OUR QUEST FOR NURSING EXCELLENCE. Care Compassion Collaboration

OUR QUEST FOR NURSING EXCELLENCE Care Compassion Collaboration NURSING ANNUAL REPORT 2013

2500 Grant Road Mountain View, CA 94040-4378 Phone: 650-940-7000 www.elcaminohospital.org I am pleased to present the 2013 Nursing Annual Report for El Camino Hospital. This report illustrates why I am so proud of the many ways El Camino Hospital nurses contribute through their caring, compassion, and collaboration in providing evidence-based clinical care. Nurses are an integral part of the care team at El Camino Hospital and continue to be passionate about our patients and our profession. This year s Nursing Strategic goals focused on patient safety, patient experience and staff development. Our safety initiatives are one way we demonstrate our caring for our patients. One very important patient safety initiative was the implementation of Knowledge Based Medication Administration (KBMA) which brought bedside medication bar coding to the majority of our nursing departments. Major initiatives to improve both patient safety and experience were purposeful hourly rounding, bedside handoff report, and daily medication printouts for patients. In the area of staff development we started planning the re-birth of a training program for new graduate RNs. For our own staff development we hosted nationally recognized nursing experts on topics of pain management, conducting nursing research, and professional peer review. We also partnered with the University of San Francisco School of Nursing and San Jose State School of Nursing to enhance the clinical experience of their students while at El Camino Hospital. Many of our El Camino Hospital nurses shared their clinical expertise with others at both the local and national level. Our nurses presented El Camino Hospital nursing outcomes at the national NICHE conference, the national Oncology Nursing Congress, Allscripts User Group and the 2012 Magnet Research Symposium. We really are leading change both at El Camino Hospital and nationally. Several El Camino Hospital nurses collaborated on the multidisciplinary team to reduce readmissions through the Transitions Program. Nurses developed a risk assessment tool and conducted follow-up rounds on patients in local skilled nursing facilities and at home. El Camino Hospital nurses also shared their expertise with nurses at the post-acute facilities to further enhance the care for our discharged patients. Included in these pages are just a few of the many stories of how El Camino Hospital nurses continue to serve our community. Thank you to our nurses for the inspiring things you do every day to provide great care to our patients and families and to support each other. We are proud of your contributions to our community and to the Nursing profession. Congratulations on another very successful year. Diana Russell, MS, RN, NEA-BC Chief Clinical Operations/Chief Nursing Officer Diana Russell, CCO/CNO, discusses patient care with nurses on the preadmission short-stay unit.

MESSAGE FROM THE MAGNET COMMITTEE Countdown to quest for third designation For over 30 years American Nurses Credentialing Center (ANCC) has administered the Magnet Recognition Program for hospitals throughout the United States, and the world. El Camino Hospital has a long history with the Magnet Program, first as one of the original 41 Magnet Hospitals, then achieving our first designation in 2005, our second designation in 2010, and now, in 2013, kicking off the one-year countdown to our submission of documentation for our third designation in June 2014. In this 2013 Nursing Annual Report, the Magnet Committee is proud to honor our nurses and all they have accomplished as individuals and in teams. Jennifer Borrelli, RN, Clinical Manager, Telemetry/Stroke Unit Monica Hite, RN, Clinical Manager, Medical/Surgical Oncology Sherrie Karleskind, RN, Clinical Nurse III, Mother-Baby Unit Vivian Low, RN, Clinical Manager, Cardiac & Pulmonary Wellness Center Cathy Patton, RN, Manager, Nursing Education Audrey Prairo, RN, Clinical Nurse III, Emergency Services Cheryl Reinking, RN, Vice Chief Clinical Operations Diana Russell, RN, CCO/CNO Kim Tabellion, RN, Clinical Nurse III, Telemetry Chris Tarver, RN, Director, Medical/Surgical Services The Magnet Model consists of five Model Elements which provide a framework for practice. Within this report, you will find nursing highlights for each Model Element: Model Element Pages Transformational Leadership... 2-5 Structural Empowerment... 6-9 Exemplary Professional Practice... 10-13 New Knowledge, Innovation and Improvements... 14-17 Empirical Quality Outcomes... 18-21 1

