Nursing Annual Report 2012

Table of Contents Message from the Chief Nursing Officer. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Transformational Leadership. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Structural Empowerment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Exemplary Professional Practice. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 New Knowledge, Innovations and Improvements. . . . . . . . . . . . . . . . . . . . . . . .20 Publications, Posters and Presentations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Every day I hear the stories of how you make the most of moments with your patients. Your way of building relationships in life’s best and most challenging moments, inspires all of us dedicated to the Premier patient experience. Bobbie Gerhart, RN President and Chief Executive Officer Individually and as a team, you are making a powerful contribution to our journey to Target Zero. You are terrific partners in ensuring safe, effective care for patients. Gary Collier, MD Vice President, Clinical Consulting / Chief Medical Officer, 2004-2012 Thank you for giving so generously of yourselves for the patients and families served at Miami Valley Hospital and Miami Valley Hospital South. You make an unforgettable difference in their lives. Anita Moore Chair, Miami Valley Hospital Board of Trustees

On behalf of our entire nursing team, I have the pleasure and privilege of sharing the 2012 Miami Valley Hospital Nursing Annual Report. This report reflects the work of over 2,400 talented nurses who are unwaivering in their commitment and passion to achieve excellence . . . every patient, every time. The year 2012 was marked by substantial change and progress as we move toward a more integrated health system. As nurses, we recognize the very important role we play in shaping this new future, not only at Premier Health but also at the national level. Many nurses have participated in and/or led system-wide teams to redefine the patient experience with a focus on quality, safety, service and inclusion. Throughout the years, nurses at Miami Valley Hospital have participated in education that focused on healing relationships, inclusion, and prevention of patient harm. The integration of this education into nursing practice has brought some outstanding results in 2012 for which we all feel a great sense of pride. These include, but are not limited to, the following examples: • 40 percent reduction in hospital acquired conditions • 30 percent reduction in stage 3-4 pressure ulcers • 27 percent reduction in catheter associated urinary tract infections (CAUTI) • 33 percent reduction in hospital acquired injuries • Improved Surgical Care Improvement Project (SCIP) core measure compliance from 91.7 percent to 96.02 percent • Best quartile performance on the CMS scorecard for central line blood stream infections (CLABSI). Results such as these do not happen by chance. They are truly the hallmark of talented individuals who exceed their own individual capacity and embrace a true team culture. At the heart of this sacred work are our patients and families whose hearts and lives are touched by the compassionate care they receive at Miami Valley Hospital. As one recent patient wrote: “You have shown me a level of compassion and care unlike anything I have ever experienced in 62 years. You not only have the gift of compassion and the skills required to perform at the highest level, but you are the gift needed by anyone in your care.” I am so proud of all of the nurses at Miami Valley Hospital and am honored to be your chief nursing officer.

Deb Mals, MS, RN, NEA-BC Vice President, Hospital Operations and Chief Nursing Officer

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Transformational Leadership – is leadership that identifies and communicates vision and values and asks for the involvement of the work group to achieve the vision.

Advanced Practice Registered Nurse Council The unique functions of the APRN within the hospital and health care system offer the opportunity to advance the four principles of shared governance: partnership, equity, accountability and ownership. Miami Valley Hospital’s APRN Council has evolved far beyond its beginning in the last decade with networking among peers. The council has established a formal leadership structure and charter. Two co-chairs facilitate monthly meetings. Council sub-committees address education, orientation, legislative, credentialing and marketing topics. Co-chairs Debbi Matosky, MS, APRN, FNP-BC, and Erin Kelly, MSN, APRN, CWS, FACCWS, facilitate Miami Valley Hospital’s APRN Council.

The council’s second annual education conference attracted strong attendance and achieved evaluation scores of >94 percent satisfaction. In addition, the council has invited external APRNs to participate. The APRN web portal has progressed to include: APRN directory with biographies and photos, preliminary credentialing information, and the capability to share information internally and externally with our community. In a survey following the launch of the initial portal content, 80 percent of responding APRNs reported that the portal has increased their access to practice related information.

Patient Experience and Behavioral Standards Miami Valley Hospital adopted a revitalized set of behavior standards for all employees as part of a system-wide recommitment to creating the best experience for patients and families. At Premier Health the Patient Experience encompasses the elements of quality, safety, service and inclusion. The corresponding behavior standards are defined by Premier’s core values of Respect, Integrity, Compassion and Excellence. All Premier employees participated in Patient Experience enrollment and education sessions sponsored by their immediate supervisor and department

2 • M iami Valley H ospital

director. The revised behavior standards, which emphasize the importance of healthy relationships, quality and service, are now a component of annual performance appraisals and Nursing peer review. For 2012 over 50 percent of MVH patient care units exceeded the 50th percentile in the Patient Experience for the focus of courtesy, listening, education, and responsiveness. Some areas are consistently above the 75th percentile including MVH Emergency and Trauma Center and Miami Valley Hospital South’s Emergency Center and inpatient units. Both campuses continue to score above the 90th percentile for the HCAHPS discharge domain.

The Emergency Center at Miami Valley Hospital South and the MVH Emergency and Trauma Center were consistently rated above the 75th percentile by patients surveyed. Employees throughout Premier Health adopted revitalized Patient Experience behavior standards in 2012.

Nursing’s Patient Experience Healthy Relationships Subcommittee consisting of the unit practice council chairpersons and nurse managers continues to implement the “critical few” strategies defined by the Premier Patient Experience Steering Committee with input from the Voice of the Patient Advisory Council. Patient stories are shared at each monthly meeting as a learning experience for the team.

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Building Understanding through Dialogue Chief Nursing Officer Deb Mals, MS, RN, NEA-BC, hosted multiple “Dialogue with Deb” sessions and the Nursing 2012 Annual Update. Deb reviewed they key themes for Nursing and Premier Health’s strategic plan including integration of patient experience, quality, service and system goals. The recurring dialogues also were opportunities to discuss trends in nursing practice, including a formalized expectation that all new hires in Nursing have or obtain their BSN within five years of employment. All Premier facilities implemented this policy in August 2012 through a common CNO statement. Another critical topic was the Institute of Medicine (IOM) Future of Nursing report and the Ohio Action Coalition plans to develop our state’s response. Dialogues are a timely opportunity to discuss topics for nursing practice such as bed capacity changes and to listen to nurses’ ideas in regard to core practice.

Communication Performance Improvement In the first quarter of 2012 Miami Valley Hospital extended its use of Vocera as the primary communication tool in the majority of inpatient units at both hospital campuses. The implementation resulted in a work redesign performance improvement project. The Nursing-led project engaged interdisciplinary teams and human factors and biomedical engineers with the commitment to enhanced communication and responsiveness to patients. The teams conducted a survey about communication and Vocera-related workflow with physicians, key interdisciplinary team members, nurses and patient care technicians/health unit coordinators. Wireless phones were reintroduced, in combination with Vocera devices, as a result of a Nursing-led communication performance improvement project.

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Based on the survey results, wireless phones were reintroduced, in combination with the Vocera devices, on performance improvement pilot units. In addition, workflow was redesigned for alarm/patient call integration. These changes have improved satisfaction with device utilization for the patient care team members and physicians, with some noted improvement in patient responsiveness. This implementation will continue in 2013.

Fellowship Program Builds Leadership Diversity The Minority Nurse Manager Fellowship continues to assist Miami Valley Hospital’s commitment to ensure that its personnel reflect the diverse population of patients served. The nine-month program, which pairs minority nurses considering administrative roles with experienced mentors, is a collaboration of Nursing, Premier Health’s Office of Diversity and Miami Valley Hospital Foundation. To date, 80 percent of fellowship participants have been transitioned through promotion to a new position after completion of the program. Sophia Gordon is the latest graduate of the fellowship program to join Nursing’s leadership team. She was promoted to nurse manager of the Medical Surgical unit in December 2012. Gordon brings with her a focus on patient and family experience and a passion to model the way.

Eighty percent of Minority Nurse Manager Fellowship graduates have transitioned to new positions after completing the ninemonth program funded by Miami Valley Hospital Foundation.

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Nurses Drive Inpatient Rehab Improvements Miami Valley Hospital’s CARF-accredited Inpatient Rehabilitation Program has increased capacity from 39 to 45 beds, including 38 private patient rooms. The change responds to patient and family requests and promotes the family’s ability to be present for therapies and participate in patient care in preparation for discharge.

The Inpatient Rehabilitation Unit Council considered safety and staff-patient communication as they determined technology placement and workflows in their expanded unit.

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Inpatient Rehab staff were involved in every aspect of planning, including the physical environment, placement of equipment and supplies, and key decisions about workflows. Workflows were re-evaluated with the interdisciplinary care team beginning in December 2011, months before construction meetings began. The Unit Council and others met monthly during and after construction to plan, evaluate and make additional recommendations to improve the environment for patients and staff.

DAISY, Sunflower Awards Recognize Excellence Each month two Miami Valley Hospital nurses are chosen to receive the DAISY Award in honor of their exceptional skills, judgment and compassion. Now in its third year at MVH, the award is a partnership with The DAISY Foundation, created in memory of Patrick J. Barnes. Other area sponsors include United Healthcare and Miami Valley Hospital Foundation. The hospital’s Nurse Recognition Committee created the Sunflower Award to honor Nursing’s vital care partners. Each month a Sunflower Award is presented to a PCT, HUC or emergency tech who demonstrates extraordinary care.

Corey Alsept, RN, pictured with MVH Chief Operating Officer Barbara Johnson and Neuro ICU Nurse Manager Amy Teague, BSN, RN, was among the 2012 recipients of the DAISY Award.

