Welcome from Cheryl Reinking, CNO Welcome to our Nursing Annual Report. I m Cheryl Reinking, Chief Nursing Officer. 2015 was an amazing year, and I want to congratulate and thank the nurses and staff of El Camino Hospital for achieving our 3rd Designation as an ANCC Magnet Hospital. I would like to take a moment to review some of the highlights of 2015 in regard to our Triple Aim. We will all remember November 7, 2015 as the day we launched our new Electronic Health Record, icare. It was amazing to see the dedication of hundreds come together for a system that will improve continuity of care, availability of information, and our patients experience. We will improve patient care quality as we continue to optimize icare. Focusing on service, we also rededicated ourselves to Purposeful Rounding. Rounding by staff has improved our patients satisfaction and safety. Managers rounding on patients can use the Vocera Rounding Tool to get specific assistance as needed. All staff use visual management boards to monitor the impact of rounding on call light data and the progress of HCAHPS scores. In 2015 we continued our work with the Patient Family Advisory Council (called PFAC), and began work on developing a more Patient/Family-Centered approach to our decision making and program implementation. In the area of affordability, we developed strong teams to focus on length of stay and reducing readmission. Several nursing units across the organization hold daily length-of-stay rounds focusing on each patient s clinical and psycho-social needs while ensuring the plan for post-acute care is appropriate to the patient s condition and social support These rounds are attended by nurses, physicians, care coordinators, ancillary departments such as dietary, and at times our partners at Pathways Home Health and Hospice. Over the next few years, we have so much to look forward to. We begin the construction on the Integrated Medical Office Building, remodel the Women s Hospital and continue to remodel and refurbish units and departments on both our campuses. Finally we are looking forward to our new Behavioral Health Building. Thank you for and for caring for our patients and their families with such dedication and compassion. 2016 El Camino Hospital E-2127_NursingAnnualReport_May16 www.elcaminohospital.org/nar2016
Magnet Committee Message LETTER 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, designated after a nationwide study in 1981. We renewed our commitment to the Magnet Journey in the early 2000s, and in 2005 became the first Bay Area Magnet Hospital. We received our second designation in 2010. In June 2015, we became part of a distinguished group of just over 100 hospitals to receive a third designation. This designation would not have been possible without every nurse at El Camino Hospital, the tireless contributions of the Magnet Committee and the support of all employees. 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: Transformational Leadership Structural Empowerment Exemplary Professional Practice New Knowledge, Innovation & Improvements Empirical Outcomes The Magnet Committee is proud to honor our nurses and the excellence they have achieved. This was reflected in our Magnet Documentation and Site Visit, and is also reflected in this 2016 Nursing Annual Report. Please enjoy exploring this report and join us in celebrating nursing at El Camino Hospital! Magnet Committee Magnet Committee Message COMMITTEE MEMBERS Magnet Committee Jennifer Borrelli, RN Jody Charles, RN Pamela Fiehmann, RN Bonnie Gebhart, RN Monica Hite, RN Sherrie Karleskind, RN Jackie Keane, RN Vivian Low, RN Kelsey Martinez, MPA Audrey Prairo, RN Cheryl Reinking, RN Kim Tabellion, RN Chris Tarver, RN Catharine Walke, RN
