Making a Difference. everyday nursing Biennial report nursing Biennial report

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1 Making a Difference everyday nursing Biennial report

2 Table of Contents 1 Chief Nursing Officer s Letter 2 Transformational Leadership Transforming Emergency Care Enhancing Delivery of Care Blending Patient Comfort and Efficiency in New Cardiac Catheterization Suite A New More Therapeutic Inpatient Psychiatric Unit 6 Structural Empowerment Forces of Magnetism Continuously Raising the Bar Groundswell of Support for CNS Contributions Nurses Recognized by Joint Commission 10 Community Involvement Saving a Mother s Life Helping Officer DiPonzio Defy the Odds Saying Thank You to Those Who Have Served our Country Starting Healthy Habits Early Excel Internships Ease Transition to Employment Improvising Amidst Devastation 16 Exemplary Professional Practice Safety is about Culture Comprehensive Program Enhances Safety for Newborns and More Changing our Philosophy and Saving Lives Helping Patients Live Better with Home Dialysis New Videoconferencing Communication Enhances the Healing Process for Surgery Patients Incredible Devotion Making it Possible for a Mother to Attend her Son s Wedding 22 New Knowledge, Innovations and Improvement Using Evidence to Advance the Nursing Profession Wiping out Infection 26 Awarda, Grants, Presentations, Publications and Research Awards Grants Presentations Publications Research Cover photo: Grace Dengler, RN, Clinician I (see page 14)

3 High quality care, exceptional service & compassion Dear Colleagues, It is with great pleasure that I present the Rochester General Hospital 2009/2010 Biennial Nursing Report. It is both an honor and a privilege to work with one of the finest group of professionals, our nurses. They, along with the entire healthcare team, demonstrate a commitment to serve our patients and our community by providing high quality care and exceptional service with compassion. Faced with financial challenges, I made a dramatic change in the nursing leadership structure in 2009, only eight weeks prior to our Magnet redesignation site visit. Building on our shared governance model, the structure was flattened, truly embracing leadership at the front line. The nurses, with the entire healthcare team, demonstrated their ability to work together for a common purpose to provide the highest standards of respect, patient safety, and clinical excellence to our patients, families, and community. During our site visit in March, it was evident to the Magnet Appraisers that our entire team was engaged and focused on outcomes. They witnessed and experienced respect, knowledge, research, quality, collegiality, and collaboration at all levels within the organization and our community. As a result, we were redesignated as a Magnet Hospital in May of 2009, a recognition achieved by less than 7% of all U.S. hospitals, demonstrating our commitment to continue our journey in clinical and nursing excellence. In 2010, we underwent an unannounced Joint Commission survey. Most evident in this survey was the culture and attitude of our nursing team in providing excellent care to our patients. The nurses were recognized for delivering compassionate, individualized care. The surveyors left Rochester General Hospital with best practices they intended to share with others throughout the country. Nursing is both an art and a science. What we do isn t easy it takes dedication and commitment. It is both physically and mentally challenging. Our nurses are passionate about what they do and they continue to raise the bar. At Rochester General Hospital, clinical excellence is more than competence and skill; it s about caring for our patients, each other and our profession. We serve as both a resource and mentor for other organizations. In the following report, you will see highlights of our accomplishments and stories representing both the art and science of nursing. At Rochester General Hospital, we are united by a common purpose and the opportunity to do meaningful and worthwhile work. I am proud of our nurses and the entire healthcare team. They make a difference every day. Cheryl Sheridan BS, RN, MPA, NE-BC Senior Vice President Patient Care Services and Chief Nursing Officer 1

