News & Views

news views Fall 2012

A Publication of the Department of Nursing and Patient Care Services

University of Maryland Medical Center

UMMC Falls Prevention Program: Changing Our Culture One Staff Member at a Time Jennifer Motley, BSN, RN, Senior Clinical Nurse I, Multitrauma IMC, R Adams Cowley Shock Trauma Center, and Chair, UMMC Falls Committee Kate Keefer, BSN, RN, Senior Clinical Nurse I, 13 East/West, Departments of Medicine and Surgery, and Co-Chair, UMMC Falls Committee Luiza Lima, MS, RN-BC, Professional Development Coordinator, Clinical Practice and Professional Development, UMMC Falls Committee Facilitator

The University of Maryland Medical Center (UMMC) is fully committed to reducing the incidence of patients suffering falls while in our care. It is a key component of patient safety. While falls are not consistently a challenge in every patient care area, the Medical Center in FY 2012 incurred a total of 418 falls, of which 102 resulted in injury. Consequently, fall prevention at UMMC has been targeted as a hospital-wide process improvement initiative, and planning is in progress to extend this program to all hospitals within the University of Maryland Medical System (UMMS).

The Medical-Surgical Progressive Care Unit on Gudelsky 5 East has been successful in reducing their fall rate. Armed with enthusiasm, empowerment, and diligence, the staff of this unit developed and implemented a falls-prevention bundle. This project incorporated the multidisciplinary team and forged a strong partnership to prevent falls and dramatically decrease fall rates.

The accomplishments and successful strategies of Gudelsky 5 East were the impetus for the UMMC Falls Committee to coordinate and implement a hospital-wide falls prevention bundle. This initiative, the Falls Prevention Program, is focused on decreasing the number of UMMC falls by engaging clinical and non-clinical staff, patients, and visitors. The program objectives are to: ◗◗ Standardize the approach to falls prevention at the unit level; ◗◗ Enhance knowledge of contributing factors and prevention measures related to falls; ◗◗ Cultivate a sense of pride and ownership in falls prevention; and ◗◗ Achieve excellence in patient satisfaction scores for staff responsiveness to call lights.

The first phase of the UMMC Falls Prevention Program required that every unit designate a “falls champion” to be in charge of the program execution in his or her clinical area. With the support of

senior leadership, directors of nursing, nurse managers, and the UMMC Falls Committee, the second phase involved educating falls champions about program details, expected outcomes, and role responsibilities. The UMMC Falls Committee offered a total of 16 drop-in education sessions over four weeks.

Falls champions will facilitate the implementation of the falls prevention program, and they will monitor compliance with the critical components of the program. The full implementation of the program relies on falls champions and unit-level leadership. The complete implementation of the falls prevention program in all patient care areas, with the exception of pediatric units, is targeted for autumn of 2012.

Each unit champion received a falls tracking board with tools for posting, clinical and non-clinical self-learning modules, templates of daily and post-fall huddles, and a guide to standardized post-fall management. Every staff member will sign a commitment to prevent falls upon completion of the self-learning module.

Call Don’t Fall

continued on page 4.

Lisa Rowen’s Rounds: Magnet Conference 2012 Last month, many Medical Center nurses and I had the privilege of attending the American Nurse Credentialing Center’s (ANCC) National Magnet Conference. The conference theme was “Reaching for the Stars” and over 7,000 nurses from across the country as well as many other countries traveled to Los Angeles to share evidence-based practices with each other. Conference attendees were nurses and others in a variety of roles who are interested in the ongoing improvement of their institution’s nursing care and outcomes, want to learn more about Magnet, and have been selected to showcase best nursing practices for the Magnet community.

We were proud to have three live posters, one virtual poster and one concurrent session accepted for presentation.

Lisa Rowen, DNSc, RN, FAAN Read on for descriptions of the posters, reflections from conference attendees, and the abstracts accepted by the ANCC. Senior Vice President and Chief Nursing Officer, Nursing and Patient Care Services

continued on page 8.

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Fall 2012

In This Issue 1

UMMC Falls Prevention Program

1

Lisa Rowen’s Rounds

2

Corporate Compliance

3

Transitional Care Coordination

5

Falls Prevention on 11 East

6

Announcement of New Dean

7

Nursing Satisfaction Survey Results

11 Core Measures 12 The Role of the Nurse Midwife 13 Certification Corner 13 Honorable Mention 18 We Discover 18 New Wound Management Assessment Tool 20 Clinical Practice Update

Corporate Compliance Christine Bachrach, UMMS Vice President and Chief Compliance Officer, and Toya Jackson, UMMC Compliance Manager

Compliance FAQ

The Medical Center Compliance Program provides this Frequently Asked Question (FAQ) section for each issue. The goal is to reach out to UMMC employees and raise awareness of compliance topics. If you would like additional information or would like to suggest content for future issues, please send your comments to compliance@umm.edu or tjackson4@umm.edu.

It is important to remember that you may not make any comments regarding the patient’s care, including the fact that you know the person because they were a patient at UMMC. The patient may share this information with others, but you cannot.

A: You are not required to accept this request as a Medical Center employee. When engaging in social networking activities on the Internet, employees must comply with all applicable Medical Center policies and procedures, including—but not limited to —the Terms and Condition of Participation, Code of Ethics, Social Networking/Social Media (HRM-504), Behavioral Standards (HRM 505), Workplace Language (HRM516), as well as all policies and procedures concerning confidentiality, release of patient information, computer, e-mail and Internet use, compliance, and use of photographs and video.

Q: A patient whom I took care of last week sent me a friend request in Facebook. Should I accept the patient’s friend request?

Find News&Views online at http://www.umm.edu/nursing/newsletter.htm and on the UMM Intranet at intra.umm.edu/ummc/nursing-dept/newsviews.htm

Editor

Anne E. Naunton, MS, RN-BC Professional Development Coordinator Clinical Practice and Professional Development Editorial Board

Susan S. Carey, MS Professional Development Coordinator Clinical Practice and Professional Development Mary Ellen Connolly, MS, CPNP Pediatrics Suzanne Leiter Executive Assistant to the Senior Vice President and Chief Nursing Officer, Nursing and Patient Care Services Greg Raymond, MS, MBA, RN Director, Nursing and Patient Care Services Lisa Rowen, DNSc, RN, FAAN Senior Vice President and Chief Nursing Officer, Nursing and Patient Care Services Mihae Shin-Diep, MS, CRNP Interventional Radiology Angela Sintes Tyrrell, MS, RN, CNL Clinical Education Specialist Clinical Practice and Professional Development

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.

Submission Guidelines

Send completed articles via e-mail to anaunton@umm.edu.

Please follow the guidelines provided below.

1. Font – Times New Roman – 12 pt. black only.

2. Length – Maximum three double spaced typed pages.

3. Include name, position title, credentials, and practice area for all writers and anyone named in the article.

4. Authors must proofread the article for spelling, grammar, and punctuation before submitting.

5. Provide photos and embedded images in separate .jpg files.

6. Submit trend data in graphic format with labeled axes.

7. References must be numbered consecutively and provided at the end of the article.

8. Editor will seek expert review of articles to verify and validate content.

9. Articles will be accepted based on appropriateness of content and availability of space in each issue.

10. Articles that do not meet the above guidelines will be returned to the author(s) for revision and resubmission.

ISSUE Fall 2012 Winter 2013 Spring 2013 Summer 2013

DUE DATE October 1, 2012 January 7, 2013 April 1, 2013 May 22, 3013

Displaying Credentials

The UMMC Standard for displaying of credentials is based on the ANCC Guidelines.

The preferred order is: • highest earned degree (can list more than one if in different fields) • licensure • state designations or requirements • national certifications and honors • other recognitions Nurses with two or more nursing degrees (MSN, BSN) should only list their highest nursing degree, along with other degrees obtained. Example: Betty Smith, MSN, MBA, RN. Why this order: The education degree comes first because it is a “permanent” credential, meaning it cannot be taken away except under extreme circumstances. The next two credentials (licensure and state designations/requirements) are required for you to practice. National certification is sometimes voluntary. Awards, honors, and other recognitions are always voluntary.

If you would like additional information, please visit http://www.nursecredentialing.com and search using the word “credentials”.

news &views

3

Transitional Care Coordination Improves Patient Experiences Jennifer Togioka, MS, RN, Program Manager, Care Coordination, Ambulatory Services, UMMC, and Paul Sacamano, BSN, RN, ACRN, Student Intern, Johns Hopkins University School of Nursing

In November 2011, with the support of the Health Services Cost Review Commission (HSCRC), Ambulatory Services initiated the Transitional Care Coordination (TCC) program to facilitate improved health outcomes by focusing on efficient, safe, and high-quality patient experiences.

The TCC program consists of a multi-disciplinary team that includes: Anne Connor, BSN, RN, CCM, Nurse Care Coordinator; Sara Eltaki, PharmD, BCPS, Clinical Pharmacy Specialist; Sharon Eiler, BSW, RN, EMT-B, Nurse Care Coordinator; Teresa Fleming, BS, CPhT, TCC Program Assistant; and Jennifer Togioka, MS, RN, Program Manager, Care Coordination. The team coordinates care for targeted hospitalized patients who are at risk for hospital readmission.

Avoidable hospital readmissions that are an inefficient use of health care resources, cost Maryland an estimated $656 million per year, and are non-reimbursable under health care reform. It is estimated that UMMC has 2,200 readmissions per year.

The TCC team provides interventions aimed at addressing patient-related and health care-system barriers during the first 30 to 45 days post discharge. TCC interventions include: ◗◗ Reconciliation of inpatient and outpatient medications; ◗◗ Follow-up telephone calls within 72 hours after discharge; ◗◗ Communication of discharge information to primary care providers and specialists within 72 hours of discharge; ◗◗ Accompanying patients to follow-up appointments within seven days of discharge; ◗◗ Referral to community resources for disease management, transportation, nutrition, counseling, and other services; ◗◗ Education regarding “red flag” symptoms that indicate the need to contact a health care provider; ◗◗ Education regarding medication administration; ◗◗ Provision of bus tokens or cab fare for health care visits; and ◗◗ Continued phone support through the critical 30- to 45-day post-discharge period to address patient concerns that could negatively impact self-care success.

