2D time at St. Luke’s is 60 minutes. St. Luke’s fastest reported time in 2012 was 22 minutes. St. Luke’s beats the national standard, opening blocked arteries in a fraction of the time most hospitals strive for, as we set standards on our own.
Whiteboards As part of the Comfort model discussion with patients, caregivers ask questions and write patient goals on the whiteboard.
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Exemplary Professional Practice
“ One of my nurses said one of our pieces of safety equipment (the standing and raising device) changed her life. She used to go home hurting every day and she doesn’t anymore.”
UNIT-BASED SAFETY PROGRAMS
Christine Rutledge, RN, MSN, CRRN, CBIS Physical Medicine and Rehabilitation Nurse Manager
“If you don’t have the nurses to take care of the patients, you can’t provide quality care and you can’t provide teamwork,” said Physical Medicine and Rehabilitation Nurse Manager Christine Rutledge, RN, MSN, CRRN, CBIS. “One of my nurses said one of our pieces of safety equipment (the standing and raising device) changed her life. She used to go home hurting every day and she doesn’t anymore.”
Injuries
6 West patient handling injuries
Associate safety, safe-patient handling Many nurses and nursing assistants leave the profession because they simply can’t perform the work required once they’ve been injured. Handling patients safely – and making it a priority – is a win-win situation for everyone involved.
St. Luke’s emphasis on safe-patient handling began in 2008 after performing a needs analysis of lifting tasks throughout the hospital. St. Luke’s spent a half million dollars on equipment and clinical expertise, trained over 1,000 associates and then kicked off the effort with education, training and lots of due-diligence. In 2010, safe patient handling was incorporated into the hospital’s Standards of Excellence. Next it was included in performance appraisals for anybody who would do any sort of safe-patient handling. The hospital has continued to retrain and focus on this effort.
10 8 6 4 2 0 2008 2009 2010 2011 2012
“Key to the program is staff engagement and leadership support,” Rutledge explained. “I support it on my unit, 6 West, and have an excellent coach.” The results on 6 West have been phenomenal: in 2008, there were 10 injuries related to patient handling; in 2009, there were two; in 2010 and 2011, there were no injuries and last year, there was only one. Safe-patient handling coaches are self-selected frontline staff. About 40 individuals perform this function throughout the hospital. The radiology department has become an excellent example of using safe-patient handling techniques. A very engaged leader invested time in developing coaches, scheduling regular meetings, even sending staff to national conferences. “They’ve empowered their transporters to say, ‘I’m not lifting the patient without that sheet.’ It’s a culture change. It’s so different from what anybody’s done before. I know we’ll get to a point where we won’t lift patients without using the safety support,” Rutledge said, comparing it to the culture change of always using gloves with IVs. “Before long, we won’t remember a time without it.”
Preventing infections
6
Higher percentages are better.
98
100
100 99 98 97 96 95 94 93 92 91 90 89 88
97
Percent of patients
Outpatients having surgery who received the right kind of antibiotic
Patients are at risk to develop wound infections during their stay in a hospital following surgery. Hospitals can reduce this risk by administering the proper medicines at the correct time on the same day of surgery. The chart, at left, shows how often St. Luke’s administers an antibiotic before surgery to decrease infections. This is just one way St. Luke’s is applying best practices for better patient care. Developing an infection while in the hospital is something St. Luke’s takes very seriously. In fact we want to eliminate hospital acquired infections (HAI), which can lead to readmissions and other complications. Several years ago St. Luke’s launched an initiative called Passion for Prevention to irradiate infections. The program raised awareness among caregivers, patients and visitors about the importance of appropriate hand-washing and keeping patient areas disinfected and clean. Our efforts to prevent HAIs has seen tremendous success.
St. Luke's Average for all Average for Hospital reporting hospitals all reporting in Iowa hospitals in U.S.
Creating the ideal transition home Hospital stays can be overwhelming for patients and families – this is especially true for chronic heart failure patients. Many of these patients are newly diagnosed and unsure of the new medications, diet restrictions and wellness choices they face. This uncertain territory can land them back in the hospital if they have difficulties managing their care. With this in mind St. Luke’s created the Transitions Home Program for chronic heart failure patients to help them successfully navigate their return home. “St. Luke’s focused on heart failure because of the high readmission rate,” said Peg Bradke, RN, MA, St. Luke’s Heart Care Services director. “We looked at how we could make the patient’s transition home more family friendly. And in particular, we identified specific ways where there was a breakdown in communication, which in many cases led to the patient being readmitted to the hospital.” One such change was having nurses use the Teach Back technique at discharge. Rather than asking questions, such as “do you understand your instructions” or “do you have any questions,” nurses ask patients to explain specific details of their new care regime. “At discharge, when going over medications, we’ll say ‘show me which of these medications you’d take for excess fluid.’ Or ‘tell me the signs and symptoms you experience when you’re getting excess fluid,’” explained Aimee Traugh, RN, BSN, nurse manager, 3C Telemetry. “Teach Back is about asking questions in a way that gets patients to teach information back to us at discharge.” Teach Back questions are listed on the back of patient education packets, and nurses use these questions as a reference guide for patient education. Patients no longer have the option to say “yes, I understand” a new medication, simply because they want to get home fast. Since the program was implemented, St. Luke’s has seen a significant reduction in readmissions and has even been recognized as a national model of care in articles published in The Wall Street Journal and The Washington Post.
St. Luke’s Hospital
Teach Back DVD
After hearing Peg Bradke, RN, MA, St. Luke’s Heart Care Services director, speak at an Institute for Healthcare Improvement forum, St. Luke’s received requests for copies of the Teach Back DVD from healthcare providers, including a hospital as far away as Sweden.
“Teach Back is about asking questions in a way that gets patients to teach information back to us at discharge.” Aimee Traugh, RN, BSN Nurse Manager, 3C Telemetry
Innovations in Patient Care award Sponsored by the Iowa Association of Nurse Leaders, the Innovations in Patient Care award honors nurses who have designed and/or contributed an innovative approach to the delivery of quality patient care. St. Luke’s Intensive Care Nurse Manager Jill Morgan, RN, BSN, MBA, NE-BC, won the prestigious award in 2012 for her entry “Behavioral Health Medical Emergency Team.”
