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2014 Nursing Annual Report Once upon a time there was a wise man who used to go to the ocean to do his writing. He had a habit of walking on the beach before he began his work. One day as he was walking along the shore he looked down the beach and saw a human figure moving like a dancer. He smiled to himself at the thought of someone who would dance to the day and so he walked faster to catch up. As he got closer he noticed that the figure was that of a young man and that what he was doing was not dancing at all. The young man was reaching down to the shore picking up small objects and throwing them into the ocean. He came closer still and called outGood morning May I ask what it is that you are doing The young man paused looked up and repliedThrowing starfish into the ocean. I must ask then why are you throwing starfish into the ocean asked the somewhat startled wise man. To this the young man repliedThe sun is up and the tide is going out. If I dont throw them in theyll die. Upon hearing this the wise man commentedBut young man do you not realize that there are miles and miles of beach and there are starfish all along every mile You cant possibly make a difference At this the young man bent down picked up yet another starfish and threw it into the ocean. As it met the water he said It made a difference for that one. Loren Eiseley A Letter from the Vice President and Chief Nursing Officer AtlantiCare nurses play a vital role in transforming care delivery through safe professional practice. Our nurses are integral members and leaders of interprofessional teams councils and committees. They continuously work to improve patient safety and quality of care at the unit department and organization levels. We believe everyone can make a difference. This is witnessed each day in all healthcare settings and in the community. As AtlantiCare continues to grow throughout the region nurses are touching more lives on a personal level. As nurse-scientists lead the way in developing new knowledge clinical nurses are leading the charge in translating that science into real-world practice by investigating and applying the most relevant strategies for quality improvement patient safety care coordination workflow enhancements and expanded use of technology throughout the care continuum. As Johann Wolfgang von Goethe notedKnowing is not enough we must apply. Willing is not enough we must do. To all the nurses and our partners in caring a special thank you for your inspiring dedication to providing excellence in care. Robyn Begley D.N.P. R.N. NEA-BC ABOUT ATLANTICARE REGIONAL MEDICAL CENTER AtlantiCare a member of Geisinger Health System is an integrated system of services designed to help people achieve optimal health. It includes AtlantiCare Regional Medical Center AtlantiCare Health Engagement the AtlantiCare Foundation and AtlantiCare Health Services. Its more than 5221 employees and more than 700 physicians serve the community in nearly 70 locations. A 2009 Malcolm Baldrige Award winner AtlantiCare was also included in Modern Healthcare Best Places to Work in Healthcare for 2010. ARMC became the 105th hospital in the nation to attain status as a Magnet-designated hospital in March 2004 and was redesignated a Magnet hospital in 2008 and 2013. Specialized healthcare services are offered at AtlantiCare Regional Medical Centers Wound Healing Centers AtlantiCare Cancer Care Institute a Fox Chase Cancer Center Partner Neurosciences Institute AtlantiCare Womens Health Wellness The Childrens Hospital of Philadelphia CHOP Care Network at AtlantiCare newborn and pediatric care The Center for Surgical Weight Loss Wellness at AtlantiCare Regional Medical Center Regional Trauma Center at AtlantiCare Regional Medical Center The Heart Institute at AtlantiCare Regional Medical Center the regions only full-service cardiac surgery program The Joint Institute at AtlantiCare Regional Medical Center The Center for Childbirth which includes the regions only Neonatal Intensive Care Unit The Stanley M. Grossman Pediatric Center AtlantiCare nurses share the same vision mission and values as our parent organization. The vision provides the direction for where we are headed. The mission relays our purpose. The values are the foundation for our actions. Vision AtlantiCare builds healthy communities. Mission We deliver health and healing to all people through trusting relationships. Values Safety Teamwork Integrity Respect Service Safety safety for everyone is our top priority Teamwork we work together to achieve our goals Integrity our behaviors consistently reflect the highest ethical standards Respect we treat each individual with dignity and compassion Service we create loyalty by delighting those we serve The5 Bsare the overarching performance excellence dimensions guiding actions to achieve organizational