2012 DAISY Award Honorees Kathy Adams PACU Corey Alsept Neuroscience Intensive Care Veanna Archer Medical Intensive Care Liz Brech Pulmonary Becky Bussy Behavioral Health Charlotte Cantrell Mother-Baby Care Crystal Cooper Heart and Vascular Katie Fulkersin Spine Center Jan Hankins Berry Birthing Center Kay Hirst Neonatal Intensive Care Nicole Jefferies Surgical Intensive Care Chasity Lemons Neuroscience Rita Loy Surgical Intensive Care Becky Marcum Trauma Audrey Miller Medical Intensive Care Monica Mirrow Gynecologic Oncology Melissa Murphy Heart and Vascular Intensive Care Cindy Plummer Advanced Treatment Area Melissa Trimm Medical-Surgical Geoffery Underwood Heart and Vascular 6 Erin Waite Trauma Jessica Welch Pulmonary Shelly Langston Blood and Marrow Transplant

2012 Sunflower Award Honorees Amy Brooks Burn Center Maria Deng Pulmonary Emily Evans Orthopedic Total Joint Karen Hill Advanced Care Diana Ligier ATA/EAU Linda Louth Berry Birthing Center Dani Oliver Neuroscience Shirley Patton 3WSW Medical Pulmonary Sarah Sisco Medical Intensive Care Sarah Snow Renal Alice Watts Surgery Admission/Discharge Anjanette Winston Behavioral Health

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Structural Empowerment – demands that solid structures and processes developed by influential leaders provide an innovative environment where strong professional practice flourishes and where the mission, vision and values come to life to achieve important outcomes. In an empowering environment, staff have access to information, resources and support.

Nursing Council Evaluates Practice Model Professional Practice Model

Sands of Time

In June the Professional Practice Council evaluated Nursing’s professional practice model (PPM) developed in 2008 to see if it accurately represents how nursing care is being delivered at MVH.

Professional Model of Care

Care Delivery Models

Following an overview of the model, council members and nursing leaders used response cards (Turning Technologies Clickers) to respond to a PowerPoint presentation inclusive of eight questions.

MVH Nursing

Nurses determined that the ‘hour glass’ professional practice model represents current nursing practice at MVH across all settings. Discussion uncovered an interest in having the ability to modify the dynamic PPM as health care reform and the health care environment evolve. Members determined that Question 5 (“Rank Forces which Drive MVH Nursing Practice”) could be used as a future strategy to modify the PPM.

SCIP Measures Reach Goal Nurses contributed to strong improvement in Surgical Care Improvement Project core measure performance during 2012. Compliance with SCIP measures reached goal, extending a three-year improvement trend. These outcomes were the result of collaboration among direct care givers, physicians and nursing leaders. A continued focus on EMR integration to assist with documentation cueing contributed to the team’s success.

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Bed Flow Success Nursing recognizes its role in facilitating bed flow in service to the organization and patient needs of the community. Through Nursing leadership and interdisciplinary and interdepartmental collaboration, the hospital exceeded its 2012 targets for timely patient admissions and transfers including the metrics of: Request to Call when patient has order, Call to bed assignment time, and Request to Arrival time. In addition, the PACU Wait Time Goal was exceeded with a reduction of 20 minutes.

Around-the-clock collaboration between the hospital’s patient flow managers and nursing unit leadership delivered above-goal performance for timely patient admissions and transfers.

SCIP Measure Compliance 2009-2012

100%

Target 96% 96%

90%

92% 85%

80% 79% 70% 60% 50% 2009

2010

2011

2012

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Nursing Satisfaction The National Database for Nursing Quality Indicators (NDNQI) is an important resource for assessing our nurses’ satisfaction with their work environment. Miami Valley Hospital nurses at both campuses continue to demonstrate strong interest in the NDNQI satisfaction survey. In 2012: • The average unit/work group participation rate at the MVH main campus was 73 percent, up from 67 percent in 2011. At Miami Valley Hospital South, the average participation rate was 96 percent compared to the national average of 75 percent. • 42 percent of units reached the goal of 80 percent participation, up from 31 percent.

• 51 percent of units reached 75 percent participation, up from 37 percent. • Nurses from 57 units, departments, programs and services participated. • 1,332 nurses out of an eligible total of 1,821* full-time, part-time and support RNs took the survey . • 16 units/work-groups reached 100 percent participation, up from 10 in 2011.

Miami Valley Hospital outperformed the NDNQI Teaching Hospital Mean for all 10 measures of RN satisfaction in 2012. Among nurses at the main campus, mean scores improved for RN-MD interactions, decision making, professional status, pay, professional development and nursing administration. Satisfaction among nurses at Miami Valley Hospital South increased for nine of 10 indicators. Survey results are shared with the Professional Practice Council and Nursing leadership for discussion at the unit and department level. *Nurses eligible to participate are those who spend at least 50 percent of their time in direct patient care and have worked on their unit for at least three months.

RN Satisfaction – NDNQI MVH Above Teaching Hospital Mean

4

Tasks



+

RN-RN Interactions

Year-over-year improvement

RN-Physician Interactions Decision Making Autonomy Professional Status Pay Professional Development Nursing Management Nursing Administration

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4 4 4 4 4 4 4 4 4 4

+ + + + + +

MVH South

4 4 4 4 4 4 4 4 4 4

+ + + + + + + + +

Matching Staffing to Patient Needs The Staffing Collaborative assisted Nursing work groups throughout the hospital with their implementation of the “My Schedule” electronic scheduling program and continued their focus on developing schedules to match patient needs and patient flow. During 2012 subgroups were defined to focus on continuity of patient care, staffing policy, the floating experience, and retention/recruitment. In September each unit participated in evaluating its staffing plan with the help of a formal template that presents the components of patient care ratios, acuity, admission, discharges and transfers, as well as the unit’s clinical outcomes, patient satisfaction performance and any other key indicators driving staffing effectiveness. Information from the unit evaluation was used to finalize budget planning and resource allocation for 2013.

More Nurses Certified in Area of Specialty Professional certification is an integral component of nursing practice at Miami Valley Hospital and demonstrates core knowledge in nurses’ area of expertise.

Ongoing integration of “My Schedule” was among the priorities of the Staffing Collaborative in 2012. The electronic scheduling program is one of the tools used to match staffing with patient needs.

The overall number of nurses with certification increased 13 percent from 2011 to 2012. Thirty-five percent of MVH nurses are certified in their area of specialty, including 31.8 percent of nurses in direct care and 43.2 percent of those in nursing leadership. The hospital encourages nurses to seek certification by sponsoring access to the online PearlsReview and prepaying the registration fee for certification examinations. Chief Nursing Officer Deb Mals, MS, RN, NEA-BC, hosted the annual Certification Recognition Tea for all professional certified RNs. The recognition is held in conjunction with the American Nurses Credentialing Center (ANCC) annual Certification Day on March 19.

Clinical Ladder Evolves with Premier Health System Advancing Clinical Excellence (ACE) explored new communication and learning options in 2012, reflecting the group’s expanded footprint as Premier Health’s nursing clinical ladder program. Generations in the Workplace was the topic for the fourth annual ACE Education Day, which included ACE nurses from Premier Health’s Upper Valley Medical Center for the first time. Dr. Linda Burrs, a 2012 YWCA Dayton Woman of Influence, was the keynote speaker.

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The Premier Health ACE Committee collaborated to provide live and videoconference education events, including Nurse Heal Thyself, Value Based Purchasing, and The Body-Brain Connection: Diabetes and Stroke. The committee also offered ACE exemplar writing workshops using Go-to-Meeting and Skype options as well as live classroom sessions to meet nurses’ differing learning and availability needs. ACE participation at Miami Valley Hospital increased to 579 nurses including: • 95 at Level 2 • 339 at Level 3 • 142 at Level 4 With the opening of additional inpatient services at Miami Valley Hospital South, the facility hosted its own ACE recognition celebration in 2012.

Jerry Colp Center Advances Professional Education The Jerry Colp Center of Nursing Excellence at MVH coordinated extensive professional education using a variety of learning methods during 2012. • Over 200 nurses participated in a three-day Advanced Care class focusing on anticipating and responding to changes in patient status. • Center of Nursing Excellence staff wrote, videotaped and edited nursing grand rounds programs approved for independent study CE and provided through HealthStream online learning. Topics included Transporting the Critical Cardiac Patient and Journey to Green. • The Premier Health Risk Management Department’s Risks in Nursing continuing education attracted over 350 attendees. • As an Ohio Nurses Association CE provider, Miami Valley Hospital submitted 117 documents meeting criteria for contact hours for a total of 288.55 contact hours in 2012. • Nearly 1,200 nurses participated in the MedNews Plus online learning site with an average of 24.3 CEs per user. In addition, the center oversees all clinical rotations with the hospital’s nursing staff. Miami Valley Hospital nurses precepted 1,246 undergraduate nursing students and over 40 graduate nursing students in 2012.

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Outstanding Achievements Patti Schairbaum, RN-BC, was selected as Miami Valley Hospital’s Cameos of Caring winner for 2012. Described as a fantastic leader and co-worker in the hospital’s Ambulatory Treatment Area (ATA)/ Express Admission Unit (EAU), Schairbaum began her career at MVH in 1981. She is credited with being one of the original nurses to start ATA, which serves patients having invasive diagnostic procedures, chemotherapy treatments and other infusions. She and other Cameos of Caring winners were honored Oct. 20, 2012, during ceremonies sponsored by the Wright State-Miami Valley College of Nursing and Health at Wright State University. Cass Swank, RN, Oncology case manager and 42year employee, was honored as the MVH medical professional in the fourth annual Champions of Hope event sponsored by Miami Valley Hospital Foundation. Champions of Hope honors individuals who are making a difference in the fight against cancer with proceeds benefiting the hospital’s cancer program. Critical care nurses played a central role in Miami Valley Hospital’s eligibility for a Bronze Medal of Honor for Organ Donation presented by the United States Department of Health and Human Services (HHS) in October 2012. The award recognizes hospitals for achieving and sustaining national goals for donation, including a donation rate of 75 percent or more of eligible donors at their facilities. Nurses in the hospital’s emergency departments and intensive care units work closely with Life Connection of Ohio (organ procurement organization for northwest and west central Ohio), chaplains and members of the hospital medical staff to assist patients and families opting for organ donation.

