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. A new e-ticket is helping ensure that when hospital inpatients are moved from an inpatient unit to diagnostic areas, their safety information is front-and-centre when they arrive. If the patient is at risk of falling, needs special equipment or extra infection-control precautions, this information is automatically pulled from the patient’s electronic medical record and highlighted in the e-ticket for transfer. “Before now, we would call Medical Imaging to make sure they had the details about the patient that we thought were of note,” said Carl Leushuis, a Registered Nurse and Best Practice Guideline (BPG) Nurse Champion in Oncology & Infectious Disease. “However, working on the project, it became clear that the information we were choosing to highlight for each patient was very subjective. What we thought was important for the Medical Imaging staff to know may not have been what they actually needed in order to do their work and keep the patient safe in their context.” Leushuis co-led a pilot of the e-ticket and associated decision-making guidelines in Hematology/Oncology, along with Registered Nurse and BPG Nurse Champion Suzanne Scotland. Nephrology and Medical Imaging also piloted the tools. The project contributed to the hospital’s implementation of the Registered Nurses’ Association of Ontario Best Practice Guideline to promote safe and effective care transitions, and builds on the successful
work to implement hospital-wide, shift-to-shift transfer of accountability. “The e-ticket doesn’t replace our telephone communication, but it guides the questions the receiving unit or area can ask,” said Scotland. “They can see all the pertinent information right away, and then use the phone call to verify it with us. I feel that this is the key to implementing a BPG. In order for it to be successful, you have to tie it into the work you already do. We weren’t reinventing the wheel, we were articulating, standardizing and improving the way we already provide care.” The pilot was part of an interprofessional and interdepartmental research, education and qualityimprovement initiative to develop and implement the e-ticket and Transfer of Accountability guidelines to ensure safe transfer of non-critical patients. The project required education, engagement and practice change amongst: Registered Nurses as well as patient-transport assistants, clinical assistants, clerical and medical imaging staff across the hospital. An ongoing, hospital-wide research project is evaluating staff perceptions of the tool and guidelines. Scotland and Leushuis’ education plan for Oncology was carefully tailored to the unit’s needs. “We knew it had to be short, convenient, and flexible,” said Scotland. “We paid attention to workload and if a day was very busy, we would cancel the inservice and wait for a better 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 Murray Krock Director, Nursing Practice and Education
What does being a BPSO mean to you? This is our fifth year as a designated Best Practice Spotlight (BPSO) Organization with the Registered Nurses’ Association of Ontario (RNAO) after embarking on our journey in 2009 and achieving distinction in 2012. St. Michael’s nurses continually demonstrate strong leadership in quality patient care by successfully sustaining and implementing best practice guidelines (BPGs) throughout the organization. We have implemented an impressive 33 BPGs as we continue to build capacity and clinical leadership with nurses who are committed to expanding an evidence-based practice culture. Approximately 30 percent of nurses from inpatient and outpatient areas have become BPSO Champions. Our BPSO designation is a distinction that formally recognizes the high level of quality care and dedication that St. Michael’s is recognized for both nationally and internationally. As St. Michael’s celebrated the 125th anniversary of its opening on July 1st, we have come to appreciate the privilege of working in a hospital that has a rich history of supporting and advancing compassionate care and professional development.
What changes has BPSO brought to SMH? Sustaining and implementing BPGs contributes to advancing evidence-based practice among nurses and interprofessional teams who demonstrate creative synergies to successfully implement and sustain best practices. As patient care becomes more complex, BPG Nurse Champions, nursing and clinical staff are ready to respond to changing care needs and drive clinical practice that 2 I October 2017
ensures excellence in providing safe, quality care for all. We are providing an opportunity to learn and grow professionally while building capacity for champions, and clinical leaders who are passionate about best practices and doing what is best for patients. Many of the BPGs led by BPG Nurse Champions also support St. Michael’s strategic plans including the Corporate, Interprofessional and Senior Friendly Strategic Plans.
What is a memorable BPSO moment for you? What comes to mind is when I have had the opportunity to participate in BPG Communities of Practice (CoPs) and celebrate accomplishments during SMH annual Poster Gallery Walk. During CoPs, I am particularly struck by the atmosphere of collegiality, enthusiasm and exhilaration among BPG Nurse Champions. BPG Nurse Champions share and present their progress and work during scheduled CoPs and also prepare for the annual Nursing Week Best Practice Guidelines Sustainability Poster Gallery Walk. It is during this Gallery Walk where their quality BPG work is formally recognized and celebrated. Nursing Professional Practice is a strong advocate and supporter of CoPs that contribute to the accomplishments of BPG Nurse Champions. Having been adopted from the business sector for improving organizational performance, CoPs have been introduced in health care as a way to improve quality care. BPG Nurse Champions and their mentors come together to share knowledge, advice, tools and problem solving strategies in a supportive learning environment that facilitates the implementation and sustainability of BPGs and also, leadership development. The knowledge that BPG Nurse Champions gain about methodologies of quality improvement including the Model for Improvement (Plan-Do-Study-Act) is well demonstrated in every BPG Nurse Champion initiative. The annual Poster Gallery Walk is truly a memorable event that recognizes and celebrates BPG Nurse Champions and all the nurses and teams who have led and mentored BPG initiatives.