4 transformational leadership An infrastructure to remain dynamic Rochester General Hospital s nurses are empowered to create valuable, positive change through a commitment to collaboration and leading-edge care. As a result of physical and organizational changes throughout the hospital, we ve fostered a sense of belonging that welcomes new voices, boosts morale, enhances performance, and encourages a team approach that benefits our entire organization. Transforming Emergency Care Joelle Marcaida, RN, Clinician III (l) and Christine Fiordeliso, BS, RN, Administrative Clinical Leader (r). The new Emergency Department s thoughtful and expansive layout brings patients closer to medical personnel and vital resources. A better equipped, more collaborative atmosphere in the B. Thomas Golisano Pavilion and Emergency Center has allowed team members to realize efficiencies that were impossible in the previous space. Now we have all the tools, resources and staff we need to do our job effectively, states Michelle Johnson, RN, Clinician III. Nurses played an integral role in the changes, which have resulted in a higher level of care. Patients have noticed. Emergency Department patient satisfaction scores escalated from the single digits to the 90th percentile in A major reason is that patients are seen much more quickly; wait times have been slashed dramatically to approximately 15 minutes. Among the other significant transformations: nursing stations have been replaced with work stations, where nurses, physicians and secretaries function as a team. Rooms are private and spacious with TVs, well-stocked supply carts, and a state-of-the-art monitoring system allowing continuous communication between patients and medical personnel. 2 In the ED, nurses, physicians and secretaries operate as a team. Peter Sichak, RN, Administrative Clinical Leader (l); Bryan Gargano, MD.

5 Enhancing Delivery of Care Laura Stahl, RN, CEN, Clinician III, at computer workstation in a patient room. The new ED demonstrates a significantly higher level of care. The redesign has affected both atmosphere and attitude. We can greet people with a clear conscience, knowing we can help everybody in a timely fashion, says Mary Mahler, BSN, RN, Administrative Clinical Leader. And we re happy because our patients are happy. How can we make this our home? That s the question nurses asked during construction of the 12-bed Sands Family Cardiothoracic Intensive Care Unit (CTICU). Among the answers: Larger patient rooms with windows, wall-mounted computers with bedside labeling systems, ergonomic sinks, hooks on the backs of doors, and bedside carts to store supplies. We help each other as much as possible. Ginny Riggall With everything at the bedside, nurses are in charge of their practice says Ginny Riggall, MS, RN, CCRN, Clinical Nurse Specialist in the CTICU. They are also able to spend more time with their patients, affording them the opportunity to make subtle observations. For example, when nurses recognized that patients were unfamiliar with bedside clocks that displayed military time, they replaced them with standard-time models. The new space with close proximity to the Przysinda Family Foundation Cardiac Catheterization Suite has had the added benefit of encouraging more teamwork between the two units. Nurses communicate more easily and effectively about patient flow, collaborate on order sets and training, and work better as a team to improve outcomes. Relationships have also improved with respiratory therapists, who now round with nurses and midlevels, an arrangement that has strengthened communication. We help each other as much as possible, says Ginny. With better communication, you can offer suggestions and come up with better solutions for the patient. Ginny Riggall MS, RN, CCRN 3

6 Blending Comfort and Efficiency in Cardiac Catheterization 4 Sharon Babicz, BSN, RN, Clinical Leader, Clinician III (above). Renovations, made with recommendations from nurses and patients, have translated into more time at the bedside and higher patient satisfaction. In a high-volume, highly technical environment like Rochester General Hospital s Przysinda Family Foundation Cardiac Catheterization Suite, special attention must be given to the delicate balance between patient comfort and team member efficiency. Using recommendations from both patients and team members during the renovations, the attention paid to even the smallest details down to the paintings on the walls has caused patient satisfaction scores to soar from the single digits to the 90th percentile. The patients come and go from the same room, with the same nurse, so it feels like they re getting one-on-one care, says Aileen Mancini, BSN, RN, Nurse Manager. Nurses are equally appreciative of the new environment. I don t feel as rushed, explains Sharon Babicz, RN, Clinical Leader, Clinician III. I can say, I m going to be your nurse and this is what s going to happen. The patients definitely have less anxiety. During renovations, nurses offered their opinions

