2013 | NURSING ANNUAL REPORT

Contents

1 Transformational Leadership4 Structural Empowerment6 Knowledge, Innovations, Improvements8 Professional Practice

On the cover: Amy Howell, MSN, RN, Medical/Surgical/Pediatrics and Mary Sullivan, BSN, RN, Emergency Department

Dear Colleagues,

Another fantastic year is reflected in this Annual Report for the many ways in which we touch lives - including those of each other! As you will note throughout the pages, we have focused this report on the many ways we mentor one another and the ways in which we hand off information for the benefit of those who follow after us so that they may possibly learn from our experience. Ben Franklin once said “Tell me and I forget, teach me and I may remember, involve me and I learn.” Perhaps, in addition to being a Statesman, he was also once a nurse! Regardless of his chosen profes-sion, he clearly understood the value of mentoring where a developmental relationship is more than a process for simply passing experiential knowledge to someone with less experience. He knew that true mentoring is about an ongoing relationship of learning, dialogue and challenge.

As you review the content of our newest Nursing Annual Report, you will find many examples of staff in mentoring relationships such as through the Magnet Champions, the handing-off of the Clinical Practice Council, the ED-to-Floor Hand-off team, and the orientation of a novice nurse by a more experienced nurse. At MSMH and within

MaryLou Watson, MS, RN, Vice President, Nursing exchanges ideas with Robbin Young, MSN, RN, Director, Telemetry/Intensive Care Center.

Nursing, we are rich with opportunities to mentor and this is one of the strengths of Nursing at MSMH. We complement that with a genuine nurturing and caring for each other as we face challenges and learn new IR procedures, achieve NICHE certification or Baby Friendly designa-tion, and grow on the clinical ladder.

Through my own thoughts, it is this effort to mentor that I see the early beginnings of transformational leaders which occurs when leaders and followers (mentors and proteges) make each other advance to a higher level of morale and motivation. And through the strength of their vision and personality, these transformational leaders are able to inspire others to change expectations, perceptions, and motivations to work toward common goals. So as we move to improving efforts toward transformational lead-ership on our Magnet journey, please reflect on the importance of the mentoring that is accomplished along the way and the many nurses who have assumed that role on this journey.

Congratulations on a very fine 2013!

MaryLou Watson, MS, RN

Welcome and Appreciation

Transformational Leadership

New Nursing Leaders

Darla Hardy, MHA, MSN, RN, NE-BC, was named the new Director of Nursing Resources in June 2013. Darla received her bachelor’s degree in nursing from the University of Maryland in 2005. She also holds masters’ de-grees in nursing leadership & management and in healthcare administration from Walden Uni-versity. Prior to her arrival at MedStar St. Mary’s, Darla was the administrative director of Medical Surgical Services at Calvert Memorial Hospital. She was also the director of Calvert’s Progressive Care Unit from 2008–2012.

Robbin Young, MSN, RN, was named the new Director of the Intensive Care Center/Telemetry in August 2013. Robbin received her bachelor’s degree in nursing from the University of Mary-land and her master’s degree in nursing from the University of Phoenix. Prior to her arrival at MedStar St. Mary’s, Robin began her career at MedStar Washington Hospital Center. She then served Inova Fairfax Hospital as the director of the Cardiac Telemetry and Critical Care Coro-nary Unit.

Melanie Trifone, RN, became the Women’s Health & Family Birthing Center (WHFBC) Clinical Coordinator in August 2013. Melanie joined MedStar St. Mary’s in December 1982 as a nursing tech on WHFBC. She graduated from nursing school in 1983 and accepted a position as an LPN. Throughout her career at MedStar St. Mary’s she has worked in various departments including Emergency Department and Periop-erative Services. Melanie is currently working on her RN to master’s degree and will graduate in 2015.

HSCRC Tuition Support

Seventeen MedStar St. Mary’s nurses were named recipients of the RN to BSN/MSN Tuition Support program in December 2013. Funding was made possible through the Health Services Cost Review Commission (HSCRC) Nursing Excellence Grant. This is the largest number of nurses to receive tuition support in a given year. The HSCRC scholarships are one more way that MedStar St. Mary’s is helping associates achieve their BSN/MSN by 2020.

