providence holy cross 2009 nursing annual report

Nurses of PROVIDENCE

2009 Nursing Annual Report

MissionAs People of Providence, we reveal God’s love

for all, especially the poor and vulnerable, through our compassionate service.

seulaV eroC Respect

All people have been created in the image of God. Genesis 1:27We welcome the uniqueness and honor the dignity of every person.We communicate openly and we act with integrity.We develop the talents and abilities of one another.

Compassion

Jesus taught and healed with compassion for all. Matthew 4:24We reach out to people in need and give comfort as Jesus did.We nurture the spiritual, physical and emotional well-being of one another and those we serve.We embrace those who are suffering.

Justice

This is what the Lord requires of you: act with justice, love with kindness and walk humbly with your God. Micah 6:8We believe everyone has a right to the basic goods of the earth.We strive to remove the causes of oppression.We join with others to work for the common good and to advocate for social justice.

Excellence

Much will be expected of those who are entrusted with much. Luke 12:48We set the highest standards for ourselves and for our ministry.We strive to transform conditions for a better tomorrow while serving the needs of today.We celebrate and encourage the contributions of one another.

StewardshipThe earth is the Lord’s and all that is in it. Psalm 24:1We believe that everything entrusted to us is for the common good.We strive to care wisely for our people, our resources and our earth.We seek simplicity in our lives and in our work.

The PROVIDENCE

CommitmentThe work of the Nurses at Providence Holy Cross Medical Center is guided by the

following foundational precepts:

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PROVIDENCE HOLY CROSS MEDICAL CENTER was founded in 1961

to provide healing and health care to the San Fernando, Santa Clarita and Simi Valleys.

A 254-bed, not-for-profi t facility, the medical center offers both inpatient and outpatient

health care services, including state-of-the-art Cancer Centers, a Heart Center, Orthopedics,

Neurosciences and Rehabilitation Services as well as Women’s and Children Services.

Located in the San Fernando Valley of Southern California, Providence Holy Cross Medical

Center has a medical staff representing more than 600 physicians and nearly 50 specialties.

SERVICES INCLUDE:

Cancer

Heart & Vascular

Women’s Services

Orthopedics

Neuroscience

Rehabilitation

Subacute

Surgery

Digestive Disorders

Trauma & Emergency

STATISTICS OF INTEREST (2009):

Employees: 1,700+

Medical Staff: 600+

Licensed Beds: 254

Births: 2,938

Admissions: 15,229

Average Daily Census: 230.9

Outpatient Visits: 59,501

Emergency Room Visits: 61,591

Trauma Cases:1,588

Inpatient Surgeries: 5,469

Outpatient Surgeries: 1,912

Average Inpatient Length of Stay: 4.59

2009 Nursing Leadership• Betty Newsom, RN, MS, CNAA, Chief Nursing Offi cer

• Jerilyn Brown, RN, OCN, Director Patient Care Support Services

• Linda Coale, RN, BSN, MBA, Magnet Program Director,

and Transformation of Care Project Leader

• Tricia Burkholder, RN, BSN, Director Maternal Child Health

• Annette Cordero-Britton, RN, BSN, Director of Occupational

Safety, Health and Wellness

• Jane Flaherty, RN, MSN, CNS, PCCN, CCRN, Director Education

• Ken Archulet, RN, Manager Epidemiology and Infection Control

• Yvonne Gaffney, RN, BSN, MBA, CNOR, Director

Perioperative Services

• Patty Mayberry, RN, Director Clinical Project Implementation

• Debbie Bergida, RN, BSN, OCN, CMSRN, Manager Medical Surgical

• Missy Blackstock, RN, Manager Emergency Department

• Kate Connolly, RN, Manager Sub Acute and Acute Rehabilitation

• Cindy Damboise, RN, BSN, MSN, MHA, PCCN, CCRN,

Manager Telemetry

• Jennifer Fulton, RN, BSN

• Sherri Friedrich, RN, MSN, FNP-BC

• Tim Gilmore, RN, MHA, Manager Special Projects/Data Support

• Joanna Kuzmak, RN, BSN, CCM, Manager Case Management

• Pam Rick, RN, BSN, Manager Intensive Care Unit

• Barbara Rozewicz, RN, MSN, CCRN, CMC, NP-C, Manager Cardiology

• Carrie Sayeski-Reid, RNC, BSN, BC-In Patient OB, Manager

Outpatient Diagnostic Center

• Ronda McPhail, RN, Clinical Nurse Leader Labor and Delivery

• Barbara Thomas, RN, CMSRN, Clinical Nurse Leader Medical Surgical

• Cathy Yee, RN, MSN, CCRN-CSC, Clinical Nurse Leader

Cardiology Wellness

• Crystal Akao, RN, BSN, CCRN, Modifi ed Clinical Nurse

Leader Telemetry

• Heinrich Huerto, RN, BSN, ONC, Modifi ed Clinical Nurse Leader

Medical Surgical

Table of ContentsMessage from CNO 3

Introduction 4

Transformational Leadership 5

Structural Empowerment 8

Exemplary Professional Practice 12

New Knowledge, Innovations & Improvements 18

Empirical Quality Outcomes 26

Awards & Accomplishments 30

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2009 Nursing Leadership• Betty Newsom, RN, MS, CNAA, Chief Nursing Offi cer

• Jerilyn Brown, RN, OCN, Director Patient Care Support Services

• Linda Coale, RN, BSN, MBA, Magnet Program Director,

and Transformation of Care Project Leader

• Tricia Burkholder, RN, BSN, Director Maternal Child Health

• Annette Cordero-Britton, RN, BSN, Director of Occupational

Safety, Health and Wellness

• Jane Flaherty, RN, MSN, CNS, PCCN, CCRN, Director Education

• Ken Archulet, RN, Manager Epidemiology and Infection Control

• Yvonne Gaffney, RN, BSN, MBA, CNOR, Director

Perioperative Services

• Patty Mayberry, RN, Director Clinical Project Implementation

• Debbie Bergida, RN, BSN, OCN, CMSRN, Manager Medical Surgical

• Missy Blackstock, RN, Manager Emergency Department

• Kate Connolly, RN, Manager Sub Acute and Acute Rehabilitation

• Cindy Damboise, RN, BSN, MSN, MHA, PCCN, CCRN,

Manager Telemetry

• Jennifer Fulton, RN, BSN

• Sherri Friedrich, RN, MSN, FNP-BC

• Tim Gilmore, RN, MHA, Manager Special Projects/Data Support

• Joanna Kuzmak, RN, BSN, CCM, Manager Case Management

• Pam Rick, RN, BSN, Manager Intensive Care Unit

• Barbara Rozewicz, RN, MSN, CCRN, CMC, NP-C, Manager Cardiology

• Carrie Sayeski-Reid, RNC, BSN, BC-In Patient OB, Manager

Outpatient Diagnostic Center

• Ronda McPhail, RN, Clinical Nurse Leader Labor and Delivery

• Barbara Thomas, RN, CMSRN, Clinical Nurse Leader Medical Surgical

• Cathy Yee, RN, MSN, CCRN-CSC, Clinical Nurse Leader

Cardiology Wellness

• Crystal Akao, RN, BSN, CCRN, Modifi ed Clinical Nurse

Leader Telemetry

• Heinrich Huerto, RN, BSN, ONC, Modifi ed Clinical Nurse Leader

Medical Surgical

Providence nurses embrace their heritage of compassion, courage, and leading-edge care as a steadfast, sacred presence in protecting and easing the way for those in need.

Our Providence Holy Cross Medical Center Nursing Philosophy Statement refl ects the unique theoretical underpinnings of our approach to nursing care and professional development:

In concert with the mission and core values of Providence Holy Cross Medical Center, our professional nursing staff is dedicated to the promotion of health and wellness as the basis for nursing practice. In collaboration with the healthcare team our nurses attend to patient needs with the highest level of ethics, judgment, confi dentiality and respect for human rights, dignity and diversity. It is our belief that a holistic and caring environment nurtures and supports the patient on a journey toward self care. We are responsible for illuminating the path and competently leading the way.

Our Nursing Vision Statement

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Message from CNO

Caring, Compassion and

Competence are three

words that carry a special

meaning for the nurses

of Providence Holy Cross

Medical Center. These

three C’s are integral to

our nursing philosophy

and our model of care.

Dear Colleagues,

As we move into our third year of being a Magnet Organization, the drive for nursing excellence remains a major focus at Providence Holy Cross Medical Center despite the downturn in the national economy and California’s growing fi nancial problems.

Larry Bowe, who came in April to Providence Holy Cross Medical Center as our new Chief Executive, has been very supportive of Magnet. His focus is on patient satisfaction, driven by excellent care, provided by nurses.

At Providence Holy Cross, the strong positive culture that exists enhances our ability to adapt to change and to move forward with innovative ideas spurred by shrinking fi nancial resources, regionalization of operations within Providence’s California facilities and a growing list of regulatory requirements.