TRANSFORMATIONAL LEADERSHIP The KBMA bar coding project launch Diana Russell, CNO, knew that the missing link in our medication safety program was the use of bar coding at the bedside for medication administration. Diana presented the need for this expected standard of care to our Board of Directors for approval, as the initiative to institute bedside bar coding would require a multi-million dollar budget. Diana was able to gain the approval of the Board and to set into motion a determined effort to make this needed technology a reality. On October 23, 2012, medical/surgical oncology (4B) launched Knowledge Based Medication Administration (KBMA). The nurses were enthusiastic about this new tool to help prevent medication errors, and the patients gave us positive feedback. The metrics goalposts for this project included: Units scanning 70 percent of scannable medications by three months after the initial go-live date. Units scanning 90 percent of scannable medications by six months after the initial go-live date. Within the first week, the medical/surgical oncology unit (4B) exceeded the initial 70 percent goal. KBMA continues to roll out through the first week of May 2013, when the project culminates with a go-live at the Los Gatos campus. Athena Lendvay, RN, nursing educator, medical/surgical oncology, was one of a team of educators that taught KBMA to hundreds of nurses and respiratory therapists. 2

TRANSFORMATIONAL LEADERSHIP Avoiding Readmissions Coalition (ARC) Led by our Vice Chief Cheryl Reinking, in 2012 we received a Gordon and Betty Moore Foundation Grant to aid our health care team in reducing readmissions. The work of our Avoiding Readmissions Coalition (ARC) has included: Development of a standardized Transfer Checklist and verbal hand-off report addressing issues such as delirium, dementia, medications, and end-of-life care. Development of a process to identify patients at high risk for readmission. Follow-up phone calls by the gerontology nurse practitioner to skilled nursing facilities (SNFs) within 24 48 hours of discharge for patients meeting high-risk readmission criteria. Case reviews of every readmission within seven days conducted by the Geriatric Nurse Practitioner and SNF administrators. Pharmacist review of medications, including discharge medication plan, for patients at high risk for readmission. Better use of and referral to the on-campus Senior Health Center for patients without a primary physician. From April 2012 to June 2012, the unplanned readmission rate within seven days from SNFs decreased to 3.9 percent, exceeding our goal. Jodie Sugiyama, NP, Senior Health Center, teaches Mr. Pacheco how to use an inhaler spacer, while his daughter and granddaughter look on. Mr. Pacheco was an inpatient on our medical unit in December 2012. Upon discharge, he was referred to our Senior Health Center. Through regular visits to the Senior Health Center physician and nurse practitioner, he has learned how to manage his chronic respiratory illness and has avoided readmission to the hospital. 3

TRANSFORMATIONAL LEADERSHIP RNs as leaders In 2012, El Camino Hospital nurses held leadership positions in local, state and/or national organizations. We are proud to recognize their commitment to improving the care of various patient populations and specialty nursing care. Digant Dave, RN, Clinical Manager, Behavioral Health Services President of Bay Area Managers Association of Psychiatric Services Michael Fitzgerald, RN, Director, Behavioral Health Services Past President, California Chapter of the American Psychiatric Nurses Association Board Member, Drug and Alcohol Commission of Santa Cruz County Board Member, California Heathcare Association, Behavioral Health Center Athena Lendvay, RN, OCN, Educator, Medical/Surgical Oncology Virtual Community Coordinator, Santa Clara Valley Chapter, Oncology Nursing Society Vivian Low, RN, FPCNA, Clinical Manager, Cardiac & Pulmonary Wellness Center Steering Council Member, The Improvement Science Research Network (ISRN) San Francisco Bay Area Chapter Co-Chair, Preventive Cardiovascular Nurses Association (PCNA) Site Coordinator, Research Days Center for Nursing Research and Innovation, University of California San Francisco Lynn Taylor, RN, Assistant Manager, Progressive Care Treasurer, South Bay American Association of Critical Care Nurses Digant Dave, RN, (right), clinical manager, Behavioral Health Services, leads discussion with his staff, Felicia House, RN, and Stephen Miao, RN. 4