Jill Morgan, RN, BSN, MBA, NE-BC, St. Luke’s Intensive Care Nurse Manager
St. Luke’s established the Behavioral Health Medical Emergency Team (BH MET) to provide early intervention into a deteriorating (or potentially deteriorating) situation using our own behavioral health resources to de-escalate a situation before it becomes a safety threat. The BH MET was developed in collaboration between Behavioral Health Services, Critical Care and Medical Surgical Nursing. When a patient situation escalates or becomes a safety concern, a BH MET member is called to assess and assist, providing patients and staff with an intermediate level, timely response from a Behavioral Health nurse.
BH MET was modeled after the Institute for Healthcare Improvement’s Rapid Response Teams, which documented a reduction in Code Blues outside of Critical Care areas when using Rapid Response Teams. Likewise the BH MET goals include eliminating or reducing the number of Emergent Code 33 calls through BH MET early intervention.
How to get the Appropriate Level of Behavioral Health Nursing Consulation for Non-Behavioral Health Units SAFETY LEVELS: • LOW: (CONSULT) Requesting a mental status assessment from a behavioral health staff (either a nurse or physician) to access the level of safety risk or assist with treatment plan. (Call corresponding inpatient unit: 1W = older adults, 2E = adults or 3E = children) • MODERATE: (BH MET) Timely response of behavioral health nurses to provide assessment and assistance of an escalating situation or safety concern. (Call phone #3334). • HIGH: (CODE 33) Prompt response by trained behavioral health staff and Security for an escalated situation in which there are safety risks or violence. (Call stat line #7111).
The most common reasons for initiating a BH MET call include: agitation, escalating confusion and combative behavior.
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Exemplary Professional Practice
Sharing our expertise Throughout the year, St. Luke’s associates, managers and directors speak at conferences and events around the country to share their expertise and success stories with peers and various groups and organizations. Stephanie Anderson, RN, MSN, CHPN Director, Hospice and Palliative Care Hospice and Palliative Care: Cedar Rapids, IA
Jeremy Hudson, NHPCO, Hospice Spiritual Distress and Assistance: Orlando, FL
IPOST: Cedar Rapids, IA; Des Moines, IA; Dubuque, IA; Fort Dodge, IA IHS Palliative Care Outcome Measurement Project: Des Moines, IA Outpatient Palliative Care: Cedar Rapids, IA Peg Bradke, RN, MA Director, Heart Care Services Bundled Payment with SNFs: Webinar Cross Continuum Teams: Des Moines, IA
Kimberly Ivester, RN, MS, BSN, RN, OCN Administrative Director, Cancer Care Lung Care Program: Wauwatosa, WI; Moline, IL
Patient Navigation and Survivorship: Washington, DC
Cross Continuum of Care: Brookings Institute webinar; IHI National Forum Readmissions: Des Moines, IA; Chicago, IL; Lansing, MI; Tampa, FL; Boston, MA; Austin, TX
Kent Jackson, MA, LMSW Director, Behavioral Health
Teach Back: Wichita, KS; Des Moines, IA; Columbia, MO; Webinar
Adverse Childhood Experiences: Cedar Rapids, IA; Des Moines, IA
Denise Easley, RNC-NIC Birth Care Center Period of PURPLE Crying Legislation: Boston, MA
Kristi Fuller, OT, Pediatrics/PICU/NICU Successful Feeding in NICU Developing Individualized Programs: New York, NY
Mary Hagen, RN, MSN, Administrative Director, Organizational Effectiveness Making the Connection: An Approach to Aligning Associate Goals with Organized Strategy, IHS Leadership Symposium, Des Moines, IA
Mary Ann Osborn, RN, MA Vice President and Clinical Officer Cross Continuum of Care: Brookings Institute webinar IQ4: It is a Lifestyle, Not a Go-Live: Moline, IL Successfully Managing Technology Adoption and Transition to New Clinical Workflows: Des Moines, IA Nursing Documentation Principals: Cedar Rapids, IA
Julie Sturbaum, RN, BSN Surgical Services Prevention and Control of Infections in Surgery: Iowa City, IA
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Cooling treatment helps oxygen-deprived newborns Doctors and nurses at St. Luke’s Newborn Intensive Care Unit (NICU) use a pediatric cooling blanket to lower the body temperature of newborns experiencing neonatal encephalopathy, or difficulty initiating and maintaining respiration, shortly after birth. “Any time a baby doesn’t have a heart rate for a period of several minutes, we are concerned about the potential lack of oxygen in the baby,” said Dennis Rosenblum, MD. “The longer a baby goes without breathing or a heart rate, particularly at around 10 – 15 minutes of age, the more concerned we are about the worst possible prognosis. We worry about transient effects, like damage to the liver, kidneys and heart. But more importantly we are concerned about long-term effects, particularly to the brain, that may not be reversible.” The cooling treatment is called systemic hypothermia or total body cooling. St. Luke’s NICU team used a pediatric cooling blanket on Deegan Mizaur when he was born without a pulse and remained that way for nine minutes. The team lowered his body temperature to 92.3° Fahrenheit for 72 hours and then slowly rewarmed him to normal temperatures. Cooling the body slows down the basic functioning of the body and may decrease injury to the brain caused by the lack of oxygen (hypoxia) and the lack of blood flow. St. Luke’s started offering this treatment because a number of large research studies have shown when babies are treated with hypothermia shortly after birth, they have less risk of dying and less brain injury. This means fewer cognitive and motor problems compared to those babies not treated with hypothermia. “We are grateful we were at St. Luke’s NICU where they have this treatment available,” said Gale Ziese, Deegan’s mother. “Deegan’s care was pretty amazing. I was so impressed with the doctors and nurses in St. Luke’s NICU.” For babies who have had prolonged hypoxia, this treatment decreases death rates or rates of moderate to severe neurologic impairment to about 30 – 50 percent, compared to a 50 – 80 percent rate of death or neurologic impairment for those who don’t receive this therapy. “As a team, we are always trying to stay on the cutting edge of best practices and providing the highest quality outcomes for our patients and their families,” Dr. Rosenblum said.
St. Luke’s started offering this treatment because a number of large research studies have shown when babies with neonatal encephalopathy are treated with hypothermia shortly after birth, they have less risk of dying and less brain injury. This means fewer cognitive and motor problems compared to those babies not treated with hypothermia. St. Luke’s NICU is part of the Vermont Oxford Network, a world wide database that includes over 900 NICUs.
