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Nursing Services Annual ReportNovember 2015

#CompassionCampaign

Medical City Dallas Hospital/Medical City Children’s Hospital

Medical City Dallas Hospital/Medical City Children’s Hospital (MCDH/MCCH) is a 668-bed medical center, known as a leading

healthcare provider of subspecialty care throughout the Dallas-Fort Worth Metroplex, the North Texas Region and extending

into neighboring states. With 97 specialties practiced at the hospital, patients from all over the country and as many as 75

countries across the world have sought care at MCDH/MCCH. Patients come for the type of advanced, specialized medical and

nursing care represented so aptly by the hospital’s tag line…It’s Better in The City.

In this Report Transformational Leadership ..........................................pg. 4-7

Structural Empowerment ................................................pg. 8-24

Exemplary Professional Practice ..................................pg. 25-33

Our Mission:

Above all else, we are committed to the

care and improvement of human life. In

recognition of this commitment, we will

strive to deliver high quality, cost effective

healthcare in the communities we serve.

Nursing by the NumbersTotal Number of Nurses 1431

Nurse Tenure (average) 8 years

Nursing Staff with a BSN 65%

Eligible nurses holding professional certification 41%

Nursing Leaders with BSN as highest degree 68%

Nursing Leaders with Graduate degree or higher 32%

Nursing Leaders with professional certification 72%

Total Nursing Certification Reimbursement YTD: $168,000

Total Tuition Reimbursement YTD: $560,766

Total Nursing Career Enhancement YTD: (535 RN participants) $487,750

New Knowledge, Innovations and Improvements ....pg. 34-38

Inspirations .........................................................................pg. 39-42

Caring for the Community ................................................pg. 43-46

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Medical City Dallas Hospital/Medical City Children’s Hospital Message from the Chief Nursing Executive

My Gratitude for Your Compassion

I am incredibly humbled to be writing my first letter as Medical City’s Chief Nursing Executive for our Nursing Services Annual Report. The humility comes because of the exquisite excellence that occurs within and beyond the walls of our hospital on a daily basis by our exceptional Magnet® nurses and patient care team; I am honored to be working with and for you. This report is reflective of the daily positive impact you make in the lives of our patients and their families—without you this report would not be possible.

As we approach the time of year where we gather with family and friends to celebrate our gratitude and show appreciation for each other, I too want to thank you for all you do. I hear about your caring every day and, in fact, I just finished responding to a family member who emailed me about the excellent staff who cared for her, and that she “owes us every breath she takes”. This is just one of hundreds of thousands of moments of caring that resonated and transformed the lives of the patients and families who received care at Medical City Dallas Hospital and Medical City Children’s Hospital in the last year. We are seeing this impact translate into the best patient satisfaction scores we have ever seen in the history of our hospital. We are well on our way to achieving our goal of being “world class” and achieving that national 95th percentile result in patient satisfaction. We know attaining that milestone is not about the number, rather a validation that the care we provide is among the best in the world, the type of care that we would want if it was us, our mother, our spouse, or our child in that bed.

As part of this journey this report serves to kick off what we will be calling our “Compassion Campaign”. This campaign will focus on the care and compassion we provide, and will highlight our excellence in this space over the coming months and year. You will see examples highlighted within these pages, in our employee forums, and we will also showcase this excellence in Caring Competencies in early 2016 where we will each commit to hardwiring caring behaviors proven to produce that world-class patient experience. The caring behaviors, hourly rounding and bedside shift report, are a few tools that when performed with quality and consistency are designed to produce patient satisfaction results that are second to none. I know we are doing these well today, and I have seen you in action performing them, but as a three-time recognized Magnet® organization we are obligated to strive for even greater excellence—and we will do it together, for our patients.

Have you stopped recently to think about the difference that you make, and will continue to make in the coming years? I bet not, because as nurses and caregivers we are typically very humble. But during this season of gratitude, I ask that you reflect on the difference you, a peer, leader, physician, or a fellow employee makes and thank them for their excellence. I thank you for all you do each and every day. Let’s commit to continue to build upon our legacy of human caring, one that is framed within our Human Caring Professional Practice Model, by creating compassionate connections with each and every person we encounter. I hope you enjoy this report, which highlights just a fraction of your exceptional caring.

With a Grateful Heart for Your Incredible Care,

Zach Mueller, DNP, RN, NEA-BCSenior Vice President & Chief Nursing Executive

2015 Nursing Annual Report2

Messages from the CEO’s

Dear Colleagues,It is with much appreciation that I congratulate you on another exceptional year of nursing at Medical City Dallas and Medical City Children’s Hospital. As I visit with patients across our healthcare system, I am deeply moved by how often I hear heartfelt

appreciation and praise for our outstanding nurses.

As a vital part of the entire Medical City Family, our nurses bring skill, competency and compassion to the patient’s bedside and in many outpatient areas where care is provided.

Every day, nurses at Medical City make tremendous contributions to the patient experience as advocates, decision-makers, educators and collaborators. They are on the front lines of healthcare delivery and we are grateful for their service.

With this annual report, we celebrate nursing at Medical City by reflecting on our accomplishments this past year and by continuing on our Magnet® journey. Additionally, we have the opportunity to rejoice in our commitment to making a difference in the lives of those we serve.

I hope you will enjoy reading about our outstanding nurses and their remarkable initiatives in the pages that follow. Consider this message a “thank you” for your outstanding service and for your role in the “Care and Improvement of Human Life”.

Warm Regards,

Troy A. Villarreal, FACHEChief Executive Officer

Above all else we are committed to the care and improvement of human life… this is the first line of our mission statement. While everyone at Medical City Children’s Hospital is committed to always living out the mission statement, nursing is one of the key professions that have the greatest

impact on improving human life. I have the utmost respect for the profession of nursing and I am awed by the highly engaged, high quality and highly trained, Magnet® nurses providing care for our pediatric patients each day.

Our nurses are at the bedside with our pediatric patients twenty-four hours a day for the duration of their hospital stay. In addition to providing exceptional care for pediatric patients by monitoring, assessing, and administering medications; they personalize the patient experience for each child and family.

A Chief Executive Officer may be a more prominent and visible position, however, our nurses play a significant and more personal role for the patient and their family members. A heartfelt thank you for your focus on excellence always in caring for our children at Medical City Children’s Hospital.

Best Regards,

Keith V. Zimmerman, FACHECEO, Medical City Children’s Hospital

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Message from the Assistant CNO

Clinical ExcellenceThe Human Caring Model continues as the Professional Practice Model at MCCH/MCDH providing the foundation of nursing care and clinical excellence. On a daily basis, nurses in all departments are impacting the lives of patients through an individualized, personal approach to care delivery. The bedside shift report highlights the patient’s progress through the previous shift and identifies the most important goal of the patient for the next shift, demonstrating the essence of individualized care. This level of communication and coordinated care planning extends to hourly rounding and the “No Pass Zone” to provide an environment of healing, responsiveness and safety. As a result of nursing’s commitment to our patients, we reached the national 80th percentile in “overall rating of the hospital” in the adult inpatient setting in the third quarter of this year.

Nursing demonstrated a focused approach to quality improvement of nurse sensitive patient care indicators in 2015. One example of this dedicated clinical improvement centered on the reduction of catheter associated urinary tract infections (CAUTI) in both the adult and pediatric hospitals. An energized, interprofessional team developed a comprehensive plan to decrease CAUTIs after analysis of the data and review of evidence based practices. In our commitment to excellence always, a nurse driven catheter protocol was developed and implemented with every registered nurse validated on skills related to Foley catheter interventions. The improved outcome of a 50% reduction in CAUTIs through the third quarter of 2015 from the previous year reflects a successful initiative for clinical excellence. During this same timeframe, 18 of the 22 nursing units monitored for CAUTI, had a lower device utilization rate than the rest of the nation.Patient centered care, teamwork, patient advocacy, communication, and servant leadership define the values of nursing at MCCH/MCDH as nursing care is executed with compassion in every interaction.

As affirmed by these patient statements, I am proud of our nursing care excellence:

“I had confidence in the nurses and in their abilities.”

“My visit was for wound care, I had outstanding staff. Nursing staff were very attentive.”

“They were very sensitive to my privacy and needs. I felt very safe & secure in the hospital.”

“I was taking better at Medical City better than I have ever been taken care of at any hospital.”

“The nursing staff cared for me as they were caring for my mother during her last days, I am so grateful.”

A heartfelt thank you to all the nurses and colleagues who individually and collaboratively practice the art and science of nursing with a commitment to excellence always.

Cathy McLaughlinAssistant Chief Nursing Officer


“Transformational leaders are those who stimulate and inspire followers to both achieve extraordinary outcomes and, in the process, develop their own leadership capacity.”

