Building on Success: Leading Innovations & Achieving Results

Clinical Nurse Leader (CNL) Summit

Poster Presentations

Thursday, February 23, 2017

5:15 – 6:30 p.m.

American Association of Colleges of Nursing

Master’s Education Conference Poster Presentations

Thursday, February 23, 2017 5:15 – 6:30 p.m.

Numbers listed above the poster titles indicate

the designated location on the poster boards within Marquis C&D.

-1-

Achieving Optimal Infection Prevention through Interprofessional Practice Pamela L Abraham, MSN,RN,CNL

Co-Presenters: Cathy Consalvo, MSN,RN,CNL Jennifer Kareivis, MSN,RN,CNL

Marianne Sweeney, MSN, RN, CNL Hunterdon Medical Center Flemington, New Jersey

-2-

clinical nurse leader collaborative to reduce hospital acquired venous thromboembolism Bettie Agyekum, MSN

Co-Presenter: Nkechi Aikheule, MSN WellStar Cobb

Austell, Georgia

-3- Coordinated Blood Glucose Management to Prevent Hypoglycemia

Kristen Barnes, CNL Co-Presenters: Beverly Green, CNL

Diane Giles, CNL Lillian Dyson, CNL Tammy Law, CNL

Wellstar Douglas Hospital Douglasville, Georgia

-4- Decreasing Hospital Acquired Pressure Ulcers

Kristen Barnes, CNL Co-Presenters: Elia Caldwell, RN BSN

Lillian Dyson, CNL Diane Giles, CNL Tammy Law, CNL

Beverly Green, CNL Wellstar Douglas Hospital

Douglasville, Georgia

-5- Let's get certified! A CNL-Led CCRN Review Class Melchora "Toy" R Bartley, MSN, RN, CNL,CCRN

Sparrow Health System Lansing, Michigan

-6-

Hospital Acquired Reversal of Ketosis Kentlee P Battick, MSN

Johns Hopkins All Children's Hospital Saint Petersburg, Florida

-7-

Knowledge Dissemination with an “Information Station” Christina F DiBernardo, MSN, RN-BC, CNL

Co-Presenter: Pearl Chaparro, MSN, Ed-RN Department of Veterans Affairs, Long Beach

Long Beach, California

-8- Decreasing Congestive Heart Failure Readmission

Lillian Dyson, RN, MSN, CNL Co-Presenters: Josh Whitman,

Steve Williams, MS Allison Blank, MSN

Wellstar Health System Douglasville, Georgia

-9- Communicating CARE to Improve Patient Experience and Reduce Call Light Usage

Anthodith M Garganera, MSN/MHA RN CMSRN Texas Health Presbyterian Hospital of Plano

Plano, Texas

-10- Eight Bundle Care Strategies + CHG = Prevents CAUTI

Anthodith M Garganera, MSN/MHA RN CMSRN Texas Health Presbyterian Hospital of Plano

Plano, Texas

-11- CNL/Physician Collaboration

Bobbi Hardman, MSN, RN, CNL, CEN Co-Presenter: Erin S Munoz, MSN, RN, CNL, CCRN

Texas Health Resources Fort Worth, Texas

-12-

Getting Administrative Buy-In for Practice Integration of the CNL Angie F. Hatley, DNP

Queens University of Charlotte Charlotte, North Carolina

-13-

Implementation of Simulation-Based End-of-Life (EOL) Care Training for Nursing Staff Sheena Y Hess, MSN, CNL

Co-Presenters: Sheni Meghani, MD Michelle Ralston, BSN

VHA Topeka, Kansas

-14-

The Effects of Mock Codes on the Confidence Levels of Nurses Responding to Codes Sharon Frazier Hood, MSN

Carolinas Medical Center Charlotte, North Carolina

-15- Working Together To Achieve Success: An Interprofessional Approach To Reducing Length of Stay

Jennifer Hubbard Kareivis, MSN, RN, CNL Hunterdon Medical Center Flemington, New Jersey

-16-

Power of Nursing Leadership: Clinical Nurse Leader ( CNL) Role Implementation in Japan through Academic Clinical Collaboration

Asako Takekuma Katsumata, PhD, RN,CNL ASA Nurse Scholar Consulting

Rockford, Illinois Co-Presenters: Minami Kakuta, MSN, RN, CNL

Saint Anthony College of Nursing Rockford, Illinois

Gordana Dermody, PhD, RN, CNL Washington State University College of Nursing

Spokane, Washington Kazuko Nin, PhD, RN

Kyoto University, Department of Human Health Science, Clinical Nursing Kyoto-city, Japan

-17-

Using the CNL Role to Improve Cost, Quality, and Service Outcomes in Elective Total Joint Care Tammy Law, MSN, CNL

WellStar Health System/ WellStar Douglas Hospital Douglasville, Georgia

-18-

copd mini rounds Catherine A Lorenzo, MSN

Co-Presenter: Hernande Augustin, MSN WellStar Cobb

Austell, Georgia

-19- Improving patient outcomes in a transfemoral transcatheter aortic valve replacement procedure.

Lori M Lowry, RN-BC, BSN Saint Francis Hospital and Medical Center

Hartford, Connecticut Co-Presenters: Noel Harrington, MSN

BayState Medical Center Springfield, Massachusetts

Joslin Leasca, DNP Linda Cook, DNP

Sacred Heart University Fairfield, Connecticut

-20-

meds to beds Sonal Makin, MSN

Co-Presenter: Latesha Tsoungi, MSN WellStar Cobb

Austell, Georgia

-41- Hardwiring Bedside Shift Report( BSSR)

Elizabeth C Mathew, MSN,RN, CCRN, CNL Co-Presenters: Shakeithra Hodges, MSN,RN NE-BC

Karen Aylor, BSN,RN Molly Alex, MSN, RN, NE-BC

camelle Samuels, MBA, BSN, RN Michael E. DeBakey VA Medical center

Houston, Texas

-42- A Clinical Nurse Leader's Journey to Decrease Aspiration Pneumonia Rates

Jennifer A. Morgan, MSN, CNL Co-Presenter: Samantha Stone, MSN

Robley Rex Veteran's Affairs Hospital Louisville, Kentucky

-43-

Clinical Nurse Leaders: Improving Flow and Capacity Between Two Hospital Facilities Heena Vallabhji Nagarji, MSN, RN-BC, CNL

Co-Presenter: Valerie Denise Short, MSN,CMSRN,CNL Carolinas Medical Center Charlotte, North Carolina

-44- Let’s Show More PC! Palliative Care = Improving the Patient’s Quality of Life

Alexander D. Nava, MSN, RN, CNL Co-Presenter: Melanie Hanes, BSN, RN, CCRN

Texas Health Resources Plano, Texas

-45-

CNL Team Collaboration Improves Institutional Central Line Flush Practice and Financials Sonja Orff, RN, MS, CNL

Co-Presenter: Carrie Strick, RN, MS, CNL, CMSRN Maine Medical Center

Portland, Maine

-46- Impact of Social Media Technology in Healthcare to Improve Patient Quality and Outcomes:

Imperatives and Challenges for 21st Century Nurse Leaders Carol M Patton, Dr. PH

Drexel University Waynesburg, Pennsylvania

-47-

Up Times Three Improves Functional Mobility in the Elderly Cynthia B Presley, MSN, RN, CNL, PCCN

Texas Health Harris Methodist Hospital Southwest Fort Worth Fort Worth, Texas

-48-

Perception is Reality: How a Clinical Nurse Leader Strengthened Working Relationships between Nursing Assistants and Nurses on a Pediatric inpatient Unit

Angie Ramsey, MSN Co-Presenter: Mallory Lexa, BSN

UNC Health Care Chapel Hill, North Carolina

-49- Improving Safety in the Emergency Department: Early Recognition of Escalating Patient Behaviors

Laurie A. Schwartz, MSN Mercy Health Saint Mary's Grand Rapids, Michigan

-50-

Model C Graduates Transition to Practice Bobbi Shatto, PhD

Co-Presenters: Kristine L'Ecuyer, PhD Geralyn Meyer, PhD

Saint Louis University St. Louis, Missouri

-51-

38% Falls Reduction in a Mental Health Residential Setting Nadine A Terese, CNL

Veterans Affairs Eastern Kansas Healthcare System Topeka, Kansas

-52-

Prevention of Avoidable Hospital Acquired Pressure Ulcer Using Two RN'S Skin Verification in the Initial Skin Assessment

Tessy B Thomas, MSN, CCRN,CNL Co-Presenters: Smith Jason, MSN

Molly Alex, MSN,NE-BC Michael E DeBakey VA Medical Center

Houston, Texas

-53- Accurate Mobility Assessment to Prevent Falls

Latesha Denise Tsoungui, MSN, RN, CNL WellStar Cobb Hospital

Austell, Georgia

-54- Implementing a Patient-Centered Admission Binder in an Inpatient Leukemia Unit

Jessica Vaughn, CNL The University of Texas MD Anderson Cancer Center

Houston, Texas

-55- Patient-Nurse Therapeutic Engagement as a Predictor of Improved Patients' Experience and Clinical

Outcomes SERGE WANDJI, MSN

Charleston VA Medical Center Charleston, South Carolina

-56-

Decreasing Unnecessary EKG and Pulse Oximetry Alarms in the ICU Laura Warburton, MSN

