news views Summer 2016
A Publication of the Department of Nursing and Patient Care Services University of Maryland Medical Center
Lisa Rowen’s Rounds: Interweaving Tragedy and Inspiration Working in health care exposes us to a multitude of tragic and heartbreaking situations. Frequently, I am struck by the blended nature of these circumstances, which always reminds me that tragedy is often interwoven with acts of inspiration.
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Lisa Rowen, DNSc, RN, CENP, FAAN Chief Nurse Executive University of Maryland Medical System Senior Vice President of Patient Care Services & Chief Nursing Oicer University of Maryland Medical Center Associate Professor University of Maryland School of Nursing
onsider Angela Weir, BSN, RN, CCRN, a senior clinical nurse in the Critical Care Resuscitation Unit, who came upon a horriic, iery motor vehicle crash in the early morning hours on her way to work out. While not a irst responder, Angela asked her husband to pull over so she could ofer her help and expertise. In the darkness, Angela jumped over the Jersey wall without realizing she was on a bridge. Free-falling about 100 feet, Angela believed these moments in the air would be her inal ones. Although jagged rocks were on either side of her, she landed in water and was able to swim to shore. Calling for help, the irst responders on the accident scene above her were able to pull Angela to safety and transport her to the UMMC R Adams Cowley Shock Trauma Center, where she was admitted as a patient to the Trauma Resuscitation Unit (where she used to work), and where her beloved colleagues cared for her with their extraordinary skill. Angela told me she would do the same thing all over again if necessary, albeit this time knowing where she was placing her feet. From the tragedy of a terrible crash, an inspirational act of kindness and response to human need arose. Thank you, Angela, for inspiring each one of us in how you modeled kindness as a human being and extending yourself as a skilled and caring nurse in a terribly dangerous situation.
Daisy Award Beginning this issue, we will be posting the names and photos of monthly DAISY Award honorees as a regular feature in News & Views. See page 5 for our irst award honorees.
Consider Kevin Ben, a mental health associate in the Child Psychiatry Day Hospital Program. Two decades ago, Kevin brought his 2-year-old son to UMMC to be treated for cancer. Kevin lived through this tragedy as a loving father praying for his son to return to health. Inspired by the excellent care his son received, Kevin decided he wanted to “give back,” so he joined the UMMC team as a volunteer. This experience led him to grow his career in health care and take care of fragile children to honor the care his son received, the caregivers who provided it, and other pediatric patients who need specialized care. By the way, Kevin’s son is now a healthy 23-year-old man. Thank you, Kevin, for not only caring enough to pay it forward through your volunteerism, thank you also for making health care at UMMC your profession. Consider Tamesha Bell, a certiied nursing assistant on the Pediatric Intensive Care Unit. She witnesses tragic situations daily and was so inspired by how her patients, their family members and her colleagues rise up to meet the challenges, she enrolled in the University of Maryland School of Nursing to continue her own professional development. In addition, Tamesha has quickly established herself as the PICU’s artist-in-residence by helping to brighten the environment for its young patients. (Read more about Tamesha’s contributions on page 13.) Thank you, Tamesha, for your motivation to continue your education, your desire to develop your skills and expertise, and your desire to make a diference in the lives of our patients. You are an inspiration to us. Inspiration and tragedy walk hand-in-hand throughout our lives. We witness tragedy and feel its heartbreak. When it inspires us to extend ourselves in ways that help others, that’s when the beauty of our humanness emerges. u
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Summer 2016
In This Issue 1
Lisa Rowen’s Rounds
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Mohan Suntha, MD, MBA, new UMMC President and CEO
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Corporate Compliance
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High-Reliability Organizations: The Five Characteristics
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Achievements
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Daisy Award
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Student Nurse Residency Program
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MASTRI Center – High-Fidelity Simulation at UMMC
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Building MyPlate – Connecting Patients and Families with Knowledge and Resources
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Journal Club
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Our own Artist-in-Residence in the PICU
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Respiratory Care
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Spotlight on Pharmacy
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Publications and Presentations
20 Clinical Practice Update
NEWS & VIEWS is published quarterly by the Department of Nursing and Patient Care Services of the University of Maryland Medical Center. Scope of Publication The scope of NEWS & VIEWS is to provide
clinical and professional nursing practice topics that focus on inpatient, procedural, and ambulatory areas. Editor-in-Chief
Carolyn Guinn, MSN, RN Magnet Director, Clinical Practice and Professional Development Managing Editor
Susan Santos Carey, MS Manager, Operations Clinical Practice and Professional Development
Mohan Suntha, md, mba, is new ummc President and ceo Mohan Suntha, MD, MBA, is the new president and CEO of UMMC, our two-hospital academic medical center comprised of University and Midtown Campuses. From 2012 to 2016, Dr. Suntha was president and CEO of the University of Maryland St. Joseph Medical Center. Dr. Suntha irst joined UMMC as a resident in the Department of Radiation Oncology in 1991. He has been a member of the faculty at the University of Maryland School of Medicine since 1995. Based on his clinical and academic accomplishments, he was awarded the Marlene and Stewart Greenebaum Professorship in Radiation Oncology in 2008. He has assumed numerous administrative roles within the Medical System and School of Medicine. He served as the vice chairman and clinical director in the Department of Radiation Oncology, University of Maryland School of Medicine, and the associate director for clinical afairs in the Marlene and Stewart Greenebaum Cancer Center. In 2009, he was appointed vice president for system program development for the University of Maryland Medical System. In this role, he successfully leveraged the strengths of the University of Maryland School of Medicine faculty to address clinical needs across the Medical System. Dr. Suntha earned his A.B. from Brown University in 1986 and his medical degree from Jeferson Medical College in 1990. He received his MBA from the Wharton School of Business at the University of Pennsylvania in 2009. We look forward to Dr. Suntha’s vision and partnership as he leads us forward in a spirit of alignment, transparency, and accountability. Together with our board of directors, Dr. Suntha will focus our collective eforts on the patient experience, employee engagement, inancial stewardship, physician alignment, and community engagement. Find
news&views
online at http://umm.edu/professionals/nursing/newsletter and on the
UMMC INSIDER at http://intra.umms.org/ummc/nursing/cppd/excellence/publications/news-and-views
Corporate Compliance
Editorial Board
Lisa Rowen, DNSc, RN, CENP, FAAN Chief Nurse Executive University of Maryland Medical System Senior Vice President of Patient Care Services & Chief Nursing Officer University of Maryland Medical Center Associate Professor University of Maryland School of Nursing Greg Raymond, MS, MBA, RN Director, Nursing and Patient Care Services Clinical Practice and Professional Development, Neuroscience and Behavioral Health Suzanne Leiter Executive Assistant to the Senior Vice President of Patient Care Services and Chief Nursing Officer Chris Lindsley Director, Communication Services University of Maryland Medical System Anne Haddad Publications Editor University of Maryland Medical System
Andrea Alvarez, Compliance Specialist – Education and Training Corporate Compliance and Business Ethics Group
In each issue, the Medical Center Compliance Program provides a short Frequently Asked Question (FAQ) for News & Views. We are looking for new ways to reach out to employees to raise awareness of compliance issues. Please let us know what you think, or suggest topics by emailing compliance@umm.edu or aalvarez1@umm.edu. Compliance FAQ Q: What happens after I report an allegation to the Corporate Compliance and Business Ethics Group (CCBEG)? A: When an employee reports a potential violation of law or company policy to CCBEG, an investigation begins with an initial review. The case is then logged according to the UMMS ailiate involved and is assigned to one of the four CCBEG teams based on the nature of the allegation. All cases are handled conidentially and only discussed with those persons relevant to resolving the matter. If the case has been reported anonymously, we work with the information provided to investigate and substantiate the allegation to the extent continued on page 11. that we are able.