Th e achievement of high quality outcomes and other successes continue to bring awards and other accolades to Providence Holy Cross as demonstrated by the following pages in the 2009 Annual Nursing Report.

Sincerely,Betty Newsom, RN, MSChief Nursing Offi cerProvidence Holy Cross Medical Center “

”

Introduction

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SAN FERNANDO & SANTA CLARITA VALLEYS’ DEMOGRAPHICS

Total Population: 2,089,774 SFV SCVChildren (0-17 years) 25.1% 28.1%Adults (18-64 years) 63.7% 64.3%Seniors (65+ years) 11.2% 7.6%

Ethnic Composition SFV SCVCaucasian 40.2% 63.0%Latino 41.6% 23.3%Asian/Pacifi c Islander 10.3% 6.7%African American 3.6% 3.3%Other 4.3% 3.7%

Payor Mix SFV SCVMedi-Cal 24.6% 14.2%Medicare 34.0% 25.7%HMO 19.4% 30.7%PPO 10.5% 20.6%Other 11.58% 8.8%

Percent of Uninsured SFV/SCV Children (0-17 years) 8.0%Adults (18-64 years) 20.0%

Magnet Model

Characteristics of Our Physicians, Nurses & Staff First community hospital in Los Angeles County to receive Magnet Status for Nursing Excellence from the American Nurses Credentialing Center (ANCC)

Recognized by HealthGrades® as being among the top 5% of all hospitals in the nation for clinical excellence—four years in a row

Nurse vacancy rate remains below the national and state average at 2% (as of February 2010)

Total number of certifi ed nurses: 130 (as of March 2010) More than 650 physicians on staff , representing more than 50 specialties

Characteristics of Our CommunitiesProvidence Holy Cross serves more than 2 million people:

San Fernando Valley: Densely Populated; Highly Ethnically Diverse; Growing Uninsured Population

Santa Clarita Valley: Young Families; Highly Educated; One of the Fastest Growing Areas in Southern California

EMPIRICALOUTCOMES

STRUCTURALEMPOWERMENT

NEW KNOWLEDGE,INNOVATIONS &IMPROVEMENTS

TRANSFORMATIONALLEADERSHIP

EXEMPLARYPROFESSIONAL

PRACTICE

Glo

ba

l Issues in Nursing and Health C

are

The Dance©

by Linda Harrington, RNC

This poem was written by a Providence Holy Cross nurse, Linda Harrington, for the Magnet Art Room. Many of the nurses who read this poem were inspired and some even cried because of its powerful message. This poem expresses the Providence Holy Cross nursing belief in the development of nurses through Benner’s Novice to Expert Theory.

I am a new grad.Fear and anxiety are my constant companions. I am often on the brink of tears: my feelings of inadequacy are overwhelming at times.I am positive that I learned nothing in nursing school.I am fi lled with doubt.Th e nurses around me are moving to music I cannot hear.Gracefully and effi ciently they complete their tasks. I watch this ballet of competency, fearing I will never learn the dance.For now, I will mimic the steps as best I can.

Time passes……

A metamorphosis occurs.Experience dispels the uncertainty I once felt.I realize it was not expected that I feel comfortable.A novice never does.Mentors emerge; acting as choreographers, they demonstrate the intricacies of the dance.Th ey insist on perfection and practice.Th ey move aside when they are sure I’ve learned the steps.I’m beginning to hear the music.Humming the melody, I join in the dance.

Time passes…………

Th e music has become a symphony and I dance with confi dence. Profi cient and specialized, I am considered an expert now.I thrive on the complexities of this Art Form called Nursing.As a mentor I seek center stage; I share my skills, I teach. Knowledge is handed down and passed on. As the performance continues, so too, does the expertise of the dancers.

Th is evolution of excellence cannot be stopped.

Time passes………….

I’ve been dancing for a long time now.On some days the music is faint or even mute. Perhaps it’s time to leave the theater.I close my eyes and can’t help wondering why I still do this.I decide to relax and take refuge in the silence.

Th e brief intermission is interrupted by a request for help.An anxious new grad has a question about her patient’s deteriorating status.We discuss theory and collaborate on a new strategy. Without missing a step, the dance continues.

Th e novice nurse takes action and the patient’s condition improves.

Th e patient senses relief and whispers, “Th ank you”. Th e novice smiles, a new skill has restored her confi dence, gratitude has restored her spirit.I walk away feeling fortunate to have been a part of this magical exchange.

I didn’t notice exactly when it resumed, but I hear the music again.

Th e reward of the moment reminds me why I still do this… I’m addicted to the music….. ....I love the dance.

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Th e day before a team of Providence California leaders headed to Tijuana to help families build homes, we asked Ken Keller, Regional Director of Physician Business Services, to send us occasional updates: On Friday morning, 16 Providence California Region leaders headed to Tijuana for an annual Ministry Leadership experience helping a community development fund that works with families to build homes. Th e backdrop is one of extreme poverty, but one tempered by a strong sense of community and a shared drive to work together for a better future. Ken called in Monday with poignant messages of the group’s fi rst few days of their fi ve-day project south of the border. Th e fi rst thing that hit the group as they crossed the border was the contrasts, Ken said. From the lush hills of San Diego to the barren ones of Tijuana, the scenery drew a line between the “haves” and the “have nots.” And once in Mexico, the crew saw further contrasts in the new sparkling factories that were built among Tijuana’s shanties.

But it wasn’t long before this crew realized the riches these families share. “We’re realizing after three days of work that we’re gaining so much more from this experience than we can give these people,” Ken said. Th e Providence group was split to work on two diff erent homes. One group spent the day digging foundations and trenches in very compacted clay, grueling work under the hot sun. Th e second group laid blocks with cement, backbreaking yet very satisfying labor, the kind where the sense of accomplishment is immediate. Th e lessons learned this day centered on Community and Family. “Th e group is forming into a family,” Ken said. “We, as people of Providence, came down to help as part of a larger group. Even though these families don’t have a lot, they are very proud of what they do have and they are supportive of each other. Th ey work harder than all of us out here. Th ey’re open, willing to give, charitable – again we took away more than we gave.

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Global Issues in HealthcarePROVIDENCE HEALTH & SERVICES EL SALVADOR IMMERSION TRIPTricia Burkholder, RN, BSN In November 2008, I had the opportunity to participate in an immersion trip to El Salvador with Providence Health & Services. Our group consisted of clinical and nonclinical staff from Providence facilities in Southern California, Washington and Oregon. While there, we provided health screenings and basic medical care during home visits in rural areas in addition to working on community service projects. We screened and treated many with chronic health conditions such as hypertension, diabetes, kidney failure and malnutrition. We also provided treatment for acute illnesses and participated in a lot of health education. It was a gift to practice the

very basics of nursing with minimal supplies but still accomplish so much. Poverty was rampant, but a clear sense of community was evident. We interacted with a number of grassroots agencies that were dedicated to improving health care and education. We were able to assist with fi nancial support and donated medical supplies. Highlights of the trip included visits to a local hospital, an HIV clinic and a community organization making natural medications. We had many opportunities to interact with the local people to discuss their struggles and hopes for the future as well as observe and learn about their culture.

PROVIDENCE HEALTH & SERVICES TIJUANA IMMERSION TRIPKen Keller, Regional Director of Physician Business Services

Managers involve staff at all levels of the organization. Nurse leaders make

an effort to communicate with staff, and staff members feel their opinions

are heard and valued by management.

Accountability & evidence-based standards of care are chief among the leadership standards at Providence Holy Cross Medical Center. Under the guidance and mentorship of our Chief Nursing Offi cer, Betty Newsom, nursing leadership has helped propel our nursing staff towards several benefi cial changes in 2009. Betty Newsom, RN, MSN, CNAA, Chief Nursing Offi cer and Linda Coale, RN, BSN, MBA, Magnet Program Director led our Magnet Committee through a review of our foundational nursing philosophy and theoretical base. Th ere was a high level of learning and recommitment to our continuing Magnet Journey as we prepare for our re-designation in 2011. Our strategic plan for nursing, with input from and fi nally presented to nurses at every level allows our leadership to work within the department of nursing to promote excellence and continuous improvement. Our patient satisfaction scores, nursing employee satisfaction scores and our physician satisfaction scores demonstrate a shared commitment to provide outstanding patient care and to promote a healthy work-place environment.

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Transformational Leadership

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MAGNET RETREAT - OCTOBER 2009


Our Magnet Retreat began with our experienced Magnet champions pinning green Magnet ribbons on our newest Magnet champions. Th us began an exciting day of renewed commitment, learning, discussion, planning and shared decision-making. Agenda items included icebreakers for welcoming in our new champions, and trivia games to help energize us in the morning. Educational sessions on shared governance and nursing philosophy were followed by active discussion and planning. An especially meaningful session centered on revising our visual model of nursing care from the 3Cs of Nursing at PHCMC: Caring; Compassion and Competence, to the 4Cs of Nursing at PHCMC: Caring; Compassion; Competence and Collaboration.

