nursing report - sharp healthcare · pdf filenursing report accomplishments for ... identified...
TRANSCRIPT
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Nursing ReportAccomplishments for 2016
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The Power of One Idea
“When you’re confronted with a problem, don’t get down — get excited, get involved.
A problem is an opportunity to do something generous or positive for the world.”
—HeidiWills,author
ItisanhonortopresentSharpMemorialHospital’s2016NursingAnnualreport.Thesestories
reflectonlyasmallselectionoftheamazingworkaccomplishedoverthispastyear,andthey
demonstratethesignificantimprovementsthatgroupsoflike-mindedpeoplecanachieve.Our
successesnotonlyimpactpatientsandstaffatSharpMemorial,buttheyreveallearningsthat
canbesharedwithotherhospitalswithinandoutsideofSharpHealthCare.
Inmanycases,theseprojectsbeganasoneidea,fromoneindividual.Iamcontinuallyimpressed
bythenumberoftimesaSharpMemorialnurseconfrontsachallengeandmakestheconscious
decisiontoworkonsolvingthatproblemforthebettermentofourpatients,staffandcommunity.
SharpHealthCare’sjourneytobecomeaHighReliabilityOrganizationdependsuponsharing
concernsandchallenges.Anditisbestservedbytheactiveinvolvementofthoseclosesttothe
issues.Thesestoriesdemonstrateourcommitmenttothishigh-reliabilitymindset.
Toournurses,Ihopethisreportmakesyoufeelproudtoworkforanorganizationthatvalues
continuallearning,problemsolvingandimprovement.Iencourageyoutoreadeachstoryand
sharethereportwithyourpeersandinterprofessionalcolleagues.Wearemakingadifference,
andI’mgratefulfortheopportunitytoshareyouraccomplishments.
Finally,Ihopetheseinspirationalsuccesseswillpromptreflectionandadditionalideastoimprove
ourpracticeenvironmentandcare.
PamWells,MSN,MSA,RN,NEA-BC
ChiefNursingOfficer
VicePresident,PatientCareServices
SharpMemorialHospital
COVER: (From left) April Henderson, Ellen Schroeder, BSN, RN, CNOR, Gisela Ruvalcaba-Sanchez and Lindsey Lown, RN, CNOR, helped coordinate the launch of SurgiNet in Surgical Services (see page 6).
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identifiesandcommunicatesvisionandvalues,andaskstheinvolvementofthe
workgrouptoachievethatvision.
Transformational Leadership
Michele McCluer, BSN, RN,CNOR, Sharp Memorial Outpatient Pavilion Surgical Services, and Joe Pieper, BSN, RN, PCCN, 4 West, were recognized with Nurse of the Year awards in 2016.
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“I hope that what I
leave behind will grow
through someone else
and become better
than where I was able
to take it.”
–StevieWonder
Change Your Tune: Strategic Planning Decreases Sepsis Mortality
Sepsisaffectshundredsofthousandsofpatientsperyear.Thecondition
canleadtohighmorbidityandmortalityasthesyndromeprogresses
throughseveresepsisandsepticshock.
Areviewofpatientoutcomedatarevealedthattherateofsepsismortality
atSharpMemorialHospitalwashigherthanatsimilarhospitals.Sharp
Memorialleadersformedaninterprofessionalteamofnurses,physicians,
andrepresentativesfromQualityandPharmacytoincreaseunderstanding
ofthekeydriversofsepsismortalityandtodesignnewtoolstoimprove
identificationofsepsis.
Theteaminvestigatedbestpracticesanddevelopedguidelinesforsepsis
identification,includingsignsandsymptomsofSystemicInflammatory
ResponseSyndrome(SIRS),sepsis,severesepsisandsepticshock;early
interventionbasedonthree-hourandsix-hourbundles(setsofevidence-
basedpractices);andbadgecardswithsepsis-identificationinformation
foreasyreference.
Subsequently,theteamimplementedthefollowingimprovementsin
clinicalpractice:
• AddedsepticshockbundlesfortheEmergencyDepartment
• Launchedsepsisordersetsfortheelectronicmedicalrecord(EMR)
• Updatedtheemergencystandingordersstandardizedprocedure
• Enhancedunithand-offcommunicationrelatedtosepsis
• Designedanddisseminatededucationfornursesonearlyrecognition
ofpatientswithsepsisandtreatmentprotocols
InJune2016,anewEMRSepsisEarlyWarningAlertwentliveatSharp
Memorial.Thistoolaggregatescriticalvaluesandalertsnursesand
providersofat-riskpatients.
Outcome:
Followingimplementationofsepsisinterventions,fewerpatientsdiagnosed
withsepsisdied.SharpMemorial’ssepsismortalityratedecreasedfrom
18.8percentto11.2percent.
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Ring a Bell: Greater Awareness of Opioid Management Leads to Reduction in Adverse Drug Events
SharpHealthCareisonajourneytobecomeaHighReliabilityOrganization
aimedatachievingzeroharmtopatients.Anintensivistsharedaconcerning
observationwithChiefNursingOfficerPamWellsthatanincreasingnumber
ofpatientseither“bouncedback”totheintensivecareunitorrequireda
higherlevelofcare,whichhesuspectedwasassociatedwithover-sedation
fromopioids.
Anextensivechartreviewon72patientswhorequiredareversalagent
(medicationusedtoreversetheeffectsofover-sedation)revealedsignificant
opportunitiestoimproveopioidmanagementandreduceadversedrug
events(ADEs).ThedataalsorevealedahigherthanexpectedrateofADEs.
Aninterprofessionalteam—comprisedofphysiciansandrepresentatives
fromPharmacy,Quality,ClinicalInformatics,SystemSafetyandNursing—
identifiedkeyfocusareasforimprovement,includingeducation,electronic
medicalrecordtools,andalternativestoopioidsforpainmanagement.The
teamcreatedanddisseminatededucationtophysiciansandnursesabout
theresultsofthechartreviewandopioidADEdata.
Educationfornursesemphasizedhowtosafelyadministeropioids,how
toavoidtheriskofdosestacking,andhowtomonitorforover-sedation.
Physicianeducationconcentratedonincreasingsituationalawarenessabout
thispatientsafetyissue.
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Figure 1: Sharp Memorial’s sepsis mortality rate decreased following implementation of sepsis identification improvement measures.
Sepsis Mortality Rate
JFM15
18.8%
AMJ15
18.4%
JAS15
15.3%
11.5%
OND15
15.7%
JFM16
11.2%
AMJ16
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Outcome:
Effortstoincreaseawarenessandunderstandingofopioidmanagement
risksamongphysiciansandnursesresultedinareductioninopioid-
associatedadverseeventsatSharpMemorial.
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Figure 2: With greater awareness of opioid management risks, adverse drug events in patients receiving opioids decreased from 0.77 percent to 0.40 percent in seven months.
Opioid Adverse Drug Events (ADEs)
Feb 2016
0.77%
Mar 2016
0.44%
0.67%
Apr 2016
0.53% 0.55%
May 2016
0.65%
0.56%
Jun 2016
0.40%
Sep 2016Jul 2016 Aug 2016
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Fit as a Fiddle: SurgiNet Implementation Streamlines Surgical Care
In2015,SharpHealthCarebeganimplementingSurgiNetacrossall
Sharphospitals.Thisinformationsystemforsurgeryandanesthesia
integratesperioperative,proceduralandanesthesiacareintothepatient’s
electronicmedicalrecord.
Thegoaloftheprojectwastoimprovehandoffsandeliminategaps
amongthesurgicalcareteamsbystoringcaseinformationelectronicallyin
asinglesystem.
Priortoimplementation,allperioperativenursesandOperatingRoom
(OR)staffcompletedonlinelearningmodulesaboutdocumentationwithin
SurgiNet.Staffreceivedhandoutsspecifictotheirroleinthesurgical
processandhands-ontrainingfromClinicalInformaticsSpecialistsand
SuperUsers.Duringhuddlesandstaffmeetings,ORleadersreviewed
SurgiNetplanswithstaffandlistenedtoconcernsandfeedback.
ToensurethetransitiontoSurgiNetwentsmoothly,auserguidewascreated
andpostedineachoperatingroomsuiteaswellasonthehospital’sintranet.
Additionally,anextra20minuteswereaddedtoroomturnovertimesduring
theimplementationperiodtoallowtimeforcirculatingnursestofinish
documentationinthenewsystem.Additionalnursesandacirculatorstaffed
theORsuites,andanInformationSystemssupportteamwasavailable24
hoursaday.
WhenSurgiNetlaunchedatSharpMemorialinJune2016,ORleadersheldat
leasttwomeetingseachdayforthefirstthreeweekstoaddressissuesand
listentoconcernsandsuggestions.TheORleadershipteamalsorounded
regularlywithstaff.Issueswereaddressedasmuchaspossibleinrealtime
andupdateswerepresentedtostaffduringhuddles.