A telephone survey was used to evaluate the patient experience upon completion of the program. The results of the survey are presented in Table 1. Although the effectiveness of medication education received a positive score, we have identified opportunities for improvement with other responses.

As the program continues to evolve, future efforts will focus on shortening the time between discharge and the first follow-up appointment and improving patient attendance to appointments.

Additionally, the program is identifying and developing expansion opportunities to include an early emergency department intervention program and partnerships with federally qualified health centers to ensure access to primary care services. Since the primary program goal is to prevent avoidable readmissions, we are conducting a statistical analysis to compare program participants to the general hospital population.

The TCC team provides valuable interventions to reduce readmissions, improve patient outcomes, enhance self-efficacy in illness management, and reduce health care costs through transitional care coordination. The program continues to evaluate post-discharge outcomes and patient satisfaction to promote enhanced continuity of care after hospitalization.

Table 1

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Fall 2012

Falls Prevention Program, continued from page 1.

Multidisciplinary team accountability, including the non-clinical staff, is the cornerstone of the falls prevention program. This results in the incorporation of falls prevention into daily practice and communication, promotes the concept of all individuals on the team taking ownership of the goal to reduce falls, and the support for hourly caring rounds.

Accountability means that falls prevention is everyone’s responsibility and is vital to reducing the number of patient falls.

UMMC’s success in decreasing falls will be achievable by disseminating best practices from our staff, incorporating falls prevention into our daily culture, instilling a sense of pride and ownership in all members of our health care team, and increasing communication about patient safety. “Call Don’t Fall” will be

Call Don’t Fall

synonymous with a significant reduction in falls at UMMC. We look forward to partnering with other UMMS hospitals to share our strategies.

A link for the UMMC Falls Prevention Program information is located on the UMM intranet Nursing page at http://intra.umm. edu/ummc/nursing/falls-prevention-program.htm. The UMMC Falls Committee, Gudelsky 5 East staff, and the Office of Clinical Practice & Professional Development are available to provide support during implementation. If additional information is required, please contact Jennifer Motley, jmotley@umm.edu; Kate Keefer, kkeefer@umm.edu; or Luiza Lima, llima@umm.edu.

UMMC Falls Prevention Program Components

Daily Huddles ◗◗ Conducted in the morning, in the afternoon, and at night ◗◗ Discussions that address individualized patient care, including fall risk, fall prevention interventions, pressure ulcers, unit outcome data, and other topics relevant to the patient population Post-Fall Huddle ◗◗ A multidisciplinary, focused discussion to analyze the context of a fall, contributing factors, status of the patient, lessons learned, and changes to the plan of care Hourly Caring Rounds and Bedside Shift Report ◗◗ Falls prevention discussions are incorporated into these two methods of communication to reinforce awareness and provide consistency in approach to falls reduction Clinical and Non-Clinical Staff Education Learning Cascade ◗◗ Reviews impact of falls and expectations of team members for falls prevention ◗◗ Unit champions educate nurse managers, senior clinical nurses, charge nurses, and direct care nurses, and they, in turn, educate others Partnering with Patients, Families, and Visitors ◗◗ Through open communication, timely response to call lights, hourly caring rounds, bedside report, falls prevention on-demand video, and educational handouts ◗◗ Emphasis on “Call Don’t Fall” as the program objective Falls Tracking Board ◗◗ Displays the unit’s fall information in one consistent location to promote awareness ◗◗ Includes a calendar marking the day when a fall occurred ◗◗ Displays the number of days without a fall, the unit’s fall data, interventions and goals, what to do in an event of a fall, and a completed post-fall huddle form ◗◗ Highlights “the number of days without a fall” to motivate staff

Falls toolkit

news &views Implementation of Falls Prevention Program on 11 East Lucy Miner, BSN, RN, PCCN, Senior Clinical Nurse II, Division of Medicine and Surgery

The staff of 11 East, an acute care medical unit at the Medical Center, is taking a new approach to reducing falls. This 19-bed unit primarily serves a patient population with infectious disease, as well as other acute medical conditions. Over the last few years, the staff on 11 East has struggled with the unit’s increasing fall rate, which has been well above the National Database of Nursing Quality Indicators (NDNQI) benchmark. Other acute care units at UMMC face the same challenge. Motivated by UMMC’s primary focus on patient safety, 11 East began the implementation of an extremely successful falls-prevention initiative.

This program was adapted from the falls bundle that was developed by the Medical Surgical PCU, Gudelsky 5 East. The bundle was created by the nursing staff and has been responsible for a cultural change and a substantial reduction in falls. As a consequence of the effectiveness of this initiative, the University of Maryland Medical System has embraced this strategy for a system-wide prevention program.

The core concept is that everyone takes responsibility for preventing falls. The bundle focuses on the promotion of ownership with all hospital staff, both clinical and non-clinical. There is an education component for patients and families. The staff huddles three times a day to boost awareness of patients at high risk for falling. Discussions about falls prevention occur repeatedly so that falls are in the forefront of everyone’s mind. An easily accessible “falls board” is in place on the unit to display the date of the last fall, unit data, information from the falls group, post-fall huddle audits, and the names of the falls champions. The bundle is all inclusive and targets falls from every angle, from prevention to post-fall huddle debriefing.

Falls tracking board GOALS & EXPECTED OUTCOMES

FALLS TRACKING POSTER DAYS WITHOUT A FALL OUR COMMITMENT TO PATIENT SAFETY

MONTH: Mon

Tue

Wed

Thu

Fri

Sat

Sun

THROUGH: _____________________________

DON’T BREAK THE STREAK! ACTION PLAN & INTERVENTIONS

FALLS NEWS, UPDATES & DATA IN THE EVENT OF A FALL

POST‐FALL HUDDLE

FALLS COMMITTEE MEMBERS

Call Don’t Fall

Nurse Manager Shawn Hendricks, MSN, RN, and Lucy Miner, BSN, RN, PCCN, Senior Clinical Nurse II, provided the leadership for 11 East to jumpstart the falls prevention program on the unit. Recruiting interested staff for this initiative was easy, as 11 East had recently combined two of their committees to tackle the falls problem. By combining the two committees, more falls champions were identified to capture all shifts and represent the staff.

The 11 East champions include: Reddouane Ammar, BSN, RN, CNI; Alexis Andino, Student Nurse; Grace Cerbo, BSN, RN, SCNI, Discharge Facilitator; Debbie Galloway, BSN, RN, CNII; Latisha Jones, BSN, RN, SCNI; Ursula Jones, PCT; Naomi Nicdao, BSN, RN, SCNI; Francis Oduah, BSN, RN, CNII; Ramiro Racey, BSN, RN, CNII; and Metzel Tropia, BSN, RN, CNII. The program implementation started with education. Falls champions and senior clinical staff introduced the self-teaching modules to staff during the recent competency marathon. Staff were asked to sign a commitment form to acknowledge understanding of the program and the willingness to take ownership in preventing falls on the unit. An educational board and a prototype of the falls board were placed in the break room as a reference for the staff. The senior clinical staff and charge nurses have been incorporating fall risks and falls prevention discussions into routine and change-of-shift huddles.

Staff education will continue on a regular basis. Champions have identifed creative ways to boost awareness. For example, Ramiro Racey suggested having a “bed-alarm reminder” period each day when one person would make an overhead unit announcement to remind staff to check their bed alarms. Audits to compare falls documentation to interventions in place have begun. Post-fall huddles have also been initiated. This has been a great way to encourage everyone to take ownership of each fall on their unit.

The post-fall huddle provides an excellent opportunity for learning and allows the unit to see what they can do differently to prevent a future fall. A great example of the post-fall huddle being instrumental in preventing future falls occurred on 11 East’s sister unit, 10 East. A post-fall huddle revealed that several bed alarms were not functioning properly. This led to both units implementing a routine bed-alarm check on each bed, every day.

Next steps for a complete falls prevention program rollout are in place. The falls champions will meet in the near future to discuss unitspecific action plans and interventions, as well as to plan an official kick-off. The implementation of the program pilot on 11 East allows an insight on successes and barriers that may be encountered with the rollout across the organization and the system. There is a noticeable change in staff awareness of fall prevention, and 11 East is well on its way to zero falls.

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6

Fall 2012

Jane M. Kirschling, PhD, RN, FAAN

October 11, 2012 Dear Colleagues:

It is with great pleasure that I write today to announce that Jane M. Kirschling, PhD, RN, FAAN, dean of the University of Kentucky College of Nursing and president of the American Association of Colleges of Nursing, has been appointed dean of the University of Maryland School of Nursing, effective Jan. 14, 2013. Dr. Kirschling replaces Janet D. Allan, PhD, RN, FAAN, who will retire on Dec. 31, 2012, after 10 years as dean of the School of Nursing.

I would like to express my deepest gratitude to Dr. Allan for her dedication and commitment as she led the University of Maryland School of Nursing – one of the nation’s oldest and largest nursing schools – to its current ranking of 11th by U.S. News & World Report and 19th in National Institutes of Health funding.

In her new role, Dr. Kirschling will take the School of Nursing to the next level. I expect her to further strengthen our nursing programs at the Universities at Shady Grove, and to further develop the School’s research enterprise, particularly as it relates to the national focus on health reform. Dr. Kirschling also will lead the School’s transition of its advanced practice program from the current master’s in science to a doctorate in nursing practice.

Dr. Kirschling has served as dean and professor at the University of Kentucky College of Nursing since 2006. Previously she held administrative and faculty positions at the University of Southern Maine (dean and professor, College of Nursing and Health Professions), University of Rochester (associate dean for academic affairs and professor, School of Nursing), and Oregon Health & Science University (associate dean for graduate studies and professor).

She received her BSN from Viterbo College in LaCrosse, Wis., and her MSN and PhD from Indiana University School of Nursing. She is an alumna of the Robert Wood Johnson Foundation Nurse Executive Fellows Program (2000-2003) and was inducted as a fellow in the American Academy of Nursing in 2009.