2012 El Camino Hospital E-2126_CAM Jan 2012 TRANSFORMATIONAL LEADERSHIP YES WE CAM! Suann Cirigliano Schutt, MS, RN-BC, CEP Christine Tarver, MS, RN, CNS Educators, innovators and experts CONFUSION ASSESSMENT METHOD (CAM) Unrecognized and untreated delirium is associated with increased morbidity and mortality, length of hospital stay, and increased risk of cognitive decline, functional decline, and institutionalization (Inouye, 2006). Dr. Sharon Inouye developed the CAM tool to identify patients at risk for developing Acute Delirium. EMR EXAMPLES CAM DRIVING GERIATRIC NURSE PRACTITIONER CASE FINDING In October 2011, a dedicated NICHE APN began working full time at El Camino Hospital. This Nurse Practitioner utilizes CAM scores to prioritize patient assessments/consultations. CAM scores allow for focused diagnoses, recommendations and evaluation of patient progress that were not previously available for our >65 year old population. Number of evaluations 70 Our El Camino Hospital nurses shared their projects, research and best practices across the country this past year. MARCH 2012: Suann Schutt, Medical Services and Chris Tarver, Medical/Surgical Services: NICHE Conference in New Orleans, Louisiana: Yes We CAM! MAY 2012: Monica Hite, Medical/Surgical Oncology: ONS National Congress in New Orleans, Louisiana: Hurry Up and Wait: A Multi-Factoral Process for Improving Ef ficiencies in Inpatient Chemotherapy Administration Workflow JULY 2012: Maria Gonzales, Telemetry/Stroke; Kaye Jaramillo, Norma Melchor Heart & Vascular Institute; and Jennifer Borrelli, Telemetry/Stroke: ISRN Conference in San Antonio, Texas: Changing Nursing Culture to Embrace Hourly Rounding with Purpose JULY 2012: Bonnie Gebhart, Christina Reich, and Vivian Low, Cardiac & Pulmonary Wellness Center: ISRN Conference in San Antonio, Texas: Motivational Interviewing to Reduce Cardiovascular Risk in Female Healthcare Employees SEPTEMBER 2012: Cheryl Reinking, Patient Care Administration: AllScripts Users Group in Chicago, Illinois: ARC Work: Readmission Potential: Providing Focus on Patients Who Need It EDUCATION FOR IMPLEMENTATION CAM tool was taught to nurses at a monthly scheduled inservice. CAM AND THE ELECTRONIC MEDICAL A Healthstream module was created to reinforce the inservice and to be available for all new hires. RECORD (EMR) El Camino Hospital sought to incorporate CAM into the daily nursing assessment utilizing our EMR (electronic medical COMPLIANCE WITH COMPLETING DAILY CAM record); however, we discovered no methodology for this had been Due to the fact that the task appears on the nurses worklist, and developed in our current (AllScripts SCM ) system. Through creates a flowsheet for data entry, nursing compliance is nearly collaboration with Clinical Informatics, Information Technology 100%. Tasks on the worklist that are not completed turn red and Nursing, configuration was incorporated with auto-generated allowing easy identification of missed tasks, including the CAM. scoring functionality. Age-related triggers were also incorporated, so that all patients >65 have a a task created on the nursing work list for daily CAM assessment. Also developed was a selectable Plan of Care for Acute Delirium. 2500 GRANT ROAD MOUNTAIN VIEW, CA 94040 815 POLLARD ROAD LOS GATOS, CA 95032 WWW.ELCAMINOHOSPITAL.ORG 60 50 40 30 20 10 0 October November December References References: Adapted from: Inouye SK, vandyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI. Clarifying confusion: The Confusion Assessment Method. A new method for detection of delirium. Ann Intern Med. 1990; 113: 941-948. Confusion Assessment Method: Training Manual and Coding Guide, Copyright 2003, Sharon K. Inouye, M.D., MPH. SEPTEMBER 2012: Bonnie Gebhart, Christina Reich, and Vivian Low, Cardiac & Pulmonary Wellness Center: AACVPR Conference in Orlando, Florida: Motivational Interviewing to Reduce Cardiovascular Risk in Female Healthcare Employees OCTOBER 2012: Suann Schutt, Medical Services; Mae Lavente, NICHE Program; and Chris Tarver, Medical/Surgical Services: Magnet Conference in Los Angeles: Together We CAM! OCTOBER 2012: Kaye Jaramillo, Norma Melchor Heart & Vascular Institute and Vivian Low, Cardiac & Pulmonary Wellness Center: Magnet Conference Research Symposium in Los Angeles: Panel Presentation for I-HO Study: Participating in Multi-site Studies: A Direct Care Nurse and Research Nurse Perspective OCTOBER 2012: Joanne Koering, Operating Room and Mary Rivera, Peri-operative Services: OR Manager Conference in Las Vegas: Operation HAPU Prevention Protecting Skin during the Continuum of Care 5