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New Knowledge 2012 Nursing research studies
Advanced degrees and certifications
The Effect of Enhanced Psychosocial Assessment on Re-Admissions of COPD Patients. Jennifer Owens, LMSW, principal investigator; Kelly Pottebaum, RN, BSN, Kristina Elder, RN, BSN, Sherrie Justice, RN, MA, CPHQ, Kirk Phillips, PhD, Renee Grummer Miller, student intern, supporting investigators.
In 2012, we had 317 certified RNs, a 19 percent increase from 2011. Certification is validation of the knowledge and critical thinking skills our nurses bring to our patients with each interaction. Our patients benefit each day from their commitment to excellence.
RN Evaluation of IQ4 Implementation. Diane Seelau, RN, MBA, principal investigator; Sandi McIntosh, RN, MA, NE-BC, Debra Johnston, RN, MSN, supporting investigators. Effectiveness of ED Care Plans in Reducing Frequency of Patients’ Visits to the Emergency Department. Marilyn Gerhold, MSW, LMSW, principal investigator; Doralyn Benson, MSW, LMSW, Joshua Pruitt, MD, Amy Engelman, DO, Bonnie Lunsford, RN, BSN, CEN, Jill Wilson, RN, Fred Nesbit, RN, MSN, CNL, Sandi McIntosh, RN, MA, NE-BC, supporting investigators. Effectiveness of Pre-operative Administration of Flomax at Reducing Postoperative Urinary Retention in Male Patients Undergoing Primary Hip or Knee Arthoplasty. Lynn Haro, principal investigator; Julie Sturbaum, RN, MSN, Cheryl Mahoney, RN, MSN, supporting investigators.
Advanced degrees Sarah Baumert, RN, MSN, 5 East Penny Dullea, BSN, Pain Clinic manager Kara Flack, RN, BSN, CRRN, CBIS, 6 West
Amanda Langfitt, RN, BSN, RNCHPN, Hospice Krystal Lien, BSN, Infusion
Erica Grandy, BSN, Intensive Care Unit
Teresa Ludolph, BSN, CGNR, Digestive Health
Jeremy Hauge, BSN, Infusion
Christine Martin, BSN, 5 West
Rosetta Hedges, MSN, Medical Staff Office
Karen McCommis, BSN, 2 East manager
Bianca Hogge, RN, BSN, 5 East
Sue Novak, BSN, Digestive Health
Sarah Hunefeld, RN, BSN, 5 West
Amy Veit, RN, MSN, Performance Improvement department
Shelley Kramer, RN, BSN, RNDC, Psych Partial Hospitalization program manager
New certifications Stephanie Asmussen, RN, BSN, OCN, CMSRN (Med/Surg Certification), 5 Center
Courtney Green, RN, MSN, CCRN (Critical Care Registered Nurse), Intensive Care Unit
Diana Bahr, MSN, CMSRN (Med/Surg Certification), Med Surg float pool
Jared Hanson, RN, BSN, CCRN (Critical Care Registered Nurse), Intensive Care Unit
Jamie Canterbury, RN, BSN, CMSRN (Med/Surg Certification),4 Center
Jan Kriegel, RN, ONC (Orthopedic Nurse Certification), 4 Center
Increasing Identification of At-Risk, Drug-Exposed Newborns. Holli Nusser, LBSW, MSW student, principal investigator; Diane Sorensen, LMSE, Diane Seelau, RN, MBA, supporting investigators.
Kellie Carpenter, RN, BSN, OCN (Oncology Nursing Certification), 5 Center
Robyn Kolbet, BSN, Neonatal/Pediatric Certification, NICU/Peds, PICU
Toni Cress, RN, CRRN (Rehabilitation Certification), 4 Center Ortho
Resolving Barriers to the Use of Emergency Department Triage Protocols – Chest Pain. Dan Howlett, DNP candidate to the University of Iowa, principal investigator.
Dawn Cook, RN, OMC (Orthopedic Certification), 4 Center
Vickie Nimmer, RN, DPN, Certified EECP (Enhanced External Counterpulsation) Therapist CET (Cognitive Enhancement Therapy), Heart Holding
Patients with Heart Failure Readmitted to the Hospital. Greg Clancey, RN, MSN, DNP candidate to the University of Minnesota, principal investigator. Symptom Interpretation and Communication. Heide Bursch, RN, MSN, PhD candidate to the University of Iowa, principal investigator.
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Laura Diers, RN, CAPA, (Certified Ambulatory Perianesthesia), SurgiCare Shelly Evans, RN, BA, CGRN (Certified Gastroenterology Registered Nurse), Digestive Health Becky Gatewood, RN, OCN (Oncology Nursing Certification), 5 Center
Val Obabdal, RN, OCN (Oncology Nursing Certification), 5 Center Lorrie Prasil-Holcomb, MSW, ACHPSW (Advanced Certification of Hospice and Palliative Care Social Work), Hospice Michelle Wenzel, BSN, CWON (Certification in Wound Ostomy Nursing), Inpatient Skin Care
Helping frequent ER users lower costs, improve care
Comfort Room
Scores of patients who were frequent users of St. Luke’s ED are now receiving consistent care as a result of an innovative program at St. Luke’s. It’s called the Emergency Department Consistent Care Program (EDCCP), which got its start from a $50,000 gift from Transamerica. It’s an effort to coordinate care between St. Luke’s, the patient’s doctor, home care and mental health care.
The Behavioral Health older adult unit needed an option to help patients relieve stress and anxiety and improve their self-soothing skills. “We were looking for an alternative to medication,” said Ikami Sasa, RN, BSN, 1 West, Behavioral Health. Research showed a Comfort Room provides a safe space for patients, promoting self-care, resilience and recovery while offering an option for crisis prevention and de-escalation.