Congratulations to the recipients, including: Darcy Bishop, RNFA, CNOR, Stacey Corrick, RN, CNOR, Cynthia Dean, RN, CNOR, Kathy Keister, RN, Kristen McVerry, BSN, RN, Justine Reimer, RN, Hollie Ridgell, RN, Shemeka Robinson, RN and Rebecca Wathen, RN, Perioperative Ser-vices; Colleen Corliss, RN, Sharon Hutchins BSN, RN, and Denise Meyer, RN, Medical/Surgical/Pediatrics; Patty Hall, RN, Intensive Care Center/Nursing Resources; Danielle Hardy, BSN, RN, Telemetry; Pam Riley, RN, Pul-monary & Cardiac Rehabilitation; and Skye Ryan, RN and Melanie Trifone, RN, Women’s Health & Family Birthing Center.

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Charge Nurse Huddles

Patient Care Supervisors have embraced transformational leadership and have started Charge Nurse Huddles as a result. Occurring twice daily at 7:45 a.m. and 7:45 p.m., huddles are chaired by the supervisor and all charge nurses are in attendance. During the huddles, information is shared that shapes the expectation of the particular shift. Specifically, the group works toward a common goal of ensuring safe patient care and placing patients on the appropriate care unit based on their individual healthcare needs. The huddles are successful in developing teamwork amongst associates and expanding awareness of the needs of individual units.

Each clinical nursing department has a nurse representative on the Magnet Champion Council. These Magnet Champions have an interest in helping lead MedStar St. Mary’s on its Magnet Journey. They share their enthusiasm and excitement for the journey with associates in their departments by keeping them informed and answering ques-tions about Magnet Recognition.

Special thanks to the following Magnet Champions: Linda Cunningham, RN, Behavioral Health; Cathy Fenwick, BSN, RN, OCN, Cancer Care & Infusion Services; Brittany Szaks, BSN, RN, and Shannon Seney, BSN, RN, CEN, Emergency Department; Teresa Brannigan, MSN, RN, Hospice; Pam Barnard, MSN, RN, Human Resources; Heather Swan-Jones, BSN, RN, Intensive Care Center; Lisa Yager, BSN, RN Interventional Radiology , Anita Wetzel, RN, Jonathan Szaks, RN, Medical/Surgical/Pediatrics; Karen McCleaf, CRNP, Occupational Health; Kelly Day, RN, CNOR, Perioperative Services; Danielle Hardy, BSN, RN, Telemetry; and Megan Dodge, RN, and Katie Shea, BSN, RN, Women’s Health & Family Birthing Center.

Recognizing Magnet Champions

Amanda Dyson, BSN, RN, Clinical Coordinator, Telemetry and Darla Hardy, MHA, MSN, RN, NE-BC, PCCN, Director, Nursing Resources

Applauding Certified Nurses

Certification is a key factor in the assurance of minimum standards of knowledge, skills and abilities in nursing specialty practice and contributes to better patient outcomes. While a registered nurse (RN) license provides entry to general nursing practice, the knowledge-intensive requirements of nursing today re-quire extensive education, as well as a strong personal commitment to excellence by the nurse. National certification allows nursesto be recognized for competence in their specialty.

MedStar St. Mary’s encourages national board certification for all its nurses and would like to acknowledge and thank the more than 90 nurses who have achieved certification in their specialty areas.

Proven Leader

As a result of consistent clinical performance, in 2013 the hospital was recognized with the Gold Level Maryland Performance Excellence Award (MPEA). MaryLou Watson, MS, RN, VP, Nursing is a Baldrige Examiner and has guided this journey along with Joan Gelrud, RN, MSN, FACHE, VP and the hospital Administrative team. The hospital was also listed among the Nation’s Top 100 Hospitals by Truven Analytics. To conduct the 100 Top Hospital study, Truven Health researchers evaluated 2,922 short-term acute care, non-federal hospitals across the Nation. Additionally, the hospital received the Healthgrades Patient Safety Excellence Award™. The distinction places MedStar St. Mary’s within the top 10 percent of all hospitals for its excellent performance in safeguarding patients from serious, poten-tially preventable complications during their hospital stays.