STRUCTURAL EMPOWERMENT Autonomy and teamwork: Central Partnership Council 2012 highlights Central Partnership Council Co-chair Bonnie Gebhart, RN, (left), pelvic/gynecological health, presents data to the council. Nurses, including Sandra Waters, RN, (right), Women s Hospital, participate through tele-presence. Some Central Partnership Council (CPC) accomplishments: Reviewed CPC Charter and By-laws emphasizing the Shared Governance model for direct care nurses and nursing management to collectively participate in improving patient care delivery/satisfaction, quality improvement activities and communication. Shared best practices between Los Gatos and Mountain View campuses. Presentations included pain management improvements, use of INTROS for bedside handoff, and rolling out a Nurse-MD note which is an informal way of communicating with doctors to address non-critical patient needs. Focused on wellness topics including: Going4Ten Team Challenges, health screenings available at El Camino Hospital, dense breast tissue awareness, and a nurse-led guided meditation to educate on stress management techniques. Review of National Database of Nursing Quality Indicators (NDNQI) RN Satisfaction Survey results and formulation of divisionwide goals. 6

STRUCTURAL EMPOWERMENT Nurses continue on the educational journey in 2012! Earning a Bachelor of Science in Nursing (BSN) is a wonderful accomplishment and shows the dedication these nurses have in obtaining their university degree. It also supports the Institute of Medicine Future of Nursing goal of having 80% of direct care nurses have BSNs by 2020. Congratulations to... Anne Cincotta, RN, Medical/Surgical Oncology Inessa Davitian, RN, Orthopedic Pavilion Sandra Diaz, RN, Medical Services Elizabeth Hemsley, RN, Medical/Surgical Oncology Alexandra Kamensky, RN, Orthopedic Pavilion Kathleen Munro, Emergency Services Everlyn Nyakoe, Acute Rehabilitation Cindy Ragsdale, RN, Medical/Surgical Another group of nurses took their educational path to a new level by earning their Master of Science Degree in Nursing. Congratulations to... Mary Anderson, RN, Care Coordination Alicia Antonio, RN, Dialysis Services Lotta Alba, RN, Emergency Services Jody Charles, RN, Neonatal Intensive Care Unit Left to right: Alicia Antonio, RN, clinical manager, dialysis services and Lilian Wu, RN, emergency services, are two of our 2012 graduates! Valerie Llavore, Telemetry Stacy Maguire, RN, Mother-Baby Unit and Labor & Delivery Erin McCalley, RN, Patient Care Resources Michael Purnell, RN, Critical Care and Progressive Care Lilian Wu, RN, Emergency Services Melissa Sideco, RN, Medical/Surgical Oncology Alida Lorenz, Interim Stroke Coordinator at Los Gatos, earned her Master of Arts Degree in Nursing Informatics!...And our First Fellow Vivian Low, RN, Cardiac & Pulmonary Wellness Center was selected by the Preventive Care Nurses Association as a Fellow. Congratulations Vivian! 7

