unitypoint health patient services annual report 2012

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  • UnityPoint Clinic | UnityPoint at Home | UnityPoint Hospice

    Patient Care Services

    Focusing on patients and quality care

    ST. LUKES

    AnnUAL REpoRT 2012

  • Table of Contents

    1 -3 preparing for the Future

    4 patient Care Services Strategic plan 2012

    5-9 Exemplary professional practice 10-12 new Knowledge 13-15 Structural Empowerment 16-19 Transformational Leadership 20-21 Community Contributions

    Dear Colleagues,

    Welcome to the 2012 Patient Care Se

    rvices Annual Report. By the time yo

    u receive

    this we will be well on our way with

    our 2013 efforts and things like IQ4 G

    o-Live (our

    electronic health record launch) will

    be a distant memory. However, I wa

    nt to take

    this opportunity to say thank you o

    ne more time for the exceptional car

    e you provided

    during 2012. As you read through th

    is report and reflect on our many acc

    omplishments,

    I hope you feel a sense of pride. It is

    evident we do not have pockets of ex

    cellence, but

    rather a culture of striving to provide

    exceptional care in all settings.

    This culture has led to another year

    of external recognition such as Truv

    en Health

    Analytics Top 100 Hospital designat

    ion for the fifth time and Top 50 Hea

    rt Hospital for

    the fourth time in a decade. We also

    received Joint Commission Disease

    Specific Desig-

    nations for Advanced Heart Failure,

    Total Hips and Total Knees, Stroke a

    nd Palliative

    Care. This external validation of our

    work communicates to our patients

    and commu-

    nity that they can trust us to provid

    e the very best care. Our Magnet de

    signation also

    continues to convey to our colleagu

    es and the community that we are co

    mmitted to

    exceptional nursing care and work en

    vironment.

    Throughout the report you will see e

    xamples of Exemplary Professional P

    ractice, such

    as best practice door-to-dilation tim

    es for acute myocardial infarction an

    d infection

    prevention. Also highlighted are Inn

    ovations in Care, such as the Behavi

    oral Health

    Medical Emergency Team (MET) an

    d pediatric cooling in the Newborn In

    tensive

    Care Unit (NICU) to prevent brain

    injury. St. Lukes nurses and clinical

    colleagues are

    contributing to New Knowledge deve

    lopment through participation and

    leadership in

    research studies.

    The accomplishments illustrated th

    roughout the report reflect the impa

    ct of Shared

    Governance and Transformational L

    eadership. The department-based U

    nit Practice

    Councils have been instrumental in

    improving care at the unit level, wh

    ile the interde-

    partmental councils such as Practic

    e Council and Performance Improve

    ment Council

    drive house-wide improvements.

    Opportunities for celebration, rewa

    rd and recognition occur throughout

    the year and

    are highlighted in the Annual Repor

    t. Nursing Excellence Awards, new ce

    rtifications

    and degrees as well as other accomp

    lishments are signs of individual and

    organizational

    commitment. I hope you enjoy readi

    ng about your colleagues and their a

    chievements,

    as well as seeing your own efforts rec

    ognized and celebrated. St. Lukes is

    successful

    because of you as individuals and a

    s teams of individuals committed to

    our mission.

    Thank you and enjoy!

    Sincerely,

    Mary Ann Osborn, RN, MA

    Vice President and Chief Clinical O

    fficer

    UnityPoint Clinic | UnityPoint at Home | UnityPoint Hospice

  • preparing for the FutureNurses guide renovationA newly designed orthopedic and neurosurgical unit opened at St. Lukes in early January. Patients and their families are benefiting from the efforts of frontline nursing staff, who were a driving force behind incorporating specific elements to support patient-centered care.

    Carmen Kinrade, RN, MSN Director, St. Lukes Nursing Operations

    Direct care nurse champions gave input and gathered feedback from their peers. They advocated for bedside workstations, nursing workspaces that most efficiently accommodate patient and nursing work-flow, and additional supply and equipment storage thats easily accessible to nurses when caring for patients, said Carmen Kinrade, RN, MSN, director of St. Lukes Nursing Operations.

    Safety features in each of the 23 private rooms include nonslip flooring in bath-rooms, gently sloping shower floors, pull-down shower seats that reduce the risk of falls, special lighting and the ability to easily accommodate specialty beds and equipment. Whiteboards allow staff mem-bers to post key messages and plan-of-care goals to keep patients, family members and the multidisciplinary team informed.

    Direct care staff and patient care leadership worked together on the set-up for patient rooms and support areas, such as the nurs-es station, medication and storage rooms, assuring supplies and equipment were

    arranged to support the most logical flow of care. Its a beautiful and functional unit for patients and staff. We can thank our direct care nurses and healthcare team for setting the standard, Kinrade said.

    Prepping a new inpatient hospice unitPlanning the new Ed and Joan Hemphill Hospice Unit for St. Lukes involved more than architects and administrators. The hospice supervisor and frontline staff to be working with patients in the new inpatient hospice unit when it opened were involved at an early stage, making important decisions about equipment, processes and ambience.

    We went through every need patients may have, said Denise Abel, RN, BSN, OCN, hospice inpatient manager. Unit processes came from the frontline staff. They made suggestions for items such as waste stations for narcotics. They also considered the ambience. We wanted to make it like home, Abel said. Now the unit offers quilts on the beds and cookies for patients and family members.

    Education was another area of focus for frontline staff. They specifi-cally recommended books and educational material for the unit. In preparation for the opening, nurses received symptom management education from pharmacists and attended orientation with the units social worker, chaplain and medical director.

    Our missionTo give the healthcare wed like our loved ones to receive.

    Our VisionBest outcome for every patient every time.

    Our Values Patients first We are here to serve patients. We put patients needs above all else. The patient is the center around which the entire organization revolves.

    Doing the right thing Do the best possible good for all we serve because its the right thing to do.

    Care in our heart It is our personal mission to help others, not only in work but also in life. It is in our hearts.

    Respect for all We value all people. We treat all with dignity, courtesy and attentiveness. We listen.

    Teamwork We before me. No one stands alone. We are committed to teamwork as teams of people outperform individuals.

    1

    Nearly 1,000 individuals annually

    will receive the best possible

    end-of-life care.

  • A five-time Top 100 HospitalFor the fifth year, St. Lukes has been named to the Truven Health Analytics 100 Top Hospitals list. St. Lukes achieved Top 100 status nine years ago and then in 2005, 2009, 2012 and 2013.

    If all Medicare inpatients throughout the country received Top 100 Hospital award-winning care, then:

    St. Lukes among Top 50 Heart HospitalsSt. Lukes joined an elite group as Truven Health Analytics pared its nationally recognized list from 100 to only 50 Top Cardiovascular Hospitals. This is the fourth time in a decade St. Lukes has been nationally recognized for Heart Care by Truven Health. St. Lukes is one of only three Iowa hospitals honored.

    Top 50 Heart Hospitals have:

    More than164,000 lives could be saved

    82,000 additional patients could be complication-free

    $6 billioncould be savedThe average patient stay would decrease by half a day

    41% fewer deaths

    Lower complications

    Lower hospital readmission rates

    higher30-daysurvival rates

    Intraoperative Electron Radiation Therapy (IOERT)St. Lukes is leading technological advancements in cancer care by offering IOERT for early stage breast cancer patients through an international clinical trial. IOERT allows patients to receive a concentrated dose of radiation during surgery. After the surgeon removes the tumor, a radiation oncologist applies a concentrated dose of electron beam radiation directly to the tumor bed. A shield and cone protect healthy tissue from unnecessary radiation.

    A core group of St. Lukes associates (RNs, surgical techs, sonographers, radiation therapists and a radiation physicist) have trained to use IOERT, said Callie Engelbrecht, RT (R) (N), CNMT, manager of Imaging Services. During the initial start-up phase in October, these nurses attended group training and went through a dry run. They also traveled to Sioux Falls, South Dakota, to witness IOERT at Avera Healthcare.

    IOERT allows doctors to administer high doses of radiation without exposing healthy organs to radiation. In one to two minutes, patients receive radiation equal to five to seven daily radiation treatments, enabling them to spend only three weeks on follow-up radiation treatments instead of six. Studies show IOERT offers low recurrence rates because it treats the precise area where most breast cancers recur. Costs are 26 percent less than traditional radation treatment.

    da Vinci surgical robotSt. Lukes has been using surgical robots for minimally invasive procedures since 2005, first for urology and then gynecology in 2008. In late 2011, St. Lukes began using surgical robots for general surgery which expanded the knowledge and expertise of the Operating Room (OR) team because new sets of people were trained in robotics. In 2012, the FDA approved single-site surgery for general surgery, which involved more changes and training. St. Lukes robotics team performed the first single-site robotic gallbladder removal in Cedar Rapids on April 5, 2012.

