2014 Nursing Annual Report - Shakopee, Minnesota · Nursing practice at St. Francis is based on providing exceptional patient care through caring and advocacy within a healing environment

Highlighting 2014

Accomplishments

and Outcomes

2014 Nursing Annual Report

Cover: Renee Geske, RN

It’s hard to believe it’s been a year since we published our last Nursing Annual Report. As I reflect on the year, what I am most proud of is the impact our nurses have had on patient care. Their willingness to lead, learn, and implement changes that improve care for our patients makes our organization a leader in providing high quality, cost effective care. They are engaged and energized when it comes to better serve our patients.

Our Transforming Care at the Bedside (TCAB) initiative is a great example. After its fourth year nurses are still looking for better and more efficient way to create a positive work environment. Working together they address problems and find solutions, tackling everything from clutter control to work space organization to better communications between departments.

Ninety of our nurses are certified in almost 30 specialties, illustrating their passion for taking next steps in doing what’s best for our patients. Supporting our nurses as they pursue opportunities to grow and develop professionally is a commitment St. Francis takes seriously. Professional development leads directly to a strong, empowered and engaged staff.

I’m also proud of how our nurses have stepped up to help others through volunteer programs. They’re participating in global mission projects, organizing book and food drives, packing dinners at Feed My Starving Children and serving meals and breakfast to children who haven’t a place to call home.

The communities we serve are undergoing great growth and we will be challenged to step up to a bigger and better presence in health care. By anticipating this changing environment and continuing to foster innovation, we will move out of our comfort zone and do even more for our patients.

This annual report clearly illustrates that we have a lot to be proud of at St. Francis and I am grateful for every St. Francis nurse for all they do to make a difference in the lives of our patients and their families.

Deb Ryan, RN MPH NEA-C Vice President, Patient Care and CNO

Greetings from St. Francis Regional Medical Center

Deb Ryan, Rn MPH nea-C, ViCe PResiDent, Patient CaRe anD CnO

I n t r o d u c t I o n

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Introduction

Welcome – Deb Ryan ..........................................................................................................................2

Nursing Vision and Core Beliefs: Professional Practice Model ............................................4-5

Philosophy of Nursing .........................................................................................................................5

transformational Leadership

Partnership Nursing Model ................................................................................................................6

Providing a Calm Environment for Healing ..................................................................................7

Advocating for Safety ..........................................................................................................................8

Exemplary care

In-Reach Interview ............................................................................................................................ 10

POKE Protocol ..................................................................................................................................... 11

Keeping Patients Close to Home ................................................................................................... 12

Trauma Designation .......................................................................................................................... 13

Structural Empowerment

Heart Failure Outreach ..................................................................................................................... 14

Battling Depression After Heart Failure ....................................................................................... 15

Palliative Care For Heart Failure Patients .................................................................................... 16

Celebrating Our Patients ................................................................................................................. 16

Fresh Ideas Grow at St. Francis ....................................................................................................... 17

Hand Hygiene ..................................................................................................................................... 17

new Knowledge and Innovation

2014 RN Certifications ...................................................................................................................... 18

Providing Relief For Chronic Conditions ..................................................................................... 19

Water Birth Clinical Trials at St. Francis ........................................................................................ 20

Daisy Awards in 2014 ................................................................................................................................. 21

2014 Eileen Dietz Nursing Scholarship ................................................................................................. 21

2014 Honors and Awards .......................................................................................................................... 22

t a b L E o f c o n t E n t S

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St. francIS rEgIonaL MEdIcaL cEntEr in

Shakopee is a partner with Essentia community

Hospitals and clinics, allina Health and

Park nicollet Health Services. this unique

structure enables us to combine the caring and

compassion of a community hospital with the

modern medical technology, specialties, and

services found in the metro area. We provide

a full range of inpatient, outpatient, and

emergency care services on a collaborative

medical campus.

St. francis primarily serves residents in

Shakopee, Jordan, chaska, Prior Lake, Savage,

belle Plaine and carver as well as those in new

Prague, Eden Prairie, bloomington, Lakeville,

burnsville, chanhassen, Victoria, cologne,

Excelsior, Henderson, Elko, new Market,

Montgomery and Le Sueur.

n u R s i n g V i s i O n• St.Franciswillbenationallyknownandtrusted

for exceptional nursing practice.

• St.Francisnursescombinethebestofscienceandcaring to provide exceptional patient care through trusted partnerships and effective stewardship.

• St.Francis’healingenvironmentfostersnursingpractice that is evidence-based, innovative, and patient/family centered.

• St.Francisnursesarepowerful,passionateanddiverse in talents and thought.

• NursingcareerpathsprovideSt.Francisnurses with dynamic opportunities for career enhancement to help them achieve their highest potential.

• Nursingleadershipisrelationship-centered,holistic, progressive, and responsive.

Our Mission


4

At St. Francis, we

work together to

provide all people

the healing experience

we would expect for

ourselves and our families.

P H i l O s O P H y O f n u R s i n g St. Francis’ Philosophy of Nursing was created by gathering feedback from direct caregivers who serve our patients in all departments. Patient Care Councils met jointly in June 2013 to create this unique philosophy from the feedback. It was then approved by the Nurse Practice Council. The St. Francis Nursing Philosophy has three elements:

Nursing practice at St. Francis is based on providing exceptional patient care through caring and advocacy within a healing environment that promotes health, and empowers patients and their families through the continuum of life, and supports them through difficult experiences.

St. Francis nurses combine the best of science and the art of caring, through collaborative partnerships and a commitment to professional growth and development that is supported by St. Francis’ Mission, Vision, and Values, the Allina Charter for Professional Nurses, and the American Nurses Association Code of Ethics and Scope and Standards of Nursing.