STRUCTURAL EMPOWERMENT Disease-specific certification soars to new heights Orthopedic services triple certification In May of 2012, after a two-day site visit from The Joint Commission for a trio of certifications for our Hip Replacement, Knee Replacement and Hip Fracture Programs, the reviewer had no findings. The surveyor complimented our hospital, stating that our programs were the best programs that she has reviewed so far and that we set the bar high. We became the first hospital in California certified for a hip fracture program! This achievement happened due to the work of a multi-disciplinary team thank you to all! And more program certification news Our Chest Pain Center and Stroke Center also achieved re-certification in 2012. Our goals will continue to advance us to new levels as we strive in 2013 to achieve the goals of Cancer Services Center of Excellence, and Stroke and Orthopedic Certification at the Los Gatos campus. Debbie Smyth, RN, orthopedic surgery program coordinator, teaches a weekly pre-op class for all total joint replacement patients. 8

STRUCTURAL EMPOWERMENT New 2012 nursing certifications Tiffany Cardona, Orthopedic Pavilion, Orthopedic Certification Michaella Cavarlez-Sarinas, WOCN, Foot and Nail Care Certification Mabel Cheng, Medical/Surgical Oncology, OCN Alisa Cross, Emergency Services, CEN Molly Cyr, Surgical/Pediatrics, Medical-Surgical Certification Lanh Dang, Mother-Baby Unit, CLC Inessa Davitian, Orthopedic Pavilion, Orthopedic Certification Suzanne DeSandre, Mother-Baby Unit, IBCLC Bernice Fullerton, Medical/Surgical, Medical-Surgical Certification Irene Gotgelf, Medical/Surgical Oncology, Medical-Surgical Certification Diane Harada, Emergency Services, CEN Monica Hite, Medical/Surgical Oncology, Nurse Executive Certification Alexandra Kamensky, Orthopedic Pavilion, Orthopedic Certification Mandeep Manku, Medical/Surgical, Medical-Surgical Certification Grace Nabas, Telemetry and Telemetry/ Stroke, PCCN Janheen Pascual, Acute Rehabilitation, CRRN Jessica Storlie, Medical/Surgical Oncology, OCN Annette West, Emergency Services, CEN Grace Nabas, RN, (right), nurse educator for telemetry and telemetry/stroke, coaches (left to right) Amanda Hrobsky, RN, and Kassahun Mellese, RN. 9

EXEMPLARY PROFESSIONAL PRACTICE The Peer Review Committee completes pilot in 2012 Enthusiastically led by co-chairs Catharine Walke, RN, critical care and Marie Winquist, RN, telemetry, the Peer Review Committee successfully developed a process for peer review. The committee of direct care nurses created process documents, developed timelines and refined competencies in order to make peer review a reality. Two pilot units, labor & delivery and critical care, spent the month of November reviewing their peers on the medication administration process. The outcome of this peer review pilot can be seen by examining medication errors and patient satisfaction with medication communication. The goal is to have the Peer Review Process utilized on all nursing units in 2013! Intensive care unit nurses (left to right) Maureen Maghari, RN, and Danielle Kingston, RN, participate in peer review at the bedside to improve patient care. 10

