News and views Spring 2015

news views

A Publication of the Department of Nursing and Patient Care Services

Spring 2015

University of Maryland Medical Center

LEAD – Administrative Professionals on the Move Marisol Tobaldo, Administrative Coordinator; Thomas Harris, Tekiyah Shabazz, and Lindsey Pescrille, Unit Secretaries

It all began with a passionate and innovative idea that was presented by Marisol Tobaldo, administrative coordinator to Tina Cafeo, DNP, RN, director of nursing for Medicine, Surgery, and Cardiac Services. With the enthusiastic support of Tina, Marisol put together a small group of unit secretaries to plan and implement a council structure that would engage and strengthen administrative team members among these three clinical services. After five months of extensive planning, she convened the administrative professionals council, now known as LEAD, on March 19, 2013.

LEAD — Learn, Experience, Achieve, and Develop — is a council that aims to provide mentorship, education, training, and engaging experiences to administrative professionals at UMMC. Various initiatives were developed within LEAD to give administrative professionals a chance to implement new ideas with the desire of disseminating successful practices to other units. The initial project focused on the key areas of process improvement, operational effectiveness, retention, growth and development, and recognition of administrative staff.

One of the first initiatives was to adopt a best practice from the Medicine Telemetry unit on 13 East/West called Rapid Improvement for Discharge. The objective of this initiative was to create a more effective and efficient discharge process. Thomas Harris, Jr., a unit secretary on 10 East, facilitated a group of unit

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secretaries to come up with a particular method known as the “Discharge Pass.” On many units, discharge is very random; this group was challenged to devise a process that would make it useful and more time efficient.

After testing, implementation, and collaboration with discharge facilitators, Transplant 8 Gudelsky, and the LEAD council, the “Discharge Pass” was transformed into the “Go Card.”

The “Go Card,” a discharge checklist placed on the patient’s bedside chart to identify a patient for discharge, helps to shorten the discharge process time, allows for unit secretaries to have a continued on page 14.

Lisa Rowen’s Rounds: PICU Receives CNO Award for Team Excellence Talk about doing it all! The Pediatric Intensive Care Unit (PICU) staff are skilled to care for critically ill newborns to young adults: their competencies include every service and specialty we offer in pediatrics; they are the code and rapid response team for all pediatric patients at the Medical Center; they provide post anesthesia care for pediatric patients requiring extended care, as well as at times on weekends and nights when the Peds PACU is closed.

They do all of this for vulnerable patients while embracing, educating, and including anxious and Lisa Rowen, DNSc, RN, FAAN protective parents in a truly patient and familySenior Vice President of centered approach. As Melissa Bierly, RN, said, Patient Care Services and “I love it here. It’s hard; you never know what Chief Nursing Officer you’ll learn.”

Adrian Holloway, MD, PICU attending, said, “Our nurses are very adaptable. The ICU has grown a great deal this past year and constantly changes.

We’ve increased the complexity of cardiac surgery and ECMO patients and are now planning for

BMT and neurosurgery patients. The nurses have embraced rapid change with great facility. They’ve met every challenge.”

On my rounds in the PICU, I noted repeatedly the wonderful and collaborative relationship between the staff and the providers. Lauren Manrai, RN, CCRN, is currently in the RN-to-MS program at the University of Maryland School of Nursing (UMSON).

She said she worked three years at a children’s hospital in Chicago. I asked her how we compare, and Lauren said we compare very well. She explained continued on page 6.

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Spring 2015

In This Issue

Corporate Compliance

1

LEAD — Administrative Professionals on the Move

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Lisa Rowen’s Rounds: PICU Receives CNO Award for Team Excellence

Kallie A. Smith, Corporate Compliance Analyst, UMMS Corporate Compliance and Business Ethics Group

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Corporate Compliance

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Visitation by a Patient’s Personal Pet

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Professional Advancement Model – Coaching for Coaches

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UMMC Sponsors Nurses at Consortium

In each issue, the Medical Center Compliance Program provides a short Frequently Asked Question (FAQ) for News & Views. We are looking for new ways to reach out to employees to raise awareness of compliance issues. Please let us know what you think, or suggest topics by emailing compliance@umm.edu or tjackson4@umm.edu.

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Nurses Week 2015

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Embracing Our Teamwork and a Shared Vision for the Future

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Achievements

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Spotlight on Pharmacy

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Bed Management in Portfolio

20 Comprehensive Nutrition Support Guidelines for Critical Care 21

Trends Conference 2015

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Certification Corner

24

Clinical Practice Update

Compliance FAQ Q: Some of my co-workers have been posting patient information on Facebook and commenting on each other’s posts; should I report this activity?

A: Yes! Even if pages are set to private on Facebook, we must all remember that our posts are never truly hidden on the internet. It is so important to practice caution when posting on social media and commenting on other’s posts.

Whether at work or home, protected

health information should never be discussed outside of the patient care setting and we must all abide by HIPAA to protect the privacy of our patients.

If you or anyone else is questioning the content of a post on social media, please call our anonymous compliance hotline at 410-328-3889 or Martina Sedlak, privacy officer and compliance director, at 410-328-4757 and alert them of any issues or concerns.

Find news&views online at http://umm.edu/professionals/nursing/newsletter and on the UMMC INSIDER at http://intra.umms.org/ummc/nursing/cppd/excellence/publications/news-and-views

Editor-in-Chief

Kimmith Jones, DNP, RN, CCNS, RN-BC Director of Translation to Nursing Practice Clinical Practice and Professional Development Managing Editor

Susan Santos Carey, MS Lead, Operations Clinical Practice and Professional Development Editorial Board

Lisa Rowen, DNSc, RN, FAAN Senior Vice President of Patient Care Services and Chief Nursing Officer Suzanne Leiter Executive Assistant to the Senior Vice President of Patient Care Services and Chief Nursing Officer Greg Raymond, MS, MBA, RN Director, Nursing and Patient Care Services Clinical Practice and Professional Development, Neuroscience and Behavioral Health Chris Lindsley Director, Communication Services University of Maryland Medical System Anne Haddad Publications Editor University of Maryland Medical System

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

Scope of Publication The scope of NEWS & VIEWS is to provide clinical and

professional nursing and patient care services practice topics that focus on inpatient, procedural, and ambulatory areas.

Submission Guidelines

Send completed articles via e-mail to scarey@umm.edu Please follow the guidelines provided below.

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

2. Length – Maximum three double spaced typed pages.

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

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

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

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

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

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

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

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

ISSUE DUE DATE Summer 2015 July 6, 2015 Due to organization focus on Epic Portfolio, there will be no Fall issue.

Winter 2016 January 4, 2016 Spring 2016 April 4, 2016

Displaying Credentials

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

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

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

news &views Visitation by a Patient’s Personal Pet Susan Carole Roy, D.Min., BCC, Director, Pastoral Care Services

Imagine that you are hospitalized and that a very special friend is so distraught that they have stopped eating in your absence. Your friend is old and nearing the end of his life. Desperate to help your friend, you convince the medical team to roll you out the front door on a stretcher in your fanciest hospital attire; and on a cold, rainy Saturday in November, you coax your friend to eat amidst bus fumes, honking car horns, cigarette smoke, hurried visitors and curious staff in the traffic circle in front of the Medical Center. I happened to be one of those curious staff members who watched that day as a mother-to-be on bedrest during her first pregnancy tried to help her elderly dog cope with her absence.

While stories about sneaking pets inside health care facilities to see their owners or patients going outside to rendezvous with their pets are legendary, there is perhaps another way to bring patients and their beloved pets together, which is safer and more welcoming for all concerned. It is also a testimony that advances in patient care can occur when intuitive and compassionate practices stand up to the rigors of science, and then finally become accepted as hospital policy. This is the case with UMMC’s policy that allows a patient’s pet to visit, bringing a healing power that is, in fact, somewhat measurable.

In the late 1970s, researchers studied the one-year survival rate of 92 patients after they were discharged from the coronary care unit of University of Maryland Hospital. The research focused on the independent importance of social factors in the determination of health status. To their knowledge, no previous studies had included pet ownership among those social variables. The investigators were shocked to discover that the presence of a pet was the second-strongest predictor that the patient would still be living a year later.1 As one of the researchers, James Lynch, said of the study in his book, A Cry Unheard, in which he further explored the subject of loneliness and health outcomes as well as the emerging therapeutic benefits of animal companions on human health: “Almost four times more petless patients had died in that first year, even though they represented only 42 percent of the sample population.”2 Furthermore, the researchers discovered that the type of pet did not affect the outcome. In fact, “the relationship between pet ownership and survival remained significant even when subjects owning dogs were eliminated from the analysis.”1 Almost 25 years after this study, UMMC became one of a few academic medical centers to allow patients’ pets to visit them. While medical science may be slow to embrace such new ideas, cardiologist Erika Feller, MD, one of the policy’s greatest champions, says “There are few downsides to allowing pets to visit their ailing owners in the hospital. There is much to be gained by all. Not only do patients derive emotional, continued on page 4.

Joseph Gallagher visits with his cat, Lyle.

According to Lauren Perrella, Mr. Gallagher’s daughter:

“The pet visit was the highlight of my dad’s three-week stay in the CPCU unit. My dad and Lyle were very close companions and spent all day, every day, side by side. While my dad was in the hospital, he was very worried about his cat and how lonely he must be. When I mentioned to Dr. Feller that my dad would love to see his cat, she put things in motion and we had a visit set up right away. Dad could hardly wait.

His visit was extraordinary. Lyle was very relaxed and calm and stayed for four hours. My dad pet, stroked, and held him the entire time. It was very touching to see. He invited all of the staff in to see his beloved cat, and they made a big fuss, to my dad’s delight. The following day was my dad’s best day. He seemed to be even more driven to get out of the hospital to go to home hospice.

Lyle and his family were waiting for [Dad] when he arrived. He enjoyed his brief time at my house until his passing. Lyle was by his side or on his bed the entire time, even in the hours after his death.”

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Visitation by a Patient’s Personal Pet,

continued from page 3.

tangible benefit, but hospitals are seen less as sterile, stark, and unemotional places but as multidisciplinary environments where healing is encouraged at all levels. Having pets visit their patients is a win-win for everyone involved.”

Under the leadership of Pastoral Care Services, the hospital approved the policy called Visitation by Patient’s Personal/Family Pet (POC-002). It can be found on the UMMC Insider under the Provision of Care policies. This policy allows a patient to receive visits from their own dog or cat. Most visits occur when a patient makes a request, a member of the health care team observes the importance of a patient’s pet, the patient has a long length of stay, the pet or patient is experiencing some stress from being separated, or the patient is nearing the end of life. Pastoral Care meets with the family and, when appropriate, the patient, to explain the process, complete the forms, ascertain approvals, and coordinate and oversee a safe visit. The pet’s veterinarian must complete the health form. The patient/family must sign the Release from Responsibility waiver. The clinical care team — nurse manager, attending physician or physician assistant, and the staff from Infection Prevention — also must approve the visit.