At the University of Kentucky, Dr. Kirschling oversees a robust clinical research enterprise. She initiated a program that sustained support for senior investigators while investing in the development of junior scientists with time for research and significant startup support for pilot work. She also led the redesign of the college’s research infrastructure support to enhance investigators’ ability to focus on their science in writing grants.

Dr. Kirschling’s clinical expertise is in mental health nursing with a focus on end-of-life care. For more than a decade, Dr. Kirschling’s scholarship has focused on workforce development with a special emphasis on rural states. Earlier in her career her scholarship focused on family caregivers for persons with a terminal illness and grief following the loss of a family member. She founded the Kentucky Nursing Capacity Consortium and co-convenes Kentucky’s Action Coalition, which is working to implement the Institute of Medicine’s 2010 recommendations on the “Future of Nursing.” Dr. Kirschling serves on the University of Kentucky’s Center for Interprofessional HealthCare Education, Research and Practice Board of Directors. I expect Dr. Kirschling to bring her expertise on statewide and rural issues to effect change here in Maryland.

At the national level, Dr. Kirschling has been active in the Hospice and Palliative Nurses Association, serving as president of the Board of Directors in 2002 and 2003. She also has been an active member of Sigma Theta Tau International – The Honor Society of Nursing. She co-chaired the International Advisory Council of Chief Nursing Officers and Deans (2007-2009).

In addition, Dr. Kirschling has served on the American Association of Colleges of Nursing (AACN) Board of Directors since 2004 and began a two-year term as president in 2012. From 2006 to 2010, she served as the AACN’s representative to the American Nurses Association Congress on Nursing Practice. She represented the AACN on the expert panel that developed Core Competencies for Interprofessional Collaborative Practice, sponsored by the Interprofessional Education Collaborative, released in May 2011.

Dr. Kirschling also will serve as University director of interprofessional education (IPE) for the University of Maryland, Baltimore. Working with the president’s IPE Task Force, she will lead the implementation of IPE recommendations that are emerging from the University’s strategic planning implementation group.

Please join me in welcoming Dr. Kirschling to the University of Maryland, Baltimore.

Sincerely yours, Jay A. Perman, MD President Reprinted with permission from Jay A. Perman, MD

news &views

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Nursing Satisfaction Survey Results Kristin L. Seidl, PhD, RN, Director of Nursing Outcomes, Research, and Evidence-Based Practice

Overview In May 2012, all direct care nurses at UMMC were invited to participate in a nurse satisfaction survey conducted by the National Database of Nursing Quality Indicators (NDNQI). This is the fifth year that UMMC has participated in the NDNQI survey, and 75% of direct care nurses completed it. The 116-item survey measures nurse satisfaction by using three different scales: the NDNQI-Adapted Index of Work Satisfaction, the NDNQI-Adapted Nursing Work Index, and the Job Enjoyment scale.

The Adapted Index of Work Satisfaction consists of seven subscales that measure perceptions and opinions about tasks, nurse-nurse interactions, nurse-physician interactions, decision-making, autonomy, professional status and pay. The Adapted Nursing Work Index has three subscales that measure perceptions and opinions about professional development, nurse management, and the chief nursing officer. The Job Enjoyment scale measures how much nurses enjoy their jobs. Together, these 11 scales and sub-scales provide UMMC leaders with a valid and reliable measure of how satisfied UMMC nurses are with various aspects of their jobs.

2012 NDNQI RN Survey: (2.3) Index of Work Satisfaction

Data Description All survey data is measured at the unit level, meaning that the scales are intended to measure the satisfaction of a particular nursing unit, not the satisfaction of an individual nurse. All data is reported as a T-Score. A T-Score is a normalized score where a score of 50 represents the mean, or average. Therefore, a score is considered average if it falls between 40 and 60. Scores below 40 are considered less favorable, and scores above 60 are considered very favorable.

Although the range of possible scores goes from 0 to 100, a T-score is NOT a percentage. If you get confused—just remember that higher scores are always better!

NDNQI also provides us with benchmark data. “Benchmark” is a term that describes a target for performance, or a score to achieve.

Benchmarking allows for comparisons between groups and can help identify strengths and successes, as well as opportunities for improvement. Unlike the T-scores, the benchmark data provided by NDNQI is based on percentile ranks, and allows us to compare the satisfaction scores of nurses at UMMC to the satisfaction scores of nurses from academic hospitals across the country. UMMC’s goal is to score above the 50th percentile on all subscales at a minimum, and to strive for the 75th and 90th percentile.

Results Overall, our 2012 survey results were good. When the results of each unit are compiled together, our satisfaction levels are at or above the 50th percentile on 9 of 11 measures, and above the 75th percentile on one scale: satisfaction with our Chief Nursing Officer, Lisa Rowen.

Conclusion What does all this mean? Overall, it means that compared to nurses in other academic medical centers around the country, nurses who work at UMMC are as satisfied or more satisfied with their job than most.

These results are a reflection of UMMC’s commitment to nurses and to the nursing profession. You might remember that nurse satisfaction is considered a “Nurse-Sensitive Quality Indicator,” which means

2012 NDNQI RN Survey: (2.2) Job Enjoyment & (2.4) Nursing Work Index

that nurse satisfaction is one component of the quality of nursing care. These results will be included in our Magnet® re-designation application and will showcase that excellence is truly a description of nursing at UMMC! Next Steps By this time, you will most likely have reviewed your unit’s data with your manager. When you are reviewing your results, you will also see that your unit’s data is compared to two benchmarks: other “like” units within UMMC and other “like” units in academic medical centers across the country. For example, nurse satisfaction on a specific ICU at UMMC will be compared to nurse satisfaction on all UMMC ICUs and to nurse satisfaction in the ICUs of academic medical centers around the country. Nurses are encouraged to work with their co-workers and managers to identify targets for improvement over the next year.

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Fall 2012

Rounds: Magnet Conference, continued from page 1.

Live Posters 1. Carol Armstrong, BSN, RN, CPN, CDE, and Catherine DiBlasi, RD, RN, CDE; Improving the Effectiveness of Diabetes Care Visits Through Computer-Assisted Analysis of Blood Glucose Readings

Figure 1 illustrates the Magnet Model and how its five elements of transformational leadership; structural empowerment; exemplary professional practice; new knowledge, innovation and improvements; and empirical quality results relate to each other and to global issues in nursing and health care. (http://www.nursecredentialing.org/magnet/ programoverview/new-magnet-model) As in the past, the autumn Rounding Report is a compilation of insight and reflections from the Medical Center staff members who attended the Magnet Conference. As you read on, consider the 5 Model Components and how they factor into what your colleagues learned or noted.

Figure 1

2. Lisa Rowen, DNSc, RN, FAAN; Kristin Seidl, PhD, RN; Christina Cafeo, MSN, RN; Greg Raymond, MS, MBA, RN, and Rachel Hercenberg, BA; Can a Brief Intervention Increase Awareness of Disruptive Behavior in the Workplace?

3. Paul Thurman, MS, RN, ACNPC, CCNS, CCRN, and Rebecca Gilmore, RN; other authors include: Tonya Bane, BSN, RN; Karen McQuillan, MS, RN, CCRN, NCS-BC, FAAN; Beth Pruitt, BSN, RN; Kathryn Von Rueden, MS, RN, ACNS-BC, FCCM; Impact of Nursing Council Participation in the Reduction of CLABSI Virtual Poster Deborah Schofield, DNP, CRNP, and Carmel McComiskey, DNP, CRNP; The NP Critical Care Trauma Postgraduate Residency: An Innovation to Improve Novice Transition to Practice Live Concurrent Session Kathryn Von Rueden, MS, RN, ACNS-BC, FCCM and Tiffany Blacklock, MS, RN, CRNP presented; other contributors were: Karen McQuillan, MS, RN, CCRN, NCS-BC, FAAN; Paul Thurman, MS, RN, ACNPC, CCNS, CCRN; Breighana Wallizer, BSN, RN, CCRN; and Jennifer Merenda, MS, RN; Delirium in Trauma Patients: NurseDriven Research and Evidence-Based Guideline Development

In this issue of News & Views, we have included the abstracts submitted to the ANCC that were accepted. I encourage you to read these abstracts and consider your own work and that of your team for submission to the next Magnet Conference. We sometimes do not stop to consider the great work and outcomes we accomplish at the Medical Center that should be disseminated on a larger, national scale. We saw and heard about many innovations and practices at the conference we have already implemented or are in the process of implementing.

The Magnet Conference, like its Recognition Program, advances three goals within health care organizations that: ◗◗ Promote quality in a setting that supports professional practice ◗◗ Identify excellence in the delivery of nursing services to patients ◗◗ Disseminate best practices in nursing services (http://www.nursecredentialing.org/MagnetModel.aspx)

I found the opening General Session to be particularly meaningful. Stephen M. R. Covey, author of The Speed of Trust, discussed the concept of trust and how it has become the most critical leadership competency of the new global economy. He made a convincing case that trust is a measurable accelerator to performance and that when trust increases, the speed of transactions also increases while cost decreases, thus producing a “trust dividend.” Noting that the nursing profession has been voted the most trusted profession every year for the past decade, Covey discussed the human qualities nurses demonstrate and how these translate into public trust. He also identified behaviors common to nurses as well as high-trust leaders throughout the world and how each of us can sincerely and persuasively exhibit actions—such as to demonstrate respect, create transparency, practice accountability, listen first, keep commitments and extend trust—that enable us to shift behavior to increase and inspire trust in our work and lives. Covey’s point is that learning how to expand our own credibility enhances our influence every day.

Covey asked us to think about our relationships at work. Whom do we trust the least and what is it like to work with those individuals?

Whom do we trust the most and what is it like to work with those individuals? What are the differences in these two scenarios? Why is it so much easier to accomplish more with people we trust? These are important questions we should consider and discuss on a local level because as trust increases, the speed of what we can accomplish is increased and the cost is reduced, and trust-building becomes a worthwhile investment of energy—as well as the right thing to do.