~ 2014 Magnet® Application Manual

Transformational Leadership

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Committed to the Next Generation of Transformational LeadersJoyce Winbush, BSN, RNC, CMSRNIn Jim Collins classic leadership book, Good to Great, the most successful, engaged leaders (referred to as a Level 5 Leader) are embodied with a paradoxical blend of personal humility and professional will. They are personally ambitious but put the needs of the organization first and foremost. They position future leaders for success. Additionally, Level 5 leaders are driven by the need to produce sustained results. For the past 25 years, Joyce Winbush, BSN, RN-BC, CMSRN, has provided leadership within Medical-Surgical Services at Medical City with the enthusiasm and diligence of a Level 5 leader. On her watch Medical-Surgical services grew and evolved in quality outcomes, efficiencies and reputation in our community. Joyce’s personal and professional passion has

underscored Medical-Surgical Nursing as a respected clinical specialty at Medical City. In September of 2015 we leveraged Joyce’s expertise and valued skill-set and established the new role of Director of Professional Development and Programs. In her new role Joyce will assume responsibilities that provide key support and leadership at an organizational level. Within her scope she will lead and elevate programs in our various centers of excellence; ensure leader competence related to strategic processes, metrics, and data collection; facilitate excellence in physician satisfaction and partnerships and lend full support to ensuring that our patient promise initiatives are enculturated and hardwired at the organizational level. Joyce will integrate her mission-oriented experience and zeal for “the care and improvement of human life…” to promote excellence throughout Medical City. She will help develop our next generation of transformational leaders.

Kathy Walton, MBA, BSN, RN, CPNAnother important transformational initiative that has been hardwired in 2015 is our Patient Promise New Leader Onboarding Class (PPNLO). Six classes were held throughout 2015 to help equip new leaders with essential information and tools that they need to successfully enculturate into their leadership role at Medical City. Topics include fundamental Patient Experience tactics such as Key Words at Key Times, AIDET, Hourly Rounding, Patient Promise Proof of Performance Board, and Leader Goal Alignment. The PPNLO curriculum, offered to new leaders at all levels, is taught by our current leadership team members who serve as content experts. Not only does this offering establish a solid foundation for our new leaders, it also provides a forum for our experienced leaders to share their experiential knowledge and sharpen their presentation skills. Each attendee receives

a reference notebook that provides a review of the daylong learning along with respected leadership books such as The HCAHPS Handbook, and Straight A Leadership.

Medical City is committed to our patients and to ensuring that the care and service that they receive is world class. Evidence of that commitment is exhibited in the creation of a new role within the organization, Administrative Director of the Patient Experience and Organizational Learning. Kathy Walton, MBA, BSN, RN, CPN serves in this role and with the administrative support of Robert Peterson, leads the PPNLO initiative. This orientation class has proven to be an invaluable offering to help new leaders feel comfortable and well-prepared as they embark on the path of leadership at Medical City Dallas. Shanna Warren, MAM, SPHR, Vice President of Human Resources and Employee Health, recent attendee of the PPNLO, comments, “The commitment to growth and development is clearly a priority at Medical City Dallas Hospital as countless leaders spend quality time orienting and onboarding new leaders into the company. Their engagement and enthusiasm is contagious and I am glad to be a part of such a wonderful leadership team.”



Emerging Leaders ProgramThe North Texas Division (NTD) Emerging Leaders Program was developed by NTD CNO’s to recognize those with leadership skills and offer opportunities for growth and development. The goal of the 12 month program is to select high performing supervisors and team leads and provide them with leadership development skills, thus influencing promotions and succession planning within the organization. Candidates must submit an application and receive recommendations and approval by the facility CEO. A multidisciplinary team evaluates final candidates and either approves or rejects admission into the program. Curriculum and assignments include, but is not limited to, business/financial acumen, effective communication strategies that lead to results, and change management. The participants also present a group project that could have a positive impact for the organization to senior executives prior to graduation. MCDH/MCCH had the following 9 participants in the Emerging Leaders Program for 2015:

• Beth Barnhouse, BSN, RN, OCN, Manager Medical Oncology and Surgical Oncology• Crystal Crawford, BSN, RN, Supervisor 6North Pediatrics• Ramey Griffith, Supervisor Plant Operations• Stephanie Howard, BSN, RN, CCE, CEIM, Manager Newborn Nursery and Parent Education• Heather Linskie, BSN, RN, CAPA, Supervisor Outpatient Surgery• Shivas Niduasa, BSN, RN, ONC, Supervisor 6South Orthopedics• Brandt Oliver, OR Business Manager (Transferred to The Medical Center of Plano) • Geraldine Perez, BSN, RNC-NIC, Supervisor NICU• La Cresha Pree, RN, Supervisor SICU

Three of the leaders listed above have already received promotions in 2015: Beth Barnhouse, Stephanie Howard and Brandt Oliver. We congratulate all of our Emerging Leaders on their accomplishments!

Pictured left to right, Lacresha Pree, Stephanie Howard (standing), Beth Barnhouse, Geraldine Perez, Shivas Niduasa, Ramey Griffith

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Ebola Virus – A Public Health EmergencyIn October of 2014 a complex, frequently fatal infectious disease, known as Ebola, was first diagnosed in Dallas, TX. Unlike the anticipated seasonal flu or Respiratory Syncytial Virus (RSV) season, this highly contagious disease was not foreseen. This experience impacted not only the north Texas community but the entire nation. The Ebola virus came without warning and completely changed the view of infectious disease control and healthcare management in United States. The crisis hit home at Medical City as the first Ebola patient presented at a nearby urban hospital only a couple of miles away. Our nursing leaders stepped up immediately to stay informed on best practice from the Center for Disease Control (CDC). Led by Nancy Quelland, MS, BSN, BC, and Christy Zumwalt, RN, CIC, carefully structured, intensive training began to ensure that our staff were equipped and prepared to provide safe care for potential Ebola patients. Earlier this year, Medical City led a Division-wide initiative to applaud and recognize Texas Health Resources Presbyterian Dallas Hospital in Dallas for their work and their perseverance as pioneers in Ebola care.

Ebola Training Medical City leaders and staff presenting Appreciation Banner to Texas Health Resources in recognition of their fight against the deadly Ebola virus.

HCA North Texas Division (NTD) CNO’s receiving thank you gift from Texas Health Resources (THR). The painting was completed by THR nurses.


Structural Empowerment

“Magnet structural environments are generally flat, flexible, and

decentralized. Nurses throughout the organization are involved in shared-

governance and decision-making structures and processes that establish

standards of practice and address opportunities for improvement.”

~ 2014 Magnet® Application Manual

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“Magnet® organizations will serve as the fount of knowledge and expertise for the delivery of nursing care globally. They will be solidly grounded in core Magnet principles, flexible, and constantly striving for discovery and innovation. They will lead the

reformation of health care; the discipline of nursing; and the care of the patient, family and community.”

~The Commission on Magnet Recognition, 2008

What does it really mean to be a nurse in a Magnet-recognized facility? It means the ability to provide compassionate, high-quality care in an environment that supports evidence-based best practices and collegial relationships with nurses that have the highest commitment to their chosen profession. It means the opportunity to advance your education and career with the financial support of your employer, as well as the opportunity to provide a voice in your practice setting. As nurses in a three-time Magnet-designated organization, it’s often easy to forget the

benefits of that world-class designation. However, we must never forget that we are a part of a very elite group – only 7% of hospitals in the United States have been awarded this honor, the most prestigious distinction an organization in healthcare can receive for nursing excellence and quality outcomes.

As we move toward the application for our fourth designation in 2016, we must not rest on our laurels. Instead we must all continue to achieve excellence in nurse-sensitive indicators and other quality metrics. We must continue to provide person-centered care and elevate our patient’s experience. And we must all continue to learn, grow and advance in our profession.

I am proud to be a nurse in a hospital with such a long history of excellence in nursing. Medical City was the first hospital in Dallas to achieve Magnet® designation and we will be the first to achieve a fourth designation. Now that is truly a source of great pride.

Sincerely,

Rose Johnson, MS, BSN, RN NE-BCMagnet Program Director

Magnet



CVICU Receives Esteemed Beacon Award for Excellence

Caregivers in the CVICU at Medical City Dallas Hospital recently received the Silver Beacon Award for Excellence. Units that receive the Beacon Award for Excellence meet criteria in six categories: leadership structures and systems; appropriate staffing and staff engagement; effective communication, knowledge management, learning and development; evidence-based practice and processes; and outcome measurement.1 The criteria are consistent with Magnet® Recognition, The Malcolm Baldrige National Quality Award and the National Quality Healthcare Award. Recognition for the esteemed award will be announced in the AACN Bold Voices, the monthly award-winning member magazine distributed to more than 100,000 acute and critical care nurses nationwide, as well as at the National Teaching Institute & Critical Care Exposition, the world’s largest educational conference and trade show for nurses who care for acutely and critically ill patients and their families.

While the entire staff of the CVICU deserves praise for achieving the significant milestones required to be considered for the award, Megan Brunson, MSN, RN, CNL, CCRN-CSC Interim Manager of the CVICU, and Chelsea Zepeda, BSN, RN, CCRN-CSC, Supervisor of the CVICU were the principal authors responsible for the application submission. Megan explains that the impetus for beginning the journey came from Employee Engagement feedback where CVICU staff expressed a desire to have their own identity and meaningful recognition for how they contribute to the success of the organization. The outcome-driven Beacon Award For Excellence was the perfect avenue for the CVICU to showcase their commitment to exceptional patient care and achieving a healthy work environment. Congratulations team!