Our overall objectives were certainly realized: 1. List the Magnet Components and the 14 Magnet Forces that reside within them. 2. Discuss aspects of their department that fi t into two diff erent Magnet Forces. 3. Discuss the vision and philosophy as it currently exists and proposed changes. 4. Identify the model of care and discuss application of each aspect to nursing care at PHCMC. 5. Compare and contrast the nursing theories of Patricia Benner and Jean Watson 6. Defi ne shared governance. 7. Discuss two aspects of shared governance in a nursing department at PHCMC. 8. Compare and contrast the concepts peer review and peer evaluation.

Th e following is a comment received by a newly Magnetized participant:

I just wanted to thank you all so very much for all of your time and eff orts that went toward hosting such a FABULOUS meeting. As a “newbie” I learned so much and how fortunate and grateful am I to work with such an incredible group of experts!! Th ank you AGAIN!!

Achieving Excellence in an Evidence Based Practice Environment

PH&S Nursing VisionStatement

Mission and Core Values

Patient and Family

PHCMC Nursing Philosophy

9


A SAMPLING OF THE PHCMC NURSING STRATEGIC PLAN 2009

By 2011, Nursing at Providence Holy Cross Medical Center will strive

to achieve 7% net operating income while achieving 90th percentile

performance on all national quality measures.

Continue development and expansion of Advance Care and

Palliative Planning Program

Continue to identify Foundation grant support opportunities

Integrate services in the PH&S Valley Service Area

Prepare staffi ng model for hospital expansion

Stroke Program/Certifi cation

ADA Recognition/Certifi cation for Diabetic Services

Construction of new patient expansion

Outpatient services such as radiology and lactation will be

expanded to Porter Ranch

Reduce premium pay management

Implement initiatives to achieve Corporate Quality Strategic Plan

Clinical Reliability Index – 94% (AMI, SCIP, Pneumonia, HF)

Nursing sensitive indicators above the mean or median

Patient Safety Index (Falls, Critical Values, Medical Records)

Observed vs. Expected Mortality – OE Ratio < 1 (.73)

Magnet re-designation 2011

STRATEGIESCOMMITMENTS

Hire RNs and MD for program

Employee capital campaign

Standardization process and documentation

In partnership with human resources, form teams for specialty areas

to explore, discuss and plan staffi ng

Hire NP for stroke program, develop policies and procedures based

on best practice; develop and implement education program for

staff; submit application for certifi cation

Work with manager of diabetes services and diabetes educators to

address standards for compliance

Nurses at the bedside will be involved as appropriate in decision-making

for equipment, technology, processes and models of care delivery

Construction in progress

Reduce use of registry and traveler support by fi lling vacancies and

reduction in turnover rate

Enhance quality audit team and tracer committee; develop and

distribute Falls newsletter; expand email to all employees at PHCMC

and distribute selected quality measure data for increased awareness;

utilize quality improvement processes

Gap analysis completed with action plan developed and leads

designated for each component

PHYSICIAN, NURSING &PATIENT SATISFACTION Despite increasing patient volumes, our satisfaction scores remain high.

PHYSICIAN SATISFACTION* 99th Percentile for overall quality of care

99th Percentile for Emergency Department

94th Percentile for quality of nursing staff

NURSING SATISFACTION 85% would recommend Providence to others as a great place to work

87% are extremely satisfi ed with Providence as a place to work

PATIENT SATISFACTION 92.1% of patients would recommend the hospital to others (Press Ganey)

* 2008 Survey


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Structural EmpowermentNurses are seen as essential to the hospital’s delivery of patient care.

Th e professional practice environment at Providence Holy Cross Medical Center is based on our Mission, vision and core values to achieve exemplary patient outcomes with a nursing staff that recognizes its vital role within our hospital as well as our larger community. Continuing programs in 2009 toward these objectives included our Nursing Clinical Ladder program and reimbursement for education and certifi cations. Th ese programs recognize the importance to the individual nurse and the organization of continuous professional growth. A Perinatal Collaborative has been formed among the fi ve Providence Hospitals in Southern California. It is a forum for nurses and physicians in the perinatal areas to share best practices, plan improvements in information technology, human resources and quality as they relate specifi cally to perinatal care. A highlight of this initiative has been a regional plan for perinatal documentation that will deploy early in 2010. Another program that has begun to unfold with great success is our palliative care program. Th ese structural improvements will be followed in 2010 with our long-awaited structural achievement-our new addition. As we watch the construction we know that the active planning by nursing staff will allow us to provide the optimum care for our community.

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In 2009, we celebrated the ongoing construction of our new patient care wing by signing beams that would become part of the framework of the project. Th is community event brought our physicians, nurses, staff , community leaders and community members together to celebrate the new patient wing. Th e 138-patient bed expansion will help us care for the increasing number of patients who have been coming to the hospital over the past few years. Additional medical-surgical beds, telemetry beds, a GI Lab and a new Women’s Pavilion featuring Labor/Delivery/Postpartum suites and a 12-bed NICU will be part of this new wing. Th e incredible excitement of our staff at Providence Holy Cross was evidenced by the successful employee campaign to support our new wing. Our employee campaign was led by Carrie Sayeski-Reid, RN, BSN, and Sherri Mendelson, RNC, CNS, PhD, with the assistance from a multidisciplinary group of employees from various departments in the hospital. Th ere were 77 employees who formed fundraising teams. Th rough this four-week employee campaign, nearly 600 employees off ered personal donations to raise more than $600,000 for the new patient wing.

Structural Empowerment

EMPLOYEE CAMPAIGN FOR NEW PATIENT CARE WING


CLINICAL LADDER FOR NURSES Last year we introduced our Clinical Ladder for non-exempt Registered Nurses. Th e Clinical Ladder policy and application process includes fi ve levels based on Patricia Benner’s novice-to-expert theory.

Level I RNs are at the novice level that includes newly graduated RNs. Level II RNs have an expectation of competent clinical practice.Level III, IV and V RNs demonstrate additional achievements at increasing

levels of competency and involvement in four categories: clinical practice, shared governance, research and education.

We proudly present our 2009 Clinical Ladder Participants:

Kimberly Crabtree-Loyd, PACU, Clinical Ladder Level V Sherri Mendelson, Education, Clinical Ladder Level V Cynthia Funakoshi, Education, Clinical Ladder Level IV Terri Gately, Education, Clinical Ladder Level IV Tanya Haight, Education, Clinical Ladder Level IV Melinda Gruman, Labor and Delivery, Clinical Ladder Level IV Linda Harrington, Labor and Delivery, Clinical Ladder Level IV Yajaira Angulo, Labor & Delivery, Clinical Ladder Level IV Debbie Welch, Telemetry, Clinical Ladder Level IV Sherri Friedrich, Telemetry, Clinical Ladder Level IV Kathy Cadden, ICU, Clinical Ladder Level IV Carole McKennan, ICU, Clinical Ladder Level IV Christina Consolo, ICU, Clinical Ladder Level IV Terrie Bybee, Medical Surgical/Oncology, Clinical Ladder Level IV Barbara Russo, Special Care Nursery, Clinical Ladder Level III Kristina Shannon, Labor & Delivery, Clinical Ladder Level III Teodora Tiongson, Medical Surgical/Oncology, Clinical Ladder Level III Ingrid Blose, Medical Surgical/Oncology, Clinical Ladder Level III Sylvia Pacis, SubAcute, Clinical Ladder Level III Terri Halverson, Emergency Department, Clinical Ladder Level III Aurora Tweddell, Education, Clinical Ladder Level III

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Our Palliative Care Program at PHCMC has been signifi cantly enhanced this year through the leadership of Barbara Whitlatch, Manager, and Leah Phillips, RN, BSN, PHN, Palliative Care Clinician. Th e program aims to work with physicians to provide symptom management, pain management, end-of-life care, advanced care planning, and to serve as a liaison for other support services off ered to patients. Th e following was an education posting for telemetry staff : Palliative Care Versus Hospice Debbie Welch, RN, PCCN, Assistant Manager, Telemetry Palliative care can be defi ned as, “an approach that improves the quality of life of patients and their families, facing the problems associated with life-threatening illness, through the prevention and relief from suff ering, by means of early identifi cation, impeccable assessment, treatment of pain and other problems physical, psychosocial and spiritual” (Sepulveda et al., 2002; World Heath Organization, 2002).