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Advanced Practice Nurses

Driven by the provisions of today’s health care, Advanced Practice Nurses (APNs) are filling the gap created by the shortage of primary and acute care physicians. APNs have the skills to provide acute and chronic care management along with preventative services.

At MedStar St. Mary’s, we are proud to have a strong team of 20 APNs to fill these identi-fied gaps by working in physician practices, in perioperative and women’s health services, as occupational health specialists, and as acute care hospitalists. Meeting the needs of our growing community can be a challenge, but with our incredible team of APNs, we have risen to this challenge and have succeeded in providing high quality safe patient care.

Transformational Leadership (cont.)

Shared Governance Coordinating Council

The purpose of the Shared Governance Coordinating Council (SGCC) is to provide leadership and structure to unit-based councils, while upholding MedStar St. Mary’s Nursing model of caring. The SGCCsupports the promotion of professional nursing development through respect, partnership, equity, accountability, owner-ship, and transformational leadership.

In 2013, the SGCC continued to experience positive growth. Many of our unit-based councils continue to report an overall increase in staff engagement and participa-tion, and pursuit of best practices in patient care delivery. Each unit council held an open house to increase associate awareness of Shared Governance and participation in unit activities. The SGCC also collaborated with nursing leadership to collect stories of caring for the second annual Jean Watson Awards that were presented during National Nurses’ Week.

Through their shared work on the Clinical Practice Council, Darla and Amanda identify evidence-based best practices and determine how to remove barriers to needed resources.

Daisy Awards

Daisy Award 2 Caption

Patient Safety Heroes

Good Catch Award

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Patient Safety Hero and Daisy Recognition/Rewarding Bedside Leadership

According to the American Nurses Creden-tialing Center, a transformational leader is one who, “Stimulates and inspires followers to both achieve extraordinary outcomes and, in the process, develops their own leadership capacity.” MedStar St. Mary’s recognizes nurses for their exemplary perfor-mance and leadership at the bedside with two awards: Patient Safety Hero and the Daisy Award.

Linda Miedzinski, BSN, RNC, and Janet Tipton, RN, Perioperative Services were named Patient Safety Heroes in the months of June and November, respectively.

Shemeka Robinson, RN, Perioperative Services, and Susan Bricker, RN, Intensive Care Center, were recognized in 2013 with Daisy Awards

for going above and beyond to assure that compassionate and quality care were

received by patients and families while under their care. The not-

for-profit Daisy Foundation, based in Glen Ellen, Calif.,

was established by the family of J. Patrick Barnes, who passed away at age 33 in late 1999. The care he and his family received from nurses inspired this means of recognition nurses for making a profound difference in the provision

of care and is supported at MSMH by the Foundation.

In addition, Brittany Szaks, BSN, RN, Emergency Depart-

ment, received the “Good Catch” Award for the entire MedStar Health

system in November for going the extra mile to “catch” a discrepancy before giving a patient medication.

Heather Swan-Jones, BSN, RN, Intensive Care Center and Danielle Hardy, BSN, RN, Telemetry

Sharing her experience in establishing committees in ICC, Heather mentors Danielle as she establishes a shared governance committee for Telemetry.

Structural Empowerment

Patient Safety Becoming Transparent

The new software, Patient Safety Event (PSE) Management System, assists associates in managing reporting issues with the goal of becoming a transparent High Reliabil-ity Organization (HRO). A critical step in enhancing a culture of patient safety, this system provides associates with the means to report real or potential safety issues, including patient harm, near misses and unsafe conditions to achieve the goal of zero preventable harm and the highest quality patient care.

