Our Journey to Nursing Excellence is back and stronger than ever! Over the past month, the Magnet Champions and Unit Practice Chairs have met with Rhonda Foster, our Magnet Consultant, to gauge our readiness for the next phase of this exciting process. During these two-day meetings, we were asked to break into smaller groups and assess our current knowledge of the process for document submission, Evidence-based Practice and how we use it, as well as our corporation’s values, vision, and mission statements. During this process, we were able to determine our areas of strengths and implement action plans for areas of weakness. It has been unanimously determined that we will be moving forward to document submission in 15 months.

The document submission date is rapidly approaching — we are currently at month 14 and have much work to do! To be successful, we need each of you actively engaged in your Unit Practice Councils and the Shared Governance Model embraced by The Medical Center. Our focus has not changed: as nurses, our goal has always been to provide Nursing Excellence for each of our patients. Nursing Excellence is how we achieve quality patient outcomes and exceed our customer service expectations — this is NOT new to The Medical Center. The only “new” thing will be obtaining Magnet accreditation which recognizes the awesome job we are already doing everyday! Magnet accreditation is an award set aside for healthcare elite — the Gold Standard of Nursing. In the United States, there are currently 5,815 hospitals and out of those only 368 have achieved this level of designation (ANCC, 2010). In Kentucky, there are 372 hospitals and only 5 have Magnet accreditation (ANCC, 2010)! I look forward to working with each of you as we join together to achieve the next level of Nursing Excellence.

~ Communicating Helps Caregivers ~

Our Journey Continues by Rechelle Wood, BSN, RN, CNIVA u g u s t 2 0 1 0IN THIS EDITION

1 Our Journey Continues

2 Betsy’s Corner

2 From the Committees

3 A Day in the Life of Care Coordination

4 CNA Spotlight

4 Robotic Surgery

4 What If? Hands-On CPR

5 Movin’ On Up

5 Dear Flo

6 Adult Immunizations

6 Thank You Nursing Resource Team!

6 Med/Surg Certification Review Course

7 National Cholesterol Education Month

7 Nursing Orientation

7 Corn Bread Salad

8 Education Station

Page 2

Betsy’s Corner

Betsy KullmanChief Nursing Officer

August is here, summer vacations are just memories, the children are back in school and nurses continuing their education will soon be back in class again. We will welcome back nursing students in the next few weeks as Western Kentucky University classes begin on August 30.

Once again, I want to encourage everyone to provide every learning op-portunity available to our students as they may be our future employees.

Our Evidence-based Poster Presentation will be held in the Auditorium on September 15 and 16. I am very anxious to see what every unit has been working on during the past months to improve care. Mark your calendars to attend so that you can receive free CEUs needed for your license renewal in October. There will be no shared governance meetings for the month of September, so everyone can attend our poster presentations.

The Med-Surg certification re-view class will be held September 21 and 22 in the Auditorium. If you have been considering pursuing your certification, now is the time to take the challenge as you no longer have to pay to sit for the exam. All nurses who want to sit for the Med-Surg exam need to contact Vickie Taylor for details on registration.

Our new expansion will be open-ing the first of September and an employee open house will be held so that everyone will have an opportunity

to see the new area. The staff has been busy learning how to use the new equipment for their floors and are looking forward to their moving date.

A Nursing Excellence workout session was held on August 6 in the Auditorium to further develop the action steps that were established dur-ing Rhonda’s visit. There were eight groups that each had three action steps to develop, to assign responsibility and to report off to the group at the end of the meeting. The meeting was very productive and many creative ideas were put into writing.

Thanks to everyone for your continued support of Evidence-based Practice and the implementation of it on your units. Our outcome data continues to improve which is proof that what we are doing is truly making a difference for our patients.