news &views High-Reliability Organizations: The Five Characteristics Deborah L. Schoield, DNP, CRNP, FAANP, Director of Quality and Patient Safety and Mangla Gulati, MD, FAHS, CPPS, Vice-President and Associate Chief Medical Oicer, Patient Safety and Clinical Efectiveness
As we continue on our High-Reliability Organizational (HRO) journey, it is essential to understand those characteristics which foundationally reflect such an organization. HROs are those organizations which have succeeded in avoiding catastrophes in an environment where normal accidents can be expected due to risk factors and complexity (Van Stralen, 2014). Essentially, an HRO expects its organization and its sub-systems will fail and works very hard to avoid failure, while preparing for the inevitable so that they can minimize the impact of failure (AHRQ, 2008). The classical sustainable examples of an HRO include aviation and nuclear industries. The best HROs anticipate that people will eventually make mistakes and their systems can become vulnerable. HRO principles help to build, thrive in, and sustain healthy safety cultures (AHRQ, 2008). Health care organizations are on the journey to becoming an HRO; some are further along the journey than others. So what are the characteristics associated resists accepting simple explanations with an HRO? There are ive principles of for identiied problematic processes or Preoccupation with failure an HRO as identiied by Weick, MD and systems. It is important to remember Sutclife, MD (2013), who are principally that explanations for identiied responsible for the “mindfulness” that problems, which may seem obvious, keeps an HRO working well when facing need to be further investigated as, often, an unanticipated situation (Anderson an alternative cause for the problem Sensitivity to operations may turn out to be the real source Center for Health Systems Excellence, (Gamble, 2014). 2015). First, there is the preoccupation Deference to expertise is the fourth with failure. Again, HROs anticipate that Reluctance to accept simple explanations characteristic of an HRO. This means people are fallible and that systems and for faulty processes or problems. that an employee at any level, with the processes can be vulnerable to failure. most experience with a problem, process Employees at all levels are encouraged or task, should be consulted on the issue to both identify which processes are at hand. Leaders are encouraged to working well and to begin to analyze Deference to expertise consult front-line staf regularly to solicit processes that may be susceptible to their opinions on identiied problematic failure (Gamble, 2014). Once a process issues, no matter where the employees is identiied as vulnerable in one area, fall in the hierarchy of the organization it is important to extrapolate this to Resiliency of an organization (Gamble, 2014). other areas which may be employing The ifth HRO characteristic the same process to assess whether risk includes resiliency of an organization. exists. It is important to note here that This involves being both relentlessness in how to respond to HROs encourage reporting of faulty processes and systems by failures and creative in exploring and inding new solutions employees, notably “de-stigmatizing” failure. Employees who to problems. Although failures are anticipated, HROs are report faulty processes and systems or medical errors are not characterized by their rapid response to avoid catastrophic punished in the just (fair) culture of an HRO. outcomes and development of new solutions to prevent these The second HRO characteristic surrounds sensitivity to failures. The classical example is the “search for the black box” and operations. Both leadership and staf need to maintain a constant the mobilization of a SWOT team to the site of an airplane crash vigilance and awareness of how processes and systems are every time (Chassin & Loeb, 2013). afecting the organization (Gamble, 2014). HROs promote and How does health care difer? Often in health care, the encourage data sharing and constant operational awareness collective health care team fails to bring their concern of unsafe among employees at every level. One tactic to increase sensitivity conditions, practices and behaviors to attention. One might ask why to operations is to promote daily rounding in the place where the this is? Poor communication, inadequate transitions of care, multiple work is done; this allows employees and leadership to experience hands-ofs, and unnecessary hierarchies are often the reasons cited. irst-hand processes, which may be either burdensome and When caregivers come to expect poor communication, they become concerning to staf or working very well for them (Gamble, 2014). desensitized to its hazards. In one analysis, such a culture of low The third HRO characteristic involves a reluctance to accept expectations explained a substantial number of errors that led to simple explanations for faulty processes or problems. An HRO, continued on page 11. instead, digs deeper for the root causes of the problems and
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Achievements
University of Maryland Medical Center Partners with itWORKS Learning Center, Inc. Patricia Y. Wilson, MA, BSN, RN, FCN, Clinical Practice and Development Coordinator, Clinical Practice and Professional Development and Maxine Rush, M. Ed., GCDF, JCTC, Career Development Specialist, Community and Workforce Engagement Department
This past spring, the University of Maryland Medical Center’s Community and Workforce Engagement Department hosted itWORKS Learning Center, Inc.’s patient care technician (PCT) education and training program. itWORKS is a health care training school providing licensed CNA/GNA nursing assistant training. It ofers twelve weeks of didactic and hands-on clinical and simulation training led by registered nurses.
Twenty-five students were selected to participate in the program. The majority were former students of itWorks Learning Center, Inc., and are currently working as certified nursing assistants and geriatric certified nursing assistants (CNA/GNA) in local nursing facilities. Each candidate was vetted by Ruth Borkoski, BSN, RN, nurse manager, Medical IMC and 13 East/13 West; Simone Odwin-Jenkins, MBA, BA, BSN, RN, nurse manager, Gudelsky 5 East - VSPCU; Patricia Wilson, MA, BSN, RN, FCN, clinical practice and development coordinator, Clinical Practice and Professional Development; Mildred Yarborough, MS, RN, senior educator and clinical instructor, itWorks Learning Center, Inc.; Jo-Ann Williams, MS, director of community and workforce engagement;
Vicki Wrisk, BSN, RN, supplemental staffing; and Joshua Kanoff, human resources recruiter. This program is designed to train experienced CNAs/ GNAs within the community and advance their current skills to work in a hospital facility. They learn the following competencies for a patient care technician (PCT): • Cultural competence and inclusion in health care • Computerized documentation (EPIC) • Communication/conflict and stress management • Infection control • Pathophysiology of organs of the human body • Systems review and the disease processes • Patient safety • Clinical skills and special procedures
On July 8, 2016, 18 of the 25 students successfully completed the program. The PCT closing ceremony took place in the Medical Center auditorium. Family, friends, and UMMC staff celebrated as the participants received their certificates and other awards. Greetings were given by Dana Farrakhan, MHS, FACHE, senior vice president, strategy, community and business development, UMMC; and Karen Doyle, MBA, MS, RN, NEA-BC, FAAN, senior vice president, nursing and operations, R Adams Cowley Shock Trauma Center. Vanzetta James, MS, MBA, RN, CCRN, nurse manager, Multi-Trauma Intermediate Care 6, Trauma Acute Care, and Orthopaedic Acute Care, delivered the congratulatory address. Mildred Yarborough, MSN, RN, itWorks, presented the awards. Morton Lapides, president of itWorks and Janet Palmer, MA, M.Ed., provided the closing remarks. On July 13, 2016, all eighteen students passed their patient care technician exam and are now nationally board-certified patient care technicians. Many of them (see names below) are now employees of the Medical Center. u
Congratulations to all who successfully completed the program. Amber Aye Ciara Barnes Sheena Copeland Britney Goldston Winter Lacks Brittany Oakley Constant Nemi Pondy Aquetta Pryer Katherine Russell Ashley Thomas Chiquita Waters Ajeenah Wilkins Ebrah Wright
itWORKS new board-certiied patient care technicians alongside some of their Medical Center mentors continued on page 5.
news &views Achievements,
continued from page 4.
Congratulations to the following UMMC nurses promoted in July 2016! Professional Advancement Model Senior Clinical Nurse I
Kathleen O’Doherty, BSN, RN, CCRN Medical Intensive Care Unit
Yonas Abebe, BSN, RN Vascular Surgery Progressive Care Unit
Christine Oliver, BSN, RN, CCRN Cardiac Surgery Intensive Care Unit
Karen Conrad, BSN, RN Adult Emergency Department
Amber Pyzik, BA, MS, RN, CNL, CCRN Lung Rescue Unit
Julie Landon, BSN, RN, CCRN Cardiac Care Unit 3W
Michelle Walsh, BSN, RN, CCRN Critical Care Resuscitation Unit
Tina Nicklas, BSN, RN Surgical Acute Care
Amanda Zambrano, BSN, BS, CCRN Lung Rescue Unit
Senior Clinical Nurse II Nicole Hodski, BSN, BS, RN, CCRN, FCCS Medical Intensive Care Unit Alison Lembo, MSN, MBA, RN, CMSRN Shock Trauma Acute Care Kara Stevens, MS, RN, CMSRN Medical Telemetry N13
DAISY Award Beginning this issue, we will be posting the names and photos of monthly DAISY Award honorees as a regular feature in News & Views.
The DAISY (Diseases Attacking the Immune System) Award was established by The DAISY Foundation in memory of J. Patrick Barnes, who died at 33 of ITP, an auto-immune disease. The Barnes family was awestruck by the clinical skills, caring, and compassion of the nurses who cared for Patrick and created this international award to say thank you to compassionate nurses everywhere. UMMC has made the decision to join the DAISY Foundation and recognize our most caring and compassionate nurses with this honor. DAISY Award honorees are selected from nominations generated by patients, families, or co-workers. Individual nurses, teams, or nursing leaders are all eligible for the DAISY Award. The UMMC DAISY steering committee is a sub-committee of the Staf Nurse Council and will review all nominations and select a DAISY Award honoree every month. We will celebrate each honoree in a public and special way. DAISY Award honorees are nationally recognized and respected for their ability to transform patient care through their compassion.
Daisy Award Honorees MAY Tya Schoppe, BSN, RN, CNII NeuroTrauma Critical Care Unit
JUNE Rachael Martin, BSN, RN, CPN, CNII Pediatric Acute Care
JULY Tim Kane, BSN, RN, CNII Neuro Intensive Care Unit
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2016 Student Nurse Residency Program Cyndy Ronald, BA, Manager, SON Partnership Programs
The University of Maryland Medical Center’s (UMMC) Student Nurse Residency Program has just completed its tenth year. This highly competitive program has been a valuable recruitment tool for top new graduate nurses at the Medical Center – over 83% of last year’s residents have been hired as new graduate nurses. The summer internship places students entering their senior year of nursing school on units ranging from adult medical to critical care in a variety of specialties, to include pediatrics. This year the Lung Rescue Unit participated in the program and accepted one student nurse resident. During the program, the residents work one-on-one with a nurse preceptor (three 12-hour shifts/week), attend bi-weekly education sessions, complete journals, and develop an evidence-based poster for presentation in the Weinberg Atrium on July 28th and 29th.