1Retrieved from http://www.acn.org/beacon-program-overview

First row: Jessica Reeves, BSN, RN, CCRN-CSC, Priya Srinivas, BSN, RN, CCRN, Jessica Thompson, BSN, RN, Cindi Stock, MSN, RN, CCRN, Val Sanders, BSN, RN, CCRNSecond Row: Amanda Billings, BSN, RN, Eric Willborn, BSN, RN, CCRN, Josh Boswell, BSN, RN, Colleen Pierce, BSN, RN, CCRN

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Megan Brunson, MSN, RN, CNL, CCRN-CSC and Chelsea Zepeda, BSN, RN, CCRN-CSC

AACN confers Beacon Award for Excellence – Page 1 of 2

American Association of Critical-‐Care Nurses recognizes the Cardiovascular Intensive Care Unit at Medical City Dallas Hospital with silver Beacon

Award for Excellence

National three-‐year award with gold, silver, bronze designations marks a significant milestone on the path to exceptional patient care and achieving a healthy work

environment

Dallas, TX. – September 16, 2015 – The American Association of Critical-‐Care Nurses (AACN), Aliso Viejo, Calif., recently conferred a silver-‐level Beacon Award for Excellence on the CVICU at Medical City Dallas Hospitals, Dallas, TX.

The Beacon Award for Excellence — a significant milestone on the path to exceptional patient care and healthy work environments — recognizes unit caregivers who successfully improve patient outcomes and align practices with AACN’s six Healthy Work Environment Standards. Units that achieve this three-‐year, three-‐level award with a gold, silver or bronze designation meet national criteria consistent with Magnet Recognition, the Malcolm Baldrige National Quality Award and the National Quality Healthcare Award.

AACN President Teri Lynn Kiss, RN, MS, MSSW, CNML, CMSRN, applauds the commitment of the caregivers at the CVICU at Medical City for working together to meet and exceed the high standards set forth by the Beacon Award for Excellence. These dedicated healthcare professionals join other members of the exceptional community of nurses who set the standard for optimal patient care.

“The Beacon Award for Excellence recognizes caregivers in stellar units whose consistent and systematic approach to evidence-‐based care optimizes patient outcomes. Units that receive this national recognition serve as role models to others on their journey to excellent patient and family care,” she explains.

Beacon Award Press Release



Career Enhancement ModelThe Career Enhancement Model (CEM) program is designed to create an environment where the art and science of professional clinical practice can flourish and Nursing and Allied Health Professionals are valued and respected. In 2015, 535 nurses participated in the program and were paid out $487,750 in rewards. The CEM program rewards RNs for advanced education, specialty certification, continuing education, EBP and nursing research activities, teaching, coaching, mentoring, professional organization participation, committee participation and individual or team projects. The program is available to a cadre of disciplines at Medical City and participation has increased significantly each year.

The graphs below represent total participation for all disciplines and total dollars rewarded.

Career Enhancement Participation

683

806 859

0

200

400

600

800

1,000

2013 2014 2015

Career Enhancement Dollars Awarded

$581,000

$637,000

$692,000

$500,000

$550,000

$600,000

$650,000

$700,000

$750,000

2013 2014 2015

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Voice of the Nursing Staff: NDNQI Practice Environment SurveyMedical City nursing staff participates in an annual survey conducted by the National Database of Nursing Quality Indicators (NDNQI®) RN Practice Environment Survey. The survey provides data pertaining to the organizational characteristics of the practice environment that facilitate or constrain professional nursing practice. The subscales include: Nurse Participation in Hospital Affairs; Nursing Foundations for Quality of Care; Nurse Manager Ability, Leadership and Support of Nurses; Staffing and Resource Adequacy; and Collegial Nurse-Physician Relations. The graph below represents PES results for 2012, 2013 and 2014 in which Medical City nursing staff described a practice environment that outperforms the national mean in all sub-scales.

NDNQI PES Results

2.92

3.20

3.07

2.82

3.21

3.04 2.97

3.21 3.14

2.86

3.22

3.08

2.97

3.19 3.16

2.78

3.21

3.06

2.40

2.60

2.80

3.00

3.20

3.40

Governance Quality Leadership Staffing/ Resources

RN-‐MD Collegiality

Mean PES Score

Nat'l Mean '12

MCDH 2012

Nat'l Mean '13

MCDH 2013

Nat'l Mean '14

MCDH 2014


DFW Great 100 Nurses


The mission of the DFW Great 100 Nurses is to recognize nurses for excellence in the art and science of nursing. The event honors one hundred RNs who were nominated by their peers and selected for being role models, leaders, community servants, compassionate caregivers and significant contributors to the nursing profession.

This year 8 nurses from the Medical City family were chosen for this esteemed award. Below are excerpts from their nomination letters:

Tammy Luther MSN, RN, CNLDirector, Advanced ClinicalsWhen our organization identified the need for a clinically competent effective leader with an interest in informatics to lead the hospital’s electronic medical record order entry implementation, this nominee was the perfect choice. Her proven ability to manage change and to measure its outcome through her background as a Clinical Nurse Leader helped in the selection decision. But it was her resilience and perseverance in the face of the myriad reactions to change that proved her true leadership merits throughout this demanding assignment. She proved over and over again, that she was up for the challenge and is now making a difference daily in refining the system and helping clinicians and physicians to leverage its functionality.

Jim Allard MSN, RN, NEA-BCDirector, Pediatric ServicesThis nominee would be described as an authentic, analytical, and transparent leader that empowers his team in a collaborative spirit. He is always approachable, accountable, and supportive. He takes the time to sit down and listen, provides feedback, and encourages us to work hard to achieve our own personal and professional goals. This nominee is always willing to help, will be at the bedside at a moment’s notice to support the units as a clinical expert, is present, and leads with confidence. He champions the shared governance model, and effectively delegates in a way that empowers others. This nominee never misses an opportunity to recognize others and humbly accepts praise.

Amber Alipour ADN, RNStaff Nurse, Congenital Heart Surgery UnitOne of the most significant contributions this nurse has made to our patients is related to the bereavement process. She has been innovative and compassionate by creating a process to make positive memories for our families. She has coordinated professional photographers to donate their time and resources to photograph our critically ill infants. When the family has never taken their baby home and he/she dies, having these lasting memories is priceless. She has built a guidebook for all staff to understand the bereavement process and provides training sessions to the team.

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Michelle McNinch MSHAI, BSN, RNC-OBManager, Labor and Delivery and AntepartumMy nominee’s influence has often gone beyond the borders of our nation. She is an active missionary, having traveled to Kenya, Costa Rica and Riga, Latvia on several medical mission trips. She was active and involved in the development and opening of a medical clinic to a severely under-served area in Kenya. Her eyes genuinely shine when she speaks about her time on the mission fields. It is obvious this nurse finds immeasurable joy in helping the less fortunate and she often speaks about the fact that she receives so much more than she gives during her mission trips.

Trayce Rhoads MSN/Ed, RNManager, MICU and NVICUIn addition to participating in all organizational sponsored community partner events (which have included supporting the local food bank, women’s shelter, and creation of a clinic to serve indigent patients) this nominee regularly volunteers at a homeless shelter in Collin county, specifically helping adults study for and successfully obtain their GEDs. This nominee is quick to offer aid to communities in need, traveling to communities ravaged by hurricanes to triage patients, provide direct ICU care, and relief nursing support.

Jeff Riley BSN, RNC-NICStaff Nurse, Neonatal Intensive Care UnitMy nominee truly exemplifies what being a nurse is all about. The day before discharge, I was becoming tearful at the thought of losing his support every day. He was our nurse on the last night. I was rooming in with my son…so I wouldn’t see this nurse as much throughout the night. The next morning he came in to say goodbye. I was very tearful. He picked up my son and I took the sweetest picture of him holding my son. That picture will be framed in my son’s nursery and this nurse will be a part of my son’s life forever. I will always tell my son about this nurse who saved our lives. I really think he loved my son.

Jeanne Vogel, RNManager, Day Surgery, Pre-Admission, HoldingHer work with our future nurses is lasting and commendable. This nurse sets high standards and expectations for her mentees. She instills in students many tips on how to always be searching for more information – you cannot learn too much. She arranged for one student to be in attendance in a laparoscopic adrenalectomy procedure on a 55 year old man, who they met beforehand. This nurse comforted the man when she sat down next to him and asked about his life, his kids and grandchildren. Soon after, the patient was taken to surgery and was less anxious and more comforted. The student never forgot what this nurse taught her about being present and compassionate.



Angela Vulich MSN/Ed, RN, CCRNStaff Nurse, Pediatric Intensive Care UnitRecently the PICU had a baby who desperately needed a trach. My nominee excelled in compassionate care. She worked with the mother of the patient who refused a trach for her baby. They spent many shifts talking about the benefits and she determined the mother was a person who liked “facts” from the internet. She challenged the mother to search the internet one night for information that supported her point of view that the baby should not be trached, and she was going to go home and find sites that supported why her baby should have a trach. By morning the mother stated all that she read had so many reasons why her baby would benefit from a trach. The day her baby had surgery for the trach they shared inspirational music together and prayed before sending the baby to surgery.