One of the key aspects of HROs is the trans-parent reporting of events that cause harm, and equally as important, near misses and unsafe conditions. The reporting of such events allows for open and honest reflection, feedback and mindful awareness of areas in need of improvement. A culture that em-braces, rather than punishes, reporting is referred to as a “just culture.” It is an import-ant component of HROs where this behavior is the norm, not the exception. Healthcare organizations who have adopted this mind-set have shown significant improvements in the care they provide their patients.

The new PSE Management System, run by RL Solutions, will serve as the system’s single reporting tool and replaces all existing occurrence reporting tools. It will be available on nearly all computers in care areas at all MedStar patient care entities in the acute and non-acute care environments via the intranet.

Health Enterprise Zone Focuses on Communities

Under the leadership of Vice President Joan Gelrud, RN, MSN, CPHQ, FACHE, the hospital directed a community coalition of dedicated partners in a successful bid to designate the communities of Lexington Park, Park Hall and Great Mills as one of Maryland’s first Health Enterprise Zones.

Initiatives under the $3.4 million award include the implementation of a Care Coordination Program staffed by Vivian Lopez, RN and Renee Shively, RN. The program is supported by six Neighborhood Wellness Advocates to reduce unnec-essary readmissions and non-emergent visits to the Emergency Department. Also included in the project are language lines for area medical facilities, a dental van, transportation route, cultural competency training, evidenced based chronic disease programs, and the completion of a community health center.

Express Care Revamped

Express Care in Charlotte Hall, Maryland, began offering appointments this year. While walk-in care remains available, appointment scheduling has helped im-prove the patient experience and associate efficiency. As a result, patient experience scores have improved and volumes have increased by more than 25 percent. Nurse practitioners now staff the clinic where patients receive a timely evaluation and return to the comfort of their own home.

SAFE Nurses/Grant Deliver Robust Program for Victims

Sexual assault and domestic violence are a reality in nursing and health care in general. In response to a community need, MedStar St. Mary’s applied for grant funding to combine the SAFE program with the DV program under one coordinator, Yvonne Dawkins, RN, FNE-A. Yvonne ensures that victims of such violence receive the appro-priate care and that patients and providers are educated on available services offered through advocacy groups.

Falls Restraint Analysis Team

The Falls Restraint Analysis Team or FRAT was created in Sept. 2013 when the Restraint Task Force joined the Falls Team. The team meets monthly to review hospital restraint and fall events and reviews current Safety Risk Level Guidelines. Serving on FRAT are registered nurses, clinical coor-dinators, nursing directors, and associates from Organizational Learning & Research and Performance Measurement.

In 2013, FRAT made improvements to the hospital’s restraint documentation and compliance with current State, Centers for Medicare & Medicaid Services and The Joint Commission standards. The rate of compliance for nursing restraint documentation improved from 71 to 96 percent during the year.

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Amanda Dyson, BSN, RN, Telemetry

Christine Taylor, RN, Health Connections (then Perioperative Services)

Diane “Dee Dee” Johnson, BSN, RN, Women’s Health & Family Birthing Center

Heather Farr, RN, Emer-gency Department

Jennifer Alvey, BSN, RN, Emergency Department (then Imaging)

Linda Miedzinski, BSN, RN, Perioperative Services

Renia Bugayong, BSN, RN, Medical/Surgical/Pediatrics

Steve Alvey, RN, Informa-tion Technology

Amy Magyar, BS, RN, Imaging

Tracey Wilkinson, LPN, Hospice

Handoff of Clinical Practice Council

In 2009, Vice President, Nursing MaryLou Watson empowered the Policy & Procedure Committee to form a nursing professional practice council. Nursing Informatics Coordinator Liz Schaeffer, BSN, RN, NE-BC, and Behavioral Health Day Treatment Nurse Susan McCabe, RN took the lead in developing the initial structure of what came to be known as the Clinical Practice Council (CPC).

The CPC has been a dynamic force, growing and responding to change as represented by the Vision Circles. Through mutual respect and collaboration, nursing continues to prove itself an integral and essential member of the healthcare team. Then Chairperson Susan McCabe, RN, along with Vice Chairperson and Telemetry Clinical Coordinator Amanda Dyson, BSN, RN, led the council through interdisciplinary expansion bringing Organizational Learning & Research and Performance Management along as partners in collaboration.