EXEMPLARY PROFESSIONAL PRACTICE Focus on improving elder care Our NICHE (Nurses Improving Care of Healthsystem Elders) Committee was very productive in 2012. In the first half of the year, 255 nurses participated in the GIAP (Geriatric Institutional Assessment Profile) survey, providing helpful feedback for the committee to further refine a timeline for improvement of elder patient outcomes. Seven nurses took an all-day GRN (Geriatric Resource Nurse) course taught by Mae Lavente, Geriatric NP, and Suann Schutt, RN, educator, medical services: Sherri Cozzens, RN, nursing education Ashley Zimmerman, RN, medical services Sherwin Delegencia, RN, medical services Belcy Villarin, RN, medical services Fanny Wang, RN, medical services Colleen Talamantes, RN, medical services Jennifer Shepherd, RN, medical services These seven nurses committed to completing the rest of the GRN modules to receive their GRN Certificate from the NICHE program. Ashley Zimmerman, RN, medical services, enjoys caring for the geriatric patient population. The NICHE Committee also provided GREAT Kits (Geriatric Resources: Education and Tools) to all units as a resource of activities to use with patients, such as puzzle games, cards, busy blankets, and music. To help keep the kits well stocked, a Giving Tree was set up in December, and generous El Camino Hospital staff made a large number of contributions. 11

EXEMPLARY PROFESSIONAL PRACTICE Improving chemotherapy administration Debbie Bergman, RN, Infusion Center, develops strong relationships with the patients who come to our center, including Mr. Freitas. The outpatient Infusion Center nurses and the inpatient medical/surgical oncology nurses together with the pharmacists, embarked on a collaboration to improve chemotherapy administration. From decreased patient wait times to standardized administration procedures, our oncology patients have benefitted from this hard work. The oncology pharmacist teaches a weekly medication huddle session with an accompanying one-page teaching sheet that is available to all oncology nurses. Also, medical/surgical oncology educator Athena Lendvay completed the coursework to become an ONS certified chemotherapy instructor. Upon analysis of six months of data for inpatients, it was clear that there was delay from patient arrival to time of administration, averaging 5.3 hours. The average start of administration was 4 p.m. After tests of change and PDSA (Plan, Do, Study, Act) cycles, the average time from arrival to administration is now 2.5 hours, and the average start of administration is now before 12 p.m. 12

EXEMPLARY PROFESSIONAL PRACTICE Caring Nurse Award winner: Sandra Bennett, RN, Critical Care Sandra is recognized as one of the most expert nurse clinicians on our staff, but her demeanor is one of humility, and she is known as a downto-earth person. She has cared for hundreds of patients but she makes each one of them feel as if they are the only one for whom she is caring. Other nurses nominated for the Caring Nurse Award include: AndreAnn Broglia, RN, Telemetry/Stroke: She frequently proactively addresses pain and end of life needs. She recently spent her lunch break in a patient s room because she did not want him to die alone. Eric Garcia, RN, Behavioral Health Services: His expressions of empathy and caring are shown by the time he spends with each patient, his ever safe presence shared by his present stance when a patient is fearful. Mary Old, RN, Progressive Care: It is almost impossible to find her when she is working as a primary nurse because she is usually behind closed curtains assessing patient needs and providing expert care. She knows what matters most to patients. Missy Von Luehrte, RN, Cardiac & Pulmonary Wellness Center: Her commitment to the whole person she interacts with is an exemplary reflection of our El Camino Hospital nursing vision and professional practice model. Bev Wilson, RN, Behavioral Health Services: She is relentless in her advocacy for patients and their families. She always goes above and beyond. Excerpts from nominations written by colleagues. PREVENTATIVE SCIENCE & INNOVATION GROWTH-COLLABORATION-EDUCATION PATIENT CARE TEAM EXCELLENCE PATIENT RESTORATIVE Nursing Professional Practice Model PSYCHOLOGICAL SPRIRITUAL COMMUNITY FAMILY CARING COMPASSION 13