Mahogany’s Child, Miami Valley Hospital’s nursing-led health program dedicated to African American women, received the Community Service Award from the Top Ladies of Distinction, a non-profit educational, humanitarian organization that strives to enhance and enrich the lives of youth and adults through national and community based programs. Bonnie Coalt, MS, RN, was promoted to administrator for Hospital Operations with responsibility for Emergency and Trauma Services, CareFlight Air and Mobile as well as emergency care construction/renovation projects. She was previously director of Nursing. Kim Hensley, MS, RN, NE-BC, was promoted to vice president, Hospital Operations, with responsibility for Hospitalist Program, Laboratory, Medical Imaging, Nutrition Services, Respiratory Care and physician on-call coverage. She was previously administrative director of the Hospitalist Program. Claire Rodehaver, RN, MS, NE-BC, was appointed administrative director of the MVH Hospitalist Program. Rodehaver has worked in various clinical and management roles at MVH for the past 29 years, most recently as director of Nursing.

Patti Schairbaum, RN-BC

Cass Swank, RN

Bonnie Coalt, MS, RN

Kim Hensley, MS, RN, NE-BC

Robin Rutledge, MS, RN, was promoted to vice president, Service Integration – Heart and Vascular Services for the Premier Health system. She was previously director of Cardiology at Miami Valley Hospital. Claire Rodehaver, RN, MS, NE-BC

Robin Rutledge, MS, RN

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Nursing Recognition winners and honorable mentions

VeAna Archer Medical ICU Leadership

Judie Woods Lifetime Achievement Award, Leadership Honorable Mention Winners Clinical Practice Bryan Agee Neuro ICU Esther Akerele Inpatient Rehabilitation Heather Anderkin Neonatal Intensive Care Karen Anderson Heart & Vascular 7 Pearl Apiado Surgical Patient Care Megan Bettag Neonatal Intensive Care Carlisa Combs Heart & Vascular ICU Deb Connett Postanesthesia Care/Preop Tiffany Cydrus-Beckel Orthopedic Total Joint Vanessa Dixon Renal Patient Care Steven Josh Estes Medical ICU Mary Fairhurst Pulmonary Advanced Care Sheri Fleming Neonatal Intensive Care Renee Fritz Neonatal Intensive Care Carolyn Gray Cardiac Rehab Brooke Harris Heart & Vascular ICU Chaunda Hopkins Neonatal Intensive Care Lindsey Hopkins Ortho Total Joint Audra Johnson Inpatient Rehabilitation Holly Maddox Mother-Baby Care Becky Marcum Trauma Patient Care Education Lauren Miyamasu Teresa Naas Cecilia Njie Sandra Swanson Heather Vocke

Orthopedic Total Joint Heart & Vascular ICU Inpatient Rehabilitation Center of Nursing Excellence Heart & Vascular 6

Leadership John Campbell Ashley Cecil Angela Coppinger Tonja Fote Sheri Hall Jessica Hallum Cathy McHugh Laura Meeker Megan Sortman Beth Tabor-Cruea

Emergency & Trauma Center Neuro Advanced Care Surgery Admission/Discharge Surgical Patient Care Neonatal Intensive Care Inpatient Rehabilitation Surgery Admission/Discharge Heart & Vascular 6 Inpatient Rehabilitation Berry Birthing Center

Performance Improvement/Research Darin Stoutenborough Postanesthesia Care/Preop Preceptorship Kathleen Cook

Neuro ICU

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Ruthanna Cydrus Orthopedic Total Joint Performance Improvement/ Research

Jamie Harrod Trauma Patient Care Leadership

Treva Batcho Medical Oncology Performance Improvement/ Research

Daisy Dronen Orthopedic Total Joint Leadership

Debbie Jeffries Berry Women’s Care Clinical Practice

Christine Broomhall Premier HeartWorks Performance Improvement/ Research

Penny Campbell Surgical Services Education

Michael Gilles Renal Patient Care Preceptorship

Jessie Grubb Neonatal Intensive Care Clinical Practice

Mary Lou Moyer Pulmonary Advanced Care Clinical Practice

Deb Nordstrom Cardiac Rehab Clinical Practice

Tracy Rucker Neuro ICU Leadership

Shannon Oberding Five Rivers Health Centers Performance Improvement/ Research

Ashley Peter Heart & Vascular ICU Leadership

Alison Potts Nursing Administration Leadership

Andie Slivinski Emergency & Trauma Center Performance Improvement/ Research

Allison Tayloe Heart & Vascular ICU Clinical Practice

Emily Tracy Medical ICU Clinical Practice

Focus on Community Service Miami Valley Hospital has a long tradition of collaborating with other organizations to build healthier communities. In recent decades the hospital has significantly increased the role of partnering with the community to enhance the learning opportunities for health care professionals. Employees are encouraged to expand their involvement in community service activities to ensure strong participation, communication and presence in the community that is served. Nursing aligns with this objective to advance a culture of servant leadership. In 2012, 2,237 MVH nurses completed the American Nurses Credentialing Center (ANCC) Demographic Information Form, an online internal survey. Among the nurse respondents, 499 (22.3 percent) reported community involvement ranging from scouting activities to community health fairs/screenings, Habitat for Humanity and service at other local organizations. Many of the nurse respondents are involved in more than one community activity.

Nurses’ Community Service by Type

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Exemplary Professional Practice – means that the true essence of a Magnet® organization stems from exemplary professional practice within nursing. Exemplary Professional Practice requires a comprehensive understanding of the role of nursing, the application of that role with patients, families, communities and the interdisciplinary team, and the application of new knowledge and evidence.

Patients and Families at the Center When Frank Berger received bad news about his cancer prognosis, his daughter Leah and longtime friend Damon Breeden decided they couldn’t wait any longer to be married. They opted to tie the knot at Miami Valley Hospital where Mr. Berger was hospitalized. The couple asked if the hospital could provide a chaplain and a place for a small reception. That’s when Rachel Ramey, RN and her co-workers started a ripple that turned into a torrent – all in the space of 24 hours. While Damon asked Frank for his daughter’s hand, they were enlisting the help of Catering, Pastoral Care and other departments. The following evening Frank gave his daughter away in a sun-dappled hospital courtyard. Leah walked on a white runner laid between rows of cloth-covered chairs. The 35 guests enjoyed refreshments and a small wedding cake. Damon said it best: “Someone remarked that we could have planned for six months and not have had a wedding as nice as ours.” Oncology Nurse Rachel Ramey, RN, and her managers quickly enlisted the help of several departments so that a patient’s daughter would have a beautiful wedding ceremony in the hospital courtyard.

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Study Compares Monitoring for Oversedation in Trauma Patients A research study conducted by Miami Valley Hospital trauma and pain management nurses examined the benefits and burdens of concomitant capnography (EtCO2) and oximetry (SpO) monitoring in a population of trauma patients outside the ICU receiving intravenous patient controlled analgesia.

These nurses were among those who gathered data for research evaluating the benefits of electronic monitoring for preventing adverse events among trauma patients receiving intravenous patient controlled analgesia.

There were no changes in patient care procedures during the research study using the Alaris EtCO2 Module System. Data collected with 65 patients over eight weeks included: number of pump alerts, IV PCA pauses due to low respiratory rate, alarms due to high or low EtCO2, no breath events, and medication dose. The study findings suggest that capnography with continuous respiratory rate monitoring may provide a more accurate predictor of adverse event risk compared to intermittent nursing assessment of respiratory rate during therapy. This important finding may also have significant future safety implications since unexpected deaths and complications during hospitalization more often begin and end with signs of respiratory failure.

Ohio Transition to Practice Sixty-nine new graduate nurses participated in the Ohio Transition to Practice Study, part of a state/national collaborative that is investigating the transition of new nurses from the academic to practice setting. Brenda Barnes, MS, RN, serves as principal investigator for Miami Valley Hospital’s participation in this statewide research study.

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Nurturing Resilience in the First Year of Practice A poster featuring insights of Miami Valley Hospital’s Bridge to Practice Program attracted much attention at the 2012 Magnet conference and Ohio Organization of Nurse Executives (OONE) conference. Two-year outcomes revealed incredible insights. New nurses experience significant shock transitioning from academia to the bedside and carry within them great Authors: anxiety and fear of harming patients. They lack tools to respond to suffering in patients, self, and others. Feelings of inadequacy were thought to exist only within themselves, until hearing others share their experiences.

participants, 97.4 percent found BPP helpful and learned how to continue their development. Average 24-month turnover has decreased from 17-18 percent to 11 percent, overall vacancy rate is less than 1.0 percent and annualized turnover is better than the 50th percentile.

