Pushing the Boundaries: A Community Health System s Nursing Research Program s Contributions

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Jerome Merritt
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1 Pushing the Boundaries: A Community Health System s Nursing Research Program s Contributions Donna Herrin-Griffith, MSN, RN, CENP, FACHE, FAAN Senior Vice President (Martin Health System) Carlo Parker, Ph D, RN Assistant Professor (University of Northern Colorado)

2 WELCOME Disclosures Today s presenters do not have any relevant financial interests or endorsement of products. Participants must attend the entire session(s) in order to earn contact hour credit. Continuing Nursing Education credit can be earned by completing the online session evaluation. The American Organization of Nurse Executives is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center s Commission on Accreditation.

3 Session Goals Describe how philanthropy & academic partnerships can support the nurse executive s priorities for a program of research Outline elements of a mid-size health system s approach to a program of research Highlight two programs that have produced positive patient outcomes

6 Awards and Recognition 100 Top Hospitals Award Seven time recognized One of only 5 Florida hospitals 50 Top Cardiovascular Award Two time recognized-one of 2 in Florida Accredited by The Joint Commission Certified Primary Stroke Center Joint Commission accreditation for joint replacement Top 14% highest score in nation Nationally Recognized Employer of Choice VHA SE Top Quality Scores 4 consecutive quarters 2010 Best Places to Work in Martin County and St. Lucie County

7 Mission Vision

8 Patient Care Vision TO BE A DESTINATION HEALTHCARE ORGANIZATION KNOWN FOR EXCELLENCE IN PATIENT CARE DELIVERY THROUGH INTERDISCIPLINARY TEAM WORK AND EVIDENCE-BASED PRACTICES

9 Nurse Executive Priorities Much Like CEOs.. Payment Systems Cost of Care Patient Safety & Quality Uncertainty Accelerated Change And Some Unique Future Leadership Outcomes Direct to Nursing Effectiveness Future Workforce Availability Workforce/Nursing Engagement Profession s Goals

10 Background, Rationale and Challenges Nursing outcomes are directly impacted by nursing practice that is based on evidence and sound research. Microsystems in healthcare have unique problems that often require unique solutions. This requires research customized to that microsystem. Creating an environment where practice is based on outcomes can be challenging in smaller community health systems due to resource issues.

11 Elements for Success Vision and Framework Funding Expertise and Partnership

12 The Martin Center for Clinical Excellence Provides an infrastructure to plan, implement and evaluate strategies that support the advancement of the clinical professionals to higher levels of excellence. Provides a framework for experimental patient-focused initiatives (outside day-to-day operations) The purpose of the CCE is to enhance professional growth through practice innovation, clinical education and clinical mentoring discovery and implementation of evidence-based clinical programs.

13 Center for Clinical Excellence The CCE provides support for: new approaches to patient care delivery through the use of pilot projects, incorporation of new treatments and clinical practices testing new care delivery models The CCE programs include Practice Innovation Projects Clinical Education and Clinical Mentoring Evidence-Based Clinical Programs clinical research and investigation programs grant development to support larger programs of inquiry collaborative programs of inquiry with institutions of higher learning and faculty.

14 Philanthropy as a Solution The effort or inclination to increase the well-being of humankind, as by charitable aid or donations. Mission alone doesn t create donor passion. VISION does! The steps Build meaningful relationships The compelling case Making an ask Stewardship: The Promise WOW Experiences

15 Elements of Success with the Academic Partnership for Research Knowledge is shared among partners Lifelong learning Shared current best practices Joint preparation for certifications, accreditation, regulatory Interprofessional education Joint research Joint committee appointments Joint development of competencies AACN-AONE Guiding Principles on Academic- Practice Partnerships

16 The Martin Nursing Research Program Purpose of the MHS Nursing Research Program Structure and Function of the MHS Nursing Research Program Results of MHS research programs have resulted in improved patient outcomes!

17 How it Works Problem focused clinical nursing research program Staff nurse driven Supported by nurse researchers with doctoral level education and research expertise Contracted partnership Philanthropy funded

18 OVERVIEW OF PROJECTS MAKING A DIFFERENCE

19 Martin Post-Operative Discharge Screening Tool - MPOST Research Fellow: Margot Rabren BSN RN-BC with team PI Donna Herrin-Griffith and Dr. Carlo Parker Purpose: Reduce readmissions for postoperative complications. MPOST is used by nursing to assessing suitability of post-operative patients for discharge. Data Analysis Methods: Pre-post comparison of readmission rates for Postop complications. Quantitative analysis of MPOST data using stepwise linear regression modeling to determine predictive ability.