    We have branched out with robotics, involving a new team and new procedures, said Kiley Stineman, RN, OR supervisor. Colon resections have always been done in an abdominal approach, and with the robot we are now able to get the patient back to normal activities quicker with smaller incisions. Weve taught a whole new team from the beginning. We have had many in-services, mentoring of staff, and cross-training with those who already used robotics. We also have sent many people to train with the doctors, flying to Atlanta, Houston and Cincinnati. This not only helps the staff, but helps show our doctors we are engaged in what they are doing.

    We have branched out with robotics, involving a new team and new procedures.

    Kiley Stineman, RN, OR Supervisor

    2

    Preparing for the Future

    For patients, robotic surgery is dramatically different from traditional surgery incisions are smaller, pain is minimized and recovery is much faster. St. Lukes first single-site robotic gallbladder patient, Sylvester Kafer, said he had no pain after his surgery. I had surgery on a Thursday and I was back to driving the school bus by Tuesday, mainly because they didnt have school on Monday, Kafer said. I had aortic surgery and recovery took a long time. This made me feel like did I even have surgery?

  • Community Anticoagulation Therapy Clinic In April 2012, the freestanding Community Anticoagulation Therapy (CAT) Clinic became a department of St. Lukes, after seven years as part of the Cedar Rapids Healthcare Alliance. We were surviving on donations. St. Lukes recognized we were providing a service that fit into their mission and with the goals of their outpatient clinics, said Carla Huber, MSN, ARNP, certified in anticoagulation management.

    Neonatal outreach into other communities St. Lukes new-born intensive care unit (NICU) neonatal nurse practitioners, nurses, outreach personnel and doctors are help-ing in the NICU at Allen Hospital in Waterloo, Iowa, and Trinity Health System in Moline, Illinois, and Bettendorf, Iowa. St. Lukes provides neonatologists and educates the existing care teams to build on current competencies and improve perinatal culture, enabling the NICU to handle more complicated cases that may have been transferred to another facility in the past.

    Allen nurses were unfamiliar with the use and care of PICC lines, explained Sandra Lathrop, RN, BSN, RNC-NIC, St. Lukes neonatal outreach coordinator. We provid-ed our protocols and then met with the staff to educate them on the care after placement of the PICCs. We provided a mannequin that had a PICC and supplies to do dressing changes. We discussed different issues that could arise and problem-solved together. The practice change of using PICC lines has allowed Allen to provide better pain control to infants by eliminating multiple needle sticks with IV starts.

    The CAT Clinic cares for 550 patients taking a variety of anticoagulation medications, all of which are high risk and can cause problems if not managed closely. Clinic nurses have extensive experience in critical care and other areas of nursing.

    The clinic is important to the community because we prevent hospitalizations related to clotting or bleeding. We provide extensive education to our patients about their medica-tions and conditions. We assist patients that need to stop their anticoagulation medications for procedures, Huber said.

    The main goal of the CAT Clinic is to provide patients with a better quality of service by improving communication between healthcare providers and implementing a process for quality assurance.

    Making house calls In 2012, St. Lukes acquired the Visiting Nurse Association (VNA), now called UnityPoint at Home. The organization specializes in comprehensive home care services for patients of all ages and has served Cedar Rapids and surrounding communities since 1919. St. Lukes started working closely with VNA in 1989, providing management services, while VNA continued as a free-standing agency. Bringing VNA into the UnityPoint family helps provide a complete continuum of care for St. Lukes patients, enabling us to focus on coordinated care at the doctors office, in the hospital and at home.

    UnityPoint at Home serves patients within a 50 mile radius of St. Lukes, delivering services such as skilled nursing care, physical and occupational therapy, speech therapy, childrens health services, flu clinics, home health aides and social services.

    Sandi Lathrup, RN, BSN, RNC-NIC

    Skilled nursing care

    Childrens health services

    Home health aides

    Flu clinics

    Physical,occupational

    & speech therapy

    Social services

    UnityPoint at Home

    3

  • patient Care Services Strategic Plan 2012

    WorkflowdesignandEpicclinicaltoolsdevelopment

    Trainingofcertifiedtrainers(CTs),superusersanddirectcareproviders

    Establishtrainingfornewhiresandstudents

    ContributetopostIQ4Go-Liveoptimization

    CareRounding

    BedsideReport

    Take5/Take2

    TeachBack

    AddtravelersduringIQ4Go-Livetoensureadequateresourcesforpatient care while staff are adding new skills with the electronic health record

    Reducetravelerswithin3060daysofIQ4Go-Live

    Reduceend-of-shiftovertime

    Addpatientcaretechstotheresourcepoolfor1:1sittercoverage

    Monitorsuppliesandinventoryinproceduralareas

    Createcapacityforadditionalpatientsbymanagingpatientflow and throughput

    Create,implementandmonitordepartmentlevelaction plans for improvement

    EngageUnitPracticeCouncilsinimprovementefforts

    IQ4 implementation

    Patient Family Experience

    Productivity

    Operating Margin

    1

    2

    3

    4

    The organizational priorities for 2012 centered on the Big Five.

    5 Great Place to Work

    Patient Care Services (PCS) Strategic Plan 2012 cascaded from the Big Five:

    4

  • Exemplary Professional Practice A new way to CAREOur Patient Care Delivery Council researched patient care theories to find a common vision for guiding the way we provide care to our patients. The council selected Comfort Theory by Katharine Kolcaba because it not only provides direction for our patient care, it reflects and builds on practices we already have in place.

    Our Patient Care Practice model is the overarching umbrella that guides our culture, beliefs and practice. The Patient Care Delivery model is HOW we apply these principles.

    Were taking a holistic view of our patients, not just viewing them as their diagnosis or illness. Seeing our patients as whole persons helps us work to meet all of their needs, not just their physical needs. In order to provide this type of care, we consider fouraspectsofthepatientsexperience:

    Physical pain relief, symptom management How does the patient feel physically?

    Psychospiritual self-esteem, the meaning in ones life, spiritual well-being What does this illness mean to the patient?

    Sociocultural interpersonal, family and societal relationships, traditions and rituals What does this illness mean to the various roles that the patient has?

    Environmental hospital room, patients living situation once discharged Does the environment promote the patients healing and wellness?

    The strength of this theory is that it applies to all disciplines and roles at St. Lukes. Having the same beliefs about patient care allows multiple disciplines to speak the same language when discussing the patient and their needs. Every person from housekeepers and mainte-nance to nursing and respiratory therapists play a role in providing comfort to our patients and making sure all needs are met.

    As part of the Comfort model discussion with patients, caregivers ask questions and write patient goals on the whiteboard.

    St. Lukes average time to open blocked arteries.

    Baseline 2007 2008 2009 2010 2011 2012

    Min

    utes

    Opening heart blockages faster

    Lower is better.

    National benchmark

    78

    68 62 62 65 60

    Setting the standard for fast heart attack care Survival and quality of life after a heart attack depend upon the speed in which patients are treated after their heart attack begins. Door to dilation (D2D), or door-to-balloon time, measures the time it takes a heart-attack patient to get from entering the hospital to having blood flow restored to their affected heart muscle through the inflation of a balloon in their blocked coronary artery.

    120

    90

    60

    30

    0

    The gold standard for getting a patient from the Emergency Department (ED) to opening a blocked artery is 90 minutes or less, a timetable that saves lives and leads to better outcomes. The average D2D time at St. Lukes is 60 minutes. St. Lukes fastest reported time in 2012 was 22 minutes. St. Lukes beats the na-tional standard, opening blocked arteries in a fraction of the time most hospitals strive for, as we set standards on our own.

    5

    Whiteboards

    109

  • Outpatients having surgery who received the right kind of antibiotic

    100999897969594939291

    908988

    St. Luke's Average for all Average for Hospital reporting hospitals all reporting in Iowa hospitals in U.S.

    pe

    rcen

    t of p

    atie

    nts

    Higher percentages are better.