From the Committees...Research CouncilThe Research Council is currently seeking a co-chair. If anyone is interested, please contact Jessica Bechard, chair of the council. The annual Evidence-based Poster Presentation will begin on September 15 at 8 a.m. and conclude at 4 p.m. on September 16. There will be a workout session to put posters together on August 31 from 8:30 a.m. to noon in the Auditorium. Posters are located in the Nursing Office.

Recruitment, Recognition, Retention Council• The Nursing Survey is finished and results will be published in

Nursing Notes.• Reimbursement for certification testing was approved. • Bowling Green Technical College nursing students will be in-

cluded in the SNR program.

Carolyn Simons, RNNursing Excellence :The sky’s the limit!

Page 3Page 3

A Day in the Life of Care Coordination

When you ask someone at The Medical Center what Care Coordinators do, most people say we are the “chart police,” or think we’re just here to kick patients out of the hospital. So we were thrilled at the opportunity to tell you a little about what we do.

First of all, Care Coordinators are all experienced Registered Nurses who pos-sess a high level of clinical knowledge across a variety of patient populations. We have been trained in utilization re-view, clinical documentation strategies, discharge planning and case manage-ment. Care Coordinators must be highly detail-oriented, highly organized, highly motivated nurses who can effectively interact with people of varying back-grounds and educational levels. Care Coordinators use the nursing process everyday, so they must possess strong assessment and critical thinking skills to identify patient needs; to coordinate care; to develop, implement and evalu-ate discharge plans; and to troubleshoot, integrate knowledge and solve problems when they arise.

Care Coordinators typically have a nurse to patient ratio of 1:24 and are “unit-based,” meaning each nursing unit is assigned a specific Care Coordinator who works directly with the patients, their families or caregivers, physicians

and all members of the healthcare team on that particular nursing unit.

Care Coordinators wear many big hats and have a lot of daily responsibili-ties to their patients and to the hospital:

Utilization Review – we wear this hat to make sure the hospital gets paid for the care and services provided to our patients. There are lots of insur-ance rules to keep up with that seem to change every other week. One of the most important roles we play is help-ing the admitting physician navigate these rules and get the patient in the appropriate billing status — Inpatient vs. Observation vs. Outpatient. Each insurance company has different rules for how that determination is made, so sometimes we work with special-ized physician advisors from Executive Health Resources (E.H.R.), who are experts and who help our admitting physicians get the patient status right. If we don’t get it right, the hospital doesn’t get paid! For patients without insurance, we work with financial counselors and consultants to help patients qualify for government programs or charity care.

Clinical Documentation Improvement – we wear this hat to ensure the hospital gets paid everything it deserves, not just the minimum pay-ment. We prompt physicians, nurses,

therapists and other specialists to “think in ink” and “connect the dots” so the medical record accurately reflects the severity of the patient, as well as the intensity of treatment provided. Good documentation translates into regulatory and accreditation compliance, bet-ter coding, better reimbursement, and protection from audits and denials. The difference between bad documentation and good documentation can be thou-sands of dollars in payment.

Care Coordination – we wear this hat to follow patients throughout their stay so we can facilitate and coordinate care across disciplines and across de-partments. This ensures safe and timely patient movement through the hospital setting. It seems like there is always another patient waiting for a bed some-where so we try to make sure any delays in care or discharge are minimized.

Case Management and Discharge Planning – we wear these two hats in both routine and complex cases by working with patients, families and the healthcare team to develop and imple-ment safe discharge plans and ensure continuity of care once patients leave The Medical Center. Social Workers are a very important part of the Care Coordination Team and work very close-ly with us in identifying and meeting a patient’s discharge needs.

So as you can see, we are much more than the chart police or just dis-charge planners. If we don’t do a good job, the hospital doesn’t get paid and our patients stay in the hospital longer than they need to. We couldn’t do our job without all of you, so we want to take this opportunity to thank everyone we work with on a daily basis, from our assistant care coordinators, our clinical managers, nurses, techs and unit clerks as well as our physicians, therapists, specialists, educators, and providers. We’d also like to thank our director, Bill Singletary, for his guidance and support and for always putting the patient first. (He has a staff of all women, so pray for him.) One thing’s for sure, there is never a dull moment in Care Coordination.

