2015 Nursing Annual Report

Throughout 2015, MedStar Southern Maryland Hospital Center (MSMHC) demonstrated steady progress on its journey to becoming a high-reliability organization. With this inaugural edition of the MedStar Southern Maryland Hospital Nursing Annual Report—the first since our merger with MedStar Health—I’m pleased to recognize the contributions that the MSMHC nursing team has been making on this journey.

As a team, our nurses demonstrated continuous improvement in several critical areas in 2015, including providing our patients with the safest, highest quality care; creating a “best place to work” culture; ensuring patients have the best experience possible; demonstrating the skills and commitment that maintain market leadership; and using the technical and procedural tools that help us remain fiscally strong.

Nurses play key roles in our drive to achieve high reliability, and their efforts are producing outstanding results. In 2015, for the first time in the history of MSMHC, the Joint Commission recognized us for overall progress in our quality measures. Through a partnership with the Notre Dame University of Maryland, we supported 21 scholars with a BSN education on MSMHC’s campus, and moved closer to our goal of ensuring that 80% of our nurses earn bachelor’s degrees by 2020. Nurses also contributed to MSMHC’s market leadership and fiscal strength: we could not have opened our state-of-the-art hybrid cardiac catherization lab, nor introduced robotics surgery, without our nurses’ expertise. Our nurses’ participation in MedStar’s system supply chain initiatives and their innovative work with EMR contributed to MSMHC’s fiscal well being.

To continue the momentum, we introduced new nursing councils in 2015, both at the corporate and local levels. Although our patient experience scores have consistently improved, we reinvigorated our efforts to raise scores even higher by establishing a Data Dashboard that captures and measures the nursing-driven components that enhance patient experience.

It is with much enthusiasm that I invite you to review this report. It is one means in which we proudly recognize the ways in which MSMHC nursing professionals are making a difference on our ongoing journey to become a high-reliability organization and provide the best possible care to our community. I am honored to be practicing nursing here with each and every one of you.

Kindest regards,

Pat Scalfari, MSN, RN, ACNS-BC, NEA-BCChief Nursing Officer, MedStar Southern Maryland Hospital Center

Dear Friends,

Table of Contents:

Page 1 Letter from Pat Scalfari, MSN, RN, ACNS-BC, NEA-BC - CNO

Page 2 - 7 Highest Quality & Safety

Page 8 - 9 Best Place to Work

Page 10 - 13 Best Patient Experience

Page 14 - 15 Market Leadership

Page 16 - 17 Fiscal Strength

Cover Photo, from left to right: Karen Dunlap, RN, Brenda Hill, BSN, RN, Pat Frasier, RN, Dvika Kandhai, BSN, RN, Shannon Holton, RN, Mary Ann Lucero-Pierce, BSN, RN

To be named a Top Performer, hospitals must achieve:

•Cumulative performance of at least 95 percent across reported accountability measures;

•Performance of at least 95 percent on each accountability measure with at least 30 denominator cases; and

•A composite rate of 95 percent or greater in one or more core measure set(s), and a performance rate of 95 percent or greater on applicable individual accountability measures within the set(s).

Nationwide, only 1,043 hospitals earned recognition from the Joint Commission this year, and the knowledge and training of our nursing team were integral to MSMHC’s accomplishment.

Highest Quality & Safety

Page 2 - 2015 Nursing Annual Report Highest Quality & Safety - Page 3

Our Hospital-Wide Commitment to Becoming a High-Reliability Organization

At MSMHC, we know that quality and safety go hand in hand. Developing and applying effective solutions to healthcare’s most critical safety and quality problems is key to achieving High-Reliability Organization (HRO) status.

In 2015, our ongoing commitment to a patient-first philosophy moved us significantly closer to our goal. Today, all MSMHC associates have been trained in HRO, and the nursing team has entered “Phase 2” of our journey. We’re realigning processes to reflect what we’ve learned over the past year; reviewing safety events and improving our responses with more efficient approaches and thorough documentation; and assessing our skills and effectiveness as individuals as well as a team. MSMHC is still early in its journey to transform our hospital into an HRO, but we’re encouraged by our substantial progress as we find even more ways to improve care for our patients and create a workplace culture in which we can all thrive.