St. Vincent's Medical Center Bridgeport, Connecticut

Co-Presenter: Sally Gerard, DNP Fairfield University

Fairfield, Connecticut

-57- Effecctive Mass Notification improves Patient Safety

Donna B. Whitehead, MSN Co-Presenter: Comfort Gbadebo, MSN

WellStar Kennestone Regional Medical Center Marietta, Georgia

-58-

Using Dry-Erase Boards to Improve Nurse Communication Scores David M. Wolf, BSN

Texas Health Resources Plano, Texas

-59-

Back to Basics Joselyn Wright, MSN, CMSRN, CNL

Co-Presenters: Heather Helton, MSN, CMSRN, CNL Lisa Fry, BSN

Carolinas Medical Center Charlotte, North Carolina

Achieving Optimal Infection Prevention through Interprofessional Practice Pamela L Abraham, MSN,RN,CNL; Cathy Consalvo, MSN,RN,CNL

Jennifer Kareivis, MSN,RN,CNL Marianne Sweeney, MSN, RN, CNL

Hunterdon Medical Center Flemington, New Jersey

The risk of acquiring a healthcare-associated infection (HAI) is increasing as patient acuity increases and medical care becomes more complex. HAIs are associated with significant morbidity, mortality, and cost. The rate of HAIs reflects the quality of patient care and is publicly reported. Growing rates of HAIs alongside evidence suggest that active surveillance and infection control practices can prevent HAIs. 1 In July 2015, a new Cardiovascular Care Unit opened at Hunterdon Medical Center. Opening with all private rooms and experienced staff members, it was unexpected that the Vancomycin Resistant Enterococcus (VRE) rate for 2015 was 3.2. In December 2015, the Clinical Nurse Leader collaborated with nurses from the Infection Prevention Department and clinical champions on the unit to develop an interactive educational program called “Back to Basics of Infection Prevention.” Topics included infection prevention techniques, proper donning and doffing of personal protective equipment, hand hygiene, correct Methicillin Resistant Staphylococcus Aureus (MRSA)/VRE screening techniques, and staff accountability. Due to a rise in VRE rates on 3 additional units, the Clinical Nurse Leaders collaborated with Infection Prevention and began education in July of 2016 on the other units. VRE rates decreased from 3.2 to 0.6 for year to date 2016 on the Cardiovascular Care Unit. So far, the VRE rate on the Progressive Care Unit has decreased from 4.6 to 0.0. The VRE rate on the Medical Specialty Unit decreased from 5.6 to 1.6, and the Surgical Unit just completed education with a baseline rate of 3.4. Interprofessional Practice using various methods of education models facilitates optimal patient outcomes in the complex acute care setting. As a result, an environment of health and wellness is created. Collaboration with the experts in their specialties enhances the results that the Clinical Nurse Leader is striving to achieve. 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3021207/

clinical nurse leader collaborative to reduce hospital acquired venous thromboembolism Bettie Agyekum, MSN; Nkechi Aikheule, MSN

WellStar Cobb Austell, Georgia

The goal of this project was to increase awareness of DVT/PE complications and to reduce occurrences of Hospital- Acquired Venous Thromboembolism (HA-VTE). VTE, which includes deep vein thrombosis (DVT) and pulmonary embolism (PE), affects more than 900,000 patients in the U.S. yearly with an annual cost of $10 billion or more. Accurate VTE screening is essential in applicable prevention measures being applied to each patient. Clinical Nurse Leaders (CNL), aided by the Quality department, completed random chart audits at a 382 bed community hospital. The VTE screening tool was being filled out incorrect or incompletely. It was decided that the entire screening tool should be completed at the bedside with either the patient or family involved in the process. The CNL’s developed an education tip sheet for staff to refer to. Education with nurses regarding importance of screenings was done. Education time frame was from October - November 2015. Leadership completed direct discussions with individual nurses to identify barriers and to rectify incomplete or incorrect screenings. In addition data was pulled from an Intelligence Analyst regarding all hospital acquired DVT’s and PE’s from July 2015 to March 2016. By raising the awareness of accurate screening and its effect on the incidences of PE/DVT, we demonstrated a reduction in VTE. Post implementation results indicated that when nurses perform VTE screening accurately, the incidence of PE’s dropped from nine to three occurrences from July 2015 to March 2016. DVT’s dropped from five to three occurrences from July 2015 to March 2016. This was an average savings of $293,528. The implication of this practice change involved complete and accurate documentation, improved patient outcome, and an increase in patient safety. Decreasing VTE decreases length of stay, readmissions, and overall cost.

Coordinated Blood Glucose Management to Prevent Hypoglycemia Kristen Barnes, CNL; Beverly Green, CNL

Diane Giles, CNL; Lillian Dyson, CNL Tammy Law, CNL

Wellstar Douglas Hospital Douglasville, Georgia

Aim To decrease the incidence of hypoglycemic events through coordinated blood glucose management from nurses, care partners, and dietary. Background Douglas Hospital’s 3 North medical unit had 98 hypoglycemic events over a two month period. After completing a hypoglycemia drill down for every patient with a blood sugar less than 70 the conclusion was uncoordinated blood glucose management between dietary, nursing and care partners. This uncoordinated blood glucose management attributes to the number of hypoglycemic events. The initiative is to better coordinate blood glucose management by checking glucose levels prior to meal consumption and administer insulin/medication (if needed) with meal delivery. The goal is to decrease the number of hypoglycemic events through better coordinated blood glucose management. Methods Bedside nurses and care partners (CPs) were educated via computer-based and verbal education for coordinated blood glucose management. CPs were instructed to check the patient’s blood glucose with meal in route and nurses were instructed to administer insulin with meal delivery. A phone was designated for the kitchen liaison to notify staff of which diabetic trays were on the way. Appropriate timing of glucose checks, meal and snack delivery with medication administration can decrease hypoglycemic episodes. Outcomes Over a three month period 3 North decreased the number of hypoglycemic events by 60%, from 63 events in one month to 25. Better coordinated blood glucose management provides patients with optimal outcomes to prevent hypoglycemic events and ultimately improves patient care. Summary Recommendations Ensuring that all staff are coordinating blood glucose checks, meal delivery, and insulin administration. Leadership will continue to monitor the process and the incidence of hypoglycemic events. The next step will be to decrease the number of hyperglycemic events (blood glucose >150).

Decreasing Hospital Acquired Pressure Ulcers Kristen Barnes, CNL; Elia Caldwell, RN BSN

Lillian Dyson, CNL; Diane Giles, CNL Tammy Law, CNL; Beverly Green, CNL

Wellstar Douglas Hospital Douglasville, Georgia

Aim To decrease the incidence of hospital acquired pressure ulcers (HAPU) and improve care of patients at high-risk of skin breakdown as evident by a decrease in the number of HAPUs on the monthly HAPU report. Background Douglas hospital’s medical unit had four HAPUs from January to April 2016 and the hospital as a whole had 21. This indicated an area in need of improvement to prevent HAPUs in the future. Although nursing staff were aware of the requirement to turn patients every two hours and consult wound care for skin breakdown, the incidence of pressure ulcers confirmed the need for staff education and continued surveillance for support and practice change. Methods Bedside nurses and care partners were educated via an Evidence-based Journal Club and unit huddles on performing a dual RN sign-off for the admission skin assessment. Staff were educated with tools to guide practice: a peach sign for skin precautions, a turn clock, a pressure ulcer prevention challenge to encourage appropriate care, and a pressure ulcer treatment and prevention guideline. The unit CNL led the education, implementation, and evaluation of this process through chart audits, daily leadership rounds and/or interdisciplinary rounds. Patients at high risk of skin breakdown were included in the daily unit huddle to heighten awareness of these patients. Outcomes After implementation of these practice changes the medical unit had a five month stretch without any HAPUs, while the hospital as a whole had four HAPUs. In turn, these practice changes decreased length of stay, health care cost, and increased patient satisfaction. Summary Recommendations Ensure all inpatient units are utilizing the dual RN sign-off for patient admissions, as well as providing appropriate care to those at high risk of skin breakdown. Leadership will assess the implementation of these practice guidelines for patients during daily interdisciplinary rounds.

Let's get certified! A CNL-Led CCRN Review Class Melchora "Toy" R Bartley, MSN, RN, CNL,CCRN

Sparrow Health System Lansing, Michigan

Let’s Get Certified! A CNL-Led CCRN Review Class Background: In July 2015, a CNL new to the hospital system noticed that increased turnover of nurses resulted in a shortage of experienced nurses. The CNL assessed the need for increased education and presented the idea of a two-day review class for critical care nurses. Method: Utilizing resources and books from AACN, the CNL created a two-day review class for the nurses. The CNL met with the Unit Manager and the Education Coordinator (EC) to plan for the class. The EC took care of the room reservations, contact hours and the Unit Manager provided food. PowerPoint materials were provided. Scenario-based multiple choice test questions were given at the end of each organ system topics. After the two-day classes, daily bedside “5-Minute In-services” were held. The CNL met with each of the staff prior to their CCRN testing dates, to share test taking strategies and ensure readiness for the exam. The CNL offered a total of four sets of two-day review classes for the year. Outcomes: Over 100 nurses attended the review classes. Within six months of the staff taking the CCRN Review Class, 15 critical care nurses took the CCRN exam and 100% successfully passed on their first attempt. After the initial year, 24 nurses were certified. Due to the number of staff who passed, registration for future review classes increased significantly. Summary Recommendations and Impact: The whole process of participating in the two-day review class significantly improved the way nurses care for their patients and for one another. CCRN certified nurses were observed to be more involved in the care of their patients. Increased height of nursing empowerment, knowledge and knowledge-sharing and a pure sense of accomplishment were the most notable benefits of the CNL-Led CCRN Review Class.