“The EDCCP began in January 2012 with the enrollment of 103 patients,” said Sallie Selfridge, LBSW, St. Luke’s social worker. “To date, there are 233 patients in the program. These are patients who have been treated in St. Luke’s ED 12 or more times during the previous year. Many used the ED because they did not have a family doctor, had difficulty keeping doctor’s appointments or had financial or insurance issues.” For example, Theresa Brown, 51, visited St. Luke’s Emergency Department (ED) 12 times in 2011. She was diagnosed with chronic obstructive pulmonary disease (COPD) just over a decade ago. She also suffers from congestive heart failure and Gitelman’s syndrome, which causes kidney problems and lowers her potassium levels. “It has been a rough several years,” said Brown. “I have been in and out of St. Luke’s a lot. Mainly because I would get sick and couldn’t breathe. It can be scary.” This program has been a huge help to Brown. “Things were so much harder for me before this program was implemented. Oftentimes I felt very overwhelmed. I’m glad St. Luke’s started this program.” The EDCCP has reduced patient visits by two-thirds. During the first nine months of 2012, the original 103 EDCCP patients visited the ED 438 times compared with 1,377 visits during the same period of 2011. “We want patients to use St. Luke’s ED when they have an emergency,” said Selfridge. “This isn’t meant to keep these patients out of the ED, we just want to make sure they are getting the most appropriate and timely care,” she said.
Improve
self-soothing skills
Decrease stress and anxiety
“We wanted to create a low-stimulus, calming environment,” said Laura Christen, RNC, 1 West, Behavioral Health. The unit adapted a former interview room and chose calming colors and items based on the literature about Comfort Rooms. Now, when patients get nervous, anxious or are having personality conflicts with another patient, they are offered the option to go to the Comfort Room. “Nurses will tell them, ‘I know an area that’s quiet,’” said Christen. The room is small and painted in soothing colors with a waterfall mural. It has dimmable lighting, a beanbag chair and rocking chair, soft carpet and stress balls. Calming, soothing music can be played in the room by staff if requested. There is no TV in the room. It is monitored via a camera by staff and patients are checked on during rounds. Patients choose when to go into the Comfort Room and when they’re ready to leave.
The efforts of the EDCCP Program have reduced patient visits by two-thirds.
Since implementation, there has been a decrease in anxiety medications and acting out from personality disorder patients, and they’ve avoided many restraint and seclusion episodes. Feedback and survey results from both staff and patients have been positive. “In 2012, the frequency of using the room increased,” Christen said. “Staff members recommend it more. We’re educating clients on something they can do when they go home.”
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New Knowledge
St. Luke’s Heart Failure Clinic educates and monitors heart failure patients Heart failure patients can quickly end up in the emergency room and stay for an extended time in the hospital. Nearly one in four will be back in the hospital within 30 days, according to a 2009 American Heart Association journal report. Nationally, institutions with heart failure clinics report a significant decrease in readmissions for patients in their programs. Peg Bradke, RN, MA, Heart Care Services director, said, “Some heart failure
clinics we talked to reported their hospital readmission rates were 30 to 40 percent lower than the national average.” St. Luke’s Heart Failure Clinic is helping heart failure patients and their families improve self-management as they treat and improve their symptoms. “We know many physicians’ offices are extremely busy. Heart failure management can be challenging and some patients need very close supervision. We combine not
only medication management but, more importantly, education, referral to services if needed and sometimes daily telephone monitoring by our heart failure nurse. Our goal is to keep patients out of the hospital and improve their quality of life at home,” said Sue Halter, ARNP, clinical director for St. Luke’s Heart Failure Clinic. Every St. Luke’s patient who receives a discharge diagnosis of heart failure is seen by clinic staff three to five days after they’re discharged. Physicians and cardiologists refer chronic heart failure patients to the clinic when a patient needs close follow-up. “We want our patients to be able to fully live their lives without repeated hospitalizations or frequent trips to the doctor and ultimately optimize the quality of their life. If we can do that by closely monitoring them and keeping them out of trouble, that’s our goal,” said Halter. “Being located at the hospital allows us to direct our patients to resources that may help, like home health care, cardiac rehabilitation and pulmonary rehabilitation if needed.”
In 2012, St. Luke’s
Heart Failure Clinic saw 1,332 heart failure patients at the clinic and in the nursing homes where they reside.
On average, more than
85% of patients
attending the Heart Failure Clinic can successfully teach back information that will help them improve their heart failure and avoid
further hospitalizations.
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Structural Empowerment Nurse residency program
St. Luke’s Councils
For new nurses, the honeymoon phase of the job wears off quickly and disillusionment sets in. Many leave their first job within a year or two then find another, only to feel dissatisfied there as well. Research backs up the idea that new nursing graduates find it difficult to acclimate to their first job. Training in school is much different from the actual experience of caring for people and the adjustment is stressful. Nurses question whether or not they’re confident enough to take care of patients.
Representatives from every department in the hospital sit on the following councils, which meet regularly throughout the year to accomplish specific tasks.
Nurse residency programs help decrease turnover and increase engagement. They provide emotional support and help new nurses gain extra knowledge and skills. St. Luke’s began its nurse residency program in 2010. It holds two cohorts a year, one in the spring and one in the fall. Since the program was initiated, 182 residents have completed the program and our one-year retention for newly graduated nurses is at 95 percent. “We wanted to be proactive even though St. Luke’s retention rate was high before the program began,” said Joanie Copper, RN, MSN, practice development coordinator who co-facilitates the program with Julie Zimmerman, RN, MSN, Birth Care Center staff nurse. She cited the nursing shortage, anticipation of nurses retiring and fewer individuals entering the nursing profession than have in the past as some of the reasons behind implementing the program. “We can use the nurse residency program as a recruitment tool. We want our nurses to be successful and retain them after their first year. It’s costly to train new nurses and have them leave. Training can cost twice their yearly salary, depending on the type of nurse it is,” Copper said. “The nurse residency program helps us develop confident, competent nurses able to provide higher quality care for patients.” Average cohort size is 40 nurses. Once nurses are hired, they spend six to 12 weeks learning their jobs in their units under guidance of a preceptor before being automatically enrolled in the nurse residency program. Nurses attend 12 three-and-a-half hour sessions that cover a variety of topics, from time management to ethics, conflict management, stress release and taking care of a changing patient condition. They learn on simulators, through role playing and discussions, small group activities and going over case studies in an environment where it’s safe to talk. And they learn that every nurse goes through the same doubts and adjustment difficulties that they experience. “We encourage them to find a mentor during their residency,” Copper said. “We believe every nurse should have this opportunity. I get so much enjoyment watching them grow and teach each other, share experiences and gain confidence in what they’re doing. And we have a lot of fun.”