Outcome:
ThetransitiontoSurgiNetwentsmoothlyatSharpMemorial.Nursing
documentationbytheORteamisnowimmediatelyaccessibleforall
disciplinescaringforeachsurgicalpatient.
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Music to My Ears: Improvement to Electronic Medical Record Removes Charting Redundancies
In2008,SharpMemorialbecamethefirstSharpHealthCarehospitalto
implementtheCernerElectronicMedicalRecord(EMR).Asadditional
hospitalslaunchedtheEMR,SharpHealthCareleadershipestablisheda
requirementthatallhospitalsmustagreetoanyEMRchange.
FollowingthelaunchoftheEMR,SharpMemorialnursesexpressed
frustrationwithredundantchartingandexcessivetimespentin
documentation,pullingthemawayfromdirectpatientcare.TheSharp
HealthCareInformationSystemsteaminchargeofoverseeingchanges
totheEMRknewaboutthischallenge,andhadidentifiedthatimproving
theAdultInitial/OngoingAssessmentintheEMRwasthefirststepin
optimizingdocumentation.However,competingprioritiesacrossthe
systemslowedprogressonthiswork.
WhenChiefNursingOfficer(CNO)PamWellsjoinedSharpMemorial
in2013,sheinitiatedadiscussionattheSharpHealthCareCNOCouncil
regardingcontinuingfeedbacksheheardfromclinicalnursesrelatedto
chartingredundancy.TheotherCNOsvoicedsimilarconcernsfromtheir
nurses,andtheCouncilformallyaskedthenewlypromotedDirectorof
SharpHealthCareClinicalInformaticstosharetheirconcernswiththe
SharpHealthCareInformationSystemsleadership.
AfterreceivingfeedbackfromtheCNOs,InformationSystemsleadership
agreedtoreprioritizetheirprojects,enablingtheredesignofthe
assessmenttooltomoveforward.
(From left) Jocelyn Stewart, RN, BSN, OCN, 1 West, and Gretchen Hiegel, RN, Clinical Informatics, worked closely with Information Systems to reduce charting redundancies in the electronic medical record.
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Outcome:
ThenewAdultInitial/OngoingAssessmentlaunchedintheEMRinFebruary
2016.Theredesignstreamlineddocumentationandsignificantlyreduced
redundantcharting.Theimpactonnursingtimewasconsiderablegiventhe
numberofredundanciesidentifiedandeliminated.
March to the Beat of Your Own Drum: Remote Video Interpretation Improves Patient Satisfaction
Literaturesuggeststhat20percentofhospitalstaffdonotuseformal
interpreterswhencommunicatingwithpatientswhoneedlanguage
interpretation.Alsoaccordingtoliterature,staffwhoarefamiliarwith
interpretiveservicesaremorelikelytousethoseservices.
Afternoticingpatientsatisfactionscoresrelatedtonursescommunication
hadroomforimprovement,membersofaSharpMemorialClinical
PracticeCouncilsubgroupsurveyedfrontlinestaffontheirknowledge
andsatisfactionwiththehospital’sinterpretationpolicyandprocedure.
Feedbackfromstudyparticipantsrevealedapreferenceforin-person
translationratherthanthepolicy-guidedpracticeofusingthephone.
Participantsalsorecommendedexploringotheroptions,suchasremote
videointerpreters.
TheseresultsweresharedwithSharpHealthCareleadersresponsiblefor
interpretationservicesacrossthesystem.TheyaskedSharpMemorial’s
EmergencyDepartmenttoconductapilotofremotevideointerpretation
services,whichresultedinpositivefeedbackfrombothstaffandpatients.As
aresult,SharpHealthCareleadersdecidedtocontractwitharemotevideo
interpretationservicefortheentiresystem.
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Figure 3: After the redesign of the Adult Initial/Ongoing Assessment, charting redundancies decreased 86 percent.
Before Improvement After Improvement
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Outcome:
SharpMemoriallauncheditsvideointerpretationprograminMarch2016.
Throughtheremoteservice,patientscanuseanelectronictablettospeak
withalive,trainedinterpreter24hoursadayinsignlanguageandmany
spokenlanguages.Atleastoneremotevideointerpretationtabletis
availableineachpatientcarearea.
Patientsatisfactionwithnursecommunicationimprovedafterremote
videointerpretationwentlive.
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Figure 4: After the remote video interpretation service launched, patient satisfaction with nurse communication increased from the 24th percentile rank to higher than the 80th percentile rank.
Patient Satisfaction
Jan 2016
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88
Mar 2016
88
Apr 2016
81
May 2016
96
Jun 2016
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Jul 2016
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developsstrongpartnershipstoimprovepatientoutcomesandthehealthofthecommunitiesweserve.
Structural Empowerment
(From left) Susan Moore, MSN, RN, CNS, Short Stay/Observation, and Heather Bongiovanni, BSN, RN, CBN, CMSRN, 6 North, were recognized with Nurse of the Year awards in 2016.
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March to the Same Tune: Developing a Delirium Protocol for Hospitalized Patients
Inearly2015,nursesfromhospitalsacrosstheSharpHealthCaresystem
cametogethertoimprovetherecognitionandtreatmentofdelirium,a
stateofmentalconfusionthatcanoccurfromillness,surgeryoruseof
somemedications.Deliriumcancontributetolongerhospitalstays,a
highercostofcare,long-termcognitiveimpairmentandevendeath.
PhysicianshadusedSharpMemorial’sestablisheddeliriumtreatmentplan
fortheintensivecareunits(ICU)onlytwiceinsixmonths.AcrossSharp
HealthCare,therewasnostandardizedassessmenttoolinplacefordelirium
outsideoftheICUs.
Throughareviewoftheliterature,theteamofnursesdiscoveredthat
assessmenttoolssuchastheConfusionAssessmentMethod(CAM)help
identifypatientswithdelirium,leadingtoearliertreatmentandimproved
outcomes.Twoformsofthemethod—CAM-ICUandbriefCAM(bCAM)—
canbeusedtoassessdeliriuminverbalandnon-verbalpatients.
NursesacrossSharpHealthCarelearnedthetwomethodsthroughonline
andin-personclasses,aswellasone-on-oneinstruction.Thetoolsarenow
embeddedinCerner—Sharp’selectronicmedicalrecordsystem—and
nursesareexpectedtoperformanassessmentoneverypatient,everyshift.
TheteamalsodevelopedaprotocolinCernerforphysicianstoinitiateonce
apatientisdeterminedtobeCAM-positive.Thisprotocolincludesnursing
interventionsandmedicationsforpreventingandtreatingdelirium.
“When you hit a wrong
note, it’s the next note
that makes it good or
bad.”
–MilesDavis
(From left) Melissa Yager, MS, RN, CNS, ONC, 4 North, Stacy Parker, BSN, RN, ONC, 4 North, and Jessica Sullivan, BSN, RN, CCRN, Medical Intensive Care Unit, helped formalize delirium assessment tools across Sharp HealthCare.
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Outcome:
SharpMemorialnursescontinuetousethenewdeliriumassessmentmethods
andprotocol,leadingtoincreasedidentificationandtreatmentofpatients
withdelirium.
Eric Turrubiartes, BSN, RN, 7 West, and Tracy Nanthavong, BSN, RN, OCN, CHPN, 1 West, serve as co-chairs on the new Night Shift Practice Council (see page 13).
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SMH Delirium Assessment and Protocol Implementation
Figure 5: Nurses are now assessing patients for delirium and implementing prevention and treatment plans.
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* THE TREATMENT PROTOCOL IN CERNER WENT LIVE TWO WEEKS BEFORE THE ASSESSMENT TOOLS.
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Music of the Night: New Night Shift Practice Council Expands Nurse Participation in Collaborative Governance
Periodically,SharpMemorialnursescompleteasurveyontheir
perceptionsof—andcommitmenttoward—thehospital’scollaborative
governance(CG)structureandprocesses.Surveysconductedin2014
and2015revealedlower-trendingscoresacrossallitems.
Toaddressthisconcern,hospitalleadershiphelda“CG3.0Retreat”
withinterprofessionalstaff,frontlinenursesandleaders.Participants
identifiedandprioritizedseveralthemestoenhancetheCGstructure
andprocesses.Onethemethatemergedwasthelackofopportunityfor
somenursestoparticipateincollaborativegovernance,particularlyfor
clinicalnursesonthenightshift.
InJune2016,ChiefNursingOfficerPamWellslaunchedthefirst
NightShiftPracticeCouncil,comprisedofnightshiftnursesand
interprofessionalstaff.Thenewcouncilcreatedacharter,identified
prioritiesandestablishedworkgroups.Pamattendseachmeeting,which
areheldeighttimesayear.