20 Driving Factors Deficit Reduction Act of 2005 and CMS integrity program Medicare Payment Advisory Committee (MedPAC)- readmissions cost Medicare 15 billion annually MedPAC has recommended changes in reimbursement rates, so that hospitals with high risk-adjusted rates of rehospitalization receive a lower average per case payment. MedPAC is currently studying hospital readmission rates to determine which causes of readmission will trigger lower payments.chf and what is next?... Postop complications?

21 MPOST Participants (N=236) consisted of in-patient laparoscopic and laparotomy patients Surgical Procedures: cholecystectomy, bowel, urological or gynecological procedures. Inclusion criteria: Age 18+, legal competence, and the ability to speak/read English. Exclusion criteria: Patients requiring emergency surgery, receiving chemotherapy, radiation therapy, dx with heart failure or uncontrolled diabetes.

22 MPOST Data Analysis Results Results: Readmission rate has dropped from 17% to 4.6%. The overall MPOST tool is not predictive of readmission. 2 items in the MPOST tool are predictive of readmission O2 sat ( p=.048 ) & Respiratory rate (p=.036 ). Hawthorne effect? Second phase of data collection underway

23 MPOST Data was collected over 1 year (pre and post implementation). Retrospective chart review identified patients who were readmitted within 30 days for treatment of a postop complication. Readmission rate for postoperative patients who participated in the study was compared to the readmission rate for postoperative patients in the 12 months preceding the study (N=704) using the same inclusion and exclusion criteria. Preliminary results to be published in JONA in May 2013

24 Enhancing Neonatal Wellness through Multiple Mother Baby Home Visits Nursing Research Fellows: Lorna Sinclair, RNC-OB, BA & Genee Warmuskerken, RN Purpose: Measuring the effectiveness of multiple post partum home visits conducted by Mother/Baby nurses to assess for jaundice, newborn weight gain, and breastfeeding. Methods: Quantitative data: Readmission for jaundice, weight loss. Breast feeding rates at 6 & 12m Qualitative survey on patient satisfaction with visitation services. Results: Results indicated a reduced LOS at MHS upon readmission is 1 day vs. national average of 3 days. Breast feeding rate at 6months above national and regional averages (47.2 vs 49%)

25 COMPLETED & ONGOING STUDIES

26 HUSH: Hospital Ultimate Silence for Health Nursing Research Fellow: Maricel Hinkulow, MSN, RN, CNL Purpose: Status: Reduce noise level in patient care areas to promote a healing and restful environment and to increase patient satisfaction (measured by HCAPS). Pre data collected and bundle implemented in March. Positive patient interviews show success so spread across all units has begun.

Grant Funded Enhancing Critical Thinking Abilities of New Graduate RNs through the Novice Nurse Program Nursing Research Fellow: Roseann Maresca, RN, PCCN Purpose: Status: Determine the impact of the

27 Grant Funded Enhancing Critical Thinking Abilities of New Graduate RNs through the Novice Nurse Program Nursing Research Fellow: Roseann Maresca, RN, PCCN Purpose: Status: Determine the impact of the MHS Novice Nurse Program on critical thinking abilities of newly licensed nurses Preliminary data indicate that the program increases critical thinking skills. Increase in critical thinking skills is known to improve nurses abilities to intervene earlier in complex patient care thus preventing /reducing patient complications. Ongoing data collection will guide program adjustments and effectiveness, including ROI.

28 Completed MHS Nursing Research Studies Patients Perceptions of the Restraint Experience while on Ventilator Care in the Intensive Care Unit. -Patient s perceptions of their experience; themes identified included a sense of powerlessness of the patient. Empowering Patients with a Voice in Decision Making. -Patient involvement in the creation of an individualized plan of care using a custom designed whiteboard; resulted in whiteboards installed in all patient rooms

29 Completed MHS Nursing Research Studies Empowering Patients with a Hotline to the Chief Nursing Officer. -Patients were provided a direct line of communication (a hotline ) to the CNO; themes included identifying the hotline as reassuring, and also an avenue to voice complaints Posters presented at regional and national forums Umbilical Cord Blood for Newborn DNA Identification. -Study compared cord blood with heel stick sample for newborn identification; study confirmed that cord blood is an exact match to the genetic profile of the heel stick sample and can be used in place of a heel stick, reducing trauma to the newborn Published in JOGNN

30 Take-Aways Small and Mid-Sized health systems can have research programs Philanthropy is being more and more important in the nurse executive competency set Projects from Small and Mid-Sized systems can make a difference in care outcomes

31 Future

32 Discussion

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