    97

    98

    100

    One of my nurses said one of our pieces of safety equipment (the standing and raising device) changed her life. She used to go home hurting every day and she doesnt anymore.

    Christine Rutledge, RN, MSN, CRRN, CBIS Physical Medicine and Rehabilitation Nurse Manager

    2008 2009 2010 2011 2012

    Inju

    ries

    6 West patient handling injuries

    1086420

    Associate safety, safe-patient handling Many nurses and nursing assistants leave the profession because they simply cant perform the work required once theyve been injured. Handling patients safely and making it a priority is a win-win situation for everyone involved.

    If you dont have the nurses to take care of the patients, you cant provide quality care and you cant provide teamwork, said Physical Medicine and Rehabilitation Nurse Manager Christine Rutledge, RN, MSN, CRRN, CBIS. One of my nurses said one of our pieces of safety equipment (the standing and raising device) changed her life. She used to go home hurting every day and she doesnt anymore.

    St. Lukes emphasis on safe-patient handling began in 2008 after performing a needs analysis of lifting tasks throughout the hospital. St. Lukes spent a half million dollars on equipment and clinical expertise, trained over 1,000 associates and then kicked off the effort with education, training and lots of due-diligence. In 2010, safe patient handling was incorporated into the hospitals Standards of Excellence. Next it was included in performance appraisals for anybody who would do any sort of safe-patient handling. The hospital has continued to retrain and focus on this effort.

    Key to the program is staff engagement and leadership support, Rutledge explained. I support it on my unit, 6 West, and have an excellent coach. The results on 6 West have beenphenomenal:in2008,therewere10injuriesrelatedtopatienthandling;in2009,thereweretwo;in2010and2011,therewerenoinjuriesandlastyear,therewasonlyone.Safe-patienthandlingcoachesareself-selectedfrontlinestaff.About40individualsperform this function throughout the hospital.

    The radiology department has become an excellent example of using safe-patient handling techniques. A very engaged leader invested time in developing coaches, scheduling regular meetings, even sending staff to national conferences. Theyve empowered their transporters to say, Im not lifting the patient without that sheet. Its a culture change. Its so different from what anybodys done before. I know well get to a point where we wont lift patients without using the safety support, Rutledge said, comparing it to the culture change of always using gloves with IVs. Before long, we wont remember a time without it.

    UNIT-BASED SAFETY PROGRAMS

    Preventing infectionsPatients are at risk to develop wound infections during their stay in a hospital follow-ing surgery. Hospitals can reduce this risk by administering the proper medicines at the correct time on the same day of surgery. The chart, at left, shows how often St. Lukes administers an antibiotic before surgery to decrease infections. This is just one way St. Lukes is applying best practices for better patient care.

    Developing an infection while in the hospital is something St. Lukes takes very seriously. In fact we want to eliminate hospital acquired infections (HAI), which can lead to readmissions and other complications.

    Several years ago St. Lukes launched an initiative called Passion for Prevention to irra-diate infections. The program raised awareness among caregivers, patients and visitors about the importance of appropriate hand-washing and keeping patient areas disinfected and clean.

    Our efforts to prevent HAIs has seen tremendous success.

    Exemplary Professional Practice

    6

  • After hearing Peg Bradke, RN, MA, St. Lukes Heart Care Services director, speak at an Institute for Healthcare Improvement forum, St. Lukes received requests for copies of the Teach Back DVD from healthcare providers, includ-ing a hospital as far away as Sweden.

    Creating the ideal transition homeHospital stays can be overwhelming for patients and families this is especially true for chronic heart failure patients. Many of these patients are newly diagnosed and unsure of the new medications, diet restrictions and wellness choices they face. This uncertain territory can land them back in the hospital if they have difficulties managing their care. With this in mind St. Lukes created the Transitions Home Program for chronic heart failure patients to help them successfully navigate their return home. St. Lukes focused on heart failure because of the high readmission rate, said Peg Bradke, RN, MA, St. Lukes Heart Care Services director. We looked at how we could make the patients transition home more family friendly. And in particular, we identified specific ways where there was a breakdown in communication, which in many cases led to the patient being readmitted to the hospital.

    One such change was having nurses use the Teach Back technique at discharge. Rather than asking questions, such as do you understand your instructions or do you have any questions, nurses ask patients to explain specific details of their new care regime. At dis-charge, when going over medications, well say show me which of these medications youd take for excess fluid. Or tell me the signs and symptoms you experience when youre getting excess fluid, explained Aimee Traugh, RN, BSN, nurse manager, 3C Telemetry. Teach Back is about asking questions in a way that gets patients to teach information back to us at discharge.

    Teach Back questions are listed on the back of patient education packets, and nurses use these questions as a reference guide for patient education. Patients no longer have the option to say yes, I understand a new medication, simply because they want to get home fast. Since the program was implemented, St. Lukes has seen a significant reduction in re-admissions and has even been recognized as a national model of care in articles published in The Wall Street Journal and The Washington Post.

    Innovations in Patient Care awardSponsored by the Iowa Association of Nurse Leaders, the Innovations in Patient Care award honorsnurseswhohavedesignedand/orcontributedaninnovativeapproachtothedelivery

    of quality patient care. St. Lukes Intensive Care Nurse Manager Jill Morgan, RN, BSN, MBA, NE-BC, won the prestigious award in 2012 for her entry Behavioral Health Medical Emergency Team.

    St. Lukes established the Behavioral Health Medical Emergency Team (BH MET) to provide early intervention into a deteriorating (or potentially deteriorating) situation using our own behavior-al health resources to de-escalate a situation before it becomes a safety threat. The BH MET was developed in collaboration between Behavioral Health Services, Critical Care and Medical Surgical Nursing. When a patient situation escalates or becomes a safety concern, a BH MET member is called to assess and assist, providing patients and staff with an intermediate level, timely

    response from a Behavioral Health nurse.

    BH MET was modeled after the Institute for Healthcare Improve-ments Rapid Response Teams, which documented a reduction in Code Blues outside of Critical Care areas when using Rapid Response Teams. Likewise the BH MET goals include eliminating or reducing the number of Emergent Code 33 calls through BH MET early intervention.

    ThemostcommonreasonsforinitiatingaBHMETcallinclude:agitation,escalating confusion and combative behavior.

    Teach Back is about asking questions in a way that gets patients to teach information back to us at discharge.

    Aimee Traugh, RN, BSNNurse Manager, 3C Telemetry

    Jill Morgan, RN, BSN, MBA, NE-BC, St. Lukes Intensive Care NurseManager

    St. Lukes Hospital Teach Back DVD

    7

    How to get the Appropriate Level of Behavioral Health Nursing Consulation

    for Non-Behavioral Health UnitsSAFETY LEVELS:

    LOW: (CONSULT) Requesting a mental status assessment from a behavioral health staff (either a nurse or physician) to access the level of safety risk or assist with treatment plan. (Callcorrespondinginpatientunit:1W= olderadults,2E=adultsor3E=children)

    MODERATE: (BH MET) Timely response of behavioral health nurses to provide assessment and assistance of an escalating situation or safety concern. (Call phone #3334).

    HIGH: (CODE 33) Prompt response by trained behavioral health staff and Security for an escalated situation in which there are safety risks or violence. (Call stat line #7111).