All world religions have sacred texts that include the importance of animals. One of the most famous comes from the Old Testament prophet Job, who reminds readers to “ask the animals, and they will teach you.” (Job 12:7) Many saints, such as St. Francis of Assisi, were particularly close to nature and animals, leading us to consider the healing aspect of our interaction with these creatures. Others, like John of the Cross, remind us that animals can lift our spirits because they do not chatter and are full of love and understanding. In fact, patient pets have clearly understood the gravity of the patient’s situation, exerting tremendous emotional energy to be present to all. Families report so often that the dogs go home and crash for several days that we now warn family members to be attentive to the fatigue displayed by dogs, in particular, after visits. The patient’s personal pet often leads to significant ministry between pastoral care staff and patients and/or families.

Most visits are by dogs, but there are also requests made for cat visits. Some staff have had concerns about extending visiting rights to felines. However, several cats who have visited their hospitalized owners at UMMC dispelled any concerns about a cat’s ability to handle the hospital environment. One such example was the visit by Lyle, a cat who belonged to Joseph Gallagher, a former Medical Center patient. Pets who visit must be thoroughly brushed and groomed and must wear some type of clothing to contain dander and fur. Often dogs wear a T-shirt.

Lyle, not to be outdone by a dog, arrived wearing a fashionable infant onesie.

“Many of us have known the great comfort and love we’ve received from our own pets. Translating this into policy and practice to facilitate a patient to hold his beloved cat shows

the difference we can make in someone’s life, and sometimes, in someone’s death,” says Lisa Rowen, DNSc, RN, FAAN, senior vice president and chief nursing officer, who supports the policy.

She goes on to say that “We’re able to allow the pets in to do the good they can do, with a policy that spells out how we will make sure to prevent any problems, such as for people with allergies.

It is part of our mission to seek and find ways to allow positive things to happen for a patient.”

Over the years we have learned some important lessons that ensure a positive visit. Often when a patient has been ill for an extended period of time, it is easy for them to miss taking their pets for yearly check-ups and vaccinations. If the pet is not current on all necessary vaccines, there is an automatic 14-day waiting period once the pet receives a vaccine and is allowed to visit. This is why we often advise families and staff to wait to inform a patient about the possibility that their pet can visit until all the documentation has been approved, so as not to disappoint a patient and further add to their distress.

Sometimes the staff delights in the visiting pets, too, so we ask members of the health care team to exercise restraint, allowing the pet to acclimate to the situation and giving the patient ample time to visit, before asking the patient/family permission to touch or interact with the pet. Staff also must practice hand hygiene after any encounter with a patient’s pet.

The patient’s pet is not allowed, under any circumstances, to visit other patients or families, be left unattended, or be in the hallway without a pastoral care escort.

Although some have proposed expanding the ways in which animals currently visit the Medical Center, recent publications indicate careful consideration must be given whenever animals are introduced to an acute care setting. The recent publication of an article on reducing the risk of animals in health care settings by the Society for Healthcare Epidemiology of America (SHEA) suggests that more study is needed before expanding to other types of programs, such as pet therapy. The safety and wellbeing of patients, families, staff and visitors — and even the animals — inform decisions about the kind of programs involving animals in the Medical Center and the formation of our current policies and procedures.

On behalf of all, special thanks to everyone who helps make these visits successful for the patient, family, staff, and pet. As Reverend Dave Simpson, father of sixteen-year-old Autumn, said of her cat Luna’s visit during her hospitalization at the Medical Center: “Thank you for making it possible for Luna to visit Autumn. That was the absolute best encouragement Autumn received during the six days she was there.”

References 1. E. Friedmann, A. Katcher, J. Lynch, and S. Thomas. Animal companions and one-year survival of patients after discharge from a coronary care unit. Public Health Reports, 1980; 307-312.

2. James J. Lynch. A Cry Unheard: New Insights into the Medical Consequences of Loneliness. Baltimore, MD: Bancroft Press, 2000.

news &views Professional Advancement Model: Coaching for Coaches Erin Barnaba, MS, RN, OCN, CNL, Clinical Practice and Development Coordinator

Coaching for Coaches was held in February 2015 as an educational opportunity for employees to gain an improved understanding of the nursing Professional Advancement Model (PAM), which is designed to “recognize and reward nurses based on their professional contributions to advancing practice and the profession of nursing.” The course was intended for nurses who coach other nurses within the model, but was open to anyone with interest.

Content included the background of the model, components required for advancement, advice for portfolio compilation, descriptions of supporting evidence in a portfolio, examples of leadership, and skills for coaching applicants. In addition to these discussions, sample portfolios were provided. The class also focused on utilization of the materials available on the Insider.

Fifty-nine nurses, including members of the Professional Advancement Council (PAC) and the Professional Advancement Review Team (PART), were educated. In an effort to keep council and review team members up-to-date on coaching techniques, all members of the PAC and new members of the PART were required to attend the course. Positive feedback was received, including comments such as: “I will be more prepared to apply for advancement.”

“I will use this information for the development of my own portfolio and share it with my co-workers who are also interested in advancement.”

“Very informative — explanations helpful.”

“I am consistently mentoring staff on PAM … thanks for the info. Very helpful!”

“I know it’s hard work to coach someone but you’ve made it easier.”

“Very helpful. I feel as though I can better explain the process of promoting.”

“Will encourage growth on the unit.”

Future Coaching for Coaches classes will be available at least once per year in an attempt to provide this valuable information and mentorship to multiple nurses. Registration will be in Healthstream®. All nurses, especially those who coach others within the model, are strongly encouraged to attend.

Furthermore, members of the PAC and the PART remain available for one-to-one consultations throughout the year.

Potential applicants are encouraged to seek this feedback prior to submission.

Employees are encouraged to utilize the Insider for PAM resources. A survey regarding the PAM was open to nurses within the model during September and October of 2014. Results from this survey provided valuable input to the Professional Advancement Council in evaluating the model.

This data, in conjunction with the Medical Center’s initiatives and strategic planning, will be thoroughly analyzed to consider potential modifications to the model. If changes are implemented, they will be reflected on the Insider.

For more assistance with the Professional Advancement Model and coaching process, please consider the following resources: Professional Advancement Model Insider page: http://intra.umms.org/ummc/nursing/cppd/excellence/ professional-advancement-model List of PAM coaches (located on the Insider) The Professional Advancement Council leadership: Julie Busseau, BSN, RN, CPAN (juliebusseau@umm.edu) Erin Barnaba, MS, RN, OCN, CNL (erinbarnaba@umm.edu)

How to Build Your CV and Portfolio Step-By-Step class (registration in Healthstream®) Sample portfolios located in the CPPD office (located in the Paca Pratt Building on the second floor)

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Rounding Report, Patient Label

continued from page 1.

Hospital Day #

Date: POD #:

Reason for Admission/PMH:

Events over the past 24 hours:

Vital Signs Previous Weight:________ Current Weight: ______ +/- _______ kg Tmax: HR: RR: BP: SPO2/FIO2: CVP: NIRS (C/R): Total Intake: __________ (Enteral_____ IV _____) Total Output: _________ +/-______ UOP: _______ ml/kg/hr Stool _____ Drain/CT _______ Output ________ Drain/CT _______ +/- ________ Drain/CT _______ +/- ________ Neuro Drips: # PRN in 24 hours:

Sedation Adequate?

Pain Score: ______ SBS _____ WAT/NAS ______ CAP-D _____

Labs/Lines/Tubes  PIV  Central (day) Adequate Y/N  Urine Catheter (day)  PICC (day)  Arterial (day) Issues with access: ABG q ____ Ical/Lactate q ____ BMP q ____ MG/Ph q _____ CBC q ____ CMP q _____ Skin At risk for injury?  Yes  No Restraints: Yes (ordered)  No DVT Prophylaxis: ______________

Wound Consult:  Yes  No

Services Involved  PT  OT  Speech  Child Life  Social Work  Pastoral Care  Palliative Care

Kasey Brown, BSN, RN, has worked in the PICU since her graduation from Morgan State University two years ago.

Agreeing that nursing’s lead role in rounds has been a great step forward for the PICU, she said, “The nurse is the first presenter for the plan of care for the day. The night shift nurse puts the plan together and the day shift nurse adds to it and presents it to the rounding team. The residents may not have known all of what happened to the patient over the past hours, but the nurses are aware of everything and can provide a great summary so the plan of care can offer continuity.”

Christine Ho, CRT, explained she rotates between pediatrics and adults to provide respiratory therapy. She has been in the PICU for a little under a year and really enjoys the environment.

“I like the teamwork, good communication with hand-offs, and the nurses are great to work with.”

Kasey agrees and said “I’m proud of our teamwork and how we help each other. In this ICU environment, we need each other for better patient care and we all help each other out, regardless

Family/Social Concerns:

Streamline (labs and orders) Access (adequate, d/c any lines, PICC candidate) FLACC, WAT, SBS (adequate pain, withdraw and sedation mgmt) Eliminating tubes (urine catheter, CT, NG, etc) Transitioning IV to PO Verbal Re-Cap of Plan:

NOT PART OF THE MEDICAL RECORD! ONLY KEEP FOR 24 Hours! ***

Figure 1

that although the team cares for critically ill children, which is stressful, “... we have a wonderful collaborative relationship with the different specialties. Working with so many services can challenge communication, but we do really well and have collegial relationships.”

Lauren looks forward to the implementation of Portfolio, likes that senior PICU nurses have become trained to insert PICC lines, and enjoys that nurses present in rounds. Lauren said that part of the reason the team is so terrific is that “Mary Jo, our nurse manager, is great at interviewing.” The nursing team has been carefully screened and selected.

Mary Jo Simke, MS, BSN, RN, said the team is always learning and growing professionally. Like Lauren, Mary Jo is an advocate of nurses presenting their patients in rounds. Believing that it empowers nurses to participate in rounds, Mary Jo said it “ensures the team is on the same page; the nurse re-caps the plan for the day so everyone has the same understanding.”

Melissa said, “The best thing that has happened over the past year is nurse-led rounds. Things change and happen so fast here it helps to have people on the same page with the same perspective for the plan of care. They don’t teach you in nursing school how to do rounds. We use a short and to-the-point tool for this purpose.” (Figure 1) The nurses explained that the multidisciplinary group worked on the tool and have tweaked it every few months based on team input.

Nurse Residency Evidence-based Practice poster

of role. The nurses, techs, secretaries — it’s a great team.” In fact, the PICU nurses nominated the PICU nursing assistants and unit secretaries for the Nursing Support Staff Award as part of UMMC’s Nursing Awards Ceremony this year.

Melissa, a graduate of Frostburg State University, said she enjoyed the project she and Abigail Holden, BSN, RN, completed for their Nurse Residency Evidence-Based Practice requirement.

They studied family presence in pediatric resuscitations. Their literature review yielded that 100% of parents who were present during the resuscitation of their child would opt to be present in the future.