The Registered Nurse is the leader and integrator of patient care and St. Francis’ healing environment fosters nursing practice that is a hallmark of excellence recognizing staff as the most valued resource.

n u R s i n g C O R e b e l i e f s•Advocacy•Caring•ContinuousImprovement•CulturalAwarenessandRecognition• Ethics• Leadership• Relationships• Stewardship


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6

t r a n S f o r M at I o n L E a d E r S H I P

Pa R t n e R s H i P n u R s i n g M O D e l

Prior to implementing TeamSTEPPs, St. Francis Surgical Services experienced two adverse health events and a critical event. In completing a root cause analysis for each event, communication was identified as a causative factor by the staff and physicians. In addition, St. Francis Surgical Services teamwork perception was reported to be below the national mean in two surveys. St. Francis made it a top priority to initiate team communication tools through TeamSTEPPS for patient safety in Surgical Services.

“TeamSTEPPS has been utilized by hospitals nationwide to improve surgical teamwork and decrease adverse patient outcomes, so the training is not new,” Elizabeth Rodgers, RN, Patient Care Manager of Surgical Services said. “What is new and innovative is how St. Francis implemented the training to empower staff members to develop an effective tool.” Rodgers, the project leader, suggested that team training would require partnership between leaders and staff and that staff was empowered to act and design a specific tool to improve team interaction as well as become team trainers. There were four surgical nursing staff members, one surgical technician, an anesthesiologist and surgeon on the guiding team. These members were involved in the recent critical events and were engaged in this process.

Team training with the use of standardized pre-flight checklists or team briefs, have been utilized successfully in aviation, and have shown to increase safety. St. Francis developed the “pre-

flight brief” or “debrief” best practice tool. Debriefs enhance individual leadership skills in an interdisciplinary team. Because the debrief takes place at the conclusion of the surgical case with the patient anesthetized, there is no opportunity to engage the patient family. In this initiative, the engagement of staff impacts improved communication and thus patient family safety.

Post TeamSTEPPs implementation, there have been no further adverse or critical events in surgical services following implementation of the debrief process. A “Safety Attitudes Questionnaire” provided the pre and post-test for teamwork and safety assessment. Pre intervention teamwork was reported at 74% and safety at 64% and post intervention, teamwork was 77% and safety 70%.

There are lasting results for this patient safety improvement related to communication errors for critical surgical information. Sustainment of the debrief program continues and there are plans to expand to endoscopy. This initiative shows the impact of implementing partnerships with staff in initiation of tools to improve communication leading to long term patient safety.

St. Francis has spread this initiative to nursing leaders and plans to implement this project in other departments. The initiative was also shared through a research competition in 2014 for leaders and nurses at Allina. This team culture training could be easily adapted to additional surgical units, hospitals and clinics across our state and beyond.

leads to Patient safety improvement

Lack of effective teamwork

communication is a frequent root cause

of patient errors. Hospitals can have

difficulty implementing effective team

training programs as cultures are built

upon hierarchy and team training can

be difficult with top-down approach for

initiating change. In response, St. francis

developed an innovative approach,

encompassing a partnership nursing

model and teamStEPPS training to

develop a new debrief tool.

Elizabeth Rodgers, RN and Amy Maloney, RN

7


The outpatient infusion room in St. Francis’ Cancer Center is a large open room with ten bays, two rooms with individual televisions, and a large nursing station situated prominently in the center of the room with numerous telephones and computer work stations. It’s a busy location with constant communication, use of technology, and high traffic flow, resulting in noise levels that create many distractions and chaos.

Care team members were concerned that this atmosphere created a stressful environment for both patients and caregivers and, consequently impacting patient care and safety.

As a result, the Cancer Center Patient Care Council examined issues and concerns. An action plan was created to enhance the healing environment for both patients and staff. The plan focused on assuring privacy and a peaceful environment for patients receiving chemotherapy, infusions, and transfusions.

30 patients and the entire oncology staff were surveyed on privacy and noise levels in the infusion room from April 9to May 7, 2014. The survey instrument was created by the Patient Care Council after reviewing evidence based practice to determine appropriate survey questions and survey methods (Mazer, S., 2014). All infusion therapy patients were encouraged to participate in the survey, and all patients queried responded to the survey. Staff and patients could only participate in the survey once during the survey time frame.

After the initial concerns and the survey results were compiled, staff met to review the results and discuss possible solutions. Surprisingly, staff members reported more concerns with noise/privacy issues than the patients reported.

After reviewing evidence based research for best practices the Patient Care Council made recommendations that were subsequently approved to begin within the week:

1) Plant Maintenance lowered the tone on the pneumatic tube alarm.

2) Nurses integrated an “ear tug” signal to gently remind each other if voice volume is too loud.

3) Nurses were reminded to respond promptly to IV pump alarms.

4) Privacy curtain were to be pulled for patient teaching and extraordinary support needs or private rooms used as necessary, based on patient preference.

5) Ear phones were offered for patient’s requiring increased television volume.

6) Patients/visitors were reminded to keep cell phone ring tones low and conversations short.

A follow-up survey of Registered Nurses (RNs) working in the Infusion Room was completed July 1to July 8, 2014 , measuring effectiveness of the recommendations. Seven of the eight staff RNs took the survey. The results included:

• 4of7appreciatedthelowertoneonthepneumatictubealarm.

• 1wasnotyetusedtolisteningforthelowertubealarmtone.

• 3of7felttheeartugsignalhelps,3hadnotseenitused,and1 felt it did not work. 1 RN also felt we needed more time to assess this intervention.

• 5of7feltloweringcellphonetones,turningtelevisionvolumes down/offering headsets helped decrease noise.

• 7of7felttheyweremoreawareofmaintainingpatientprivacy.

• ThemajorityofRNsfelttherewasimprovementin3ofthe4areas addressed.