strategic priorities. Our 5 Bs Nurses in all roles partner with AtlantiCare colleagues and together they help advance the organizations strategic priorities through both individual contributions and team-based project work. 2015 STRATEGY MAP BEST IN CLASS Employee Engagement CUSTOMER LOYALTY Customer Experience Index KEEPING ATLANTICARE FIRST Patients Cared For By Our Physician Network SUSTAINABILITY Operating Margin COMPREHENSIVE CARE TRANSITIONS Readmission Rate VISION WHERE WE ARE HEADED. ATLANTICARE BUILDS HEALTHY COMMUNITIES. VALUES HOW WE ACT. 5 BS PERFORMANCE EXCELLENCE COMMITMENTS HOW WE DO IT. TRANSFORMATIONAL LEADERSHIP Transformational Leadership in Action Valuing Safety AtlantiCare promotes an open visitation policy. Patients families and guests are welcome to visit at any time day or night. A post-trauma unit at AtlantiCare Regional Medical Centers ARMCs Atlantic City Campus 4 Harmony was experiencing an increased number of patients with special needs which resulted in increased patient requests to limit visitors due to their personal wishes or the nature of their illness. This increased staff stress and created safety concerns. Staff communicated their concerns to the clinical manager discussed them with senior leaders during rounding and commented during the annual employee satisfaction survey. A performance-improvement initiative to address these concerns was implemented to evaluate current unit trends ascertain best practices in the literature and network with similar units in like organizations. Through this initiative 4 Harmony staff unit leadership senior leaders and the Security department collaborated on process changes to enhance staff and patient safety in the unit. Their goals were to improve the safety of the staff patients and visitors to 4 Harmony through appropriate visitor access and to implement new processes for effective and efficient security interventions. After reviewing all the factors involved the team decided to limit access to the unit by incorporating new access technologies to enhance safety and security in a respectful and effective way. A special ID reader device similar to one used in the critical care area was installed along with cameras and monitors in two locations. Under the new process 4 Harmony staff members control access to individuals without a designated badge. Visitors must identify themselves via an intercom system to gain access to the unit. This limited access provides enhanced safety and security for staff patients and visitors on the unit and it is compliant with regulatory requirements. Patients are involved with access decisions and are asked at the beginning of each nursing shift if they wish to limit visitors for any reason. The process for identifying patients with visitor limitations was reinforced with Customer Relations front desk Patient Access and Security. These areas are provided with an electronic list each day. Communication regarding updates is promptly disseminated to ensure all areas are continuously informed of any changes. The lists are posted at the nursing stations throughout the unit. Documentation is kept outlining patient and safety requests. The use of security transactions was monitored pre- and post-implementation and the outcomes were positive. The proactive processes improved the timeliness of responses by both Nursing and Security. Both departments have come to rely on each other and both are expressing increased satisfaction with appropriate calls and response times. Patients see their input as being valuable in care-related decisions. STRUCTURAL EMPOWERMENT Safety Huddles in the Emergency Department Clinical nurses Shannon Marrone B.S.N. Lisa McColgan B.S.N. and Stacey Meers B.S.N. along with Clinical Nurse Manager Janice Quay M.S.N. R.N. CEN began a journey of improvement to enhance quality of care advance patient and staff safety enrich teamwork and improve efficiency. Based on the IOM reportTo Err Is Humanand in alignment with the newPatient Safety Systems Chapterby the Joint Commission the AtlantiCare Emergency Department ED developed a proactive safety huddle program. Adoption of the new model was implemented to promote situational awareness of patient and staff safety issues. The model positively impacted quality of care improved patient and staff safety and enhanced accountability and communication. The model has increased trust and knowledge both within the ED and with external colleagues and also reduced fear and blame. All of the ED staff were invited to participate in the development of safety huddles and subsequently in huddle participation. This evidence-based best practice based on Team STEPPS was formulated after reviewing the literature networking with nursing colleagues outside the organization and ascertaining the current practice. The team used guidelines issued by the Agency for Healthcare