7 Suite on what would make waiting and recovery time more pleasant. Now, there are additional rooms that are larger and include solid walls between them to reduce noise and enough space for visitors to sit down. Computers are on wheeled carts instead of fixed to a central station for more accessible information at the bedside. Windows were added for more natural light. Families are able to wait in a nearby room instead of being sent to another floor, allowing physicians to communicate with them more easily in person. The nurses looked at this project not only practically, but emotionally. They really owned it to make it right. Aileen Mancini In addition, because of the more structured assignments, nurses are able to spend more time educating patients throughout their stay, providing a continuity of care that makes both patients and their families feel safer and more valued. The proof is in the numbers the result of extreme dedication and tireless planning on the part of the nursing staff. The nurses looked at this project not only practically, but emotionally, Aileen adds. They really owned it to make it right. A New More Therapeutic Inpatient Psychiatric Unit Nurses and patients were consulted in the design phase of the newly renovated G1, Inpatient Psychiatric Unit. Swathed in soothing colors, the 30-bed unit now boasts big-screen TVs, quicker access to medical charts and computers, cubbies for patients, a locker/coat room for staff near the new guest lounge area, an exam room that doubles as space for family conferences, and a large conference room. As a result of the changes, We re heading toward a more therapeutic milieu, says Lynsay Smith, MS, RN, LMHC, Director of Behavioral Health Acute Care Services. We are now able to provide more patient-centered, individualized treatment options. The unit is participating in a New York State Office of Mental Health learning collaborative, with the focus on reduction of restraint use. In addition, team member training in Dialectical Behavioral Therapy helps patients learn how to regulate emotions and when to use self-soothing techniques. With the additional, space, a comfort room for patients is also being added. By recognizing subtle changes in mental status and therefore providing earlier interventions before behavior escalates, restraint use on the unit decreased by one-third from 2009 to We all worked together to get it done and it s beautiful. Sue Ceretto It all comes down to one thing, says Lynsay: We re being more proactive than reactive. Overall, the unit is now more spacious and filled with light, which enhances both patient and team member experiences. Says Sue Ceretto, RN, Clinician III, We all worked together to get it done and it s beautiful. Sue Ceretto RN, Clinician III 5

8 STRUCTURAL empowerment Demonstrating commitment to the practice and to each other The heart of a Magnet hospital can be found in the role of a nurse in the myriad ways frontline nurses drive improvement through collaboration, communication, ethical decisions, and a deep understanding of what constitutes a strong professional practice. Forces of Magnetism Continuously Essential to the success of Rochester General Hospital s Magnet redesignation process, Magnet Unit Champions from every unit built enthusiasm and guided colleagues through what to expect during a three-day site visit in March And their hard work was duly noted. Magnet Unit Champions enthusiastically exemplify the highest standards of care and commitment. 6

9 Raising the Bar The appraisers told us our passion was palpable, remembers Barb Thompson, MS, RN, Magnet Program Co-Director. As ambassadors with a mastery of the 14 Forces of Magnetism and other components of a Magnet organization, they champion the nursing excellence practiced on a daily basis. The Forces of Magnetism are not something that we talk about just to prepare for a redesignation survey they are woven into our culture, says Trish Koops, BSN, RN, CCRN, Magnet Unit Champions Committee Chairperson. It s what we do every day. The Champions used a variety of methods to prepare team members throughout the hospital. For example, a Magnet Jeopardy game had teams of nurses answering potential questions from appraisers, while weekly newsletters publicized performance improvement projects and highlighted nursing accomplishments. On the logistical side, the Champions coordinated transportation needs during the site visit and served as escorts for the appraisers. Team members from all departments joined Cheryl Sheridan, BS, RN, MPA, NE-BC, CNO, in the Twig Auditorium in May 2009 as she received the call from the Commission on Magnet announcing Rochester General Hospital s second Magnet designation. Magnet Unit Champion Jennifer Morath, BSN, RN, CNOR, Clinician IV, recalls continuing the celebration five months later at the American Nurses Credentialing Center 2009 National Magnet Conference, which she attended with 16 colleagues and a nursing student. In nursing school at the time and working at Rochester General Hospital for just two years, Sarah Yaeger, Patient Care Technician on 5200, the Interventional Cardiology Unit, felt enlightened after attending the ANCC 2010 conference. She recalls leaving with a newfound confidence in her ability to blend compassionate patient care with the practical information she was learning in the classroom. We have a very tight-knit group here, and we were reminded at the conference how special that is. Sherri Bernier It was very exciting to see the passion that nurses throughout the country and the world have for their careers, says Sarah, now an RN working full time on Thousands of people were there to show what they do, and how much they care. It was an eye opener that nursing really is one big family. A group of Patient Care Services team members from all levels returned from the three-day event with inspiring stories, suggestions for improvement, and a renewed excitement and energy for the work that they do. Sherri Bernier, LPN II on 6800, the Orthopaedic Surgery Unit, and currently enrolled in an RN program, was one of those fortunate to attend the Magnet conference. Throughout the next week, she shared her experiences with nursing colleagues, physicians and other team members during daily huddles. Sherri explains, We have a very tight-knit group here, and we were reminded at the conference how special that is. The Champions already have started preparations for the next site visit in Still energized, they continue to exemplify the standards that demonstrate their commitment to the practice and each other. It s a journey, says Donna Tydings, MS, RN, CNS-BC, CCRN, Magnet Program Co-Director. We want to sustain the momentum to continuously raise the bar. Sherri Bernier LPN II 7