MSMHC Achieves NICHE Level 3 Designation

Nurses Improving Care of Health System Elders (NICHE) is a national program providing education, resources, and practices to improve geriatric nursing care. In 2015, MSMHC launched several initiatives and met the criteria to achieve the third of four levels of the NICHE process. Initiatives included making all patient rooms senior friendly by the end of 2016, with environmental changes such as improved lighting and doorframes painted in contrasting colors so those with low vision can identify bathrooms. Nurses and CNAs supported MSMHC’s early mobility program by keeping older patients as ambulatory as possible during the day to prevent functional decline. Nurses also started

Infection Prevention HeRO Recognition Banquet to honor our work on ICU CLABSI reduction.Pictured from left to right: Janice Pineda, MSN, RN, David Mayer, MD, Vice President of Medical Affairs, MedStar Health, Renee Sicheri, MSN, RN, Rebecca Cook, BSN, RN, and Faye Goode, MSN, RN

Greg Purell, RN assisting NICHE patient

MSMHC Earns Joint Commission Top Performer Status on Six Quality Measures

In 2015—for the first time in our history—MSMHC was recognized by the Joint Commission as a Top Performer in its Key Quality Measures® Program. We were honored for our achievements on six sets of accountability measures reported in 2014: heart attack, heart failure, stroke, pneumonia, surgical care, and perinatal care.

collecting data in 2015, which will be used to evaluate the success of the mobility program. MSMHC started the NICHE program on units 1 East and 4 East. We will be implementing the program on all units in the hospital and NICHE implementation will be completed in 2016.

NICHE-related efforts are part of MSMHC’s longstanding commitment to exemplary care for elder patients. All CNAs are encouraged to complete Geriatric Patient Care Associate (GPCA) training, and MSMHC has a dedicated team of geriatric resource program nurses (GRNs), who model NICHE’s nursing practices.

Highest Quality & Safety

Hand Hygiene Compliance Improves as Units Compete for Recognition

According to the World Health Organization proper hand-washing techniques can save lives. That’s one reason why the Nursing Quality & Safety Council chose hand hygiene compliance as its first initiative. In April 2015, the council launched an intranet video called “Wash It Off,” choreographed to a popular song and featuring associates who demonstrated hand-washing techniques that reduce the risk of infection. A second event was held on May 5—to celebrate International Hand Hygiene Day.

The council and MSMHC continue to reinforce hand hygiene practices with a friendly competition. Each quarter, the unit or department with

the highest percentage of hand hygiene compliance is awarded a trophy. The Infection Prevention and Quality and Risk departments, assisted by a cadre of trained undercover observers, help determine the winners. The first unit to win the award was 4 East, followed by OR/PACU. But even more important: hand hygiene compliance has increased hospital-wide, from 89% to 92%, since the program’s inception.

Using MOST to Manage Critical Situations in Obstetrics

MedStar Obstetrical Safety Training (MOST), our system-wide training program, helps obstetrics nurses improve their emergency response by standardizing healthcare communications. MOST promotes patient safety and high reliability, and improves the way healthcare professionals function as a team.

As a result of MOST preparation in 2015, MSMHC obstetrics nurses increased their use of critical language at key times during emergency situations to bridge communication gaps and enhance their collective skills. By educating nurses on the proper use of Situation, Background, Assessment, and Recommendation (SBAR), MOST is helping our teams better manage critical situations and achieve safer patient outcomes.

Page 4 - 2015 Nursing Annual Report Highest Quality & Safety - Page 5

Nursing Councils Provide Support, Education, and Innovative Ideas

Our Nursing Collaborative Governance Coordinating Council (NCGCC), Nursing Quality & Safety Council (NQSC), and Nursing Practice Council (NPC) have distinct roles to support and enable collaboration among our nursing professionals.

The NCGCC oversees the NQSC and NPC and is integral to their operations. Comprised of the chief nursing officer and nurse leaders, the NCGCC facilitates communications and collaboration between the NQSC and NPC, and guides them toward the goals outlined in the nursing strategic plan. The NCGCC also reduces potentially redundant activities among nursing councils and departments.

The NQSC designs, implements, and evaluates the entity-level nursing safety and improvement program; measures patient outcomes sensitive to nursing intervention; and promotes improvement of patient safety and clinical outcomes.

In 2015, the NQSC celebrated its inaugural year of first-rate initiatives, starting with hand hygiene compliance. The council launched a video on hand-washing techniques and a quarterly competition to recognize the unit with the highest percentage of compliance. Hand hygiene has now increased significantly hospital-wide. The NQSC’s second initiative, “Back to You,” featured massage, exercises, safe lifting techniques, equipment, and prizes to promote back health and back injury prevention while caring for patients. The council’s third initiative, “Armed Against CLABSI,” launches in 2016, and will increase CLABSI awareness and identify unit-specific clinical champions.