Nurturing Resilience in the 1st Year of Practice • Brenda Barnes MS, RN — [email protected] • Anitra Martin MS, RN — [email protected] • Patricia O’Malley PhD, RN, CNS — [email protected] • Mary Pat Thomas MS, RN, AHN-BC — [email protected]

Bridge to Practice Program (BPP) participants explore interventions for moral distress, reality shock, imposter syndrome, bullying and incivility, conflict resolution, self care and responding to human suffering. The novice nurses receive evidence-based tools, tips and resources to facilitate continued personal and professional growth and thus resiliency. Among 600+

Program Setting

Outcomes: Participant Evaluations

• 900+ beds Level 1 Trauma, Level 3 NICU Academic Medical Center • Magnet Designation 2004 & 2008 • Average of 204 new graduates hired per year.

• “I really liked hearing the other’s experiences. I am glad to know I am not alone” • “This class was very helpful. It is nice to know there are people who care…” • “It’s nice to be able to verbalize experiences in a safe environment” • “I found this seminar reassuring”

Objectives 1. Describe the factors affecting the transition to practice of the new graduate 2. Describe the aspects & outcomes of the transition to practice program – Bridge to Practice

Rising 24 month turnover- 17 to 18% 2007

Current Evidence

The Plan

The Aging Dilemma

• Developed an evidence based Bridge to Practice Program (BPP) • Mandatory for nurses at two months & five months after hire • Program elements: • Semi structured & confidential 4 hour sessions • Directed self assessments, writing, discussion & reflection

• Average age of a nurse is 47 • 45% of nurses are age 50 or greater & 55% will retire by 2020. • Nursing shortage is expected to increase 2 to 3% annually • The profession may have a shortage of 500,000 nurses by 2025

The New Graduate Dilemma • New graduates are the largest pool of available nurses in the current market • New graduates account for 10% of the current workforce • 25-67% will leave their first position within the first year of hire • 30-61% will change place of employment the first year

Our Problem

Core Elements of Bridge to Practice Programs

Nursing Turnover: 12 Months or Less Tenure 30% 25% 20% 15%

National % Turnover

18%

10%

11%

5% 0%

2010

2 Month Program

5 Month Program

• Work-life balance & adaptation • Reality shock stages & new grad stresses • Delegation & conflict resolution • Imposter Syndrome • Lateral violence (bullying & incivility) • Critical thinking • Time management & prioritization • Managing crisis • SBAR

• Self-care & wellness • Imposter syndrome • Nursing ethics • Moral distress • Solving ethical dilemmas • Human suffering • Available resources

MVH % Turnover

22.9%

21.9%

• Receiving confirmation and validation with the positive and negative experiences thus far” • “Ways to cope with stress and knowing that what I’m feeling is normal and shared with my fellow nurses” • “Sharing stories with people who understand and can relate” • “Learning to care for ourselves”

Lessons Learned about Bridge to Practice • BPP has favorable personal & professional benefits for the new graduate nurse • BPP provides community for support & confirmation • BPP provides a framework for the new nurse to build resiliency needed to remain in practice • ROI favorable- turnover reduced 7%

The Organizational Dilemma • Nursing orientation/investment ranges from $50,000.00 to $145,000.00 • New graduate turnover has significant negative consequences on budget, morale, quality and risk for adverse events

Outcomes: Participant evaluation: what was most helpful?

Future Plans • Re-evaluate metrics for benchmarking • Develop & implement a Mentor Program to sustain the journey from novice to expert

References 1. Advisory Board Company. (2006). Transitioning new graduates to hospital practice. Essay: Assessing the trend toward nurse residency programs. Washington, DC: Nursing Executive Center.

Outcomes

2. Advisory Board Company. (2012). Turnover and vacancy benchmark: Final report for the calendar year 2011. Washington, DC: Nursing Executive Center.

• Over 600 participants from 2008-2012 • 97.4% found BPP helpful in development of resiliency • 98% believed BPP should be required 1st year

3. Bratt, M. (2009). Retaining the next generation of nurses: The Wisconsin nurse residency program provides a continuum of support. Journal of Continuing Education in Nursing, 40(9), 416-425.

Average 24 month turnover 2010-2011 decreased from 18% to 11%

2011

4. Bullock, L., Paris, L., Terhaar. (2011). Designing an outcome-focused model for orienting new graduate nurses. Journal for Nurses in Staff Development, 27(6), 252-258. 5. Friedman, M., Cooper, A., Click, E., Fitzpatrick, J. (2011). Specialized new graduate RN critical care orientation: Retention and financial impact. Nursing Economics, 29(1), 7-14. 6. Halfer, D. (2011). Job embeddedness factors and retention of nurses with 1 to 3 years of experience. Journal of Continuing Education in Nursing, 42(10), 468-476. 7. Hirschkorn, C., West, T., Hill, K., Cleary, B., & Hewlett, P. (2010). Experienced nurse retention strategies: What can be learned from top-performing organizations. Journal of Nursing Administration, 40(11), 463-467. 8. Welding, N. (2011). Creating a nursing residency: Decrease turnover and increase clinical competence. Medsurg Nursing, 20(1), 37-40.

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G U I DI NG A M E R IC A TO BE T T E R H E A LT HC A R E

9. Zeller, E., Doutrich, D., Guido, G., Hoeksel, R. (2011). A culture of mutual support: Discovering why new nurses stay in nursing. Journal of Continuing Education in Nursing, 42(9), 409-414.

A Bridge to Practice Program poster received first place in the education division at the Ohio Organization of Nurse Executive (OONE) annual conference. Content from the poster also was presented at an Ohio Hospital Association Quality Summit.

Interdisciplinary Collaboration Achieves Quality, Safety Gains The interdisciplinary care team’s relentless focus on quality and patient safety delivered a 40 percent year-over-year reduction in hospital acquired conditions (HAC) from 2011 to 2012. Among the many successful interventions in 2012 was an Outcomes Academy implemented by Nursing to review key patient safety expectations and interventions. The idea for the academy evolved from MVH participation at the 2011 Magnet National Conference. Professional Practice Council members enlisted content experts to gain input and approval of the concept. More than 2,100 inpatient direct caregivers in eight disciplines attended Outcomes Academy.

18 • M iami Valley H ospital

All disciplines received fall prevention education as well as education on safe patient handling for activity progression and techniques for helping a patient out of bed safely. Target Zero initiatives continue throughout Miami Valley Hospital, including the use of a daily check-in meeting and inclusion of patient safety stories on all agendas and unit safety huddles. Nursing Quality measures reported through NDNQI are reviewed with bedside staff quarterly through the Professional Practice Council. The data is also reviewed quarterly at Nursing Leadership and posted electronically for unit leadership use.

2012 Nursing Quality Highlights Central Line Blood Stream Infections (CLABSI) 75 percent of units outperforming NDNQI Teaching Hospital Mean • Monthly deep dives of infections to determine cause and correction • Green Curos caps implemented in all areas • Central line education and competency by the IV Therapy team

Ventilator Associated Pneumonia (VAP) 75 percent of units with ventilator days outperforming NDNQI Teaching Hospital Mean Patient Restraints 72 percent of units outperforming national peer groups

CLABSI Rate Comparison Infections per 1,000 Central Line Days 3.5 3.0 2.5 2.0 1.5 1.0

n MVH n MVH South n NDNQI Teaching Hospital mean

0.5 0.0 2011 Q2

2011 Q3

2011 Q4

IV Therapy Competency Education

2012 Q1

2012 Q2

2012 Q3

2012 Q4

Curos Cap Implemented

Falls 66 percent of units outperforming NDNQI Teaching Hospital Mean (up from 55 percent) • Decision by Professional Practice Council to ensure patients with fall risk score >16 will have a bed alarm • Staff nurse-driven audits for monitoring documentation and policy compliance • Bed alarm, fall assessment, and fall best practice bundle education through Outcomes Academy • Increase stock of portable bed alarms in Central Distribution • Plan to place bed alarms in every patient room for use while patient is in the chair

• Heart and Vascular ICU and Pulmonary units continue to increase patient activity while participating in research study on the benefits of activity. Hospital Acquired Pressure Ulcer (HAPU) 66 percent of units outperforming NDNQI Teaching Hospital Mean (up from 55 percent) • Two-person skin assessment now implemented in high risk areas with Epic documentation support • Initiation of a product to protect vulnerable skin areas • Review of skin assessment, wound staging and skin best practice bundle with hands-on education through Outcomes Academy

N u r sin g A nn ual Repo rt 2 0 1 2 • 1 9

New Knowledge, Innovations and Improvements – calls for the organization to conscientiously integrate evidencebased practice and research into clinical and operational processes to advance the practice of nursing and improve the quality of patient care and outcomes.

Mock Codes Hone Crisis Skills Over 1,950 nurses in 30 patient care units at the main campus and Miami Valley Hospital South participated in simulation learning to enhance patient care and patient safety during 2012. Unannounced mock codes are keeping skills sharp among physicians, nurses and respiratory therapists who participated in simulation learning organized by Nursing.

20 • M iami Valley H ospital

The unit-level mock codes were interdisciplinary, including participation of Department of Medical Education and Respiratory Care personnel. This provides an exciting opportunity to bring simulation education to the direct patient care unit bedside.

Simulation Technology Adapted for OB Nursing implemented simulation scenarios specific to the care of the high risk and normal newborn clinical situations using human simulator technology purchased with a grant from Miami Valley Hospital Foundation. The new simulation lab is offered in partnership with perinatologists and neonatologists from the MVH Medical Staff, the hospital’s OB Safety Committee and nursing unit practice councils.

Perinatal Safety Officer Tammy King, BSN, RN, preps the Berry Women’s Center simulation room for an exercise.

