Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements This annual newsletter highlights some of St. Michael’s best practice achievements with examples of how our nursing teams are implementing, evaluating and sustaining best practice guidelines (BPGs) into standardized processes that support evidence-based nursing practice.
From Champion to Manager: How experience leading change initiatives shaped mentorship and support for BPG Nurse Champions A unit culture that fosters professional development and empowers nurses and teams to lead change initiatives is an environment Vasuki Paramalingam is accustomed. It was an environment she wanted to expand while interim Clinical Leader Manager (CLM) for Inpatient Mobility (Orthopedics/Neurology/ENT). Vasuki’s permanent role is Clinical Nurse Educator for the Trauma Neurosurgery Intensive Care Unit (TNICU).
October to March 2018, Inpatient Mobility implemented the following BPG initiatives with support from Vasuki and the BPG Mentor Lory Lee who was the unit’s Clinical Nurse Educator.
Vasuki began her nursing career at St. Michael’s as a Registered Nurse in TNICU. As a staff nurse Vasuki Championed many unit level quality initiatives. As a Clinical Nurse Educator in TNICU she became a BPG Mentor, and supported her nursing colleague’s and team to implement best practices. “Through these wonderful professional growth opportunities, I developed a strong appreciation for the impact BPGs have on staff, patients and, families” said Vasuki.
2.
RN to RN Bedside shift-to-shift Transfer of Accountability (TOA): BPG Nurse Champion, Maria Fernanda Bacerra Gomez, created a new nursing Kardex to reflect the components of TOA and safety checks.
3.
PACU to Inpatient Mobility TOA: This initiative was initially started two years ago by BPG Nurse Champions Louie Juanchu and Peter Quan Van Lee. BPG Nurse Champion Jennifer Wong, lead the development of a new tool. The tool is now part of the patients chart.
When Vasuki became interim CLM for Inpatient Mobility in August 2017 a priority for her was to encourage and motivate the unit to lead new BPG initiatives to further enhance nursing practice and quality care. “When I asked the nurses if they wanted to be part of this opportunity, I had a large number of nurses who were interested and came forward –it was amazing!” said Vasuki. From
1. Falls Prevention: BPG Nurse Champion, Denis Aleynikov, implemented intentional rounding on nights. This led to an impressive reduction in falls during the night.
As interim CLM, Vasuki reflected on her own experience implementing quality initiatives and this guided her on how she could effectively support the BPG Nurse Champions, BPG mentor and team. “When I championed quality initiatives at the unit level, I appreciated the support and guidance from the leadership Continued on page 3
BPSO stands for Best Practice Spotlight Organization, the designation awarded by the Registered Nurses’ Association of Ontario (RNAO) to organizations upon successful implementation, evaluation and knowledge translation of established nursing best practice guidelines (BPGs). St. Michael’s has been a proud designated BPSO since 2012.
with Ashley Skiffington Evidence Based Practice Nursing Manager
What does being a BPSO mean to you – in one sentence? I am proud to work in a hospital that is a designated Registered Nurses’ Association of Ontario (RNAO) Best Practice Spotlight Organization (BPSO).It demonstrates our ongoing commitment to our patients, families and broader community that we strive to provide the highest standard of care which is current and evidence based.
What is one change BPSO brought to SMH? I believe BPSO was the vehicle to further enhancing an evidence based nursing culture at St. Michael’s. Our journey has brought opportunities and demonstrated outcomes that have raised the profile of nurses as knowledgeable leaders who actively contribute to quality improvement (QI) and implementing best practices. While many generic nursing programs have now introduced QI into education curriculum, I wasn’t introduced to QI as a nursing student. When I entered the nursing workforce, I didn’t associate QI in nursing. That changed when I had the opportunity to become a BPG Nurse Champion over 8 years ago. For me, the opportunity to lead a BPG initiative that I was passionate about and I believed would make a difference for patients and families, was a very rewarding experience and it inspired me to do more. Through my experience as a BPG Nurse Champion I acquired new knowledge and skills. The opportunity and experience to become a BPG Nurse Champion largely contributed to the realization of my passion for evidence based practice, QI, education and mentoring that led me to pursue my current role. 2 I October 2018
Every year, Nursing Professional Practice offers frontline nurses the opportunity to lead BPG implementation, evaluation and sustainability initiatives in their local areas. BPG Nurse Champions develop capacity in quality improvement, project management and leadership while spreading evidence based practice. Many of these nurses present internally and externally at conferences at local and international levels. Through their BPSO work, nurses and teams are not only impacting patient care within our organization but they are also informing care across the globe. Some BPG Nurse Champions pursue leadership roles in clinical practice, education, mentorship, research and management. As we continue our BPSO journey we are building capacity at all levels of our organization and a nursing workforce that is inspired to lead changes that improve patient care.
