News and Views by UMMS

news views Spring 2012

A Publication of the Department of Nursing and Patient Care Services University of Maryland Medical Center

Dr. Janet D. Allan Retiring as Dean of the University of Maryland School of Nursing Janet D. Allan, PhD, RN, FAAN, Dean and Professor, University of Maryland School of Nursing, has announced her retirement. As a tribute to Dr. Allan, it is important to recognize her lifetime achievements in the leadership of nursing, the education of nursing professionals, and the strength of the collaborative relationship that she has cultivated with the University of Maryland Medical Center. Dr. Allan was appointed dean of the University of Maryland School of Nursing in June 2002. She previously served as dean and professor at the University of Texas Health Science Center at San Antonio, School of Nursing. In her national role, Dean Allan serves as treasurer of the Board of Directors for the American Association of Colleges of Nursing (AACN), and is its representative on the multidisciplinary Healthy People Curriculum Task Force. She serves as the AACN Grassroots Liaison for Maryland. After the Institute of Medicine/Robert Wood Johnson Foundation (RWJF) released the Future of Nursing report in 2010 recommending advancing health through nursing, Dean Allan initiated and currently is a co-chair of Maryland’s Action Coalition, a large group of diverse stakeholders charged with developing a blueprint for implementing the recommendations in Maryland.

She was a member of the AACN task force that developed the Essentials of Doctoral Education for Advanced Nursing Practice and board liaison for the task force on The Research-Focused Doctoral Program in Excellence: Pathways to Excellence. Dean Allan served on Senator Benjamin Cardin’s Congressional Health Advisory Committee and was also a member of the Board of the Association for Prevention Teaching and Research. She is a past member of a RWJF advisory panel, where she served on a five-year project, “Prescription for Health.” Dean Allan was vice-chair of the U.S. Preventive Services Task Force from 1998 to 2004 and served as the lead spokesperson on topics such as breast cancer screening, hormone replacement therapy, and adult obesity. She formerly served as a member of the Board of Directors of the American Academy of Nursing. Dean Allan has been president of the National Organization of Nurse Practitioner Faculties (NONPF), which doubled its membership under her direction, and president of the Southern Nursing Research Society, which experienced similar growth under her leadership. continued on page 5.

lisa Rowen’s Rounds: Adult Emergency Department Question: How do you spell “team” using only three letters? Answer: AED

Lisa Rowen, DNSc, RN, FAAN

The Adult Emergency Department (AED) is a bustling place of constant unpredictability, complexity and motion where patients can rely on one more crucial constant — a great team. Talk to any one of the many staff and physicians in the AED and ask the question, “What do you like best about working here?” The response will always include mention of the great interdisciplinary team. This year, the CNO Team Award for Extraordinary Care goes to the AED team for the care, service and teamwork that all members demonstrate on a daily basis. Nurse manager Tom Crusse, MS, RN, CEN, escorted me on rounds and navigated me through the patient flow process. Patients and family members enter the AED via the Lombard Street entrance and are directed to the Quick Reg area for registration. I spoke with Veronica Smith, who explained she and the other registrars ask for the patient’s name, date of birth, social security number, and the reason the patient has come to the AED. The registrars enter the information in the patient’s electronic record and place an ID band on the patient’s wrist. The registrars check their list of patient symptoms that require immediate notification of the triage nurse, NP or physician, such as shortness of breath, chest pain, asthma or behavioral health issues. If patients are experiencing life-threatening symptoms, they bypass Quick Reg for emergent care from clinicians. Veronica said, “Helping patients… that’s what we’re here for.” continued on page 6.

Spring 2012

A Showcase of Professional Accomplishments at the Nurses Week Clinical Practice Summit Brian Burke, MS, BSN, RN-BC, CPN, Clinical Practice & Education Specialist, Clinical Practice & Professional Development

The tri-annual Clinical Practice Summit, hosted by the Office of Clinical Practice & Professional Development (CPPD), was widely viewed by attendees as a great success. Poster submissions were collected for the two-day summit from a diverse group of participants, such as from members of the R. Adams Cowley Shock Trauma Center, Ambulatory Nursing units, Behavioral Health Nursing, Pediatric Acute Care, the Neonatal Intensive Care Unit, Cardiology & Radiology Nursing, the Hyperbaric Unit, the Department of Medicine, The Cancer Center, The Rapid Response Team and Maryland Express Care. Consistent with the theme of Patient and Family Education, multiple shared governance and multidisciplinary councils such as the Falls Committee, the Patient & Family Education Council, the Professional Advancement Council and the Shock Trauma Clinical Practice Council submitted posters for display and presentation. Between Wednesday and Thursday morning, over fifty staff members participated in poster presentation rounds, which were flawlessly facilitated by Cynthia Bauer, Karen Cossentino, Dawn Clayton and Katherine Von Reuden. Surveys to provide feedback on the event were received from over 80 people, including nurses, PCTs/CNAs, nurse practitioners, students, patients or visitors and other staff. CPPD relies heavily on the feedback from events like the Clinical Practice Summit to evaluate programs and make changes or improvements. The next Clinical Practice Summit is scheduled for September 18th and 19th. A list of poster submissions, authors and contact information from this Summit is available through CPPD, 8-6257, to support communication with contributors and to advance your own practice. We look forward to the presentation of everyone’s efforts again in September.

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

In This Issue Dr. Janet D. Allan Retires

Lisa Rowen’s Rounds: Adult ED

Clinical Practice Summit

UMNursing 3 STC Nurses Walk Like ‘MADD’

Certification Corner 5 Nurses on a Mission to Advancement

Honorable Mentions 9 The Charge Nurse Council

Core Measures 11 Nurses Week 2012

Holistic Nursing Practice

We Discover 15 Lessons Learned from Safety Discussions

STC DVT Awareness Campaign

Evelyn Jordan Center Unit Quality Project

Nurse Practitioner Contributions

A Weekend with RAM

UMMC Nursing Around the World

NEWS & VIEWS is published quarterly by the Department of Nursing and Patient Care Services of the University of Maryland Medical Center. Scope of Publication

Clinical and professional nursing practice in inpatient, procedural, and ambulatory areas that is evidence-based, innovative and outcomes driven. Focus on divisional, departmental, and/or organizational strategic goals. Guidelines for Article Submission

1. Times New Roman - 12 pt black font only. 2. Length - three double spaced, typed pages maximum 3. Include name, position title, credentials, and practice area for all writers. 4. Credentials must be provided for anyone named in the article. 5. Proofread article for spelling, grammar, and punctuation before submitting. 6. Provide photos in .jpg format. 7. Send completed articles via e-mail to anaunton@umm.edu by the due dates noted in the box below. 8. Editor will seek expert review of articles to verify and validate content. 9. Submit trend data in graphic format with labeled axes.

2012 ISSUE Winter Spring Sumer Fall

2012 DUE DATE Feb 13 May 14 Aug 13 Nov 12

Editor

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

Lisa Rowen, DNSc, RN, FAAN Senior Vice President and Chief Nursing Officer, Nursing and Patient Care Services Ann E. Regier, MS, RN Director, Clinical Practice and Professional Development Kristin Seidl, PhD, RN Director of Nursing Outcomes, Research, and Evidence-based Practice Angela Sintes, MS, RN, CNL Clinical Education Specialist, Clinical Practice and Professional Development Susan S. Carey, MS Professional Development Coordinator, Clinical Practice and Professional Development

news &views UMNursing Kristin L. Seidl, PhD, RN, Director of Nursing Outcomes, Research, and EBP and Robin Newhouse, PhD, RN, NEA-BC, FAAN, Professor and Chair, Organizational Systems and Adult Health, University of Maryland School of Nursing

Founded in 2007, UMNursing is an innovative partnership between the University of Maryland School of Nursing (UMSON) and the University of Maryland Medical Center (UMMC). The partnership aims to promote innovative opportunities for research, practice, and education in order to optimize healthcare outcomes. Under the guidance of Janet Allan, PhD, RN, FAAN, Dean of the School of Nursing and Lisa Rowen, DNSc, RN, FAAN, Senior Vice President and Chief Nursing Officer of the Medical Center, this unique partnership has grown and relationships between UMSON faculty and UMMC staff have prospered. From 2007 to 2010, UMNursing has supported four research studies, the development of a new graduate nurse residency program and enables UMMC nurses to serve as clinical instructors for the UMSON. Upon the release of the Institute of Medicine’s (IOM) report “The Future of Nursing: Leading Change, Advancing Health,” key leaders and stakeholders from both UMMC and the SON met for a strategic planning meeting to evaluate the UMNursing partnership in light of the IOM’s recommendations. Table 1 includes the IOM recommendations. As a result of that meeting, it was apparent that the UMNursing partnership is a critical component in advancing the IOM’s recommendations, but in order to do so, the partnership needed some restructuring. The core components of UMNurisng were redefined and new stakeholders were invited to participate. UMNursing now includes four components, which are co-chaired by a UMSON faculty member and a UMMC employee; these components include: Entry Level Education and Practice, Graduate Level Education and Practice, Infrastructure, and Research (Figure 1). Using a Table 1 Institute of Medicine: Recommendations for the Future of Nursing Nurses should practice to the full extent of their education and training Nurses should achieve higher levels of education and training through an improved education system that promotes seamless academic progression Nurses should be full partners with physicians and other health care professionals in redesigning health care in the United States Effective workforce planning and policy making require better data collection and an improved information infrastructure

collaborative and transparent approach, the co-chairs of each component developed a two-year strategic plan that includes outcome-focused deliverables that have mutual value for both the UMSON and UMMC. The overarching goal of both the Entry Level and the Graduate Level Education and Practice components is to create synergy between the SON and UMMC by developing and sustaining complementary programs and educational opportunities in both the classroom and the clinical settings. The co-chairs of the Entry Level Education and Practice component are Janice Hoffman, PhD, RN, CCRN, Assistant

Entry Level Education & Practice

Graduate Education & Practice

INFRASTRUCTURE Research

Figure 1. UMNursing Components and Structure Dean for the Baccalaureate program (SON) and Angela Sintes, MS, RN, CNL Clinical Education Specialist (UMMC). In the next two years, goals of the Entry Level Education and Practice component include exploring educational gaps related to nursing practice, exploring innovative solutions to meet the educational needs of experienced nurses, and exploring strategies to facilitate UMSON students in completing their final practicum on the unit of hire. To date, the partnership has supported the addition of Ms. Sintes on SON committees and Dr. Hoffman on UMMC councils, and has continued support for the new graduate residency program. The Graduate Level Education and Practice component is chaired by Jane Kapustin, PhD, CRNP, BC-ADM, FAANP, Assistant Dean for the Master’s and DNP Programs (SON) and Carmel McComiskey, DNP, CRNP, Director of Nurse Practitioners (UMMC). This component aims to identify the practice pre-requisites and education necessary to achieve a more prepared graduate, improve the transition of new graduate nurse practitioners to professional practice, and to explore innovative solutions to meet the professional educational needs of advanced practice nurses. In the past year, Drs. Kapustin and McComiskey have conducted a gap analysis of the educational needs of nurse practitioner students, facilitated improvements in the clinical experiences of nurse practitioner students, and overseen the development of a nurse practitioner residency program. The Research component is co-chaired by Susan Dorsey, PhD, RN, FAAN, Associate Dean for Research (SON) and Ingrid Connerney, Dr. PH, RN, Senior Director of Quality and Safety (UMMC). The overarching goal of the Research component is to strategically partner researchers and clinicians in order to foster clinically relevant and meaningful research. The co-chairs of this component hope to identify and sustain a research agenda consistent with the UMNursing strategic priorities and to develop a strategy for sustained funding. The Research component just recently awarded a research grant to Lyn Stankiewicz Murphy, PhD, MBA, MS, RN, Specialty Director, Health Services Leadership and Management (SON) and Badia Faddoul, DNP, RN, Clinical Practice Coordinator (UMMC) called “Understanding the Second Victim: A Qualitative Approach.” Using qualitative methods, the research team aims to study the impact of adverse events on healthcare workers so that effective support strategies can be developed. Finally, the Infrastructure component exists to create the structures and processes that are required to develop, sustain and advance the UMNursing Mission. Marisa Wilson, DNSc, MHSc, RN-BC, Director of the Masters program (SON), and Ann Regier, MSN, RN, Director of Clinical Practice and Professional Development (UMMC) continued on page 11.