The interview process was held in March which included participation in a group discussion about an article sent to them prior to the interview. After this group discussion, the students were then taken to the computer lab where they were given a writing assignment and had 30 minutes to respond. Over 130 students took part in the process and 52 students were selected. Even though students selected are Maryland residents, they represented 15 diferent nursing schools in the country. The students started on May 23rd and after one week of hospital and residency orientation, worked for nine weeks on their unit of placement. Through their sessions with mentors from Clinical Practice and Professional Development, feedback from preceptors and journal entries, it is exciting to report that each of the residents learned a great deal during their time at
UMMC and have grown in their skills and conidence toward becoming a competent, safe, and compassionate nurse. The unit staf, preceptors, senior leadership, and other clinicians that the students interacted with, embraced them, supported them, and ofered multiple opportunities for learning. Because of this incredible experience, the students feel they are well on their way to transitioning from student to new graduate nurse and will emulate the positive professional behaviors they witnessed. They were especially grateful for their preceptors and the amount of time they took to teach and challenge them every shift. At the end of the program, many of the students transferred to student nurse positions until graduation. We are extremely proud of this group of student nurse residents. The following are some excerpts from their last journal entries speaking to the UMMC culture and their experiences.
Left to right: Liz Fordyce, Christine Kantner, Adam Flanick, and Kaitlyn Colliton
continued on page 7.
news &views 2016 Student Nurse Residency Program, continued from page 6.
Left to right: Nanci Collins, Sarah Krashoc-Tunis, and Emily Zweig
Kelli Blue, NeuroTrauma Critical Care University of Maryland School of Nursing I am so appreciative of this experience for helping me gain more conidence and allow me to explore my areas of strengths and weaknesses. I am thankful for my preceptor as well as the other nurses on the unit for helping me in this endeavor. They have taught me and guided me as I practiced developing new skills and were all readily available and willing to help me learn and practice skills. This experience has only made me more excited to become a nurse and I cannot wait to see what next semester and the future has in store for me. Kattrina Merlo, Labor & Delivery University of Maryland School of Nursing I will really miss working on the loor and following my preceptor, Morgan Leighton, BSN, RN, all over the place. I learned so much over the past couple months and Morgan was so patient and upbeat with me. I’m sure at times it would have been faster if she had been alone but she was also so willing to let me try things, congratulate me on things I had done well (even sending me encouraging text messages), answer all my questions, teach me what diferent things meant, quiz me on my strip assessments, and ask me questions why certain outcomes happened. She was also great at inding new experiences for me and getting many things crossed of my bucket list. Even today, we set up a delivery cart because it was something on my list that we still hadn’t had a chance to do. This was such a great experience and I am so happy I was able to spend the summer on the labor and delivery loor with her.
Liz Fordyce, Medical ICU University of South Carolina I really have learned that sometimes nursing isn’t about helping all of your patients get better, but sometimes it’s about making death a beautiful part of life and easing the sufering as much as you can. I think that having learned this thought process, I can much more easily handle the kinds of patients that I have seen on this loor and know that I will be able to apply that thought process to my future as a nurse. I have learned the most valuable lessons this summer, and look forward to my future as an RN with excitement, conidence, and pride. I have loved everything about UMMC and am so glad to have been at a teaching hospital that cares so much about all of their employees, including their students. Adam Warth, Cardiac Critical Care University of Maryland School of Nursing Needless to say, my time in this program has taught me a lot about myself. My preceptor, Tara Daniels, BSN, RN, is a great role model and I feel fortunate that I had the privilege to work alongside her. She’s taught me to treat my patients like they were my family and to advocate for them to receive anything that might enhance their care. With her, I’ve learned what it really means to preserve my patients’ dignity: to care for their emotional, as well as their physical well-being. In my humble opinion, the knowledge, ine attention to detail and work ethic she brings to the CCU rate her as one of the top nurses in the CCU. They are extremely fortunate to have such a great nurse and person in their midst. I am sad to be leaving a unit where I have found myself at home for the past two months. However, I am pursuing a student nurse position on the CCU for this coming fall with the hope of working when I’m back in school. So, in many ways, this isn’t so much the end of my time as a student nurse resident as it is the beginning of my career. Never before have I felt such a strong sense of satisfaction from a workplace as I have this summer. I look forward to even better experiences to come in the not too distant future.
Dolly Bindon, Medical IMC University of Maryland School of Nursing I’ve never had a job that has challenged me in such diverse ways. It has challenged my knowledge, my teamwork skills, my critical thinking, my emotional intelligence, my negotiation skills, my prioritization and lexibility, and my organizational skills. It has challenged me physically, mentally, and emotionally, and yet I am excited every day that I get to spend the rest of my career only getting better and learning more.
Left to right: Brendan Gonski and Ryan Swentzel
Adam Flanick, Medical ICU Towson University The ten-week summer nurse residency program is now coming to a close. I cannot believe it. This summer has literally lown by. As I relect on this past summer, I am amazed at how much I have learned and how I have grown. I started out lacking conidence in many of my nursing skills, assessment skills, and communication skills. Although I have in no way mastered these skills, I have become more competent and conident in my abilities to perform them. I have learned to manage my tasks, take initiative, and plan out my duties. I have seen growth in myself, especially in the last two weeks of this program. During these inal two weeks, my preceptor has pushed me to do my best and take complete charge of the responsibilities and duties of a nurse. She has allowed me to work independently under her supervision so that I could act and react to situations on my own. This, by far, has been one of the greatest opportunities for growth this entire summer. When I realized that I was not simply taking part in the care, but rather taking charge of the care, I had a greater sense of responsibility and purpose in my actions. continued on page 8.
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2016 Student Nurse Residency Program, continued from page 7. Ellie McManuels, Oncology N8/N9 University of Maryland School of Nursing Finally, I’ll end with the biggest lesson I learned (or, more accurately, relearned) this summer. It is human nature to jump to conclusions about someone, even when we hardly know anything about that person. However, nurses must be especially aware of this instinct and refrain from indulging in it. We see people at both their best and worst. However, we often see them at their worst before we see them at their best. Pain and sufering have a tremendous efect on a person’s demeanor. It is essential that we never take personally the things that our patients say to us when they are feeling their worst. That isn’t to say we don’t do everything in our power to help them feel better. Simply put, we must consistently make a conscious efort to imagine our challenging patients in a healthier state. If possible, it helps to ask their family and friends to share their stories of the patient. However, I need to learn how to listen to such stories while simultaneously completing a full assessment and hanging multiple IV luids.
Left to right: Margaret Davies, BSN, RN (preceptor), Arwa Salhab, Tara Daniels, BSN, RN (preceptor), Adam Warth, Ronnie Schoenberger, BSN, RN (preceptor), and Paul Swift
Left to right: Kate Chucko, Tess Quinn, Holly Weinschenk, and Jordan Wood
Tess Quinn, Pediatric ICU Boston College My preceptor motivated me, challenged me, valued me, appreciated me, and welcomed me. She has been an incredible role model for me to follow, in order to become a better, more intelligent, and more dedicated nurse. Her patients are her top priority and she shows that in every step she takes while at work. It has been such a wonderful experience learning from her and working with her as a team to provide the best care we can! This unit has made me want to join their team of nurses. Every single nurse, doctor, resident, respiratory therapist, tech, and secretary that I meet on this unit has shown such pride and joy in their work and has been nothing short of welcoming and wonderful towards me. Even after the hardest, most stressful days, I enjoyed coming back to this unit, knowing how much every staf member cares for these children. There are deinitely some patients from this unit that I cared for that will stay with me for the rest of my nursing career. These children have a special place in my heart and I cannot wait for the day that I will be a registered nurse and will be able to care for children just like these once again.