Research and Quality AHRQ with the exception of mandatory attendance. They chose to huddle every day at 8 a.m. a time when patient volume is typically at its lowest which allows for increased staff participation. Huddle times extend from five to 10 minutes and are initiated with a unit announcement. They are led by the safety officer of the day a staff member appointed by the daily nurse team leader. The team uses a worksheet to enhance communication and reviews issues that occurred over the past 24 hours along with corrective actions or continued needs. Huddle time is also used to communicate any care updates such as changes to personal protective equipment and other departments are invited to attend if they wish to be involved. Themes discovered include Computer technology Equipment Environmental Maintenance Patient or staff safety concerns Staff feedback during the trial included the following The informal huddle makes it nonconfrontational a no-blame atmosphere. Originally I was not onboard but I found things really get addressed. I like the face-to-face communication. This holds people accountable for getting things done. The truepulse checkis the occurrence of the huddles with or without manager presence. Staff members know issues will be addressed for the benefit of the team and patients. This is a proactive team approach to daily work. Findings also demonstrated a reduction in unplanned meetings improved teamwork and collaboration increased visibility of nurse leaders and an enhanced interprofessional approach to safety measures. The results were discussed at the Nurse Advisory Council by unit forum leaders. Nurse leaders and frontline staff were excited to adopt this best practice and it was adopted by all three Emergency Departments. Nurses at ARMC as a Magnet organization recognize the importance of making professional contributions and maturing our Magnet culture. Participating in shared governance at the unit committee project or council levels demonstrates how nurses are making a difference every day. The professional practice model is rooted in our organizational values and professional standards of practice. It is nurtured by our dedication to caring principles and demonstrates our passion for professional growth and development. In recognizing the shining accomplishments of nurses throughout the organization we honor their professional dedication their personal growth and their commitment to our organization. 2014 Nursing Partners in Caring Awards Interprofessional Partners in Caring Award Clinical Gemma Downham Interprofessional Partners in Caring Award Non-Clinical Juliann Henry Pastoral Care Michael Lea Security PROFESSIONAL RECOGNITION AtlantiCare Nursing iCare Awards The nursing annual recognition program celebrated during National Nurses Week has been transformed over the past several years. In 2012 the program was redesigned and renamed to capture the essence of the award integrate the program with our caring science theory and demonstrate alignment with the organization. The new name aptly called the iCare Award encompasses this. Recipients are recognized at a special ceremony held in their honor. The award categories reflect the Magnet components caring science theory our professional practice model and the mission vision and values of AtlantiCare. Leaders and nurse colleagues submit nominations through a structured application process. In 2013 the program expanded to recognize our partners in caring. Nurses openly express their gratitude to our colleagues who collaborate as a team in providing excellence in service. 2014 AtlantiCare Nursing iCare Honorees Transformational Leadership Heather McVey Ginny Rohan Structural Empowerment Sue Leonard Exemplary Professional Practice Antomie Blanco New Knowledge Innovation Improvement Michele Gaguski Kristin Logue Nursing Support Staff The Virginia Lanning Caring Award Michelle Gratz Caritas Nurse of the Year Award Maria Sandy Osmena The DAISY Award The DAISY Award founded by the Barnes family in memory of their son Patrick recognizes the extraordinary efforts of nurses. DAISY stands for diseases attacking the immune system. The foundation became a way to honor and recognize nurses for their compassion and caring education and training as well as the profound impact they have on patients and families. AtlantiCares first DAISY Award nominees and winner came from the AtlantiCare Cancer Care Institute in 2014. A selection team chose the winner from six nominations submitted by colleagues and patients. Those individuals were Karen Brady R.N. OCN Doreen Carlton R.N. OCN Josie Ellis R.N. OCN Allison Gibase R.N. OCN winner Bambi Goldberg R.N. OCN Alice Malfi R.N. OCN Allison Gibase R.N. OCN Here are some of the heartfelt recommendations from colleagues and patients about Allison Allison has been with me and my partner from the beginning and she is