Spring 2012

STC Nurses Walk Like ‘MADD’ Katherine Mulligan-Vann, BSN, RN, SCN I, Shock Trauma Acute, STC

As nurses in the R Adams Cowley Shock Trauma Center, on a daily basis we witness the impact that impaired driving has on individuals, families, and communities. Far too often young lives are forever changed or tragically ended as a consequence to the decision that an individual or group of individuals makes to get behind the wheel while intoxicated. Even with profound statistics like “an average drunk driver has driven drunk 80 times before the first arrest” (CDC, 2011) and “one in three people will be involved in an alcohol-related crash in their lifetime” (NHTSA, 2001), drunk driving accidents, injuries, and deaths are still a prevalent health issue facing Maryland residents. A group from Shock Trauma Acute Care (STA) recognized that individually making a commitment not to drink and drive or pledging to provide designated drivers, was not enough to support the eradication of alcohol related motor vehicle accidents. As we sought out a way to address the issue from a preventative approach, we found an organization that was fighting the war on drunk driving from a primary, secondary, and tertiary standpoint. MADD, or Mothers Against Drunk Drivers, is a nationally recognized organization that was founded with one goal in mind — to eliminate unnecessary deaths that are a result of drunk driving. The MADD “organization began with a mother who lost her child in a drunk driving crash. She turned grief into positive change. Her work and the work of so many other mothers, fathers, sisters, and brothers started a movement that has saved 300,000 lives…and counting” (MADD, 2011). MADD has three main initiatives: to support and enhance law enforcement; to mandate breath-a-lyzers in the vehicles of first time offenders; and to mainstream technology that can be implanted in vehicles that will detect an alcohol level of greater than .08 in the driver and disabling the car. MADD has been able to accomplish so much since the 1980’s, including impacting legislation, supporting victims, and raising awareness. All of the work done by MADD has been funded by private donations and fundraising efforts. This is where the STA nurses come into play. In 2008, team leaders Sara Hake, BSN, RN, CN II and Allison Payne, BSN, RN, SCN I, caught wind of a local fundraiser to benefit MADD. The largest annual Maryland based fundraiser for the organization, called “Walk Like MADD”, takes place in the spring at Federal Hill Park in Baltimore. The first year that the nurses from STA participated in the event was 2008. Last year, there were over 20 participants on the STC team, with representatives from nearly every unit. The team raised over $2000 and was among the top fundraising teams. In 2012, the STC team was represented again and was successful in their fundraising effort.

For more information about this annual event, contact either Katherine Mulligan-Vann via email kmulligan@umm.edu, Allison Payne via email apayne@umm.edu or visit the MADD webpage http://www.madd.org/. References Centers for Disease Control. “Vital Signs: Alcohol-Impaired Driving Among Adults— United States, 2010.” Morbitity and Mortality Weekly Report. October 4, 2011. http://www. cdc.gov/mmwr/preview/mmwrhtml/mm6039a4.htm National Highway Traffic Safety Administration. “The Traffic Stop and You: Improving Communications between Citizens and Law Enforcement.” National Highway Traffic Safety Administration. March 2001. DOT HS 809 212. http://www.nhtsa.dot.gov/people/ injury/enforce/Traffic%20Stop%20&%20You%20HTML/TrafficStop_index.htm Mothers Against Drunk Driving. “Campaign to Eliminate Drunk Driving.” Retrieved March 15, 2012 from http://www.madd.org/drunk-driving/campaign/

news &views Certification Corner

The Value of Professional Nursing Certification

Why Get Certified? 1 – Patients value certification.

By 2002, 8 out of 10 patients were aware of nurse certification. Seventy-three percent of patients said that they would choose a hospital with a high percentage of certified nurses. 2 – Certified nurses could earn more.

Mylene de Vera, BSN, RN, OCN, SCN I, BMT

I became certified in Oncology nursing in 2007. I remember that time very well because my oldest son was only 2 years old. As a busy mom, I could only read one page a day of the review book. After a few months, I was able to finish the book. In my situation, I did the best I could to prepare for the exam. My efforts paid off much more than I could ever imagine. Aside from passing the test, I gained a lot of knowledge that improved my nursing practice. I am able to make better clinical decisions. I improved my ability to educate my patients about their disease and symptom management. Certification has opened up a lot of doors in my career. I have been a biotherapy and chemotherapy trainer for the Oncology Nursing Society (ONS) since 2007. Now I am able to participate in research, present at national conferences, and lead committees.

In a 2008 RN Job survey by Advance for Nurses magazine, specialty certified RNs in Maryland earned an average of $11,000 per year more than nurses who were not certified.

I pursued certification in Oncology nursing because this is my passion. I want to be the best bedside nurse possible and being certified means being the best in your field. Eligibility Criteria ◗◗ Current, active, unrestricted nursing license; ◗◗ Minimum of one-year experience as an RN within the three years prior to application; and ◗◗ Minimum of 1,000 hours of oncology nursing practice within the 30 months prior to application.

3 – Employers prefer certified nurses.

Eighty-six percent of nurse managers surveyed indicated they would hire a certified nurse if everything else were equal. 4 – Be the best in your field.

In a recent study published in the Clinical Journal of Oncology Nursing (2009), “Effect of Certification in Oncology Nursing on Nursing-Sensitive Outcomes,” certified nurses scored higher than noncertified nurses on the Nurses’ Knowledge and Attitudes Survey Regarding Pain, as well as nausea management. Chart audits showed that certified nurses followed the National Comprehensive Network (NCCN) guidelines for chemotherapy induced nausea and vomiting management more often than non-certified nurses. The OCN test is computer-based and includes 165 multiple choice items. The test is conducted at more than 230 Pearson Professional Centers around the country. OCN certification is valid for four years.

Certified and Recertified Nurses Have you recently become a certified nurse or recertified? If so, please take the following steps: 1. Please email education_benefits@ umm.edu and fax a copy of your certification card, a completed Tuition Reimbursement form, and copy of the receipt for reimbursement to Shirley Sagbay at fax # 8-9091. 2. E-mail CPPD at certification@umm.edu with the following information: your name, your unit, name of your certification, start date of certification, and expiration date. These steps will help ensure that your continuing education funds will appropriately reflect your advanced certification, support you in reimbursement, and help to track certification numbers for your units and the organization.

Dr. Allan Retiring, continued from page 1. Dean Allan was named to Maryland’s Top 100 Women Circle of Excellence in 2008. In 2002, she received NurseWeek magazine’s Nursing Excellence Award for service to the profession and also received the NONPF Lifetime Achievement Award. In 2001, she received the Southern Nursing Research Society Distinguished Researcher of the Year Award. Since her arrival in Maryland, Dean Allan has led her peers and collaborated with health care providers to develop the Nurse Support Program II, a 10-year grant program that provides nearly $10 million annually to fund educational initiatives aimed at alleviating the state’s shortage of nursing faculty and bedside nurses. She is a founding steering committee member of the multi-sector “Who Will Care” collaboration that joined academia, industry, professional

organizations, and philanthropies together in developing the business case for addressing Maryland’s nurse shortage and establishing a $17 million dollar grant program to support nursing education. Dean Allan also serves as a member of the competitively selected state team representing Maryland at the National Nursing Education Capacity Summit sponsored by the U.S. Department of Labor, RWJF, the Center to Champion Nursing in America, and the U.S. Department of Health and Human Services. Dean Allan holds a PhD in medical anthropology from the University of California, San Francisco and Berkeley; a MS from the University of California, San Francisco; and a BS from Skidmore College. Her research focuses on weight management of women across ethnic populations. Dean Allan conducted one of the first studies in continued on page 10.

Spring 2012

Rounding Report, continued from page 1. A regular presence in the AED is our Security team. Officer Theo Byrd is frequently posted in the AED and said he is able to calm “rowdy” patients and/or family members just by his presence and proximity. Theo said, “I like interacting with the people and the nursing staff. I love being down here, I love the people.” The next people a patient would encounter are in the Triage Area. Erin DeSalvo, CRNP, nurse practitioner, explained the AED team’s goal is for a licensed independent provider to see 100% of the patients as soon as possible after arrival. The team has already cut the average time from three hours to about 30 minutes. In this way and in conjunction with the triage nurse, the provider can make a timely mini-assessment and decision about some of the necessary tests. The provider can enter orders immediately. Together with the triage nurse, they move the patient through a more efficient flow. Following triage, if patients are not emergent, they wait in the new waiting area. Because the AED will expand into the new critical care building on the corner of Lombard and Penn streets, the old waiting area was closed to facilitate connection with the new building. The outcome was the creation of a new waiting area that takes advantage of the natural light streaming in from the AED windows on the Lombard Street side. When the new building opens, the AED will grow to three triage booths with six procedural areas. The AED team worked with consultants to model future space for greatest work efficiency. In addition, the team made site visits to look at AEDs in other hospitals and their configurations and work flow. The AED Redesign Team, a project team consisting of UMMC AED physicians and nurses, developed a new flow process that will complement the physical layout of the future AED. The Redesign Team developed processes that support the overall goals of decreasing door-to-provider times and decreasing the number of patients who leave the AED before being seen by a physician. This lends to our “pull to full” process. “Pull to full” is a direct-bedding concept, where the AED team moves (pulls) patients out of the waiting area to a quick look by the triage nurse and then directly to an available AED bed. Once the department is full, patients are started in the Intake Area. In this space, the nurses and techs are able to begin completing the preliminary orders written in the Triage Area, and perform EKGs, start IVs and fluids, draw blood and get other specimens. Melissa Cross, BSN, RN, one of the nurses who work in the four-room Intake Area, said, “I like the acuity in the AED. We stay busy, see a diversity of diagnoses and use our critical thinking to figure out what’s going on with these patients.” She and Lauren Theil, MS, CNL, RN, and Kristen Dehn, a nursing student from Stevenson University, explained the purpose of the Intake Area. The team members in the Intake Area determine who needs to stay in an Intake Room, or whether the patient should go to a patient chair in the Sub-Wait Room, which is closer to the clinicians than the Waiting Area. The Intake Area team may also decide whether a stable patient should be moved back to the Waiting Area if more acute patients require a closer proximity to the clinicians. Lots of patient-flow decisions, lots of moving parts, a constantly changing landscape — all based on patient status and care requirements. The many patient care areas in the AED allow ballooning to accommodate higher patient volume and acuity. We see more patients on the weekdays than weekends. For example, on a Sunday in April, we saw about 120 patients versus 175 patients the next day on Monday. AED patients are given a severity score, which ranges from Emergency Severity Index (ESI) 1 to 5. See Figure 1 to understand the Index, where the circled numbers indicate the ESI score.

Figure 1 Emergency Severity Index Conceptual Algorithm (http://www.ahrq.gov/research/esi/esifig21.htm) A

patient dying?

yes

no yes

shouldn’t wait? no

how many resources? none

one

many

vital signs

consider

I was curious about Box D in Figure 1 — what does it mean? I learned The Emergency Severity Index (ESI) Handbook, 2012 Edition, explains “Vital signs can play a more important role in the evaluation of some patients at triage, especially those triaged as ESI level 3. The range of vital signs may provide supporting data for potential indicators of serious illness. If any of the danger zone vital signs are exceeded, it is recommended that the triage nurse consider up-triaging the patient from level 3 to level 2. Vital signs explicitly included in ESI triage include heart rate, respiratory rate, and oxygen saturation (for patients with potential respiratory compromise). Temperature is specifically used in ESI triage for children under age 3. It is important to note that when considering abnormal vital signs, blood pressure is not included in the ESI algorithm. This does not mean that the triage nurse should not take a blood pressure or a temperature on older children or adults, but that these vital signs are not necessarily helpful in selecting the appropriate triage acuity level.” (http://www.ahrq.gov/research/esi/esi5.htm). Laura Ferguson-Weigman, BSN, RN, CEN, established Waiting Room Rounds, and the team is in the process of testing this care process. The concept behind Waiting Room Rounds is that the AED experience starts in the waiting room. A big piece of customer service is keeping patients informed on a regular basis, which is particularly important on days with long wait times. We hope to improve customer service not only for our patients, but for our staff as well. We have already found that it is a great satisfier to nursing and physician staff. The triage staff and the charge nurse are frequently called out into the waiting room to answer patient questions and to deal with patient complaints. Often, service recovery is necessary, which can be time-consuming, taking the clinicians away from the patients who are being seen in the AED. By implementing Waiting Room Rounds, we increase our patient and staff satisfaction. Some ideas so far include providing staff with scripts to help explain the process and to defuse unhappiness or anxiety due to waiting. Moving along on our rounds, we met Alex Brown, the Outreach Coordinator for the JACQUES initiative. Alex explained we are trying to increase the voluntary testing for HIV while patients are being seen in the AED. Alex, who is a phlebotomist, swabs the patient’s cheek to perform a rapid HIV test. He also runs the results in about 20 minutes, so patients can receive the results while they are with us and have continued on page 7.