™

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Standards of Nursing Practice Council (SONPC)

2015 SONPC Members

Shared governance is a hallmark of a Magnet® organization and MCDH/MCCH has a rich history of providing structures and processes that allow and enable nurses to participate in organization decision-making through our Standards of Nursing Practice Council (SONPC) and Unit Practice Councils (UPC). Under the leadership of Chairperson Amelia Neal, BSN, CCRN, the council focused much of their efforts on providing structured support for interns and new nurses by collaborating with the Staffing Committee to make substantial changes to policies regarding floating and patient assignments. They also developed a process to invite an intern to each meeting in an effort to introduce the interns to the shared governance process and recognize them for their hard work. In addition, the council focused on strengthening the UPC’s throughout the organization by providing them with framework, guidance and an opportunity at each meeting to share best practices. One of the highlights of the year for committee members was their attendance at the 9th Annual North Texas Division (NTD) Research/Evidence Based Practice (EBP) Day. Many members were motivated by the incredible work and vowed to begin their own EBP projects. In an effort to ensure organizational alignment and the

continued evolvement of the committee, sub-committees were redesigned into the following three categories:

• Employee Engagement• Nursing Quality• Patient Experience



Shared Governance Reigns in the NICUThe NICU Unit Practice Council (UPC) serves as an exemplar of effective shared leadership and participative decision making that has led to significant improvements in patient care and staff engagement. One of the keys to their success may lie in the council’s clearly stated goal: “To promote structural empowerment and employee voice that will facilitate high quality evidence-based patient care and improved patient outcomes.” The council is skillfully led by Michelle White, RNC-NIC and has been responsible for leading many successful initiatives over the past year. Council membership is limited to established eligibility requirements and includes several disciplines such as Registered Nurses, Respiratory Therapists, dieticians, and ancillary. The breadth and depth of disciplines allows the council to truly consider all aspects of patient care when developing plans for change. UPC members are also active in at least one of the many sub-committees in the NICU which include Bereavement, Community & Spirit, Clinical Excellence (EBP), Staff Education, and Scheduling. Sub-committee members are required to report at each UPC meeting to maintain open lines of communication and alignment of objectives. A leadership liaison (supervisor or manager) is required to attend, however they are not voting members.

Below are just a few of the many successful initiatives developed and led by staff members of the NICU UPC:• Development and implementation of Staff Suggestion box• Employee Engagement “Action Taken” board• Cue-Based Feeding program• Physician Corner and Physician Birthday Recognition• “ALWAYS” Nurse Board

The NICU is led by managers Kimberly Carter, BSN, RNC-NIC and Julie Henry, BSN, RNC-NIC. Both leaders have truly embraced the concept of shared leadership and actively and effectively support staff in decision-making processes to support organizational goals. Even in the midst of exponential growth and staffing challenges, the NICU UPC has been influential in creating a cohesive culture and engaged staff resulting in significant improvements in Employee Engagement Scores and NDNQI Practice Environment Scale (PES) scores.

NICU UPC left to right:Rachel Fritzler, Heather Briggs, RNC-NIC, Carlyn Lynch, BSN, RN, Amber Smith, RNC-NIC, Caitlin Schumann, BSN, RN, Holly O-Quinn, BSN, RNC-NIC, Elaine Buchannan, BSN, RN, Michelle White, RNC-NIC, Linda Gano, RRT

18 2015 Nursing Annual Report

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Advanced Practice CouncilAdvanced Practice Professionals (APP) are invaluable members of the healthcare team at MCDH/MCCH and in accordance with the Magnet® principle of shared governance an Advanced Practice Council was established in 2007. Currently under the leadership of Jennifer Kurre Weber, MSN, RN, FNO-BC, ACNP-BC, the council meets every other month to discuss opportunities and legislative updates significant to advanced practice, and ways to elevate the practice of bedside nursing through education and support. This year with the assistance of Cheryl Thaxton, MN, RN, CPNP, FNP-BC, CHPPN the council developed its first newsletter. The goal of the newsletter is to keep members better informed and to provide an opportunity for members to share pertinent articles/updates with the group. The plan is to publish four newsletters per year – winter, spring, summer and fall. Besides being an excellent forum for networking and receiving information, the council seeks to improve the practice setting by setting yearly goals. The 2015 goals for the council are:• Develop a formal orientation process for APP new hires• Place a summary of roles and responsibilities on SharePoint as a resource for the organization• Develop a collaborative research project• Sponsor a mix and mingle social to provide support to all APPs, employed and affiliated• Expanded council to include Physicians Assistants

Advanced Practice Council Newsletter

Fall 2015

Announcements/Conferences

Texas Nurse Practitioners is having an annual CE conference September 24-27 at the Sheraton Hotel in Dallas. Visit the website: www.texasnp.org

Association of Pediatric Hematology/Oncology Nurses 39th Annual Conference & Exhibit - September 17-19 at the Rhode Island Convention Center, Providence RI. Visit the website: http://www.aphon.org/conference/files/full_brochure.pdf

Please let us know if you are presenting a poster or speaking at a conference, we’d love to spread the word.

Jennifer Kurre Weber, RN, MSN, FNP-BC, ACNP-BC

Welcome to the Medical City Dallas Advanced Practice Provider Council! We encourage all advanced practice providers with hospital privileges to join our group. The purpose of the group is to discuss any concerns that advanced practice providers may voice, we set yearly goals for the group and it provides a great opportunity for networking. Our goal for starting a newsletter is to keep members better informed and to provide an opportunity for members to share pertinent articles/updates with the group. We also hope to include bios on members so that we can become more familiarized with one another and our varying roles in the organization. Please email me anytime at [email protected] if you have contact information for new or potential members, to make newsletter submissions, or for any suggestions to make our group stronger.

Sincerely,

Jennifer Kurre Weber

Committee Updates

Pain Committee, contact: Eric Buchl, PA-C

CHF Committee, contact: Michael Limerick, APN

Save the date! Next meeting APC meeting:

Thursday 9/17/15 @ 1500 in classroom E-1

Sarah Green, Advanced Clinical Program Manager will be giving an update on CPOE and the new ICD-10

With the new day comes new strength and new thoughts. Eleanor Roosevelt

Welcome New APC Members

Hailey Hosak, PA (General Surgery)

Ashton Lafferty, PA-C (Ortho Surgery) Selina Martin, PA-C (Ortho Surgery) Patrick Smalley, PA-C (Emergency

Medicine) Cheryl Thaxton, CPNP, FNP (Palliative

Care) Theodore Theologes, PA-C (Emergency

Medicine)

Medical City Dallas/Medical City Children’s

Advanced Practice Council Newsletter



Patient Throughput Initiative – It Takes a CityA few of the strategies that have been implemented throughout the facility in an effort to improve patient throughput are listed below:

The incremental improvements noted below have been accomplished by a vast array of strategies throughout the facility:• Hourly alerts are sent to leadership when patients have been waiting for more than an hour for an available bed. This helps prompt

our inpatient unit leaders to reach out for an arrival time of their patient from the ED, or communicate to the ED and their patient the readiness steps in motion to receive them.

• Leaders from every unit meet daily at 9 a.m. to discuss options and create a plan to ensure we find a bed for every patient to reduce wait time.

• Nurses collaborate with physicians and the care team to anticipate next day discharges in order to prepare the patients and families for discharge prior to 11 a.m. Once our patients are medically ready to go home, physicians place discharge orders in the electronic medical record with the goal of having the discharge complete within two hours.

• The discharge center is open to receive discharged patients waiting for family. As soon as the patient has left their room, many of our nursing units have reduced the time by 50% to complete our system discharge thus triggering our EVS team to turn the room around for our next patient.

Moving our patients safely and efficiently through our healthcare system is not an easy task. However, Medical City nurses and staff don’t shy away from a challenge. They attack it with ingenuity, innovation and of course, a little fun. It really does take a city…

Patient Hold Hours in ED

3517 3696 4089

3542 3313

2340

0

1000

2000

3000

4000

5000

MCDH 5/31

MCDH 6/30

MCDH 7/31

MCDH 8/31

MCDH 9/30

MCDH 10/31

Discharge Before 11am

9% 12% 13% 13% 13%

11%

5% 7% 9%

11% 13% 15% 17% 19%

MCDH 5/31

MCDH 6/30

MCDH 7/31

MCDH 8/31

MCDH 9/30

MCDH 10/31

21


Discharge to HOME

136

129 127 128 129 126

120

125

130

135

140

MCDH 5/31

MCDH 6/30

MCDH 7/31

MCDH 8/31

MCDH 9/30

MCDH 10/31

[goal = 120 mins]

Discharge ENTERED in Meditech

31

23 16 17 17 17

0

10

20

30

40

MCDH 5/31

MCDH 6/30

MCDH 7/31

MCDH 8/31

MCDH 9/30

MCDH 10/31

[goal = 10 mins]

A few creative examples from the CNE’s Throughput Picture Contest



Collaborative Education: CAUTI CrusadeEarly in 2015, nursing leaders recognized a trend of increasing Catheter-associated Urinary Tract Infection (CAUTI) rates and immediately developed a plan to take action. The CAUTI committee was tasked to address this upward trend. The committee was comprised of frontline nurses, a nurse from Infection Prevention and Control and two physician champions. Cathy McLaughlin, MSN,BSHM,RN,OCN, Assistant Chief Nursing Officer served as the Executive Chair of the committee.

The first order of business was a 90-day action plan to address the rising CAUTI rates, “The CAUTI Crusade.” Action item #1 addressed the need to improve appropriate insertion documentation processes. Trayce Rhoads, MSN/Ed, RN, Manager, MICU and NVICU, and co-chairs Lacresha Pree, RN, Supervisor SICU, and Julie Samuel, MBA, RN, Manager 7S Diabetic/Endocrine, in tandem with Sarah Green, BSN, RN, interim Director of Advanced Clinicals, electronic documentation processes were streamlined so that Foley necessity could be easily assessed by the registered nurse and necessary documentation populated into Meditech. The next initiative was focused on decreasing foley days and developing a robust CAUTI Elimination Audit Tool including a process for accountability. This massive endeavor could only be accomplished through interprofessional collaboration.

