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Journal of Nursing at Shore Health
System
The
Beacon
P r o f e s s i o n a l Development
Check this site often so that you are dated on up-coming profes-sional develop-ment series that may be go-ing on in or around SHS!
this issue~
~ Flu Shots~ Magnet Convention ~ Where and How Can I
Get a BSN?
~ Medication Administra-tion and Patient Safety O c t o b e r
2 0 1 1
10
The Beacon Issue 10 October 2011
Shore Health System welcomes E. Patricia (Patty) MacDougall, MSN, RN, BC as the Nurse Manager of Women’s and Children’s Health. Patty comes to SHS from Sentara Norfolk General
Hos-pital. She has 16 years experience in Labor and Delivery, High Risk Antepartum, Postpartum, Nursery, OR, Recovery, and GYN nursing and education. Please join me in welcoming Patty to the Nursing Management Team.
The construction project for Shore Behavioral Health Unit at Dorchester General Hospital began on October 3, 2011. Phase I in-cludes demolition of the Intensive Outpatient (IOP) area and the area where the Balance Center vacated. Once Phase I is completed (approximately 12 Weeks), IOP, physician offices and some therapy offices will be relo-cated to the new space. Phase II will begin on or around January 20, 2012.
Research Seminar
Research Seminar
CORE MEASURES AND
CORE MEASURES AND
EVIDENCE
EVIDENCE
-
-
BASED PRACTICE
BASED PRACTICE
by
Robert Carroll
Director, Performance Measurement and Improvement
November 10, 2011 1200-1300 MHE BOARDROOM
(BEFORE RESEARCH COUNCIL MEETING)
Just over 50 years ago MRSA (methicillin-resistant Staphylococcus aureus) emerged into the world. As you know, handwashing is one of the most important ways to decrease the spread of MRSA in healthcare facilities. However, healthcare workers often skip this important step.
New Nurse Manager of Women’s and
Children’s Health…
Submitted by Ruth Ann Jones, EdD, MSN, RN, NEA-BC, Director of Acute Care
Shore Behavioral Health Construction...
Magnet Convention 2011...
Barbara Bilconish, MSN, RN, NEA-BC, Director, Professional Nursing Practice/Magnet Program
At the ANCC National Magnet Conference®, more than 7,600 nurses and nurs-ing executives from top hospitals celebrated Magnet Recognition and gathered to share evidence-based practices. Annually, this is the official conference of the prestigious Magnet Recognition Program®, serving as both a celebration of ac-complishment for newly designated Magnet® organizations and a showcase of best nursing practices for the Magnet community. Our Shore Health System at-tendees returned home energized to improve their nursing practices and equipped with proven methods to do so. We did not go unnoticed with the stead-fastness of our volunteers who directed, pointed in the right direction and often hand-led exhausted and lost nurses in the Baltimore Convention Center. Our volunteers received many positive comments about their willingness and thoughtfulness in how they conducted themselves at the convention. We were noticed and acknowledged for a job very well done. A special thanks goes out to Shelley Stone for coordinating the volunteer efforts for SHS. Now I must ad-mit that some of those exhausted and lost nurses at the convention were our very own SHS nurse attendees. But amid all the activity they sought out every learn-ing opportunity. What lies in store for us can only be surmised by the varied topics that they attended from transformational leadership to exemplary profes-sional practice, new knowledge and innovations, and structural empowerment. Many times people think that attending a convention is all fun and games, but believe me, based on the objectives below it was far from a ride on easy street:
Describe the implications of a changing healthcare delivery system on nursing's delivery of care across the continuum.
Discuss the art and science of nursing as it relates to leadership, prac-tice, and outcomes.
Synthesize understanding of nursing's history, current trends, and the impact of Magnet on nursing's future role(s) in health care.
So in the words of John Quincy Adams…. If your dreams inspire others to dream more, learn more, do more and become more, you are a leader.
Thanks to the leader that is in all of you as we prepare for the next phase of our Magnet journey….Redesignation!
Magnet Convention 2012…. October 10-12, 2012, Los Angeles Convention Center, Los Angeles, California.
