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  5. 5. -1- Empowering the Novice Staff Nurse to Become a Certified Pediatric Oncology Nurse Heather Ambrose RN, BSN, CPON®, CPN Children’s Hospital of Pittsburgh of UPMC As the nursing profession strives to achieve excellence, nursing certification is essential to this journey. Professional organizations throughout nursing support and encourage nurses to develop in their profession through certification, which is also crucial to achieve ANCC’s Magnet Recognition. With the nursing shortage increasing, hospitals are faced with turnover and a novice staff. Children’s Hospital of Pittsburgh of UPMC hematology/oncology/BMT unit is no exception. The heme/onc unit is a 17 bed unit with 33 full and part time nurses. The average experience for nursing is 4 years. Zero percent of the Heme/Onc staff had achieved professional nursing certification until 2007. To help fill this void, a review course that specifically targeted the Certified Pediatric Oncology Nurse (CPON®) exam was developed. During this 16 hour 2 day didactic course, essential concepts were reviewed via flash cards and CPON® practice questions. Beginning in late December 2006, the nursing staff was challenged to take the CPON® exam within the next year. As of November 2007, six nurses have successfully completed the review program with a 100% passing rate. We have also had three nurses complete the CPN (Certified Pediatric Nurse) exam with success. In addition, there are a minimum of five nurses scheduled for the CPON® exam in 2008. With the utilization of the review course and the encouragement of their peers, the heme/onc unit has 27 % of the staff with professional certification. Our goal is to have a minimum of 40 % of the staff achieve certification by the end of 2008. ___________________________________ Presenter: Heather Ambrose is the Training and Education Specialist in Hematology/Oncology/BMT for Children’s Hospital of Pittsburgh- UPMC. You can reach her at
  6. 6. -2- Integrating the Pieces of Professionalism into Daily Practice Janet Bischof RN, PhD, CCRN, CNA Wheeling Jesuit University Problem Statement: integrating many “pieces of the puzzle” of professionalism into daily practice is a challenge for managers and leaders. By identifying these themes and using them in daily practice areas, both staff and managers can identify and validate those behaviors. Professionalism Themes: Identifying the 12 “puzzle pieces” of professionalism which include, education, respect, commitment, behavior, honesty, integrity, competence, service, research, self- regulation, membership, and communication; and giving the staff and managers concrete ways to integrate these “puzzle pieces” into practice will make the concept of professionalism a realistic goal Solutions: Professional actions are incorporated into the performance evaluation, reward system, clinical ladder, and Education – requiring specific inservice programs or number of yearly hours Respect – acts in an ethical manner Commitment – keeps deadline commitments Behavior – dresses and acts in a professional manner Honesty – accurate, timely documentation Integrity – follows the organization’s value statements Competence – completes required yearly competency requirements Service – assists with one community program yearly Research – updates a policy/procedure based on current literature Self-regulation – maintains unencumbered RN license Membership – member of a professional nursing organization Communication – Verbal and written concise, clear, and timely Conclusions: By using specific examples of professional practice and incorporating them into organizational expectations, the staff nurse has clear expectations. _______________________________________ Presenter: Dr. Bischof is currently an Assistant Professor of Nursing and Director of the Graduate Nursing Administration and Education Specialist tracks at Wheeling Jesuit University. She also works casual in the Education Department at Trinity Health System where she worked full-time in the department for 14 years. Her Masters degree in from Ohio State University and her PhD is from Duquesne University. Her dissertation was entitled A Comparison of the Adult Patient with Heart Failure’s Quality of Life when managed in different medical settings: A Heart Failure Clinic and a Physician Practice. You can reach her at
  7. 7. -3- Senior Management and Front-line Staff – A Partnership for Patient Safety Karen Bray & Addie Lapinski Grove City Medical Center Objectives: • Discuss the evolution of the medication event review process as a method to reduce adverse outcomes. • Identify outcome improvements resulting from a review process grounded in complexity science. • Describe the positive relationships, mutual respect and enhanced concern for patient safety that developed between senior management and front-line staff as a result of the medication event review process. Since the seminal IOM report raised awareness reading the cost of medical error, human and fiscal, there has been an increased focus by providers, payers and consumers have focused increasingly on patient safety and the reduction of adverse events. This presentation will discuss show senior leadership in partnership with front-line staff has applied the principles of complex adaptive systems to reduce adverse outcomes. A trans-disciplinary team consisting of the Vice President of Patient Care Services, Vice President of Quality/Risk Patient Safety, Director of Pharmacy, Director of Patient Care Department and the staff member(s) involved in the medication error meet to discuss the event. During these weekly meetings, they conduct a “mini” root cause analysis of all medication events that occurred in the prior week, brainstorm solutions and when indicated, implement and monitor a rapid test of change. The team focuses its analysis using the fundamental principles of complexity science. They emphasize how relatively simple rules, with a “good enough vision”, creates a system where widespread innovations at front- line staff level can improve patient safety and care outcomes. Outcomes include a shift from a staff that was extremely anxious about meeting with senior management to one who is enthusiastically engaged in clinical process improvements. There is an increased comfort with the reporting of adverse events along with a concomitant reduction in medication errors. This presentation will present an implementation plan along with specific practice changes that can bring about transformational change and improvement in