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moment. If needed, we came in on our days off to catch people on slower days.” They personalized their teaching to different staff members’ roles and experiences, and used the adult learning principles taught in their BPG Nurse Champion Community of Practice led by Nursing Professional Practice. “Our Community of Practice was a great support,” said Leushuis. “We’d update them on how things were going,
and the challenges we were facing. They’d always have great feedback on how to improve our process and address certain roadblocks.” Now that the e-ticket and guidelines have been successfully implemented in their unit, sustainability is top-of-mind for Leushuis and Scotland. “There are always new initiatives – it’s a challenge to keep up with them as a staff member,” said Scotland. “But we’ve generated a lot of buy-in through our education and advocacy, so it feels like we’re set up for success.”
Cardella Scholarship Award Recipients 2017: from 2 Donnelly Inpatient Unit: Carl Leushuis, Suzanne Scotland; Donor: Jennifer Cardella (center)
Nursing Professional Practice staff update… Welcome to Donna Romano who will be filling in for Ashley Skiffington as the interim Evidence Based Practice Nursing Manager, Professional Practice including BPSO Designationand Sustainability Lead. Donna has over 23 years of experience including operational and professional practice leadership roles. Most recently, Donna was the Interprofessional Care (IPC) and Education (IPE) Leader at University Health Network. Ashley Skiffington is currently on maternity leave until summer 2018 after delivering a baby girl on June 13th. Both mom and baby are doing great.
Congratulations to Ashley and a warm welcome to Donna! October 2017 I 3
Who Were Our 2016/17 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 2017, there were 35 BPG Nurse Champions from across 21 clinical areas who led BPG initiatives in their local areas/departments. To learn more about our 2016/17 BPG Nurse Champions visit St. Michael’s BPSO intranet page. 4 I October 2017
What are key qualities of a BPG Nurse Champion? •
A nurse who demonstrates initiative and commitment to best practices in their current role;
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Passionate about a BPG topic, patient population and the potential outcomes that can be achieved;
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Has the ability to lead, coordinate and facilitate an initiative/ project and, Role models positive clinical leadership
2017 Nursing Week BPG Sustainability Gallery Walk
In 2017 we celebrated St. Michael’s fifth year as a designated RNAO BPSO and the implementation of 33 BPGs since 2009. This year also marked the seventh annual Nursing Week BPG Poster Gallery Walk event. During this year’s BPG Poster Gallery Walk we celebrated and recognized the many achievements of nurses and teams in their BPG informed quality improvement (QI) initiatives that 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. The 2017 Piera Cardella Scholarship recipient was the Oncology/Hematology team on 2 Donnelly. The late Piera Cardella was a nurse at St. Michael’s who was dedicated to the needs of all those who were in her care. The Cardella family generously established this scholarship to support quality improvement initiatives that enhance nursing care and services. The Oncology/Hematology team received the
scholarship in support of the BPG initiative entitled “Piloting the Intrahospital Transfer of Accountability Guidelines,” which was informed by the RNAO Care Transitions Best Practice Guideline. BPG Nurse Champions Carl Leushuis RN and Suzanne Scotland RN championed this important quality improvement initiative on 2 Donnelly. Mentorship provided by Cecilia Santiago, Nursing Practice Manager and also the support of Charmaine Mothersill, Clinical Leader Manager, 2 Donnelly. Joining in the celebrations was Piera’s daughter, Jennifer Cardella. May 2017 marked the last year of Irmajean Bajnok as the Director of RNAO’s International Affairs and Best Practice Guidelines Programs as she prepared for retirement. She provided welcoming remarks during the event and introduced the new Director of RNAO’s International Affairs and Best Practice Guidelines Programs, Valerie Grdisa. Both Irmajean and Valerie spoke highly of SMH as an “exemplary BPSO model for other organizations.” October 2017 I 5
Highlights from last year (2016-2017)
Best Practice Guidelines COMMUNITIES OF PRACTICE 2016-2017 Best Practice Guidelines Nurse Champions and Mentors Supporting Best Practice Guideline (BPG) Nurse Champions is important to assure success as we continue to sustain our Best Practice Spotlight Organization (BPSO) designation with the Registered Nurses’ Association of Ontario (RNAO). Communities of Practice (CoP) have been used to support the development of BPG Nurse Champions and teams in leading projects aimed at implementing and sustaining BPGs. Based on positive feedback received from past champions, Nursing Professional Practice once again offered BPG Sustainability CoPs monthly from October to March in 2016/17. The first half of the CoP was dedicated to round table discussions that gave BPG Nurse Champions the opportunity to share experiences, including successes and challenges, related to implementing