Patient Care Delivery Council, chaired by Carmen Kinrade, RN, MSN Developed and implemented Comfort C.A.R.E. Professional Practice Model Performance Improvement Council, chaired by Sherrie Justice, RN, MA 1. Review nurse sensitive indicator data, such as falls, pressure ulcer, blood stream information, hospital performance against national benchmarks. 2. Unit Practice Councils reported quarterly on their individual department progress on patient and family experience and quality indicator performance. 3. Twenty departments presented case studies for group learning. Practice Council, chaired by Peg Bradke, RN, MA 1. Documentation and workflow clarification for Epic. 2. Developed Diabetes Education Toolkit and Care of Dying Patient Resource packet. 3. Evaluated and approved new products and equipment, such as IV pumps, Pyxis machines, epidural pumps, feeding tube connections, Accucheck machines, razor and shaving cream, slippers, combs and toothbrushes. 4. Reviewed and revised policies related to tracheotomy care, tube feedings and the care of the bariatric patient. Professional Development Council, chaired by Diane Seelau, RN, BSN, MBA The Career Achievement Program (CAP) was developed in 2008 to recognize nurses, respiratory technicians, social workers and dietitians who are engaged in house-wide councils and projects. Participation has nearly doubled since its inception. In 2012, 41 individuals received the Gold award, 128 received Silver and 95 received Bronze for a total of 264 participants. The Professional Development Council evaluates entries and determines award level, which includes a bonus reward. Research Council, chaired by Sandi McIntosh, RN, MA, NE-BC 1. Revised and implemented Evidence Based Project and Research Toolkit, placed on Intranet. 2. Changed Council model to Advanced Practice Nurse (APN) model, so APNs are mentoring staff nurses on how to perform research. 3. All APNs, chairs and co-chairs have completed National Institute of Health web-based training “Protecting Human Research Participants.” 4. SLH completed three research studies in 2012.
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Structural Empowerment
Extraordinary people – exceptional care Every year during Nurse Week, St. Luke’s holds a Nursing Awards ceremony to recognize, celebrate and thank nurses in our organization who were nominated by their peers for nursing excellence. The awards and scholarships give our hospital an opportunity to say a heartfelt thank you to nurses who are living our mission every day. The awards and scholarships are provided by generous donors in our community who believe in the mission of St. Luke’s Hospital and St. Luke’s Foundation.
Outstanding New Graduate Award Elyse Chodur – Cancer Care/Neuro Unit
C.A.R.E. Service Award Kati Rizzio – Medical Unit
LaMorgese Award for Excellence Nancy Lamb Skogsbergh & Edna Lamb in Neurological Nursing Nursing Leadership Award Jenny Houlihan, RN, MSN – Cardiac Care Unit Samantha Feddersen, RN, BSN – Cancer Care/Neuro Unit Excellence in Behavioral Health Awards Rachel Brecht, RN, MSN – Older Adult Unit Carroll H. & Lena Nelson Critical manager Care Award Sandra Bills, RN, BSN, SANE – Adult Unit Julie Gilmore, RN, BSN, CCRN – Intensive Care Unit Victoria Van Voorst, RN – Child/Adolescent Unit Angela Ulferts, RN, BSN – Post Surgical Unit, Joy Cummings, RN, BSN – Psychiatric Home 3 West Care/VNA Dr. Stephen & Peg Vanourny Award for 100 Great Iowa Nurses Excellence in Obstetrical & Gynecological Carol Franzenburg, RN, BSN – 5 West Urology Nursing Debra Langager, RN, BSN, RNC-OB – Carol Haendler, RN, BSN, CRRN, CDIS – Birth Care Center Physical Medicine & Rehab Ida Martin Sorensen, RN – ER, Social Worker Award Family Health Center Nancy Hagensick, OSWS – Helen G. Nassif Community Cancer Center Sandra McIntosh, RN, MA – ER
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Elaine Young Leadership Award Denise Abel, RN, BSN – Cancer Care/Neuro Unit Anna Purna Ghosh Oncology Nursing Award Stephanie Asmussen, RN, BSN, OCN, CMSRN – Cancer Care/Neuro Unit supervisor Darrell Dennis Pulmonary Medicine Award Stacey Below – Respiratory Care Smulekoff Family Award for Nursing Excellence Erin Boone, BSN, RN-BC – Post Surgical Unit, 3 Center Kiley Finke, BSN, PCCN – Telemetry Unit, 3 Center Lindsey Ricklefs, RN, BSN, RNC-NIC – Newborn Intensive Care Unit Bryce Richmond, BSN, CNMSRN – Cardiac Care Unit, 5 West Dale & Ruby Morgan & Mable Ray Endowment Award Robyn Kolbet, RN, BSN – Newborn Intensive Care Unit
Scholarship winners Greta N. Schuchmann Scholarship Lindsey Mullenbach – Laboratory Kimberly Wilson – Cardiologist, LC Nursing Scholarship Sheryl Bosch, RN, BSN, CCRN, NIH – Cardiac Cath Lab
Guardian Angel Award winners Natalie and Joe Cohn Scholarship Tessa Kvidahl – Imaging Services, Radiology Transporter Aimee Traugh, RN, BSN – Telemetry manager 3 Center Brittany Werling, CPhT – Pharmacy
The Guardian Angel program at St. Luke’s gives families a way to recognize St. Luke’s associates who have made their journey easier. They offer a donation in honor of a St. Luke’s staff member, doctor, volunteer or department, and those individuals receive a Guardian Angel Award and recognition among their peers for exemplary care.