Nursing Research Members of the Professional Practice Council’s Nursing Research Collaborative explored several topics in 2012, including: • Nursing Certification • Light Therapy at End of Life • Writing in Nursing • Bundling Best Practices at the Bedside • Compassion Fatigue • The Evidence Base for Glycemic Control • Ethics of Genetics in Research • Scientific Misconduct • Comfort Significant research studies coordinated through the Jerry Colp Center of Nursing Excellence included: • National Pain Prevalence Study – NDNQI Cheri Rawe, MS, RN, CNS, and Pain Research Interest Group, Patricia O’Malley, PhD, RN, CNS • Transitions in Practice – National Council of State Boards of Nursing Brenda Barnes, MS, RN • Benefits of Activity Progression in Critical Care Amy Shay, MSN, RN, CNS-BC, Lisa Brennan, MSN, RN, CNS,CCRN, Patricia O’Malley, PhD, RN, CNS • End Tidal CO2 Monitoring Outcomes Beth Larsen, MS, RN, CNL, Becky Dwenger, BSN, RN, Patricia O’Malley, PhD, RN, CNS, Liz Denlinger, BSN, RN, Carole Smith, MS, RN, CNS, Cheri Rawe, MS, RN, CNS, Christopher Connelly, BSE, MS, Jayne Gmeiner, MS, RN, NEA-BC, Angela Wale, MSN, RN • Development of a Web Portal for Advanced Practice Laura Sorg, DNP, RN-BC, EPHIMS

N u r sin g A nn ual Repo rt 2 0 1 2 • 2 1

2012 Publications, Posters and Presentations Publications O’Malley P. (2012). Baby Boomers and Substance Abuse: The Curse of Youth Again in Old Age. Clinical Nurse Specialist. 26(6): 305- 307. O’Malley P. (2012). Caffeinated Energy Drinks. Risks Assumed With Consumption When Competing, Working, and Drinking. Clinical Nurse Specialist. 26(5): 250-253. O’Malley P. (2012). This Pretty Balloon Might Kill You. The Rise of Inhalant Abuse and Resources for Practice. Clinical Nurse Specialist. 26(4): 200-202. O’Malley P. (2012). Preventing and Reporting Adverse Drug Events. Pharmacovigilance for the Clinical Nurse Specialist. Clinical Nurse Specialist. 26(3): 136-137.

22 • M iami Valley H ospital

O’Malley P. (2012). A Looming Threat – Increasing Drug Shortages in the United States. Resources for the Clinical Nurse Specialist. Clinical Nurse Specialist. 26(2): 71-73. O’Malley P. (2012). Prescription Opioid Abuse. Update for the Clinical Nurse Specialist. Clinical Nurse Specialist. 26(1): 19-21. O’Malley P. Screening for GERD in Hospitalized Patients. Mosby Nursing Consult. Elsevier Press. July 20, 2012. Available at nursingconsult.com.

O’Malley P. Patient Lift Team Program Reduces Injuries and Boosts Productivity Among Nurses. Agency for Healthcare Research and Quality- AHRQ Innovations Exchange. United States Department of Health & Human Services. August 15, 2012. Available at innovations.ahrq.gov/innovations_qualitytools. aspx?search=Lift%20team. O’Malley P. Zeta Phi Chapter Hosts a Nightingale Tea. Chapter Leader Emphasis. Sigma Theta Tau International – Honor Society of Nursing. 2012; 19(2): 5. Shay A. Nurse-Administered Pulmonary Protocol Increases Out-of-Bed Activity, Shortens Length of Stay and Reduces Readmissions. Agency for Healthcare Research and Quality- AHRQ Innovations Exchange. United States Department of Health & Human Services. June 27, 2012. Available at innovations.ahrq. gov/content.aspx?id=2425&tab=1.

Posters/Presentations American Association of Neuroscience Nurses March 9-12, 2012 Charlotte, North Carolina Team Neuro: A New Neuro Intensive Care Unit Vicki Wright, MS, MSN, RN, CNRN Vermont Oxford Network Meeting April 11, 2012 Using Qualitative Data to Improve the Rate of Direct Breastfeeding in the NICU Richard Arends, PharmD, Marc Belcastro, DO, Penny Blair, RT, Robin Bliss, RNC, Karyn Catrine, MS, RD, LD, Amy Clayton, RNC, Donna Fisher, RNC, Deb Gregory, MSN, NNP-BC, Erin Pryor, MPH, RD, LD, Tracy Morrison, RN, Tammy Samiec, MD, Julie Scanlan, RN, Suzette Smith, MS, RRT, Julie Wannamacher, RRT, NPS, Marie Wise, BSN, RN, IBCLC Wound Ostomy and Continence Nurses Society June 9-13, 2012 Charlotte, North Carolina Case Study – Difficult Enterocutaneous Fistula Kimberly Butana, BSN, RN, CWON, Cecilia Krusling, MSN, CNS, CWOCN American Association for the Surgery of Trauma Annual Meeting Sept. 12-15, 2012 Kauai, Hawaii End Tidal Carbon Dioxide Monitoring for Over Sedation Uncovers Previously Unanticipated Respiratory Pathology Beth Larsen, MS, RN, CNL, Becky Dwenger, BSN, RN, Patricia O’Malley, PhD, RN, CNS, Liz Denlinger, BSN, RN, Carole Smith, MS, RN, CNS, Cheri Rawe, MS, RN, CNS, Christopher Connelly, BSE, MS, Jayne Gmeiner, MS, RN, NEA-BC, Angela Wale, MSN, RN

National Leadership Academy, Sigma Theta Tau International Honor Society of Nursing Sept. 20-22, 2012 Indianapolis, Indiana How to Build Relationships Across Four Generations of Nurses: Hold a Nightingale Tea and Building Successful Collaborative Chapter Relationships Patricia O’Malley, PhD, RN, CNS ANCC National Magnet Conference Oct. 10-12, 2012 Los Angeles, California Nurturing Resilience in the First Year of Practice Brenda Barnes, MS, RN, Anitra Martin, MS, RN, Patricia O’Malley, PhD, RN, CNS, Mary Pat Thomas, MS, RN, AHN-BC Ohio Organization of Nurse Executives (OONE) Nov. 7-9, 2012 Columbus, Ohio End Tidal Carbon Dioxide Monitoring for Over Sedation Uncovers Previously Unanticipated Respiratory Pathology Beth Larsen, MS, RN, CNL, Becky Dwenger, BSN, RN, Patricia O’Malley, PhD, RN, CNS, Liz Denlinger, BSN, RN, Carole Smith, MS, RN, CNS, Cheri Rawe, MS, RN, CNS, Christopher Connelly, BSE, MS, Jayne Gmeiner, MS, RN, NEA-BC, Angela Wale, MSN, RN Nurturing Resilience in the First Year of Practice Brenda Barnes, MS, RN, Anitra Martin, MS, RN, Patricia O’Malley, PhD, RN, CNS, Mary Pat Thomas, MS, RN, AHN-BC

End Tidal Carbon Dioxide Monitoring for Over Sedation Uncovers Previously Unanticipated Respiratory Pathology Authors: • Beth Larsen, MS, RN, CNL – Nurse Manager-Trauma

Project Background

Methods

• Becky Dwenger, BSN, RN – Educator/Associate Nurse Manager

• A variety of professional organizations recommend use of EtCO2 monitoring to reduce adverse events associated with IV PCA therapy • Recent integration of capnography (EtCO2) & oximetry (SpO2) monitoring into a closed-loop single platform which can stop or pause intravenous patient controlled analgesia (IV PCA) and provide an alarm provides significant safety benefits for patients receiving IV PCA therapy • In a saturated alarm environment, addition of technology must be based on evidence of safety benefits without increased alarm fatigue 1

• Approved by the Institutional Review Board • No changes in patient care or monitoring protocols during the study period • Patient identity was protected by assigned codes for module programming • Module data wirelessly transferred to CareFusion® for analysis

• Patricia O’Malley, PhD, RN, CNS – Nurse Researcher • Jayne Gmeiner, MS, RN, NEA-BC – Director- Center of Nursing Excellence • Angela Wale, MSN, RN – Director Nursing • Cheri Rawe MS, RN, CNS – Clinical Nurse Specialist-Pain Program • Carole Smith, MS, RN, CNS – Clinical Nurse Specialist-Pain Program • Liz Denlinger, BSN, RN – Trauma Program Manager • Christopher Connelly, BSE, MS – Quality Management • Jonathan Saxe MD – Sponsor - Department of Surgery Wright State University School of Medicine • Miami Valley Hospital – Dayton, Ohio • Miami Valley Hospital Trauma Program • Center of Nursing Excellence – Miami Valley Hospital • Wright State University Boonshoft School of Medicine

Outlier Analysis (5 Infusions/1600 Alarms) 4.58 22.67 90.1 5.92 20

4

107.4 4.5 16.96

3

87.2 4.11 18.06

2

103.4

Extent of the Problem • Annual US error rate for IV PCA related error- 406.8 per 10,000 persons which represents $388 million dollars of additional burden on the health care system • The most costly errors: opioid related adverse events ($13,803.00/event) followed by operator-related errors ($2,955.00/event) • The annual device related error rate 17 per 10,000 persons 2

Considerations for Capnography or EtCO2 Monitoring • Designed to capture early rather than late respiratory decline • Provides significant cost savings compared to repeated arterial blood gas measurement • Respiratory rate (RR) may be more accurate because the value is a function of expired level of CO2 rather than the rise & fall of the chest • RR may also be more accurate since the very presence of the clinician assessing the rate may stimulate the patient-which results in a higher rate than baseline 3

2.44

Average length of monitoring & therapy........ 22.4 hours Total number of alarms ........................................ 4066 (1466 for 5 infusions) Median number of alarms per infusion ........ 20 (range 1 - 76 alarms) Deaths or adverse events

................................ 0

Transfers to intensive care ................................ 0

Alarm Type Excluding Outliers 3%

1%

Classification & Percent for 2600 Alarms

17%

25%

BPM High EtCO2 Low BPM Low BPM Low & EtCO2 Low FiCO2 High EtCO2 High BPM High & EtCO2 Low PCA Pause Alarm Events- (4.27% of all alarms)

PCA Pause Alarm by Infusion Type Morphine Hydromorphone Fentanyl

10%

Subjects 31%

10 Pain

Results

Single in-patient step-down trauma unit in a Level One Trauma Center over a six week period

Patients requiring IV PCA therapy for pain control

79.85

0

For trauma patients outside the ICU receiving opioid analgesia via IV PCA therapy with the Alaris® EtCO2 Module, what are the benefits & burdens of concomitant capnography & oximetry monitoring?