“Most interesting,” said Melissa, “is where the parents want to be located.” Many PICUs place parents in the hallway outside of the room. Parents want to be in the room at the head of the bed, whispering loving and encouraging words to and physically touching their child.” Melissa explains that the EBP project reinforced her thoughts that for many children’s entire lives, the parent has served as a protector. Separating a child and parent during the resuscitation, while previously thought to be more continued on page 7.

news &views Rounding Report,

continued from page 6.

humane for the parent, is actually in contrast to how they’ve lived their lives with their children. Melissa and Abigail are planning to share the information they gleaned from the literature with their multidisciplinary PICU colleagues. Together they will determine how to best apply this knowledge to their approach to resuscitation management.

The PICU nursing staff members engage their patients’ parents, whenever possible, in a patient/family relationshipbased care model. I spoke with the mother of a four-month old who said “I’m so thrilled with the care my baby receives here.

They involve me every step of the way and treat my daughter and me with unbelievable compassion and care. I have never seen such knowledgeable experts — every single one of them — who are also able to relate to us like members of their families.”

The PICU nursing staff are also a compassionate group of individuals. They ensure patient birthdays and other life events are celebrated. Taka Hayakawa, RN, CCRN, a senior clinical nurse I in the PICU who is also a professional photographer, worked with nursing leadership and the legal department to verify if he could comply with a parent’s request that her child have professional pictures taken while a patient in the PICU, as she was not sure her child would ever be well enough to go home. The photography session will always hold a special place in the heart of this family. The PICU staff were also uplifted by the experience to create such meaningful memories for the family.

Jessica Dolim, BSN, RN, who attended Penn State University, said, “I love it here. I like the patient population, the wide range of ages and diagnosis, and how I am always learning.” Jessica used to work on Gudelsky 8, an adult transplant unit, and was able to translate her skills in the pediatric setting. She serves as a member of the Pediatric Pharmacy and Therapeutics Committee and described how senior clinical nurse II Diana Novak, MS, RN, CCRN; Jill Thomas, MS, CRNP; and Susan Mendley, MD; looked across the country at protocols for CRRT that create less of a reaction during initiation of CRRT in young children. Together, this team developed a protocol specific to UMMC. Mary Jo added staff from Respiratory Care Services, Blood Bank, Lab, and the Pediatric Pharmacy, all of whom were integral in developing and sustaining this protocol. Jessica said, “We are always being educated and encouraged to stay abreast of current literature.

The senior nurses are so helpful and present.”

Jamie Tumulty, MS, CRNP, has worked in the PICU for 20 years. She said, “You feel good about your practice here. We always stay on top of or ahead of the curve. And the attendings are committed to process improvement.”

For example, we have a Half-Pint Study looking at the effects of tight glucose control on the outcomes of critically ill children and a macrophage study on sputum. We’re also examining the cardiovascular effects of Precedex. Mary Jo added that Jamie is completing a three-year study of alarm recognition by nurses, funded by the American Association of Critical Care Nurses. Jamie presented the results at the National Teaching Institute in May.

PICU staff, left to right: Natalie Santana, BSN, RN Clinical Nurse II Dovita Lerner, BSN, RN Clinical Nurse II Lori Dittmar, BSN, RN Christina Fellner, MS, RN, CCRN Senior Clinical Nurse I

PICU staff, left to right: Lauren Manrai, RN, CCRN Clinical Nurse II Kristin Lewis, BSN, RN Clinical Nurse I April McCoy Unit Secretary Sasha Harris, BSN, RN Clinical Nurse II

Katharine Katsion, BSN, RN Clinical Nurse II Mary Jo Simke, MS, BSN, RN Nurse Manager Jill Thomas, MSN, CPNP-AC Jordin Mazer, BSN, RN Clinical Nurse I Jessica Dolim, BSN, RN Clinical Nurse II

Megan McQuillan, BSN, RN, CPN Clinical Nurse II Mary Jo Simke, MS, BSN, RN Nurse Manager Kasey Brown, BSN, RN Clinical Nurse II Julie Furey, BSN, RN Clinical Nurse I Samla Doura, BSN, RN Clinical Nuse II

Jamie further explained that the nurse practitioners, residents, and attendings have a number of studies and grants. PICU lead NP Shari Simone, DNP, CPNP-AC, APRN-BC, FCCM, soon to be inducted as a fellow in the American Academy of Nurse Practitioners (AANP), has been working for the past year with the multidisciplinary team to screen, prevent, and treat delirium in PICU patients; the PICU nurses have had 100% compliance with screening patients for delirium.

Brain Rounds, part of the delirium project, is an interdisciplinary conference that includes residents and attendings from the areas of pediatric critical care, child psychiatry, and neurology, along with pediatric pharmacists continued on page 8.

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Rounding Report,

continued from page 7.

PICU Highlights 2014-2015 SAFETY AND QUALITY > > > > >

Serve on Pediatric Arrest team, Pediatric Rapid Response team, and Pediatric ECMO team 50 weeks without a CLABSI No CAUTIs from summer 2014 to present Began barcode of breast milk in 2014 (Women’s and Children’s initiative) Weekly multidisciplinary QI meeting > Nurse-led root cause analysis of events related to nursing practice: breast milk management, line management, weight documentation > PICU nurse presented AU study to Maryland Nurses Association > Participated in Departmental Safety Rounds > Participate in multidisciplinary research and evidence-based practice > Half-Pint Study- A multicenter study evaluating critically ill intubated children with high blood sugar who are randomized to one of two groups of target glucose levels; outcomes studied include: survival, organ failure, length of ICU stay, and brain function.) > Created a new CRRT protocol for children using established protocols in the literature to meet the needs of the device and circuit used for infants at UMMC. The Z Buf, Zero Balance Ultrafiltration Procedure is used for washing blood primed CRRT Circuits; the aim is to produce an optimal electrolyte and acid-base balance when using a blood prime

SERVICE > Since opening new PICU in October 2013: > Enhanced Children’s Heart Program – Increase in number and complexity of cardiac surgical patients with UMMC mortality below the national average in the Society for Thoracic Surgeons database (2.9/3.6 respectively) – Collaborated with Adult Cardiology and CSICU in management of two adolescent heart failure patients who subsequently received ventricular assist devices > ECMO – Began eCPR in 2014 – 1 of 3 hospital units which contributed to UMMC’s attainment of the ELSO Center of Excellence award > Acknowledged in several Great Stories in 2014 and 2015

PEOPLE > Bedside nurse presentation of patients in daily rounds > Provided a photography option for family desiring to capture memories with their child

STEWARDSHIP > Coordinated PICU Running Team for 2014 Heart Walk > Plans for a PICU T-shirt Fundraiser and Half Marathon Running Team for spring 2015

INNOVATION > Implemented a daily Quiet Hour on unit for children and families

continued on page 9.

news &views Rounding Report,

continued from page 8.

April McCoy, unit secretary

Christine Ho, CRT

Melanie Carpenter, BSN, RN, clinical nurse I, and Mary Jo Simke, MS, BSN, RN, nurse manager

and PICU nurses. The group reviews all patients experiencing Tina discussed the competencies required for ECMO delirium that receive pharmacotherapy and patients with other and the team’s focus on quality outcomes and performance mental health issues. A grant application is in process to study improvement. She said, “I’m on the Pediatric ECMO Council, how well team members — fellows, residents, attendings, nurse which is a multidisciplinary team that looks at different ways to practitioners, and collaborative educators (FRANCE) — work improve the program for ECMO activation. Last week, we did a together. Jamie is interested in the effect of parental mock cannulation of a patient. All roles were filled mental illness on children’s health. She explained, and we had the Pharmacy send medications and the “Do the parents forget to fill the medication orders?

Blood Bank was told to intentionally send expired Do they hear and understand us when we give blood so we could practice this scenario. The pediatric instructions?”

OR team participated and we examined surgeon A Pediatric Early Warning Scores tool (PEWS) response time.” used at UMMC in the past two years to identify Tina said the PICU staff took in stride the at-risk children who may need closer monitoring addition of ECMO responsibilities. She said, or critical care has led to the development of a “The PICU staff are really adaptive. We need to PEWS protocol for all UMMS hospitals that care for learn quickly so we can provide the best care PICU Multidisciplinary children, with Diana Novak and Jason Custer, MD, to our patients. That’s why we provide a lot of Quality Initiative PICU medical director, leading this work.

ECMO reference materials, conduct mock reviews, Faith Hicks, MS, RDN, CSP, senior clinical dietitian, has and offer a lot of lectures about ECMO. We are learning all worked in the PICU for over 25 years. She explained, “The PICU of the time.” is challenging, interesting and a most collaborative environment.

The spirit of learning is evident in the PICU. Tina Fellner, Right now we are studying best feeding strategies for singleTaka Hayakawa, and Megan Hansen, BSN, RN, studied, practiced, ventricle patients.” and demonstrated competency for PICC line insertion and are All of the staff commented on the excellent physician now competent to perform this skill on pediatric patients. A few leadership of Adnan Bhutta, MBBS, FAAP. They spoke of more PICU nurses are also in the process of becoming trained.

Dr. Bhutta as someone who is collaborative, an expert, good for The staff love the many opportunities afforded them to learn morale, and who recruits great pediatric specialists. For example, new knowledge and skills. the pediatric bone marrow transplant program is scheduled to Faith noted that the nurses’ competency for patients begin in the near future. In addition, the pediatric ECMO program who breastfeed has greatly improved on the PICU. She said and Children’s Heart Program have expanded in both volume and Tina Fellner has been a champion for this work. Tina is on the complexity of patients.

Neonatal Intensive Care Unit’s Breastfeeding Council, along Mary Taylor, MS, RN, director of nursing for Women’s with members from the Mother/Baby Unit and the Center and Children’s Services, said, “The staff have expanded their for Advanced Fetal Care. The UMMC world of caregivers is knowledge regarding the management of children with severe connected and collaborative for the children and moms among heart anomalies. They provide excellent care. Our cardiac surgery our patients. outcomes are better than the national average.”

The PICU staff show passionate commitment to their Tina Fellner, MS, RN, CCRN, senior clinical nurse I, has patients. Kristin Lewis, BSN RN, said working in the PICU was worked on the unit for the past five years. She is a graduate of her first choice after having loved working there as a clinical the Clinical Nurse Leader program at UMSON. Tina coordinates scholar when she attended UMSON. Tammi Kim, BSN, RN, ECMO classes twice a year for the PICU, the OR, and interested CCRN, commutes 90 minutes each way across the Bay Bridge.

NICU nurses.

Originally a paramedic, Tammi worked for Maryland ExpressCare continued on page 10.

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Spring 2015

Rounding Report,

continued from page 9.

Samla Doura, BSN, RN, clinical nurse II

Megan McQuillan, BSN, RN, CPN, clinical nurse II

for two years and has worked in the PICU for 13 years. She said, “I love the people I work with, have made a lot of good friends and forged strong friendships, and I’m drawn to the high-tech environment of the PICU.” Diana Woodall, BSN, RN, said she likes how the team joins together to focus on the patient. She explained the PICU recently went 50 weeks (yes, fifty!) without a CLABSI. “I feel like we’ve changed practice so much with central lines. We’ve focused on the number of times we access the line. And I’m not talking about just the nurses. The attendings are also sensitive to how frequently the lines are accessed.” Mary Jo added that the PICU requires two nurses to change all of the central line dressings so that there is remarkably standardized and consistent practice.