Please read on as our colleagues share their insights. continued on page 9.

The ANCC’s vision is that Magnet-recognized organizations will serve as the source of knowledge and expertise for the global delivery of nursing care. They expect nursing care in these organizations will be solidly grounded in core Magnet principles, remaining flexible but constantly striving for discovery and innovation and able to lead the reformation of health care.

news &views Rounds: Magnet Conference, Attendee Reflections continued from page 8.

Reflections from:

Kathryn T. Von Rueden, MS, RN, ACNS-BC, FCCM Clinical Nurse Specialist R Adams Cowley Shock Trauma Center

I attended nearly every session related to clinical research and was most inspired by the outside-the-box, creative ideas shared by all of the speakers. Not surprisingly, a consistent theme that applies to us at UMMC is: “Research is not most nurses’ life work.” Caring for patients/ families and achieving good outcomes is. So, let us tie these together.

Direct care nurses have great ideas and clinical questions. I have pages of notes of novel strategies related to how hospitals move forward and prioritize these ideas, and help nurses to take the lead in not just research, but implementing data driven PI and EBP initiatives. Another theme was “true collaboration” with other disciplines and nursing school faculty; linking other clinical experts (eg PharmD, RT, PT) faculty, PhD, and DNP student projects with staff nurses’ clinical questions. In addition, we are an organization with a huge amount of data, so how can we better capitalize on this? One suggestion as a source of clinical questions and improvement opportunities, and outcomes that we might consider is to create a “data catalogue” of what data are available and who owns them. Related to using currently available data, others focused on nurse sensitive quality indicator data to prioritize research, EBP and PI programs. Conversely, another speaker discussed idea generation at the unit level, brainstorming, no wrong ideas, and having staff identify their clinical questions and prioritize them. Sources of funding were a big topic too. Novel approaches involved talking about nursing research projects to community groups and hospital foundation members or contributors. These are just a few examples of the many different approaches to clinical nursing research, none of them wrong, and many we could explore at UMMC.

Reflections from:

Cathy DiBlasi, RD, RN, CDE Nurse Manager Center for Diabetes and Endocrinology

The 2012 Magnet conference was a wonderful experience that gave me the chance to see the work and accomplishments of nursing around the world, and recharge my commitment and passion for quality care. The poster sessions were a favorite. It was amazing to stand in conversation with nurses from Thailand, who showed great interest in our poster and the work of the UM Center for Diabetes! The poster sessions also allowed me to spend time with other nurses who had identified and implemented best practices on relationship-based care and transitional care planning. How great is that to get national-level help on two of our 2013 ambulatory division strategic goals! These nurses generously offered their time, ideas, and encouragement on our project plans.

Even though we were thousands of miles from UMMC, I felt very much at home at this conference because I realized that, like UMMC, Magnet is on a mission—to create a workforce of capable and committed individuals who provide the best and safest care in the world.

Reflections from:

Visitacion “Bing” Casal, BSN, RN Senior Clinical Nurse I Gudelsky 5 East

I gained new insights, met new people and learned new things. I felt so honored and privileged to be chosen as one of the 20 staff out of this big institution to represent UMMC nurses at this conference. Mr. Covey, who talked about trust, was a powerful speaker. He described trust as the number one competency of a leader needed in healthcare today, and that trust is a learnable competency. It made me think about how I often doubt myself. The personal experience shared by the couple from the Daisy Foundation made me teary-eyed. It made me ponder on how nurses impact one’s life and being a nurse we tend to think that we are just doing what is expected of us; and I’m no exception to that, not realizing that in the eyes of other people, nurses are heroes. Truly, that was the most inspiring part for me. It made me realize that the tiniest thing that we do as nurses could mean a lot to a sick patient and a distressed family member.

That’s the real essence of nursing, to care for that patient.

Based on the sessions I attended, we are ahead in terms of our purposeful hourly rounding process. During the Q & A portion of this session, some hospitals are still struggling with the implementation of this initiative. I am also proud to say that we have an excellent presenter in the person of Ms. Kathryn Von Rueden. She was very well versed on the topic of delirium and presented interesting facts and delivered the content fluently, with enthusiasm and confidence.

I attended a session on “Spirituality in the Workplace Increases Job Enjoyment.” I think that having this program in our institution would benefit the nurses and, in turn, the patients. This is conducted in a Catholic institution, but I guess we can implement something similar to this. It is a way for a nurse to regroup during a busy shift and spend as little as five minutes just to focus on oneself and be recharged. Based on experience, nurses always care for other people and seldom care for themselves.

Reflections from:

Carole Malinowski, BSN, RN, CPN Senior Clinical Nurse I General Pediatrics

My Magnet experience was wonderful!!! I learned many new things and met many new fellow UMMC co-workers. Since I am interested in staff recognition, mentorship, and leadership, I centered my sessions around those areas. Many times when I was sitting in a session I would say to myself “we do that on my unit.” I felt as if we were living the Magnet Life! For example, the one session on unit councils made me realize that our unit council is definitely promoting future leaders under the guidance of senior staff. As far as having a healthy work environment, I felt that the session supported some of the things that we do on our unit to make each day rewarding. Since I am a pediatric nurse, I found the exhibits unique and interesting. There are so many products and services available to consumers that I never imagined. I was also very proud that our hospital was represented by several posters.

I was very honored and humbled that I was asked to attend the conference. I have shared with my co-workers that if they ever get the opportunity to attend a Magnet Conference that it would be very continued on page 10. rewarding.

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Rounds: Magnet Conference, Attendee Reflections continued from page 9.

Reflections from:

Rebecca Gilmore, RN Clinical Nurse II TRU, R Adams Cowley Shock Trauma Center

The opening session on trust made me think about how I act in my role as charge nurse on the unit, and also to consider ways in which I may be able to foster a more trusting relationship between staff, as well as making myself more trustworthy. I attended a lecture on Transformational Leadership in which I learned different ways of approaching staff in my role as a charge nurse in order to ascertain better how I am able to provide help and support in different situations.

I attended a lecture on civility in the workplace in which I gained insight into how to defuse situations and help staff work together to improve interpersonal relationships.

On my first day back to work post conference, I was very enthusiastic to put some of my newfound techniques into practice.

Some of these worked better than others, some opened up areas for discussion, and some made me realize that I work in a very unique area where the staff have a somewhat different relationship with one another than in most “usual” units within the hospital.

I would also like to say that I was very impressed by Kathryn Von Rueden’s presentation on delirium. I realize that I am probably slightly biased, but I felt that her delivery was second to none. She has the ability to engage the audience and hold the attention throughout the presentation, something that was lacking in a few of the sessions.

I feel proud to be part of such a diversified, talented, and committed group of health care professionals.

Reflections from:

Jeremy Kirlew, BSN, RN Senior Clinical Nurse I Cardiac Cath Lab

This was my first Magnet conference. In fact, it was the first nursingfocused conference I have attended. All of my previous conferences were focused on cardiology, which is my specialty. I thought the theme of the conference “Nurses as Superstars” was inspiring. It was great to see so many institutions that value nurses and applied for the nursing Magnet recognition. To be honest, I was not aware that the nursing Magnet recognition had been around for so long.

Three specific presentations inspired me and they are interrelated. The first was the keynote address by Stephen Covey on trust. While the idea of trust is simple, he really highlighted how a lack of trust is so fiscally costly for society and an abundance of trust will improve our bottom line.

The second presentation that inspired me was the “Transforming Staff Leaders” by the staff at Shands Hospital in Gainesville, Fla. They described how they evolved from a top-down model of leadership to a more shared governance model by inspiring the staff to take charge of the problems and set goals to fix them. I found it refreshing from the nurse manager’s perspective how challenging it was for her to give up so much control, but how it ultimately freed up so much time for her.

Once she trusted her staff to make good decisions, her staff trusted her to support their decision making. She also acknowledged that she discovered that there was a mismatch between what the staff thought was important and what she thought was important. The staff’s issues were easy to fix and resulted in greater satisfaction scores by the staff.

One other standout for me was the presentation of how the ED team from Robert Packer Hospital in Pennsylvania used the Six Sigma process to improve some processes in the ED at that hospital.

From what I read about Six Sigma before, it seemed difficult to apply to health care, but the presenter deconstructed the process enough that I believe it can be applied in the processes of nursing. I am very interested in seeing if a similar system could be applied here at UMMC. It is hard to compare so many disparate institutions, but my sense is that with regard to nursing research, we are ahead of the pack because we have so much support from the top.

Reflections from:

Christine L. Byerly, BSN, RNC-NIC Senior Clinical Nurse II Neonatal Intensive Care Unit

There are so many great benefits to attending the Magnet conference —almost too many to name. First and foremost, it is an incredible honor to be asked to attend, knowing you are representing the University of Maryland Medical Center nurses, the finest and brightest around. There is a tremendous sense of pride, camaraderie and team spirit felt within the group. We were especially excited knowing that we would have four poster presentations sharing best practices and shining examples of excellence in care for our patients and one another. And, as you sit in the convention center at the opening session surrounded by over 7,000 nurses, you realize you are merely a micro-speck of something so much grander—an entire army of nurses all gathered together in the pursuit of providing the safest quality care and service excellence.

To be afforded the opportunity to hear Stephen Covey as the keynote speaker was quite a professional high. Mr. Covey spoke on the Speed of Trust. Trust, the one quality that is germane to every successful relationship, business, and partnership. It made me reflect on our own culture of trust. How do we develop trust with our patients and families?

How is trust extended in councils, meetings, and forums? Do we sustain trust? Do we do what we say we are going to do? Do we walk the walk?

I am in awe of the remarkable amount of trust that our patients and families extend to us as their caregiver. I thought of the trust we extend to each other as a care team working to coordinate services, as council members coming together for a shared vision, and as individuals. I was so inspired by the premise that increased trust leads to increased joy and energy (synergy) that I immediately bought the book. Thus far—a great read!

I also had the chance to hear two great concurrent sessions: one on civility and the other on shared governance (professional practice).

