RENEWAL EXCELLENCE. Elizabeth Newton, Meg Cashion, Lisa Bovender, Aquinetta Faulk, Crystal Hill, Janet Payne and Laurie Smith

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1 We are honored to present our second edition of High Point Regional Health System s Nursing Annual Report. As we continue to pursue nursing excellence, we are proud to be a Magnet Hospital. Elizabeth Newton, Meg Cashion, Lisa Bovender, Aquinetta Faulk, Crystal Hill, Janet Payne and Laurie Smith 601 North Elm Street High Point, North Carolina HighPointRegional.com 011 RENEWAL N U R S I N G of EXCELLENCE A N N U A L R E P O R T

2 Key Indicator (Departmental Measurement) QUALITY Annual Stretch Goal Annual Target Goal Desired Trend Q1 011 Q 01 Q3 01 Q4 01 Total Patient Falls Zero Zero Patient Falls with Injury Zero Zero Hospital Acquired Pressure Ulcers Zero Zero Medication Errors Zero Zero empirical Outcomes Pain Assessment/ Reassessment 100% 100% 90.6% 91.64% 89.83% 011 RENEWAL of EXCELLENCE NURSING ANNUAL REPORT SBAR 100% 100% 99% 99% 99% Hand Hygiene 100% 100% 97% 99% 99% Central Line Infection Zero Zero Zero VAP Zero Zero Zero AMI Composite 100% 100% 100% 100% 100% CHF Composite 100% 98% 99% 97% 99% Pneumonia Composite 100% 98% 98% 97% 95% SCIP Composite 100% 98% 98% 97% 97% Restraint 0% 0% 3.66% 0% 1.35% Medication Reconciliation 100% 90% 93.75% 98.56% 96.7% VALUE LPMS 100% 100% 97% 97% 97% ALOS Readmits within 30 days all causes 15% 18% na na % Color Codes: Stretch Target Within 5% of Target or Improving Less than 95% of Target and Decreasing 18

3 empirical Outcomes Continuous quality improvement is essential in a Magnet organization. Magnet believes that it is not What do you do? or How you did it? but, What difference have you made? At High Point Regional, Total Care means achieving the best outcomes for our TABLE of CONTENTS WELCOME Transformational Leadership Structural Empowerment Exemplary Professional Practice New Knowledge, Innovations & Improvements patients by adhering to evidence-based practices. By collecting data and tracking our progress over time, professional nurses can make Empirical Outcomes a difference in the quality of care delivered. Key Indicator (Departmental Measurement) SERVICE Annual Stretch Goal Annual Target Goal Desired Trend Q1 011 Q 01 Q3 01 Q4 01 Communication with Nurses 100% 75% 80th % 74th % 9nd % Pain Well Controlled 100% 75% 7nd % 79th % 86th % Communication about medicine 100% 75% 69th % 51st % 49th % The ANCC Magnet Recognition Program model serves as a road map for organizations seeking Magnet recognition and provides a framework for nursing practice and research into the future. ANCC Magnet-recognized organizations will serve as the fount of knowledge and expertise for the delivery of nursing care globally. Grounded in core Magnet principles, they will be flexible and constantly striving for discovery and innovation. They will lead the reformation of health care, the discipline of nursing, and care of the patient, family, and community. Cleanliness and Quietness 100% 75% 49th % 66th % 77th % Discharge instructions 100% 75% 45th % 9th % 47th % Responsiveness 100% 75% 74th % 81st % 90th % PEOPLE Overall turnover rate 10.50% 11% 8% 8% 8% Global Issues in Nursing & Health Care BSN Rate 80% 40% na na 37.5% RN Turnover 10.50% 11% 6.8% 5.93% 6.84% ACCESS ED Door to Telemetry Bed ED Door to ED Discharge OR Room Turnover Rate < 0 min < 30 min 4 min 8 min 5 min These core principles are the ruler by which we measure ourselves.