practice. _________________________________________________________ Presenters: Karen A Bray is currently serving as the Vice President of Patient Care Services at Grove City Medical Center in Grove City, PA. Prior to that she has held various management and clinical positions in the Pittsburgh area including the VP of Patient Care Services at Pittsburgh’s Ohio Valley Hospital; Director of Critical Care Services and Associate Nurse Executive at The Washington Hospital; Critical Care Educator at West Penn Hospital; Critical Care Nurse Manager at Braddock General Hospital and Staff Nurse at Allegheny General Hospital. Karen graduated from the University of Pittsburgh with her BSN as well as a Master’s Degree in both Nursing Administration and Nursing Education (Cardiovascular Clinical Specialty). She is also a Licensed Nursing Home Administrator. She can be reached at Addie Lapinski is currently serving as the Director of Med-Surg/Peds and Outpatient Oncology at Grove City Medical in Grove City, Pa. Prior to that she has held various management and Clinical positions in the Pittsburgh area including Manager of PACU and Ambulatory Surgery at St. Francis Central Hospital; Director of Surgical Services UPMC McKeesport; Supervisor PACU Mercy Hospital, and Staff Nurse St. Francis Medical Center. Addie graduated from St. Francis Hospital School of Nursing with a Diploma in Nursing, California University with a BS in Education and a Master’s in Health Administration from St. Francis College. She can be reached at
  8. 8. -4- The Value of Integrating Emotional Competence into Leadership Roles Michelle Dellaria Doas RN, MSN, EdD Chatham University Emotional competence was a key topic in a recent Leadership for Change MSN course. The course consisted of eighteen MSN students. All eighteen students were employed full time in acute care settings and ten students held management positions. The remaining eight students served as preceptors and/or charge nurses. Description of findings The entire class found emotional competence a vital leadership skill. The following objectives were achieved during the semester: • Describe why today’s nursing leaders need to display emotional competence • Identify the philosophical underpinnings of the assertion that emotional competence is a vital leadership tool • Discuss the role of caring, compassion, self-awareness, impulse control, and mutual respect in the development of emotional competence • Describe the phases of mastering emotional competence for the individual and health care team • Identify specific challenges of measuring, validating, and documenting the organizational impact of emotional competence Students were able to practically apply each objective coupled with specific clinical experiences. Each experience led to in depth discussions, alternative strategies, and an overwhelming need for integrating emotionally competent behaviors into the workplace. Conclusions or solutions to the problem Students were truly fascinated with the vast amount of knowledge and problem solving skills gained from studying emotional competence. They were eager to share their newly gained knowledge with staff, management teams, and interdisciplinary health care colleagues. Evaluation of the relevance of the study (to other settings and countries) In an ever changing health care environment, leaders must have not only technical management skills but also skills in managing emotions, theirs as well as those of other individuals in the organization. Emotionally competent leadership exhibits a high regard for colleagues and subordinates, an awareness of basic motivations as well as basic respect, a willingness to take productive, efficient, and aggressive action when necessary. In summary, the presentation would highlight the five stages of emotional competence acquisition along with key concepts and behavioral assessment categories. ____________________________________ Presenter: Michelle Doas is currently teaching in Chatham’s MSN and DNP programs. She maintains a clinical practice by working on a part time basis as a staff RN. She can be reached at
  9. 9. -5- Using an Electronic Health Record to Address Findings of Post Resuscitation Committee (PRC) in a Community Hospital Pamela M. Donovan, RN, MSN; Susan Hoolahan, RN, MSN, CNAA-BC UPMC St. Margaret In today’s complex health care settings, information technology is seen as the number one method for improving efficiency and quality. A poll recently taken by Modern Healthcare found 66% of 214 policy leaders believe rapid adoption of electronic health records (EHR) and other IT systems is the best solution for addressing inefficiency and uneven quality of care. In 2004, President Bush called for the majority of Americans to have interoperable health records within 10 years. This presentation will introduce the through quantitative data the impact a small community hospital has made using technology (electronic health record) to address the poor quality and in-efficiency findings of their resuscitation audits/monitoring of all resuscitation events by the Post Resuscitation Committee (PRC). In addition, the role and responsibility of the PRC will be introduced and discussed. Through the development of electronic order sets, rules (ex. code status rules), decision support, tasks, and electronic forms (for documentation), physicians and nurses are proactive in reducing errors by preventing cardiac and respiratory conditions from occurring. Abstract quantitative outcomes/bibliography: Quantitative data will be presented from audits conducted monthly, but reported in a quarterly fashion via graph and tables. Various types of descriptive statistics will be used such as means, percentages, standard deviations, ranges and frequencies. Examples of processes used to collect data and tools to record information will be presented. In addition, the development of electronic reports will discussed in relation to savings in time and increase in efficiency. Results: Post Resuscitation Committee established in February 2004. Data collected since inception but highlighted the results from January 2007 through December 2007. Data collection continues quarterly and reported at the Post Resuscitation Committee meetings for discussion and development of action plans as necessary. Based on data collection and review of rapid response team efforts the following outcomes were demonstrated: • Rapid response teams developed for Condition A which is a full cardiac arrest and Condition C for a change in clinical status. Study showed a 3-year trend indicating an overall