The NPC develops and reviews MSMHC’s nursing standards of care and contributes to policies and procedures that support the exemplary professional practices that are critical to excellent nursing care.

In 2015, the NPC researched the use of whiteboards as a tool for communicating, facilitating patient discharges, and supporting patient care. The council proposed a pilot study in which whiteboards will be installed in each room on certain units, updated after each nurse’s shift, and provide pertinent information, such as the patient’s treatment goals and anticipated discharge date, for easy reference by the patient, family, and staff. The pilot was approved for 2016, and the NPC will provide oversight and present results at its conclusion.

2015 Nursing Collaborative Governance Members, from left to right: Laura Shwartze, BSN, RN, Kim Elliot, MSN, RN, Jacquie Payne-Borden, PHD, RN, Monique Dillard, MSN, RN, Lisa Douglas, BSN, RN, Ellena Arellano, BSN, RN, Karol Edwards, MSN, RN, Aldene Doyle, BSN, RN, Luis Corpin, MSN, RN, Janice Pineda, MSN, RN, Christine Galvez, MSN, RN, seated: Pat Scalfari, MSN, RN

Beverly Francis, CNA, 3 East

Nurses Use RL Solutions to Build Unit-Wide Safety Culture

RL Solutions, an incident reporting and feedback system, is helping nurses identify and follow up on safety concerns and create a safer environment at MSMHC. Safety-related events are logged into the system and addressed by the appropriate individual or department. Because the tool tracks and compiles data about each event, it provides critical information about the type of events occurring and how long it takes to close them, and identifies trends to prevent future incidents. The system also recognizes individuals who make good catches and prevent errors from happening.

The nursing team is using system data in daily safety huddles to identify patients at risk and find areas for process improvements. For example, when a nurse reports a fall, it prompts a safety huddle to identify contributing factors and interventions that can avoid another fall. RL Solutions can also provide data to support recommended initiatives, such as the need for bed alarms that was recently addressed at MSMHC, and shorten the distance from identifying a safety concern to resolving it.

Core Measures Guide Nurses in Best Practices Compliance

The Joint Commission, Centers for Medicare and Medicaid Services (CMS), and a number of healthcare plan and provider organizations collaborated to develop a set of quality measures—i.e., standardized best practices—against which MSMHC and other hospitals assess patient care. These core measures provide a consistent, industry-wide unit of measurement to evaluate improvements, especially in

MSMHC Quarterly Core Measures Data-FY14, FY15 & FY16

Delmarva Venous Thromboembolism - VTE FY14 FY15 FY16 Jul FY16 Aug Pts who receive VTE within 24 hrs admission/surgery or who have

documentation why none given 89% 97% 100% 100%

ICU admission VTE prophylaxis 92% 97% 100% 100% Pts with anticoag overlap 96% 98% 100% 100% Pts received unfractionated heparin w/ dosages/platelet count 100% 100% 100% 100% Warfarin therapy discharge instructions 83% 91% 100% 100% Hospital acquired VTE 5% 4% 0% 0%

Immunization -IMM FY14 FY15 FY16 Jul FY16 Aug Influenza vaccine compliance 96% 95% NA NA

Stroke (NEW 2014) FY14 FY15 FY16 Jul FY16 Aug VTE Prophylaxis documentation 96% 99% 100% 100% Antithrombotic therapy at discharge 95% 97% 98% 100% Ischemic pts with atrial fibrillation who are prescribed anticoagulation

therapy at discharge 98% 88% 63% 100%

Acute ischemic stroke pts who arrive w/in 2 hrs of time last known well and whom IV TPA was initiated w/in 3 hrs of times last known

86% 60% 75% 25%

Ischemic stroke pts admin. antithrombotic therapy by day 2 99% 98% 95% 95% Ischemic stroke pts with LDL>=100mg or LDL not measured or who were

on a lipid lowering meds prior to arrival are prescribed statin meds. 95% 97%

100% 100%

Stroke Education 96% 95% 94% 100% Patients who were assessed for rehab services 99% 99% 97% 100%

Perinatal FY14 FY15 FY16 Jul FY16 Aug Elective Delivery >37 <39 weeks (low rate good) N/A 0% 0% 0% C-section rate (low rate good) N/A 43% 45% 56% Antenatal Steroids for preterm newborns N/A 100% NP NP BSI in newborns N/A 0% 0% 0% Exclusive Breast feeding N/A 26% 30% 17% Exclusive Breast feeding due to Mothers choice N/A 56% 56% 44%