Amanda took the mantle of leadership after Susan bid farewell to MedStar St. Mary’safter 25 years of service. As chairperson, Amandais fostering the growth of shared decision making asCPC continues to make meaningful contributions to clinical outcomes.

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SPIRIT Award Winners

The associates who have received the SPIRIT Award are individuals that have been empowered to transform their professional practice to a higher level of performance.

PATIENT

NursingPeer Case

ReviewCommittee

Nursing Unit Councils

Nursing Shared GovernanceCoordinating Council (SGCC) Hospital

LearningCouncil

NursingDepartment

LeaderCouncil(NDLC)

HospitalPatientSafety

Council

Peer Councils& Committees

Magnet ChampionCouncil

Hospital ValueAnalysis Committee

Patient& Family

EducationCommittee

NursingEBP &

ResearchCouncil

NursingClinicalPracticeCouncil

NursingProfessional

Development& Education

Council

NursingQualityCouncil

NursingManagement

CouncilNursingInformatics

Council

Trina Gardiner, BSN, RN, Health Connections and Summer Seastrand, RN, Health Connections

Trina is helping mentor Summer who is working toward taking her lactation exam. She and the team are helping Summer to achieve the required number of hours needed to sit for the exam in July.

PowerChart Maternity and FetaLinkThe Women’s Health & Family Birthing Center (WH&FBC) began working with Information Technology and a team from Cerner on building PowerChart Maternity in August 2012. PowerChart Maternity is a Cerner charting system built for the specialty of Obstetrics.

The program offers many exciting features, including an automatic transfer of infor-mation from the mother’s chart to the newborn’s chart. This reduces the amount of double and triple documentation that WH&FBC nurses had to do prior to going live and also helps to reduce errors from re-transcribing. In addition, with Power-Chart Maternity, notes and fetal heart rate strips from previous visits will be right at the nurse’s fingertips on the patient’s Pregnancy Summary.

Patient Call ManagerNurses on Behavioral Health, Telemetry, Medical/Surgical/Pediatrics and Intensive Care Center began using the Studer Patient Call Manager application for their discharge phone calls in March 2013. The goal is to con-tact 100 percent of all patients that had an inpatient visit within 10 days of their discharge and to complete the call survey on at least 70 percent of the calls.

The purpose of the calls is to improve patient compliance with discharge instructions, which improves clinical outcomes. The nurses have an opportunity to further explain the patient’s discharge instructions and discuss the importance of the follow-up appointment with their primary care physician. They can also provide service recovery in cases when we have failed to meet a patient’s or a family’s expectations.

Knowledge, Innovations, Improvements

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Along with PowerChart Maternity, WH&FBC included Cerner’s fetal heart rate monitor-ing system, FetaLink. Now with FetaLink, anything charted on the fetal monitoring strip, including vital signs will populate in the patient’s chart as well. The nurses are very satisfied with not duplicating their documentation.

The unit successfully went live with the new system June 4, 2013. We continue to evaluate our new charting product to ensure that the staff can document as seamlessly as possible.

Quiet Team Institutes Quiet TimeThe “Quiet Time” project is working to create a quiet and healthy environment for all patients at MedStar St. Mary’s. The team conducted patient surveys to deter-mine what keeps patients awake at night. A process map was completed to identify patient interruptions. The goal of the project is to improve patient experience for quietness such that the scores directly related to noise level show improvement. Indirectly, the “overall rating of the hospital” and “willingness to recom-mend the hospital to family” scores should improve as well.

Patient ContactsAttempted (CY13)

Patient ContactsCompleted (CY13)

Unit Count Percent Count Percent

Behavioral Health 407 94.87% 232 54.08%Intensive Care Center 75 80.65% 43 46.24%Medical/Surgical/Peds 1771 99.89% 1425 80.37%Telemetry 1392 99.78% 1030 73.84%

TOTAL: 3645 98.78% 2730 73.98%

Care Onboard the New Health Center

The Dr. J. Patrick Jarboe Mobile Health Center made its much anticipated public debut in Nov. 2013. But what makes the 40 foot mobile unit so special is the team of nurses providing primary care onboard to St. Mary’s County’s underserved residents as part of the Get Connected to Health pro-gram. This team of nurses includes Deborah Foerter, CRNP, Dawn Weber, RN, Yulissa Brown, RN, ONS, and Shejuan Bush, CNA.