Sitting L to R: Mary Thompson, Bonnie Lewis, Amy Bratton, Rhoda Chism. Standing L to R: Donna Thomason, Norma Johnson, Martha McGrane, Brandy Flora, Velda Alexander. Not Pictured: Tammy Childress, Carol Hathaway, Teresa Shaw, Verna Lovan, Natalie Crume, Paulette Clardy.

Page 4

Ask Brandy Bland, CNA, about her job and a smile immediately covers her entire face. “I love what I do. I enjoy taking care of patients and making them feel safe and secure.” Brandy has been with CHC for almost seven years. She has always worked in CCU. “I have grown so much over the past seven years. When I came here, I knew nothing and everyone has been so good to me. I am more confident now, and I know I can make a dif-ference.” Brandy’s co-workers describe her as loyal and kindhearted. Karen Holman, RN, says, “Brandy takes her time with the patients, and they really appreciate that.”

Karen says patients always compliment the care they received from Brandy. “You can tell she really cares.”

Brandy’s hopes for the future include going back to school and helping her daughters become the best young ladies they can be. In her spare time, she enjoys reading and spending time with her girls, Destiny and Jasmine. Thank you, Brandy, for the excellent care you give our patients!

CNA Spotlight on Brandy Bland by Paula M. DeVore, RN, CCRN, CNIV, SANE

Page 4

“What if”You are sitting at a ball game and an adult suddenly collapses. What should you do?

You should:

1. Call 911

2. Push hard and fast in the center of the chest.

This person’s survival depends greatly on you. They need immediate CPR. Studies of real emergencies that have occurred in homes, public locations and work, show that these two steps, called Hands-Only CPR (American Heart Association) are as effective as conventional CPR. Providing Hands-Only CPR to an adult who has collapsed from cardiac arrest can more than double their chance for survival.

So, if you see an adult suddenly collapse, call 911 and push hard and fast in the center of the chest. DON’T BE AFRAID. YOUR ACTIONS CAN SAVE A LIFE.

Resource:American Heart Association Hands-Only CPR  (http://handsonlycpr.org)

Since starting my career in 1984, Surgery has been my life and passion. I have found it a challenge because it is a constantly changing, evolving environment. When I began my career in Surgery, you basically had to know only several trays of instru-ments and several basic ways to position patients for their operations. We would perform open procedures in just about every aspects of the surgical environment. Today, we have progressed to laparoscopic equipment in which we can

operate in the smallest body cavities, such as the maxillary sinuses, and computer-generated images to guide in total knee replacements, sinus surgery and brain surgery. The advancements have been steady and sure through the past several decades. But the thought of a surgeon seated at a control module controlling minimally invasive laparo-scopic instruments in a precise and delicate manner with his fingertips was truly just a Star Trek® thought back in 1984.

The Medical Center ventured down the Star Trek journey and purchased a da Vinci Surgical System in September 2009. With this venture, the Surgery staff has had to once again adapt to a new way to perform skills and delicate techniques to assist with this state-of-the-art technology. Our team of dedicated nurses, surgical technicians, and first assistants has worked alongside the surgeons to become skilled at these new and dynamic procedures. They have increased their knowledge by online programs, attending training sessions, traveling to other facilities to glean knowledge from others who have gone before us, and then precepted others in the knowledge they have learned.

Since purchasing the da Vinci Surgical System, over 150 gynecological and urological procedures have been performed at The Medical Center. We were the first hospital in the state of Kentucky to perform a robotically assisted cystectomy and ileo- conduit. We have seen growth in our robotics program with more surgeons pursuing their training, and the Surgery staff is up for the challenge of staying on the cutting edge of the surgical world.