** DELMARVA GOAL-96% **

NRC Average Jul 2015 Aug 2015 Sep 2015 Total

Positive Positive Positive Positive Positive

HCAHPS: Did everything to help your pain 79.5 78.5 74.7 80.3 77.7HCAHPS: Drs explained things understandably 76.1 75.2 81.3 78.2 77.9HCAHPS: Drs listened carefully to you 79.1 78.1 81.3 81.8 80.1HCAHPS: Got help as soon as wanted 63.0 52.9 57.1 55.1 54.9HCAHPS: Help going to bathroom as soon as wanted 69.3 62.3 67.2 61.4 63.7HCAHPS: Nurses explained things understandably 74.8 72.7 77.0 66.7 72.6HCAHPS: Nurses listened carefully to you 75.8 70.9 75.2 66.3 71.1HCAHPS: Pain well controlled during stay 64.5 68.2 63.9 70.5 67.3HCAHPS: Quiet around room at night 59.1 52.4 58.0 55.3 55.0HCAHPS: Rate hospital 72.5 54.0 58.7 50.6 54.7HCAHPS: Received info re: symptoms to look for 90.6 89.0 94.3 88.9 90.8HCAHPS: Room kept clean during stay 72.3 62.7 70.3 65.9 66.0HCAHPS: Staff described med side effects 50.0 55.9 50.0 51.0 52.7HCAHPS: Staff took preferences into account 44.8 27.3 32.7 32.5 30.4HCAHPS: Talked about help you would need 85.0 84.9 86.7 77.2 83.5HCAHPS: Told what medicine was for 77.5 72.1 76.0 84.0 76.8HCAHPS: Treated w/courtesy/respect by Drs 86.9 87.7 88.3 83.9 86.9HCAHPS: Treated w/courtesy/respect by Nurses 85.6 78.7 83.3 83.1 81.3HCAHPS: Understood managing of health 53.4 43.3 45.4 48.8 45.4HCAHPS: Understood purpose of medications 61.8 52.9 53.2 58.0 54.3HCAHPS: Would recommend hospital to family 75.0 55.6 64.2 54.1 58.1IP: Received follow up after leaving hospital 76.9 82.3 81.1 67.1 77.9IP: Staff taking action for safety 79.1 76.3 72.2 70.4 73.4

Page 1 of 1©2015 National Research Corporation

µ - Warning: n-size is under 30!Yellow - score is less than the NRC AverageGreen - score is equal to or greater than the NRC Average

Catalyst Trend by Questions - Southern Maryland Hospital IP-A OverallOct 26, 2015

HCAHPS - Patient Perception of Care Survey ResultsINFECTION PREVENTION QUALITY INDICATORS

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100%

MSMHC Hand Hygiene Complance Rate Hospital Wide

% of Compliance

MD Goal

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Number 4 4 3 6 2 2 6 1 2 5 2 3 3 5 4

Rate 8.7 9.36 6.7 13 4.65 4.1 11.8 1.9 3.55 9.01 3.83 5.67 5.63 10.44 8.24

0

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MSMHC C. difficule Lab ID Event Rate per 10,000 Patient Days

Goal = < 7.0

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14-Jul 14-Aug 14-Sep 14-Oct 14-Nov 14-Dec 15-Jan 15-Feb 15-Mar 15-Apr 15-May 15-Jun 15-Jul 15-Aug 15-Sep Number 1 0 0 0 1 2 0 0 1 0 0 1 2 2 1

Rate 1.8 0.0 0.0 0.0 2.0 3.9 0.0 0.0 2.1 0.0 0.0 2.2 3.6 3.8 2.1

MSMHC Non-ICU Central Line-Associated Bloodstream Infection Rate per 1,000 Catheter Days

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14-Jul 14-Aug 14-Sep 14-Oct 14-Nov 14-Dec 15-Jan 15-Feb 15-Mar 15-Apr 15-May 15-Jun 15-Jul 15-Aug 15-Sep Number 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0

Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0

MSMHC ICU-Central Line-Associated Bloodstream Infection Rate per 1,000 Catheter Days

Coun

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Goal = < 0.9

good catches, bed availability, and admission or staffing concerns. If there are new policies, the Education Department will discuss them. If a technology update will impact EMR, IT will alert the group. If a construction project is starting, Facilities will announce it.

In 2015, adjustments were made to the format to make calls even more helpful. One change is that the on-call administrator now announces the day’s visitor wristband color, which will help associates to ensure that visitors have checked in at the desk.