Outcome:
TheNightShiftPracticeCouncilenablesnursesandinterprofessional
stafftohavedirectaccesstotheChiefNursingOfficerandto
communicateissuesspecifictothenightshiftpracticeenvironment.
Sincetheinceptionofthecouncil,thefollowingnursepractice
environmentissueshavebeenaddressed:
• Openedasecondparkinglaneintotheemployeeparkinggarageto
easecongestionforoncomingnightshiftstaffandpreventtardiness
• Addedmorevarietytomenuoptionsforeveningmealsin
thecafeteria
• ImprovedresponsivenessofEnvironmentalServicesregardingtrash
collectionandbedcleaning
• Increasedinventoryofisolationstoragecaddiestoenhance
recognitionofpatientsinisolation
• Identifiedsafetyissues:
- Highlightedanissuerelatedtoalook-alikemedicationinPyxis,
themedication-dispensingsystem
- AlertedPharmacyleadershipandthevenousthromboembolism
taskforceaboutanorderingandtimingissueforthe
medicationLovenox
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Clear as a Bell: Aligning Expectations for Discharge Readiness
SharpMemorialcontinuedtoreceivelower-than-desiredHospital
ConsumerAssessmentofHealthcareProvidersandSystems(HCAHPS)
patientsatisfactionscoresinthedischargeinformationdomain.Dataand
commentsfromsurveyrespondentsrevealeddissatisfactionwithdischarge
communication,timingissuesandgapsindischargepreparation.
AsubgroupoftheClinicalPracticeCouncilstudiedthisissueand
determinedthatadischargereadinesstoolcouldhelppatientsand
caregiversbetterpreparefordischarge.
Nursesonthesubgroupdraftedanewtoolanddischargeprocess.The
toolincludedsixstepsthatmustbecompletedbeforethepatientcan
bedischarged.Theseincludeunderstandingmedicationsthatapatient
needstotakeafterleavingthehospitalandidentifyingsomeonewhowill
helpcareforapatientathome.
Duringapiloton4North,anacutecareunit,nurseswithinthesubgroup
obtainedstaffperceptionsofthetoolandusedtheirfeedbacktomake
adjustments.Theyalsocreatedanddisseminatedan“elevatorspeech”toall
staffthatframedthechangeinpractice,andthenursesprovidedengaging
inservicestostaffonthedischargereadinesstool.
(From left) Mykal Fernandez, BSN, RN, OCN, 1 West, and Yvonne Vargas, MSN, RN, ONC, 4 North, helped launch a discharge readiness tool on their units.
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Outcome:
Patientsatisfactionimprovedinthedischargeinformationdomain
followingthelaunchofthe4Northdischargereadinessprocessandtool.
Following4North’ssuccess,anotheracutecareunit,1West,launched
thetoolandachievedsimilaroutcomes.
Plansaredevelopingtospreadthisbestpracticeacrossallunitsin
thehospital.
With Bells On: Annual Career Expo Offers Guidance on Nursing Advancement
SharpHealthCare’ssevenPillarsofExcellencesetthefoundationfor
achievingtheorganization’svisionoftransformingthehealthcare
experience.The“People”pillarisfocusedoncreatingavalues-drivenculture
thatattracts,retainsandpromotesthebestandbrightestpeople,whoare
committedtoandalignedwithSharpHealthCare’smissionandvision.
Eachyear,nursesfromacrosstheSharpMetropolitanMedicalCampus,
whichincludesSharpMemorialHospital,sponsorajointnursingcareer
expo.Thisannualeventisopentoanyemployeeorcommunitymember
interestedinbecomingaregisterednurse.Currentnurseswhoattendthe
expocanreceiveinformationaboutadvancingtheirnursingeducation.
MONTH
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Patient Satisfaction in the Discharge Information Domain: 4 North
Feb 2016
73
Mar 2016
97 97
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Apr 2016
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May 2016
98 99 99
Jun 2016 Jul 2016 Sep 2016Aug 2016
Figure 6: Following implementation of the discharge readiness tool on 4 North, patient satisfaction in the discharge information domain reached the 99th HCAHPS percentile rank.
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Outcome:
The2016nursingcareerexpowasheldAugust18.Ofthe162participants,
70non-nursesattended,including13communitymembersandvolunteers
interestedinbecomingregisterednurses.
Fourteennursingschoolssentrepresentativestotheevent.Attendeeshad
theopportunitytospeakwiththesenursingschoolrepresentativesaboutthe
applicationprocess,curriculumandfinancialaid.Inaddition,attendeeslearned
aboutSharpHealthCare’stuitionreimbursementbenefitandscholarshipsas
wellasprofessionaldevelopmentopportunities.
Jazz It Up: Nursing Education and Certification
Qualitypatientcaredependsonaknowledgeableandwell-educatednursing
workforce.SharpMemorialleadersencouragenursesintheireffortstoseek
baccalaureateandgraduateeducation,aswellasnursingcertification,which
allowsindividualnursestodemonstratetheirspecificknowledgebaseina
specializedareaofpractice.Thenursebecomescertifiedbytakingandpassing
aninitialexam,usuallyaftertwoyearsofexperienceinapracticearea.Nurses
maintaintheircertificationsthroughongoingprofessionaldevelopment.
80
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77
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73
71
72
70
Direct-Care Nurses with BSN Degree or Higher
Figure 7: More than 78 percent of direct-care nurses at Sharp Memorial have earned a nursing degree at the baccalaureate level or higher.
PE
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FISCAL YEAR
FY 2015
77.5%
FY 2013
74.9%
FY 2014
75.4%
FY 2016
78.7%
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Direct-Care Nurses with Certifications
Figure 8: Nearly 40 percent of direct-care nurses at Sharp Memorial have earned a nursing certification.
PE
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FISCAL YEAR
FY 2015
37.7%
FY 2013
32.2%
FY 2014
33.9%
FY 2016
39.1%
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isanoverarchingconceptualframeworkforcontinuous,consistent,efficientand
accountablepatientcaredelivery.
Exemplary Professional Practice
(From left) Jess Schroeder, BSN, RN, CWOCN, Wound Healing, Vince Christensen, BSN, RN, CWON, Home Health, and Janet Buenaventura, RN, Sharp Memorial Outpatient Pavilion Surgical Services, were recognized with Nurse of the Year awards in 2016.
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Strike the Right Note: Advanced Illness Management Program Improves Quality of Care for Patients at the End of Life
SharpMemorialhadexperiencedanincreaseinphysicianrequests
forconsultationswithpatientsattheendoflife.Consultationsinclude
discussionsaboutadvancedcareplanning,completingPhysicianOrders
forLife-SustainingTreatment(POLST)forms,andhospicereferrals.
However,onlyonenursewasassignedtothisrole.Atthesametime,the
hospital’sinpatientmortalityratewashigherthanexpected,resultingin
penaltiesfromtheCentersforMedicareandMedicaidServices(CMS).
HospitalleadershipbelievedaformalAdvancedIllnessManagement
programatSharpMemorialcouldhelpaddressthesechallenges.They
authorizedanadditional3.2full-timeequivalent(FTE)employeestoform
anAIMteam,oneofwhichwasaprogrammanager.
Asaninitialstep,theteamlaunchedapilotprojectintheEmergency
Department(ED)forpalliativecareandhospiceconsultations.Forfour
months,thenewAIMprogrammanagerroundedwithEDphysiciansand
stafftohelpidentifypatientsandfamilymemberswhocouldbenefitfrom
adiscussionaboutpalliativecareandend-of-lifeoptions.
TheAIMprogrammanager’sconstantpresenceintheEDandthestaff’s
increasingsupportofend-of-lifeservicesledtoanincreaseinconsult
requestsinboththeEDandinpatientunits.
Outcome:
In2016,theAIMteamfacilitatedmorethan400hospicereferralsandmet
withnearly750EDpatientstodiscussend-of-lifecaregoals.Totalinpatient
visitsbytheAIMteamincreased55percent.EDphysiciansarenow
initiatingupto45percentofAIMconsults.
Recognizingtheincreasedneedforconsultations,hospitalleadership
authorizedanadditional1.7FTEstojointheteaminfiscalyear2017.
Inaddition,otherSharpHealthCareentitiesareestablishingAIMprograms
basedonSharpMemorial’smodel.
“To play a wrong note
is insignificant; to play
without passion is
inexcusable.”
–LudwigvanBeethoven
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Eddie Wagner, BSN, RN, CCRN, Rapid Response Team, helped establish an inpatient STEMI code and protocol for patients experiencing a heart attack while in the hospital (see page 21).
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Figure 9: Following the launch of a formal Advanced Illness Management program, end-of-life consultations increased in the ED and inpatient units.