decline in mortality rate. • Adverse drug reaction related condition calls reflected an increase in sedation codes identifying a need for change in drug electronic order sets and reflects a decrease in hypoglycemic conditions reflecting appropriate use of the hypoglycemic order sets. • Codes by AHA type per 1000 discharges reflects some treatable arrests outside of the ICU last quarter but overall trend decreasing with no cardiac arrests outside of the ICU in September 2007. • Intubation Condition C (non-monitored unit) per 1000 discharges demonstrated decreasing intubation during a Condition C outside a monitored unit. • Code status established improved to 75% ________________________________________________ Pamela Donovan is currently employed by UPMC St. Margaret as the Inpatient Director of Nursing. Current Role is to ensure nursing care is provided according to current policy, standard of care, regulatory and budgetary guidelines, Accountable for achieving quality patient care thorough appropriate leadership and utilization of human and fiscal resources. Graduate of Penn State University with a BSN and the University of Pittsburgh with MSN. - Susan Hoolahan has 25 years progressive nursing experience in critical care, nursing leadership, and hospital operations in academic/community teaching organizations. Susan is currently Vice President, Patient Care Services/Chief Nursing Officer for UPMC St. Margaret, a 255-bed acute care teaching hospital serving over 250,000 residents of Allegheny County, part of a 19 hospital Health System in Western Pennsylvania. Susan is responsible for Inpatient Nursing, Emergency, Outpatient/Surgical Services, Nurse Practitioners, Quality, Infection Control, Respiratory, Imaging Services, Laboratory, Pharmacy, Occupational/Physical Therapy, Nursing Education, Schools of Nursing, Wellness/Centers of Excellence. -
  10. 10. -6- Preventing Bed Entrapment – A Best Practice Al Dunn, RN, BHA, Leah Laffey, RN, MSN, DNP-C Kindred Hospital Pittsburgh Since 1985, through 2007, the FDA has reported that 413 people have died from bed entrapment. 120 patients were injured. Key body parts at risk of entrapment are head, neck, and chest. In reality, many cases go unreported and the number of entrapments and deaths is even higher. This problem has become an area of focus within the Kindred Long-Term Acute-Care Hospitals (82) throughout the Nation. Goals of the project were to: • Reduce the risk of death or injury by entrapment from the bed system (bed & mattress). • Educate the clinical nursing staff to assess for bed entrapments upon a patient’s admission. The current practice before implementation of the entrapment assessment was to complete a neurological assessment, but not for bed entrapment. Implementation at the assessment process now includes specific assessment quantifiers to determine patients at risk for bed entrapment, i.e., confusion, level of conscious changes? Performance improvement studies of the new bed entrapment assessment completion rate is 82%. Housekeeping staff, maintenance staff, and rehabilitation staff are now engaged in the entrapment process. Further modifications to the electronic medical record must occur to prevent the RN from bypassing the assessment. Prevention of entrapment is now part of the nursing care plan when applicable. _____________________________________ Presenters: Al Dunn is the Chief Clinical Officer at Kindred Hospital Pittsburgh, located in Oakdale, Pennsylvania. Mr. Dunn is a leader on the National Nursing Council, which represents 80+ Kindred Hospitals. Mr. Dunn has held various nurse leader roles for the past ten years. - Leah Laffey is the CEO at Kindred Hospital Pittsburgh – North Shore. Ms. Laffey has held various positions in healthcare leadership throughout the Pittsburgh / New Castle area for the last twenty years. Ms. Laffey is currently completing her doctorate of NP at Waynesburg University. -
  11. 11. -7- Strategies for implementing New Technology Patricia Glod, BSN, MSN, RN, Eileen Skalski BSN, MSN, DNP-C, RN UPMC St. Margaret Healthcare organizations today have the challenge of building practice models that ensure consistent and effective patient care. Implementing new technology in the workplace to improve nursing practice and increase patient satisfaction can be challenging in the healthcare environment. Although change interventions could have a positive impact on patient care when implemented successfully, barriers must be investigated. This presentation will outline the effectiveness and barriers of new product implementation on a 34 bed medical surgical unit. Consideration was given to multiple factors including stakeholder’s positions, product practicality, as well as incorporation of the new technology into nursing processes. A Patient Vigilance System and a Mobile Medication Work Station were trialed with the intention of improving patient care, increasing nursing satisfaction and patient centeredness by bringing the nurses to the bedside for care. Both products also intended to support the University of Pittsburgh Medical Center (UPMC) St Margaret’s mission of providing the right care to the right patient every time and meet the 2008 Joint Commissions Patient Safety goal #16, improving recognition and responsive to changes in a patient’s condition. ___________________________________ Presenters: Patricia Glod is an Informatics Nurse at UPMC St Margaret. You can reach her at Eileen Skalski is a Unit Director at UPMC St. Margaret. She can be reached at
  12. 12. -8- Fall and Injury Prevention: a Triad for Outcome Improvement Peggy Jenkins RN, MSN, CMSRN St. Clair Hospital Problem: We set a challenge to decrease the number of patient falls and fall related injuries. Method: In order to accomplish this goal, we implemented a three tiered approach; • Timely evaluation of falls to determine what could have prevented each fall from occurring, • Ongoing evaluation of risk assessment processes and fall and injury prevention protocols • Repeated dissemination of the fall and injury prevention education to staff. We established weekly meetings to review the medical records and occurrence related documents of all falls. A structured analysis, adapted from an IHI template, is completed to evaluate factors impacting falls. The goal of the analysis is to gain insight from every fall by evaluating with multidisciplinary experts such as staff nurses, unit managers, physical therapy, pharmacy, and risk management. We then evaluate our protocols and determine the need for modifications. Finally we disseminated the valuable