Sarah Connolly, Labor & Delivery Notre Dame of Maryland University As I enter the inal week of this program, I cannot help but relect. The time has truly lown by and I am sad to see this amazing experience come to an end. My time in the labor and delivery unit this summer cannot be summed up in just a few words. I have seen a newborn take their very irst breath, heard their very irst cry, and held them in my arms when they open their eyes for the very irst time. I am privileged enough to partake in the most important day in many peoples’ lives and witness some of their most personal and intimate moments. Throughout this program I have learned so much about this incredible ield and my place within it. Now I could tell you about all of the knowledge that I have gained and the skills that I conquered, but that it not what obstetric nursing is truly about. Down to its core it is about something a whole lot deeper. It’s about holding the hand of an anxious patient as they travel down this scary new road to a whole new life. Labor and delivery nurses have a very special relationship with their patients – one that involves a level of trust not always seen in other specialties. We are their guide throughout their labor. We have the answers to their questions. We are the hope to quell their fears. We are the words of encouragement ofered in their time of need. u
news &views The MASTRI Center – High-Fidelity Simulation at UMMC Katie Gordon, MSN, RN, CNE, Simulation Educator
The Maryland Advanced Simulation, Training, Research, and Innovation Center, otherwise known as the MASTRI Center, is located on the 7th floor of the South Hospital. We have added new staff and now have three simulation educators/training specialists: Kerry Murphy, DVM; Katie Gordon, MSN, RN, CNE; and Maggie Ryan, MS, RN. The Center allows staff and students the opportunity to experience real-life scenarios in the safety of the simulation environment. The activities are formative in nature – there is no pass or fail and they are intended to better prepare staff for emergency situations which may occur on their unit. If you have identiied an educational need that would be best served by the creation of a simulation-based training scenario, you can schedule a meeting with one of the educators to help create an individualized training activity to best meet the needs of your staf. They will help to determine what type of simulation is best for your unique situation. This could be a low-idelity simulation that would include skills stations and role playing. Or, perhaps, maybe you require a higher-idelity educational experience that would include use of the SimMan3G manikin. The simulation experience provides the kinesthetic learner the opportunity to really put their “hands on” the patient to learn in an active manner. Whatever your educational goal, the educators in the MASTRI center will help you achieve them in a safe, low-pressure environment. This is a wonderful resource which is available to you and all UMMC clinical staf. We welcome the opportunity to work with new graduates, seasoned nurses, or multidisciplinary groups and introduce them to the simulation learning environment. If you would like to meet with one of the MASTRI Center educators to discuss the possibilities available to you, please call 410-328-8428 and our administrative assistant, Rose Drayton-Trudge, will connect you with one of the educators. We look forward to meeting with you! u
Douglas G. LaTourette, MS, BSN, RN, CCRN and Jamie Morris, BSN, RN
Internal Medicine interns work through a mock code simulation. Left to right: David Gottlieb, MD; Rinita Chakrapani, MD; Karan Kapoor, MD; Ameef Patel, MD; and Zachary Strumpf, MD
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CLINICAL NUTRITION
Building MyPlate: Connecting Patients and Families with Knowledge and Resources Leahandra Wendland, RD, CSP, LDN, Nutrition Specialist for the Children’s Heart Program
We know that many of our patients who work and live in Baltimore City encounter barriers that prevent them from making the best food choices. Unfortunately, the grocery store and where our patients and families actually buy food are often two very different places. To maximize opportunities for making sound food selections and to minimize the disparity of where food is purchased, a team from the Children’s Heart Program at UMMC decided to create a nutrition program: Building MyPlate. The goals of this program are twofold: (1) to provide real-life application to concepts taught in the clinic setting, and (2) to teach patients and families about resources to help guide them in making healthy food selections. Building MyPlate became a reality through a partnership with this UMMC team and Shoppers Food and Pharmacy. Creating a Partnership When selecting a store with which to partner, it seemed to be in the best interest of our community to choose a community-based grocery store. Shoppers Food and Pharmacy has more locations than any other supermarket within the Baltimore City limits. We set up a meeting to propose our idea to Shoppers’ leadership and their goals were an identical match to ours: improving quality of life through providing nutritional educational opportunities and connecting patients and customers to resources. With that, a partnership was formed. Getting Participation and Staing the Event Our team primarily reached out to patients and families within the Children’s Heart Program, but we also included those from the pediatric gastrointestinal practice. A total of 42 people RSVP’d “yes” to our Building MyPlate program. On the day of the event, we had 16 participants from ive families, equaling a 38% turnout rate. Representatives from Clinical Nutrition Services: pediatric dietitians and dietetic interns; and Pediatric Cardiology: a cardiologist, nurse manager, QI coordinator, sonographers, and medical assistants, provided staing for the program. Our Event To help make the participants feel welcome and get them excited about this nutrition program, we kicked of our event with an interactive dance video from the website, “GoNoodle.” Using this video gave us the opportunity to highlight the importance of physical activity. With the safety of playing outside being a concern for our community, we were able to show parents an alternative way to get their children active. Once the participants warmed up and were feeling relaxed, we discussed Building MyPlate. We encouraged audience participation by asking everyone to share favorite foods from each food category: protein, grain, fruits/vegetables, and dairy. We then discussed the nutrition facts label and showed a video from the Food and Drug Administration illustrating the importance of paying attention to this information when selecting foods to eat. Next, we discussed the usual layout of a grocery store and how to visit the healthier
Children’s Heart Program staf: Left to right: Beth Sherfy, MS, RN, CPHQ-QI Coordinator; Yvette Bagley, MA; Leahandra Wendland, RD, CSP, LDN, nutrition specialist; Peter Gaskin, MD, cardiologist; and Eveena Felder, MS, RN, nurse manager.
sections around the perimeter vs. the middle sections. We then moved on to talk about cost, debunking the myth that healthier food is more expensive. We examined both the nutritional and inancial cost of building one’s own lunch vs. buying a prepackaged lunch and of making one’s own oven fried chicken vs. buying a fried chicken meal. Once the classroom component of the session was completed, each family started at a diferent part of the “grocery store,” represented by a food group. At each station, a volunteer discussed speciic foods from the food group, comparing and discussing labels and how to ind the healthier options. Once everyone went through each food group station, we asked participants to choose the food item they thought had a speciic nutrient just by looking at a photo so as to reiterate the importance of label reading. Then, we held a question-and-answer continued on page 11.
news &views Clinical Nutrition,
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session and a “inish your shopping,” during which time families were able to take home the donated food items that had been used as examples. For home use, each family was given nutrition education materials and heart-healthy recipe booklets, highlighting foods discussed during the session. Outcomes and Barriers Feedback from attendees was overwhelmingly positive. As families were leaving, we had comments such as, “This was much more than I expected.” The best feedback came from an attendee who stated, “We’ve been attending your nutrition workshops; when is the next one?” Based on the survey we gave to families, everyone reported that they learned something new at the workshop. In addition, all stated they would attend another workshop in the future. Upon making follow-up phone calls, some of the barriers to attending were noted to be: sporting events for other children, one or both parents working late and sick children at home. To combat attendance issues in the future, we plan to reach out to as many people as possible in person and continue to ofer great incentives for participation. Looking Forward Survey results showed the most frequent request was to have a session about proper portions and portion control. In the fall, we plan to continue our partnership with Shoppers Food and Pharmacy by bringing participants to one of their nearby locations for a grocery store tour. We hope to incorporate portion control and ethnic foods into the upcoming event. Our intent is to further our goals of reinforcing healthy eating principles and connecting our families to community resources. u
High-Reliability Organizations, cont’d from page 3. a patient undergoing an invasive procedure that was intended for someone else (Chassin &Loeb, 2013). The three essential domains of an HRO are leadership; a culture of safety, where all are comfortable speaking up where safety is of concern; and continuous robust process improvement. UMMC is on the road to becoming an HRO. It is an evolutionary journey which engages and empowers all members of the health care team. u References Agency for HealthCare Research and Quality. (2008). Becoming a High Reliability Organization: Operational Advice for Hospital Leaders. Retrieved from http://archive. ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/hroadvice/ hroadvice.pdf James M Anderson Center for Health Systems Excellence. (2015). Becoming a High Reliability Organization. Retrieved from http://www.cincinnatichildrens.org/service/j/ anderson-center/safety/methodology/high-reliability/. Chassin, R. & Loeb, J. (2013). High Reliability Health Care: Getting there from here. Retrieved from: https://www.jointcommission.org/high-reliability_health_care_ getting_there_from_here/ Gamble, M. (2013). 5 Traits of High Reliability Organizations: How to Hardwire each in your Organization. Retrieved from http://www.beckershospitalreview.com/hospitalmanagement-administration/5-traits-of-high-reliability-organizations-how-tohardwire-each-in-your-organization.html. Van Stralen, D. (2014). High Reliability Organizing. Retrieved from http://high-reliability. org/faqs. Weick & Sutclife (2013). Models of HRO. Retreived from http://high-reliability.org/ Weick-Sutclife
Corporate Compliance, continued from page 2. If you provide your contact information for follow-up, we may reach out for clariication and assistance in our investigation. When appropriate, UMMS management, Human Resources, the Oice of General Counsel, or other designated individuals may be involved in the investigation and resolution of the case. If the case involves Protected Health Information (PHI), the patient(s) may be notiied with a letter providing brief details of the incident and what steps have been taken to remediate the issue. However, the identity of the employee who reported the incident or committed the violation is not disclosed to the patient. The government requires that HIPAA cases be resolved within 60 days of when the hospital or covered entity was notiied or discovered the allegation. Therefore, it is very important that UMMS employees report concerns promptly to CCBEG. All cases are reviewed by the ailiate compliance oicer and/or CCBEG directors to ensure that all identiied allegations are fully investigated, resolved, and when necessary, remediated. See policy “CC1201 Procedures for Managing Compliance Incidents” on the intranet for more detailed information regarding this process. u
SPECIAL TOPICS IN
TRAUMA CARE 2016 Friday, November 4, 2016 • 8 am – 4 pm Southern Management Corporation Campus Center 621 West Lombard Street • Baltimore, Maryland 21201
• Specialty Care for Speciic Injuries, Populations and Complications • Challenges in Trauma Care • Updates in Trauma Resuscitation • Single-System Injuries and Multisystem Impact of Injury • Speciic topics include: Caring for Transgender Trauma Patients,
Integrative Therapies, Monitoring Patients with Severe Traumatic Brain Injury, Emergency Preservation and Resuscitation and many more!