2016 AIM Consults: ED and Inpatient
FebJan Mar Apr May Jun Jul Aug DecNovOctSep
MONTH
ED CONSULTSINPATIENT CONSULTS
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The Beat Goes On: Inpatient STEMI Protocol Improves Outcomes for Hospitalized Patients
TheAmericanHeartAssociation(AHA)identifiesspecialtystandards
andguidelinesformanydiseases,includingheartattacks.Theseinclude
definingcriteriaforearlyrecognitionandtreatmentofpatientswithsigns
andsymptomsofnarrowingorblockedarteries.
AtSharpMemorial,nursesandphysiciansincorporatethesespecialty
standardsintotheircaretoensurethatcaredeliveryforthispatient
populationmeetstheAHAguidelines.A“door-to-balloon”timeof90
minutesistheAHAgoldstandardforpatientswithSTSegmentElevation
MyocardialInfarction(STEMI),themostcommonformofheartattack.
Door-to-balloontimemeasuresthetimebetweenapatientarrivingto
theEmergencyDepartment(ED)tothetimeapercutaneouscoronary
interventiondeviceisusedtocleartheblockedartery.
AcardiologistatSharpMemorialreviewedcasesofhospitalizedpatients
withSTEMI.Hediscoveredpatientswhoexperiencedanin-houseSTEMI
didnothavethesamesuccessfuloutcomesaspatientsintheED,where
aSTEMIprotocolhadbeeninplace.Thecardiologistrecommended
theRapidResponseTeam(RRT)incorporatetheSTEMIcriteriaintothe
inpatientsettingbecauseoftheteam’spivotalroleinearlyrecognitionof
patientdeterioration.
TheRapidResponseTeam,comprisedoffrontlineclinicalnurses,worked
withphysicianstakeholderstodefinethecriticalelementsfornurses
toassessandtreathospitalizedpatientsexhibitingsignsofSTEMI.The
teamdevelopedanin-houseSTEMIprotocol,whichincludedan“EKG-to-
CatheterizationLab”timeof60minutesandan“EKG-to-Balloon”timeof
90minutes.
Withintheprotocol,eitherthebedsidenurse(inintensivecareor
progressivecareunits)ortheRRTnurse(inacutecareunits)canorderan
initialelectrocardiogram(EKG),or,ifaSTEMIisoccurring,placethepatient
onoxygentherapyandadministermedications.AnRRTnursewouldthen
callaCodeSTEMI,whichwouldactivatetheteamintheCatheterization
Lab,wheretheproceduretocleartheblockedarteryisperformed.
ThenewprotocolwentliveinMarch2016.Nursesreceivededucationon
thepracticechange.Unitsthatcarefornon-cardiac-monitoredpatients
wereeducatedonatypicalsignsofaheartattack.
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Outcome:
Sinceimplementation,nurseshaveactivatedthenewSTEMIprotocolon
sixinpatients.
OneoftheseactivationsoccurredinJuly2016whenapatientwentinto
ventricularfibrillation.Oncethepatientwassuccessfullyresuscitated,the
RRTnurserecommendeda12-leadEKGbecompleted.TheEKGrevealeda
STEMIwasinprocessandaCodeSTEMIwascalled.Thepatientwastaken
totheCatheterizationLabwithin30minutesoftheEKG.Theblockagewas
successfullyremovedandthepatientleftthehospitalforhomewithinsix
daysoftheevent.
(From left) Boni Bogart, BSN, RN, PCCN, and Julie Tarbell, BSN, RN, helped address staffing and workflow challenges on 7 West (see page 23).
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Chime In: Nurse Participation in CSI Academy Leads to New Staffing Model on 7 West
DuringSharpMemorial’sannualbudgetingplanningprocess,nurseson7
West,aprogressivecareunit,providedinputtotheirnurseleadersabout
limitedunitresources,inefficientworkflowsandinconsistentteamwork
relatedtosupportstaff.Thenursesrecommendedananalysisofunit
staffingpatternsandskillmix.
Tohelpaddressthesechallenges,theunitappliedtotheAssociation
ofCritical-CareNursesClinicalSceneInvestigator(CSI)Academy.This
16-month,hospital-basednursinginnovationandleadershipprogramis
designedtoempowerclinicalnursesasleadersandchangeagentsto
improvepatientandfiscaloutcomes.Participationincludesa$10,000
granttosupportthelaunchofaproject.
Fournursesfrom7Westwereselectedtoparticipateintheprogramand
workonaddressingthestaffingandworkflowchallengesontheirunit.
Aspartoftheprogram,theCSITeamsurveyed7Westnursesontheir
perceptionsofcurrentstaffing.Withthisinformation,theydevelopeda
proposalthatwouldshifttheroleof7Westnurseswithinthecaredelivery
model.Thenumberofnursingassistantswouldincreasetooneassistant
pertwonursesandnursingassistantswouldtakeonmoretasks.
Traditionally,7Westnursesmaintaineda1:3nurse-to-patientratio,butit
wasincreasinglyclearthatthismodelwouldbeunsustainablelongterm,
giventrendsinhealthcareexpenseandreimbursement.Underthenew
staffingmodel,whichthegroupnamed“TeamworkLeadstoDreamwork,”
thenurse-to-patientratiowouldexpandto1:4,creatingapositivebudget
varianceandenablingclinicalnursestotakeonabroaderroleinthe
caredeliverymodel.Withmorenursingassistantsupport,nursescould
focusmoreoncareplanningwithpatientsandfamilies,increasingpatient
educationandimprovingqualityoutcomes.
“TeamworkLeadstoDreamwork”launchedinJune2016.TheCSITeam
roundeddailywithstafftoobtainfeedbackanddetermineimprovements
tothemodel.
Outcome:
Thelaunchof“TeamworkLeadstoDreamwork”on7Westresultedin
aredistributionofnursingresources,anenhancedcaredeliverymodel
focusedontheprofessionalnurserole,andpositivefiscaloutcomes.Since
June2016,budget-to-actualdollarvariancetrendson7Westshiftedfrom
unfavorabletofavorable.
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Fine Tuning: Acute Inpatient Rehabilitation Reduces Patient Falls After Enhancing Fall-Prevention Measures
SharpMemorial’sAcuteInpatientRehabilitationUnitcaresforpatientswith
spinalcordinjuries,braininjuries,strokeandothercomplexmedicalissues.
Thesepatientsfaceanincreasedriskforsignificantinjuryfromafalldueto
theirfunctionallimitationsandotherfactorsrelatedtotheircondition.
Theunitwasexperiencinganincreasingtrendofpatientfalls.Memberson
theunit’sSafePatientMobilization(SPM)Committeeanalyzedtheincrease
anddeterminedthatproactivefall-preventionmeasureshadlapsed,become
lessconsistent,orwerenotcompletelyunderstoodbyinterprofessional
teammembers.
(From left) Tracie Neff, BSN, RN, Marilyn Marshall, BSN, RN, CRRN, and Parvin Mokayef, BSN, RN, CRRN, worked on the project to improve fall-prevention measures on the Acute Inpatient Rehabilitation Unit.
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Severalstrategieswereimplementedtoaddressthischallenge:
1. ReinstatingroundingonpatientswiththehealthcareteamandSPM
representatives,withafocusonstrategiestomobilizepatientsand
preventfalls
2. Addingareviewofhigh-riskfallpatientstothereportingstructureof
theunit’sdailypatientsafetyandoperationshuddle
3. RevisingtheSPMriskassessmenttoolbasedonnursefeedback
4. Updatinghandofftoolstomoreeasilyidentifypatientsathighestrisk
offalling
Thecommitteeestablishedaroundingprocessduringtheirmonthly
meetingstoevaluateuseofthenewtool,riskdocumentationandrisk
communicationpractices.Membersalsotrackedtheimpactoftherevised
practicesonpatientfallratesandcommunicatedunit-leveldatatostaff
duringhuddlesandstaffmeetings.
Outcome:
Bythemiddleof2016,therateofpatientfallsontheAcuteInpatient
RehabilitationUnitdecreased66percent.
CY QUARTER
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2
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Figure 10: Improvements to fall-prevention measures in Acute Inpatient Rehabilitation led to a decrease in patient falls.
Acute Inpatient Rehabilitation Fall Rate
JFM15
5.22
AMJ15
4.09
3.61
JAS15
2.26
OND15 JFM16
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AMJ16
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And All That Jazz: Other Nursing-Sensitive Indicators
CY QUARTER
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Figure 11: Sharp Memorial outperformed the state benchmark for acute care injury falls in seven out of eight quarters.