information learned from these analyses in multiple venues. For example our biweekly newsletter, The Fall Scene Investigator, published on the hospital intranet, reaches hundreds of employees and highlights the positive “catches” and focuses on specific interventions. We also customize educational programs to relate to the work flow of our ancillary staff, such as dietary or housekeeping. During new employee orientation we stress our blame free, proactive culture and showcase measures that employees can use to keep patients safe. Results: As of April 2008, we experienced a 36% decrease in major injuries and a 34% decrease in fall rates to of 1.9/1000 patient days, significantly lower than the VHA national benchmark of 3.5. Relevance of the Process: This ongoing process of evaluation and improvement has been recognized nationally through the VHA Blueprinting Process, enabling hospitals world wide to learn from the strategies that have led to our success. ____________________________________ Presenter: Peggy Jenkins is the Clinical Educator at St. Clair Hospital. She can be reached at
  13. 13. -9- Making Learning Fun - A “FAIR” to Remember Barbara Jordan, RN, MSN, CCRN, NEA-BC, Diane Corr, RN, BSN, MEd UPMC St. Margaret The UPMC St. Margaret Patient Safety Fair Team presented four unique and fun fairs to educate the hospital and medical staff regarding The Joint Commission National Patient Safety Goals (NPSG) and other identified hospital safety initiatives. These programs were presented using a fair concept. A multidisciplinary team from across the organization was formed to plan and organize the events. Quality methods such as the nominal group technique were used to choose the fair theme and the organization specific safety initiatives. Team members volunteered to be the captain of a specific NPSG or safety initiative. The captains and their team members created the booths and accompanying materials. Each safety goal or initiative was represented at the fair using unique themes including “A Patient Safety Cruise”, (2004), “A Patient Safety Cineplex” (2005), “A Patient Safety Sports Expo,”(2006) and “Honoring our Heroes of Safety” ( 2007). Participants entered the fair with tickets, visited each booth, and had their ticket validated by completing a quiz or participating in an interactive game that demonstrated some aspect of a National Patient Safety Goal. Booth team members also dressed in costume attire relating to the fair theme. Themed refreshments such as movie candy and popcorn for the Cineplex theme were provided by the Dietary Department. Raffle prizes donated by the booth presenters enhanced attendance. Attendance at the events ranged from 500-800 staff members from all departments in the hospital. Each year new ideas are used to create and plan the fair based on feedback from the previous fair. Attendance increased each year. Hospital staff was able to speak confidently and knowledgeably to the Joint Commission surveyors during the organization’s successful accreditation survey in December 2007. The fairs also increased the camaraderie among the staff attending the fair as evidenced by the laughter and excitement at the fair! __________________________________________ Presenters: In her current role as the Clinical Director of Infection Control/Regulatory Compliance at UPMC St. Margaret in Pittsburgh, PA, Barbara Jordan is responsible and accountable for the management and leadership of the hospital-wide infection control program to improve the quality of patient care for inpatients, outpatients, employees and the community. Responsibilities also include coordination of compliance with The Joint Commission, Pennsylvania Department of Health, OSHA, and CMS regulations and standards. She assists directors/managers/supervisors in identifying indicators and developing performance improvement monitoring tools as well as process improvements. She also collaborates with Medical Staff Committees and hospital departments to assure compliance with related standards. Barbara graduated from Duquesne University with a Bachelor of Science in Nursing and from The University of North Carolina at Chapel Hill with a Master of Science in Nursing. She recently enrolled in the DNP program at Waynesburg University. During most of her 27 years in nursing she has held various leadership positions in critical care nursing. She has worked in a variety of settings including community hospitals, tertiary care facilities, staffing agency, and a telephone advice call center. She also teaches in the RN to BSN Program at Waynesburg University. Barbara has given presentations on MRSA, CLABS prevention, Avian Flu preparedness and UTI reduction and prevention. - _________________________________ In her current role as Education Project Coordinator at UPMC St Margaret Hospital, Diane Corr is responsible for the coordination and planning of education programs for a selected group of clinical areas as well as coordinating special projects/initiatives within the Nursing Education Department and the Hospital. Since Diane has graduated from Indiana university of Pennsylvania with a BSN in 1973 and a Masters in Education from Penn State University in 1995, she has had held various positions within nursing, from staff nurse, team lead, hospital supervisor and manager of the Education Department. Diane has worked in a variety of settings, including medical surgical units, outpatient surgery, and a cardiac unit. Presently, as an educator she coordinates inservice education, unit competencies and over sees the development of CEU programs, as well as providing education guidance to new nurses at UPMC St. Margaret. Diane also participates on various hospital committees and facilitates presentations within the community. -