Barbara Haeder, RN, BSN – Heart Care Center
May G. Gortner Scholarship
Kathy Gilliland and her pet therapy dog Misty
Kiley Finke, RNBSN – Telemetry
Sara Goslin Neff, RN, BSN, BA, RNC-NIC – Newborn Intensive Care Unit
Kimberly Woods, RN, RNC-OB – Birth Care Center
Jennifer Bielefeld, Bridget McCullough, Nicole Baccam, Melissa Delaney, Beth Walker, Kathy Martensen
Laura Ramsey, RN, ARNP, MSN, NNP-BC, CPNO-AC – Newborn Intensive Care Unit
Dr. J. Stuart McQuiston Scholarship
Beatha Kuntz Scholarship Rachel DeWalle, RN, MSN, RNBC – Cancer Care/Neuro Unit Dr. Charles Schwartz Scholarship Joanie Copper, RN, MSN – Nursing Services
Nic Hughes, Bill Feldhaus, Jessie Merrill Diane Kladivo
Jayne Hildebrand – Surgery Center
Tami Mora, Mindie Manning, Debra Sanders, Vickie Nimmer
Julie Martin – Medlabs
Melissa Watson (Cobb)
Julie Smith – Respiratory Care
Amber Dull Bruce Wlosinski, Beth Mehmen Mary Anne Berry, Bruce Wlosinski, Bobby Dickerson and Dr. James Bell Cassie Wallace Julie Trachta Kristin Watts, Nikki Yakish, Colleen Bentley Dr. John Roof Mary Ann Osborn, Dr. Josh Pruitt Amy Boteler, Janet Brown, Pam Cohn, Bev Faber, Jennifer Hickey, Sue Novak, Justine Obert, Joan O’Connor Kelly Printy, Jeremy Hague Janelle Latimer, Cassandra Woodward Dr. Dana Messenger, Dr. Adam Shires Kali Gleason, Lynsey Hawn, Shannon Timp, Ashley Jensen Jill Hendricks Dr. Robert Struthers Mona Cook Michael Fahrenkrog-Pullen Karin Kurisu and her pet therapy dog Reese’s Chris Montross Dr. Keith Kopec Barbara Peterson, Lorrie Prasil-Holcomb, Jeremy Hudson, Pauline Moermond, Amanda Langfitt, Falecia Wilson, Anita Horak Denise Behmer, Jean Hachey Erin Williams, Dani Broederson
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Transformational Leadership Nurses led projects in the following areas and provided many additional examples of leadership: Associate training at St. Luke’s: Mary Hagen, RN, MSN, Mary Springsteen, RN, BSN, and Bonnie Carpenter, RN, BSN, RNE-MB, selected CTs and Super Users, identified classroom space, created the training calendar and built the post go-live training program for new hires and students.
Adaptive design workflow efforts in the pre and post go-live phases: Led by Carmen Kinrade, RN, MSN, Gretchen Aschoff, RN, BSN, CPHQ, Connie Bulman, RN, CMSRN, Julie Cayler, RN, MSN, Cheryl Mahoney, RN, MSN, CMSRN, and Peg Bradke, RN, MA. This was identified as a best practice by our Epic partners and external consultants.
Operation Time application: Led by Carol Duit, RN, Janna Peterson, RN and Julie Sturbaum, RN, MSN.
ASAP application: Led by Kathy Ross-Garron, RN, MSN, CEN, CFRN and Sandra McIntosh, RN, MA.
Stork application: Led by Phyllis Maeder, RN, BSN, Kathy Manderschiedt, RN, MSN, RNC-OB and Diane Seelau, RN, MBA.
Clinical informaticists: Led by Mary Springsteen, RN, BSN, with Michelle Puls, RN, BSN and Rose Hedges, RN, MSN. Multiple nurses served in CT and super user roles.
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An “Epic” change at St. Luke’s The June launch of a new electronic health record at St. Luke’s successfully resulted in 90 percent user compliance within five months and a $4,815,422 meaningful use reimbursement within 10 months by the Centers for Medicare and Medicaid Services. The electronic health record allows healthcare providers quick access to critical patient information, including medical history, test results and prescriptions. IQ4 implementation was an excellent example of nursing leadership and interdisciplinary collaboration. Mary Ann Osborn, RN, MA, vice president and chief clinical officer served as the clinical adoption executive for both St. Luke’s and UnityPoint Health, helping establish the governing principles for the design work, facilitate workflow sessions, create certified trainers (CTs) and super user selection criteria, establish the informatics team post go-live infrastructure and define go-live command center roles. Osborn worked closely with Pat Thies, RPh, MS, FACHE, director of pharmacy and St. Luke’s Epic project lead and Dustin Arnold, DO, CMIO, to align resources and communicate to all key stakeholders.
SimFam: Meet SimMan, Noelle and MegaCode Kid During yearly competencies at St. Luke’s, the resident fake family earns its keep. High-fidelity mannequins SimMan, Noelle and MegaCode Kid “breathe,” “talk,” receive IVs and shots, and generally get into difficult health situations at the push of a button. Noelle, the pregnant patient simulator, has a heartbeat, she bleeds and gives birth on a routine basis, all in the name of practicing successful deliveries. Her baby has problems of its own, providing nurses and doctors with newborn intensive care training. All of the mannequins encounter any number of complications thanks to special computer programs. In 2012, Birth Care Center simulations focused on maternal seizures. “My simulation team worked on a postpartum seizure related to preeclampsia, and then our labor-trained staff worked on laboring patient who had a seizure related to preeclampsia,” said Rachel Smith, BSN, RNC-OB, obstetrical outreach coordinator in St. Luke’s Birth Care Center. “We limit simulations to seven people because small groups work better. We videotape them so we can see what’s been done and we discuss it in a debriefing afterwards.” The exercise is typical for all St. Luke’s patient care unit competencies. It’s a great way to train nurses, doctors and whole teams on events, particularly low-volume, high-risk events. “Staff can learn in a safe environment, where it’s okay to make errors,” said Joanie Copper, RN, MSN, practice development coordinator. “They debrief afterwards and go over what they could have done better.” The process teaches better teamwork, communication and competency, which are the cornerstones to quality healthcare.
The Bridges to Excellence The Bridges to Excellence program provides associates and affiliates funding to attend conferences for professional and career development by paying expenses up to $2,000.
St. Luke’s certifications and accreditations
Advanced Certification in Palliative Care: Awarded by The Joint Commission September 20, 2012 – valid for two years. St. Luke’s is the first healthcare provider in Iowa to receive this certification, which is based on review of compliance with national standards, clinical guidelines and outcomes of care. In addition, the requirements include: • A formal, organized palliative care program led by an interdisciplinary team whose members possess the requisite expertise in palliative care • Leadership endorsement and support of the program’s goals for providing care, treatment and services • A special focus on patient and family engagement • Processes that support the coordination of care and communication among all care settings and providers • The use of evidence based national guideline or expert consensus to guide patient care Advanced Certification in Stroke (Primary Stroke Center): Awarded by The Joint Commission May 2012 – valid for two years. St. Luke’s was first awarded Advanced Certification in Stroke and designated a Primary Stroke Center in 2006 and has received four consecutive certifications since then.