Injury Falls — Acute Care
JFM15
0.57
AMJ15
0.51
0.58
JAS15
0.53
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OND16AMJ16 JAS16
SMH SCORE CA BENCHMARK
CY QUARTER
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2+
Figure 12: Sharp Memorial outperformed the state benchmark for hospital-acquired pressure ulcers in seven out of eight quarters.
Hospital-Acquired Pressure Ulcers (Category 2+)
JFM15
0.87
AMJ15
0.82
1.05
JAS15
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0.39
1.00
OND15
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OND16AMJ16 JAS16
SMH SCORE CA BENCHMARK
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1.6
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CLASBI Rates
Figure 13: Sharp Memorial continued to show improvement in the rate of central line-associated bloodstream infections (CLASBI) for three of four quarters in 2016.
JFM16 JAS16AMJ16 OND16
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3
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CAUTI Rates
Figure 14: Sharp Memorial showed improvement in the rate of catheter-associated urinary tract infections (CAUTI) in three of four quarters in 2016.
JFM16 JAS16AMJ16 OND16
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2.3
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3.5
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NDNQI RN Survey with Practice Environment Scale
Figure 15: Nurse satisfaction scores on the National Database of Nursing Quality Indicators (NDNQI) with Practice Environment Scale outperformed the national mean in four of five categories.
Nursing Foundations for Quality
of Care
Staffing and Resource Adequacy
Collegial Nurse-Physician
Relationships
Nurse Manager Ability,
Leadership, and Support
of Nurses
Nursing Participation in Hospital
Affairs
Mean PES
SC
AL
E
QUESTIONS
SMH RATING MAGNET HOSPITALS MEAN
4-POINT SCALE: 1 = STRONGLY DISAGREE, 4 = STRONGLY AGREE
3.24 3.12 3.04 2.95 3.23 3.08 2.98 2.75 3.12 3.013.11 3.17
100
40
20
60
80
0
Patient Satisfaction
Figure 16: Sharp Memorial consistently met its goal to be in the top 10th percentile for patient satisfaction compared with all large hospitals.
CY 2012 CY 2014 CY 2015CY 2013 CY 2016
PR
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S G
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CALENDAR YEAR
SMH RANK GOAL 90TH PERCENTILE
92 98 98 96 92
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aretheintegrationofevidence-basedpracticeandresearchintoclinicaland
operationalprocesses.
New Knowledge, Innovations & Improvements
(From left) Leslie Barkley, MSN, RN, CNS-BC, CAPA, CMSRN, Surgical Procedure Area; and Naomi Miyazono, BSN, RN, CBN, CMSRN, were recognized with Nurse of the Year awards in 2016.
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Face the Music: 5 North Improves Patient Satisfaction with Quietness After Launching “Question of the Night”
Patientsatisfactionregardingthequietnessofthehospitalenvironment
istypicallythelowest-scoringmeasureontheHospitalConsumer
AssessmentofHealthcareProvidersandSystems(HCAHPS)survey.
Numerousnursingactivitiesanddevicesinthecareenvironmentcan
generateloudnoises,whichhavebeenshowntohavenegativeimpacts
onpatients(e.g.,anxiety,stress,andsleepdisturbances)andhospitalstaff
(e.g.,irritability,decreasedproductivity,andincreasederrors).
HospitalreimbursementfromtheCentersforMedicareandMedicaid
Services’HospitalValue-BasedPurchasingProgramistiedtoseveral
measures,includingpatientexperienceofcare.
5North,anacutecareunit,experiencedadownwardtrendintheunit’s
HCAHPSscoresregardingquietnessatnight.Nursesontheunitreviewed
theliteraturetodeterminebestpractices,includingquiethours,minimizing
conversationsnearpatientrooms,postingsignage,dimminglights,setting
phonesonvibrate,providingpatientswithearplugs,and,ifappropriate,
closingpatientdoors.
Theydevelopeda“QuestionoftheNight”promptforpatientsusing
GetWellNetwork,thetelevision-basedinteractivepatientcaresystem.At
9p.m.eachevening,patientsusingtheirtelevisionsseeamessageasking
iftheyfeelitisquietontheunit.Patientscanselectaresponseusingtheir
remotecontrol.
Ifpatientsrespondeither“maybe”or“no,”analertissenttothededicated
chargenursepagerthatdisplaysthepatient’sroomnumber.Withreal-
timenotification,thechargenursecanfollowupimmediatelywith
thepatient,evaluatetheenvironmentandresolveissues,ifpossible.
Discussionswithpatientsmayalsoincludewaystopromoterestand
relaxation,includingutilizingroutines,music,eyemasks,earplugs
andaromatherapy.
Outcome:
Followingimplementationofthe“QuestionoftheNight,”5North’spatient
satisfactionHCAHPSscoresimprovedconsiderably.Theunitexperienced
aone-timedecreaseinscoresinJuly2016,whichwasattributedtoalower
responserate(averagesurveyrespondentsdecreasedfrom22to12).
“The more I learn, the
more excited I get.”
–JohnnyCash
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MONTH
20
70
54
62
97
54
94 93
10
30
50
100
80
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70
60
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40
HC
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Figure 17: Following implementation of the “Question of the Night” on 5 West, patient satisfaction scores increased to the 93rd percentile.
5 North Patient Satisfaction
Mar 2016 Apr 2016 May 2016 Jun 2016 Jul 2016 Aug 2016 Sep 2016
(From left) Reanna Cook, BSN, RN, PCCN, 5 West, and Maryette Ann Kumphet, PTA, Physical Therapy, helped design and establish a workflow for the No Falls Protocol on 5 West (see page 32).
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It Takes Two to Tango: Launch of No Falls Protocol on 5 West Helps Reduce Patient Falls
Fallsareaprevalentpatientsafetyproblem,withupto1millionfalls
occurringinU.S.hospitalseachyear.Injuredpatientsrequireadditional
treatmentandlongerhospitalstays,resultinginhigherhealthcarecosts.
Fallpreventioninvolvesmanagingapatient’sunderlyingfallriskfactors
whileoptimizinghospitalsafetystrategies.
Byspring2014,allSharpMemorialHospitalinpatientunitswereequipped
withtheHill-RomNaviCareNurseCallandSmartClientprograms.Within
thissystemisaNoFallsProtocol(NFP),whichdisplaysonadashboardthe
statusofcertainbedsafetyfeaturestoassistwithfallprevention.Patients
atriskforfallingcanbeplacedintotheNFP,allowingcaregiverstocheck
onbed-statusindicators,suchasbedexitalarms,rails,heightandbrakes,
andbealertedifthereareanychanges.
Therewasanincreasedrateofpatientfallson5West,aprogressivecare
unit.The5WestUnitPracticeCouncilcreatedaFallReductionTaskForce
toanalyzetheincreaseanddevelopanactionplan.Theydiscoveredthat
forapproximately50percentofpatientswhoexperiencedafallinthe
previoussixmonths,staffhadforgottentosetthebedalarm.
ThetaskforcedeterminedtheunitneededtoleveragetheNFPtechnology
toassistwithfallpreventionandnotificationofbed-alarmstatus.The
availabletechnologyhadnotyetbeenactivatedbecauseseveralstructures
andprocesseswerenotyetinplace.
Taskforcemembersdesignedaworkflowtoimplementthenew
technologyintoclinicalpracticeandeducatednursesontheunitbefore
the“go-live”date.Educationincluded:
• FollowingthenewNFPunitworkflow
• Verifyingthebedisconnectedtothecallsystem
• EnteringpatientsintotheNFP
• Usingonly“alarmpause”tosilenceabedexitalarm(andnotturning
thebedexitalarmoff)
• ReadingandmonitoringtheNFPdashboard
• Recognizingandmonitoringdomelightindicatorslocatedaboveentry
intopatientrooms(i.e.,onceafall-riskpatientisenteredintotheNFP,
ayellowindicatorlightisilluminated)
• Respondingwhenthealarmisactivated
• Resolvingbedsafetyissuesindicatedonthedashboard
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(From left) Charley Anderson Dean, BSN, RN, and Melody Shedlosky, BSN, RN, worked on the team that led the expansion of the Emergency Department (see page 34).
Outcome:
FollowingimplementationoftheNFP,therateofpatientfallsdecreasedon
5West.
CY QUARTER
1
3.33
2.18
0.94
1.31
1.611.41
0.5
1.5
2.5
4
3.5
3
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Figure 18: The patient fall rate on 5 West decreased 58 percent after No Falls Protocol went live.
5 West Fall Rate
JFM15 AMJ15 JAS15 OND15 JFM16 AMJ16
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Pull Out All The Stops: Emergency Department Expansion Helps Maintain Patient Throughput Goal
TheEmergencyDepartment(ED)experiencesanincreaseinvolumeeach
year.Despitethegrowth,theEDworkshardtomaintainamedianadmit
timeof60minutes;thatis,60minutesfromthetimeadoctorcompletes
anordertoadmitapatienttoSharpMemorialtothetimethepatient
arrivesinaninpatientroom.