  • Stephanie Anderson, RN, MSN, CHPN Director, Hospice and Palliative Care Hospice and Palliative Care: Cedar Rapids, IA

    IPOST: Cedar Rapids, IA; Des Moines, IA; Dubuque, IA; Fort Dodge, IA

    IHS Palliative Care Outcome Measurement Project: Des Moines, IA

    Outpatient Palliative Care: Cedar Rapids, IA

    Peg Bradke, RN, MA Director, Heart Care Services Bundled Payment with SNFs: Webinar

    Cross Continuum Teams: Des Moines, IA

    Cross Continuum of Care: Brookings Institute webinar; IHI National Forum

    Readmissions: Des Moines, IA; Chicago, IL; Lansing, MI; Tampa, FL; Boston, MA; Austin, TX

    Teach Back: Wichita, KS; Des Moines, IA; Columbia, MO; Webinar

    Denise Easley, RNC-NIC Birth Care Center Period of PURPLE Crying Legislation: Boston, MA

    Kristi Fuller, OT, Pediatrics/PICU/NICU Successful Feeding in NICU Developing Individualized Programs: New York, NY

    Mary Hagen, RN, MSN, Administrative Director, Organizational Effectiveness Making the Connection: An Approach to Aligning Associate Goals with Organized Strategy, IHS Leadership Symposium, Des Moines, IA

    Jeremy Hudson, NHPCO, Hospice Spiritual Distress and Assistance: Orlando, FL

    Kimberly Ivester, RN, MS, BSN, RN, OCN Administrative Director, Cancer Care Lung Care Program: Wauwatosa, WI; Moline, IL

    Patient Navigation and Survivorship: Washington, DC

    Kent Jackson, MA, LMSW Director, Behavioral Health Adverse Childhood Experiences: Cedar Rapids, IA; Des Moines, IA

    Mary Ann Osborn, RN, MA Vice President and Clinical Officer Cross Continuum of Care: Brookings Institute webinar

    IQ4: It is a Lifestyle, Not a Go-Live: Moline, IL

    Successfully Managing Technology Adoption and Transition to New Clinical Workflows: Des Moines, IA

    Nursing Documentation Principals: Cedar Rapids, IA

    Julie Sturbaum, RN, BSN Surgical Services Prevention and Control of Infections in Surgery: Iowa City, IA

    Sharing our expertiseThroughout the year, St. Lukes associates, managers and directors speak at conferences and events around the country to share their expertise and success stories with peers and various groups and organizations.

    Exemplary Professional Practice

    8

  • Cooling treatment helps oxygen-deprived newbornsDoctors and nurses at St. Lukes Newborn Intensive Care Unit (NICU) use a pediatric cooling blanket to lower the body tem-perature of newborns experiencing neonatal encephalopathy, or difficulty initiating and maintaining respiration, shortly after birth.

    Any time a baby doesnt have a heart rate for a period of several minutes, we are concerned about the potential lack of oxygen in the baby, said Dennis Rosenblum, MD. The longer a baby goes without breathing or a heart rate, particularly at around 10 15 minutes of age, the more concerned we are about the worst possible prognosis. We worry about transient effects, like damage to the liver, kidneys and heart. But more importantly we are concerned about long-term effects, particularly to the brain, that may not be reversible.

    The cooling treatment is called systemic hypothermia or total body cooling. St. Lukes NICU team used a pediatric cooling blanket on Deegan Mizaur when he was born without a pulse and remained that way for nine minutes. The team lowered his body temperature to 92.3 Fahrenheit for 72 hours and then slowly rewarmed him to normal temperatures. Cooling the body slows

    down the basic functioning of the body and may decrease injury to the brain caused by the lack of oxygen (hypoxia) and the lack of blood flow. St. Lukes start-ed offering this

    treatment because a number of large research studies have shown when babies are treated with hypothermia shortly after birth, they have less risk of dying and less brain injury. This means fewer cognitive and motor problems compared to those babies not treated with hypothermia.

    We are grateful we were at St. Lukes NICU where they have this treatmentavailable,saidGaleZiese,Deegansmother.Deeganscare was pretty amazing. I was so impressed with the doctors and nurses in St. Lukes NICU.

    For babies who have had prolonged hypoxia, this treatment decreases death rates or rates of moderate to severe neurologic impairment to about 30 50 percent, compared to a 50 80 percent rate of death or neurologic impairment for those who dont receive this therapy. As a team, we are always trying to stay on the cutting edge of best practices and providing the highest quality outcomes for our patients and their families, Dr. Rosenblum said.

    St. Lukes started offering this treatment because a number of large research studies have shown when babies with neonatal encephalopathy are treated with hypothermia shortly after birth, they have less risk of dying and less brain injury. This means fewer cognitive and motor problems compared to those babies not treated with hypothermia.

    9

    St. Lukes NICU is part of the Vermont Oxford Network, a world wide database that includes over 900 NICUs.

  • 2012 Nursing research studiesThe Effect of Enhanced Psychosocial Assessment on Re-Admissions of COPD Patients. Jennifer Owens, LMSW, principalinvestigator;KellyPottebaum,RN, BSN, Kristina Elder, RN, BSN, SherrieJustice,RN,MA,CPHQ,KirkPhillips,PhD,ReneeGrummer Miller, student intern, supporting investigators.

    RN Evaluation of IQ4 Implementation. Diane Seelau, RN, MBA, principal investi-gator;SandiMcIntosh,RN,MA,NE-BC,Debra Johnston, RN, MSN, supporting investigators.

    Effectiveness of ED Care Plans in Reducing Frequency of Patients Visits to the Emergency Department. Marilyn Gerhold,MSW,LMSW,principalinves-tigator;DoralynBenson,MSW,LMSW,Joshua Pruitt, MD, Amy Engelman, DO, Bonnie Lunsford, RN, BSN, CEN, Jill Wilson, RN, Fred Nesbit, RN, MSN, CNL, Sandi McIntosh, RN, MA, NE-BC, supporting investigators.

    Effectiveness of Pre-operative Adminis-tration of Flomax at Reducing Post- operative Urinary Retention in Male Patients Undergoing Primary Hip or Knee Arthoplasty. Lynn Haro, principal investigator;JulieSturbaum,RN,MSN,Cheryl Mahoney, RN, MSN, supporting investigators.

    Increasing Identification of At-Risk, Drug-Exposed Newborns. Holli Nusser, LBSW, MSW student, principal investiga-tor;DianeSorensen,LMSE,DianeSeelau,RN, MBA, supporting investigators.

    Resolving Barriers to the Use of Emergency Department Triage Protocols Chest Pain. Dan Howlett, DNP candidate to the University of Iowa, principal investigator.

    Patients with Heart Failure Readmit-ted to the Hospital. GregClancey,RN,MSN, DNP candidate to the University of Minnesota, principal investigator.

    Symptom Interpretation and Com-munication. Heide Bursch, RN, MSN, PhD candidate to the University of Iowa, principal investigator.

    Advanced degrees and certificationsIn 2012, we had 317 certified RNs, a 19 percent increase from 2011. Certification is validation of the knowledge and critical thinking skills our nurses bring to our patients with each interaction. Our patients benefit each day from their commitment to excellence.

    New certificationsStephanie Asmussen, RN, BSN, OCN, CMSRN(Med/SurgCertification),5Center

    DianaBahr,MSN,CMSRN(Med/Surg Certification), Med Surg float pool

    Jamie Canterbury, RN, BSN, CMSRN (Med/SurgCertification),4Center

    Kellie Carpenter, RN, BSN, OCN (Oncology Nursing Certification), 5 Center

    Toni Cress, RN, CRRN (Rehabilitation Certification),4CenterOrtho

    Dawn Cook, RN, OMC (Orthopedic Certification),4Center

    Laura Diers, RN, CAPA, (Certified Ambulatory Perianesthesia), SurgiCare

    ShellyEvans,RN,BA,CGRN (CertifiedGastroenterologyRegisteredNurse), Digestive Health

    BeckyGatewood,RN,OCN (Oncology Nursing Certification), 5 Center

    Advanced degreesSarah Baumert, RN, MSN, 5 East

    Penny Dullea, BSN, Pain Clinic manager

    Kara Flack, RN, BSN, CRRN, CBIS, 6 West

    EricaGrandy,BSN,IntensiveCareUnit

    Jeremy Hauge, BSN, Infusion

    Rosetta Hedges, MSN, Medical Staff Office

    Bianca Hogge, RN, BSN, 5 East

    Sarah Hunefeld, RN, BSN, 5 West

    Shelley Kramer, RN, BSN, RNDC, Psych Partial Hospitalization program manager

    new Knowledge

    Amanda Langfitt, RN, BSN, RNCHPN, Hospice

    Krystal Lien, BSN, Infusion

    TeresaLudolph,BSN,CGNR, Digestive Health

    Christine Martin, BSN, 5 West

    Karen McCommis, BSN, 2 East manager

    Sue Novak, BSN, Digestive Health

    Amy Veit, RN, MSN, Performance Improvement department

    CourtneyGreen,RN,MSN,CCRN(CriticalCare Registered Nurse), Intensive Care Unit

    Jared Hanson, RN, BSN, CCRN (Critical Care Registered Nurse), Intensive Care Unit

    Jan Kriegel, RN, ONC (Orthopedic NurseCertification),4Center

    RobynKolbet,BSN,Neonatal/PediatricCertification,NICU/Peds,PICU

    Vickie Nimmer, RN, DPN, Certified EECP (Enhanced External Counterpulsation) Therapist CET (Cognitive Enhancement Therapy), Heart Holding

    Val Obabdal, RN, OCN (Oncology Nursing Certification), 5 Center

    Lorrie Prasil-Holcomb, MSW, ACHPSW (Advanced Certification of Hospice and Palliative Care Social Work), Hospice

    Michelle Wenzel, BSN, CWON (Certification in Wound Ostomy Nursing), Inpatient Skin Care

    10

  • Scores of patients who were frequent users of St. Lukes ED are now receiving consistent care as a result of an innovative program at St. Lukes. Its called the Emergency Depart-ment Consistent Care Program (EDCCP), which got its start from a $50,000 gift from Transamerica. Its an effort to coordinate care between St. Lukes, the patients doctor, home care and mental health care.