NEW KNOWLEDGE, INNOVATION AND IMPROVEMENTS Use of tele-presence with skilled nursing facilities to reduce readmission and improve care Left to right: Cheryl Reinking, RN, Vice Chief Clinical Operations,and Mae Lavente, RN, Gerontology Nurse Practitioner, conduct a tele-presence meeting with staff of a skilled nursing facility, to discuss patients recently discharged to that facility. In order to improve the care of patients discharged to skilled nursing facilities (SNFs), El Camino Hospital designed an innovative tele-presence meeting model. In examining our discharge patterns, we first set up this model with the two SNFs with the highest numbers of our patients. Weekly, a team from El Camino Hospital, led by NICHE Nurse Mae Lavente, Geriatric NP, reviews all recent high risk discharges and readmissions. The goal in 2013 is to increase the number of SNFs we interact with in this way. This work with the SNFs has contributed to our reduction in readmissions. In Fiscal Year 2012, we saw our seven-day unplanned readmission from SNFs drop from 4.8% to 3.9%. 14

NEW KNOWLEDGE, INNOVATION AND IMPROVEMENTS Nurses Peter Ostrowski, RN, and Sheila Pitfield, RN, of the medical/surgical unit complete a bedside handoff. INTROS In the Spring of 2012, the medical unit, Orthopedic Pavilion and rehabilitation services piloted the use of INTROS as a bedside hand-off methodology. After a successful pilot, the unit s staff presented their idea at Central Partnership Council, and INTROS is now the standard for bedside handoff enterprise-wide. INTROS stands for: I = Introduce yourself and update whiteboard N = Narcotics: check PCA/IV/Epidural/Oral Pain Meds and Pain Scale T = Tubes: trace all tubes to patient to insure accuracy including IVs/Foleys/ NG Tubes R = Review plan for the shift and update daily goals on whiteboard prn O = Observe and assess LOC/neuro status, skin, abnormal findings S = Safety and bed alarm; activity level 15

NEW KNOWLEDGE, INNOVATION AND IMPROVEMENTS Women s Hospital grows! In 2012 we made several changes in the Women s Hospital to accommodate our growing numbers of pre-term mothers, and mother-baby couplets. In Fall 2012, the mother-baby unit expanded to 3C West. This unit opened after careful planning by a team from mother-baby, establishment of criteria for admission to the satellite unit, inspections by the county, and day in the life drills for the motherbaby unit and code response staff. This satellite unit allows for families and babies to get to know each other in all-private settings no more double rooms. This has led to an increase in patient satisfaction. In labor & delivery, four new graduate RNs were hired. A program was designed especially for the new graduates which focused on the special needs of the laboring patient, as well as the continuum of care from ante-partum to post-partum and newborn care. Clinical manager Indira MacKay, educator Stacy Maguire and labor & delivery staff collaborated to successfully mentor the new grads in their new roles. Work also began on the physical space for labor & delivery, with a goal of opening an additional delivery room and exam room in 2013. Lisa Hu, RN, mother-baby unit, works with new mother Elisabeth Kahler and her three-day-old daughter Julie. 16

NEW KNOWLEDGE, INNOVATION AND IMPROVEMENTS The best machines for our most critical patients Continuous veno-venous hemofiltration (CVVH) is a treatment for patients with failing kidneys, for whom traditional hemodialysis has failed or is not an option. In 2012 a team from dialysis services, working with a team from critical care, successfully executed the purchase of newer, smaller Prisma CVVH machines and developed a new order set to accompany the new machines. When asked about the advantages of this new system, the critical care staff state that the new machine is user friendly and that the set-up and exchange are much easier, with no more weighing required. The staff also appreciate that the machine can do both filtering and/or removal of fluid, and can be run very slowly to remove fluid gently for the most critical patients. Wendy Morrison, RN, critical care, programs the new Prisma. 17