10 Groundswell of Support for CNS Contributions A new working group meets twice a month to plan and execute the unique and valuable contributions that Clinical Nurse Specialists (CNS), a team of advanced practice nurses, provide to patients, other nurses, and the entire organization. The CNS Group, with 12 members, highlights the versatility, in-depth knowledge and specialized expertise these nurses exhibit in clinical practice, teaching, research, consulting and leadership. Changes are being made and it s affecting patients at the bedside. Maureen Krenzer Maureen Krenzer, MS RN, ACNS-BC, Clinician VI, Clinical Nurse Specialist for Members spent six months compiling a list of needs throughout the hospital, then used their big-picture perspectives to match the appropriate CNS with each need. For example, using simulation equipment, they made it possible for newer nurses to practice the code blue process Maureen Krenzer MS, RN, ACNS-BC Clinical Nurse Specialists are known for their unique and valuable contributions to the entire organization. in non-emergency situations to increase their confidence after orientation. The people we train are able to take the information we ve given them and move ahead with it, says Maureen Krenzer, MS, RN, ACNS-BC, Clinical Nurse Specialist for 2800, General Surgery Unit. Changes are being made and it s affecting patients at the bedside. The Committee has also helped support the push for title and regulatory protection, served as a link to preceptors for CNS graduate students, participated in the change to an electronic medical records system, and created a comprehensive, cross-referenced resource manual for staff nurses needing help on any number of issues. In 2010, the CNS group was consulted to help develop the nursing team members at Newark-Wayne Community Hospital, an affiliate of Rochester General Health System. Members are updating protocols to reflect both sites, using telemedicine

11 equipment to broadcast meetings, and providing professional education. This accomplished group stays current through membership in professional associations (many have published and lectured at the local, state and national levels), and reaches out to the community by offering information and free screenings at health fairs and other public events. Arleen Beck-Miller, BSN, RN, CCRN, Clinician IV, a CNS student preparing to graduate, feels uplifted after every meeting. You see how advanced practice nurses affect the hospital, she explains. I come out and know that this is what I want to do, that I chose the right path. Maureen says she appreciates the groundswell of support as the Committee expands its scope, which will, if all goes as planned, include training in what would become Rochester General Hospital s own simulation lab. We are being appreciated as a united group that can impact every area of the organization. There s more recognition of what a CNS has to offer. Earning Recognition from the Joint Commission Surveyors from the Joint Commission re-accreditation process complimented Rochester General Hospital as being among the best and most cooperative hospitals in the nation when they were here for our recent re-accreditation survey. Most evident in the recent survey was the culture and the attitude of our nursing team in providing excellent care to our patients. Cindy Bileschi And at the end of their intensive five-day visit in November 2010, they took some documents they felt could be useful in establishing best practices at other hospitals, including the Sepsis Screening Tool developed by a multidisciplinary team and the Skin Assessment Flowsheet developed by RGH nurses. Most evident in the recent survey was the culture and the attitude of our nursing team in providing excellent care to our patients, says Cindy Bileschi, BSN, RN, Senior Director, Office of Clinical and Regulatory Compliance. It showed that they are proud of what they re doing. Nurses were recognized for staying current with regulatory standards, implementing changes required for remaining in compliance, and Cindy Bileschi, BSN, RN, and Patty Johns, MPA, RN, CPHQ, help maintain Rochester General Hospital s distinction as one of the nation s best and most cooperative hospitals. delivering compassionate, individualized care. All units use self-assessments and daily tracers to find opportunities for improvement and ensure highquality care at all times not just in preparation for visits from surveyors. They don t have to memorize answers to questions, adds Cindy. This is what they do. 9