Ashley Deavers, BSN, RN, has worked on the unit for the past six months. Ashley, a Stevenson University graduate, said her two years of experience at Mt. Washington Pediatric Hospital gave her a good foundation to join the PICU team.

Tracy Kratz, BSN, RN, senior clinical nurse II, has worked in the Pediatric ED for about six years and transferred to the PICU this past year. A graduate of the University of Pennsylvania, Tracy is now in the Master’s Program at Drexel University and is two classes away from a master’s degree in the Clinical Nurse Leader program. Tracy served as one of the nurse ambassadors for UMMC’s marketing program. She said “I like the interaction

Julia Furey, BSN, RN, clinical nurse I

with the families. I feel appreciated by the family members and feel like I can make positive changes in a child’s life. I also like the challenge of critical care.”

Tracy pointed out that she likes the many studies that are conducted in the PICU. In particular, she likes the Half-Pint Study.

This is a nationwide, multi-site study that examines the outcomes from tight glycemic control in critically ill children. The staff draw blood every hour and instead of wasting blood from the arterial line, it is drawn in a way that does not contaminate it and the staff return it to the child. The blood draw procedure is going so well that the PICU team is considering using the methodology for every patient. This approach is labor intensive so the nurses are also performing a complementary study on workload related to the procedure.

Because of their innovation, adaptability, teamwork, focus on best practices, continuous process improvement, and patient and family-centered care, the PICU has been selected to receive the 2015 CNO Award for Team Excellence. Not only do they do it all, the PICU team wants to do it all. They are energetic and enthusiastic, always searching for ways to improve their care and their patients’ outcomes. This is exactly what we hope for in the care of all of our patients, and in particular, our smallest and most vulnerable ones.

Left to right: Jessica Dolim, BSN, RN, clinical nurse II; Lynda Sempele, RRT; Cindy Clark, CRNP; Odiraa Nwankwor, MD; and Courtney Foster, MD

Faith Hicks, MS, RDN, CSP

news &views University of Maryland Medical Center sponsors fifteen nurses at the Central Maryland Medical-Surgical Consortium Patricia Wilson, MA, BSN, RN, FCN, Clinical Practice and Development Coordinator

The University of Maryland Medical Center (UMMC) sponsored fifteen nurses to attend a four-day review course this spring that was presented by the Central Maryland Medical-Surgical (CMMS) Consortium. This twice-a-year course offering is held to prepare nurses for the certification exam.

The Consortium (http://www.pagespan.com/cmdmedsurg.org.) is a group of hospital nurse educators formed in 2001 to provide quality education and clinical expertise with the goals of promoting critical thinking skills and standardization of bedside practice. Its purpose is to prepare medical-surgical nurses for the medical-surgical certification examination. These individuals meet the fourth Friday of every month from 9:30 a.m. to 11:30 a.m. at Carroll Hospital Center in Westminster. Patricia Wilson, MA, BSN, RN, FCN, clinical practice and development coordinator, is the Consortium’s nurse representative for UMMC. The Consortium-sponsored three-day course was hosted by the University of Maryland Baltimore Washington Medical Center on March 11, 13, and 18. There were over 80 nurses in attendance from over 20 organizations from across the state of Maryland.

Completion of the course gave nurses 18.5 continuing education credits. Rebecca Holford, MSN, RN, CCRN, NREMT, clinical practice and development coordinator, was one of the review course faculty members.

Course content focused on disorders of the human body systems, including musculoskeletal, neurological, cardiovascular, failing heart, endocrine, genitourinary, gastrointestinal, respiratory, immune, and integumentary systems. Additional information included in the course was test-taking strategies, case studies, nursing interventions, treatment modalities, patient and family education, diagnostic studies, pharmacologic treatments, clinical manifestations and disease processes, signs and symptoms, and clinical assessments.

According to the American Nurses Credentialing Center’s (ANCC) Medical-Surgical Nursing Board, the certification examination is a competency-based examination that provides a valid and reliable assessment of the entry-level clinical knowledge and skills of registered nurses in the medicalsurgical specialty after initial RN licensure. Once a participant completes the eligibility requirements to take the certification examination and successfully passes the exam, they are awarded the credential — Registered Nurse-Board Certified (RN-BC). This credential is valid for five years. Participants can continue to use this credential by maintaining their license to practice and meeting the renewal requirements in place at the time of their certification renewal. The National Commission for Certifying Agencies and the Accreditation Board for Specialty Nursing Certification accredits this ANCC certification. (http://www. nursecredentialing.org/medical-surgicalnursing).

The Academy of Medical-Surgical Nursing lists the benefits of becoming a certified medical surgical nurse: ◗◗ promotion of quality patient care; ◗◗ evaluation of the standards of medical-surgical nursing practice; ◗◗ documentation of this specialized knowledge base; ◗◗ peer recognition; ◗◗ increased self-esteem and satisfaction; and, ◗◗ advocacy for the specialty of medical-surgical nursing. (https://www.amsn.org/certification/med-surg-certification) This three-day course will be offered again on September, 28, 29, and October 5, 2015 and will be hosted by Carroll Hospital Center. For more information on the CMMS Consortium, please contact the Office of Clinical Practice and Professional Development at 410-328-6257 or professionaldevelopment@ umm.edu.

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Nurses Week

2015

Ethical Practice, Excellent Care

NURSES

Leonard Taylor, MFA, MBA, and Greg Raymond, MS, MBA, RN, serving breakfast to our nurses and support staff WEEK

COFFEE

BAR Saturday, Ma y 9 • 6:30 –

8:30 Patient Res our Assembly Roo ce Center, m (S1D03) ra

Catered by Pane

Bread for UMM

(UMMC Employ C ee ID badge requiredNursing Staff )

Mark Washenko, Director, Food Services and his team

am

Kick-off Event — Trends in Nursing Practice Conference 2015 — “Sex and Sexuality: Crucial Conversations for the Health Care Provider” — April 29, 2015 The purpose of the conference was to assist health care providers in identifying and overcoming barriers that prevent open communication about sexual health and sexuality, and to focus on assessing, addressing, and meeting the needs of health care providers to best meet the sexual health education of patients and their families.

Support Staff Salute Day and Team Celebrations — May 4, 2015 Individual units celebrated and recognized their support staff and their entire nursing team in various ways, including hosting breakfasts and lunches and giving out small tokens of appreciation.

Nursing Staff and Nursing Support Staff Breakfast — May 5, 2015 Over 1,200 nurses and support staff attended the breakfast where they were served a variety of delicious offerings by senior hospital leadership.

New to the breakfast this year were waffles with strawberry topping and whipped cream.

NURSES WEEK

Breakfast TUESDAY, MAY 5

6 – 9 am , After Hours Dining Area Main Cafeteria rt

All nursing staff and unit suppo staff are invited.

Clinical Practice Summit — May 6 and May 7, 2015 Over 50 abstracts were submitted for the Summit this year using an improved online submission process. Twenty-two posters were presented during rounds, with such topics as code blue education, NPO after midnight, and nutrition delivery implications. For the first time, many of the councils submitted posters showcasing the immense amount of work performed by our nursing governance councils.

Amber Spencer, BSN, RN, and Lisa Rowen, DNSc, RN, FAAN

news &views Below: David Glenn, MS, RN, and Patricia Woltz, PhD., RN

Rachel Godwin, DNAP, CRNA, and Linda Goetz, MHS, CRNA

Above: Lea Marineau, MS, CRNP, and Carmel McComiskey, DNP, CRNP, FAANP

Nursing Grand Rounds — May 6, 2015 Topic: Celebrate Nursing & Nursing Research Speakers: Susan G. Dorsey, PhD., RN, FAAN Associate Professor and Chair Department of Pain and Translational Symptom Science University of Maryland School of Nursing Associate Professor, Department of Anesthesiology University of Maryland School of Medicine Barbara Resnick, PhD., CRNP, FAAN, FAANP Sonja Ziporkin Gershowitz Chair in Gerontology Professor, Department of Organizational Systems and Adult Health University of Maryland School of Nursing Nursing Excellence Awards — May 8, 2015 Special Achievement and Living Excellence award recipients were recognized during a ceremony hosted by senior vice president and chief nursing officer Lisa Rowen, DNSc, RN, FAAN. This year, we had many of our nursing staff recognized for media, regional, and national awards and nominations. Award booklets are available in the Clinical Practice and Professional Development office in the Paca Pratt Building and the satellite office in the Medical Center.

Above, left to right: Carmita Bunn, RN; Megan Garrity, MS, BSN, RN; Gisele Stevenson, MS, RN; and Sylvia Rose, BSN, RN

John Taylor, patient care technician

Coffee Bar — May 9, 2015 Weekend nursing and support staff were treated to a continental breakfast catered by Panera Bread and served by senior nursing staff from Medicine Telemetry 13 East/West.

Left to right: Judith Hill, BSN, RN, ACRN; Joseph Mendiola, BSN, RN, CCRN; Tina Cafeo, DNP, RN; Nisha Kumar, BSN, RN, FNE-A; and Melinda Timlen, BSN, RN

Above, left to right: Christine Cascio, BSN, RN, OCN; Nancy Gambill, MS, RN, CRNP, OCN; and Shannon O’Brien, RN

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LEAD – Administrative Professionals on the Move, continued from page 1. more direct role with patients, and is used as an interdisciplinary communication tool. The ingenuity and training from this group was used to not only start to adapt and implement this project throughout the division, but to make way for other great process improvement ideas. As Harris stated, “I have seen through the work being done and involvement of unit secretaries that LEAD has been a breath of fresh air. The unit secretaries have been so open-minded and willing to step into a bigger role of responsibility. We want everyone to know that we are here, we do matter, and we have a lot to offer. We will take every opportunity afforded us to step out of the shadows, into the light, and shine bright for our patients and UMMC. We have been empowered through the LEAD initiative.”

Another initiative that was introduced was a journal club for unit secretaries. The first one held was far different from a traditional journal club. A group led by Angel Hurst, unit secretary, Weinberg 5, Surgical Acute Care, did a dramatization of an article written by Lisa Evans titled “Weighed Down by Negativity.”1 This allowed participants to understand the article through demonstration of real patient and job examples.

Back row, left to right: Crystal Ray, MIMC; Lisa Brice, 13 East/West; Thomas Harris, 10E; and Marisol Tobaldo, Medical and Surgical Services and Cardiac Care Front row, left to right: Ciara Smith, 13 E/W; Simone Ramsahoye, 13 East/West; Renee Saulsbury, Cardiac SICU; Lindsey Pescrille, MIMC; and Andrea Everett, Weinberg 5, Surgical Acute Care

Through the LEAD meetings, other basic issues that challenge administrative staff every day are addressed.

For example, Alicia Chambers, a unit secretary from the transplant unit on 8 Gudelsky, enlightened council members on the many functions of GroupWise. As an alternative to the instructions provided by IT, which were sometimes hard to understand, a subgroup of her administrative peers had created

a powerpoint presentation with simpler explanations of how to easily use this messaging and collaboration platform. This met with much success as it made it much easier for users to embrace and use the many features of GroupWise.