Th e goal of palliative care is to prevent and relieve suff ering and to support the best possible quality of life for patients and their families, regardless of the stage of the disease or the need for other therapies. Th is care is provided by an interdisciplinary team who identify physical, psychological, spiritual, and practical burdens of illness. Goals include; enhancing quality of life for patients and family members, helping with decision-making, and providing opportunities for personal growth. Palliative care can be rendered along with life-prolonging treatment or as the main focus of care. Hospice care is a service delivery system that provides palliative care for patients who have a limited life expectancy and require comprehensive biomedical, psychosocial, and spiritual support as they enter the terminal stage of an illness or condition (National Quality Forum, 2006). Hospice supports the patient through the dying process and the surviving family through the dying and bereavement processes. Hospice provides comprehensive medical and supportive services across a variety of settings and is based on the idea that dying is a part of the normal life cycle. Traditionally, the current practice of Hospice and Palliative Care is: terminally ill patients have a long trajectory of curative treatment(s), followed by palliative care (if all treatment is deemed to be futile) and then a short period of time with hospice. Th e goal is for palliative care to receive the same focus as curative care. Patients receive attention to the prevention and relief of suff ering by means of early identifi cation and impeccable assessment. Th e goal is not always specifi cally about cure, but rather improving the quality of life for both the patient and his/her family. Th e patient may be actively receiving treatment for symptoms of the disease (e.g. surgery, radiation, etc) at the same time they are receiving palliative care. When the patient is at the terminal phase of their illness then hospice care would take over along with bereavement support.

“You matter because you are you. You matter to the last moments of your life, and we will do all we can, not only to help you die peacefully, but to live until you die” Dame Cicely Saunders

PALLIATIVE CARE PROGRAM GROWS


LIBRARY SUPPORTS NURSING EDUCATION AND RESEARCH Th e Strazerri Library at PHCMC is fortunate to have Caroline Elman, MLS,and Pam Gay, Library Assistant, serving our nurses. Th rough our nursing journal collection, nursing books, and their assistance with securing on-line resources, our nurses are supported as they delve into evidence-based practice, nursing research or in continuing their education.

PROVIDENCE CALIFORNIA REGIONAL PERINATAL COLLABORATIVE AND PERINATAL DOCUMENTATION PROJECT

A Providence California Region Perinatal Collaborative was formed in 2009 to maximize resource sharing and standardization of best-practice processes. Among the signifi cant work that has resulted from the team eff ort, a wide area network perinatal documentation project was proposed to regional administrative groups and funded in 2009. Documentation consumes excessive amounts of nursing time and directly infl uences the quality of clinical practice, research, administration and education. Poor documentation of care not only impedes communication among providers, but often complicates defense against malpractice claims. Th is project has signifi cant IS implications. Th e intention was to form a clinical/IT partnership to maximize use of perinatal documentation systems in each of the fi ve California ministries. Th is partnership developed best practice for perinatal documentation, maximized computer effi ciency within our region and created the algorithms to deploy these evidence-based documentation practices. A perinatal computer documentation process must make best use of information technology and clinical practice. A perinatal steering committee from all fi ve hospitals within the Providence Health & Services region was formed. Best practice for Labor and Delivery care is represented by the steering committee to translate into the perinatal documentation program. Th e project directors interfaced with a multidisciplinary team to implement the documentation system and assure that needs were met in diverse areas such as medical records and pharmacy.

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Exemplary Professional PracticeNurses are allowed and expected to work autonomously, consistent with

professional standards as members of a multidisciplinary team.

Patient and family advocacy within a framework of nursing excellence is the key to nursing role satisfaction leading to excellent patient outcomes. Providence Holy Cross Medical Center is a Magnet Designated hospital for excellence in nursing, as well as Baby Friendly Designated for promotion of breastfeeding as the optimal method for infant nutrition. During our yearly Nurse’s Week Celebration we recognized peer-nominated nurses in several key categories. Members of the Magnet Committee and some interdisciplinary leaders were asked to share their thoughts on nursing. Th ey answered the question: what do you believe about nursing? An example of the outstanding interdisciplinary collaboration at PHCMC is shared in a heartfelt letter from Maternal-Child Nursing to the Critical Care Nurses. Also in 2009 our eff orts to reduce catheter-related urinary tract infections and to recognize and provide early treatment for those present on admission was a resounding success, again demonstrating the exemplary profession practice of the nurses at PHCMC.

Exemplary Professional Practice

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NURSES WORKING TOGETHER AS A TEAMTh e following communication was sent by a nursing director following a successful outcome on an unusual high-risk obstetrical case. Th is highlights the wonderful teamwork at all levels and across disciplines enjoyed at our hospital.

“Birthing Babies in the ICU” I would like to recognize the teamwork and eff orts by ALL involved in the care of a very high-risk OB patient yesterday. Th is woman came in thru the ER and was transported to L&D. She had a very complicated history with many high-risk factors and could not safely be transferred to another facility. Th e decision was made to care for her in the ICU with both L&D and ICU nurses providing care to meet all her needs. A plan was formulated to be able to deliver the preterm infant in ICU in order to safely monitor and provide care for the mother as well. Th e patient progressed so quickly that the baby was actually delivered by the L&D nurse. Special Care Nursery and Respiratory Th erapy attended to stabilize this preterm infant who is currently being cared for in SCN. Mom remains in ICU for observation and care. A safe outcome was achieved for both Mom and baby with the help of all involved. A special thanks to the ICU resource nurse and the anesthesiologists involved in this case. Th ey were actively involved in assessing her risk and assisting in formulating her plan of care and were readily available to assist in any way necessary. An anesthesiologist was present for the actual delivery. Th e teamwork demonstrated in this unusual case is what PHCMC is all about. Please recognize and express my thanks to all the individuals involved in the care of this patient and her baby.

Tricia Burkholder RNDirector Maternal Child HealthProvidence Holy Cross Medical Center

Exemplary Professional Practice

“Like orchestra conductors, nurses coordinate our patients’ care in a harmonious melodic fashion. Unforeseen staccato surprises may arise, yet our nurses draw us through with their compassionate leadership, thus setting the tone for our patients’ care experience.” Edna Banayat, RD, Manager, Patient Clinical Nutrition Services

“To be a nurse is to be a compassionate being ready to care for those who need healing. I believe it’s the critical thinking skills, clinical experience and most importantly the ability to communicate and educate clearly that makes for this brave profession. In an industry fi lled with multiplying duties, advanced technology and endless expectations, it is a nurse who shines the excellence of care.” Eddie Avedekian, PharmD, Manager Pharmacy Operations

“Would you ask a bird to explain why it fl ies? Th e bird fl ies because he was born to fl y. It is a gift the bird possesses, he simply does it. I practice nursing because I was born to do this.Nursing is a gift I was given, I simply share it.” Linda Harrington, RNC, Labor and Delivery

“Nursing is a profession that allows for ingenuity, passion, critical thinking, autonomy, collaboration and personal growth while caring for individuals, families and communities ….this I believe is nursing.” Ronda McPhail, RN, CNL, Labor and Delivery

“Nursing is the skeleton of a body. Th e skeleton (nursing) provides the structure (coordinating medications and treatments), support (human touch and compassion) and movement (implementing the treatment plan) of the body. Some see the beautiful face (the building),or handsome body (the physician) that could not exist without the skeleton. ” Barbara Lange MS, CCC-SP Supervisor,

Speech Pathology

“Nursing sometimes means you get a lot more letters after your name than RN. I believe that education is an ongoing process for nurses, that nurses have a responsibility to learn and question new patient care procedures and treatments. Nursing education and practice should be evidence-based. Nurses are the primary source of healthcare delivery and patient advocacy, they need to stay current with education and best practice.” Terri Gately RN, BS, MS, CRRN, RN-BC, DSD,

Acute Rehab/SubAcute

“Nursing is a calling that is not for everyone. Nursing is about health and wellness; a belief that relationships, caring and education can heal the body and the spirit. Nurses combine caring, technical skills, critical thinking and teamwork for success in patient care. Nursing is the ultimate love for mankind.” Sherri Mendelson, RNC, CNS, PhD, Nursing Education

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NURSES WHO INSPIRENurses on our Magnet Committee, as well as various members of the multidisciplinary team were asked to write a short statement on THIS I BELIEVE ABOUT NURSING:

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New Knowledge, Innovations & ImprovementsStaff nurses participate in the quality improvement process and believe

that it helps improve patient care within the organization.

Quality outcomes are the end result of increased nursing education, support for nursing innovation and research, and continuous quality improvement that are the expectation of all nurses at Providence Holy Cross Medical Center. We encourage educational attainment through tuition reimbursement programs and on-site bachelor’s degree and master’s degree programs. Our education department off ers a full complement of continuing education programs to keep our nurses up to date on current evidence-based knowledge in many specialty areas as well as comprehensive didactic and practicum programs for new graduate RNs. Our educators work within their specialty to mentor and teach nurses both in the classroom and in the clinical environment. Our disaster planning for the entire community demonstrates our commitment to implement our new knowledge. Th e excellent results we attained through the 4A transformation of care project will be shared throughout PHCMC as innovative programs are trialed on a small scale and then implemented house-wide as improvements are demonstrated.

New Knowledge, Innovations & Improvements

PREVENTING FALLS WITH TEAM ROUNDING PREVENTING FALLS ON THE ONCOLOGY UNIT was a very successful program instituted on the Oncology Unit by Tanya Haight RN, OCN, MSRN, ONC; Kathy Christian, RN, BSN, OCN, CMSRN; Ingrid Blose, RN, CMSRN; and Mona Rojas, RN with the support of their Manager, Debbie Bergida, RN, MSN, OCN, CMSRN.