The last and most complex aspect of the action plan was a mandatory skills lab for clinical staff. Since Central Line Associated Bloodstream Infection (CLABSI) is a nurse-sensitive clinical indicator, the decision was made to incorporate central line dressing changes into the mandatory skills labs. A comprehensive education plan was developed based on committee input by Nancy Quelland, MS, BSN, BC Manager, Organizational Development and her talented team of Nurse Educators. The plan was presented and accepted by the CLABSI/CAUTI Collaborative and included:• Development of skill validation forms that included:

» Critical elements for both skills » CAUTI – alternatives to catheter, insertion (male/female), care of, troubleshooting, collecting sample from catheter,

documentation, education » CLABSI – central line entries, dressing/cap/tubing change, blood draws, blood cultures, documentation

• Skills stations – as indicated by role and assigned unit• Skill validation for CLABSI/CAUTI for RNs added to Nursing Orientation. • Education for radiology transport team on correct management of catheters during transport• Required attendance for all RNs who care for patients with or have the potential for Foley catheters and/or central lines. This

included the procedural areas and transport teams. • Required attendance for all PCAs/MSTs/EMTs who care for patients with, our have the potential for, a Foley catheter for pericare

skill validation.

Fourteen skill validation sessions were held April - June 2015. To facilitate the clinical educators with the validations, staff nurses were recruited, trained and validated. To date, over 1,000 RNs and over 100 PCAs/MSTs/EMTs have been validated.

23


The Future of Nursing is Here: Implementing a Nurse Residency ProgramIn the 2011 Institute of Medicine (IOM) landmark report on the future of nursing, the recommendation for healthcare organizations was to support nursing transition to practice through nurse residency programs.1 Medical City leaders immediately recognized the merit of such a program and under the leadership of Nancy Quelland, MS, RN, BC, Manager Organizational Development, the first nurse residency program began in July 2014.

An internship provides the didactic preparation for a specific clinical area. A nurse residency program assists in the transition from academia to the hospital and individual clinical practice. Medical Center Lewisville developed a pilot program based on recommendations from Nurse Residency Builder: Tools for a Successful New Graduate Program. 2 Utilizing lessons learned from the pilot, our first residency was comprised of six RNs from Med-Surg and Oncology units. Since that time, three additional groups have begun for a total of 134 nurses in the first year of the program.

Residents meet monthly for ten months, beginning at approximately week ten. The meetings are comprised of topics to help the transition into the profession such as Compassion Fatigue and Professional Development. In addition, there are ice-breakers, debriefing, mentor selection and identification of a Process Improvement project. A graduation is held the month of their one year anniversary in which they celebrate their first year and present their projects, which includes attendance by their leaders and the CNE.

Feedback is solicited from each group and used to develop content for future programs. Comments have included “This has been more than beneficial” and “I will recommend this program because I think it helps a lot to improve your skills and confidence.” Carolyn Schaefer, BSN, RN, CMSRN, Residency Coordinator states one of the biggest benefits is the camaraderie and the common bond that occurs with those beginning their professional career together.

From left to right: Rebecca Shooter, BSN, RN; Cynthia Kemboi, BSN, RN; Sara Lovejoy, BSN, RN; Libbie Schmidt, BSN, OCN, Clinical Education Specialist; Carolyn Schaefer, BSN, CMSRN, Clinical Education Specialist; Misty Kazyaka, BSN, RN; Samantha Bigham, BSN, RN; Molly Bishop, BSN, RN

1Robert Wood Johnson Foundation (2011) IOM Recommendations. Retrieved from http://www.thefutureofnursing.org/recommendations,

2Hanson, J. (2011). Nurse Residency Program Builder: Tools for a Successful New Graduate Program. HC Pro, Inc.



Texas Two Step ProgramThe “Grow Your Own Program” was a very successful nursing pipeline for the North Texas Division (NTD) for many years. However, the program did not fully align with the Institute of Medicine’s (IOM) recommendation outlined in the Future of Nursing Report, which called for 80% of nurses holding a BSN by 2020. In March of 2013, the CNOs from across the North Texas Division (NTD) made a formal recommendation to modify the program to align with the IOM recommendations by the program’s next start date in August 2013. Accordingly, in August 2013, the “Grow Your Own Program” became the “Texas Two-Step Program” in which non-nurses would attain an Associate Degree in Nursing with the formal expectation that the employee continue his or her education and complete the second step, a baccalaureate degree in nursing.

El Centro College, in cooperation with HCA, offers the first step of the Two Step Program to obtain an Associate Degree in nursing via a distance learning opportunity. Acceptance into the El Centro College Associate Degree Nursing program at HCA is determined utilizing a competitive ranking process for selection based on a points-award system for designated criteria and meeting specific eligibility guidelines determined by HCA.

The purpose of the program is to provide an educational pathway for HCA non-nurse employees to become nurses and to retain them as HCA employees. The nursing shortage along with a hyper-dynamic market and the large number of hospitals and employment choices in the DFW area creates a higher than desired turnover and vacancy rate in the HCA Division. This leads to the use of premium labor with associated higher costs. The initial goal was to decrease premium labor costs by “Growing our Own” nurses. When the program was adopted across the entire HCA NTD, three goals emerged:

• Increase available pool of RNs including those who are culturally diverse• Promote an ongoing pipeline of employees• Reduce costs associated with recruitment, turnover, and vacancies in hard-to-fill positions

The HCA NTD Nursing program has changed many lives. The program has created first generation college graduates who without this opportunity would have never been able to attend nursing school. It has given several employees a better quality of life with their families as they are no longer struggling financially or living paycheck to paycheck. Without the support of the hospital, this opportunity would not have existed for these fortunate employees.

Since its inception, 171 employees of HCA NTD facilities have graduated from this program and have become nurses. The first time pass rate on National Council Licensure Examination (NCLEX) for students has risen from 74% in 2011 to 96% in 2013 as the program has made adjustments to the curriculum to support the changes made to the NCLEX exam. The overall one-year retention rate for the program’s graduates is 84%. Many of the graduates have either obtained their BSN, or are working on pre-requisites to enroll in an ADN to BSN program of study. In 2012, the contract was amended to state all incoming students must enroll in an RN to BSN program of study within a year of graduating.

There are three cohorts in the Texas Two Step Program and each cohort has a designated site coordinator. The Site Coordinator at Medical City Dallas is Debra Mezo, MSN, RNC-OB. Part of her role is assuring eligible employees are aware of the program and support the students during their Nursing school journey. Currently there are 2 students in second semester, 8 students in the third semester, and 5 students are currently completing their precepted clinical assignments in the following units: Emergency Room, Pediatric unit, Surgical Orthopedic unit, and Surgical services.

25

Exemplary Professional Practice

“Exemplary professional practice in Magnet-recognized organizations

is evidenced by effective and efficient care services, interprofessional

collaboration, and high-quality patient outcomes.”

~2014 Magnet® Application Manual



Our Professional Practice Model

Human Caring ModelCompassion: The Pathway for Human Connection

Person Centered Care » Listens with authentic presence to learn patient’s story » Reviews plan of care/orders with patient and family » Involves patient & family in setting goals and planning

care; gives choices » Creates a healing environment

Servant Leadership » Demonstrates unconditional devotion to lifting others up » Gives priority attention to needs of patients and to needs

of colleagues » Goes the extra mile; influences others to do the same » Commits to self-care and to lifelong learning

➢ Patient Advocacy

» Combines the science and art of nursing to overcome hurdles for patients

» Empowers patients for optimal health » Provides accurate information and timely response » Rounds hourly for patient safety

Communication » Intentionally uses positive, therapeutic non-verbal cues » Personalizes information exchange » Uses key words at key times to instill confidence and

reduce anxiety » Informs, clarifies, and validates for understanding » Narrates the story of care for the patient/family & team » Hands off care with meticulous attention to detail

Teamwork » Proactively moves toward a common goal » Sees the big picture and collaborates to effectively use

resources » Connects to others with compassion

Person-Centered Care

Teamwork

Compassion

Human Caring

Compassion

Compassion

CommunicationPatient Advocacy

Servant Leadership

27


Employee EngagementAnnually feedback is solicited anonymously from the staff and department leaders engage staff members to develop robust action plans based on the feedback. Progress on action items are communicated frequently utilizing tools such as the “Stoplight Report” and the “Patient Promise Proof of Performance Board.” Another key strategy for obtaining employee voice is through Employee Rounds. As a result MCDH/MCCH continues to enjoy a rich culture with engaged employees as evidenced by annual Employee Engagement Survey results below

Employee Engagement Participation

84% 86% 87% 82%

94% 96%

70%

75%

80%

85%

90%

95%

100%

2013 2014 2015

HCA Par5cipa5on

MCDH Par5cipa5on

Employee Engagement

Key Units of Improvement at

73% 85%

59%

81% 72% 79% 74% 71%

87% 84% 83% 80%

0%

20%

40%

60%

80%

100%

Apheresis Surgery/Bariatrics Cath Lab PCU

2013

2014

2015

Employee Engagement

66% 61%

70% 79% 82% 80%

57% 67% 67%

88% 88% 83%

77% 80%

93%

0%

20%

40%

60%

80%

100%

Labor & Delivery Pedi Medical NICU Post Partum Congen5al Heart ICU

2013

2014

2015

Key Units of Improvement at

Employee Engagement Results

72% 73% 74%

79% 79% 81%

66% 68% 70% 72% 74% 76% 78% 80% 82%

2013 2014 2015

HCA Overall Favorability

MCDH Overall Favorability



Employee engagement, a key driver of positive patient experiences and outcomes, has been the focal point of the Congenital Heart Program and the Congenital Heart Surgery Unit. Both teams celebrate diversity (multiple disciplines located within each department), a spirit of inclusiveness (patient and team centric), shared decision making (via unit and hospital based committees and task forces), and teamwork towards a common goal (excellence always in care delivery). Both teams and their outcomes are discussed separately below.