Robotic Surgery at The Medical Center by Jodi Hanna, RN, CNOR, Surgical Services Educator

da Vinci Surgery staff members from right to left:AmyJoCarroll,CST;StephanieBryant,CST;LindseyFinley,RN;TriciaNewton,RN;StacyKirby,CST;KaseyLivingston,CST.(Not present:BillyHarris,KCSA,andKamalaEmbry,KSCA,FirstAssistants.)

Page 5

Dear FloCan you help me understand our pain assessment policy? Thank you! Concerned CathyDear Cathy,

Let me start off with a true story that may help you appreciate our policy: A woman in her early 20s comes in to a hospital for an elective hysterectomy due to ongoing gynecological problems. She arrests and dies on the second day post op, allegedly due to an overdose of pain medication. The patient’s husband sues the hospital. The hospital reaches a confidential settlement with the husband.

What are the issues in regard to the nursing care of this patient?• Was she having severe pain?• Was this reported to the physician?• Were the orders for pain medication(s) clear?• When do particular pain medications peak? Are they being given orally, IM,

IV, or a combination? • If medications are given via different routes, is the peak time going to

overlap? • Are any other sedatives being given in combination with the pain

medications?• Was the pain level assessed prior to the medication(s), and at the time the

medication(s) should peak?• Are other comfort measures employed besides pain medications?• How was her respiratory status being monitored?

Do you know what the MCBG Pain Assessment Policy: NP 97 says?

•Pain will be assessed, reassessed and documented: o on initial screening, o after pain producing events, o with any new reports of pain, o at regular intervals, o after each pain intervention once a sufficient time has elapsed

for the medication to reach peak effect, and o at the report of inadequate pain control.

• Patients acknowledging pain will be further assessed using the comprehensive assessment tool, “with care.” This tool assists in documenting location (where?), intensity, time it lasts, how it affects the person, characteristics, aggravating factors, relieving factors and other effects it causes.

• Pain will be documented using the pain scale. Documentation will reflect the degree of pain on a 1–10 scale.

• Measures are to be taken to decrease the side effects of pain medication. • Alternative comfort measures should also be employed, such as positioning,

massage, diversion activity, and environmental factors. *Nursing Judgment Issue: Giving various pain medications via different routes can make it difficult to predict when and how a patient will respond.

I hope this helps!

Flo

Please join us in congratulating our colleagues who have advanced in their careers and/or education! The following names were submitted for recognition:

Donna Higdon, RN, BSN, CNOR (Surgical Nurse), has passed her certification in July, 2010.

Congratulations to Alex Healey, ED Tech, on completion of EMT Class and National Certification.

Ashley Perring, RN (4A), graduated with her BSN.

Gladys Sublett, RN, CMSRN (4A), just passed her Med-Surg certification.

Movin’ On Up!

Page 6

Adultimmunizationsimportantforhealthcareworkersby Shala Wilson, Adult Nurse Practitioner, Employee Health Clinic

“I thought I was finished with immuni-zation shots when I finished school,” is a common reaction of adults when told an immunization is recommended. The fact is that immunizations are important regardless of age since they help protect from disease — and for healthcare work-ers, it is especially important that your immunizations be up-to-date since the potential for exposure is greater than for the general population.

Common adult immunizations and the benefits are as follows:

• MMR – Provides protection against Measles, Mumps and Rubella, which may lead to ear infection, deafness, seizures, tes-ticular or ovarian swelling, ster-ilization or arthritis. Exposure to Rubella can also cause birth de-fects if women are exposed to the disease during early pregnancy.

• Tetanus or Tdap — In the past, CDC recommended a tetanus shot every 10 years for adults, plus diph-theria and whooping cough during early childhood. In 2005, a new lifetime vaccine was developed which offers protection against tetanus, diphtheria and whooping cough. Although the incidence of these diseases has been reduced, if infected with any of them, compli-cations can lead to breathing prob-lems, heart failure, pneumonia and death.