Highest Quality & Safety

cardiology, orthopedics, and five other clinical areas considered to be the core set of medical practices. Because core measures are tied to federal reimbursements and must be reported, they also promote transparency; the public knows which hospitals are in compliance and can track their year-to-date performance.

At MSMHC, these guidelines are helping to improve patient outcomes, decrease the length of hospital stays, and reduce readmissions. Each nursing unit addresses core measures during daily multi-disciplinary rounding. As an additional motivator, unit-based teams compete informally to have the highest compliance scores.

Page 6 - 2015 Nursing Annual Report Highest Quality & Safety - Page 7

Daily Safety Huddles - A 15-Minute Call to Support 24-Hour Safety

A short phone call that occurs every weekday morning at 8:45 is helping to keep MSMHC patients, staff, and visitors safe and secure, around the clock. All department leaders participate in the daily safety huddle to make each other aware of any safety-related matters that occurred over the previous 24 hours, or are anticipated that day. They cover a lot of topics in just a few minutes, including medical issues and

Dr. Taylor, Dr. Nair, Kim Bushein, RN, Tara Mclane, BSN, RN, Julie Gato, BSN, RN Mabvuto Mayaya, RN

Best Place to Work

Page 8 - 2015 Nursing Annual Report Best Place to Work - Page 9

RN to BSN Program Benefits Patients as well as Nurses

In accordance with The Future of Nursing Report from the Institute of Medicine (IOM) MSMHC encourages all nurses to advance their education. To support our nurses who are interested in earning their bachelor’s degree, MSMHC is allowing them to apply for full scholarships to Notre Dame of Maryland’s RN to BSN Program. The program bridges the educational requirement from current RNs to BSNs and offers convenient weekly classes at MSMHC. To qualify, nurses must meet academic and MSMHC criteria and remain at the hospital as full-time employees for a specified time.

Today, the nurses who comprised the program’s first cohort are not only enjoying new career opportunities at MSMHC, but also using their improved competency and critical thinking skills to provide better patient care. In addition, several nurses are now taking advantage of MSMHC’s graduate-level tuition reimbursement program to pursue their master’s degrees. The second cohort of 22 nurses graduates in May 2016; the third cohort starts in August.

Nursing Promotions from Within

MedStar Southern Maryland Hospital Center believes in promoting outstanding individuals into roles with greater impact and responsibility. In 2015, three nurses received significant promotions that have broadened their capabilities and career options, and introduced new avenues for growth in the future.

Karen Elliot, MHA, RN, was promoted from Director of Nursing to Senior Director of Nursing. Karen oversees the inpatient medical surgical units and ICU/CCU, directs staffing, bed management, and the nursing supervisors. She has previously served as Nursing Director of 1E and 1W; prior to joining MSMHC she was a Nurse Manager at MedStar Franklin Square Medical Center; and Assistant Manager of Emergency Services at MedStar Washington Hospital Center.

Angela Sykes, BSN, RN, was promoted from Interim Director to Nursing Director of 1E/1W. In 2008, Angela started her nursing career at our hospital as an LPN. She then undertook the challenging—and ultimately successful—goal of earning her RN designation (2009) and BSN (2013), and will complete her master’s in nursing this year.

Dominique Stuckey, MSN, RNC-OB, C-EFM, was promoted from Nursing Director of Labor & Delivery to Nursing Director of the

Women’s & Newborn Center. She oversees daily operations of the Labor and Delivery Unit, Mom and Baby Unit, Special Care Nursery, Antenatal Testing Unit, and Lactation Services.

Reception Honors Nurses on the Road to GRN Certification

For many nurses and CNAs, Gerontology Resource Program Nurse (GRN) certification provides knowledge they can use every day to care for the needs of older patients. GRN training focuses on geriatric issues such as falls and confusion, and emphasizes care strategies that promote patient mobility and discourage the use of restrictive devices. In May 2015, MSMHC held a ceremony to award nurses and CNAs who have completed the prerequisite training towards achieving GRN certification. This year, they’ll have the opportunity to sit for the GRN exam and earn national certification, and MedStar is sponsoring review courses to help them prepare.

Residency Program Eases Transition for New-to-Practice Nurses

By providing our new-to-practice nurses with both education and support, the Vizient/American Association of Colleges of Nursing Nurse Residency Program (NRP) is moving MSMHC closer to being a Best Place to Work. Our nursing team and nursing administration work with the NRP to help new-to-practice registered nurses with baccalaureate degrees make the transition from advanced beginners to competent professionals. In 2015, our inaugural cohort of nine nurses graduated from the 12-month NRP, and we welcomed a second cohort of seven nurses.

