Q1 2024 Nursing Newsletter

The Joyful Scoop

This quarterly newsletter highlights recent developments within Summa Health Nursing.

Joy at Work – Protect Me and Care for Me

Bonnie Jensen, MSN, RN Vice President, Chief Nursing Officer – Hospitals

The gifts of hope, confidence, and safety that health care should offer patients and families can only come from a hopeful, confident, and safe workforce. Joy in the work is an essential resource for the enterprise of healing. – Don Berwick

It’s been a while since we discussed joy in the workplace. The last time, we discussed the importance of hearing what our team has to say and listening to hear, understand, and address concerns to the extent we can. The next two drivers for joy in the workplace are protecting and caring for me.

Protect Me is related to reducing the risk of staff harm, whether emotional, physical, financial, or socio behavioral. We do that by creating an environment where employees feel that leadership is involved in actively working to mitigate situations that may be harmful. We also need to ensure that people feel comfortable and safe reporting instances of harm, whether from leaders, co-workers, patients or community members, without fear of retaliation.

Care for Me refers to providing holistic support for team members, such as ensuring that resources are available when problems arise to help people get through whatever situation has occurred. One of the ways we care for employees is by ensuring that managers have time to be on the unit, rounding on both team members and patients to understand challenges and help resolve issues. The organization also demonstrates caring through our Employee Assistance Program, recognition programs such as Summa Stars or The DAISY Award, situational reporting through Midas, and continuous professional development opportunities.

Our team wants and deserves to work in a place with respect, courtesy, communication, assistance, understanding, and responsiveness. Every member of Summa Health needs to be heard and treated like family because you are making a difference and providing purposeful and worthwhile work while caring for our patients.

Help us to create the culture in which you want to work!

Updates from CNE

Penelope

Gorsuch, DNP, RN, NEA-BC, FACHE, USAF Col (retired) Senior Vice President and Chief Nursing Executive

Welcome to 2024! It’s the year I have been waiting for since my arrival in 2021 – to reinvigorate and reestablish Shared Governance! During this first quarter, we launched our new Professional Governance structure and had an amazing retreat. Our first Professional Governance Day was on March 21. I believe in frontline involvement in decision making regarding nursing professional practice and look forward to this year to see what we accomplish together.

I would also like to share the 2024 focus areas and goals. Key this year is our continued focus on our nursing quality indicators. We remain committed to decreasing falls and pressure injuries. In these very complex initiatives, we are going to focus on the top five interventions that are seen in the literature to be most effective. Let’s make this the best year ever to be a Summa Health Nurse and see improvements in our patient outcomes. I am deeply grateful to each one of you for all you do every day in caring for your patients!

2024 Focus Areas Goals

Refine and Sustain The Center for Clinical Inquiry ™

(Quality Focus Elevate Nursing Practice)

1. Redesign the model defining the internal infrastructures to include inputs and outputs from The Center for Clinical Inquiry™ by the end of second quarter

- Create a Nursing Data Informatics central repository by second quarter

- Evaluate the ambulatory nurse leader’s span of control

2. Quality focus measures:

- Complete the top five EB interventions to prevent a fall by end of first quarter

- Implement the top five EB interventions on 4S SHB Campus in April 24 as part of the Nationwide NDNQI study on bed/chair alarms

- By division and unit-specific data decrease fall rate by 10%

- Implement the HAPI reduction protocols on Feb 13, 2024

- By division and unit-specific data decrease HAPI rate by 10%

3. Implement professional governance in hospitals on March 21 with a retreat on February 29, 2024

4. Plan for professional governance implementation in the ambulatory setting by fourth quarter 5.

Non-Pharmacological Methods to Prevent and Treat Delirium

Encephalopathy Quality Improvement (QI) Committee

Delirium is a common issue in hospitalized patients. It is well documented in the literature that patients who become delirious have poor outcomes, including an increased length of stay, increased risk for higher level of care at discharge, and increased mortality. Numerous studies have documented the benefits of non-pharmacological methods to prevent delirium. The Encephalopathy QI committee has been working with the volunteer department to increase access to these materials.