EMPIRICAL QUALITY OUTCOMES The journey to being published! As directed by our Magnet Site Surveyors in 2010, part of taking our Magnet Journey to the next level is to share our knowledge with our profession. Three nurses did just that in 2012 and we are so proud of them. As they can attest, writing a manuscript or working with journal editors may be arduous; however it is worth the effort, once you see that the work you have done to improve patient care is being shared with others. Congratulations to progressive care and labor & delivery nurses: Rafael Romo, RN, PHN, MSN, (and seven others): The Gerontologist: Perceptions of successful aging among diverse elders with late-life disability, December 2012. Marguerite Kunz, MSN, RNCC, CNS; Rebecca Loftus, MSN, RNCC, CNS and Dr. Amy Nichols: JOGNN: Incidence of Uterine Tachysystole in Women Induced with Oxytocin, accepted 2012 for publication January 2013. Marguerite Kunz, RN, labor & delivery, monitors patients for uterine tachysystole. 18

EMPIRICAL QUALITY OUTCOMES Fatima Mendoza, RN, and Cindy Ragsdale, RN, medical/surgical and Orthopedic Pavilion, take special care to prevent pressure ulcers on their patients. When a research study goes really right... A research study led by Nancy Woodward, MS, RN, CNS, CWON with critical care RNs Mei Chan, RN; Theresa Wang, BSN, RN, CCRN; Esther Nickols, BSN, RN, CCRN began at the end of 2011. The Institutional Review Board approved study was: Addition of a prophylactic dressing in high risk critical care patients throughout their hospital stay, and included implementation of a pressure ulcer prevention bundle. The results were dramatic: only one patient had a new breakdown in a sample size of 100. The study was terminated early, as it reached statistical significance in reducing the incidence of hospital acquired sacral and coccygeal pressure ulcers, and a positive practice change was achieved. In 2012 we brought the silicon dressing into regular use for both treatment and prevention of pressure ulcers. 19

EMPIRICAL QUALITY OUTCOMES Nursing research honored by the Board of Directors On September 12, 2012, the El Camino Hospital Board of Directors honored the Nursing Research Council and the more than 100 works of research and quality improvement projects that have been completed since 2006. 20

EMPIRICAL QUALITY OUTCOMES Evidence Based Practice Model INNOVATION NURSING RESEARCH Generate idea Determine method IRB approval Collect data Analyze Disseminate EVIDENCE BASED PRACTICE Discovery Summary Translation Integration Evaluation QUALITY/ PERFORMANCE IMPROVEMENT Plan Do Study Act IMPLEMENTATION 1 DISCOVERY 5 EVALUATION 2 SUMMARY 4 INTEGRATION 3 TRANSLATION Nursing Research Council hard at work Knowledge Transformation ACE Star Model 2004 The Nursing Research Council (NRC) at El Camino Hospital had another active year. NRC established the goal to empower nurses with the skills and knowledge to understand and engage in nursing research. Nurses are given assistance and guidance in the process of submitting a nursing research project to the hospital Institutional Review Board. NRC has established policies and guidelines to help nurses understand how this work is to be done, and also supports all evidencebased work including quality performance improvement projects. NRC has also assisted over a dozen nurses in submitting abstracts for poster or podium presentation at regional, national and international conferences. After acceptance, NRC coaches nurses through poster or PowerPoint development, offering support and encouragement. Nurses who are seeking advanced degrees are given support for their research projects that involve common patient care goals. NRC is proud of its own Evidence Based Practice Model (EBP), which has been shared at regional and national EBP conferences as well.

Front cover, left to right: Belcy Villarin, RN, medical services; Debbie Bergman, RN, and Jen Landes, RN, Outpatient Infusion Center; Sandra Bennett, RN, critical care and the 2012 Caring Nurse Award winner. Back cover, left to right: Preeti Kadem, RN, with patient, and Yoli Dela Torre, RN, progressive care; Mark Garvey, RN, and Jeremy Bruce, RN, emergency services. is a federally registered servicemark of El Camino Hospital 2013 El Camino Hospital E-2127_NursingAnnualReport Apr13 150 800-216-5556 www.elcaminohospital.org Two campuses 2500 Grant Road, Mountain View 815 Pollard Road, Los Gatos