news &views Rounding Report, continued from page 6. access to counseling and plans for follow-up. Alex explained positive manner. The team did everything possible for this family during an cheek swab test results are correct 99.4% of the time. If a positive unexpected tragedy, and one by one, each family member entered the result is found, Alex follows up with a confirmatory blood draw, which patient’s AED room to say goodbye. He remarked that her husband is correct about 99.7% of the time for positive results. Alex said, “Our was eternally grateful to the staff and physicians for their caring, main job is to get the patient the care he or she needs. Sometimes, respectful facilitation of the needs and desires of the family. a patient has an order for HIV testing. Other times, patients may When asked about the challenges of working in the AED, Joe said choose to have the test after reading a flyer about the JACQUES our AED has the same challenge as other AEDs across the country — initiative in the Waiting Area. I also walk around when patients are gridlock. When does gridlock occur? When there are no open beds in rooms to ask if they want to be tested, mindful to approach every for AED patients to move to and the AED becomes increasingly full in patient in a non-judgmental way.” See the flyer in Figure 2. Alex the Waiting, Triage, Intake, and Sub-wait areas with all rooms filled. focuses on the linkage from diagnosis to care. He said some patients with He said, “The medicine part is not the tough part of caring for AED HIV were diagnosed previously but may not have done anything to seek patients, the gridlock is the tough part.” care and live in denial. “My job is to snap the denial to get them to care To help decrease gridlock, we have started moving some Medical providers in the community. I want to get them a linkage to care,” he said. Center patients to our neighboring sister hospital, Maryland General Theresa Gerrity, a student nurse and clinical scholar who works in (MGH). As part of a 12-hospital system, we can capitalize on the the AED part-time and will graduate in May, worked with Alex the day proximity of MGH, as well as the fact that many of our attendings and I rounded in the ED. When asked what she liked about the ED, Theresa residents see patients there. Every day, Abel Joy, MD, works with case responded, “I like the pace and the variety of patients.” Meghan managers to facilitate decisions related to patients moving to the AED Connelly, BSN, RN, who also started working in the AED as a student, or an inpatient unit at MGH. Staff, physicians, and leadership at the said she likes the fact that the AED is “…not boring and we have really Medical Center and MGH have recognized how helpful this effort has good teamwork. We have a good support system of co-workers and been in decreasing the wait time in the AED. friends. I love it when I can help patients get situated and all of the Abel said he and the case managers “…determine if patients sudden, they have a smile on their face should be admitted to the Medical Center and say they feel better – it can be or Maryland General. We work on the that immediate.” disposition of the patients and I may Emily Kay, BSN, RN, currently also complete the history and physical orients Ashley DiMaggio, BSN, RN, as well as admitting orders.” Case a new graduate. Emily said, “I like managers Gail Brandt, BSN, RN, CEN, the people I work with and we learn COHN, and Joyce Carroll, MS, RN, CMS, together every day. I’m proud to say make recommendations for whether a I work here in the AED. It’s a good patient meets criteria to be observed or place to be. I learn something new admitted. Observation patients usually every day; we have an incredible complete care within 24 to 48 hours. learning atmosphere. Working here They explained they use Milliman and has taught me how much I can and Interqual programs to run algorithms of cannot tolerate. I’ve learned how severity of illness and intensity of service. to tolerate and cope with certain These algorithms serve to facilitate situations I may have thought were too dialogue between treatment team The Institute of Human Virology’s JACQUES Initiative stressful before.” Emily and Meghan members for plan of care. is conducting FREE, RAPID HIV testing in the Emergency Departent Please tell your ER doctor or nurse if you are interested in an pointed out, “Our attendings are great. The AED team measures the HIV test TODAY!! They advocate for us, treat us as success of this work by reviewing To be tested at another time and location, just walk in Mon-Fri 9-3 or contact us at equals and are easy to approach.” specific metrics, such as length of stay in 725 W. Lombard St. Joseph Martinez, MD, who the AED, volume of AED patients seen, Baltimore, MD 21201 (410-706-4323) has been an attending physician in number of patients sent to MGH, number www.jacques.umaryland.edu the AED for many years, has seen a of patients sent to a medical unit at the lot. He cared for the victims of the Medical Center, and patient satisfaction Baltimore Water Taxi accident and for scores for patients moved to MGH. The countless patients who were victims of house fires, as well as patients first month Abel and the case managers worked to facilitate efficiency, who come to the AED because they have no other health care provider. 49 patients moved to MGH. The second month saw 63 move, and by Joe genuinely likes his patients and his colleagues, pointing out that the third month (March, 2012) 84 patients had moved from the Medical the great nurses, techs and support staff all contributed to outstanding Center to MGH. This is a win-win for all involved, as the Medical Center teamwork and compassionate care. He related the story of a sad but continues to increase its patient acuity as the University of Maryland rewarding case: An elderly woman was brought into the AED with a Medical System’s academic medical center. life-threatening intracerebral hemorrhage. As the patient was dying “Nothing is simple,” said Ben Lawner, MD, an attending physician and in the midst of a resuscitation effort, her husband shared they had in the AED since 2005. We have high-acuity patients, and that requires a 8 children and 30 grandchildren, all of whom wanted to come in to say lot of continuing education for the Emergency Medical Service providers goodbye to this special woman. The patient’s husband noted that only in the field. Ben focuses on EMS education, especially about ST segment yesterday, his wife was baking pies in their kitchen and today she was elevation myocardial infarction (STEMI) patients and their special dying. He asked the AED team to keep his wife alive so her children requirements. As he discussed the need for EMS continuing education, and grandchildren could say goodbye to her in a caring and dignified a call came in from EMS. They were bringing in a critically ill patient who continued on page 23.

Spring 2012

Nurses on a Mission to Advancement Michele Zimmer, MS, RN, Chair PAC, Brian A. Burke, MS, BSN, RN-BC, CPN, Co-Chair PAC, and Luiza Lima, MS, RN, PAC CPPD Facilitator

The Professional Advancement Council (PAC) was launched in August 2011with a group of motivated members dedicated to advancing and supporting the ongoing professional growth of nurses at UMMC. PAC activities emphasize the development of mentorship, certification, stewardship, organizational involvement, and leadership. The focus is to increase the number of successful applications for advancement under the Professional Advancement Model (PAM). PAM provides the framework for the role of the nurse and requirements for advancement. Every nurse’s performance at his or her annual evaluation is based upon this framework. Feedback on performance using the PAM is a useful tool for helping to look toward advancement. Equally important, is the discussion with the nurse manager about the desire for advancement during the annual evaluation. Nurses that are considering applying for advancement are encouraged to attend one of the two Professional Development course offerings, “How to Build a CV & Portfolio Step-by-Step” or “Looking Good in Print: How to Develop a CV & Portfolio.” These courses, with registration available through HealthStream, are a great support for the nurse in actual curriculum vitae (CV) and portfolio development skills. These courses offer insight on where a nurse may need to focus efforts towards advancement. Portfolio review cycles occur quarterly in January, April, July, and October. The development of a portfolio takes time. A successful portfolio is not built in the two weeks leading up to submission. A comprehensive list of requirements and practice focus areas for advancement to SCN I and SCN II can be found on the intranet under Professional Development (http://intra.umm.edu/ummc/advancement). Basic Requirements for Advancement to SCN I Demonstrated evidence of professional growth and development through: ◗◗ ◗◗ ◗◗ ◗◗ ◗◗

Enrollment or degree program during the past 2 years, OR Active specialty certification, OR Teaching in formal hospital programs, OR Teaching outside of the hospital, OR Board/Committee member of a professional association

Readiness for SCN I and SCN II Roles Many nurses have questions about the role of the SCN I and SCN II. Active words like “leads, actively participates, coordinates, advances, demonstrates active involvement, oversees, performs change, and mentors” highlight the roles of SCNs. This differs from the CN II role, which describes the competent CN II as a participant in unit activities. The SCN I is a leader at the unit/division levels, while the SCN II is active as a leader beyond the unit/divisional level and a mentor to others.

Process Improvement (PI) and Evidence-based Practice (EBP) Projects There are numerous opportunities on every unit for an EBP or PI project. This is possibly the biggest barrier for nurses looking toward advancement. Initiatives related to nurse-sensitive quality indicators, changes to improve or establish a process, ways to improve cost, and decreasing inefficiencies in workflow are examples of PI or EBP projects. Usually, issues that interrupt nursing practice or delay patient care generate PI projects; the only difference is by taking the lead on seeking alternative solutions, therefore influencing nursing practice and/or patient outcomes. Role of Professional Advancement Council Members of the PAC have been developing coaching and mentoring skills, as well as how to evaluate a portfolio prior to submission. In learning how to evaluate a portfolio for advancement, members can better understand how to coach staff with developing a successful portfolio, identifying areas for improvement, and highlighting contributions that most effectively support promotion. Portfolio Submission Process During each cycle, at least two review team members independently review applications from divisions or services different from their own and recommend outcomes. When the Professional Advancement Review Team (PART) meets, the reviewers present the applications to the team, answer questions, and present their recommendations. Occasionally, when PART deems necessary to bring applicants to clarify aspects of their work, interviews are scheduled and notifications go out to applicants. Embracing the Advancement Model and Next Steps The Professional Advancement Council is excited to announce that there were 16 applications for advancement submitted during the April 2012 cycle, one of the largest cycles in the past year. The advancement of nurses will continue to be cultivated and the number of successful applications for advancement should continue to rise. If you have further questions, talk with your manager, your senior leadership, or reach out to Michele Zimmer (mzimmer@umm.edu), Brian Burke (bburke@umm.edu) or Luiza Lima (llima@umm.edu).

news &views

Honorable Mentions

UMMC Nurse Residents Present Poster at National Conference Kristy Gorman, MS, RN, OCN, Nurse Residency Program Coordinator and Ayyub Hanif, BSN, RN, Post Transplant Coordinator

The Annual UHC/AACN Nurse Residency Program (NRP) meeting was held on March 6-8, 2012, in Amelia Island, Florida. There were 72 evidence-based project abstracts submitted by new graduate nurse residents from across the country that reflected excellent nursing work and research. Out of the 28 abstracts accepted for the poster session, two abstracts were accepted from UMMC nurse residents. Nurse Residents Ayyub Hanif, Angela Lewis, Veronica Rosales, and Victoria Johnson (Transplant IMC and Cardiac PCU) presented the topic, “What is the recommended interval between glucose testing and insulin administration in the acute care setting?” Nurse Resident Kathy Tran and Michele Scala, MS, RN, CPEN, Clinical Practice and Education Specialist, Pediatric Emergency Department, presented the topic, “Will the combination of a comprehensive isolation procedure and continued education improve nursing compliance with initiating precautions from triage?” As participants in the new graduate residency program at UMMC, residents are encouraged to address a clinical issue relevant to their unit practice and use EBP methods to solve the issue. Now, after beginning their cohort in the summer of 2010, they are still engaged with their EBP project implementation. UMMC supports and encourages nurses to attend national conferences such as this to provide valuable opportunities to network with peers and enrich their professional awareness. Hanif states, “The support and opportunities provided to new graduates at UMMC speaks volumes about the high quality of the nursing leadership.”

Society of Trauma Nurses Leadership Award Each year the Society of Trauma Nurses presents the Trauma Leadership Award. The award recognizes an individual, in the medical or non-medical field, who has demonstrated outstanding leadership in trauma through practice, research, publication, education, patient advocacy, injury prevention, trauma system development, or legislative involvement during his or her career at a local, state, or national level. This year the society has announced the 2012 recipient is Kathryn T. Von Rueden, MS, RN, ACNSBC, FCCM, associate professor at the University of Maryland School of Nursing and Interim Specialty Director of the Trauma/Critical Care/ED Advanced Practice Nurse graduate program. In addition to her roles at the University of Maryland School of Nursing, Ms. Von Rueden is in a joint appointment as a Clinical Nurse Specialist at the R Adams Cowley Shock Trauma Center at the UMMC. She is a Fellow of the American College of Critical Care Medicine, is a recognized expert in areas related to care of critically ill and injured patients and clinical outcome management, and has been invited to lecture internationally and nationally on a variety of subjects related to trauma, critical care, and performance improvement.