Signifi cance and Background: Among patients with cancer, the risk of falls increases. Th is can occur as a result of the disease process itself and of cancer treatment. Older adults undergoing cancer treatment have a signifi cantly higher risk and occurrence of falls compared to oncology patients not undergoing cancer treatment. Th e Joint Commission has identifi ed the need to reduce patient falls and implement risk reduction strategies. It has identifi ed root causes as related to caregiver communication issues and environment of care.

Purpose: Th e purpose of this 45-day pilot study on the Oncology unit was to introduce an evidence-based intervention that identifi ed patients at increased risk for falls and ultimately prevent falls, while improving both caregiver and patient communication. Team Rounding was suggested as a risk reduction strategy that would comply with the Joint Commission recommendations.

Intervention: Th e interdisciplinary team was composed of the Oncology/Medical-Surgical staff . Th e Rounding Team observed the patient, the room environment and assessed the patient for the “Th ree P’s (pain, potty and positioning). Lead nurses on the pilot study provided weekly feedback on a designated form and off ered suggestions for improvement. Based on this feedback, Team Rounding was scheduled every two hours during day shift and every hour during night shift.

Evaluation: After 45 days the Team Rounding pilot study was anonymously evaluated by the Oncology/Medical-Surgical staff using a four-point Likert Scale measuring six elements pre and post implementation. Staff compliance with Team Rounding was 100%. Team Rounding increased general awareness of patients at increased risk for falls, unit acuity and individual patient needs, in addition to preventing actual patient falls. Patient satisfaction scores increased and falls decreased 80% over the course of the study and 65% for six months afterward.

Discussion: Because of the signifi cant reduction in falls on the Oncology unit, Team Rounding was successfully implemented hospital-wide with the same positive results. In addition to signifi cantly preventing patient falls and resultant injuries, Team Rounding provided the added benefi ts of improved interdisciplinary communication, safe nursing practice and quality patient care.

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INNOVATIVE SOLUTIONS TO CRITICAL EMERGENCY PREPAREDNESS NEEDS Our Disaster Committee has demonstrated continuous commitment to planning for safety during any of the potential disaster situations that may occur in Southern California. A Magnet-designated Level II Trauma hospital in Southern California has helped create and implement several innovative solutions to critical emergency preparedness needs. One of these innovative solutions addresses the need of educating both clinical and non-clinical staff on how to safely conduct mass decontamination operations. Th e training curriculum includes 16 online training modules coupled with 8 hours of practical training. Th e training modules are computer-based and Continuing Education Unit (CEU) accredited. Th e online training provides staff members with Just-in-Time (JIT), annual refresher and competency-based training with it being accessible by staff at any computer. Two other areas have also been addressed. Th e fi rst addressed providing the hospital with a back-up emergency oxygen delivery system to back-feed their patient care areas with oxygen from their bulk storage in the event the hospital’s rigid underground oxygen-delivery pipes are severed during an earthquake. Th e second addressed providing hospital staff with a multi-use mobile hospital command center trailer. As an alternate or back-up hospital command center complete with its own multi-facetted communications room or as an area to triage victims of a mass casualty or pandemic event are just a couple ways in which this trailer can be used. Th e mass decontamination training program, oxygen back-up system and mobile hospital command center trailer have been identifi ed by several agencies as being hospital-based “Best Practices.” A writer for the Joint Commission, Environment of Care News interviewed emergency preparedness management staff for published articles on these innovative solutions; published dates scheduled for January and February 2010.

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PREVENTING VENOUS THROMBOEMBOLISM A variety of educational techniques were utilized in 2009 at PHCMC to assist our nurses in achieving exemplary professional practice including newsletters and on-line education programs through Healthstream. One example is our VTE Newsletter by Terri Gately, RN, BS, MS, CRRN, RN-BC, DSD.

Monitoring for VTE

NEWSLETTER DATE: JUNE 2009 PROVIDENCE HOLY CROSS MEDICAL CENTER

VTE—Update

�� There are also check-off boxes for contraindications t o P h a r m a c o l o g i c prophylaxis.

�� The items on the VTE risk assessment filled out by the nurse, are listed on the back of the MD Order Set.

�� NOTE: Remember to fill in the reason the patient is on an anticoagulant if one was ordered prior to admission

�� There is more information on the Internet, here are a few good sites:

http://www.vteconsultant.com/vteconsultant/VTE-patients.html

http://cme.medscape.com/viewarticle/560804

http://www.redorbit.com/news/health/509941national_quality_forum_edorses_consensus_standards_for_prevention_and_care

�� Did you know that VTE is still considered the n u m b e r o n e preventable cause of hospital deaths?

�� That VTE is the most common cause of readmission to the hospital after hip replacement surgery?

�� Prevention is the key to reducing the risk of developing VTE and death. The National Q u a l i t y F o r u m recommends regular a s s e s s m e n t o f p a t i en t s f o r r i s k factors.

�� Last year PHCMC a d o p t e d a r i s k assessment tool for VTE. The tool is filled out each shift on the Meditech screen and a

risk score of 0, 1, 2 or 3 is determined.

�� If the patient is at risk and there is no order for VTE prevention, an MD Order Set is placed on the chart by the nurse.

�� If the existing order is not consistent with prevention guidelines, an order set needs to be placed on the chart as well.

�� Nurses need to have a conversation with the physician to make sure they are aware of the order set and guidelines for prophylaxis.

�� G u i d e l i n e s f o r thromboprophylaxis and contraindications are listed on the order set for the physician to check off.

Recommended Guidelines for Ordering Thromboprophylaxis

If the patient’s risk factor is 1 (low risk) the recommendation is:

�� Early Ambulation

If the patient’s risk factor is 2 ( m o d e r a t e r i s k ) t h e recommendation is to choose one of the following:

�� SCDs

�� Heparin 5000 units SubQ every 8 hours

�� Enoxaparin (Lovenox) 40 mg SubQ Daily

�� Enoxaparin (Lovenox 30 mg SubQ Daily (Renal dosing)

�� Enoxaparin (Lovenox 30 mg SubQ every 12 hours (for obese patient BMI >30)

�� Other ——— (physician to fill in)

If the patient’s risk factor is 3 (high risk) use SCDs and one of the following:

�� Heparin 5000 units SubQ every 8 hours

�� Enoxaparin 40 mg SubQ Daily

�� Enoxaparin 30 mg SubQ Daily (renal dosing)

�� Enoxaparin 30 mg SubQ every 12 hours BMI>30)

�� Warfarin (Coumadin) __mg x1 then adjust dose per daily INR (goal 2-3)

�� Warfarin (Coumadin) Protocol

�� Other _____________

National Quality Forum (NQF) Safe

Practices for Healthcare Update

2009

Safe Practice 28:

Venous Thromboembolism Prevention

�� Evaluate each patient upon admission, and regularly thereafter, for the risk of developing venous thromboembolism

�� Utilize clinically appropriate, evidence-based methods of thromboprophylaxis

Nurses can also refer to the Healthstream education on VTE Assessment and prevention

PAGE 2 VTE—UPDATE

Please remember to document

Anticoagulant Education in

Meditech. It is mandatory

that this education provided be documented at least once !

Anticoagulation Education for the Patient and Family

Is your patient on:

�� Coumadin

�� Heparin

�� Lovenox

If So,��Print patient information from Micromedix ��Educate the patient and family ��Document in Meditech under Process

Intervention: Education: Anticoagulation

Help keep your patient safe while they are on an anticoagulant

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Evidence-based standards of care in nursing involve taking the lead to fi nd the evidence, evaluating the strength of that evidence, as well as producing the evidence when appropriate. Our Nursing Research Committee has been actively seeking knowledge and engaging in the research process. We recognize the importance of not only producing new knowledge to produce optimal outcomes but also the necessity to disseminate that knowledge to a wider audience. Our nurses conduct independent research as well as partner with nurse researchers from neighboring academic centers. Our table of current Nursing Research Studies is presented on the next page. We are especially proud of our nurses for the knowledge acquisition and practice changes they have adopted to encourage optimal empirical outcomes.

Empirical Quality OutcomesNurses believe they are giving high quality care to their patients, and

their organization sees high-quality care as a priority.