What is one memorable BPSO moment for you? The annual Nursing Week BPG Sustainability Poster Gallery Walk event is always a very memorable event for me. This event was created to profile BPG Nurse Champions and initiatives that are undertaken each year. It is an opportunity to recognize and celebrate frontline nurses applying QI methodologies coupled with their clinical expertise and creativity to improve patient care and/or the quality of their work environment. At this event there is always enthusiasm and positive energy coming from the BPG Nurse Champions and also from colleagues, interprofessional team members and management. It’s an opportunity to congratulate everyone on their achievements. It is amazing to watch the knowledge sharing and networking. It is one of St.Michael’s most popular Nursing Week events and one of my favourites!
Continued from page 1
team; they helped me grow. I learned from role modeling. In my role of CLM, my goal was to simply replicate the same support and guidance for my BPG Nurse Champions and BPG Mentor. It was really nice watching them apply their learnings from the BPG Communities of Practice (CoP), excel in their work and grow as professionals” said Vasuki. The Clinical Nurse Educator role was introduced on the Inpatient Mobility unit in September 2017. “This role made a huge difference on the unit with respect to the uptake and sustainability of our BPG initiatives” said Vasuki. Balancing day to day duties of a CLM while supporting 3 BPG initiatives is not an easy undertaking. Vasuki saw it as a unique opportunity to apply her leadership and mentorship skills in a different way. “I made myself available for the BPG Nurse Champions to bounce ideas off me on top of scheduling ongoing huddles to discuss their initiatives. Lory and I also took turns observing TOA and checking to make sure the new intentional rounding sheets were completed daily. Lory and I also met with our BPG Nurse Champions after the BPG CoPs to touch base and help in any way we could. These initiatives were important and I wanted the staff to know I fully supported them through the process” said Vasuki. When asked about ways other leaders can support their BPG Nurse Champions and teams at the unit level Vasuki said “Taking advantage of the opportunities offered by Nursing Professional Practice will help create a healthy
and positive work environment that promotes professional growth of staff. Support BPG Nurse Champions and other staff by encouraging open communication and an open door policy. Support the BPG Mentors and work closely with them. Empower BPG Nurse Champions to be leaders in their respective areas. Let them shine, and celebrate the BPG team and their achievements at every opportunity!”
Vasuki Paramalingam, Clinical Nurse Educator for the Trauma Neurosurgery Intensive Care Unit (TNICU)
Vasuki would like to express appreciation to the following groups for supporting and welcoming the implementation of the above mentioned BPG initiatives: Nursing Professional Practice, Elizabeth Butorac, (Interim Director for Trauma Neurosurgery & Mobility Program), Lory Lee (Clinical Nurse Educator), BPG Nurse Champions Denis Aleynikov, Maria Fernanda Bacerra Gomez and Jennifer Wong and all the staff on Inpatient Mobility. “It was an incredible year”said Vasuki. Vasuki will return to the role of Clinical Nurse Educator in TNICU in September 2018.
Did you know? SMH was featured in a chapter of a newly released book entitled, Transforming Nursing Through Knowledge : Best Practices for Guideline Development, Implementation Science, and Evaluation. The book coauthored by RNAO’s Chief Executive Officer Doris Grinspun and former Director of the International Affairs and Best Practice Guidelines Centre director, Irmajean Bajnok, tells the story of the association’s best practice guidelines (BPG) program from its inception in 1998 to the growth and reach the program enjoys today. The book shows how BPGs are developed, implemented and evaluated. It also provides readers with a behind-thescenes look at how nurse executives, health-care organizations, and professionals create evidence-based cultures. St.Michael’s is featured in a case study in the chapter, Creating Evidence Based Cultures Across the Health Continuum.
October 2018 I 3
Who Were Our 2017/18 BPG Nurse Champions?