MSMHC’s first NRP covered an array of interactive topics, including ethics, leadership, and delegation. It culminated with “Patient Safety: Effectiveness of Remote Telesitters vs. Face-to-Face Sitters,” an evidence-based project to enhance patient care and outcomes. Results indicate that remote telesitters improve the psycho-social aspects of patient hospital stays, directly contributing to patient satisfaction.

New nurses in the nurse residency program, back row: Verna LaFleur, PhD, RN, Program Facilitator, Jasmine Atwater, BSN, RN, Beatrice Kauemou, BSN, RN, Dr. Alawode, MD, Nancy O’Rourke, BSN, RN, Jessica Koster, BSN, RN, Ashley Siemonh, BSN, RN, Brianna Dozier, BSN, RN, Jacqeline Payne-Borden, PhD, RN, Program Coordinator, front row: Lielte Estifanos, BSN, RN, Ida Hometowou, BSN, RN, Koudjo Elitsa, BSN, RN

Pat Scalfari, MSN, RN-CNO, presents Christopher Bowling, RN with a scholarship in MSMHC’s RN to BSN Program

Best Patient Experience

Page 10 - 2015 Nursing Annual Report Best Patient Experience - Page 11

Patient Experience Council Initiatives Receive Enthusiastic Support

2015 was a good year for the Patient Experience Council: it introduced successful initiatives that attracted substantial support and wide participation. One initiative introduced the SPIRIT Award, honoring one associate each month who demonstrates “above and beyond” performance. Next, the council agreed to choose one philosophy or theme per quarter to hardwire into our hospital practices and professional behavior. First choice: AIDET—Acknowledge, Introduce, Duration, Explanation, Thank you.

But the most powerful initiative was to invite one patient each quarter to speak at a council meeting. It’s an opportunity for the patient to ask questions and for the council to fully understand how well we’re meeting our objectives of care. This year, the council will use these and upcoming dialogues to explore more innovative approaches to improve patient experience.

AIDET Video Showcases the Hidden Talents of MSMHC Staff

Now playing on the intranet: “AIDET,” the blockbuster music video. In 2015, the Patient Experience Council, with the help of associates throughout MSMHC, produced “AIDET” to underscore its importance and remind us to use it in our interactions with patients and visitors.

Marketing and the HCAHPS Steering Committee took the lead, but the video was a hospital-wide effort. Starting with the melody from the song, “Happy,” the team revised the lyrics to emphasize the meaning behind AIDET (i.e., Acknowledge, Introduce, Duration, Explanation, Thank you) and its role in delivering high-quality care and improving communication with our patients. The video also highlights the distinctive dance moves and perfect pitch of several associates. Cast and viewers agree: the production will enjoy a long run at MSMHC. Directors are presenting it in staff meetings, and it will also be incorporated into our staff orientation program.

Providing Patients with Customized Care—Quickly, and Under Budget

One of our most impressive accomplishments in 2015 was our fast implementation of Plan of Care software in the EMR system. The module tailors care to each patient’s unique problem and aligns it with specific goals. For example, if a patient has a high risk of falls, the software alerts nurses to start fall-prevention care, including explaining the risk to the patient, goals they’re working toward, and interventions they’re taking, such as providing yellow socks, noting the risk on the bracelet ID, and ensuring the way to bathroom is obstacle free.

When the Plan of Care was initiated in January 2015, there were 97 different plans available to patients, and the vendor anticipated a three-month process. However, Nursing Informatics and the vendor developed an efficient approach to teach nurses about the software, and the nurses then created a Plan of Care with each of their patients—all in just five weeks. Not only did they complete the project in record time, but their quick work also saved MSMHC $6,000.

Post-visit Phone Calls Ensure Continued Care

At MSMHC, our connection with patients doesn’t end when they leave the hospital. To ease the transition from in-patient status to home, MedStar uses a call management system to assist nursing to perform post discharge calls to patients. Nurses attempt to call patients on the first or second day after discharge to answer any questions they have and check on their status. For example, has the patient picked up his or her medications from the pharmacy? Does he or she understand all discharge instructions?

In 2015, our post-visit calls were especially timely: a few prompted the nurse to ask the patient to return to MSMHC for evaluation. Nurses continue to strive to meet the benchmarks for call attempts and completions: with a goal of calling 100% of the discharged patients, and completing 80% of those calls. It’s one more way nurses ensure care is continued as patients re-enter the community.

