Memorial Hermann Greater Heights Hospital
2015 Nursing Annual Report
Greater Heights
Taking Nursing Care to Greater Heights. Excellence. Always!
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Contents
Mission
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Message from the Chief Nursing Officer
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Transformational Leadership
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Structural Empowerment
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Exemplary Professional Practice
needs of our community.
New Knowledge, Innovations and Improvements
Nursing Vision Statement
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Empirical Outcomes
Our mission for nursing at Memorial Hermann Greater Heights is to ensure exceptional quality outcomes driven by compassionate patient- and familycentered care that meets the unique
Our vision is to relentlessly pursue Greater Heights in nursing.
The Memorial Hermann Greater Heights Hospital 2015 Nursing Annual Report covers the fiscal year of July 1, 2014, to June 30, 2015.
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Message from the Chief Nursing Officer We often hear Memorial Hermann Greater Heights Hospital is like a family. I see that every day. Much like a family, we experienced tremendous joy and celebration during fiscal year 2015, such as when we won the President’s Cup Award for the best acute care performance in the Memorial Hermann Health System! We also experienced great sorrow, such as the untimely death of one of our fellow nurses. Through it all, we have maintained that family atmosphere that is our calling card. With our goal to become a Magnet®-designated organization, we have become an even stronger family delivering clear outcomes that speak to the high quality of nursing care we provide every day. In addition to winning the President’s Cup Award, some of our many FY 2015 achievements include: • Zero catheter-associated urinary tract infections (CAUTIs) in the ICU and CVICU for eight consecutive months following process improvement • Zero retained foreign bodies in the OR for five years – a first in the System • Zero Serious Safety Events 1 & 2 for the third consecutive year – a first in the System • Superior hand hygiene compliance of 97 percent and higher – best in the System • Leapfrog Safety Score of “A” • Primary Stroke Center designation by The Joint Commission • Truven Top 50 Heart & Vascular Hospital recognition • Pathway to Excellence® redesignation Sustained improvement is evident as we work together to examine and share solutions that drive improvements and exceptional patient experiences. This report highlights some of the initiatives that have resulted from your input. The hand hygiene accomplishment, highlighted above, required a huge effort. Now this standard of patient care is second nature to you. This is sustained improvement! Opening the Admissions Processing Unit (APU) in January 2015 has improved hospital throughput, too.
By gathering patient history and conducting an admissions assessment, medication reconciliation and other important admissions tasks in the APU, patients receive skilled nursing care more rapidly. We recently had a nurse return to work with us. Her reason was music to my ears: “This place is home to me, the quality is beyond compare and I feel like a unique individual rather than a number… the focus on patient safety is first and I know I will be supported.” Memorial Hermann Greater Heights is a family, my family, and I am honored to be in the company of such incredible caregivers. I am so proud of all of you and everything you accomplished in 2015. Thank you! I look forward to continuing our work together, as a family, to reach our vision to “Relentlessly Pursue Greater Heights in Nursing!” Sincerely,
Melody Dickerson, RN, M.S.N., CPHQ Vice President and Chief Nursing Officer Memorial Hermann Greater Heights Hospital
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Transformational Leadership The Magnet® model defines transformational leaders as those who stimulate and inspire followers to both achieve extraordinary outcomes and, in the process, develop their own leadership capacity.
At Memorial Hermann Greater Heights Hospital, it is our goal to make sure that nursing leaders at all levels of the organization demonstrate advocacy and support on behalf of staff and patients. We understand that health care is always evolving; there will always be more comorbidities and complex patient populations in need of care. It is for this very reason that we are committed to Excellence Always. This drives us to stay abreast of current technology, nursing and evidence-based practice and to be a catalyst of support for our patients, families and community in the Greater Heights, Houston and surrounding areas. Memorial Hermann Greater Heights Vice President and Chief Nursing Officer (CNO) Melody Dickerson, RN, M.S.N., CPHQ, is highly committed to developing leaders at various leadership tracts: bedside nursing, education and management. One example of transformational leadership at Memorial Hermann Greater Heights was exhibited by labor and delivery nurse Tracy Brown, RN.
Leadership in Mother-Baby Bonding Brown, working with the mother-baby bonding and skin-to-skin initiative in the Family Birthing Center, began discussing her desire and passion for mothers to connect with their infants. Feeling empowered to make changes in her department, she shared this desire with her supportive management team. As a result, Brown and her team are now highly motivated to provide skin-to-skin for every mother-infant encounter. Mother-baby bonding has increased from 25 percent to 75 percent of new births. Brown was chosen to present her findings at the global healthcare conference, “Compassion and Caring in the Clinical Environment” held March 16-17, 2015, at Houston Baptist University in Houston, Texas. She was also a nominee for her work on “Skin-to-Skin Delivery” in the Memorial Hermann Greater Heights Frontline Leadership Summit held September 26, 2014, at Memorial Hermann Greater Heights.