While I learned some new practices and had some thoughts for our organization, I also realized that we are already doing well in both of those areas and I would say we are leading the race. I feel strong in this conviction given the fact that we openly engage in civility conversations in the Staff Nurse Council and other venues, asking “What have we done to harm or almost harm each other?” The second current session on professional practice led to the conclusion that our governance structure is strong with great participation and decision-making abilities to prioritize, plan, and strategize to achieve outcomes.

The most rewarding part of going to the conference is that renewed sense of excitement…that feeling that we are excelling in our service, care, compassion, and teaching provided to our patients and families. And, the sense that we have formidable structures and processes in place to continue to strive for Living Excellence! continued on page 14.

news &views

Measure

The graph below shows our performance on the stroke measures for January—June 2012. For half of the measures (STK-1, STK-4, STK-8, and STK-10), we are performing better than average compared to other US hospitals reporting to The Joint Commission. For the remainder of the measures, we have an opportunity to improve our performance. At the Medical Center, a multidisciplinary stroke steering committee focuses on our areas of opportunity to ensure that our patients receive the highest quality of care.

UMMC

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100 80 60 40 20 0 ST

Since 2006, the Medical Center has participated in the Get With the Guidelines (GWTG) program for stroke patient care.

This program helps to ensure consistent

elements contained in the GWTG stroke patient management. The stroke core measures are: ◗◗ medications prescribed at discharge ◗◗ risk factors for stroke ◗◗ warning signs and symptoms of stroke

Stroke Core Measures

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The Medical Center will be required to collect and report data on stroke patients to the Maryland Healthcare Commission (MHCC), as will all other hospitals in Maryland, starting in January 2013. The MHCC is the health regulatory system that drives the quality of services provided in the state. Through this function, the commission determines the evidence-based performance metrics that must be collected, reported, and improved upon by Maryland hospitals. The stroke core measure set will allow the Medical Center to meet three specific regulatory requirements: 1. Reporting requirements for MHCC 2. Primary stroke center designation by Maryland Institute for Emergency Medical Services Systems (MIEMSS) 3. Primary stroke center designation by The Joint Commission

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Sylvia Daniels, BSN, RN, Manager, Regulatory Compliance and Outcomes

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The Newest Core Measure Set: Stroke

application of the most recent American Stroke Association (ASA) scientific guidelines for patient treatment. Participation in this program is a requirement to maintain the certification by MIEMSS as a primary stroke center in Maryland. The stroke measures are required by The Joint Commission to maintain primary stroke center certification.

The Medical Center has maintained this certification since 2004. Karen Yarbrough, MS, CRNP, Stroke Program Director, has facilitated the Medical Center’s participation in the MIEMSS and Joint Commission certification programs.

The stroke (STK) core measures were developed in collaboration with the American Heart Association (AHA), the ASA, and the Brain Attack Coalition (BAC). The development of the stroke core measures followed the specifications of the data

Performance Rate

Core Measures

Joint Commission Description

STK-1: Venous Thromboembolism (VTE) Prophylaxis

Ischemic and hemorrhagic stroke patients who received VTE prophylaxis or have documentation why VTE prophylaxis was not given the day of or the day after hospital admission.

STK-2: Discharged on Antithrombotic Therapy

Ischemic stroke patients prescribed antithrombotic therapy at hospital discharge.

STK-3: Anticoagulation Therapy for Atrial Fibrillation/Flutter

Ischemic stroke patients with atrial fibrillation/flutter who are prescribed anticoagulation therapy at hospital discharge.

STK-4: Thrombolytic Therapy

Acute ischemic stroke patients who arrive at this hospital within 2 hours of time last known well and for whom IV t-PA was initiated at this hospital within 3 hours of time last known well.

STK-5: Antithrombotic Therapy by End of Hospital Day 2

Ischemic stroke patients administered antithrombotic therapy by the end of hospital day 2.

STK-6: Discharged on Statin Medication

Ischemic stroke patients with LDL greater than or equal to 100 mg/dL, or LDL not measured, or who were on a lipid-lowering medication prior to hospital arrival are prescribed statin medication at hospital discharge.

STK-8: Stroke Education

Ischemic or hemorrhagic stroke patients or their caregivers who were given educational materials during the hospital stay addressing all of the following: ◗◗ activation of emergency medical system ◗◗ need for follow-up after discharge ◗◗ medications prescribed at discharge ◗◗ risk factors for stroke ◗◗ warning signs and symptoms of stroke

STK-10: Assessed for Rehabilitation

Ischemic or hemorrhagic stroke patients who were assessed for rehabilitation services.

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Answering Common Questions About the Role of the Nurse Midwife Jan M. Kriebs, MSN, CNM, FACNM, Assistant Professor and Chief, Midwifery Division, Department of Obstetrics, Gynecology, and Reproductive Sciences

“I didn’t know there were midwives here.”

“You’re a midwife? What do you do here?”

“I thought midwives only did home births!”

Even now, 16 years since certified nurse midwives began caring for patients and delivering babies at University of Maryland Medical Center (UMMC), some patients, visitors, and even staff are surprised to learn this fact. Nurse-midwives are educated with masters or doctoral degrees and must pass a national certifying examination before beginning practice. As part of the OB/GYN faculty practice group, midwives see patients in the clinical office setting for prenatal care or well-woman visits; attend births in the Labor and Delivery Unit; or help the next generation of obstetricians learn about normal pregnancy and birth, in both the classroom and clinical setting.

I always enjoy talking to people about our practice. Many people are surprised to find out what modern midwifery has to offer.

“Oh, I don’t need a midwife. I’m not having a baby.”

Many of our patients are not pregnant. In addition to the focus on care during pregnancy and birth, midwives provide health care that includes family planning, birth control, preconception care, and health screenings, such as Pap smears and infection checks.

Preconception visits offer women and couples a chance to discuss ways to have a healthy pregnancy, as well as meet one of the team members who will care for them. Women who are finished having children may still choose the midwives for their periodic visits.

“Why would I want to see a midwife anyway?”

Much of the care that midwives provide is similar to what physicians do. After all, listening to a baby’s heartbeat or performing a breast exam is straightforward. One difference is that because midwives are not surgeons, we do not see the most complex pregnancies. We focus our practice around helping women become healthy and stay healthy, while our physician colleagues focus on major obstetrical problems. In the OB/GYN department, physicians and midwives work together to develop a truly collaborative model of women’s health care.

At UMMC, one exciting collaborative opportunity has been the establishment of the Centering Program for group prenatal care in the clinic on Penn Street. With funding from Amerigroup and the March of Dimes, midwives, nurses, and other clinic staff members have been trained in this innovative model. In the Centering Program, a group of eight to 12 women with due dates in the same month have two-hour sessions at regular visit intervals. These sessions include both private

time for individual examinations and an extended “circle time” where they discuss a range of topics such as aches and pains, nutrition, the birth experience, and parenting. This sharing of the experience of pregnancy with other women at the same stage helps new mothers gain a fuller understanding of the many choices that are made in the process.

“I can’t see the midwife, because I want an epidural. Don’t you have to ‘go natural’ to see the midwife?”

As part of a collaborative practice in an academic medical center, we are able to provide midwifery care to women who want a natural labor and birth, as well as to those who will make the choice to have pain medication during labor and those who may have medical risks during pregnancy.

Our goal is for every woman to have a safe birth and the opportunity to make individual choices. After all, midwife means “with woman,” and that is where we choose to be.

POLICY CHANGE NON-PAPER ITEMS CONTAINING PATIENT INFORMATION Examples | Medication Packaging | Patient I.D. Bands

| Red Embossing Name Plates (Addressograph)

Discard in Clear Trash Bag

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Includes:

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• Packaging materials • Isolation gowns • General trash, food

• • • •

Clear Bag Waste Only Gloves Exam paper Personal hygiene items Diapers

Please contact Denise Choiniere via dchoiniere@umm.edu for additional information.

Find News&Views

online at http://www.umm.edu/nursing/newsletter.htm on the UMM Intranet at intra.umm.edu/ummc/nursing-dept/newsviews.htm

news &views Certification Corner Becoming a Critical Care Registered Nurse Melisha Spahr, RN, CCRN, Clinical Nurse II, Interventional Radiology

As a novice, I ventured out to become a dialysis nurse. During my first year of practice, I realized that I needed a stronger foundation of nursing skills for the population that I served. The patients whom I cared for deserved my best work and would benefit from the growth in my nursing knowledge and experience. Therefore, I made the decision to seek a position as a critical care nurse.

In the intensive care unit, I was like a sponge, eager to learn and proud to be a nurse. After two years of practice in this clinical area, the next logical step in my professional career was certification.

Many of my nursing colleagues considered critical care registered nurse (CCRN) certification, but they were intimidated about studying for a difficult

exam. The possibility of failure and financial loss was a deterrent to me at first, too. However, I went to work every day and constantly asked myself, “Why am I here?”

And then I answered myself: “I am here to provide the best care for all types of patients.” The patients expect the bedside nurse to be completely knowledgeable, and I felt like I owed it to my patients and myself to learn as much as I could.

I became a member of the American Association of Critical-Care Nurses (AACN), which has a vast amount of information on the CCRN specialty certification for nurses providing care for the acute and/or critically ill adult, pediatric, or neonatal populations. Nurses with this certification work in specialty areas such as intensive care units, cardiac care units, medical/surgical ICUs, trauma units, or critical care transport. The AACN website (http://www.aacn.org) was userfriendly and offered information on initial certification requirements, study guides, upcoming certification seminars, testing sites, and sample tests.

As part of the preparation for the exam, I found two reference books and DVDs by Laura Gasparis Vonfrolio, PhD, RN, CEN, CCRN, to be beneficial. The DVDs were amazing and full of great information that made studying very enjoyable.

Once I qualified to sit for the exam, I mapped out a three-month plan for studying. Each week I focused on two sections of content, based on the AACN Synergy Model for patient care. The last two weeks were devoted to practicing test questions and review. The more I studied, the more my thought processes started to change. I started seeing certain practices and disease processes in a different light.