4 East earns #1 in key patient experience metrics 2 West earns #1 in patient satisfaction for quarter 2 Nursing associates showcase their talents in AIDET Video EMR Team members: Teresa Waldron, RN, Shelly Martin, RN, Alie Kamara, BSN, RN

EMR Team member: Tina Gray, RN Teresita Domagas, BSN, RN, 2 East

Best Patient Experience

Monitoring Care in Coordination with the MedStar Way

Even before Southern Maryland Hospital Center joined MedStar, both organizations shared a similar vision: to serve our patients, our associates, and our community. Now that we’re part of MedStar’s network, MSMHC is demonstrating steady improvement in our patient experience scores—thanks largely to the dedication of our nurses.

But we know we can do better. So, in 2015, we created a Nursing Data Dashboard to measure the nursing activities and interdisciplinary collaboration that enhance patient experience. The Dashboard provides a visual, at-a-glance representation of our compliance with

nine nursing-driven initiatives. Each month, the tool shows where benchmarks were exceeded, met, or missed, and where performance has or has not improved, and monitors how well we function as a team and support the MedStar Way.

In 2015, we’re proud that our nursing team demonstrated consistently outstanding performance in bedside shift reports, physician and RN collaborative rounding, shift huddles, and coordinating plans of care with in-room communication boards. In the upcoming years, the Dashboard will continue to guide us in our ongoing efforts to improve patient care. Going forward nursing will be focusing a lot of effort in establishing a method to connect with our patients post discharge.

Multi-Disciplinary Rounding: How We’re Improving on Success

The nursing team at MSMHC is always exploring new ways to keep patients updated about their plans of care and provide timely answers to their questions. As part of this effort, multi-disciplinary rounding with physicians from our Georgetown and MDICS hospitalists has been one of our success stories. But we knew we could make it better. In 2015, we worked with the hospitalists to streamline our approach, make it more meaningful for patients, and hardwire it with informative content.

Today, a nurse, physician, and case manager, frequently joined by one or two colleagues from the Quality or Education departments, round together to visit every patient. These multi-disciplinary rounds are an opportunity to review the patient’s daily care plan, discuss quality measures and discharge plans, and address any other concern that the patient might have. Patient feedback ensures we’re on the right track. This year, we’ll videotape rounds for new hires, so they can see what a meaningful and effective round looks like.

iPad Rounding Provides Critical Data to Enhance Patient Experience

Gathering and documenting data on each patient’s needs is now much more efficient with iPad rounding. By displaying detailed questions, such as whether a patient is experiencing side effects from medication, iPads help nurses address patients’ immediate and potential health concerns while they’re still in the hospital. The iPad’s EMR interface provides nurses with up-to-the-minute clinical information, and its connection to other departments streamlines communications between teams. After the technology was deployed in 2015, patients responded enthusiastically, thanking nurses for quick responses to their concerns. What’s next? MSMHC is exploring options to implement phone apps, so patients can easily access discharge instructions and other information from home.

Page 12 - 2015 Nursing Annual Report Best Patient Experience - Page 13

2015 MSMHC NURSING DATA DASHBOARD

Jan Feb March April May June July Aug Sept Oct Nov Dec Benchmark

Hourly Rounding N/A 70% 80% 68% 103% 94% 76% 99% 83% 84% 89% 94% >90

Bedside Shift 91% 98% 100% 109% 143% 147% 100% 100% 100% 100% 100% 100% 100

MD/RN Round 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% >90

Shift Huddle 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 100% 99% 100

Leader rounding iPad N/A 48% 51% 56% 60% 62% 70.5% 67% 71% 70% 70% 68% >70

Communication Board N/A 97% 99% 99% 97% 98% 94% 97% 98% 96% 93% 98% >90

D/C Calls Attempted 100% 100% 100% 100% 100% N/A 92% 87% 100% 96% 98% 91% 100

D/C Calls Connected N/A N/A N/A N/A N/A N/A 50% 47% 56% 60% 60% 49% >80

No Pass Zone N/A N/A N/A N/A N/A N/A 76% 91% 80% 100% 97% 99% >95

Kristin Gajda, MSN, RN

Market Leadership

Page 14 - 2015 Nursing Annual Report Market Leadership - Page 15

Enhancing the Pre-operative Assessment Process

Pre-operative planning reduces patient stress, minimizes cancellations, and produces better surgical outcomes. Throughout 2015, MSMHC continued to improve the efficiency of pre-operative assessments and successfully close the loop on communications. By streamlining the operative process we substantially reduced the number of canceled surgeries.