• Arecommendationwasmadetoreassesstheeartugsignalfollowing a longer trial period was supported.

Providing a calm and quiet environment for patients enhances the healing process, protects patient privacy and supports patient safety.

P R O V i D i n g a C a l M e n V i R O n M e n t f O R H e a l i n g

Emergency Department RNs Maren Davis, Melissa Vanvoorst and Jessica Gallagher present Cancer Center staff with hats crocheted by ‘Kaffeeklastch & Crochet’, a group of St. Francis nurses who ‘meet, crochet and provide something lovely for cancer patients and other charities.’ The hats provide comfort for patients who have suffered hair loss. Pictured, left to right: Melissa Vanvoorst, RN, Marti Auringer, RN, Kelly Benning, RN, Renee Geske, RN, Deb Sissler, RN, Jessica Gallagher, RN, Maren Davis, RN and Chris Kroeg, RN.

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Family Birth Place nurse, Marilyn Freeman, RN, was injured while helping transfer a patient. As a result of her injury, she discovered that there was a knowledge and resource gap for care team members of the Birth Place around safe patient moving equipment, patient and staff safety.

Freeman became an advocate for staff and patient safety, and joined the Safe Patient Moving Team, reviewing policies. She realized that the Family Birth Place was not included in the integration of safe patient moving initiatives, but really needed to be. After surveying other Allina Health Birth Centers to determine resources already in place, Marilyn enlisted support from her Patient Care Manager, Ann Friedges, RN, MAN. Together they developed a plan and identified equipment and resources needed to support staff and patient safety.

Friedges worked on obtaining patient transfer and moving equipment, including ceiling lifts, air transfer mats, stand and transfer aids, and leg slings. Because many Birth Center patients receive epidural medication which limits mobility, this equipment enables staff to move and position patients ergonomically, while providing a safe, smooth and effortless transfer for patients.

Freeman focused on training and educating care team members, starting with one-to-one education, approaching and coaching care team members about safe patient moving. She presented education on safety equipment and safe patient moving strategies at the Family Birth Place Clinical Education Days, and to the system-wide Allina Pregnancy Care Council. Because of her personal experience and dedication she was able to relate meaningful education to the receptive staff. Freeman said, “I’d ask does the patient weigh more than 32 pounds which is the maximum recommended lifting weight, and staff could easily determine when safe patient moving equipment was needed.”

Their work supporting this culture of safety for all care team members as well as patients has been successful. Since implementing the safe patient moving strategies in 2014, there have been no reported injuries by Family Birth Place staff.

a D V O C at i n g f O R s a f e t y

Marilyn Freeman, RN

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Deb Ryan, RN, CNO helps fit a pair of shoes at Free Shoes 4 Kids.

Ashley Morehouse, RN, Dorinda Vloo, RN, patient care supervisor, and Aurora Valdivia, RN in simulation training.

Erin Kiernan-Johnson, RN and Amanda Saathoff, Health and Safety program manager, Health and Safety, were honored with a Key Contributor award for their work on Ebola preparation. Presenting the two with their award are, left to right: Mike McMahan, St. Francis president, Saathoff, Kiernan-Johnson, Nancy Wolf, director, Quality and Safety, and Deb Ryan, RN, CNO.

Lonna Selkirk, RN gives St. Francis president Mike McMahan his annual flu shot.

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E x E M P L a r y c a r E

Patients seeking unnecessary care in Emergency Departments (ED) have become a common issue for hospitals. To assist these patients decrease reliance on the ED, St. Francis created the In Reach program. In-Reach provides a consistent process to identify and assist patients with undetected or absent disease management, social and illness complexity and individual vulnerability. These three patterns may reveal significant issues such as anxiety, depression, substance abuse or social issues such as homelessness, inability to pay for prescriptions or lack of transportation.

What makes this program different from other disease management or care management models is the added presenceofaLicensedSocialWorker(LICSW)intheED.BethanyGabor,LICSW,tracksandfollowspatientsbeyondtheir ED visits. She connects In Reach patients with services that address their needs—whether it is transportation, housing, mental health or substance abuse.

In some cases, the patient isn’t aware that multiple visits have become an issue. “Most of our patients have no one to hold them accountable to keep track of their health care,” Gabor said. “They’re taking care of their parents or their children and life stressors have created a situation where the ED is just the most convenient place for them to come. It’s almost a sanctuary for them.”

This isn’t the case for everyone, of course. Individuals seeking narcotics are fairly savvy at presenting to the ED for pain killers. Gabor is able to identify this population with help from the ED physicians. “I call them and watch them every time [the patient] comes into the ED,” she says. “I’m very honest and up front, letting them know that I’m here to help with their pain, but I will not allow narcotics to be prescribed.”

Gabor helps schedule appointments at a pain clinic or a primary care physician, if pain is the patient’s chronic condition and even goes to the appointment with them if necessary. She also develops Unique Treatment Plans which are placed in their medical record, stating No Narcotics Should be Given at Discharge. This is up to the discretion of the treating physician, but most physicians are on board with the plans, and the program has been a success because of their support.

As the following charts indicate, the program has been successful. Nineteen patients were seen as part of the In-Reach program after its inception in September 2013. That number increased to 43 patients seen in the year 2014.

i n - R e a C H : l O O k i n g b e n e at H t H e s u R fa C e

2013

$100,000

$200,000

$300,000

$400,000

$500,000

0

$600,000

2014

Prior Visit ChargesDuring Visit Charges1 Yr Post Visit Charges

$308,282

$52,484

$118,406

$186,985

$81,147

Charges for Closed Cases$571,182

2013

$20,000

$40,000

$60,000

$80,000

$100,000

0

$120,000

$140,000

2014

Prior Visit Variable CostDuring Visit Variable Cost1 Yr Post Visit Variable Cost

$44,219

$7,767$17,668

$121,805

$26,473

$12,880

Variable Cost for Closed Cases

Both variable costs and charges for closed cases decreased substantially as a result of the In-Reach program.