• Chickenpox (Varicella) — Once thought to be a harmless childhood

disease, varicella can be especially serious for young children, preg-nant women and adults who are immuno-compromised. Exposure during the first trimester of preg-nancy has been associated with birth defects.

• Hepatitis: Hepatitis A is a serious disease spread from person to per-son or from contaminated food and can cause liver damage. It is usu-ally initially manifested by nausea, vomiting, diarrhea and jaundice (changes of skin color and whites of the eye to various shades of yel-low, depending on severity). It is especially important to be immu-nized if you are planning to travel to countries with a high prevalence of disease. For more travel infor-mation, go to www.cdc.gov/travel.

Hepatitis B is a blood-borne patho-gen spread by contact with blood or body fluids of an infected person. Immunization for all healthcare workers is strongly recommended since potential for exposure is high. Hepatitis B can lead to se-vere liver disease and death, and at present there is not a cure for this disease.

Other immunizations that are recom-mended for adults are: Pneumococcal for adults who smoke, have a chronic condi-tion or are over 65 years old; and Herpes Zoster (shingles) for those over 60 years of age.

Thankyou!

...to our awesome Nursing Resource Team for all of your hard work! We appreciate you and

all you do for us!

The Nurse Team at The Medical Center

at Bowling Green

ATTENTION, NURSES!Are you thinking about becoming certified in Medical/Surgical Nursing?

AMedical/SurgicalCertificationReviewCoursewillbeheldSeptember21and22inTheMedicalCenterAuditorium.

Speaker:LeannaMiller,RNfromVanderbiltUniversityMedicalCenter

ContinuingEducationHours:13.75ANCCand16.5KBN

SignupinNetLearningforthis2-dayreview! 

Forinformationontestingdatesforthereview,gotowww.amsn.org

Page 7

National Cholesterol Education Month by Janie Davis, Nurse Practitioner, Employee Health Medical Clinic

September is National Cholesterol Education Month. It is estimated that approximately 65 million Americans have been diagnosed with elevated cholesterol levels in the bloodstream. Elevated cholesterol levels increase a person’s risk for heart disease.

Cholesterol is a chemical compound that is made up of fat and a steroid. Approximately 80 percent of a person’s cholesterol is made within his/her liver. Cholesterol is used by the body to repair cells.

Besides the cholesterol that occurs due to normal liver function, cholesterol is also found from dietary sources. Cholesterol is found in meat, poultry, fish, and dairy products. Organ meats, such as liver, are especially high in cholesterol.

Today, we understand more about the effect of cholesterol on the body. It is recommended an initial screening of cholesterol levels be conducted around age twenty. The blood levels should be reviewed with a healthcare provider. A family history of high cholesterol, heart disease as well as other risk factors such as smoking, diabetes, and/or high blood pressure may prompt your healthcare provider to discuss options to lower your cholesterol values.

Today, healthcare providers use several ways to consider your risk based on cholesterol values. There are several types of cholesterol. Low density lipoprotein (LDL) or “bad cholesterol” leaves deposits in blood vessel walls. These deposits make blood vessels hard and narrow. The second type is very-low density lipoprotein (VLDL) which contains the most triglycerides. This type of cholesterol will narrow blood vessels. High-density lipoprotein (HDL) or “good cholesterol” picks up excess cholesterol and takes it back to the liver.

There are several modifiable risk factors for high cholesterol that someone can change to lower his or her cholesterol levels. These are as follows:

1. Smoking2. Obesity 3. Poor diet4. Lack of exercise5. Hypertension6. Diabetes 7. Family history of heart disease

before age 55.If you have questions or concerns

about your cholesterol levels, please contact the Employee Health Medical Clinic at 745-1263 to schedule an appointment with a nurse practitioner.