Congenital Heart ProgramThe Congenital Heart Program (CHP) is a diverse team consisting of pediatric perfusionists, echo techs, advanced practice nurses, an ECMO Coordinator, and congenital heart surgeons. Each team member is tasked with participation in hospital based committees and task forces of their own choosing and supported by their department leader Kathy Drescher, DNP, APRN, CNS-CC, CPNP, CNML, Director, Pediatric Congenital Heart Program. At monthly team meetings employees report out on their respective committee involvement. In addition, team celebrations are held to recognize employees for both individual and team accomplishments which have included publishing articles in professional journals, DFW Great 100 nurse recognition, D Magazine Excellence in Nursing award winner, election as a National Perfusion Board member, selection as an ECHO fellow in the American Society of Echocardiography, National Physician Hero in a White Coat award recipient, and ECMO Center of Excellence Designation.

The ultimate connection to the above with the patient experience is the stories that each team member must share regarding how they contributed to the patient experience connecting the professional practice model for nursing (which has been embraced by all disciplines) – The Human Caring Model, and the hospital’s Patient Promise initiative. Identifying and celebrating successes promotes replication, instills confidence, and creates a connectedness between the employee, patient, and organization. It is this connectedness that has driven sustained employee engagement and 100% retention year after year (Figure 1).

Employee Engagement: Alignment with Outcomes

Congenital Heart Program and Congenital Heart Surgical Unit Teams

29


Congenital Heart Surgery UnitThe congenital heart surgery unit (CHSU) touts similar diversity with a cadre of disciplines (nursing, medicine, pharmacy, respiratory therapy, social work, child life, and skilled support team members) joined in caring for a highly specialized patient population. Led by Janie Garza, BSN, CCRN, Director, Pediatric Cardiac Services also celebrates a high level of sustained employee engagement among all provider groups (Figure 1). As the CHP has grown, the CHSU has been challenged with onboarding new team members, retaining the vulnerable group of first year registered nurses, and sustaining the engagement year over year among all team members. Initiatives to promote engagement, inclusiveness, and recognition of the unique contribution of each team member include daily team rounds led by frontline staff presenting to the team about their respective patients, family presence during rounds and procedures, collaborate nurse physician research projects, unit-based councils, and team celebrations (such as greater than 650 CLABSI free days, greater than two years without a CAUTI or VAP and NRC Picker patient experience scores far exceeding national benchmarks [Figure 2]). Such initiatives have resulted in elevation of employee engagement scores, onboarding a large volume of nurses to accommodate program growth and RN turnover rates (both first year and beyond) well below the national average (Figures 3 & 4).

For the CHSU team, the ability to make a positive difference in the lives of their patients is what sustains their inclusive, team spirited, patient centric excellence always culture. Employee engagement is not optional, but rather part of the team’s DNA. It is also a learning culture, one which embraces innovation, encourages inquiry, and focuses on outcomes as demonstrated by high level of recruitment, low turnover, sustained employee engagement, and patient satisfaction results exceeding national benchmarks.

Figure 1. CHP and CHSU 3 - year employee engagement survey results with participation percentage.

CHP/CHSU Employee Engagement Results

CHP/CHSU Employee Engagement Results

83

88 93

100 100 100

0

20

40

60

80

100

120

2013 2014 2015

CHSU

CHSP



Figure 2. CHSU NRC Picker patient experience: overall rating of hospital comparison to national average.

Figure 4. Overall Turnover rate and 1st year RN Turnover rate in the CHSU.

Figure 3. CHSU RN hires to accommodate CHP program growth.

RN Hires to Accommodate Growth

29 36

43

58

8 7 15

0 10 20 30 40 50 60 70

2013 2014 2015 YTD

Total RN's RN's Hired Linear (Total RN's)

CHSU Turnover Rate

CHSU RN Turnover Rate

Magnet OrganizaGon CharacterisGcs Pediatrics

Turnover Rate (287 beds)

Magnet OrganizaGon CharacterisGcs Turnover Rate (501-‐600 beds)

2015 NaGonal Healthcare RetenGon

Report

2014 6.8% 9.21 10.06% 16.4% 2015 YTD 5.0%

1st Year RN Turnover Rate 2014 0 %

2015 YTD 0 %

31


Elevating the Patient ExperienceThe intent of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiative is to provide a standardized survey instrument and data collection methodology for measuring patients’ perspectives on hospital care. In 2015, MCDH/MCDH continued the commitment to improving the patient experience and perception through several evidence-based strategies such as: AIDET, hourly rounding, nurse leader rounding, bedside shift report, discharge phone calls, and No Pass Zone. The hard-wiring of these strategies has resulted in sustained, incremental improvements with the Q32015 data showing the highest Adult Inpatient Overall Rating in Medical City’s history! While the same strategies have been deployed for the pediatric population, we continue to struggle with an insufficient number of returns, and thus have not seen the same results as the sample size is not statistically significant.

Adult Inpatient HCAHPS Results

74%

72% 72.7%

73.4%

78.6%

68%

70%

72%

74%

76%

78%

80%

Overall Ra5ng

3rdQ 2014 4thQ 2014 1stQ 2015 2ndQ 2015 3rdQ 2015*

Pedi Inpatient Satisfaction Results

79.0%

74.6%

67.6%

78.1%

60.0% 62.0% 64.0% 66.0% 68.0% 70.0% 72.0% 74.0% 76.0% 78.0% 80.0%

Overall Ra5ng

4thQ 2014

1stQ 2015

2ndQ 2015

3rdQ 2015*



Adult Critical Care Units Winning the CLABSI Battle

NVICU Nurses from left to right: Jamie Stone, BSN, RN (floor), Angelica Robles, BSN, RN, Sophie Costilow, RN, Nfally Kora, BSN, RN, Jeanne Fortner, BSN, RN, CNRN, Kara Ragle, BSN, RN, Joyce Bernardo, BSN, RN

Jennifer Reeder, MBA/HCA, RN, NE-BCVice President, Clinical Excellence

Medical City Dallas has four adult critical care units – CVICU, MICU, NVICU, and SICU. Central line-associated bloodstream infections were a concern across all of the units. A monthly performance improvement committee of staff nurses and leaders from the care areas throughout the hospital met to review events, evaluates processes, and make improvements. In May 2013, the hospital converted to neutral-pressure hubs on all central lines to comply with evidence-based practice recommendations. In September of 2013, universal decolonization with CHG bathing and mupirocin nasal ointment was adopted by all adult critical care units after a study demonstrated decreased infection rates. Compliance climbed through 2014 with consistent bath compliance of greater than 90% after June. A trial with alcohol-impregnated caps began in April 2014. The committee collaborated with Organizational Development for a hospital-wide skills fair that included central-line care from April to June 2015. The skills fair was attended by 881 nurses. Central line-associated bloodstream infection rates began to decrease steadily. There were no central line-associated bloodstream infections in the adult ICUs at Medical City for 2Q15.

CLABSI Adult Critical Care (2012-2015)

0 0.2 0.4 0.6 0.8

1 1.2 1.4 1.6 1.8

2

1Q12 2Q12 3Q12 4Q12 1Q13 2Q13 3Q13 4Q13 1Q14 2Q14 3Q14 4Q14 1Q15 2Q15

Combined adult rate per 1000/ central line days * CVICU, MICU, NVICU, & SICU combined data.

33


Delivering High Quality Care for Children with Asthma at MCCHMedical City Children’s Hospital (MCCH) uses evidence-based interventions to improve outcomes in the pediatric population. MCCH has a total of 156 licensed pediatric beds divided among four units. The nursing staff, physicians and families partner together to deliver high quality care for children with asthma by emphasizing the importance of an effective home management care plan. MCCH has performed at 100% over the past four quarters in the “Home Management Plan” core measure. Lucy Clevenger, RN, Performance Improvement Coordinator, who spearheaded a comprehensive nursing and physician education program. The physicians and nurses work collaboratively, together with the PI coordinator to ensure the children with asthma are discharged home with a plan of care designed to keep the patient safe, and the parents are educated to care for their child with asthma. The nurses and physicians have since hardwired the process.

Each morning the Performance Improvement Coordinator reviews all four units for patients that have been admitted for respiratory problems. Pediatric patients admitted with a diagnosis of asthma and/or reactive airway disease are identified and placed on the asthma core measure. Once asthma/RAD patients are identified, the charge nurse on each unit reviews with the PI coordinator those patients currently on the asthma core measure. At the time of discharge, the physician completes the “Pediatric Asthma Home Management Plan” and discusses the plan with the parents. Nurses further review the home management plan with the parents at discharge and answer questions. Prior to discharging the patient, the nurse caring for the patient reviews the HMCP with another RN for completeness and accuracy.