In addition to the In-Reach Program, Gabor sees patients for other needs, such as nursing home placement, home care and hospice, chemical health referrals, child protection assessment and reporting, and vulnerable adult assessment and reporting.

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Monisha Husom, Neonatal Nurse Practitioner, saw an opportunity to decrease pain for newborns by collaborating with theLaboratoryPatientExperienceteamtocombineblooddrawsanddecreaseneedlessticks.Together,theLabandFamilyBirthPlacestaffworkedonthePOKEinitiativefortheLevel2Nursery. POKE is a technique utilized to provide newborns a form of pain management during blood collection or an IV start; POKE is an acronym for Positioning, Oral sucrose, Kangaroo, EMLAtopicalanesthesia.Theteamfocusedonpositioning(swaddling) and administration of oral sucrose (Sweet-Ease) to newborns at the time of a needlestick. Sweet-Ease is just sugar water but can mimic a narcotic effect in neonates.

As the Family Birth Place nurses began to adopt the POKE process,nursingandLabstaffobservedanincreaseinpositivecommunication between departments resulting in fewer repeat blood collections due to uncoordinated care of Newborn Screen Testing and Total Bilirubin testing.

During the documentation period from July to September, 55 outofthe58recordedbabiesintheLevel2NurseryreceivedSweet-Ease. Fifty-two of those babies only had one needle poke and 49 of them never cried. Families commented on the positive impact of the process change, especially those who previously experienced a distressed newborn from multiple needle sticks without the aid of swaddling and Sweet-Ease. Fewer needle sticks lowered anxiety of blood draws and babies experienced less pain.

The Allina Health Phlebotomy Process Improvement team is considering adopting the protocol in all Family Birth Place Units throughout the Allina Health hospitals.

P O k e P R O t O C O l ;

W o r k i n g t o g e t h e r f o r f e w e r n e e d l e p o k e s i n t h e L e v e l 2 N u r s e r y

Rebecca Barnack, RN

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A plan was developed to vary core staffing in the inpatient units to better meet daily patient census variations. The plan excluded patients who were transferred from St. Francis for reasons other than bed capacity or staffing availability. The plan consisted of three components:

• Quarterlyreviewofcensusversuscorestaffingforkeydepartments;

• IncreaseortransferofFTEpositionstoInpatientCareandthe critical care float pool to meet implemented core changes specific to days of the week and shifts with high census points and divert trends; and

• Cross-trainingofInpatientcarestafftosupporttheneedsofthe SCU.

A Divert Task Force was developed and led by Deb Ryan, MPH, RN, NEA-BC and Christine Wolf, MSN, RN, NE-BC and the Patient Flow Team. The goal of the Task Force was to create a “no divert” culture at St. Francis. Involving nurses at the bedside, charge nurses, nurse leaders, and executive leadership was crucial to supporting this “no divert” culture.

Tactics put in place to reduce diverts included:

• Anorganizational“DivertPrevention”policy;

• ADivertPreventionStatusReportForm;

• Adiverthuddleconferencingprocess24/7(involvingtheAdministrative Supervisor, shift Charge Nurse and on-call administrative team member and on-call nurse leader);

• Monthlyandquarterlyscorecardreportingforeachnursingunit; and

• Recognitionofpositivedevianceindivertpreventionwhichincluded sending out “thank you” cards to care team members who stay late or come in extra to care for patients.

The “Divert Prevention” policy was introduced to Emergency Department physicians and Hospitalists to clarify the role of the Administrative Supervisor in supporting a “no divert” culture. In 2014 tremendous strides were made toward the culture of “no diverts”. Only five patients were diverted due to staffing considerations, well below the Task Force’s goal of less than or equal to 15.

The organization has effectively transitioned to a culture that supports the ebb and flow in patient census and staffing, supported by appropriate stewardship of human resources and exemplary patient care. Support and inter-professional collaboration for our no divert culture is evidenced from the ED to inpatient units, as team members work closely to provide the resources necessary to support the unique needs of our patients.

k e e P i n g Pat i e n t s C l O s e t O H O M e

Patients come to St. francis regional

Medical center because they want to

receive care in their own community.

When the number of inpatient diverts

increased from 12 in 2011 to 34 in

2013, it became a patient satisfaction

issue and an organizational concern.

bed capacity was one reason for the

diversions, but staffing shortages that

occurred during census fluctuations

or acuity of care concerns were more

likely to blame. all three inpatient

units, Inpatient care, family birth

Place and the Special care unit (Scu),

were affected.

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St. Francis is unique in that it’s considered a rural hospital by state standards yet offers the same quality oftraumacareasmanyofthemetrohospitals.ItsLevel3 Trauma Center designation assures residents and emergency responders they’ll receive fast, appropriate and competent trauma care.

“Trauma is often a person’s first experience in health care,” Susan Berens, RN, Trauma Outreach Coordinator, said, “and we take that responsibility veryseriously.EarningourLevel3Traumastatusisincreasingly difficult to maintain for both rural and metro hospitals. We concentrate on a coordinated effort by all involved staff. This means very active ongoing internal education sessions, review and community outreach.”

To do this, Berens reviews the hospital’s ED cases daily, tracking all trauma, reviewing the care provided as well as the appropriateness of calling a ‘code trauma’. She works closely with the Minnesota Department of Health (MDH), identifying patients who meet trauma status, integrating the information to educate staff in trauma care. She leads bimonthly Trauma Committee meetings that bring multidisciplinary caregivers together to assess and facilitate ongoing excellence in trauma care, as well as bimonthly peer review meetings with the Trauma Medical Director. In addition, Berens monitors policies and procedures critical to patient care and attends bimonthly MDH trauma meetings.