The items listed below may be ordered through Lawson or obtained from Volunteer Services:

Lawson

 Activity Aprons, Order #100122: Activity aprons have sensory items to keep patients with cognitive disorders engaged in the activities on the apron.

 Quiet at Night Kits, Order #82760: Insomnia is a known contributor to delirium. Quiet at Night Kits have earplugs, headphones and a “Tips to Prevent Insomnia” card that was developed by the Encephalopathy QI committee.

Volunteer Services

The volunteer department often has most of the products listed below. To order any of these items, contact the volunteer department at 330 375 3790 from 8 a m to 3 p m Monday through Friday

For those with cognitive disorders:

 Sensory Mats: Mat have sensory items to help keep patients with cognitive disorders engaged in activities on the mat. Volunteers sew mats per specifications approved by Geriatric Psychiatry. Availability depends on volunteer availability.

 Children’s Coloring Books and Crayons or Pencils

 Comfort Blankets or Hats

 Simple Puzzles

For those at risk of delirium:

 Word Search Puzzles

 Crossword Puzzles

 Sudoku Puzzles

 Adult Coloring Book and Colored Pencils

 Decks of Playing Cards

Leaping into Professional Governance

Karrie Boss, DNP, RN, APRN, ACCNS-AG, EBP-C, CCRN, System Director, Evidence-Based Practice

On February 29, The Center for Clinical Inquiry hosted its first Professional Governance Retreat with more than 100 staff nurses and nursing leaders in attendance. Professional Governance is a structure that empowers professionals to contribute collaboratively as decision makers regarding their practice environment. In the new Professional Governance, nurses will contribute to standards of practice, policies and procedures, evidence-based practice, and quality improvement.

The retreat was a daylong event that introduced the nursing strategy, as well as provided education on communication, leadership, evidence-based practice and more. The Divisional teams were able to work with their clinical and administrative leaders to strategize barriers and facilitators to improving falls within the hospitals, as well as discuss potential goals for the new Professional Governance structure. Nurses are eager to make meaningful and positive changes within their care areas!

We look forward to teamwork and collaboration to help achieve optimal outcomes!

I Stop Pressure Injuries: The Top 5

Sarah Gustafson, MEd, BSN, RN, EBP-C, Evidence-Based Practice Specialist

Since 2021, Summa Health has experienced a considerable increase in hospital-acquired pressure injuries (HAPIs), but that trend stops now. According to the evidence, as many as one in 20 patients that come through the door of a U S hospital, to stay the night, will develop a pressure injury. These HAPIs cause our patients harm and cost our healthcare system millions of dollars. At Summa Health, we have asked you to commit to the “I Stop Pressure Injuries” initiative, implement this Top 5 approach, and document the steps of Pressure Injury Prevention provided to our patients.

You have responded! During the first quarter of 2024, the 4-eye assessment has reached nearly 80% compliance, use of the Braden score is improving, pressure injury identification is on the rise, more preventative interventions have been put into place, and wound care consults have more than doubled – calling specialists to the patient earlier.

You are key to the successful implementation and sustainability of this initiative. Thank you for your efforts to make best practice our current practice!

Have feedback on this initiative?

Please share! To start, scan the QR code.

EBSCO Procedure Platform

On February 27, we switched over to Dynamic Health, EBSCO procedure platform from Lippincott. This new platform has some great features with evidenced-based information, informative videos and competency checklists that will flow right into HealthStream You also earn continuing education credits when you search within the platform

The RN Educators and CNS team have been rounding to show this new resource. It’s accessible from the Summa@Work home page (Popular Links area) from within Epic when you click F1 and on the Rover devices. Please reach out to one of the RN Educators or CNS team members if you have any questions about this new procedure resource.