    The EDCCP began in January 2012 with the enrollment of 103 patients, said Sallie Selfridge, LBSW, St. Lukes social worker. To date, there are 233 patients in the program. These are patients who have been treated in St. Lukes ED 12 or more times during the previous year. Many used the ED because they did not have a family doctor, had difficul-ty keeping doctors appointments or had financial or insurance issues.

    For example, Theresa Brown, 51, visited St. Lukes Emergency Department (ED) 12 times in 2011. She was diagnosed with chronic obstructive pulmonary disease (COPD) just overadecadeago.ShealsosuffersfromcongestiveheartfailureandGitelmans syndrome, which causes kidney problems and lowers her potassium levels. It has been a rough several years, said Brown. I have been in and out of St. Lukes a lot. Mainly because I would get sick and couldnt breathe. It can be scary. This program has been a huge help to Brown. Things were so much harder for me before this program was implemented. Oftentimes I felt very overwhelmed. Im glad St. Lukes started this program.

    The EDCCP has reduced patient visits by two-thirds. During the first nine months of2012,theoriginal103EDCCPpatientsvisitedtheED438timescomparedwith 1,377 visits during the same period of 2011.

    We want patients to use St. Lukes ED when they have an emergency, said Selfridge. This isnt meant to keep these patients out of the ED, we just want to make sure they are getting the most appropriate and timely care, she said.

    The efforts of the EDCCP Program have reduced patient visits by two-thirds.

    Helping frequent ER users lower costs, improve care Comfort RoomThe Behavioral Health older adult unit needed an option to help patients relieve stress and anxiety and improve their self-soothing skills. We were looking for an alternative to medication, said Ikami Sasa, RN, BSN, 1 West, Behavioral Health. Research showed a Comfort Room pro-vides a safe space for patients, promoting self-care, resilience and recovery while offering an option for crisis prevention and de-escalation.

    Improve self-soothing skills

    Decrease stress and anxiety

    We wanted to create a low-stimulus, calming environment, said Laura Chris-ten, RNC, 1 West, Behavioral Health. The unit adapted a former interview room and chose calming colors and items based on the literature about Comfort Rooms. Now, when patients get nervous, anxious or are having personality conflicts with another patient, they are offered the option to go to the Comfort Room. Nurses will tell them, I know an area thats quiet, said Christen.

    The room is small and painted in sooth-ing colors with a waterfall mural. It has dimmable lighting, a beanbag chair and rocking chair, soft carpet and stress balls. Calming, soothing music can be played in the room by staff if requested. There is no TV in the room. It is monitored via a camera by staff and patients are checked on during rounds. Patients choose when to go into the Comfort Room and when theyre ready to leave.

    Since implementation, there has been a decrease in anxiety medications and acting out from personality disorder patients, and theyve avoided many restraint and seclusion episodes. Feedback and survey results from both staff and patients have been positive. In 2012, the frequency of using the room increased, Christen said. Staff members recommend it more. Were educating clients on something they can do when they go home.

    11

  • New Knowledge

    Heart failure patients can quickly end up in the emergency room and stay for an extend-ed time in the hospital. Nearly one in four will be back in the hospital within 30 days, according to a 2009 American Heart Associ-ation journal report. Nationally, institutions with heart failure clinics report a significant decrease in readmissions for patients in their programs. Peg Bradke, RN, MA, Heart Care Services director, said, Some heart failure

    clinics we talked to reported their hospital readmissionrateswere30to40percentlower than the national average. St. Lukes Heart Failure Clinic is helping heart failure patients and their families improve self-management as they treat and improve their symptoms.

    We know many physicians offices are extremely busy. Heart failure management can be challenging and some patients need very close supervision. We combine not

    St. Lukes Heart Failure Clinic educates and monitors heart failure patients

    only medication management but, more importantly, education, referral to services if needed and sometimes daily telephone monitoring by our heart failure nurse. Our goal is to keep patients out of the hospital and improve their quality of life at home, said Sue Halter, ARNP, clinical director for St. Lukes Heart Failure Clinic.

    Every St. Lukes patient who receives a discharge diagnosis of heart failure is seen by clinic staff three to five days after theyre discharged. Physicians and cardiologists refer chronic heart failure patients to the clinic when a patient needs close follow-up. We want our patients to be able to fully live their lives without repeated hospital-izations or frequent trips to the doctor and ultimately optimize the quality of their life. If we can do that by closely monitoring them and keeping them out of trouble, thats our goal, said Halter. Being located at the hospital allows us to direct our patients to resources that may help, like home health care, cardiac rehabilitation and pulmonary rehabilitation if needed.

    On average, more than 85% of patients attending the Heart Failure Clinic

    can successfully teach back information that will help them improve their

    heart failure and avoid further hospitalizations.

    In 2012, St. Lukes Heart Failure Clinic saw

    1,332 heart failure patients at the clinic and

    in the nursing homes where they reside.

    12

  • Structural EmpowermentNurse residency programFor new nurses, the honeymoon phase of the job wears off quickly and disillusionment sets in. Many leave their first job within a year or two then find another, only to feel dissatis-fied there as well. Research backs up the idea that new nursing graduates find it difficult to acclimate to their first job. Training in school is much different from the actual experience of caring for people and the adjustment is stressful. Nurses question whether or not theyre confident enough to take care of patients.

    Nurse residency programs help decrease turnover and increase engagement. They provide emotional support and help new nurses gain extra knowledge and skills. St. Lukes began its nurse residency program in 2010. It holds two cohorts a year, one in the spring and one in the fall. Since the program was initiated, 182 residents have completed the program and our one-year retention for newly graduated nurses is at 95 percent.

    We wanted to be proactive even though St. Lukes retention rate was high before the program began, said Joanie Copper, RN, MSN, practice development coordinator who co-facilitates theprogramwithJulieZimmerman,RN,MSN,BirthCareCenterstaffnurse.Shecitedthenursing shortage, anticipation of nurses retiring and fewer individuals entering the nursing profession than have in the past as some of the reasons behind implementing the program. We can use the nurse residency program as a recruitment tool. We want our nurses to be successful and retain them after their first year. Its costly to train new nurses and have them leave. Training can cost twice their yearly salary, depending on the type of nurse it is, Copper said. The nurse residency program helps us develop confident, competent nurses able to provide higher quality care for patients.

    Averagecohortsizeis40nurses.Oncenursesarehired,theyspendsixto12weekslearningtheir jobs in their units under guidance of a preceptor before being automatically enrolled in the nurse residency program. Nurses attend 12 three-and-a-half hour sessions that cover a variety of topics, from time management to ethics, conflict management, stress release and taking care of a changing patient condition. They learn on simulators, through role playing and discussions, small group activities and going over case studies in an environment where its safe to talk. And they learn that every nurse goes through the same doubts and adjustment difficulties that they experience.

    We encourage them to find a mentor during their residency, Copper said. We believe every nurse should have this opportunity. I get so much enjoyment watching them grow and teach each other, share experiences and gain confidence in what theyre doing. And we have a lot of fun.

    St. Lukes Councils Representatives from every department in the hospital sit on the following councils, which meet regularly throughout the year to accomplish specific tasks.

    Patient Care Delivery Council, chaired by Carmen Kinrade, RN, MSN

    Developed and implemented Comfort C.A.R.E. Professional Practice Model

    Performance Improvement Council, chaired by Sherrie Justice, RN, MA

    1. Review nurse sensitive indicator data, such as falls, pressure ulcer, blood stream information, hospital performance against national benchmarks.

    2. Unit Practice Councils reported quarterly on their individual department progress on patient and family experience and quality indicator performance.