TheEDhadbeenreachingcapacityduetosteadilyincreasingvolumes
andwasexperiencingchallengesinmaintainingtheirthroughputgoal.
LeadershipandstaffidentifiedaneedtoexpandtheEDtoaccommodate
thegrowingvolumeofpatients,especiallyforpatientswhowerelessacute
andrequiredfewerresources.
AnEDLeanteamidentifiedavailablespaceforexpansioninthehospital’s
originalED,whichhadbeenusedasmeetingspacesincetheEDrelocated
tothenewSharpMemorialhospitalin2009.Afterhospitalleadership
approvedtheplan,theEDLeanTeamanalyzedhowtobestredesign
theareaforclinicaluse—fromthelocationofbloodpressurecuffsto
thepositioningofvital-signmonitors.Thenursesmetregularlywith
Engineeringandcontractorstodesignthespaceandensureclinicalcare
itemswereplacedinthemostefficientspots.Additionalnurses,nursing
assistantsandphysicianswerehiredtostaffthenewarea.
“ED2”openedinJanuary2016asanexpansionareatoservenine
additionalpatients.Resourceswerereallocatedtoassistwithefficiency,
suchasanadmittingclerktoregisterpatients,alaboratorytechnician
todrawneededlabs,aradiologytechniciantoperformX-rays,and
acomputerizedtomography(CT)transportertotakepatientstothe
inpatientCTscanner.
Outcome:
TheopeningofED2resultedinanimprovementintheED’smedian
throughputgoal,despiteincreasingpatientvolumes.
Featured Research Study
Predictors of Septic Patient Outcomes
Introduction
Nursingplaysavitalroleincoordinatingthecomplexcareofseptic
patients.Becausesepsisisacommonmedicalemergencywithahigh
rateofmortality,itisimperativeforhealthcaresystemstoimprove.
Carefulobservationbynursesiscriticaltodetectingsepticpatientsand
applyingspecificcare-managementprocesses.Thepurposeofthestudy
wastoidentifyfactorsassociatedwithmortalityinpatientswithsepsis-
relateddiagnoses.
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Methods
Datawereextractedfromtheelectronicmedicalrecordsof482patients
admittedthroughtheEmergencyDepartmentwithseveresepsisorsepsis
shockfromJuly1,2014throughJune30,2015.Thesamplewasfairlyevenly
distributedbygender—248,51.5percentmale;234,48.5percent
female—andethnicallydiverse.Theprincipalinvestigatorworkedclosely
withQualityandMedicalRecordstafftogathernecessaryinformationand
analyzetheresults.
Results
Ingeneral,patientswhowerefemale,older,and/orhadincreased
comorbiditiesweremorelikelytodiefromtheircondition.
Studyfindingsrevealedsignificantresultsbetweengender:maleshadlonger
hospitallengthsofstay,highercomorbidityscores,arrivedtoinpatientunits
fasterthanfemales;wereprescribedantibioticsfaster;andhadantibiotics
administeredinlesstimethanfemales.Thestudyalsofoundstatistically
significantdisparitiesinprocessesofcare:moremalesreceivedmechanical
ventilation,centrallinesandvasopressorsupport.
Althoughnotstatisticallysignificant,inthisstudymalesweremorelikelyto
haveinitiallactateandbloodculturesdrawn,andwereadmittedtohigher
levelsofcarethanfemales(intensivecareunitsvs.acutecareunits),despite
thefactthatlactatelevelsinfemaleswerehigherthaninmales.
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Initial Lactate Measured
Blood Culture Before Antibiotics
Adequate Fluid
Packed Red Blood Cell Transfusion
Vasopressor Administered
Central Line Placed
Mechanical Ventilation Used
Initial Lactate Level, Mean, (SD), mmol/L
Time of Initial Lactate,a (Median, IQR), Minutes
Time ABX Prescribed,a (Median, IQR), Minutes
Time ABX Administered (Median, IQR), Minutes
Fluids Administered, Mean, (SD), ml/kg
Mortality
MALE (N = 248)
89.5%
93.9%
26.4%
16.1%
63.3%
57.3%
43.5%
3.1 (2.8)
51 (31-137)
128 (67-252)
179 (106-348)
20 (21.5)
30.6%
FEMALE (N = 234)
88.0%
90.6%
39.5%
18.1%
53.8%
47.9%
35.1%
3.6 (3.1)
57 (32-140)
161 (89-313)
226 (142-396)
27 (24.7)
32.1%
P
ns
ns
*
ns
**
*
**
ns
ns
*
**
**
ns
SD = Standard Deviation; a Calculated from ED arrival; ABX = antibiotics; IQR = interquartile range; ns = not statistically significant; *p < .05, **p < .001.
Table 1: Treatments initiated in 482 patients with severe sepsis or septic shock by gender.
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Table 2: Logistic regression analysis predicting mortality (n = 423).
Discharge Diagnosis
Gender
Age, (Years)
Charlson Comorbidity Index Scoreb
Urinary Tract Infection
Intra-Abdominal Infection
Initial Lactate Level, (mmol/L)
Recommended Fluids
Length of Stay, (Days)
χ 2
df
Correctly Classified
-.895
-.520
-.034
-.170
2.277
1.697
-.213
.684
.032
118.38,
p < .001
12
77.3
PREDICTOR ODDSRATIO
PWALDSEB 95% CONFIDENCEINTERVAL
.288
.259
.009
.045
.961
.365
.050
.283
.012
.232
.358
.951
.773
1.482
2.668
.733
1.139
1.008
.719
.988
.984
.921
64.090
11.166
.891
3.449
1.058
.409
.595
.967
.843
9.746
5.458
.808
1.982
1.033
.002
.045
< .001
< .001
.018
< .001
< .001
.015
.010
9.65
4.03
14.86
14.54
5.61
21.59
18.44
5.86
6.65
Lower Upper
Discussion
Theresultsofthisinvestigationsuggestgender-relateddifferencesexistin
thecareofsepticpatients.Therefore,opportunitiesexisttoaddressdecision-
makingwithregardtopotentialgenderbiasandtoimprovetheprocessesof
careforsepticpatients.
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Toot Your Own Horn: Sharing Best Practices
Thefollowinglistincludestheinvolvementofnursesinscholarlyactivities.
BoldedauthornamesarenursesatSharpMemorial.