4 INTRODUCTION Tammi Erving-Mengel, RN, MSN, NEA-BC Vice President & Chief Nursing Officer How fast our world is changing! As I reflect on the past year, I also have to think about our future. What will health care be like? What role will nursing play in health care reform? How will the Nursing Staff of High Point Regional Health System influence the health of our patients? I have so many questions and so many dreams. We have reviewed The Future of Nursing report from the Robert Wood Johnson Foundation and the Institute of Medicine. Our Professional Practice Council and our nursing leaders have accepted the recommendations of the report and will use it to serve as a blueprint for our 013 Strategic Plan. They have established goals to increase the number of BSN prepared nurses caring for patients to 50 percent by 015 and to 80 percent by 00. We are making decisions that will impact the next generation of nurses which will ensure the exceptional care of our patients and our community continues. Our Professional Practice Model will be our guide as we prepare for the future. We will continue to be Living Proof of Total Care if we continue to develop our practice using CARE. Our role in Coordinating care will become more important as patients are admitted to the hospital less frequently and for shorter lengths of time. We will all be Accountable for insuring that the patients needs are met while in the hospital, and for confirming that the patient and family are able to manage the illness/recovery at home. We will need to Recognize and Reward each other for professional growth and achievements that will ultimately improve our ability to provide care to our patients. Finally, it will be imperative that we develop Effective personal relationships with our colleagues in nursing and all health care disciplines to promote positive health outcomes for our patients and for the health of our community. Our world will continue to change. One thing that does not change is my pride in the work that the nursing staff at High Point Regional Health System does each and every day. As you read the accomplishments of the past year, my wish is that you are reminded of why you became a nurse. You are Living Proof of Total Care. Thank you for all that you do to make each patient s experience a special one. I continue to be honored and humbled to serve as your Chief Nursing Officer. Tammi Erving-Mengel, RN, MSN, NEA-BC In preparation for CPOE, High Point Regional Health System is also implementing an Enterprise Single Sign-on Solution (SSO). The SSO will allow users to authenticate once by manually entering a login code and then swiping or tapping a badge. The total solution results in clinical applications running in a session on a server after a user authenticates once. The clinical applications follow the user similar to a virtual desktop. SSO Benefits include: Reducing the total amount of time users spend logging into the network and clinical software applications Improving service Reducing costs significantly over time davinci Surgical System The davinci System is a sophisticated robotic platform designed to expand the surgeon s capabilities, and for the first time, offer a minimally invasive option for major surgery. With davinci, small incisions are used to introduce miniaturized wristed instruments and a high-definition 3D camera. Seated comfortably at the davinci console, the surgeon views a magnified, high-resolution 3-D image of the surgical site. At the same time, state-of-the-art robotic and computer technologies scale, filter and seamlessly translate your surgeon s hand movements into precise micro-movements of the davinci instruments. Allowing users to focus additional time on patient care Improving usability Security Improving satisfaction At High Point Regional the davinci Surgical System is being used to perform minimally invasive surgery for prostate issues, endometriosis, hysterectomies and the treatment of fibroids. In 011, High Point Regional hosted a davinci day that provided staff throughout the hospital and members of the community with the opportunity to see the davinci Robot up close and personal. More than 400 individuals were able to explore the robot s capabilities and actually try using the system. High Point Regional also hosted a special women s focused davinci seminar with a panel of physicians who spoke on the benefits of using the system to treat women s gynecological issues. Time Wa$ter: The Cost of Tracking IV Pumps and Channels The nursing staff has a surprising financial impact on the health system outside of just focusing on salaries. After much discussion over the time staff spend searching for IV pumps and channels, six nursing units participated in a six week study tracking the amount of time they spent locating IV pumps and channels. If the time proved a significant cost factor for the health system, radio frequency identification devices would be purchased. After six weeks of data collection and a thorough review of websites and journals with similar studies, the nursing staff determined the amount of time spent searching for IV channels and pumps was not a drain on the health system financially. With the data collected, our nursing staff saved the health system thousands of dollars for unnecessary equipment. NEW KNOWLEDGE, Innovations and Improvements 16