Community outreach is an important part of the Trauma Designation status. Programs like DriveNowTXTL8Rareactivelypromotedinlocal schools and the group participates in several Community Health Fairs.

When asked why the program is so successful, Berens says, “Every discipline at our hospital strives for excellenceincare.DepartmentslikeED,Laboratory,Diagnostic Imaging, Respiratory Therapy, Surgical Services, Hospitalists, Special Care Unit and Inpatient Care staff work together to give our patients great care. No one does it alone.”

The program has been recognized for the quality of care it provides. Hennepin County Medical Center (HCMC) recently honored St. Francis with an Excellence of Trauma Care award. During its last re-designation site visit, a reviewer, who happens to be a trauma surgeon ataLevel1Traumahospital,complimentedtheteamby saying “…St Francis Medical Center could be the exampleofexcellenceofaLevel3Hospitalthatallothers should look to.”

t R a u M a D e s i g n at i O n

Susan Berens, RN

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S t r u c t u r a L E M P o W E r M E n t

Because St. Gertrude’s is physically attached to the hospital, it is convenient not only for the health care team but also for local families. However, further analysis showed that although the two facilities are physically connected, there was minimal workflow planning or communication between them.

Discussions with the St. Gertrude’s leadership highlighted three areas of opportunity:

• St.Gertrude’snursingstaffreceivedminimalevidencebasedHF education to guide patient care.

• Thenursingfacilityhadaveryhighannualnursingstaffturnover rate (24.0%).

• HFpatientsweredischargedfromthehospitalpriortomeeting discharge criteria. They were not off of IV diuretics and stable on oral diuretics for 24 hours prior to discharge.

Angelina Buerke, RN and St. Francis’ Heart Failure Coordinator collaborated with St. Gertrude’s leadership to develop shared readmission reduction tactics. HF readmission case reviews were completed jointly between the two facilities, increasing awareness of workflow and opportunities for improvement. St. Gertrude’s leadership joined the St. Francis HF Program Team to identify barriers and increase communication and care coordination between the two facilities. Other interventions included:

• St.FrancissharedevidencebasedHFpatienteducationtoolswith St. Gertrude’s to assure consistency between the two organizations.

• St.FrancisprovidedHFeducationtoallSNFpatientcarestaff (Registered Nurses (RN), Nursing Assistants, Dietary, and Physical Therapy). The education offerings were available quarterly to address the high staff turnover rate.

• Handofftoolsweredevelopedandutilizedbetweenthehospital RN Care Coordinators and receiving SNF RNs to ensure core information was communicated during the transition between organizations.

To address the issue of discharging patients prior to meeting HF discharge criteria, data was shared with physicians and education was developed and rolled out to the Hospitalist group. A discharge checklist tool was developed for hospital staff and shared with the SNF, allowing St. Gertrude’s the ability to decline a patient until discharge criteria was met.

HF readmission within 30 days from St. Gertrude’s significantly decreased from 35.0 % in 2013 to 14.0% in 2014, a reduction of 21.0%. This significant reduction contributed to St. Francis decreasing the organization’s 30-day HF readmission rate from 24.14% in 2013 to 18.75% in 2014, demonstrating an overall decrease in 30-day HF readmission by 5.7% in one year.

St. Francis Regional Medical Center and St. Gertrude’s Skilled Nursing Facility are co-located facilities that had opportunity to increase their connectedness in caring for their HF patients. By enhancing collaboration between the two facilities, decreased readmissions and improved patient outcomes were achieved for the HF population.

In 2013, St. francis had the highest Heart failure (Hf) readmission rate (24.41%) in a 12 hospital system, whose overall goal was 15.5%. analyzing the Hf readmission data showed that patients discharged to St. gertrude’s rehabilitation facility, the most frequently used skilled nursing facility (Snf), had a 30-day readmission rate of 35.0%.

H e a R t fa i l u R e O u t R e a C H

Angelina Buerck, RN

15


Studies show that patients suffering from heart failure are more likely to suffer from depression. Not only does this affect their quality of life, but also whether or not they will follow through on a medication regime which will affect their ability to recover. Readmission rates among heart failure patients with depression are as high as 67% versus 44% among heart failure patients without depression. Unfortunately, until now, these patients were rarely assessed for depression.

With this in mind, Sarah Amendola, RN, manager of Inpatient Care at St. Francis and Angelina Buerke, Heart Failure Program Coordinator initiated a movement to assess all heart failure inpatients at St. Francis for depression, utilizing the PHQ-9 depression screening tool. Caregivers were then able to identify patients at risk for depression and intervene to improve outcomes and quality of life.

Sarah and Angelina created and implemented education for inpatient care staff on the value of depression screenings. Staff meetings, poster presentations, and random chart audits were tactics actively used in the learning process. Feedback from direct care staff proved to be valuable tools for the program as well.

Documentation was critical, regardless of whether or not a psychological consult was indicated. Inserting forms into the heart failure education booklets given to patients and their families served as a reminder to staff to complete the screening. In addition, the PHQ-9 flow sheet was added to the electronic medical record to facilitate documentation and a request to add it to the heart failure order set will be completed in 2015, prompting an automatic psychology consult if necessary.

Screening heart failure patients for depression is a fairly new concept in inpatient care. St. Francis is leading the way in hardwiring the measure, through education, documentation and easier access to the questionnaire.

b at t l i n g D e P R e s s i O n a f t e R H e a R t fa i l u R e

Sarah Amendola, RN, manager Inpatient Care

16


An estimated 50% of patients with Heart Failure (HF) live less than five years after their initial diagnosis. Experts believe a palliative care consult provides patients with early symptom control, improved patient satisfaction, decreased readmissions and reduced overall cost of care. Yet, although it is a covered benefit, it is rarely ordered because providers don’t understand the role of palliative care.