  14. 14. -10- Medication Reconciliation in the Outpatient Setting: Strategy for Implementation Barbara Jordan, RN, MSN, CCRN, NEA-BC UPMC St. Margaret Patient safety across the health care continuum is imperative. Identifying and reconciling patients’ medications as they transition through the health care system is critical to their safe care. The Institute for Healthcare Improvement reports that 46% of medication errors occur on admission or discharge from a facility. This presentation will demonstrate an initiative to fully integrate medication reconciliation as performed in the inpatient areas into all outpatient settings associated with the hospital. Some settings include Ambulatory Surgery, Radiology, clinics, and the Emergency Department. Nursing, pharmacy, informatics, and allied health representatives from all outpatient areas convened to form a plan to meet the requirements for medication reconciliation. Departments use electronic or paper documentation so different documentation formats were developed. Each department developed procedures specific to the services they provide in collaboration with their departmental and medical staff. Education plans for hospital and medical staff were developed and implemented. The procedures were implemented in August 2008. Monthly audits were created to track the success of the procedures. The goal of the measures was a compliance rate of 90%. Early results from the audits showed a lack of consistency in faxing the discharge form to the next provider of care, completion of the discharge form, presence of a signature by the physician/designee on the admission or discharge form, and documentation of the last dose given. Education was provided to the involved staff and compliance quickly improved. Most of the measures are 90% compliant or greater. Some of the departments have revised their procedures in order to improve compliance with the goals. Education is provided as needed to the medical and hospital staff. Monitoring compliance continues. The 2009 National Patient Safety Goal for medication reconciliation has some minor changes which will be addressed in the fall of 2008 and implemented on January 1, 2009. ________________________________________________ Presenter: Barbara Jordan’s current role includes responsibility for accreditation, compliance, and infection control activities of UPMC St. Margaret. She works with medical, nursing, and hospital staff to improve the quality of patient care for inpatients, outpatients, employees and the community. She has over 20 years of progressive nursing leadership experience in critical care and nurse staffing services. She is also an instructor in the Waynesburg College RN-BSN program specializing in leadership, research and evidenced-based practice. -
  15. 15. -11- Medication Error Prevention Initiative (MEPI) Sue Ann Langfitt, RN, BSN St Clair Hospital Intro: In June 2005, the Commission of Performance Excellence was formed at St Clair Hospital to synthesize and direct safety & quality initiatives. As part of this Commission, the Medication Error Prevention Initiative (MEPI) was created to help reduce medication errors & potential adverse patient outcomes throughout the hospital. Problem/Issue: Systematic research and evaluation of all medication occurrence reports yielded the finding that the most frequent causes of medication errors was; failure to follow the 5 Rights, and transcription errors. The medications most frequently involved were narcotics, antibiotics, anticoagulants, and insulin. Our initiative formulated the goal to decrease all medication errors throughout the hospital with particular emphasis on reducing narcotic medication related errors. Focus: The initiative took several approaches to finding a solution to reduce medication errors. Posters and flyers were created to make staff aware of the potential causes for transcription and administration errors, such as, look alike and sound alike medications (predominantly narcotics). The goal was to focus staff awareness of the difference between sustained release medications and immediate release medications, and guiding staff to double check and verify discrepancies or unverified medications from pharmacy. Veriscan, a bar coded point-of-care software technology was introduced to staff in February 2004 through December of 2004 and was made a required component of medication administration. Linked to computer medication order entry system, Veriscan automatically incorporates the five rights into medication delivery through a process of scanning the patient and the medication. Veriscan automatically documents medications given, alerts nursing staff with information to help prevent errors, enables new orders entered into the system to cross over to the PDA device within 3 minutes and allows nurses to view all medications and IV’s including discontinued medications. A new order entry system was introduced and house wide education was provided through the HIS department In ongoing efforts to promote a culture of safety staff is encouraged to report near misses and medication errors. Each occurrence is individually analyzed from a systems perspective. In addition, through an in-house nursing publication, anecdotes of recent near misses and medication errors are presented so that future occurrences might be prevented. The medication administration policy was reviewed thoroughly and revised to incorporate the changes the initiative had made. Order entry screens were changed to prevent the selection of prn orders for sustained release narcotics. A Unit Secretary Forum was created to engage secretaries in the process of patient safety and quality . The forums provide the opportunity for secretaries to express their concerns. This forum provides education that targets their role in the process of medication error reduction. Utilizing an open discussion as well as computer order-entry training environment, forum participants review potential and actual medication transcription errors and formulate possible solutions for process improvement. Conclusion: Via heightened awareness of the 5 rights, current technology, support for a culture of safety and process changes we have seen a significant decrease in the number of medication errors. Our goal was to achieve a 10% reduction in the number of medication administration errors which we exceeded by achieving a 16% reduction _________________________________________ Presenter: Sue Ann Langfitt has been an RN for 18 years with Bachelors degree in Nursing from LaRoche College. She is currently the Nurse Manager of a 23 bed Medical Surgical and Detoxification unit with 41 employees and has been the team leader of the Medication Error Prevention Initiative since 2005. Additional committee involvement includes; Professional Advancement Ladder, CPR and CPR subcommittee, Hospira Smart Pump, Hospira Clinical Team, Patient Safety Committee, Regulatory Affairs, Infection Control, Joint Commission on Disruptive Behavior, and Professional Exchange Report. -