A BPG Nurse Champion is a registered nurse selected to lead, facilitate and inspire the BPG implementation and evaluation process in their local unit. From October to March 2018, there were 45 BPG Nurse Champions who led BPG initiatives in their local areas/departments. To learn more about our 2017/18 BPG Nurse Champions visit St. Michael’s BPSO intranet page. 4 I October 2018
What are key qualities of a BPG Nurse Champion? •
A nurse who demonstrates initiative and commitment to best practices in their current role;
•
Passionate about a BPG topic, patient population and the potential outcomes that can be achieved;
•
Has the ability to lead, coordinate and facilitate an initiative/ project and, role models positive clinical leadership
2018 Nursing Week BPG Sustainability Poster Gallery Walk This year we celebrated St. Michael’s sixth year as a designated RNAO BPSO and the implementation of 36 BPGs since 2009. This year also marked the eighth annual Nursing Week BPG Sustainability Poster Gallery Walk event. During this year’s BPG Poster Gallery Walk we celebrated and recognized the many nurses and teams who showcased their achievements. The event profiles quality improvement (QI) initiatives that are informed by RNAO BPGs and contribute to quality patient care. BPG Nurse Champions and their mentors received custom designed “BPG Champion” and “BPG Mentor” pins in recognition of their dedication to excellence in patient care and quality improvement. Joining in the celebration was Heather McConnell, RN, BScN, MA(Ed) from the RNAO. Heather is the Associate Director Guideline Implementation and Knowledge Transfer at the RNAO. During her Nursing Week Greetings she referred to St. Michael’s Hospital as belonging to “an elite group of health and academic organizations across the province, the country and abroad. The common thread you share is the desire to prepare nurses and others with best practices, apply them to everyday practice, and have a positive impact on outcomes for clients, providers, the organization and the system. There is no doubt that you are helping to make our health-care system more effective, efficient and responsive”.
RN Champion Pin
RN Mentor PIN
From left to right: Heather McConnell, Associate Director - Guideline Implementation and Knowledge Transfer at the Registered Nurses’ Association of Ontario (RNAO); Jennifer Trieu, RN, Cardiology; Marie Prystay, RN, Cardiology; Donna Romano, former Interim Evidence Based Practice Nursing Manager; Sonya Canzian, Vice President, Programs, Chief Nursing and Health Disciplines Executive
October 2018 I 5
Highlights from 2017-2018
BPG COMMUNITIES OF PRACTICE Last year there were 30 BPG quality improvement initiatives implemented across 21 different clinical areas from October 2017 to March 2018. These initiatives were led by 45 BPG Nurse Champions and supported by 24 BPG Unit Mentors and 4 Mentors in Professional Practice. Supporting BPG Nurse Champions is important to assure success as we continue our BPSO sustainability and designation with the RNAO. In addition to mentorship, CoPs have been used to support the development of BPG Nurse Champions and teams in implementing and sustaining BPGs. Based on positive feedback received from past champions, Nursing Professional Practice decided to once again, offer the BPG CoP in 2017/18. A CoP was held monthly from October to March. The evaluation and feedback received from BPG Nurse Champions who participated in the 2017/18 CoP was positive. Here are a few comments from BPG Nurse Champions about their experience participating in the BPG CoPs.
Each learning session was relevant to my BPG and I was able to apply what I learned to my initiative
Thank you to Nursing Professional Practice for this wonderful opportunity and experience. I learned so much that can be applies to other initiatives as well
I found the open structure helpful. Being able to openly describe my project and problem solve This was a very helpful way to stay with my mentor and colleagues was helpful on track and keep focused throughout the BPG
Nursing Professional Practice Staff Update Welcome back Ashley Skiffington, Evidence Based Practice Nursing Manager. Thank you to Donna Romano, former Interim Evidence Based Practice Nursing Manager and congratulations on your new role as Manager, Mission and Values.