Spring 2012

The Charge Nurse Council Anne Johnston, BSN, RN, CCRN, SCN II, Interventional Radiology

The newly formed Charge Nurse Council consists of several charge nurse representatives from inpatient and procedural areas within the Medical Center. It is a subgroup of the Professional Advancement Council. This council is responsible for supporting and managing the development of the charge nurse leaders across the organization through education, resources, role definition, and relationship building. This group first met in November 2010 and became the Charge Nurse Council after recommendations from the Magnet surveyors. The surveyors recommended this because we already had a strongly identified group of charge nurses across the organization, and the Medical Center and staff would benefit from a forum or council as a supportive structure. The goal was to look for ways to standardize the training and resources available to charge nurses. At the first meeting, the Council brainstormed ideas toward accomplishing this goal. The Council’s decision was to focus on defining the role expectations of the charge nurse, provide strategies for conflict resolution, and develop a structured orientation to train new charge nurses and cultivate their leadership skills. Although the charge nurse duties may differ among units, the basic qualities that the charge nurse demonstrates should be standardized throughout the Medical Center. The council tasked each member with bringing their unit’s charge nurse expectations/ responsibilities to the group. Subsequent meetings revolved around the planning of an online reference manual and a workshop to train charge nurses. The Charge Nurse Reference manual became available to all staff in 2011. This online manual offers a centralized tool to locate the necessary resources to manage patient flow, assess staffing needs, ensure patient safety, and support an environment that is patient and family centric. The reference manual also includes support for independent problem solving of situations that can occur during the day including: the coordination of services for patients during the

admission/discharge/transfer process; tools to assist with keeping the environment clear of any safety risks; and promoting unit behaviors consistent with the National Patient Safety Goals. Phone numbers of unit charge nurses, patient care coordinators, code beeper responsibilities, Rapid Response Team contacts, and various patient care services are also in this manual. The Development of a Charge Nurse Workshop is another achievement of the Charge Nurse Council. The first workshop was held on February 24, 2012. Topics included the role of the charge nurse, use of nursing coordinators, human resources, and disaster/ emergency management. The feedback was very positive from the 25 attendees from UMMC and Kernan Hospital. Positive aspects included the topics on stress management, service recovery, managing patient assignments, security, and communication. The segment on relationship building with supplemental staffing was of particular interest to the participants. The feedback was so considerable that this topic will be expanded on for future workshops. Feedback also showed that the content was relevant to practice, and the wealth of information and resources available to the charge nurses was great. Suggestions for improvement will be included in future workshop planning. The next goal of the Charge Nurse Council is to restructure the role of the charge nurse and standardize role aspects throughout UMMC. The Council will primarily focus on formulating expectations of the charge nurse and plan the appropriate education. The Council will assess how charge nurses are oriented throughout the institution and make recommendations for the training of charge nurses for consistency throughout UMMS. This will take an understanding of the differing roles of the charge nurse in the diverse areas such as inpatient, ambulatory, and procedural areas. The Council will review each clinical area’s guidelines for the role and see how it can make a basic blueprint to help better prepare the nurse for this leadership role. Due to the overwhelming positive feedback, the Charge Nurse Council is considering the expansion of the workshop. The Charge Nurse Workshop is offered four times a year. If you are interested in attending a workshop, please register in HealthStream or call the Office of Clinical Practice and Professional Development for additional information at ext. 8-6257.

Dr. Allan Retiring, continued from page 5. the nation on the comparison of women from different ethnic groups’ practices, values, and beliefs about weight and how to manage it. She has also studied the problems of living with HIV and was instrumental in the creation of a hospice for HIV patients that serves as a national model. As a result, Dean Allan was one of nine nurses in the nation honored by the U.S. Assistant Secretary of Health for contributions to the care of people with AIDS and HIV infection. Dean Allan has published nearly 160 articles, book chapters and abstracts. She is interviewed regularly by both print and electronic media on the nurse shortage, nursing faculty shortage, breast cancer screening, hormone replacement therapy, weight management in women, obesity, and her role as dean of the School of Nursing.

The University of Maryland School of Nursing, founded in 1889, is one of the oldest and largest nursing schools, and is ranked 11th nationally. Enrolling more than 1,600 students in its baccalaureate, master’s, and doctoral programs, the School develops leaders who shape the profession of nursing and impact the health care environment. With appreciation and gratitude for the contributions made by Dean Janet Allan to nurses and nursing practice, the University of Maryland Medical System proudly announced the creation of the Dean Janet D. Allan Scholarship Fund. The System has sponsored this fund, in honor of Dean Allan, which will be used to support student awardees who attend the University of Maryland School of Nursing.

news &views Core Measures

New Immunization Core Measure Patty Dumler, BSN, RN, Quality Measure Coordinator, Quality and Safety

Effective with January 1, 2012 discharges, the Maryland Health Care Commission mandated data collection for the new Immunization Core Measure. The new Immunization Measure focuses on the screening and vaccination of admitted patients, when indicated, for the influenza and pneumococcal vaccines. The scope of this influenza and pneumococcal immunization measures has grown from what was previously required under the Pneumonia Core Measure. Prior to January 1, 2012, data for influenza and pneumococcal vaccine status for the core measure was collected only for patients discharged with a principal diagnosis code for pneumonia that met the age criteria of 50 years and older for influenza vaccine and 65 years and older for pneumococcal vaccine. The new Immunization Core Measure will collect data for all admitted patients, regardless of their diagnosis code. Age criteria for the influenza vaccine has been expanded to include admitted patients age 6 months and older. The pneumococcal vaccine covers three different age levels: all patients age 65 years and older; patients age 6-64 years with high-risk conditions (diabetes, nephrotic syndrome, ESRD, CHF, COPD, HIV, or asplenia); and patients age 19-64 years with asthma.

The importance of all core measures can not be emphasized enough. Core measure compliance continues to be used to measure hospital compliance with evidence based practice standards by The Joint Commission and The Centers for Medicare and Medicaid Services (CMS). CMS uses performance on the core measures to determine reimbursement for all states except Maryland. In Maryland, the Health Services Cost Review Commission (HSCRC) uses core measure performance to determine hospital reimbursement. Additionally, The Joint Commission has incorporated the core measures into the hospital survey process. Accurate documentation is extremely important for all core measures to demonstrate compliance with evidence-based practice standards. In anticipation of this new measure set, revisions to the immunization assessment tools in Power Chart were made on December 27, 2011 to ensure compliance in assessment and vaccination. ◗◗ ALL admitted patients are assessed for influenza and pneumococcal immunization status using the influenza and pneumococcal patient assessment forms in PowerChart. ◗◗ Patients are vaccinated if they meet inclusion criteria and do not refuse the vaccine or do not meet any of the exclusion criteria on the influenza and pneumococcal patient assessment forms. ◗◗ If the patient is unable to recall their vaccine status, check: • With the patient’s family; • Outside forms, if the patient was transferred from another facility (inpatient hospital, skilled nursing facility, etc.); and • The Immunization tab in PowerChart.

◗◗ If deferral criteria is checked on either of the vaccine assessment forms, the patient must be reassessed when the deferral criteria is no longer met. ◗◗ If vaccine reassessment is performed, do not change the original assessment. Instead, open a new form from AdHoc charting rather than modifying the original assessment. ◗◗ On the influenza and pneumococcal patient assessment forms, the “Clinician ordering the vaccine” is the nurse completing the assessment. ◗◗ The Immunization tab in Power Chart can be used to determine if the patient has received the pneumococcal vaccine any time in the past or if they have already received the influenza vaccine during the current flu season here at UMMC. ◗◗ The vaccines column on the Quality Dashboard is to be used daily to: • Verify that vaccine assessments are being completed; • Identify patients with deferred vaccine assessments with vaccine reassessment when the deferral criteria is no longer met; and • Identify patients that have one or both of the vaccines ordered, but it has not yet been signed off as given on the eMar. For questions about the Immunization Core Measure, please contact Patty Dumler via email pdumler@umm.edu.

UMNursing, continued from page 3. co-chair the Infrastructure component and in the next two years, their strategic plans include the identification of the SON and UMMC governance structures relevant to UMNursing, the creation of a joint appointment advisory board, and the development of mechanisms to effectively share relevant information, such as events and accomplishments, between the SON and UMMC. Under the leadership and guidance of Dean Allan and Dr. Rowen, the UMNursing partnership has evolved and prospered. Not only is this

unique partnership one of the only such partnerships in the United States, but its visionary and innovative structure makes it an effective tool for the achievement of the IOM recommendations. As Dean Allan prepares for retirement, she and Dr. Rowen can be proud of their success in developing and advancing a successful partnership that will shape the future of nursing.

Spring 2012

Nurses Week 2012 N U R S I N G O N A M I SS I O N TO E XC E L L E N C E

A Civil Day at UMMC Erica Bergstein, BS and Rachel Hercenberg, BA, Special Projects Coordinators, Clinical Practice and Professional Development

The 2012 Trends in Nursing Practice Conference, “Interprofessional Civility in Healthcare: Awareness, Impact, & Outcomes,” held on May 1, 2012, highlighted a relevant and pertinent topic in contemporary nursing. Over 185 participants engaged in a full day of learning about interprofessional civility in health care and its impact on the safety and health of health-care providers and the patients they serve. Angela Sintes, MS, RN, CNL, Clinical Education Specialist, Clinical Practice and Professional Development, chaired the Planning Committee and invited a diverse and dynamic group of speakers to present their contributions, outlooks, and recommendations regarding civility. A culture of safety is characterized by open and respectful communication among all members of the health care team. Disruptive behavior in health-care settings interferes with effective communication among health care providers, negatively impacts performance and outcomes, and threatens safe patient care. The concept of civility, while seemingly simple or innate, has a multitude of contributing factors and impacts health care workers and patients both professionally and personally. The Trends in Nursing Practice Conference provided a foundation of what civility looks like, concrete tools for enhancing interprofessional communication and teamwork, successful accounts from those who studied and changed their hospital-wide culture, and preparation tools for engaging in civil interactions while finding inner peace. David Feldman, MD, MBA, CPE, FACS, Senior Vice President and Chief Medical Officer of Hospital Insurance Company/FOJP, keynote speaker, candidly and humorously shared his journey about his establishment and implementation of the Maimonides Medical Center Code of Mutual Respect in Brooklyn, New York. Although his work originally focused on operating room culture, the program was implemented hospital wide and resulted in a significant cultural change in interprofessional conduct. The success of Dr. Feldman’s program can be partly attributed to the multiple interdisciplinary team training sessions that were provided for staff. Finally, he reinforced that although changing a culture can take years of work and leadership buy-in, the benefits were palpable. Following Dr. Feldman’s thought provoking address, Gregory D. Raymond, MS, MBA, RN, Director of Nursing and Patient Care Services, NeuroCare and Behavioral Health Services, provided a strong

foundation and literature review of workplace civility as it relates to nursing. He discussed civility as it impacts patient and employee safety, and financial and emotional costs. Once the participants gained a strong understanding of civility, Karen Doyle, MBA, MS, RN, NEA-BC, Vice President of Nursing and Operations, R Adams Cowley Shock Trauma Center and Adult Emergency Department, and David G. Hunt, MSN, RN, Director of Nursing, Cardiac Care and Radiology, further raised civility awareness by sharing a number of real accounts of incivility, workplace bullying, and the impact on the workplace. They encouraged staff to report both overt and covert occurrences of incivility. Lisa Rowen, DNSc, RN, FAAN, Senior Vice President of Patient Care Services and Chief Nursing Officer, interjected in agreement, emphasizing that in leadership meetings we have been asking how we have harmed or almost harmed a patient, but we should also consider how we harm or almost harm each other. Deborah Dang, PhD, RN, NEA-BC, Director of Nursing, Practice, Education, and Research at The Johns Hopkins Hospital, educated the participants by sharing her research study from The Johns Hopkins Hospital regarding the impacts of disruptive behavior on hospital employees. She stressed that disruptive behavior can be prevented at all levels. Caryn Zolotorow, MS, BSN, RNC-OB, Nurse Manager, Labor and Delivery, Inpatient Perinatal/Gynecology, Full Term Nursery Services, shared the successful implementation of TeamSTEPPS on several units at UMMC. Caryn reviewed a number of approaches to conflict resolution and the critical components to a strong functioning team. Afterwards, Maurice (Mo) Davis, Lieutenant Colonel Ret., MS, Manager of Security Services, dynamically provided concrete verbal and body language communication tips that promote thoughtful, meaningful, and safe interactions. Mo quoted UMMC staff member, Willie Williams, “Before you were anything, you were human,” emphasizing the importance of treating everyone as human beings. Following lunch, the speakers shifted their focus towards self care and introspection. Dan Eisner, OTR/L, Certified Coach, Department of Psychiatry, discussed the importance of emotional intelligence, self awareness, and conscious movement. Bonnie Tarantino, MFA, Director of the Healing Pathways Program, University of Maryland School of Medicine, Center for Integrative Medicine, and Lolly Forsythe-Chisolm, BA, Integrative Care Technician, closed the conference with a calming operationalization of Dan’s presentation. Bonnie and Lolly emphasized the importance of receiving; they explained that being civil involves both giving and allowing others to give to you. They discussed energy as it relates to civility, and shared Maya Angelou’s quote, “People will forget what you said, people will forget what you did, but people will never forget how you made them feel.” Finally, Bonnie and Lolly concluded the conference with a guided imagery meditation session using therapeutic bowls. The 2012 Trends in Nursing Conference provided participants with the tools to promote civility with use of de-escalation techniques, appropriate interpersonal communication skills, and compassionate self care. Participants left the conference looking united, present in the moment, and more aware of themselves and their surroundings. The Trends in Nursing Conference presenters and Planning Committee provided participants with genuine, informative, and practical information that staff can easily integrate in their practice.

news &views Nursing Excellence Awards Anne E. Naunton, MS, RN-BC, Professional Development Coordinator, Clinical Practice and Professional Development

The hallmark event for Nurses Week is the annual nursing awards program. Award recipients, guests, and attendees filled the UMMC auditorium on May 9, 2012 and brought an abundance of enthusiasm and pride. The program began with a musical prelude by Certified Music Practitioners Carol Loeb, BSN, RN and Martha Vance, Student Intern, from the Integrative Medicine Team. Lisa Rowen, DNSc, RN, FAAN, Senior VP of Nursing and Patient Care Services and Chief Nursing Officer, hosted the event and welcomed our distinguished colleagues that included Janet Allan, PhD, RN, FAAN, Dean and Professor, University of Maryland School of Nursing; Jay Perman, MD, President, UMAB; Robert Chrencik, President and CEO, UMMS; and Jeffrey Rivest, President and CEO, UMMC. Dr. Allan was the recipient of the University of Maryland School of Nursing Colleague Award, which is presented to a faculty member who exemplifies excellence as a mentor, leader and educator.