  16. 16. -12- An Evidence Based Approach to Enteral Feeding Lu Ann King, RN, BSN, NHA UPMC Horizon The application of an evidence based model to the development of clinical practice protocols has become a standard of quality in healthcare. This study will describe the role of an Evidence Based Nursing (EBN) Council in the development of a protocol for the administration of enteral feedings and related patient care in a small community hospital in northwestern Pennsylvania. A survey of nurses’ knowledge and practice was developed and administered as baseline measurement. A convenience sample of (30) patient records was identified for retrospective review. Charts were analyzed for the presence of key elements of prescribing and care. Findings were then compared to current nursing practices as reported on the baseline survey. The EBN Council participated in an evidence-based review which included a critical appraisal of the literature along with a query of regional and national practice trend within nursing and clinical dietetics. A multidisciplinary team of nurses, pharmacists, physicians and dieticians collaborated to revise existing policy, design a protocol of care and develop an educational plan for clinicians. Impact of this initiative on practice will be evaluated at six and twelve month intervals post implementation to measure changes in nurses’ knowledge, practice and perceived role. This study provides a template for responding to clinical questions presented to an EBN Council and validates the ability to generate advances in professional practice and clinical care using an evidence based model. _______________________________________ Presenter: Lu Ann King is the Magnet Coordinator and Unit Director of Extended Care Services at UPMC Horizon. She can be reached at
  17. 17. -13- Communication Handoff – A Best Practice for Reporting Critical Test Results M. Melissa Kolin, RN, CRNP, BSN, MSN, DNP-C UPMC Horizon Ineffective communication is the most frequently cited root cause of sentinel events. Consistent with its commitment to patient safety and quality, the organization acknowledged the need for a formal process to meet the intent of the Joint Commission 2007 National Patient Safety Goal (NPSG) #2. The goals of this initiative included that critical test results be repeated and verified by the receiver; that the record reflect that the physician was notified and the result repeated and verified; and that the physician be notified within one hour of receipt of the results. Following the implementation of continuous and progressive process changes, validation that critical results were repeated and verified by the receiver increased from 54% to 100%; documentation that the physician was notified and the result repeated and verified increased from 50% to 100%; and physician notification within one hour of the receiver having results remained constant at 100%. The application of standardization, front line staff input and innovative technology achieved sustainable results and could be universally applied to multiple healthcare settings. _______________________________________ Presenter: Melissa Kolin is the Program Director of Inpatient Nursing at UPMC Horizon. She can be reached at
  18. 18. -14- Nursing Unit Resuscitation with ABC’s - Attitude, Behavior, Communication and Collaboration Sharon McEwen RN BSN CCRN UPMC Shadyside A healthy practice environment is vital for recruitment and retention of nurses. Improved patient safety and outcomes are two important benefits of a stable nursing staff. When the turnover rate was 18% in the Surgical Intensive Care Unit, exit interviews were reviewed to identify areas for improvement. Comments focused on nurses feeling stagnant, unmotivated, not challenged and lacking managerial support. A change in leadership and a staff involvement program has decreased the turnover rate to 6.9%, increased morale and motivation. Leaders play a pivotal role in retention of nurses by shaping the clinical and cultural environment. Unit leaders were identified by the staff and encouraged to develop. Poor communication was the first hurdle identified to begin the change. Staff attended communication classes. A mission statement was developed and adopted. Staff identified that the unit had no life and needed resuscitated. The unit was resuscitated with ABC’s: Attitude, Behavior, Communication and Collaboration. The staff embraced the need to have a positive attitude, behave professionally communicate effectively and collaborate skillfully. The ABC’s are reflected in annual evaluations. Staff started becoming more involved in unit projects and began to work together to improve patient care. In order to further build relationships monthly UNO, “Unit Night Out” was started. _________________________________________ Presenter: Sharon McEwen has been a Registered Nurse for 22 years at UPMC Shadyside. She has been the Unit Director of Surgical ICU for the past 18 months. Previous experience includes Clinician Surgical ICU, Surgical Trauma ICU, Float Pool ICU, ER, and Oncology. Her undergraduate studies were completed at Carlow University and a Bachelor of Science in Nursing was received in 1995. She is currently enrolled in graduate school pursuing a Master’s Degree in Nursing Informatics with an anticipated graduation date of June 2010. She is actively involved in mentoring new Unit Director’s and serve on the Unit Director Task Force; which is a new committee formed to review the role and job description of Unit Directors across the UPMC Health System. She has also serve on the Graduate Nurse Residency program Task Force; which is a task force combined of Unit Directors within the Health System focusing on the development and retention of graduate nurses. She is a member of the American Association of Critical Care Nurses (AACN) and American Nursing Informatics Association (ANIA). -
  19. 19. -15- Integrating Evidence Into a Hospital Nursing Culture Through the Transformation of the Nursing Education Department Jacqueline O’Brien, MSN, RN, CIC, Susan Hoolahan, MSN, RN UPMC- St. Margaret The mission of National Institute of Nursing Research, focused on extending nursing science by integrating biological and behavioral sciences while using technology to research questions. In order to successfully integrate evidence into practice, an identified group must become prepared as the experts. Our goal was to utilize the nursing educators to embark on this endeavor. Three strategies were chosen to implement this project. They were: Outline strategy to transform traditional nursing education into clinical model, define methods used to engage educators in the strategic vision while integrating evidence based nursing expertise into clinical areas, and identify challenges and resolutions made in integration of EBP/EBR. Nursing education department members were interviewed and surveyed at the onset of the department restructuring. Questions were designed