Nurses, medical staff, and anesthesiologists collaborated to develop criteria that identify the patients who should meet with anesthesiologists before their pre-op appointments. As a result, the number of pre-op visits has been reduced and nurses have more time to prepare patient data. On the day of surgery, more patients are now fully informed, have received medical clearance, and have made arrangements for post-op recovery. The nursing team is striving to improve the assessment process even further, committing to a goal of calling patients a minimum of 72 hours before their surgery dates.

Nursing Support is Critical for Successful Robot-Assisted Surgery

Use of robot-assisted surgery is growing exponentially in the healthcare field. Because this exciting technology is minimally invasive and improves precision, it can reduce patients’ pain and shorten hospital stays. It also provides opportunities for increased collaboration between nurses and surgeons. With tools such as the da Vinci robot, MSMHC has the technology to meet the increasing need and provide patients with the most advanced healthcare available.

Robot-assisted surgery, however, requires highly trained surgeons with exceptional professional knowledge and refined skills. The support team must be just as specialized as the surgeons, and participate in ongoing education programs and frequent simulations to keep their skills current. At MSMHC, robot-assisted surgery is benefitting many patients, as well as the nurses who care for them. This past year, more MSMHC nurses opted to strengthen their career opportunities with specialized training.

MedStar Southern Maryland Hospital Center’s Cath Lab Linda Black, RN, and Dorel Marks, RN Josephine Gloria, Surgical Tech, and Ann Cunningham, RN

Hybrid Cath Lab Improves Cardiac Services—and Convenience

When MSMHC opened its hybrid catheterization lab a few years ago, patients gained immediate access to an expanded range of healthcare services, right in their neighborhood. Combining high-definition imaging with specialized equipment and intervention capabilities helps surgeons and interventional cardiologists coordinate approaches to complex health problems. Services such as electrophysiology,

which treats irregular heartbeats, no longer require a commute to Washington or Baltimore.

In 2015, the lab continued to streamline processes, allowing nurses to monitor patients even more carefully and with a greater focus on safety. This year and beyond, MSMHC interventional physicians will continue to rely on nurses’ critical skills and ongoing training for support.

Visibility Boards Monitor Patient Safety Around the Clock

Whether you’re in a hallway, a nurses’ station, or the ED, you can check on a patient’s status: just look up at a visibility board. MSMHC was the first hospital in MedStar’s network to use visibility boards, and they’ve quickly become a valuable tool for supporting safe, effective care.

The boards not only provide 24-hour visibility, they also collect patient data. They access real-time information from the EMR, environmental services, and other hospital systems to monitor clinical measures, and use color and icons to display a room’s layout, availability, and status. This provides real time communication to the health care team to help improve patient outcomes. The visibility board displays real time clinical and safety alerts that flow from the patient’s electronic medical record.

Fiscal Strength

Streamlined Supply Chain Means More Time for Patients, Less for Paperwork

IMPPACT software standardizes and automates businesses processes and information sharing across the MedStar network. In 2015, IMPPACT was a key factor in helping the MSMHC nursing team increase efficiency by managing its supply budget.

IMPPACT improves the accuracy of each transaction by showing where supplies are delivered and the quantity available in each department, as well as usage, pricing, and other data. Because the system also reduces paperwork, nurses have more time available to serve patients.

By centralizing and standardizing supplies throughout MSMHC and the MedStar network, IMPPACT not only manages supply cost and demand, it also coordinates with our sister hospitals so we can obtain specific products if the need arises. In addition, IMPPACT’s supply chain model improves resource alignment with clinical service areas. In the long term, it will contribute to MSMHC’s fiscal strength by supporting market growth and sustainability.

Nursing Retention is Improving at MSMHC

Turnover rates at MSMHC have averaged about 16%. But turnover is more than a number: it has far-reaching consequences. For the nursing department, attrition means new nurses must be recruited, trained, and allowed time to be orientated and become productive. Retention is important, as the financial cost of losing a single nurse has been calculated to equal up to twice the nurse’s annual salary.

MSMHC continues to pay close attention to key statistics involving nurse vacancy and turnover. We are working diligently to fill vacant positions quickly by improving initiatives to recruit nurses. Nurses who choose to pursue a career with MSMHC have access to generous associate benefits, opportunities to further education, and the possibility of career advancement within the organization. There’s another benefit to our improved retention: increased nurse satisfaction, which can have a positive impact on our patient’s experience with their care.

Page 16 - 2015 Nursing Annual Report Fiscal Strength - Page 17

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