Home Management Plan of Care

98.8

99

99.2

99.4

99.6

99.8

100

3Q2014 4Q2014 1Q2015 2Q2015

Perc

enta

ge

A team of Pediatric Nurses with the Quality Coordinator (white coat) following Children’s Asthma Core Measure Huddle From left to right: Rikki Gauna, RN; Ashley Heflin, BSN,RN; Sonjia Brazel, BSN, RN; Marcia Crise, RN; Lucy Clevenger, RN, PI Coordinator; Courtney Wiggins, BSN, RN; Hailee Scoggins, BSN, RN; Deanna Jones, RN.



New Knowledge, Innovations and Improvements

“Innovations in patient care, nursing and practice environment are the

hallmark of organizations receiving Magnet® recognition.”

~2014 Magnet® Application Manual

35


The Evolution and Advancement of Nursing ResearchNurses at MCDH/MCCH continue to pursue clinical excellence through the advancement of nursing science. The Nursing Research Committee, which is comprised of RNs from all levels of nursing practice, collaborated with their peers to conduct nursing research, share evidence through poster and podium presentations, and began focused work on manuscript writing.

Val Sanders, BSN, RN, CCRN, Supervisor CVICU and Amy Milliron, BSN,RN, 6N Pediatrics were selected to participate in the Texas Christian University (TCU) Evidence Based Practice Fellowship, a program aimed to increase the use of evidence to guide the delivery of healthcare. The hospital sponsored their tuition and supported their time to participate in this year-long program. Each fellow evaluated an evidence based practice in their respective clinical specialties and both presented posters at the North Texas Division (NTD) 9th Annual Research/Evidence Based Practice Day held on August 28, 2015. Over 150 registered nurses from NTD hospitals attended the program entitled: Nursing Research: Making a Difference at the Bedside. Guest speaker, Karen Speroni, PhD, RN presented the impact of nursing research in current clinical practice and defined the components of nursing research, evidence based practice and quality process improvement. The following represents MCDH/MCCH nurses that participated in local or national conferences with posters, podium presentations and publications.

POSTER PRESENTATIONS: • Kanlaya Ditthakasem, MNS, RN, CCRP, John Kolar, PhD. Static Foot Pressure Distribution in Apert Syndrome Patients. 9th Annual

NTD Research/Evidence Based Practice Day, August 2015.

• Kanlaya Ditthakasem, MNS, RN, CCRP. Apert Syndrome: A Review of the Nursing Research Literature. Poster presentation 9th Annual NTD Research/Evidence Based Practice Day, August 2015.

• Amy Milliron, BSN, RN, CPN. Replacement of Central Line Administration Sets in Pediatric Patients: A Review of Literature. 9th Annual NTD Research/Evidence Based Practice Day, August 2015.

• Rodney Moffet, BSN, RN, BMTCN, Mary Barnhouse, BSN, OCN, Keith Murray, RN, CCRN, Ashley Evenson, BSN, OCN, Caitly Donegan, PT, DPT. Falls Innovations: A Multimodal Initiative to Decrease Falls in the Blood and Marrow Transplant Setting. 9th Annual NTD Research/Evidence Based Practice Day, August 2015.

• Valria R. Sanders, BSN, RN, CCRN. The Evaluation of Communication as a Skill between Novice and Expert RN. 9th Annual NTD Research/Evidence Based Practice Day, August 2015.

PODIUM PRESENTATIONS: • Kanlaya Ditthakasem, MNS, RN, CCRP, John Kolar, PhD. Static Foot Pressure Distribution in Apert Syndrome Patients. Sigma

Theta Tau International Nursing Research Congress, San Juan, Puerto Rico, July 2015.

• Janie Garza, BSN, RN, CCRN, Kathy Drescher, DNP, APRN, CNS-CC, CPNP, CNML. Living the Dream: Beyond the Third Magnet® Designation. ANCC National Magnet® Conference, Atlanta, GA, October 2015.

• Zach Mueller, DNP, RN, NEA-BC. Innovating Leadership to Energize the Workforce & Achieve Results. ENA Emergency Nursing Conference, Orlando, FL, September 2015.

PUBLICATIONS:• Kimberly A. Schuettner, MS, BSN, RN, CCRN, Sharon L. Van Sell, EdD, RN, PAHM, and Susan Sheriff, PhD, RN. (2015). Nursing

Administration Degree as the Foundation of Practice for Future Nurse Managers. Nurse Leader. 86-97.



2015 MCDH/MCCH Nursing Research Projects

71%

18% 11%

45 total

Nursing Research Studies

EBP Projects

QI ac5vi5es

Kanlaya (Kay) Ditthakasem, MNS, RN, CCRP, Craniofacial Research Nurse, was competitively selected to give a podium presentation on her research study in collaboration with Dr. John C. Kolar at the prestigious Sigma Theta Tau International’s 26th International Nursing Research Congress in San Juan, Puerto Rico where more than 800 nurse researchers representing 36 countries were in attendance. The findings of this ground-breaking research indicate the importance for nurses caring for patients with Apert syndrome to be alert of the patient population’s high risk for falls. Additionally, Kanlaya was selected to give a podium presentation on her abstract “A Randomized Controlled Trial of Oral vs. I.V. Non-narcotic Protocols Post Craniosynostosis Repairs” at the 16th Congress of International Society of Craniofacial Surgery in September 2015 in Maihama, Japan. This study is in collaboration with our Craniofacial Surgeon, Dr. Jeffery A. Fearon.

Nurses at MCDH/MCCH embrace nursing research to innovate and continually improve patient care with the foundation of science to drive the future. The graph below represents the total nursing research/EBP/QI activities:

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Just Culture “The single greatest impediment to error prevention in the medical industry is that we punish people for making mistakes”- Dr. Lucian Leape, Professor, Harvard School of Public Health, Testimony before Congress on Health Care Quality Improvement

There is arguably no more complex business than that of healthcare. At bedside, healthcare providers must tend to the safety, dignity, privacy, comfort, and medical needs of their patient – all within an ever changing environment of care. In response to the 2014 Agency for Healthcare Research and Quality (AHRQ) Survey of Safety Culture, MCDH/MCCH created an AHRQ Safety Task Force. This task force, led by our Chief Nursing Executive comprised multidisciplinary leaders and staff throughout the organization.

To further improve patient safety and support our Patient Promise, MCDH/MCCH will strengthen our culture – not by demanding perfection, but instead by designing safer systems and being more critical of our everyday choices within those systems. As healthcare providers, we are entrusted with the care of a nation. It is our culture of safety that will influence how well we fulfill that trust. How will we do this? By creating a culture that is open and fair, reviewing and designing safe systems and developing a process to manage behavioral choices. The initial introduction to a Just Culture was provided to our Supervisor-level leaders and above in our quarterly Results Based Leadership Institute (RBLI). This training included an overview, how to look for risks in the systems in which we work, our behavioral choices, enhancing reporting through recognition of “close calls” and truly how to participate in a learning culture. Following this training, the AHRQ Task Force further developed training for the next RBLI to sharpen leader’s ability to complete and event investigation and support employees in a transparent learning culture. Additionally, frontline staff received information in support of this culture change from our Senior Leadership Team in quarterly Forums. To further develop our leaders we rolled out a six-hour online learning for Managers that will be followed with breakout sessions for event investigation at our next RBLI. To continue this journey, plans have been set to add an “all staff” orientation to Just Culture online, coupled with LIVE follow-up training sessions from their leaders. Our Just Culture journey supports the components of the Magnet Recognition Program®, will help improve care delivery systems for patients, and the work environment for staff.

As part of promoting our Just Culture from the top of the organization, CNE Zach Mueller talks about the non-punitive, yet accountable culture with every new nurse during the hospital’s nursing orientation. A commitment is made to ensure that every employee feels comfortable reporting safety events, both actual and near-misses. Furthermore, the continual learning culture that is present is also highlighted to underscore the importance of coaching, education, and professional development to support Medical City nurses in reaching their full potential and goals. All of which contributes to our goal of being “world class” (95th percentile performance in key goals), and more importantly, creates an environment where patient safety is paramount.



TeamSTEPPSSince 2010, the HCA Risk and Patient Safety department has supported the implementation of Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) through its Risk Reduction Program incentives. TeamSTEPPS is an evidence-based framework for optimizing team performance across a healthcare delivery system. Its focus is on key principles between team structure and four valuable skills: communication, leadership, situation monitoring and mutual support. The interaction between skills and outcomes is the basis for delivering safe care and supporting quality improvement.1

In January 2015, Medical City Labor and Delivery began the journey to utilize the TeamSTEPPS approach as a process improvement methodology for the management of Oxytocin infusions. The change team consisted of Michelle McNinch, MSHAI, BSN, RNC-OB, Interim Director of Women’s (Team Lead), Kim Nelson, BSN, RNC-OB, Interim Nurse Manager L&D, Sherri Harris, BSN, RNC-OB, Supervisor L&D and Kelli Culpepper, MD. The opportunity for improvement was defined as consistent utilization of the Oxytocin checklist and adhering to the Oxytocin guidelines by both nursing staff and OB physicians. In 2014, the Fetal Heart Monitoring (FHM) and Oxytocin Management Aggregate Scores were steadily improving however not meeting the HCA expectation of 95% consistently.

