Holy S pir i t H os pita l

Nursing in Motion Fall 2012/ Winter 2013

2012 NIGHTINGALE AWARDS Michelle E. DeFabio, MS, RN, ACNS-BC

Inside this issue:

Magnet Conference

2

Medical Infusion New Location

3

Infection Control & Prevention - Employee Health Bug Fair

4

Cath Lab & New Technologies

4

KBMA Start-Up MICU/ SICU

5

Penn State Nursing Program

6

And The Magnet Plate Goes To... SICU

7

Banner Recipients

8, 9 & 10

Council Updates

11 & 12

“Nightingale Awards of Pennsylvania is a statewide, non-profit foundation created to help recruit and retain nursing professionals. It is governed by a 24 member volunteer Board of Trustees, consisting of individuals who are leaders in nursing, business, industry, and other health care fields. To achieve its objectives, the foundation has established a scholarship fund and awards program.” Nightingale Awards of Pennsylvania proudly announces its award winners for 2012. Finalists were honored and the winners were declared at the 23rd Annual Gala on Friday, October 26, 2012, at the Radisson-Penn Harris.

Sister Romaine and 2012 Nightingale Award Winner Sue Landau, RN

Since 1990, the Nightingale Awards of Pennsylvania foundation has honored nurses throughout Pennsylvania for excellence in Nursing. The 23 rd Annual Gala was held at the Radisson-Penn Harris in Camp Hill on October 26. The 2012 awards program consisted of nine categories with over 80 nominations. Our HSH nominees were Maryann Brogden for the Advanced Practice RN category, Sue Landau for the Clinical Practice RN category, Susan McQuade for the Nurse Administration category, and Kathy Shea for the Nurse Educator category. ...Continued on page 7

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Susan McQuade, Maryann Brogden, Sue Landau, & Kathy Shea

MAGNET CONFERENCE 2012

Patricia A. Carnes, MHA, BSN, RN, NE-BC The ANCC National Magnet Conference “Reaching for the Stars” was held in Los Angeles, California October 10 – 12, 2012. Pat Carnes, Magnet Hospital Leader, Kathy Holtzman, Nurse Manager – 4 Main, Nicole Allen, RN – Birthplace, Connie Dorff, RN – Operating Room, Janice Hestor, RN – NICU, Susan Kaufmann, RN – OPS, Ellen Kirker, RN – OPS, Jennifer Mosey, RN – Inpatient Behavioral Health, Tracy Mullen-Hoon, RN – Diabetes Services, and Jaclyn Rhoads, RN – SICU were among more than 7,000 nurses from twentyfour countries in attendance. All were inspired to reach for the stars in their practice. Guest presenters included Stephen Covey, Melissa Gilbert, and Mark Feuerstein. Stephen Covey is the bestselling author of The Speed of Trust. The take away is that trust is a learnable and measurable skill that makes organizations more profitable, people more promotable, and relationships more energizing. Melissa Gilbert and Mark Feuerstein, Hollywood ac-

Magnet Conference in Photos

HSH Magnet Champions Attendees: From Left to Right (top) Tracy Mullen-Hoon, Jennifer Mosey, and (bottom) Connie Dorff, Nicole Allen, Ellen Kirker, Susan Kaufmann, Kathy Holtzman, and Jaclyn Rhoads Not Shown: Janice Hestor & Pat Carnes

tors, presented their personal experience on the impact nurses had in their lives. Celebrations focused on special awards, prizes, and recognitions. These included celebrating the newly designated and redesignated Magnet organizations. There are now 395 designated Magnet organizations. Magnet organizations are encouraged to give back to the community. This year ANCC partnered with two organizations – Para Los Niños and Flowers 4 the Float.

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Para Los Niños is a nonprofit organization that has worked for more than thirty years to created academic success and social well-being for children. Through wellness centers and many other services, they offer support to thousands of children living in at-risk neighborhoods in Los Angeles County. Sally Bixby, the first nurse to hold the office of President of Tournament of Roses, is leading the Flowers 4 the Float project creating a nurses’ float for the 2013 Rose Bowl Parade. The theme of the float is “A Healing Place”. It celebrates, honors, and thanks nurses for all they do for their patients. Those in attendance had the opportunity to meet Sally during the poster sessions.