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Initiatives to Promote Transformational Leadership Among the ways that Memorial Hermann Greater Heights promotes transformational leadership is through these initiatives: Shared Governance Councils
Leader Rounds
These consist of the Professional Practice Council, Professional Development Council, Performance Improvement and Safety Council, and Coordinating Council, which are led by our bedside nurses. The council chairs are the voice for nursing care at Memorial Hermann Greater Heights.
Our CNO spends time on various shifts rounding on the nursing staff to provide support and to get feedback from the nurses about enhancing the culture at Memorial Hermann Greater Heights.
Frontline Leadership Programs
These programs, supported by our CNO, provide frontline leaders, newly hired managers and directors with ongoing professional development and management tools to make them effective leaders.
New Nurse Breakfasts
Our CNO meets monthly with newly hired nurses during their first year of employment. This is a time for two-way communication with the CNO as she shares information and accepts feedback from the new nurses in a highly supportive atmosphere.
“With Shared Governance, I feel empowered to make change, always for the better.� Debra House-Shannon, RN, B.S.N., First Step 4
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Structural Empowerment In MagnetÂŽ organizations, structural environments are generally flat, flexible and decentralized. Nurses throughout the organization are involved in shared-governance and decisionmaking structures and processes that establish standards of practice and address opportunities for improvement.
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Memorial Hermann Greater Heights has a solid strategic plan, structure, systems, policies and programs in place to empower nurses to be the central part of the patient care decision-making process. The Shared Governance structure is a reflection of the nurses’ empowerment and decision-making structure.
ED Uses Structural Empowerment to Drive Improvements The Emergency Department Performance Improvement Team (PIT) is a group of RNs in the ED who consistently use structural empowerment to drive improvements. The nurses work together on department projects,
as needed, incorporating other disciplines such as lab, radiology and pharmacy, as well as physicians, when appropriate. The PIT, led by an ED nurse, has been successful at making many improvements. Some examples include getting results for pending labs and tests for a more efficient, safe discharge or admission of patients; proper labeling of patient tubes for patient safety; adding a refrigerator for blood in the ED for resourcefulness and storage; packaging an emergency respiratory bag for faster access; and the development of protocols for mass transfusion and diabetic ketoacidosis.
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Nursing Recognition During fiscal year 2015, several awards were presented to Memorial Hermann Greater Heights nurses to recognize their commitment to Excellence Always in delivering quality nursing care. Healthcare Excellence Award for Nursing
Melody Minnick, RN, who works in the ICU, received the Healthcare Excellence Award for Nursing. This award, open to the more than 7,600 nurses in the Memorial Hermann Health System and the nearly 500 at Memorial Hermann Greater Heights, is presented annually in late May to one nurse in each hospital. Employee of the Year
Twin sisters Anu Flemin, RN, and Binu Aji, RN, were named Memorial Hermann Greater Heights Employees of the Year in December 2014. The twins were nominated by hospital employees and selected by a committee of their peers for their Partners in Caring attitudes and for going above and beyond to make patients and visitors feel comfortable. The duo works in the ICU.
Professional Development Lifelong learning is essential to enhance professional competency and deliver safe, high-quality nursing care. At Memorial Hermann Greater Heights, we provide an environment of learning with clinical coaches who serve as vital preceptors to bridge the gap between nursing school and the hospital. Nurses are empowered to enhance their knowledge through the addition of online courses. Clinical Coach of the Year
Jennifer Meadors was honored as the first Memorial Hermann Greater Heights Clinical Coach of the Year in November 2014. She was nominated by her peers for the excellence she provides to her patients and those she trains.
CEdirect for Free Continuing Education To provide nurses with support for career advancement and professional development, CEdirect, a free online education program, was added in 2015. It is available 24/7 for nurses to earn continuing education credit and to complete national certification exam reviews. In fiscal 2015, a total of 363 Memorial Hermann Greater Heights nurses logged into CEdirect and spent 658.7 hours engaged in learning. 7
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DAISY Award The DAISY Award recognizes nurses, on a monthly basis, who go above and beyond to provide extraordinary care and Excellence Always. Memorial Hermann Greater Heights began presenting the DAISY Award in July 2014. DAISY is an acronym for Diseases Attacking the Immune System. The DAISY Foundation was established in 1999 by family members of Patrick Barnes. He died at the age of 33 from ITP. The family was so impressed by the amazing care that he received during his eight-week hospital stay that they created the foundation to positively impact nurses around the world in his memory. They believe that nurses are unsung heroes of our society who deserve far more recognition and honor than they receive. Anyone can nominate a nurse for the DAISY Award, including patients and their families. Four nomination boxes are located throughout the hospital. The award is presented to the honoree on their units in front of their peers and the administrative team. Honorees for fiscal year 2015 include: • Julie Hung, RN, Emergency Department, July 2014 • Claudia Chavana, RN, Family Birthing Center, August 2014 • Grayson Ford, RN, CVICU, September 2014 • Regina Allen, RN, M.S.N., ICU, October 2014 • Brenda Johnson, RN, 3 South, November 2014 • Shirley Watson, RN, 6 North, December 2014 • Nkechi Okeke, RN, 6 North, January 2015 • Mosie Arrington, RN, 6 North, February 2015 • Norah Owino, RN, 3 North, March 2015 • Adelaida Atkinson, RN, Emergency Department, April 2015 • Veronica Flores, RN, Rehabilitation, May 2015 • Taylor Tomaro, RN, 3 North, June 2015
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Exemplary Professional Practice At the organizational level in the Magnet model, nurse leaders ensure that care is patient/family centered. Magnet-recognized organizations take the lead in research efforts to create and test models that promote the professional practice of nurses.