Hospital Acquired Reversal of Ketosis Kentlee P Battick, MSN

Johns Hopkins All Children's Hospital Saint Petersburg, Florida

In mid-2013, our institution saw an increased trend in patients who inadvertently came out of ketosis during their inpatient stay due to a non-ketogenic diet form of medication or IV fluid ordered, thus causing the patient to have seizures. This was causing harm to our patients as well as an increased stay in the hospital to get the patient back into ketosis. Therefore, a large multi-disciplinary task force, including IT, pharmacy, nutrition, and front-line nursing staff convened to decide ways to prevent harm to our Ketogenic diet patients. Some of the initiatives included a method to better identify a patient on the Ketogenic Diet within the Electronic Medical Record. We also educated staff on the diet to understand it's importance in maintaining the diet. A pediatric friendly Ladybug door and bedside signage was created to identify a patient on a Ketogenic Diet. Following these initiatives, we saw an increase in near miss reports, of which prior to the task force were non-existent and we have not had any diet reversals for 18 months.

Knowledge Dissemination with an “Information Station” Christina F DiBernardo, MSN, RN-BC, CNL; Pearl Chaparro, MSN, Ed-RN

Department of Veterans Affairs, Long Beach Long Beach, California

In today’s rapidly changing healthcare environment, it is challenge to disseminate new information as it pertains to policies, procedures, practice changes, standards, equipment, announcements, etc. Common methods of information dissemination include e-mails, fliers, impromptu announcements, and formal staff meetings. Within the inpatient setting where patients need to be cared for 24/7 and nurses usually work 12 hour shifts, it can be difficult to have consistent communication at the unit level. On a weekly basis, the Clinical Nurse Leader (CNL) and Nurse Manager (NM) collaborate to select a topic relevant to the needs of the units and staff. Once a topic has been selected, a 5-7 minute presentation is developed with an associated handout. To include both day shift and nigh shift, each day M-F at 7:55am (end of shift change) the CNL or NM present and engage staff by asking for answers to fill-in-the-blank, True/False, and brief open-ended questions. Because the same “Information Station” content is offered 5 days a week, the nursing staff is able to choose which day they want to attend the IS. This facilitates a brief and convenient option for acquiring information as it pertains to practice and delivery of care. 99% of nurses on the unit agree/strongly agree "IS is a good use of my time" and 100% of nurses on the unit agree/strongly "During IS I learn at least one new thing I can apply to my nursing practice". Information Stations improve the quality of healthcare delivery by facilitating consistent, brief, convenient, interactive, and in-person mini-meetings for disseminating practical information as it relates to nursing knowledge, practice, and outcomes.

Decreasing Congestive Heart Failure Readmission Lillian Dyson, RN, MSN, CNL; Josh Whitman

Steve Williams, MS Allison Blank, MSN

Wellstar Health System Douglasville, Georgia

At Douglas hospital the readmission rate for Heart Failure patients was significantly high at 23.9% in 2014/2015. Many of the CHF patients are going home to care for themselves, but they were being readmitted due to not following up and not having the tools or the knowledge to care for themselves. Methods Heart failure academy (HFA) is a weekly meeting over four weeks. Over the four weeks patients are equipped with the tools to assist them in achieving their goals i.e. Scale, pill box, and water pitcher with gradient, stress ball. Roll out was October 21, 2015. Heart Failure Medications are provided free of charge, to newly diagnosed CHF patients for 30 days and patients with existing diagnosis of CHF but has no insurance. CHF patient will have follow up appointments with cardiology three to five days upon discharge from the hospital. Unit secretary will call cardiovascular medicine (CVM) for appointment, and alert them to Heart Failure or CHF diagnosis to schedule appointment for three to five days after discharge. This patient list is faxed to CVM office every evening, Mon-Fri. Outcomes Overall Douglas readmission rate has gone down overtime to 11%, 4.8%. Data shows when all of the processes are followed we have great outcomes. Summary Recommendations Standardizing the process for all the inpatient unitsIncreasing HFA referrals from the physiciansEducating physicians to the referral process for HFA in Epic

Communicating CARE to Improve Patient Experience and Reduce Call Light Usage Anthodith M Garganera, MSN/MHA RN CMSRN

Texas Health Presbyterian Hospital of Plano Plano, Texas

Communication is a valuable and critical tool in every care delivery process and patient interaction. With the integration of advanced communication technologies, nurses can influence patients’ perception on call light use and staff response. As a leader at point-of-care, the clinical nurse leader (CNL)/Patient Care Facilitator (PCF) collaborated with the interdisciplinary team in applying evidence-based practice. The Dartmouth microsystem assessment and Plan-Do-Study-Act (PDSA) method were used as tools. The process improvement (PI) project entitled, “Communicating care on hourly rounding or CARE rounds” was based on evidence-based practice. The goal of the project was to provide proactive hourly rounding through the use of “CARE rounds script”. CARE stands for call light usage, action plan, respond and review patterns and establish routine. The plan was to implement the project on a period of 12 weeks in an orthopedic/Medical-Surgical unit. The project showed significant improvement with scores above 86% on nurse communication and staff responsiveness scores, and a decreased number of call light by 10%. Several literature reviews supported the goals of this project. A study by Tea, Ellison & Feghali (2008) indicated that use of “I Care Rounding” model was a proactive approach which provided staff members the ability to organize their daily tasks, anticipate and address patients’ needs in a timely fashion, and lead to increase in staff responsiveness scores. Ford (2010) stated that nurses proactive with rounding were finding their shifts less stressful, their time more productive, and patient safety and satisfaction scores were hitting all-time highs. References: Ford, B.M. (2010, May/June). Hourly rounding: A strategy to improve patient satisfaction scores. MEDSURG Nursing, 19, 188-191. Retrieved from http://www.medsurgnursing.net/cgi-bin/WebObjects/MSNJournal.woa/wa/viewSection?s_id=1073744495 Tea, C., Ellison, M., & Feghali, F. (2008). Proactive patient rounding to increase customer service and satisfaction on an orthopedic unit. Orthopedic Nursing, 27, 233-240. doi:10.1097/01.NOR.0000330305.45361.45

Eight Bundle Care Strategies + CHG = Prevents CAUTI Anthodith M Garganera, MSN/MHA RN CMSRN

Texas Health Presbyterian Hospital of Plano Plano, Texas

A catheter-associated urinary tract infection (CAUTI) is considered one of the hospital-acquired infections (HAI) by Centers for Medicare and Medicaid Services (CMS). The implementation of Section 3008 of the Patient Protection and Affordable Care Act (ACA) established the Hospital-Acquired Condition (HAC) Reduction Program to provide an incentive for hospitals to reduce HACs (including CAUTI) (CMS, 2016). CAUTI reduction has been a consistent challenge and struggle for many hospitals across the country. Studies showed that a “bundled” approach and use of Chlorhexidine gluconate (CHG) significantly reduce incidence of CAUTI (Strouse, 2015). To address the pressing issue on CAUTI prevention, the Clinical Nurse Leader (CNL) / Patient Care Facilitator (PCF) collaborated with the unit manager and unit educator in introducing and leading the “Eight Bundle Care Strategies plus CHG prevents CAUTI” as evidenced-based practice (EBP). The goals of the EBP project were to prevent incidence of CAUTI and decrease Foley catheter (FC) days. The plan was to pilot and use “Eight Bundle Care Strategies plus CHG” for a period of 12 weeks among Medical-Surgical patients in October 2015. The staff nurses and patient care technicians (PCTs) were trained on the bundle care strategies and proper use of CHG wipes on FC and perineal catheter care. The result showed decrease of CAUTI cases from 4.74 to zero and decrease of FC days from 211 days to 174 days for more than seven months among target population. References: Centers for Medicare and Medicaid Services (CMS). (2016). Fiscal Year (FY) 2016 Results for the CMS Hospital-Acquired Conditions (HAC) Reduction Program. Retrieved from https://www.cms.gov/NewsroomMediaReleaseDatabase/Fact- sheets/2015-Fact-sheets-items/2015 Strouse, A. (2015). Appraising the literature on bathing practices and catheter- associated urinary tract infection prevention. Urologic Nursing, 35, 11-17. doi: 10. 7257/1053-816X.2015.35.6.271

CNL/Physician Collaboration Bobbi Hardman, MSN, RN, CNL, CEN; Erin S Munoz, MSN, RN, CNL, CCRN

Texas Health Resources Fort Worth, Texas

Background/Objectives: The purpose of this study was 1) Determine the effect of a Clinical Nurse Leader (CNL)-Physician collaboration intervention (CPI) on length of stay (LOS) in days on the study unit and 2) determine the effect of CPI on patient satisfaction scores as measured by commercial surveys. Methods: This study was a retrospective study and was approved by the relevant Institutional Review Board. CNLs review patient charts admitted to two designated hospitalist groups and either rounded on the patient with the physician or discussed the plan of care outside of the patient’s presence. Data points were monitored for changes in nurse and physician communication scores and LOS following implementation of the intervention. Results: Results of this study will provide knowledge resulting in changes in hospital procedures to assist with more efficient discharges. Shorter LOS in the hospital are associated with lower healthcare costs and improved patient satisfaction. Preliminary results were obtained from actively participating physicians in the study, including LOS, readmission and complication rates, and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). There was a decrease in LOS over a five month period of 1.2 days. The HCAHPS scores on nursing and physician communication increased to the 90th percentile by the fifth month of the collaboration. Conclusions: The Institute of Medicine (IOM) identified the challenges and changes in our healthcare system today revealing fragmentation of care including a shifting focus on patient safety and quality outcomes. The solution to these issues led to the creation of the CNL role by the American Association of Colleges of Nursing (AACN). The CNL presence in an acute care hospital setting closes gaps in patient care and promotes effective communication among rotating physicians within a hospitalist group promoting quality outcomes and cost-effectiveness.