Unit secretaries are accustomed to all levels of patient care. They communicate with the doctors, nurses and patients, and manage the medical record. Through intra-divisional precepting, unit secretaries who work on acute care units are given the opportunity to understand the way intensive care units work. Unit secretaries are cross-trained with the purpose of understanding the continuum of care.

LEAD initiatives have even gone as far as helping the physicians at UMMC. Brian Edwards, MD, asked Lindsey Pescrille, unit secretary from the Medical IMC (MIMC), to document and collate the statistics of patient flow, which include the locations where patients were admitted/transferred from and where they were discharged/transferred to. Lindsey created a patient database that not only made this information easily accessible, the database also calculated the average length of stay, the name of each patient’s medical service, and even the male to female ratio for the unit. She has gone on to train other unit secretaries to use the database, making it accessible and specific to each unit. Lindsey explains that, “LEAD has given us the opportunity to take our ideas and make something great out of them.”

Retention and recognition strategies provide LEAD council members with a reason to be proud of their accomplishments and give them a sense of joy and fulfilment. Starting in May 2014, LEAD’s recognition team created the division’s first administrative professionals Meet and Greet. During these sessions, Dr. Cafeo extends a warm welcome and gets to know each new individual. Each Meet and Greet is composed of new and tenured employees who come together from throughout the division to network and share stories of encouragement. A new employee resource packet is handed out, including a booklet created by Crystal Ray, a unit secretary from the MIMC. This booklet contains stories and quotes with encouraging words from current and former unit secretaries. Cynthia O’Carroll, MS, RN, nurse manager from the transplant unit on 8 Gudelsky, is one of the many managers shown on a welcome video presented at this meeting. Cynthia states that, “If patient care is at the hub of what we do, then the administrative assistants, unit secretaries, and inventory specialists are at the helm.”

To date, the LEAD council’s accomplishments are many, including special medical center tours, invited speakers, and an eight-hour education and training day. Recently, there was a behind-the-scenes tour of the morgue led by Matthew Zamenski, autopsy coordinator for the histopathology laboratory. In addition, Marcia Assanah, MS, RN, from 10 East helped unit secretaries understand the dynamics of the nursing role and the death certificate process from a multidisciplinary team perspective. This was very impactful to many of us, as we continued on page 15.

news &views LEAD – Administrative Professionals on the Move, continued from page 14. learned the value and importance of our roles in maintaining records, accurate documentation, and the coordination of patient care services.

Presentations have provided administrative professionals the opportunity to hear and learn from other points of view on the valuable role others play in caring for our patients.

Patricia “PJ” Wilson, MA, BSN, RN, FCN, a clinical practice and development coordinator, taught us about how self-reflection and perception is viewed from the perspective of our patients, families, and visitors. Patricia Jefferson, senior administrative coordinator, gave a presentation on customer service and etiquette, reiterating the importance of facial expression and body language, as well as the introduction of standardized scripting across the division. Tia Milburn, MA, project specialist from Clinical Practice and Professional Development, provided in-depth, hands-on computer training for all administrative

Left to right: Carolyn Chambers, unit secretary, Gudelsky 8 Transplant Surgery; Cynthia O’Carroll, MS, RN, nurse manager, Gudelsky 8 Transplant Surgery; and Tina Cafeo, DNP, RN, director of nursing, Medical and Surgical Services and Cardiac Care.

staff in an effort to ensure uniform knowledge and practice of composing professional e-mails and navigating the UMMC Insider. Maurice “Mo” Davis, director of security, presented “De-escalation of a situation from the eyes of a unit secretary,” which provided skills and insight to maintain safety on our units.

Lindsey Barnes, administrative assistant for Cardiology, said “The focus of the LEAD meetings was on unit secretaries and the amazing impact they have on patients, their families, and their units. These meetings highlight the concept that our unit secretaries are the gatekeepers of our units, the ones that keep the units moving along.” LEAD meetings have become the gateway for creating leaders out of our administrative professionals. Not only are we taught to mentor our peers, we create process improvement initiatives to engage our peers and enhance the quality and workflow of our units. In January 2015, the Division of Medicine, Surgery, and Cardiac Services facilitated its first unit secretary education and training day. With the assistance of staff from Clinical Practice and

Professional Development, the short-term goal was to meet the professional and personal development needs of this division’s service lines. The core elements around the education day were communication and conflict resolution, customer service and etiquette, health information management, admitting, safety, joint commission standards, and computer navigation.

LEAD has been said to be one of the best things that has happened to administrative staff here at UMMC. Ray stated, “LEAD has helped me to connect with secretaries of all talents and titles, as well as become acquainted with fresh new ideas and broadening aspirations for the next generation of secretaries.

This experience has opened the door for inspiration and greater educational opportunities for all.” The projects have given administrative staff the chance to not only be heard, but to be recognized for what they do. A survey facilitated by Cheryl Eubanks, administrative assistant for the Surgical Acute Care Unit, showed that administrative staff are excited to be involved and have countless ideas that will bring great benefit to our Medical Center.

As administrative professionals, we value our work and the skills we bring to service patients, families, and customers.

Having the gateway to facilitate and develop within our role has proven to be fulfilling. LEAD believes in creating leaders within the different roles, as well as mentors to assist with continuous growth within our division. In the future, we look forward to implementing recognition of shining stars, continuing education, personal and professional development, providing crossdepartment mentoring, and using divisional “best practices.”

As Tobaldo says, “Being provided the platform and support to work with phenomenal administrative professionals from different walks of life is nothing short of amazing. I do not take this opportunity for granted, and look forward to more outstanding initiatives to develop from this awesome group.”

A special THANK YOU goes out to the nurse managers of the Division of Medicine, Surgery, and Cardiac Services, Lucy Miner, BSN, RN, PCCN, and Stacey Caprino and Megan Prendergast from Human Resources. We would also like to recognize the following individuals for their dedication and hard work in assisting with the education and training day and the development of the LEAD council. They include: Jennifer Clinkscales, RHIT; Shahada Riley, CHAA; Christine Provance, MS, RN, CCNS; Sherry VanHoy, MSN, RN, ACNS-BC; Diana Johnson, MS, PT; Grace Nkonge, MPH, MT; Vicki Wrisk, BSN, RN; Chris Harvey; Susan Hartka; Patricia Wilson, MA, BSN, RN, FCN; Tia Milburn, MA; and Patricia Jefferson.

Reference 1. Evans, Lisa. “Weighed Down By Negativity.” OfficePro 73.2 (2013): 10-11. Print.

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PATIENT CARE SERVICES | RESPIRATORY

Embracing our Teamwork and a Shared Vision for the Future Christopher D. Kircher, MS, RRT-ACCS, Director, Respiratory Care Services

The year 2015 has already been an eventful one for all within Respiratory Care Services. As I prepare to highlight a few of the endeavors that are currently underway, I would first like to thank all of our UMMC colleagues who have for many years partnered with Respiratory Care to help bring it to the exceptional level for which it is now well known. Additionally, as the new director for this amazing department, I would like to offer that we will continue to develop Respiratory Care’s support of this organization in ways that are in sync with UMMC’s vision and strategic plan, bring direct benefits to our patients and their families, and empower staff by rewarding participation and contribution. Whether at the beginning of each shift with our team huddles, during physician rounds or as part of a growing committee structure, the work of our therapists and the ability to communicate as part of an interdisciplinary care team will be the primary focus. As is so often stated, a staff that feel engaged and satisfied in their work will directly lead to gains in teamwork and patient satisfaction.

The previous five respiratory care articles in News & Views have covered the many areas of clinical services where respiratory therapists work, and have stressed the importance of unitspecific expertise and interdisciplinary partnership. To further solidify this ability, additional supervisors have been added to the night shift which completes the day and night supervisory partnership for each clinical area. Staff has been further engaged via survey and individual conversations to determine where their skills have been best suited and in which area they feel most personally connected. In what now is entitled the “service area roster,” all staff in the Critical Care division of Respiratory Care has been divided into four main areas representing our medical/cardiac, surgical/neuro, trauma, and the pediatric/ neonatal areas. Though staff has indicated the desire to retain the ability to move between units and continue a growing skills base, there has been a stabilizing of our service areas for both day and night shifts. A combined balance of more senior staff and those newer to the field has helped provide a renewed sense of reliance shift-to-shift, and an increased comfort level with our ability to support our patient’s continuity of care. The same efforts are strengthening the Procedural Diagnostics division of Respiratory Care, where therapists and nurses are working to cross train additional staff to cover these areas in times of increased workload and vacations. Moving forward,

departmental resources will be continuously reassessed as we partner with the many clinical areas around interventions that would enhance patient flow, quality management programs, and the need for cutting-edge respiratory equipment and pathways, and procedure management.

Over the past six months, there has been a renewed effort to champion change and to do so in a way that both individual and organizational perspectives are balanced. Staff has been given the opportunity to partner with the management team on a series of committees that are working to rebuild several key operational programs. The Education Committee is represented by our department’s education coordinator Matt Davis. Together with a therapist team from both shifts,

Sunshine Committee (seated front row, left to right): Kara Vogt, RRT; Brittany Rub, RRT; and Becky Sonn, RRT. (standing back row, left to right) Hayley Pope, RRT; Suzette Champ, RRT; John Wood, RRT; Melissa Thurber, RRT; Candace Holloway, RRT; Colleen Githens, RRT; and Allison Giammanco, RRT. Not pictured: Maria Madden, RRT; Francine Jones, RRT; Beth Ward, RRT; Jamie Morgan, RRT; Melissa Blair, RRT; and James Huff, RRT.

Matt has utilized staff input to redefine an education plan for 2015. The program is well publicized and is being managed in a way that enables improved staff participation. This has further led to the formation of a Scholarly Works Committee led by supervisor Maria Madden, BS, RRT-ACCS. Staff is learning how to approach research and gain IRB approval for abstracts and/or professional papers. Members of the Respiratory Care Professional Advancement Model Committee have been working to build a respiratory care-specific model that will help staff understand the connection between more objective individual accomplishments with that of the more subjective activities that demonstrate growth toward professionalism and career dedication. Most recently, a team led by supervisors Rob Smith, BS, RRT, and Cheryl Epps, BS, RRT, have been working to bring a 360-degree review process to the department’s performance continued on page 17.

news &views Achievements

for the award by December 2014. “I knew the staff of MTIMC6 was excellent, but I wanted the world to know it,” said James.

“I also knew it was one of the few nurseMulti-Trauma awards – maybe the only one – Intermediate Care 6 specific given to an individual unit, rather than an Wins Beacon Award entire hospital. I believed this was a goal we could set and achieve, as long as every member of the team was committed to it.”

The Multi-Trauma Intermediate Care The whole unit team embraced the goal.