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OUTPATIENT MEDICAL INFUSION UNIT Sabrina Andrews, RN The Outpatient Medical Infusion Unit opened for business in our new location on September 24th. The unit also celebrated our 6th anniversary on October 6th. We are now located in suite 100 of the Medical Arts Building. Our new location is equipped with 8 private patient care bays with recliners, television, oxygen and suction. A stretcher is available for non-ambulatory patients. We also have 2 handicapped accessible bathrooms, a small kitchenette area for patient use, and a new blanket warmer. For those of you who are wondering about the role of Outpatient Medical Infusion, we do many different things.

The unit is staffed by 2 fulltime ACLS certified RN’s: Sabrina Andrews, and Lesly Miller-Jacobs, who is a certified registered infusion nurse. We have several volunteers, who assist with answering phone calls, scheduling, filing, patient comfort and refreshment, and transporting blood specimens and

blood products to and from the main hospital. We transfuse packed red blood cells, platelets, and fresh frozen plasma. We also infuse many medications, including those for MS, ulcerative colitis, Crohn’s disease, osteoporosis, infections and more. As the health system’s slogan says: We’re here for you!

Because we are here, patients are able to drive here in the morning, use the valet parking, get their treatment, pick up their car, and drive home. Because we are here, people can receive transfusions without an emergency room visit, or hospital admission. Because we are here, there is another option for those facing weeks of antibiotic therapy besides nursing home admission for those whose insurance will not cover home therapy. The next time you are in employee health, stop by for a tour and see what we do! E-Copy Nursing in Motion Newsletter located at http://www.hsh.org/nursing-annual-report-newsletters/

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INFECTION CONTROL & PREVENTION EMPLOYEE HEALTH BUG FAIRE Jessica Oaks, Coordinator of Infection Control Technology The annual Infection Control & Prevention Employee Health Bug Faire was held on Friday, September 14th. Employees and staff were lined up and eager (or at least willing) to get their influenza vaccination as well as PPDs and Fit testing when doors opened at 7:30 a.m. The crowd was steady throughout the day making for a record turnout of 767 attendees. Education was available on the importance of the influenza vaccine along with the necessity of other recommended vaccinations for both adults and children. The Faire also included information and reminders on precautions and multi-drug resistant organisms. Those individuals who completed and turned in a post test from the educational material were eligible to win a fun fall or Halloween themed door prize! A total of 767 flu vaccines were administered, 203 PPDs given and 132 Fit Tests performed. The Bug Faire was a successful day that helped kick off flu season by taking the first and most important step in prevention

CATH LAB NEW TECHNOLOGY—TVAR Clyde Tinner, RN

What are they having done? A TAVR What does TAVR stand for? Transcatheter Aortic Valve Replacement. A patient requires Aortic Valve Replacement when they have severe Aortic Valve stenosis. However, not every patient is a candidate for cardiac surgery due to several factors. If a patient needs aortic valve replacement and are not surgical candidates they have another option. Patients are screened prior to surgery and must meet certain requirements to be considered candidates for TAVR. Here at Holy Spirit Hospital an Interventional Cardiologist, Cardiovascular surgeon, Diagnostic Cardiologist, two cath lab staff members, two CVOR staff members, a team member from echo, anesthesiologist, perfusionist along with the Edwards Lifesciences staff. The procedure involves accessing the aorta via a large sheath in the groin. A catheter is fitted with new aortic valve at the end of a catheter. The catheter is advanced via the sheath up through the aorta, over and around the aortic arch and into the space of the patient’s aortic valve. Once the exact location is confirmed, the heart is rapidly paced and the new aortic valve is deployed. The Edwards trans-catheter valve is available in two sizes 23mm and 26mm to allow for wide coverage of patient population. In order to acquire proper valve sizing the patient must have a pre-op CT Scan, Transesophogeal Echocardiogram (TEE) and right and left heart cath. The procedure takes place in the Ortenzio Heart Center operating rooms. Following the procedure the patient is admitted to the CVICU for post-operative care. The hospital stay is usually 4-5 days. E-Copy Nursing in Motion Newsletter located at http://www.hsh.org/nursing-annual-report-newsletters/