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Transformational Leadership
St. Luke’s certifications and accreditations
IMPROVING LIVES THROUGH CHANGES IN IOWA LAW Iowa Physician Orders for Scope of Treatment St. Luke’s played a key role in getting a new healthcare law passed in March 2012 that creates the Iowa Physician Orders for Scope of Treatment (IPOST). This is a legal doctor’s order that allows an individual’s healthcare wishes to be documented, communicated and honored as they pass through various healthcare settings.
Commission on Accreditation of Rehabilitation Facilities (CARF): Surveyed by CARF November 17–18, 2011 – accreditation valid for 3 years in the following programs: • Inpatient Rehabilitation – adults • Inpatient Rehabilitation – children and adolescents
The one page document allows a person to communicate their preferences for key lifesustaining treatments including: CPR, general scope of treatment, artificial nutrition and more. People may refuse treatment, request full treatment or specify limitations. It is primarily used by the chronically or seriously ill who have frequent contact with healthcare providers, a person with a life-limiting illness or the frail and elderly residing in a nursing facility or in the home. The portability of the IPOST form (it “travels” with patients as they move from one healthcare setting to another) belongs to the patient and allows seamless documentation of treatment preferences. It complements an Advance Directive by translating patient wishes into legal medical orders, which due to the passing of this legislation, will now be honored in all healthcare settings across Iowa. IPOST also helps to facilitate conversations between family members and the physician in order to make a person’s wishes known.
• Inpatient Rehabilitation – brain injury adults • Inpatient Rehabilitation – brain injury children and adolescents • Inpatient Rehabilitation – stroke specialty program – adults St. Luke’s is the first rehabilitation program in Iowa to receive the Commission on Accreditation of Rehabilitation Facilities (CARF) Inpatient Rehabilitation Stroke Specialty Program accreditation. St. Luke’s Inpatient Rehabilitation unit received their twelfth consecutive three-year accreditation for the unit. Advanced Certification in Heart Failure: Awarded by The Joint Commission September 25, 2012 – valid for two years. Certification in Joint Replacement – Hip – Knee: Awarded by The Joint Commission July 21, 2012 – valid for two years.
The IPOST project began back in 2006 when Dr. Ralph Beckett, Stephanie Anderson, RN, MSN, director of St. Luke’s Palliative Care and UnityPoint Hospice, and Christine Harlander, Palliative Care at Mercy Medical Center, identified a gap in care. They often discovered their patients’ healthcare treatment wishes were not being met after leaving the hospital. Too often, people were receiving treatment they did not want because their wishes were not communicated as they crossed various healthcare settings. Anderson and Harlander found their solution in a similar program that began in Oregon (POLST). In 2008, state lawmakers chose Linn County to pilot the IPOST tool as part of Iowa’s Health Care Reform Act. In 2010 the project was expanded to include Jones County where Jones Regional Medical Center rolled out the tool and adapted it to fit a more rural population.
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Shaken baby prevention: Period of PURPLE Crying program In October 2012, Denise Easley, RNC-NIC, spoke at the International Shaken Baby conference in Boston about Iowa’s legislation written specifically around the Period of PURPLE Crying program. It was the culmination of years of dedication by Easley to improve Iowa’s education regarding shaken baby syndrome and decrease Iowa’s shaken baby rate. It all began in 2007 when Easley attended the National Association of Neonatal Nurses Conference in San Diego, California, using money from the Bridges to Excellence Fund. At the conference, she learned about the Period of PURPLE Crying program. “What I loved about the program was that it is evidence-based, prepared for third-grade level understanding, easy for nurses to implement and parents to understand, and economical,” Easley said. “My initial goal was to get this program at St. Luke’s.” After attending a summit in Des Moines on shaken baby syndrome the following year, she realized she could bring the program to the entire state. Easley worked to spread awareness about the program, and in March 2009, Iowa passed shaken baby legislation based on the Period of PURPLE Crying Program. Later that year St. Luke’s became the first hospital in Iowa to start the program and other Iowa hospitals soon began implementing it. Easley became a trainer to teach nurses how to deliver the program and she speaks about it at conferences and does presentations. “By October of 2011, 80 percent of Iowa’s birthing hospitals were delivering the program. That happened in less than two years,” Easley said. “Shaken baby rates have declined since the program was initiated. There was not a single shaken baby death in Iowa in 2011 or 2012.”
“ What I loved about the program was that it is evidence based, prepared for third-grade level understanding, easy for nurses to implement and parents to understand, and economical.” Denise Easley, RNC-NIC
P
Peak of Crying Your baby may cry more each week. The most at two months, then less at three-five months.
U
Unexpected Crying can come and go and you don’t know why.
R P Resists Soothing
Pain-Like Face
Your baby may not stop crying no matter what you try.
A crying baby may look like they are in pain, even when they are not.
L
Long Lasting Crying can last as much as five hours a day or more.
E
Evening Your baby may cry more in the late afternoon and evening.
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Community Contributions St. Luke’s works to ensure there are programs in our community providing services to prevent illness and promote health and healing in response to identified community needs. The goal is to improve residents’ access to healthcare, enhance the health of the community, advance medical or health knowledge, or relieve the burden on government or other community efforts. St. Luke’s community benefits include education, charity care, subsidized health services, community health improvement activities and more.
Bras for the Cause is a nonprofit organization that raises funds for mammograms and cervical screenings and promotes women’s health and wellness education. Photojeania, Inc.
Photos from left to right: Breast Cancer Awareness “Bat” Boat; “Pink in the Rink”; Breast Health Summit
Free Mammography Day
Breast Health Summit
“Pink in the Rink”
St. Luke’s Breast and Bone Health provided no-cost mammography screening to 29 uninsured or underinsured women over the age of 40 on March 19. Three of the women received additional imaging and follow-up.
For the first time in Cedar Rapids, last March over 100 women gathered to focus on education, risk prevention and detection of breast cancer in African American women. The conference was held at the African American Museum and was organized with assistance through the Iowa Cancer Consortium, Iowa Department of Public Health and many community partners, including St. Luke’s Cancer Care and Breast and Bone Health.
St. Luke’s Breast and Bone Health and Cancer Care partnered with the Cedar Rapids Roughriders Hockey organization to promote breast cancer awareness on September 19. Over $2,300 was raised for the Spirit Fund through ticket sales – with the Rough Riders donating $2 of every ticket sold – and a silent auction.