Communication
Patient Family Community
Growth Fa m
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tie Pa Memorial Hermann Greater Heights Nursing Professional Practice Model
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Primary Nursing & Relationship Based Care
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Quality & Safety
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Teamwork
Here at Memorial Hermann Greater Heights, we have a motto: Family Caring for Families. We are a family with a rich history of caring for each other and the community. Our families are different sizes, makeups and cultures, but all families have basic morals and values. Our principles are honesty, kindness, love, compassion and respect. We promote exemplary professional practice by utilizing our Professional Practice Model and Care Delivery System.
Self Memorial Hermann Greater Heights Care Delivery System
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Our Professional Practice Model is aligned with the Vision and Values of the Memorial Hermann Health System. The model is based on a commitment of improving the health care for the people of Southeast Texas by providing superior quality, cost-efficient, innovative and compassionate care. Our Care Delivery System is primary nursing integrated with relationship-based care. This system promotes continuous, consistent, efficient and accountable delivery of nursing care. The sum of these relationships is a healing environment enacted through compassionate care, competent clinical interventions, listening and seeking to understand each person’s experience.
Jessie Dunn and the Skin Champions Jessie Dunn and the Skin Champion team are examples of patient-/family-centered care. This team performs ongoing surveillance of every patient’s skin, including quarterly bedside checks of every patient to make sure his or her skin is intact and all care is documented. The team acts strategically by conducting monthly meetings and also provides CEU opportunities for nursing at least three times a year. These CEU presentations, called “All About Wounds,” include a case study and deposition to teach best practices. The information presented in the continuing education event, as well as the monthly meetings, provides evidence-based data to our nurses about proper skin and wound care.
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New Knowledge, Innovations and Improvements Magnet-recognized organizations conscientiously integrate evidencebased practice and research into clinical and operational processes. Nurses at Memorial Hermann Greater Heights are educated about evidence-based practice and research, enabling them to appropriately explore the safest and best practices for their patients and practice environment and to generate new knowledge. Our nurses are empowered to make evidence-based decisions and process improvement changes.
Making Supplies Available in the Pyxis Lalimol John, RN, wanted to improve the process of making supplies readily available for patients recovering in the post-anesthesia care unit (PACU). Through John’s intervention, including work with the Memorial Hermann Health System, the PACU went from paper to electronic scanning in fiscal year 2015. As a result, scanning and quantity compliance increased from 16.80 percent to 99 percent. Activity compliance rose from 60.9 percent to 99 percent. Not only did this initiative reduce waste, but most importantly, nurses now have supplies readily available for patient care in the PACU.
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Empirical Outcomes In the Magnet model, outcomes are defined as quantitative and qualitative evidence related to the impact of structure and process on the patient, nursing workforce, organization and consumer. These outcomes are dynamic and measurable and may be reported at an individual unit, department, population, or organizational level.
MHGH Adult ICU Catheter-Associated Urinary Tract Infections (CAUTI) 3
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0 July Aug Sept Oct Nov Dec Jan Mar Apr May June 2014 2014 2014 2014 2014 2014 2015 2015 2015 2015 2015
MHGH Compliance on Hand Hygiene 100% 99% 98% 97% 96% 95% 94% 93% 92% 91% 90% July Aug Sept Oct Nov Dec Jan Mar Apr May June 2014 2014 2014 2014 2014 2014 2015 2015 2015 2015 2015
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At Memorial Hermann Greater Heights, we have many success stories that indicate the impact of structure and process in creating quality outcomes in patient care. One of the many successes is that our facility has maintained Excellence Always in several areas related to quality and safety. These include: • Zero Serious Safety Events 1 & 2 for the third consecutive fiscal year (2013, 2014, 2015). Memorial Hermann Greater Heights has surpassed three years (1,095 days) without a Serious Safety Event 1 or 2. This is the first time this has happened inside of Memorial Hermann Health System and, to our knowledge, the first time in the country. An achievement of this magnitude is not achieved without a significant commitment to processes, learning and a determination to do what is right for every patient, every time. As a reminder, a Serious Safety Event 1 or 2 is either death or detectable permanent harm that is not related to the natural or expected course of the patient’s illness or underlying condition. • Zero catheter-associated urinary tract infections (CAUTIs) in the ICU and CVICU following process improvement and interventions in October 2014 • Zero retained foreign bodies in the OR • Superior compliance on hand hygiene
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Taking Nursing Care to Greater Heights. Excellence. Always!
Greater Heights 1635 North Loop West Houston, TX 77008 713.867.2000 memorialhermann.org 713.222.CARE (2273)
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