St. Francis was consistently seeing HF patients readmitted within 30 days so it made sense to explore opportunities to integrate palliative care into their plan of care. An initiative was put in place to determine its impact on all primary HF patients for symptom management and early discussions around care goals, leading to advanced care planning.

Two palliative care nurse practitioners were hired to assess patient needs and educate hospitalists and staff on the difference between palliative and hospice care. It was expected that all patients with a primary diagnosis of HF would be screened appropriately for palliative care.

Results were impressive. The 30-day HF readmission decreased from 24.4 % (N=31) in 2013 to 18.8% (N=21) in 2014; a total 30-day HF readmission reduction of 5.6% in one year.

By involving Palliative Care early in the HF process and educating staff and physicians on the service’s benefits, HF patient outcomes were improved. As a result, St. Francis has been asked to move this work forward in all Allina hospitals by participating in a HF task force. Staff has now requested default Palliative Care consults for all Chronic Obstructive Pulmonary Disease patients, another high 30-day readmission diagnosis at St. Francis.

Jen Hentges, BSN, RN, OCN of St. Francis’ Cancer Center was caring for a patient who had had a difficult time with his chemotherapy treatment. When he finally reach the end of the treatment successfully it was a day for celebration, but the individual was alone without family or friends to share in his accomplishment.

“After that day I started to think about something that I could do to help people feel special and to celebrate their treatment journey,” she said.

Working with her nursing leader, Nancy Menth, RN,BSN,MA, she brought the idea of patient celebrations to the Cancer Center staff, all of whom whole-heartedly endorsed the idea. Working with staff and nutrition services, she created ‘Today We Celebrate You’ for patients who have completed important milestones in their treatment.

The celebration has become a Cancer Center tradition that is loved and appreciated by staff, patients, and their families. Patients receive a celebration cake, and a card signed by all the staff that honors the special accomplishment that cancer patients make, day to day. These celebrations demonstrate true compassion and caring among the staff toward their patients.

“I don’t think they’re necessarily excited for the actual cake,” Hentges said. “I believe it is the meaning behind it. We go through months to years of chemotherapy treatments with our patients. We often see them at their worst as they try to manage side effects, financial stress, depression and the many other issues that cancer patients face.”

All nurses, staff and often the doctors participate in the ‘Today We Celebrate You’ celebrations, to honor the accomplishments of their patients as they navigate through the life changing experience of cancer treatment.

Pa l l i at i V e C a R e f O R H e a R t fa i l u R e Pat i e n t s

C e l e b R at i n g O u R Pat i e n t s

Jennifer Hentges, RN, was honored with a quarterly Award of Excellence for the work she has done for patients.

It started with an idea. In this case, an idea for a seed. From that seed, there grew a garden. From there, a community giving garden.

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Hand hygiene is one of the most important ways to stop the transmission of germs and prevent infections. By employing different tactics that emphasized the importance of hand hygiene, St. Francis met its 2014 goal of 86% (Goal >85%) compliance with hand hygiene upon room entry and exit.

Tacticsincludeda‘You’veGotaLotonYourHands’campaign. This consisted of a ‘toolkit’ of colorful posters, handouts, and other collateral that was shared across the organization. Posters that showed department specific data were posted in each unit. In addition, an ‘approach & coach’ accountabilitymodelwascoupledwitha‘StoptheLine’policy.By engaging front line staff, momentum for the initiative grew and consequently contributed to the program’s success. Individual departments who met the goal at year-end were recognized with “Clean Hands Heroes” awards.

A system standardized third party auditor education was completed to assure a consistent audit process is followed, with the ‘Five Rules for Hand Hygiene Observation’. Progress reports were sent mid-month to third party observers and supervisors/managers to further encourage audit submissions.

In addition, hand hygiene education was featured at the annual Safety Fair, with data comparisons across departments. A separate Hand Hygiene page was added to the Allina Knowledge Network (AKN), St. Francis’ intranet resource, and isolation carts were refreshed with inventory lists created.

The Hand Hygiene Team will meet bi-monthly in 2015. The team evaluates data and develops/implements new strategies to support hand hygiene goals and is led by the RN Infection Preventionist. 2015 St. Francis hand hygiene compliance goal is >90%.

The community giving garden is the brainchild of John Zweber, St. Francis CRNA. Zweber spear headed the project with the Surgical Services Department to provide fresh herbs and vegetables to the local food shelf for distribution. Zweber is a Dakota County Master Gardener and very familiar with best practices for planting, growing and harvesting vegetables.

Zweber approached hospital management and asked if they could use idle land across the street from the hospital to plant the garden to produces nutritious food for the CAP Agency Food Shelf. He graciously spent his own time, money and leadership skills to grow this project into success.

He gathered groups of co-workers from surgical services to prepare the gardens and hosted planting events. He even sent out numerous newsletters regarding the garden progress and needs, sharing wonderful pictures for all to see how their contributions were growing. The team regularly gathered to weed, water and harvest the herbs and vegetables, discussing their own gardens at home, the weather or even their work across the street at St. Francis. It was a great chance for the department to spend time together, bonding over their yield.

“This was a great opportunity to put empty space to good use and gather outside of work with co-workers in a worthwhile activity,” John Zweber, CRNA said. It’s great to help someone with the end result, healthy food.”