12 community involvement 10 Compassion beyond the bedside Rochester General Hospital nurses willingly and generously lend their time, skill and philanthropic resources to make sure patients and their families receive the best care possible in the region and across national borders. Their level of concern for the community and for each other is a daily testament to the power of the human spirit. They provide so much more than treatment. They get involved. Saving a Mother s Life InterVol assists children in a remote village in Belize. In her mid-30s and a mother of five, Cheryl Ritchie had literally dragged herself for two days from her remote village in Belize to wait in line with hundreds of others hoping for medical care. She had been diagnosed with a bad heart valve, and without treatment she had less than a year to live. It s a one-in-a-million chance that this woman is still alive and with her children. Susan Richmond-Austin Dr. Gerry Gacioch, Rochester General Hospital s Division Head of Cardiology, had traveled to Belize with members of the nonprofit international relief agency InterVol, which has a formal partnership Susan Richmond-Austin RN, CCRN, Clinician III with the hospital. He took Ritchie s information and promised that someone would be in touch. She had heard that before, more than once. Out of options, she headed back to her family with no hope for recovery. A few months later, InterVol, along with help from numerous community partners, flew Cheryl and her mother to Rochester for an all-expenses-paid heart valve replacement. They were here for six weeks, in the middle of winter. In addition to the medical and emotional support they provide all patients, nurses went above and beyond to offer comfort in such a foreign environment. They weren t used to the cold, so the nurses bought them sweaters, coats and scarves, recalls Susan Richmond-Austin, RN, CCRN, Clinician III. I took them out to lunch, to a museum. Some of the others took them shopping. They didn t know anybody, and we wanted to make their stay nicer. When it was time for Cheryl to return home, the nurses hosted a luncheon for her at the hospital. It s a one-in-a-million chance that this woman is still alive and with her children, Susan says, We were her last resort, and she was very grateful. The next time InterVol was in Belize, she showed up and volunteered for days. She wanted to give something back. It s just very emotional to be able to help someone like that.

13 Helping Officer DiPonzio The personal connections our nurses make with patients are an essential part of the miraculous journey from near death to a new beginning. Anthony DiPonzio can attest to that. The 23-yearold was a little more than a year into his career with the Rochester Police Department when he was shot in the back of the head by a 14-year-old boy. Though chances for survival were slim, he continues to make an extraordinary recovery. In a journal presented to Anthony after his release from the Surgical Intensive Care Unit, nurses privately documented their thoughts about their high-profile patient s condition and progress. Some offered appreciation for the honor of taking care of him, others called him a hero. I ve got an incredible team that gives 100%, so it s nice to see that this young man is starting to put his life back together. Diana Blauw Anthony continued to receive visits from Rochester General Hospital nurses. He s currently recovering at home. Diana adds: I ve got an incredible team that gives 100 percent, so it s nice to see that this young man is starting to put his life back together. These miracles motivate us to continue to give everything to our patients every day. Antonio Lagares, RN, Clinician I, one of the many SICU nurses who felt honored to care for and develop friendships with Officer DiPonzio. It took a hospital-wide effort to accommodate the outpouring of support from turning over a staff lounge to Anthony s family and colleagues to advocating for Anthony s privacy during his most frustrating days. You d have the district attorney, the county executive, the mayor, and half the police force there, but his needs came first, recalls Diana Blauw, RN, BSN, NE-BC, Nurse Manager, SICU. That s how it is with every patient here. After being transferred to a rehabilitation facility, Wounded Rochester Police Officer, Anthony DiPonzio 11