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Journal Club Anne Johnston, BSN, RN, CCRN, senior clinical nurse II, Interventional Radiology, facilitated the June Journal Club for the article “Higher volume endovascular stroke centers have faster times to treatment, higher reperfusion rates, and higher rates of good clinical outcomes� (Gupta et al., 2013) Th
h esearch c w o t e h h v e cent e e eicient at delivering
endovascular approaches for patients with large vessel occlusion in acute ischemic strokes compared to lowvolume (LV) centers.
The investigators hypothesized that patients treated with endovascular therapies at HV centers have lower times from CT scan acquisition to groin puncture, lower procedural times, and higher reperfusion rates than LV centers. This was a retrospective analysis of 442 consecutive patients treated with endovascular therapy at nine tertiary stroke centers from September 2009 – July 2011. Patients with anterior circulation large vessel occlusions were included and presented to the hospital within eight hours of symptom onset. Data was collected regarding demographic, radiographic, and angiographic variables and assessed by multivariate analysis to determine if HV centers were quicker at delivering care. A HV center was defined as one that performed fifty or more endovascular procedures a year. This was the median across the nine participating centers. The Department of Neurointerventional Radiology at UMMC was one of the nine centers that participated in this study. A series of time points from CT scan to end of endovascular procedure were recorded to determine how quickly it took for each event. Successful reperfusion, symptomatic intracerebral hemorrhage, and clinical outcomes were defined. Data was collected on patient demographics (age and sex), previous medical history (hypertension, afib, diabetes and dyslipidemia), location of thrombus, successful reperfusion, symptomatic hemorrhage, median
infarct volume, clinical outcomes, administration of IV tPA, and if patient was transferred from another facility. Several time intervals were assessed in the delivery of care. The following time points were recorded: time from symptom onset to CT scan, CT scan to groin puncture, groin puncture to catheter placement into the targeted vessel to treat, first angiogram image revealing the treatable occluded segment to placement of the microcatheter into/distal to the thrombus, and total procedure time. Reperfusion status, hemorrhage type and clinical outcomes were decided and recorded by each individual participating center. Baseline characteristics between HV and LV centers were compared using the Fisher exact test for categorical variables and the Student t test or Mann-Whitney U tests, as appropriate. Secondary analysis was performed comparing patients with good clinical outcomes to those with poor outcomes and predictors of successful reperfusions. In both analyses, variables with a p value < 0.02 were entered into the multivariate binary logistic regression model to determine independent predictors of a good clinical outcome and successful reperfusion. Results showed that there was no statistical difference with regards to age, use of the National Institute of Health Stroke Scale (NIHSS), location of thrombus, and hemorrhage rates between the HV and LV centers. HV centers performed better than LV centers from CT scan to groin puncture (OR 0.991, 95% CI 0.989 to 0.997, p=0.001), and total procedure times (OR 0.991, 95% CI 0.986 to 0.996, p=0.001). Patients treated at HV centers had better clinical outcomes (OR 1.86, 95% CI 1.111 to 3.10 p< 0.018) and successful reperfusion (OR 1.82, 95% CI 1.16 to2.86, p<
0.008). HV centers treated more patients transferred in to their institution than LV centers (64% vs. 31%, p< 0.001). HV centers were more likely to treat patients after receiving IV tPA (48% vs. 38%, p< 0.04). Based on the results, the authors concluded that HV centers perform endovascular procedures more efficiently then LV centers for acute stroke patients. These patients have a higher rate of reperfusion and better clinical outcomes post-procedure. Recommendations include implementation of future studies that focus on providing more efficient treatment to endovascular stroke patients. These studies should be prospective, focusing on each step in the treatment process and creating parameters that reduce time to treatment. Study limitations were identified as follows: â&#x20AC;˘ Time of day that patients were treated not assessed. â&#x20AC;˘ Unable to consistently capture the time of hospital arrival which coincides with treatment onset. â&#x20AC;˘ Patients may have been enrolled in studies which can cause delays due to protocol and consent requirements. â&#x20AC;˘ Imaging was interpreted by each center instead of an objective body. Discussion:
The golden rule for stroke patients equates to, â&#x20AC;&#x153;time is brain.â&#x20AC;? In treating strokes at a large tertiary hospital that is also a designated comprehensive stroke center, it is important to understand and improve the delays that can occur in patient flow from diagnosis to reperfusion after an acute ischemic stroke caused by an occlusion in a large vessel. This is essential to achieving better clinical outcomes for patients. Multidisciplinary collaboration is vital in achieving quicker treatment for patients. This is significant to nurses as they are involved at every time point of care. From admission through post-procedural care, nurses can help improve efficiencies continued on page 13.
news &views Journal Club,
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in the sequence of events needed to treat this patient population. The journal club members found this article, including the literature review, relevant and timely since UMMC is a Certified Stroke Center and captures procedure data on this patient population. The members strongly agreed that the citation from Neurology (2009) was significant to this study: “Time delays to reperfusion impact clinical outcomes. For every thirty-minute delay in reperfusion, there is a 12% decrease in the probability of
good clinical outcomes.” (Khatri et al., 2009) This supports how the UMMC nurses in the Neuro Interventional Radiology department can impact the care of stroke patients from admission through intervention by ensuring timely treatment. The use of Certified Stroke Center metrics to justify the time points also helped to contribute to the validity of the study. Most agreed with the limitations of the study but some identified that the sample size of this study might not be reflective of the number of patients treated each year.
Overall the members were interested in learning that UMMC is a Certified Stroke Center and is continuing to capture data to improve patient outcomes. u References Gupta, R., Horev, A., Nguyen, T., Gandhi, D., Wisco, D., Glenn, B., et al. (2013). Higher volume endovascular stroke centers have faster times to treatment, higher reperfusion rates and higher rates of good clinical outcomes J NeuroIntervent Surg; 5:294-297. Khatri P, Abruzzo T, et al (2009). IMS I and II Investigations. Good clinical outcomes after ischemic stroke with successful revascularization is timedependent. Neurology, 73; 1066-72.
Our own Artist-in-Residence in the Pediatric Intensive Care Unit Mary Jo Simke, MS, BSN, RN, Nurse Manager, Pediatric Intensive Care Unit
Think of how stressful it is for you or a loved one to be in a hospital – whether it be for outpatient surgery, a visit to the emergency department, or admitted to an inpatient unit. Now, close your eyes and imagine the patient is a child, and you are a parent, grandparent, friend, or sibling of a child who is hospitalized. Add to this the many unfamiliar noises (beeps, emergency bells), the visits from strangers (staff from the hospital), and the fear of painful procedures. This is what someone will most likely experience as part of the daily life in the Pediatric Intensive Care Unit (PICU) at UMMC. This is the reality for many patients and families of children (infants to young adults) who are cared for in the PICU for a day, a week, a month, and sometimes, for a year.