In its first year, the garden grew enough produce for the staff to donate to the food shelf and to make salads for lunch at work, promotinghealthyeating.Lettuce,radishes,carrots,beans,brussel sprouts, cucumbers, tomatoes and various herbs were all part of the bounty. The produce was regularly delivered to the food shelves, eight times throughout the season, and is a great example of how one person’s idea can make a difference for the community.

f R e s H i D e a s g R O w at s t. f R a n C i s

H a n D H y g i e n e

John Zweber, CRNA

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n E W K n o W L E d g E a n d I n n o V at I o n

Melissa Abeln

Sarah Amendola

Bethany Anderson

Christy Anderson

Rebecca Argetsinger

Joel Aronson

LynelleAukes

Rebecca Barnack

Jon Bartlett

Kelly Benning

Susan Berens

Kris Beuch

Victoria Black

Chris Breimhorst

Kristy Breimhorst

Peter Breimhorst

LindsayBrowning

Angelina Buerck

Angie Christian

Kerry Callahan

Megnan Clay

Crystal Creighton

Arlanda Dahnert

Jennifer Eide

Jennifer Finger

Deanna Francis

Claire Freking

Ann Friedges

Renee Geske

Kathleen Giddings

Jacqueline Gifford

Debora Gunderson

Kelli Gunderson

Kelly Hagen

Wendy Haller

Sarah Hallman

Jennifer Hentges

Christine Jeurissen

Jacqueline Kalal

Meagen Kelly

Mimi Kennedy

Erin Kiernan-Johnson

Dawn Kraus

AnitaLaffen

CherylLamping

MistyLopez

Kathy Mason

Michelle Mattison

Sandra McGoldrick-Kendall

Kathleen McKoy

Teresa Meyer

Kimberly Nachreiner

Teresa Nida

MaryJo O’Malley

Amy Onson

Karen Ortberg

Nancy Pint

Debra Reynolds

Melissa Rezny

Tanya Rodenhaver

LizRodgers

Colleen Roethke

Monique Ross

Deb Ryan

Micheline Schultz

Sharon Schwichtenberg

Sue Seifert

LonnaSelkirk

Pam Sinness

Deb Sisler

Karen Sonnenburg

Caroline Stacke

Becky Stacken

Ann Stenson

Jamie Stolee

Marsha Sullivan

Sharon Sunde

Tamara Svihel

Rose Swanson

Cassandra Terwey

Kimberly Timm

David Tetley

Brianna Thompson

Benjamin Patrick Turner

Timothy VanVoorst

Dorinda Vloo

Alina Vogel

Chris Wolf

Nancy Wolf

Robyn Wagner

Jennifer Washburn

Nathaniel Willey

Judieth Wolpers-Dees

Amy Zhdankin

2 0 1 4 C e R t i f i e D n u R s e s

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Chronic, non-healing wounds can be caused by many things, including diabetes, radiation therapy, hypertension and often cause a marked reduction in quality of life for patients. Joel Aronson, RN, noticed a continual growth in patients with chronic wounds at St. Francis and recognized these patients needed ongoing care and education.

“Patients are living longer than ever with these chronic conditions,” Aronson said, “and fewer physicians are available to help manage wounds that just don’t heal. It became obvious to me that patients needed a higher level of care by specialist nurses to improve their independence and live a better quality of life.”

Aronson received certifications in Rehabilitation Registered Nurse (CRRN) and Wound, Ostomy and Continence Nurse (CWOCN) to gain a better understanding of treating the conditions. He continued to notice an increasing number of his patients receiving chemotherapy or radiation develop wounds or burns due to impaired skin integrity.

Soon the Cancer Center staff enlisted his help to assist with outpatient follow-up. The program expanded from there. He also discovered a substantial gap in services for patients needing foot and nail care and the fact that reimbursement to podiatrists for foot and nail care had decreased or been eliminated.

Aronson recognized something had to be done to help this patient population so he took the next step and enrolled in the Certified Foot Care Nurse (CFCN) program at the University of Wisconsin/Eau Claire for sharp wound debridement and compression therapies.

When completed, he worked with Cancer Center’s outpatient care supervisor, Chris Kroeg, RN to create a Wound and Foot Clinic, located in the St. Francis Cancer Center.

“The program has been a great collaborative effort with Park Nicollet Health Services and Allina Health physician providing full support,” Aronson said. “Anne Dietrich, MD, agreed to be the consulting physician, and primary care physicians from both campus organizations are fully supportive.”

Clinic services have already expanded. Aronson now sees patients in the Emergency Department as well, integrating them in the clinic as needed. Patients appreciate the continuity of care with great outcomes because they are seen by the same wound care nurse in both inpatient and outpatient settings.

The clinic has had its share of challenges however. “Coordinating the necessities of creating policies which address multiple regulations, finding space and equipment in a tough economic climate has had its challenges,” Aronson said. “It has been a learning experience for me.”

P R O V i D i n g R e l i e f f O R C H R O n i C C O n D i t i O n s

Chris Kroeg, RN and Cancer Center outpatient care supervisor and Joel Aronson, RN, CRRN, CWOCN.

Water births are a popular birthing option that means at least part of a mother’s labor, delivery or both happens in a birth pool filled with water. St. Francis began offering water births in 2011 at the request of patients who felt they offered increased relaxation and decreased pain during birth.

Although no mom or baby has been injured during a water birth, the American College of Obstetricians and Gynecologists (ACOG) questioned the birth method in 2014, saying there wasn’t enough information to decide how safe or useful the practice is in birth. In response, Allina Health hospitals, which includes St. Francis, discontinued water births until better guidelines were in place.

After a brief suspension, St Francis resumed its water birth practices conducting clinical trials with other hospitals in the Allina Health system. Multidisciplinary teams were created, charged with developing system-wide policies, procedures and guidelines. A research proposal for clinical water birth trials was submitted to the Institutional Review Board (IRB). As part of the research, St Francis nurses and Park Nicollet Certified Nurse Midwives are researching four questions to quantify the impact on the patient’s labor and delivery experience.

1. How long was labor? Was the baby delivered in the tub?

2. What was the baby’s outcome?

3. What was the perineal integrity?

4. Did the baby need NICU care?

Nurses were educated on the new procedures and stricter guidelines. Many mothers use hydrotherapy and labor in the tub, but now only low risk patients are allowed to deliver in the water with a certified nurse midwife in attendance. Nurses have a critical role in the research, with documentation being key in getting results. Time spent in and out of the tub, and labor observations are noted in the Excellian, the electronic medical record, to help extract data for the research.