Getting Administrative Buy-In for Practice Integration of the CNL Angie F. Hatley, DNP

Queens University of Charlotte Charlotte, North Carolina

The demand for advanced practice nursing is escalating at an alarming rate in the US. Providing quality patient care while reducing cost is paramount to the success and redesign of healthcare. Implementation of advanced practice nursing roles proves to be challenging due to the lack of clear role explanations for various roles and organizational knowledge or experience with advanced nursing roles. The role of the Clinical Nurse Leader role is vast with the responsibility of patient care outcomes and the integration or application of evidence based practice as a guide for the delivery of healthcare. It has been reported that many healthcare executives perceive the role as nebulous and are challenged with determining the applicability of the role within the healthcare organization. The utilization of professional practice model illustrations have proven beneficial in developing a consensus of practice within healthcare organizations in pursuit of Magnet Designation. It is advantageous for CNLs to utilize an illustrated professional practice model in steering the dialogue with healthcare executives in the implementation of the CNL role. Through the use of an illustration, the various roles and practice expectations of the CNL in advanced practice nursing are less ambiguous allowing the executives to clearly visualize the CNL role in the daily operations in the organization. The essential aspects of the CNL role include clinician, outcomes manager, client advocate, educator, information manager, systems analyst/risk anticipator, team manager, member of a profession, and lifelong learner is at the front for the illustration created by this author. The illustration provided by this author includes the inputs, throughputs, and outputs that impact the practice of the CNL. Applying this illustration as a discussion guide on the practice integration of the CNL role can unify the expectations among practice and administrative leaders.

Implementation of Simulation-Based End-of-Life (EOL) Care Training for Nursing Staff Sheena Y Hess, MSN, CNL; Sheni Meghani, MD

Michelle Ralston, BSN VHA

Topeka, Kansas Background: Many nurses receive little formal training in EOL care. Providing training that combines traditional lecture based principles with simulation technology is one way to promote high-quality EOL care. Method: 1.Tools: A.EOL Care Pathway: clinical protocol to manage EOL care B.EOL Care Training: didactic training on care pathway, symptom management, nursing interventions C.Simulation Scenario: patient care scenario using computer-controlled manikin D.Observer Evaluation Tool: to assess participants as they complete steps during simulation scenario E.Participant Evaluation Tool: to assess the effectiveness of training 2. Training: CNL, physician and educator provided training to nursing staff on a skilled nursing unit. Training consisted of EOL Care presentation followed by simulation scenario. Based on the scenario, participants identified common EOL symptoms, administered medications and provided care using a manikin. The Educator assessed the performance of participants using the Observer Evaluation Tool followed by a debriefing session. Participants completed a pre and post-training Participant Evaluation Tool rating their confidence with using the EOL Care Pathway. Outcomes: 1.A total of 40 staff participated in training. 2.Participants rated their confidence on a Likert scale of 0-5, 0 being no understanding of the EOL Care Pathway and 5 being fully confident in using the Pathway. The average pre-training score was 3.6, which increased to 4.5 after the training. 3.Using the Observer Evaluation Tool, it was noted that participants performed well (score of 4/4) in the areas of death pronouncement and postmortem care. The areas of care coordination (score of 1.4/4) and general patient care (score of 2/4) had opportunities for improvement. Summary Recommendations: 1.Simulation-based training has the potential to enhance confidence of nursing staff in providing EOL care. 2.Simulation training can assist in identifying components of nursing practice and areas of care that could be improved upon.

The Effects of Mock Codes on the Confidence Levels of Nurses Responding to Codes Sharon Frazier Hood, MSN Carolinas Medical Center Charlotte, North Carolina

During code blue events, nurses are usually the first respondents, the first link in the chain of survival, and are an important determinant in the patients’ outcomes. (Wilson, Phelps, Downs, & Wilson, 2010). On a busy medical surgical nursing unit at a large trauma I hospital, nursing staff experienced three code blues within a year. During these code blue events, Clinical Nurse Leaders observed a lack of knowledge, skills and coordination among the nursing staff responding to the code prior to the arrival of the hospital's code team. Nursing staff struggled to locate and utilize appropriate emergency medical equipment, and initiate high quality cardiac pulmonary resuscitation (CPR) in a timely manner. A delay in the initiation of high quality CPR decreases a patient's survival during a code blue event. A quasi-experimental design was used in this project. A mock code survey was created that measured the perception of the participants' confidence level pre and post interventions. Interventions consisted of an education session and random mock codes. The overall outcomes demonstrated a significant improvement. Post interventions, there was a 16% increase in the number of staff who strongly agreed that they felt confident recognizing a decline in a patient's medical status, a 24% increase in the number of staff who strongly agreed that they felt confident calling a code blue, and a 31% increase in the number of staff who strongly agreed that they felt confident performing CPR during the first 3-5 minutes of a code blue event. Based on the results obtained from this project, I recommend that hospitals perform random mock codes routinely to ensure that nurses are knowledgeable and confident when responding to code blue events.

Working Together To Achieve Success: An Interprofessional Approach To Reducing Length of Stay Jennifer Hubbard Kareivis, MSN, RN, CNL

Hunterdon Medical Center Flemington, New Jersey

Background: To provide the best patient experience, using a teamwork approach to transition patients safely and effectively to home/facility at discharge is key. Evidence suggests nursing-led coordination of care can positively impact length of stay and readmission rates (Forbes, 2014). On a Medical-Specialty Unit, the patient census decreased from 48 to 32 beds resulting in re-structuring and reassignment of the Patient Care Management and Social Work staff to facilitate care coordination. Goal/Methods/Programs/Practices: The goal was to formulate a new inter-professional team related to the recent changes. The team included the Patient Care Manager, Social Worker, Unit Director, and the Clinical Nurse Leader (CNL). A priority of the team was to improve communication between nursing staff, Patient Care Management and Social Work in order to facilitate care coordination. Roles of each discipline were discussed and shared with nursing staff to assist in the “who do I call when I need…?” The CNL facilitated education to staff, signs were posted around the unit to describe roles of each discipline, as well as phone numbers for the Patient Care Manager and Social Worker. Social Work began attending morning briefings to discuss discharge planning and shared the information with patient care management. Evaluating LOS and 30-day readmission rates are metrics used to measure efficacy. Outcome Data: Collaboration between Patient Care Management, Social Work, the CNL, and nursing staff has led to a decrease in LOS by 0.5 days (1st Quarter 2016 = 5.3 to 3rd Quarter 2016 = 4.9). The 30 day readmission rate dropped from 25 in January 2016 to 16 in September 2016. Conclusion: The improved, increased inter-professional communication between nursing, Patient Care Manager, Social Worker, and the CNL contributed to the successful decrease of patient length of stay as well as rate of readmissions on a Medical-Specialty Unit. Teamwork works!

Power of Nursing Leadership: Clinical Nurse Leader ( CNL) Role Implementation in Japan through Academic Clinical Collaboration

Asako Takekuma Katsumata, PhD, RN,CNL ASA Nurse Scholar Consulting

Rockford, Illinois Minami Kakuta, MSN, RN, CNL Saint Anthony College of Nursing

Rockford, Illinois Gordana Dermody, PhD, RN, CNL

Washington State University College of Nursing Spokane, Washington Kazuko Nin, PhD, RN

Kyoto University, Department of Human Health Science, Clinical Nursing Kyoto-city, Japan

There is an emerging interest in the Japanese nursing community in creating new nursing role that is generalist at the bedside and engages in patient care coordination. Currently, there is no CNL program established nor there is no certified CNL practicing in Japan. For the future implementation of CNL role, it is critical to develop a group of certified CNL faculty to facilitate to develop accredited CNL programs in higher education in Japan. Intense retreat style CNL review courses were offered as a joint effort with a Japanese Colleges of Nursing, a Japanese Red Cross Society, a College of Nursing in Illinois, and two Magnet hospitals. Seminar contents included historical context of CNL development, assumptions of the CNL role, transformational leadership, change theory, microsystem analysis, evidence based practice, emotional intelligence, complex theory, quality improvement, and cause and effect analysis. Over 60 qualified nurse leaders with master degree or above from throughout Japan completed this review program since 2014. Three regional consortiums are actively promoting sense of ownership of this initiative by meeting regularly to promote certification preparation processes. The participants are eligible to take faculty CNL certification exam with completion of clinical immersion experience with CNLs. Challenges identified throughout this seminar was that Japanese nurses struggled to shift their focus from traditional care provision to outcome and data driven approach. Some issues were presented how to facilitate inter-professional collaboration for patient care coordination and quality improvement. The issues were discussed with the traditional roles of the professions and current socio-cultural understanding of the physicians, and nurses’ roles. Implementation of certified CNL would be a significant change agent to advance Japanese nursing practice in the future. Continuous facilitation of CNL faculty development in Japan is critical to support advancement of nursing. Innovation and transformational leadership can impact advancement of nursing globally.