The UMMC theme for Nurses Week 2012 was “Nursing on a Mission to Excellence.” Every day, nurses at UMMC fulfill our mission to provide exemplary patient care. The Nursing Excellence Awards recognize the talents, skills, knowledge, and expertise of our nurses. It is a special opportunity to celebrate UMMC nurses who are willing and able to share their passion for excellence in patient care delivery. A complete listing of all nursing award nominees and recipients is located on the UMM intranet under the “Nursing” section.

UMMC Nurses Give Back to the Community

donation, and diabetes. Nurses from UMMC, as well as nursing students from the University of Maryland School of Nursing, took blood pressures readings throughout the entire fair, a resource that many attendees greatly appreciated. Sean Brannon, GI Tech, shared that members of his family suffer from diabetes and cancer. He volunteered at the health fair as a testament to his family and that he embraces any opportunity to educate others about healthy living. Eveena Felder, RN, Nurse Manager, Pediatric Heart Center, shared that this health fair is an, “opportunity to keep in touch with the community that UMMC serves.” Thank you to all departments and staff that helped make this year’s health fair another success.

Stephanie Hague, BA, Special Projects Coordinator, Clinical Practice & Professional Development

On Thursday, May 10, 2012, more than 90 nurses from throughout UMMC gathered at Lexington Market for the Nurses Week Community Health Fair. The four hour health fair welcomed more than 800 community members, who collected information about varying topics such as smoking cessation, pediatric asthma, heart disease, organ

The Art of Perception: Nurses Week Grand Rounds Stephanie Hague, BA, Special Projects Coordinator, Clinical Practice & Professional Development

The ability to learn and reconsider how one perceives the world is essential in linking the eye and the mind. Amy Herman, JD, MA, taught this essential lesson and others related to perception, communication, and observation to a full UMMC auditorium on May 8th for an enhanced Nurses Week Grand Rounds. Originally designed in 2000 to help medical students improve their observation and communication skills with patients, “The Art of Perception” was subsequently adapted for law enforcement professionals and leaders in healthcare, education, and finance. Ms. Herman recently began presenting more substantially in the nursing community. Ms. Herman’s multimedia presentation was complete with videos, slides, interactive activities, and audience engagement. It focused around captivating works of classical art, historic photographs, and modern law investigations. She used these tools to emphasize multiple points essential to nursing: cultural competence, perceptual empathy, clear communication, and unintentional blindness. Ms. Herman also said, “No two people see anything the same way.” Because of this, specifically in healthcare, both written and verbal communication must be as clear and well-articulated as possible. Often times, people leap from their observations to inferences, almost instantaneously, which can greatly affect the information that is transferred and ultimately the care the patient receives. Kristy Gorman, MS, RN, OCN, Clinical Education Specialist, Clinical Practice & Professional Development, heard Ms. Herman’s presentation, “The Art of Perception” at the annual UHC/AACN Nurse Residency Program (NRP) meeting in Florida this past March. Kristy reflected on the importance of this presentation for hospital staff and why this is an ideal program for Nurses Week. “In direct patient

care, effective communication is key,” Kristy said. “One omission of an important detail can drastically impact patient care and safety.” Veronica Rosales, BSN, RN, Clinical Nurse II, Progressive Care Unit, also heard Ms. Herman present at the conference and was very excited about the prospect of Ms. Herman presenting at UMMC. “Her session was extremely helpful to nursing, in both documentation and communication between fellow nurses and the entire interdisciplinary team,” Veronica said. “In addition to addressing how to communicate information effectively, her presentation also helps nurses broaden their perspective of crucial information.” This presentation offered an enlightened and unique perspective to all staff members present and forced everyone to reconsider how they view others. It was also one of many exciting additions to Nurses Week 2012. One participant, while exiting, commented that this program was, “The best Nurses Week gift I could ask for.” For more information about Amy Herman, and the Art of Perception, please visit her website at http://aop.artfulperception.com/

Spring 2012

Holistic Nursing Practice: An Opportunity For Caring and Job Satisfaction Cynthia Kerr Salmond, DNP, CRNP, Nurse Practitioner, Acute Pain Management Service, R Adams Cowley Shock Trauma Center

HEART

Caring and Job Satisfaction

MIND

Nurses are trained how to do the job of nursing and caring for others, but not how to care for the self (Watson, 2008). Magnet recognition of UMMC shows that nursing care is exemplary, with advanced educational levels, flexible management styles, and abundant research opportunities reflected in the excellence of care given to patients. Magnet status is an important measure for consumers of health care. While most components of the Magnet model are directed to patient care, management, and education, there is little to exhibit the impact of self-care practices on the nursing staff, which should also be considered significant. Self care and caring science theory may be seen as unusual content in a fast paced academic medical environment. While this theory is grounded in the discipline of nursing, there is relevance to all health and human sciences and professions (Peery, 2010). The processes of caring science, as theorized by Jean Watson, include being present and moving beyond ego-self, the creative use of self and engaging in authentic teaching learning experiences (Watson, 2008). These processes among others in the theory direct the nurse to focus on self in order to be able to best care for patients. Watson (2008) also notes that caring science is complementary to curing science. Nurses are well versed in the curing science of patients, as demonstrated by proficiency in skill sets and pathway outcomes. However, many may argue that the real satisfaction within nursing is the caring component, which has been overshadowed by an exclusive curing model. Amendolair (2012) notes that through caring, nurses find meaning in their work and from caring they can achieve job satisfaction and become engaged in the role of nursing. Job satisfaction is a critical and consistent challenge for healthcare organizations. Nursing staff will go to institutions that they believe will support satisfaction. Gullatte and Jirasakhiran (2005) note that while organizations spend thousands of dollars for recruitment of staff, retention initiatives receive little fiscal support. Zangaro and Soeken (2007) designed a meta-analysis to show that positive work environments, among other factors, increase job satisfaction as well. Readers may conclude from these studies that the impetus is on hospital administrators to change the work environment; however, it is in fact possible for individual nurses to first create a nurturing environment within themselves through self-care practices such as yoga, meditation and mindfulness-based

stress reduction (MBSR). This change in self can lead to more positive interactions with other staff and patients. Moreover, modeling these behaviors to other staff members can foster curiosity and awareness of the multitude of self care processes and could lead to a resultant positive change in retention rates. Holistic nursing includes the daily practice of personal dedication to engagement in self reflection and self care activities that support the healing of mental, physical, emotional, spiritual, and relational aspects of oneâ&#x20AC;&#x2122;s life and others (Dossey and Keegan, 2009). Self-care activities can encompass a variety of methods, but the underlying requirement is participation in an activity that only the individual can do for him or herself. It is mandatory to cultivate these personal practices in order to be prepared for participation in the experiences of our patients and colleagues (Watson, 2008). Understanding and appreciating the concepts of unity, totality, and connectedness of everyone and everything are imperative in holistic practice and can have a direct positive effect on experiences in daily life. The meaningful relationships created as a result of honoring others and their experiences can contribute to self-worth and well-being, which lead to an increase in job and career satisfaction (Amendolair, 2012). Furthermore, as holistic nursing encompasses all of nursing practice environments and demographics, it takes place wherever healing occurs; so every nurse can be a holistic nurse (Mariano, 2009).

S OU L

Negative themes common in nursing practice environments include job stress, rates of burnout, and rates of turnover. Nurses at the University of Maryland Medical Center (UMMC) are not exempt from these themes. As this tertiary care center expands technological capabilities and surgical interventions, nurses are expected to increase their knowledge base to keep pace with these advances and those in computerized order entry system, pharmacy delivery methods, and other indirect patient care tasks. However, less and less time is dedicated to managing the non-technological duty of care of self and others which can decrease stress and burnout (Amendolair, 2012).

B O DY

The American Holistic Nurses Association (AHNA) was created in 1980 to foster a community of holistic health and nursing. The UMMC chapter of this organization, started in February 2012, was formed to uphold the AHNA vision to unite nurses in healing. The chapter meets three times monthly, in order to accommodate multiple schedules and to engage in a range of topics. Individuals are encouraged to discuss self-care practices and encounters in clinical settings that could benefit from holistic practice processes. The participants have noted that they feel energized to share information with their coworkers and leaders after leaving meetings. The overall goal of the chapter is to increase education in holistic practice, including understanding important concepts of presence, empathy, and stress; development of research projects; and expression of self-reported improvement in delivery of care to patients and colleagues as a result of embracing holistic ways. It is the hope of the chapter leaders that individuals and collective units throughout the clinical areas can experience and continued on page 15.

news &views We Discover

Journal Club Hot Topics Luizalice Lima, MS, RN-BC, Professional Development Coordinator, Clinical Practice & Professional Development and Patricia Woltz, MS, RN, Research Nurse, Nursing and Patient Care Services

The March meeting of the Journal Club was hosted by Patricia Gent, MS, RN, CCRN, from the GI Endoscopy Lab. Patricia competently and passionately guided the audience through the article, “A Randomized Controlled Trial on Nurse-Led Care for Symptomatic Moderate-Severe Obstructive Sleep Apnea (OSA)” (Antic et al., 2009). This multicenter noninferiority clinical trial compared nurse-led patient management to specialist-directed care in 174 individuals

2012 Nursing EBP and Research “We Discover” Series Patricia Woltz, MS, RN, Research Nurse, Nursing and Patient Care Services

Supporting the educational needs and professional advancement of UMMC nurses, the “We Discover” series offers presentations and workshops by experienced

who had been referred to academic sleep medicine services with clinical suspicion of OSA. The primary study outcome was daytime sleepiness after 3 months. Secondary outcomes included quality of life (QOL) and cost-effectiveness. The study demonstrated that a simplified package of care incorporating nurse-led home diagnosis and controlled positive air pressure (CPAP) therapy for patients with moderate to severe OSA compared to physician-led current best practice in OSA management produced similar results (was noninferior) in reducing daytime sleepiness. There were no differences in QOL or patient satisfaction, but the nurse-led model was more cost-effective. It was noted that nurses participating in the simplified model were specialists in OSA who consulted with physicians at their discretion. The discussion that followed was enriched by Janet Hanson, NP from the University of Maryland Sleep Center. With extensive experience and knowledge in OSA, Janet contributed to a quality discussion among the nurses in attendance who represented a broad

cross-section of the UMMC.

presenters on evidence-based practice and research-related skills and methods. In response to popular demand, this year’s topics include preparing for poster presentations, translating evidence into practice and the purpose of audits, measuring outcomes, and two-part workshops on literature searching and on abstract writing. In the last session, “We Discover” was hosted by the HSHSL SON librarian and nursing liaison Katherine Downton, MS, LIS. We looked at levels of evidence and explored finding systematic reviews

and professional guidelines on websites like Cochrane and AHRQ’s National Guideline Clearinghouse. The follow-up session in June includes hands-on guidance searching for primary sources in databases such as CINAHL and PubMed. Mark your calendars. Classes are held on the third Wednesday of the month from 1:30-2:30 PM (no sessions are scheduled in July and Sept). Notifications of upcoming sessions are emailed to all staff 2-3 weeks in advance. Contact: Ana Costache via email acostache@umm.edu or Pat Woltz via email pwoltz@umm.edu.