5 NEW KNOWLEDGE, Innovations and Improvements NURSING Mission: To provide exceptional nursing care to the people of our region. Nurses at High Point Regional are encouraged to seek new knowledge, implement innovative change and work continually for improvement in the care and outcomes of our patients. HHS/CPOE - Information Technology Advancements Many information technology advancements are occurring at High Point Regional Health System. All of these advancements are necessary as we move towards Meaningful Use (MU). In order for us to comply with MU, health care providers must be able to share patient information electronically; everyone must collect the same data the same way. This is called structured data. This means better care for our patients. Horizon Health Summary (HHS) is a component of MU. HHS replaced PAM (Problems, Allergies, Medications) and resulted in a new nursing admission assessment section for the nurses at High Point Regional Health System. In February 013, we will begin system wide Computerized Patient Order Entry (CPOE) which means orders will be placed directly in the computer system by the physicians/providers. Several departments have already implemented CPOE with great success. We are doing this to: 1 3 Enhance Order Accuracy/Patient Safety There is decreased potential for misunderstanding what the physician wants if they place orders directly into the computer. Enhance Operational Efficiency Decrease in calls for clarification of orders, checking charts to make sure all orders were entered or delays in order entry. Meet the American Reinvestment and Recovery Act Requirements So we can meet MU as required by 013. NURSING Vision: NURSING Values: NURSING Philosophy: To be the best place to receive care, the best place to work and the best place to practice nursing. Teamwork, compassion and integrity. We believe the Forces of Magnetism are the foundation for excellence. Our highest priorities are caring, advocacy, innovation and education for our patients, ourselves and each other. Those priorities and the following guiding principles support our quest for nursing excellence. The power and impact of nurses and nursing Leaders who advocate and support staff Leadership styles that promote shared decisionmaking and ownership for individual practice Provision of exceptional nursing care through continuous process improvement Interdisciplinary collaboration that welcomes all contributions Promotion of wellness through education and information Environments that support mentoring and nurturing of each other Commitment to life-long learning, education and career growth Recruitment and retention of the best nurses 4

6 TRANSFORMATIONAL Leadership At High Point Regional Health System, transformational leadership is about leaders creating an environment that allows individuals to contribute to their fullest potential to deliver exceptional care to the people of our region. Transformational leadership requires vision, influence and clinical knowledge and is about being rightly positioned to meet the demands of the future. Hourly Rounding With Purpose Hourly rounds intentionally checking on patients at regular intervals help nurses find their shifts less stressful, their time more productive, and patient safety and satisfaction scores hitting all-time highs. While making rounds, staff engages patients by addressing the 5 P s : pain, position, potty (elimination), possessions and patient focus. Patients are told that staff will check on them frequently, so hourly rounds help manage patients expectations. Patients feel less anxious about getting their needs met as they learn to trust the process of hourly rounds. Attending to patients comfort, safety and environmental needs may also prevent adverse events like falls, pressure ulcers, or unrelieved pain; and contribute to patients satisfaction with nursing care. Hourly rounds also help organize workflow, giving nurses time back as they proactively anticipate and attend to patients needs. The Oncology Care Unit was one of the units to implement hourly rounding to great success in 011. The nursing staff worked with the nursing assistant staff to create a plan for patient hand-off. The nursing assistants complete the first round; then they follow up with a joint rounding with the on-coming/off-going nursing assistants. The patients calls are answered quickly and efficiently while the nurses have uninterrupted time for taking reports. In addition, it provides the patient with a face-to-face introduction to the on-coming staff. COMMENTS FROM PATIENTS The staff has been very uplifting, positive, funny and appear to really enjoy what they do. They share my plan of care each day and keep me updated. It makes me feel like I m moving forward. Once in a lifetime That is what Pic and Jane Schrum had in mind when their daughter told them she was getting married. Pic was overjoyed at the thought of walking his youngest daughter down the aisle, so when he was told that open heart surgery just two weeks before the wedding was his only option, his spirits were crushed. The nurses and team of medical professionals involved in Mr. Schrum s care were phenomenal and instrumental in his being able to be with our family on the most special day of our daughter s life according to Mrs. Schrum. The Schrum s of course expected excellent care from High Point Regional, but the little efforts are what made the challenging experience bearable. Get me to the church on time was the theme that revolved around Mr. Schrum s care and recovery with 11 short days until his daughter s wedding, every rule and instruction by the doctors and nurses had to be followed. The nurses even put up a poster in his room with a daily chart showing him the countdown until his daughter s special day! Now that s motivation! Thanks to the caring and skilled team at High Point Regional Health System, Mr. Schrum was able to walk his daughter down the aisle, which was nothing short of a miracle. exemplary Professional Practice 14