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KNOWLEDGE BASED MEDICATION ADMINISTRATION (KBMA) STARTUP IN MICU/SICU By Scott Smallwood, BSN, RN, CCRN

On August 27, 2012 the nurses in MICU and SICU were the first units in the main portion of Holy Spirit Hospital, to incorporate KMBA into their everyday nursing practice. The bar-coded medication administration enables nurses to quickly and intuitively verify the five rights of medication administration – right medication, right dose, right time, right route and right patient – all to produce dramatic improvements in accuracy as part of an organizational initiative to improve care delivery at Holy Spirit Hospital. This past summer, in a collaborative effort, IT, Pharmacy, and the Clinical Informatics Council (CIC) set out to initiate and incorporate KMBA into the workflow process of all nurses administering medication to patients. John Knapp, MSISEM, BSBA, CPHIMS (Director, Nursing Informatics), Jody Harclerode, RN, MS, CPHQ (Nursing Informatics), Julie Gregoire, RPh (Pharmacy Informatics Specialist), and Kerry Starner, RN, CCRN (Patient Care Data Analyst II), have worked tirelessly to educate and instruct to make the transition to KMBA as simplistic as possible for nursing. Members of CIC, notably Ann Chambers, RN (Float Staff RN), and Scott Smallwood, BSN, RN, CCRN (MICU/SICU staff RN), have also contributed to the development of the workflow and training process for Holy Spirit RN’s. Nicole Griffie, BSN, RN, CCRN, (Assistant Nurse Manager, SICU), also contributed in the earlier stages of education and training process for KBMA. The Behavioral Health Department has utilized KMBA since 2009 and in May 2012 started to use the new hand-held medication scanners currently being used in MICU and SICU. In a successive wave of training and education Kelly Peel, RN, CCRN doing the 1st bar-coded throughout September, October, and Novemmedication administration in MICU ber of 2012, KMBA has now been introduced into the workflow process of the CVICU, CVU, and 4 Main. Education and training for the rest of the floors/units is to begin in 2013. Tentative "Go-Live" dates are to occur from February 2013 through May 2013 for 6 - Main, 6 - East, 7 - Main, 8 - TCU, and Birthplace/NICU. Relatively speaking, the work flow process, systems, and computer issues have been quite minimal with respect to KBMA. Any unforeseen issues continue to be collaboratively discussed and rectified during CIC meetings. As training and education continues, and each unit is introduced to the KMBA process, improved and safer methods of medication administration have been idealized and implemented. These new insights into medication administration are to help and improve the overall work flow process of KBMA for all nurses. The ultimate goal and subsequent end result will help to ensure safer medication administration to all patients here at Holy Spirit Hospital.

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They Are PENN STATE! Christine Braunegg, MSN, RN-BC By now you have noticed the familiar Penn State University (PSU) colors of blue and white on nursing students here at Holy Spirit Hospital (HSH). These students are in the PSU second degree program. The second degree program is an intensive 16-month nursing program open to individuals that have a bachelor’s degree in another field. The students in this program come from a variety of backgrounds; not necessarily health care related, for example students have bachelor’s degrees in Psychology, Nutrition, Marketing, Kinesiology, and Information Technology. A few students in the program have master’s degrees in Nutrition, Public Health Administration and English. During the 16 months of the program, students spend clinical time at several area facilities. However, their very first clinical experience takes place in the fall of their first semester here at Holy Spirit Hospital. Other clinical rotations here at HSH are the medical/surgical rotation in the spring and labor and delivery rotation during the summer. Students in this program also spend observational time with the Venous Access Team and Wound Care nurses. Also they will observe the entire surgical process; following a patient through pre-op, surgery, and post-op care. Thank you to Michelle DeFabio and everyone in these departments for allowing the students to spend time learning from you! Students may soon spend observational time in some of our procedural and outpatient areas as well. In their final semester beginning in the fall, students complete a practicum and capstone. During the practicum and capstone the students work one-on-one with a Registered Nurse preceptor. Students are allowed to choose the facility in which to complete these experiences. Currently we have three students here at HSH for practicum and capstone-Thank you to our RN preceptors Bobbi Rogers, Terri Biebuyck, Sasi Bimini-Krishnamurthy, and Peggy Trahan and to the managers and staff on 4M, CVICU and 8M!! If you have time, ask a PSU student what their previous degree is; perhaps they could share some knowledge with you and we can all learn from each other! Thank you to everyone for assisting and allowing our future colleagues to begin their clinical experiences at HSH; our Spirit Behaviors and Relationship Based Care in action!!