The Jarboe Mobile Health Center replaced the road weary 12-year-old van, which is being retrofitted as a dental clinic with funds from a U.S. Department of Agriculture grant and the state’s Health Enterprise Zone grant. The “new” dental clinic will serve those resi-dents of the county with a substantial need.

Lean Storage Improvement/Lean Six Sigma Supply Chain Project

For the first half of the year, Telemetry and the Intensive Care Center participated in a Lean Six Sigma (LSS) Kaison event with Materials Management to adjust the par levels of supplies. The goal was to reduce the number of stock supply requests, after hour walk-in requests and phone requests. The result has been a 25% reduction in staff time away from the patient. It saved time by reducing items transported by 42%.

Some of the components of the project included data collection, eliciting staff feedback, and using LSS methodologies to determine ways to improve processes. The team also conducted a par optimization with a major hospital supply vendor. Dia-grams were also created to help staff find the supplies on the unit and better organize supply rooms. The end result of this LSS project was a decrease in the number of after hour supply requests by 55 percent.

Endoscopy Nurses

Endoscopy nurses at MedStar St. Mary’s provide care for patients requiring exam-ination, diagnosis and/or treatment for gastrointestinal concerns. While the patient is undergoing the procedure, the endos-copy nurse provides sedation to increase patient comfort and safety, and also assists the physician with the various gastrointes-tinal procedures. The nurse also helps to maintain the endoscopy suite equipment.

Interventional Radiology (IR) Nurse/New ProceduresIR nurses embraced several challenges and opportunities this year when they began offering a number of new procedures not previously available to patients. Some of the new services offered include, uterine artery embolization, kyphoplasty, epidural steroid injections, tumor embolizations, gastric tube placement, port insertion, inferior vena cava filter placement, and placement of percuta-neous drainage catheters.

While implementing the new procedures, Interventional Radiology nurses ensured patient safety while also developing new policies and procedures, as well as patient and staff education. The team of nurses is thrilled to provide these new services to the community.

Pink Ribbon Expansion

The Komen Foundation-funded Pink Ribbon Project Grant was expanded this year. Led by Tami Gaido, BSN, RN, the project now offers services to women of any age who are in need of breast cancer screenings who are uninsured or underinsured and not previously covered by the existing Breast and Cervical Cancer Program (BCCP). Tami also serves as the Women’s Wellness liaison with the Health Department working part time with the BCCP. In 2013, the two pro-grams provided needed services and case management to 154 women. As a result of the 110 mammograms performed, three new cases of cancer were detected by the Komen program in women who wouldn’t normally have been screened.

Breastfeeding Conference

Held on August 10, 2013, the 1st Annual Interdisciplinary Breastfeeding Conference provided the foundation for MedStar St. Mary’s journey toward becoming a Baby Friendly Hospital. Community partners gathered at the College of Southern Maryland’s Leonardtown Campus to hear lectures rich in evidence based information from prominent Maryland pediatricians Dana Silvers, MD, and Michael Young, MD. The more than 40 attendees included physicians, nurse practi-tioners, high school counselors and others.

Induced Therapeutic Hypothermia

Improving outcomes for patients following a cardiac arrest is a goal for any medical practitioner. At MedStar St. Mary’s, the Intensive Care Center (ICC) has embraced the practice of induced hypothermia in an attempt to preserve neurological function and increase survival during the first 24 hours following cardiac arrest.

Guidelines that have been supported by the American Heart Association, New England Journal of Medicine, the American College of Emergency Physicians and the American Association of Critical-Care Nurses, among others, have set strict criteria that must be followed for the best patient outcomes. By following these guidelines, this is yet another way the ICC keeps current with best practices.