Using the CNL Role to Improve Cost, Quality, and Service Outcomes in Elective Total Joint Care Tammy Law, MSN, CNL

WellStar Health System/ WellStar Douglas Hospital Douglasville, Georgia

Background: The purpose of the project was to review and identify current and regional/national evidence-based care practices to reduce hospital costs which affect patient care and the financial stability of the orthopedic program with bundled payments. Objectives: To review current and evidence-based practices in elective total joint care. To reduce or maintain length of stay in elective total joint replacement patient microsystem To reduce or maintain readmission rate for elective total joint replacement patient microsystem System Transformation/Integration: The CNL assisted with Orthopedic Evidence-Based practice to manage hospital costs and improve processes while maintaining high and consistent patient satisfaction. As a part of the multi-disciplinary team, the CNL (as clinician/educator) reviewed bed side care for accuracy and process consistency. The CNL communicated missing quality elements and removed barriers within the team. Lean/Six Sigma methodology was used to focus on patient flow, investigate opportunities for improvement, and identify/remove process barriers. Outcomes: With patient focused initiatives, steps were removed, processes improved, patient satisfaction was high and maintained with 100% patient satisfaction feeling prepared for discharge readiness. The decrease in elective knee surgery ALOS reduction of $22,549.00, in 10 months, decreased elective surgery 30 day all-cause readmission sustainability with previous improvements $10, 200.00, decrease elective hip surgery ALOS/processes of care practice of $66,887.14, decrease elective hip surgery 30 day all cause readmissions during one performance period $12,300.00 with a total savings of $101, 736.14. Results/Summary: With a patient focused collaboration, patient satisfaction remained high while providing quality outcomes. The CNL facilitated patient focused care with team members with excellent outcomes in financial savings and thus making the business case, impact, and value for sustaining the CNL role.

copd mini rounds Catherine A Lorenzo, MSN; Hernande Augustin, MSN

WellStar Cobb Austell, Georgia

COPD was among the top chronic conditions driving unplanned 30-day readmissions from May 2014-April 2015. Data identified a lack of comprehensive and consistent multi-disciplinary rounding for COPD patients with an average of 18.5% for FY15. The goal of this project is to reduce hospital COPD readmissions by a minimum of 10% from the current baseline of 18.5% for FY15 to 16.65% for FY16. In November 2015, a focus group titled COPD Mini Rounds was created specifically to patient population, and to assist with any identified barriers to a safe discharge. This multi-disciplinary group consisted of Clinical Nurse Leaders (CNL), a Clinical Pharmacist, a Transitions Coach, a Respiratory Therapist, and a Care Coordinator. The CNL’s identified the COPD patient population on their units and worked with the interdisciplinary team to stream-line the process for identifying and resolving potential barriers to discharge for these patients. This collaborative approach improves patient quality and safety by facilitating focused and effective communication to address patients’ active-care needs, and to ensure a safe transition to the next level of care for this complex patient population. The most recent readmission data for this facility demonstrates a witnessed reduction for COPD 30-Day All Cause Readmissions from 18.6% (FY15) to 13.9% (FY16 through April). Furthermore, for COPD 30-Day All Cause Readmissions for patients ≥65 years and older, a witnessed reduction of readmissions from 23.1% (CY14) to 14.6% (FY16). The overall objectives and goals were successfully met as demonstrated by the witnessed reduction in readmission rates for this complex and high-risk patient population. The reduction in readmission rates indicates that our patients are being properly treated during their hospitalization and their active care needs are being adequately addressed prior to discharge.

Improving patient outcomes in a transfemoral transcatheter aortic valve replacement procedure. Lori M Lowry, RN-BC, BSN

Saint Francis Hospital and Medical Center Hartford, Connecticut Noel Harrington, MSN

BayState Medical Center Springfield, Massachusetts

Joslin Leasca, DNP Linda Cook, DNP

Sacred Heart University Fairfield, Connecticut

As the transfemoral transcatheter aortic valve replacement (TFTAVR) patient transitions through multiple units, the standard of care between units varies. There is a significant variation in post procedure length of stay after TFTAVR ranging from 1 to > 10 days for many reasons. With rising health care costs, there is an urgent need for effective, efficient, and continuously improving health care for all TAVR recipients. The potential for quality improvement exists with Clinical Nurses Leaders leading practice change and contributing to improved outcomes. There are limited caremap resources for nursing staff to refer to for the care of patients undergoing TAVR. Standardizing processes of care, and facilitating a safe transition to home which may decrease length of hospital stay might be achieved with the design and implementation of an evidence based caremap for the TFTAVR population. Methods utilized included a pre and post caremap implementation design measuring post procedure length of stay. As the result of this quality improvement project, preliminary results are presented that suggest that standardized patient care driven by the caremap has the potential to shorten patients’ length of stay, return patients to their baseline unit of functioning, and improve outcomes for patients. Keywords: transcatheter aortic valve replacement, standards of care, improved outcomes, caremap, clinical pathways

meds to beds Sonal Makin, MSN; Latesha Tsoungi, MSN

WellStar Cobb Austell, Georgia

According to population health data, 45% of Medicare patients are readmitted within seven days of discharge. Studies demonstrate that nearly one in three patients do not fill their first prescription after discharge. Strong correlation between medication adherence and readmission rates led to the development of an Interdisciplinary Transition of Care process focusing on improving patient access to medications and providing medication counseling prior to discharge. A rapid cycle process improvement study was conducted from May 9 through July 8, 2016 to determine the impact of 30-day all cause readmissions for adult patients admitted and discharged with a primary diagnosis of COPD, HF, or AMI. Patient’s discharged to skilled nursing facilities or hospices were excluded. The interventions provided were bedside delivery of medications (meds-to-beds) and medication counseling for patients who agree to have their prescription filled at the on-site retail pharmacy prior to discharge. The goal was to capture 30% of eligible discharges and achieve a readmission reduction of 5% for the intervention group compared with the non-intervention group. Thirty-day all-cause readmission rates were compared between patients who agreed to utilize the bedside medication delivery service and those who did not utilize the service. There was an observed reduction in readmission rates for the intervention group of 12% over the 9-week study period compared with the non-intervention group. In addition to the achieved outcomes, it was estimated that the cost avoidance resulting from the reduced readmission rates for meds-to-beds patients was $78,780.00. Due to the success of the pilot study, the health system has committed to adding transition of care clinical pharmacists to the hospital in order to improve our ability to target high-risk patients who could benefit from meds-to-beds services. The process will be optimized for sustainability and transferability to all other hospitals in the system.

Hardwiring Bedside Shift Report( BSSR) Elizabeth C Mathew, MSN,RN, CCRN, CNL; Shakeithra Hodges, MSN,RN NE-BC

Karen Aylor, BSN,RN; Molly Alex, MSN, RN, NE-BC camelle Samuels, MBA, BSN, RN

Michael E. DeBakey VA Medical center Houston, Texas

Objective of the quality improvement project was to hardwire bedside shift report to promote a culture of patent centered care, ensure patient safety by exchange accurate and useful information during shift change and improve patient experience which impacts patient satisfaction. The practice change was implemented on a 25 bed med surgical unit. Background: Observation and surveillance with the current hand off communication during shift change revealed noncompliance on critical elements of BSSR during shift change. Literature review reveals that BSSR improves patient involvement and safe transition of care between providers in addition to promote trust with caregivers which impacts patient satisfaction. Joint commission recommended a standardized BSSR as a patient safety goal to improve patient safety. The method utilized was Lewis‘s theory of change, unfreezing, moving and refreezing. Prior to implementation, data collected through direct observation and surveillance on the current practice of exchange information during shift change. Formed group and elicited feedback on perceived barriers. Benefits of BSSR discussed with staff and how to address perceived barriers. Education provided with role play and PowerPoint presentation. Developed standardized bedside shift report tool with patient information and critical elements in SBAR format. BSSR was implemented successfully with support of staff and leadership. Outcome: Direct observation on post implementation data showed an increase in proficiency as measured by critical elements of BSSR and an increase in nursing specific patient satisfaction indicators and press ganey patient satisfaction report. Patient satisfaction rate improved from 86.1% to 92.5% on press ganey report, patient experience improved from 91% to 98.3% and communication improved from 82.2% to 93.2% on Shared hospital experience for patients (SHEP) survey. BSSR Disseminated to sister units. Plan to implement BSSR throughout facility by March 2017 Recommendation: Continued team dialogue, coaching, and rounding by the leadership team will be integral in sustaining BSSR.

A Clinical Nurse Leader's Journey to Decrease Aspiration Pneumonia Rates Jennifer A. Morgan, MSN, CNL; Samantha Stone, MSN

Robley Rex Veteran's Affairs Hospital Louisville, Kentucky

At the Robley Rex Veteran’s Affairs Hospital the CNL is responsible to review data in his/her area to identify areas for improvement. One of the sources of this data is the Strategic Analysis for Integration and Learning (SAIL) data center. While reviewing this data it was noted that one area for improvement was in the hospital acquired conditions, specifically pneumonia. We had a rate of 11 cases of hospital acquired pneumonia in the month of April, 2016 which put us above the national average for the complexity level of our hospital. The data was drilled down to the patient specific information to look for trending in the group of HAP cases. It was discovered through this process that a majority of the patients were diagnosed with aspiration pneumonia. This prompted us to look into our current protocols and assessments of patients in order to prevent aspiration pneumonia, what we discovered were a lack in recognition and identification of those with aspiration difficulties. We brought together a multidisciplinary team of nurses, physicians, dieticians and speech pathologist in a quest to identify our weaknesses and to come up with a solution. We went through several of the patient specific scenarios that helped us determine the deficiencies and look for ways to promote best practices. We discovered a lack of education on the nurses and nursing aide side on the true definition of aspiration precautions and how they affect the direct care of the patient. In response we put together a multi-system aspiration bundle to help decrease our aspiration cases. The bundle involved components of education, system redesign and protocol changes. This bundle has resulted in a reduction of 50% in our pneumonia cases to date and continues to improve.