Setting

20.09

1

53%

Study Objective

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Figure 3. Relationship of Pain Score & Heart-Respiratory Rate for 72 Hours of EtCO2 Monitoring-5 Outliers

5

59%

• 39 of the 65 infusions had PCA pause alarm mean 2.8 per infusion • Infusion start to first PCA pause alarm mean 102 minutes

20 RR

30

40

50

60

70

80

90

100

HR

• Pain medication type and dose, mean pain scores & activity progression metrics were found acceptable. • Serial chest radiographs revealed that all five subjects had evidence of atelectasis; one subject also had evidence of pnemothorax • Radiological findings appear to better explain RR alarms than pain scores.

Study Implications • EtCO2 monitoring is an effective tool in monitoring for respiratory compromise during IV PCA therapy • EtCO2 monitoring also appears to be effective in monitoring & identifying respiratory compromise • Findings suggest that the Alaris® EtCO2 Module may provide a more accurate and complete picture of the variance in ventilation, oxygenation, and respiratory rate parameters in trauma patients receiving IV PCA compared to intermittent nursing assessments. • With emerging evidence that unexpected deaths & complications during hospitalization often begin and end with falling then rising EtCO2, stable then falling PaO2 and sustained high respiratory rate, continuous EtCO2 monitoring may provide a significant safety benefit for high risk patients with & without PCA therapy. 4

Selected References 1. Calkins P, McMurray S, McDowell D, Bingle G, Birk C, Indianapolis Coalition for Patient Safety (ICPS). Hospital Coalition Group Endorses APSF Recommendations for PCA Monitoring. APSF Newsletter, Spring 2010. Available at: http://www.apsf.org/newsletters/html/2010/spring/12_coalition.htm. 2. Meissner B, Nelson W, Hicks R, Sikirica V, Gagne J, Schein J. The Rate and Costs Attributable to Intravenous Patient-Controlled Analgesia Errors. Hospital Pharmacy. 2009; 44(4): 312-324. 3. (Maddox R & Williams C. Clinical Experience with Capnography Monitoring for PCA Patients. APSF Newsletter. 2012; 26(3): 41-68. Available at http://www.apsf.org) 4. Lynn L & Curry J. Patterns of Unexpected In-Hospital Deaths: A Root Cause Analysis. Patient Safety in Surgery. 2011, 5:3. Available at http://www.pssjournal.com/content/5/1/3.

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Nurses Achieving ACE Clinical Ladder Recognition Miami Valley Hospital congratulates the 579 registered nurses who achieved Advancing Clinical Excellence (ACE) status in 2011-2012. ACE is Premier Health’s clinical ladder program recognizing nurses who voluntarily demonstrate a higher level of clinical practice. Level 2 Terry Alsept Tina Arstingstall Jennifer Bailey Emily Baker Amanda Baranyi Audrey Bateman Jessica Bauer Penney Bentley Andrea Berner Zingela Besaw Terri Blanton Lisa Blevins Jamie Bockelman Tara Boehmer Rachel Boes Eric Bowers Noel Briones Rachel Burke Sheila Callicoat Sara Carlson Rebecca Crouch Rachel Darby Kimberly Dill Whitney Dunbar Lori Edgington Christy Fetzer Amanda Fines Deborah Fish Karis Freije Michael Gilles Kimberly Gilley Jenna Grigsby Julie Guzman Chrystie Hall Cheree Harding Emily Harker Jamie Harrod Lorie Heagerty Michele Hisle Stephanie Holland Vanessa Holley Vickie Hollo Andrea Hook Chaunda Hopkins Jessica Hous Kristin Houser Michelle Isaly Audra Johnson Heidi Johnston Lindsey Jones Patricia A Kelley Jessica Krebs Judy Little Jennifer Long Katherine Loper Brian Louallen Breann Maas Eva Magnuson Sara Marker Katie McMenamin Brooke Meadows Christine Messer Audrey Miller Tinesha Mitchell Holly Moore Janice Officer Stefanie Parry Timothy Pennington Ginger Phelps

Maryann Prichard Linda Puckett Michelle Purdy Jeanne Puthoff Rebecca Reynolds Teresa Rich Rachel Risner Christina Roadruck Rachel Roberts Sarah Rodewald Lindsay Roock Duana Rose Ashley Sears Amber Serna Tammy Sharp Susanna Siple Sharon Smith Theresa Smith Barbara Sowders Shannon Stireman Jacquelyn Surant Sheena Thurmond Dusti Toman Stephanie Tozzi Carol Tyson Erin Vitale Tiffany Warren Janet Weaver Brendan Weigand Mary Weller Teresa Wells Kathleen Whelan Phyllis Williams Taryn Williams Heather Wofford

Level 3 Mary Adams Linu Ajai Esther Akerele Angela Alderman Maki Amemiya Ashley Ampleford Karen Andersen Pearly Apiado Erin Archer VeAna Archer Brenda Bailey Debbie Bales Melissa Barnett Candace Bauer Laura Bednarczyk Dena Bell Elissa Bell Christine Bennett Constance Bennett Susan Berger Melissa Bergman Sara Bertke Colleen Bevins Christi Bilinski Lynne Bingham Janelle Birdsall Wendy Bishop Donna Blackwell Lynne Blackwell-Williams Nina Blair Lisa Bolton Kathy Bossong Amanda Bowsman

24 • M iami Valley H ospital

Shelley Brant Sophia Briley Jaclyn Briones Jessica Brock Colleen Brown Amy Bulcher Alicia Bumgarner Cynthia Burt Kellie Carabell Anna Carr Karen Carter Balinda Cash Linda Clark Lisa Clark Barbara Collins Karen Combs Amber Conley Tamela Conley Kim Conway Emily Cook Kathleen Cook Carole Cornwell Karen Crabtree Heather Cramblett Nancy Craycraft Cheryl Credit Gina Cullom Mary Cure Jessica Curran Kimberly Dano Beverly Davis Amy Dehus Brooke Deister Maria Delgado Diane Dempsey Kathleen Dillon Holly Dixon Vanessa Dixon Ginger Domer Kristen Duff Lisa Dunn Delinda Eaton Stephanie Eilerman Frannie Ellerbrock Debora Emmons Rhonda Erbes Jennifer Evans Mary Fairhurst Holly Fiora Jon Fiora Stephanie Fliehman Glenna Florence Joe Floyd Denise Flucas Tanya Fowler Angela Franklin Teresa Frisch Cynthia Frontz Donna Fugate Kimberly Garrett Teresa Gatzulis Patricia Gay Mary Gaytko Holly Geglein Lindsay George Shiny George Mary Clare Geraghty Michelle Gilbert Debbie Gillum Matthew Gimmison

Nancy Golden Carolyn Gray Janell Green Kelly Green Connie Griffin Carol Griffith Karen Paige Griffith Theresa Groff Amanda Hallahan Kimberley Halsey Cheryl Hamilton Carrie Hamrock Amy Haney Linda Harbaugh Dawn Hartman Vicki Hathaway Cynthia Hayden Lisa Hayes Renee Heitzman Casey Henderson Kim Hentrick Emily Herkins Christian Hess Lindsey Highley Susan Hoff Stacy Hoover Alisha Howell Monica Hudson Janet Hunt Aamie Inskeep Madhavi Inturi Kami Jackson Deborah Jenkins Lyndsey Johns Denise D. Johnson Jeanne Johnson Lisa Johnson Mandy Johnson Gwen Jones Stephanie Jones Gayle Jordan Sarah Kahlig Debra Kash Melanie Kautz Nicole Kearns Sarah Keechle Shelly Kersey Lori Kessler Emily King Johnny King Gina Kiser Erin Klein Anna Knisley-Houser Megan Kramer Melissa Kulow Stella Lanter Angela Lawrence Julie Layton Marnina Leal Laura Leighninger Kelly Leopold Katina Levell Leah Levier Paulette Leyrer Patricia Ann Lindner Isi Litfin Jill Lockwood Melissa Lokai Jamie Long Sandee Long

Linda Longo Jennifer Mackey Jane MacPherson Michele Mannix Jody Manzo Becky Marcum Deborah Marr Sharon Marshall Therese Martin Mary Masekar Roshini Mathew Mildred Mathews Colleen McCoart Tammy McCrabb Valerie McGinnis Susan McIntosh Beth McKeever Lee McLaughlin Kathy McNicholl Michelle Meade Trina Melzoni Judy Meyer Scott Middleton Susan Mielke Annette Miller Theresa Miller Tristin Minton Lauren Miyamasu Daylene Mize Linda Moorman Tracy Morrison Valisha Moss Carol Mousa Melissa Murphy Jennifer Murray Sharon Murray Kimberly Myers Emily Neal Robin Neal Stacey Nisonger Cecilia N’jie Jessica Oakley Sheila Oberer Roberta O’Bryant Meghan Olinger Connie Ortiz Jane Palazotto-Crisler Audrey Palmer Karen Pearson Ashley Peczkowski Tammie Perkins Stacey Phillips Wanda Piper Tiffany Pittman Cindy Plummer Kimberly Porter Rhonda Qasem Janet Rafferty Rachel Ramey Linda Raterman Judith Ray Jon Reichman Alyse Reineke Kristie Reis Elizabeth Reyes Jessica Reynolds Kristine Reynolds Anne Richardson Katherine Rickard Elizabeth Rike