Medication Administration and Patient Safety…
Submitted by Cynthia Beemer, MSN, RN, CCRN, NEA-BC, Manager of ICU/ Tele at MHE
In an effort to comply with federal mandates in the reduction of medication errors
Electronic Medication Administration Record (e MAR) and Bedside Medication Verifi-cation (BMV) went live at Shore Health System (SHS) in September of 2009. This process affected many of the departments and staff at SHS including nursing, pharmacy, and physicians. Over the next year and half as staff in many departments learned the process it became apparent that there were issues with the process that needed to be re-viewed in an effort to maintain safety of our patients and reduce the number of interrup-tions that nurses and pharmacists experienced. A Medication Administration Task Force between Pharmacy and the ICU’s was started in early 2011. The team was facilitated by Robert Carroll, Director of Performance Measurement and Improvement. The team ex-amined every step in the processes from the time a medication is ordered until the time it is administered to the patient. The goal of the task force was to identify the root causes of the issues being identified for rejection of medication orders and to change processes to reduce the chance of error, thus, decreasing harm to our patients. After understanding the complex processes involved the top three issues found to cause rejections by the nurse were duplicate orders, wrong dose, and wrong frequency.
The Task Force met over the course of 120 days. And implemented the following interventions:
Provided visual reminders of the order notification process by using screen savers
Placed a pharmacy tech in a position to handle phone inquires, thus, decreasing interruptions of the pharmacist entering orders
Standardized the way that pharmacists process orders
Added patient identifier to pharmacists queue to decrease duplicates
Implemented the use of STAT sleeve to scan stat orders to pharmacy so the phar-macist knows the order needs to be done first.
Changed Meds Tracker processes to eliminate some confusion with home medica-tion continuamedica-tion.
After putting these interventions in place, the rejections have decreased by 50%. Hav-ing reached its goal, the task force disbanded in October 2011. This is a prime example of how we implement the SHS improvement model of FOCUS PDSA, We found an opportunity, organized a team, considered the process, understood variation and selected improvements based on root causes. Then planned interventions, did the improvement activities, studied the results and are spreading the changes. Members of the Medication Administration Task Force were:
Robert Carroll, Director Proformance Measurement and Improvement; Ruth Ann Jones, EdD, MSN, RN, NEA-BC, Director Acute Care, Susan Siford, PharmD, MBA; Holly Frase, RN, CCRN; Tracy Roe, RN, CCRN; Cynthia Beemer, MSN, RN, CCRN, NEA-BC; Ruth Thompson, RPH; Ryan Foster, MSN, RN, CNML, NEA-BC; Kim Marks, RPH; and JoAnne Thomson, MNRN, Director of Nursing In-formatics and Practice Innovation.
Magnet Conference Quotes and Photos
….
Submitted by Staff
"Going to the Magnet Conference in Baltimore allowed me to see how I am a part of something big-ger than the small isolated area of the hospital where I work. I have never been in a crowd of over 7,000 nurses before and I felt proud that I can call myself a nurse and know that I work at a Magnet Hospi-tal."
Judith C. Bennett
After being overwhelmed by the number of nurses present for the Magnet convention, I was so excited to be a part of all those nurses whose desire is to be a great nurse and to give great patient care.
Marilyn Higley, RN, Digestive Health Center
Stacey and I experienced a wonderful opportunity assisting some of the 7,768 atten-dees at the 2011 ANCC National Magnet Conference® October 4-6, in Baltimore, Maryland. Our roles included helping attendees in finding their way around the con-ference and introducing speakers before each session. As volunteers, we also had the opportunity to attend some of the general sessions, enjoy the poster area, exhibit hall, and displays. Volunteering was an excellent way to connect with other Magnet or-ganizations. We were able to share our experiences in how our system excels in nurs-ing services and patient care. This was a wonderful opportunity, and we look forward to next year’s conference.
Amy Stafford, RN & Stacey Kram, RN
Top Five Reasons “
Why Staff Nurses Should Attend the Magnet Conference”
… Submitted by Janet Wilson , BSN, RN
1. Learning about what it means to be a Magnet Facility (What we have accomplished and what are we planning on accomplishing).
2. Continuing education credits (Learn the latest trends in your practice area-don’t be surprised if we are already doing it here! It will get you thinking about presenting!).
3. Meeting nurses from other hospitals (Share ideas- develop professional relationships. Nurses come to the convention from around the world).
4. Traveling-always a great city to visit (Explore the Other Side of the Bridge).
Out and About at the Magnet Convention
Pictured from left to right are two of SHS’s Magnet representatives, Cristine Curto and Cyndy Hagstrom.
Residential Washers May Not Kill
Hospital-Acquired Bacteria…
Submitted by Gail Shorter, MSN, RN, CEN,Manager CCU/GU
Residential washing machines may not always use hot enough water to elimi-nate dangerous bacteria like methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter, a Gram-negative bacteria, from hospital uniforms, according to a study published in the November issue of Infection Control and Hospital Epidemiology.
The study, conducted by researchers from University College in London, was prompted by changes in Britain’s National Health Service that led many hos-pitals in the UK to end in-house laundry services. The researchers investigated the effectiveness of resi-dential washing machines’ lower water temperatures in eliminating hospital-acquired bacteria.
Through a series of experiments, researchers found that washing uniforms in residential washing
ma-chines with detergent and water temperature of 60 degrees Celsius (140 de-grees Fahrenheit) was enough to eliminate both MRSA and Acinetobacter. At 40 degrees Celsius (104 degrees Fahrenheit), MRSA was eliminated, but sub-stantial amounts of Acinetobacter were detected. In the UK, energy-saving washers often operate at temperatures near 40 degrees.
However, the researchers found using a hot iron on fabric after a 40 degree Celsius wash did eliminate the Acinetobacter. The effect of tumble drying the uniforms was not tested.
"The results stress the importance of ironing hospital uniforms after washing them in a domestic washing machine that operates at less than 60 degrees Cel-sius," said Dr. John Holton, one of the study’s authors. "We show that laundry and ironing in a domestic setting is effective in producing a uniform free of ac-cumulated hospital bacteria safe to wear to work,"
The experiments were performed on nurses’ uniforms worn during a work day, as well as swatches of fabric artificially contaminated with MRSA and Acine-tobacter. The researchers studied the two bacteria because both are often asso-ciated with healthcare-acquired infections (HAIs), and represent two important bacterial types. MRSA is known as a Gram positive bacteria and Acinetobacter as Gram negative. The distinction involves differences in the walls of the bac-terial cells. The researchers expect their results are applicable to other types of Gram negative and positive bacteria.
Researchers are planning additional studies to see if common HAI bacteria can remain and develop in residential washing machines after laundering hospital uniforms.
From Infection Control Today website
It’s that time of the
year for your
Yearly Flu Shot.
Flu shots are available for employees, physi-cians, active volunteers and contracted em-ployees.
REMINDER: You will need to see Employee Health in Room 259 on regularly scheduled clinic hours: Monday 0730 – 1030, Wednesday, 1300 – 1600 and Friday 0730 – 1030 or visit Shore Works Monday through Friday from 0800 – 1630. Employees, medical staff or volunteers must receive the vaccine or complete a declination form with appropriate documentation as per
policy, prior to November 30, 2011.
Thank you for your cooperation and understanding.
Cryoprecipitate – Prepooled 5
...
Submitted byPatricia Schwaninger, Blood Bank Clinical Specialist
Effective Monday, November 14, 2011
Dorchester General Hospital and Memorial Hospital at Easton, Maryland will be discontinuing the use of single units of Cryopreci-pitate (CRYO). The new product that will be available at both facili-ties will be the Cryoprecipitate – Prepooled 5 (CRYOPP).
Description: Cryoprecipitate is prepooled by the Blood Bank of Delmarva for the convenience of the hospital transfusion services. The prepooled dose is 5 units of Cryoprecipitate per bag. For adults, two pools of CRYOPP are dispensed for the standard adult dose of 10 units. The CRYOPP is suspended in 124 mL to 136 mL of
Plasma. A pool of 5 units is expected to raise the fibrinogen level 25 to 50 mg/dL. CRYOPP must be used within 6 hours of thawing. Transfusion does not need to be ABO compatible except for new-borns (<4 months). Allow 20 minutes for thawing.
University of Maryland School of Nursing
www.nursing.umaryland.edu
Online program with monthly on-site assistance with admission and registration Stevenson University
www.stevenson.edu
Online program with option to attend electives on campus. Diploma-nurse friendly during admission process
Wilmington University
www.wilmu.edu
Has campuses in Georgetown DE and Dover DE. Their classes are set on an 8-week cycle and you go to campus one evening a week. I believe some classes are a hybrid on online and on campus.
Salisbury University
www.salisbury.edu
Program offers many classes on-campus, some classes are a combination of online/in class.
There are also several other totally online programs like:
Walden University www.waldenu.edu University of Phoenix www.phoenix.edu
Regis University www.regis.edu and Saint Joseph’s of Maine www.sjcme.edu
also have online RN-BSN programs. Former CCU/GU nurses are enrolled in both these programs and are very satisfied.
Please feel free to contact me for assistance in finding your way to the school that is your best fit. You can find me at gshorter@shorehealth.org or x5357.
Where and How Can I Get A BSN?
…Submitted by Gail Shorter, MSN, RN, CEN, Manager, CCU/GU
As part of my role as the SHS liaison to the University of MD School of Nursing, my name has become visible as someone who might have information about formal academic education programs for nurses. In the last month, I have received multiple calls and hallway consults. The Beacon seemed to be the most effective way to share information with a large number of nurses at one time.
Finding the Best Fit
The first thing I like to tell everyone is that there is a ‘best-fit’ school for every nurse, but there is not one school that is right for everyone. Different schools have different admissions requirements. Those admis- sions requirements help you to narrow down your choices of the school that will fit your needs and your life today.
Transcripts
No matter what schools you choose to investigate, you will need to get official (sealed envelope) copies of your transcripts from any and all schools who have granted you academic credits since you graduated from high school. It does not mat-ter if all your credits come from one school or you have gathered knowledge from 10 different schools across the United States. It doesn’t matter if there are grades you would rather forget about. Some computer stores that information and it will show up.
Many schools have a transcript request on their website. This is definitely the easi-est way to order them. You can order more than 1 copy. If you have already targeted specific programs, have the transcripts sent directly to the school(s). If not, order at least 3 copies. Many schools do this without an attached fee.
All of the records from Macqueen Gibbs Willis are housed in the Shore Health Sys-tem Human Resources department. If you are a diploma graduate, this is where to start your search.
Which school would you recommend?
Many schools are now offering RN-BSN programs. I will start with a brief list in this issue but will continue to bring information to you monthly.
Urinary Catheter (Foley) Order & Documentation Changes
Effective November 1, 2011
Submitted by Jo Anne Thomson, MN, RN
Director of Nursing Informatics and Practice Innovation
Catheter Associated Urinary Tract Infections (CAUTI’s) increase a patient’s risk of mortality, increase length of stay and increase healthcare costs. With a focus on the prevention of CAUTI’s, in June 2011, SHS implemented a Urinary Catheter protocol which was developed using evidence based practice. The protocol includes details about insertion, requires daily assessment by the RN regarding the need for the cathe-ter and automatic cathecathe-ter removal if the patient no longer meets established cricathe-teria. Orders and documentation screens were changed in Meditech to align with the policy.
On Nov 1, 2011, changes will be made to the Meditech screens for the inpatient areas. The changes are being implemented to improve documentation and are based on feed-back from nursing staff.
Changes include:
Orders:
There are now FOUR orders related to Urinary Catheters:
Urinary Cath Foley PER Protocol – Preferred Order
Urinary Cath Foley NO Protocol - Use if the MD
does not write a protocol order. Contact MD for protocol order
Continue Urinary Foley Catheter – Use to enter Reason to Continue Foley
D/C Urinary Foley Catheter – Use if the MD writes specific Discontinue date. Be sure to enter Directions – ie - if order is tomorrow – enter tomorrow’s Start Date
Documentation:
There is now a PER PROTOCOL Foley Assessment and a NO PROTOCOL Foley Assess-ment. You must assess the need for the Foley every day. A daily order to continue Foley will be required if the protocol order is NOT used
ALL Foley Documentation (Insertion and Daily Assessment) will be done on the Foley
Assessments (Protocol and No Protocol). The daily Foley assessment is no longer in the shift assessment
Don’t COMPLETE the Foley Assessments until the Foley has been discontinued
***Foley Insertion done in the ED or by a Nursing Tech will recall into the Per Proto-col and No ProtoProto-col Assessments.
The interdisciplinary CAUTI Task Force is providing education regarding the changes for each RN, US, NT and Physician.
News From Shared Leadership Global…
Submitted by Janet Wilson, BSN, RN, Chair Shared Leadership
A Note from the Global Chair:
October has been a busy month for everyone; it is hard to believe that the holidays are just around the corner. During the October’s Nursing Shared Leadership meeting, we reflected on our two years of having Magnet Desig-nation. There was discussion about the Magnet Conference from attendees, as well as volunteers. From that discussion, the theme became clear-we are proud to be nurses in a Magnet facility where there is a continued commit-ment to nursing excellence. The Council was introduced to the new nurse manager of Women’s and Children’s Health Services, Patty MacDougall. We are excited that she has decided to be a part of Shore Health System’s management team. We welcomed three new members: Tracie Nolan (Telemetry-MHE) Tara Smith (Surgical Unit-MHE) and Diane Blazejak (Admissions Nurse). Thank you Renee Thomas and Laura Lloyd for your participation in Nursing Shared Leadership, you will be missed!
The general policies that were under consideration for review/revision were: Renal Peritoneal Dialysis Monitoring (PD)
Parenteral Nutrition (TPN/PPN)
The general policies that will be under consideration for review/revision in November are:
Scheduling Policy
Suctioning, Nasopharyngeal of an Adult Patient Suction, Disposable System
Suctioning, Tracheotomy
Endotracheal Tubes with a Single use Catheter
Suctioning with Closed System Endotracheal Tube, Tracheotomy Tube
The Living Legacy Foundation will be recognizing Dorchester General Hospital for achieving timely referral of cardiac deaths greater than 90%.
The Living Legacy Foundation of Maryland honors its community partners’ dedication to raising awareness for organ, eye, and tissue donation and their commitment to
encouraging others to donate life on November 10th, 2011 at 6:00pm at the Baltimore Hilton (401 West Pratt Street, Baltimore, Maryland).
Cocktails & Hors’doeuvres will be served.
Congratulations!
Submitted by Ruth Ann Jones, EdD, MSN, RN, NEA-BC, Director of Acute Care
Congratulations to Gail Shorter, MSN, RN, CEN, Manager, Critical Care/Graduate University, who has been appointed to the National Nursing Staff Development Organization (NNSDO) Research Commit-tee. The function of this Research Committee is to stimulate proposals for nursing professional development related to research.
Congratulations Gail!
Congratulations to Barbara Bilconish, MSN, RN, NEA-BC, Director, Professional Nursing Practice/Magnet Program for receiving the Mentorship Award through the Maryland Nurses Association. She was nominated by Jane Flowers, MSN, RN, Manager of Dorchester Surgical and Ambulatory Services. Barbara received the award on October 14, 2011.
Congratulations to Donna Campbell, RN, who has received her Cardiac Vascular Nurse Certification.
Congratulations to Amy Brockson, RN, who was nominated for the 2011 Frontline Impact Award on behalf of the Talent Development Division of The Advisory Board Company. She was awarded a certificate of rec-ognition by Catherine Ewell, Managing Director of the Advisory Board.
Pictured above is Barbara Bilconish re-ceiving her award at the Maryland Nurses Association Awards Ceremony. Presenting is the MNA President, Pat Travis. The ward Ceremony was on Friday, October 14, 2011.