The Red Discharge Envelope

The Red Discharge Envelope is an innova-tive approach to patient education that was introduced in 2013 by the Inpatient Experi-ence Team. It contains valuable information about a patient’s medication and diagnosis. Patients and their families are introduced to the red envelope by a registered nurse during the admission process.

The Red Discharge Envelope contains tips on how to clearly communicate health in-formation to physicians. It is also the central location for clinical staff to place information the patient needs regarding medications and diagnosis. The use of the medication in-formation from the Red Discharge Envelope during each bedside shift report promotes consistent communication and allows an opportunity for the nurses to engage and educate the caregivers, not just the patient.

The final review of the medication infor-mation sheets, discharge instructions, prescription medications and the diagnosis occurs at the time of discharge. The patient is given the Red Discharge Envelope with instructions to take the packet to his/her first physician visit after discharge.

Community Benefits Funding

In Fiscal Year 2013, Medstar St. Mary’s invested over $11 million in Community Benefit efforts. This includes charity care/bad debt, medical education, community health services and research.

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Charity Care $6,250,461

Health Professions Education $233,956

Community Health Services $4,914,157

Medicaid Assessments$560,546

Behavioral Health Family Education

Based on feedback from patients and their family members, the Behavioral Health Unit welcomed a Family Nurse Educator in 2012. The position was created to better inform family members on their loved one’s diagnosis and medication. Three times a week, the Family Nurse Educator meets with patients and families to review the patient’s care, after care needs, diag-noses and medication education.

Nancy Moran, PhD, RNC, leads the pro-gram that has garnered much praise from patients and their families alike. “Family members have many questions and con-cerns regarding how to support their loved ones at home,” said Nancy. “This program helps them understand how to help some-one in crisis, recognize early warning signs of suicide, access community support and reinforce the important role of medications for relapse prevention.”

Since Oct. 2013, more than 180 families have taken advantage of the program (approximately 32 percent of all patient admissions).

Hand-off Communication Improves

Hand-off communication between caregiv-ers plays an immensely important role in safe patient care. To improve our processes, a team made up of clinical coordinators and front line nurses reviewed methods for patient hand-off between the Emergency Department (ED) and inpatient units. As a result, the team redesigned the hand-off process which helped to decrease patient wait time in the ED and improved the care-giver to bedside hand-off. Communication now involves the patient and their family members. Processes were also put in place to receive timely feedback from front line nurses to evaluate these new changes.

Professional Practice

Adding Care Coordinators

Helping patients navigate their care from the hospital setting to the primary care setting are MedStar St. Mary’s care coordinators. For patients with chronic conditions, proper care coordination can mean the difference between better control of their health issues and a revolv-ing door of hospital visits.

In 2013, the care coordination team grew with the addition of two full-time outpatient coordinators through the Health Enterprise Zone project. Working closely with in-house case managers, these nurses carry on where traditional case management ends. They continue to work with high need patients at least 30 days post discharge to stabilize medical issues and remove health barriers at home.

Emergency Department New Graduate Program

New nurse graduates in the Emergency Department (ED) are undergoing a more extensive orientation process that includes a robust six month curriculum unique to the ED. Developed by ED leadership, the week-ly courses are taught by associates who are highly skilled on a particular topic.

The goal of the new education sessions is to provide novice nurses additional assess-ment tools, standards and expectations. It also gives the graduates an opportunity to talk about the previous week, their progress and their needs.

NICHE Designation and Care for Older Adults

Nurses Improving Care for Healthsystem Elders or NICHE is the leading nurse-driven program designed to help hospitals improve the care of older adults. Three RNs from Medical/Surgical/Pediatrics (MSP) participated in the NICHE program based at New York University School of Nursing. Thanks to their completion of the Leader-ship Training Program (LTP), MSP received NICHE designation.

MSP associates will complete the Geriat-ric Institutional Assessment Profile (GIAP) survey. MSP has selected the Geriatric Resource Nurse Core Curriculum for the NICHE Training for registered nurses and the Gero Patient Care Associate Core Curriculum Training for NICHE Training for nurse technicians over the next year.