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And Magnet Plate Goes To...! Ann Chambers, RN The Magnet Plate goes to a team that demonstrates their leadership clearly in their planning, advocacy, influence, visibility, accessibility, communication, professional development of nursing, teaching, mentoring and coaching abilities. They support nursing in multiple venues, they lead the practice and profession by engaging the frontline workers in processes and decisions. This is evidence in both hospital and unit based councils, committees, PI teams, focus groups, and individual mentoring sessions. It would have been easy for me to solely pass this plate on to this next team, but what makes it amazing and meaningful is the direct care providers from the Resource Team cohesively made this decision. Our team touches every inpatient nursing unit, the ED, and various other departments when a need arises. They have a pulse check on what’s going on “out there.” I cannot speak for all the areas lead by this group, but I can say my team mostly likely represents the general consensus for nursing. The Nursing Resource staff offered the following for their reasoning in the selection of this team:  They are our biggest supporters  They devote their time and energy to making our profession important  They understand how hard we try  The team leaders stayed all night with us during super storm Sandy. They rounded and offered help and that spoke volumes. They left their families behind to help keep our patients and staff safe.  We like how they stop and talk to us (one-on-one) – They know our names! This team has over 150 years of combined leadership, healthcare, and nursing experience and is dedicated, dynamic; spends endless and thankless hours supporting nursing and patient care. Thank you because you are greatly appreciated and recognized! Congratulations to the Nursing Executive Leadership Team!

2012 NIGHTINGALE AWARDS—Continued Michelle E. DeFabio, MS, RN, ACNS-BC This year, our very own, Sue Landau, MSN, RN from 6 Main was declared the winner of the Nightingale Clinical Practice RN Award. With great enthusiasm, Sue’s colleagues stood and cheered at the announcement, as Sister Romaine and Dr. Torchia beamed with pride. Sue was selected as the best candidate among her peers throughout Pennsylvania. She is an exemplary nurse, exhibiting superior clinical skills and professional practice, while striving to provide outstanding quality and compassionate patient care. Sue is known for her attention to detail and is actively engaged in advancing the profession of nursing and contributing to the local community. We are very thankful to our Medical staff for sponsoring our seats at this event and, in doing so, supporting the efforts of The Nightingale Awards of Pennsylvania to recognize the positive impact of nursing. And, we are so very proud of Sue’s achievement! E-Copy Nursing in Motion Newsletter located at http://www.hsh.org/nursing-annual-report-newsletters/

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Excellence Banner Recipients Announced

August Recipient—NICU received the Excellence Award for No VAPS and CLABSI for 5 years.

August Recipient—OR received the Excellence Award for improved workflow.

Congratulations on receiving the Excellence Banner!!!

August Recipient—8 Main received the Excellence Award for Patient Satisfaction/Staff Satisfaction.

October Recipients—PICC / IV Team received the Excellence Awards for Patient Satisfaction

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Excellence Banner Recipients Announced

October Recipients—CIC received the Excellence Award for great support with down time and electronic discharge summary, KBMA implementation

November Recipients—Outpatient Medical Infusion received the Excellence Award for a smooth transitional move to the Medical Arts Building

Congratulations on receiving the Excellence Banner!!!