Clinical Nurse Leaders: Improving Flow and Capacity Between Two Hospital Facilities Heena Vallabhji Nagarji, MSN, RN-BC, CNL; Valerie Denise Short, MSN,CMSRN,CNL

Carolinas Medical Center Charlotte, North Carolina

Our practice setting is a Level I Trauma Center (TC) that serves as a teaching facility with multiple designations including Magnet and NICHE. As the mothership of our healthcare system, our TC accepts the highest acuity level of patients often resulting in transfers from other smaller less-equipped facilities. In order to maintain superior clinical care quality the CNL role was initiated in 2008 with the first unit go-live in 2010. The role was quickly spread to other medical-surgical units throughout the TC, focusing primarily on work within the microsystem of the unit. Within the last few years this role has advanced at our TC to focus on care within the mesosystem. Our TC, like many others comparable in size, mostly operates at an above capacity state. In 2016, a plan was constructed to level the patient load between the above capacity TC and the below capacity sister facility which has less than 200 beds. The premise behind facilitating these transfers to the sister facility creates bed availability at the TC and increases the flow efficiency within the ER thereby improving flow and capacity of the entire organization. Two CNLs were identified to help lead this initiative. The CNLs collaborated with a LEAN sensei to create specific medical pathways to screen patients in the ER. A daily goal was set to transfer 10 patients to the sister facility with each transfer taking less than 80 minutes. A workflow was created by the CNLs to provide structure and coordinate the transfer process from transfer request time to departure time. The CNLs collaborated with the leadership team from both facilities, bed management, medic, and the ER providers to streamline this transfer process. This project has already made a significant financial impact with goal-exceeding outcomes to the organization by increasing patient volume and revenue.

Let’s Show More PC! Palliative Care = Improving the Patient’s Quality of Life Alexander D. Nava, MSN, RN, CNL; Melanie Hanes, BSN, RN, CCRN

Texas Health Resources Plano, Texas

Background In 2013, a suburban mid-sized hospital in the Southwestern United States formed an inpatient palliative care (PC) team consisting of an advanced practice nurse (APRN), social worker, chaplain, and physician. A multidisciplinary hospital committee met monthly to track the number of PC referrals, consults, and 30-day readmission rate. Despite educating the nursing staff, the number of PC referrals were below expectations. In 2016, the PC team asked the CNL team to initiate referrals and consults for appropriate patients. Methods For each patient, the CNL utilizes a PC criteria sheet on whether to order a referral. The CNL documents the rationale for the referral in the order. Each CNL chairs a daily care briefing (DCB) to discuss their patients' barriers to discharge and interventions to decrease their risk of readmission. During the daily care briefing (DCB), the CNL indicates the appropriateness of a PC referral with other healthcare disciplines. Outcomes The number of PC referrals by the CNL team in 2016 has doubled in six months compared to the previous year. The addition of a CNL intern in the ICU has dramatically increased the number of PC consults from the single digits to the hundreds. The all cause readmission rate has decreased from 6.4% to 4.6% since palliative care has been utilized as an intervention to reduce the risk of readmission in chronic disease patients.

CNL Team Collaboration Improves Institutional Central Line Flush Practice and Financials Sonja Orff, RN, MS, CNL; Carrie Strick, RN, MS, CNL, CMSRN

Maine Medical Center Portland, Maine

Background: An innovative Normal Saline Flush project presented at the 2015 Summit stimulated six Maine Medical Center CNLs to investigate central line practice and documentation. During a software conversion, scheduled normal saline flush orders were omitted, directly impacting the ability to audit documentation. With approximately 14,000 central line days a month, data showed only 756 scanned flushes in March 2016. Alteplase usage was high, with some patients receiving multiple doses. These data suggested the need for education and order sets supported by evidence based practice. Methods: The CNLs led an interprofessional team from pharmacy, the central line team, and informatics to address central line flush practice. Using evidence from the literature and a survey of hospitals, the team developed scheduled and prn electronic Central Line Order sets, and audited central line flushes. When best practice recommendations varied; the team selected 12-hour saline flushes by consensus. The order sets were built so that the number of flushes to be given coincides with the number of central line lumens. Partnering with the central line team, staff development and unit educators, a standardized educational plan was developed prior to implementing the order sets in May 2016. Outcomes: Comparing March and October 2016, the number of central line flush orders increased from 1196 to 7049, a 489% change in workflow. Scanning documentation increased from 62% to 75%, and the number of scanned medications improved from 756 to 5519 (630% change). In eight months, this represents approximately 3 million revenue recovered. Conclusions and Implications for Practice: An organizational system that supports CNL-led, collaborative initiatives greatly benefits quality patient care and institutional financials. Our next steps include collecting data concerning saline flush volume, developing strategies to improve unit-specific scan rates and further investigation of Alteplase to target educational needs that are aligned with evidence based practice.

Impact of Social Media Technology in Healthcare to Improve Patient Quality and Outcomes: Imperatives and Challenges for 21st Century Nurse Leaders

Carol M Patton, Dr. PH Drexel University

Waynesburg, Pennsylvania There is no doubt that healthcare informatics and technology is going to playing an even greater role in 21st century healthcare delivery systems particularly in the area of patient quality and outcomes. There is increased impetus and pressure for healthcare organizations to integrate healthcare informatics and technology into the United States healthcare system as a result of President Obama’s pledge of $50 billion dollars over 5 years to meet the goal that every American will have an electronic health record by 2014. Not only are healthcare organizations and healthcare providers being mandated to integrate healthcare informatics and technology by external federal policies but there is also growing external force to integrate social media technology to engage with patients in a variety of ways. For example, some healthcare organizations are communicating with patients through social media technologies to better meet patient and consumer demands, needs and expectations. As a result of increased patient and consumer demands some healthcare organizations are using email to send laboratory results to patients and to schedule patient appointments. It is imperative for nurse educators to integrate knowledge, skills, and competencies for master’s prepared nurses in graduate nursing programs. The purpose of this presentation is to: 1) Define “social media technology”, 2) Discuss evidence-based strategies for best practice on integration of social media to engage patients/consumers in healthcare organizations; 3) Examine challenges using social media technology to engage with diverse patient populations to enhance relationship-based care, 4) Identify strategies to integrate social media technology to enhance quality healthcare experiences, and 5) Explore the role of clinical nurse leaders regarding social media policies internal and external to the healthcare organization.

Up Times Three Improves Functional Mobility in the Elderly Cynthia B Presley, MSN, RN, CNL, PCCN

Texas Health Harris Methodist Hospital Southwest Fort Worth Fort Worth, Texas

Functional decline, resulting from decreased mobility has been identified as the leading complication of hospitalization in the elderly. Research suggests that 30-50% of the inpatient elderly experience functional decline. Nurse-driven interventions have shown to improve outcomes such as reduction in falls. During the NICHE designation process, the need to improve elderly population outcomes through increased mobility was identified. The CNL replicated an EBP project, utilizing a multi-disciplinary team approach to improve compliance with activity orders in patient age >65 years of age as evidenced by increased mobility and decreased fall rates. Mobilization was defined as into chair at mealtime. The CNL led a team comprised of NICHE taskforce members, which included bedside staff, nurse educators, ancillary staff, and leadership. Staff education was provided regarding the importance of mobilizing the elderly population. The “Up Times Three” initiative assisted patients > 65 with activity orders out of bed and into chair at mealtime. During rounding, the CNL provided education to patients and families regarding the initiative, and encouraged patients to be “up to chair” for meals. Check boxes on the whiteboards were used to monitor progress. Activity orders were discussed during Daily Care Briefing, a CNL led multidisciplinary meeting regarding barriers and plans for discharge. Information was disseminated though daily huddles, Emails, and staff meetings. Compliance was measured by direct observation, chart and whiteboard audits. A midpoint review identified inconsistent documentation and lack of specific activity orders. Tip Sheets were provided to staff and the CNL reached out to providers. Activity in our elderly population increased from 25% to 89.9%. Fall rates decreased by 47%. Staff improved documentation by 50%. Providers are now including specific activity orders. Efforts continue to hardwire this process. This project highlights the CNL role in improving the quality and outcomes of the microsystem.

Perception is Reality: How a Clinical Nurse Leader Strengthened Working Relationships between Nursing Assistants and Nurses on a Pediatric inpatient Unit

Angie Ramsey, MSN; Mallory Lexa, BSN UNC Health Care

Chapel Hill, North Carolina Background: More than half of today’s healthcare workers are categorized as Nursing Assistants (NA); turnover among these workers is a notable problem in healthcare systems nationwide. A major factor that plays into this turnover is the NAs’ perceptions of a lack of respect for their role and a lack of teamwork and communication between NAs and other members of the inter-professional team. These factors lead to job dissatisfaction and inconsistencies in the timely completion of patient-care tasks. Methods/Design: To test the effect of pairing NAs and RNs together for teambuilding, an eight-hour workshop was created which focused the importance of the NA role and practicing strategies for meaningful dialogue between registered nurses (RNs) and NAs. NAs were paired with RNs and anonymous collection of perceptions about “positive” and “negative” aspects of NA to RN interactions at the workplace were collected. The first half of the workshop utilized teamwork principles to engage NAs in practicing strategies for improved communication. The second half of the workshop included participation in a unique board game that allowed both disciplines to collaborate on improving their relationships using role play and in-action debriefing. RN/NA pairs were also given interactive activities and work-related projects on which to collaborate over the next six months. Results: Post-project surveys and NA charting audit results both show an immediate, overwhelmingly positive outcome. Currently, data collection is still in progress and focused on a pre/post survey among the NAs to determine if relationships are continuing to improve. Recommendations: NAs are a large portion of our workforce but the way in which their relationships with other disciplines affect patient care is often underestimated. It is recommended that hospitals identify the gaps surrounding this vital relationship and utilize creative, engaging and safe improvement processes to enhance it.