    3. Twenty departments presented case studies for group learning.

    Practice Council, chaired by Peg Bradke, RN, MA

    1. Documentation and workflow clarification for Epic.

    2. Developed Diabetes Education Toolkit and Care of Dying Patient Resource packet.

    3. Evaluated and approved new products and equipment, such as IV pumps, Pyxis machines, epidural pumps, feeding tube connections, Accucheck machines, razor and shaving cream, slippers, combs and toothbrushes.

    4.Reviewed and revised policies related to tracheotomy care, tube feedings and the care of the bariatric patient.

    Professional Development Council, chaired by Diane Seelau, RN, BSN, MBA

    The Career Achievement Program (CAP) was developed in 2008 to recognize nurses, respiratory technicians, social workers and dietitians who are engaged in house-wide councils and projects. Par-ticipation has nearly doubled since its inception. In 2012,41individualsreceivedtheGoldaward,128received Silver and 95 received Bronze for a total of264participants.TheProfessionalDevelopmentCouncil evaluates entries and determines award level, which includes a bonus reward.

    Research Council, chaired by Sandi McIntosh, RN, MA, NE-BC

    1. Revised and implemented Evidence Based Project and Research Toolkit, placed on Intranet.

    2. Changed Council model to Advanced Practice Nurse (APN) model, so APNs are mentoring staff nurses on how to perform research.

    3. All APNs, chairs and co-chairs have completed National Institute of Health web-based training Protecting Human Research Participants.

    4.SLH completed three research studies in 2012.

    13

  • Extraordinary people exceptional careEvery year during Nurse Week, St. Lukes holds a Nursing Awards ceremony to recognize, celebrate and thank nurses in our organiza-tion who were nominated by their peers for nursing excellence. The awards and scholarships give our hospital an opportunity to say a heartfelt thank you to nurses who are living our mission every day. The awards and scholarships are provided by generous donors in our community who believe in the mission of St. Lukes Hospital and St. Lukes Foundation.

    Outstanding New Graduate AwardElyse Chodur Cancer Care/Neuro Unit

    Nancy Lamb Skogsbergh & Edna Lamb Nursing Leadership AwardJenny Houlihan, RN, MSN Cardiac Care Unit

    Excellence in Behavioral Health AwardsRachel Brecht, RN, MSN Older Adult Unit manager

    Sandra Bills, RN, BSN, SANE Adult Unit

    Victoria Van Voorst, RN Child/Adolescent Unit

    Joy Cummings, RN, BSN Psychiatric Home Care/VNA

    100 Great Iowa NursesCarol Franzenburg, RN, BSN 5 West Urology

    Carol Haendler, RN, BSN, CRRN, CDIS Physical Medicine & Rehab

    Ida Martin Sorensen, RN ER, Family Health Center

    Sandra McIntosh, RN, MA ER

    C.A.R.E. Service AwardKati Rizzio Medical Unit

    LaMorgese Award for Excellence in Neurological NursingSamantha Feddersen, RN, BSN Cancer Care/Neuro Unit

    Carroll H. & Lena Nelson Critical Care AwardJulie Gilmore, RN, BSN, CCRN Intensive Care Unit

    Angela Ulferts, RN, BSN Post Surgical Unit, 3 West

    Dr. Stephen & Peg Vanourny Award for Excellence in Obstetrical & Gynecological Nursing Debra Langager, RN, BSN, RNC-OB Birth Care Center

    Social Worker AwardNancy Hagensick, OSWS Helen G. Nassif Community Cancer Center

    Structural Empowerment

    14

    Elaine Young Leadership AwardDenise Abel, RN, BSN Cancer Care/Neuro Unit

    Anna Purna Ghosh Oncology Nursing AwardStephanie Asmussen, RN, BSN, OCN, CMSRN Cancer Care/Neuro Unit supervisor

    Darrell Dennis Pulmonary Medicine AwardStacey Below Respiratory Care

    Smulekoff Family Award for Nursing ExcellenceErin Boone, BSN, RN-BC Post Surgical Unit, 3 Center

    Kiley Finke, BSN, PCCN Telemetry Unit, 3 Center

    Lindsey Ricklefs, RN, BSN, RNC-NIC Newborn Intensive Care Unit

    Bryce Richmond, BSN, CNMSRN Cardiac Care Unit, 5 West

    Dale & Ruby Morgan & Mable Ray Endowment AwardRobyn Kolbet, RN, BSN Newborn Intensive Care Unit

  • Guardian Angel Award winnersTheGuardianAngelprogramatSt.Lukesgives families a way to recognize St. Lukes associates who have made their journey easier. They offer a donation in honor of a St. Lukes staff member, doctor, volunteer or department, and those individuals receive aGuardianAngelAwardandrecognitionamong their peers for exemplary care.

    KathyGillilandandherpettherapydogMisty

    Jennifer Bielefeld, Bridget McCullough, Nicole Baccam, Melissa Delaney, Beth Walker, Kathy Martensen

    Nic Hughes, Bill Feldhaus, Jessie Merrill

    Diane Kladivo

    Tami Mora, Mindie Manning, Debra Sanders, Vickie Nimmer

    Melissa Watson (Cobb)

    Amber Dull

    Bruce Wlosinski, Beth Mehmen

    Mary Anne Berry, Bruce Wlosinski, Bobby Dickerson and Dr. James Bell

    Cassie Wallace

    Julie Trachta

    KristinWatts,NikkiYakish,ColleenBentley

    Dr. John Roof

    Mary Ann Osborn, Dr. Josh Pruitt

    Amy Boteler, Janet Brown, Pam Cohn, Bev Faber, Jennifer Hickey, Sue Novak, Justine Obert, Joan OConnor

    Kelly Printy, Jeremy Hague

    Janelle Latimer, Cassandra Woodward

    Dr. Dana Messenger, Dr. Adam Shires

    KaliGleason,LynseyHawn,ShannonTimp,Ashley Jensen

    Jill Hendricks

    Dr. Robert Struthers

    Mona Cook

    Michael Fahrenkrog-Pullen

    Karin Kurisu and her pet therapy dog Reeses

    Chris Montross

    Dr. Keith Kopec

    Barbara Peterson, Lorrie Prasil-Holcomb, Jeremy Hudson, Pauline Moermond, Amanda Langfitt, Falecia Wilson, Anita Horak

    Denise Behmer, Jean Hachey

    Erin Williams, Dani Broederson

    Greta N. Schuchmann ScholarshipLindsey Mullenbach Laboratory

    Kimberly Wilson Cardiologist, LC

    Nursing ScholarshipSheryl Bosch, RN, BSN, CCRN, NIH Cardiac Cath Lab

    Barbara Haeder, RN, BSN Heart Care Center

    Sara Goslin Neff, RN, BSN, BA, RNC-NIC Newborn Intensive Care Unit

    Laura Ramsey, RN, ARNP, MSN, NNP-BC, CPNO-AC Newborn Intensive Care Unit

    Beatha Kuntz ScholarshipRachel DeWalle, RN, MSN, RNBC Cancer Care/Neuro Unit

    Dr. Charles Schwartz ScholarshipJoanie Copper, RN, MSN Nursing Services

    Natalie and Joe Cohn ScholarshipTessa Kvidahl Imaging Services, Radiology Transporter

    Aimee Traugh, RN, BSN Telemetry manager 3 Center

    Brittany Werling, CPhT Pharmacy

    May G. Gortner ScholarshipKiley Finke, RNBSN Telemetry

    Kimberly Woods, RN, RNC-OB Birth Care Center

    Dr. J. Stuart McQuiston ScholarshipJayne Hildebrand Surgery Center

    Julie Martin Medlabs

    Julie Smith Respiratory Care

    Scholarship winners

    15

  • Transformational LeadershipAn Epic change at St. LukesThe June launch of a new electronic health record at St. Lukes successfully resulted in 90 percentusercompliancewithinfivemonthsanda$4,815,422meaningfulusereimburse-ment within 10 months by the Centers for Medicare and Medicaid Services. The electron-ic health record allows healthcare providers quick access to critical patient information, including medical history, test results and prescriptions.

    IQ4implementationwasanexcellentexampleofnursingleadershipandinterdisciplinarycollaboration. Mary Ann Osborn, RN, MA, vice president and chief clinical officer served as the clinical adoption executive for both St. Lukes and UnityPoint Health, helping establish the governing principles for the design work, facilitate workflow sessions, create certified trainers (CTs) and super user selection criteria, establish the informatics team post go-live infrastructure and define go-live command center roles. Osborn worked closely with Pat Thies, RPh, MS, FACHE, director of pharmacy and St. Lukes Epic project lead and Dustin Arnold, DO, CMIO, to align resources and communicate to all key stakeholders.