FHM and Oxytocin Management Aggregate Score

Q1 2014 Q2 2014 Q3 2014 Q4 2014

80% 85% 90% 95%

The aim of the TeamSTEPPS intervention was to establish consistency of nursing practice during Oxytocin infusions. Based on the audits and consistent with our Just Culture, persistent, non-compliance would result in progressive disciplinary action due to the potential severity of adverse outcomes with the misuse of Oxytocin. Furthermore, any deviation from the guideline required a physician order. After initiating the defined interventions, the Q1 2015 aggregate score for FHM & Oxytocin Management improved to 98%. The next step was to develop a plan for sustained improvement. At the end of Q2 2015, a variable was identified that negatively affected the process. The variable was an increase in the use of contract nurses. It was determined that while they were trained on the usage of the checklist and guidelines, the training was not in-depth enough to stress the importance of utilizing interventions based on the guidelines. As a result, the Q2 2015 aggregate score decreased to 93%. The TeamSTEPPS team altered the orientation plan for contract employees to include in-depth education and follow-up for utilizing the Oxytocin checklist and guidelines. Preliminary data for Q3 looks promising for improvement.

1 Laxton, B. (2015). TeamSTEPPS Implementation Supports Quality Improvement in HCA Facilities. Safety Matters. Retrieved from http://www.atlas2.medcity.net

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Inspirations

“…you decided that day to calm our fears with patience, to answer our questions

in detail, to stretch the rules but not break them, and to hold close to your heart a

stranger who means the world to us. Thank you for your dedication to a job that

I can only imagine brings joys and heartache in equal measures. You shared our

emotions at their most raw and held together a family. Nursing is not just a job.”

~ Medical City Children’s Hospital Patient


Inspirations

Life Saver LuncheonsOn Wednesday, February 11, 2015 at 4:44 p.m., Dallas Fire and Rescue 22 was dispatched on a call for breathing difficulty at a residence in North Dallas. They arrived to find a 60 year old male, Richard San Soucie, experiencing shortness of breath. Mr. San Sourcie had a recent history of surgery to repair two fractured legs. Paramedics, Ernest Koester and Yu-Hsuan Yang noted diminished breath sounds with oxygen saturations of 76 on room air. Saturations improved with the administration of oxygen, however, the patient was still experiencing symptoms of distress. The paramedics placed the patient on Continuous Positive Airway Pressure and began transport. Upon arrival to the Emergency Department, the patient arrested and cardiopulmonary resuscitation (CPR) was initiated.

Mahesh Thiagarajah, MD, ED physician diagnosed the patient as experiencing a pulmonary embolism and ordered tissue plasminogen activator (tPA), an FDA approved clot dissolver. A pulse returned with Advanced Cardiac Life Support (ACLS) medications within eight minutes of CPR being initiated. The patient was transferred to ICU where therapeutic hypothermia protocol was initiated. This therapy has been shown to improve mortality and neurological outcomes in patients who have survived cardiac arrest. Mr. San Soucie’s condition continued to improve over the next few weeks due to the life-saving efforts of the Dallas Fire Department paramedics, and the talented MCDH staff. He was discharged on March 3, 2015 and has since made a full recovery.

Life Saver Luncheon awardees and attendees: February 11, 2015

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Inspirations

Life Saver LuncheonsAndrew Allen was born on October 28, 2014 at Presbyterian Hospital of Rockwall in respiratory distress and was diagnosed with Congenital Diaphragmatic Hernia, a malformation of the diaphragm allowing abdominal organs to push into the chest cavity. The decision was made to transfer Andrew to a facility that could provide a higher level of care shortly after his birth and he was transferred to Presbyterian Hospital of Dallas. Initially his condition stabilized after transfer, but during the night and into the next day, his condition worsened and the decision was made to transfer to MCCH for an Extracorporeal Membrane Oxygenation (ECMO) evaluation. ECMO is a technique of providing cardiac and respiratory support for patients whose heart and lungs are unable to provide an adequate amount of gas exchange to sustain life. Andrew was stable in the PICU for 13 days without ECMO, but complications arose and on November 11th, he was placed on the life-saving support until he was stable enough for reparative surgery.

The surgical repair went well and Andrew was transferred to the NICU on December 3, 2014 for ventilator management, feeding issues and developmental evaluations. During his stay in the NICU, he continued to encounter feeding problems and had to go back to surgery for a g-tube placement. After all of the medical treatments, Andrew was finally well enough to go home on January 15, 2015. His very special life was truly saved by a team of professionals including the Pediatrix Medical Group, Pediatric Acute Care Associates of North Texas (PACANT), Pediatric Surgeons Dr. Lanoue and Dr. Kadesky, Anesthesia Resources for Children (ARCh), MCCH ECMO team, Pediatric Perfusionists, the nurses and respiratory therapists from the PICU, CHSU, and all of the support staff that cared for him during his stay at Medical City Children’s Hospital.

Life Saver Luncheon Awardees and Attendees: May 7, 2015


#showmeyourstethoscope

Inspirations

#showmeyourstethoscopeKelley Johnson, Registered Nurse and Miss Colorado, talked about her career in helping Alzheimer’s patients in 2015’s Miss American contest in the talent portion of the competition. The hosts of the daytime television talk show, The View, questioned why she was wearing scrubs and asked the now infamous question, “Why does she have a doctor’s stethoscope?” Taking a professional stand and forming a nationally united front, nurses “joined hands” across social media in a campaign that soon became known as “Show Me Your Stethoscope”. To join the national effort, Nursing Leaders at Medical City and Medical City Children’s Hospital scheduled a photo-op with stethoscopes intact. Nursing Leaders at MCDH/MCCH…representing!

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#showmeyourstethoscope

Caring for Our Community

“To be completely honest everyone there was fantastic, every nurse, transporter, radiology, ER staff, everyone we came in contact with was friendly and courteous and always greeted us with a smile. The phenomenal care we continue to receive is the reason I always bring my kids to Medical City for any emergent care they may need. You guys have never let me down and I really appreciate everything you have done for my family over the years. Thank you so much for all of your help and your time.”

~ Medical City Children’s Hospital Patient



Caring for the community is an important component of a Magnet® organization and MCDH/MCCH nurses and staff extend their compassionate care beyond the walls of the hospital in a variety of ways.

The Texas Emergency Medical Taskforce (EMTF) for Region 2 Mobile Medical Unit (MMU) is comprised of HCA North Texas and Questcare personnel. The team has the capability of setting up and running a 32-bed hospital, completely self-contained, without re-supply, for up to 72 hours or more in the event of a disaster. This includes critical care, sonography and advanced airway therapies. Several members of the MCDH Maternal Transport Team participate in these life-saving, emergency preparedness drills.

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MCCH sponsors a First Aid Class for Children open to all children in the community. During the class, children learn the basics of CPR, how to recognize an emergency, when to call 911 as well as how to bandage wounds and care for minor scrapes. The children meet local firefighters and hear a basic fire safety talk.

The MCDH Bariatric Program was also the proud presenting sponsor of this year’s Dallas Walk from Obesity on October 10, 2015. The Walk from Obesity is an event that raises funds to support eh American Society of Metabolic and Bariatric Surgery Foundation’s mission to fight obesity through prevention, education and research.



MCDH/MCCH staff members participate in the Annual March of Dimes March for Babies each year. Through multiple fund-raiser events, staff members raised over $11,000 for this worthy cause.

MCDH Bariatric Program in conjunction with Women’s Services and the Marketing department hosted a Women’s Wellness Celebration on September 24, 2015. Registered attendees enjoyed healthy snacks as they listened to Dr. Jeffrey Henke talk about obesity and the importance of maintaining a healthy weight in order to experience optimal health. Dr. Winfred Parnell also spoke to the group about robotic surgery and the speedy recovery most patients experience after this type of minimally invasive surgery.

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National Certified Nurses Day March 19, 2015

Celebrations


Nurses Day May 6, 2015

Celebrations

“I cannot emphasize enough how grateful I am for my care at Medical City Dallas Hospital. From Pre op, post op, recovery, ICU and for my almost a week stay on the 5th floor. I have been to many hospitals for a variety of reasons several of which include major surgeries. I have never experienced the kindness, the efficiency, the promptness and attention to detail as I have here.”

~ Medical City Dallas Hospital patient

I am Medical City

I am who patients and visitors see when they come here.

Mine are the eyes they look into when they are worried or lonely.

Mine is the voice they hear when they ride the elevators, when they try to sleep, and when they try to process complicated, sometimes devastating information.

Mine is the face that they connect with when they are lying on a stretcher or bed in need of a kind, human touch.

I am who they meet on the way to the appointments that could affect their destinies. Mine is the voice that educates, congratulates, and comforts.

If I am loud, so is the hospital. If I am rude, so is the hospital. If the care and service I provide are brilliant, so is Medical City.

Visitors and patients remember what they see, hear, and feel. They will know that I am compassionate and dedicated to safe, exceptional care and to exceeding their expectations when they personally experience my commitment.

Patients are counting on my skills and caring. I am privileged to be present here … sometimes in the first moments of life … sometimes in the last.

I am responsible for my attitude and actions. I have a personal stake in the collective attitudes and actions of everyone who works at Medical City. My performance helps to define all of us.

Medical City is the care that I give … the service I provide and … the courtesy I extend.

I am Medical City.

nursing services annual report - medical city dallas … city dallas hospital/medical city...

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