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Empirical Quality Outcomes

PROJECT NAME STATUS LEAD(s) DESCRIPTION

Smoking Cessation for Patients and Staff at a Community Hospital

IRB Approved 12/04; 10/05; 10/06; 10/07; 10/08 Data Collection and Analysis COMPLETE FOR PILOT Renewed 10/09

Terri Gately, RN, BS, MS, CRRN, DSD /Sherri Mendelson, RNC, CNS, PhD

Staff survey on knowledge; focused interviews on views; patient smoking on readmit post information on last visit

The Identification and Prevalence of Patients with Chronic Wounds/Ulcers in the Hospital Setting

IRB Approved 4/07; 4/08; 4/09

Monica Tweddell, RN, WCC Prevalence Study

Prevalence of Chagas Disease in Pregnant Women From Latin America

IRB Approved 8/08 Renewed 6/09

Sherri Mendelson, RNC, CNS, PhD (In collaboration with Olive View Medical Center)

Prevalence Study

Care Redesign Using ZynxCare IRB Approved 10/08 Renewed 10/09

Sherri Mendelson, RNC, CNS, PhD

Outcomes Study

One Touch TGC GateWay Usability and Human Factors

IRB Approved 6/08 completed

Donna Ryan, RN RD, MPH, CDE, Kathy Cadden, RN, MSN, Cathy Yee, RN, MSN

Validation Study

Effectiveness of Nurse Manager Training Study

IRB approved 8/08 completed

Sherri Mendelson, RNC, CNS, PhD Site PI

Doctoral Study of Jane Rosati: University of Phoenix

Evaluation of the Pediatric Assessment Triangle (PAT) as an Assessment Tool for Children in the Prehospital Setting (PAT Project)

IRB Approved 1/08; 1/09

Theresa Lacroix, RN- Site PI Validity and Reliability Study

Diabetes Prevalence and Outcomes Study of Patients at PHCMC

IRB Approved 6/08; 8/09

Donna Ryan, RN RD, MPH, CDE, Reza Bonabi, MD, Kathy Cadden, RN, MSN, Cathy Yee, RN, MSN, Sharon Elliston, RD, CDE

Prevalence and Correlation Study

Insulin Therapy in Diabetic Patients Receiving Enteric Tube Feedings in a Sub Acute Unit: A Case Series Study

IRB Approved 9/07; 8/08; 8/09.

Reza Bonabi, MD, Robert Robertson, MD, Donna Ryan, RN RD, MPH, CDE, Terri Gately, RN, BS, MS, CRRN, DSD, Sylvia Pacis, RN, BSN-PI

Case Series Study

In-Patient Nursing Education Home Blood Pressure Monitoring To Manage Hypertension

IRB Approved 12/08 Renewed 10/09

Susie Parker, LVN, Sherri Mendelson, RNC, CNS, PhD, Debbie Tsunoda, ACNP-BC

Interventional one-group study

Do We Need to Hold Continuous G-Tube Feeding During Patient Repositioning

IRB Approval 8/09 Terri Gately, RN, BS, MS, CRRN, DSD, Sylvia Pacis, RN, BSN-PI

Outcomes study

Compassion Fatigue and Spiritual Caring in Oncology Nursing Staff

IRB Approval 10/09 Ingrid Blose, RN, OCN, CMSRN, Dory Tiongson, RN, OCN, CMSRN Terrie Bybee, RN, CMSRN Tanya Haight, RN, OCN, CMSRN

Interventional one group pre and post intervention outcome study

Project HOPE: Health Promotion for a Healthy Pregnancy and Family

IRB Approval 10/09 Sherri Mendelson, RNC, CNS, PhD

One group Pre and Post intervention longitudinal outcome study

CALNOC Interdisciplinary Nursing Quality Research Initiative Study

IRB Approval 10/09 Donna Ryan, RN, CDE, CPH, RD

Prevalence and correlation study

PHCMC NURSING RESEARCH PROJECTS 2009

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4A REDESIGN PROJECT OUTCOMESTh rough a generous grant from UniHealth Foundation, our Telemetry Unit embarked on the Health Systems Enhancement Patient Care Redesign Project at Providence Holy Cross Medical Center in 2009. Th e purpose of the project was to design reliable processes of care that assure consistent and timely delivery of evidence based patient care each and every time, thus improving patient satisfaction and outcomes.

Th e Patient Care Redesign pilot project involved a 20-bed unit with patient care processes designed by patients, nursing staff , a clinical nurse manager and ancillary personnel providing care on the unit, physicians, facilitated and lead by a process engineer (Six Sigma Black Belt). Th e redesigned patient care unit provided patients and clinical staff with an environment of collaboration and innovation based on Watson’s Caritas Principles to promote the development of reliable care delivery along the continuum of care.

Th e project allowed healthcare providers to deliver excellent quality care, each and every time by: Serving as an alpha site for development and implementation of an electronic “key process indicator status board”—an add-on module to our electronic medical record that provided caregivers with visual, real time cues indicating the status of key clinical processes. Assuring consistent adherence to evidence-based practices as a result of the ability to monitor key processes in real time. Hardwiring evidence-based practices. Understanding and focusing on patient needs. Addressing sustainability.

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Quality Dashboards Quality outcomes come from evidence based practice in the hands of knowledgeable nurses working within a supportive interdisciplinary environment. Our quality outcomes for our Rapid Response Team demonstrated that we could be doing better to identify patients with signifi cant changes prior to arrest outside of the ICU. With this information and a review of the literature, a position was created to monitor vital signs changes and critical lab values for patients who had left the ICU and others identifi ed with high-risk conditions. Th is addition to the Rapid Response team was implemented at the end of 2009. Another quality improvement success was with our fall rates on the acute care units. Our falls decreased from 3.39 per 1000 patient days January – November 2008 to 2.7 per 1000 patient days January – November 2009. Since then, our fall rate has been below the CalNOC mean for like hospitals since June of 2009.In addition, only one case of ventilator-associated pneumonia has been identifi ed in the Medical/Surgical ICU since March 2008. Also the Hospital Acquired Pressure Ulcer rate was zero (0) for Q3 2009; below CalNOC like-hospital mean 7 out of 8 quarters since Q4 2007.

PHCMC ACUTE FALL RATE 2009

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1 2 3 4 5 6 7 8 9 10 11 12

Months

Fall

Rat

e pe

r 100

0 Pt

. Day

s

HC Falls per 1000 Pt. DaysPHCMC MeanCalNOC All Hosp Mean

Rapid Response Team 2009

0

0.5

1

1.5

2

2.5

3

3.5

4

4.5

1 2 3 4 5 6 7 8 9 10 11 12

Months

Cal

ls P

er 1

000

Dis

char

ges

PHCMC RRT Calls/1000 DischargesPHCMC MeanTarget

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Awards & AccomplishmentsThe nurses at Providence Holy Cross Medical Center share their knowledge

through publications, presentations and nurse-directed research studies.

Our nurses are committed to advancing the nursing practice and making

a difference in the lives of others.

OUR NURSES ARE HEROES AWARDS - 2009

Linda CoskranNominated by Anita Reinhardt Th ere is a family out there who can take comfort in knowing that even though they lost a loved one, they passed on the gift of life to others. Nurse Linda Coskran of the Critical Care Unit here at Providence Holy Cross helped this grieving family through the selfl ess act of organ donation. In supporting this family, devastated and in despair, Linda proved heroic in working with them through the process of organ donation. She was very patient, understanding and supportive as the family dealt with the stages of grief, including the anger over their loved one’s death Linda understood their sorrow and spent time with them, showing empathy, compassion and respect. Th e family did decide to donate the organs of this loved one and by doing so saved lives – and helped ensure other families might not experience the tragedy of losing their loved ones to organ failure.

Cathy CarterNominated by Jennifer Lindskog and Carol Carter Cathy Carter is passionate about the care she gives her Emergency Department patients and refused to stand by while politics blocked the expansion of Providence Holy Cross, which threatened to delay new badly needed beds to alleviate the current overcrowding. Before initiating her personal campaign, she educated herself about the issues then set about informing the Los Angeles City Council, her co-workers, her patients, the community and even the opposition about the impacts of the delay of the 138-bed expansion. Cathy courageously voiced her opposition by megaphone during a rally for the project and she printed fl yers directing patients to call to urge support for the expansion. One patient called a reporter, prompting a Page 1 newspaper story about our crowded ED. And within weeks, the council voted unanimously to allow construction to resume. In a few weeks, construction will resume, in part because of Cathy’s eff orts. Cathy is a dedicated caregiver like all of our nurses here, but she took an extra step, took a risk, in fact, to ensure work resumed on the new Patient Care Wing so future patients won’t wait in the hallways for a room.

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Awards & Accomplishments

Amalia ChoyNominated by Cindy Damboise A year ago one of our certifi ed nursing assistants fell tragically ill. While all of us were sympathetic and prayed for Isabel Castro, CNA Amalia Choy from Telemetry stepped forward and cared for her. Amalia exhibited to Isabel the tender loving care and compassion she shows to all of her patients and to their families. She proved to us all how her vocation is much more than a career, much more than a job. She donated her time to care for Isabel, her beloved friend, both in the hospital and at home. She rose the ranks of hero in sacrifi cing her own time to show compassion for a co-worker, who passed away in November. Isabel was blessed to have a friend like Amalia. And we are blessed to have her both as an example and as a reminder of why we were motivated to become caregivers.