14 Saying Thank You to Those Who Have Served Our Country 12 I don t think there s a way to describe how it makes you feel, says Hope Monje, BSN, RN-BC, Administrative Clinical Leader, pictured here with Vincent Capriotti, World War II veteran from Honor Flight. Hope has been on two flights so far. It makes me stand a little taller just to be with these men. They were at Arlington Cemetery, getting ready to board the bus, when a couple from overseas approached and asked, Are you a World War II veteran? Sally Sackett, BSN, RN, CPAN, CAPA, Clinician IV, quietly stepped aside so the gentleman she had been accompanying could have his moment. He nodded. The questioning continued: Could my sons take a picture of you? You re the most important thing we ve seen all day. Sally recalls this story as a shining example of why she and other Rochester General Hospital nurses give their time to the national Honor Flight Network, a nonprofit organization that gives World War II veterans a free trip to Washington, D.C. to visit the Memorial and other sites that pay tribute to their sacrifices. The nurse volunteers hold hands, offer tissues, handle logistical challenges, and are there for those who have done so much for so many. In nursing we take care of people every day, says Sally, who now serves in a leadership position as a health coordinator for the organization. But I m doing this because I want to say thank you not because it s my job. Wanting to do even more, she enlisted nurses from the Day of Surgery Unit to help organize a fundraiser for Honor Flight. They raised more than $1,100 at the event, held in December 2010 on Pearl Harbor Day. The entire experience is infectious. It gets in your blood and you just can t stop. Carole Ann Lee During the two-day excursion, a deep sense of trust emerges between the nurses and veterans, some of whom have been homebound for years. They tell us stories they haven t told anybody, notes Carole Ann Lee, RN, Clinician III.

15 Starting Healthy Habits Early Sally Sackett, BSN, RN, CPAN, CAPA, Clinician III, and Carole Ann Lee, RN, Clinician III, give back by volunteering with Honor Flight. That connection has helped volunteer Matthew Barnum, BSN, RN, Clinician III, hold his position at the hospital in higher esteem. We take our medical knowledge for granted because we do it every day, says Matthew. But when you re a volunteer, you really appreciate who you are and what you mean to people. It takes me back to the bedside with a greater respect for myself and what I have to offer. The entire experience is infectious, says Carole Ann, who has since returned as a medical leader and recruited her husband as a guardian. It gets in your blood and you just can t stop. With all the concern these days about childhood obesity, echoed by an acquaintance who teaches sixth grade, Karen Riordan, IABPT, suggested starting a partnership between the Przysinda Family Foundation Cardiac Catheterization Suite and a Rochester elementary school. Knowing the importance of instilling positive habits in children at an early age, I thought, Wouldn t it be great if we brought healthy things to them? she recalls. We were able to go back several times and see the kids grow. The experience not only allowed us to open their eyes to opportunities in the healthcare field, it strengthened our team. Christy Hoover The partnership with Audubon School No. 33 began with a health fair staffed by nurse volunteers. Students in grades four through six moved from one station to the next, sampling fruit smoothies, exercising, and learning ways to make meals more nutritious. Entire families participated in a subsequent career fair, which drew more volunteers from the hospital including nurses, nurse practitioners, Christy Hoover BSN, RN, CVN, Clinician IV dental clinicians, patient care technicians and radiology technicians as well as some of their children, who demonstrated fun and easy ways to incorporate movement into daily activities. During the holidays, nurses from the lab hosted a party for the students and distributed hats and mittens bought with their donations. We were able to go back several times and see the kids grow, says Christy Hoover, BSN, RN, CVN, Clinican IV. The experience not only allowed us to open their eyes to opportunities in the healthcare field, it strengthened our team. 13