It was an emotional time for me when I passed the CCRN exam. I was so proud of what I had accomplished. I knew that my patients would benefit from my strong dedication and passion for nursing.

I recommend specialty certification for all nurses as a personal and professional goal. It is a major accomplishment. A strong education and knowledge base keeps nursing alive as a profession and has been my inspiration to consistently push myself further.

Surgical Intensive Care Unit Receives Society of Critical Care Medicine Award

with interdisciplinary communication and participation in decision-making. The team included representatives from nursing, palliative care, social work, pastoral care, patient advocacy, and the acute care surgery and SICU intensivist teams. Team members include: Meredith Huffines, BSN, BA, RN; Karen Johnson, PhD, RN; Linda Smitz Naranjo, DNP, RN; Matthew Lissauer, MD; Marmie Ann-Michelle Fishel, MS, BA; Susan D’Angelo Howes, BSN, RN; Diane Pannullo, BSN, RN, CHPN; Mindy Ralls, BS, ADN, RN; and Ruth Smith, MHL, BCC. The team will be recognized at a ceremony at SCCM’s Annual Scientific Congress on January 21, 2013 in Puerto Rico.

Honorable Mention Jeffrey Rivest Receives CEO Award Jeffrey Rivest, President and Chief Executive Officer of UMMC, has been honored as one of “Maryland’s Most Admired CEOs” for 2012.

The Daily Record created the Most Admired CEOs Award to recognize the most talented CEOs leading Maryland’s nonprofit, for-profit, and public companies. The winners were selected based on their demonstration of strong leadership, integrity, values, vision, commitment to excellence, financial performance, and ongoing commitment to their communities and to diversity. Under Rivest’s leadership since 2004, UMMC has seen significant growth and increased national prominence.

The Society of Critical Care Medicine (SCCM) announced that the Surgical Intensive Care Unit (SICU) Supportive Care Team has been selected to receive the SCCM Family-Centered Care Innovation Award. The award is given to an intensive care unit or program that demonstrates novel, effective methods of providing care to critically ill and injured patients and their loved ones.

The SICU Supportive Care Team developed an evidence-based practice program to improve family satisfaction

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Rounds: Magnet Conference, Attendee Reflections continued from page 10.

Reflections from:

Patricia Woltz, MS, RN Nurse Researcher Clinical Practice and Professional Development

Most of my day focuses on the work of nurses around issues related to patient hospitalization, quality, and safety. However, I was most inspired at the conference to hear from several presenters about Magnet’s Force 10, which emphasizes the relationship between a hospital and its community. Described by one presenter as the hospital’s way of “giving back” to the community that supports it, the hospital-community relationship is a powerful, albeit somewhat under-recognized, influencer of health outcomes. Based on trust, people in the community make choices every day about where to go to for health information and services. They may seek help from family members, support groups, a church, the Internet, a public health clinic, primary care provider, an emergency room, or a hospital. When they choose to come to UMMC for services, our community members in essence say that they support our mission and our academic research programs.

Through community mechanisms, UMMC can impact health access and services, which can lead to increased understanding about prevention of illness and maintenance of good health. As nurses concerned with patients’ outcomes, how well do we represent UMMC excellence in this Magnet mission? To assure that the community perceives our organization as a strong, positive, and productive corporate citizen, how do UMMC nurses evaluate the structures and processes that we have built for successful community service and outreach? Are we asking the right questions and then listening to the community about what they need from us? Is our community presence strong in terms of the variety of ongoing, long-term outreach programs? Are we taking advantage of opportunities to leverage politicians, obtain funding, garner media exposure, and partner with stakeholders to offer presentations and publish for positive change? Nurses have great capacity to impact health through all these mechanisms (Wilkinson, 2011).

Perhaps in our daily jobs it is easy to lose focus of the bigger picture that drives excellence in health care. But as the Magnet standard reminds us, we need to serve our unique communities to fully recognize and impact health and quality of life.

Reflections from:

Paul Thurman, MS, RN, ACNPC, CCNS, CCRN Clinical Nurse Specialist R Adams Cowley Shock Trauma Center

Reflections from:

Love Eugenio, BSN, RN, CNOR Senior Clinical Nurse 1 General Operating Room

The opening keynote speech delivered by Mr. Stephen M. R. Covey, author of the book The Speed of Trust, struck and inspired me the most.

I know that “trust” is a very important virtue in our everyday life at home, at work and just about everywhere we go. But he demonstrated that trust is a hard-edged, economic driver—a learnable and measurable skill that makes organizations more profitable.

The session called “Theater in the Round: Using Role–Playing to Improve Patient Satisfaction Scores,” made me curious because I did a similar approach here in the OR. When we rolled out the new policy about dress code. I directed a fashion show here in the OR, showing the do’s and don’ts of the items included in the new dress code and in line with the Behavioral Standards of Appearance. I submitted it as a PowerPoint for the C2X board.

The response to that fashion show was amazing! I think making it fun is a good way to learn.

The presenter said that they have a room that is set up already for any role-playing they want their staff to watch. And they also do it for new employees in a quarterly basis.

The conference allowed me to see that we are ahead of the pack in terms of actually being a Magnet facility. Most of the nurses I met at the conference are just starting and a lot of them are still thinking of applying.

I think we have a lot of our processes and policies/procedures already in place like the work of our trauma nurses presented at one of the concurrent sessions, “Delirium in Trauma Patients: Nurse-Driven Research and Evidence-Based Guideline Development.”

Another one is the work of our CNO and other staff about promoting civility in the workplace. The Operating Room can be a stressful place, especially if the patient is not doing well or it’s an 18-hour case, and everybody is tired and cranky. The guidelines about civility helps the members of the team act like teammates and work together to keep the patient safe.

The most meaningful and significant things about this conference is, first, the camaraderie that I’ve seen with my fellow UMMC nurses and staff. The planning skills of Ms. Rachel Hercenberg are commendable and amazing. She made sure everybody was aware of what to do and where to be.

What also struck me was the number of attendees in that conference. It shows that many facilities are striving to be better in their service to the people.

The 2012 Magnet Conference was an amazing experience. It was wonderful spending time with coworkers I knew and getting to know others, as well. It is always great presenting the wonderful improvements we have made at the Medical Center. Many people viewed our poster for reducing CLABSIs in the STC. The most memorable aspect was hearing Dr. Jean Watson discuss her Nursing Theory of Caring. In some ways I agree with her that nursing is at a crossroads in the profession. Today’s health care environment places many time constraints on our practice, sometimes forcing us to be task oriented, which reduces us to technicians. Nursing’s roots are based in “caring,” which should define our practice.

Hearing a theorist was an incredible experience and truly made me think about nursing’s direction for the future.

continued on page 15.

news &views Rounds: Magnet Conference, Attendee Reflections continued from page 14.

Reflections from:

Rachel Hercenberg, BA Special Projects Coordinator Clinical Practice and Professional Development

I absolutely loved the entire Magnet Conference experience, especially getting to know some UMMC employees that I may have never met in our regular work settings. Last year, I caught a glimpse of the conference from the Baltimore Convention Center’s volunteer office, and I felt the energizing buzz created by thousands of proud nurses.

This year, I was fortunate enough to attend sessions, and hear what they had to share. As a first-time Magnet Conference attendee, firsttime poster presenter, and one of the few non-clinical participants at the Magnet conference, I feel that I had a unique opportunity to observe my surroundings. Although the health care field has evolved

into a competitive business in many ways, the Magnet Conference felt extremely collaborative; participants were excited to share their ideas, learn from each other, and collectively improve health care together.

One thing was very evident from this conference: nurses are proud of their profession, and they should be!

I was most impressed with the conference’s concurrent sessions, and I was pleased that this thought entered my head many times: “We do that at UMMC, too!” Two concurrent sessions particularly inspired me: Theater in the Round: Using Role-Playing to Improve Patient Satisfaction Scores; and 30 Tips From 30 Years of Shared Governance.

Both of these sessions reiterated to me how innovation, structure, multidisciplinary communication, and outcome-oriented strategies can create sustainable methods to improve patient care.

Rounds: Magnet Conference, Accepted Abstracts Abstract

Can a Brief Intervention Serve to Increase Awareness of Disruptive Behavior in the Workplace and its Frequency?

Lisa Rowen, DNSc, RN, FAAN; Kristin Seidl, PhD, RN; Tina Cafeo, MSN, RN; Greg Raymond, MS, RN; Rachel Hercenberg, BA

The following five abstracts were accepted for the ANCC’s 2012 National Magnet Conference.

Workplace violence and disruptive behaviors between co-workers is not unusual and has become a growing problem in the United States. The healthcare sector leads all other industry sectors in nonfatal workplace assaults, with nurses and nursing assistants the most frequent victims. Disruptive behavior in the workplace interferes with effective communication and teamwork among healthcare providers and negatively impacts performance and outcomes. This type of behavior does not support a culture of safety for patients, nurses or the healthcare team.

Healthcare leaders must proactively address and minimize disruptive behaviors to transform the work environment and foster safety for patient care. An initial step in changing a culture to one with less disruptive behavior is to increase employee awareness of the issue. A performance improvement project was conducted in a large academic medical center to determine if a brief educational intervention would serve to increase participants’ awareness of disruptive behaviors and their frequency of occurrence.

The intervention was a one hour presentation on workplace civility, disruptive behaviors and workplace violence, offered at Advanced Practice Nursing Grand Rounds. The education was provided by the Chief Nursing Officer to emphasize senior leadership commitment to transforming the culture. It included a discussion of the requirements of a safe and healthy work environment; definitions and descriptions of disruptive behavior, lateral violence, verbal abuse, incivility, workplace bullying, and workplace violence; and the reasons the healthcare sector is at increased risk to be an unsafe or uncivil environment.

A pre-test and post-test survey was distributed prior to and following the hour-long educational session. Sixty-seven participants completed the surveys and provided demographic information. Demographics included gender, decade born, racial/ethnic group, professional role and years in professional role. Three survey questions were included on both the pre-test and post-test, along with the frequency noted for each item. The items asked were: • In the past year, I have personally experienced disruptive behavior by a colleague in the work setting.