The research project will have a regional impact, regardless of the results. With over 50,000 labors needed in the control group, this wide scale effort requires partners. As the leading research partners, Allina Health and Children’s Hospitals and Clinics are crafting a data sharing contract that will allow Fairview, Health Partners, Park Nicollet, Health East, HCMC, and Sanford Health System request to participate in the data collection portion of the research. The research proposal is expected to last for two years, but will continue until a statistically significant finding has been made.

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w at e R b i R t H C l i n i C a l t R i a l s at s t f R a n C i s


DAISY is an acronym for Diseases Attacking the Immune System and recognizes nurses that personify St. Francis’ remarkable patient experience. These nurses consistently demonstrate excellence through their clinical expertise and extraordinary compassionate care. Nominated by both peers and patients, they are recognized as outstanding role models in our nursing community.

The DAISY Foundation was formed in November 1999, by the family of J. Patrick Barnes who died at age 33 of complications of Idiopathic Thrombocytopenic Purpura (ITP). They wanted to do something to honor the wonderful person Patrick was and to express their profound gratitude to nurses for the work that they do for patients and their families every day.

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D a i s y a w a R D s i n 2 0 1 4

St. Francis nurses received DAISY Awards in 2014: Nancy Pint, John McKowen, Carrie Kronquist, and Patty Simones.

Meagan Kelly and Christy Anderson were awarded 2014 Eileen Dietz Nursing Scholarships. The scholarships are dedicated to the memory of and contributions of Eileen Dietz for her 20 years of nursing at St. Francis. Pictured are Deb Ryan, CNO, Meagan Kelly, and Alan Spillers, executive director of Saints Healthcare Funds.

2 0 1 4 e i l e e n D i e t z n u R s i n g s C H O l a R s H i P

Carrie Kronquist John McKowen Nancy Pint Patty Simones

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accrEdItatIon and cErtIfIcatES Hospital Accreditation by The Joint Commission

Heart Failure Disease Specific Program Certification by The Joint Commission

Commission on Cancer Accreditation by the American College of Surgeons

Cardiac Rehab Program Certification by the American Association of Cardiovascular and Pulmonary Rehabilitation

LaboratoryAccreditationbytheCollegeofAmericanPathologists

Diabetes Self-Management Education Program Certification by the American Diabetes Association

American College of Radiology Accreditation: CT Scan, MRI, Ultrasound General and Breast, Mammography, Nuclear Medicine, Echo

Sleep Center Accreditation by the American Academy of Sleep Medicine

LevelIIITraumaCenterdesignationbytheStateofMinnesota

Acute Stroke Ready Hospital designation by the State of Minnesota

IndIVIduaL HonorS

2 0 1 4 H O n O R s a n D a w a R D s

Minnesota Hospital Association-Good Catch for Patient Safety Award Winners: • LisaGinn,CST,SurgicalServices • DaneNelson,MLS,Laboratory • PamSolberg,RN,SurgicalServices • AshleyEvans,RN,Med/Surg • JenniferLevar,RT,DiagnosticServices • KatiePaulson,MammoTech,DiagnosticServices • PeggyMiller,RN,SurgicalServices • Dr.MathewBraasch,Surgeon • VickiJohnson,RN,SurgicalServices

organIzatIon HonorS 2013 & 2014 Star Tribune Top 100 Workplace –

LargeCompany

2013 & 2014 Valley Rehab Services Top 100 Workplace – Small Company

2013 & 2014 Allina Best Care (ABC) Award

2013 & 2014 Joint Commission Top Performer on Key Quality Measures

2013 & 2014 Shakopee Chamber of Commerce Member Business of the Year – LargeBusiness

2014 Minnesota Hospital Association Save Our Skin Award

2014 Women’s Choice Award – Best Hospital for Patient Experience in Emergency Care

2014 Minneapolis/St. Paul Business Journal Second Shortest Emergency Department Wait Times in the Region

2014 Consumer Reports Top Rated Safety Score (Twin Cities-Metro)

2014 Minnesota Department of Health FLUSAFEProgramRecognition

2014 Hennepin County Medical Center Trauma Team Excellence Award

2014 Minnesota Hospital Association Community Benefit Award – Witaya Care

2014 Minnesota Hospital Association Partnership for Patients Award

Mary Bothof, RN, 2014 March of Dimes Community Health Nursing Nurse of the Year Award

Joel Aronson, RN, 2014 March of Dimes Staff Nurse-Critical Care Nurse of the Year Award

Jamie Stolee, RN, ED Patient Care Manager, 2014 Allina Uncommon Caring Award

Steve Wilson, RN, Critical Care Float, 2014 Allina Uncommon Caring Award

Mary Bothof, RN and Joel Aron-son, RN were recipients of 2014 March of Dimes awards. Bothof was honored with the Community Health Nursing Nurse of the Year award and Aronson for the Staff Nurse – Critical Care Nurse of the Year Award.

Jamie Stolee, RN and patient care manager and Steve Wilson, RN were recipients of 2014 Awards of Excellence by Allina Health, honoring employ-ees who demonstrate exceptional care for pa-tients, communities and each other. The two were recognized for their commitment to making sure patients and visitors have a positive experience, both inside and outside the hospital.

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S413684 15-131355 0415 ©2015 ALLINA HEALTH SYSTEM. TM - A REGISTERED TRADEMARK OF ALLINA HEALTH SYSTEM.

Documents

2014 Nursing Annual Report - Shakopee, Minnesota · Nursing practice at St. Francis is based on providing exceptional patient care through caring and advocacy within a healing environment