6 Unit (MTIMC6) team has earned a “This would mean sustaining silver-level Beacon Award for Excellence high standards 100 percent of the time, – the most highly regarded national recognition for intensive and intermediate making sure we do the right thing 100 percent of the time for all patients,” care units – from the American James said. Along with the hospitalAssociation of Critical-Care Nurses wide tracking of patient outcomes data, (AACN). At UMMC, only one other the nurses on MTIMC6 monitored unit currently holds the Beacon honor. their unit-specific quality measures and The Cardiac Care Unit earned a silverimplemented strategies for reducing level Beacon Award in 2012, and will hold that distinction through November or eliminating central-line associated bloodstream infections (CLABSI), and 2015. MTIMC6 is the first Shock catheter-associated urinary tract infections Trauma unit to be recognized with this (CAUTI). They also focused on fall award. Throughout Maryland, only five prevention and maintaining compliance other nursing units have been awarded with hand hygiene.

Beacon status.

All members of the MTIMC6 More than two years ago, Vanzetta unit staff contributed to this effort: James, MS, RN, CCRN, the MTIMC6 nurse manager, proposed to her leadership unit secretaries, patient care assistants, and the entire nursing staff, more than team that the unit set a goal of applying

half of whom completed certification as progressive-care certified nurses (PCCNs).

“I am thrilled,” said Karen Doyle, MS, RN, MBA, NEA-BC, vice president for nursing and operations at the R Adams Cowley Shock Trauma Center. “This is the first, but not the last, trauma unit to receive this prestigious award. For nurses, a Beacon Award signals a positive and supportive work environment with greater collaboration between colleagues and leaders, as well as higher morale and lower turnover,” Doyle said. “For patients and families, the Beacon Award signifies exceptional care through improved outcomes and greater overall satisfaction.”

Doyle praised James for her determination, leadership, mentorship, and commitment to her team, and thanked the senior clinical nurses: Elizabeth “Buffie” Wingo, BSN, RN, PCCN; Jessica Farace, BSN, RN, PCCN; Jennifer Motley, BSN, RN, PCCN; Samantha Dayberry, BSN, RN, PCCN; Laura Bothe, BSN, RN, PCCN; Katherine McGinley, BSN, RN, PCCN; and Mari Shade, RN, PCCN.

Respiratory, continued from page 16. evaluations. The ability for staff to help better define their own growth and to receive constructive feedback from their peers will not only be a new, but also a rewarding, practice. Marlin Martin, RRT, and Pete Saunders, RRT, both supervisors with years of experience as the department’s schedulers, have improved the process through staff participation and a few simple accounting mechanisms. This has enhanced staff understanding of the process and has made scheduling decisions more equitable and transparent. Currently under investigation is the movement from a paper schedule to the online ANSOS software.

The most recent highlight is the 3rd Annual Respiratory Care Symposium which brought over 130 therapists and product vendors together on April 3rd for a day of education and professional interaction. In attendance was the president of the Maryland/D.C. Society for Respiratory Care who commented that other than the society’s official state conference, the UMMC program is one of the best-conducted independently. Early planning will begin in May 2015, as the Symposium Committee looks to lock in a date for 2016. All of this professional activity is brought to the lighter side as the Sunshine Committee has held a Christmas party, bake sale, and will begin early planning for the 2015 Respiratory Care Week. This group was started at the staff level and looks to bring some fun and a sense of comradery to the team.

In the book Remarkable Leadership, the author proclaims that, “A belief in one’s potential is the first and most important

step toward helping him or her develop more fully and more rapidly.”1 To solidify trust and build effective leadership, it is imperative that we involve staff and utilize their input and expertise as changes are first being discussed. In future articles, we will again highlight our several service areas and focus on the work of our staff as they become more involved with their clinical area’s initiatives and programs. Taken from a management enhancement presentation by our senior vice president and chief nursing officer, Lisa Rowen, DNSc, RN, FAAN, the Forbes magazine article, “7 Sure-Fire Ways Great Leaders Inspire People To Follow,” highlighted that, “For a vision to really grab the attention of the team, it has to incorporate the hopes, dreams, and aspirations of those you are attempting to lead. If they can’t see themselves in the picture, then they can’t imagine that it’s a possibility for them.”2 Staff involvement in the work behind the scenes and the encouragement of bedside leadership will redefine our team’s efforts and better enable a sense of ownership, pride in the department, and a shared vision for our future!

References 1. Eikenberry, K., (2007). Remarkable Leadership. San Francisco:Jossey-Bass.

2. Gallo, C., (2012). 7 Sure-Fire Ways Great Leaders Inspire People To Follow Them.

Forbes, Retrieved from http://www.forbes.com/sites/carminegallo/2012/09/06/ 7-sure-fire- ways-great-leaders-inspire-people-to-follow-them/.

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Spotlight on Pharmacy

To-Go Medications for Decreasing Emergency Department Return Visits Bryan D. Hayes, PharmD, DABAT, FAACT, Clinical Manager, EPIC project, and Clinical Pharmacy Specialist, Departments of Pharmacy Services and Emergency Medicine

Program Description — Between 1997

and 2007, the number of visits to U.S. emergency departments (EDs) increased 23%.1 In 2007, the Centers for Disease Control and Prevention (CDC) reported 116.8 million ED visits, with 19.2 million resulting in admission to the same hospital or to an observation unit or transfer to another hospital. Although the number of visits is increasing, many EDs are closing.2 More patients, fewer EDs, and insufficient inpatient beds are straining existing resources to provide emergency care efficiently and safely.

Upon discharge from an ED or a hospital, many patients receive prescriptions for medications. Nationally, at least 15.3% of all ED visits involve patients without health insurance. These patients often lack sufficient funds to fill medication prescriptions. Saunders et al. report that 21% of uninsured patients fail to have their prescriptions filled after discharge from the ED.3 Cost is the most common reason for unfilled prescriptions; transportation restrictions and wait times at the pharmacy are also frequently reported.4 In our experience in the ED at the University of Maryland Medical Center, failure to fill a prescription leads to a return ED visit when the condition does not improve or worsens.

Unplanned return visits to the ED within 72 hours are common (3.2%).5 For conditions that may be treated adequately with outpatient medications, return visits represent an avoidable strain on resources or an avoidable expense, especially if the return visit results in hospitalization. Cellulitis and urinary tract infection (UTI) represent two conditions that may be effectively treated with outpatient antibiotics. Preliminary

data at our hospital demonstrated a 6.9% return rate with these selected conditions within seven days of the initial visit. This prompted the departments of Pharmacy Services and Emergency Medicine to explore opportunities to decrease the number of return visits and reduce the strain on an already overcrowded ED. Based on the literature and our urban patient population, we suspected that providing therapy for treatable, acute conditions with a defined course of antibiotics would reduce return rates. We coined this initiative the “To-Go Meds” program. The primary objective of the To-Go Meds program was to determine if to-go medications would result in decreased return visits to the ED for the same disease state in a seven-day period.

Solution — The process began with

several meetings in the late fall of 2008 to discuss project details, such as selection of disease states and medications, program costs, proper labeling, and the ordering/dispensing process.

Simultaneously, we worked with the information technology group to create an electronic ordering process using the hospital’s Computerized Physician Medication Order Entry (CPMOE) system and developed a pharmacy policy that defined the internal process for ensuring compliance with outpatient state and federal pharmacy dispensing laws. Implementation of the To-Go Meds program occurred in November 2009.

Role of Collaboration and Leadership —

The departments of pharmacy, nursing, and emergency medicine collaborated to conceive, plan, and implement this program. Our chief medical officer at the time approved and supported the project in all phases.

Process — To-Go Meds were provided at

no charge to patients discharged from the ED. Primary candidates for the program included those with no health insurance, limited resources, or those being discharged when nearby pharmacies were closed. Disease states targeted were UTIs, cellulitis/abscess, and dental infections.

Medications included in the program were clindamycin, sulfamethoxazoletrimethoprim DS (TMP-SMZ), penicillin VK, and nitrofurantoin.

Measureable Outcomes — In the first full

year of the program, 4,316 patients were observed in the ED. There were a total of 229 participants in the To-Go Meds program, including 112 being treated for cellulitis/abscess, 89 treated for dental infection, and 28 treated for UTIs. Of these 229 patients, eight (3.5%) had return visits within seven days. This was a statistically significant decrease (p=0.04) from the 281 (6.9%) of 4,087 patients who did not participate in the To-Go Meds program. One hundred percent patient satisfaction with care at the ED after receiving free medication was documented.

Innovation — Among the many personal,

local, and societal implications of health care reform are the ones that affect our immediate sphere of care; ones that affect the financial health of our practice sites; ones that affect the logistics of how we provide care; ones that affect the outcomes of our patients; and ones that affect the roles and responsibilities of our practitioners. Health care organizations must drastically re-think what we do and how we do it to impact all the ramifications favorably. This innovative program describes one such approach that produced a mix of favorable results, but that required a small upfront cost, and completely avoided acquisition of equipment, remodeling, major inconvenience, and distasteful role changes. Hospitals will need to consider continued on page 19.

news &views Bed Management in Portfolio Sarah Waters, Communications Director for the Electronic Health Record

Decades ago, when someone made a phone call, an operator had to manually connect him or her to the party being called. All over the country, operators wore headsets and sat at switchboards to connect calls one at a time. Today, most of us don’t think twice about how a phone call happens. As long as the caller follows the right directions — uses the correct phone number — the call is usually successful.

Bed management at UMMC can be a little like the old phone system. If a patient comes into the ED and is registered in STAR, clinical activities and bed placement begin immediately.

But as soon as that patient needs to be admitted from the ED to an inpatient unit, the process becomes part technology, part manual activity, since the Teletracking system cannot transfer information to STAR or Cerner.

When the decision is made to admit a patient who has already been registered in the ED, a Patient Access Services (PAS) staff member must manually enter information about the admission into STAR — and often correct errors to ensure that charging/billing will be accurate.

Spotlight on Pharmacy,

Next, someone on the originating unit (such as the ED) must manually place the bed request into Teletracking. The nurse coordinator from the Patient Placement Center finds a bed. The bed is assigned, the patient is physically moved to the receiving unit and the unit clerk places the unit and room order in Cerner and then contacts PAS. Finally, as soon as possible, a PAS staff member opens up STAR again to manually enter the patient’s new location.

Other kinds of transfers and even discharges can be equally cumbersome and require significant coordination between systems that are not well-integrated, and busy people who have to wait for the information they need.

Bed Management in Portfolio Portfolio is an integrated system in which registration, clinical and billing functions are all tightly linked. When we move to Portfolio on November 7, Teletracking and STAR will go away. In addition, Portfolio is a “provider’s-order driven” electronic health record system. That means that orders alert bed management staff that a patient is ready for admission or transfer. So, here are the steps: 1. Provider places an admission or transfer order.

2. Nursing coordinator assigns destination unit.

3. Receiving unit assigns room/bed.

4. Sending unit gives report and moves the patient physically.

5. When the patient arrives, a staff member on the receiving unit completes the transfer in Portfolio, and the provider or nurse on the receiving unit releases orders to continue care.