Laurie MacArthurNominated by Missy Blackstock At the beginning of a night shift in the ER, a Code Blue in the Nursery was paged overhead. Our hearts sank as we waited for it to be canceled, but that page never came. Th ank goodness Laurie MacArthur was on that night. Without thinking, Laurie said “going to the nursery,” grabbed the hand of our ER doctor and hurried on a mission. About 30 minutes later our doctor returned shaking his head, obviously upset. He explained a tragedy that had unfolded in the nursery and how he was stunned by Laurie’s expertise in working with the nursery staff and the neonatologist who had tried in vain to save the newborn. Laurie didn’t come back to the ER for several hours. She worked with the SCN staff , who appreciated for Laurie’s calm demeanor, how she knew when it was time to stop resuscitation and how she tenderly helped the parents deal with the loss of their baby. Laurie works full-time in the NICU at UCLA and unfortunately sees these situations frequently. She also works here at Holy Cross, a single mom who takes the night shift so she can spend time with her children during the day.

Laurie personifi es our core values, living excellence, compassion and respect to ensure the best care for her patients. Her attitude is exemplary. I don’t think I’ve ever seen her have a “bad day.”

Ramona RojasNominated by Debbie Bergida A nurse can do everything right, but still our patients’ care is compromised if we can’t ensure their safety. Ramona “Mona” Rojas of the Medical Surgical team took that to heart, worried about the issue of patient falls and determine to help fi nd a solution. After attending a System-wide initiative on falls, Mona brought back information she shared and helped implement. Initially patient falls did not decrease. In fact we had a record number one weekend. So Mona started talking to the staff about how we could reduce the falls to protect our patients. One staff member gave her an idea, which Mona implemented on 3B as a pilot program. One caregiver would go on rounds hourly, checking on patients and ensuring they understood the hazards of trying to get out of bed on their own. So far, the results have been remarkable and the practice since has been adopted throughout the hospital

Pamela AbdulnourNominated by Debbie Bergida Pam wanted to become more involved in the goings-on of the Medical Surgical Unit. As a CNA there are not too many opportunities but she joined the Falls Committee and has made it her personal mission to ensure that the night shift had the tools it needed to keep patients safe. Pam, a preceptor on her unit for new employees, is one of those people who likes to come to work. She’s extremely dedicated. On her own, she took the rounding idea that had worked so well on 3B to guard against patient falls, and introduced the proposal in her unit. Because Pam takes initiative, nurses love to work with her. Her style of motivation makes her a hero.

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PROVIDENCE HEALTH & SERVICES PRESIDENT’S AWARDS - 2009

Care for Gestational Diabetes through Teamwork-Parish Nurses and Diabetes Educators Rise to the Challenge Executive Sponsor: Betty Newsom Team Members: Sherri Garber Mendelson, RNC, CNS, PhD; Donna Ryan, RN, MPH, RD, CDE; Sharon Elliston, MS, RD,CDE; Juanita Arvisu, RN, BSN; Grace Cahoon, RN, BSN; Jennie Rosales, RN, BSN; Sylvia Duncan, RN, BSN; Marlene Mancia, RN, BSN; Deborah Benada, RN, MSN; Marian Oliver, RN, MSN; Connie Cruz, RN, BSN; Estevan Solarte, BS; Marc Incerpi, MD; Patrick Mullin, MD; Richard Lee, MD.

Interdisciplinary Approach to Improvement in Core Measure Compliance Leadership Award – Improved Hand Hygiene Practice Among Healthcare Workers Executive Sponsor: Betty Newsom Team Members: Frankye Baurle, ANM PACU; Debbie Bergida, Nurse Manager, M/S; Missy Blackstock, Manager ED; Jeri Brown, Director of Patient Care Support Services; Karen Broggie, QM; Charles Chidsey, General Surgeon; Brigitte Condie, Pulmonary NP; Kim Crabtree-Lloyd, Staff RN PACU; Cindy Damboise, Nurse Manager, Telemetry; Yvonne gaff ney, Director, Periops; Karen Klein, QM; Kelly Kurcz, Director of Emergency Services & Clinical Outcomes; Becky Lee, Clinical Coordinator, Pharmacy; Patty Mayberry, Clinical Project Implementation Director; M. Reza Nahed, Pulmonologist; Kelly Pagel, ANM Short Stay; Judy Pharris, Interim Manager, Critical Care; Marianne Plakas, QM; Sheila Ritchie, QM; Carole Rozner, QM; Cyndie Speen, QM; Steve Tanner, Director QM; Debbie Tsunoda, Cardiology, NP; Dan Worthen, Staff RN, Surgery; Ting Yee, Cardiologist.

Hospital Acquired Pressure Ulcer Reduction on Telemetry Executive Sponsor: Betty Newsom Team Members: Cynthia Damboise, Sherri Friedrich, Debbie Welch, Barbara O’Reilly, Wendell Garcia, Lourgelie Vergel De Dios, Marilyn Sluka, Anu Randhava, Monica Tweddell, Robert Mejia, Karen Sinnet-Frydman.

Improved Hand Hygiene Practice among Health Care Workers Executive Sponsor: Kerry Carmody Team Members: Ken Archulet, Manager, Infection Prevention; Providence Holy Cross Medical Center Staff and Volunteers.

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Other Awards & Accomplishments Th e Association of Women’s Health, Obstetric and Neonatal Nurses (AWHONN) presented its Best of JOGNN Writing Award to Sherri Garber Mendelson, BSN, MSN, PhD, Clinical Nurse Specialist, for the paper she co-authored titled “A Community-Based Parish Nurse Intervention Program for Mexican-American Women with Gestational Diabetes.” Th e award was presented at AWHONN’s annual convention in convention in San Diego. Trauma Program at PHCMC celebrated its 25th anniversary on May 16, 2009. Th e celebration featured a reunion of staff , former patients and recognition from civic and government offi cials. PHCMC received a “Certifi cate of Excellence” award from the California Hospital Assessment and Reporting Taskforce (CHART) for achieving “Superior” or “Above Average” results across the majority (7 of 8) of outcomes and process measures publicly reported by CHART. PHCMC was one of only 35 California hospitals to receive this recognition and ranked second in terms of overall percentage. PHCMC was certifi ed by the American Diabetes Association for diabetes care. Th is is a 3-year certifi cation. Two podium presentations were accepted at the National Association of Diabetes Educators Conference in August 2009: “What your CEO Needs to Know” by Donna Ryan, RN, CDE, RD, MPH, and “A Community-Based Parish Nurse Intervention Program for Mexican-American Women with Gestational Diabetes” by Sherri Mendelson, RNC, PhD, CNS. Terri Gately, RN, was appointed to the California Hospital Association Medical Safety Committee. Ken Archulet, RN, will be president-elect in 2010 and president in 2011 of the San Fernando Valley Chapter of APIC. Sherri Mendelson, BSN, MSN, Ph.D, Clinical Nurse Specialist, was appointed to the California Breastfeeding Roundtable delegation for 2009-2012.

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2009 CERTIFICATIONSICUKathy Cadden, CCRN