Bras for the Cause Carousel Motors, a major contributor to the Bras for the Cause organization, chose St. Luke’s to receive $10,000 in Bras for the Cause donations. The money will be used primarily for screening mammography for the uninsured and underinsured. St. Luke’s Breast and Bone Health, in collaboration with St. Luke’s Foundation, is planning a screening event in June 2013 to provide approximately 57 screenings to women who otherwise would not receive recommended breast screenings.
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Breast Cancer Awareness “Bat” Boat St. Luke’s Breast and Bone Health and Cancer Care once again sponsored the Breast Cancer Awareness “Bat” Boat, an offshore racing boat with a “batwing” design. The boat helps promote breast cancer awareness and education in the community when it appears at events such as the Uptown Marion Market and Cedar Rapids’ St. Patrick’s Day and Holiday DeLight parades.
Click for Babies St. Luke’s recruited knitters and crocheters to make purple caps for babies. The caps were given out at the hospital in November to new parents after they viewed their Period of PURPLE Crying DVD. Using social media, knitters united across the country while making purple baby caps, and St. Luke’s collected 6,800 caps to distribute.
Go Red for Women
Community boards
St. Luke’s Hospital is the primary sponsor of Cedar Rapid’s Go Red for Women, which is a luncheon and program following a vendor fair, silent auction and breakout educational sessions to raise awareness about heart disease as the number one killer of women in the U.S.
Stephanie Anderson, RN, MSN, Director, UnityPoint Hospice and St. Luke’s Palliative Care: Hospice and Palliative Care Association of Iowa board, Palliative Care Advisory Group for Iowa Pam Burrack, RN, BSN, 3 Center: American Association of Critical-Care Nurses secretary
Bike helmet giveaways
Lifeguard Air Ambulance St. Luke’s Lifeguard crew participates in events happening in small, rural communities where a large percentage of Lifeguard customers – Emergency Medical Services (EMS) and community hospitals in outlying areas – are located. “We do things like fly in for their town celebrations and allow people in their community to look at the helicopter and sit in it. Kids love it and it also allows us to see patients we have cared for in the past and help build a strong reputation for Lifeguard and St. Luke’s Hospital,” said Lynn Tschiggfrie, RN, CEN, Lifeguard Air Ambulance supervisor. “We also go out to EMS services and do education classes.”
St. Luke’s Physical Medicine and Rehabilitation brain injury community outreach fits and distributes approximately 2,000 bike helmets every year. They began the program seven years ago because the acute inpatient rehab unit serves many patients who have experienced traumatic brain injuries and they felt it was important to prevent even one brain injury by keeping kids safe.
Eastern Iowa Retreat and Refresh Stroke camp Held annually at Camp Courageous in Monticello, Iowa, since 2008, this camp offers fun activities, relaxation and support to stroke survivors and their care givers. It is funded by a joint collaborative effort between St. Luke’s Physical Medicine and Rehabilitation, Mercy Medical Center and University of Iowa Hospitals and Clinics. In addition to funding, St. Luke’s supplied 10 volunteers for the three-day weekend retreat.
Peg Bradke, RN, MA, Director, Heart Care Services: American Heart Association executive committee, Go Red for Women 2012 event chair Mary Hagen, RN, MSN, Administrative Director, Organizational Effectiveness: Catherine McAuley Center board, Transitional Housing for Women and Adult Education program, Human Resources committee Kent Jackson, MA, LMSW, Director, Behavioral Health: Linn County Severe Emotionally Disturbed (SED) advisory board, Linnhaven board, Magellan Clinical Advisory committee, Early Childhood of Eastern Iowa board, Linn County MH/DD Advisory committee, United Way Health Impact team Carmen Kinrade, RN, MSN, Director, Nursing Operations: Aging Services board president Shelley Kramer, RN, BSN, Adult Partial Hospitalization: National Alliance on Mental Illness (NAMI), second vice president of executive board, NAMI treasurer Mary Ann Osborn, RN, MA, Vice President and Chief Clinical Officer: Eastern Iowa United Way board, executive committee, chair of Children’s and Youth Allocation team, chair of Impact Cabinet
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Magnet Champions Throughout the year, representatives from every area of the hospital meet to share news and innovations from their departments. It offers inspiration and facilitates collaboration across disciplines.
Here’s what our Magnet Champions are saying:
“ The new interdisciplinary tracheotomy team was created to enable St. Luke’s patients
to come here as outpatients and have their tracheotomies changed every month by the people they’re familiar with. It’s absolutely the right thing to do for our patients. It helps us merge hospital care with home care to get our patients comfortable at home.
Sarah Erickson, RT, Respiratory Care
”
“ Early ambulation protocol brings together nurses, respiratory therapists and
therapists to huddle with patients on ventilators, ensuring the right people are in place to walk with patients when they’re ready. Nursing research and nursing protocols drove this practice change. It has decreased length of stay, ventilation days, and expense.
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Jaclyn Hall, PT, GCS, supervisor of acute therapies
“ In the Birth Care Center, we implemented subgaleal hemorrhage protocol for babies
with head trauma or vacuum or forceps delivery. The new protocols, such as taking vitals and measuring head circumference to make sure their head isn’t swelling, gives us a way to catch subgaleal hemorrhage before it’s too late.
Shawna Meyer, RN, Birth Care Center, Magnet Champion
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“ We changed our Critical Care Unit transfer process. Our nurses now go up to the
patient’s bedside to get the report before they’re transferred out. It allows us to see if the patients are ready and puts them in a better frame of mind so they’re not as scared before coming down. It has decreased the number of unplanned transfers back to critical care. We’ll soon expand the process to the Intensive Care Unit. Amanda Plummer, RN, Telemetry, Magnet Champion
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“ In Behavioral Health, our patients face daily challenges above and beyond their
physical health, leaving them vulnerable to readmission. Our innovative approach to discharge planning involves all caregivers – including pharmacy, home health, social workers, nursing – and begins when patients arrive in our unit and involves daily meetings. We follow up with phone calls after patients leave. Our revamped discharge, safety and success plans are proactive and set up for success.
Sandy Bills, RN, BSN, SANE, Adult Behavioral Health, Magnet Champion
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Connect with St. Luke’s at unitypoint.org/cedarrapids UnityPoint Clinic | UnityPoint at Home | UnityPoint Hospice 1026 A Avenue NE | Cedar Rapids, IA 52402 | 319/369-7211