Bridgette Rillo Sharon Rittinger Beth Rogers Annette Ruckrigl Karis Russell Connie Rutherford Amy Salyer Gregory Sanchez Colleen Sanford Lisa Saul-Creager Debra Schaeffer Emily Schmitz Tatja Schneider Amy Schommer Christine Scites Diana Scott Katy Sebald Nancy Shaffer Marti Shapiro Angela Sheline Kara Shelton Karen Shoopman Gregory Short Gayle Shover Teresa Siefke Ruthann Simms Lynne Skowronski Angela Smith Erica Smith Holly Smith Anessa Snapp Nicole Snell John Snow Kelly South Sandra Speck Jeanette Sprouse Stephanie Stacy Ayren Staton Sara Stowe Ashleigh Stroble Debra Stull Karen Stumpf Barbara Suddith Patti Sweeney Kathleen Tabisz beverly Tate Allison Tayloe Jonathan Taylor Tammy Temple Erin Theodor Jason Thompson Michelle Thompson Virginia Thompson Jacqueline ThompsonCornett Jessica Threnhauser Stephanie Tortorici Emily Tracy Cheryl Trick Carrie Trimborn April Turner Mandi Turpin Connie Tyree Eileen Vagedes Mary Vandagriff Angela Via Kristen Von De Linde Jane Von Dohre Rhonda Voskuhl Rebecca Waggoner

Bethany Wagner Maureen Walker Erika Warner Lynn Warren Dana Webb Shannon Webb Jessica Welch Dawna Wellbaum Renee Weller Judy Wickline Rebecca Wilder Nicole Wilhelm Dawn Williams Vickie Williams Vicki Williford Erica Willson Judith Wilson Susan Wilson Kelly Winship Melissa Winterquist Julie Wooddell Katherine Wright Lisa Young Lynn Zack Kellye Zehring Erika Zimpfer

Level 4 Bryan Agee Brenda Allard Cynthia Anderson Veronica Armstrong Robin Arthur Summer Babis Rachel Baggett Catherine Bailey Michelle Baldwin Pamela Bartlett Lynda Beck Lorraine Bellan Carrie Bellnoski Megan Bettag Ramona Bittner Theresa Blake Robin Bliss Donna Bova Janette Braun Kelley A Brown Sue Bush Barbara Campbell Charlotte Cantrell Delena Caughenbaugh Patricia Chambers Melissa Cho Angela Cochran

Carlisa Combs Deborah Connett Jacquelyn Cox Rosemary Critchley Brandon Daum Victoria Dean Sara DeLauro Pamela Denniston Terri Dorsey Annie D’souza Katherine Dunlap Vickie Edmonds Joan Everson Pamela Fecher Diane Feeser Donna Fisher Cheryl Gerber Janice Gordon Maria Greene Tracy Greenwell Jessie Grubb Melissa Gundolf Paul Gyorgyfi Sheri Hall Meghan Halsey Jan Hankins Linda Hargrove Brooke Harris

Diana Hatton Amy Hayes Martha Heaton Kimberly Hedrick Patricia Howard Marilyn Huffman Pam Hume Jefferleif Jabola Gail Jeffery Carol Johnson Deana Johnson Amanda Jones Amy Kacho Amy Kerr Nancy Kessinger Michelle Knorr Cara Koesters Barbara Kohn Leah Krickenbarger Bonnie Lambert Deb Lechner Thelma Lee Sandy Lunsford Gayl Marvin Leeba Matthew Peggy McNamee Vida McQuiston Pamela Miller

Toni Miller Monica Mirrow Cary Mohr Sheryl Mohr Neeta Monteiro Michelle Nissen Deb Nordstrom Elizabeth Obermeyer Patricia Okolish Terri O’Leary Theresa Petrosino Jennifer Phelps Melanie Phipps Edith Porter Angela Ream Angela Robinson Peggy Roche Marcia Roemer Kristina Rudd Victoria Ryan April Sappe Patricia Schairbaum Cynthia Schneider Jennifer Schueler Angela Sebald Donetta Setters-Leach Katie Shoemaker Jacqueline Simpson

Kathleen Sizemore Esther Kaye Snow Jennifer Spalding Sandra Stegman Denise Stewart Darla Subler Danielle Sundermeyer Jaime Swallow Regina Templonuevo Jennifer Thompson Rebekah Thurston Karen Trapani Belinda Vallo Amber VandenBos Vikki Wagner Deborah Warniment Kim Weber Kimberly Weisenberger Ronald Weneck Angela Westbeld Susan White Julie Whitis Marcia Williams Holly Woods Judith Worley Elisabeth Zimmerman

Nurses with Advanced Certification Miami Valley Hospital patients benefit from the 543 registered nurses who hold professional certification in one or more areas of expertise. This listing includes all nurses who reported their certification status through July 15, 2013. Beka Abraham Jai Abraham Linda Adams Bryan Agee Michele Alberts Brenda Allard Cindy Anderson Megan Anderson Sarah Anousheh Veronica Armstrong Laura Atkinson Travis Avery Summer Babis Rachel Baggett Catherine Bailey Teresa Baker Michelle Baldwin Kathleen Ballman-Parks Cheryl Barker Margaret Barnes Melissa Barnett PAM BARTLETT Diane Batcher Brian Bates Bonnie BaumgartnerZimmer Elaine Beaver Lynda Beck Victoria Bell Lorraine Bellan Carrie Bellnoski Deb Bentley Sara Bertke Zingela Besaw Megan Bettag Colleen Bevins Beverly Bias Lynne Bingham Ramona Bittner Pam Black

Theresa Blake Terri Blanton Robin Bliss Brenda Bodenmiller Lora Bogan Rhea Botschner Donna Bova Steven Bower Eric Bowers Kelly Bradshaw Cheryl Brainard MaryAnn Brandell Lisa Brennan Suzanne Brooks Anne Brower Heather Brown Holly Brown Kelley Brown Phyllis Brown Carol Broyles Annette Brumberg Patti Brunett Barbara Brush Allison Burger Dawn Burger Judith Burk Sally Bussey Kimberly Butana Rachel Byelene Mary Caldwell Barbara Campbell Charlotte Cantrell Melissa Capps Jamie Carman Ellen Cato Marie Chambers Patricia Chambers Dawn Chaney Melissa Cho Amy Clayton

Jossie Clouse Angela Cochran Brandi Cogdill Marquetta Colbert Theresa Coldiron Carlisa Combs Karen Combs Clare Common Nancy Conley Katherine Conn Deborah Connett Emily Cook Becky Coons Rosemary Coutinho Jackie Cox Michelle Crabtree Cheryl Credit Ann Crenshaw Rosemary Critchley Jill Crouch Megan Crouse Amy Crowe Kathleen Crowe Gail Crump Mary Cure Catherine DaGrossa Brandon Daum Gloria Davis Victoria Dean Audrey Deck Angela Deere Suzanne Deis Elizabeth Delaney Sara DeLauro Andra DeNise Melissa Dennis Porothea Dennis Rebecca DeSerisy-Davis Danielle Deski Johnnie Dillinger

Michele Dinkledine Michelle DiPaolo Roxanne DiSalvo Ginger Domer Cathy Donaldson Terri Dorsey Michelle Doyle Gretchen Driscoll Debbie Duff Anastasia Dugan Angela Dunigan Rebecca Dwenger Vickie Edmonds Rhonda Erbes Barbara Etter Jane Evans Debbie Fagan Pam Fecher Jennifer Fecke Diane Feeser April Fender Kathleen Fennig Christy Fetzer Alice Fields Mary Fillios Donna Fisher Elizabeth Fitch Stephanie Fitchpatrick Sharon Flynn-Nelson Tonya Fowler R.J. Francisco Christine Frisby Sue Fritz Nadia Futoryansky Madalyn Galloway Sandi Galvan Tiffany Gamble Lorraine Gardner Brenda Gauby Currie Mary Gaytko

Amber Geiman Helen George Cheryl Gerber Jenifer Gerber Dawn Getsfred/Chaney Julie Giffen Michael Gilles Roberta Ginter Amanda Glossette Jayne Gmeiner Sandy Goins Tina Golden Janice Gordon Michelle Gragg Danielle Graham Carolyn Gray Cheryl Gray Kelly Green Tara Green Maria Greene Tracy Greenwell Connie Griffin Karen Paige Griffith Adria Grillo-Peck Janet Grimberg Theresa Groff Jessie Grubb Melissa Gundolf Tammy Gustin Rosalyn Guzman Paul Gyorgyfi Donna Haerr Carissa Haines Catherine Hall Chrystie Hall Sheri Hall Meghan Halsey Jan Hankins Linda Hargrove Brooke Harris

Nastoshia Hart Diana Hatton Amy Hayes Emily Hayes Peggie Haywood Lorie Heagarty Martha Heaton Kim Hedrick Brenda Hemphill Casey Henderson Kim Hensley Deborah Herman Beth Heyse April Hickey Patricia Howard Marilyn Huffman Lisa Hughes Pam Hume Claudia Hurd Daniel Hurley Jefferleif Jabola Debra Jefferies Nicole Jefferis Gail Jeffery Jaime Jenkins Cynthia Jennings Debbie Jessup Mandi Jeter Audra Johnson Carol Johnson Deana Johnson Lisa Johnson Mandy Johnson Amanda Jones Gwen Jones Lindsey Jones Amy Kacho Kimbra Kahle Paden Amel Kaidi Lisa Katz