    Nurses led projects in the following areas and provided many additional examples of leadership:Associate training at St. Lukes: Mary Hagen, RN, MSN, Mary Spring-steen, RN, BSN, and Bonnie Carpenter, RN, BSN, RNE-MB, selected CTs and Super Users, identified classroom space, created the training calendar and built the post go-live training program for new hires and students.

    Adaptive design workflow efforts in the pre and post go-live phases: Led by Carmen Kinrade, RN, MSN, GretchenAschoff,RN,BSN,CPHQ, Connie Bulman, RN, CMSRN, Julie Cayler, RN, MSN, Cheryl Mahoney, RN, MSN, CMSRN, and Peg Bradke, RN, MA. This was identified as a best practice by our Epic partners and external consul-tants.

    Operation Time application: Led by Carol Duit, RN, Janna Peterson, RN and Julie Sturbaum, RN, MSN.

    ASAP application: LedbyKathyRoss-Garron,RN,MSN,CEN, CFRN and Sandra McIntosh, RN, MA.

    Stork application: Led by Phyllis Maeder, RN, BSN, Kathy Manderschiedt, RN, MSN, RNC-OB and Diane Seelau, RN, MBA.

    Clinical informaticists: Led by Mary Springsteen, RN, BSN, with Michelle Puls, RN, BSN and Rose Hedges, RN, MSN.

    Multiple nurses served in CT and super user roles.

    16

  • The Bridges to Excellence

    The Bridges to Excellence program provides associates and affiliates funding to attend conferences for professional and career development by paying expenses up to $2,000.

    St. Lukes certifications and accreditations

    Advanced Certification in Palliative Care: Awarded by The Joint Commission September 20, 2012 valid for two years.

    St. Lukes is the first healthcare provid-er in Iowa to receive this certification, which is based on review of compliance with national standards, clinical guide-lines and outcomes of care. In addition, the requirements include:

    A formal, organized palliative care pro-gram led by an interdisciplinary team whose members possess the requisite expertise in palliative care

    Leadership endorsement and support of the programs goals for providing care, treatment and services

    A special focus on patient and family engagement

    Processes that support the coordination of care and communication among all care settings and providers

    The use of evidence based national guideline or expert consensus to guide patient care

    Advanced Certification in Stroke (Primary Stroke Center): Awarded by The Joint Commission May 2012 valid for two years.

    St. Lukes was first awarded Advanced Certification in Stroke and designated a Primary Stroke Center in 2006 and has received four consecutive certifications since then.

    SimFam: Meet SimMan, Noelle and MegaCode KidDuring yearly competencies at St. Lukes, the resident fake family earns its keep. High-fi-delity mannequins SimMan, Noelle and MegaCode Kid breathe, talk, receive IVs and shots, and generally get into difficult health situations at the push of a button. Noelle, the pregnant patient simulator, has a heartbeat, she bleeds and gives birth on a routine basis, all in the name of practicing successful deliveries. Her baby has problems of its own, providing nurses and doctors with newborn intensive care training. All of the mannequins encounter any number of complications thanks to special computer programs.

    In 2012, Birth Care Center simulations focused on maternal seizures. My simulation team worked on a postpartum seizure related to preeclampsia, and then our labor-trained staff worked on laboring patient who had a seizure related to preeclampsia, said Rachel Smith, BSN, RNC-OB, obstetrical outreach coordinator in St. Lukes Birth Care Center. We limit simulations to seven people because small groups work better. We videotape them so we can see whats been done and we discuss it in a debriefing afterwards.

    The exercise is typical for all St. Lukes patient care unit competencies. Its a great way to train nurses, doctors and whole teams on events, particularly low-volume, high-risk events. Staff can learn in a safe environment, where its okay to make errors, said Joanie Copper, RN, MSN, practice development coordinator. They debrief afterwards and go over what they could have done better. The process teaches better teamwork, communication and competency, which are the cornerstones to quality healthcare.

    17

  • IMPROVING LIVES THROUGH CHANGES IN IOWA LAW

    Iowa Physician Orders for Scope of TreatmentSt. Lukes played a key role in getting a new healthcare law passed in March 2012 that creates the Iowa Physician Orders for Scope of Treatment (IPOST). This is a legal doctors order that allows an individuals healthcare wishes to be documented, communicated and honored as they pass through various healthcare settings.

    The one page document allows a person to communicate their preferences for key life- sustainingtreatmentsincluding:CPR,generalscopeoftreatment,artificialnutritionandmore. People may refuse treatment, request full treatment or specify limitations. It is primarily used by the chronically or seriously ill who have frequent contact with healthcare providers, a person with a life-limiting illness or the frail and elderly residing in a nursing facility or in the home.

    The portability of the IPOST form (it travels with patients as they move from one healthcare setting to another) belongs to the patient and allows seamless documentation of treatment preferences. It complements an Advance Directive by translating patient wishes into legal medical orders, which due to the passing of this legislation, will now be honored in all healthcare settings across Iowa. IPOST also helps to facilitate conversations between family members and the physician in order to make a persons wishes known.

    Commission on Accreditation of Rehabilitation Facilities (CARF): Surveyed by CARF November 1718, 2011 accreditation valid for 3 years in the following programs:

    Inpatient Rehabilitation adults

    Inpatient Rehabilitation children and adolescents

    Inpatient Rehabilitation brain injury adults

    Inpatient Rehabilitation brain injury children and adolescents

    Inpatient Rehabilitation stroke specialty program adults

    St. Lukes is the first rehabilitation program in Iowa to receive the Commis-sion on Accreditation of Rehabilitation Facilities (CARF) Inpatient Rehabilitation Stroke Specialty Program accreditation.

    St. Lukes Inpatient Rehabilitation unit received their twelfth consecutive three-year accreditation for the unit.

    Advanced Certification in Heart Failure: Awarded by The Joint Commission September 25, 2012 valid for two years.

    Certification in Joint Replacement Hip Knee: Awarded by The Joint Commission July 21, 2012 valid for two years.

    St. Lukes certifications and accreditations

    The IPOST project began back in 2006 when Dr. Ralph Beckett, Stephanie Anderson, RN, MSN, director of St. Lukes Palliative Care and UnityPoint Hospice, and Christine Harland-er, Palliative Care at Mercy Medical Center, identified a gap in care. They often discovered their patients healthcare treatment wishes were not being met after leaving the hospital. Too often, people were receiving treatment they did not want because their wishes were not communicated as they crossed various healthcare settings. Anderson and Harlander found their solution in a similar program that began in Oregon (POLST).

    In 2008, state lawmakers chose Linn County to pilot the IPOST tool as part of Iowas Health Care Reform Act. In 2010 the project was expanded to include Jones County where Jones Regional Medical Center rolled out the tool and adapted it to fit a more rural population.

    Transformational Leadership

    18

  • In October 2012, Denise Easley, RNC-NIC, spoke at the International Shaken Baby conference in Boston about Iowas legislation written specifically around the Period of PURPLE Crying program. It was the culmination of years of dedication by Easley to improve Iowas education regarding shaken baby syndrome and decrease Iowas shaken baby rate.

    It all began in 2007 when Easley attended the National Association of Neonatal Nurses Conference in San Diego, California, using money from the Bridges to Excellence Fund. At the conference, she learned about the Period of PURPLE Crying program. What I loved about the program was that it is evidence-based, prepared for third-grade level understanding, easy for nurses to implement and parents to understand, and econom-ical, Easley said. My initial goal was to get this program at St. Lukes. After attending a summit in Des Moines on shaken baby syndrome the following year, she realized she

    could bring the program to the entire state.

    Easley worked to spread awareness about the program, and in March 2009, Iowa passed shaken baby legislation based on the Period of PURPLE Crying Program.

    Later that year St. Lukes became the first hospital in Iowa to start the pro-gram and other Iowa hospitals soon began implementing it. Easley became

    a trainer to teach nurses how to deliver the program and she speaks about it at conferences and does presentations.

    By October of 2011, 80 percent of Iowas birthing hospitals were delivering the program. That happened in less than two years, Easley said. Shaken baby rates have declined since the program was initiated. There was not a single shaken baby death in Iowa in 2011 or 2012.

    P U R P L E UnexpectedCrying can come and go and you dont know why.