Research Implementation of the ABCDEFG Protocol, CCU Nurses participated in Multi-Site Collaborative Comparing Pain Management Modalities and Post- Op Ambulation for Total Knee Replacement Patients, Research completed by Debbie Smyth, RN Analyzing Retrospective Data to Determine Patients Needing PSA (Patient Safety Attendant) Services on Medical Unit, Capstone project completed by Shefali Desai, RN Sepsis Enterprise Process Vigilance, Research conducted by Kelly Nguyen, RN READI (Readiness Evaluation and Discharge Intervention), Multi-Site Study led at El Camino Hospital by Allison Layton, RN and Ann Marie Barsanti, RN Survey of Nurses Opinion on Methods of Quality Improvement, Capstone project completed by Allison Gorman, RN
Organizational Overview ABOUT EL CAMINO HOSPITAL As an independent, nonprofit organization with campuses in Mountain View and Los Gatos, El Camino Hospital takes a dynamic approach to healthcare and is redefining what it means to be a community hospital. Combining the latest thinking, treatments and technology, we bring passion to our work and deliver care in the most personal way possible. Our team is driven to create programs and services that never existed before to meet the unique challenges people sometimes face. Our medical specialties include cancer care, heart and vascular services, mental health and addictions, men s health, orthopedics, rehabilitation services, senior health, spine surgery, urology, and women s health including mother-baby care. El Camino Hospital, Mountain View El Camino Hospital, Los Gatos Transformational Leadership CIPN Kathleen Hall, RN performs assessment for CIPN. In May 2015, the second Diana K. Russell Leadership Grant was presented to Kathleen Hall, RN in the Outpatient Infusion Center. Kathie was honored for her dedication to improving care for oncology patients suffering from Chemotherapy Induced Peripheral Neuropathy (CIPN). On January 23, 2016, international expert Dr. Ellen Smith arrived at El Camino Hospital to teach an all-day workshop on this important topic. Kathie conducted a Nurses Knowledge Survey both before and after the workshop. Results revealed statistically significant improvement in the nurses knowledge of CIPN. Next steps for this project include baseline and post-intervention chart review to capture improvements in assessment and treatment for CIPN.
Transformational Leadership icare On November 7, 2015, El Camino Hospital implemented icare, the Epic Electronic Health Record, across the enterprise. This was a monumental undertaking with Go-Live encompassing not only clinical users, but supporting departments such as registration, finance and environmental services. Literally hundreds of staff supported Go-Live by being super users on the units, identifiable by their orange vests, and ever ready to support the end users. Key Takeaways Cheryl Reinking, CNO discusses icare documentation with nursing analyst Kathleen Faubion, RN. Over 30 El Camino Hospital staff joined the icare Team in Fall 2015 to become Credentialed Trainers. icare has allowed for information from other Epic sites to be brought in through Care Everywhere. Patients also have access to their own records through use of MyCare. Transformational Leadership THIRD TIME Achievement of Third ANCC Magnet Designation: On June 16, 2015, El Camino Hospital joined the ranks of just over 100 hospitals worldwide by becoming a third-time designated ANCC Magnet Hospital. Magnet Designation is the highest honor bestowed in the nursing profession, signaling excellence in nursing care. To achieve this designation three consecutive times salutes the long-time commitment of El Camino Hospital nurses to provide the best care possible for our patients and families. Outperformance of national mean for Core Measure Acute Myocardial Infarction: Aspirin on Arrival for eight straight quarters. Outperformance of national mean for Core Measure Pneumonia Care: Blood Culture in the ED before First Antibiotic for eight straight quarters. When the Commission on Magnet conferred the third Designation to El Camino Hospital, it also awarded exemplar recognition for several achievements: Increasing nurse certification to a total of 468 certified nurses in 2015, with eight units exceeding 50% of their clinical nurses having certification. Jeremy Bruce, RN is diligent in collecting blood cultures before administering antibiotics.