N u r sin g A nn ual Repo rt 2 0 1 2 • 2 5

Denise Keinow Patricia Kelley Melissa Kerns Amy Kerr Nancy Kessinger Lori Kessler Diane Kimpel Katie King Tammy King Melissa Kinnaird Sharen Kirkland Jana Kloecker Faith Knick Michelle Knorr Cara Koesters Barbara Kohn Rhonda Konicki Heather Koster Jennifer Kreigbaum Kara Kreill Leah Krickenbarger Sara Krumlauf Diana (Dede) Kruse Cecilia Krusling Bonnie Lambert Ramona Langston Elizabeth Larsen Donetta Leach Deb Lechner Jessica Ledford Thelma Lee Matthew Leeba Melissa Lehmann Sheila Leis Anna Lelbecke Anna Lepone patricia, Ann Lindner Janet Liston June Litmer Henryetta Lloyd Sandy Lunsford Natasha Luster-George Krissy Macke Holly Mallaney Deborah Mals Saranda Manning Holly Martin Therese Martin Gayle Marvin Mary Masekar Deborah Matosky Leeba Matthew Alleda Maxwell Cindy Mays Susan McCappin Mathew McCarty Elizabeth McIntosh Susan McIntosh Amy McKenna Cheryl McKinney Catherine McLaughlin Peggy McNamee Vida McQuinston Laura Meeker Lisa Meiring Debbie Melko Jennifer Melton Susan Mescher Crystal Meyer Elena Mikalauskas Adrian Miller Audrey Miller Carol Miller Jamie Miller Pamela Miller Toni Miller Monica Mirrow Cary Mohr Ralf Mohr Sheryl Mohr Dina Mokas

26 • M iami Valley H ospital

Neeta Monteiro Holly Moore Sheila Moore Cherry Morris Rhonda Moses Carol Mousa Michael Moyer Kim Muha Shahzad Mujeeb Eddie Mulkey Melissa Murray Amanda Musser Teresa Naas LaTisha Newport Molly Nickell Michelle Nissen Deb Nordstrom Nicole Norman Cathy Norris Peggy Nutt Elizabeth Obermeyer Brooke O’Brien Elizabeth Obringer Janice Officer Shannon Ohl Danielle Olding Terri O’Leary Patricia O’Malley Sharon Orozco Cheryl Osler Carolyn Palmer Nisha Panday Anita Patton Tracy Payne Tim Pennington Rachel Perretta Karen Persinger Theresa Petrosino Martha Petty Louisa Phillips Melanie Phipps Lindsey Poling Jeanne Ponziani Edith Porter Kimberly Porter Lori Puca Janet Rafferty Yevetta Rainey Cheri Rawe Angela Ream Tamela Rehm Alyse Reineke Darinda Reis Joni Reser Karin Revers Anne Richardson Anita Rike Angela Robinson Margaret Roche Claire Rodehaver Marcia Roemer Jackie Roethlisberger Keith Rooker Sheryl Ross Suzanne Rotzell Kristina Rudd Victoria Ryan Greg Sanchez Jean Sands April Sappe Lisa Saul-Creager Julie Sawyer DeShay Scandrick Patricia Schairbaum Lisa Scherbauer Marilyn Scheu Cynthia Schneider Heidi Schneider Shannon Schraeder Jennifer Schueler Lee Schweiterman

Lori Sears Angela Sebald Teresa Seidenschmidt Jan Semler Christine Sexton Margo Seyfang Pam Shadley Mary Shaw Amy Shay Katie Shoemaker DeAnne Short Jacqueline Simpson Kathleen Sizemore Julie Skaggs Andie Slivinski Angie Smith Cindy Smith Melissa Smith Penny Smith Carole Smith Cheryl Smith Esther “Kaye” Snow Kamie Snure Iris Snyder Janet Snyder Laura Sorg Megan Sortman Lynn Sowders Patricia Sparkman Julie Spatz Jennifer Spaulding Sandra Speck Karen Sperry Erin Stafford Sandra Stegman Denise Stewart Darin Stoutenborough Linda Strickland Ellen Strome Jesse Stroud Mark Strutt Darla Subler Tonya Summe Danielle Sundermeyer Jan Suttmiller Jaime Swallow Sandra Swanson Patti Sweeney Soraya Tabatabaie Elizabeth Tabor-Cruea Allison Tayloe Ann Taylor Deloris Taylor Hannah Taylor Kimberly Temple Regina Templonuevo Sandra Tester Bonnie Thacker Joyce Tharp Nancy Thoma Mary Thomas Shelia Thomas Ann Thompson J.T. Thompson Tashowa Thompson Rebekah Thurston Stephanie Tortorici Kimberly Tracy Karen Trapani Lisa Trefz Valerie Trick Melissa Trimm Stephanie Triplett Timothy Troxell Mandi Turpin Deanna Vacha Eileen Vagedes Catherine Vallandingham Belinda Vallo Amber VandenBos Anna Vaughn

Janette Velicaria Stacey Viers Karen Vigeant Deanna Vocha Heather Vocke Ann Voge Jane Von Dohre Amber Wagner Mary Ann Wagner Vikki Wagner Helen Wagoner Cynthia Walker Maureen Walker Tari Walker Elizabeth Wallace Michelle Wallace Donna Walls Deborah Warniment Kara Warren Michelle Warren Lisa Weaver Kim Weber Kimberly Weisenberger Linda Welin Dawna Wellbaum Ron Weneck Lori Wenning Sue Werline Angie Westbeld Kara Westerfield Melissa Whisner Susan White Julie Whitis Ameila Whitlatch Wendy Widerhold Jamie Wiley Marcia Williams Robin Williams Ryan Williams Susan Wilson Melissa Winterquist Deborah Wise Marie Wise Marietta Wise Patricia Wisecup Amanda Wolfe Chris Womack Kathy Wood Valerie Woodley Holly Woods Judith Worley Vicki Wright Lori Wulf Rachel Yockey Becky Young Jill Young Ye Zhou Mallory Zilz Elisabeth Zimmerman Erika Zimpfer Colette Zollars

2012 Nursing Leadership

Deb Mals, MS, RN, NEA-BC Vice President, Chief Nursing Officer

Robert Bowman, MS, RN Vice President, Hospital Operations

Bonnie Coalt, MS, RN Administrator, Hospital Operations

Kathy Erbes, MS, RN Director, Clinical Operations, Berry Women’s Center

Jayne Gmeiner, MS, RN, NEA-BC Director, Center of Nursing Excellence

Adria Grillo-Peck, MS, RN, CMC Director, Integrative Care Management

Cathy Hall, MS, RN, NE-BC Director, Clinical Operations, MVHS

Kim Hensley, MS, RN, NE-BC Vice President, Hospital Operations

Beth Heyse, BSN, RN Director, Surgical Services

C.J. Kostecka, BSN, RN Director of Nursing

Melissa Merritt, MSN, RN Director of Nursing

Alison Potts, BSN, RN Director of Nursing

Claire Rodehaver, MS, RN, NE-BC Administrative Director, Hospitalist Program

Robin Rutledge, MS, RN Director of Cardiology

Chris Sexton, BSN, RN Director, Women’s Center, MVHS

Candy Skidmore, BSN, RN Director, CareFlight Air and Mobile

Angela Wale, MSN, RN Director of Nursing

Chris Coffield, MHA Director, Surgery Center at MVHS

Mary Johnson, BS, RT, CRA Director, Medical Imaging

Ric McAllister, MSW, ACSW Director of Behavioral Services

N u r sin g A nn ual Repo rt 2 0 1 2 • 2 7

Facts about Miami Valley Hospital Mission: We will build healthier communities with others who share our commitment to provide high-quality, cost-competitive health care services.

Founded in 1890, Miami Valley Hospital is a full-service, acute care hospital located in Dayton, Ohio. Miami Valley has the region’s only Level I trauma center and is a Magnet® hospital for nursing excellence. Miami Valley is a member of Premier Health. Services • T  he area’s only Level I Trauma Center with CareFlight, the area’s only air ambulance service Key Facts (2012) Licensed Beds Physicians Physician Specialties Employees Volunteers Inpatient Admissions Outpatient Visits ER Visits

• T  he only Regional Adult Burn Center 974 1,151 70+ 6,545 967 41,555 289,952 125,622

Key Phone Numbers Main Campus (937) 208-8000 Miami Valley Hospital South (937) 438-2400 Patient Relations (937) 208-2666 Job Search (937) 208-2064 Physician Referral (866) 608-FIND

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• D  ayton’s first accredited Primary Stroke Center with Neurology Unit/ICU • T  he area’s first high-risk maternity and Neonatal Intensive Care Unit in the same facility • T  he area’s first robotic surgery program and the only local program with four robots • T  he area’s largest center for emergency heart care and angioplasty for heart attack patients • T  he Rehabilitation Institute of Ohio, one of the most comprehensive, hospital-based programs Go to our website, mvh.org to see our latest recognitions and accreditations. Further explore the latest community involvement projects and health events we offer.

The Magnet Recognition Program® of the American Nurses Credentialing Center (ANCC) recognizes health care organizations that demonstrate excellence in nursing practice and adherence to national standards for the organization and delivery of nursing services. Research shows that Magnet hospitals consistently outperform other facilities in recruiting and retaining quality nurses.

One Wyoming St. Dayton, Ohio 45409 mvh.org

Nursing Annual Report 2012