November Recipients–4Main received the Excellence Award for Patient Satisfaction (D/C plans).

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November Recipients–The Nursing Resource Team received the Excellence Award for Patient Satisfaction/Staff Satisfaction.

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Excellence Banner Recipients Announced

December Recipients — NICU received the Excellence Award for the staff working extra to meet the needs of the unit during high census

Congratulations on receiving the Excellence Banner!!!

December Recipients —OR received the Excellence Award for teamwork with new technology and procedures

December Recipients — CVOR received the Excellence Award for teamwork with new technology and procedures (No Picture Available)

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COUNCIL UPDATES Education Council Mandy Poff, RN 







Competency Day was held December 27 in the auditorium. Restrain and Crash Cart Competencies were on display. They both need to be done in person so nurses can demonstrate their competency. Six additional competencies are being assigned to all RNs! Blood Transfusion and Gift of Life Annual Competencies are available for completion. You may need to self enroll for these. If you have any questions regarding how to self enroll please feel free to email ([email protected]) or see me. Competencies need to be completed by March 31, 2013 deadline. You can self-enroll in Blood Transfusion and Gift of Life competencies. The required competencies will be assigned to you before the March 31st deadline. We want to remind you that all RNs need 16 hours of CNE (continuing nursing education) hours each year. To see if a program meets this requirement please check the bottom of flyers and other programs to see if it meets the PA requirements. FYI: Please keep all certificates from each program you attend. If you get audited by the PA State Board of Nursing with your RN license renewal then you need your certificate and the hospital transcript showing how many hours. You attended Health stream education-please see Friday update and attached sheet in education binder. We are working to keep our RNs informed on what needs to be completed, what is self-enrolled vs. assigned. Post tests-with each program there are post tests. Some managers are asking staff to keep them while others say they don’t need to be kept. According to Sue Swails, a decision was made by nursing executive council that RNs do not have to keep the post tests. Make sure you sign in to each program/competency you attend/do so that it shows up on health steam transcript.

Relationship Management Council Mary J. Brinson, RN May, June, July 2012



The RMC chose 2 areas that we will be working on to help improve the hospital HCAHP scores: 1. Medication-what it is for & the side effects 2. Responsiveness –call bell answered in the time the patient wanted and got to the bathroom in the time you wanted.



We had a patient’s daughter come to our meeting & share the experience she and her father had during his stay at Holy Spirit. She talked about things that went well & areas that we need to focus on to improve our patient’s stay. We are going to try to have a patient or their family member come every 3 months to share their experience.



RMC is developing an improved system for tracking the Code H responses since this hotline deals with patient/ family concerns.



Our next culture poster to be hung in the cafeteria will be on the Amish Culture.

Nursing Excellence Council

Night Shift Council Denise Cutting, RN, MHS



Heartcode BLS will be offered on evening shift quarterly next year – see schedule



Night shift nursing grand round presentations are happening on an almost monthly basis



Competency night continues on a quarterly basis with PPD, flu shots and fit testing being offered



We combine competency night with a “food court” where staff volunteers to bring in food

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Betsy Davis, RN 

The Council explored education reimbursement and grant loan procedures with Human Resources



The Council is interested in decreasing turnover and asked for more specific information regarding resignation