16 Excel Internships Ease Transition to Employment Rochester General Hospital s Excel Nursing Internship Program provides nursing students valuable experience before they formally enter the profession. Just ask Amy Koster, RN, Clinician I, whose paid summer internship program allowed her to work as a patient care technician on 6800, Orthopaedic Surgery Unit, where she was assigned a preceptor and learned how to organize care delivery for multiple patients. By the time she started work on the same unit after graduation, I already knew the people, the unit, and the kinds of patients I was going to be caring for, she says. It made the transition so much easier. Upon graduation in spring 2009, 70% of Excel nurse interns who were offered RN positions at the hospital accepted. That number grew to 71% in Candidates in the competitive program must be enrolled in a Registered Nurse degree program and within one year of graduation. Under the mentorship of a professional nurse, interns have the opportunity to establish therapeutic and personal relationships with patients, visitors and other hospital team members, as well as shadow nurses in other departments. Upon graduation in spring 2009, 70% of Excel nurse interns who were offered RN positions at the hospital accepted. That number grew to 71% in Grace Dengler, RN, Clinician I, who spent her 10-week internship on the 5100, Mendick Cardiac Evaluation Unit, chose to shadow nurses in the Medical Intensive Care Unit, the Emergency Department, and the Operating Room. The experience afforded her a view of the continuum of care delivery across various levels. You learn different things from different people, she says. The program also helped Grace, who received the 2010 Outstanding Adult Student Award by the Continuing Education Association of New York, feel more confident in a fast-paced atmosphere: I m now an RN on 5100 and the Excel experience helped me a lot in my transition. Grace Dengler RN, Clinician I

17 Improvising amidst Devastation in Haiti Nurses traveled to Haiti to provide much-needed care after the devastating earthquake in Shari McDonald, BS, RN (left), with a nurse from Haiti. Some of the vivid images Rochester General Hospital nurses brought back with them from the devastation in Haiti, where they voluntarily provided desperately needed medical assistance after the devastating earthquake in 2010, include an infant throwing up worms, burning body limbs, and amputations with hacksaws and no anesthesia. You checked your ego at the door and did what you had to do for the people, says Gloria Berent, MS, RN, CNOR, Director of Nursing for Perioperative Clinical Services. Improvisation was key. Under primitive conditions and with very limited medical equipment, the nurses quickly figured out ways to use ordinary supplies in unconventional ways. Catheter bags were reused as garbage bags, crutches became IV poles, and donated urine cups that were useless without the means to conduct lab tests were turned into pharmaceutical containers. You made the best of the situation, recalls Laura Stahl, RN, CEN, Clinician III. It has made me so much more appreciative of who I am, where I live, and the patients we serve. Shari McDonald The nurse volunteers worked with Haitian nursing students. The students who chose to help without knowing if their own families were alive or dead understood that the nurse volunteers were there only to train and assist, not to take over. They organized supplies, labeling boxes first in Creole and then in English, taught sterilization techniques, and used pantomime and drawings to overcome the language barrier when discussing treatments. They were so appreciative, says Shari McDonald, BS, RN, Emergency Department Nurse Manager. And it has made me so much more appreciative of who I am, where I live, and the patients we serve. Despite the horrors all around, the Haitian people were stoic in their resilience. Their determination and innovation one woman sat in a wheelchair made from a plastic lawn chair and spare wheels inspired those who had come from so far to help out. Gloria remembers that wheelchair: I thought, if they can do that, then we can do this. 15

18 exemplary professional practice 16 Changing the culture to enhance patient outcomes Rochester General Hospital nurses have helped advance quality and patient safety to unprecedented levels of priority. From spearheading innovative efforts that touch every department to focusing on ways a single unit can improve, they demonstrate an autonomy and interdisciplinary competence that takes into account the unique needs of every patient. Kristin Opett BS, RN, MSHA Safety Is about Culture Safety needs to be about culture, not just statistics. Nurses at RGH are helping to drive changes that redefine the organization s approach to quality. Together with the Patient Safety Institute, they are working on collaborative patient safety goals while continuing their focus on assuring regulatory compliance. Their contributions were paramount in initiating Comprehensive Unit-based Safety Programs (CUSPs), forming a Patient Safety Advocacy Team to track standards of care, and launching the hospital s new Institute for Patient Safety and Clinical Excellence. Patient safety is a new and emerging science, says Kristin Opett, BS, RN, MSHA, Senior Leader, Patient Safety Officer. It is truly about continuous improvement. On a three-day observation trip to Johns Hopkins in the summer of 2009, a multidisciplinary team of nurses, physicians and administrators met with a wide range of experts, sat in on unitbased safety team meetings, saw firsthand how the hospital handles adverse situations, and learned ways to restructure broken systems. The Patient Safety Advocacy Team helps prioritize quality and patient safety throughout the hospital. In a sense, everybody was new. There was so much going on, this gave the nurses one less thing to worry about. Kayleigh Fahey Returning home inspired, the group hosted a two-day Safety Summit with a standing-roomonly crowd of more than 650 of its organizational leaders, which led to improvements systemwide. One of the most notable was the launch of Comprehensive Unit Based Safety Programs a national best practice. As an example: CUSPs in 5200, Interventional Cardiology Unit, included nurses collaborating with the Przysinda Family Foundation Cardiac Catheterization Suite on hand- Kayleigh Fahey BSN, RN