Discussion:

◗◗ Sleep centers, which arose in early 1980s, continue to evolve in care delivery. Use of CPAP equipment began in late 1980s. ◗◗ OSA is a pervasive issue that crosses all areas of patient care. Nurses encounter patients with OSA in all specialties and levels of care. Hospital night shift nurses are in an opportune position to identify persons with OSA. ◗◗ The study raises awareness of OSA. There is increased need for patient assessment, especially in patients who are overweight, and in the understanding of issues related to patient adherence to CPAP therapy. ◗◗ Education of nurses as well as patients and patient referral to the University of Maryland Sleep Center can promote early diagnosis and patient-centered approaches.

Holistic Nursing Practice, continued from page 14. incorporate holistic practice in order to balance the stress and well-being that is constantly challenged in a large medical center environment. Although it is impossible to remove stressful situations that arise as a result of working in an esteemed medical center, if self-care practice is included in daily routine, positive reactions to the stress can help to decrease dissatisfaction. Holistic nursing is a welcome addition to practice for every nurse in every clinical area, with the potential to positively impact every patient’s experience in the organization, while also helping to heal him or her self. For more information about the UMMC Holistic Nurses chapter, please contact Diane Smith at dsmith2@umm.edu or Cynthia Salmond at csalmond@umm.edu.

References Amedolair, D. (2012). Caring Behaviors and Job Satisfaction. The Journal of Nursing Administration, 42 (1), 34-39. Dossey, B. M., & Keegan, L. (Eds.). (2009). Holistic nursing: A handbook for practice (5th ed). Sudbury, MA: Jones and Bartlett. Gullatte, M. and Jirasakhiran, E. (2005). Retention and Recruitment: Reversing the order. Clinical Journal of Oncology Nursing, 9, 597-604. Mariano, C. (2009). Holistic nursing: Scope and standards of practice. In B. M. Dossey, & L. Keegan (Eds.), Holistic nursing: A handbook for practice (5th ed). Sudbury, MA: Jones and Bartlett. Peery, A. (2010). Caring and Burnout in Registered Nurses: What’s the connection? International Journal for Human Caring, 14(2), 53-60. Watson, J. (2008). Nursing: The Philosophy and Science of Caring. Boulder: Colorado: University Press of Colorado Zangaro, G. and Soeken, K. (2007). A Meta-Analysis of Studies of Job Satisfaction. Research in Nursing and Health, 30, 445-458.

Spring 2012

Lessons Learned From Safety Discussions During Staff Nurse Council Meetings Christine Byerly, BSN, RNC-NIC, SCN II, NICU

The Staff Nurse Council (SNC) members are empowered to create hospital-wide changes and initiatives through safety discussions between staff nurse representatives and nursing leadership at monthly council meetings. Every month, Lisa Rowen, DNSc, RN, FAAN, Senior VP and Chief Nursing Officer and Christine Byerly, BSN, RNC-NIC, SCN II, NICU, ask the council “What have we done to harm or almost harm a patient?” With this question as a catalyst, the SNC has worked to create long-lasting enhanced safety changes through interdisciplinary communication and sustainable teamwork. The following items and stories are examples of the impact of these safety discussions to educate staff and improve patient safety. Current Safety Discussions

5 East Gudelsky

Elevator Safety and Safe Transportation of Patients: The SNC is now partnering with facilities to find lasting solutions for elevator access, prioritizing floors, and modifying sensors.

A council member reported a miscommunication between a nurse and a provider regarding PTT lab value results and Argatroban (anticoagulant). The nurse communicated to the provider that the patient’s medication dose was “3.8,” but did not clarify that this was the rate on the pump and not the actual dose in terms of mcg/kg/min. The incident did not result in any patient harm. The staff viewed this as a learning opportunity and completed cascade learning, in addition to having discussions with members from the MEADE Council (Medication Error Adverse Drug Event Council). The big takeaway was the importance of clear communication between all members of the interdisciplinary team and specifying all essential values with units of measure.

Alaris Pumps: The main challenge with the pumps is the channel disconnect that causes pumps to shut off. The SNC is working with Clinical Engineering to identify the scope of problems and appropriate reporting. General Pediatrics Staff recognized several safety issues with the PhaSeal device that was previously attached to chemotherapy administration sets. The PhaSeal was designed to create a closed system for chemotherapy administration; however, the negative impact was found to outweigh the positive. Nurses noted that the weight of the PhaSeal device bent the IV tubing, thus resulting in occlusion errors, which would ultimately run the tubing dry. In addition, several nurses experienced needle exposure when manipulating the PhaSeal connectors. In raising this issue at a SNC meeting, the Pharmacy representative stated that several spills had also recently occurred after introducing the PhaSeal. Shortly after the SNC meeting, Pharmacy had a meeting with PhaSeal representatives, and the product was temporarily removed while Clinical Practice and Professional Development worked with pertinent staff on re-education. Peds Surgery Center Patients are pre-medicated prior to surgery with Versed. The majority of patients take the drug orally, and the nurses know the color and consistency of the drug very well. Versed was easily identified in the Omnicell. Now the drug comes in light blue flat tubs. One morning while preparing to administer the drug to a patient, the nurse noticed the medication was orange when pouring it into the medicine cup. On investigation, the nurse found that Methadone was stocked in the Omnicell drawer with Versed. The packaging for Methadone and Versed was the exact same color and size and did not have scanable bar codes. One key lesson learned is to always double check medications removed from Omnicell. As a result of this discussion, Pharmacy added a bar code to all Versed cups. The larger impact is that Pharmacy is completing a gap analysis of all medications that they prepare and dispense that do not have a bar code.

Would you like to have your article published in News&Views ? Submitted articles should: • Cover clinical and professional nursing practice in inpatient, procedural and ambulatory areas that are evidencebased, innovative and outcomes driven. • Focus on divisional, departmental and/or organizational strategic goals. See page 2 for guidelines for submission.

news &views Shock Trauma Center DVT Awareness Campaign Becky Barlow, MS, RN, CN II and Kathryn T. Von Rueden, MS, RN, ACNS-BC, FCCM, Clinical Nurse Specialist, R Adams Cowley Shock Trauma Center

In 2005, the U. S. Senate named March “DVT Awareness Month” in response to deep vein thrombosis (DVT) being a major source of morbidity and mortality in the United States. In conjunction with the national “DVT Awareness Month,” the Shock Trauma Center Nursing Quality Council (QC) has focused on education and awareness of DVT prevention. March 2012 was the 6th year that the QC has used this opportunity to improve DVT awareness for staff, patients and their families. The importance of DVT awareness and prevention has been well documented and championed by public institutions such as the National Quality Forum, the Joint Commission, and the Centers for Medicaid and Medicare Services. In the trauma population, DVT prophylaxis is especially important because DVT is reported in up to 60% of trauma patients, and pulmonary embolus occurs in up to 24% of trauma patients.1 The Shock Trauma QC has heightened awareness of this public health issue with the use of a variety of interactive educational activities. This past March DVT Awareness Month was celebrated using a roving educational cart complete with leg lamp lights and a leg lamp-attired council member (see photo), DVT prevention logo screensavers on all nursing unit computers (see photo), and unit posters/bulletin boards (see photo). The QC partnered with the education representative from Covidien to educate staff through roving inservices and to distribute DVT self-risk assessments for nurses to use on themselves and their own family members. In addition, “Not-sotrivial Pursuit” quizzes were distributed to nursing students’ clinical instructors. The students took the quizzes and discussed their patients’ DVT prophylaxis and risk factors as part of their clinical conferences. Previous years have included decorated DVT educational socks for nursing stations, DVT “Not-so-trivial Pursuit” contest with prizes, and Heparin versus Lovenox fact sheets developed by PharmD’s.

Historically, the QC has collected and reported DVT prophylaxis data on a quarterly basis. The audit includes: physician order for pneumatic compression device (PCD), the PCD machine properly working, properly applied to patient, and documented. This year for DVT Awareness Month, a Shock Trauma-wide DVT prophylaxis prevalence study was conducted that included 79 inpatients plus an additional 112 audits conducted by QC members. This comprehensive evaluation of DVT prevention practices is being compared with data from prior quarters and will be reported to the nurses and physicians at Shock Trauma. References

Rogers F, et al: Venous thromboembolism in trauma. J Intensive Care Med. 2007;22:26-37. 1

Evelyn Jordan Center Strives to Increase Patient Adherence to Colposcopy Sheila Lee, BSN, RN, ACRN, SCN I, Evelyn Jordan Center

In July 2011, the Evelyn Jordan Center nursing staff launched a unit quality improvement project to improve patient adherence to colposcopy appointments. Implementation of these innovations may result in better patient outcomes including early cancer diagnosis, treatment and reduced mortality cases. Research has demonstrated that HIV infected women have rates of cervical dysplasia 10 to 11 times greater than rates observed in HIV negative women. However, in 2010 the nurses noted that only 37% of the patients with abnormal Pap smears actually followed through with colposcopy procedures. As a result, the nurses implemented several strategies with the goal of increasing the adherence rate from 37% to 50% or greater. Strategies included staff education about patient/provider communication,

cultural sensitivity, health literacy, and potential barriers. Patients were counseled, educated, and pre-screened for possible barriers to adherence. Nurses promptly notified patients of results by phone, and provided mail and reminder calls on the day prior to the appointment. First quarter colposcopy appointment adherence data demonstrates a 12% decrease from the previous year 2010 data of 37% to 25%. However, second quarter data demonstrates a 20% increase/improvement over the first quarter data of 25% to 45%. Unfortunately the third quarter data demonstrates a 15% decrease from the second quarter data of 45% to 30%. Nurses continue to re-evaluate interventions toward a future goal of 50% or greater for colposcopy appointment adherence.

Spring 2012

Making a Difference for Maryland’s Women & Children: Nurse Practitioner Contributions Shari Simone, DNP, CPNP-AC, FCCM

National Nurses Week is a time to recognize and celebrate the tremendous performance of our nurses on a daily basis. As the lead Nurse Practitioner (NP) for Women’s and Children’s Services, I have the opportunity and privilege of working side by side with an exemplary group of advanced practice nurses (APN) and routinely witness the dedication, commitment, and tireless effort to provide expert care and improve outcomes for their patients. Although the NPs are highly visible at the bedside, many of their contributions to the organization and nursing practice are less evident and also deserve recognition. As we celebrate nurses and their accomplishments, I would like to highlight some of the important activities of this advanced practice nursing team. Caroline Bauer, MSN, CPNP-PC and Peggy Dorr, MS, CPNP-AC, Pediatric Cardiology, championed UMMC’s participation in a Single Ventricle Program that is part of a larger national initiative. This comprehensive effort has multiple ongoing projects, but the most notable achievements have included the home monitoring program, feeding protocol, and discharge planning/family education. The NPs manage the home monitoring project, which includes frequent communication with families to monitor daily weights and pulse oximetry values. This data provides critical information to ensure early interventions for these fragile babies, thereby reducing the high mortality rate. In addition, the NPs partnered with an interdisciplinary team to create an EBP feeding protocol to standardize postoperative feeding practices. The NPs have also developed comprehensive tools to facilitate discharge planning and prepare families to care for their child with complex cardiac needs at home. Mary Ellen Connolly, MSN, CPNP-BC; Andrea French, MS, CPNPBC; and Rita Tracewell, MS, CPNP-AC, Pediatric Surgery, partnered with the lactation specialists to promote breast milk as the primary nutrition in the surgical infant. This EBP endeavor ensures that women who are expecting an infant with a surgical problem are seen by the lactation specialist prior to delivery and receive education on benefits and technical skills. The NP team works closely with the NICU staff to encourage mothers to breastfeed after delivery. In an effort to assist families of limited means during their hospitalization, the NP team donates cafeteria meal tickets. The tickets are given to needy families with children who may not be able to purchase food in the cafeteria. The NPs are partnering with other subspecialty NPs and child-life specialists to improve the pediatric preoperative process that includes teaching integrative medicine techniques to prepare for surgery. The NPs also published several manuscripts over the past year on the obese child having surgery, the benefits of breast milk to prevent obesity complications, and the management of the child with intestinal failure. Dyana Conway, MSN, CRNP, Pediatric Sedation, has led the pediatric sedation service for outpatient and inpatient diagnostic studies for the past 2 years. This service has rapidly expanded to provide procedural sedation for children in the pediatric units and outpatient areas. This service is projected to provide sedation to over 400 children this year. In addition, Dyana championed the development of a Pediatric PICC team and chairs the highly successful annual NP conference.