6 I Octoober 2018
36 BPGS & Counting‌! St. Michael’s is one of the few BPSO organizations that have implemented a total of 36 RNAO BPGs 1. Assessment and Management of Pain 2. Assessment and Device Selection for Vascular Access 3. Assessment and Management of Foot Ulcers for People with Diabetes 4. Assessment and Management of Venous Leg Ulcers 5. Assessment and Care of Adults at Risk for Suicidal Ideation and Behaviour 6. Breastfeeding Best Practice Guidelines for Nurses 7. Caregiving Strategies for Older Adults with Delirium, Dementia and Depression 8. Care and Maintenance to Reduce Vascular Access Complications 9. Care Transitions 10. Client Centred Care 11. Crisis Intervention 12. Decision Support for Adults Living with Chronic Kidney Disease 13. Delirium, Dementia and Depression in Older Adults 14. Developing and Sustaining Effective Staffing and Workload Practices 15. Developing and Sustaining Interprofessional Health care 16. End of Life Care During the Last Days and Hours 17. Engaging Clients Who Use Substances 18. Embracing Cultural Diversity in Health Care 19. Establishing Therapeutic Relationships (ETR) 20. Integrating Smoking Cessation into Daily Nursing Practice 21. Interventions for Postpartum Depression 22. Nursing Management of Hypertension 23. Person and Family Centred Care 24. Preventing and Managing Violence in the Workplace 25. Prevention of Falls and Fall Injuries in the Older Adult 26. Preventing and Mitigating Nurse Fatigue in Health Care 27. Professionalism in Nursing 28. Promoting Safety: Alternative Approaches to the Use of Restraints 29. Promotion of Continence using Prompted Voiding 30. Risk Assessment & Prevention of Pressure Ulcers 31. Screening for Delirium, Dementia and Depression in Older Adults 32. Strategies to Support Self Management in Chronic Conditions 33. Supporting and Strengthening Families through Expected and Unexpected Events 34. Stroke Assessment Across the Continuum of Care 35. Woman Abuse: Screening, Identification and Initial Response 36. Workplace Health, Safety and Well-Being of the Nurse October 2018 I 7
FAST FACTS Over the course of our 2016-2018 BPSO Designation Term… 1
3
81 RNs participated
2 54 BPG
17 St. Michael’s nurses
in the BPG CoP and implement 55 BPG initiatives
posters displayed during the Nursing Week BPG Sustainability Walk
presented BPG work externally at national and international conferences
Congratulations to the following BPG Nurse Champions, Mentors and teams who have presented BPG work at external conferences in 2017/18: Cecilia Santiago
Nursing Practice Manager
Professional Practice
International Council of Nurses
Barcelona, Spain
Evaluating the Impact of Managing Responsive Behaviours Education Workshop on Staff Knowledge, Confidence, and the Use of Patient Care Plans
Cecilia Santiago/ Bridgette Delaurier
Nursing Practice Manager/RN
Professional Practice/MSICU
Dynamics of Critical Care Conference 2017
Toronto, Ontario
Conversations Matter: Attitudes and Perceptions about Family Presence in the Medical-Surgical ICU
Sarah Beneteau
Team Leader
Mental Health Services
Nursing Leadership Network of Ontario (NLN.ON)
Toronto, Ontario
Interprofessional Care Planning for Inpatient Mental Health
Cecilia Santiago
Nursing Practice Manager
Professional Practice
International Council of Nurses
Barcelona, Spain
The Development of Constant Care Guidelines for an Academic Health Science Network
Cecilia Santiago
Nursing Practice Manager
Professional Practice
International Council of Nurses
Barcelona, Spain
Enhancing the Patient Experience through Standardized Nurse-to-nurse Intershift Bedside Transfer of Accountability
Corporate Nursing Education Manager
Professional Practice
Nursing Leadership Network
Toronto, Ontario
The Power of Simulation in Enhancing the Sustainability of RN-to-RN Intershift Bedside Transfer of Accountability
Jennifer Rogers
Team Leader
Mental Health Services
American Psychiatric Nurses Association
Phoenix, Arizona
Promoting Safety: Using a Violence Risk Assessment Tool and Policy to Guide Care Planning to Prevent the Use of Restraints and Increase Staff Safety.
Prafulla Savedra
Resource Nurse
MSICU
Dynamics of Critical Care Conference
Toronto, Ontario
Transfer of Accountability between the Emergency Department (ED) and the Intensive Care Unit (ICU)
Nurse Practitioner
CVICU
Canadian Cardiovascular Congress
Vancouver, British Columbia
Every patient must have a destination: Transitioning care within the intensive care unit
Canadian Association of Critical Care, Dynamics Conference
Toronto, Ontario
The Development and Implementation of a Transfer of Accountability Tool between the Cardiac Catheterization Laboratory and the Cardiac Intensive Care Unit
Colleen McNamee
Mary Mustard
M Aquino,RN, CICU M D’Cambre, RN, Cardiac Cath Lab V Buczek, CLM, Cardiac Cath Lab N Meleca, CLM, CICU/Cardiology C Santiago, Nursing Practice Manager, Professional Practice
Check out our BPSO Intranet Site to learn more about the BPG initiatives that have been implemented over the past years Stay tuned...
Please send your comments or story ideas to Marta Sliz slizm@smh.ca Shining the Light on St. Michael’s Best Practice Spotlight Organization Achievements is an annual newsletter created by the Nursing Practice and Education Department at St. Michael’s Hospital. Design by Medical Media Centre, St. Michael’s Hospital