19 off reports, training new hires, and leading daily tours to familiarize staff with post-construction layouts all of which boosted nursing team member morale and improved quality of care. As a result, patient satisfaction scores rose. Scores were in the 99th percentile in late 2010, up from the mid-70th percentile earlier in the year. And all nurses, no matter their level of work experience, appreciated the chance to become familiar with the new environment. In a sense, everybody was new, says Kayleigh Fahey, BSN, RN, Administrative Clinical Leader. There was so much going on, this gave the nurses one less thing to worry about. Meanwhile, the Patient Safety Advocacy Team has met monthly to highlight individual department achievements, discuss ways to replicate those successes, address questions, and share detailed reports on safety data none of which is blinded. Adds Bernadette Murphy, BS, RN, Director of Clinical Excellence and Performance Improvement: The idea was that we were going to be truly transparent. Comprehensive Program Enhances Safety for Newborns The idea struck when Lori Houppert, MS, RN, Clinician III, accompanied a new mother to her car after discharge. After watching the woman loosely strap her newborn into the car seat, she pointed out that the straps needed to be much tighter for the baby to be safe. The woman said she lived only five minutes away. With each initiative, nurses have felt a greater sense of empowerment. And boom, they were gone, Lori remembers with a heavy heart. I was almost in tears. I thought, This is ridiculous. We ve got to do something. In response, the Drs. C. Samuel and Jeanne E. Grove Women s Care Unit created a Comprehensive Unitbased Safety Program (CUSP) for car seat use, one of several CUSPs the unit has initiated since (continued) 17

20 18 (continued from previous page) Nurses were trained by a county agency to guide parents on adjusting straps and making sure babies are secure. And every discharge folder includes a brochure listing places that inspect car seats, a service that will be available at Rochester General Hospital the first hospital in the region to offer it after nursing team members complete an upcoming certification process. The unit has been busy with several other CUSPs as well: Reinforcing among team members and patients that hand washing is the best way to Lori Houppert, MS, RN, Clinician III, instructing a mom on safe car seat use. Nurses in the Drs. C. Samuel and Jeanne E. Grove Women s Care Unit created several safety initiatives to take patient care to the highest level. prevent the spread of infection, using teambuilding exercises to point out potentially unsafe conditions, creating triage handoff sheets to improve communication between shifts, and promoting a deeper awareness of sensitive patient information in the busy triage area. With each initiative, nurses have felt a greater sense of empowerment a sense shared by everyone at the consistently packed, multidisciplinary CUSP meetings held monthly. It s always standing room only, says Sarah Miller, BSN, RN, Clinical Leader. They are taking ownership of problems and are involved in the solutions. They are engaged and excited and feel like their voices are being heard. Changing Our Philosophy and Saving Lives SICU Team Members celebrate 500 infection-free days near the end of A prominent sign near the entrance of the Surgical Intensive Care Unit (SICU) not only trumpets the number of days without a central line-associated bacteremia infection, but the pride and dedication behind it. The SICU had logged 515 infection-free days in a row by the end of Such a record comforts nervous families with loved ones who are critically ill and preparing for yet another invasive procedure, according to Meredith Dawes, RN, Clinician I. It s a nice thing for us to share with

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