Chris Consolo, CCRN

Shirley Ibarra, CCRN

Melissa Tell, PCCN

Carole McKennan, CCRN

Brenda Mitchell, CCRN

Melanie LaMadrid, CCRN

Amy Rosengran, CCRN

MEDICAL-SURGICAL /ONCOLOGYLois Agler, CMSRN

Suzanne Bart, CMSRN

Pamela Baylon, CMSRN

Ingrid Blose, OCN, CMSRN

Dee Dee Bubalo, OCN, CMSRN

Terrie Bybee, CMSRN

Cynthia DaSaad, OCN

Eileen Diaz, OCN

Marisia Duarte, ONC

Riza Estranero, OCN, CMSRN

Barbara Farrar, OCN

Gemma Francisco, ONC

Kathy Gilmore, CMSRN

Christian Gonzalez, CMSRN

Heinrich Huerto, ONC

Dary Hult, OCN

Vener Lineses-Diaz, CMSRN

Veronica Lozano, CMSRN

Mary Mahn, CMSRN

Bilma Mathew,CMSRN

Cathy Millan, CMSRN

Janine Montero, CMSRN

Johanna Ongjoco, OCN, CMSRN

Maria Rodriguez, OCN

Leticia Salvador, OCN

Betsy Smith, OCN, CMSRN

Jackie Sullivan, CMSRN

Barbara Thomas, CMSRN

Dory Tiongson, OCN, CMSRN

Denise Wilmarth, OCN, CMSRN

SUPER FLOAT POOLMary Ellen Hazle, CMSRN

Seta Velasquez, CMSRN

CASE MANAGEMENT Betsy Jansen, CHPN

Kathy Menard, CPHQ, CPRM

Jinky Rivera, CPUM

Edna Tiongco, CRRN, CCM

NURSING MANAGEMENTKen Archulet, CFRN

Debbie Bergida, OCN, CMSRN

Jerilyn Brown, OCN

Cindy Damboise, PCCN, CCRN

Jane Flaherty, PCCN, CCRN

Sherri Friedrich, ANCC-FNP

Yvonne Gaffney, CNOR

Joanna Kuzmak, CCM

Betty Newsom, CNAA

Barbara Rozewicz, CCRN, CMC, NP-BC

Carrie Sayeski-Reid, RNC-OB

EMERGENCY DEPARTMENTSue Baunsgard, CEN

Cathy Carter, CEN

Jennifer Dodson, CEN

Terri Halverson, CEN

Deanna Hayden, CEN

Heidi Krause, CEN

Alicia Lopez, CEN

Rosanna Macklin, CEN

Marjorie Moon-Weitz, CEN

Melissa Parsons, CEN

Melanie Ridgley, CEN

Anaya Rosen, CEN

Jacquie Siddens, CEN

ACUTE REHAB/SUB ACUTENadine Smeke, CRRN

Terri Gately, CRRN, RN-BC

NURSING EDUCATIONKathy Christian, OCN, CMSRN

Cynthia Funikoshi, PCCN

Tanya Haight, OCN, CMSRN, ONC

Sherri Mendelson, RNCC-OB, NIC, C-EFM, IBCLC

Kristi Miura, CCRN

Donna Ryan, CDE

Monica Tweddell, WCC

Karen Watson, CMSRN; ANCC-MS

TELEMETRYCrystal Akao, CCRN

Beverly Gumogda, PCCN

Linda O’Reilly, PCCN

Ulla Smith, PCCN

Therese Villanueva, PCCN

Debbie Welch, PCCN

CARDIOLOGYHannah Rhodes, PCCN

Cathy Yee, CCRN-CSC

PERIOPERATIVEFrankye Bauerle, CPAN

Ed Betker, CNOR

Kim Crabbtree-Loyd, FNP-BC, CPAN

Renee Dove, RNFA, CNOR

Lisa Eberhart, CNOR

Maria Gelato,RNFA

Karen Kelsey, RNFA, CNOR

Elizabeth Klein, CNOR, RNFA

Nora Lucas, CPAN

Elizabeth Pleasant, CNOR

Marilyn Seckar, CPAN

Louisa Singer, CNOR, RNFA

Roxanne Smith, CNOR

Susan Zavala, CCRN, CPAN

Gail Zerby-Cook, CNOR, RNFA

Melanie Ylagan, CNOR

NURSE PRACTITIONERSBrigitte Condie, ANCC-ACNP

Deborah Tsunoda, ANCC-ACNP

MATERNAL CHILD HEALTHYajaira Angulo, RNC-OB

Pamela Appleton, RNC-MNN

Debbie Felkel, IBCLC, RNC-MNN

Alexis Fischer, RNC-MNN

Therese Gass, IBCLC

Melinda Gruman ,RNC-OB, C-EFM

Linda Harrington, RNC-OB

Marilyn Haro, RNC-MNN

Jenni Kohl, RNC-OB

Nancy McClenaghan, RNC-LRN, NIC

Nanette Moffet, RNC-LRN

Arvy Quizo, RNC-LRN

Tenesa Reid, RNC-OB

Delores Relucio, RNC-OB, C-EFM

Sally Ritter, RNC-OB ; C-EFM

Kristina Shannon, RNC-OB

Danielle Silvieri-Anthony, IBCLC

Julie Tannaci, RNC-MNN

FAITH COMMUNITY NURSINGConnie Cruz, RNC-OB

NURSING QUALITY ANALYSTSKaren Broggie, CPHQ

Sheila Ritchie, CPHQ

Cyndie Speen, CPHQ, RN-BC

Marianne Plakas, CCRN

31


PUBLICATIONS, PRESENTATIONS & GRANTSPublications:b Kathy Cadden, MSN, RN, CCRN, Judy Pharris, BSN, RN, Donna Ryan, MPH, RN, RD, CDE, & Cathy Yee, MSN, RN, CCRN-CSC; Featured article, Advance for Nurses, April, 2009; Overcoming Barriers to Nursing Research in a Community-Based ICU: Correlation of Capillary and Arterial Blood Glucose Levels. b Sherri G. Mendelson, RNC, PhD, CNS, IBCLC; PACLAC Guidelines for Maternal Care, 2009. Los Angeles, CA.

Abstracts Submitted in 2009 for 2010 Conferences AWHONN1. Regional Perinatal Documentation Project; Ronda McPhail, RN, Sherri Mendelson, RNC, PhD, CNS, IBCLC. (Accepted for Poster presentation).2. Breaking Out of Our Silos; Adriana Basurco, RN, BSN, PHN, Yajaira Angulo, RNC, BSN, PHN, Sherri Mendelson, RNC, PhD, CNS, IBCLC. (Accepted for Poster presentation).3. SLE: A 36 Year Longitudinal Case Study; Sherri Mendelson, RNC, PhD, CNS, IBCLC. (Accepted for Poster presentation).

ACNL 1. ACNL Environment of Practice Standard and Instrument for Measurement Healthy Work Environment Assessment Tool Introduction; Round Table; Timothy Gilmore, RN, MHA. (Accepted for Round Table presentation).2. For Your Information: Admission and Discharge Videotape; Cynthia Damboise, RN, MSN, MHA, PCCN, CCRN; Linda Coale, RN, MBA. (Accepted for Poster presentation).3. Regional Perinatal Documentation Project; Ronda McPhail, RN, Sherri Mendelson, RNC, PhD, CNS, IBCLC (Accepted for Poster presentation).

Arizona State University Research 1. Regional Perinatal Documentation Project; Ronda McPhail, RN, Sherri Mendelson, RNC, PhD, CNS, IBCLC (Accepted for Podium presentation).

ONS 1. Team Rounding: Preventing Falls on the Oncology Unit. Kathy Christian RN, BSN, OCN, CMSRN, Tanya Haight RN, OCN, CMSRN, ONC. (Accepted for Poster presentation).2. Improving Knowledge of Oncologic Emergencies; Kathy Christian RN, BSN, OCN, CMSRN, Tanya Haight RN, OCN, CMSRN, ONC. (Accepted for Poster presentation).

Presentations/Lectures:b Donna Ryan, RN, CDE, RD, MPH; National Association of Diabetes Educators Conference, Atlanta, Georgia; August, 2009; Podium presentation: What your CEO Needs to Know.b Sherri Mendelson, RNC, PhD, CNS, IBCLC; National Association of Diabetes Educators Conference, Atlanta, Georgia; August, 2009; Podium presentation: A Community-Based Parish Nurse Intervention Program for Mexican-American Women with Gestational Diabetes.b Tanya Haight, RN, OCN, CMSRN, ONC; Kathy Christian, RN, BSN, OCN, CMSRN; ONS 34th Annual Congress: San Antonio, Texas; April, 2009; Poster presentation: Improving Communication Using a Cancer Treatment Schedule Tool.b Kathy Cadden, RN, MSN, CCRN; Chris Consolo, RN, CCRN; Carla Hentz, MS. 5th National Learning Congress, United States Department of Health and Human Services; Grapevine, Texas, 2009; Podium presentation: Honoring Donor Families Th rough Collaboration. b Terri Gately RN, BS, MS, CRRN, RN-BC, DSD; National Magnet Conference; Louisville, Kentucky; October, 2009; Podium presentation: Do We Need to Check G Tube Residuals in Sub Acute? b Terri Gately, RN, BS, MS, CRRN, RN-BC, DSD; CMRS and HSCC 2009 Annual Conference: Transitioning Patients Transforming Care; San Diego, California; 2009; Poster presentation: Do We Need to Check G Tube Residuals in Sub Acute?b Karen Watson, RN, BSN, CMSRN, RN-BC, and Monica Tweddell, RN, WCC; National Magnet Conference; Louisville, Kentucky; October, 2009; Poster presentation: Save Our Heels. b Karen Watson, RN, BSN, CMSRN, RN-BC, and Monica Tweddell, RN, WCC; AMSN 17th Annual Conference, Nashville, Tennessee, 2009; Poster presentation: Save Our Heels. 1st Place Prize Winner.b Missy Blackstock, RN, Melanie Ridgley, RN, and Patricia Aidem; National Emergency Management Summit; Washington, D.C.; March, 2009; Podium presentation: PHCMC’s Response to the Metrolink Train Crash. b Sherri Mendelson, RNC, PhD, CNS, IBCLC; University of Iowa Research Conference, Iowa City, Iowa; April, 2009; Poster presentation: Development of an Instrument to Determine Risk of Hyperbilirubinemia.b Tanya Haight, RN, OCN, CMSRN, ONC, Presented a poster titled: Improving Communication Using a Cancer Treatment Schedule Tool at AMSN-Academy of Medical-Surgical Nurses, 18th Annual Convention, 9/9-9/14/2009, Washington, DC.

Grants Obtained: b California Department of Public Health: Birth and Beyond California Breastfeeding Promotion (continuing).b First 5 LA Best Babies Collaborative Case Management Program for Improvement of Maternal Child Health (continuing).b UniHealth Foundation: Transformation of Care Project (continuing).

Providence Holy Cross Medical Center15031 Rinaldi Street Mission Hills, California 91346(818) 365-8051

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