their BPG initiatives. The second half focused on methodologies of quality improvement and education in support of the professional development of BPG Nurse Champions, providing them with strategies and tools that could be applied to the implementation of their BPG initiatives. This year a formal unit mentor was added to the mix. BPG Nurse Champions were assigned a mentor from their clinical unit in addition to a Nursing Professional Practice Mentor. Mentors provided BPG Nurse Champions with their knowledge and expertise. They acted as a support and resource to assist BPG Nurse Champions in putting their BPG plans into action and implementing them at the unit level. Nursing Professional Practice Mentors provided one on one coaching and consultation based on project focus, while Unit Mentors provided additional support and guidance to champions. This two tier support system was positively embraced by BPG Nurse Champions and mentors. The evaluation and feedback received from BPG Nurse Champions who participated in the 2016/17 Communities’ of Practice was positive. Below are a few comments from BPG Nurse Champions. “Helped me grow. Broadened my horizons and learned 6 I Octoober 2017
about other areas of this large hospital. We all seem to work in silos but it is nice to meet others who also have similar challenges and share ways to surmount them” “Thank you for the experience and it is so exciting to be a part of the 5th year of our BPSO designation. Would highly recommend BPG and CoP to many of my colleagues!” “Overall, excellent experience!” Based on this positive feedback, Nursing Professional Practice will continue to support local unit BPG Nurse Champions and BPG activities through the Communities of Practice which will start again this coming October.
National and International Visitors St. Michael’s Hospital (SMH) is recognized as an exemplar RNAO Best Practice Guideline Organization and is periodically asked by the RNAO to host national and international BPSO visitors. This year SMH has hosted visitors from St. Francis Xavier University, Nova Scotia (May 2017) and Peking University Hospital, China (August 2017). The St. Michael’s BPSO team was thrilled to be able to share their lessons learned and to inspire others in their pursuit of excellence in best practices.
(L to R: Shangqian Gao, Peking University First Hospital, Donna Romano, Murray Krock, St. Michael’s, Zhuo Liu, Peking University First Hospital)
33 BPGS & Counting…! St. Michael’s is one of the few BPSO organizations that have implemented a total of 33 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 Care of Adults at Risk for Suicidal Ideation and Behaviour 5. Breastfeeding Best Practice Guidelines for Nurses 6. Caregiving Strategies for Older Adults with Delirium, Dementia and Depression 7. Care and Maintenance to Reduce Vascular Access Complications 8. Care Transitions 9. Client Centred Care 10. Crisis Intervention 11. Delirium, Dementia and Depression in Older Adults: Assessment and Care: 12. Developing and Sustaining Effective Staffing and Workload Practices 13. Developing and Sustaining Interprofessional Health care: Optimizing patients/clients, organizational and system outcomes 14. End of Life Care During the Last Days and Hours 15. Embracing Cultural Diversity in Health Care: Developing Cultural Competence 16. Establishing Therapeutic Relationships (ETR) 17. Integrating Smoking Cessation into Daily Nursing Practice 18. Interventions for Postpartum Depression 19. Nursing Management of Hypertension 20. Person and Family Centred Care 21. Preventing and Managing Violence in the Workplace 22. Prevention of Falls and Fall Injuries in the Older Adult 23. Preventing and Mitigating Nurse Fatigue in Health Care 24. Professionalism in Nursing (PIN) 25. Promoting Safety: alternative approaches to the use of restraints 26. Promotion of Continence using Prompted Voiding 27. Risk Assessment & Prevention of Pressure Ulcers 28. Screening for Delirium, Dementia and Depression in Older Adults 29. Strategies to Support Self Management in Chronic Conditions 30. Supporting and Strengthening Families through Expected and Unexpected Events 31. Stroke Assessment Across the Continuum of Care 32. Woman Abuse: Screening, Identification and Initial Response 33. Workplace Health, Safety and Well-Being of the Nurse October 2017 I 7
Refreshed BPG Intranet Site... Check our refreshed BPSO intranet page to learn about quality improvements initiatives has been underway this past year to support the integration of best practices.
FAST FACTS Over the course of our 2014-2017 BPSO designation term… 1
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St. Michael’s hosted four (6) national and international BPSO visitors from Nova Scotia, Australia, Chile, Columbia and China to learn from St. Michael’s BPSO journey
Thirty nine (39) St. Michael’s nurses presented BPG work externally at national and international conferences
Eighty Five (85) BPG initiatives led by BPG Nurse Champions were implemented across the hospital
STAY TUNED!
Starting in October, a new group of nurses will take on the role of BPG Nurse Champion to lead the implementation, evaluation and sustainability of BPG initiatives in their local units.
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 Marcelo Silles - Medical Media Centre, St. Michael’s Hospital