Structural Empowerment CERTIFICATION REVIEW COURSES Grace Nabas, RN, Educator, Telemetry and Telemetry/ Stroke, and Mae Dizon, NP, NICHE program, collaborated to bring two certification review courses to El Camino Hospital. Held in Spring 2015, the Gerontology Review Course and the PCCN/CCRN Course both had standing room only attendance! Nurses were very positive about being able to attend the courses at our hospital, and two more review courses are planned for Fall 2016. In 2015: Two nurses achieved Gerontology Certification after attending the review course Six direct care nurses passed the examination to become PCCNs Eight direct care nurses earned their CCRN Structural Empowerment NEW CERTIFICATIONS 2015 The ANCC Magnet Recognition Committee recognized El Camino Hospital with an exemplar for outstanding work in increasing certification of nurses to a total of 468 nurses in April 2015, and particularly in the Peri-Op area on the Los Gatos campus, where 67% of staff achieved CNOR certification. The number of certified nurses continues to grow! View the list of nurses with new certifications earned in 2015. CNOR nurses (left to right): Cynthia Harmer, RN; JoAnn Medina, RN; Nancy Kenny, RN; Eunah Kang, RN; Masha Pavlov, RN; Yuet Ho, RN
Structural Empowerment NEW CERTIFICATIONS 2015 2015 was a fantastic year for new certifications which contributed to El Camino Hospital nursing staff receiving an exemplar from the ANCC Commission on Magnet for achievements in percentage of certified nurses. Congratulations to all our certified nurses! Below is a partial list of new certifications achieved in 2015. Case Management Certification (CCM): Donna Dillon, RN, Care Coordination Pamela Knudsen, RN, Care Coordination Boris Kotelnikov, RN, Care Coordination Melody Millet, RN, Care Coordination Nicole Peattie, RN, Care Coordination Rowena Subijano, RN, Care Coordination CCRN: Dhanya Anand, RN, ICU Yi Xin Chen, RN, CCU Chrissy Dahl, RN, CCU Danielle Herbst, RN, ICU Shawn Kelley, RN, ICU Rosielyn Tayao, RN, CCU Sandy Tran, RN, CCU Jessica Williams, RN, ED CEN: Ellen Moss, RN, ED Erika Taylor, RN, ED Nam Thai, RN, ED Scott Vesalo, RN, ED CGRN: Lilybelle Chen, RN, Endoscopy Certified Lactation Educator: Pauline Li, RN, MBU Kohar Kourouyan, RN, MBU Tanti Usong, RN, MBU Sally Hung, RN, MBU Marsha Ma, RN, MBU Ardele Moline, RN, MBU CNRN: Sandy Tran, RN, CCU CPAN: Catherine Escoto, RN, Endoscopy Ilana Fishkov, RN, PACU Lori Story, RN, PACU CRRN: Everlyn Nyakoe, RN, Acute Inpatient Rehabilitation Unit CV-Nursing Certification: Molly McCarthy, RN, Cardiac & Pulmonary Wellness Center ENPC: Rodolfo Calderon, RN, ED Krista Lim, RN, ED Catherine Tran, RN, ED Gerontology Certification: Wendy Bunnell, RN, Surgical/ Pediatric Services Heather Wright, RN, Medical Services Inpatient OB Low Risk: Sharon Foster, RN, MBU Courtenay Pasiczniak, RN, MBU Lactation Educator Counselor: Jolie May David, RN, MBU Eva Ifeishat, RN, MBU Labor and Delivery: Rochelle Popyon, RN, L&D NCC Maternal/Newborn: Jane Bao, RN, MBU Daphne Singh, RN, MBU NVRN BC: Ellen Moss, RN, ED Sandy Tran, RN, CCU Prabha Upadhyaya, RN, CCU Nurse Executive Advanced Certification: Chris Tarver, RN, Patient Care Administration Medical Surgical Nursing: Theresa Hibionada, RN, Medical/ Surgical Oncology ONC: Maridel Liang, RN, Medical/ Surgical Oncology Loralee Marlow, RN, Medical/ Surgical Oncology Shara Vinco, RN, Medical/Surgical Oncology PCCN: Tammy DeLeon, RN, Telemetry/Stroke Heather Frazee, RN, Telemetry/Stroke Angelina Festejo, RN, Telemetry/Stroke Eunissa Kang, RN, Telemetry Jessiree Primitivo, RN, Patient Care Resources Chris Ralston, RN, Progressive Care Unit Professional Development Certification: Jake Grossman, RN, Patient Care Resources Psych-Mental Health Nursing: Terence Dzelambong, RN, BHS Amanda Kight, RN, BHS RNC Low Risk Neonatal: Dana Peterson, RN, Patient Care Resources TNCC: Gayatra Bhattaral, RN, Patient Care Resources Charlotte Madamba, RN, ED Veronica Palsutra, RN, ED Laurie Santo, RN, ED Nam Thai, RN, ED Catherine Tran, RN, ED Scott Vesalo, RN, ED Courtney White, RN, ED Jessica Williams, RN, ED WOCN: Cindy Ragsdale, RN, Med/Surg