Nursing Orientation

Corn Bread Salad1 box Jiffy Corn Bread (Prepare as directed on box)1 medium onion – chopped1 can whole kernel corn (drained)1 can Pinto beans (drained)1-2 medium tomatoes – dicedRanch dressingAmerican or mild cheddar cheese (as much as you like)

Crumble corn bread into salad bowl.Mix corn, beans and onions together; then spread over corn bread.Spread Ranch dressing over all.Top with grated American or mild cheddar cheese and chopped tomatoes.

SIMPLE AND TASTY!

Terri Webb, RNCorporate Audit and Appeals Coordinator

Seated: Kellyn Campbell, 3B; Brittany Ward, 5A; Katie Steele, 3B. Standing: Stephanie Barnett, 3B; Kelli Carter, Intern Surgical Care; Brittany Ashley, Dialysis; Beverly Childress, CSR; Tabitha Wett, CRSH.

Seated: Amanda Parsons-Cole, 4B; Steve Gravette, Cath Lab; Rayli Howard, 4A. Standing: Natasha Norman, Emergency Department; Brittany Thomas, 5A; Ashley Craig, Open Heart.

Seated: Kimberly Meredith, 4A; Megan Wisdom, Open Heart Recovery. Standing: Sarah Ashby, Labor & Delivery; Katelyn Hale, Cal Turner Extended Care Pavilion.

Page 8

Education Station – August 2010 

• Nursing Care of the Bariatric Patient – August 25 Noon – 1:00 p.m.  (Bring your lunch), or 3:00 – 4:00 p.m. The Medical Center Auditorium Continuing Education Hours:  1  

• CNA, Unit Clerk, Monitor Tech Core Competency Validation  – August 26, 27, 30 & 31 Session start times vary per day.  Sign up for a start time in NetLearning. Classroom 3 – First Floor Medical Plaza, Suite 101  

• Shift Facilitator Training – September 9 8:00 a.m. – 4:30 p.m.  The Medical Center Auditorium Continuing Education Hours:  5.75 (ANCC) and 6.9 (KBN)   

• Etiology & Interventions: Pressure Ulcers – September 14 7:30 – 8:30 a.m., or Noon – 1:00 p.m. (Bring your lunch), or 3:00 – 4:00 p.m. The Medical Center Auditorium Continuing Education Hours:  1  

• Medical / Surgical Certification Review Course –  September 21 and 22 8:00 a.m. – 4:30 p.m. each day The Medical Center Auditorium Continuing Education Hours:  13.75 (ANCC) and 16.5 (KBN)  

 • Preceptor Training Class – September 28 

8:30 a.m. – 4:00 p.m. Classroom 3 – First Floor Medical Plaza, Suite 101 Continuing Education Hours:  6.25 (ANCC) and 7 (KBN)  

 • RN / LPN Core Competency Validation  – October 13 ­ 19 

Session start times vary per day. Sign up for a start time in NetLearning. Classroom 3 – First Floor Medical Plaza, Suite 101 

 For more details and to register, log onto NetLearning. Reminder – PearlsReview provides computer­based certification review courses in a wide variety of specialties. Contact Mary Pat Jackey at 270­796­6839 or email jackmp@chc.net for more information. 

Contact Information: Main office – 2566 Alicia Pennington CME Coordinator  Andy Sturm– 6523 Patient Educator  Carolynn Burton– 6548 Clinical Educator: Nursing  David Smith– 2976 Clinical Educator:  MCS & MCF  Jodi Hanna – 2498 Surgery Educator  Mary Pat Jackey– 6839 Clinical Educator : Net Learning and PEARLS  Paula Sipes– 6587 Clinical Educator: Critical Care    Sherry Suggs – 6819 Staff Development Educator AHA & Trauma Programs  Vivian McClellan– 1147 Corporate Director  Resources: Apple icon in iCare  Mosby’s Skills & Consult  PEARLS Review  Courses  Patient Education: KRAMES  HealthFlix  PT. Education icon in iCare