ourgo-toperson. No matter what is going on she talks to me and gets the job done. She is the most knowledgeable about what is going on with our care and is as professional as it gets Allison made a tough time easier for me and I was less afraid of chemo she is always so compassionate and caring and eased my fears so I would understand what was going to happen and be less confused. She actually motivated me to have hope for recovery I knew I was in good hands every time. It can go absolutely without saying that being diagnosed with cancer leaves one completely in a frenzy and each time I came for my visit her polite smile always greeted me and her calmness and expertise instilled in me a sense that I will be well. Allison always allayed my anxiety and she had my best interest at heart she cares deeply and it is an honor to nominate her for this award. I have worked here for over two years and I can attest that there has never been a time when Allison has not taken the time to sit and answer questions posed by patients and families. She is knowledgeable compassionate and caring each and every time with patients. She leads by example and I have learned so much by following in her footsteps. I respect her and admire her professionalism and commitment to our patients. I was very afraid and I didnt want to feel the pain but Allison held my hand and had such kindness that I felt you know it would be OK. I love her and she will always be very special to me. She made the procedure much less painful. As long as I have been coming here Allison has taken the time to make sure I understand what is going on even if I ask the same questions. She shows concern and caring all the time and has helped me with all aspects of my recovery. I do not know where I would be without her. 2014 ATLANTICARE NURSE ACADEMIC ACHIEVEMENTS AND CERTIFICATIONS AtlantiCare leadership is very supportive of our nursing staff in obtaining professional certifications and furthering their academic achievements. The following colleagues advanced their education and training during the 2014 reporting year Professional Certifications NAME CREDENTIALS WORK AREA 2014 CERTIFICATION Dolores Holzer R.N. CCM Case Management Case Management Sharon McDermott R.N. CCM Case Management Case Management Mary Grace Moore R.N. CCM Case Management Case Management Joseph Brennan R.N. CCRN ICU Critical Care Rachel Davis Bohs R.N. B.S. Process Management Lean Six Sigma Black Belt Megan Calabria R.N. CNRN ICU Neuroscience Lori Carmean R.N. CNRN ICU Neuroscience Rhonda Gareau R.N. CCRN ICU Neuroscience Prudence Lanuza R.N. B.S.N. CNRN ICU Neuroscience Kimberly MacKinnon R.N. CNRN ICU Neuroscience Graziella Morgan R.N. B.S.N. CCRN ICU Neuroscience Scott Tilton R.N. CCRN CNRN ICU Neuroscience Jacinth Brown R.N. OCN Medical Oncology Oncology Doreen Carlton R.N. OCN Medical Oncology Oncology Trisha Geary R.N. OCN Medical Oncology Oncology Adam Brooks R.N. ONC 2 Meadow Orthopedics David Day R.N. ONC 2 Meadow Orthopedics Alyssa Siazon R.N. ONC 2 Meadow Orthopedics Janine Begasse R.N. B.S.N. CPHQ Quality Management Professional Healthcare Quality Sandra Osmena R.N.C. B.S.N. PCCN 4 Harmony Progressive Care Shannon Patel R.N. B.S.N. PCCN CCRN CMC Professional Practice Progressive Care Sherry Pharo R.N.C. B.S.N. 4 Harmony School Nurse Rachel Baldomar R.N. B.S.N. CNRN SCRN ICU Stroke L.P.N. to R.N. Shevron Cross R.N. R.N. to B.S.N. Shirley Armbruster R.N. B.S.N. Lisa Atkinsson R.N. B.S.N. Sally Brackney R.N. B.S.N. Rosemarye Copeland R.N. B.S.N. Kelly Lindner R.N. B.S.N. Graziella Morgan R.N. B.S.N. Esther Schairer R.N. B.S.N. Phyllis Sodatis R.N. B.S.N. M.S.N. Lauren Cooke R.N. M.S.N. Jennifer Defelice R.N. M.S.N. Marlon Migioia R.N. M.S.N. Christian Peterson R.N. M.S.N. Jennifer Serback R.N. M.S.N. Pamela Walch R.N. M.S.N. ErinYakopcic R.N. M.S.N. Huiching Wang-Yuen R.N. M.S.N. Outstanding Internal and External Recognition Nurses at AtlantiCare led several initiatives in 2014 that were recognized organizationally for outstanding improvements or innovations. Medical Oncology Department Acuity Model Development Best Practice Team Michele E. Gaguski M.S.N. R.N. AOCN CHPN APN-C led the way in developing this innovative model. She and her team members were recognized by the Oncology Nursing Society ONS and the AtlantiCare iCare Awards program. The Department of Medical Oncology and Infusion Services at the AtlantiCare Cancer Care Institute identified the need for improving the accuracy of patient scheduling to provide a more comprehensive efficient and evidence-based approach to cancer treatment services. The team reviewed scientific findings demonstrating patient population acuity systems in the outpatient oncology practice areas. These systems have been validated in determining the hours of care a patient requires through the measurement of patient needs or nursing tasks. The staff analyzed current practices and implemented changes based on the literature and organizational findings. Our interdisciplinary team was responsible for adopting national standards and guidelines and for applying scientific evidence into clinical practice. Team members created an acuity model to support quality cancer care for patients requiring chemotherapy and supportive treatments as part of their overall plan of care. Outcomes demonstrated decreased wait times for patients and decreased overtime for staff. 