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Brittany and Andrew are a team even though they work day and night shifts in their department. During their overlapping handoff hours they focus on reporting and communication ensuring patient safety and quality care.

Brittany Szaks, BSN, RN, Emergency Department and Andrew Hollopeter, RN, Emergency Department

50%

3%

36%

11%

Associate’sDegree

Bachelor’sDegree

Master’s& PhD

Diploma

CCIS STEPPS Up

Cancer Care Infusion Services (CCIS) began the Team STEPPS journey on Nov. 12, 2013. All staff attended three two-hour sessions to learn a teamwork process designed for healthcare professionals. Fortunately, Magnet Coordinator Gina Steele, BSN, RN, CNOR, was available to serve as the instruc-tor. The results were tools and concepts that are helping CCIS associates and physicians to build on teamwork skills to achieve the best clinical outcomes for patients.

As a department, CCIS is building team awareness and learning how to deal with any barriers by communicating openly. Through the training, they were able to learn helpful techniques. Many in the department expressed that effective feed-back would be particularly useful. Feedback helps individual improvement by providing timely, respectful and specific tips to prevent an incident from occurring in the future.

With this extra knowledge, CCIS intends to build upon the quality of care they provide for their patients daily in a nurturing and safe environment.

Clinical Ladder

There are currently 76 nurses who are participating in the MedStar St. Mary’s Nursing Clinical Ladder program. This peer review recognition program provides mon-etary rewards for nurses as they advance in their clinical practice. The Clinical Ladder Committee meets monthly to review and approve candidates. In 2014, the program welcomed 14 new applicants and saw eight advancements and 54 renewals!

Nurse Sensitive Indicator Dashboard

Nurse-sensitive quality indicators are critical elements when it comes to establishing evidence-based practice guidelines. They reflect the structure, process and outcomes of the nursing care delivered at MedStar St. Mary’s. As nurses, it is our responsibility to measure, evaluate and improve the quality of nursing practice. As a useful means of measurement, the dashboard reflects areas of quality outcomes for our patients while also highlighting those areas in need of improvement.

Patient Satisfaction Awards

In fall of each year, a commemorative pin is awarded to those hospital departments which have maintained the highest patient satisfaction. For the inpatient setting, the winning area was the Women’s Health & Family Birthing Center with an average of 75.9 percent.

Both Rehabilitation Medicine and The Grace Anne Dorney Pulmonary & Cardiac Rehabilitation Center led the outpatient settings with scores of 87.8 and 97.2, respectively. The area of strongest support was Clinical Resource Management with 85 percent. In a category all their own, Hospice surpassed both the state and national scores by more than five percentage points in the Overall Rating category.

A much deserved congratulations is extended to these departments for the great care they provide our patients each and every day!

Stroke Recertification

MedStar St. Mary’s received a four-year re-designation as a Primary Stroke Center in June 2013 after a May survey. The Joint Commission’s (TJC’s) Certificate of Distinc-tion for Primary Stroke Centers recognizes centers that make exceptional efforts to foster better outcomes for stroke care. Cer-tification signifies that the services provide the critical elements to achieve long-term success in improving outcomes. It is the best indicator to the community that quality care is effectively managed to meet the unique and specialized needs of stroke patients.

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AA/BSN Breakdown

Over 47% of MSMH’s nurses have obtained a Bachelor’s degree or higher. MSMH is well on the path of reaching 80% BSN prepared nurses by 2020!

MedStar Franklin Square Medical Center MedStar Georgetown University Hospital MedStar Good Samaritan Hospital MedStar Harbor Hospital MedStar Montgomery Medical Center MedStar National Rehabilitation Network MedStar Southern Maryland Hospital Center MedStar St. Mary’s Hospital MedStar Union Memorial Hospital MedStar Washington Hospital Center MedStar Family Choice MedStar Ambulatory Services MedStar Health Centers MedStar Visiting Nurse Association MedStar Institute for Innovation MedStar Health Research Institute

25500 Point Lookout RoadLeonardtown, MD 20650

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