Tamesha Bell with some of her artwork
When one shares with others that they work in a PICU, the irst question often asked is “How can you be around critically ill children every day?” Over the years, my answer has been that these children and parents are going to have to face their illness, no matter what, and if I and the nursing team can help them in any way, then we will do so knowing that the rewards will far outweigh the diicult times. Many of our PICU colleagues contribute to bringing some kind of normalcy and cheer to our patients, families and staf. One notable staf member, Tamesha Bell, CNA, has a unique talent for doing so. Unbeknownst to her colleagues, we discovered very recently that Tamesha is a talented artist! Tamesha started working in the PICU at the end of 2015. In the late winter/early spring of this year, when the unit was quieter, Tamesha was found to be drawing child-friendly cartoon characters on the glass doors of the patients’ rooms. Several parents had commented on how the drawings helped to brighten the PICU. Moreover, one could also see how these drawings were helping to provide a pleasant distraction for our patients; by focusing on them they could tune out, at least temporarily, the strangeness and unfamiliarity of this ICU environment. Thanks Tamesha for helping to cheer the lives of so many – particularly our patients – in the PICU. u
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PATIENT CARE SERVICES | RESPIRATORY
Pediatric and Neonatal Respiratory Therapists strive for commitment to service excellence, communication, and team collaboration Elshadie Ramdat, MHA, RRT-NPS; Greg Ludvik, MS, RRT-NPS; Paul Johnson, RRT; and Hamid Reza, RRT
The pediatric and neonatal respiratory therapists are key members of the Neonatal and Pediatrics Intensive Care Unit teams. Their roles are very broad and differ from one institution to another. At the University of Maryland Medical Center, the therapists work in the ICUs, labor and delivery, the acute care areas, and the pediatric emergency room and are also actively involved in research and patient and family education. Over the years, the respiratory therapy group has enhanced this service area by continuing to demonstrate excellent customer service, communication, and team collaboration. Elshadie Ramdat, MHA, RRT-NPS, pediatric respiratory supervisor, acknowledged that, “The efort and the amount of support provided by respiratory care leadership, Chris Kircher, MHA, RRTACCS, director of respiratory care, and respiratory care managers, Robin Smith, BS, RRT and Oswald Murray, MHA, RRT, together with the pediatric supervisory team, enables the respiratory therapists (RTs) to provide high-quality patient care that has made a signiicant diference.” This positive patient care involvement has been recognized by many. The 52-bed, Level-4 NICU (the highest level NICU designation) at UMMC is unique in many ways. Our patients are often here for prolonged periods of time and have the most advanced respiratory support technology available to keep their lungs healthy. According to experts, a new baby is born every eight seconds in the United States (Minority Nurse Staf, March, 2013). In our NICU, the respiratory therapists are part of the multidisciplinary team that attends all high-risk deliveries. Almost all therapists are Neonatal Resuscitation Program (NRP) certiied and are actively involved in the resuscitation process, where they systematically assist with diicult intubations. It is through this collaborative efort that many babies with challenging disease processes are safely delivered. We just inished our NRP re-certiication process of our entire pediatric respiratory therapist team with our very own NRP instructors, Wendy Riggin, BS, RRT-AEC from night shift and Kathleen Slater, RRT-NPS from day shift. Our entire team greatly appreciates their commitment to their service area and their eforts in making this program a success. The NRP course was detailed and included reading, testing, and multiple hands-on simulation training in our high-tech simulation lab. As Dina El Metwally, MD, PhD., associate professor and medical director of the Drs. Rouben and Violet Neonatal Intensive Care Unit stated, “The consistent pool of NICU/PICU dedicated respiratory care practitioners in the NICU has improved the communication with the NICU primary care providers. Our respiratory care therapists are integral to the care of the fragile population of the NICU. They are NRP qualiied and are present at the neonatal resuscitations for assessment and prompt intervention, especially the golden hour for infants < /= 32 weeks, where right beginnings dictate good outcomes. I am glad to see
Left to right: Francine Jones, RRT-NPS and Sayed Hashmi, MS, RRT-NPS
our RTs at the bedside morning rounds, and it is a practice that I would like to emphasize in importance, as their suggestions, shared experience, and brainstorming over respiratory management is indispensable. I also would like to acknowledge the respiratory care leadership’s proactiveness, continuous support 24/7 and timely responses to the emerging challenges. Kudos!” The respiratory therapists are deeply involved and invested in the I-STAT process in both the NICU and PICU. The supervisory team is in close contact with the point-of-care team under the direction of Laboratory Services, to ofer complete, fast, and accurate laboratory testing. Many other areas of the Medical Center utilize I-STAT capabilities for quick testing. However, in the pediatric and neonatal settings, the therapist running the I-STAT tests allows for an instantaneous collaboration with the ICU team and more immediate changes for our sickest patients. Our involvement has been crucial in the process of testing the continuous renal replacement therapy (CRRT), priming blood continued on page 15.
news &views Respiratory,
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to ensure the electrolyte balance is suitable for small infants and children. Once the electrolyte values are obtained, they are used by the department of nephrology to ine-tune the patient’s dialysis therapy. The respiratory therapists are also involved in running activated clotting time (ACT) I-STAT tests for pediatric extracorporeal membrane oxygenation (ECMO), which monitors the efects of heparin on clotting time. These values allow for the ECMO specialist and physician to adjust various settings on the ECMO pump to keep this intervention running smoothly. The respiratory therapist may have to run these tests every hour to guide the physician’s treatment plan. The pediatric group understands and embraces the importance of efective communication and team collaboration in order to provide the best in patient care. Therefore, as part of our team’s initiatives, the therapists are involved in diferent committees within respiratory care service and with other multidisciplinary groups. For instance, The Critical Review Improving Safety and Processes (CRISP) is a PICU initiative where respiratory care is substantially involved. It is an opportunity for respiratory therapy to be a part of an exciting collaborative team approach where health care providers do their absolute best to improve and engage in best care practice. According to PICU nurse manager Mary Jo Simke, MS, BSN, RN, “The pediatric respiratory therapists are an integral part of the daily care provided to patients and families being cared for in the PICU. Therapists partner with providers and nurses to plan and deliver individualized care to the patient, whether it be assisting intubated patients to walk, taking technology-dependent babies on a stroller ride within the unit, or teaching parents to care for children who will be discharged with a newly placed tracheostomy and ventilator. Partnerships have been formed at the unit level where staf and leadership participate in standing unit meetings focused on improving the patient experience, discussing safety, and making changes to improve future processes, developing protocols, and teaching new physicians and nurses vents, oxygen delivery, etc.” Paul Johnson, RRT, pediatric respiratory supervisor, states that “Being part of this team collaboration has been an excellent experience not only by actively participating in this meeting, but also learning and seeing diferent practices. Working with such an enthusiastic group of individuals with the common goal of safe practice and working to help our patients in the PICU is so enlightening and well-respected. Being able to bring ideas and partake in this experience is just amazing.” Having the very talented and focused respiratory therapy group has facilitated our involvement in research. One of our biggest accomplishments this year has been to complete our irst
pediatric abstract entitled “Intrapulmonary Percussive Ventilation’s (IPV) Assist in Weaning Pediatric Patients from ECMO.” This abstract was well-prepared and written by Maria Madden, BS, RRT-ACCS, interim education supervisor, Deborah Linehan, BS, RRT-NPS, Jason Custer, MD, Elshadie Ramdat, MHA, RRT-NPS, and Paul Johnson, RRT. The article has been accepted by the American Association for Respiratory Care (AARC) Journal and will be presented by Linehan and Ramdat at the 2016 Maryland Respiratory Care State Conference. The rationale behind the research is important because there are no published studies to support this therapy for the pediatric population. The therapists took the initiative to do our internal research to validate whether or not the treatment is, in fact, efective. The pediatric and neonatal team will continue to strive to provide compassionate care for our children and families in need. It takes all of us working together as a team to accomplish our common goals. We will embrace our strength, core values (teamwork, communication, collaboration, accountability, ownership, and respect), and work on our diferences together to push forward for continued distinction in the ield of respiratory care. u Reference Minority Nurse Staf. (2013, March). A Day in the Life of a Respiratory Therapist. Minority Nurse, Retrieved from http://minoritynurse.com/a-day-in-the-life-of-arespiratory-therapist
Pediatric
Nursıng ED U CA T IO N SY M PO SIU M
Fall intoEnlightenment NOVEMBER 2, 2016 University of Maryland, Baltimore Southern Management Student Campus Center 617 West Lombard Street Baltimore, MD 21201 For more information, call 410-328-6257 or email prof sionaldevelopment@umm.edu
8am – 5pm
Featured Topics: Pediatric Nursing and the Art of the Science Trends in Pediatric Neurology Pediatric Autism Palliative Care Population Health Pediatric Bone Marrow Transplant
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Spotlight on Pharmacy
Pharmacists Join UMMC Brain Attack Team in Response to Alerts of Inpatients with a Suspected Acute Ischemic Stroke Michelle C. Hines, PharmD, Clinical Specialist, Emergency Medicine, Department of Pharmacy Services
“ ime is brain” – swift intervention is essential to restoring cerebral blood low and preserving brain tissue in patients with an acute ischemic stroke (Jauch et al., 2013). The use of intravenous (IV) recombinant tissue plasminogen activator (rtPA) is associated with neurologic improvement and better outcomes when given early to patients with an ischemic stroke – the efect of rtPA on recanalization may decrease as time progresses (Jauch et al., 2013; Muchada et al., 2014).