• I have personally observed co-workers who have been the target of disruptive behaviors in the past year.

• In the past year, I have perpetrated disruptive behavior toward a colleague in the work setting.

The respondents selected either yes, no or declined to answer the three items. If they responded yes, they were asked the frequency of the item, with the options of one time only, rarely, monthly, weekly, daily, or they could decline to answer.

Pre-test and post-test data supported that a one hour educational intervention was successful in increasing the awareness of disruptive behaviors in the workplace. A Related-Samples Wilcoxon Signed Ranks Test revealed a statistically significant difference at p<.001 level between the participants’ responses before and after the education intervention for all three measures. Following the intervention, participants reported an increased awareness of disruptive behaviors occurring for all three items as well as an increase in the frequency of the behaviors of each of the three items.

There is value in an a brief educational session to increase awareness of disruptive behaviors in the workplace, both observed toward others as well as received and perpetrated by an individual. Increased awareness of disruptive behaviors could positively serve an organization’s commitment to foster a safe, civil and healthy work environment. continued on page 16.

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Rounds: Magnet Conference, Accepted Abstracts continued from page 15.

Abstract

Improving the Effectiveness of Diabetes Care Visits Through Computer-Assisted Analysis of Blood Glucose Readings Carol Armstrong, BSN, RN, CPN, CDE, and Catherine DiBlasi, RD, RN, CDE

Self-monitored blood glucose readings1 are routinely used by physicians and nurse practitioners as the basis for decision making in the treatment of diabetes. However, studies2,3 show patient-prepared logbooks and patient recall are more likely to be inaccurate with missed data points and falsified results, versus data obtained directly from the memory of the glucometer. At the diabetes clinic, frequent inconsistencies in self-reported blood glucose data when compared to hemoglobin A1C results raised concern over the validity of the data. Based on this evidence, a nurse led improvement was developed to make downloaded meter data available to providers at each clinic visit. The project included determining the most commonly used glucometers for download and installation of vendor provided software by the Information Technology department. Training material, checklists, and competencies were developed and a multidisciplinary team of medical assistants, educators, and clinical nurses were instructed on the procedure. The existing work flow was altered to include collection and downloading of glucometers before patients’ visits with providers.

Patients were encouraged to bring their glucometers to each visit, reinforcing the importance of home monitoring in their treatment. Eighteen providers were surveyed at the end of four months using a brief questionnaire. Survey results demonstrated that 100% felt the project had a positive impact on patients and patients’ visits and 100% recommended continuing the project. Providers commented that the meter download data increased their confidence in insulin adjustments, reinforced importance of monitoring, and encouraged patient participation in care.

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2

3

Odegard, P. S., & Beach, J.R. (2008). Blood Glucose Monitoring: A Practical Guide for Use in the Office and Clinic Setting. Diabetes Spectrum, 21(2), 100-111.

Kalergis, M., Nadeau, J., Pacaud, D., Yared, Z., & Yale, J.F. (2006) Accuracy and Reliability of Reporting Self-monitoring of Blood Glucose Results in Adults With Type 1 and Type 2 Diabetes. Canadian Journal of Diabetes, 30(3), 241-247.

Kendrick, J.M., Wilson, C., Elder, R.F., & Smith, C.S. (2005). Reliability of Reporting of Self-Monitoring of Blood Glucose in Pregnant Women. Journal of Obstetric, Gynecological, & Neonatal Nursing, 34(3), 329-334.

Abstract

The NP Critical Care Trauma Postgraduate Residency: An Innovation to Improve Novice Transition to Practice Deborah Schofield, DNP, CRNP, and Carmel McComiskey, DNP, CRNP

The Institute of Medicine (2010) has recognized the national need for innovative programs aimed at recruiting and retaining nurses, citing, “health care organizations should take actions to support nurses’ completion of a transition-to-practice program (nurse residency) after they have completed a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas.”

Opportunities for Critical Care NPs are rapidly expanding. Although acute care NP programs provide a broad underpinning in acute care advanced practice nursing, they cannot be expected to ready students to provide critical medical decision making about specific critically-ill patient populations. Data obtained from physician colleagues and NP interviews support this observation. A comprehensive post-graduate critical care residency program to support both new graduate NPs and experienced NPs who lack critical care expertise has been developed. This includes a nine month, immersive, structured clinical and didactic residency, directed by an interprofessional team of APNs and collaborating physicians with expertise in critical care, cardiac surgery, general and emergency surgery, radiology and infectious diseases, pain management, palliative care, and colleagues from the Schools of Pharmacy, Nursing, Social work. Post graduate rotations in each of five specialty intensive care units include weekend and night coverage and on-call expectations. Early evaluations demonstrate improved performance, improved decision making, improved MD satisfaction, decreased role confusion and improved transition to independence. This approach offers the time-honored advantages of structure, support, definitive benchmarks for performance, fiscal responsibility and determination of “fit” (future employment) for the team. continued on page 17.

news &views Rounds: Magnet Conference, Accepted Abstracts continued from page 16.

Abstract

Delirium in Trauma Patients: Nurse-Driven Research and Evidence-Based Guideline Development Kathryn Von Rueden, MS, RN, ACNS-BC, FCCM, and Tiffany Blacklock, MS, RN, CRNP, presented; other contributors were: Karen McQuillan, MS, RN, CCRN, NCS-BC, FAAN; Paul Thurman, MS, RN, ACNPC, CCNS, CCRN; Breighana Wallizer, BSN, RN, CCRN; and Jennifer Merenda, MS, RN

Direct care and advanced practice nurses collaboratively questioned practice, engaged in research, and established an evidence-based guideline to improve patient care and clinical outcomes related to acute delirium. Members of the Nursing Research Council were concerned that delirium incidence was high and that deliberate actions were needed to prevent it. A team designed, implemented, and completed a research study that identified delirium prevalence, associated risk factors and predictors in three trauma critical care (ICU) and three intermediate care (IMC) units. In a sample of 215 patients, delirium prevalence was 24%; 36% in ICU and 11% in IMC patients. Delirium was significantly related to older age, higher APACHE score, lower RASS, use of mechanical ventilation, anesthetic sedatives and psychotropic agents.

Agitated patients with higher RASS were less likely to have delirium. A model including these variables predicted delirium explaining 51.9% of variance. Inclusion of ICU and IMC trauma patients in this study provided an examination of delirium not previously reported, and confirmation that delirium occurs in both areas. Following study completion, results were disseminated by the team through interdisciplinary committees, nursing councils, and staff meetings; Understanding the predictors of delirium in trauma patients can identify those at highest risk, affording opportunity for early implementation of preventive strategies. Thus, based on the study results, the team developed evidence-based, nurse-driven delirium prevention guidelines, identified “delirium champions” on all units, and conducted education and training of other nurses in order to facilitate the implementation of an organization-wide delirium assessment and prevention program.

Abstract

Impact of Nursing Council Participation in the Reduction of CLABSI Paul Thurman, MS, RN, ACNPC, CCNS, CCRN, and Rebecca Gilmore, RN; other authors include: Tonya Bane, BSN, RN; Karen McQuillan, MS, RN, CCRN, NCS-BC, FAAN; Beth Pruitt, BSN, RN; Kathryn Von Rueden, MS, RN, ACNS-BC, FCCM

With CLABSI rates 2 times higher than the Centers for Disease Control average for trauma units (14.3 vs 7.0 CLABSI/1000CL days), staff nurse champions, Nursing Shared Governance Councils, and advanced practice nurses engaged other disciplines in efforts to reduce infection rates. Staff led quality, clinical practice and education councils worked together with leaders to create an environment where nurses were empowered to make a difference and healthcare providers viewed themselves as a team in achieving high quality patient outcomes. This nurse led campaign employed shared governance councils and multidisciplinary forums to review CLABSI data, identify root causes for results and develop and implement processes and standards to support evidence-based best practices. Numerous interventions to reduce CABSI were implemented, such as repeated education, nurse training on ultrasound-guided peripheral intravenous catheter placement and use of chlorhexidene impregnated site dressings, CL kits with a full drape and gown, antibiotic impregnated CLs, CL insertion carts, and a checklist. Nursing and physician leaders empowered nurses to stop CL insertion if sterile technique was broken. Unit specific and aggregate data was monitored and reported quarterly to staff, councils and interdisciplinary forums showing the impact of EB practice. The councils were responsible for sharing CLABSI data, developing EB standards, educating staff on these standards, holding all providers accountable for consistent adherence and tracking compliance with EB process measures. As a result the aggregate CLABSI rates decreased from 14.3 in 2006 to 1.9 in Q2FY12, a relative reduction of over 175%, with many units achieving zero CLABSI’s.

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We Discover Journal Club Hot Topic Sherly Binu, BSN, RN, CLNC, Clinical Nurse II, Cardiac Surgery Intensive Care Unit

Article Koh, D., Robertson, I., Watts, M., & Davies, A. (2012). Density of Microbial Colonization on External and Internal Surfaces of Concurrently Placed Intravascular Devices.

American Journal of Critical Care, 21(3), pg. 162-171.

This article describes a prospective observational study that examined the density of microbial colonization on external and internal surfaces of concurrently placed intravascular devices: central venous lines, arterial lines, and peripherally inserted central catheters. The study involved five hospital units in one facility and a sample size of 289 patients. The authors concluded

that the area of heaviest microbial colonization was at the proximal segment of the intravascular device, possibly due to the micro-organisms originating from the skin around the insertion site. An increased risk of microbial colonization was also noted with the increased duration of catheter stay and with use of multi-lumen catheters. The discussion that followed focused on the implications of this study for clinical practice at the University of Maryland Medical Center (UMMC).

Discussion ◗◗ Catheter-related bloodstream infections (CRBSIs) account for 250,000 to 500,000 cases in the US, resulting in extended hospital stays, higher costs, and increased morbidity and mortality rates. ◗◗ Arterial lines should be considered of equal importance as central venous catheters (CVC) when systemic sepsis is suspected.