Clinical Training & Development: Delegated Caregiver Orientation

Amanda McComas, MSN, RN, NPD-BC, Manager, Clinical Training & Development

Delegated Caregiver Orientation is offered twice a month for all new nursing assistants, medical assistants (going to SDS), behavioral health associates (BHAs), ED techs and EKG techs (Day 1 only). Delegated Caregiver Orientation covers the following training:

Day 1: General Information (Vocera, Red Rules, UKG/Lawson/Email, Dress Code, Attendance Policy, Midas, Codes, RRT, Vocera and HealthStream). ED techs/BHAs/MAs complete venipuncture training, and ED techs/MAs complete training on removing an IV. Delegated caregivers complete training on restraint application and bed/chair alarms.

Day 2: BGT training, mobility training with use of gait belts, obtaining vital signs using the capsule, measuring I&Os, Summa Health products review, 1:1 constant care companion role, and purposeful rounding. The delegated caregiver orientation just added a new Sim Lab to our Skills Training Day. New hires work in small groups to complete three stations, including two self-guided stations and one station with an instructor. Topics at the different stations include re-positioning, pressure injury prevention, infectious disease prevention, purposeful rounding and proper use of Summa Health products.

Day 3: Epic training via HealthStream (new as of 02/09/2024), aging and empathy class, BLS training, and hands-on practice making a bed with a patient in it and transferring a patient from bed to cot.

Once all training is completed at the Corporate Office, delegated caregivers transition to orienting on their units

We are continuously assessing our orientation to ensure engaging and learner focused content to grow and develop the new hires to provide care beyond expectations to our patients. Enjoy some pictures (on the next page) from our newly added stations for delegated caregivers

Clinical Training & Development, continued

Did You Know?

Did you know the RN Educators in HR Organizational Development are American Heart Association (AHA) instructors? Recently, Jennifer Yamokoski and Jeanne Dages provided HeartSaver AED training at the Fellowship Baptist Church of Medina. The church was gifted an AED through the generous support of the Kent Area (Ohio) Chapter of the Links Incorporated and the Summa Health Foundation. Jenn and Jeanne facilitated the parish staff in setting up the AED and becoming familiar with its added features and accessories.

Shout Out

A big shout out to the Akron Campus Critical Care Team and Triad who participated in the Portage Lakes Polar Plunge! They had a great time and raised $6,000 for the Akron-Canton Regional Foodbank. Great time with a great team!

From the Library…

Charlotte Sievert, MLS, AHIP, Medical Librarian

There are two ways to have your favorite journal’s table of contents (ToC) delivered to your email.

Method 1: Use Browzine, a service provided by the Summa Health Library and available as a mobile app

To use Browzine, you can start at the Summa Health Medical Library website at https://medlib.summahealth.org. You can also get to the Medical Library’s website in two places on Summa@Work: on the Departments webpage (under Clinical Departments) and Resources page. At the Library’s homepage, look for the large Quick Links heading. Browzine is the first link under Quick Links. If you are off-campus, you will need to use your Library user login to access the Browzine homepage (see image).

Set Up Browzine Account & Request Email Notifications

If you have never set up a personal Browzine account, you will need to do that first. Look for the Settings logo (a gear) in the upper right corner of the screen. In the mobile version of Browzine, click on the menu icon (three stacked horizontal lines), often located in upper left corner, and then select Settings. Select the Login link on the Settings screen (first link). If you don’t already have a Summa Health Browzine account, you can sign up for one here. As you are establishing your account, you can tick the box for “I would like to receive email notifications” on the Sign Up screen.

You can register with your work email address or your personal email account. A confirmation email will be sent to the email address you use. It is often more seamless for accessing the full text of articles if you are using your Summa Health email account, but either will work. When you receive the email, confirm the account.

If you already have an account and have not yet done so, you can select “I would like to receive notifications…” from the Settings page after you sign in. To find out more about the email notifications, visit this page: https://support.thirdiron.com/support/solutions/articles/72000584833-browzine-email-notifications

Method 2: Navigate to the public website of your favorite journal to sign up

Enter the title of the journal into a search engine to find the publisher’s website. If you can’t find the journal’s website, try putting the title in quotes or adding the word “journal” to the search box. See example below, where I looked for a journal named MCN (as in Maternal Child Nursing):

From the Library…, continued

Adding the word journal should really help to get the desired journal’s website to come up near the top of the search results. Once at the journal’s website, look for a link like the one circled in the image. The wording and location on the screen of the ToC link will differ depending on the publisher.