The decision to administer rtPA involves weighing the potential benefit of recanalization against the risk of bleeding, including intracranial hemorrhage. The 2013 American Heart Association/ American Stroke Association (AHA/ASA) stroke guidelines recommend that patients eligible for IV rtPA receive treatment as quickly as possible given this timedependent benefit to rtPA therapy (Jauch et al., 2013). These guidelines provide a treatment window of within three hours of symptom onset, and this treatment window may be extended to 4.5 hours in certain patients who do not meet additional exclusion criteria. Target: Stroke is an AHA/ASA quality improvement initiative which aims to achieve door-to-rtPA time of <60 minutes in patients who present with suspected ischemic stroke who are eligible to receive rtPA (Fonarow et al., 2011). This initiative has identified 10 best practice strategies (see Table 1). The inclusion of pharmacists in the stroke team may augment strategies 7, 8, and 9. In fact, a recent study showed a shorter door-to-rtPA time when a pharmacist was present at emergency department stroke calls compared to when a pharmacist was not present (Gosser et al., 2016). The UMMC Code Stroke Committee meets quarterly to identify areas for improvement in the management of patients who receive rtPA for the treatment of a suspected acute ischemic
Target: Stroke best practice strategies 1. Advance hospital notiication by EMS 2. Rapid triage protocol and stroke team notiication 3. Single call activation system 4. Stroke tools 5. Rapid acquisition and interpretation of brain imaging 6. Rapid laboratory testing (including point-of-care testing if indicated)
7. Mix rtPA medication ahead of time 8. Rapid access to IV rtPA 9. Team-based approach 10. Prompt data feedback Table 1
stroke. To minimize delays in rtPA administration due to elevated blood pressure, this group recently authored a guideline for blood pressure management in patients with acute ischemic stroke being considered for fibrinolytic therapy. Elevated blood pressure (systolic >185 mmHg or diastolic >110 mmHg) is listed as an exclusion criteria for rtPA treatment (Jauch et al., 2013), and as many as 15% of acute ischemic stroke patients who present to the emergency department have elevated blood pressure (Qureshi et al., 2007). This blood pressure management guideline was approved at the May 2016 UMMC Pharmacy and Therapeutics Committee meeting, and
its implementation is anticipated to help facilitate the safe and timely utilization of rtPA in hypertensive patients. To further improve the management of inpatients who develop an acute ischemic stroke at UMMC, pharmacists on the Code Blue Team will now be joining the UMMC Brain Attack Team in responding to alerts of inpatients with a suspected acute ischemic stroke. The pharmacist’s role as part of the Brain Attack Team will be to assist the team with implementation of the blood pressure management guideline when indicated and to facilitate the timely procurement, preparation, and safe administration of rtPA. The pharmacy department looks forward to our new role in helping improve the acute management of inpatients with an acute ischemic stroke. u References Fonarow, G.C., Smith, E. E., Saver, J. L., et al. Improving door-to-needle times in acute ischemic stroke: the design and rationale for the American Heart Association/American Stroke Association’s Target: Stroke initiative. Stroke 2011; 42:2983-9. Gosser, R. A., Arndt, R. F., Schaafsma, K, et al. Pharmacist impact on ischemic stroke care in the emergency department. J Emerg Med 2016; 50:187-93. Jauch, E.C., Saver, J. L., Adams, H.P., et al. Guidelines for the early management of patients with acute ischemic stroke: A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 2013; 44:870-947. Muchada, M., Rodriguez-Luna, D., Pagola, J., et al. Impact of time to treatment on tissue-type plasminogen activator-induced recanalization in acute ischemic stroke. Stroke 2014; 45:2734-8. Qureshi, A.I., Ezzeddine, M.A., Nasar, A., et al. Prevalence of elevated blood pressure in 563,704 adult patients with stroke presenting to the ED in the United States. Am J Emerg Med 2007; 25:32-8.
news &views
th annual
N ! "# $ %"& C ' ITIONER & PHYSICIAN ASSISTANT
CLINICAL CONFERENCE
NOVEMBER 16, 2016 7:30 am â&#x20AC;&#x201C; 5:00 pm
University of Maryland, Baltimore Southern Management Student Campus Center
For more information, call 410-328-6257 or email professionaldevelopment@umm.edu
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Summer 2016
UMMC Staff Publications and Presentations Peer-reviewed publications and presentations by Patient Care Services staff. Notifications of Acceptance July 1, 2015 through June 30, 2016
Congratulations to accomplished staff!
Publications
Connolly, () *) + -./012y, 3) () 456789: ; Q<=>?@y ?ABCDvEAEF@ BCDGEH@ @D ?FHCE=IE JCE=I@ A?>m ExBCEII?DF: Journal of Pediatric Surgical NursingK LK 4L9K 75MN7OL : Corbitt, P) 456789: SC=FIB=CEFHy U=mEI = Diference When Creating a Culture of Safety [web log post]. http://connect.ons.org/ ons-connect-blog/transparency-makes-adiference-when-creating-a-culture-of-safety. V12WW, X. (2015). Promoting the Safety
and Dignity of Patients who have DNR orders. Clinical Journal of Oncology Nursing, 1;19(6):667-9. KaY., Z) P), (/[\]^_0ey, [), -./012`, b) Derkada`^aW, f), V\ga, i), bofgr2W, ()Z), McIlv2WWaW, [) 3), + j211_, P) (2016). Advanced practice provider patient ratios and workload: Results of multi-institutional survey. Journal of Nursing Administration, accepted for publication, March, 2016. ba`g^2`^, Z), k usco, P)(), l^]\W2, l), ja10er, b)3 ), (\`naW, f)Z), pa`q.\W^, 3 )Z) (2015). Efects of Clonidine on Withdrawal from Long-Term Dexmedetomidine in the Pediatric Patient. The Journal of Pediatric Pharmacology and Therapeutics, 20(1), 45-53.
McC\]^_0ey, [) (2015). Preparation for Practice: Interprofessional Practice: Certiication, Licensure, Credentialing Documentation, Billing, and Coding; “Documentation, Billing and Coding”. In Kline-Tilford, A., & Haut, C. (Eds.). Wolters Kluwer Health. McC\]^_0ey, [) (2015). Pediatric Nursing: Scope and Standards of Practice, (2nd Ed.) Published by the American Nurses Association, National Association of Pediatric Nurse Practitioners and the Society of Pediatric Nursing. (^nWaW\, f), (^W2`, b), [areo, [), lY2W/ er, X., V.1at^, (), -`owW, i), -\`0\_0^, s), V^q_\Wu (an`^, 3), [aWdoniero, f), V\ttlieb, f., Row2W, b) (May/June, 2016). The Routinization
of HIV Testing in an Inpatient Setting: A Systematic Process for Organizational Change. Journal for Healthcare Quality, 38(3), 10-18.
Mos_, () + l^]\W2, l) (2015). Physical Design and Personnel Organization of the PICU. In Rodgers Textbook of Pediatric Intensive Care, 5th Edition. Philadelphia: Wolters Kluwer & Lippincott, Williams & Wilkins. Russo-McC\.`t, i), + -a.]aW, () (2016). Caring for patients with spinal cord injuries. American Nurse Today, 11(5), 18-23. Schoield, D. & McComiskey, C. (2015). Post-graduate nurse practitioner critical care fellowship: Design and implementation, and outcomes at a tertiary medical center. Journal of Nurse Practitioners, 11, (3), e19-e26.
Corbitt, N., Latsko, J., Navada, S., Weinstein, B. (2016). Latest Developments in Treating MDS – An Update on Molecular Testing, Low-Risk and High-Risk MDS Therapies, and Disease Management. Oral Presentation at the 2016 Oncology Nursing Society 41st Annual Congress, San Antonio, TX. Corbitt, N. (2015). Chapter Communications. Oral Presentation at the Oncology Nursing Society Leadership Weekend, Pittsburgh, PA. Corbitt, N. (2016). Infusion Reactions. Oral Presentation at the 2016 Oncology Nursing Society 41st Annual Congress. San Antonio, TX.
Simone, S. (2015). Metabolic Disease. In Tilford A. & Haut C. Lippincott Certiication Review: Acute Care Pediatric Nurse Practitioner. Textbook. Philadelphia, MA: Wolters Kluwer/ Lippincott.
DeVera, M., Malick, L., Ruehle, K., Miller, K., Rutter, M., Nickel, J. (2016). Stem Cell Infusion Education: A Creative Approach. Poster Presentation at the 2016 BMT Tandem Meetings. Honolulu, HI.
Simone, S. & Sorce, L. (2015). Pain and Sedation. In Tilford A. & Haut C. Lippincott Certiication Review: Acute Care Pediatric Nurse Practitioner Textbook. Philadelphia, MA: Wolters Kluwer/Lippincott.
DiNardo, T. & Doyle, K. (2016). Pre-Conference (six-hour session). “I Didn’t Sign Up For This: Workplace Violence.” NTI. American Association of Critical Care Nurses.
Sorce, L. & Simone, S. (2015). Pain and Sedation Management in Mechanically Ventilated Children. Journal of Pediatric Intensive Care, 4(2).
Presentations
Arrington, J., Masters, J., Spillman, K., Szekley, D. (2015). Think Outside the Heart: Pediatric Cardiac Surgery Post-Operative Complications. Poster Presentation at the 2015 Northeast Pediatric Cardiology Nurses Association Annual Conference, Washington, DC. Ball, C., Cysyk, B., Woltz, P. (2016). Improving DTN Time in Maryland: Results from the Stroke Rapid-Treatment Readiness Survey. Oral Presentation at the Maryland Institute for Emergency Medical Services System bimonthly meeting, May 13, 2016, Baltimore, MD. Bell, R., Espeso, L., Foertsch, S. (2015). Nurses leading the change to educate the staf about CALS and no I didn’t misspell ACLS! Poster Presentation at the 2015 Maryland Nurses Association Conference, Linthicum Heights, MD.