Structural Empowerment NEW NURSING DEGREES 2015 New BSN Degrees 2015 Florence Commodore, RN, Labor & Delivery Marina Cottle, RN, Medical/Surgical Patti Lanet, RN, Medical Services New MSN Degrees 2015 Regina De Los Angeles, RN, Medical Services: MSN Nursing Education Shefali Desai, RN, Medical Services: MSN CNL Rochelle Popyon, RN, Labor & Delivery: MSN CNL New Doctorate Degrees 2015 Luis Barberia, RN, PeriOp: Doctorate of Nursing Practice Chris Tarver, RN, Patient Care Administration: Doctorate of Nursing Practice (Left to right) Shefali Desai, RN, MSN; Luis Barberia, RN, DNP; Chris Tarver, RN, DNP have all had multiple opportunities to disseminate their individual research at healthcare conferences, and the doctoral studies were both published in professional journals. Structural Empowerment CENTRAL PARTNERSHIP COUNCIL El Camino Hospital nurses participate in an active shared governance model. The Central Partnership Council (CPC) is the overarching council for all shared governance, and includes clinical nurses from every nursing department, as well as one management representative per service line, and then representatives from various other councils such as Nursing Research Council. CPC meets monthly and is chaired by two clinical nurses: Lori Story, RN, CPAN and Karen Roman, RN-BC. (From left) Lori Story, RN, CPAN and Karen Roman, RN-BC collaborate to successfully lead CPC meetings and encourage members.
Exemplary Professional Practice CARING NURSE AWARD Caring Nurse Award Winner: Karen Roman As always, it was a challenge to select the Caring Nurse Award winner for 2015 from among the exemplary nominees. Karen was recognized not only for her work at El Camino Hospital, but also her community service, with contributions including: Serving as Chairperson of the Central Partnership Council Leading the Laughter Yoga Program Developing the Patient Education Medication Module Karen Roman, RN-BC enjoys nursing care in the outpatient setting, including encouraging patients to achieve optimal health. Leading the Women s Heart Support Group Serving as Director/Founder of the Los Altos Stake Family Life Council, which establishes programs, policies, and procedures and provides training on family relationship and abuse issues. Exemplary Professional Practice PATIENT SATISFACTION In 2015, the concept of patient rounding gained a renewed commitment through the guidance of the Patient Experience Team, and led by educational efforts of Jake Grossman. The concept at El Camino Hospital is Purposeful Rounding meaning that patients and nurses partner together to plan the rounding. For example, nurses and patients at the beginning of night shift will discuss how rounding will occur at night: does the patient want to be woken at certain intervals or prefer to sleep through the visual checks by the nurse? (Top) Jillian Graves, RN, CRRN rounds on patients as they move through their various rehabilitation activities. In her roles as both direct care nurse and charge nurse, Jillian assures that Inpatient Rehabilitation patients feel safe and have a high level of satisfaction. Rounding on patients in Jillian s unique unit could mean finding patients in the dining room, activity gym or patio. (Left) Alice Dutton, RN rounds on a postpartum patient and her newborn.