Jessica Strohm Farber, DNP, CRNP, PNP-BC, CCRN; Jennifer Hughes, MSN, CPNP-AC; Jennifer Nordling, MS, CPNP-AC; Jill Siegrist, MSN, CPNP-AC; Jamie Tumulty, MS, CPNP-AC; and Anne Vasiliadis, MS, CPNP-AC, Pediatric Critical Care, have led several research investigations and currently include a NIH funded multi-center pediatric sedation study, “Randomized Evaluation of Sedation Titration for Respiratory Failure” and an AACN-funded study, “AIRS: Alarm Identification and Response Simulation.” A third study, “Objective Measure of Level of Care for Pediatric Hospitalized Patients: Use of the Pediatric Early Warning Score (PEWS)” is planned to start this summer. Several of the NPs presented at APN conferences and authored chapters in a recently published Pediatric NP Acute Care textbook. Courtney Rawls, MSN, CRNP, Maryland Women’s Center, conducted an assessment of knowledge of birth control methods among underprivileged women seeking termination of pregnancy. The Maryland Women’s Center was awarded the Ryan Residency training status, which provided funding and technical expertise to expand outpatient family planning services. Results of the assessment will be used to guide family planning services including education, counseling, and provision of free, long-acting reversible contraceptives. Courtney is also participating in efforts to build relationships with freestanding family planning clinics and regional maternal/fetal medicine departments to provide compassionate care to women with genetic abnormalities of pregnancy. Lisa DiStefano, MS, CPNP-PC, Breathmobile, provides free asthma care to underserved children in Baltimore. The mobile clinic travels to local schools, Head Start centers, and a Latino community center, making it easier for families to receive preventive care and education. The evidence-based care combined with a communitybased approach, has decreased ER visits, hospital admissions, and missed school days for these children. Eighty percent of the children have achieved asthma control within three visits, regardless of their baseline disease severity. Under Lisa’s leadership, the program saw approximately 500 children last year and continues to provide care as it champions the, “Play Hard Breathe Easy” campaign in partnership with Kohl’s to demonstrate that children with controlled asthma can enjoy physical activity and play. Tamara Hill, MS, CPNP-AC, Pediatric Nephrology, is a critical link in the provision of continuity, family-centered care for children on peritoneal dialysis. Tamara’s ongoing communication with these children and their families has been key to promoting treatment compliance. Tamara is currently leading a quality improvement project aimed at reducing peritonitis rates and is the study coordinator for the Chronic Kidney Disease Study and the North American Pediatric Renal Transplant Cooperative Study. Susan Lovelace, MSN, CRNP, Pediatric Immunology, is passionate and committed to children at risk and infected with HIV and was a speaker on Pediatric HIV in the Bahamas, Kenya and Guyana. She is currently developing a transitioning program for HIV infected young adults. Susan is also active in planning health fairs and leading support groups for adolescents and young adults with HIV infection. She was also selected to speak at an annual international AIDS conference. Melanie Muller, MS, CPNP-AC, Pediatric Cardiothoracic Surgery, has rapidly gained expertise in providing seamless, comprehensive care to this highly complex patient population. This service has continued on page 23.

news &views A Weekend With RAM Jean Rochevot, MS, RN, CCRN, SCN I, Nurse Transport Specialist, Maryland ExpressCare and Karin Wallace, BSN, RN, CCRN, CN II, Surgical Intensive Care Unit

Remote Area Medical (RAM) is a non-profit organization that provides free medical, dental, and vision care to underserved and uninsured populations around the world. Founded in 1985 by Stan Brock, RAM also has a domestic program. The domestic aspect, Rural America Program, accounts for more than half of RAMâ&#x20AC;&#x2122;s programming. This part of the program concentrates on poverty pockets of Southern Appalachia, and consists of volunteer run clinics that provide an assortment of free health care services, with no requirement for insurance or ability to pay. Karin Wallace, RN, CCRN, CN II, Surgical Intensive Care Unit, has worked with RAM for several years. It was through her conversations regarding a RAM volunteer weekend that close friend and former co-worker Jean Rochevot, MS, RN, CCRN, SCN I, Nurse Transport Specialist, Maryland ExpressCare, decided to plan a trip to Buena Vista, Virginia to take part in a clinic. Karin is constantly sharing stories about her work at RAM weekends and the wonderful people she has met. Jean was looking for volunteer work as a way to give back, but she lacked the time and finances to travel overseas. So, RAM was the perfect opportunity. Jean and Karin teamed up for a road trip to the Buena Vista clinic on a rainy weekend in March. The volunteer response was encouraging, and there was an excess of nurses available at this particular event. Willing to do anything to help out, Jean and Karin found themselves working in the dental clinic running the sterile processing of instruments. As nurses, they felt experienced in this area and took on the task. They found it to be hard work, yet immensely enjoyable. They did not have direct running water, which made the experience similar to a field unit. Their system was reliant on young volunteers who would run buckets of fresh water to them every few hours. Within a short time their team had mastered the soaking, scrubbing, ultrasound, and autoclaving of the different dental instruments. It was wonderful for them to meet new people, learn new skills, and give back to the community. At the end of the experience, Jean and Karin were totally exhausted but grateful for the opportunity.

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Spring 2012

UMMC Nursing

Around the World

Foreign Surgical Missions Offer Unique Experiences and Challenges Darlene Carco, BSN, RN, MHA, CNOR, SCN II, Operating Room, STC

It has been my privilege to participate in many foreign surgical missions throughout the past seven years. My first experience was to Guayaquil, Ecuador in February of 2006, with the Ecuadent Foundation. The gratification I experienced from that initial trip had an overwhelming effect on my life. In June of that same year, I joined a second mission, this time to Esmeraldes, Ecuador. In 2006 I became a standing member of Ecuadent and continue to participate in surgical missions every February. My passion for surgical missions has only grown over the past years. I have participated in two UMMC missions to Haiti, and last year I worked with another foundation, the Healing Hands Foundation, where I traveled to Guatemala. It is amazing to see the beauty in these countries, while also immense poverty and destruction. Amazingly enough, amid all the poverty and destruction, there is an overwhelming sense of national pride and joy. The focus of these missions is to provide high quality surgical care to underprivileged children and adults. Because I typically work with an adult population, this is a pleasant change for me. Surgeries performed include cleft lip and palate repairs, burn scar revisions, and corrections of congenital deformities. It is wonderful to see the look on the faces of the parents and their extreme appreciation when we correct a severe cleft lip. Each mission trip is unique and offers experiences and challenges. I recommend this experience for experienced nurses, as well as new nurses.

Creation of New Trauma Centers in Rio de Janeiro, Brazil Guided by STC & CNMC Joint Venture Deanna Holler, RN, MS, Trauma Nursing Coordinator, STC

The anticipation of hosting the World Cup Soccer Games in 2014 and the Olympics in 2016 in Brazil is an exciting proposition, but it requires an inordinate amount of planning and preparation. This preparation includes the creation of four trauma centers in Rio de Janeiro, Brazil. When the state of Rio began to search for consultants to aid in the planning of four new trauma centers, they sought advice and guidance from John Spearman, MBA, Senior Vice President, External Affairs & Global Health Initiatives, at UMMC. In response to their request, a six-week intensive training program in Adult and Pediatric Trauma was created for a team of 17 Brazilian nurses and physicians through a cooperative effort with the R Adams Cowley Shock Trauma Center (STC) and the Childrenâ&#x20AC;&#x2122;s National Medical Center (CNMC). In January of this year, six nurses from the Hospital Estudual Alberto Torres Trauma Center (HEAT) arrived in Baltimore to participate in this training program designed by Karen McQuillan, MS, RN, CNS-BS, CCRN, CNRN, FAAN, Clinical Education Specialist, STC. The nurses spent four weeks at STC, followed by two weeks at CNMC in Washington, D.C. to learn about trauma systems and trauma care throughout the entire continuum â&#x20AC;&#x201D; from pre-hospital care through rehabilitation. At STC, their program was composed of a combination of teaching modalities including didactic lectures and presentations, clinical observations,

simulation, participation in multidisciplinary meetings and shared government councils, and shadowing key leadership individuals. The nurses spent each day actively involved in the aforementioned activities, and concluded each afternoon with a daily debriefing. Following a short break before dinner, they finished their evenings by reconvening in their hotel to reflect upon what they had learned that day and to incorporate this information into the development of a strategic plan to present to their government and implement upon their return to Rio. At the conclusion of their educational experience in STC, the joint nurse and physician group presented their plan for implementation to our staff, initially at HEAT, and then ultimately for the opening of three additional trauma centers in Rio. When reflecting back upon this experience, I believe it is safe to say that everyone who had the opportunity to participate in this training program felt privileged, not only to have taught, but also to have learned from our Brazilian colleagues. They were a very intelligent, insightful, skilled, warm, and engaging group of professionals, who showed an unquenchable thirst for knowledge, and a genuine desire to improve trauma care for the citizens of Rio. Many lessons were learned during our four weeks together. It was with pride that we observed the evolution and transformation of these nurses and physicians as they developed their plans for HEAT, focusing on communication, teamwork, safety, education, competency, and quality improvement. Their future will be both exciting and challenging. Their professionalism, tireless dedication, commitment, courage, and strength will serve them well. The leaders and pioneers will develop a world class trauma system for the state of Rio de Janeiro. These nurses and physicians are our lifelong friends and colleagues, and will always remain a source of our inspiration.

news &views Infection Reduction Realized in New Dehli, India Trauma Center Through Collaboration With STC Nurses Linda Byrne, MS, RN, SCN II, Neurotrauma, STC

In 2009, the R Adams Cowley Shock Trauma Center (STC) initiated a strong relationship with the JPN Apex Trauma Center (JPN) in India after nurses from the STC were invited to speak and serve as chairpersons for the nursing track at the conference, “Trauma 2009 International Congress, CME cum Live Workshop and Second Annual Conference of the Indian Society for Trauma and Acute Care.” Nurses from the STC have continued to be invited to speak every year since 2009. These visits offered an opportunity to share knowledge about the care of trauma patients and forged new friendships with our colleagues practicing in India. Despite the stark differences in many aspects of our care environments, we recognized that we shared many common challenges in our care of trauma patients, including the need to reduce hospitalacquired infections. In February 2011, Karen McQuillan, MS, RN, CNS-BC, CCRN, CNRN, FAAN, coordinated efforts to have several of the nurses from our STC Quality Council join forces with several nurses in India to establish an infection reduction collaborative. Members of this collaborative, which met for the first time in March 2011, include Beth Pruitt, BSN, RN, SCN I, Multitrauma IMC; Tina Gerlack, RN, SCN I, Neurotrauma IMC; Linda Byrne, MS, RN, SCN II, Neurotrauma; Rebecca Gilmore, RN, CN II, TRU; Michele Emerick, BSN, RN, CIC, Infection Control; Karen McQuillan, MS, RN, CNS-BC, FAAN; Kathryn Von Ruden, MS, RN, CNS-BC, FCCM; Manjari Joshi, MD, MBBS, Infectious Disease; Carla Aresco, MS, CRNP; and Ellyn Tennyson, MS, CRNP. We communicate through monthly teleconferencing. Our first initiative has been to help in the reduction of CLABSI rates. During our first teleconference, we discovered that at JPN, infection rates were not publicly displayed for the staff. We encouraged the nurses to do quality boards and sent photos of our own to increase awareness of infection rates and to provide education. Each STC nurse was partnered with a nurse at JPN who worked in a similar trauma area to provide mentorship.

Example of a Quality Board at JPN We shared the importance of documenting on a central line insertion checklist and holding everyone accountable for maintaining sterility and “speaking up” when sterility is not maintained. Unfortunately, this is difficult for the nurses in India because of their culture. They do not feel comfortable speaking up or questioning a physician. Deepak Agrawal, MD, Associate Professor, Neurosurgery, JPN, has joined forces with our collaborative and has agreed to help the nurses feel empowered in accomplishing this difficult task. We have also advised the nurses to wear a mask and cap when assisting the physicians with line insertions. With our advice and support and the help of Dr. Agrawal, we have been able to foster changes to their practice. Line Cart Over the past several months we have helped them develop more stringent audit tools to monitor this quality initiative while discussing best evidence-based catheter insertion and line maintenance practices. Monthly, we share ideas and discuss what is working well and areas that still need attention. Carla Aresco, RN, MS, CRNP, rounding with the medical team in India We are extremely excited to report that through this collaboration, the Neurotrauma Critical Care Unit at JPN had zero CLABSI’s for the month of January 2012. It is truly amazing that we were able to help patients in a trauma center across the world. Through communication, education, and friendship we were able to improve patient outcomes and really make a difference miles and miles away from home.