Improving Safety in the Emergency Department: Early Recognition of Escalating Patient Behaviors Laurie A. Schwartz, MSN Mercy Health Saint Mary's Grand Rapids, Michigan

An increasing number of psychiatric patients presenting in the emergency department (ED) census (including those demonstrating violent behaviors) prompted this CNL to explore how to engage staff in recognizing escalating behaviors. By recognizing these behaviors interventions could be implemented with patients earlier to prevent violent episodes thus increasing staff and patient safety in the ED. The Broset Violence Checklist had already been implemented within the Psychiatric Medical Unit (PMU) in this same hospital and within a neighboring psychiatric hospital and was chosen as the tool to be introduced. An interdisciplinary approach was organized by this CNL to educate and implement the tool within the ED. Education was completed about the tool and its use with the ED nursing and medical provider staff with the help of the PMU RN staff using didactic and patient scenarios. Electronic medical record documentation options were explored and documentation standards were set. Daily chart auditing and mentoring of staff was then employed. Competencies of all RNs were validated at an educational "blitz" six months after education. Surveys were conducted with the PMU and the psychiatric hospital staff for verification of ED RN knowledge and use of the tool. Through use of this violence checklist tool a "common" language has been established between the ED nursing staff, PMU staff, ED providers, and outside psychiatric hospital. Early awareness of escalating patient behaviors demonstrate a downward trend of staff injuries (with continued tracking) and decreasing rates of restraint use by earlier pharmacologic and non-pharmacologic interventions. Monitoring of these rates are ongoing within this ED and this tool has proven to be an effective, sustainable way for staff to recognize and intervene early to prevent violent behaviors from occurring.

Model C Graduates Transition to Practice Bobbi Shatto, PhD; Kristine L'Ecuyer, PhD

Geralyn Meyer, PhD Saint Louis University

St. Louis, Missouri Background: Graduates from Model C CNL education programs enter nursing with masters of science in nursing degrees and have advanced leadership training. It is unknown if the experience of transition to practice of Model C CNL students is different than traditionally educated nurses. Even though Model C programs have existed since 2005, there is little research on how these graduates transition to staff nurse roles, leadership roles, or the role of a Clinical Nurse Leader. A recent CINAHL and Ovid search revealed only one published research study which addressed this topic and that study focused on the clinical immersion of the CNL student and ended one year post graduation. Purpose: This study explored the transition to practice experience of graduates from our first cohort of Accelerated Masters of Science in Nursing program. The aim was to assess how they were using their advanced degrees after three years of practice. Methods: Semi-structured telephone interviews lasting an average of 45 minutes each were conducted. Fifteen of the 21 graduates chose to participate. The interviews were transcribed and coded for themes. The themes were checked and agreed upon by all investigators. Outcomes: The themes included use of their advanced degrees, use of CNL competencies, career trajectory, loans/debt, and satisfaction with their decision to pursue an accelerated master’s program. The majority were happy they pursued a master’s degree, but many of the students were not sure it was worth the amount of debt they incurred as a result of their program. Results were mixed concerning utilizing their CNL competencies but the vast majority said they were not currently using their advanced degrees fully

38% Falls Reduction in a Mental Health Residential Setting Nadine A Terese, CNL

Veterans Affairs Eastern Kansas Healthcare System Topeka, Kansas

Approximately 50 Veterans Affairs Medical Centers include a Mental Health Residential Rehabilitation and Treatment Program (MHRRTP) called a Domiciliary. Common diagnoses include substance abuse and post-traumatic stress syndrome (PTSD) and admitted Veterans are expected to independently perform Activities of Daily Living (ADLs). Despite these criteria, the 120-bed Eastern Kanas Domiciliary experienced the medical center’s highest number of falls (42) during FY 2015, therefore selected as the FY 2016 focus area by the hospital’s Falls Prevention Root Cause Analysis (RCA) team. The facility’s Mental Health CNL was appointed as the project lead with resulting outcomes including a 38% reduction in resident falls and $16,000 in cost savings, with actual savings likely higher given the Centers for Disease Control and Prevention (2009) cost estimate of $17,086 for a single fall with injury. Nursing was at the forefront of a multidisciplinary approach that partnered with medical providers, pharmacy, patient safety personnel, and rehabilitation technicians (administrative and general oversight staff). Nursing staff were educated on the nature of Domiciliary falls and refreshed on Morse Fall Score assessment along with related VA practice guidelines. Nurses were also encouraged to fully work within their scope of practice in the performance of both pre-and post-fall assessments resulting in a 43% decrease in residents sent to the Emergency Department. Additional interventions included Domiciliary-wide staff education and practice changes, including tools for direct care staff to help identify, monitor, and actively communicate about high fall risk residents, and performance of frequent environmental assessments. This project’s successful outcomes demonstrate the CNL's ability to significantly impact patient safety and increase nursing empowerment through evidence-based education tailored to the microsystem, improved multidisciplinary collaboration, and effective clinical leadership. CNLs in any area of care can apply these lessons by identifying gaps in best practice and creating tools to facilitate improved knowledge and outcomes.

Prevention of Avoidable Hospital Acquired Pressure Ulcer Using Two RN'S Skin Verification in the Initial Skin Assessment

Tessy B Thomas, MSN, CCRN,CNL; Smith Jason, MSN Molly Alex, MSN,NE-BC

Michael E DeBakey VA Medical Center Houston, Texas

Objectives: The objective of the quality improvement project was to prevent the incidence of an avoidable hospital - acquired pressure ulcers by using two registered skin verification at the time of admission. The practice change was implemented in a medical-surgical unit with a bed capacity of 25. Background: Prevention of hospital-acquired pressure ulcer (HAPU) is a constant challenge in the medical surgical floors. In the Fiscal year 2015, there were six incidences of pressure ulcers in the unit. Analysis of the charts of patients who developed pressure ulcers showed that six of these HAPU’S were avoidable and there was a lack of comprehensive skin assessment at the time of admission. Literature review shows that a comprehensive skin assessment and early preventive measures can reduce the incidence of HAPU. Method: A Plan Do Study Act (PDSA) model was used for the project implementation. Prior to the project implementation, observation of current admission skin assessment, and chart audits on initial skin assessment in 100 admissions was done. Only 65% of charts showed proper skin assessment at the time of admission. The staff was educated on the need of skin assessment, Braden scale documentation, and staging of pressure ulcer. Prior to implementation of the project, staff meetings were conducted and discussed the perceived barriers for project implementation. The staff was encouraged to come up with solutions to overcome the barriers for implementation of the project. With continued support and guidance from leadership and management, the project was implemented successfully. Outcome: The incidence of HAPU dropped from 6 to zero and admissions skin assessment admission improved from 65% to 90%. Two RN verification is disseminated to the other surgical units and the plan is to spread facility-wide by May 217. Recommendation: Staff empowerment, adequate staffing, celebrating success, and continued teaching is necessary for sustainability.

Accurate Mobility Assessment to Prevent Falls Latesha Denise Tsoungui, MSN, RN, CNL

WellStar Cobb Hospital Austell, Georgia

Introduction/Background: From January – June 2015, the number of correct assessment of patient’s mobility after surgery is at 50% reliability rate at WellStar Cobb Hospital 4 North Surgical, 33 bed unit. This causes patients to get up without proper fall precaution instructions and fall. There were 12 falls between January - June 2015 at WellStar Cobb Hospital 4 North Surgical Unit. The average fall cost is $11,402. These falls from 4 North have cost the hospital approximately $136,824 ($68,412 from inaccurate mobility assessment). Methods: The Lean Six Sigma process was used to identify the root cause and to provide a resolution. Through direct observation and chart reviews it was identified that many falls had occurred with patients that did not have an accurate fall assessment. A team was developed to assist with the education of the nurses on how to complete an accurate mobility assessment on patients. Results: July – September 2015 the falls decreased to a total of three. The cost for these falls was $34, 206; one of these falls was from inaccurate mobility assessment at a cost of $11,402. However, this fall was on 07/07/15 before the implementation date of 07/24/15. Therefore, the total potential savings from this project on correcting inaccurate mobility assessment is $68,412. Discussion: This initiative improved the safety and quality of care provided to the patient. There was a significant cost savings to WellStar Cobb Hospital from 4 North Surgical. The staff is more aware of the mobility status of their patient. Conclusion: There is an ongoing process to hardwire this initiative by implementing: Reminders during huddle; Random chart reviews; Involvement of Cobb 4 North Leaders, staff, patients, & family; Changing practice to be proactive instead of reactive; 200% Accountability

Implementing a Patient-Centered Admission Binder in an Inpatient Leukemia Unit Jessica Vaughn, CNL

The University of Texas MD Anderson Cancer Center Houston, Texas

On an inpatient leukemia service, educational disparity was identified in the care continuum from diagnosis and transition to outpatient status. Patients admitted through outpatient services received educational materials, whereas those admitted emergently had no educational opportunities. Patients are not able to attend educational classes due to strict isolation protocol lasting for approximately 28 days and education resources are not readily available. Literature cites factors related to educational access as multimodal, including institutional barriers related to care coordination. The need for innovative information dissemination was supported by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). In December 2015, 85% of patients were satisfied with the discharge information received whereas only 70% of patients perceived adequate care transitions. The aim of this program was to develop an admission resource binder to improve HCAHPS Discharge and Care Transitions domains by 5% in a-six month period. The resource binder provided essential information related to new diagnosis, roles of interdisciplinary team members, available online patient care resources, and discharge information. Utilizing the patient-centered approach, the Clinical Nurse Leader (CNL) collaborated with nursing, medical, and interdisciplinary care teams, as well as patients and family caregivers in completing this project. The CNL purposefully met with patients on admission and throughout their length of stay to discuss and organize the binder according to treatment goals and care plans. During the first phase of project implementation, Discharge and Care Transitions scores increased to 90.6% and 72.9% respectively. Leadership rounds yielded positive patient feedback on how the binder provided critical information throughout the treatment trajectory. The second phase commenced August 2016 whereby the focus is engaging staff as champions for this initiative. Collaborative partnership with the patient education team is underway to ensure equal and easy access for both inpatient and outpatient providers.