Simple, fast, and everyone’s on the same page. In Portfolio, all aspects of bed management will be faster and easier, with less room for error.

continued from page 18.

supporting programs such as the To Go Meds program that are aimed at improving health outcomes, especially when an initial financial investment is required. In summary, the To-Go Meds program, with a small $1,000 one-year expense, demonstrated a 50% reduction in ED return visits for patients who were given a free, complete course of antibiotics at discharge for select conditions.

Sustainability — Providing free, full-

course antimicrobial therapy upon discharge from the ED demonstrated a greater than 50% reduction in return visits for the selected medical conditions.

Because of these positive results, we have expanded the program to include additional medications to treat community-acquired pneumonia and asthma. Recently, we moved the To-Go Meds to the ED unit-based medication storage cabinet for easier access. We now prescribe about 300 To-Go Meds each month and estimate that in 2015, 206 revisits and 58 admissions will be avoided as a result of the program.

The program resulted in a paper being published in the American Journal of Emergency Medicine and presented nationally at a UHC Conference.6

References 1. Niska R, Bhuiya F, Xu J. National Hospital Ambulatory Medical Care Survey: 2007 emergency department summary. Natl Health Stat Report 2010;26:1-31.

2. Hsia RY, Kellermann AL, Shen YC. Factors associated with closures of emergency departments in the United States. JAMA 2011;305:1978-85.

3. Saunders CE. Patient compliance in filling prescriptions after discharge from the emergency department. Am J Emerg Med 1987;5:283-6.

4. Kripalani S, Henderson LE, Jacobson TA, et al.

Medication use among inner-city patients after hospital discharge: patient-reported barriers and solutions. Mayo Clin Proc 2008;83:529-35.

5. Pham JC, Kirsch TD, Hill PM, et al. Seventy-two-hour returns may not be a good indicator of safety in the emergency department: a national study. Acad Emerg Med 2011;18:390-7.

6. Hayes BD, Zaharna L, Winters ME, Feemster AA, Browne BJ, Hirshon JM. To-Go medications for decreasing ED return visits. Am J Emerg Med 2012;30:2011-4.

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Spring 2015

CLINICAL NUTRITION

Comprehensive Nutrition Support Guidelines for Critical Care Natasia Tomlinson, RD, LDN, Nutritionist, Clinical Nutrition Services

By some estimates, as many as one third of patients admitted to hospitals are malnourished, and of those remaining, an additional one third become malnourished throughout the course of their hospitalization. Beyond malnutrition, a great number of patients admitted to UMMC require some form of nutrition support therapy, including enteral and parenteral nutrition support. The registered dietitians (RDs) within the department of Clinical Nutrition Services are pivotal in providing expertise and evidenced-based nutrition practices to interdisciplinary teams across the Medical Center. One such interdisciplinary effort, between Clinical Nutrition Services and Acute Care Emergency Services (ACES), is currently underway with the goal of creating guidelines for providing nutrition support to critically ill patients admitted with a variety of conditions.

This current collaboration, initiated by Jose J. Diaz, Jr., MD, CNS, FACS, FCCM, stems from a desire to create an easily accessible resource for clinicians within the hospital to obtain guidance on nutrition support for their critically ill patients. When the project is complete, access to information, such as a nutrition support initiation decision tree, specific nutrition considerations based on clinical condition, and access to pertinent nutrition support hospital policies and procedures, will be available via the Intranet. The guidelines and recommendations that will be featured are being developed to include the most recent evidence-based practices. Some of the clinical conditions that will be included are severe pancreatitis, open abdomen, and feeding patients who are hemodynamically unstable.

There is already a significant collection of hospital policies and guidelines in place at UMMC for providing safe and effective nutrition support and monitoring. Some of these include an extensive enteral nutrition policy, as well as evidence-based guidelines to estimate patient calorie and protein requirements for a variety of disease states and clinical conditions. The ongoing collaborative effort is aiming to go a step further by collating all of these documents into a one-stop, easilyaccessible comprehensive nutrition support resource. In addition to existing materials, the individuals involved with this project have identified other resources that can be included in the comprehensive nutrition support guidelines to assist and enable clinicians to provide the best nutrition support care for their patients. The creation of these new additions to the guidelines is currently underway.

The first priority was to design a decision tree detailing nutrition support initiation for the critically ill patient. This large undertaking will combine policies and guidelines already in place with an extensive literature review to create a practical but evidence-based tool for clinicians to utilize with their critically ill patients. This algorithm, once fully approved and implemented, will assist the provider in making safe and effective treatment decisions relating to initiation of enteral or parenteral nutrition, including determining the most appropriate method, site, and formula selection.

Interdisciplinary Team Members: Jose J. Diaz, Jr., MD, CNS, FACS, FCCM, chief, Acute Care Emergency Services (ACES) Barbara Walsh, RD, LDN, CNSC, senior nutrition specialist Catherine Schroder, RD, LDN, nutritionist Natasia Tomlinson, RD, LDN, nutritionist Karen Riggin, RD, LDN, CNSC, senior nutrition specialist Lynsie Daras, RD, LDN, CNSC, nutrition specialist I Stacy Pelekhaty, RD, LDN, CNSC, nutrition specialist I Ellen Loreck, MS, RD, LDN, director, Clinical Nutrition Services Beyond the achievement of creating the Nutrition Support Initiation Algorithm, the team identified specific clinical conditions and disease states where a more detailed set of nutrition recommendations would greatly benefit providers and their patients. Some of the identified subjects include nutrition support for patients with severe pancreatitis, feeding patients with an open abdomen, recommendations for initiating nutrition support in hemodynamically unstable patients, and evidence-based recommendations for additional micronutrient or antioxidant supplementation in critically ill patients. To achieve this, the RDs involved in this project are conducting extensive literature reviews to identify the best practices, which will then be included in the Comprehensive Nutrition Support Guidelines to support UMMC clinicians in providing the best nutrition care possible.

The RDs within the department of Clinical Nutrition Services at UMMC are continually evaluating the current research and practice recommendations to ensure the best nutrition care for their patients, while also actively participating within interdisciplinary teams throughout UMMC. The current collaboration to create and implement comprehensive nutrition support guidelines for critically ill patients at UMMC will serve to further support clinicians in providing the most effective nutrition care across the Medical Center.

Reference 1. Tappenden KA, Quatrara B, Parkhurst ML, Malone AM, Fanjiang G, Ziegler TR. Critical Role of Nutrition in Improving Quality of Care: An Interdisciplinary Call to Action to Address Adult Hospital Malnutrition. JPEN. 2013; 37(4): 482-497. Available at SAGE Journals. Accessed March 30, 2015.

news &views Trends Conference 2015 Hosts Nationally and Internationally Recognized Keynote Speakers Tia Milburn, MA, Project Specialist, and Patricia Y. Wilson, MA, BSN, RN, FCN, Clinical Practice and Development Coordinator

The Trends in Nursing Practice Conference 2015 – Sex and Sexuality: Crucial Conversations for the Health Care Provider – was held on Wednesday, April 29 at the University of Maryland, Baltimore, Southern Management Campus Center. The purpose of the conference was to assist health care providers in identifying and overcoming barriers that prevent open communication about sexual health and sexuality and to focus on assessing, addressing, and meeting the needs of health care providers to best meet the sexual health education of patients and their families.

The objectives of the conference were to: ◗◗ explain the potential barriers of health care providers discussing sex and sexuality in the diverse patient populations; ◗◗ identify and describe best practice methods for initiating and integrating crucial conversations about sex and sexuality between patients and health care providers; ◗◗ examine health care providers’ knowledge, attitudes, and levels of sexual competence in providing health care; and, ◗◗ empower health care providers to drive and impact change in sexual health education.

The conference hosted the following nationally and internationally recognized keynote speakers: Lisa Rowen, DNSc, RN, FAAN, senior vice president and chief nursing officer opened the conference with a warm welcome.

Anne Katz, PhD., RN, FAAN, offered the opening keynote address. Dr. Katz is an internationally recognized speaker, author, and sexuality counselor at CancerCare Manitoba and a clinical nurse specialist at the Manitoba Prostate Centre. She is the editor of the Oncology Nursing Forum, the premier research journal of the Oncology Nursing Society. Dr. Katz maintains a joint appointment in the College of Nursing at the University of Manitoba and was recently inducted as a fellow into the American Academy of Nursing.

The closing keynote speaker, Eric Marlowe Garrison, MSc, MAEd, is a certified sexuality counselor, author, trainer, teacher, mentor, and international consultant in a variety of areas relating

to sexology, social justice, and higher education, including the training of medical, law, business, and education students. He offered the closing keynote topic, “Let’s Talk about Sex: PatientCentered Sexual Health Provision within Nursing.”

Local content experts also shared their knowledge and expertise; Patricia Y. Wilson, MA, BSN, RN, FCN, presented “Sex 101: The Media and Its Impact on Sex Education;” Rodney Perkins, MPH, MSN, RN, educated on “Creating a Place of Inclusion: A Lesson in Cultural Competence;” Andrew C. Kramer, MD, shared about “Sexual Dysfunction and Modern Medicine;” Peter H. Gorman, MD, MS, presented the topic of “Sexual Dysfunction After Spinal Cord Injury;” Travis Brown, MS, MBA, and Christopher Roberson, MS, CRNP, ACRN, co-presented “Control and Management of Sexually Transmitted Infections.”

The most impactful highlight of the conference was “The Patient Experience: The Voice of the Patient: Sex Before and After Illness or Injury.” There was a panel of seven patients who shared their personal experiences in reference to sexual health education and learning. The patient panel included patients with the following illnesses or injuries: quadriplegia, paraplegia, AIDS, cancer, multiple traumatic injuries and closed head injury, and a heart transplant. Patients discussed the importance of touch, crucial conversations, resources, and nursing sensitivity. They also discussed patient privacy, body image, intimacy, and sensitivity to gender identification.

University of Maryland School of Nursing Ranked Sixth in U.S. News & World Report The University of Maryland School of Nursing (UMSON) is now ranked No. 6 among all accredited graduate nursing programs by U.S. News & World Report in its 2015 edition of “America’s Best Graduate Schools.” UMSON advanced from a No. 11 ranking in 2011 to a tie for No. 6 with the schools of nursing at Duke University, New York University, and the University of Michigan — Ann Arbor. In addition to its overall ranking of No. 6, five UMSON master’s specialties/options are ranked in the top five in the 2015 U.S. News & World Report listing.

The clinical nurse leader option and nursing informatics specialty are ranked No. 1; the adult/ gerontology primary care nurse practitioner specialty is ranked No. 4; and the administration and family nurse practitioner specialties are each ranked No. 5.

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Spring 2015

Certification Corner

UMMC Celebrates Certified Nurses Day Mylene R. de Vera, BSN, RN, OCN, BMTCN, and Erin Barnaba, MS, RN, OCN, CNL

The annual Certified Nurses Day was held on March 20, 2015 from 7:00 a.m. to 9:00 a.m. in the Weinberg round room and was attended by over 125 certified nurses.