7 Governance Councils There are eight governance councils that are responsible for nursing and patient care functions across the Health System. Nursing Leadership Council provides leadership, guidance and support for the Total Care Professional Practice Model and ensures that nursing care is patient-centered. Nursing Manager Council provides leadership in the development of environments through shared decision making that promotes and facilitates the practice of professional nursing. Professional Practice Council provides leadership in development and promotion of a nursing care delivery system that is patient-centered and creates a professional practice that is nurse-centered. Clinical Information Advisory Council promotes integrated patient-centered clinical information systems that reduce redundancy, promote cost effective care, improve continuity of care and streamline the transfer of critical information. Patient Experience Advisory Council develops, implements and improves processes which enhances patient care and patient outcomes through interdisciplinary collaboration and coordination across the Health System. Evidence Based Practice and Research Council assures a quality standard of patient care though research and performance measurement. Nursing Strategic Plan The Nursing Strategic Plan creates a vision and direction for nursing s preferred future at High Point Regional Health System. The Forces of Magnetism are recognized as characteristics that distinguish nursing excellence, therefore, providing the framework for nursing s preferred future. The strategic plan is an evolving document that supports the quest for nursing excellence. The plan supports the Health System s strategic plan. Organizational Goals: Quality, Service Preferred Future: A professional practice model grounded in accountability, care coordination and development of relationships that will ensure patient safety, patient comfort and quality care through role optimization of the registered professional nurse. Priorities: 1 Determine effectiveness of the Total C.A.R.E. Professional Practice Model Employee engagement Quality outcomes Participation in shared governance activities Patient satisfaction TRANSFORMATIONAL Leadership Peer Review Council improves patient outcomes and enhances nursing performance by supporting Just Culture. Magnet Council champions a professional practice environment through the deployment of the Forces of Magnetism. 3 4 Design staff roles that ensure best patient outcomes and service excellence. Develop and implement strategies that promote caregiver knowledge of patients. Promote implementation of evidence-based practices that enhance patient outcomes and perceptions of service delivery. EXEMPLARY Professional Practice 6

8 Organizational Goal: People Preferred Future: High Point Regional Health System is the preferred employer of professional nurses in the region. Priorities: 1 Monitor outcomes of existing reward and recognition programs. Identify gaps and re-design as appropriate Engage RN staff in decision-making related to nursing practice, work re-design. Ensure appropriate resources (equipment, supplies and staff) are available for provision of patient care. Continue existing partnerships with area Schools of Nursing and pursue additional opportunities. Provide ongoing education and service training that promotes healthy relationships with professional colleagues. Promote communication for all nurses with nursing leadership (CNO rounds, website). Promote a culture of accountability for professional practice and patient outcomes. Preferred Future: High Point Regional Health System is a learning environment that fosters continual professional growth and development. Priorities: 1 Promote attainment of BSN degrees. Goal 40 percent by 013. COMMENTS FROM PATIENTS This hospital is different from others. It s like being with family. I m a person here, not just a patient. Your staff works very well as a team. They help each other out and pitch in when needed. Some other hospitals have made me feel distant and like I didn t connect with the staff. That s not the case here. Professional Practice Model in Action: The Ethelyn Juska Clinical Performance Award Ethelyn Juska contributed more than 40 years of service to High Point Regional Health System, the nursing staff and the community of High Point. This award honors her by recognizing members of the nursing staff who demonstrate extraordinary clinical performance. Jill Reuille received the award in 011. Covering for a co-worker to go to lunch is usually an uneventful, routine daily task, for most nurses. But on this day, Jill Reuille s experience was anything but typical. After the esbar report, Jill knew her patient had been seen in another emergency department the night before with little progress made on her issues. There were numerous unsuccessful attempts to obtain blood samples and the patient was in pain, vomiting and growing increasingly frustrated. As part of the person-centered care practiced at High Point Regional, Jill began coordinating care closely with laboratory personnel and the Emergency Department physician assistant regarding this patient. Remembering the Nursing Code of Ethics, she gave the patient a voice, explaining how critical the blood tests were and spent extra time comforting the patient and helping her calm down. Finally, a successful blood sample was taken and sent to the lab. Jill s co-worker returned and Jill went about her day. The next day when Jill arrived at work, she was greeted by the Emergency Department staff and began receiving great accolades. Because of Jill s persistence, intuition, clinical expertise and caring she had been able to help a very ill young woman begin treatment for acute liver failure from an accidental acetaminophen overdose. The patient was transferred to an academic medical center where she received treatment and her liver failure was reversed. This wonderful outcome was possible because Jill took an extra minute to make a difference that will last a lifetime. Jill Reuille Emergency Department exemplary Professional Practice TRANSFORMATIONAL Leadership 1