45 40 35 30 25 20 15 10 5 0 Year 2013 Year 2014 Timeinminutes Patient Wait Times Pre- and Post-Acuity Implementation 2014 April May June July August 250 200 150 100 50 0 Timeinhours Infusion RN Overtime Hours RN Overtime Hours 2013 2014 Code Stroke Task Force Dr. Brett Greenfield EMS medical director and Liz Deleener B.S.N. R.N. neurosciences program manager were instrumental in developing a successful program to quickly triage and treat stroke patients demonstrating improved patient outcomes. Both ARMC campuses have earned the Joint Commissions Certificate of Distinction for Primary Stroke Centers. In addition ARMCs Atlantic City Campus is a designated New Jersey Comprehensive Stroke Center. In 2014 the Code Stroke Task Force successfully implemented theCode Strokequality-improvement project. Other initiatives were also launched including the adoption of the direct-to-CT program with enhanced pre-hospital single-call activation by EMS and the direct-to-CT program from triage led by highly trained Emergency Department nurses. As a result of this work outcomes demonstrated significant improvements in performance and patient results Door-to-needle times decreased from 70-90 minutes to 45-60 minutes. Door-to-recognition of acute neurological conditions leading to shortened door-to-CT interpretation times decreased from 45 minutes pre-implementation to less than 20 minutes post-implementation. Faster time to imaging doubled the number of eligible t-PA candidates. The number of symptomatic intracranial hemorrhage rates 36 hours after receiving t-PA decreased to 1.8 percent. Discharges to home increased by 10 percent. Cardiovascular Critical Care Unit Receives the Beacon Award The American Association of Critical-Care Nurses AACN recognized the Cardiovascular Critical Care Unit CVU at ARMCs Mainland Campus with its silver Beacon Award for Excellence in 2014. The CVU joins the Mainland Intensive Care Unit ICU which earned the same award in 2013 as a distinguished recipient of the AACNs national recognition. According to AACN President Vicki Good M.S.N. R.N. CENP Units that achieve this three-year designation meet national criteria consistent with Magnet Recognition the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award. ARMCs dedicated healthcare professionals join other members of the exceptional community of nurses who set the standard for optimal patient care. The Beacon Award for Excellence recognizes caregivers in stellar units whose consistent and systematic approach to evidence-based care optimizes patient outcomes. Those who receive this national recognition serve as role models to others on their journey to excellent patient and family care. EXEMPLARY PROFESSIONAL PRACTICE Nurses and clinical colleagues throughout AtlantiCare continuously strive to improve quality and safety. Excellence in Action Infection Prevention and Control Leads the Way This new team expands the meaning of shared governance with the healthcare-acquired infection HAI subcommittee. 2014 was a great year for our Infection Prevention and Control team which initiated several cutting-edge programs to lead the way in promoting patient and staff safety and to improve quality of care. For example Mary Beth Kelly R.N. B.S.N. MAS-CIC director of Patient Safety and Infection Prevention and Control and her team of clinical experts brought together the first healthcare-acquired infection HAI subcommittee. The goal of this interprofessional team is to improve patient care enhance safety and achieve the Centers for Medicare Medicaid Services CMS performance threshold for CLABSI CAUTI MRSA BSI VRE and C. difficile. These conditions are all hospital-acquired infections that increase the morbidity and mortality of patients. They are also part of the CMS Pay-for-Performance program and are associated with substantial financial achievement and penalty portion of the Value-Based Purchasing program. Throughout the first year the HAI subcommittee evolved to a decentralized defect analysis format. Throughout the evolution frontline staff members participating as infection prevention liaisons CAUTI champs andor CLABSI experts have spearheaded case reviews. Staff members in conjunction with nursing leaders on their unit debrief the case with their peers interview 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.00 Target Average Unit Result Rate 2014 MRSA HAI