At the journal website, you may need to create a free account (this can vary from publisher to publisher). Sometimes, however, a publisher will allow you to simply type in your email address. If you are required to create a personal account with the publisher/journal, you can select for email notifications for your account.

For additional help, please contact your Medical Library at amedlib@summahealth.org or 330.375.3260.

Trauma Program Updates

Alexandra Carpenter MHA, BSN, RN, CPEN, TCRN, Trauma Program Manager

The Summa Health Trauma Program is excited to share with you some of our exciting changes happening in 2024. Did you know Summa Health System – Akron Campus has been a Level I Trauma Center since 1997? We were also the first adult Trauma Center verified by the American College of Surgeons in the Akron area.

As a Trauma Program, we are required to review our activation criteria annually and, this year, we made some significant changes. You may have noticed you no longer hear “Trauma Team” and “Surgical Team” paged overhead. In order to align more closely with other trauma centers in our area and across the country we have adopted a new nomenclature for activations. For our most significantly injured patients, the Level I Trauma Activation now replaces the old “Trauma Team” activation and Level 2 Trauma Activation replaces the previous “Surgical Team” activation. We have also added a new third tier, Level 3 Trauma Activation. While the names and some criteria have changed, the immediate response by our trauma team to initiate lifesaving care at the bedside of our seriously injured patients will always remain the same.

Another important part of trauma resuscitation is the rapid administration of blood products. When a patient is actively bleeding, one unit of packed red cells may not be enough. Our patients often need all the different components of blood products to achieve what we call a “balanced resuscitation.” When our patients are acutely hemorrhaging, the team may need to activate the Massive Transfusion Protocol (MTP) to have immediate access to not only packed red cells but also fresh frozen plasma and platelets. We have worked collectively with our blood bank, Epic and nursing partners to streamline our MTP process, as well as create an electronic order set, new documentation form and new comprehensive education for all nursing staff that may need to activate MTP. Some of you may have already received the education in HealthStream. There are also Belmont rapid infusers available in our simulation labs for hands-on practice if you need to use these devices in your area. Keep in mind, you must still call blood bank to activate MTP, but do not forget to add the electronic order set in Epic!

Trauma Program Updates, continued

Lastly, are you interested in becoming a Trauma Certified Registered Nurse (TCRN)? The TCRN exam validates your mastery of the care of the injured patient across the trauma care continuum from injury prevention to prehospital and acute care to rehabilitation. We are excited to announce that we will be hosting a two-day TCRN Exam prep course October 17 and 18, 2024. We also have several TCRN prep books and practice exams available for check out at the Summa Health Medical Library (https://medlib.summahealth.org).

For more information on the TCRN Prep Class and other Trauma Education opportunities, please contact Amy Hirnikl at hirnikla@summahealth.org

Advanced Practice Providers (APPs)

Diana Vance MSN, APRN-CNS, CCNS-BC, CCRN, System Director, Advanced Practice Providers

Within Summa Health, there are nearly 500 advanced practice providers (APPs) that provide both direct and indirect care to our patient population to help support our mission to provide the highest quality, compassionate care to our patients and members and to contribute to a healthier community.

An APP is a healthcare professional who undergoes specialized education, training and certification at the graduate level that enables them to provide such services as establishing a medical diagnosis and treatment plan for the medical management of one’s care. They provide education to patients, families, and the community at large on health and wellness, and work to improve healthcare system management through evidenced-based practice.

Within our system, they include certified nurse practitioners, clinical nurse specialists, physician assistants, certified nurse midwives and certified registered nurse anesthetists. Among this group are 23 lead APPs that are directly employed by either Summa Health Medical Group or Summa Health System. Our Advanced Practice Council maintains a core group of four elected officers who along with the lead APPs support the initiatives and advancement of our practice here at Summa Health.

Submit an Article

If you would like to submit an article for the quarterly Nursing Newsletter, please email

Karen Steiner, MSN, RN, NE-BC, NPD-BC at steinerkb@summahealth.org