Patient-Nurse Therapeutic Engagement as a Predictor of Improved Patients' Experience and Clinical Outcomes

SERGE WANDJI, MSN Charleston VA Medical Center

Charleston, South Carolina Introduction: Common nursing practices such as: Patient assessment, patient communication, education, and timely nursing intervention are widely implemented at in-patient settings. Low patient satisfaction results, raise questions about the historical practice of "therapeutic connection" as a healing variable for patients' positive outcomes. Background: Consecutive below average patient satisfaction scores, coupled with personal observation of nursing staff failing to actively engage with patients, prompted a Clinical Nurse Leader (CNL) call for action. Satisfaction patient survey identified four main themes: A decreased trust in providers and staff, a decreased in patients satisfaction with treatment, a decreased in treatment adherence, and a decreased in patients' quality of life and hope. These patient reports are consistent with prior literature findings, (Dziapa, K. and Ahern, K,;2009); (Larsen, J. et al; 2008) Description of Methods: The process of developing and implementing a CNL-initiated "effective patient engagement" routine consisted of : Developing, defining and communicating the value of staff-patient engagement; Promoting the implementation of a patient engagement by selling its "WHY" value proposition; Providing mentorship that promotes growing self-awareness; Influencing staff scheduling adjustment that facilitate and promote therapeutic relationships; Outcomes/Data: This CNL initiated and led intervention, increased the overall patient experience score from 38 percentile to 75 percentile in just three months. The total number of seclusions and restrains in any form, during those first three months period was zero. Summary Recommendations: The key to eliciting the staff's behavior change toward developing therapeutic relationships with their patients lies in the CNL's commitment to model the desired behaviors, encouraging and providing positive reinforcement for the staff and most importantly, having the leadership support of our Chief Nursing Education and the Chief Nurse Officer. Further studies that identify cost savings for both the medical facility and the patient as a direct result of patient engagement is recommended.

Decreasing Unnecessary EKG and Pulse Oximetry Alarms in the ICU Laura Warburton, MSN

St. Vincent's Medical Center Bridgeport, Connecticut

Sally Gerard, DNP Fairfield University

Fairfield, Connecticut Background: The increasing number of technical alarms has caused nursing staff to become desensitized to the alarms leading to a delayed response time. This can compromise patient safety and lead to sentinel events. The purpose of this study was to decrease the number of false/unnecessary electrocardiogram (ECG) alarms and pulse oximetry alarms that occur in the 14-bed Intensive Care Unit (ICU) and 16-bed Progressive Care Unit (PCU) at St. Vincent’s Medical Center. St. Vincent’s is a 473- bed community teaching hospital located in Bridgeport CT and is part of the Ascension Health Network. Methodology: The interventions involved multiple approaches to reducing alarm errors and unnecessary alarms. These interventions included education for nursing and ancillary staff regarding proper skin preparation for electrode placement and storage, education to nurses on how to safely tailor alarm parameters to meet the individual needs of their patients, and working with a team to change policies on the default settings of the EKG monitors. Data/Results: The data was collected from the central monitors where patient alarms are recorded. Multiple data points were collected during a seven-day time frame both before and after interventions were implemented. The total number of alarms that occurred in a 7-day time frame in the ICU pre-intervention was 14,041. The total number of alarms post intervention decreased to 8150, which is a 42% decrease. In the PCU the total number of alarms that occurred in a 7-day time frame pre-intervention was 11,292. The total number of alarms post intervention decreased to 5198, which is a 54% decrease. Limitations: Changing the default settings on the EKG monitors was not able to be completed because the hospital decided to invest in new monitors which may have resulted in inaccurate data collection. Recommendations: A multi-pronged approach can help decrease unnecessary EKG and pulse Oximetry alarms.

Effecctive Mass Notification improves Patient Safety Donna B. Whitehead, MSN; Comfort Gbadebo, MSN

WellStar Kennestone Regional Medical Center Marietta, Georgia

Objective/Purpose: Improve communication between Administrative Nursing Supervisors (ANS) and nursing units and ancillary departments facility wide during night and weekend shifts. As CNLs, we were able to identify a gap in communication and strategically seek a permanent solution. Multiple nursing units and ancillary departments were unable to receive real time communications through mass notification in a 633 bed Level 2 trauma center. Significance: Infective communication can lead to increased length of stay, delayed diagnoses, medical treatment errors and other outcomes that negatively impact health care systems. Additionally, ineffective communication has been identified as the leading factor contributing to sentinel events. The Joint Commission has established improving staff communication as a 2016 National Patient Safety Goal. Method/Description: The effectiveness of the mass notification process was evaluated over a 90 day period. Units of measure included the number of nursing units and ancillary departments that received mass notifications along with the amount of time utilized by ANS facilitating communication for nursing units that failed to receive mass notification. Interventions include literature review, baseline data collection, designing a new platform, unit notification strata, universal access, individualized departments and accountability review. Findings/Outcomes: Confirmation of receipt of mass notifications increased from 20% to 98% for all aggregate areas. ANS time spent on notifying individual units decreased from 30 minutes to less than one minute consistently. Conclusion/Implications for Practice: Consistency of mass notifications has increased trust between leaders and individual departments. Timely notification with real time feedback has improved patient safety. For example, after mass notification, team members were able to find a lost patient immediately. Another example is after mass notification; team members were able to prepare to receive patients from a public protest demonstration.

Using Dry-Erase Boards to Improve Nurse Communication Scores David M. Wolf, BSN

Texas Health Resources Plano, Texas

Enhanced communication promotes health and well-being, improves patient outcomes, and reduces readmissions by improving both patient adherences to the treatment plan and self-care skills (Street et al., 2008). In a study performed by Booth-Thomas (2007), dry erase boards decreased the discharge time by four hours for patients discharging home and decreased the discharge time by an hour and a half for patients transferring to a skilled nursing facility. However, the study performed by Booth-Thomas (2008) involved using dry erase boards to communicate information solely to hospital staff members, not to patients or their families. This project sought to determine if consistently updating dry erase boards in the patient rooms to communicate important information, specifically goals for the day, patient preferences, and when the next pain medicine dose is due, to patients and their family members/visitors will improve nurse communication scores. After educating the staff about the project, two CNL students performed daily dry-erase board audits to assess for compliance in updating the boards. The unit manager created a binder to document coaching/applause opportunities for each staff member. Anytime a fall-out occurred, either the CNL students, unit manager, or nursing supervisor provided coaching to the staff member and documented it in the binder. To track improvement in nurse communication scores, the team leader ran a weekly report of received Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Staff compliance in documenting on the dry erase boards went from 72% pre-intervention to 93% post-intervention. Nurse communication scores improved from the third percentile to the 85th percentile on received HCAHPS surveys. Dry erase boards are a fairly inexpensive way to improve nurse communication scores on a medical-surgical unit as long as the unit leadership holds staff members accountable for using them.

Back to Basics Joselyn Wright, MSN, CMSRN, CNL; Heather Helton, MSN, CMSRN, CNL

Lisa Fry, BSN Carolinas Medical Center Charlotte, North Carolina

Objectives/Purpose: The purpose of this study is to review fundamentals of nursing to improve the quality and safety of patients. The clinical question for this study is: What is the effect of implementing a monthly multimodal educational intervention on knowledge of medical telemetry nurses and medical errors? Background: On a medical telemetry unit, several incidents jeopardizing patient safety and quality occurred in 2016. The unit’s care event reporting data showed 28% medication errors, 23% related to patient falls, and 10% inadequate treatment. The unit has attained 28 falls year-to-date, as well as other hospital-acquired. Oftentimes the staff focus on the completion of tasks, leaving fundamentals to the wayside. The clinical nurse leaders (CNLs) determined the need for new evidence-based practice projects in the setting of inadequate care. Methods: Care event data was collected by the CNLs. A multimodal educational plan for each topic was developed; including testing, inservices, videos, and hands-on development activities. The first month’s topic was emergency responsiveness. The nursing staff received a pre-test prior to education. A multimodal education was provided, utilizing a PowerPoint and video. Hands-on demonstrations were conducted. Following simulation, a debriefing feedback session occurred. The staff reflected and developed tactics to improve future performance. After the education, the staff completed a post-test to determine if knowledge is improved. Each month, the team will meet and repeat the process for the following month’s educational plan. Outcomes/Data: Each month, staff knowledge will be analyzed using a t-test. Nurse-sensitive indicators will be utilized to determine the effectiveness of education based on the monthly topic. For the first month, the results of the pre- and post-test demonstrated a statistical significance with a p-value of 0.003. The goal is to continue to achieve a statistical significance of p<0.05 to indicate that the educational intervention for each month was effective.