Internal Presentations — Poster
Austin, A.,Wyma, H.,ED Nurse-Driven Urinary Catheter Insertion Protocol
to Reduce CAUTI,SharpHealthCareResearchandInnovationConference,
SanDiego,CA,Feb.26,2016
Donnelly, J.,Use of Video Games in Patients’ Self-Management of Pain: A
Feasibility Study,SharpHealthCareResearchandInnovationConference,
SanDiego,CA,Feb.26,2016
Moore, S.,Engaging Nurses in Quality Projects,SharpHealthCareResearch
andInnovationConference,SanDiego,CA,Feb.26,2016
Moore, S.,Mastectomy Infection Reduction,SharpHealthCareResearchand
InnovationConference,SanDiego,CA,Feb.26,2016
Tecca, P.,Donnelly, J.,Improving Safety for Confused and Special Needs
Patients with Implementation of the Patient Safety Observer,Sharp
HealthCareResearchandInnovationConference,SanDiego,CA,
Feb.26,2016
Tecca, P.,Donnelly, J.,Improving Safety for Confused and Special Needs
Patients with Implementation of the Patient Safety Observer,Sharp
HealthCareDoNoHarmConference,SanDiego,CA,Sept.9,2016
Internal Presentations — Podium
Baehrens, D.,Mead, K.,Survey S.,Thematic Approach to Action
Planning,SharpHealthCareQuarterlyLeadershipDevelopmentSession,
SanDiego,CA,Aug.9,2016
Baehrens, D.,Sitzer, V.,Yellowbelt Workshop,SharpHealthCareLearning
Center,SanDiego,CA,Aug.24,2016,Nov.11,2016,Nov.16,2016
Chillcott, S.,HeartMate II LVAS Advanced Training — Discharge Planning
and Team Building,ThoratecOn-siteEducationTrainingProgram,Sharp
MemorialHospital,SanDiego,CA,June7,2016
Chillcott, S.,HeartMate II LVAS Surgical Training — Equipment Overview,
Device Troubleshooting and Discharge Planning,ThoratecOn-site
EducationTrainingProgram,SharpMemorialHospital,SanDiego,CA,
Aug.5,2016
Donnelly, J.,Use of Video Games in Patients’ Self-Management of Pain:
A Feasibility Study,Share,Inspire,TransformPresentationSeries,Sharp
MemorialHospital,Feb.22,2016
Donnelly, J.,Panel Discussion: Research Study Lessons Learned,Share,
Inspire,TransformPresentationSeries,SharpMemorialHospital,
Sept.26,2016
Doolittle, T.,Avoiding Hospital-Acquired Conditions: A Qualitative Analysis,
Share,Inspire,TransformPresentationSeries,SharpMemorialHospital,
July25,2016
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Ecoff, L.,Colette, A.,Reavis, K.,Engaging Clinical Nurses in Research,Clinical
PracticeCouncil,SharpGrossmontHospital,SanDiego,CA,Aug.2,2016
Ecoff, L.,Nuggets of Knowledge from the Magnet Research Symposium,
Share,Inspire,TransformPresentationSeries,SharpMemorialHospital,
Oct.24,2016
Failla, K.,Predictors of Septic Patient Outcomes,Share,Inspire,Transform
PresentationSeries,SharpMemorialHospital,April25,2016
Moore, S.,Wallace, M.,Enriquez, V.,Delara, J.,Mastectomy Infection
Reduction,SharpHealthCareDoNoHarmConference,Sept.9,2016
Nasshan, S.,Reducing HF Readmissions by Implementing Handoff Protocol,
Share,Inspire,TransformPresentationSeries,SharpMemorialHospital,
July25,2016
Sitzer, V.,Build Your Bridge as You Walk on It,NurseResidencyProgram
Cohort16GraduationKeynoteSpeech,SharpMemorialHospital,
Feb.12,2016
Sitzer, V.,The Basics of Meeting Agendas and Minutes,Interprofessional
CouncilforEducationFuelYourPracticeSeries,SharpMemorialHospital,
March21,2016
Sitzer, V.,Ecoff, L.,Magnet Writing Workshop,SharpMemorialHospital,
July19,2016,Aug.5,2016,Aug.10,2016,Aug.25,2016
Wells, P.,Corder, B.,Miyazono, N.,Garst, C.,Eusebio, R.,Failla, K.,White,
T.,My Magnet Conference Experience,ProfessionalPracticeGrandRounds,
SharpMemorialHospital,Feb.18,2016
Wells, P.,Kozub, L.,Rauschl, C.,Ecoff, L.,Rubin, C.,Sitzer, V.,My Magnet
Conference Experience,ProfessionalPracticeGrandRounds,SharpMemorial
Hospital,March24,2016
Wells, P.,Fox, T.,Building Resiliency Through Accountability,Sharp
HealthCareDoNoHarmConference,SanDiego,CA,Sept.9,2016
Internal Presentations — Webinar or Other
Failla, K.,Predictors of Septic Patient Outcomes: Does Gender Matter?,Sharp
HealthCareQualityHuddle,SanDiego,CA,June10,2016
External Presentations — Poster
Austin, A.,Wyma, H.,ED Nurse-Driven Urinary Catheter Insertion Protocol
to Reduce CAUTI,AssociationofCaliforniaNurseLeadersInnovations
Conference,SanDiego,CA,April15,2016
Baehrens, D.,Acute Brain Injury Rehabilitation Care Model Based on Patient/
Caregiver Activation,InternationalPlanetreeConference,Chicago,IL,
Oct.31,2016
Brazeau, R.,Keeping Patients Out of Restraints: ED Violent Patient
De-escalation,AssociationofCaliforniaNurseLeadersInnovations
Conference,SanDiego,CA,April15,2016
DeJesus, M.,Smith, C.,Bringing It Back To Basics,UniversityofCalifornia,
9thAnnualUCSanDiegoNursingInquiryandInnovationsConference,
SanDiego,CA,June8,2016
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Delara, J.,Mastectomy Infection Reduction,AssociationofCaliforniaNurse
LeadersInnovationsConference,SanDiego,CA,April15,2016
Donnelly, J.,Use of Video Games in Patients’ Self-Management of Pain: A
Feasibility Study,AssociationofCaliforniaNurseLeaders,SanDiego,CA,
Feb.26,2016
Donnelly, J.,Use of Video Games in Patients’ Self-Management of Pain:
A Feasibility Study,WesternInstituteofNursingAnnualCommunicating
NursingResearchConference,Anaheim,CA,April7,2016
Donnelly, J.,Use of Video Games in Patients’ Self-Management of Pain:
A Feasibility Study,UniversityofSanDiegoResearchConference,
SanDiego,CA,April28,2016
Doolittle, T.,Avoiding Hospital-Acquired Conditions: A Qualitative Analysis
of Early Top Performers,WesternInstituteofNursingAnnual
CommunicatingNursingResearchConference,Anaheim,CA,April7,2016
Ecoff, L.,Evaluation of a CNL Leadership Course Using Kirkpatrick’s
Evaluation Model,AmericanAssociationofCritical-CareNursesSummit,
LongBeach,CA,Jan.14-16,2016
Failla, K.,Predictors of Septic Patient Outcomes,WesternInstituteof
NursingAnnualCommunicatingNursingResearchConference,
Anaheim,CA,April6,2016
Fox, T.,Bringing It Back to Basics: Reducing Clostridium Difficile
Transmissions on a Surgical Acute Care Unit,AcademyofMedical-Surgical
NursesAnnualConvention,Washington,DC,Sept.30,2016
Fox, T.,Bringing It Back to Basics: Reducing Clostridium Difficile
Transmissions on a Surgical Acute Care Unit,InternationalPlanetree
Conference,Chicago,IL,Nov.2,2016
Marinelli, D.,Yager. M.,Go with the FLO: An Evidence-Based Approach
to Fluid Level Optimization,NationalAssociationofOrthopaedicNurses
AnnualCongress,Orlando,FL,May21,2016
Moore, S.,Engaging Clinical Nurses in Quality Improvement Projects,
AssociationofCaliforniaNurseLeadersInnovationsConference,
SanDiego,CA,April15,2016
Moore, S.,Pain and Anxiety Attenuation with Integrative Therapy in Post-
Operative Orthopedic Patients,AssociationofCaliforniaNurseLeaders
InnovationsConference,SanDiego,CA,April15,2016
Pang, W.,Standardization of Nasogastric Tube Insertion Protocol Using
Lidocaine Gel,UniversityofSanDiegoResearchConference,SanDiego,CA,
April28,2016
Parker, S.,Yager, M.,Developing a Comprehensive Delirium Protocol for
Orthopedic Patients,NationalAssociationofOrthopaedicNursesAnnual
Congress,Orlando,FL,May21,2016
Reavis, K.,Dalgren, L.,Brief De-Briefing of Critical Incidents with Medical
Intensive Care Staff,WesternInstituteofNursing’s49thAnnualNursing
ResearchConference,Anaheim,CA,April8,2016
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Sigmon, S.,Schroeder, J.,Sitzer, V.,Impact of a Support Surface Algorithm
on Hospital-Acquired Pressure Ulcers and Bed Rentals,2016Collaborative
AllianceforNursingOutcomes(CALNOC)Conference,Monterey,CA,
Oct.24,2016
Sitzer, V.,Feiler, J.,Two Problems, One Solution: Impacting Patient Falls
and Worker Injuries through a Safe Patient Mobilization Program,2016Safe
PatientHandlingandMobilityConference,Glendale,AZ,April11-15,2016
Sitzer, V.,Feiler, J.,Sustained Improvement in Fall Prevention through a Safe
Patient Mobilization Program,2016CALNOCConference,Monterey,CA,
Oct.24,2016