DiNardo, T. & Doyle, K. (2016). Three-hour Podium Presentation. “Workplace Violence: Do You Have a Plan.” NTI, American Association of Critical Care Nurses. Dougherty, R. & Cascio, C. (2015). Battling Cancer Related Fatigue: Designs and Implementation of the Cancer Warrior Exercise Program. Poster Presentation at the 2016 Oncology Nursing Society 41st Annual Congress. San Antonio, TX. Graves, J. & Choiniere, D. (2016). Do no harm: Making the case for a nurse led sustainability program. Oral Presentation at the 2016 ANCC National Magnet Conference, Orlando, FL. Hofman, S. B., Terrell, N., Driscoll, C. H., Davis, N. L. (2016). Impact of High-Flow Nasal Cannula Use on Neonatal Respiratory Support Patterns and Length of Stay. Respiratory Care. Hufer, D. & Gorman, K. (2015). Optimizing Preceptor Resources: Retool for a brighter future. Oral Presentation at the 2015 Maryland Educators Collaborative, Maryland. continued on page 19.
news &views Publications and Presentations, Kaiser, K., McGuire, D., Shanholtz, C., Haisield-Wolfe, M., Deeley, M. vz{|}~ Implementing an Evidence-based Tool for Assessing Pain in Non-communicative Palliative Care Patients: Challenges and Solutions oster Presentation at the 2015 American Academy of Hospice and Palliative Medicine and Palliative Nursing Association Annual Assembly, Chicago, IL. Kapu, A. N., McComiskey, C., Raaum, J.W., & Selig, P.M. (2015). Advanced Practice Patient Ratios and Workload: Results of MultiInstitutional Survey. Oral Presentation at the 2016 ANCC Magnet Conference, Orlando, FL. McComiskey, C. (2016). The Role of the Pediatric Nurse Practitioner: A 50-year history. What is our future? Keynote Address, National Association of Pediatric Nurse Practitioners (NAPNAP) Maryland Chesapeake Chapter, Baltimore, MD.
continued from page 18.
Miner, L., Mignano, J., Cafeo, C., Brown, T., Gulati, M., Lathan, V., Chance, G., Rowen, L. (2015). Transitions in Care for Persons Living with HIV Accessing the Acute Care Setting. Poster Presentation, 2015 Maryland Nurses Association 113th Annual Convention, Linthicum Heights, MD. Nair, P., McComiskey, C., Zeller, J. (2016). Transitional Surgery Center: An innovative multidisciplinary approach in reducing 30-day hospital readmissions. Oral Presentation at the 2016 ANCC National Magnet Conference, Orlando, FL. Noll, C. and Doyle, K. (2015). Behavioral Emergency Response Team: Implementing a Performance Improvement Strategy to Address Workplace Violence. Poster Presentation at the 2015 ANCC Magnet Conference, Atlanta, GA.
Simone, S.L. (2016). Case Studies in Acute and Chronic Ventilation. National Association of Pediatric Nurse Practitioner Conference. Atlanta, GA. Simone, S.L. (2016). Unmasking and Managing Pediatric Vasculitis: Case Study Analysis. National Association of Pediatric Nurse Practitioner Conference. Atlanta, GA. March 2016. Simone, S.L. (2016). “Interprofessional Collaboration for Delirium Management in a Pediatric Intensive Care Unit.” Oral Research Snapshot presentation at SSCM Critical Care Congress, Orlando, FL. Simone, S.L. (2016). “Aint Got No Rhythm: Pediatric Case Studies of Sudden Cardiac Arrest.” AACN National Teaching Institute. San Diego, CA. May 2015. Simone, S.L. (2015). Sudden Cardiac Arrest in Children and Adolescents. Baltimore NAPNAP Chapter Symposium. Baltimore, MD.
McComiskey, C. (2016). Academic-Practice Partnerships for Preparing the NP of the Future. Panel Discussion, National Organization of Nurse Practitioner Faculties Special Topics Conference, Crystal City, VA.
Poynter, S., Arrington, J., Heishberger M., Mansai, L., & Ruof, C. (2015). ALCAPA and Left Ventricular Dysfunction: A Podiatric Case Study. Poster Presentation at the 2015 Northeast Pediatric Cardiology Nurses Association Annual Conference, Washington, DC.
McComiskey, C. (2015). Leading Leaders: Keys to Creating an Advanced Practice Structure. Panel Discussion, Children’s Hospital Association Executive Leadership Webinar.
Roane, L. and Novak, D. (2015). Impact of building design on medication error rates in the ICU setting. Poster Presentation at the 2015 ANCC National Magnet Conference, Atlanta, GA.
Tumulty, J., Woltz, P., Rowen, L. (2016). Alarm identiication and response simulation (AIRS). Podium Presentation at the 2016 ANCC National Magnet Conference, Orlando, FL.
McComiskey, C. (2015). Research, EvidenceBased Practice or Quality Improvement – That is the Question. Keynote Address, Nursing Research Conference Shore Health Medical Center, Cambridge, MD.
Rowen, L. (2016). Nursing: The Art of the Science. 2016 June Staf Nurse Council. University of Maryland Medical Center. Baltimore, MD.
Woltz, P., Ellis, C., Nahm, E., Everhart, L., Stanek, G., Anderson, S., Sagherian, K. (2015). Application of the Rapid Cycle Research Framework in an Integrated Health IT System Implementation. Poster Presentation at the 2016 Society of Behavioral Medicine Annual Meeting, Washington, DC.
Minas, N. and Ruehle, K. (2015). The Process of Choosing the best match for BMT Informatics Software. Oral Presentation at the 2016 CRPDM Conference BMT Tandem Meeting, Honolulu, HI. Miner, L., Mignano, J., Cafeo, C., Lemkin, D., Gulati, M., Rowen, L. (2016). Utilizing the HER to overcome barriers of a Routine HIV Testing and Linkage to Care Program. Poster Presentation, 2016 Summer Institute in Nursing Informatics, Baltimore, MD. Miner, L., Mignano, J., Cafeo, C., Brown, T., Gulati, M., Lathan, V., Borkoski, R., Rowen, L. (2015). Increasing access to HIV Care through Institutional Policy in the Acute Care Setting. Poster Presentation, 2015 Maryland Nurses Association 113th Annual Convention, Linthicum Heights, MD.
Rowen, L. (2016). Nursing: The Art of the Science. 2016 Nursing Grand Rounds, University of Maryland Medical Center. Baltimore, MD. Rowen, L. (2016). Nursing: The Art of the Science. 2016 Nursing Grand Rounds, University of Maryland Medical Center Midtown Campus. Baltimore, MD. Rowen, L. (2016). Strengthening Leadership Skills. 2016 Leadership Retreat, for Rehabilation Therapy, Respiratory Therapy and Dietitian Leaders, University of Maryland Medical Center. Baltimore, MD. Simone, S.L. (2016). Dazed and Confused: Assessment and Management of Delirium in the Pediatric Intensive Care Unit. National Teaching Institute. New Orleans, LA. Simone, S.L. (2016). Medical and Surgical Management of Pediatric Pneumonia. National Association of Pediatric Nurse Practitioner Conference. Atlanta, GA.
Simone, S.L. (2015). Synaptic Overload: Refractory Status Epilepticus. National Association of Pediatric Nurse Practitioner Conference. Las Vegas, NV.
Yu, T., Mignano, J., Brown, T., Garcia, M., Lathan, V., Chance, G., Seidl, K., Cafeo, C., Miner, L., Gulati, M. (2016). Implementation of a Routine Inpatient Hepatitis C Virus (HCV) Screening and Outpatient Linkage to Care Program. Poster Presentation, 2016 Society of Hospital Medicine, San Diego, CA. Zimmer, M., Woltz, P., Barnaba, E., Raymond, G. (2016). Professional Advancement Model Outcome Evaluation Fosters Organization Changes to Increase Nurse Engagement and Advancement. Poster Presentation at the 2016 ANCC National Magnet Conference, Orlando, FL. u
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22 South Greene Street Baltimore, Maryland 21201 www.umm.edu
Clinical Practice Update July 19, 2016
Change in Allergy Wristbands: Effective August 1, 2016
Current Product
Background: To ensure patient safety, UMMC will transition to a new allergy armband to simplify and standardize the patient allergy identification process. The new band will be consistent with the following American Hospital Association (AHA) recommendations: • •
Red band with bold ALLERGY alert, indicating “Stop” or “Danger.” Bands should omit handwriting/specific allergy lists to avoid transcription errors or issues with legibility. Our electronic health record provides a comprehensive list of allergies, and is updated with new allergies identified during hospitalization. How will this impact nursing staff?
Nursing will no longer handwrite/list specific allergies on patient allergy armbands. Nursing will place a red allergy alert armband on patients with identified allergies upon admission. Beginning August 1st, the new product will be utilized for new admissions. All clinicians will refer to the electronic health record to review and update patient allergies. Outpatient/procedural staff will place an allergy armband if a patient is latex-allergic and requiring a procedure, or when medications or radiopharmaceuticals are administered during the visit.
New Product: Go Live 8/1/16
What else do I need to know?
New bands will be stocked on unit par. When necessary, clinicians will refer to paper Ticket to Ride to review allergies during transport. In the event of an electronic health record downtime, downtime documents are inclusive of patient allergy information.
Please review policy COP-020 (Go-Live 8/1) for more information. For questions, contact Kara Stevens at kstevens1@umm.edu