Newsletter articles for next Nursing In Motion

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COUNCIL UPDATES Evidence-Based Practice/Research Council Danne Palm, AD, RN, Jen Boyarski, BSN, RN, PCCN and Michelle DeFabio, MS, RN, ACNS-BC May Updates Reviewed restraint documentation Jen Boyarski investigated timing of patient admissions IV securement was selected for Journal Club, Kim volunteered to find article. It was picked from a four part question that follows the PICO principle. PICO stands for Patient Problem or Population, Intervention, Comparison, Outcome (s). Discussed the new foley catheters June Updates Kimberly Rathnam presented during Journal Club on the practice of chevroning tape for IV securement, after Tegaderm placement. Additional discussion & plan to explore manufacturer -made Peripheral IV Securement Devices Michelle DeFabio continued to encourage member suggestions on the proposed Procedure Guidelines that are being creating Michelle DeFabio reported on the Council approved changeover of foley drainage bags to urine meters in the 16 French & 18 French trays Capnography monitoring of PCA patients golive was June 25 Marlene Robbins presented on a newly created Birthplace policy & the Council collaborate on changes & the policy was finalized Discussions about ED Level 4 announcements & ways to improve h&-off communication & patient flow Nursing Literature Updates are now being sent out electronically by Edie Asbury. This change has been well received. New Diabetes Order Set was presented & discussed New VTE Prophylaxis Order Set was presented & discussed Proposed OR Report call discussed, whereby bedside nurses would call the OR on surgical patients to inform of Latex Allergy & Isolation Precautions Results of keyboard cultures discussed Fall CORE Essentials program discussed July Updates Capnography monitoring during Code Blue events go-live was July 1 Alcohol Withdrawal screening & order set to be initiated soon Ongoing challenge of appropriately fitted slipper

socks for bariatric patients was discussed

OR Report proposal finalized & 6 East Ortho to trial the process

Collaborative effort between Council, staff

nurses, & the Venous Access Team to trial IV Securement devices over the next several months Centurion Peripheral IV Securement Device was demonstrated Awaiting final approval for foley drainage bag changeover to urine meters Edie Asbury demonstrated the use of a link in Sunrise that will take an end-user directly to the Nursing Reference Data in the Library Sue Nesmith presented a document that the Diabetes PI Team created that will be used to educate Diabetic patients & alert Nursing, related to the need for blood sugar checks to be completed BEFORE meals Jody Harclerode discussed the KBMA implementation plan; updated the Council on the 6 East Ortho pilot of the electronic discharge instructions; discussed changes to proposed Adult Patient Profile Danne presented the new process & form for Supply & Supply Tower Change/Addition Requests & Approvals; this was a collaborative between Nursing & Materials Management Council bylaw changes were approved by Coordinating Council Jonna Morris & Maureen Asper discussed challenges with Nurse to Physician communication; a decision-tree flowchart was presented & discussed; suggestions offered by Council to improve clarity Kendra Wilson was chosen for the Professional Development topic; she shared 6 East Ortho efforts & successes related to Customer Service Jenny Brewer presented a PICO card submission about wasting medications into the water system; discussion ensued about conflict of local versus federal guidelines & alternative wasting methods; Journal Club to explore alternative wasting methods Additional PICO Question card submissions were discussed &, although topics are not “Research-worthy”, they are appropriate clinical questions that Council will continue to explore & find answers

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Nursing Quality Council Tina Lowe, RN

Nursing Quality Council continues to focus on improving patient falls throughout the hospital. We work diligently on a monthly basis to support our staff on any quality issues that may occur. Recently we have updated the Mandatory education of Falls in Health Stream as well as updated the Policy S-100 Fall Prevention Program We continue to look at our NDNQI and dashboard data to improve our quality of care. As of January 2013, Effective Communication will become part the Nursing Quality Council, we look forward to providing our help in this endeavor. As a Hospital Council we are here to serve so if you know of any quality issues that you would like help with, the Nursing Quality Council would be glad to assist.

Clinical Informatics Council (CIC)

Kerry (Clarence) Starner, RN, CCRN Below is list of CIC accomplishments that oxxueewsover that last year:  Improvements made to the Adult Patient Profile  Reviewing Assessment &Intervention parameters and making changes as needed  Upgrade sunrise to 5.5  Improved downtime documentation  Assisted in pain documentation  John Knapp became Director of Nursing Informatics  Added Capnography parameter to the EMR  Census boards roll out was initiated  Audio button added to the emar to document side effect teaching  New barcode scanners for KnowledgeBased Medication Administration (KBMA)

 Clinical Institute Withdrawal Assessment (CIWA) and Intraoseous parameters built PAGE 12