Philippine Nurses Association of Maryland travels to Philippines to Offer Medical Care, Donate, and Support Local Programs Pat Wilson, BSN, RN, Clinical Transition Coordinator, Clinical Practice and Professional Development and Fe Nieves Khouw, MSN, RN, President, Philippine Nurses Association of Maryland

The Philippine Nurses Association of Maryland Chapter (PNAMC) traveled to the Philippines in January and February, 2012. The objectives were to: ◗◗ Educate nurses at the Saint Louis University School of Nursing; ◗◗ Offer medical services to the people of Bakun, Benguet, Phillipines; ◗◗ Visit and donate money to the Saint Louis University Sunflower Centennial Halfway House for Boys; and ◗◗ Donate a medical mobile to the community of Davao City.

Pat Wilson (PJ), BSN, RN, Clinical Transition Coordinator, Clinical Practice and Professional Development, joined over 30 members of the PNAMC and sister chapters from five other states as they traveled to the Philippines to teach at a Trends of Nursing conference at St. Louis University and to complete a medical mission in the mountain province of Benguet. Lovella Eugenio, BSN, RN, SCN I, CNOR, Perioperative Services and Minette Vergara, BSN, RN, CN II, MICU, were part of the Medical Center team with Fe Nieves Khouw, MSN, RN, President, PNAMC. Nurses from local hospitals such as Johns Hopkins, Franklin Square, Maryland General, Greater Baltimore Medical Center, and Mercy Medical Center were also part of the trip. They were joined by nurses continued on page 22.

Spring 2012

Philippine Nurses Association, continued from page 21. from New Jersey, California, Washington D.C., West Virginia, and North Carolina. Trends of Nursing Practice Conference The PNAMC, in collaboration with the Saint Louis University School of Nursing, sponsored a nursing conference on February 2. The conference, part of the Philippine Nurses Association of America’s initiative called “Balikturo” (return to teach), is designed to facilitate Filipino expatriates to give back and share knowledge and expertise with their Filipino counterparts in the native land. The general purpose of the conference was to ensure that faculty, staff, and student participants from the Cordillera region of the Philippines learned timely and evidence-based information about nursing and nursing practice to keep pace with developments in the United States. The conference was entitled, “Trends in Nursing Practice” and was offered completely free to all registrants. There were over 300 attendees, including nurses, faculty, and nursing students from various colleges and universities. PJ Wilson gave a podium presentation entitled “Nursing in America: Critical Success Factors.” Other topics touched on a wide range of clinical topics, such as evidence-based nursing practice, robotic surgery, trends in critical care nursing, patient safety, and quality. Additional topic areas such as finance in nursing, patient satisfaction, and improving your odds for working abroad were also presented. Medical Mission The PNAMC conducted general health, dental and minor surgery services in the beautiful mountains of Bakun, Benguet on January 30 and 31, 2012. The clinic was held in partnership with the faculty of Saint Louis University (SLU), physicians and medical practitioners from the hospital affiliated with SLU, and the local health officers of the town of Amposungan. Rural health officers included dentists, general practitioners, and other ancillary staff. The local government also provided security services through their local police department, a necessary component of any health mission in a foreign land. Many of the patients walked for miles and hours to get to the health clinic. The clinic staff included a multidisciplinary team of dentists, medical technicians, nurses, researchers, surgeons, physicians, and pediatricians. Nurses functioned in multiple roles from registration, triage, health teaching, research, phlebotomy, medication dispensing, teaching, and assisting in dental extraction and minor surgery. The role of the nurse is vital to meeting the needs of the patients. The health mission screened and treated 649 patients that included adults and children. Patients that presented for services at the health mission had a wide range of complaints, ranging from chronic conditions such as

hypertension, heart disease, and diabetes to acute infectious illnesses such as UTI, URI, or amoeba infestations. Many adults, adolescents, and children had decayed teeth that needed extractions, which may be from poor nutrition and inadequate dental hygiene. Pediatric patients were treated mostly for upper respiratory illnesses, as well as asthma. Sunflower Centennial Halfway Home for Boys The health mission team visited the Saint Louis University Sunflower Centennial Halfway Home for Boys. The Halfway House provides programs and services for boys, 5-17 years old, who have experienced abuse, abandonment, and/or neglect. This center is the first and only one of its kind in the Philippines, as it focuses on the treatment of boys. Most services in the Philippines are focused on treating girls. This home and the services it offers is built on the premise that male children who suffer physical/sexual abuse and/or abandonment have unique psychiatric and psychosocial needs that merit specific focus and attention. Residents in this program are halfway in their journey of healing and recovery. The program promotes re-integration with capable family members or possible referral to a child caring institution that will care more permanently for his overall welfare. PNAMC gave a generous donation of over $2,000 to the organization. The donation covers over three months of operational programs and services, including salaries, food, and recreational activities. Donation and Celebration of Mobile Clinic A formal dedication of the medical mobile clinic was held on February 6, 2012 by the US project partners in conjunction with the San Pedro Alumni Association and PNAMC. The PNAMC, in partnership with the Rotary Club of Pikesville and Rotary partners, District 7620, spearheaded the donation of a mobile clinic to the residents of Davao City through the San Pedro College Community Extension Services (SPCCES), who will provide the technical and logistical support and will coordinate the manpower support throughout the operation. The mobile clinic is equipped with dental and medical provisions and has laboratory capability. The project will provide free health care to thousands of underserved recipients in the remote areas of Davao City, Philippines. The dedication ceremony was attended by the President of San Pedro College, the Dean of Academic Affairs, representatives from PNAMC, and representatives from the San Pedro College of Nursing Alumni Association.

news &views Nurse Practitioner Contributions, continued from page 18.

rapidly grown, and she has been instrumental in developing pre and postoperative education tools, order sets, and discharge education materials. Melanie also participated in the development of the pediatric ECMO service and is a research staff member for the PICU sedation study. Diane Wells, MSN, CRNP, Pediatric Hematology & Oncology, is active in many pediatric oncology research investigations. She was the primary investigator of a Children’s Oncology Group protocol studying caregiving demands of parents of children with

leukemia enrolled in a particular clinical trial and randomized between two therapies and is currently preparing the manuscript for publication. Diane is collaborating with the Director of the Pediatric Hematology and Oncology Service in the development of a comprehensive Cancer Survivorship Program for children, adolescents, and young adults treated at UMMC and others who lack this resource. Diane is also facilitating an outreach service where oncology patients from other centers without a radiation facility are receiving their radiation treatments at UMMC.

Rounding Report, continued from page 7. was “found down” in the bathroom. There were no empty rooms for this patient and the least sick patient in the AED was brought out of her room so that it could be cleaned and ready to go for this new patient. I watched as the AED team prepared for the patient. Every member of the team used hand gel, gowned and wore a face shield. The team knew both of the paramedics, who began giving report as they wheeled the patient in the room. Jeremy White, a firefighter and paramedic, explained the patient was found unresponsive. Because they needed to maintain the c-spine, there was no way to bring the patient down the steps from the second story with the patient on a long board. So, they called for backup from their firefighter colleagues, who brought a truck with an extension ladder. They put the patient flat in what he referred to as a basket, and were able to maintain spinal alignment with the patient remaining flat rather than on a slant. Jamison Anderson, RN, was the charge nurse when I rounded. She said, “I’ve been here for six years. We’re a big family, like brothers and sisters. We may disagree with each other sometimes, but we adore each other, including the physicians . . . We’re all one big team. Our manager, Tom, is incredible. He’s fair, and he doesn’t feed into our ‘stuff.’ In fact, it rolls off his back. Tom doesn’t ask anything of you he wouldn’t do himself. He laps this place constantly, looking to see how he can help. He supports and advocates for us and for patients. And, Tom knows what he is doing — he is a clinical expert.” Jamison said that Karen Doyle, Vice President for Nursing and Operations for Shock Trauma and the Adult ED, “has been amazing in her support. If we start talking about the possibility of going on yellow alert, she calls us to ask what she can do. She loves the AED!” Regardless of whether the team member is in management or is a clinician or a staff member who supports clinical practice, the work is meaningful to all. Just ask the AED transporters. Jimmy Williams, who has been with the Medical Center for 11 years with three in the AED, was the first AED transporter. He said, “We keep things moving. I like the excitement, learn a lot and meet a lot of people.” Richard Howard, an AED transporter, said, “I never considered working in a hospital before, but it’s rewarding most days because you feel like you’re helping someone without expecting anything in return.” Jimmy and Brittannie Richardson, AED transporters, took me over to see the You Were Noticed board, where team members write each other notes of thanks for their help. While reading the messages of thanks and appreciation, you can’t help but note the care the team members have for each other. Moving on in our rounds, we entered the Ambulatory Zone, affectionately referred to as the AZ. Nora Dunlap, BSN, RN; Lauren Schroeder, CRNP; and Chelsea Ruch, BSN, RN (who has also been a registrar and patient care technician) explained the AZ is the care area where less-emergent patients are routed. Typically, patients who are ESI 4 and ESI 5 will come to this area, such as patients with

conjunctivitis, lumps, bumps, fractures, sprains, abscesses and dental issues. The AZ has 8 patient rooms/booths and gets about 28% to 30% of the total AED volume. Open Monday at 7 a.m. through Saturday at 7 a.m., the AZ is run by the AED nurse practitioner (NP) team. Erin DeSalvo said, “The AZ was groundbreaking. It was the first time NPs practiced in the AED.” Now, 11 NPs work in the AZ. Nicole Cypress, BSN, RN, has been in the AED since 2010, transferring from Weinberg 5. Nicole said, “I learn something new every day. We have a mix of senior and newer nurses and great teamwork. Tom is an awesome manager. He is flexible, understanding and a big help.” As we wrapped up rounds, we stopped at the AED Discharge Lounge. This room can hold up to 10 patients who will soon be discharged, but may have a few needs to address. They might need a last set of vital signs, or a last pain score assessment or to receive their paperwork. The Discharge Lounge frees up other beds for the most acutely ill. If all of this isn’t enough, the AED team is also always working on performance improvement projects and research studies. Mike Witting, MD, has worked with nurses on many studies. Recently, he and Stacey Hydorn, BSN, RN, began studying orthostatic blood pressures and their interpretation. They found a lot of variety in how blood pressure readings are taken and interpreted. Mike explained, “We all need to be on the same page in our care of our patients in a standardized fashion.” Michael Winters, MD, is the medical director for the AED. He said, “It is truly a privilege to be working with such a talented team of physicians, nurse practitioners, nurses, case managers, patient care technicians, transporters, and administrative staff. In the face of increasing volume and patient acuity, the AED team is continually changing so that we can provide the most efficient and safest care to all who walk into our AED. Through Tom Crusse and Karen Doyle’s amazing leadership, we are moving confidently in the direction of becoming the nation’s premier place for emergency care, patient safety, and education. Quite simply, the AED team is outstanding!” “Our emergency department is a complex environment, and it is staffed by many outstanding individuals with unique qualifications and expertise,” said Brian Browne, MD, chief of Emergency Medicine. “But we are more than the sum of our parts. We are a team! Everyone — physicians, nurses, and staff members — plays a vital role in our delivery of care. If anyone is missing, we notice . . . and we don’t function as well without them. When we work together, great things can happen, including the occasional miracle.” There are so many more stories and examples of why the AED team is remarkable. The area is full of excitement, the work is intense and the people are extraordinary. What more could we ask for? How do you spell team? AED.

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Clinical Practice Update: May 15, 2012 PowerChart Enhancements Education Materials Learn about how the new features in PowerChart function. w Review the attached Educational Packet of Nursing Updates w View the interactive Online Training module for hands-on practice at

www.umm.edu/cernertraining/elearning/RN_Cerner2010_upgrade.htm Entering Home Medications: w Home medications must be documented within 24 hours of admission w New features in PowerChart streamline this process w Enter medication list with appropriate option: w Select “No Known Home Meds” w Select “Unable to Obtain Information” w Enter medication list (Document Medication by Hx) w Use existing list from previous admission

Verify for completeness and accuracy and make any modifications Select “Use Last Compliance” to attest to this verification Don’t forget to “Complete” old prescriptions (Add to Home Med List if still taking the medication). For questions about this Clinical Practice Update, please contact Susanne Anderson at manderson1@umm.edu