Exemplary Professional Practice PROFESSIONAL PRACTICE MODEL El Camino Hospital s nursing Professional Practice Model (PPM) emphasizes the patient being at the center of all care. Words chosen by nurses to reflect their professional practice Caring and Family spiral outward from the patient. Excellence refers to the goal to deliver the highest quality care to patients. Next, Community represents the hospital s history as a community-built organization and its future: broadening delivery of care across the continuum and into the community. Next in the outward spiral is Compassion: a word nurses often use to describe how they and their colleagues deliver care. Science and Innovation reflect our legacy as the first hospital in the world to implement an Electronic Medical Record in 1971, and the current strong support of Nursing Innovation through the Nursing Research Council. Patient Care Team captures the collaborative nature of care at El Camino Hospital. Four key aspects of care enclose the labyrinth: Preventative, Restorative, Psychological-Spiritual, and Growth-Collaboration-Education. Nursing Professional Practice Model New Knowledge, Innovation & Improvements DECREASING FALLS Using Lean Methodology and supported by Patient Centered Transformation (PaCT), a group of clinical nurses, educators and nurse leaders formed the A3 Fall Prevention Taskforce. Specific measures were put in place, which resulted in a significant decrease in falls. These improvements included: An interface from the Call Light System to Vocera to alert nurses of patients at risk for falls New signage in the patient rooms reminding patients to call before getting out of bed or up from a chair New decals for patient rooms to better communicate the patient s fall risk and bed alarm information Trial and selection of new chair alarms Audit tool development and implementation New education for CNA staff on fall prevention
New Knowledge, Innovation & Improvements OSA Danielle Holman, RN secures OSA band to patient in the pre-operative setting. A nursing protocol was developed for all identified adult surgical obstructive sleep apnea (OSA) patients. The protocol ensures that the most at risk patients receive collaborative consultation with nursing, respiratory care specialists, physicians, and care coordinators. All patients who screened positive are provided specialized OSA education, and discharge instructions on the crucial elements of risk and safety. Patients who experience clinically significant hypoxemic events are scheduled for a follow up sleep study. Collaboration between nursing and the multidisciplinary care team resulted in 100% of all preoperative patients being screened and educated. Positive outcomes include increased patient and staff awareness and education for OSA. Clarification and improvement of existing policies for home CPAP equipment led to improved equipment safety and infection prevention. Next steps are to expand risk screening and nursing protocol implementation to all appropriate at risk hospitalized patient populations. New Knowledge, Innovation & Improvements WOMEN S HEALTH In the realm of Community Outreach, a robust partnership was formed between Nursing and Rehabilitation Services to conduct courses to help women experiencing bladder incontinence. Starting with a free class taught every 1 2 months by a specialty nurse, women in the community are taught options to help control bladder incontinence. One of the options is a multi-week course that is provided by a specially trained physical therapist. Athena Lendvay, RN and Tara Huebner, Sr PTA work closely together to provide excellent education opportunities for the community.
Empirical Quality Outcomes POST-OPERATIVE AMBULATION Debbie Smyth, Orthopedic Surgery Program Coordinator, conducted a retrospective study to examine the effects of various pain management measures on the post-op ambulation ability of total knee replacement patients. Debbie found that with the right combination of pain medications, patients can ambulate significantly farther in the first 24 hours post-op. Oral only pain medication patients ambulated an average of 44 feet! Debbie shared the information with physicians and therapists to improve patient outcomes and reduce length of stay. 150 120 90 60 30 0 Empirical Quality Outcomes WALK TESTING Starting Patient s Exercise: Alternative assessment of exercise tolerance for select groups of cardiac rehabilitation patients. Cardiac rehabilitation programs perform a functional assessment on patients to develop safe exercise prescriptions. The six-minute walk test (6MWT) is the most frequently used test for assessing exercise tolerance. However, the test falls short when patients have skeletal muscle disorders or unsteady gait, require walking assist devices, or are physically high functioning individuals. To evaluate an alternative assessment of exercise tolerance, a study was conducted using a Recumbent Cross Trainer Test (RCTT) to address these limitations and improve the experience for patients. Forty-six patients completed both tests and were categorized as low, moderate or high functioning. We conclude that the RCTT is a valuable option for patients who can t demonstrate their abilities through walking, or who are high functioning and would be limited by the ceiling effect of a walk test. Nanette Malgesini, RN explains the walk test to a patient in CPWC.
Empirical Quality Outcomes ACHIEVING ZERO Preventing Hospital Acquired Pressure Injuries has been the tireless work of El Camino Hospital s Wound and Ostomy Nurses, clinical nurses, nursing assistants, respiratory therapists and ancillary staff, supported by departments such as Materiel Management (to obtain new equipment) and Administration. El Camino Hospital was able to achieve ZERO HAPUs in calendar year 2015. In fact, this remarkable outcome started prior to 2015, and continued into 2016, marking over 18 months with zero stage III or stage IV hospital acquired pressure ulcers. Cheryl Brandt, RN and Marissa Syzslowski, WOCN discuss options to prevent pressure injuries in critically ill patients.