to assess each individual’s perceived competency in areas of leadership, educational style, and management. Staff members will be asked to complete a post implementation survey and interview to determine effectiveness of interventions. Clinical leaders will be surveyed to determine effectiveness of the clinical integration of the educators with departments. Measurements of course offerings compared with prior time frames will be analyzed. Evaluations will be compared from pre-implementation and post-intervention period. To improve patient out comes and enhance the patient healthcare experience, integration of evidence based practice is unquestionably the option to select. The sustainability of the change can be achieved through integration at multiple layers of the organization. Utilizing the expertise, experience, and visibility of the nursing education group, the nursing educators were chosen as a group to facilitate the integration to the level of the bedside nurse. ____________________________________________ Presenters: Jacqueline M. O’Brien is the Director of Nursing Education for UPMC St. Margaret in Pittsburgh, Pennsylvania, a 255-bed acute care teaching hospital, part of the University of Pittsburgh Medical Center (UPMC). Ms. O’Brien is responsible for the intellectual preparation of the nursing staff within the hospital and out patient areas, integration of evidence based practice, preparing and implementing all continuing education for all nurses. Jacki’s role in this project was to complete an interdepartmental assessment of the current state of the nursing department, one year post-initial implementation, identify strengths and areas of opportunities that exist from the assessment, continue to develop strategies to strengthen the relationships between nursing education and the nursing department, and enhance the nurse educator influence on the bedside nurses through their intervention and expertise. She is currently enrolled at Waynesburg College in the Doctor of Nursing Practice Program, anticipated date of completion December 2009. Achievements include integration of technology into an infection control department, published in AJIC, April 2008; Awarded RWJ Salk Fellowship & Nurse Navigator Fellowship; to be published in Feb 09, in Smart Nursing as the best practice related to this work. Adjunct faculty for Waynesburg University graduate and undergraduate Nursing Programs. - Susan E. Hoolahan is Vice President of Patient Care Services/CNO for UPMC St. Margaret in Pittsburgh, Pennsylvania, a 255-bed acute care teaching hospital, part of the University of Pittsburgh Medical Center (UPMC). Ms. Hoolahan is responsible for the Inpatient Nursing, Emergency and Outpatient Departments, Surgical Services, Nurse Practitioners, Quality Management, Infection Control, Respiratory, Imaging Services, Pharmacy, Occupational/Physical Therapy, Nursing Education and Schools of Nursing. She has 25 years nursing experience in critical care, nursing leadership, and hospital operations in academic and community teaching organizations. Formal positions included: Administrative Liaison, Hillman Cancer Center; Director, Inpatient Nursing, UPMC Shadyside; Clinical Director, Critical Care Services, UPMC Presbyterian; and a number of leadership positions within UPMC. Ms. Hoolahan is a Magnet Appraiser Fellow for the ANCC’s Commission on Accreditation. She is Adjunct Faculty for the University of Pittsburgh School of Nursing. Recipient of the first “Leading with Wisdom” award sponsored by UPMC (2008). -
  20. 20. -16- Nurse Executives’ Experiences of Social Support Mary A. O’Connor, Ph.D., RN California University of PA, Department of Nursing Nurse Executives’ (NES) roles in today’s environment may result in increased job stresses and role strain, and affect NE|S’ job satisfaction and well being. This study used a triangulated, multimethod survey design to explore NES’ experiences of social support, and the relationships among perceived stress, social support, job satisfaction, and well-being. Ninety-two NES were surveyed using the Perceived Stress Scale-10, the Norbeck Social Support Questionnaire, the Job Satisfaction Survey, and the Medical Outcomes Study Short-form 36. The NES’ responses to the questionnaires overall showed no relationship between stress and social support; however, source-specific data indicated that 2/3rds of NES felt less stress related to coworker support. NES who reported low stress also reported high well-being. A subsample of 14 NES who were interviewed revealed higher stress and well being problems since the onset of managed care, particularly in organizations that merged. Two thirds of the NES interviewed reported feeling better as a result of their social supports. The remaining one third of the NES, however, reported that they used non-social support activities and internal coping instead of social support to relieve their stress. NES’ stress was correlated with overall job dissatisfaction and poor well being. Social Support was correlated with positive mental health. NES experienced greater well being when they received support from mid-level nurse administrator, in the form of help with day-to-day tasks. In addition, NES experienced poorer general health when they had first line nurse managers reporting to them as direct reports with no middle manager level to intervene. This study found that stress and social support explained 67% of NES’ well-being and 30% of NES’ job satisfaction. Findings from this study may assist NES with the design of their support structures in the organization, and encourage use of social supportive activities to assist them ameliorate the effects of job stress and role strain, and to improve job satisfaction and overall well being. ____________________________________ Presenter: Mary O’Connor is a professor at California University of PA’s RN to BSN program and Coordinator of the BSN program’s off campus site at CCAC South. Dr. O’Connor has been a Director of Nursing at two major teaching hospitals in the Pittsburgh area, and coordinated the MSN program in Nursing Management at La Roche College. She can be reached at