Soto, P.,Improving Patient Safety Through Closed-Loop Communication,
AssociationofCaliforniaNurseLeadersInnovationsConference,
SanDiego,CA,April15,2016
Swanson, N.,Wyma, H.,Are you Thinkin’ Sepsis?,AssociationofCalifornia
NurseLeadersInnovationsConference,SanDiego,CA,April15,2016
Tecca, P.,Donnelly, J.,Improving Safety for Confused and Special Needs
Patients with Implementation of the Patient Safety Observer,Association
ofCaliforniaNurseLeadersInnovationsConference,SanDiego,CA,
April15,2016
Venzke, M.,Cross Monitoring and Peer Review for Safety in Clinical
Practice,AssociationofCaliforniaNurseLeadersInnovationsConference,
SanDiego,CA,April15,2016
Wann, K.,An Exploration of Registered Nurse-Physician Collaboration,
AssociationofCaliforniaNurseLeadersInnovationsConference,
SanDiego,CA,April15,2016
External Presentations — Podium
Baehrens, D.,Collaborative, Interprofessional Bedside Rounding: Achieving
Safe Hospitalization and Discharge through Patient/Family Empowerment
and Activation,InternationalPlanetreeConference,Chicago,IL,Nov.1,2016
Donnelly, J.,Use of Video Games in Patients’ Self-Management of Pain:
A Feasibility Study,AssociationofCaliforniaNurseLeadersInnovations
Conference,SanDiego,CA,April15,2016
Ecoff, L.,The Advanced Practice Nurse Role in Healthcare Reform:
Value-Based Purchasing,PointLomaNazareneUniversity,SanDiego,CA,
Feb.5,2016
Ecoff, L.,KeynoteSpeaker,SchoolofNursingPinningCeremony,National
UniversitySchoolofNursing,SanDiego,CA,June10,2016
Ecoff, L.,Evidence-Based Practice Enriches Perianesthesia Patient Outcomes,
37thPerianesthesiaNursesAssociationofCaliforniaAnnualMeetingand
Seminar,SanDiego,CA,Oct.14,2016
Ecoff, L.,Etland, C.,Advancing Nursing Research and Dissemination of New
Knowledge Through Implementation of a Mini-Grant Program,American
NursesCredentialingCenterNationalMagnetConference,Orlando,FL,
Oct.6,2016
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Ecoff, L.,Colette, A.,Reavis, K.,Rique, K.,Engaging Clinical Nurses in
Research,9thAnnualUCSanDiegoNursingInquiryandInnovations
Conference,SanDiego,CA,June8,2016
Failla, K.,Predictors of Septic Patient Outcomes,DoctoralDefense
Presentation,UniversityofSanDiego,SanDiego,CA,March15,2016
Failla, K.,Predictors of Septic Patient Outcomes,KaiserPermanente
NursingResearchConference,SanDiego,CA,Aug.10,2016
Failla, K.,Connelly, C.,Septic Patient Outcomes: Does Gender Matter?,
CouncilfortheAdvancementofNursingScienceStateoftheScience
Congress:DeterminantsofHealthConference,Washington,DC,
Sept.15,2016
Holsworth, C.,Care of the Bariatric Patient,AlaskaNursesAssociation,
Anchorage,AK,Jan.15,2016
Kozub, E.,Brown, L.,Cultivating Emotional Competence for the
CNS,NationalAssociationofClinicalNurseSpecialistsConference,
Philadelphia,PA,March3,2016
Kozub, E.,Brown, L.,Cultivating Emotional Competence for the Nurse
Leader,AmericanAssociationofCritical-CareNursesNationalTeaching
Institute&CriticalCareExposition,NewOrleans,LA,May11,2016
Magdaluyo, P.,Staff Engagement in Patient Safety,InternationalPlanetree
Conference,Chicago,IL,Oct.31,2016
Moore, S.,Johnston, H.,Pain and Anxiety Attenuation Using Healing
Touch,AssociationofCaliforniaNurseLeadersInnovationsConference,
April15,2016
Moore, S.,Etland, C.,The Journey to Yes with Open Medical Records,
InternationalPlanetreeConference,Chicago,IL,Oct.31,2016
Sitzer, V.,Performance Improvement Using the A3,GuessLecturer,School
ofNursing,UniversityofSanDiego,SanDiego,CA,Oct.17,2016
Sitzer, V.,Impact of Support Surfaces: Data-Driven Action and Leadership,
PanelPresenter,2016CALNOCConference,Monterey,CA,Oct.24,2016
Sitzer, V.,Marinelli, D.,Fernandez, M.,The Down and DiRTy on Preparing
Patients for Hospital Discharge,2016InternationalPlanetreeConference,
Chicago,IL,Oct.31,2016
Tade, T.,Wisler, S.,Handoff Tool For Safety,Evidence-BasedPractice
InstituteConference,SanDiego,CA,Nov.8,2016
Yager, M.,Walsh,C.,Levin,B.,The Good, the Bad and the Ugly:
Neurovascular Assessments and Competency — Clinical and Legal
Issues,NationalAssociationofOrthopaedicNursingAnnualCongress,
Orlando,FL,May21,2016
Yager, M.,Defend Against Delirium,BonefideOrthopedicNursesEducation
Seminar,UniversityofCalifornia,SanDiego,SanDiego,CA,Oct.21,2016
Yager, M.,Marinelli, D.,Nevin, K.,Miller,J.,Turqote,E.,Finding the Value
in Value-Based Purchasing to Improve Orthopaedic Patient Care,National
AssociationofOrthopaedicNursesAnnualCongress,Orlando,FL,
May21,2016
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External Presentations — Webinar
Sitzer, V.,Corder, B.,Miyazono, N.,Rubin, C.,A Frontline Approach to the
Personalization of Patient Care,Planetree,March24,2016
Publications
Custis,L.,Hawkins,S.,Thomason, T.,(2016).AnInnovativeCapstoneHealth
CareInformaticsClinicalResidency:InterprofessionalTeamCollaboration.
Health Informatics Journal,1-11.DOI:10.1177/1460458215627188.
Ecoff, L.,Palomo, J.,Stichler, J.,(2016).DesignandTestingofa
PostanesthesiaCareUnitReadinessforDischargeAssessmentTool.Journal
of Perianesthesia Nursing.
Gonzales,L.,Glaser,D.,Howland,L.,Hutchins,S.,Macauley,K.,Close,J.,
LipkinLeveque,N.,Failla, K.,Brooks,R.,Ward,J.,(2016).AssessingLearning
StylesofGraduate-EntryNursingStudentsasaClassroomResearch
Activity:AQuantitativeResearchStudy.Nurse Education Today,48,55-61.
DOI:10.1016/j.nedt.2016.09.016.
Hawkins,S.,Thomason, T.,Steen,F.,(2016).AMultimodalTechnology
InterventionforHeartFailurePatientstoReduceReadmissions.Clinical
Nursing Studies,4(1),6-15.DOI:10.5430CNS.V4n1p6.
Kim,S.C.,Stichler, J.,Ecoff, L.,Brown,C.,Gallo,A.M.,&Davidson,J.,(2016).
PredictorsofEvidence-BasedPracticeImplementation,JobSatisfaction
andGroupCohesionamongRegionalFellowshipProgramParticipants.
Worldviews on Evidence-Based Nursing,13(5),340-348.
Kozub, E.,Brown, L.,Ecoff, L.,(2016).StrategiesforSuccess:Cultivating
EmotionalCompetenceintheClinicalNurseSpecialistRole.AACN
Advanced Critical Care,27(2),145-151.
Le Danseur, M.,Stutzman,S.,Wilson,J.,Sislak,I.,Olson,D.,(2016).Isthe
CABICCleanIntermittentCatheterizationPatientEducationEffective?.
Rehabilitation Nursing,http://onlinelibrary.wiley.com/doi/10.1002/
rnj.306/full.
Peavy,G.,Edland,S.,Toole, B.,Hansen,L.,Galasko,D.,Mayo,A.,(2016).
PhenotypicDifferencesBasedonStagingofAlzheimer’sNeuropathologyin
Autopsy-ConfirmedDementiawithLewyBodies.Parkinsonism and Related
Disorders,72-78,DOI:10.1016/j.parkreldis.2016.07.008.
Schettle,S.,Staley,L.,Schroeder,S.,Luckhardt,A.,Chillcott, S.,Kasper,M.,
Bjelkengren,J.,Marchand,C.,Stulak,J.,Dunlay,S.,(2016).ASeven-Center
ReviewofLeftVentricularAssistDevice(LVAD)CaregiverPerceptions.The
Journal of Heart and Lung Transplantation Abstracts,April2016.
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Call the Tune: Earned/Advanced Nursing Degrees in 2016
Janet Donnelly,DoctorateofPhilosophyinNursing,UniversityofSanDiego,
SanDiego,CA,May2016
Tammy Doolittle,DoctorateofPhilosophyinNursing,UniversityofSanDiego,
SanDiego,CA,August2016
Kim Failla,DoctorateofPhilosophyinNursing,UniversityofSanDiego,
SanDiego,CA,May2016
Tricia Hicks,Master’sofScienceinNursing,HealthCareInformatics,
UniversityofSanDiego,SanDiego,CA,May2016
Josie McDowell,Master’sofScienceinNursing,GrandCanyonUniversity,
Phoenix,AZ,October2016
Wei Pang,Master’sofScienceinNursing,UniversityofSanDiego,
SanDiego,CA,May2016
Lori Rodgers,Master’sofScienceinNursing,GrandCanyonUniversity,
Phoenix,AZ,October2016
Yvonne Vargas,Master’sofScienceinNursing,WesternGovernors
University,SaltLakeCity,UT,March2016
Kim Failla, PhD, RN, NE-BC, Nurse Residency Program, earned her Doctorate of Philosophy in Nursing in 2016.
Sharp Memorial Hospital7901 Frost St.
San Diego, CA 92123858-939-3400
sharp.com/memorial
M1661.05.17©2017SHC~ A Health Care Organization Designed Not For Profit, But For People ~