REDUCTION INITIATIVE Mainland and City Campuses 1st Q 2014 2nd Q 2014 3rd Q 2014 4th Q 2014 those involved and thoroughly examine potential root causes for infection. The unit establishes action plans to prevent the type of infection from occurring again. The team plan for 2015 was to continue internal efforts as well as to participate with various networks including the New Jersey Hospital Association and the Partnership for Patients work through the Premier Hospital Engagement Network. Through these external resources we will share and learn new methods for improvement in this important work. Several highlights demonstrating the positive outcomes of this new committee are provided. Three Harmony an intensive care unit decreased the incidence of CAUTI by 62.65 percent SIRs criteria through the implementation of new urinary catheter care protocols. The unit is trending toward the national benchmark. 0.70 0.60 0.50 0.40 0.30 0.20 0.10 0.00 Target Average Unit Results Rate 2014 C-diff HAI REDUCTION INITIATIVE Mainland and City Campuses 1st Q 2014 2nd Q 2014 3rd Q 2014 4th Q 2014 0.80 0.70 0.60 0.50 0.40 0.30 0.20 0.00 Target Average Rate 2014 VRE HAI REDUCTION INITIATIVE Mainland and City Campuses 1st Q 2014 2nd Q 2014 3rd Q 2014 4th Q 2014 NURSE-SENSITIVE INDICATORS Nurses at all levels of the organization are involved with quality initiatives. Nursing leadership nurtures a culture where nurses feel empowered to utilize meaningful data to initiate changes in patient care delivery. Nurses are encouraged and rewarded for participating aschampionsand change agents. Nurse champions are mentored in a specific patient care delivery initiative and become experts and consultants. Champions lead colleagues in exploring and strategizing initiatives best suited for their patient populations and unit needs. This integrative approach has created a culture of ownership and increased positive patient outcomes and staff satisfaction. The indicators and recognitions demonstrate their effective contributions. 2014 Nurse Sensitive Indicator Results Like units are benchmarked using the National Database of Nursing Quality Indicators NDNQIs. The results are colorized using green to indicate quarterly results demonstrating the majority of units did outperform the mean or blue to demonstrate all units submitting data outperformed the mean. Unit population types submitting data MedicalSurgicalMedical Surgical combinedCritical CareStep DownBlended UnitsPediatricsBehavioral Health The inpatient Behavioral Health Unit 1 Pines consistently performed in the 10th to 25th percentile ranking when compared at the national level with like units. Nurse Sensitive Indicators Pediatric-specific indicators reported to NDNQI once again achieved zero occurrences of IV infiltrations all four quarters. Pain cycle assessments demonstrated 100 percent compliance all four quarters. Congratulations for this wonderful accomplishment Nurse Sensitive Indicators Pediatric 1st Q 2014 2nd Q 2014 3rd Q 2014 4th Q 2014 IV Infiltrations Pediatric Pain AIR Cycles Behavioral Health 1st Q 2014 2nd Q 2014 3rd Q 2014 4th Q 2014 Total Assault Assault with Injury Nurse Sensitive Indicators 1st Q 2014 2nd Q 2014 3rd Q 2014 4th Q 2014 Patient Falls Patient Falls with Injury Hospital Acquired Pressure Ulcers Stage II Above Restraints During PI In 2014 the patient fall prevention committee under the leadership of Sue Battaglia R.N. B.S.N. and Rocky Ricapito R.N. B.S.N. was extremely involved with the fall champions. The committee was comprised of acute care nursing unitbased champions and champions from ambulatory care radiology and specialty areas of practice who worked to find innovative ways to decrease patient falls and falls with injury. Through analysis of data and review of each fall for trends and opportunities they collaborated on changes that influenced positive results. The champions collaborated with Clinical Informatics to enhance risk stratification documentation and care planning including patient involvement in developing a personal plan for fall prevention. They educated all Transport Department personnel in fall prevention strategies to ensure everyone was engaged. Champions were instrumental in evaluating the bed alarm systems and selecting new beds to enhance safety and comfort for our patients. This last initiative was a very large financial investment for the organization. All the initiatives synergistically enhanced safety and quality of care and produced positive outcomes for the patients. 2.50 2.25 2.00 1.75 1.50 1.25 1.00 0.75 0.50 0.25 0.00 Target Fall Rate Rate 2014 PATIENT FALL PREVENTION Mainland and City Campuses 1st Q 2014 2nd Q 2014 3rd Q 2014 4th Q 2014 Falls with Injury Rate st Q 2014 2nd Q 2014 3rd Q 2014 4th Q 2014 NEW KNOWLEDGE INNOVATIONS AND IMPROVEMENTS The Nursing Research Council is responsible for promoting the conduct and evaluation of nursing research and the integration of evidence-based practice into patient care at ARMC. Council members serve as leaders consultants educators and mentors in research methods and processes creating a culture of inquiry new knowledge and innovation. Members support the nursing and organizational annual plan. They assist with the review and approval of all nursing research conducted at ARMC and increase nursing research visibility in ARMC and beyond. AtlantiCare nurses are well represented and respected as voting members of the Internal Review Board IRB. In 2012 six nurses were accepted to the IRB as voting members. In 2013 that number increased to seven and was maintained in 2014. Nursing Research Studies Conducted During 2014 Study Title Principal Investigator AtlantiCare Coordinator Location Local Adaptations of the Pearl Naylor R.N. Ph.D. Mary Jean Burke R.N. Multisite-RWJ Foundation Transitional Care Model B.S.N. M.S.-BC How Many Nursing Professional Julia Aucoin R.N. Ph.D. Angela Miggliaccio R.N. B.S.N. Multisite-ANPD Development Specialists Do We Have Pressure Ulcer Risk and Prevention Sandra Bergquist-Beringer Mary Jean Burke R.N. NDNQI-Multisite Assessment Study Examining R.N. Ph.D. B.S.N. M.S.-BC the Inter-rater Reliability of NDNQI Indicators Multisite Study Certification Barbara Williams R.N. Ph.D. Mary Jean Burke R.N. NDNQI-Multisite Clinical Advancement Work B.S.N. M.S.-BC Empowerment Engagement Health Care Outcomes Investigation of Relationships Maureen Schneider R.N. Ph.D.c Mary Jean Burke R.N. Ann May Center for Between Among Power Trust M.B.A. M.S.N. NEA-BC B.S.N. M.S.-BC Nursing Multisite Job Satisfaction of Nurse CPHQ FACHE and Managers in Acute Care Managers in Acute Hospitals Rose Scaffidi R.N. D.R.N.P. CNM Leadership and Attitudes Pamela Paparone D.N.P.c Angela Miggliaccio R.N. B.S.N. ARMC Infection Toward Adoption of APN FAWCCS Prevention Control Evidence-Based Practice on Influenza Vaccination Neonatal Abstinence Syndrome Elizabeth Hendricks R.N. ARMC NICN A Comparison of Methadone M.S.N. and Withdrawal to Buprenorphine Jean Paolino R.N. M.S.N. Withdrawal Innovation Change Makes a Difference Technology and Teamwork Take on the Flu Think Hot Pink Influenza vaccination status is a CMSJoint Commission IMM-2 Core MeasurePay-for-Performance Measure. Compliance with this measure is tied to substantial reimbursement in the CMS Value-Based Purchasing program. A collaboration of efforts among Infection Prevention and Control Information Technology Nursing QI specialists and the Pharmacy resulted in an enhanced system for monitoring assessment and vaccination of patients. The adult immunization screening tool went live in April 2014. Clinical decision-making reminders alert nurses to rescreen every 12 hours until another answer is chosen. In addition just prior to discharge a unit-specified nurse verifies the screening is completed and the vaccination has been administered. Theunscheduled med tabchanges to a hot pink color alerting the nurse to give the vaccination. 92 90 88 86 84 82 80 78 76 74 Target Vaccine Rate PATIENT FLU VACCINATION 2013 2014 2015 1st Q PRE-IMPLEMENTATION PercentCompliancewithVaccination Requirements Flu VaccineBeach Tagsfor Staff Historically New Jersey has the lowest rate of influenza vaccination among healthcare personnel HCP in the United States reaching only 62 percent in the 2013-2014 flu season Lindley et al. 2014. Although progress toward achieving the 90 percent national benchmark for HCP influenza vaccination rates has been made state vaccination performance for HCP is 31 percent below the national requirement Healthy People 2020 2011 Lindley et al. 2014. The flu was ahottopic not only for patients in 2014 but also for staff. Being a coastal community we all recognize the beach tags required to access most public beaches in our area. Using similar imagery flu tags were designed and worn by all vaccinated employees as a symbol of vaccination. Patients and visitors were interested in the unique badge and asked questions which opened the door for vaccination discussions. Again technology assisted with making vaccinations easier for staff to obtain as did a dedicated team of volunteer nurses medical residents physicians and pharmacists who distributed both the flu vaccine and the badge. A special thanks to team members for their innovative endeavors. Their efforts made it possible to achieve an 80 percent vaccination rate for all eligible employees. This rate outperformed our target by 25 percent. Team Fluconsisted of several departments working together to increase staff vaccination efforts. Here is a list of the team members Occupational Health subcommittee members Occupational HealthMedicine Public Relations Internal Communications Infection Prevention and Control ID providers ID pharmacists Attending physicians and residents Finance Information Technology Staff nurses