  21. 21. -17- Promoting Personal Autonomy and Professional Growth through Achieving Pediatric Nursing Certification Kristen L. Straka, MSN, RN, CPN Children’s Hospital of Pittsburgh- UPMC As the nursing profession strives to achieve excellence, nursing certification is an essential piece to this endeavor. Professional organizations throughout nursing support and encourage nurses to develop in their profession through certification, which is also crucial to achieve American Nurses Credentialing Center’s (ANCC) Magnet Recognition. With the nursing shortage increasing, hospitals are faced with turnover and a novice nursing staff. Children’s Hospital of Pittsburgh of UPMC is no exception. The hospital is a 265 bed pediatric hospital, employing 800 staff nurses. The average experience for nursing is approximately 10 years. In 2005, a minimal amount of nursing staff had achieved pediatric nursing certification as a certified pediatric nurse (CPN). To help fulfill this void, a review course that specifically targeted the Certified Pediatric Nurse exam was developed by the Training and Education department. During this 16 hour 2 day course, essential concepts were reviewed via lectures, games, flash cards and practice questions. Beginning in 2006, the nursing staff was challenged to take the CPN exam within 90 days of taking the review course. To help foster professional growth among staff nurses, a professional development initiative was developed at CHP. This initiative encompassed both outpatient and inpatient nurses, and required a certification as part of their level 3 status. In 2006, 90 nurses completed the review course, and posted a 95% passing rate. In 2007, 63 nurses completed the course and posted a 90% pass rate. In addition, our institution was approved and given acceptance as a testing site for the CPN exam. With the utilization of the review course and encouragement of nursing leadership, 13% of our professional staff nurses are certified as pediatric nurses. Another 10% of clinical staff nurses hold specialty certifications in other areas. With an increase in nursing certification attainment, bedside nurses are not only developing personal growth and autonomy, but ensure best practice for patients and promote positive patient outcomes. ________________________________________ Presenter: Kristen Straka is an Advanced Practice Nurse of Children’s Hospital of Pittsburgh- UPMC. She can be reached at
  22. 22. -18- Implementation of Electronic Blood Documentation in a Community Hospital Kelley Ann Szelc RN, MSN, CDE, Susan Evans BSN, RN, CMSRN UPMC St. Margaret UPMC St. Margaret, in collaboration with other UPMC facilities, developed a plan to change the process of documenting blood product administration on paper to an electronic form. Key representatives from UPMC facilities met to design a process using electronic documentation. This process was implemented to increase patient safety by requiring two nurses to verify blood products and patient information, prior to documentation in the electronic health record (eRecord). Implementation of this new process enables multiple disciplines to view blood product administration by accessing a blood product administration FlowSheet on the All Data Tab in the eRecord. The ability to view this data enhances communication between all care providers. The representatives considered strategies to improve the process flow surrounding a blood product transfusion reaction, by developing an electronic blood product transfusion form. The form guides the nurse in performing necessary steps when a transfusion reaction occurs, including automatically generated orders for required lab work. The multidisciplinary team initiated policy development to reflect the practice change. A review of the literature was conducted to determine current best practice for blood product administration. Vital sign frequency during blood product administration, the rate of infusion and the assessment of lungs sounds prior to and during infusion were identified as key literature findings. Upon completion of the design process, information was presented to a corporate eRecord group for approval. Once approved, the process was initiated at UPMC St. Margaret and then at other system hospitals. Prior to the implementation of the pilot study, mandatory educational sessions were held to educate the care providers related to the new process. Quality improvement audits indicate communication between care providers increased related to this new process, which is directly related to better compliance with documentation on the blood product administration form. ________________________________________ Presenters: In her current role as a Nurse Educator for the Electronic Health Record (eRecord) Department, Kelley Ann Szelc is responsible for providing eRecord training classes for all new employees and providing eRecord educational updates to the nursing staff. She is also actively involved in special projects and initiatives within the Nursing Education Department and hospital. Kelley is a member of the Nursing Leadership Committee, Nursing Informatics Council, Education Network Committee, and the COPD Task Force. Kelley graduated from Carlow College with a Bachelor of Science in Nursing in 1997. She recently completed her Master of Science in Nursing Administration from Waynesburg University and is currently working toward achieving her minor in Nursing Education. She has held various positions within nursing, including staff nurse on a medical surgical unit, resource nurse (charge nurse), nurse preceptor, diabetes educator with a specialty Certification in Diabetes Education (CDE), and nurse educator in the eRecord department. - In her current role as Team Leader of the Medical Unit and Admission Team, Susan Evans is responsible for the management of delivery of care to patients needing outpatient medical services including but not limited to: blood transfusions, infusion therapies, interventional radiology/cardiology patients. She is also responsible for nurses on the admission team who provide inpatient care to new admissions. Susan also is the co-chair of the hospital Evidence Based Nursing Practice Council, which is responsible for the development and review of all hospital nursing policies. The council has evolved into a group that strives to incorporate evidence based practice into all care provided to patients. Susan is a member of the Nursing Informatics Council, Medication Management Team, Outpatient Medication Reconciliation Committee, Magnet Steering Committee, and Hospital Throughput Committee. Susan graduated from St. Margaret School of Nursing. She obtained her BSN from Penn State University and currently enrolled at Waynesburg University pursuing a Masters degree in Nursing Education. During her 32 years of nursing, she has worked on medical surgical units, outpatient surgical services, and head nurse on a medical surgical unit. She also served in the Army Reserve Corps and retired with the rank of Major. -