9 exemplary Professional Practice High Point Regional Health System is dedicated to helping nurses on their journey to nursing excellence by providing support and offering numerous opportunities for professional development. The goal is to help nurses understand the role of nursing and its application with patients, families, communities and the interdisciplinary team with the use of new knowledge and evidence. Professional Practice Model & CARE Delivery Our Total Care Professional Practice Model was introduced in 010. It defines the responsibilities and authority of registered nurses as the coordinators of patient care, while supporting and empowering the nurse in the delivery of Total Care to the patient. The acronym C.A.R.E. is used to remember the components: C A R E Coordinate The C drawer includes the Nursing Care Delivery Model which explains how the RN coordinates care delivery of patients with other care providers. Accountability The A drawer contains the elements that support accountability through a shared governance approach. Recognition, Reward & Development The R drawer contains the programs that the Health System uses to recognize, reward and assist the RN in professional development. Effective Professional Relationships The E drawer shows how the RN maintains effective professional relationships through effective communication. 3 4 Support an orientation plan for the new graduate nurse to 5 promote successful transition from the school environment to High Point Regional Health System. 6 5 Design, develop and implement evidence-based education and training for nurses utilizing a variety of methodologies that meet the educational needs of all staff (simulated training, e-learning) Organizational Goal: Quality, Service, Value, Access Preferred Future: Achievement of benchmark outcomes. Priorities: 1 3 Promote attainment of professional/specialty certification. Goal 40 percent by 013. Develop and implement a path/program for career progression that includes competency development. Monitor outcomes of evidence-based competency model. Monitor outcomes of peer review process that lead to improved processes and patient outcomes. Participate in the development and implementation of a 360 feedback tool for all levels of professional practice. Provide leadership in patient safety activities and initiatives. Incorporate evidence-based practice into daily operations. Participate in design and implementation of customer service strategies that provide an exceptional patient experience. 4 Participate on committees/councils to develop strategies and performance improvement activities that promote exceptional outcomes (Lean Six Sigma, Cardiac Center of Excellence, CARF Accreditation, ACOS Accreditation for Cancer, Stroke Center Designation). Develop strategies for patient flow/patient throughput that are patient centered. Actively contribute to High Point Regional Health System s financial viability through responsible resource utilization. TRANSFORMATIONAL Leadership 8

10 structural Empowerment High Point Regional Health System empowers nurses to practice in a professional and autonomous manner to achieve the highest degree of clinical excellence and professional fulfillment. The Health System provides an environment that maximizes professional nurses effectiveness, as well as promotes and supports their involvement in community efforts. 011 Nurse s Day On May 10, 011, High Point Regional held its annual Nurse s Day celebration to recognize our nurses contributions to the health system and community at large. The celebration always includes food, door prizes, and personal thanks for the nurses, but on this particular day, the room was also filled with large ideas, questions, discussions and nurses advocating for additional education. This truly demonstrated our commitment to professional development through formal education. Eight schools of nursing were represented on-site with information about their various programs and degree paths. The schools had information about traditional as well as online degrees, scholarships and other financial assistance. This mini career day provided a wealth of information and encouragement for the nursing staff. Representatives from the different schools were onsite for all shifts to meet with any employee interested in pursuing an advanced degree or enrolling in nursing school for the first time. All of the schools represented had an RN-BSN option; many also had RN-MSN options and doctoral degrees available. This empowerment of nurses has become a part of High Point Regional s annual Nurse s Day celebration. Certified NURSES STATS 36.1% of RNs who provide Direct Care are Certified 77.% of RNs serving in Leadership Positions ARE CERTIFIED Shared Governance Empowering nursing staff in decision-making is a critical part of the culture at High Point Regional Health System. The Nursery Shared Governance Committee (NSGC) is just one example of empowering nursing staff. The NSGC investigates, researches and communicates with management, doctors and ancillary departments as needed to implement changes. This past year they were able to make several procedural changes that benefited the entire unit including: Implementation of the use of disposable circumcision limb restraints in order to be more cost effective and meet JACHO infection control requirements Revision of the patient report form to make it more user friendly and utilize the esbar format for reporting Updating various forms to meet current standards as well as be available in English and Spanish Implementing policy changes in regards to patient consent to allow for ease of charts for admission DIRECT CARE RN Degree Percentage ADN 58.% BSN 37.5% MSN 0.9% Other 3.4% structural Empowerment 10