The celebration was planned by the Certification Committee Subgroup and included distributing raffle tickets to attendees that were entered into a drawing for individual prizes. A slideshow presentation was shown featuring certified nurses from different units in the Medical Center. Additionally, a poster honoring the ExpressCare team was displayed for having achieved a 100% certification rate for staff caring for adults and a 90% certification rate for staff caring for pediatric patients. Attendees were

encouraged to share what certification means to them and the driving factors for becoming certified; their written responses were showcased on the walls of the round room. Examples of responses include: “Obtaining and maintaining certification means to stand out among a group of nurses that are the best in what they do.”

- Cathy Wilkes, BSN, RN, CCRN “We as certified nurses are: Professional –We show expertise and dedication to our chosen specialty.

Committed – We are committed to providing quality patient care.

Credible Experts – We have demonstrated expertise and competency in our specialty.

Quality – Providing high quality care is the essence of what we do.”

- Lisa Campana, RN, CCRN

“What it means to me is professional pride and personal achievement. I am very proud that I am a CCRN. I have been certified since 2002 and it is a great source of pride for me.

- Patti Dix, MS, RN, CCRN “Being a certified nurse encourages me to embrace the network of knowledge available to us. By doing this, I am able to provide evidence-based, best care practices to my patients. In addition, I bring it to my coworkers, allowing a sharing of knowledge.

In nursing, you can never stop learning.”

- Kim Erwin, BSN, RN, CPEN, CCRN Certified Nurses Day is a national day to honor and recognize the important achievement of nursing specialty and subspecialty certification.¹ Certification is a milestone of personal excellence along the professional journey. The American Nurses Credentialing Center (ANCC) proposed March 19 as Certified Nurses Day to honor the birthday of continued on page 23.

Maryland ExpressCare: Certified for Excellence Cathy Wilkes, BSN, RN, CCRN, and Denise Grant, BSN, RN, CCRN

With 100% and 90% certification rates, the adult and pediatric nurses with ExpressCare are proud members of a highly trained and competent team.

A senior pediatric nurse on our team, Patti Dix, MS, RN, CCRN, senior clinical nurse I, has been a certified CCRN since 2002; she encourages nurses to become certified because it gives one a sense of personal pride and achievement.

Jill Dannenfelser, BSN, RN, CCRN, is an experienced pediatric nurse that joined us a year and a half ago and is a proud addition; being certified to her means being part of a truly elite team that advocates for exceptional patient care. Beth Nocar-Bowen, MS, RN, CCRN, is an adult-certified nurse that has worked for ExpressCare since the doors opened in 1993. Beth is passionate about

transport nursing and being a certified nurse. She credits her experience and advanced knowledge from certification that allows her to make proactive rather than reactive decisions leading to better patient outcomes. One of the senior adult-certified nurses, Doug La Tourette, MS, BSN, RN, CCRN, senior clinical nurse I, believes that one of the greatest challenges facing a nurse is the obligation and need to continually keep ahead of the rapidly changing face of health care, including the many and varied innovations in nursing practice. Advanced certification is one of the first steps to that end. However, in and of itself, it is only a first step. The requirement to obtain additional CEUs, which is the hallmark of advanced certification, becomes a tool to entice the nurse to continually expand their knowledge and clinical skills to seek attainment of optimal patient care.

The ExpressCare nurses take great pride in being an integral part of the greater nursing team at the University of Maryland Medical Center. They hope their accomplishments encourage other departments to challenge their nurses to meet a goal of certification. A literature review completed by Wade in 2009 reported that certified nurses report an overall sense of empowerment and that certification enhances their collaboration with the health care team. Certified nurses demonstrate that continued education reduces the nurse’s exposure to risk and better prepares them to make informed decisions that encompass a larger scope and potentially improve patient outcomes.

In addition to holding advanced certifications, the nurses and critical care paramedics at Maryland ExpressCare also hold and maintain advanced certifications continued on page 23.

news &views Certified Nurses Day, continued from page 22.

the late Margretta “Gretta” Madden Styles. She was an international pioneer of nursing certification and designed the first comprehensive study of nurse credentialing.

Becoming certified in a nursing specialty provides a major benefit to the nurse and their patients. In a survey conducted in 2005 by the American Board of Nursing Specialties (ABNS) on the perceived value of certification among nurses and their nurse managers, more than 98% of the respondents agreed that certification enhanced feelings of personal accomplishment and personal satisfaction.² Studies prove that positive patient outcomes increase as the percentage of certified nurses increases.

In a study carried out in 2009 by Gallagher & Blegen on competence and certification of registered nurses and safety of patients in ICUs, results revealed that the unit proportion of certified registered nurses was inversely related to falls – meaning the higher the proportion of certified registered nurses,

the lower the fall rate on a unit.3 In the same year, a study was done on the effect of certification in oncology nursing on nursing-sensitive outcomes.

Results revealed that certified nurses scored higher than non-certified nurses on the nurses’ knowledge and attitudes survey regarding pain, as well as nausea management. The chart audits showed that certified nurses followed evidence-based guidelines for chemotherapy-induced nausea and vomiting management more than non-certified nurses.4 In another study published in the AORN Journal (Association of periOperative Registered Nurses) in November 2014, lower rates of central line associated blood stream infections in surgical intensive care units were significantly associated with higher rates of certified nurses.5 Public awareness of certification has grown dramatically. In 1999, only one in three people were aware of nurse certification, but in 2002 that number has grown to nearly eight out

Maryland ExpressCare, continued from page 22.

in BLS, ACLS, PALS, STABLE*, and NRP (Neonatal Resuscitation Program).

In addition, they are required to attend yearly competencies in cadaver lab to validate skills, such as intraosseous access, intubation, and cricothyrotomy.

This specialized team transports patients from community hospitals in Maryland, Delaware, Virginia, New Jersey, and Pennsylvania to UMMC. Moreover, team members are trained and capable of managing certain types of patients, including complicated obstetric patients, hemorrhagic, and non-traumatic stroke patients that can be transported with intra-ventricular drains, complicated surgical patients, trauma patients, and pediatric surgical, airway, and medical emergencies; as well as equipment, such as balloon pump, ventricular assistive device, and extracorpeal membrane oxygenation.

of ten.6 People are more aware of nurse certification than teacher or physician certification. Three out of four Americans surveyed (73%) are much more likely to select a hospital that employs a high percentage of nurses with additional specialty certification.6 References 1. American Association of Critical Care Nurses (AACN) Corporation. “Celebrate Certified Nurses Day.” Retrieved from http://www. aacn.org. March, 2015.

2. Specialty nursing certification: nurses’ perceptions, values and behaviors. American Board of Nursing Specialties. December 2006. Retrieved from http:// www.nursingcertification.org.

3. Gallagher, DK & Blegen, MA, (2009). Competence and certification of registered nurses and safety of patients in ICU. American Journal of Critical Care, 18(2), 106-118.

4. Coleman, EA. et. al. Effect of certification in oncology nursing on nursing sensitive outcomes. Clinical Journal of Oncology Nursing, 13(2). Retrieved from http://www.onsmetapress.com.

5. Boyle, DK et.al. (2014). The relationship between direct-care RN specialty certification and surgical patient outcomes. Association of Perioperative Registered Nurses Journal, 100(5), 511-528.

6. Harris Interactive, Inc.(2002). American Association of Critical Care Nurses Survey. Retrieved from http:// www.aacn.org/WD/certifications.

ATTENTION ALL CERTIFIED NURSES!

The mission of Maryland ExpressCare is to bring advanced tertiary services to the community, utilizing knowledgeable transport teams to deliver quality, safe, and comprehensive care.

During ambulance transport, care is evaluated and provided by a three-person team consisting of a certified critical care nurse, critical care paramedic, and emergency vehicle operator. The transport team at Maryland ExpressCare is proud to be certified for excellence and to serve as members of the elite team of care providers at the University of Maryland Medical Center.

Reference Wade, C. (2009). Wade, C. (2009). Perceived effects of specialty nurse certification: a review of the literature.

AORN Journal, 89(1), 183. doi:10.1016/j.aorn.2008.06.015 * STABLE is the neonatal education program focusing exclusively on the post-resuscitation/pre-transport stabilization care of sick newborns.

Clinical Practice and Professional Development (CPPD) and the Certification Committee Subgroup love hearing about your accomplishments to become certified or re-certified. If you obtain a new certification or renew a certification, please let us know by emailing certification@umm.edu.

Please include the following information: ◗◗ Credential that you obtained; ◗◗ Name of the certifying organization; ◗◗ Date you obtained or renewed the certification; and ◗◗ Expiration date of the certification.

You may also update your information at any point by completing the credentialing survey through this link: https://www.surveymonkey.com/s/ ummcredentialingsurvey.

As a reminder, employees should contact HR in regard to their employee continuing education benefit when certified.

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

Clinical Practice Update Patient Safety – Hand-­‐off Communication

04/14/2015 According to the Agency for Healthcare Research and Quality (AHRQ), communication hand-­‐offs and signouts

have been linked to adverse clinical events in settings ranging from the emergency department to the ICU.

The care of hospitalized patients is marked by numerous transitions in care, including hand-­‐offs in responsibility

at change of shift. A large body of research documents that hand-­‐offs often lack important elements and that

poor quality hand-­‐offs can cause adverse consequences.

AHRQ, 2015, Reisenberger, et .al. 2009

Agreement on Hand-­‐off Communication:

Required Elements For Hand-­‐off Communication:

1.

2.

3.

4.

5.

6.

Patient Identifiers – Name and DOB or Name and Medical Record Number.

Date & Time of Hand-­‐off with Sender and Receiver Names Code status/ Advance Directive/MOLST – include documents if available.

Isolation status Recent Vital Signs, pertinent assessment Major Diagnoses/Reason for Admission/ Transfer

1. The items at the top of the form (above the grey line) are the required elements.

2. The form itself is optional provided that the mandatory elements are included in documentation

3. Nursing at the system hospitals has agreed to use the form for all patient transfers among system hospitals

PG74 New (03/15)

Consolidation of Forms

1. The area below the grey line is to be used as a template for a systems-­‐based report that may be used for a verbal report (on either side) to highlight common assessment data that may be needed by the next team.

2. Staff can choose whether to: • Print this form from FormFast (# PG74) to use as a written document, • Use template to guide the verbal communication, or • Use template to identify the electronic data that should be printed and sent with the patient

As a result of the agreement to standardize this process at a system level, multiple other documents will be retired and will be removed from FormFast. These include:

PG24 -­‐ Intrafacility Transfer Summary Note

PG30 -­‐ Unit-­‐to-­‐Unit Transfer Summary Note

PG30C -­‐ CCRU Unit-­‐to-­‐Unit Transfer Summary Note

PG26 -­‐ Temporary Hand-­‐off Communication Note PG26A -­‐ Post Procedure Hand-­‐Off Note

How Will The Communication Process Work In EPIC?

A brief Hand-­‐off Report is being created in EPIC to include the same mandatory elements for transfer in a brief (2-­‐3 page) report to be printed and sent with patients when moving to and from system hospitals.

• This document will be viewable by EPIC users, and would be printed for non-­‐EPIC users.

For questions, please contact Allison Murter amurter@umm.edu