    Resists SoothingYourbabymaynot stop crying no matter what you try.

    Pain-Like FaceA crying baby may look like they are in pain, even when they are not.

    Evening Yourbabymaycry more in the late afternoon and evening.

    Long LastingCrying can last as much as five hours a day or more.

    Peak of Crying Yourbabymaycry more each week. The most at two months, then less at three-five months.

    What I loved about the program was that it is evidence based, prepared for third-grade level understanding, easy for nurses to implement and parents to understand, and economical.

    Denise Easley, RNC-NIC

    Shaken baby prevention: Period of PURPLE Crying program

    19

  • Community Contributions

    Free Mammography Day St. Lukes Breast and Bone Health provided no-cost mammography screening to 29 uninsured or underinsured women over the ageof40onMarch19.Threeofthewomenreceived additional imaging and follow-up.

    Bras for the CauseCarousel Motors, a major contributor to the Bras for the Cause organization, chose St. Lukes to receive $10,000 in Bras for the Cause donations. The money will be used primarily for screening mammography for the uninsured and underinsured. St. Lukes Breast and Bone Health, in collaboration with St. Lukes Foundation, is planning a screening event in June 2013 to provide approximately 57 screenings to women who otherwise would not receive recommended breast screenings.

    Bras for the Cause is a nonprofit organization that raises funds for mammograms and cervical screenings and promotes womens health and wellness education.

    photojeania, Inc.

    Photos from left to right: Breast Cancer Awareness Bat Boat; Pink in the Rink; Breast Health Summit

    St. Lukes works to ensure there are programs in our community providing services to prevent illness and promote health and healing in response to identified community needs. The goal is to improve residents access to healthcare, enhance the health of the community, advance medical or health knowledge, or relieve the burden on government or other community efforts.

    St. Lukes community benefits include education, charity care, subsidized health services, community health improvement activities and more.

    Breast Health Summit For the first time in Cedar Rapids, last March over 100 women gathered to focus on education, risk prevention and detection of breast cancer in African American wom-en. The conference was held at the African American Museum and was organized with assistance through the Iowa Cancer Con-sortium, Iowa Department of Public Health and many community partners, including St. Lukes Cancer Care and Breast and Bone Health.

    Breast Cancer Awareness Bat Boat St. Lukes Breast and Bone Health and Cancer Care once again sponsored the Breast Cancer Awareness Bat Boat, an offshore racing boat with a batwing de-sign. The boat helps promote breast cancer awareness and education in the community when it appears at events such as the Uptown Marion Market and Cedar Rapids St. Patricks Day and Holiday DeLight parades.

    Pink in the Rink St. Lukes Breast and Bone Health and Can-cer Care partnered with the Cedar Rapids Roughriders Hockey organization to pro-mote breast cancer awareness on September 19. Over $2,300 was raised for the Spirit Fund through ticket sales with the Rough Riders donating $2 of every ticket sold and a silent auction.

    Click for BabiesSt. Lukes recruited knitters and crocheters to make purple caps for babies. The caps were given out at the hospital in November to new parents after they viewed their Period of PURPLE Crying DVD. Using social media, knitters united across the country while mak-ing purple baby caps, and St. Lukes collected 6,800 caps to distribute.20

  • Go Red for Women St. Lukes Hospital is the primary sponsor of CedarRapidsGoRedforWomen,whichisa luncheon and program following a vendor fair, silent auction and breakout education-al sessions to raise awareness about heart disease as the number one killer of women in the U.S.

    Bike helmet giveaways St. Lukes Physical Medicine and Rehabili-tation brain injury community outreach fits and distributes approximately 2,000 bike helmets every year. They began the program seven years ago because the acute inpatient rehab unit serves many patients who have experienced traumatic brain injuries and they felt it was important to prevent even one brain injury by keeping kids safe.

    Eastern Iowa Retreat and Refresh Stroke campHeld annually at Camp Courageous in Monticello, Iowa, since 2008, this camp offers fun activities, relaxation and support to stroke survivors and their care givers. It is funded by a joint collaborative effort between St. Lukes Physical Medicine and Rehabilitation, Mercy Medical Center and University of Iowa Hospitals and Clinics. In addition to funding, St. Lukes supplied 10 volunteers for the three-day weekend retreat.

    Community boardsStephanie Anderson, RN, MSN, Director, UnityPoint Hospice and St. Lukes Palliative Care: Hospice and Palliative Care Association of Iowa board, PalliativeCareAdvisoryGroupforIowa

    Pam Burrack, RN, BSN, 3 Center: American Association of Critical-Care Nurses secretary

    Peg Bradke, RN, MA, Director, Heart Care Services: American Heart Associ-ationexecutivecommittee,GoRedforWomen 2012 event chair

    Mary Hagen, RN, MSN, Administrative Director, Organizational Effectiveness: Catherine McAuley Center board, Transitional Housing for Women and Adult Education program, Human Resources committee

    Kent Jackson, MA, LMSW, Director, Behavioral Health: Linn County Severe Emotionally Disturbed (SED) advisory board, Linnhaven board, Magellan Clini-cal Advisory committee, Early Childhood of Eastern Iowa board, Linn County MH/DDAdvisorycommittee,UnitedWayHealth Impact team

    Carmen Kinrade, RN, MSN, Director, Nursing Operations: Aging Services board president

    Shelley Kramer, RN, BSN, Adult Partial Hospitalization: National Alliance on Mental Illness (NAMI), second vice presi-dent of executive board, NAMI treasurer

    Mary Ann Osborn, RN, MA, Vice President and Chief Clinical Officer: Eastern Iowa United Way board, execu-tive committee, chair of Childrens and YouthAllocationteam,chairofImpactCabinet

    Lifeguard Air AmbulanceSt. Lukes Lifeguard crew participates in events happening in small, rural commu-nities where a large percentage of Lifeguard customers Emergency Medical Services (EMS) and community hospitals in outlying areas are located. We do things like fly in for their town celebrations and allow people in their community to look at the helicopter and sit in it. Kids love it and it also allows us to see patients we have cared for in the past and help build a strong reputation for Lifeguard and St. Lukes Hospital, said Lynn Tschiggfrie, RN, CEN, Lifeguard Air Ambu-lance supervisor. We also go out to EMS services and do education classes.

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  • UnityPoint Clinic | UnityPoint at Home | UnityPoint Hospice

    Connect with St. Lukes at unitypoint.org/cedarrapids

    The new interdisciplinary tracheotomy team was created to enable St. Lukes patients to come here as outpatients and have their tracheotomies changed every month by the people theyre familiar with. Its absolutely the right thing to do for our patients. It helps us merge hospital care with home care to get our patients comfortable at home. Sarah Erickson, RT, Respiratory Care

    Early ambulation protocol brings together nurses, respiratory therapists and therapists to huddle with patients on ventilators, ensuring the right people are in place to walk with patients when theyre ready. Nursing research and nursing protocols drove this practice change. It has decreased length of stay, ventilation days, and expense. Jaclyn Hall, PT, GCS, supervisor of acute therapies

    In the Birth Care Center, we implemented subgaleal hemorrhage protocol for babies with head trauma or vacuum or forceps delivery. The new protocols, such as taking vitals and measuring head circumference to make sure their head isnt swelling, gives us a way to catch subgaleal hemorrhage before its too late. Shawna Meyer, RN, Birth Care Center, Magnet Champion

    We changed our Critical Care Unit transfer process. Our nurses now go up to the patients bedside to get the report before theyre transferred out. It allows us to see if the patients are ready and puts them in a better frame of mind so theyre not as scared before coming down. It has decreased the number of unplanned transfers back to critical care. Well soon expand the process to the Intensive Care Unit. Amanda Plummer, RN, Telemetry, Magnet Champion

    In Behavioral Health, our patients face daily challenges above and beyond their physical health, leaving them vulnerable to readmission. Our innovative approach to discharge planning involves all caregivers including pharmacy, home health, social workers, nursing and begins when patients arrive in our unit and involves daily meetings. We follow up with phone calls after patients leave. Our revamped discharge, safety and success plans are proactive and set up for success. Sandy Bills, RN, BSN, SANE, Adult Behavioral Health, Magnet Champion

    Magnet ChampionsThroughout the year, represen-tatives from every area of the hospital meet to share news and innovations from their departments. It offers inspiration and facilitates collaboration across disciplines.

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    Heres what our Magnet Champions are saying: