cacns annual conference 11/6/2021
TRANSCRIPT
CACNS Annual Conference11/6/2021
Lianna Z. Ansryan RN-GERO, MSN, PHN, CNSGeriatric Medicine Clinical Nurse Specialist
UCLA Health
Resnick Neuorpsychiatric Hospital
• 70 acute psychiatric hospital
• Outpatient psychiatric services
Objectives
• Describe one CNS’s practice in bridging the gap between medical and psychiatric mental health nursing care of patients
• Summarize the impact of the CNS serving this vulnerable patient population
• Define the NACNS competencies applied in operationalizing this unique CNS role
The problem…
• Burden of mental health continues to rise in the U.S
• Psychiatric mental health nurses are often challenged by their patients’ complex medical conditions in the acute care psychiatric hospital
• Deficiencies in health system integration of psychiatric and medical services
Medicine CNS role
• One innovative approach – place medicine expertise in acute psychiatric hospital
• Background on role
• Role responsibility
• Role outcomes
CNS core competencies
National Association of Clinical
Nurse Specialists (NACNS).
(2019). Statement on clinical
nurse specialist practice and
education (3rd ed.)
A day in this role
• Patient rounds
• Patient evaluation for medical clearance
• Treatment planning
• Medical emergency
• Nursing mentoring
• EBP
• CNS student precepting
Name/age:
MRN:
Location:
Vitals:
B/P: H/R:
RR: 02% Temp:
Medical Nursing care:
Ambulation:
Sitter:
Restraints:
Fall risk:
PO intake:
Behavior:
Open wounds:
Foley:
IV:
Medical Hx: Labs:
COVID:
Medical workup:
Psych Hx:
Anxiety:
Depression:
Bipolar:
Schizophrenia:
Active SI:
Other:
SUD:
Medical concerns/outstanding issues:
Misc: Meds:
CNS IMPACT: CNS MINI CONSULTSUCLA pillar
CNS sphere
Standard Work Clinical Outcomes Financial Outcomes
Patient Sphere Review patient chart for psych transfer
Visited with patient
Ensure safe transition of medical
psych patient to psych unit Prevent delayed discharge
impacts LOS.
Track LOS as a metric
Cost of Hospital day / time
saved = cost savings
Performed COVID swabs on difficult
patients
Prevent delay in ECT tx or
discharge to residential
Early catch PUI
Support RN in complex medical discharge
Consultant for complex wound care Prevent wound infection
Nurse Sphere Code Blue Debriefing
Facilitate Mock Codes
RN skill building
Prevent code blue
Cost avoidance due to cost of
nurse turnover
In-time education, review of standards of
practice and support nursing practice
• Foley catheter placement
• NG placement
• Drain site care
Zero CAUTI
NG tube – allows advancement in
treatment plan
Cost benefit
Cost savings
Cost avoidance
Organization Weekly CNS/OT fall prevention group Reduction in fall last Q4 of 2020 Cost benefit / cost avoidance
Developed patient brochure Patient satisfaction in transition Revenue
UCLA pillar/
CNS sphere
Metric CNS standard work
Process Change
Metric Clinical
Outcomes
Financial
Outcomes
Quality, Safety,
Patient Experience,
Financial
sustainability
Patient/Direct care
• CNS case
review 4N falls
• Active member
of falls
committee
• Collaborate
with OT to lead
patient fall
prevention
group (Fall
prevention
jeopardy)
CNS daily rounds with bedside
RN to identify high fall risk
patients. Ensure fall prevention
measures are in place. Promote
proactive toileting. Debrief with
staff after patient fall.
• Reduce
geriatric falls
by 50% and
injury with
falls
• Fall
prevention
jeopardy
group held
weekly
• Fall rate
reduction (see
graph on next
slide)
• Introduction of
gait belt use on
4N
Average cost of
fall with injury
$14,000
CNS IMPACT:
FALL REDUCTION Cost Savings
CNS IMPACT:
PICC LINE ASSESSMENTS
UCLA pillar/
CNS sphere
Metric CNS standard work
Process Change
Metric Clinical
Outcomes
Financial
Outcomes
Quality, Safety,
Value, Financial
sustainability
Strategic growth
and operations
Patient/Direct care
Patients with PICC
line will be
assessed daily for
s/s of infection.
CNS daily rounds with bedside
RN and review PICC line
flushing and EBP dressing
changer per policy. Also review
how to trouble shoot clogged
PICC line.
• CNS round
will lead to
0% CLABSI
rate
• Increased
knowledge,
skills and
competency
among
psych/mental
health RN in
PICC line
dressing
change
• 281 PICC line
day – 0%
CLABSI rate
• 15 RNs signed
off on
competency
Average CLABSI
cost $15,000-
$20,000
Cost of CNS time
(pay) x stopped #
CLABSI vs cost
of CLABSI =
Cost benefit
Cost Savings
WORKPLACE VIOLENCE
UCLA pillar/
CNS sphere
Metric CNS standard work
Process Change
Metric Clinical
Outcomes
Financial
Outcomes
Safety, Our people
Nurse/System
CNS review of
SOFI events
submitted
CNS review of SOFI events.
Review of data for submission to
NDNQI to assign injury level.
CNS led EBP-C WPV group with
clinical nurse representation
• Health system
recommendati
on on risk
factor
assessment
• Increase in
reporting of
WPV
• EBP risk
assessment
tool in EPIC
Average cost of
injury to nurses
$2,631
Skin and Wound Care program
• Knowledge survey
• Champions meeting
• Monthly topics• PUI staging
• Case studies
• Lacerations –SIB
• Skin tears
• Mattress overlays
• Product optimization
• Psych safe options
Role evaluation/outcomes
• Staff knowledge and skills
• Quarterly CNS report
• 1:1 with supervisor/director
• CNS peer evaluation
• NSI data
• NDNQI data
• CNS collaboration
CNS peer appraisal
• Does it have to be ONLY CNS colleagues?
• Who else do you collaborate with?
• Who are your customers?
Appraisal tools
Role Model
Performance consistently exceeds objectives and expectations. Recognized by others for their notable and valued
contributions. Produces high impact results and demonstrates behaviors and an attitude that serves as an example to
others.
ExceedsPerformance consistently exceeds most or all objectives and expectations. Exceeds expected results while demonstrating
behaviors beyond expectations.
EffectiveEffective performance in the role, meeting most or all objectives and expectations. Produces effective results, working
efficiently while demonstrating behaviors aligned with organizational expectations and values.
Needs
Development
The employee may have met some objectives, but has not consistently met all performance objectives. Employee needs to
develop and improve skills, knowledge or behavior to perform effectively in the role.
UnsatisfactoryMay meet some performance objectives, but overall does not meet performance expectations. Immediate action is required to
improve performance and/or behavior.
Job ability, Teamwork, Communication, Accountability,
Excellence, Professionalism, Self management
CNSs function as practitioner, educator, consultant, research/scientist, and leader. Please give comment and
examples by identifying which sphere(s) of influence was utilized (patient, nurse, system)
1) List 3 strengths this CNS brings to the team in improving outcomes at UCLA Health
2) Please identify 3 opportunities for growth for this CNS for the next year as he/she writes professional goals
3) Additional feedback you would like to contribute
Customer feedback
• What is your role
• Collaborates effectively with peers
• Takes responsibility for self-development and supports a learning environment
• Displays commitment to the mission of the hospital and it’s values
• Demonstrates effective leadership and management
• Demonstrates commitment to service excellence for customers and/or co-workers
• Demonstrates ownership and accountability in areas of responsibility
• Demonstrates flexibility and ability to change
• Contributes ideas for solutions to problems
• Demonstrates commitment to productions of good, quality work
• What does he/she do well?
• Constructive/helpful feedback to improve his/her performance
Role challenges
• Role confusion
• Necessity
• Balance of psychiatric mental health vs medical nursing