◗◗ Catheters that dwell for nine days or more colonize from the proximal to the distal end. ◗◗ CVCs should be removed and alternative intravenous access be identified as soon as the patients are clinically ready. ◗◗ The group identified that culturing catheters is not a standard practice at UMMC and discussed whether this should be reconsidered. ◗◗ The difference between CRBSIs and central line-associated bloodstream infections (CLABSIs) was discussed. ◗◗ The staff emphasized the adoption of best practices that prevent CLABSIs, such as central line bundles, daily inspections, and the use of antimicrobial catheters.

New Wound Management Assessment Tool Joan Selekof, BSN, RN, CWOCN, Manager, Wound Ostomy Certified Nurse Team

The University of Maryland Medical System (UMMS) is embarking on the deployment of an Enterprise Wound Management System which will be used in an inpatient, outpatient, emergency room, and cross-facility environment. This system will provide a more efficient and accurate way to improve and communicate wound assessments, objective staging, healing, and documentation. In addition, this application will support clinical trials and research initiatives, track the effectiveness of adjunctive therapies, and enhance the ability to identify secondary diagnoses that are present upon admission.

Key Goals

Deployment Timeline

1.

The Aranz camera will be piloted on the following units: Medical Intensive Care Unit, Surgical Intensive Care Unit, Multitrauma ICU, and Cardiac Surgery ICU. The anticipated rollout is expected to be January 2013.

Please contact Joan Selekof via jselekof@umm.edu if you would like additional information.

2.

3.

4.

Implement a single instance of Silhouette Central (see below) and standardize assessment and documentation of wound care.

Decrease inter-operator variability in documentation of wound assessments.

Track patient care across all venues of care and facilities and demonstrate improved clinical outcomes.

Contribute to translational research in wound management.

SilhouetteStar showing the camera face.

The center of the camera contains a digital camera that can capture information to measure a wound. The lasers and LED lights surround the camera in the blue SilhouetteStar ring. The button used for image capture is at the top.

Device Choices SilhouetteStar is a small, handheld, lightweight camera used at the point of care for imaging and taking 3D measurements of wounds.

SilhouetteStar connects via USB to a computer, capturing in a single photograph all the information required to measure a wound.

SilhouetteStar includes a digital camera, lasers, and lights that illuminate the wound during image capture. The camera is powered by the connecting computer via the USB cable and does not require any consumables such as batteries.1

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http://www.aranzmedical.com

news &views Nursing Research in the Pediatric Intensive Care Unit Shari Simone, DNP, CRNP, CPNP-AC, FCCM, Lead Nurse Practitioner, Women’s and Children’s Services

Since 2009, the University of Maryland Medical Center (UMMC) Pediatric Intensive Care Unit (PICU) has participated in a multi-center randomized control trial with 29 other PICUs at hospitals across the country. The aim of the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) study is to determine whether pediatric patients with acute respiratory failure who are managed per a pediatricsedation management protocol experience

Objective Measure of Level of Care for Pediatric Hospitalized Patients: Use of the Pediatric Early Warning Score (PEW) Jessica Strohm Farber, DNP, CRNP, PNP-BC, Nurse Practitioner, Pediatric Intensive Care Unit, and Jason W. Custer, MD, Attending Physician, Pediatric Intensive Care Unit, and Assistant Professor, Department of Pediatrics

Background: Hospitalized pediatric patients are at risk for sudden deterioration related to respiratory or cardiovascular dysfunction and failure. Early warning scoring systems have been developed for adults and, subsequently, for children. These systems rely on physiologic parameters to objectively determine the need for a higher level of care.1-5 Early warning scoring systems help to “package” physiological data, provide a framework for assessment, improve communication among providers, and empower nurses.6 Many pediatric centers incorporate these early warning scores into algorithms that trigger rapid responses and report increased survival and significant reductions in code blue events.7,8 Purpose: The purpose of this feasibility study was to evaluate whether the “Monaghan” (M-PEWS) or “Duncan” (D-PEWS) Pediatric Early Warning Score (PEWS) tools are relevant to the inpatient pediatric population at UMMC and to

fewer days of mechanical ventilation, compared to patients receiving usual care.

From the project’s inception, the PICU nursing staff and nurse practitioners (NPs) have championed the daily activities of this study and deserve recognition for the sustained exceptional site metrics. This team includes: Jessica Phillips, BSN, RN, CNII; Susan Carson, MS, RN, CCRN, CNII; Jodie McKenna, BSN, RN, CNII; Christina Fellner, MS, RN, SCNI; Jill Siegrist, MSN, CRNP, CPNP-AC; Melanie Muller, MS, CRNP, CPNP-AC; and Anne Vasiliadis, MS, CRNP, CPNP-AC. As site investigator, I have had the pleasure of working with this team of nurses and NPs who lead all daily research efforts, including screening subjects, obtaining informed consent, collecting data, conducting inter-relater review cycles for the assessment tools, and re-educating

nursing staff when needed. Their collective efforts have led to astounding results as the UMMC PICU has remained the control site with the highest number of eligible and enrolled subjects for three years and one of the top three sites with the highest total number of subjects enrolled to date. The nurses and NPs have also been instrumental in sustaining high performance metrics around sedation, pain, and withdrawal assessment, as well as the total performance scores that consistently exceed expected targets. Since this study is an important body of pediatric critical care research that may change future sedation practices, the commitment of this team to sustain this research project, despite daily competing responsibilities, demonstrates their unparalleled desire to ensure the care we provide at UMMC is top-quality and based on evidence.

describe differences between PEWS scores in each of the pediatric inpatient care areas —Pediatric Intensive Care Unit (PICU), Pediatric Intermediate Care Unit (PIMC), and General Pediatrics. All pediatric inpatients from 0-18 years were included, with the exception of those receiving mechanical ventilation, vasoactive infusions, and invasive hemodynamic pressure monitoring.

Methods: A convenience sample of 200 pediatric inpatients was scored prospectively on both PEWS tools. In addition, retrospective chart review and retrospective PEWS scores were completed for inpatients that experienced a clinical deterioration and unscheduled transfer to the PICU. Results: Interim analysis demonstrates that although there is significant overlap in PEWS scores between care areas, the range of PEWS scores is highest in the PICU and lowest in General Pediatrics. Similarly, retrospective chart review demonstrates a trend towards PEWS scores >5 at the time of transfer to the PICU. However, some patients had PEWS scores of 0 (zero) at the time of transfer to the PICU. Retrospective chart-review data also suggests a trend towards unplanned transfer to the PICU for patients with prior ICU admissions, those who are medically complex, and those with respiratory diagnoses.

Implications: Based on the research findings, the PEWS tool may be implemented as part of a rapid-response algorithm, as well as to facilitate elective

transfers between care areas at UMMC. However, the PEWS tool should not be used as a single determinant of need for transfer to a higher level of care. Further investigation is recommended.

Monaghan, A. (2005). Detecting and managing deterioration in children. Paediatric Nursing, 17(1), 3205.

2 Tucker, K.M., Brewer, T.L., Baker, R.B., Demeritt, B., Vossmyeer, M.T. (2009). Prospective evaluation of a pediatric inpatient early warning scoring system.

Journal for Specialists in Pediatric Nursing, 14(2), 79-85.

3 Duncan, H., Hutchison, J., & Parshuram, C.S. (2006).

The pediatric early warning system score: a severity of illness score to predict urgent medical need in hospitalized children. Journal of Critical Care, 21(3), 271-8.

4 Parshuram, C.S., Hutchison, J., & Middaugh,K. (2009).

Development and initial validation of the bedside paediatric early warning system score. Critical Care, 13(4), R135.

5 Parshuram, C.S., Duncan, H.P., Joffe, A.R., Farrell, C.A., Lacroix, J.R., Middaugh, K.L., Hutchison, J.S., Wensley, D., Blanchard, N., Beyene, J., Parkin, P.C. (2011).

Multicentre validation of the bedside paediatric early warning system score: a severity of illness score to detect evolving critical illness in hospitalised children.

Critical Care, 15(4), R184.

6 Andrews, T. & Waterman, H. (2005). Packaging: a grounded theory of how to report physiological deterioration effectively. Journal of Advanced Nursing, 52(1), 473-81.

7 Brilli, R.J., Gibson, R., Luria, J., Wheeler, T., Shaw, J., Linam, M., Kheir, J., McLain, P., Lingsch, T., Hall-Haering, A., & McBride, M. (2007). Implementation of a medical emergency team in a large pediatric teaching hospital prevents respiratory and cardiopulmonary arrests outside the intensive care unit. Pediatric Critical Care Medicine, 8(3), 236-246.

8 Tibballs, J. & Kinney, S. (2009). Reduction of hospital mortality and of preventable cardiac arrest and death on introduction of a pediatric medical emergency team. Pediatric Critical Care Medicine, 10(3), 306-12.

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22 South Greene Street Baltimore, Maryland 21201 www.umm.edu

Clinical Practice Update

Change to Medication Administration Go Live 10/16/12 To save keystrokes: T: for Today N: for Now

Reschedule Administration Times no longer an option

1. eMAR Med Administration Task : No more pre-filled date and time 2. NO MORE rescheduling of medication administration times: • Use the 50% Rule and keep on standard schedule • Talk to the provider if you have concerns • To see the policy and useful algorithm: http://intra.umm.edu/ummc/policies/hospital/mm-005.pdf 3. New feature: Hover over eMAR task • Displays the time the last dose of a specific medication was given by hovering over the eMAR task.

• NOTE: Will only display last administration time of this single order (single line on eMAR).

If a med is ordered both around the clock and PRN, hovering over a task for a scheduled med will not show the last PRN administration time.

• Need to see administration times of more than one specific med?

Then go to the eMAR Summary for a single screen view.

4. Not Done and Not Given • The reason why med administration is delayed or omitted must be documented by the nurse in the eMAR. For omitted doses, include the name of the provider notified in the comment section.

• Reasons for “Not Done” and “Not Given” have been modified.

5. New eMAR Progress Note for Nurses • Free text form available in ad hoc charting for additional medication documentation needs.

For questions please contact Susanne Anderson at manderson1@umm.edu